1/28. 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.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/28. Cartilaginous hamartoma of the chest wall with secondary aneurysmal cyst-like areas in an infant: a case report.A case of a four-month-old infant diagnosed as cartilaginous hamartoma of the rib is presented. This rare tumor usually presents at birth. The patient had respiratory distress syndrome. Swelling of the ribs was palpable on physical examination and the infant underwent surgery for excision of the ribs. Histopathologically, the tumor showed benign focal overgrowth of normal skeletal elements with cartilaginous, vascular and primitive-appearing mesenchymal elements. Additionally, secondary aneurysmal cyst formation coexisted with the tumor. The diagnosis was infantile cartilaginous hamartoma of the rib. In this entity, primitive-appearing mesenchymal stroma may be mistaken for a malignant condition. Usually a benign clinical course is expected and treatment is by block excision.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/28. Physical therapy for a patient in acute respiratory failure.BACKGROUND AND PURPOSE: The main indications for physical therapy for patients in intensive care units (ICUs) are excessive pulmonary secretions or atelectasis. Timely physical therapy interventions may improve gas exchange and reverse pathological progression, thereby curtailing or avoiding artificial ventilation. The purpose of this case report is to illustrate 24-hour availability of physical therapy for a patient with acute respiratory failure. CASE DESCRIPTION: The patient was a 66-year-old man who was admitted to an ICU for acute respiratory failure. Intensive physical therapy, based on Dean's physiologic treatment hierarchy for treatment of patients with impaired oxygen transport, consisted of upright body positioning, mobilization and exercise, and active cycles of breathing techniques every 2 hours for the first 12 hours he was in the ICU. OUTCOMES: In total, the patient received 11 physical therapy sessions over his 48-hour stay in the ICU (6 sessions on day 1 and 5 sessions on day 2). Arterial oxygenation improved markedly with radiographic resolution of infiltrates, and planned endotracheal intubation and mechanical ventilation were avoided. DISCUSSION: This patient with acute respiratory failure received physical therapy in a timely manner afforded by 24-hour access to physical therapy. The intensive physical therapy might be more cost-effective than if the patient had been managed with intubation and mechanical ventilation. patients in ICUs who have excessive pulmonary secretions or atelectasis may benefit from access to physical therapy 24 hours a day.- - - - - - - - - - ranking = 2.6061042588487keywords = physical (Clic here for more details about this article) |
4/28. Paraneoplastic pemphigus caused by an epithelioid leiomyosarcoma and associated with fatal respiratory failure.A patient is described who initially presented with pemphigus vulgaris, limited to the oral cavity, and weight loss. Although the various laboratory studies pointed to the diagnosis of paraneoplastic pemphigus (PNP), the underlying neoplasm was not detected until 6 months later, when the patient developed shortness of breath and routine physical examination on admission revealed an abdominal mass, which eventually was proven to be an epithelioid leiomyosarcoma. In spite of radical excision of the tumour and intensive treatment of the dyspnoea, the patient died of respiratory failure 19 months after the PNP had been diagnosed. early diagnosis of PNP is stressed to possibly prevent fatal pulmonary involvement.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/28. Non-compliance in adolescents with chronic lung disease: causative factors and practical approach.Compliance with medical therapies may be considered a challenge in many age groups but especially so in adolescence. The adolescent patient with chronic lung disease may struggle to progress smoothly through the phases of adolescence because of fears of peer rejection and isolation occurring as a result of social, emotional and physical consequences of their underlying lung disease and its treatment. Non-compliance can be viewed as a scale from episodic compliance to frequent compliance with patients moving between ends of the spectrum. health professionals need to consider the likely degree of compliance with therapies that they recommend, discuss the issue of compliance and the consequences of non-compliance with the adolescent patient and arrive at a workable compromise. This article discusses persistent asthma, cystic fibrosis and advanced neuromuscular disease to illustrate practical approaches to enhancing patient compliance in adolescence.- - - - - - - - - - ranking = 0.28956713987208keywords = physical (Clic here for more details about this article) |
6/28. Near-lethal respiratory failure after recombinant human thyroid-stimulating hormone use in a patient with metastatic thyroid carcinoma.A patient with widely metastatic differentiated thyroid cancer who had been heavily pretreated with (131)I was given recombinant human thyroid stimulating hormone (rhTSH) prior to (131)I treatment. Clinical and physical data from both this case and the literature suggest that the recombinant hormone, not the (131)I, may have caused a significant portion of the tumor swelling, which in turn was the most likely cause of the patient's symptoms. The potential effect of (131)I-induced tumor swelling and direct radiation effect on the lung is also analyzed. We review the potential hazards associated with rhTSH in patients with metastasis and propose means of minimizing this risk.- - - - - - - - - - ranking = 0.28956713987208keywords = physical (Clic here for more details about this article) |
7/28. Neuromuscular disease, respiratory failure and cor pulmonale.Respiratory muscle weakness is an uncommon cause of chronic respiratory failure and a rare cause of cor pulmonale. The problem may not be apparent unless specific physical signs are sought or appropriate investigations performed. We present three patients who presented diagnostic difficulty for prolonged periods until the presence of respiratory muscle weakness was considered. Once the diagnosis was established treatment with nocturnal nasal intermittent positive pressure ventilation produced a dramatic improvement in symptoms and allowed a return to a near normal lifestyle.- - - - - - - - - - ranking = 0.28956713987208keywords = physical (Clic here for more details about this article) |
8/28. Respiratory failure and hypercoagulability in a toddler with Lemierre's syndrome.A 3.5-year-old healthy boy with 4 days of fever was referred to the emergency department for respiratory distress. The physical examination was remarkable for stupor, tachycardia, tachypnea, and dyspnea. Initial blood tests showed pancytopenia. He rapidly developed torticollis. Computerized tomography of the neck revealed a thrombus in the internal jugular vein. A presumptive diagnosis of Lemierre's syndrome was made and he was started on antibiotics and anticoagulation. He subsequently developed adult respiratory distress syndrome and required high frequency oscillatory ventilation for 9 days. blood cultures were positive for fusobacterium necrophorum. Screening for hypercoagulability revealed 2 known risk factors: a mutation in the prothrombin gene and elevated lipoprotein a.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/28. Rapid progression of amyotrophic lateral sclerosis presenting during pregnancy: a case report.BACKGROUND: amyotrophic lateral sclerosis (ALS) is a progressive neurologic disease that is rare within the obstetric population. Only 5 reports of ALS in pregnancy have appeared in the medical literature since 1977. CASE: A previously healthy 25-year-old pregnant woman with 2 previous births presented with generalized weakness at 22 weeks' gestation. Initial laboratory values were all normal. She was admitted to hospital at 29 weeks' gestation and intubated because of respiratory compromise. Daily biophysical profiles and amniotic fluid indices were normal. Labour was induced at 34.5 weeks' gestation, and delivery was uncomplicated. She died at 9 months postpartum. CONCLUSION: pregnancy complicated by the onset of ALS is a rare event. Complications of this disease mainly affect the respiratory system. death in this case occurred more rapidly than in other previously reported cases.- - - - - - - - - - ranking = 0.28956713987208keywords = physical (Clic here for more details about this article) |
10/28. aminopterin-like syndrome sine aminopterin associated with translocation involving chromosomes 5 and 10.We studied a baby born with physical features suggestive of the aminopterin syndrome, but without exposure of the mother to aminopterin during pregnancy. G-banded chromosomes from peripheral blood lymphocytes had a normal 46,XX pattern. However, in 50 skin fibroblasts there was a normal female karyotype in 5 cells and 45 cells showed an apparently balanced reciprocal translocation involving the long arm of chromosome 5 (band q35) and the long arm of chromosome 10 (band q22). The relation of this mosaicism to the abnormal phenotype is unclear.- - - - - - - - - - ranking = 0.28956713987208keywords = physical (Clic here for more details about this article) |
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