Respiration; international review of thoracic diseases
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Comparative Study
Features of idiopathic pulmonary fibrosis with organizing pneumonia.
To characterize the clinical features of patients with idiopathic pulmonary fibrosis (IPF) having organizing pneumonia (OP), we retrospectively reviewed the clinical charts, chest X-rays, CT scans, and transbronchial lung biopsy (TBLB) specimens of patients with IPF. Patients with IPF and OP had a subacute onset of symptoms (within 2 months) (87.5%), leukocytosis (> 10,000/mm3) (62.5%), and a strong C-reactive protein (CRP) reaction (> 3+) (75%). Some of these features were distinctly different from those of IPF patients without OP (subacute onset of symptoms 0%, leukocytosis 0%, strong CRP reaction 16.7%). ⋯ Clinical features of IPF patients with OP differed from those of patients with IPF without OP. IPF patients with OP showed good clinical response to corticosteroid therapy. These findings warrant further study of the presence of OP in TBLB specimens in predicting corticosteroid responsiveness and prognosis of patients with IPF.
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Streptococcus milleri mediastinitis had resolved in a 44-year-old male after 3 weeks of combined parenteral antibiotic therapy including clindamycin, which showed the greatest in vitro activity against S. milleri isolated from this patient, and surgical drainage. This case demonstrates that primary purulent mediastinitis may be caused by a strain of S. milleri with or without other bacterial species, and suggests that S. milleri should be added to the list of causative organisms of purulent mediastinitis even when the patient has not undergone a surgical procedure.
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Patients with neuromuscular disease may suffer from nocturnal respiratory failure despite normal daytime respiratory function. The physiological reduction in muscle tone during sleep may be life-threatening in a patient with impaired muscle strength. Nocturnal respiratory failure may occur in patients with the postpolio syndrome, amyotrophic lateral sclerosis, myasthenia gravis, myotonic dystrophy, and muscular dystrophy. ⋯ Daytime symptoms may include morning drowsiness, headaches and excessive daytime sleepiness. Polycythemia, hypertension, and signs of heart failure may also be seen. Effective treatment is available, and may improve the quality of life, and possibly increase survival.
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Randomized Controlled Trial Clinical Trial
Breathing pattern and respiratory mechanics in chronically tracheostomized patients with chronic obstructive pulmonary disease breathing spontaneously through a hygroscopic condenser humidifier.
Hygroscopic condenser humidifiers (HCHs) have been proposed to artificially condition gases breathed by intubated and mechanically ventilated patients. These devices may improve viscosity and coloring of secretions, preventing further bacterial colonization, and heat inspiratory flow in chronically tracheostomized (CT) patients during spontaneous breathing. The aim of this study was to evaluate the effects of HCH on respiratory mechanics and breathing pattern in CT patients with chronic obstructive pulmonary disease (COPD) breathing spontaneously during quiet breathing and maximal voluntary ventilation (MVV). ⋯ These changes were not significantly different without the application of HCH. In CT COPD patients spontaneously breathing. HCHs have no significant effects on the breathing pattern and respiratory mechanics both during quiet breathing and MVV.
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Worsening of hypoxaemia during sleep in patients with chronic obstructive pulmonary disease has been extensively investigated in the past 20 years owing to the development of polysomnography and to the advent of reliable transcutaneous oximeters. Sleep-related hypoxaemia is characteristic of rapid-eye-movement (REM) sleep but may be present during other sleep stages. There is a strong relationship between nocturnal O2 saturation and the level of daytime PaO2: the more pronounced daytime hypoxaemia, the more severe nocturnal hypoxaemia. ⋯ The deleterious effects of sleep-related hypoxaemia include cardiac arrhythmias, 'hypoxaemic stress' on the coronary circulation and especially, peaks of pulmonary hypertension. The treatment of nocturnal hypoxaemia is conventional O2 therapy (both nighttime and daytime) in patients who exhibit marked daytime hypoxaemia (PaO2 < 55-60 mm Hg). At present data are not sufficient for justifying the use of isolated nocturnal O2 therapy in patients with nocturnal desaturation who do not qualify for conventional O2 therapy.