Chest
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Review Case Reports
A case of pancreatic carcinoma causing massive bronchial fluid production and electrolyte abnormalities.
A 39-year-old man developed massive bronchorrhea (2 to 3.5 L/d) with electrolyte and volume depletion about 2 years after undergoing a Whipple's procedure for pancreatic carcinoma. An open lung wedge biopsy specimen was consistent with metastatic adenocarcinoma with extensive growth along preexisting pulmonary architecture. ⋯ The mechanism of massive bronchorrhea is not known. Chemical analysis of bronchial fluid in comparison to serum and the temporary response to chemotherapy are most consistent with secretory and transudative mechanisms.
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Review Case Reports
Nephrobronchial fistula and lung abscess resulting from nephrolithiasis and pyelonephritis.
There are multiple etiologies reported as causes of lung abscess; however, this differential rarely includes intra-abdominal abnormalities other than extension of a hepatic process. We describe a patient who was found to have a lung abscess and empyema resulting from the development of a nephrobronchial fistula secondary to nephrolithiasis and pyelonephritis. The patient had no urinary symptoms or known abdominopelvic infection and the etiology of lung abscess was only incidentally discovered after chest CT revealed extension of pleural fluid below the diaphragm.
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Comparative Study
Cardiopulmonary effects of positive pressure ventilation during acute lung injury.
To assess the gas exchange and hemodynamic effects of pressure-limited ventilation (PLV) strategies in acute lung injury (ALI). We hypothesized that in ALI, the reduction of plateau airway pressure (Paw) would be associated with less alveolar overdistention and thus have better hemodynamic and gas exchange characteristics than larger tidal volume (Vr) ventilation. ⋯ Changes in lung volume determine Ppc and Ppl. PLV strategies do not alter hemodynamics but result in less of an increase in VD/VT than would be predicted from the obligatory decrease in VT.