RÉSUMÉ
Fiberoptic bronchoscopy (FOB) has simplified the direct examination of the lungs and is widely used for diagnosis and therapy. Fiberoptic bronchoscopes occupy a significant proportion of cross-section area of central airways, which can affect lung mechanics and gas exchanges that may lead to desaturation and cardiac arrhythmia. This makes bronchoscopy in critically ill patients with respiratory failure even more challenging. Use of noninvasive mechanical ventilation (NIV) may help to avoid use of invasive mechanical ventilation in selected patients with acute respiratory failure. It has been shown to be useful in hypoxemic patients to facilitate bronchoscopic examination for bronchoalveolar lavage, bronchial brushing, endobronchial biopsy (EBB), and transbronchial lung biopsy (TBLB). Noninvasive mechanical ventilation has also been used to facilitate other endoscopic procedures including transesophageal echocardiography (TEE) and upper gastrointestinal endoscopy for diagnostic and therapeutic interventions in hypoxemic patients. Endobronchial ultrasound (EBUS) bronchoscope, having a wider diameter than a conventional bronchoscope, may have a more pronounced effect on lung mechanics and gas exchanges, and its use in patients on NIV has not been reported. Contraindications of EBUS are mostly relative and similar to FOB. There are several studies suggesting the safety of NIV-supported FOB in hypoxemic patients. We describe our experience of the first two EBUS bronchoscopies and transbronchial needle aspiration (TBNA) was done in hypoxemic patients with NIV support.
RÉSUMÉ
An 18-year-old boy presented with a rare association of a thyroid tubercular abscess and bilateral symmetrical hilar lymphadenopathy. He was put on a Category I regimen with standard short course daily chemotherapy of four anti-tubercular drugs under the National Tuberculosis Programme. After a six-month of anti-tubercular treatment (ATT), the boy showed clinical and bacteriological improvement. The thyroid scan with Technetium 99 (Tc 99) and the chest skiagram also became normal.
Sujet(s)
Abcès/complications , Adolescent , Humains , Maladies lymphatiques/complications , Mâle , Maladies de la thyroïde/complications , Tuberculose endocrinienne/complicationsRÉSUMÉ
This study was conducted to determine the frequency of sensitization to Aspergillus antigens in 27 patients with perennial rhinitis. Immediate cutaneous reactivity was observed in 7 (26%) patients. In 3 of these 7 patients, hypersensitivity was restricted to Aspergillus antigens alone. One patient had an isolated late cutaneous reaction. Hypersensitivity was observed most commonly with A. flavus. Serum precipitins to A. flavus were detected in one patient. It is possible that sensitization to Aspergillus antigens may play an important role in the causation of perennial rhinitis and could also increase the risk of developing other Aspergillus associated hypersensitivity respiratory disorders subsequently.
Sujet(s)
Adolescent , Adulte , Antigènes fongiques/immunologie , Aspergillus/immunologie , Aspergillus flavus/immunologie , Femelle , Humains , Mâle , Rhinite spasmodique apériodique/immunologie , Tests cutanésRÉSUMÉ
A case of anaerobic lung abscess who had treatment failure after 4 weeks of supervised parenteral penicillin and oral metronidazole is described. Anaerobic pathogens resistant to one or the other of the above drugs were isolated. The patient had a striking clinical response to subsequent therapy with oral clindamycin. Failure of therapy should alert physicians to the possibility of infection with resistant anaerobic pathogens and in such situations, clindamycin is considered as an effective alternative.