5300312
A rare cause of acute respiratory failure--allergic bronchopulmonary aspergillosis.
Allergic bronchopulmonary aspergillosis (ABPA) is a complex immune hypersensitivity reaction to Aspergillus fumigatus, usually complicating the course of patients with asthma and cystic fibrosis. The common radiological manifestations encountered are fleeting pulmonary opacities, bronchiectasis and mucoid impaction. Uncommon radiological findings encountered in ABPA include pulmonary masses, perihilar opacities simulating hilar adenopathy, miliary nodules and pleural effusions. Herein, we describe a 22-year-old female patient who presented with acute hypoxaemic respiratory failure secondary to left lung collapse, which necessitated rigid bronchoscopy for management. On further evaluation, she was diagnosed to have ABPA. This is the first documented report of ABPA presenting as acute hypoxaemic respiratory failure secondary to lung collapse.
26068481
Efficacy and safety of iodopovidone pleurodesis through tube thoracostomy.
OBJECTIVE
To evaluate the efficacy and safety of iodopovidone as an agent for pleurodesis through tube thoracostomy in patients with recurrent pleural effusions and pneumothorax.


METHODS
This was a prospective study in which pleurodesis was performed with a solution of 20 mL 10% iodopovidone and 80 mL normal saline solution infused through a tube thoracostomy and left in the pleural cavity for 4 h.


RESULTS
A total of 64 patients (34 men) with a mean (+/-SD) age of 47.1 +/- 15.4 years were included. There were 37 cases of pleural effusion and 27 of pneumothorax. A complete response (neither reaccumulation of fluid nor recurrence of pneumothorax) was obtained in 32 (86.5%) patients with pleural effusion and 25 (92.6%) patients with pneumothorax. A second procedure (i.e. repeated pleurodesis) was attempted successfully in four patients in the pleural effusion group. All patients experienced chest pain to a varying degree as recorded on a Visual Analogue Scale (median 50.5, range 10-95). Seven patients developed fever and one immunocompromised patient developed empyema following the procedure. There were no recurrences at a median follow up of 5 months (range 3-15 months) in the pleural effusion group, and 13 months (range 6-24 months) in the pneumothorax group.


CONCLUSIONS
Iodopovidone can be used as an effective and safe agent for (chemical) pleurodesis (through tube thoracostomy), which is inexpensive and readily available.
33491888
Noninvasive ventilation in ARDS caused by Mycobacterium tuberculosis: report of three cases and review of literature
22528299
Pulmonary hypertension as a presenting manifestation of allergic bronchopulmonary aspergillosis.
The case of a 46-year-old lady who presented with respiratory failure and pulmonary hypertension in the absence of clinical signs of asthma or bronchiectasis, and in whom a diagnosis of allergic bronchopulmonary aspergilloma [ABPA] was made subsequently on the basis of radiological and laboratory investigations is reported. Symptomatic and objective improvement was seen with corticosteroid therapy. To the best of the authors' knowledge, such an occurrence has not been reported previously. This case highlights the importance of keeping a high index of suspicion while investigating a patient with pulmonary hypertension in whom the aetiology is not apparent on initial evaluation. Identification of the disease, in its early-stage, can prevent progression to bronchiectasis and fibrotic lung disease, and thus, patients can be saved from the morbidity related to end-stage disease.
3038618
Is the mortality higher in the pulmonary vs the extrapulmonary ARDS? A meta analysis.
BACKGROUND AND AIM
ARDS can occur from the following two pathogenetic pathways: a direct pulmonary injury (ARDSp); and an indirect injury (ARDSexp). The predisposing clinical factor can influence the pathogenesis and clinical outcome of ARDS. This metaanalysis was aimed at evaluating whether there is any difference in mortality between the two groups.


METHODS
We searched the MEDLINE, EMBASE, and CINAHL databases for relevant studies published from 1987 to 2007, and included studies that have reported mortality in the two groups of ARDS. We calculated the odds ratio (OR) and 95% confidence interval (CI) to assess mortality in patients with ARDSp vs patients with ARDSexp and pooled the results using three different statistical models.


RESULTS
Our search yielded 34 studies. In all, the studies involved 4,311 patients with 2,330 patients in the ARDSp group and 1,981 patients in the ARDSexp group. The OR of mortality in ARDSp group compared to the ARDSexp group was 1.11 (95% CI, 0.88 to 1.39), as determined by the random-effects model; 1.04 (95% CI, 0.92 to 1.18), as determined by the fixed-effects model; and 1.04 (95% CI, 0.92 to 1.18), as determined by the exact method, indicating that mortality is similar in the two groups. The mortality was no different whether the studies were classified as prospective (OR, 1.15; 95% CI, 0.87 to 1.51) or retrospective (OR, 1.01; 95% CI, 0.61 to 1.69); small (OR, 1.11; 95% CI, 0.77 to 1.60) or large (OR, 1.1; 95% CI, 0.82 to 1.49); or observational (OR, 1.10; 95% CI, 0.82 to 1.49) or interventional (OR, 0.97; 95% CI, 0.79 to 1.19). There was methodological and statistical heterogeneity (I(2), 50.9%; 95% CI, 21.3 to 66.2%; chi(2) statistic, 67.22; p = 0.0004).


CONCLUSIONS
The results of this study suggest that there is no difference in mortality between these two groups. Further studies should focus on specific etiologies within the subgroups rather than focusing on the broader division of ARDSp and ARDSexp.
45999589
Noninvasive ventilation in acute heart failure.
15280827
An Unusual Etiology of Spontaneous Pyometra Perforation; A Case Report
Introduction By presenting this case we aimed to describe an uncommon complication of generalized peritonitis following spontaneous pyometra perforation in untreated cervical carcinoma. Case Presentation This report describes a 60-year-old postmenopausal woman presenting with clinical features mimicking intestinal perforation who was later diagnosed as cervical carcinoma with pyometra perforation at exploratory laparotomy. The patient had good post-operative recovery following drainage and peritoneal lavage. Conclusion Spontaneous pyometra perforation in a case of untreated carcinoma of cervix is a rare condition, yet it should be suspected and kept in the differential diagnosis of acute abdomen in elderly women.
40070884
Relative plasma volume monitoring for identifying volume-sensitive and -resistant hypertension.
The measurement and management of volume state among long-term dialysis patients has not received much attention. Recent reports suggest that relative plasma volume monitoring may be useful in identifying patients who have volume excess. Among patients who have evidence of excess volume by relative plasma volume monitoring, excess volume removal leads to improvement in interdialytic ambulatory blood pressure. Implementation of this technique can result in improved classification of patients into volume-sensitive and -resistant categories and therefore improve the management of hypertension.
20137332
The unrecognized skeletal components of the cleft lip nose deformity.
21105377
Is continuous veno-venous hemofiltration for acetaminophen-induced acute liver and renal failure worthwhile?
We describe a patient with acute liver and renal failure secondary to acetaminophen and chronic alcohol abuse who was treated aggressively with oral acetylcysteine, continuous renal replacement therapy, glucose and branched-chain amino acid intravenous feeding and ventilatory support. The patient had a predicted mortality of > 95% without liver transplantation however, with intensive ventilatory, renal, and nutritional support he made a complete recovery. We discuss the benefits of aggressive supportive therapy and suggest that continuous renal replacement therapy may allow gentle fluid removal, excellent control of cerebral edema and intravenous feeding that may favorably influence prognosis.
24958173
Prognostic importance of ambulatory blood pressure recordings in patients with chronic kidney disease.
Ambulatory systolic blood pressure (BP) correlates better with risk factors for progression of chronic kidney disease (CKD) compared to clinic measured BP, but its role in predicting end-stage renal disease (ESRD) and death in patients with CKD is unknown. In a cohort study of 217 Veterans with CKD BP was measured by ambulatory monitoring and in the clinic. Twenty-four hour ambulatory BP was 133.5 +/- 16.6/73.1 +/- 11.1 mm Hg and clinic BP was 155.2 +/- 25.6/84.7 +/- 14.2 mm Hg. The composite renal end point of ESRD or death over a median follow-up of 3.5 years occurred in 75 patients (34.5%), death occurred in 52 patients (24.0%), and ESRD in 36/178 patients (20.2%). Thirty-nine patients died before reaching ESRD. One standard deviation (s.d.) increase in systolic BP increased the risk of composite outcome to 1.69 (95% confidence interval (CI) 1.32-2.17) for standard clinic measurement and to 1.88 (95% CI 1.48-2.39) for 24 h ambulatory BP recording. One s.d. increase in 24 h ambulatory systolic BP increased the risk of ESRD to 3.04 (95% CI 2.13-4.35) and to 2.20 (95% CI 1.43-3.39) when adjusted for standard clinic systolic BP. Non-dipping was associated with increased risk of total mortality and composite end point. In patients with CKD, BPs obtained by ambulatory monitoring are a stronger predictor of ESRD or death compared to BPs obtained in the clinic. Systolic ambulatory BP and nondipping are independent predictors for ESRD after adjusting for clinic BP. However, adjustment for other risk factors for CKD progression removes the independent prognostic value of ambulatory BP.