Chest
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Shortness of breath after pneumonectomy is a common finding that has multiple causes. We report the cases of two patients with shortness of breath on assuming an upright posture (platypnea) that followed pneumonectomy; these individuals developed right-to-left shunt across a patent foramen ovale (PFO) with normal right-sided intracardiac pressures. Both contrast echocardiography and magnetic resonance imaging (MRI), including a recently introduced dynamic ultrafast imaging technique, proved helpful in diagnosing this condition noninvasively.
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We report a dramatic case of factitious hemoptysis in a 36-year-old black man who presented with hemoptysis and chest pain. ⋯ A factitious cause should be considered in the differential diagnosis of hemoptysis of unclear etiology, especially when the medical history or the patient's behavior is unusual.
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Randomized Controlled Trial Comparative Study Clinical Trial
Should all patients undergoing cardiac catheterization or percutaneous transluminal coronary angioplasty receive oxygen?
Supplemental oxygen is routinely administered to patients with acute coronary syndromes. The risk of significant morbidity during cardiac catheterization or coronary angioplasty has been well described; however, to our knowledge, the need for routine oxygen supplementation in these patients has not been investigated. ⋯ Significant hypoxemia is a common finding among patients undergoing cardiac catheterization or angioplasty despite the absence of predictive risk factors. Severe and prolonged hypoxemic episodes occurred in 10 percent (14/142, phase 1) of patients breathing room air. Patients undergoing diagnostic catheterization with history of chronic lung disease or a baseline SpO2 < 95 percent are at high risk to develop moderate-severe hypoxemia. Oxygen therapy significantly reduced the incidence and severity of procedure-induced hypoxemia in both groups. Our data support the use of both pulse oximetry and oxygen supplementation in patients undergoing cardiac catheterization and PTCA.
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To evaluate the ability of preoperative variables to identify patients at increased risk for complications after lung resection and the usefulness of predicted postoperative FEV1 as a marker of risk for adverse outcomes. ⋯ A low predicted postoperative FEV1 appears to be the best indicator of patients at high risk for complications, and it was the only significant correlate of complications when the effect of other potential risk factors was controlled for in a multivariate analysis. Pulmonary resection should not be denied on the basis of traditionally cited preoperative pulmonary variables, and a prediction of postoperative pulmonary function by a technique of simple calculation may be useful to identify patients at increased risk for medical complications.
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Comparative Study
Assessment of interrater and intrarater reliability in the evaluation of metered dose inhaler technique.
To determine if a training session using videotaped metered dose inhaler (MDI) performances can result in high interrater and intrarater reliability of five evaluators assessing MDI technique. ⋯ High interrater and intrarater reliability in MDI evaluation is difficult to obtain. Clinicians and researchers involved in MDI evaluation and education should be trained to achieve consistency. A single training session using videotaped MDI demonstrations was not adequate in achieving consistency among evaluators. To improve accuracy of research results, researchers should include at least two evaluators to assess MDI technique or take other measures to show and report reliability.