Chest
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Comparative Study
Corrected end-tidal P(CO(2)) accurately estimates Pa(CO(2)) at rest and during exercise in morbidly obese adults.
Obesity affects lung function and gas exchange and imposes mechanical ventilatory limitations during exercise that could disrupt the predictability of Pa(CO(2)) from end-tidal P(CO(2)) (P(ETCO(2))), an important clinical tool for assessing gas exchange efficiency during exercise testing. Pa(CO(2)) has been estimated during exercise with good accuracy in normal-weight individuals by using a correction equation developed by Jones and colleagues (P(JCO(2)) = 5.5 + 0.9 x P(ETCO(2)) – 2.1 x tidal volume). The purpose of this project was to determine the accuracy of Pa(CO(2)) estimations from P(ETCO(2)) and P(JCO(2)) values at rest and at submaximal and peak exercise in morbidly obese adults. ⋯ P(JCO(2)) provides a better estimate of Pa(CO(2)) than P(ETCO(2)) during submaximal exercise and at peak exercise, whereas at rest both yield reasonable estimates in morbidly obese individuals. Clinicians and physiologists can obtain accurate estimations of Pa(CO(2)) in morbidly obese individuals by using P(JCO(2)).
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Many older patients with early stage non-small cell lung cancer (NSCLC) do not receive curative therapy. New surgical techniques and radiation therapy modalities, such as video-assisted thoracoscopic surgery (VATS), potentially allow more patients to receive treatment. The adoption of these techniques and their impact on access to cancer care among Medicare beneficiaries with stage I NSCLC are unknown. ⋯ From 1998 to 2007, the overall proportion of older patients with stage I NSCLC receiving curative local therapy decreased, despite the dissemination of newer, less-invasive forms of surgery and radiation.
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We report a case of recurrent hemoptysis due to an occult congenital fistula between the descending aorta and the left pulmonary vein in a 25-year-old female patient. The anomaly was confirmed by contrast-enhanced CT scan and angiography. ⋯ The patient was successfully managed by simple ligation of the fistula. To our knowledge, this is the first reported case of adult-onset hemoptysis caused by an occult congenital fistula between the descending aorta and a pulmonary vein.