Long-term physical training allows high exercise performance in moderate chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a major health problem, because of its prevalence, morbidity and mortality. As a result of symptoms such as cough and dyspnea patients with COPD suffer from exercise limitation and reduced health related quality of life. The present paper reports the case of a 67-year old ex-smoker patient with COPD, who had exercised regularly since when he was young, and maintained a better exercise capacity than healthy people of the same age, despite a forced expiratory volume in 1 second of the 60% of the predicted normal value. This case suggests that regular physical exercise in COPD patients may prevent the loss of exercise capacity despite significant airway obstruction.

Diffuse alveolar damage in a patient treated with gemcitabine

We present a case of diffuse alveolar damage (DAD) that occurred in a male aged 68 yrs treated with gemcitabine, a novel antineoplastic agent, that was given for hepatic relapse of a previously resected non-small cell lung cancer. The patient developed acute respiratory failure after the sixth drug dose, and died 4 days after admission. Autopsy revealed a pattern of DAD. No evidence of infection or other specific aetiologies could be found. To our knowledge, only three cases of pulmonary toxicity resulting from treatment with gemcitabine have been published; two of them were fatal and postmortem examination revealed a pattern consistent with acute respiratory distress syndrome. A careful survey may determine the incidence of pulmonary toxicity of this new drug in the future.

Prolonged ECG abnormalities in a subject with high altitude pulmonary edema (HAPE)

High Altitude Pulmonary Edema (HAPE) is an uncommon type of non-cardiogenic pulmonary edema. Few data are available regarding ECG abnormalities in patients with HAPE. They are usually slight and related to acute pulmonary hypertension. This paper describes a case of prolonged ECG abnormalities in a subject with HAPE, with no proven cardiac diseases. The Authors discuss the pathopysiological aspects of this kind of hypoxic-induced right ventricular overload with extensive T-wave negativity in precordial leads.

Pulmonary edema and acute hypercapnic respiratory failure treated with bi-level nasal-CPAP: case report

Noninvasive mechanical ventilation has been suggested for the treatment of patients with respiratory failure. We describe the case of a patient affected by bilateral cystic bronchiectasis and acute hypercapnic respiratory failure, due to a cardiogenic pulmonary edema, successfully treated with bi-level nasal-CPAP. This report suggests that in some cases noninvasive ventilatory support may mean avoiding tracheal intubation, even with critically ill patients.

Nasal-continuous positive airway pressure in the treatment of near-drowning in freshwater

In patients who have experienced near-drowning, hypoxemia is the major clinical consequence. We report two cases of patients who have experienced near-drowning in freshwater who were successfully treated with nasal-continuous positive airway pressure (N-CPAP) plus oxygen therapy. Both patients presented a radiographic appearance of bilateral pulmonary edema. We suggest the use of N-CPAP as an easier and less costly alternative to tracheal intubation for treating near-drowning in patients who are breathing spontaneously and who have not experienced loss of consciousness.

Unilateral high-altitude pulmonary edema in a subject with right pulmonary artery hypoplasia

High-altitude pulmonary edema (HAPE) is an uncommon type of non-cardiogenic, high-permeability pulmonary edema. The authors describe a case of unilateral, left-sided HAPE that occurred in a man with right pulmonary artery hypoplasia.

[A rare cause of pulmonary coin lesion: Rendu-Osler-Weber disease]

The diagnosis of lung coin lesions (peripheral lesions with a diameter of no more than 6 cm) is one of the most important problems in pneumology. Among the numerous causes of coin lesions, the presence of malignancies must always be excluded. The Authors describe an unusual case of lung arteriovenous fistula in a patient suffering from Rendu-Osler-Weber disease. The importance of a multi-step diagnosis, starting with non-invasive procedures is stressed; this is to avoid life threatening complications which may occur after lung trans-thoracic biopsies of previously undiagnosed vascular abnormalities.

[1st reported case of pneumothorax caused by sternal puncture]

The case of a woman aged 65 who presented pneumothorax following sternal marrow needle biopsy after diagnosis of thrombocytosis is reported. The complication was certainly attributable to the biopsy because chest X-ray immediately prior had been perfectly normal. No other cases of the kind have been reported. It is probable that this complication occurred because air passed into the pleural cavity, probably through a fracture rim at the internal face of the sternal bone trabeculae.