Chest
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A patient with obesity resulting from sleep-related eating disorder demonstrated signs and symptoms of obstructive sleep apnea (OSA). Incarceration restricted access to food during the night, leading to weight loss and clinical improvement. Release from prison allowed recurrence of unrestricted sleep-eating, recurrent obesity, and documented OSA. Successful treatment of sleep-related eating disorder can result in improvement in coexisting OSA.
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A 50-year-old woman with lifelong asthma had nearly total expiratory collapse of her distal trachea. The signs and symptoms were similar to those of asthma except for a pronounced upper airway component to her wheezing and the immediate onset of dyspnea on exertion. ⋯ Ultrafast computed tomography was a valuable adjunct to bronchoscopy in diagnosis and management. Expiratory collapse of the trachea should be considered in the differential diagnosis of wheezing and intractable reactive airway disease.
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To determine whether continuous Fick cardiac output measurement is applicable to exercise testing, cardiac output data obtained by the continuous Fick method (Qcf) during exercise were compared with data obtained by the thermodilution method (Qth). Seventeen patients with old myocardial infarction underwent a 1-min or 3-min incremental exercise test (protocols 1 and 2, respectively). During exercise, the oxygen consumption (VO2), arterial oxygen saturation (SaO2), and mixed venous oxygen saturation (SvO2) were monitored continuously. ⋯ In exercise protocol 2, SvO2 almost reached a steady-state by the end of each stage. The correlation between Qcf and Qth was good in protocol 1 (r = 0.86), except in phases 2 and 4, and was also good in protocol 2 (r = 0.80). We conclude that the continuous Fick method may be applicable for determining the cardiac output during exercise provided that the variation in SvO2 is slight.
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Despite encouraging results seen following bone marrow transplantation (BMT), it has been observed that once these patients become critically ill and require medical intensive care unit (MICU) admission, the chances of survival are poor. We hypothesized that while mechanical ventilation would be an important predictor for death in the MICU, those patients not requiring mechanical ventilation could be successfully discharged from the MICU. The records of 36 patients with 43 admissions to the MICU following BMT were analyzed. ⋯ The average length of stay for the survivors was 4.4 + 3.0 days, which was significantly less than the 17.8 +/- 24.0 days for those patients not surviving (p < 0.001). These data indicate that admission to the MICU may result in a beneficial outcome for critically ill patients with BMTs, but for those requiring mechanical ventilation due to respiratory failure, the chances of survival are poor. This information may be useful for providing patients with BMTs and their families with realistic estimates of prognosis prior to transfer to the MICU and mechanical ventilation.
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To examine the impact of pulse oximetry on the use of arterial blood gas and other laboratory determinations and to examine predictors of the use of arterial blood gas measurements. ⋯ The implementation of pulse oximetry in this manner gives an idea how effective the technology will be in reducing the use of arterial blood gas determinations without guidelines for the use of pulse oximetry. As only a marginal decrease was observed in the total population of medical and surgical patients, and only on the night shift, formal and standardized guidelines for the most efficient use of pulse oximetry should be considered. If these were considered, pulse oximetry may indeed make a significant contribution to improving the efficiency of care services.