Chest
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Case Reports
Prolonged treatment with almitrine for refractory hypoxemia in adult respiratory distress syndrome.
A 49-year-old man presented with an atypical pneumonia entailing an adult respiratory distress syndrome (ARDS). The refractory hypoxemia caused a myocardial infarction, leading us to try pharmacologic treatments. Almitrine bismesilate (AB) infusion allowed improvement of arterial oxygenation during 115 h without adverse effect. This case is, to our knowledge, the first reported prolonged treatment using AB for hypoxemia due to ARDS.
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Fungal endocarditis is considered an absolute indication for valve replacement surgery. We describe the successful medical treatment of recurrent Candida parapsilosis candidemia with sequential treatment with amphotericin B and fluconazole in a patient with probable prosthetic valve endocarditis. Because of the presumed effectiveness of amphotericin B and fluconazole in the treatment of this patient, medical therapy should be considered as potentially useful in the treatment of recurrent C parapsilosis fungemia or endocarditis or both.
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To examine the incidence, clinical impact, and predictors of reintubation following unplanned extubation (UE) in ICU patients. ⋯ Unplanned extubation can result in serious complications; however, about half the patients who have UE can be safely observed without immediate reintubation. Selected clinical factors, which are readily available from standard ICU records for the 24-h period prior to UE, may be useful to predict the likelihood of reintubation.
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Analysis of T-cell surface markers was carried out in peripheral blood and bronchoalveolar lavage (BAL) fluid of Japanese patients with sarcoidosis to examine the influence of differing racial background. The subjects were 26 untreated patients in whom a diagnosis of active sarcoidosis had recently been established and 9 healthy volunteers, and two-color immunofluorescence analysis was performed. CD3+HLA-DR+ cells, CD4+HLA-DR+ cells, and CD4+CD29+ cells in peripheral blood and BAL fluid were significantly increased in the patients compared with the healthy volunteers, and the mean percentages increased in parallel with the extent of the radiologic stage. ⋯ Thus, the evaluation of these antigens' expression is an important clinical approach for the staging of the disease. However, no significant differences were found in CD3+CD25+, CD4+CD45RA+, or CD8+CD11+ cells in either peripheral blood or BAL fluid between the patients and volunteers. Our results indicated that in Japanese patients with sarcoidosis, circulating T cells are activated but CD25+ cells are not increased in peripheral blood and BAL fluid, but there is not a significant association with racial background.
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Pulmonary physicians have a significant role in assessing the ability of individuals with respiratory impairments to be placed in jobs or retain current jobs. The Americans with Disabilities Act mandates a high level of rational thought and justification for any recommendation against placement or work retention. This article reviews criteria for determining if an individual with a respiratory impairment or disability can currently and safely perform a job and if there is substantial direct threat of future risk. In addition, methods of modifying the workplace to accommodate individuals with respiratory disabilities are discussed.