Chest
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Case Reports
Partial right-sided congenital pericardial defect with herniation of right atrium and right ventricle.
In an unusual case of right-sided pericardial defect with herniation of the right atrium and right ventricle, cardiac blood pool isotope imaging is introduced as a new, noninvasive diagnostic procedure. Surgery which consisted of excision of right-sided pericardium relieved the chest pain which was the only symptom the patient had prior to surgery.
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Twelve cases of necrotizing sarcoid granulomatosis are presented as a retrospective study. The population of patients consisted of ten women and two men, with an average age of 50 years. Nine patients initially had a variety of pulmonary and nonpulmonary complaints, while three were asymptomatic. ⋯ The sole death occurred in a patient treated with an immunosuppressive agent (cyclophosphamide). We conclude that the clinical behavior of necrotizing sarcoid granulomatosis is not similar to that of the other angiocentric granulomatoses and that most patients with this disease can be left untreated or be treated with steroids alone. We suggest the possibility that necrotizing sarcoid granulomatosis may be the histologic counterpart of so-called nodular sarcoid.
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Respiratory viral illness is a major cause of morbidity in both adults and children. This report focuses on both the acute and chronic effects on respiratory function of these ubiquitous infections. Infant airways are particularly vulnerable due to the relatively low conductance in immature peripheral airways. ⋯ The basic pathogenic mechanism involved in adult respiratory viral infection is bronchial hyperreactivity, presumably secondary to epithelial damage and resultant sensitization of rapidly adapting airway receptors. In addition, there may be virus-related alterations in the autonomic and humoral regulation of airway tone. Viral infections may alter the effects of common air pollutants on respiratory function.
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Fifteen patients in the early stages of the adult respiratory distress syndrome with severe hypoxemia who were capable of maintaining adequate spontaneous ventilation were treated with continuous positive airway pressure (CPAP). The optimal level of CPAP was adjusted for each patient to achieve the highest oxygenation with the least adverse hemodynamic effects. ⋯ The improvement in pulmonary status was achieved with no significant changes in cardiac output or the arterial-mixed venous oxygen content difference. Early application of an adjusted level of positive end-expiratory pressure using CPAP in patients with adequate levels of fluid is an effective and safe method of treating selected groups of patients in the early stages of the adult respiratory distress syndrome.