Respiration; international review of thoracic diseases
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Case Reports
Use of a tunnelled pleural catheter for the management of refractory hepatic hydrothorax: a new therapeutic option.
Refractory hepatic hydrothorax poses a challenging therapeutic dilemma, as treatment options are limited. Herein, we describe the case of a 48-year-old lady with advanced cirrhosis and recurrent transudative pleural effusion despite a sodium-restricted diet, optimal diuretic therapy and transjugular intrahepatic portosystemic shunt. Given the patient's platelet and coagulation disorders, thoracoscopic pleurodesis was deemed unsafe. ⋯ Subsequent follow-up revealed spontaneous pleurodesis, as no recurrence of pleural effusion was seen over a 6-month follow-up period. Very few data are available with regard to the use of indwelling pleural catheters for benign transudative pleural effusion, and more specifically hepatic hydrothorax. Herein, we present this novel potential indication of the indwelling pleural catheter and illustrate the successful clinical outcome.
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Bacterial tracheobronchitis is an extremely rare entity, which was long considered to be a pediatric disease. We report the case of a 65-year-old woman who presented with persistent wheezing, worsening productive cough and sore throat. Computed tomography of the chest revealed the presence of tracheomalacia, confirmed at bronchoscopy. ⋯ To our knowledge, this is the first case of MRSA exudative tracheobronchitis and tracheomalacia in a non-ventilated adult. Other adult cases of bacterial tracheobronchitis and MRSA tracheobronchitis in mechanically ventilated patients reported in the literature are also reviewed. Physicians should be aware of the diagnosis of tracheomalacia in adults, which can masquerade as persistent asthma and may be associated with the development of serious infections including MRSA tracheobronchitis.
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Comparative Study
Sedation during flexible bronchoscopy in patients with pre-existing respiratory failure: Midazolam versus Midazolam plus Alfentanil.
The use of sedation during flexible bronchoscopy (FB) is undisputed; however, the combination of benzodiazepines and opiates, although reasonable, is suggested to cause hypoventilation, particularly in patients with pre-existing respiratory failure. ⋯ Combined sedation during FB produced a comparable degree of desaturation and hypoventilation, and is associated with a comparable time to full recovery compared to monosedation in patients with pre-existing respiratory failure. Importantly, FB using combined sedation is better tolerated by patients despite only 50% midazolam consumption.
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Patients with Mycobacterium avium-intracellulare complex (MAC) pulmonary disease often suffer from weight loss. Adipokines are factors secreted by adipocytes, including leptin and adiponectin, as well as some inflammatory cytokines, tumor necrosis factor-alpha (TNF-alpha) and interleukin 6 (IL-6). Body mass index (BMI) is known to be inversely correlated with adiponectin and positively with leptin, TNF-alpha, and IL-6. ⋯ The results of the present study indicate that, in patients with MAC pulmonary disease, adiponectin is inappropriately secreted and may play a role in the pathophysiology of the disease.
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Obesity and obstructive sleep apnea (OSA) are both associated with the prevalence of major cardiovascular illnesses and certain common factors they are considered responsible for, such as stress oxidative increase, sympathetic tonus and resistance to insulin. ⋯ This study demonstrates that the use of CPAP can reverse the increased superoxide production, the diminished serum nitrite, nitrate and plasma adiponectin levels, and the metabolic changes existing in obese patients with OSA.