Chest
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Over a 6-month period, 6 of 54 postthoracotomy patients developed pneumonia and respiratory failure. Pneumonia was secondary to herpes simplex virus type 1 in 3 of the 6 patients. Diagnostic efforts including bronchoscopy with bronchial washing, viral cultures, and cytologic examination permitted early diagnosis and successful treatment with acyclovir. A high index of suspicion for herpes simplex pneumonia must be maintained in critically ill patients with undiagnosed pneumonia.
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Comparative Study
Volume-controlled inverse ratio ventilation in oleic acid induced lung injury. Effects on gas exchange, hemodynamics, and computed tomographic lung density.
To compare volume-controlled inverse ratio ventilation (VCIRV) with volume-controlled ventilation with conventional inspiratory to expiratory (I:E) ratio (VCV PEEP) at equal levels of end-expiratory pressure. ⋯ VCIRV was comparable to VCV PEEP at similar PEEP levels in alveolar recruitment, aeration of the lung tissues, and in oxygenating the blood. Since cardiac output also remained unchanged, oxygen delivery to peripheral tissues did not differ significantly between the two modes. Neither method has thus proved superior to the other one.
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Comparative Study
The varied manifestation of pulmonary artery agenesis in adulthood.
Unilateral pulmonary artery agenesis (UPAA), a rare congenital anomaly that is frequently associated with other cardiovascular abnormalities, is usually diagnosed in childhood. Most patients who have no associated cardiac anomalies have only minor or absent symptoms and survive into adulthood. The conditions of such patients are frequently misdiagnosed in adulthood. In this report, we describe six patients with UPAA in whom the diagnosis was first established in adulthood. The varied clinical presentation of these patients is reviewed and the relative effectiveness of a variety of diagnostic tests is compared. ⋯ UPAA is frequently misdiagnosed in adulthood and is often not considered in the differential diagnosis of the unilateral hyperlucent lung. Clinicians and radiologists should be aware of the possibility of undiagnosed cases in adults, with many atypical characteristics.
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To describe the epidemiology, microbiology, and outcome of nosocomial pneumonia with secondary bloodstream infection. ⋯ Pneumonia is an important cause of nosocomial bloodstream infection, but it is not increasing in frequency or changing in etiology in our institution. The ICUs are a major contributor to this problem but have the same case short-term mortality rate and microbial etiology as non-ICU cases. Cases associated with Pseudomonas have a much higher mortality rate.
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Egophony is a change in timbre (Ee to A) but not pitch or volume. It is due to a decrease in the amplitude and an increase in the frequency [corrected] of the second formant, produced by solid (including compressed lung) interposed between the resonator and the stethoscope head. This explains certain difficulties in learning this valuable but currently neglected sign as well as in understanding certain physiologic false-positive occurrences.