Respirology : official journal of the Asian Pacific Society of Respirology
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Evaluation of mediastinal lymphadenopathy in patients with an intrathoracic nodule post malignancy is crucial for the determination of further treatment. Different radiological modalities are available for the detection of mediastinal lymph node metastases such as multidetector helical CT, PET-scan and PET-CT. ⋯ This method is appropriate not only for cytodiagnosis but also for histological diagnosis. This current study reports a case of mediastinal lymph node metastases from renal cell carcinoma successfully diagnosed histologically by endobronchial ultrasound-guided transbronchial needle aspiration.
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Video-assisted thoracic surgery (VATS) lobectomy for primary lung cancer is considered minimally invasive. However, different procedures may be used for the VATS lobectomy, from complete videoscopic (CV) surgery to a technique similar to the muscle-sparing thoracotomy. We divided patients into two groups based on the surgical approach and analysed the outcomes. ⋯ Two methods of VATS cause less surgical damage than PL. CV, in particular, causes less damage to pulmonary function than PL, and achieves good postoperative quality of life.
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Bacterial infection is one of the major causes of acute exacerbation of COPD (AECOPD). This study was undertaken to investigate the microbiology of AECOPD. ⋯ Klebsiella pneumoniae and P. aeruginosa are the most common sputum pathogens in hospitalized patients with AECOPD in Taiwan, with the former being more commonly isolated from mild COPD and the latter associated with poor clinical outcome. These results should be considered when deciding which antibiotics should initially be used to treat patients with AECOPD.
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Case Reports
Delayed presentation of amniotic fluid embolism: lessons from a case diagnosed at autopsy.
Amniotic fluid embolism (AFE) syndrome, a catastrophic cause of respiratory failure typically occurs during labour, or soon after delivery. Systemic hypotension is the most prominent haemodynamic alteration documented in patients with AFE, a consequence principally of severe left-sided heart failure. A 22-year-old female was admitted to the respiratory intensive care unit with severe eclampsia and acute respiratory failure 4 h following delivery. ⋯ She succumbed in spite of therapy for eclampsia and mechanical ventilation. Autopsy revealed large numbers of polygonal, anucleate foetal squames and mucin in the pulmonary vasculature typical of AFE while changes of eclampsia were found in the liver and kidneys. It appears that AFE syndrome can have a delayed presentation, as late as 4 h after delivery and haemodynamic collapse may not be mandatory if the patient has coexisting systemic hypertension secondary to severe eclampsia.