ABSTRACT
A 26-year-old patient experiencing dyspnoea and wheezing during exercise was seen at the outpatient clinic. Asthma was considered, but treatment with salbutamol was unsuccessful. Spirometry revealed plateauing of the inspiratory and expiratory flow-volume loops. CT scan and additional flexible bronchoscopy with dilatation showed circumferential subglottic stenosis. ANA/ANCA tests were negative and biopsy revealed scar tissue with minimal inflammation. Based on these findings, we established a diagnosis of idiopathic subglottic stenosis.
Subject(s)
Dyspnea/diagnosis , Laryngostenosis/diagnosis , Adult , Asthma/diagnosis , Biopsy , Bronchoscopy , Diagnosis, Differential , Dilatation , Dyspnea/etiology , Humans , Laryngostenosis/complications , Respiratory Sounds , Spirometry , Tomography, X-Ray ComputedABSTRACT
Obstructive sleep apnoea Obstructive sleep apnoea (OSA) is a complex condition with many different phenotypes. Historically, OSA has been defined using the apnoea-hypopnoea index (AHI). However, because there is no clear relationship between the AHI and the severity of symptoms and comorbidities the degree of hypoxia is increasingly being used to define OSA severity. To reach a diagnosis of obstructive sleep apnoea syndrome (OSAS), it has to be shown that symptoms improve with therapy. The treatment of first choice for patients with severe OSA is continuous positive airway pressure (CPAP) therapy. The indication for other therapies depends upon the patient's characteristics and preferences. Treatment with a position trainer and implantation of a hypoglossal nerve stimulator are relatively new therapies. OSA is a cardiovascular risk factor, but the effect of OSA treatment on cardiovascular outcome measures and mortality has not been shown in clinical trials.
Subject(s)
Cardiovascular Diseases/epidemiology , Continuous Positive Airway Pressure/methods , Sleep Apnea, Obstructive/therapy , Comorbidity , Global Health , Humans , Outcome Assessment, Health Care , Sleep Apnea, Obstructive/epidemiology , Survival Rate/trendsABSTRACT
A 75-yr-old female presented with platypnoea and orthodeoxia, shortly after laying down an old and pinching corset. The injection of activated Haemaccel in the right cubital vene during transoesophageal echocardiography, in the upright position, revealed a direct blood flow from the superior caval vein at a patent foremen ovale, consequently opening it and causing a large right-to-left shunt which was calculated at 28.5%. In the supine position there was only a minimal opening of the patent foremen ovale with a calculated right-to-left shunt of 9.5%. The patent foremen ovale was successfully closed percutaneously with a CardioSEAL.
