Heliox improves pulmonary mechanics in a pediatric porcine model of induced severe bronchospasm and independent lung mechanical ventilation

Background  

A helium-oxygen gas mixture (heliox) has low gas density and lowturbulence and resistance through narrowed airways. The effects of heliox onpulmonary mechanics following severe methacholine-induced bronchospasm wereinvestigated and compared to those of a nitrogen-oxygen gas mixture (nitrox) inan innovative pediatric porcine, independent lung, mechanical ventilationmodel.     

Numerous granulocyte transfusions to a patient with severe aplastic anemia without severe complication

One of the most important morbidity causes of aplastic anemia is invasive fungal infections. It could not be possible to take control of infection without neutrophils despite the recent developments in the antifungals. In this presented case, a patient with severe aplastic anemia, granulocyte transfusion were administered as 46 times because of the presence of widely invasive aspergillosis and resistance. Only fever reaction was observed as a complication of transfusion amongst the other complications such as acute lung damage, alloimmunisation, and graft-versus-host disease. Granulosit transfusions should not be avoided in patients who had an indication for.     

Tissue-fat pulmonary embolism occurring in a patient with a severe pelvic fracture

The fat embolism syndrome following trauma is associated with fat droplets in the pulmonary microvasculature. This is the first case report of a large adipose tissue embolus obstructing a pulmonary artery after blunt injury. This embolism occurred during the resuscitation of a patient with a laceration of an iliac vein and disruption of the adjacent fatty tissue secondary to a severe pelvic fracture. Theories of the pathogenesis of the fat embolism syndrome and implications for early therapeutic modalities are discussed.     

Lowering pulmonary artery pressure in a patient with severe acute respiratory failure

A case of pulmonary arterial hypertension on the basis of ARDS is presented. The cyclooxygenase inhibitor Ibuprofen is used to lower pulmonary arterial pressure, resulting in an improvement in the right ventricular function.     

Phospholipasic and prophospholipasic activities in bronchoalveolar lavage fluid in severe acute pulmonary disease with or without ARDS

Bronchoalveolar lavages were performed in 21 patients undergoing mechanical ventilation: Group I: coma due to sedative overdose (11 cases), without pulmonary impairment, serving as control group; Group II: severe acute pulmonary disease without ARDS (5 cases); Group III: patients with ARDS (5 cases). In the recovered fluid we measured: total proteins (P) and phospholipids (PL), phospholipasic (PLase) and prophospholipasic (PPLase) activities. In ARDS group, considerable increase of P, (p<0.001), and a doubling of PL (p<0.02) was found. Total PLase activity was present in all three groups, with a higher mean level in Group III (p<0.01). PPLase activities were low or untetectable in four patients of this group. PLase/PL ratio was increased in acute respiratory insufficiency, with or without ARDS, suggesting an increase of surfactant catabolism. The decrease of this ratio when pulmonary function improved, or its increase after deterioration suggest that it is related to changes of surfactant.     

Mycobacterium sherrisii isolation from a patient with pulmonary disease

The characterization of 2 clinical isolates of Mycobacterium sherrisii provides further phenotypic and genotypic information beyond that reported in the article that originally described this species. One of our strains was responsible for pulmonary disease in a middle-aged non-HIV patient; thus, confirming the potential pathogenicity of this species previously reported only in an HIV-positive patient.     

慢性阻塞性肺疾病患者的延续护理

介绍了1例慢性阻塞性肺疾病患者延续护理的具体实施过程及护理成效。主要护理干预为出院计划,出院后家庭访视、电话随访2个阶段,包括全面的护理评估、建立共同的护理目标、个性化的健康教育、指导和咨询、治疗和程序、个案管理和监测,以及持续护理成效评价,关键是实施以循证为基础的标准化护理干预方案。     

Hyperthyroidism without elevated levels of thyroxine and triiodothyronine in a patient with pulmonary tuberculosis

We have reported a case of toxic thyroid adenoma with low T3 and low T4 syndrome in a patient who received antituberculous drugs for active pulmonary tuberculosis. Search for thyroid-hormone-binding antibodies was negative. Thyroid lobectomy was done and histologic examination confirmed toxic thyroid adenoma; two months after operation the patient was clinically and biologically euthyroid. During the course of a severe nonthyroidal illness, normal thyroid hormone levels must be regarded as an indicator of hyperthyroidism. In addition, we believe that rifampin has a significant effect on thyroid function tests and results of thyroid physiology.     

Cat scratch disease presenting with a retroperitoneal abscess in a patient without animal contacts

Cat scratch disease (CSD) is usually diagnosed in patients presenting with regional lymphadenopathy and pyrexia that follow contacts with animals. We describe here a young adult male patient who presented with marked pyrexia and a retroperitoneal abscess without relevant medical histories, illustrating that CSD can be a diagnostic challenge on selected occasions.     

Management of dyspnea in severe chronic obstructive pulmonary disease

Progression of chronic obstructive pulmonary disease (COPD) is frequently associated with increasing dyspnea; indeed, patients with severe COPD constitute the largest group of patients with chronic respiratory insufficiency. The sensation of dyspnea in these patients is mostly related to increased work of breathing, a consequence of an increased resistive load, of hyperinflation, and of the deleterious effect of intrinsic positive end-expiratory pressure (PEEP(i)). Once optimal medical treatment has been provided, pharmacological treatments of dyspnea exist (beta2-agonists, methylxanthines, opiates) but seldom suffice. Nonpharmacological complementary treatments must be envisioned. Patients with severe hyperinflation should be screened as possible candidates for lung reduction surgery. Pulmonary rehabilitation-including chest therapy, patient education, exercise training-has been established as effective on quality of life (QoL) and dyspnea. Noninvasive positive pressure devices may be effective for symptomatic treatment of severe dyspnea: continuous positive airway pressure (CPAP) counteracts the deleterious effect of PEEP(i) in patients with severe hyperinflation; intermittent positive pressure breathing (IPPB) may decrease dyspnea and discomfort during nebulized therapy; finally noninvasive positive pressure ventilation (NIPPV) has been shown to be effective on the sensation of dyspnea and QoL in COPD with severe hypercapnia.