Chest
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A patient with traumatic diaphragmatic hernia had his lesion present remotely after thoracoabdominal trauma as an asymptomatic chest wall mass. This is a rare and, perhaps, unique presentation of this entity.
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To evaluate alterations in renal blood flow in sepsis-induced renal failure, we developed and studied a percutaneously placed thermodilution renal blood flow catheter in eight critically ill patients. Para-aminohippurate extraction coefficients were decreased, supporting the need for renal vein sampling to determine CPAH in sepsis. Thermodilution and CPAH methods correlated strongly, confirming the reliability of this thermodilution method. ⋯ Glomerular filtration rate, which was reduced in four of seven septic patients, correlated with the fraction of total blood flow going to the kidneys. These results suggest that renal vascular abnormalities may be occurring during septic shock. Our study demonstrates that sepsis-induced renal dysfunction may occur despite normal ranges of total renal blood flow during shock.
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Unplanned removal of an endotracheal airway tube by a patient (SXT) represents a potentially life-threatening incident. Prospective monitoring of all intubated adult ICU patients for one year revealed that 12 of 112 extubated themselves (overall incidence, 11 percent). Comparison of SXT patients with the NXT group disclosed no risk factors for this occurrence. ⋯ The complication (and reintubation) rate in the SXT group was 31 percent. The reintubation rate in deliberate extubations was 11 percent. Self-extubation is a common occurrence which, despite obvious hazards, often is tolerated well by adults.
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We studied the long-term outcome after BAE for life-threatening hemoptysis in patients with CF. Data from pulmonary function tests were available for 18 of the 25 patients followed. A case-control comparison revealed that these 18 patients died sooner than hemoptysis-free patients with CF matched for age, sex, and pulmonary function (p less than 0.02), with the excess mortality occurring within the first three months after BAE. ⋯ Most patients experienced long intervals (greater than 1 year) free of major hemoptysis. Extended follow-up (mean, 35 months) revealed a higher incidence of recurrent severe bleeding than previously reported for 13 of these patients followed a mean of 11 months. Repeat BAE for severe recurrence was performed successfully in eight of nine patients, without complication.