Pneumothorax in neuromuscular disease associated with lung volume recruitment and mechanical insufflation ‐exsufflation

A 25 ‐year‐old male with Duchenne muscular dystrophy and a 73‐year‐old male with motor neurone disease both presented with chest pain and increasing dyspnoea following routine mechanical insufflation‐exsufflation or lung volume recruitment, on a background of long‐term non‐invasive ventilat ion. In each case, chest radiograph revealed a pneumothorax which resolved with intercostal catheter insertion and cessation of routine lung volume recruitment. This rare but serious complication highlights the need for careful risk/benefit analysis by clinicians prescribing these therapies. A 25 ‐year‐old male with Duchenne muscular dystrophy and a 73‐year‐old male with motor neurone disease both presented with chest pain and increasing dyspnoea following routine mechanical insufflation‐exsufflation or lung volume recruitment, on a background of long‐term non‐invasive ventilat ion. In each case, chest radiograph revealed a pneumothorax. In both cases the pneumothorax fully resolved following insertion of an intercostal catheter. There was no immediate recurrence and the patients were discharged home and ceased ongoing prophylactic respiratory therapy, although one person had recurrent pneumothoraces subsequently. This rare but serious complication highlights the need for careful risk/benefit analysis by clinicians prescribing these therapies.
Source: Respirology Case Reports - Category: Respiratory Medicine Authors: Tags: Invited Case Report Source Type: research

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ConclusionHemiplegic spontaneous cervical EDH occurs very rarely. It is often misdiagnosed as ischemic stroke and is likely to be administered with thrombolytic agents, making the patient's symptoms worse. Early diagnosis and rapid management of cervical EDH increase the likelihood of complete recovery of the patient's symptoms. Therefore, if there are unilateral weakness and neck pain without cranial nerve dysfunction and there is no evidence of stroke in the brain imaging, spinal EDH should be considered.
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research
We describe the case of a 37-year-old man with a 20-year history of psoriatic arthritis. The patient presented with abdominal pain, watery diarrhea with mild hematochezia, and a reported 24-pound unintentional weight loss over the past five months. Of note, the patient began treatment with etanercept five months earlier after discontinuation of infliximab for his psoriatic arthritis symptoms. Colonoscopy with terminal ileum intubation revealed active colitis and intestinal biopsy results showed marked ulcerations and non-caseating granulomas, indicative of CD. Etanercept was subsequently discontinued and the patient was st...
Source: Journal of Drugs in Dermatology - Category: Dermatology Tags: J Drugs Dermatol Source Type: research
Authors: Alexis AF, Rendon M, Silverberg JI, Pariser DM, Lockshin B, Griffiths CE, Weisman J, Wollenberg A, Chen Z, Davis JD, Li M, Eckert L, Gadkari A, Shumel B, Rossi AB, Graham NM, Ardeleanu M Abstract Dupilumab, a monoclonal antibody that blocks the shared receptor subunit for interleukin (IL)-4 and IL-13, is currently approved for the treatment of adults with inadequately controlled moderate-to-severe atopic dermatitis (AD). The efficacy and safety of dupilumab for AD among racial subgroups is unknown. This post hoc analysis from three phase 3 trials assessed the efficacy and safety of dupilumab vs placebo by ...
Source: Journal of Drugs in Dermatology - Category: Dermatology Tags: J Drugs Dermatol Source Type: research
Authors: Green LJ, Yamauchi PS, Kircik LH Abstract Psoriasis (PsO) is a common, systemic, chronic inflammatory disease characterized by key clinical symptoms, including itching, pain, and scaling, and is associated with substantial physical, psychosocial, and economic health burdens. Currently, there is no cure for PsO; however, the introduction of biologic therapies has revolutionized the clinical management of patients with PsO by expanding treatment options to include multiple therapies with different mechanisms of action targeting cytokines, including tumor necrosis factor inhibitors (TNFis), interleukin (IL)-1...
Source: Journal of Drugs in Dermatology - Category: Dermatology Tags: J Drugs Dermatol Source Type: research
ConclusionDifferent from current algorithms, our technique focuses on a particular problem in the field of speech pathology detection (SPD), not yet explored in detail, proposing a way to successfully solve it. Furthermore, the results we obtained stimulate broaden studies involving speech data inconsistencies whilst providing a valid contribution.
Source: Biomedical Signal Processing and Control - Category: Biomedical Science Source Type: research
This study determined the prevalence of complicated appendicitis in elderly patients diagnosed preoperatively with uncomplicated appendicitis.MethodsPatients with a preoperative diagnosis of uncomplicated appendicitis at an academic hospital from 11/2013 to 05/2017 were reviewed. Patients ≥ 65 years were compared to those younger. Pathology reports were categorized as either uncomplicated or complicated (COMP). The primary outcome was the prevalence of COMP appendicitis.ResultsThe prevalence of COMP appendicitis increased with age after 20 years with an abrupt increase after 65 years. Patients ≥ 65 years were more li...
Source: The American Journal of Surgery - Category: Surgery Source Type: research
Anyone else using these ALTO guidelines for non opioid pain management in your ED? We have a non opioid pain policy with big banners in the ED informing patients and although physicians are technically free to order whatever they think is appropriate, we get emails with the names of physicians who are the biggest offenders with ordering narcotics in the ER so there is definitely pressure to not order them if you can help it. FMD is 100% behind the push for no opioids. At first, I was really... ALTO....sounds like a muppet character
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Emergency Medicine Source Type: forums
Condition:   Postoperative Pain Interventions:   Drug: Piroxicam group;   Drug: Placebo Sponsor:   Ain Shams University Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Conditions:   Pain, Acute;   Preterm Infant;   Breast Milk Interventions:   Other: Olfactive stimulation intervention with familiarization;   Other: Olfactive stimulation intervention;   Other: Standard care Sponsor:   St. Justine's Hospital Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Conditions:   Substance Use Disorders;   Pain Intervention:   Behavioral: SBIRT-PM Sponsors:   Yale University;   National Center for Complementary and Integrative Health (NCCIH);   National Institute on Drug Abuse (NIDA);   US Department of Veterans Affairs Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
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