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Journal Of Respiratory Diseases

Journal Of Respiratory Diseases

Diabetes mellitus is a group of disorders characterized by hyperglycemia and the resulting macrovascular and microvascular complications.

Malignant thymoma is an indolent tumor arising from the thymic epithelial cells located in the anterior mediastinum. These tumor cells spread via regional metastasis or invade surrounding structures, including the pleural space.

Endobronchial schwannomas are rare and often benign neoplasms that develop from the nerve sheath of the peripheral nervous system.

Despite the recent development of several new therapies, pulmonary arterial hypertension (PAH) remains an incurable disease. Careful monitoring of disease progression is vital to ensuring that patients receive maximal medical therapy before the onset of overt right-sided heart failure. In part 1 of this article, I reviewed the role of the history and physical examination, chest radiography, electrocardiography, echocardiography, and pulmonary artery catheterization. In part 2, I focus on MRI, cardiopulmonary exercise testing (CPET), the 6-minute walk test, and biomarkers.

Careful monitoring of disease progression is vital to ensuring that patients with pulmonary arterial hypertension receive maximal therapy before the onset of overt right-sided heart failure. Routine follow-up includes the evaluation of symptoms, functional class, and exercise capacity and assessment of pulmonary pressures and right ventricular (RV) function. Transthoracic echocardiography (TTE) offers a noninvasive and fairly reliable technique for monitoring pulmonary artery pressure (PAP) and structural changes of the right side of the heart. However, TTE does not reliably assess cardiac output, right-sided filling pressures, or pulmonary venous pressure. Pulmonary artery catheterization may be particularly useful in patients who have inconsistent findings, such as a reduction in PAP measured by TTE in the presence of worsening symptoms or other signs of disease progression. An increase in RV end-diastolic pressure, usually above 10 mm Hg, is a concern and warrants consideration of additional therapy even if other hemodynamic and clinical parameters are unchanged. (J Respir Dis. 2009;30(1-2)

A milestone has been reached in the treatment of sepsis—the institution of protocolized management that starts in the emergency department. Early goal-directed therapy, with targeted fluid resuscitation and measures of oxygen delivery, has been shown to improve survival in patients with septic shock. Although initiating aggressive fluid resuscitation is the first priority, it is also essential to rapidly obtain cultures and infuse broad-spectrum antibiotics. Norepinephrine is a more potent vasoconstrictor than dopamine and may be more effective in treating hypotension in patients with septic shock. Vasopressin is an effective second-line agent. Treatment with recombinant human activated protein C at 24 µg/kg/h for 96 hours has been shown to reduce mortality in patients with sepsis; its benefit is greatest in the most acutely ill patients. (J Respir Dis. 2009;30(1-2))

A 19-year-old woman presented with shortness of breath, dry cough, and pleuritic chest pain of unknown duration. Her medical history included endometriosis, a benign ovarian cyst,


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