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 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Tracheobronchial ruptures are rare but potentially lifethreatening events. We report on the case of a 34-year-old suicidal unrestrained car driver, who developed subcutaneous and mediastinal emphysema and right-sided haematothorax following blunt thoracic trauma. Fibreoptical inspection of the tracheobronchial system revealed a rupture (approximately 2 cm in length) of the pars membranacea of the trachea ending shortly above the carina. CT-scan confirmed the diagnosis of mediastinal emphysema, tracheal rupture and, in addition, left-sided pulmonary contusion. A repair of the tracheal tear was performed by right-sided thoracotomy using a double-lumen tube. The left-sided double-lumen tube was used postoperatively to achieve respirator ventilation with low pressure on the tracheal lumen and on the suture of the tracheal tear. On the other hand, sufficient airway pressure with PEEP for the left lung showing contusion could be provided, using the endobronchial tube. The postperative course was without complications. The patient was on respiratory support for three days due to his-pulmonary contusion. Following final endoscopic control of the trachea he was discharged from the ICU one week after the trauma. The clinical and radiological signs of tracheobronchial ruptures are discussed (respiratory distress, haemoptysis, cyanosis, localised pain, hoarseness, coughing, dysphagia, stridor, subcutaneous emphysema and pneumothorax, tension pneumothorax, mediastinal emphysema). Fibreoptic bronchoscopy is the present gold standard for confirming the diagnosis. The surgical and anaesthesiological approach to the management of tracheobronchial ruptures is described reviewing the current literature.
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PMID:[Diagnosis and therapy of tracheal rupture after blunt thoracic trauma]. 928 31

A 44-year-old non-smoking patient with longstanding ankylosing spondylitis presented in marked respiratory distress with tachypnea, fever, cough, greenish sputum, night sweats, dyspnea and weight loss. Computed tomography showed traction bronchiectases and cavities associated with scarring. The findings were most pronounced in the upper lobes which contained multiple cavities up to 8 cm in diameter harboring fungus balls. The superior segment of the left lower lobe showed two additional cavities. Tuberculosis and atypical mycobacteria were ruled out. Antibiotic therapy resulted in transient improvement. Five months after this acute exacerbation the patient expired from massive haemoptysis. Pulmonary fibrosis is a rare manifestation of ankylosing spondylitis, may be complicated by infection and haemorrhage and determine the dismal prognosis of these patients.
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PMID:Case report and review of the literature. Fatal pulmonary complication in ankylosing spondylitis. 945 16

Eighteen cases of pneumonia developed during an outbreak of adenovirus infection in a chronic psychiatric care facility. The six patients most severely affected were admitted to the intensive care unit (ICU) at our institution. Four of these patients developed septic shock. We report the presentation, disease progression, and response to treatment of these patients. Clinical features consisted of high fever, nonproductive cough, and dense lower lobe infiltrates. Laboratory abnormalities included transient fall in white blood cell and platelet counts, and elevations of transaminases, lactate dehydrogenase (LDH), and creatinine phosphokinase (CPK). Five patients were intubated for hypoxemia and four developed the acute respiratory distress syndrome (ARDS) and septic shock (mean cardiac output, 14.1 +/- 1.3 L/min; cardiac index, 6.4 +/- 0.4 L/min/min2; systemic vascular resistance, 326 +/- 107 dyne cm/s2). All patients recovered and were discharged back to the chronic care facility except for one patient with chronic renal failure who died 2 mo after admission. Adenovirus (serotype 35) was isolated from the respiratory secretions of five patients and antibody titers increased 6-fold in the other. These patients constitute the largest series of patients with ARDS and septic shock caused by adenovirus pneumonia and the first outbreak of multiple cases of adenovirus pneumonia in immunocompetent civilian adults occurring from a single source.
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PMID:Multiple cases of life-threatening adenovirus pneumonia in a mental health care center. 947 84

A 12-year-old dachshund was referred for respiratory distress, coughing, and weight loss. Cyanosis, dyspnea, tachypnea, and harsh lung sounds were noted on physical examination. Polycythemia with an increased number of nucleated red blood cells; right atrial enlargement; severe interstitial-to-alveolar pattern in all lung fields; and peripheral, echogenic, pulmonary masses were observed. Cytological examination of pulmonary aspirates indicated possible pulmonary carcinoma. The dog was euthanized at the owner's request. Isolated right-ventricular hypertrophy and pulmonary arteriopathy with amyloid deposits of apolipoprotein A1 were identified upon necropsy and histopathology. Pulmonary vascular amyloidosis should be considered in the differential diagnoses of respiratory distress in aged dogs.
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PMID:Isolated right-ventricular hypertrophy associated with severe pulmonary vascular apolipoprotein A1-derived amyloidosis in a dog. 952 28

Children with hyper-immunoglobulin M (hyper-IgM) syndrome are at increased risk for Pneumocystis carinii pneumonia (PCP), an opportunistic infection often found in immunodeficient hosts. PCP can present with increasing hypoxia, fever, cough, and respiratory distress. We describe a child with hyper-IgM syndrome in whom bronchoalveolar washings were negative for PCP. However, there was an atypical lung response in which caseating granulomas predominated. The histopathology, resembling that found in tuberculosis, stresses the importance of a high index of clinical suspicion and histologic confirmation for early intervention and treatment. Immunocompromised children with rapidly progressive pulmonary disease may require lung biopsy and stains such as GMS to identify PCP.
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PMID:Atypical Pneumocystis carinii pneumonia in a child with hyper-IgM syndrome. 956 84

Legionellosis is an important cause of severe pneumonia in the community. Inadequate therapy will lead to respiratory distress syndrome, disseminated intravascular coagulation (DIC) and finally fatal multiple organ failure. We encountered a rare case in which early manifestation included septic shock and DIC complicated by acute myocardial infarction (AMI) suspected to be derived from Legionnaires' disease. A 54-year-old healthy female complained of lumbago, high fever and dry cough 10 days after visiting a hot spring spa. She was emmergently admitted due to shock. Physical examination demonstrated hypotension, high fever, course creakle in the right lower lung. Hepatosplenomegaly, lymphadenopathy and eruption were not found. WBC count was 34600/microliters with nuclear shift. CRP elevated. FDP, D dimer and TAT also elevated CPK elevated with dominance of the MB isozyme. Chest roentogenography revealed congestive heart failure, pleural effusion and obscure pneumonic shadow and EKG showed ST segment elevation in leads I, II, III, aVF, V4, V5, and V6. The patient was diagnosed as having septic shock, DIC and AMI. She was treated with gabexate mesilate, high dose methyl prednisolone and dopamine hydrochloride as well as piperacillin, meropenem, isepamycin and fluconzaole. Despite intensive care, the blood pressure fell again and pneumonia had progressed on the 8th hospital day. These antibiotics appeared to be ineffective. Erythromycin was then administered and a dramatic effect. was obtained as the patient recovered. Serum titer of Legionella pneumophila (serogroup 1) rose to 128-fold 2 weeks after the onset. Other serum titers such as Chlamydia psittaci, Rickettsia, Mycoplasma were all negative. Cultures obtained from the sputum, throat swab, urine and blood did not yield any microorganisms. Although the diagnosis could not be confirmed because the titer did not elevate over 256-fold of 4-fold within 2 weeks after the onset, Legionella infection was highly suspected from the clinical features. This is a rare case in which septic shock and DIC with AMI preceded pulmonary symptoms in a non-immunocompromised patient.
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PMID:[Early manifestation of septic shock and disseminated intravascular coagulation complicated by acute myocardial infarction in a patient suspected of having Legionnaires' disease]. 958 3

A 38-year-old female is described, who was admitted with increasing respiratory distress, cough and visible blood stasis in the jugular veins. The most likely diagnosis in this young women taking oral contraceptives was pulmonary embolism, however, a ventilation-perfusion lung scan was normal. Echocardiography showed a dilated right ventricle and increased systolic pulmonary pressure. Despite administration of oxygen and intravenous heparin the patient died in circulatory collapse before further investigations could be initiated. Post-mortem examination revealed diffuse adenocarcinoma of the stomach (linitis plastica) with metastasis to local lymphnodes, lymphangiosis carcinomatosa of the liver, pancreas and spleen and tumour cell masses within the lumen of small pulmonary arteries leading to variable occlusions of the vessels. Fibrocellular intimal proliferation was found, leading to further obstruction and increased resistance to flow through the pulmonary vascular bed and to subacute cor pulmonale.
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PMID:Lethal pulmonary hypertension in a young woman caused by unrecognized haemangiosis carcinomatosa. 962 64

Pediatric airway foreign bodies are potentially life-threatening situations. The otolaryngologist is often consulted to aid in the diagnosis and management of these difficult cases. Although radiographic studies are often obtained, the decision for surgical intervention is usually based on a suspicious history and physical examination. Our hypothesis is that radiographic imaging should not alter the decision for surgical intervention. We retrospectively reviewed the cases of pediatric airway foreign bodies managed by the otolaryngology department at St Louis Children's Hospital between December 1990 and June 1996 with both radiographic imaging and operative intervention. Ninety-three cases of potential aspiration were identified, with a median patient age of 20 months. The most common presenting signs and symptoms were aspiration event (n = 82), wheezing (n = 76), decreased breath sounds (n = 47), cough (n = 39), respiratory distress (n = 17), fever (n = 16), pneumonia (n = 14), and stridor (n = 7). At the time of endoscopy, 73 patients were found to have an airway foreign body. The sensitivity and specificity of the imaging studies in identifying the presence of an airway foreign body in the 93 patients were 73% and 45%, respectively. Our decision for operative intervention was based on the history and physical examination, and was not changed in the presence of a negative radiographic study. The routine use of radiography should not alter the management of airway foreign bodies, providing that there is a well-equipped endoscopic team familiar with airway foreign bodies.
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PMID:Utility of conventional radiography in the diagnosis and management of pediatric airway foreign bodies. 979 11

Lung lobe torsion, although rare in cats, can be seen as a sequela to chronic respiratory disease. Clinical signs may include lethargy, coughing, hemoptysis, and respiratory distress. Lung lobe torsion may be diagnosed using radiography, ultrasonography, contrast bronchography, bronchoscopy, or thoracoscopy. Stabilization with fluids, oxygen, and supportive care followed by thoracotomy and lobectomy of the affected lobe(s) are necessary for a successful outcome. Diagnosis and treatment of lung lobe torsion is described in a 12.5-year-old cat with a history of feline asthma.
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PMID:Lung lobe torsion in a cat with chronic feline asthma. 982 85

A 45-year-old man was admitted to our hospital because of high fever, dry cough, and respiratory distress. Chest roentgenograms and computed tomograms showed diffuse fine nodular shadows without any other interstitial or alveolar infiltrates. An examination of transbronchial lung biopsy specimens disclosed infiltration of eosinophils and lymphocytes in alveolar walls and perivascular areas. Bronchoalveolar lavage fluid revealed elevated total cell counts, mostly of eosinophils and lymphocytes. The patient was given a diagnosis of acute eosinophilic pneumonia (AEP), but his symptoms improved in a week without any medication. Although diffuse fine nodular shadows on x-ray films may sometimes be the only sign of AEP.
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PMID:[Acute eosinophilic pneumonia with diffuse fine nodular shadows]. 989 37


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