37563683
High-attenuation mucus in allergic bronchopulmonary aspergillosis: another cause of diffuse high-attenuation pulmonary abnormality.
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.
33491888
Noninvasive ventilation in ARDS caused by Mycobacterium tuberculosis: report of three cases and review of literature
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.
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.
44772256
The septospinal ligament in cleft lip nose deformity: study in adult unilateral clefts.
BACKGROUND
Septal deviation and alar cartilage deformities constitute an important component of both the aesthetic deformity and airway compromise in unilateral cleft lip nose deformity. The purpose of this study was to examine the retrocolumellar preseptal area in this deformity for evaluation of deforming forces in the adult population.


METHODS
Fifty-five patients aged 13 years or older presenting with unilateral cleft nasal deformity were included. The caudal border of the septum was accessed using an incision along the ipsilateral membranous septum. Perioperatively, the curved caudal septal edge was exposed and explored down to its attachment with the hypertrophied anterior nasal spine. The overlying tethering tissues were excised and submitted for histopathologic examination. The curved septal cartilage was straightened and the misplaced anterior nasal spine was excised. The remaining cleft nasal deformity was corrected depending on the specific presenting pathologic abnormality.


RESULTS
A well-defined, tough, fibrous band was detected extending from the deviated curved surface of the septal cartilage to the anterior nasal spine that was filling up the retrocolumellar area. Histopathologic examination revealed fibrous tissue in all cases studied, consistent with diagnosis of a ligament. Postoperatively, the nasal tip complex cosmetic result was considered to be good or very good in 89.7 percent, satisfactory in 8.1 percent, and poor in 2.0 percent of patients.


CONCLUSIONS
A well-defined ligament has been documented and demonstrated in adult patients with unilateral cleft lip nose deformity. The authors recommend that this septospinal ligament, previously unreported, should be excised in toto to achieve straightening of the septum, columellar centralization, and nasal sill symmetry in unilateral cleft lip nose deformity.
206198477
A new technique for repair of acquired split-ear-lobe deformity: the free conchal cartilage sandwich graft.
BACKGROUND
Split-ear-lobe repair is one of the commonest requests in cosmetic facial surgery. Frequently, the ear lobe split is prone to recurrence following surgical repair. A new technique is described that strengthens the ear lobe tissues using locally available conchal cartilage to prevent recurrence. A new classification of split ear lobe is also presented.


METHODS
Twenty-two women in the age range from 18 to 62 years with varying grades of split ear lobe were operated using the technique of conchal cartilage reinforcement of ear lobe. Eight females had bilateral involvement, and a total of 30 split ear lobes were repaired. A conchal cartilage disc was harvested at the time of repair of the ear lobe. This disc was placed in a pocket created in the ear lobe, and the ear lobe was repaired over this pocket. Simultaneous re-perforation of the ear lobe was done in a central location through the implanted conchal disc, and stud earring was applied.


RESULTS
Satisfactory aesthetic and functional results have been obtained in the series using the technique of conchal cartilage-graft augmentation of the ear lobe. All patients had high degree of satisfaction in being able to come out of the operating room with earrings on. There has been no stretching or re-tear of the ear lobe following implantation of conchal cartilage, over a follow-up period of 36 months.


CONCLUSION
The conchal cartilage-graft sandwich procedure allows immediate re-perforation of the repaired ear lobe at the time of repair in a central aesthetic location, as well as providing necessary strength to the ear lobe; thus preventing recurrence in primary and recurrent, acquired split-ear-lobe deformity.
19545652
What can we learn from null randomized controlled trials?
Cardiovascular disease is an important cause of mortality and morbidity in patients with CKD. Elevated serum phosphorus concentration is associated with an increased cardiovascular event rate. Recent data suggest that even in the normal range, serum phosphorus concentration is associated with an
34853627
Nonhematological Benefits of Iron
Iron deficiency anemia is common in people with chronic kidney disease (CKD) and its importance in supporting erythropoiesis is unquestioned especially in those patients treated with erythropoietin. Clinical symptomatology such as fatigability, cold intolerance, failure to concentrate and poor effort intolerance is often attributed to anemia or uremia. That iron deficiency, per se, can cause these symptoms is poorly recognized. Clinical and animal studies that support the benefits of iron supplementation, independent of increasing hemoglobin, such as those on immune function, physical performance, thermoregulation, cognition, and restless leg syndrome and aluminum absorption is the subject of this narrative review.
13054088
Volume-associated ambulatory blood pressure patterns in hemodialysis patients.
Although volume excess causes hypertension, whether it also affects circadian patterns of arterial pressures among hemodialysis patients remains unknown. To test the notion of whether volume overload is associated with a unique blood pressure (BP) "signature," a posthoc analysis was performed among 145 patients participating in the Dry-Weight Reduction in Hypertensive Hemodialysis Patients randomized, controlled trial. Using 400 ambulatory BP recordings over 8 weeks composed of 35 302 measurements, the trended cosinor model was found to be the best descriptor of BP chronobiology. The trended cosinor model may be described as a pattern of sinusoidal oscillation around a straight line with an upward trend during the interdialytic period that has an intercept at the postdialysis time. Augmented volume removal therapy reduced the intercept systolic BP and increased the rate of rise in systolic BP over the interdialytic interval but had no effect on the systolic BP fluctuation (amplitude). Thus, an elevated intercept and blunted slope pattern characterize the "volume-overload BP pattern" on ambulatory BP monitoring. Similar changes were seen for diastolic BP. Augmented volume removal therapy neither restored dipping nor was associated with a lag phenomenon for either the wake or the sleep systolic BP. Lowering of systolic BP was greater than diastolic BP such that pulse pressure was reduced. An observational cohort of 37 patients followed for 6 months confirmed these findings. Randomized trials are now needed to evaluate the clinical impact of augmented volume removal therapy on hard outcomes, because reduction of pulse pressure with this simple expedient has the potential to improve survival in hemodialysis patients.