Chest
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We tested the hypothesis that maximal exercise performance in subjects with interstitial lung disease (ILD) is limited by respiratory factors. Assuming this is so, ventilatory stimulation by added dead space (VD) should impair exercise capacity. ⋯ The decrease observed in TLIM, work rate, and peak VO2 with added VD, associated with a lack of change in VI or oxygen desaturation at end-exercise, suggests that exercise limitation in ILD is primarily due to respiratory factors.
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An autopsy was performed on a patient who had chronic hypersensitivity pneumonitis that was observed for 9 years. The patient was a farmer who developed symptoms every March through July during the use of moist hay that was infected heavily with Candida. Precipitins and an inhalation challenge test to C albicans were positive. We interpret the role of C albicans in this case.
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Prior studies have shown that nasal intermittent positive pressure ventilation (NIPPV) can improve arterial blood gas values, prevent symptoms resulting from alveolar hypoventilation, and decrease hospitalization in patients with chronic respiratory failure. Most studies have involved small samples of patients followed up for a limited time. This study reviews our experience during 5 years use of NIPPV in 276 patients with kyphoscoliosis, posttuberculosis sequelae, Duchenne-type muscular dystrophy, COPD, and bronchiectasis followed up for > or = 3 years while receiving NIPPV. ⋯ Benefit was also more short term for patients with COPD and bronchiectasis. NIPPV can sustain improvement in gas exchange, while reducing hospitalization for substantial periods of time. NIPPV can be an attractive and effective alternative to other methods of assisted ventilation such as TIPPV.
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The scimitar sign is characteristic of partial anomalous pulmonary venous drainage into the inferior vena cava (IVC). We encountered two variant cases of scimitar sign. ⋯ Retrograde balloon occlusion angiography of the scimitar vein was diagnostic. In the other case, the scimitar vein showed a meandering course, and then drained into the LA without any connection with the IVC, and surgical intervention was not required.
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The aim of the study was to identify risk factors for early onset pneumonia (EOP) in trauma patients, in order to seek possible intervention strategies. ⋯ In a trauma population, a combined severe abdominal and thoracic trauma represents a major risk factor for EOP. Mechanical ventilation administered during the first days after trauma seems to reduce the risk of EOP. As reported in previous studies, mechanical ventilatory support lasting more than 5 days is associated with an increased risk of LOP.