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Merati M, Radomski S, Below A, Lambert-Cheatham N, Keating R, Chang H, Kaufman D. Multiple Cranial Nerve Palsies as the Presenting Sign of GCA. J Neuroophthalmol 2024; 44:e252-e253. [PMID: 36892944 DOI: 10.1097/wno.0000000000001824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
- Melody Merati
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan
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Lambert-Cheatham NA, Sakuru RC, Merati M, Tessema ST, Salbert LR, Ward JH, Nagia L. A Case of Pembrolizumab-Induced Papillitis With Transverse Myelitis. J Neuroophthalmol 2023; 43:e131-e133. [PMID: 37974365 DOI: 10.1097/wno.0000000000001427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hinson SR, Honorat JA, Grund EM, Clarkson BD, Miske R, Scharf M, Zivelonghi C, Al-Lozi MT, Bucelli RC, Budhram A, Cho T, Choi E, Grell J, Lopez-Chiriboga AS, Levin M, Merati M, Montalvo M, Pittock SJ, Wilson MR, Howe CL, McKeon A. Septin-5 and -7-IgGs: Neurologic, Serologic, and Pathophysiologic Characteristics. Ann Neurol 2022; 92:1090-1101. [PMID: 36053822 PMCID: PMC9672904 DOI: 10.1002/ana.26482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES We sought to determine clinical significance of neuronal septin autoimmunity and evaluate for potential IgG effects. METHODS Septin-IgGs were detected by indirect immunofluorescence assays (IFAs; mouse tissue and cell based) or Western blot. IgG binding to (and internalization of) extracellular septin epitopes were evaluated for by live rat hippocampal neuron assay. The impact of purified patient IgGs on murine cortical neuron function was determined by recording extracellular field potentials in a multielectrode array platform. RESULTS Septin-IgGs were identified in 23 patients. All 8 patients with septin-5-IgG detected had cerebellar ataxia, and 7 had prominent eye movement disorders. One of 2 patients with co-existing septin-7-IgG had additional psychiatric phenotype (apathy, emotional blunting, and poor insight). Fifteen patients had septin-7 autoimmunity, without septin-5-IgG detected. Disorders included encephalopathy (11; 2 patients with accompanying myelopathy, and 2 were relapsing), myelopathy (3), and episodic ataxia (1). Psychiatric symptoms (≥1 of agitation, apathy, catatonia, disorganized thinking, and paranoia) were prominent in 6 of 11 patients with encephalopathic symptoms. Eight of 10 patients with data available (from 23 total) improved after immunotherapy, and a further 2 patients improved spontaneously. Staining of plasma membranes of live hippocampal neurons produced by patient IgGs (subclasses 1 and 2) colocalized with pre- and post-synaptic markers. Decreased spiking and bursting behavior in mixed cultures of murine glutamatergic and GABAergic cortical neurons produced by patient IgGs were attributable to neither antigenic crosslinking and internalization nor complement activation. INTERPRETATION Septin-IgGs are predictive of distinct treatment-responsive autoimmune central nervous system (CNS) disorders. Live neuron binding and induced electrophysiologic effects by patient IgGs may support septin-specific pathophysiology. ANN NEUROL 2022;92:1090-1101.
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Affiliation(s)
- Shannon R. Hinson
- Department of Laboratory Medicine and Pathology, Mayo
Clinic, Rochester, MN, USA
| | - Josephe A. Honorat
- Department of Laboratory Medicine and Pathology, Mayo
Clinic, Rochester, MN, USA
| | - Ethan M. Grund
- Department of Neurology, Mayo Clinic, Rochester, MN,
USA
| | | | - Ramona Miske
- Institute for Experimental Immunology, affiliated to
EUROIMMUN Medizinische Labordiagnostika, Lubeck, Germany
| | - Madeleine Scharf
- Institute for Experimental Immunology, affiliated to
EUROIMMUN Medizinische Labordiagnostika, Lubeck, Germany
| | - Cecilia Zivelonghi
- Department of Laboratory Medicine and Pathology, Mayo
Clinic, Rochester, MN, USA
| | | | | | - Adrian Budhram
- Department of Neurology, Mayo Clinic, Rochester, MN,
USA
| | - Tracey Cho
- Department of Neurology, University of Iowa, Iowa,
USA
| | - Ellie Choi
- Overlake Hospital, Bellevue, Washington, USA
| | - Jacquelyn Grell
- Department of Laboratory Medicine and Pathology, Mayo
Clinic, Rochester, MN, USA
| | | | - Marc Levin
- Department of Ophthalmology, Palo Alto Medical Foundation,
Palo Alto, CA, USA
| | - Melody Merati
- Department of Neurology, Michigan State University,
Lansing, MI, USA
| | - Mayra Montalvo
- Department of Neurology, Mayo Clinic, Rochester, MN,
USA
| | - Sean J. Pittock
- Department of Laboratory Medicine and Pathology, Mayo
Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN,
USA
| | - Michael R. Wilson
- Weill Institute for Neurosciences, Department of
Neurology, University of California, San Francisco, USA
| | | | - Andrew McKeon
- Department of Laboratory Medicine and Pathology, Mayo
Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN,
USA
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Merati M, Rucker JC, McKeon A, Frucht SJ, Hu J, Balcer LJ, Galetta SL. A Case of Opsoclonus-Myoclonus-Ataxia With Neuronal Intermediate Filament IgG Detected in Cerebrospinal Fluid. J Neuroophthalmol 2022; 42:278-281. [PMID: 35594157 PMCID: PMC9620397 DOI: 10.1097/wno.0000000000001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 62-year-old man presented with headache, fever, and malaise. He was diagnosed with Anaplasma phagocytophilum, confirmed by serum polymerase chain reaction, and started on oral doxycycline. After 5 days of treatment, the patient began to experience gait imbalance with frequent falls, as well as myoclonus, and confusion. Examination was notable for opsoclonus-myoclonus-ataxia (OMA) and hypometric saccades. Cerebrospinal fluid (CSF) autoimmune encephalitis panel demonstrated a markedly elevated neuronal intermediate filament (NIF) immunoglobulin G antibody titer of 1:16, with positive neurofilament light- and heavy-chain antibodies. These antibodies were suspected to have been triggered by the Anaplasma infection. Repeat CSF examination 8 days later still showed a positive immunofluorescence assay for NIF antibodies, but the CSF titer was now less than 1:2. Body computed tomography imaging was unrevealing for an underlying cancer. Our patient illustrates a postinfectious mechanism for OMA and saccadic hypometria after Anaplasma infection.
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Affiliation(s)
- Melody Merati
- Department of Neurology (MM, JCR, SJF, LJB, SLG), New York University Grossman School of Medicine, New York, New York; Department of Neurology (AM, MDM), Mayo Clinic, Rochester, MN; and Departments of Radiology (JH), Ophthalmology (JCR, LJB, SLG), and Department of Population Health (LJB), New York University Grossman School of Medicine, New York, New York
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Affiliation(s)
- M. Morrison
- Department of Dermatology; St. Joseph Mercy Hospital; Ypsilanti MI USA
| | - M. Merati
- Michigan State University; East Lansing MI USA
| | - J. Ramirez
- Department of Dermatopathology; St. Joseph Mercy Hospital; Ypsilanti MI USA
| | - H.C. Cha
- Department of Dermatology; St. Joseph Mercy Hospital; Ypsilanti MI USA
| | - A. LaFond
- Department of Dermatology; St. Joseph Mercy Hospital; Ypsilanti MI USA
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Sarhaddi D, Poushanchi B, Merati M, Tchanque-Fossuo C, Donneys A, Baker J, Buchman SR. Validation of Histologic Bone Analysis Following Microfil Vessel Perfusion. J Histotechnol 2013. [PMID: 26207077 DOI: 10.1179/2046023612y.0000000012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The ability to examine bone vascularity using Micro-Computed Tomography (μCT) following vessel perfusion with Microfil® and to subsequently perform histologic bone analysis in the same specimen would provide an efficient method by which the vascular and cellular environment of bone can be examined simultaneously. The purpose of this report is to determine if the administration of Microfil® precludes accurate histologic assessment of bone quality via osteocyte count and empty lacunae count. Sprague-Dawley rats (n=6) underwent perfusion with Microfil®. Left hemi-mandibles were harvested, decalcified and underwent vascular analysis via μCT prior to sectioning and staining with Gomori's Trichrome. Quantitative Histomorphometric evaluation was performed. Ninety-five percent confidence intervals were used to determine statistical differences from an established set of controls (n=12). Histologic analyses were successfully performed on specimens that had undergone previous perfusion. Quantitative measures of bone cellularity of perfused versus control specimens revealed no statistical difference in osteocyte count per high-power field (95.33 versus 94.66; 95 percent CI,-7.64 to 6.30) or empty lacunae per high-power field (2.73 versus 1.89, 95 percent CI, -1.81 to 0.13). Here we report a statistical validation allowing for histological analysis of cell counts in specimens in which Microfil® perfusion has previously been performed.
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Affiliation(s)
- D Sarhaddi
- The University of Michigan: Craniofacial Anomalies Program, Pediatric Plastic Surgery, 1500 E. Medical Center Drive, F7894 Mott Children's Hospital, Ann Arbor, Mich. 48109-5219
| | - B Poushanchi
- The University of Michigan: Craniofacial Anomalies Program, Pediatric Plastic Surgery, 1500 E. Medical Center Drive, F7894 Mott Children's Hospital, Ann Arbor, Mich. 48109-5219
| | - M Merati
- The University of Michigan: Craniofacial Anomalies Program, Pediatric Plastic Surgery, 1500 E. Medical Center Drive, F7894 Mott Children's Hospital, Ann Arbor, Mich. 48109-5219
| | - C Tchanque-Fossuo
- The University of Michigan: Craniofacial Anomalies Program, Pediatric Plastic Surgery, 1500 E. Medical Center Drive, F7894 Mott Children's Hospital, Ann Arbor, Mich. 48109-5219
| | - A Donneys
- The University of Michigan: Craniofacial Anomalies Program, Pediatric Plastic Surgery, 1500 E. Medical Center Drive, F7894 Mott Children's Hospital, Ann Arbor, Mich. 48109-5219
| | - J Baker
- The University of Michigan: Craniofacial Anomalies Program, Pediatric Plastic Surgery, 1500 E. Medical Center Drive, F7894 Mott Children's Hospital, Ann Arbor, Mich. 48109-5219
| | - S R Buchman
- The University of Michigan: Craniofacial Anomalies Program, Pediatric Plastic Surgery, 1500 E. Medical Center Drive, F7894 Mott Children's Hospital, Ann Arbor, Mich. 48109-5219
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Merati M, Khatab R, Bouazza D, Hzam M, Hakim K, Grangeo C, Jeannin L. 158 Impact du Syndrome d’Apnées du Sommeil (SAS) et son Traitement sur le Conjoint. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)72534-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jibbaoui A, Rabec C, Reybet-Degat O, Georges M, Merati M, Camus P. 163 Étude de prévalence de la fibrillation auriculaire (ACFA) dans le syndrome d’apnées obstructives du sommeil (SAOS). Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)72539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rabec C, Reybet-Degat O, Bonniaud P, Merati M, Massin F, Camus P. 46 Procédure simplifiée automatique en nuit partagée pour la prise en charge du syndrome d’apnées du sommeil. Résultats préliminaires. Rev Mal Respir 2004. [DOI: 10.1016/s0761-8425(04)71672-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rabec C, Reybet-Degat O, Bonniaud P, Merati M, Massin F, Baudouin N, Camus P. 120 Intérêt d’un système de monitorage couplé à un respirateur portable. Rev Mal Respir 2004. [DOI: 10.1016/s0761-8425(04)71746-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Reybet-Degat O, Massin F, Grangeon C, Hzam M, Merati M, Baudouin N, Noroohali B, Michaux K, Ducrocq V, Bonniaud P. [Acute respiratory failure in obesity]. Rev Pneumol Clin 2002; 58:111-116. [PMID: 12082450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Obstructive sleep apnea, obesity-related hypoventilation - a hypoventilation which is independent of apneas and increased by sleep -, and hypoxemia related to local ventilation-perfusion disorders are the main mechanisms of respiratory failure occurring during acute respiratory decompensation following an often minimal triggering event. Non-invasive ventilation has been found to be an effective treatment, particularly with a ventilator capable of maintaining positive expiratory and pressure. The level of the expiratory positive airway pressure must be adapted to cure episodes of obstructive apnea or hypopnea. The level of the inspiratory positive airway pressure (pressure support ventilator), or the tidal volume (volume-controlled ventilator) must be adapted to correct the residual hypoventilation. These adaptations can be made by proper assessment of nocturnal SaO(2) recordings. In particularly severe cases, use of endotracheal ventilation may be necessary to control a state of shock or consciousness disorders incompatible with the patient cooperation necessary for non-invasive ventilation.
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Affiliation(s)
- O Reybet-Degat
- Service de Pneumologie et Réanimation Respiratoire (Pr. Ph. Camus), CHU, BP 1542, 21034 Dijon Cedex, France
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Froidure M, Baudouin N, Merati M, Bonnaiud P, Baulot E, Piard F, Camus P. [Fat embolism with lung hemorrhage]. Rev Mal Respir 2001; 18:657-60. [PMID: 11924189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Post-traumatic fat embolism was disclosed by a picture of alveolar hemorrhage. Acute hypoxemia associated with dense bilateral pulmonary infiltrates was observed in a 21 year-old woman, 4 days after an accident with closed tibial fracture. Cruoric pulmonary thromboembolism was ruled out, as was an acute pulmonary edema. Neither infectious nor immunologic etiology was found. The diagnosis of alveolar hemorrhage was based on bronchoalveolar lavage. Lipid droplets in macrophages stained by "Oil Red O" established the relationship with fat embolism. The outcome was favorable. The association of fat embolism and alveolar hemorrhage has already been reported, but remains rare.
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Affiliation(s)
- M Froidure
- Service de Pneumologie et Réanimation Respiratoire, Hôpital du Bocage et Université de Bourgogne, CHU de Dijon
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Rabec C, Laurent G, Baudouin N, Merati M, Massin F, Foucher P, Brondel L, Reybet-Degat O. Central sleep apnoea in Arnold-Chiari malformation: evidence of pathophysiological heterogeneity. Eur Respir J 1998; 12:1482-5. [PMID: 9877513 DOI: 10.1183/09031936.98.12061482] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report on the case of two young patients with type I Arnold-Chiari malformation (ACM), as revealed by a central sleep apnoea (CSA) syndrome without any other neurological defect. Case 1 was a 14-yr-old male patient, who developed severe alveolar hypoventilation and needed long-term mechanical ventilation via a tracheostomy. Case 2 was a 39-yr-old male patient, who developed features suggestive of sleep apnoea and responded to nasal continuous positive airway pressure ventilation despite the central type of apnoeas. These two cases illustrate the different pathophysiological mechanisms involved in CSA, namely a blunted chemical drive (in hypercapnic patients) and an increased chemical drive, which destabilizes the breathing pattern during sleep (in normo/hypocapnic patients). Central sleep apnoea can be the initial manifestation of Arnold-Chiari malformation and can lead to a life-threatening condition.
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Affiliation(s)
- C Rabec
- Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier Universitaire de Dijon, France
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Foucher P, Baudouin N, Merati M, Pitard A, Bonniaud P, Reybet-Degat O, Jeannin L. Relative survival analysis of 252 patients with COPD receiving long-term oxygen therapy. Chest 1998; 113:1580-7. [PMID: 9631797 DOI: 10.1378/chest.113.6.1580] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES A survival analysis was conducted on patients with COPD receiving long-term oxygen therapy (LTOT) to compare two different statistical methods. METHODS We used a multivariate crude (observed) survival model (Cox) and a multivariate relative survival model (Hakulinen). Only the latter is able to correct the survival by adjusting it to the normal life expectancy of the studied patients. PATIENTS Two hundred fifty-two hypoxemic COPD patients (207 male) requiring LTOT were included. Mean PaO2 was <50 mm Hg before oxygen therapy. Mean age was >69 years (SE: 9.9). They had severe bronchial obstruction: mean FEV1 was <33% (10.6) of predicted values, with some CO2 retention: mean PaCO2 was 45.6 (7.1) mm Hg. By December 31, 1995, 189 patients had died (75%) and 13 (5%) were unavailable for follow-up. RESULTS The overall crude survival was poor: 80.9% after 1 year, 67.1% after 2 years, 34.7% after 5 years, and 7.1% after 10 years. In the crude multivariate analysis (Cox), the negative prognostic factors were age and hypercapnia. The overall relative survival (Hakulinen), corrected for life expectancy, was 82.8% after 1 year, 70.8% after 2 years, 41.5% after 5 years, and 10.25% after 10 years. In the final multivariate relative model, age was no longer significant and the only bad prognostic factor was hypercapnia with a relative risk of 1.97 (1.16 to 3.34). CONCLUSION This work shows the inadequacy of the Cox observed survival model when it comes to appreciating the real prognostic impact of age, because of the confusing factor associated with a normal life expectancy.
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Affiliation(s)
- P Foucher
- Department of Pulmonary Diseases, University Hospital, Dijon, France
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Rabec C, Merati M, Baudouin N, Foucher P, Ulukavac T, Reybet-Degat O. [Management of obesity and respiratory insufficiency. The value of dual-level pressure nasal ventilation]. Rev Mal Respir 1998; 15:269-78. [PMID: 9677635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obstructive Sleep Apnea (OSA), Obesity-Linked Hypoventilation (OLH)--a hypoventilation which is independent of apneas and increased by sleep--, and COPD are mechanisms for respiratory failure in obese patients. We thought nasal bi-level positive airway pressure to be a suitable treatment: EPAP is useful to maintain upper airway patency and IPAP-EPAP difference to correct OLH and COPD hypoventilation. Our purpose is to report the results of such a therapeutic approach. We included 41 patients that we first treated by nasal bi-level positive airway pressure for a respiratory failure with an uncompensated respiratory acidosis. The initial setting was about 4 cm H2O for EPAP and 16 for IPAP. Under supervision of a real-time printed oximetry tracing, we furthermore increased EPAP until disappearance of repetitive dips in oxygen saturation (that we assimilated to obstructive events) and IPAP until obtaining an acceptable level of steady saturation (we assimilated a low level to a steady hypoventilation). Age (mean +/- SD) was 63 +/- 11 years, BMI 42 +/- 9 kg/m2, pH 7.32 +/- 0.04, PaCO2 71 +/- 13 mmHg, PaO2 45 +/- 7 mmHg. Thirty-nine out of 41 patients returned home without need for tracheal intubation. At 7 days of treatment, PaCO2 was 50 +/- 6 mmHg. Thus, nasal bi-level position airway pressure appears to be an efficient treatment in these patients.
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Affiliation(s)
- C Rabec
- Service de Pneumologie et Réanimation Respiratoire, CHU, Dijon
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Foucher P, Merati M, Baudouin N, Reybet-Degat O, Camus P, Jeannin L. Fatal ball-valve airway obstruction by an extensive blood clot during mechanical ventilation. Eur Respir J 1996; 9:2181-2. [PMID: 8902488 DOI: 10.1183/09031936.96.09102181] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A ball-valve airway obstruction by a blood clot cast of almost the whole bronchial tree occurred in a small-cell lung cancer patient, who had been on mechanical ventilation for 9 days. Chest radiographs revealed overinflated lungs. Attempts to remove the cast via fibreoptic bronchoscopy were unsuccessful and the patient died. A postmortem extraction of the clot was performed with a rigid tube. This case is rare because of absence of severe haemoptysis and lung volume reduction.
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Affiliation(s)
- P Foucher
- Dept of Pulmonary Diseases, University Hospital, Dijon, France
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