Chest
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To assess blood pressure (BP) response to continuous maximal arm ergometry in patients with spinal cord injury (SCI). ⋯ These data describe, for the first time to our knowledge, that exertional hypotension is present in all individuals with SCI during continuous arm ergometry. Further studies are needed to clarify the mechanisms responsible for this phenomenon and to evaluate the long-term consequences for individuals with SCI.
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The use of electret microphones to measure lung sounds is widespread because of their small size, high fidelity, and low cost. Typically, an air cavity is placed between the skin surface and the microphone to convert the chest wall vibrations into a measurable sound pressure. ⋯ Model predictions are in general agreement with both in vitro and in situ measurements and indicate that the overall high-frequency response of the transduction diminishes with increasing cavity depth. This finding suggests that smaller cavity depths are more appropriate for detection of lung sounds over a wide band width and stresses the importance of coupler size on microphone measurements.
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Case Reports
High-dose bolus injection of urokinase. Use during cardiopulmonary resuscitation for massive pulmonary embolism.
Bolus administration of high-dose thrombolytic agents has been reported for the treatment of acute pulmonary embolism. We describe the case of a 60-year-old woman who suffered a massive pulmonary embolism with cardiopulmonary arrest 21 h after an exploratory laparotomy. After 20 min of unsuccessful cardiopulmonary resuscitation (CPR), a bolus of 2,000,000 U of urokinase was injected via a peripheral vein. ⋯ Several other case reports and small series showed successful treatment of pulmonary embolism during similar circumstances using high-dose bolus injection of thrombolytic agents. Mechanical thrombus fragmentation using a pulmonary artery catheter or pulmonary embolectomy has not been shown to be more successful during resuscitation. We conclude that bolus administration of thrombolytic agents during CPR for massive pulmonary thromboembolism may be an acceptable and successful technique, which also is available even in the community hospital setting.
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Necrotizing tracheobronchitis and acute airway obstruction from invasive mycosis developed in a patient who had undergone bone marrow transplantation. The infectious process obstructed the airway and disintegrated the walls of the right mainstem bronchus and pulmonary artery. The airway was cleared using rigid bronchoscopy to extract the detritus. The patient died of hemorrhage after rupture of the pulmonary artery through the right mainstem bronchus.