A case of right-sided congenital subclavian steal.

A 21-year-old man presented with an uncommon asymptomatic case of right-sided congenital subclavian steal. On physical examination, his blood pressure was 115/80 mmHg in the left arm, but could not be measured in the right arm. Magnetic resonance angiography demonstrated that the origin of the right subclavian artery was atretic, and supplied by a number of collaterals near the origins of the internal mammary and vertebral arteries. Subclavian steal should be a diagnostic consideration in any patient who presents with a pulse deficit or a systolic blood pressure difference of greater than 15 mmHg. A description of the acquired and congenital varieties of subclavian steal is provided.

High incidence of bronchospasm with regular administration of aerosolized pentamidine.

A systematic evaluation of changes in pulmonary status by objective spirometric assessment and subjective rating using visual analog scale was performed in a cohort of 134 patients receiving aerosolized pentamidine (AP) for the prevention of Pneumocystis carinii pneumonia. Significant bronchospasm defined as greater than or equal to 15 percent reduction in the forced expiratory volume in 1 s was noted in 26 of 100 (26 percent) of patients receiving AP alone. Despite the use of salbutamol (albuterol) as concurrent aerosolized treatment in 34 subjects, bronchospasm developed in 9 of 34 (26 percent) of the patients. The subjective respiratory status rating scale was found to be unreliable in correctly predicting the development of bronchospasm. We conclude that a high incidence of bronchospasm is present in patients receiving regular AP administration using an ultrasonic nebulizer as studied, and concurrent administration of salbutamol is not fully protective of this acute adverse pulmonary reaction.