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Journal Of Respiratory Diseases

Journal Of Respiratory Diseases

ABSTRACT: The most common causes of chylothorax are neoplasm-
particularly lymphoma-and trauma. The usual presenting
symptom is dyspnea resulting from the accumulation
of pleural fluid. The diagnosis of chylothorax is established by
measuring triglyceride levels in the pleural fluid; a triglyceride
level of greater than 110 mg/dL supports the diagnosis. The initial
approach to management involves chest tube drainage of
the pleural space. The administration of medium-chain triglycerides
as a source of fat is often useful. If drainage remains unchanged,
parenteral alimentation should be started. Surgical
intervention is indicated if conservative management is not
successful or if nutritional deterioration is imminent. If chylothorax
persists after ligation of the thoracic duct, options may
include percutaneous embolization, pleuroperitoneal shunt,
and pleurodesis. (J Respir Dis. 2008;29(8):325-333)

I have seen conflicting recommendations concerning the use of throat cultures and empirical antibiotic therapy in patients with pharyngitis. When do you consider throat cultures to be indicated? Are your recommendations different for children than for adults?

Cough can be a sign of aspiration in patients with dysphagia. Therefore, in evaluating patients with cough, the history should include a search for conditions associated with increased risk of impaired swallowing. These include conditions that require oropharyngeal suctioning, acute and degenerative neurological diseases (such as stroke, amyotrophic lateral sclerosis [ALS], and head trauma), cervical or brain surgery, head and neck cancer, and use of sedatives.1

We present a case of a 20-year old
man with massive hemoptysis
resulting from pulmonary
sequestration that involved 2
lobes (the right lower and middle
lobes). Preoperative embolization
and subsequent surgical
bilobectomy were performed.
Although the patient
had a difficult and prolonged
postoperative course, he eventually
had a full recovery.

We present a rare case of
Cushing syndrome resulting
from thymic carcinoid of the
lung. Although Cushing syndrome
is not usually associated
with respiratory muscle
weakness or restriction, our
patient had reduced lung volumes
and expiratory muscle
weakness. His reduced lung
volumes could not be completely
explained by respiratory
muscle weakness, parenchymal
lung disease, or obesity.
Six months after removal of
the carcinoid tumor, the patient's
growth hormone level
and the lung volumes improved
significantly, and he
became asymptomatic.

ABSTRACT: Although the organisms that cause community-acquired
pneumonia are similar in diabetic and nondiabetic patients,
those who have diabetes mellitus (DM) may have more
severe disease and a poorer prognosis. Elevated blood glucose
levels are associated with worse outcomes in patients with
pneumonia, and the mortality risk may be as high as 30% in patients
with uncontrolled DM. Thus, appropriate treatment-
and possibly prevention-of bacterial pneumonia should include
aggressive efforts directed at glycemic control. Other respiratory
infections, such as influenza, tuberculosis, and fungal
pneumonia, also are associated with greater morbidity in patients
with DM. Diabetic patients with tuberculosis are more
likely to present with bilateral lung involvement and pleural effusions.
(J Respir Dis. 2008;29(7):285-293)

ABSTRACT: Pulmonary manifestations, such as pleural effusions,
interstitial lung disease (ILD), and rheumatoid nodules, are
common in patients with rheumatoid arthritis (RA). For those
with pleural effusions, diagnostic thoracentesis is usually necessary
to rule out other causes. Larger effusions that cause dyspnea
may require therapeutic thoracentesis or other interventions.
The presentation of ILD is characterized by gradually
progressive dyspnea on exertion and cough. An isolated decrement
in carbon monoxide–diffusing capacity is often the earliest
abnormality seen on pulmonary function testing. Highresolution
CT is an important tool for detecting ILD; common
findings include ground-glass opacities and reticulation. It is
important to keep in mind that in RA-associated ILD, more
than one pathological process-often several-may be seen in
the same patient. (J Respir Dis. 2008;29(7):274-280)

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