Cases reported "Respiratory Insufficiency"

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1/265. Bochdalek diaphragmatic hernia presenting with acute gastric dilatation.

    Congenital diaphragmatic hernia through the foramen of Bochdalek may present after infancy. A 21/2-year-old Malay girl presented with acute respiratory distress. Chest examination showed reduced chest expansion and decreased breath sounds on the left side. Chest radiograph showed a large "cyst" in the left chest, which was thought to be a lung cyst under tension. Tube thoracostomy resulted in clinical improvement. Results of a barium study showed that the cyst perforated by the thoracostomy tube was the stomach, which had herniated through a Bochdalek diaphragmatic defect. Surgical repair of the diaphragmatic defect and closure of the perforated stomach was performed successfully. Congenital diaphragmatic hernia should be included in the differential diagnosis of respiratory distress in young children. Nasogastric tube placement must be considered as an early diagnostic or therapeutic intervention when the diagnosis is suspected.
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2/265. Transient left ventricular failure following bilateral lung transplantation for pulmonary hypertension.

    BACKGROUND: Bilateral lung transplantation is an established therapy for end-stage pulmonary hypertension. Its early postoperative outcome may be biased by various complications resulting in unexpected deterioration of the patient in terms of hemodynamics and blood gases. methods: We have reviewed the early postoperative course of patients who underwent bilateral lung transplantation for pulmonary hypertension at our institution and analyzed all available data, especially hemodynamic measurements, echocardiographic documentation and therapeutical strategies, in those cases where cardiac dysfunction was found to be responsible for clinical deterioration. RESULTS: Three out of 20 lung transplant recipients operated for pulmonary hypertension experienced severe respiratory insufficiency accompanied by hemodynamic decompensation during the first days after surgery. Clinical and laboratory findings together with results of echocardiography and pulmonary artery catheterism helped establish the diagnosis of left ventricular failure. This proved to be transitory, but the response to therapy (inotropic drugs, afterload reduction and eventually prostaglandins) was very variable. Adequately treated, this complication did not preclude the outcome of transplantation by itself. CONCLUSION: Left ventricular failure is a possible complication after lung transplantation for pulmonary hypertension. echocardiography and pulmonary artery catheterism may be useful adjuvant diagnostic tools, beside routine physical examination, chest X-ray, and laboratory analysis. Therapy of this complication must be adapted individually and may be complex.
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3/265. Bronchial mucormycosis with progressive air trapping.

    A previously healthy 70-year-old woman developed fever, cough, and exertional dyspnea. Her symptoms progressed over a 2-month period despite treatment by her primary care physician with 2 courses of oral antibiotics and the addition of prednisone. Hypoxemia and the finding of hyperglycemia with mild ketoacidosis led to hospital admission. Serial chest radiographs demonstrated diffuse heterogeneous pulmonary opacities and progressive air trapping in the right lower lobe. Fiberoptic bronchoscopy revealed a deep penetrating ulcer with exposed bronchial cartilage of the bronchus intermedius and dynamic airway obstruction with complete closure during expiration. biopsy of the ulcer revealed rhizopus arrhizus. Respiratory failure stabilized with the patient on conventional mechanical ventilation and receiving amphotericin b. Before surgery could be performed, pseudomonas aeruginosa pneumonia and septic shock developed, and the patient died.
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4/265. Noninvasive positive-pressure ventilation facilitates tracheal extubation after laryngotracheal reconstruction in children.

    Tracheal extubation after laryngotracheal reconstruction in children may be complicated by postoperative tracheal edema and pulmonary dysfunction. The replacement of a tracheal tube in this situation may exacerbate the existing injury to the tracheal mucosa, complicating subsequent attempts at tracheal extubation. We present two cases where noninvasive positive-pressure ventilation was employed to treat partial airway obstruction and respiratory failure in two children following laryngotracheal reconstruction. Noninvasive positive-pressure ventilation served as a bridge between mechanical ventilation via a tracheal tube and spontaneous breathing, providing airway stenting and ventilatory support while tracheal edema and pulmonary dysfunction were resolved. Under appropriate conditions, noninvasive positive-pressure ventilation may be useful in the management of these patients.
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ranking = 22.919629529998
keywords = breathing
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5/265. Proximal diabetic neuropathy presenting with respiratory weakness.

    A patient is described with proximal diabetic neuropathy presenting with respiratory weakness. A 50 year old man developed progressive shortness of breath over 2 months. He also had weakness of hip flexion. phrenic nerve responses were absent, and spontaneous activity was seen in the intercostal and lumbar paraspinal muscles with long duration neurogenic MUPs and reduced recruitment in the diaphragm. Without treatment, the patient began to improve with resolution of his proximal leg weakness and breathing difficulties. Proximal diabetic neuropathy is another cause of neuromuscular respiratory weakness.
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6/265. Tension pneumoperitoneum associated with a pleural-peritoneal shunt.

    The differential diagnosis of pneumoperitoneum is broad. We report a case of tension pneumoperitoneum in a patient on mechanical ventilation with initially unrecognized pneumothorax who had an indwelling pleural-peritoneal shunt. The patient developed ventilatory and hemodynamic collapse as air was diverted from the pleural space into the peritoneal cavity. Subsequent abdominal exploration revealed the source of the intra-abdominal air. Placement of a chest thoracostomy tube and removal of the pleural-peritoneal catheter resulted in significant clinical improvement. We suggest that it is important to recognize that pleural-peritoneal catheters may cause tension pneumoperitoneum without obvious concurrent pneumothorax.
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7/265. Unusual injury pattern in a case of postmortem animal depredation by a domestic German shepherd.

    A case is presented of a 38-year-old woman with skeletization of the head, neck, and collar region and a circumscribed 26-cm x 19-cm defect on the left chest with sole removal of the heart through the opened pericardium but undamaged mediastinum and lungs. The injuries showed V-shaped puncture wounds and superficial claw-induced scratches adjacent to the wound margins that have been described as typical for postmortem animal depredation of carnivore origin and derived from postmortem animal damage by the woman's domestic German shepherd. The circumscribed destruction of the left chest with unusual opening of the pericardium is explained by the physiognomy of the muzzle of the German shepherd and differs from previous reports. Any case presented as postmortem animal mutilation should be viewed with skepticism and undergo a full autopsy.
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8/265. False positive perfusion lung scintiscans in tetraplegic patients: a case series.

    An accurate diagnosis of pulmonary embolism is essential to prevent excessive morbidity and mortality from either inappropriate therapy or failure to institute anticoagulation. The diagnosis of pulmonary embolism in tetraplegic spinal cord injury patients is complicated by frequent inability to perform the ventilation portion of the ventilation-perfusion scintiscan (V/Q scan) and by controversy regarding classification of defects on perfusion-only scans, as well as by coexisting pulmonary disease, systemic illness, related injuries, and the tendency for tetraplegic patients to have unexplained fever. This report describes three tetraplegic ventilator-dependent patients with hypoxic respiratory failure and normal chest radiographs who had large defects on perfusion-only lung scans. ventilation scintiscans were not performed because the patients were ventilator-dependent with tracheostomies. Pulmonary angiography findings were normal in all patients, and all three responded to aggressive pulmonary toilet. Even large defects on perfusion-only scans despite normal chest radiographs should not be used to establish a diagnosis of pulmonary embolism in tetraplegic patients, and further diagnostic imaging is warranted.
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9/265. diagnosis of pulmonary embolus by spiral CT: a case study.

    A thirty-eight-year old immunosuppressed woman presented with respiratory distress and was diagnosed with pneumocystis carinii pneumonia. pulmonary embolism was also suspected on clinical grounds. A ventilation-perfusion Scan was indeterminate. Contrast-enhanced spiral computed tomography of the chest confirmed the presence of a central pulmonary embolus and helped to avoid pulmonary angiography in this critically ill patient.
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10/265. Respiratory failure and pulmonary hypertension associated with klippel-feil syndrome.

    A 28-year-old woman with a deformed thorax and kyphoscoliosis associated with klippel-feil syndrome developed respiratory failure with pulmonary hypertension. Pulmonary 133Xe ventilation and 99mTc-MAA perfusion scintigraphies showed maldistributions of lung ventilation and perfusion, and noticeably delayed 133Xe washout from the lungs. Dynamic breathing MR imaging showed poor and/or asynchronous respiratory movements of the chest wall and diaphragm. These findings indicate that the perfusion-ventilation imbalance, the decreased ventilatory turnover, and expiratory flow from the alveolar space partly derived from the impaired respiratory mechanics may be responsible for the respiratory complications in this patient.
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keywords = breathing, chest
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