RESUMO
PURPOSE: Tumors in the carotid bodies may interfere with their function as peripheral chemoreceptors. An altered control of ventilation may predispose to sleep-disordered breathing. This study aimed to assess whether patients with unilateral or bilateral carotid body tumors (uCBT or bCBT, respectively) or bilateral CBT resection (bCBR) display sleep-disordered breathing and to evaluate the global contribution of the peripheral chemoreceptor to the hypercapnic ventilatory response. METHODS: Eight uCBT, eight bCBT, and nine bCBR patients and matched controls underwent polysomnography. The peripheral chemoreflex drive was assessed using euoxic and hyperoxic CO2 rebreathing tests. Daytime sleepiness and fatigue were assessed with the Epworth Sleepiness Scale and the Multidimensional Fatigue Index. RESULTS: All patient groups reported significant fatigue-related complaints, but no differences in excessive daytime sleepiness (EDS) were found. The apnea/hypopnea index (AHI) did not differ significantly between patient groups and controls. Only in bCBT patients, a trend towards a higher AHI was observed, but this did not reach significance (p=0.06). No differences in the peripheral chemoreflex drive were found between patients and controls. CONCLUSIONS: Patients with (resection of) CBTs have more complaints of fatigue but are not at risk for EDS. The presence or resection of CBTs is neither associated with an altered peripheral chemoreflex drive nor with sleep-disordered breathing.
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Tumor do Corpo Carotídeo/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Tumor do Corpo Carotídeo/diagnóstico , Tumor do Corpo Carotídeo/fisiopatologia , Tumor do Corpo Carotídeo/cirurgia , Células Quimiorreceptoras/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/epidemiologia , Neoplasias Primárias Múltiplas/fisiopatologia , Neoplasias Primárias Múltiplas/cirurgia , Oxigênio/sangue , Polissonografia , Reflexo/fisiologia , Fatores de Risco , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologiaRESUMO
AIMS/HYPOTHESIS: Decreased sleep duration and/or impaired sleep quality negatively influence glucoregulation. The aim of this study was to assess subjective sleep characteristics in patients with type 1 diabetes, to relate sleep characteristics to long-term glycaemic control and to assess possible risk factors for impaired sleep. METHODS: We studied 99 adult patients with type 1 diabetes (55 men, 44 women, duration of diabetes 26.9 ± 1.2 years) and 99 age-, sex- and BMI-matched non-diabetic controls. Subjective sleep characteristics were assessed by validated questionnaires, i.e. Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and the Berlin Questionnaire. Glucoregulation was assessed by HbA(1c) values. Clinical variables were obtained from medical charts. Depression was assessed by the Hospital Anxiety and Depression Scale (HADS). Peripheral polyneuropathy was assessed by neurological examination and quantitative sensory testing. RESULTS: Of the patients with type 1 diabetes, 35% had subjective poor sleep quality compared with 20% of the control participants (p = 0.021). A higher proportion of the patients with type 1 diabetes were at increased risk for obstructive sleep apnoea (OSA) (17.2% vs 5.1%, p = 0.012). There was no significant association between individual sleep characteristics and HbA(1c) values. On logistic regression analysis, the HADS depression score, presence of peripheral polyneuropathy, habitual snoring and other sleep disturbances (e.g. hypoglycaemia) were independently associated with poor sleep quality. CONCLUSIONS/INTERPRETATION: Adult patients with long-standing type 1 diabetes mellitus have disturbed subjective sleep quality and a higher risk for OSA compared with control participants. Subjective sleep disturbances are part of the complex syndrome of long-standing type 1 diabetes.
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Diabetes Mellitus Tipo 1/fisiopatologia , Transtornos do Sono-Vigília/fisiopatologia , Adulto , Estudos de Casos e Controles , Diabetes Mellitus Tipo 1/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/fisiopatologia , Transtornos do Sono-Vigília/psicologiaRESUMO
A 54-year-old female was referred to our centre for further evaluation of recently established severe pulmonary hypertension. Six months prior to presentation to the cardiologist of the referring centre, the patient had first experienced exertional dyspnoea. At the time of presentation to the referring cardiologist, the patient's ECG showed signs of an increased right heart load. Interestingly, this patient had undergone a thorough cardiac evaluation in the referring centre seven years before when she presented with severe hyperthyroidism. At that time there were no symptoms or signs of pulmonary hypertension on ECG, echocardiography, or at heart catheterisation. Thorough evaluation in cooperation with the referring centre demonstrated that this patient was suffering from idiopathic pulmonary arterial hypertension, a rare form of pulmonary hypertension. We conclude this report with a discussion on the potential use of the ECG for the diagnosis of increased right heart load. (Neth Heart J 2008;16:250-4.).
RESUMO
We report a case of a large symptomatic angioleiomyoma of the diaphragm. The tumor was diagnosed by computed tomography and videothoracoscopic biopsy. We removed the tumor through a left thoracolaparotomy. Three months later, a local recurrence was removed through an upper midline laparotomy. The patient remains without evidence of a recurrence 48 months after the second operation.
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Angiomioma/cirurgia , Diafragma/cirurgia , Neoplasias Musculares/cirurgia , Neoplasias Torácicas/cirurgia , Angiomioma/patologia , Diafragma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Musculares/patologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Reoperação , Neoplasias Torácicas/patologia , Toracotomia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The objective of the study was to determine the prevalence of sleep complaints and of sleep disordered breathing (SDB) in hemodialysis patients not selected for sleep complaints and to determine the effect of hemodialysis on SDB. The feasibility of home recording of sleep related respiration in these patients was also studied. METHODS: The patients completed a questionnaire and parameters of SDB were examined in the home setting on nights following dialysis and nights following no dialysis with the Edentrace II Recording System. RESULTS: Six (46%) of 13 patients had sleep complaints. Symptoms suggestive for sleep apnea syndrome were found in four (31%) of these 13 patients. In three (75%) of these four patients SDB was found. Sleep related respiration was monitored in 15 patients. Registrations satisfactory for interpretation were obtained in all patients. SDB was observed in five (33%) of these 15 patients. There were no significant differences in parameters of SDB between nights following dialysis and nights following no dialysis. CONCLUSIONS: Home recording of sleep related respiration in hemodialysis patients is feasible. Sleep complaints and SDB are common in these patients. No clinically significant differences in SDB were found between nights following dialysis and nights following no dialysis.
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Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/etiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/métodos , Polissonografia/instrumentação , Estatísticas não ParamétricasRESUMO
BACKGROUND: Our aim was to construct a diagnostic model for ruling out chronic thromboembolic pulmonary hypertension (CTEPH) in symptomatic patients after acute pulmonary embolism (PE) that is based on simple, non-invasive tests. METHODS: Plasma levels of various CTEPH associated biomarkers and conventional ECG criteria for right ventricular pressure overload were assessed in 82 consecutive patients with confirmed CTEPH and 160 consecutive patients with a history of PE who were suspected to have CTEPH, but in whom this disease was ruled out. RESULTS: ECG criteria of right ventricular hypertrophy were detected more frequently in patients with CTEPH (77%) than in the patients without CTEPH (11%, Odds ratio 26, 95% confidence interval [CI] 13-53). Also, clotting factor FVIII activity and the levels of N-terminal-pro-brain-type natriuretic peptide (NT-pro-BNP), Growth Differentiation Factor-15, C-reactive protein and urate, but not D-dimer level, were higher in patients with CTEPH. A diagnostic model including ECG criteria and NT-pro-BNP levels had a sensitivity of 94% (95% CI 86-98%) and a specificity of 65% (95% CI 56-72%). The area under the receiver-operator-characteristic curve was 0.80 (95% CI 0.74-0.85) for the diagnosis of CTEPH. Even with high disease prevalences of up to 10%, the negative predictive value of this model proved to be very high (99%, 95% CI 97-100%). CONCLUSIONS: Ruling out CTEPH in patients after acute PE seems to be safe without additional diagnostic testing in absence of ECG criteria indicative of right ventricular hypertrophy and a normal NT-pro-BNP level.
Assuntos
Hipertensão Pulmonar/diagnóstico , Embolia Pulmonar/complicações , Doença Aguda , Algoritmos , Biomarcadores/sangue , Doença Crônica , Eletrocardiografia/métodos , Feminino , Humanos , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Embolia Pulmonar/sangueRESUMO
CONTEXT AND OBJECTIVE: Fatigue and excessive sleepiness have been reported after treatment of nonfunctioning pituitary macroadenomas (NFMA). Because these complaints may be caused by disturbed nocturnal sleep, we evaluated objective sleep characteristics in patients treated for NFMA. DESIGN: We conducted a controlled cross-sectional study. SUBJECTS AND METHODS: We studied 17 patients (8 women; mean age, 54 yr) in remission of NFMA during long-term follow-up (8 yr; range, 1-18 yr) after surgery (n = 17) and additional radiotherapy (n = 5) without comorbidity except for hypopituitarism and 17 controls matched for age, gender, and body mass index. Sleep was assessed by nocturnal polysomnography, sleep and diurnal movement patterns by actigraphy, and quality of life and subjective sleep characteristics by questionnaires. RESULTS: Compared to controls, patients had reduced sleep efficiency, less rapid eye movement sleep, more N1 sleep, and more awakenings in the absence of excessive apnea or periodic limb movements. Actigraphy revealed a longer sleep duration and profound disturbances in diurnal movement patterns, with more awakenings at night and less activity during the day. Patients scored higher on fatigue and reported impaired quality of life. CONCLUSION: Patients previously treated for NFMA suffer from decreased subjective sleep quality, disturbed distribution of sleep stages, and disturbed circadian movement rhythm. These observations indicate that altered sleep characteristics may be a factor contributing to impaired quality of life and increased fatigue in patients treated for NFMA.
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Ritmo Circadiano/fisiologia , Transtornos dos Movimentos/etiologia , Neoplasias Hipofisárias/complicações , Transtornos do Sono-Vigília/etiologia , Sono/fisiologia , Adulto , Idoso , Algoritmos , Ansiedade/psicologia , Índice de Massa Corporal , Depressão/psicologia , Distúrbios do Sono por Sonolência Excessiva/etiologia , Fadiga/etiologia , Feminino , Humanos , Fator de Crescimento Insulin-Like I/análise , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Procedimentos Neurocirúrgicos , Neoplasias Hipofisárias/cirurgia , Polissonografia , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Traditionally, patients with pulmonary embolism (PE) are initially treated in the hospital with low molecular weight heparin (LMWH). The results of a few small non-randomized studies suggest that, in selected patients with proven PE, outpatient treatment is potentially feasible and safe. OBJECTIVE: To evaluate the efficacy and safety of outpatient treatment according to predefined criteria in patients with acute PE. PATIENTS AND METHODS: A prospective cohort study of patients with objectively proven acute PE was conducted in 12 hospitals in The Netherlands between 2008 and 2010. Patients with acute PE were triaged with the predefined criteria for eligibility for outpatient treatment, with LMWH (nadroparin) followed by vitamin K antagonists. All patients eligible for outpatient treatment were sent home either immediately or within 24 h after PE was objectively diagnosed. Outpatient treatment was evaluated with respect to recurrent venous thromboembolism (VTE), including PE or deep vein thrombosis (DVT), major hemorrhage and total mortality during 3 months of follow-up. RESULTS: Of 297 included patients, who all completed the follow-up, six (2.0%; 95% confidence interval [CI] 0.8-4.3) had recurrent VTE (five PE [1.7%] and one DVT [0.3%]). Three patients (1.0%, 95% CI 0.2-2.9) died during the 3 months of follow-up, none of fatal PE. Two patients had a major bleeding event, one of which was fatal intracranial bleeding (0.7%, 95% CI 0.08-2.4). CONCLUSION: Patients with PE selected for outpatient treatment with predefined criteria can be treated with anticoagulants on an outpatient basis. (Dutch Trial Register No 1319; http://www.trialregister.nl/trialreg/index.asp).
Assuntos
Assistência Ambulatorial , Anticoagulantes/uso terapêutico , Nadroparina/uso terapêutico , Embolia Pulmonar/prevenção & controle , Trombose Venosa/tratamento farmacológico , Vitamina K/antagonistas & inibidores , Doença Aguda , Adulto , Idoso , Anticoagulantes/efeitos adversos , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Nadroparina/efeitos adversos , Países Baixos , Seleção de Pacientes , Estudos Prospectivos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/mortalidade , Medição de Risco , Fatores de Risco , Prevenção Secundária , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico , Trombose Venosa/mortalidadeRESUMO
BACKGROUND: The exact prevalence and etiology of exertional dyspnea in the clinical course of acute pulmonary embolism (PE) have not yet been established. METHODS: A large cohort of consecutive patients diagnosed with acute PE was subjected to a dyspnea questionnaire and invited for cardiopulmonary work-up including the 6-min walk test, spirometry and echocardiography. The prevalence, severity, determinants and underlying diseases of exertional dyspnea were evaluated. RESULTS: Of the registered 877 patients, 259 (30%) had died and 11 (1.3%) were excluded for geographical reasons. From the remaining 607 patients, 217 reported exertional dyspnea (36%; 95% CI 32-40%) 3.6 ± 1.7 years after the PE. In 76% this dyspnea had developed or worsened after the acute PE. 421 patients completed the cardiopulmonary work-up. Cardiopulmonary comorbidity (OR 12; 95% CI 6.5-20), advanced age (OR 1.02 per year; 95% CI 1.01-1.03), higher BMI (OR 1.06 per kg/m(2); 95% CI 1.01-1.1) and a smoking history (OR 1.6; 95% CI 1.02-2.6) were identified as independent predictors of exertional dyspnea. A pre-defined dyspnea explaining diagnosis could be established in all patients with exertional dyspnea. In only 4 patients, this diagnosis was directly correlated to the acute PE. Increased severity of dyspnea was associated with decreased exercise performance (p < 0.001) and a higher number of dyspnea-related diagnoses (p < 0.001). CONCLUSION: Exertional dyspnea is a frequent symptom in the long term clinical course of acute PE. More severe dyspnea results in decreased exercise capacity and increased burden of cardiopulmonary comorbidity. This dyspnea is likely to be unrelated to the past thromboembolic event in the vast majority of patients.
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Dispneia/fisiopatologia , Embolia Pulmonar/fisiopatologia , Dispneia/etiologia , Dispneia/mortalidade , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Embolia Pulmonar/complicações , Embolia Pulmonar/mortalidade , Testes de Função Respiratória , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Even though quality of life (QoL) has become a key component of medical care, there is no instrument available that specifically measures QoL after pulmonary embolism (PE). Recently, the Pulmonary Embolism Quality of Life (PEmb-QoL) Questionnaire has been developed to address this gap. OBJECTIVE: To evaluate the validity of the PEmb-QoL questionnaire. METHODS: We distributed the PEmb-QoL questionnaire and the Short Form-36 (SF-36) questionnaire twice among consecutive subjects with a history of objectively confirmed acute PE. Internal consistency reliability, test-retest reliability, convergent validity and criterion validity, and correlations between the PEmb-QoL and clinical patient characteristics were assessed using standard-scale construction techniques. RESULTS: Ninety participants completed the questionnaires twice. Internal consistency was adequate (Cronbach's alpha 0.62-0.94), as well as test-retest reliability (intra-class correlation coefficients: 0.78-0.94). Furthermore, correlation between the PEmb-QoL questionnaire and the SF-36 questionnaire supported convergent validity. Age, obesity, cardiopulmonary comorbidity, centrally located PE and a family history of venous thromboembolism were shown to be independent determinants of disease-specific QoL. CONCLUSION: The PEmb-QoL questionnaire is a reliable instrument to specifically assess QoL following PE, which is helpful in the identification of patients with decreased QoL following acute PE.
Assuntos
Indicadores Básicos de Saúde , Embolia Pulmonar/diagnóstico , Qualidade de Vida , Inquéritos e Questionários , Doença Aguda , Adulto , Idoso , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Países Baixos , Variações Dependentes do Observador , Valor Preditivo dos Testes , Psicometria , Embolia Pulmonar/psicologia , Reprodutibilidade dos TestesRESUMO
BACKGROUND: There is a lack of information on long term complications of patients with pulmonary embolism (PE), including chronic complaints of dyspnea. METHODS: Consecutive patients with a prior diagnosis of acute PE and an age and gender matched control group with no medical history of PE were presented with a questionnaire, designed to establish the presence, severity and possible causes of dyspnea in the clinical course of PE. RESULTS: The questionnaire was taken in 48 PE-survivors 40+/-7.4 months after PE; 27 patients (56%) had complaints of dyspnea. Sixteen (35%) were categorized as NYHA class II, 6 (13%) as class III and 5 (10%) as class IV. Overall, 19 patients (70%) had new or worsened complaints after PE. The study included 61 controls. Corrected for gender, age and medical history, the control group was significantly less dyspnoeic compared to the PE survivors (p<0.001). Corrected for gender and age, patients were 4 times more often in NYHA class II (OR 3.6 95%CI 1.4-9.7) and 7-fold more often in NYHA class III or IV (OR 6.5 95%CI 1.7-24), both compared to control subjects. CONCLUSION: A large percentage of patients with prior PE have persistent complaints of dyspnea at long term follow-up. The majority of them developed new or worsened dyspnea after the thrombo-embolic event. In comparison to a control population without a medical history of VTE, PE patients were overall significantly more dyspnoeic. An explanation for this phenomenon needs to be studied in further functional work-up of these patients.
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Dispneia/etiologia , Embolia Pulmonar/complicações , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Deterioration of pulmonary function after hematopoietic stem cell transplantation (SCT) is a well-known late effect of this treatment, but the course of pulmonary function over time is less clear. The aim of our study was to establish both the prevalence and course of pulmonary function abnormalities in children following SCT. METHODS: Thirty-nine of 106 patients, who visited a post-SCT late effects clinic and who underwent a pulmonary function test (PFT) both before and at least twice after SCT were included in this study. Forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), total lung capacity (TLC), and total lung diffusion capacity (TLCO) were determined and recorded as percentage predicted for age, sex, and length matched controls. Values of less than 80% of predicted were considered abnormal. Change in PFT parameters over time was determined by comparing the mean PFT parameter in our group at three different time points: pre-SCT, < or =1 year post-SCT (SCTpost1) and >1 year post-SCT (SCTpost2). RESULTS: After SCT restrictive and/or diffusion abnormalities are most prevalent (45% and 76% at SCTpost1, respectively). A significant decrease of TLC (-9.7%) and TLCO (-20.3%) was observed during the first year after SCT, with improvement over time, but no normalization. Obstructive lung disease was less common (6% at SCTpost1). Clinical signs of lung function impairment were rare. CONCLUSIONS: Restrictive and diffusion lung function disorders are common after SCT. They improve over time but do not normalize. As only a few patients with pulmonary function abnormalities had clinical signs of lung function impairment, the clinical relevance of performing long-term follow-up of PFT is questionable.
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Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Pneumopatias/etiologia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Modelos Lineares , Pneumopatias/epidemiologia , Masculino , Países Baixos/epidemiologia , Prevalência , Testes de Função Respiratória , Fatores de RiscoRESUMO
Lipomas are rare endobronchial tumors that may cause severe parenchymal damage due to bronchus obstruction and subsequent pneumonia. Therefore, accurate diagnosis and radical treatment are essential. We describe three cases of endobronchial lipoma. One patient presented with hemoptysis, two patients were initially diagnosed as COPD. They were all treated by electrocautery which achieved complete removal. We recommend electrocautery as an easy and cost-effective alternative for removal of intraluminal tumors including lipoma.
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Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/cirurgia , Eletrocoagulação , Lipoma/diagnóstico , Lipoma/cirurgia , Idoso , Neoplasias Brônquicas/complicações , Neoplasias Brônquicas/diagnóstico por imagem , Neoplasias Brônquicas/patologia , Broncoscopia/métodos , Tosse/etiologia , Diagnóstico Diferencial , Hemoptise/etiologia , Humanos , Lipoma/complicações , Lipoma/diagnóstico por imagem , Lipoma/patologia , Pneumopatias Obstrutivas/diagnóstico , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Massive hemoptysis (defined as blood loss greater than 600 ml/24h) is said to have a fatal outcome in up to 85% of patients when managed only medically. METHODS: A retrospective patient chart study was undertaken to analyse underlying pathology, management and outcome of hemoptysis patients in a hospital with no thoracic surgical, bronchoscopic or embolisation facilities. RESULTS: 63 patients were admitted for hemoptysis during a 2.5 year study period. Tuberculosis and sequelae of previous tuberculosis accounted for 65% of the cases. The patients with expectoration of more than 600 ml/24h had a shorter duration of hemoptysis (P = 0.033) and more often a history of tuberculosis (P = 0.023). The mortality rate was 6% (4/63 patients). Recurrent bleeding was not frequent (11%) and never severe enough for admission. CONCLUSIONS: Hemoptysis in a Third World city hospital is mainly caused by infectious disease. Under the above-mentioned circumstances, in view of a low mortality and recurrence rate, conservative treatment of hemoptysis in in-patients seems justified.
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Países em Desenvolvimento , Hemoptise/etiologia , Adulto , Feminino , Hemoptise/mortalidade , Hemoptise/terapia , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Tuberculose Pulmonar/complicaçõesRESUMO
We describe a case of Nocardia bronchopneumonia occurring in a patient after 5 weeks of treatment in an ICU. The clinical features were haemoptysis and fever, and an aspecific coarse nodular pattern on the chest roentgenogram. The diagnosis was made, after death, by positive blood cultures for Nocardia asteroides and autopsy showing Nocardia bronchopneumonia.
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Broncopneumonia/microbiologia , Hemoptise/etiologia , Unidades de Terapia Intensiva , Pulmão/diagnóstico por imagem , Nocardiose/diagnóstico , Nocardia asteroides , Idoso , Broncopneumonia/complicações , Broncopneumonia/diagnóstico , Humanos , Masculino , Nocardiose/complicações , Radiografia , Fatores de TempoRESUMO
Bronchomalacia in adults is rare. A case is reported here of a 65-year-old man with severe cough and mucostasis, caused by a benign bronchomalacia of the ventral wall of the left main bronchus. This was treated successfully with the insertion of a silicone Dumon stent as an alternative to surgical bronchoplasty.
RESUMO
OBJECTIVE: This study evaluated the prevalence of sleep-related and sleep-disordered-breathing (SDB)-related complaints in a group of postpolio patients compared with healthy controls. DESIGN: A questionnaire, consisting of the validated Sleep Wake Experience List (SWEL), and a list of questions pertaining to sleep-disordered breathing (SDB), was mailed to a group of 43 postpolio patients. PARTICIPANTS: The patient group consisted of 43 former polio patients who had been evaluated at a neuromuscular disease clinic in a tertiary referral center for new complaints of progressive muscle weakness. The patients were requested to select two healthy controls from their neighborhood who also filled out a questionnaire. RESULTS: In the group of postpolio patients the frequency of tiredness on waking up and during the day, headache on waking up, daytime sleepiness, and restless legs was significantly higher compared with the control group. Complaints specifically related to SDB, such as apneas and snoring, were not mentioned significantly more often by the postpolio patients. CONCLUSION: Up to half of postpolio patients report complaints of disordered sleep, which is likely to influence daytime functioning. Further studies, including sleep studies into SDB and restless legs, are necessary to elucidate the causes for these complaints.