Articles: function.
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Pleural Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Patients coming for preoperative evaluation are often diagnosed for first time with underlying diseases that go unnoticed unless patients present for evaluation. One such example is hypoxia. We present 74 year-old male with no significant past medical history coming for preoperative evaluation for cataract surgery and was hypoxic. With careful assessment of history and physical exam along with imaging revealed asbestosis, thus highlighting importance of occupational exposure. ⋯ The following authors have nothing to disclose: Meenal Malviya, Asad Omar, Navneet Kumar, Muhammad EhteshamNo Product/Research Disclosure Information.
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Interstitial Lung Disease CasesSESSION TYPE: Case ReportsPRESENTED ON: Saturday, March 22, 2014 at 09:00 AM - 10:00 AMINTRODUCTION: The course of adult Pulmonary Langerhans cell Histiocytosis (PLCH) is variable and unpredictable [1]. Conventional therapy is mainly based on smoking cessation. If the patient is severely symptomatic or the disease shows radiological or physiological deterioration after a short observation period, a course of steroids should be given. Chemotherapeutic drugs,like 2-chlorodeoxyadenosine, may be effective in childhood forms of disseminated LCH, but there is far too little experience with these agents in adult pulmonary LCH patient [1]. ⋯ The following authors have nothing to disclose: Juan Cruz Rueda, Julián Ceballos Gutiérrez, Ana Fulgencio, Jose Manuel Gonzalez de Vega, Ana Dolores Romero OrtizNo Product/Research Disclosure Information.
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DVT/PE PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: As the benefits of thrombolytic therapy in patients with pulmonary embolism, with a normal blood pressure and intermediate clinical risk, as determined by right ventricular dysfunction on echocardiography or elevated serum markers of cardiac necrosis, are uncertain, an audit of patients diagnosed with acute PE using MDCTPA was performed to determine the mortality and hemorrhagic complications in-hospital and at 30 days. ⋯ The following authors have nothing to disclose: Carla Nobre, Dinis Mesquita, Boban ThomasNo Product/Research Disclosure Information.
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Cardiovascular Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: We present a case of progressive hypoxemia with platypnea-orthodeoxia developing after lung resection surgery for lung cancer. ⋯ Symptoms of hypoxemia with platypnea-orthodeoxia are concerning for shunt physiology. The differential diagnosis includes sources of intracardiac (ASD, PFO) and intrapulmonary shunting. He had a prior intracardiac shunt on an earlier echo but not on the post-operative study. He had no evidence of other cardiac causes such as pericardial effusion, constrictive pericarditis or aortic aneurysm. He had an interstitial lung disease by CT scan but this was unchanged radiographically. There was no evidence of other pulmonary causes such as COPD, thromboembolic disease or an intrapulmonary shunt (arteriovenous malformation). He had no history of liver disease with shunt from cirrhosis or history of kyphoscoliosis. Platypnea-orthodeoxia was first described in 1949 and major causes are intracardiac shunts and intrapulmonary shunts. The intracardiac shunts are right-to-left and most often include atrial septal defect, patent foramen ovale or fenestrated atrial aneurysm. Other causes include pericardial effusion, lobectomy, pneumonectomy or upper abdominal surgery. This occurs from preferential blood flow towards the atrial septum that is accentuated by altered intracardiac anatomy, compliances of the right and left heart, pulmonary vascular resistance and transient right to left pressure gradients associated with respiratory and positional changes. This is generally not associated with pulmonary hypertension and atrial right-to-left shunting has been reported despite normal right-sided pressures. A right-to-left shunt is more likely to appear after a right-sided lung resection with most patients having symptoms develop a month to several months afterwards. Noncardiac causes can include intrapulmonary shunting, such as thromboembolic disease and AVMs, or cirrhosis and kyphoscolisoss. The key to diagnosis is clinical suspicion of symptoms of dyspnea and hypoxemia, induced or worsened by an upright posture. In conclusion, interatrial shunting through a PFO or ASD is a rare but clinically significant condition after thoracic surgery. There are several underlying etiologies and can occur in the immediate postoperative period or can be more delayed.Reference #1: Interatrial Shunting After Major Thoracic Surgery: A Rare but Clinically Significant Event. Ann Thorac Surg 2012;93:1647-51Reference #2: Dyspnoea and hypoxaemia after lung surgery: the role of interatrial right-to-left shunt. Eur Respir J 2006; 28: 174-181Reference #3: Platypnoea-orthodeoxia syndrome. Heart 2000;83:221-223DISCLOSURE: The following authors have nothing to disclose: Nitin Bhatt, Ulysses MagalangNo Product/Research Disclosure Information.
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Critical CareSESSION TYPE: Slide PresentationPRESENTED ON: Saturday, March 22, 2014 at 04:15 PM - 05:15 PMPURPOSE: Non invasive ventilation (NIV) is a standardized treatment that has proven beneficial effects in different respiratory and cardiologic diseases. The increasing development of NIV has enabled chest physicians to assist more complex patients and stimulate the setting-up of specials units (Respiratory High-Dependency Care Units [RHDCU]). These units are specialized in severe respiratory patients who need NIV and monitoring. The aim of this study was to evaluate the impact of a RHDCU in non-invasive ventilated patients. ⋯ The following authors have nothing to disclose: Alejandro Peralta, Lucia Gimeno, Cristina Oliver, Alicia Binimelis, Belen Nuñez, Miguel Carrera, Monica de la Peña, Ernest SalaNo Product/Research Disclosure Information.