Nihon Kyōbu Shikkan Gakkai zasshi
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Nihon Kyobu Shikkan Gakkai Zasshi · Aug 1997
Case Reports[Use of BiPAP during weaning from mechanical ventilation in a patient with chronic obstructive pulmonary disease and acute respiratory failure].
In a 65-year-old man with chronic obstructive pulmonary disease and acute respiratory failure, bi-level positive airway pressure device (BiPAP) was used as part of weaning from mechanical ventilation. As an outpatient, he had had dyspnea of grade V (Hugh-Jones) and was hypercapnic (PaCO2 of 70 torr) and hypoxemic (PaO2 of 60 torr), while he was receiving oxygen at 2 L/min via nasal cannula. Acute respiratory failure developed due to pneumonia, and mechanical ventilation was begun. ⋯ On the fifth day of mechanical ventilation, he was extubated and treatment with BiPAP was begun. He did not complain of dyspnea even though PaCO2 did not decrease, which indicates that BiPAP reduced the work of breathing. Use of BiPAP might make reintubation unnecessary when acute ventilatory failure develops soon after extubation in patients with COPD.
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Nihon Kyobu Shikkan Gakkai Zasshi · Jul 1997
Review Case Reports[Mediastinal esophago-bronchogenic cyst presenting as a single mass].
An abnormal shadow was found on a chest X-ray film of a 42-year-old man. The mass was 17 x 12 x 11 cm, smooth, round, homogeneous, and was seen in the left upper lung field. Chest computed tomography revealed a cystic mass in contact with the left lung, the chest wall, the esophagus, and the aorta. ⋯ The final diagnosis was mediastinal esophago-bronchogenic cyst. In previously reported cases, two cystic masses were connected by a canal. The findings in this case support the theory by Yoshii that this type of cyst originates from the diverticulum of the foregut near the lung bud.
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Nihon Kyobu Shikkan Gakkai Zasshi · Jul 1997
[Prediction of outcome after acute exacerbation of idiopathic interstitial pneumonia].
Some patients with chronic idiopathic interstitial pneumonia (IIP) experience acute exacerbations (AE). Because the precise mechanisms of AE in patients with IIP remain unclear, the treatment for AE is not established and the efficacy of steroids is controversial. Consequently, it is difficult to predict outcomes in patients with AE of IIP. ⋯ Of the 22 non-survivors, 7 had received medication before the AE; none of the survivors had received medication before the AE. At the time of the AE all patients were treated with steroid pulse therapy, and the dose of methylprednisolone used, did not differ significantly between groups. These data suggest that three factors are closely related to responsiveness to steroid therapy and to clinical outcomes after AE in patients with IIP: 1) age at the onset on IIP, 2) respiratory status before the AE, and 3) disease activity as reflected by inflammatory reactions.
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Nihon Kyobu Shikkan Gakkai Zasshi · Jun 1997
Case Reports[Farmer's lung complicated by bilateral pneumothorax and mediastinal emphysema].
A 35-year-old woman was admitted to the hospital because of severe coughing and right-sided chest pain. She had worked on a farm for 13 years. For the preceding 2 years, she noticed a productive cough, a mild fever, and dyspnea after working in a barn for longer than 6 hours. ⋯ During the steroid treatment, bilateral pneumothorax and mediastinal emphysema developed. Bullae were removed surgically because she did not respond well to medical treatment. Although steroid administration may have caused these complications, bilateral pneumothorax and mediastinal emphysema are rare in patients with chronic farmer's lung.
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Nihon Kyobu Shikkan Gakkai Zasshi · May 1997
Case Reports[Status asthmaticus treated with inhaled isoflurane and intravenous isoproterenol].
We report the case of an 18-year-old man with status asthmaticus who was treated with inhaled isoflurane and intravenous isoproterenol. The patient was intubated and mechanical ventilation was began immediately after admission to the hospital. He received intravenous methylprednisolone and aminophyline, and frequent inhalation of isoproterenol aerosol. ⋯ Isoflurane can be effective in patients with status asthmaticus, and it does not increase the arrhythmogenicity of catecholamines. Intravenous administration of isoproterenol can also be useful in the treatment of patients with status asthamticus. The combination of isoflurane with intravenous isoproterenol may be useful when status asthmaticus is hard to control with conventional therapy.