Chest
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Thoracic duct injury is a rare but serious complication following surgery of the neck or chest that leads to uncontrolled chyle leak. Conventional management includes drainage, nutritional modification, or aggressive surgical interventions such as thoracic duct ligation, flap coverage, fibrin glue, or talc pleurodesis; few successful medical therapeutics are available. ⋯ Chyle output decreased substantially after initiating midodrine, an α1-adrenergic agonist that causes vasoconstriction of the lymph system, reducing chyle flow. This case report suggests that midodrine may be a novel therapeutic for refractory chyle leaks.
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Multicenter Study Comparative Study
Methotrexate vs Azathioprine in Second-line Therapy of Sarcoidosis.
Steroids remain the first-choice therapeutic in sarcoidosis; however, long-term use is associated with toxicity. Evidence defining the best second-line therapeutic is currently lacking. The aim of this study was to compare the effect of methotrexate and azathioprine on prednisone tapering, pulmonary function, and side effects in the second-line treatment of sarcoidosis. ⋯ This retrospective study comparing the effect of second-line therapy in sarcoidosis shows that both methotrexate and azathioprine have significant steroid-sparing potency, a similar positive effect on lung function, and comparable side effects, except for a higher infection rate in the azathioprine group.
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Randomized Controlled Trial Comparative Study
Sex-Dependent Impact of OSA on Digital Vascular Function.
Indexes of associations between OSA and impaired vascular function are mainly based on small, clinic-based studies of conduit artery function in men with severe sleep apnea. Larger population-based studies show no independent associations or associations in women only. Sex differences in OSA-related mortality may exist, and sex differences in vascular function in subjects with OSA need to be explored. We, therefore, assessed whether OSA is associated with digital vascular function in a large population-based sample and whether this association is influenced by sex. ⋯ In a large population-based sample of middle-aged subjects, OSA was independently associated with impaired digital vascular function in women only.
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Comparative Study
A New Method to Detect Air Leakage in a Patient With Pneumothorax Using Saline Solution and Multidetector-Row Spiral CT Scan.
The purpose of this study was to establish a new CT scan method to show signs of air leakage and to detect the point of the lung leak in patients with spontaneous pneumothorax by using saline solution and phonation. ⋯ With a saline injection and vocalization, CT scan could demonstrate air-leak signs in patients with spontaneous pneumothorax. This method does not require contrast medium, special instruments, or high skill and, thus, is a novel and useful examination to detect the culprit lesion in pneumothorax.
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Pulmonary arteriovenous malformations (PAVMs) are abnormal vascular structures that most often connect a pulmonary artery to a pulmonary vein, bypassing the normal pulmonary capillary bed and resulting in an intrapulmonary right-to-left shunt. As a consequence, patients with PAVM can have hypoxemia and paradoxical embolization complications, including stroke and brain abscess. PAVMs may be single or multiple, unilateral or bilateral, and simple or complex. ⋯ Lifelong follow-up is important because recanalization and collateralization may occur after embolization therapy. Surgical resection is rarely necessary and reserved for patients who are not candidates for embolization. Antibiotic prophylaxis for procedures with a risk of bacteremia (eg, dental procedures) is recommended in all patients with PAVM because of the risk of cerebral abscess.