ABSTRACT
A young woman with metastatic breast cancer was found to have a regular spectral Doppler event spanning multiple cardiac cycles and timing to her tachypneic respiratory rate, which suggested an extracardiac source. A chest CT confirmed a large mediastinal mass causing a postobstructive pneumonia. This Doppler signal reflected increased turbulence across the obstructed bronchus due to sound wave conduction through a pulmonary consolidation-a Doppler equivalent of "vocal fremitus" elicited by physical examination of a patient with a lung mass or pneumonia. Careful attention to the timing of Doppler abnormalities is required to avoid misdiagnosis.
Subject(s)
Echocardiography, Doppler , Mediastinal Neoplasms/complications , Mediastinal Neoplasms/diagnostic imaging , Pneumonia/diagnostic imaging , Pneumonia/etiology , Respiratory Insufficiency/etiology , Adult , Female , Humans , Respiratory Sounds/etiology , Tomography, X-Ray ComputedABSTRACT
Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is characterised by fever, rash, eosinophilia and organ damage that develops 2-6â weeks after the initiation of a medication. We report a case of DRESS syndrome in a 79-year-old man that developed after the introduction of rifabutin, ethambutol and clarithromycin used to treat Mycobacterium avium complex (MAC) vertebral osteomyelitis. This case highlights treatment and management challenges in a patient with known MAC vertebral osteomyelitis requiring prolonged steroids. Steroids are the mainstays of treatment for moderate to severe cases of DRESS syndrome. Initiation of steroids for the treatment of DRESS syndrome among patients with concomitant infections requires multidisciplinary collaboration for optimal management.
Subject(s)
Anti-Bacterial Agents/adverse effects , Drug Hypersensitivity Syndrome/diagnosis , Mycobacterium avium Complex/drug effects , Mycobacterium avium-intracellulare Infection/drug therapy , Osteomyelitis/drug therapy , Prednisone/therapeutic use , Aged , Anti-Bacterial Agents/administration & dosage , Clarithromycin/administration & dosage , Clarithromycin/adverse effects , Drug Hypersensitivity Syndrome/drug therapy , Drug Hypersensitivity Syndrome/physiopathology , Ethambutol/administration & dosage , Ethambutol/adverse effects , Humans , Liver Function Tests , Male , Rifabutin/administration & dosage , Rifabutin/adverse effects , Treatment OutcomeABSTRACT
BACKGROUND: Slow walking speed in elderly people predicts increased morbidity and mortality. We examined factors that may be associated with decreased habitual walking speed in older men and women. METHODS: Older (range: 60-88 years, mean = 72.5 years) men (n = 25) and women (n = 24) were recruited. The Short Physical Performance Battery, body composition, VO(2peak) on a treadmill, VO2 and rated perceived exertion during 10 minutes of walking at habitual gait speed and at a walking speed of 0.9 m/s, muscle strength, and level of physical activity were measured. RESULTS: VO(2peak) was strongly related to habitual gait speed (r = .744, p < .001) and remained significant even after controlling for age, muscle strength, and gender. Compared with the tertile of fastest walkers (mean gait speed, 1.37 ± 0.04 m/s), the tertile of slowest walkers (0.87 ± 0.02 m/s) were older (p < .001), shorter (p = .026), had lower lean body mass (p = .011), lower strength ( p < .001), less self-reported daily physical activity (p = .102), and higher relative (to VO(2peak)) intensity during walking at their habitual speed (65.3% ± 3.9% vs 54.3% ± 2.1% of VO(2peak), p = .013). CONCLUSIONS: VO(p2eak) was strongly associated with habitual walking speed, suggesting that as aerobic capacity declines with age, the exertion associated with habitual gait speed increases. A slowing of walking speed may be a response to increased perception of exertion. The extent to which exercise training affects habitual gait speed and fatigue is not clear.
