Bilateral phrenic nerve paralysis manifested by orthopnea for 6 months in a patient with neuralgic amyotrophy.

Bilateral phrenic nerve paralysis (BPP) is a relatively rare disease manifested by slight dyspnea at rest and on exertion in the sitting and standing positions and by dyspnea in the supine position. A 67-year-old man, who was a painter, presented with severe pain in both shoulder regions that had evolved into orthopnea and forced him to sleep in a sitting position at night. Dyspnea and paradoxical respiratory movement in the supine position raised suspicions of BPP. The most striking feature in this case was that the rapid onset of pain in both shoulder regions was followed by BPP. The BPP was considered to be secondary to neuralgic amyotrophy (NA).

[Unilateral total pulmonary lavage for pulmonary alveolar proteinosis and an algorithm to select lavage procedures].

In 8 patients with pulmonary alveolar proteinosis (7 with autoimmune pulmonary alveolar proteinosis and 1 with secondary pulmonary alveolar proteinosis related to Behcet disease), we performed unilateral total pulmonary lavage 41 times (including 2 sessions in which lavage was discontinued) between March 1991 and January 2008. Reasons for discontinuation consisted of severe hypoxemia and leakage of lavage fluid into the non-washed lung. In this study, we describe changes in arterial blood gas and limitations in 41 sessions of unilateral total pulmonary lavage, and report an algorithm for lavage procedures prepared based on our experience and previous studies regarding unilateral total pulmonary lavage.