ABSTRACT
A 74-year-old man was admitted with respiratory insufficiency and required mechanical ventilation. Enteral nutrition was given via a nasogastric feeding tube, but persistent food retention occurred. The chest X-ray showed the nasogastric tube to be in the right pleural space. After the tube was withdrawn the patient developed a tension pneumothorax and a closed-tube thoracostomy was performed. The patient's recovery was uneventful, with resolution of the pneumothorax. It is necessary to be alert with respect to the tube position, which, if doubtful, should be checked by chest X-ray. Recognition of an aberrant position is necessary to minimize related morbidity.
Subject(s)
Intubation, Gastrointestinal/adverse effects , Pneumothorax/etiology , Aged , Chest Tubes , Humans , Male , Pneumothorax/diagnostic imaging , Pneumothorax/therapy , Pressure , RadiographyABSTRACT
A 33-year-old pregnant woman was admitted because of atypical pneumonia. She developed adult respiratory distress syndrome complicated by premature birth and perinatal mortality. The diagnosis 'psittacosis' was established on clinical grounds and confirmed serologically (complement fixation test). She was treated with doxycycline 200 mg i.v. daily for 3 weeks and was discharged in good condition after three months. Indirect case history revealed infected birds from the neighbours as the likely source of infection. Psittacosis is caused by Chlamydia psittaci and is acquired after inhalation of dry secreta or excreta from infected animals. Retrospective direct questioning often reveals contact with birds. Diagnostic delay can be considerable. Doxycycline is contraindicated in pregnant women, but erythromycine can be prescribed. Pregnant women should be advised to avoid contact with infected birds as they run an increased risk of a severe disease course.
