Thorax
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It is known that automatic breathing is controlled by centres in the lower brain stem, whereas volitional breathing is controlled by the cerebral cortical centres. In hemiplegia, lesions above the brain stem result in paralysis of limb muscles. This study was performed to determine whether the diaphragm might also be affected in patients with hemiplegia. ⋯ In four of eight hemiplegic patients reduced diaphragmatic movement was present on the paralysed side during volitional inspiration when compared with automatic inspiration. The hemidiaphragm may be involved on the affected side in patients with hemiplegia.
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Case Reports
Transient right-to-left shunting through a patent foramen ovale secondary to unilateral diaphragmatic paralysis.
A 57 year old patient presented with unilateral diaphragmatic paralysis and severe hypoxaemia secondary to transient right-to-left interatrial shunting through a patent foramen ovale. The final diagnosis was made because of the initial detection of a shunt while the patient was breathing 100% oxygen.
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Significant morbidity and mortality result from the ineffective evacuation of empyema. Failure of conventional first line treatment with closed intercostal tube drainage and antibiotic therapy may result in fibrin deposition and loculated empyema. Enzymatic debridement using intrapleural instillation of streptokinase is a non-invasive therapeutic option which may obviate the need for surgical intervention. ⋯ Intrapleural streptokinase is an effective adjunct in the management of complicated empyema and may reduce the need for surgery.