1/12. Pseudomembranous colitis without diarrhea presenting clinically as acute intestinal pseudo-obstruction.Pseudomembranous colitis usually presents with diarrhea in a clinical setting of recent antibiotic use. It is uncommon to see it as a cause of obstipation and colonic pseudo-obstruction. We report an unusual case of an elderly woman with hypertension, congestive heart failure, chronic obstructive pulmonary disease, chronic renal insufficiency, and diabetes mellitus, who was admitted with fever, abdominal pain, and distension without diarrhea. She presented with decreased stool frequency and obstipation. She did not respond to conservative management. colonoscopy revealed a picture of pseudomembranous colitis, and clostridium difficile toxin was positive. She responded well to metronidazole therapy.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
2/12. cardiac tamponade secondary to chest tube placement.A 69-year-old woman was hospitalized because of a left-sided pneumothorax due to chronic obstructive pulmonary disease. During chest tube placement she developed hypotension and a decrease in peripheral oxygen saturation. A diagnosis of heart tamponade was made and the patient was treated successfully with pericardiocentesis and placement of a pericardial drain. cardiac tamponade following chest tube placement is a rare and serious complication. When the clinical condition deteriorates following chest tube insertion, cardiac tamponade should be considered.- - - - - - - - - - ranking = 32.964766145855keywords = chest (Clic here for more details about this article) |
3/12. Varicosities of the valleculae: an unusual cause of hemoptysis?hemoptysis is a common respiratory symptom causing a great deal of anxiety. The cause is often apparent following a clinical history, upper-airway examination, bronchoscopy, and CT scanning of the thorax. We present a case of massive hemoptysis, the etiology of which was not readily apparent despite this conventional approach. Vallecular hemorrhage has been previously reported but is usually minor unless associated with surgical trauma, and can be readily missed if not aware of the possibility. We speculate about the etiology and mechanism for recurrent hemorrhage.- - - - - - - - - - ranking = 0.081601101161602keywords = upper (Clic here for more details about this article) |
4/12. Corticosteroid therapy for hemolytic anemia and respiratory failure due to mycoplasma pneumoniae pneumonia.This is a report of hemolytic anemia and respiratory failure due to Mycopkisma pneumoniae pneumonia. His chest CT scans showed bilateral diffuse thickened bronchovascular bundles and emphysematous changes. The pulmonary function test supported the diagnosis of chronic obstructive pulmonary disease (COPD). He was diagnosed as coldagglunitin-associated hemolytic anemia and M. pneumonzae pneumonia in inapparent COPD. Corticosteroid administration was remarkabily effective for hemolytic anemia and beneficial for acute exacerbation of COPD.- - - - - - - - - - ranking = 4.7092523065507keywords = chest (Clic here for more details about this article) |
5/12. Congenital high airway obstruction syndrome and airway reconstruction: an evolving paradigm.OBJECTIVES: To refine the classic definition of, and provide a working definition for, congenital high airway obstruction syndrome (CHAOS) and to discuss the various aspects of long-term airway reconstruction, including the range of laryngeal anomalies and the various techniques for reconstruction. DESIGN: Retrospective chart review. patients: Four children (age range, 2-8 years) with CHAOS who presented to a single tertiary care children's hospital for pediatric airway reconstruction between 1995 and 2000. CONCLUSIONS: To date, CHAOS remains poorly described in the otolaryngologic literature. We propose the following working definition for pediatric cases of CHAOS: any neonate who needs a surgical airway within 1 hour of birth owing to high upper airway (ie, glottic, subglottic, or upper tracheal) obstruction and who cannot be tracheally intubated other than through a persistent tracheoesophageal fistula. Therefore, CHAOS has 3 possible presentations: (1) complete laryngeal atresia without an esophageal fistula, (2) complete laryngeal atresia with a tracheoesophageal fistula, and (3) near-complete high upper airway obstruction. Management of the airway, particularly in regard to long-term reconstruction, in children with CHAOS is complex and challenging.- - - - - - - - - - ranking = 0.24480330348481keywords = upper (Clic here for more details about this article) |
6/12. harm reduction--a treatment approach for resistant smokers with tobacco-related symptoms.Smokers with chronic obstructive pulmonary disease (COPD) appear to represent a hard-core group, and this presents a dilemma for chest physicians. A reduction in cigarette smoking benefits health, and nicotine replacement therapy (NRT) can aid smoking reduction. Hence we studied the efficacy of nicotine gum in helping hard-core smokers with severe COPD to quit. Seventeen smokers with severe COPD (FEV(1) 38-47% of predicted normal) who smoked >30 cigarettes/day but were unable to quit were encouraged to reduce their smoking as much as possible by using 4-mg nicotine gum. Five gradually reduced their daily tobacco consumption and, 18 months after starting NRT, were smoking an average of 6 cigarettes/day while still using nicotine gum. Compared to baseline, their respiratory symptoms had improved, and both FEV(1) and FVC had increased. There was no improvement in pulmonary function in the group of smokers who did not reduce their cigarette consumption. No adverse events relating to nicotine occurred among the patients who used NRT to reduce their smoking. We propose that this reduction approach should be considered for patients with respiratory disease who are unable or unwilling to stop smoking.- - - - - - - - - - ranking = 4.7092523065507keywords = chest (Clic here for more details about this article) |
7/12. Primary pulmonary leiomyosarcoma. Report of a case diagnosed by fine needle aspiration cytology.BACKGROUND: Primary pulmonary leiomyosarcoma is a rare but important entity. We report a case diagnosed by fine needle aspiration cytology. CASE: A 73-year-old male presented with an asymptomatic, right, pulmonary, subpleural nodule detected by computed tomography during follow-up for chronic obstructive pulmonary disease. Fine needle aspiration cytology showed cellular smears with numerous single or loosely cohesive groups of spindle-shaped to round cells. The tumor cell nuclei were blunt ended (cigar shaped), with fine to fine-granular chromatin, prominent nucleoli and an irregular nuclear rim. The tumor cells were positive for desmin and negative for cytokeratin and S-100 protein by immunocytochemistry. Right upper lobectomy with lymph node dissection was performed. Pathologic diagnosis after microscopic, immunohistochemical and electron microscopic studies was leiomyosarcoma. CONCLUSION: To our knowledge, this is the first reported case of primary pulmonary leiomyosarcoma arising in the subpleural region diagnosed by fine needle aspiration cytology. Immunocytochemistry was useful in establishing the diagnosis in this case.- - - - - - - - - - ranking = 0.081601101161602keywords = upper (Clic here for more details about this article) |
8/12. A patient with an increased troponin level without evidence of ischaemic cardiac injury.A 74-year-old man was admitted for chest infection with acute exacerbation of chronic obstructive pulmonary disease. He was incidentally found to have an increased serum level of cardiac troponin i, despite the absence of symptoms and electrocardiographic evidence of ischaemic heart disease. troponin i became undetectable after the serum was treated with polyethylene glycol, which removed any interfering antibodies. serum cardiac troponin t was also undetectable after this treatment. Interference of the cardiac troponin i assay by heterophilic antibodies was thus confirmed. Because of the possibility of false-positive results due to immunoassay interference, clinicians should be alerted whenever laboratory findings are incompatible with the clinical picture, and should be ready to perform additional laboratory tests.- - - - - - - - - - ranking = 4.7092523065507keywords = chest (Clic here for more details about this article) |
9/12. Acute myocardial infarction associated with albuterol.OBJECTIVE: To report a case of acute myocardial infarction (AMI) following the use of albuterol (salbutamol) in a patient without preexisting coronary artery disease and to review the related literature. CASE SUMMARY: An 84-year-old white woman with no history of cardiac disease was treated for an exacerbation of chronic obstructive pulmonary disease with albuterol 5 mg and ipratropium bromide 500 microg nebulized with oxygen; the albuterol was given in the same dose every 2 hours. Her respiratory condition improved, but soon after the sixth dose of albuterol, she developed increasing chest tightness. The electrocardiogram (ECG) showed ST segment elevation in the chest leads (V(2,3)) and, subsequently, the troponin i concentration and creatine kinase rose. Urgent coronary angiography showed smooth coronary arteries with no obstructive coronary artery disease or thrombosis. Left ventriculography showed anterior hypokinesia consistent with anterior myocardial injury. A subsequent echocardiogram also revealed normal left ventricular size but anterior, anteroseptal, and apical hypokinesia. An objective causality assessment revealed that albuterol had a probable likelihood of causing the AMI in this patient. DISCUSSION: A medline search (1966-February 2004) revealed 6 other case reports of AMI associated with albuterol treatment. The possible pathogenesis of albuterol-induced myocardial necrosis includes activation of cardiac and peripheral beta(2)-adrenoceptors, inducing positive chronotropic and inotropic effects and vasodilation with coronary blood flow redistribution. albuterol can also cause hypokalemia and other metabolic and electrical changes, including prolonged QT interval. These effects may be especially detrimental in patients with hypoxia, hypercapnea, and preexisting heart diseases. CONCLUSIONS: Although myocardial injury is a rare complication following albuterol therapy, clinicians should use high-dose beta(2)-agonists with caution. Close monitoring of ECG and metabolic changes is recommended before early repeated high doses are administered.- - - - - - - - - - ranking = 9.4185046131015keywords = chest (Clic here for more details about this article) |
10/12. Bilateral tension pneumothorax.The report discusses three patients who presented with pulseless electrical activity (PEA), caused by chronic respiratory disease, with bilateral tension pneumothorax. In each case needle decompression failed to relieve the tension and cardiac output was restored only after the insertion of a chest tube.- - - - - - - - - - ranking = 4.7092523065507keywords = chest (Clic here for more details about this article) |
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