Air Pollutants ; adverse effects ; Air Pollution ; adverse effects ; Humans ; Respiration Disorders ; etiology

Aged, 80 and over ; Chordoma ; complications ; Humans ; Male ; Pharyngeal Neoplasms ; complications ; Respiration Disorders ; etiology

Deglutition Disorders ; etiology ; Humans ; Male ; Middle Aged ; Respiration Disorders ; etiology ; Speech Disorders ; etiology ; Thyroglossal Cyst ; complications

Paroxysmal autonomic instability with dystonia (PAID) appears to be a unique syndrome following brain injury. It can echo many life-threatening conditions, making its early recognition and management a challenge for intensivists. A delay in early recognition and subsequent management may result in increased morbidity, which is preventable in affected patients. Herein, we report the case of a patient who was diagnosed with PAID syndrome following prolonged cardiac arrest, and discuss the pathophysiology, clinical presentation and management of this rare and under-recognised clinical entity.
Adult ; Anxiety ; complications ; Autonomic Nervous System Diseases ; etiology ; Brain Injuries ; etiology ; Critical Care ; Diagnosis, Differential ; Dystonia ; etiology ; Heart Arrest ; complications ; Humans ; Hypoxia ; Male ; Respiration Disorders ; complications ; Syndrome ; Treatment Outcome

OBJECTIVE: To observe the expression of GABA(A) receptor alpha1 (GABA(A)alpha1) and GABA(B) receptor 1 (GABA(B)1) in human medulla oblongata solitary nucleus and ambiguous nucleus due to tramadol-induced death. METHODS: GABA(A)alpha1 and GABA(B)1 were detected by immunohistochemical SP method in tramadol-induced death group and control group. All results were evaluated by images analysis system. RESULTS: Low expression of GABA(A)alpha1 and GABA(B)1 were detected in solitary nucleus and ambiguous nucleus in the control brain tissue. In cases of tramadol-induced death, the expression of GABA(A)alpha1 and GABA(B)1 significantly increased. CONCLUSION The mechanism of tramadol intoxication death could be caused by respiratory depression induced by over-expression of GABA(A)alpha1 and GABA(B)1 in medulla oblongata solitary nucleus and ambiguous nucleus.
Adult ; Analgesics, Opioid/poisoning* ; Autopsy ; Case-Control Studies ; Cause of Death ; Female ; Forensic Toxicology ; Humans ; Immunohistochemistry ; Male ; Medulla Oblongata/metabolism* ; Receptors, GABA-A/metabolism* ; Receptors, GABA-B/metabolism* ; Respiration Disorders/etiology* ; Solitary Nucleus/metabolism* ; Staining and Labeling ; Tramadol/poisoning*

Acute liver failure (ALF) is a rare condition in which rapid deterioration of liver function results in altered mentation and coagulopathy in individuals without previously recognized liver disease. The outcomes of patients with ALF vary greatly according to etiology, and the etiology of ALF varies markedly by geographical region. In Korea, about 90% of ALF are associated with etiologies that usually result in poor outcomes, including hepatitis B virus (HBV) infection and herbal remedies. The main causes of death in patients with ALF are increased intracranial pressure, systemic infection, and multi-organ failure. Recent advances in the intensive care of patients with ALF have contributed to a marked improvement in their overall survival. Emergency adult to adult living-donor liver transplantation (LDLT) can be performed expeditiously and safely for patients with ALF, and greatly improves survival rate as well as deceased-donor transplantation. As the window during which transplantation is possible is limited, emergency adult LDLT should be considered to be one of the first-line treatment options in patients with ALF, especially in regions in which ALFs are caused by etiologies associated with poor outcome and the supply of organs is very limited.
Drug-Induced Liver Injury/complications ; Hepatitis B/complications ; Humans ; Kidney Failure, Acute/etiology ; Liver Failure, Acute/*etiology/mortality/therapy ; Liver Transplantation ; Prognosis ; Republic of Korea ; Respiration Disorders/etiology ; Survival Rate

Aged ; Animals ; Asphyxia ; etiology ; Asthma ; physiopathology ; Catheter Ablation ; Female ; Fundoplication ; Gastroesophageal Reflux ; complications ; surgery ; Humans ; Laryngismus ; etiology ; Male ; Middle Aged ; Rats ; Rats, Sprague-Dawley ; Respiration Disorders ; etiology ; physiopathology ; Treatment Outcome

OBJECTIVETo report clinical application of Extracorporeal membrane oxygenation for severe acute respiratory and heart failure in a child with severe pneumonia.

METHODA seven-year old male patient with severe pneumonia complicated with heart and lung function failure was admitted to PICU in 28th of December, 2008.Veno-artery access was set up via euthyphoria cannulation in operative incision. Blood was drained from the right atrium through a cannula introduced via femoral veins, and returned via femoral artery. The inter-surface of the ECMO equipment system was completely coated with heparin-coating technique. Anticoagulation was maintained with heparin to keep the activated clotting time (ACT) between 150 and 200 seconds and heparin usage dose was 10 U/(kg.h), mean blood flow was 1/2-2/3 of 80-120 ml/(kg.min) during ECMO assistant period. During ECMO, ventilator settings were gradually reduced to allow lung rest, i.e. peak inspiratory pressure less than 25 cm H2O (1 cm H2O=0.098 kPa), end expiratory pressure 8-10 cm H2O, rate 10-15 breaths per minute and FiO2 30%-40%.

RESULTSIn management of ECMO, the incipient blood flow was set at 0.8 L/min, the radio of oxygen and blood flow was 1:1, FiO2 60%. After ten minutes of ECMO working, the blood oxygen saturation of radial artery increased from 40 mm Hg (1 mm Hg=0.133 kPa) to 177 mm Hg, Lac decreased from 3.5 mmol/L to 2.8 mmol/L. Four hours later, blood gas analysis of radial artery showed PaO2 202 mm Hg, PCO2 44 mm Hg, Lac 1.5 mmol/L, blood flow was set at 0.6 L/min, FiO2 60%, PaO2 kept above 150 mm Hg. 96 hours after ECMO supporting, the blood flow was set at 0.4 L/min [20 ml/(kg.min)], the results of blood gas analysis of radial artery was PaO2 190 mm Hg, PaCO2 36 mm Hg, SaO2 100%, Lac 0.9 mmol/L, then the child weaned off successfully from ECMO. Two days later, the child was successfully extubated. After two weeks treatment, the patient was discharged. The main complication associated with extracorporeal membrane oxygenation were bleeding.

CONCLUSIONECMO is an effective mechanical assistant therapy method for severe pulmonary and cardiac failure in a child.

Child ; Extracorporeal Membrane Oxygenation ; Heart Failure ; etiology ; therapy ; Humans ; Male ; Pneumonia ; complications ; physiopathology ; therapy ; Research Report ; Respiration Disorders ; etiology ; therapy

The aim of this study was to investigate the possible adverse effects of Asian dust events on respiratory health in asthmatic children. Fifty-two children with mild asthma were studied for eight consecutive weeks in the spring of 2004 (March 8 to May 2). During the study period, five Asian dust days were identified; we included a lag period of two days following each of the events. Subjects recorded their respiratory symptom diaries and peak expiratory flow (PEF) twice daily during the study period; and they underwent methacholine bronchial challenge tests. The subjects reported a significantly higher frequency of respiratory symptoms during the Asian dust days than during the control days. They showed significantly more reduced morning and evening PEF values, and more increased PEF variability (10.1%+/-3.5% vs. 5.5%+/-2.2%) during the Asian dust days than during the control days. Methacholine PC20 was not significantly different between before and after the study period (geometric mean: 2.82 mg/mL vs. 3.16 mg/mL). These results suggest that the short-term Asian dust events might be associated with increased acute respiratory symptoms and changes in PEF outcomes. However, there might be little long-term influence on airway hyperresponsiveness in children with mild asthma.
Adolescent ; Asthma/*physiopathology ; Bronchial Hyperreactivity/physiopathology ; Child ; *Dust ; Female ; Humans ; Male ; Methacholine Chloride/diagnostic use ; *Peak Expiratory Flow Rate ; Respiration Disorders/*etiology/physiopathology

Dexamethasone ; adverse effects ; Femur Head Necrosis ; chemically induced ; etiology ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Respiration Disorders ; etiology ; Severe Acute Respiratory Syndrome ; complications ; drug therapy