Chest
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Physical frailty commonly is associated with COPD, and its evaluation in COPD may provide important prognostic information for risk stratification. ⋯ The study supports the use of physical frailty in addition to lung function and dyspnea in multidimensional evaluation of COPD.
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An 11-month-old boy was admitted to our hospital because of "recurrent cough with intermittent dyspnea for more than 8 months, aggravated for 1 month." The baby began experiencing a recurrent milk-choking problem within 1.5 months after birth. He had been hospitalized four times, but the symptoms recurred. ⋯ Pediatric bronchoscopy revealed bronchial inflammatory features, with hemosiderin-laden macrophages being found in BAL fluid (BALF). Also, periodic acid-Schiff (PAS) staining showed positive results, which indicated the possibility of pulmonary alveolar proteinosis (PAP) or idiopathic pulmonary hemosiderosis (IPH).
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A 68-year-old woman presented to a subspecialty complex-airways-disease clinic with chronic cough. She had a 10-pack-year history of smoking, quit over 35 years ago, and had mild atopy (dust mite) and mild rhinitis. She did not have any relevant occupational exposure or comorbidities. ⋯ It had been present for years, though it changed in nature over time. She also reported one to two episodes of streaky hemoptysis. She had not noticed significant benefit with nasal or inhaled corticosteroids, but short bursts of prednisone had temporarily modestly improved her cough.
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Although previous studies suggested that rituximab increases the risk of Pneumocystis jirovecii pneumonia (PJP), it is uncertain whether its primary prophylaxis for PJP is justified. ⋯ TMP-SMX prophylaxis significantly reduces PJP incidence with a tolerable safety profile in patients receiving rituximab treatment.
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Case Reports
Middle Mediastinal Mass Compressing the Pulmonary Trunk in a Patient With a History of Breast Cancer.
A 61-year-old White woman, nonsmoker, was referred to Respirology for evaluation of small pulmonary nodules discovered incidentally on surveillance imaging 3 years after breast cancer treatment. She had a remote left breast ductal carcinoma in situ treated with lumpectomy followed by radiation therapy, and recurrent stage 1 breast cancer (estrogen receptor/progesterone receptor-positive, human epidermal growth factor receptor 2-negative) treated with mastectomy, axillary lymph node dissection, and reconstructive surgery, followed with adjuvant chemotherapy, radiation therapy, and letrozole maintenance. Her other medical conditions included compensated cirrhosis secondary to nonalcoholic fatty liver disease, type 2 diabetes, hypertension, OSA, restless legs syndrome, obesity, anxiety, and depression. She reported no dyspnea or constitutional symptoms.