1/154. theophylline therapy for near-fatal cheyne-stokes respiration. A case report.BACKGROUND: cheyne-stokes respiration is characterized by periodic breathing that alternates with hypopnea or apnea. OBJECTIVE: To describe the effect of theophylline on near-fatal cheyne-stokes respiration. DESIGN: Case report. SETTING: Tertiary referral center. PATIENT: A 48-year-old diabetic woman with a history of three cardiorespiratory arrests, a normal coronary arteriogram, normal left ventricular function, and severe cheyne-stokes respiration. MEASUREMENTS: oxygen saturation, intra-arterial blood pressure, central venous pressure, chest wall movement, electrocardiography, electromyography, electroencephalography, electro-oculography, minute ventilation, arterial blood gases, and serum theophylline levels. RESULTS: After intravenous administration of 1.2 mg of theophylline at 0.6 mg/kg per hour (serum level, 5.6 microg/mL), both cheyne-stokes respiration and oxygen desaturation were markedly attenuated. After infusion of 2.4 mg of theophylline (serum level, 11.6 microg/mL), cheyne-stokes respiration resolved completely. No change was seen with placebo. cheyne-stokes respiration did not recur during outpatient treatment with oral theophylline. CONCLUSION: theophylline may be a rapid and effective therapy for life-threatening cheyne-stokes respiration.- - - - - - - - - - ranking = 1keywords = breathing, chest (Clic here for more details about this article) |
2/154. Expeditious diagnosis of primary prosthetic valve failure.Primary prosthetic valve failure is a catastrophic complication of prosthetic valves. Expeditious diagnosis of this complication is crucial because survival time is minutes to hours after valvular dysfunction. The only life-saving therapy for primary prosthetic valve failure is immediate surgical intervention for valve replacement. Because primary prosthetic valve failure rarely occurs, most physicians do not have experience with such patients and appropriate diagnosis and management may be delayed. A case is presented of a patient with primary prosthetic valve failure. This case illustrates how rapidly such a patient can deteriorate. This report discusses how recognition of key findings on history, physical examination, and plain chest radiography can lead to a rapid diagnosis.- - - - - - - - - - ranking = 0.36473790626611keywords = chest (Clic here for more details about this article) |
3/154. Non-heart-beating donors: a case study in procurement.To help meet the increasing need for transplantable organs, especially kidneys, organ procurement organizations are recovering organs from non-heart-beating patients. This article outlines the successful recovery and transplantation of kidneys from such a donor. Consent issues and historical background are also discussed.- - - - - - - - - - ranking = 0.0029464700625627keywords = back (Clic here for more details about this article) |
4/154. The management of non-traumatic cardiac arrest in the operating room with cardiopulmonary bypass.We present a case of a 29-year-old woman whom, while undergoing an elective gynecological procedure, acutely arrested. Closed chest cardiopulmonary compressions were not effective. Fortuitously, the cardiac surgical team was in an adjacent operating room, about to start an elective bypass case. After sternotomy, the patient was placed on cardiopulmonary bypass within 20 min of the arrest. The patient achieved return of spontaneous circulation and was ultimately discharged with only mild extremity weakness. The etiology of the arrest was never fully explained. Open chest massage and cardiopulmonary bypass should be considered early in the management of unexpected cardiac arrest, especially in the operating room where surgical expertise should be immediately available. Surgeons and anesthesiologists need to be aware of, and consider, the possibility of employing these techniques.- - - - - - - - - - ranking = 0.72947581253222keywords = chest (Clic here for more details about this article) |
5/154. On scene thoracotomy: a case report.We report a case of on scene resuscitative thoracotomy performed by an anaesthetist on a patient in cardiac arrest following a stab wound to the chest. The patient made a good recovery and was discharged from hospital within 2 weeks. The rationale for performing resuscitative thoracotomy and who should perform this procedure are discussed.- - - - - - - - - - ranking = 0.36473790626611keywords = chest (Clic here for more details about this article) |
6/154. A case of ventricular fibrillation in the prone position during back stabilisation surgery in a boy with Duchenne's muscular dystrophy.A 15-year-old boy with Duchenne's muscular dystrophy experienced prolonged cardiac arrest whilst in the prone position for spinal surgery. He was successfully resuscitated without apparent neurological sequelae by internal cardiac massage via a thoracotomy and external and internal direct current cardioversion. Recommendations are suggested for the pre- and peroperative management of such cases.- - - - - - - - - - ranking = 0.011785880250251keywords = back (Clic here for more details about this article) |
7/154. Unexplained asystole during thoracotomy irrigation: a case report.This case presentation involves a 76-year-old man with a 60-year history of smoking one and a half packs of cigarettes per day, who presented for a transurethral resection of the prostate (TURP). A preadmission chest x-ray revealed a left upper lobe lung lesion that was suggestive of carcinoma by subsequent computerized axial tomography. The TURP procedure was postponed, and the patient was advised to undergo an open thoracotomy biopsy with possible left upper lobectomy. The patient consented, and an open thoracotomy biopsy confirmed carcinoma. A left upper lobectomy was then performed. The operative procedure was significant for a 12-second acute episode of atrioventricular standstill during post-thoracotomy thoracic irrigation with warm saline. Return of sinus rhythm occurred spontaneously after cessation of irrigation. The operative field was closed, and the patient's recovery was unremarkable. Postoperative evaluation was unremarkable, and the patient was discharged 1 week later. Anatomic and physiologic vagal mechanisms are reviewed, and application to this case presentation is discussed.- - - - - - - - - - ranking = 0.38276586351549keywords = chest, upper (Clic here for more details about this article) |
8/154. Favorable outcome in a large left heart air embolism: lessons from an unusual complication of a noninvasive chest scan.OBJECTIVE: To report an unusual life-threatening complication of the performance of a computed tomographic (CT) scan of the chest. DESIGN: Case report. SETTING: University hospital. PATIENT: An intubated patient with blunt thoracic trauma. INTERVENTION: Performance of a CT scan of the chest at full inspiration. MAIN RESULT: With air insufflation, a large left ventricular air embolism occurred as a consequence of an airway breach, revealed by the simultaneous existence of a mild bilateral anterior pneumothorax. CONCLUSION: CT scan of the chest in patients at risk of airway breach (patients with acute respiratory distress syndrome, trauma patients) should first be performed at full expiration, not full inspiration.- - - - - - - - - - ranking = 2.5531653438628keywords = chest (Clic here for more details about this article) |
9/154. Transient swallow syncope during periods of hypoxia in a 67-year-old patient after self-extubation.OBJECTIVE: To describe the case of an adult patient with swallow syncope after bypass surgery, possibly related to hypoxia. DESIGN: Case report. SETTING: University hospital, medical-cardiologic intensive care unit. PATIENT: A 67-yr-old patient after second aortocoronary bypass operation for unstable angina. MAIN RESULTS: After the patient managed to extubate himself, he was in a borderline respiratory condition with an oxygen mask. When drinking for the first time after extubation, asystole was observed coincidentally with interruption of oxygen insufflation. During the next days, similar events occurred during food ingestion or when drinking liquids after a fall of oxygen saturation. The bradyarrhythmia was readily reversible on administration of atropine and ventricular backup pacing via temporary pacing wires. After normalization of gas exchange, no more episodes of swallowing-associated asystole were observed and the patient was discharged without a permanent pacemaker. There was no esophageal or gastrointestinal disease. Pre- and postoperative PR and QRS durations were normal. CONCLUSION: Extrinsic and transient mechanisms, rather than intrinsic conduction system disease, seem to have been operative in this case. It is suggested that hypoxia reinforced the vagal pharyngocardiac reflex as described in pediatric patients.- - - - - - - - - - ranking = 0.0029464700625627keywords = back (Clic here for more details about this article) |
10/154. Tracheobronchial involvement in relapsing polychondritis.Relapsing polychondritis (RPC) is a multisystem disorder of chondromalacia involving any cartilage. Respiratory tract involvement is the greatest threat to life. We report a patient with stenosis of the subglottic trachea and left main bronchus who suddenly ceased breathing. As this patient did not have any other clinical features of RPC, the diagnosis was difficult. CT showed circumferential worm-eaten-like thickening suggesting a deformity and edema of the tracheal mucosa. biopsy of the tracheal and thyroid cartilage revealed mild cartilage degeneration and infiltration with inflammatory cells. Therefore, the patient was diagnosed as having RPC. She is currently well 24 months after Montgomery T tube intubation with systemic steroids. Narrowing of the left main bronchus has not worsened.- - - - - - - - - - ranking = 0.63526209373389keywords = breathing (Clic here for more details about this article) |
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