Archivos de bronconeumología
-
Arch. Bronconeumol. · Oct 1996
Case Reports[Necrotizing descendent mediastinitis of oropharyngeal origin].
The spread of oropharyngeal infections to the mediastinum can give rise to descending necrotizing mediastinitis (DNM), which causes a high rate of mortality (around 40%), particularly when diagnosis is late and drainage inadequate. In the first case we report, successful drainage of the mediastinum was achieved at the cervical and sub-xiphisternum levels and by thoracotomy. ⋯ Cervical drains, which may be adequate when there is perforation of the cervical esophagus, is insufficient in DNM, which calls for more aggressive, early drainage, such as can be achieved by thoracotomy. Computerized axial tomography of the chest is essential for rapid diagnosis, to plan the most appropriate surgical approach and for follow-up and evaluation of drainage.
-
Arch. Bronconeumol. · Oct 1996
Case Reports[Strongyloides stercoralis infection in a cortico-dependent patient with chronic airflow obstruction].
We report a case of Strongyloides stercoralis infection in a male agricultural worker with corticoid dependent chronic obstructive air flow disease and bronchial hyperreactivity. The clinical picture initially involved digestive symptoms and bronchospasm resistant to steroid treatment. Diagnosis was established by demonstrating the larvae of S. stercoralis in stool. We emphasize that this infection should be suspected in patients living in endemic areas such as Spain, and describe S. stercoralis-caused respiratory manifestations that can be masked by bronchial disease.
-
Varicella is a self-limited, benign disease in childhood. When it affects adults, however, serious complications can develop, the most frequent and most dangerous being pneumonia. Adults who develop varicella should be followed closely, with careful attention given to respiratory symptoms in particular, from the first week the rash is evident until it begins to fade. Should pneumonia appear, early start of intravenous acyclovir therapy is indicated in immunodepressed or pregnant patients, or in immunocompetent patients with respiratory problems.
-
Arch. Bronconeumol. · Aug 1996
[Hypercapnic stimulation and ventilation response in the syndrome of sleep obstructive apnea. Comparison of reinhalation and steady state].
The objective of this study was to assess ventilatory response to stimulation with CO2 in patients suffering obstructive sleep apnea syndrome (OSAS) but without chronic obstructive pulmonary disease (COPD), by examining differences between hyper- and normocapnic patients and comparing the results obtained with the usual techniques used to stimulate hypercapnia (rebreathing and stable-state). To this end, we studied 15 obese patients, all with an apnea-hypopnea index greater than 10 from a polysomnograph lasting a full night. The following lung function tests were performed: spirometry, air way resistance measures and static lung volumes by plethysmograph and arterial gasometry. ⋯ The results from the two techniques for stimulating hypercapnia were similar within each group, with a statistically significant decrease (p < 0.03) in patients with daytime hypercapnia in delta VE/delta PCO2 delta Vt/delta PCO2, delta Vt/Ti/delta PCO2 and delta P0.1/delta PCO2. We conclude that there are no differences in the results obtained with the rebreathing and stable state techniques. Likewise, ventilatory response to stimulation with CO2 in individuals with OSAS and daytime hypoventilation is less than of normocapnic patients.