Thorax
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A thoracic duct cyst was excised from the mediastinum of an 86 year old man. It had caused acute respiratory failure through compression of the trachea.
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Mucociliary clearance is impaired in patients with Young's syndrome (obstructive azoospermia with recurrent sinobronchial disease), cystic fibrosis, and primary ciliary dyskinesia. No defect of cilia or mucus has been detected in Young's syndrome. ⋯ The relative disorientation of the distal ciliary axoneme in patients with Young's syndrome compared with normal subjects may be due to a structural defect but is more likely to be a consequence of abnormal mucus.
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The aim of this study was to determine the relation between the severity of abnormalities in ventilatory function tests and tidal breathing pattern and gas exchange indices in interstitial lung disease. ⋯ Low values of FVC were associated with increased respiratory rate and decreased tidal volume; this pattern of breathing mimics external elastic loading, suggesting that mechanoreceptors may contribute to the rapid and shallow pattern of breathing in interstitial lung disease. Hypercapnia seems to be rare in interstitial lung disease even when functional impairment is severe and tidal volume is small. The increased respiratory rate is important in maintaining adequate ventilation. In the face of a severe restrictive defect carbon dioxide production did not increase, which also contributed to the maintenance of eucapnia.
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Case Reports
Refractory hypoxaemia after pneumonectomy: diagnosis by transoesophageal echocardiography.
A patient with normal oxygenation before operation became very breathless and hypoxaemic after a right pneumonectomy. Transoesophageal echocardiography showed right to left interatrial shunting due to a patent foramen ovale. Transoesophageal echocardiography should be included in the assessment of patients who became inappropriately dyspnoeic after pneumonectomy.
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In most accidents causing smoke inhalation only a few victims actually inhale the smoke. The fire at King's Cross provided an opportunity to assess the long term effects of smoke inhalation in a larger number of patients. ⋯ Smoke inhalation may be associated with injury to the small airways.