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Superior vena cava obstruction due to total implantable venous access devices in cystic fibrosis: Case series and review

As the life expectancy of patients with cystic fibrosis (CF) improves, treatment related morbidity is increasingly recognised. Totally implantable venous access devices (TIVADs) offer reliable long term central venous access but are associated with recognised complications including venous thrombosis. Superior vena cava obstruction (SVCO) however has been rarely reported in this setting.

We report a single CF centre’s experience of SVCO associated with TIVADs in patients with CF, followed by a review of the published literature on risk factors, preventative strategies and treatment approaches.

Hypocortisolism induces chronic respiratory failure

Hypocortisolism is an uncommon condition. Its association with myopathy and respiratory failure has only rarely been described. We report the case of a 52 year-old woman presenting with progressive dyspnoea.

Work-up revealed a severe restrictive syndrome with hypoxaemia. Further investigations showed hypocortisolism of pituitary origin. Response to hydrocortisone allowed us to conclude to an unusual case of hypocortisolic myopathy affecting the respiratory muscles.

Elevated peripheral airway nitric oxide in bronchiectasis reflects disease severity

Background: Bronchiectasis is characterised by neutrophilic bronchial inflammation and patients are prone to recurrent or chronic bacterial airway infections. Direct measurement of lung inflammation would be useful in order to assess disease activity and guide need for antibiotic treatment and to monitor response. Current methods of monitoring inflammation are invasive, indirect or insensitive. Exhaled nitric oxide (FENO) is a direct simple non-invasive test of inflammation used in other airway diseases.

The aim of this study was to test whether peripheral airway nitric oxide (Calv) can provide a clinically useful direct measure of inflammation in the lungs of patients with bronchiectasis. Methods: Fifty three...

Comparison of biomarkers of subclinical lung injury in obstructive sleep apnea

Obstructive sleep apnea (OSA) has both systemic and local effects partly through the increased oxidative stress caused by intermittent hypoxia and reoxygenation. However, lung-specific biomarkers in OSA have not been fully assessed in comparison with systemic biomarkers such as C-reactive protein (CRP), although results of a recent study having a small sample size indicated KL-6 as one candidate.

Methods: Subjects of the present study were 197 patients suspected to have OSA. In addition to polysomnography, we also measured serum levels of KL-6, surfactant protein-D (SP-D) and CRP and pulmonary function. We examined the relationships of different biomarkers with OSA severity and pulmonary...

Bronchoscopy in suspected pulmonary TB with negative induced-sputum smear and MTD® Gen-probe testing

Introduction: In our institution, patients with suspected pulmonary TB undergo multiple induced-sputum sampling for microscopy, culture and nucleic acid amplification (NAA) with the MTD® Gen-probe assay. Those with negative induced-sputum results still suspected with TB are then referred for bronchoscopy.

We sought to determine the diagnostic yield of bronchoscopy in these patients with negative initial induced-sputum results both via smear and NAA testing.

Methods: We identified 30 consecutive cases of suspected pulmonary TB between 2001 and 2007, who had undergone a diagnostic bronchoscopy after negative results on induced-sputum smears and the MTD® Gen-probe on at least 2 samples. Results: The cohort (M = 20 & F = 10) had...

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