Chest
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Although perimenstrual asthma (PMA) has been associated with severe and difficult-to-control asthma, it remains poorly characterized and understood. The objectives of this study were to identify clinical, demographic, and inflammatory factors associated with PMA and to assess the association of PMA with asthma severity and control. ⋯ PMA is common in women with severe asthma and associated with poorly controlled disease. Aspirin sensitivity and lower FVC % predicted are associated with PMA after adjusting for multiple factors, suggesting that alterations in prostaglandins may contribute to this phenotype.
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Few studies of endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA) have been large enough to identify risk factors for complications. The primary objective of this study was to quantify the incidence of and risk factors for complications in patients undergoing EBUS-TBNA. ⋯ TBBx was the only risk factor for complications during EBUS-TBNA procedures.ROSE significantly reduced the use of TBBx.
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Case Reports
Long-term safety of nebulized lidocaine for adults with difficult-to-control chronic cough: a case series.
The long-term safety of patient-administered nebulized lidocaine for control of chronic cough has not been established. ⋯ Adults tolerated self-administration of nebulized lidocaine for difficult-to-control chronic cough. No serious adverse effects occurred while providing symptomatic control in 49% of patients.
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Catamenial pneumothorax (CP) is a cause of recurrent pneumothorax in women of child-bearing age. Surgical treatment has been associated with high recurrence rates. We report our experience with a totally videothoracoscopic approach involving diaphragmatic repair, pleurectomy/abrasion, and hormonal treatment in patients with proven CP. ⋯ A totally videothoracoscopic approach to CP including diaphragmatic cover with a mesh and pleurectomy/pleural abrasion is feasible, safe, and highly effective. Routine hormonal treatment (gonadotropin-releasing hormone analog) may also help reduce recurrences.
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Fentanyl and other opiates used in procedural sedation and analgesia are associated with several well-known complications. We report the case of a man who developed the uncommon complication of chest wall rigidity and ineffective spontaneous ventilation following the administration of fentanyl during an elective bronchoscopy. His ventilation was assisted and the condition was reversed with naloxone. ⋯ Management includes ventilatory support and reversal with either naloxone or a short-acting neuromuscular blocking agent. This reaction does not appear to be a contraindication to future use of fentanyl or related compounds. Chest wall rigidity causing respiratory compromise should be readily recognized and treated by bronchoscopists.