1,721,049 research outputs found
Ex Vivo lung sonography: morphologic-ultrasound relationship
No full textUltrasound (US) interstitial syndrome is a sonographic lung pattern characterized by the presence of acoustic artifacts (B-lines and white lung). The purpose of this study was to demonstrate how interstitial syndrome is determined by acoustic interactions in lungs of variable density and in healthy organs deflated to a nonphysiologic level of density. Normal rabbit lungs were studied ex vivo by US at varying known degrees of inflation, and their histologic appearances were described. In this experimental setting, US interstitial syndrome recognizes a mechanism related to tissue density or porosity. Artifacts (B-lines and white lung) appear in the normal rabbit lung through air-dependent increases in density. As in pathologic conditions, US interstitial syndrome can be reproduced in histologically normal lungs that are deflated to a critical level (>0.45 g/mL) of density, which is not achievable under physiologic conditions
Allergy to Timolol Contained in Eyedrops for Glaucoma
No full textAbstract
Background: Allergic eyelid dermatitis is a common but often misdiagnosed disease that is related to eyedrops, topical cosmetics or skin care products. With regard to eyedrops, adverse reactions can be caused by both active ingredients and excipients. Identification and elimination of causative agents is the mainstay of management.
Patient and Methods: We describe the case of a woman who had been suffering from eyelid and peripalpebral dermatitis for four months. To treat her glaucoma, for a year she used several eyedrops for one year, switched by the ophthalmologist several times. She has also been reported oculorhinitis in March for some years. The patient underwent an allergological work-up consisting in prick test for inhalant allergens and patch tests with the G.I.R.D.C.A. series, benzalkonium chloride 0.1% aq., all the involved eyedrops and additional eyedrops ‘as is’.
Results: The patch test for the G.I.R.D.C.A. series and benzalkonium chloride as well as prick tests for the main inhalant allergens were negative. Only patch test performed for eyedrops containing timolol - alone or in association with other active ingredients - gave a positive response.
Conclusion: In our patient with eyelid and peripalpebral dermatitis, we have ruled out an allergy to the most common contact and inhalant allergens, while we have identified a cell-mediated hypersensitivity to timolol among the several eyedrop used by the patient
Description of free-flowing pleural effusions in medical reports after echographic assessment
No full textN/
C-reactive Protein, Lung Hyperinflation and Heart Rate Variability in Chronic Obstructive Pulmonary Disease -A Pilot Study
No full textAbstract Chronic obstructive pulmonary disease (COPD) is associated to cardiovascular morbidity and mortality, and abnormalities of the autonomic nervous system have been described in subjects with severe disease. We studied heart rate variability (HRV) in COPD patients at rest and during the 6-minute Walk Test (6mWT) and the association with lung function impairment taking into account systemic inflammation. Thirty outpatients with stable COPD underwent lung function measurements, blood gas analysis, ECG Holter and transcutaneous pulse oximetry during 6mWT and then they were classified by BODE index. Also C-reactive protein (CRP) was measured. At rest, we observed a significant reduction of HRV for increasing BODE index. During the 6mWT, HRV tended to decrease in BODE 1 subjects whereas an increase was observed in BODE 2 and BODE 3-4 subjects. Subjects with elevated CRP values had a significant reduction in Standard Deviation of all normal RR intervals at rest (SDNN: p = 0.013), Total Power (TFA: p = 0.04) and Very Low Frequency band (VLF: p = 0.041). At rest, subjects with Inspiratory Capacity-to-Total Lung Capacity ratio (IC/TLC) < 36% had a significant reduced SDNN (p = 0.004), TFA (p = 0.001), VLF (p = 0.001), Low Frequency band (p = 0.007). During 6mWT, changes of HRV parameters were significantly related to airflow obstruction and static hyperinflation indices. At rest and during submaximal exercise, COPD patients with moderate and severe disease had an abnormal cardiac autonomic modulation which was related to both systemic inflammation and lung function impairment
Impact of preoperative chemoradiation with higher dose intensity modulated radiotherapy on pathological complete response for locally advanced rectal cancer: a systematic review
No full textIntroduction Neoadjuvant chemoradiation (CRT) followed by total mesorectal excision is the current standard-of-care for locally advanced UICC II-III stage rectal cancer (LARC). A pathological complete response (pCR) correlates with survival. Improvements of pCR, including dose escalation, should be explored. The aim of this explorative analysis is to assess the impact on pCR of intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB). Areas Covered A literature search via PICO (Population, Intervention, Comparison, Outcome) in MEDLINE/PubMed and EMBASE and a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Metanalysis) methodology were performed. Studies that reported pCR rate in patients with LARC in clinical stage T2N+M0 or cT3/4 N0/+M0 treated with preoperative CRT with SIB-IMRT/VMAT (Volumetric Modulated Arc Therapy) were included. Sixty-two studies were identified, but only eight clinical trials with a total of 311 patients were included . Median follow-up was 16-61 months. pCR reached the value of 38%. Good survival outcomes were observed with a mild toxicity profile. Expert Opinion Radiotherapy dose intensification in LARC showed a slight increase of pCR compared to historical studies. Prospective evaluations are necessary to define which patients would benefit most
Chest pain caused by tracheostomy tube malposition: the importance of choosing the right tube.
No full textWe describe a case of chest pain caused by tracheostomy tube malposition in a 65-year old woman with chronic respiratory failure due to chronic obstructive pulmonary disease. This report highlights the importance of the correct choice of tracheostomy tube devices for mechanically ventilated and/or spontaneously breathing patients
Lung ultrasonography may provide an indirect estimation of lung porosity and airspace geometry
No full textBackground: Echographic vertical artifacts (B-lines) in chest
ultrasonography have often been associated with pathological
patterns. A scientifically sound explanation of these
artifacts has not yet been proposed. Objectives: The
‘spongy’ nature of the lung in its liquid and solid components
and the changes that take place in peripheral airspace
(PAS) geometry might be the key point to understanding
these phenomena. Methods: Six excised right rabbit lungs
were obtained. Each lung underwent direct ultrasound
evaluation in two different conditions: at complete tissue
elastic recoil volume and at pulmonary expansion volume
achieved by applying a constant positive pressure of 12 cm
H 2 O. Lung volumes and densities were reported in both
conditions. Histological examination was performed on
three naturally collapsed lungs and on three lungs under
positive pressure inflation after having been fixed in formalin solution. Results: Mean volumes of naturally collapsed
lungs and fixed expanded lungs were 11.2 ± 0.36 and 44.83
± 3.03 ml, respectively. Mean densities were 0.622 ± 0.016
and 0.155 ± 0.007 g/ml, respectively. Ultrasound evaluation
of collapsed lungs showed dense vertical artifacts and a
‘white lung’ pattern, while the evaluation of expanded lungs
showed hyperechoic line and horizontal artifacts of reflection.
Histological evaluation showed a different PAS geometry
in collapsed lungs caused by alveolar size reduction and
shape changes with unfolded and closed units modifying
the peripheral porosity of the frothy nature of the lung. Conclusions:
Airspace geometry, frothy nature and porosity are
the determinants of the different behavior of ultrasound interacting
with the subpleural lung parenchyma. Chest ultrasound
may thus be interpreted as an indirect ‘estimator’ of
lung porosity
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