Chest
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Review Case Reports
A case of pancreatic carcinoma causing massive bronchial fluid production and electrolyte abnormalities.
A 39-year-old man developed massive bronchorrhea (2 to 3.5 L/d) with electrolyte and volume depletion about 2 years after undergoing a Whipple's procedure for pancreatic carcinoma. An open lung wedge biopsy specimen was consistent with metastatic adenocarcinoma with extensive growth along preexisting pulmonary architecture. ⋯ The mechanism of massive bronchorrhea is not known. Chemical analysis of bronchial fluid in comparison to serum and the temporary response to chemotherapy are most consistent with secretory and transudative mechanisms.
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Review Case Reports
Nephrobronchial fistula and lung abscess resulting from nephrolithiasis and pyelonephritis.
There are multiple etiologies reported as causes of lung abscess; however, this differential rarely includes intra-abdominal abnormalities other than extension of a hepatic process. We describe a patient who was found to have a lung abscess and empyema resulting from the development of a nephrobronchial fistula secondary to nephrolithiasis and pyelonephritis. The patient had no urinary symptoms or known abdominopelvic infection and the etiology of lung abscess was only incidentally discovered after chest CT revealed extension of pleural fluid below the diaphragm.
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Comparative Study
The effects of applied vs auto-PEEP on local lung unit pressure and volume in a four-unit lung model.
The application of positive end-expiratory pressure (PEEP) and maintenance of increased mean airway pressure (MAP) has been associated with improved oxygenation in adult respiratory distress syndrome. Recently, attention has been directed toward elevating MAP by establishing auto-PEEP when ventilating with an inverse inspiratory to expiratory ratio in opposition to applied PEEP. We theorized that FRC distribution and local lung unit end-expiratory pressure (EEP) would be different when equal levels of PEEP were established by applying PEEP or by producing auto-PEEP. ⋯ Comparing equal levels of the auto-PEEP with applied PEEP, a greater maldistribution of local lung unit EEP and EELV was established with the auto-PEEP. During auto-PEEP, the greatest EEP and EELV occurred in the slow lung unit, and the lowest EEP and EELV developed in the fast lung unit.
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Comparative Study
Management of pediatric acute hypoxemic respiratory insufficiency with bilevel positive pressure (BiPAP) nasal mask ventilation.
To evaluate the efficacy and complications of noninvasive nasal mask bilevel continuous positive airway pressure ventilation in pediatric patients with hypoxemic respiratory insufficiency. ⋯ We conclude that noninvasive nasal positive pressure mask ventilation can be safely and effectively used in pediatric patients to improve oxygenation in mild to moderate hypoxemic respiratory insufficiency. It may be particularly useful in patients whose underlying condition warrants avoidance of intubation.