Thorax
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Randomized Controlled Trial Comparative Study
High-intensity versus low-intensity non-invasive ventilation in patients with stable hypercapnic COPD: a randomised crossover trial.
The conventional approach of low-intensity non-invasive positive pressure ventilation (NPPV) produces only minimal physiological and clinical benefits in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD). ⋯ High-intensity NPPV is better tolerated by patients with severe chronic hypercapnic COPD and has been shown to be superior to the conventional and widely-used form of low-intensity NPPV in controlling nocturnal hypoventilation. High-intensity NPPV therefore offers a new promising therapeutic option for these patients.
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Comparative Study
Non-invasive assessment of pulmonary blood flow using an inert gas rebreathing device in fibrotic lung disease.
Pulmonary hypertension (PH) is increasingly recognised in patients with diffuse lung disease, and is associated with increased mortality. Cardiac output (CO) is a prognostic marker in PH. Non-invasive assessment of pulmonary blood flow (PBF(INNOCOR)) with the inert gas rebreathing Innocor device has been validated against CO in PH, but not in PH associated with parenchymal lung disease. PBF(INNOCOR) may be less accurate in patients with lung disease because of intrapulmonary shunting and/or incomplete gas mixing. Our aim was to determine the variability of PBF(INNOCOR) in normal subjects, before evaluating PBF(INNOCOR) in diffuse lung disease against CO measured by the indirect Fick method (CO(FICK)) at right heart catheterisation (RHC). ⋯ Non-invasive PBF measured by the inert gas rebreathing Innocor device has good intrasession repeatability and intersession reproducibility. In diffuse lung disease, CO can be accurately and non-invasively measured by the Innocor device.
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Case Reports
Hyaluronic acid pulmonary embolism: a critical consequence of an illegal cosmetic vaginal procedure.
The materials used for cosmetic procedures by physicians as well as illegally by non-medical personnel can cause non-thrombotic pulmonary embolism (NTPE). The case history is presented of a woman with acute respiratory failure after an illegal cosmetic vaginal procedure using hyaluronic acid (HA) dermal filler by an unlicensed medical practitioner on the day of symptom onset. Histopathological examination of a video-assisted thoracoscopic lung biopsy specimen showed a granulomatous foreign body reaction with multinucleated giant cells around amorphous basophilic materials in the pulmonary vessels and lung parenchyma, suggesting NTPE by HA. ⋯ Although HA is supposedly devoid of immunological reactions, localised complications with granulomatous foreign body reactions by HA injection have been reported after cosmetic facial procedures. However, the case of a typical NTPE syndrome has not yet been reported. This is the first reported biopsy-proven case of a patient developing NTPE caused by HA.