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Byline: Naveen. Kumar, Charanjeet. Ahluwalia, Gaurav. Singla, Swati. Singla An epignathus is an extremely rare form of oropharyngeal teratoma that arises from the oral cavity, most commonly from the palate [...]

Background: There is a lack of information on respiratory function and mechanics after COPD exacerbations. Study objectives: To find their role in short-term survival and occurrence of chronic hypercapnia after [...]

Objective: We tested the hypothesis that the mechanism of respiratory insufficiency in drug-induced coma involving benzodiazepines is an increase in upper airway resistance. Methods: Eighteen nonintubated and seven intubated (control) patients were poisoned with hypnotic sedatives involving benzodiazepines. Neurological and respiratory parameters were measured by polysomnography before and after flumazenil. Flumazenil was administered as escalating bolus doses followed by a continuous infusion. Results: Upon entry, Glasgow Coma Score was 7 [+ or -] 1 in nonintubated and 5 [+ or -] 1 in intubated patients. Snoring with flow limitation and obstructive apnea were recorded in 16 and 5 among the 18 nonintubated patients, respectively. Central apnea was not observed. Total pulmonary resistance was 2.5-fold higher in nonintubated patients than in intubated patients. Total and resistive work of breathing (WOB) was significantly greater in the nonintubated group. Flumazenil bolus administration was associated with an improvement in Glasgow Coma Score from 7 [+ or-] 1 to 13 [+ or -] 1 in the nonintubated patients, and from 5 [+ or -] 1 to 11 [+ or -] 1 in the intubated patients. Mean effective bolus doses were 0.3 [+ or-] 0.1 mg in nonintubated patients and 0.6 [+ or-] 0.1 mg in intubated patients. Tidal and minute volumes increased significantly, and WOB decreased significantly in nonintubated patients. In nonintubated patients, the decrease in total WOB resulted from a significant decrease in resistive WOB. Conclusions: Drug-induced coma involving benzodiazepines is characterized by snoring with flow limitation and obstructive apnea. The mechanism of respiratory insufficiency in nonintubated patients with drug-induced coma involving benzodiazepines is an increase in upper airway resistance and WOB., INTRODUCTION Drug-induced coma is a leading cause of poisoning-related admissions to hospitals (1). Respiratory insufficiency leading to hypoventilation is a very common drug-induced complication. Several mechanisms can contribute to drug-induced [...]

Low amniotic pressure interferes with fetal lung development even in the absence of oligohydramnios, or very low levels of amniotic fluid. Researchers created pressure loss in the amniotic sac of 20 rabbits by allowing extra fluid movement through a protected pocket in the uterine wall. Cutting through the wall removed the natural support of the uterus and produced lower amniotic pressure. The hernia operation took place on day 23 of the pregnancy followed by cesarean sections at term, on day 31. After surgery, lung functions differed between ten surviving fetuses and 14 control animals. Amniotic pressure was much lower among the surgery group. Surgery animals had lower average ratios of lung weight to body weight compared to controls. In addition, the lung structures of operated rabbits were immature and fairly irregular in appearance. In contrast, control rabbits had fully developed lung airways.

Inhalation injury predisposes burn patients to pneumonia, respiratory failure, and death, but the incidence and consequences of respiratory failure in the absence of inhalation injury are not well known. In a review of 529 burn patients admitted over a 4year period, patients with inhalation injury had a 73% incidence of respiratory failure (hypoxemia, multiple pulmonary infeetions, or prolonged ventilator support ) and a 20% incidence of adult respiratory distress syndrome (ARDS). In patients without inhalation injury, respiratory failure developed in 5% of patients and ARDS in 2% (both p

PURPOSE: Hypothyroid patients have been reported to have a blunted ventilatory response to carbon dioxide stimulation. However, previous data did not clarify the localization of abnormalities responsible for that disorder. The present investigation was aimed at evaluating to what extent central (neural) and/or peripheral (muscular) factors are involved in the abnormalities of the ventilatory control system in hypothyroid patients. PATIENTS AND METHODS: We studied 13 patients with severe hypothyroidism before and after 6 to 9 months of replacement therapy, 7 age- and sex-matched normal subjects were also studied as a control. In each subject, we assessed (1) inspiratory muscle strength by measuring maximal inspiratory pressure (MIP), and (2) respiratory control system during a carbon dioxide rebreathing test by measuring minute ventilation (VE), tidal volume (VT), mean inspiratory flow (VT/TI), and electromyographic (EMG) activity of the diaphragm ([E.sub.di]) and intercostal ([E.sub.int]) muscles. RESULTS: Compared with the normal control group (Group C), patients exhibited similar MIP, and similar VE and EMG response slopes to carbon dioxide. However, evaluating individual VE response slopes, we were able to identify two subsets of patients: Group A (six patients) with low VE response (less than mean - SD - 1.65 of Group C) and Group B (seven patients) with normal VE response. Compared with both Groups B and C, Group A exhibited significantly lower VT/TI, [E.sub.di] and [E.sub.int] response slopes, the difference between Groups B and C was not significant. Six patients (two from Group A and four from Group B) exhibited low MIP values compared with that in Group C. After replacement therapy, (1) VE, VT/TI, and [E.sub.di] response slopes increased significantly in Group A; and (2) MIP increased, but not significantly in patients with low MIP. CONCLUSIONS: We conclude that: (1) In patients with severe hypothyroidism, the ventilatory control system may be altered at the neural level as indicated by a blunted chemosensitivity, (2) Impaired respiratory muscle function does not seem to play a major role in the decreased ventilatory response to carbon dioxide stimulation, (3) Replacement therapy appears to normalize the response to hypercapnic stimulation, but not respiratory muscle strength.

Acute respiratory failure developed in two patients with hyperleukocytic acute myelomonocytic leukemia with abnormal marrow eosinophils within 1 to 3 days after the beginning of high-dose induction chemotherapy. The presence of moderate pulmonary leukostasis before chemotherapy initiation, the simultaneous occurrence of an acute tumor lysis syndrome, the lack of evidence of any other cause of respiratory distress, and the clinical evolution lead the authors to attribute pulmonary injury to lysis of resident leukemic cells. The responsibility of eosinophilic cellular constituents for the diffuse alveolar damage is discussed. Cancer 1991; 69:1356-1361.

Pulmonary complications are not uncommon among patients receiving chemotherapy. Most often, these complications are a result of infections following immunosuppression (suppression of the immune system), which occurs with chemotherapy. However, a case was recently reported in which an 11-year-old child with leukemia died as a result of respiratory insufficiency due to thrombosis (the formation of a blood clot) blocking the pulmonary circulation. The chest X-rays of the patient appeared entirely normal, and by the time the nature of the respiratory insufficiency was recognized, the use of thrombolytic enzymes to dissolve the offending clot was insufficient to save the patient. This case alerted clinicians to the possibility of pulmonary thrombosis as a complication of chemotherapy in children. Subsequently, clinicians identified six more children with the condition, indicating that pulmonary insufficiency resulting from pulmonary thrombosis may be more common than has been previously suspected. All seven patients were undergoing chemotherapy for acute leukemia, lymphoblastic in two cases and nonlymphoblastic in five. The presence of thromboemboli (fragments of clotted tissue obstructing vessels) in the pulmonary arteries of the patients was confirmed using angiography (an X-ray technique). Six of the patients were successfully treated with the thrombolytic enzyme urokinase, and in all but one patient angiography was also used to confirm the dissolution of the clot. As might be expected, the damage to the lungs in these seven cases was related to the time of diagnosis; patients diagnosed earlier had a single clot in a large arterial vessel. It is presumed that later diagnosis is a primary risk factor associated with the obstruction of multiple arteries. The cause of the thromboemboli is not known, but theory is that tiny neoplastic emboli, which result from the destruction of cancer cells by the chemotherapeutic agents, may serve to provoke the blood coagulation. (Consumer Summary produced by Reliance Medical Information, Inc.)

We report a case of an 85-year-old woman who presented with acute respiratory failure, caused by aspirating a sucralfate tablet that totally occluded her left main-stem bronchus. Acute respiratory failure [...]

Respiratory insufficiency appears common in patients with rheumatoid disease-related atlantoaxial dislocation. Rheumatoid disease is a general term for diseases that involve inflammation of the joints, ligaments or muscles. Atlantoaxial refers to the first and second cervical vertebrae. Twelve patients with atlantoaxial dislocation related to rheumatoid disease were examined. Patients with deformations of the medulla, the part of the brain that extends to the spinal cord, had abnormal nighttime blood gas measurements. Four patients with severe spinal cord compression had evidence of spinal cord disease. Three of these patients had mildly abnormal nighttime blood gas measurements. It appears that respiratory insufficiency may occur in patients with atlantoaxial dislocation without symptoms and without spinal cord compression.

AIDS is often complicated by Pneumocystis carinii pneumonia (PCP), which is fatal in 23 percent of cases, mainly due to respiratory failure. Respiratory failure in PCP is associated with a poor outcome; in one study it was fatal in all patients who required respiratory support. Recently, studies showed that steroids added to standard treatment for PCP improved the survival of patients with respiratory failure. In the current study, the effectiveness of adding corticosteroids to standard treatment of PCP was assessed in 20 patients with AIDS and respiratory failure caused by PCP. Respiratory failure was initially reversed in 14 patients, although nine of these patients suffered a relapse of respiratory failure after the steroids were discontinued. Eight patients survived and remained well three months or more after treatment. However, only 25 percent of patients who required respiratory support were still living three months after treatment. These findings show that steroids can initially reverse respiratory failure due to PCP in patients with AIDS, but survival is limited, due to relapse of respiratory failure and other complications of AIDS. Thus, more studies are needed to evaluate the role of steroids in treating respiratory failure due to PCP in patients with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Table of Contents Abstract Case Report Discussion References Abstract We report a case of HSV type 2 pneumonia in an HIV infected patient. The patient was empirically treated for severe [...]

A 68 year old man with a 60 year pack history (20 cigarettes per day for 60 years) of smoking was admitted via casualty with acute confusion, lethargy, and dyspnoea [...]

A study explores acute respiratory failure and its causes and discusses ways to assess patients with acute respiratory failure. The two types of respiratory failures are hypoxaemia and hypercapnoea, which can alter mental state, skin color and increased pulmonary secretions.

A neonate with respiratory distress due to a right pneumothorax is presented. After drainage of the pneumothorax, atelectasis of the entire right lung developed. Because the atelectasis persisted, bronchoscopy was [...]

We describe a patient with frontometaphyseal dysplasia (FMD), restrictive chest bellows disease, hypercapnic respiratory failure, and cor pulmonale. Treatment with intermittent supplemental oxygen, nocturnal nasal volume ventilation, and posture modification [...]

AMIODARONE WAS PRESCRIBED TO REGULATE THE HEARTBEAT of a patient who underwent surgery at a Veteran's Administration medical center to replace a defective heart defibrillator. The plan was to decrease [...]