Pulmonary lymphangioleiomyomatosis

A 38-year-old Iraqi female, presented with one-year history of exertional dyspnea and exercise intolerance, without systemic or constitutional symptoms. Clinical examination revealed bilateral basal crackles with signs suggestive of left side pleural effusion, chest x-ray showed left sided pleural effusion, and diffuse bilateral basal pulmonary shadowing. Her biochemical analysis, hematological tests, electrocardiogram and echocardiography were normal, aspiration of the fluid revealed a chylothorax, the radiological shadowing was proved by computed tomography scan of the chest to be diffuse cystic lesions involving mostly the lower lobes. Open lung biopsy showed dilated lymphatic vessels with surrounding inflammatory cells and smooth muscle fibers consistently with the diagnosis of pulmonary lymphangioleiomyomatosis LAM

Pain as a fifth vital sign in a standardized pain flow sheet: impact on patient-reported pain experience after cardiovascular surgery

Random pain assessments and the subsequent administration of analgesics may provide inadequate pain management, which is a major health care problem. To improve the quality of pain management, pain should be assessed as the fifth vital signs in a standardized pain flow sheet, because pain assessment is rarely complete, and because health care professionals are poor predictors of patient's pain. Thus the present study was conducted to examine the impact of nurses' use of a standardized pain flowsheet to document pain assessment and pharmacologic management on patient reported pain intensity after cardiac surgery. A pre and post implementation design was used to compare 51 patients from Cardiac Surgical Units in Shark El Madina Hospital /Ministry of Health/ Alexandria and Mansoura University Hospital. For the first [28 patients] in the pre-implementation group, traditional charting of presence or absence of pain was documented in the narrative notes and the pharmacologic management was documented in the medication profile. In the post-implementation group [23 patients], the intensity of pain and pharmacological management were documented on a pain flowsheet. Within 24 hour patients were interviewed regarding pain intensity experienced in the surgical heart unit and at the time of questioning. The distribution of these pain intensity scores was compared. Results revealed that the use of a standardized pain flowsheet to assess pain intensity and document pharmacological intervention improved pain management in post operative cardiovascular patients. Use of this scale helps patients quantify pain intensity and relief and requires the health care member to be accountable for providing effective management of pain