11/19. propranolol-induced dyspnea in a nonasthmatic male.The authors report the onset of wheezing and dyspnea in a 32-year-old, nonasthmatic male who was receiving propranolol for chronic migraine headaches of 20 years' duration. The symptoms first appeared during the "cold season"; the diagnosis was bronchitis. After three months without propranolol, the patient, prompted by continuing migraine headaches, again took the drug (40 mg bid). Within 48 hours he complained of rhinitis that rapidly progressed to wheezing, resembling bronchitis. Other reports in the literature are discussed.- - - - - - - - - - ranking = 1keywords = headache (Clic here for more details about this article) |
12/19. Alcohol-induced bronchospasm in an asthmatic patient: pharmacologic evaluation of the mechanism.A 23-year-old Asian with histamine-reactive asthma complained of recurrent chest tightness, nasal congestion and flushing immediately after drinking minimal amounts of alcoholic beverages. He was extensively studied to determine the possible mechanism of his alcohol-induced respiratory symptoms. drinking of either beer or 95 percent ethanol in apple juice immediately provoked vasomotor signs and moderately severe bronchospasm (54 percent and 73 percent decreases in specific airway conductance, respectively), which spontaneously improved over 30 minutes and two hours, respectively. Intravenous and inhaled ethanol caused less bronchospasm than observed with oral ethanol, and recovery was rapid. Pretreatment with cromolyn sodium (inhaled or oral) and isoproterenol had no inhibitory effect on the alcohol-induced bronchoconstriction, whereas atropine, acetylsalicylic acid, cyproheptadine, and chlorpheniramine appeared to have a partial inhibitory effect. Approximately 70 percent inhibition was observed after chlorpheniramine. Observations in this patient suggest that the bronchoconstriction induced by alcoholic beverages is related to their ethanol content and may be related to formation or release of one or more bronchoconstrictor and vasoactive compounds, including a stimulant of histamine1-receptors. The route of ethanol administration may also influence the bronchospastic response.- - - - - - - - - - ranking = 0.54896028284802keywords = chest (Clic here for more details about this article) |
13/19. Influence of head and neck position on endotracheal tube tip position on chest x-ray examination: a potential problem in the infant undergoing intubation.Complications related to endotracheal tubes are frequent in small children and infants. We report a case of a burned 12-month-old child in whom frequent manipulation of the endotracheal tube was required because of recurrent atelectasis and changing position of the endotracheal tube on chest x-ray film. It was then determined that because of variations in head and neck position while chest x-ray films were obtained, the endotracheal tip changed position in the trachea greater than 2.7 cm (greater than 1 inch), although endotracheal tube position was maintained at the level of the teeth. Airway care and gas exchange were subsequently improved by ensuring that patient care and chest x-ray films were performed with the head and neck in similar (neck slightly flexed, head neutral) position.- - - - - - - - - - ranking = 3.8427219799361keywords = chest (Clic here for more details about this article) |
14/19. baclofen-induced bronchoconstriction.OBJECTIVE: To report the occurrence of acute bronchospasm in one asthmatic patient and increased bronchial reactivity in another following the administration of a single dose of oral baclofen. CASE SUMMARY: On two separate occasions, a 46-year-old asymptomatic asthmatic man developed dyspnea and chest tightness one hour after the ingestion of baclofen 40 mg. Pulmonary function studies revealed a significant decrease in airflow relative to baseline. A 33-year-old asymptomatic woman with a history of exercise-induced dyspnea and wheezing displayed bronchial hyperresponsiveness to inhaled metacholine 2 hours after ingesting 40 mg of baclofen. The patient had had a negative methacholine challenge test 72 hours earlier. DISCUSSION: The gamma-aminobutyric acid-agonist baclofen has been shown to reduce airway responsiveness to various bronchoconstricting agents in animal studies. The etiology of this seemingly paradoxical response in two patients is unclear, but may offer insight into the neurally mediated airway constriction that occurs in asthma. CONCLUSIONS: Clinicians should be aware of the possibility of baclofen-induced bronchospasm, especially in asthmatic patients.- - - - - - - - - - ranking = 0.54896028284802keywords = chest (Clic here for more details about this article) |
15/19. Coexistent asthma and functional upper airway obstruction. case reports and review of the literature.Three asthmatic patients with dyspnea and episodes of apparent bronchospasm unresponsive to conventional therapy are described. During these episodes variable extrathoracic upper airway obstruction and airflow limitation typical of bronchial asthma were demonstrated by spirometry test results. In one patient, paradoxical vocal cord motion was identified by fiberoptic laryngoscopy. We believe these patients represent an unusual subgroup of asthmatic subjects who manifest laryngeal dysfunction. Recognition of this upper airway component to airflow limitation in some asthmatic patients may help physicians avoid potentially unnecessary therapy with systemic steroids and endotracheal intubation.- - - - - - - - - - ranking = 0.82998863248344keywords = upper (Clic here for more details about this article) |
16/19. Ketorolac-induced bronchospasm in an aspirin-intolerant patient.A patient, in her mid-twenties, presented with "severe polypoid sinusitis" for sphenoethmoidectomy under general anesthesia. Upon preoperative medical evaluation, it was discovered that she was "allergic" to aspirin and suffered from stress-induced asthma. Before induction of anesthesia, the patient was administered intravenous hydrocortisone and two puffs of her albuterol inhaler to prevent a possible bronchospasm due to stress of the surgery or irritation from the endotracheal tube or other stimuli. The patient was maintained throughout the case with an inhalation anesthetic for its bronchodilatory effect. The surgery proceeded unremarkably, and the patient was then administered ketorolac tromethamine for postoperative pain. After an awake extubation, the patient was transferred to the postanesthesia care unit (PACU) for further monitoring. After 15 min in the PACU, the patient claimed having difficulty breathing. She was then administered terbutaline to produce bronchodilation, but her condition did not improve. Shortly thereafter, aminophylline, midazolam, and methylprednisolone were also administered intravenously. Meanwhile, the patient had to be reintubated and placed on ventilator support with heavy sedation. At this point, it was discovered that ketorolac may have been the cause of this response. Although the patient's condition began to improve, the histamine H1- and H2-receptor blockers diphenhydramine and ranitidine were coadministered. When the patient's condition returned toward normal, she was extubated. The patient's breathing continued to improve. Thereafter, she was transferred to an overnight observation bed and later dismissed to return home. The patient was advised of the episode and warned against future intake of other nonsteroidal antiinflammatory drugs.- - - - - - - - - - ranking = 90.962419119904keywords = breathing (Clic here for more details about this article) |
17/19. Pulmonary migraine.Although it is not uncommon in bronchoesophagological practice to be consulted in cases of unexplained atelectasis, patients presenting with painful atelectasis are indeed rare. Three such cases will be described. The first case, previously unreported, for which Dr. M. E. Avery suggested the term "pulmonary migraine" is that of a 14-year-old Caucasian female with a history of recurrent "asthma" chest pain, atelectasis and migraine headache. On investigation there was demonstrable spastic obliteration of the lumen of a lobar bronchus. Two similar cases are described.- - - - - - - - - - ranking = 1.048960282848keywords = chest, headache (Clic here for more details about this article) |
18/19. diagnosis of Pfiesteria-human illness syndrome.The first case reports of human illness caused by exposure to pfiesteria piscicida toxin(s) acquired outside of a laboratory are reported. Though Pfiesteria, a toxin-forming dinoflagellate, is responsible for killing billions of fish in estuaries in north carolina, its role in human illness has remained controversial, in part due to lack of identification of the toxin. A recent fish kill in the rivers of the lower Eastern Shore has permitted careful investigation and identification of a distinct clinical syndrome resulting from exposure to the Pfiesteria toxin--Pfiesteria human illness syndrome (PHIS). patients have memory losses, cognitive impairments, headaches, skin rashes, abdominal pain, secretory diarrhea, conjunctival irritation, and bronchospasm. Not all patients have all elements of the syndrome.- - - - - - - - - - ranking = 0.5keywords = headache (Clic here for more details about this article) |
19/19. cough induced stress fracture and arthropathy of the ribs at extreme altitude.cough and chest wall pain at high altitude have only received passing mention in the medical literature. Increased minute ventilation of cold dry air at very high altitude is likely to cause airway irritation. This in turn may result in airway drying, mucus production, postnasal drip from vasomotor rhinitis, and bronchospasm acting individually or in combination to stimulate the vagal cough reflex. The cough is exacerbated further at extreme altitudes above 5500 m, and may result in intercostal muscle strain and single or multiple rib fractures. We present a case of multiple cough induced stress fractures and arthropathy documented by technetium-99 bone scan in a high altitude climber and suggest the addition of the term High altitude cough syndrome (HACS) to the medical syntax to identify this discrete medical problem of exposure to very high altitude.- - - - - - - - - - ranking = 0.54896028284802keywords = chest (Clic here for more details about this article) |
| <- Previous | |