Eclampsia as a cause of secondary non-obstructive central sleep hypoventilation.

The central alveolar hypoventilation of Ondine's curse is a disorder characterized by absent or diminished ventilatory response to hypercapnia, hypoxia or both, with parallel decrease in saturation to 50%. The secondary form may begin mainly after insult that affects the brain stem. We present a case of a 24-years old primipara in the 41st gestational week with an uncomplicated course of pregnancy and with secondary non-obstructive sleeping hypoventilation which occurred after eclamptic seizure. This obstetric case provides evidence for the benefit of home BiPAP use for patients with secondary Ondine's curse.

[Pulmonary segmentectomy for tumour]. / Plicní segmentektomie pro nádor.

BACKGROUND: An analysis of outcome data of pulmonary segmentectomy focused on local efficacy in primary non small cell lung cancer and true or seeming lung metastasis. PATIENTS AND METHODS: Miscellaneous series of twenty patients treated with classical open procedure involving individuals with primary or metachronous non small cell lung cancer, solitary pulmonary metastasis of extrapulmonary cancer and/or benign pulmonary lesions, lung metastasis mimicing. Thirteen patients after segmentectomy because of malignancy are separated into a group of 7 cases with NSCLC up to 20 mm in diameter, and a group of 6 persons with solitary pulmonary opacity up to 38 mm treated previously surgically for extrapulmonary cancer. Both without enlargement of hilar and/or mediastinal lymphatics proven on preoperative CT imaging. Third part of the group collects benign pulmonary lesions: chondrohamartoma, pneumonitis and pulmonary infarct. Persons involved through a ten years period are followed up at 3 (4)-months intervals. RESULTS: No perioperative and thirty day mortality was registered. Six cases of distant recurrence were recorded, three in NSCLC and three in extrapulmonary cancer patients. Five patients died within the follow-up period, three of them through the general progression of the oncological disease. Two deaths were non-cancer related. One R1 disease was discovered in a patient with primary lung adenocarcinoma. No local recurrence was recorded in both cancer series with median age of 63 yrs (range 45-79 yrs) and median duration of follow up 35 months. CONCLUSION: Lung segmentectomy seems to accomplish local control of early stage non small cell lung cancer and pulmonary metastasis of extrapulmonary cancer in selected patients.

Neuroprotective use of mild hypothermia in patients with severe vasospasms after subarachnoid haemorrhage.

BACKGROUND: The authors describe two cases of patients with a severe subarachnoid haemorrhage, where mild hypothermia was successfully applied as a part of comprehensive neuroprotective therapy. PATIENTS: A 56-year-old patient was admitted to an intensive care unit with the diagnosis of subarachnoid haemorrhage, with a consciousness dysfunction requiring artificial ventilation. Angiography failed to establish the cause of the haemorrhage, even after repeated examinations. Furthermore, the authors describe the case of a 28-year-old woman with negative anamnesis and without long-term pharmacological medication, who was admitted to the hospital with a severe headache and a qualitative consciousness dysfunction. Angiography showed an aneurysm appearing closely above the left internal carotid artery bifurcation. After detecting vasospasms, mild hypothermia was repeatedly used in both patients, keeping the temperature of the body core between 34-34.5 degrees C. RESULTS: The total length of the introduced therapeutic hypothermia was 12 days in the first case and 6 days in the second case. The method used was non-invasive all-body cooling by means of blankets with circulating cooling liquid (Blanketrol II, Cinncinnati Sub Zero). In both cases the computed tomography findings and the clinical conditions gradually improved and the patients were released from the intensive care unit on the 22nd and 30th day, respectively, following the disorder detection. DISCUSSION: Mild hypothermia is a clinically attainable neuroprotective method, which--in combination with other therapeutic measures--led to minimising the neurological deficit in patients with severe subarachnoid haemorrhage (Ref. 11).