A primary tracheal carcinoid tumor masquerading as chronic obstructive pulmonary disease

Primary tumors of the trachea are rare and can be missed because of the paucity of symptoms and findings and the difficulty in detecting them with chest radiographs. A 31-year-old male patient was admitted with complaints of shortness of breath, coughing, phlegm, and blood in the sputum. He stated that he was being treated for chronic obstructive pulmonary disease. Fiberoptic bronchoscopy revealed a vegetative mass with a wide base on the posterolateral wall of the distal one-third of the trachea. Postoperative histopathological examination revealed a typical carcinoid tumor. In patients with an unexplained cough, dyspnea, infrequent hemoptysis, and normal pulmonary imaging findings, tracheal carcinoma should be suspected. In such cases, early thoracic computed tomography and bronchoscopic examination can provide a rapid diagnosis and treatment options and prevent a false diagnosis.     

Therapy for chronic obstructive lung disease

CAO is a chronic, degenerative disease of the lung that produces a number of serious physiologic abnormalities in respiratory function. It is progressive and, in general, responds poorly to medical therapy. Cigarette smoking is almost universally the cause of the disease, and stopping smoking clearly slows the progress of the disorder. Therapy is of marginal value at best in a substantial number of patients with this problem, and even in those who respond well, improvement in function is not great. A conservative approach to therapy is advised, but only when its value can be documented. As the illness progresses, chronic oxygen therapy in hypoxic patients may be of value in preventing or treating cor pulmonale.     

Noninvasive ventilation in chronic obstructive lung disease

Noninvasive mechanical ventilation is provided without establishing an endotracheal airway. In acute respiratory failure due to chronic obstructive lung disease, noninvasive positive-pressure ventilation delivered through a nasal or face mask may eliminate the need for intubation and related complications, reduce the duration of hospitalisation and improve survival compared to assisted ventilation through an endotracheal tube. In chronic respiratory failure related to neuromuscular diseases and thoracic deformities, the advent of noninvasive intermittent longterm ventilation is well established. However, it is not clear, whether addition of noninvasive ventilation to standard treatment with medication and longterm oxygen improves symptoms and survival in chronic respiratory failure due to chronic obstructive lung disease. During introduction of noninvasive ventilation, patients must be monitored closely. Patient selection and information, meticulous optimization of the ventilator settings and delivery system, education and experience of the personnel have an important impact on the success of this novel way of providing mechanical ventilatory support.     

Acute respiratory failure and chronic obstructive lung disease

Patients with COPD who develop acute respiratory failure require special attention in their management. Patients with severe COPD often have cor pulmonale, complex acid/base compensations, and altered respiratory control mechanisms. These need to be considered when approaching the patient with an acute decompensation. Because of the improving prognosis in this group of patients, aggressive management should be undertaken using combinations of bronchodilator medications, oxygen, bronchial hygiene, and antibiotics.     

Occupational therapy for chronic obstructive lung disease.

The role of occupational therapy in a multi-disciplinary approach to treatment of chronic obstructive pulmonary disease is described in this paper in terms of the evaluation and implementation of the role in the general hospital settings of two neighboring Cleveland institutions. Cleveland is a heavily industrialized urban region with a high concentration of patients suffering from chronic obstructive pulmonary disease. Motivated by this fact and by the knowledge of the increasing incidence of chronic obstructive pulmonary disease in the United States, therapists at the two facilities wanted occupational therapy to become an intrinsic part of both the Lutheran Medical Center's outpatient demonstration program and St. John's Hospital's pulmonary rehabilitation team. Although of differing natures, these programs were similar in purpose, complementing one another and therefore enhancing the quality of rehabilitative care of the patient with a chronic lung disease within this geographic area.     

慢性阻塞性肺疾病合并支气管软骨瘤一例

患者,男性,48岁,农民,因“咳嗽、气促、间断咯血3年,加重伴发热4 d”于2016年11月12日入住高州市人民医院。患者4年前有肺结核病史,自诉已治愈,具体不详。患者3年前无明显诱因反复出现咳嗽,间断性咯鲜红色血,多为痰中带血丝,伴活动后气促,可自闻及喘鸣音,反复在当地医院治疗,具体用药不详,症状反复。个人史及家族史无特殊。查体:双肺呼吸音减弱,可闻及大量散在痰鸣音及少许哮鸣音,心律齐,双下肢无水肿。     

A case of laryngotracheal stenosis masquerading as asthma

This report describes the case of a 21-year-old male that presented in respiratory failure caused by laryngotracheal stenosis (LTS) related to remote endotracheal intubation. The patient sought treatment for respiratory complaints in the weeks prior, and had a poor response to treatment for asthma. Currently, LTS is predominantly seen as a sequela of invasive airway management, and this case highlights the possibility of delayed presentations. Clinical manifestations and methods of diagnosis are described. Preventive measures, temporizing therapy, and definitive treatment are then discussed. With increasing numbers of patients undergoing invasive airway maneuvers, it is increasingly important for providers to recognize this disease. As is shown in this case, the diagnosis of LTS requires a high clinical suspicion in order to achieve a timely diagnosis and decrease morbidity and mortality.     

Impaired water handling in chronic obstructive lung disease.

Impaired water excretion has been described in stable, nonedematous patients with chronic obstructive lung disease (COLD). To elucidate the mechanism involved, we measured basal glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and water, sodium, and solute excretion for 4 hours after water loading (20 ml. per kilogram orally or as D5W intravenously) in two groups of 10 age-matched, hypoxic, stable, nonedematous COLD normocapneic and hypercapneic patients (PCO2 less than or greater than 45 mm. Hg, respectively). In 5 patients of each group, additional measurements of plasma and urine osmolality and plasma vasopressin were made at 30-minute intervals after oral water loading and the results compared to those obtained in 10 normal control subjects. Hypoxic (PO2 61 plus or minus 2 mm. Hg), normocapneic (PCO2 39 plus or minus 1 mm. Hg) patients had normal GFR (114 plus or minus 5 ml. per minute) and ERPF (517 plus or minus 31 ml. per minute) and excreted the load normally (101 plus or minus 5 per cent of oral or intravenous water per 4-hours). This was associated with a normal rate of sodium excretion (34 plus or minus 5 mEq. per 4-hours) and low-normal plasma vasopressin (1.9 plus or minus 0.7 pg. per milliliter) which was suppressed appropriately with water loading. Hypercapneic (PCO2' 62 plus or minus 5), hypoxic (PCO2' 57 plus or minus 2) patients had normal GFR (106 plus or minus 7), low baseline vasopressin (1.1 plus or minus 0.2) which was suppressed appropriately, and decreased (p less than 0.05) 4-hour water excretion (63 plus or minus 8 per cent), 4-hour sodium excretion (15 plus or minus 9), and ERPF (394 plus or minus 31). A significant correlation was observed between impaired water and impaired sodium excretion (p less than 0.05). These studies indicate that in COLD patients: (1) hypercapnia but not hypoxemia is related to the abnormal water handling and to the increased reabsorption of sodium by the renal tubule; (2) the defect in water excretion is not related to abnormal vasopressin secretion or metabolism; (3) the alteration in sodium excretion may be due to hypercapneic-induced increase in renal bicarbonate reabsorption and/or abnormal renal blood flow.