Inhaled NO and sildenafil combination in cardiac surgery patients with out-of-proportion pulmonary hypertension: acute effects on postoperative gas exchange and hemodynamics.

Background: The goal of this study was to examine the effects of coadministration of sildenafil and inhaled nitric oxide (iNO) in patients with out-of-proportion pulmonary hypertension who underwent cardiac valve replacement surgery.

Methods And Results: Twenty consecutive cardiac surgery patients with out-of-proportion pulmonary hypertension were randomly assigned postoperatively into 2 groups: group A received 10 ppm of iNO followed by sildenafil (100 mg) orally 30 minutes later, and group B initially received sildenafil (100 mg) orally followed by 10 ppm of iNO 60 minutes later. Hemodynamic and gas exchange data were obtained at baseline, after administration of either iNO or sildenafil alone, and at 90 minutes from baseline.

Prone position augments recruitment and prevents alveolar overinflation in acute lung injury.

Rationale: Mechanical ventilation in the prone position may be an effective means of recruiting nonaerated alveolar units and minimizing ventilation-induced lung injury.

Objectives: To evaluate and quantify regional lung volume alterations when patients with lobar or diffuse acute lung injury (ALI) were turned prone after a recruitment maneuver.

Methods: In 21 patients with ALI, a recruitment maneuver was applied in the supine position followed by a multislice spiral computed tomography (CT) scan; then, patients were turned prone and a second CT scan was performed.

Brain tuberculomas due to miliary tuberculosis.

Brain tuberculomas are a rare complication of tuberculosis arising through hematogenous spread from an extracranial source, most often of pulmonary origin. The clinical course is usually subacute or chronic, lasting weeks or months, and they typically occur in immunocompromised patients. Recognition and prompt diagnosis of this disorder is important because early treatment can prevent patient worsening and lead to clinical improvement.