Manifestations of pulmonary disease in adults with congenital heart disease.

Children with congenital heart disease (CHD) are more frequently living into adulthood as their survival has improved due to availability of better medical and surgical management in recent times. Management of adults with CHD is emerging as new challenge in the field of medical science. Adults surviving with CHD for longer duration have been observed to develop more complications as compared to children. It is important to recognise and treat these complications early to reduce the morbidity. Pulmonary diseases are the most common systemic complications associated with adults having CHD. These individuals are presenting to clinics or emergency for pulmonary complaints, hence, pulmonologist must be aware about the pulmonary manifestations of CHD and their management.

Bronchoscopy and endobronchial disease in patients with human immunodeficiency virus infection.

The natural history of human immunodeficiency virus (HIV) infection has been significantly altered since the advent of antiretroviral therapy (ART). However, lung diseases are still common in these patients. This makes flexible fibreoptic bronchoscopy a valuable diagnostic tool. Knowledge of the visual appearance of various diseases would be of utmost importance to the bronchoscopist. Timely recognition of the endobronchial appearance of these diseases can narrow the differential diagnosis and potentially mitigate an avoidable delay in the diagnosis.

Diagnosis and management bronchopleural fistula.

The diagnosis and management of bronchopleural fistula (BPF) remain a major therapeutic challenge for clinicians. It is associated with significant morbidity and mortality. Diagnosis and localisation of BPF is sometimes difficult and may require multiple imaging and bronchoscopies. Successful management of a fistula is combined with treatment of the associated empyema cavity. The first step, therefore, should be control of active infection and adequate drainage of the hemithorax. When deemed required, definitive surgical repair should be accomplished expeditiously, minimising the number of procedures performed. In cases of a small fistula or where the surgical risk is high, various bronchoscopic methods have been used to close the fistula. When treatment is protracted, secondary complications are more likely and survival is adversely affected. In this article, approaches to the diagnosis and treatment of BPF are discussed, with particular emphasis on bronchoscopic management options.

Pulmonary manifestations of primary sjögren’s syndrome.

Sjögren's syndrome (SS) is a complex autoimmune exocrinopathy with multifactorial pathogenesis and multisystem manifestation. It is called primary Sjögren's syndrome (PSS) when the manifestations are seen without any other co-existent rheumatic diseases. The incidence of respiratory system involvement varies widely in the reported medical literature, partly due to lack of a universal agreement over the diagnostic criteria of the disease and the type of study methods employed. Respiratory system manifestations are protean; upper airway symptoms are very common and so is the complaint of dry cough. The PSS patients may develop interstitial lung diseases (ILDs) such as usual interstitial pneumonia (UIP), non-specific interstitial pneumonia (NSIP), lymphocytic interstitial pneumonia (LIP), bronchiolitis obliterans and organising pneumonia (BOOP), etc. They may also develop the whole spectrum of lymphoproliferative disorders of the lung ranging from LIP to follicular bronchiolitis, nodular lymphoid hyperplasia and low-grade lymphomas. Therapeutic options include symptomatic and supportive measures and corticosteroids as the mainstay of the treatment for ILDs occurring in these patients. In recent years, rituximab (anti-CD20) has emerged as a promising treatment for this disease, though data from controlled trials are still lacking. Pulmonary involvement may be a source of significant morbidity in these patients, though only rarely, it is the cause of death.

A contemporary review of chylothorax.

OBJECTIVES: This review will focus on anatomical and aetiologic factors as well as the conservative and operative therapy of chylothorax. DATA SOURCE: A Pubmed search for studies pertaining to the aetiology and/or treatment published in the English language from 1960 to 2007. STUDY SELECTION: Studies presenting case reports, series, observational and/or retrospective studies, and those with unique issues pertaining to chylothorax were reviewed independantly by both authors. Studies that were selected by both authors contain most clinically relevant data. RESULTS: Chylothorax is caused by injury or obstruction of the thoracic duct or its main tributaries leading to chyle accumulation in the pleural space. It most commonly occurs from trauma or malignancy, but other causes have been described. Although chylous effusions are rare, they have serious clinical consequences including cachexia and immunodeficiency. There are no evidence-based guidelines to assist in the management of this disease. CONCLUSIONS: A prompt diagnosis is needed to start treatment of the underlying cause. Treatment can be divided into conservative and surgical interventions. There are no evidence-based guidelines to assist in the management of this disease. Initial conservative therapy includes intercostal decompression of the pleural effusion along with nutritional support in the form of total parenteral nutrition, and reduction of chylous formation with somatostatin. Surgical interventions include thoracic duct ligation, pleuroperitoneal shunt and percutaneous embolisation.

Sleep in the intensive care unit.

Sleep is commonly disrupted in intensive care unit patients. The causes of this sleep disruption include the underlying medical illness itself, intensive care unit (ICU) environment, psychological stress, and effects of many medications and other treatments used to help those who are critically ill. The purpose of this review is to discuss the relevant literature in this regard, in order to improve the knowledge and recognition of this problem by health care providers. Also general and specific integrative steps to improving sleep of patients in the ICU is also described.