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Pulmonary complications including chest infections, atelectasis, pulmonary hypoplasia and ventilatory failure are the leading cause of death in the muscular dystrophies and atrophies. Ventilatory insufficiency is virtually inevita...
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Pulmonary complications including chest infections, atelectasis, pulmonary hypoplasia and ventilatory failure are the leading cause of death in the muscular dystrophies and atrophies. Ventilatory insufficiency is virtually inevitable in Duchenne muscular dystrophy and type 1 spinal muscular atrophy (SMA), but more variable in limb-girdle, congenital, and facioscapulohumeral muscular dystrophy. A cardiomyopathy may complicate Duchenne, Becker, and Emery-Dreifuss muscular dystrophies. Most patients respond well to ventilatory support with reduced pulmonary morbidity and extended survival. Careful monitoring and anticipation of complications are important so that ventilatory assistance can be started in a timely fashion.
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Years after suffering from poliomyelitis and completely recuperating from any of its acute complications, patients can develop postpolio syndrome (PPS), thought to be caused by progressive neuronal loss. The symptoms and manifesta...
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Years after suffering from poliomyelitis and completely recuperating from any of its acute complications, patients can develop postpolio syndrome (PPS), thought to be caused by progressive neuronal loss. The symptoms and manifestations of PPS vary in intensity and distribution, but many patients have respiratory involvement and will require a pulmonary evaluation for new or increased dyspnea, fatigue, or symptoms suggestive of sleep-related disordered breathing. The diagnosis, evaluation, and management of this complex problem are discussed in the first part of this article. In the second part, pulmonary complications of multiple sclerosis are described. This common neurological disease affects young adults and often requires evaluation by a pulmonologist. This review centers on the acute respiratory manifestations of multiple sclerosis and also describes the chronic effects.
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Stroke is the third leading cause of death in the United States. Stroke survivors often experience medical complications and long-term disability. Disturbances in respiratory system function and complications affecting the respira...
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Stroke is the third leading cause of death in the United States. Stroke survivors often experience medical complications and long-term disability. Disturbances in respiratory system function and complications affecting the respiratory system are common after stroke. The nature of these disorders depends on the severity and site of neurological injury. Alterations in breathing control, respiratory mechanics, and breathing pattern are common and may lead to gas exchange abnormalities or the need for mechanical ventilation. Stroke can lead to sleep disordered breathing such as central or obstructive sleep apnea. Sleep disordered breathing may also play a role in the pathogenesis of cerebral infarction. Venous thromboembolism, swallowing abnormalities, aspiration, and pneumonia are among the most common respiratory complications of stroke. Neurogenic pulmonary edema occurs less often. Close observation of the stroke patient for these potential disturbances, and implementation of prophylactic measures can prevent significant morbidity and mortality.
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Complicated relationships exist in both occurrence and progression of surgical complications, which are difficult to account for using a separate quantitative method such as prediction or grading. Data of 51,030 surgical inpatient...
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Complicated relationships exist in both occurrence and progression of surgical complications, which are difficult to account for using a separate quantitative method such as prediction or grading. Data of 51,030 surgical inpatients were collected from four academic/teaching hospitals in a prospective cohort study in China. The relationship between preoperative factors, 22 common complications, and death was analyzed. With input from 54 senior clinicians and following a Bayesian network approach, a complication grading, cluster-visualization, and prediction (GCP) system was designed to model pathways between grades of complication and preoperative risk factor clusters. In the GCP system, there were 11 nodes representing six grades of complication and five preoperative risk factor clusters, and 32 arcs representing a direct association. Several critical targets were pinpointed on the pathway. Malnourished status was a fundamental cause widely associated (7/32 arcs) with other risk factor clusters and complications. American Society of Anesthesiologists (ASA) score ?3 was directly dependent on all other risk factor clusters and influenced all severe complications. Grade III complications (mainly pneumonia) were directly dependent on 4/5 risk factor clusters and affected all other grades of complication. Irrespective of grade, complication occurrence was more likely to increase the risk of other grades of complication than risk factor clusters.
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Neuromuscular respiratory failure is a common complication of both the Guillain-Barre syndrome and myasthenia gravis. Several key pathophysiological mechanisms contribute to the spiral of respiratory insufficiency in these disease...
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Neuromuscular respiratory failure is a common complication of both the Guillain-Barre syndrome and myasthenia gravis. Several key pathophysiological mechanisms contribute to the spiral of respiratory insufficiency in these diseases, including inspiratory, expiratory, and bulbar muscle weakness. It is important to identify patients with impending respiratory failure early to avoid emergency intubations. Several clinical features and bedside pulmonary function tests (PFTs) are useful in guiding decisions about intubation. Weaning is initiated when respiratory muscles have recovered sufficiently, and again, PFT criteria are helpful. Intravenous immunoglobulin and plasmapheresis are the cornerstones of specific therapy for both illnesses when complicated by respiratory failure. Mortality and morbidity are dramatically increased by respiratory failure and are mainly due to associated medical complications. Optimal outcomes depend on avoidance of these and prompt implementation of immunomodulatory therapy.
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Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with no known cure. Involvement of muscles of the respiratory system, the inspiratory, expiratory, and upper airway muscles, is the major cause of morb...
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Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with no known cure. Involvement of muscles of the respiratory system, the inspiratory, expiratory, and upper airway muscles, is the major cause of morbidity and mortality. Dyspnea, swallowing difficulties, sialorrhea, and impaired cough are all symptoms that can be palliated with pharmacological and nonpharmacological methods. Noninvasive positive pressure ventilation (NPPV) in particular is a technique to assist ventilation that not only relieves dyspnea and ameliorates respiratory failure but may also extend the lives of patients with this disease. It should be offered to all ALS patients with a forced vital capacity of less than 50%.
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Medical care of patients undergoing total hip arthroplasty is best accomplished using a proactive, multidisciplinary approach aimed at optimizing preoperative health and reducing the incidence of delirium and cardiovascular, throm...
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Medical care of patients undergoing total hip arthroplasty is best accomplished using a proactive, multidisciplinary approach aimed at optimizing preoperative health and reducing the incidence of delirium and cardiovascular, thromboembolic, pulmonary, infectious and renal complications. All patients should receive perioperative antimicrobial and thrombo-embolism prophylaxis. Perioperative beta blockade should be initiated in most patients who have, or are at significant risk for, ischemic heart disease. Early mobilization, judicious use of pain medications, proactive bladder and bowel management, as well as close attention to pulmonary toilet, hydration and nutrition are all important additional ingredients to a successful recovery.
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Objectives: The aim of our study was to assess the incidence rate, mode of presentation, treatment and outcome measures associated with complicated sinusitis in our developing world setting. Additionally we had hope to identify po...
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Objectives: The aim of our study was to assess the incidence rate, mode of presentation, treatment and outcome measures associated with complicated sinusitis in our developing world setting. Additionally we had hope to identify possible patterns or predisposing factors that may assist us in decreasing the significant morbidity and mortality associated with this serious disease. Method: A retrospective chart review was performed on all patients treated for complicated sinusitis at 3 referral hospitals in Durban South Africa between January 2006 and September 2009. Results: A total of 220 patients were identified including 138 patients with orbital complications only and 82 with intracranial complications with or without orbital manifestations. We report on the demographics, mode of presentation, microbiology, impact on resources, management and mortality of the study group. The incidence rate was found to be 5.83 per million, the most common risk factors associated with intracranial complications, a persistent headache beyond 1 week and referral from a rural rather than urban area (OR 3.24). We found a high mortality rate of 20.7% in those patients with intracranial complications of their sinusitis. Conclusions: Complicated sinusitis is still far too common in the developing world with young adolescent males most at risk. A high index of suspicion must be maintained in detecting orbital as well as intracranial extension of disease and appropriate referral for investigation and management swift and aggressive in preventing extensive morbidity and mortality.
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Patients with Parkinson's disease are at risk for pulmonary complications as a consequence of both the underlying disease pathology and the side effects of medication. Degeneration of the substantia nigra and subsequent loss of do...
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Patients with Parkinson's disease are at risk for pulmonary complications as a consequence of both the underlying disease pathology and the side effects of medication. Degeneration of the substantia nigra and subsequent loss of dopaminergic neurons may produce changes in ventilatory parameters. Upper airway obstruction and chest wall restriction are both common, and both may respond to levodopa. However, therapy for Parkinson's may also contribute to pulmonary morbidity. Overtreatment with levodopa causes respiratory dyskinesia that may be difficult to differentiate from complications of the disease itself. Therapy with ergot derivatives may cause pleuropulmonary fibrosis. Pneumonia resulting from the respiratory complications remains a significant cause of morbidity and mortality in Parkinson's disease.
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Abstract Purpose of Review Acute and chronic sinusitis can give rise to a wide array of intracranial and orbital complications. These complications include brain abscess, subdural empyema, epidural abscess, meningitis, venous sinu...
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Abstract Purpose of Review Acute and chronic sinusitis can give rise to a wide array of intracranial and orbital complications. These complications include brain abscess, subdural empyema, epidural abscess, meningitis, venous sinus thrombosis, frontal bone osteomyelitis, and orbital cellulitis and abscess. Despite numerous medical advances, these complications carry a risk of mortality and significant morbidity. Recent Findings Recent studies have shown improvement in both the mortality and the morbidity associated with the neurologic complications of acute and chronic sinusitis. However, there are still a large portion of patients with long-term sequelae, and the literature reports a morbidity rate of approximately 30%. The most common post-treatment morbidities include permanent changes in vision, seizures, and hemiparesis. Summary Although the overall incidence of neurologic complications from a sinogenic source are rare, the potential long-term complications can be devastating making prompt diagnosis and treatment vital to improving outcomes.
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