Sarcoidosis-lymphoma syndrome: a diagnostic dilemma.

Sarcoidosis and lymphoma are generally thought of as being two mutually exclusive diseases that need to be considered in the differential diagnosis of patients with hilar/mediastianal lymphadenopathy. However, there are rare patients in whom both of these diseases coexist. These patients constitute a diagnostic challenge because their presentation (ie, clinical symptoms, imaging abnormalities and even pathology) may all be atypical when each individual disease is considered separately.

Management of idiopathic pulmonary fibrosis: selected case reports.

In 2011, revised international guidelines were issued jointly by the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society and the Latin American Thoracic Association, which provide a valuable framework for the diagnosis and management of idiopathic pulmonary fibrosis (IPF). However, due to the complexity of IPF, these guidelines may not comprehensively account for the management of individual IPF patients in clinical practice. We describe three patient cases that were presented and discussed during the 2013 AIR: Advancing IPF Research meeting in Nice, France.

Foreign-body aspiration in the adult: presentation and management.

Nonasphyxiating foreign-body aspiration in adults can be difficult to diagnose because the symptoms are nonspecific and chest x-rays may be normal due to organic composition of the foreign bodies. The diagnosis is often made via flexible bronchoscopy; however, debate remains as to whether rigid or flexible bronchoscopy is the optimal method of extraction. The authors describe a patient who was initially referred for assessment of a calcified left mainstem bronchus mass identified only on computed tomography scan of the thorax.

Cystic echinococcosis: late rupture and complication of a stable pulmonary cyst.

Cystic echinococcosis is observed worldwide. Traditional management includes an invasive surgical approach with adjunctive chemotherapy. It has been suggested that observation alone may be appropriate in asymptomatic individuals with stable cysts.

Search for chronic beryllium disease among sarcoidosis patients in Ontario, Canada.

Chronic beryllium disease (CBD) is clinically similar to other granulomatous diseases such as sarcoidosis. It is often misdiagnosed if a thorough occupational history is not taken. When appropriate, a beryllium lymphocyte proliferation tests (BeLPT) need to be performed.

Rapid eye movement-related sleep-disordered breathing: influence of age and gender.

Background: Sleep-disordered breathing (SDB) occurring during rapid eye movement (REM) sleep occurs more frequently in women than men. We sought to characterize REM SDB prevalence by gender and age to identify factors that could account for this discrepancy.

Methods: Subjects with REM SDB were identified among 2,486 patients referred to a university sleep laboratory with an apnea-hypopnea index (AHI) >or= 5 events per hour.

Clinical and immunologic features of an atypical intracranial mycobacterium avium complex (MAC) infection compared with those of pulmonary MAC infections.

Members of the Mycobacterium avium complex (MAC) may cause chronic pulmonary infections in otherwise healthy elderly persons but rarely invade parts of the body outside of the lungs in immunocompetent hosts. We present a case of an isolated intracranial MAC infection in an apparently immunocompetent individual and review previous reports. We studied the T-cell and monocyte responses in healthy volunteers, individuals with a pulmonary MAC infection, and one individual with an isolated intracranial MAC infection.

Nocturnal haemodialysis increases pharyngeal size in patients with sleep apnoea and end-stage renal disease.

Background: Sleep apnoea is common in patients with end-stage renal disease (ESRD) and is improved by nocturnal haemodialysis (NHD). Recent findings from our laboratory indicate the development of ESRD is associated with pharyngeal narrowing. We hypothesized that NHD increases pharyngeal cross-sectional area and that this is associated with an improvement in sleep apnoea.

Pharyngeal narrowing in end-stage renal disease: implications for obstructive sleep apnoea.

Sleep apnoea is common in patients with end-stage renal disease (ESRD). It was hypothesised that this is related to a narrower upper airway. Upper airway dimensions in patients with and without ESRD and sleep apnoea were compared, in order to determine whether upper airway changes associated with ESRD could contribute to the development of sleep apnoea.

Pleuroparenchymal lung disease secondary to nonoccupational exposure to vermiculite.

An unusual case of pleuroparenchymal lung disease caused by the inhalation of vermiculite dust, presumably containing asbestos fibers is described. The uniqueness of the case lies in the very indirect nature of exposure -- the wife of a factory owner, rather than a worker exposed to asbestos, whose factory manufactured vermiculite. The present case illustrates the importance of taking careful occupational histories of all household members when presented with a patient whose chest radiograph exhibits features consistent with asbestos exposure.

Tiotropium in combination with placebo, salmeterol, or fluticasone-salmeterol for treatment of chronic obstructive pulmonary disease: a randomized trial.

Background: Treatment of moderate or severe chronic obstructive pulmonary disease (COPD) with combinations of inhaled corticosteroids, long-acting beta-agonists, and long-acting anticholinergic bronchodilators is common but unstudied.

Objective: To determine whether combining tiotropium with salmeterol or fluticasone-salmeterol improves clinical outcomes in adults with moderate to severe COPD compared with tiotropium alone.

Design: Randomized, double-blind, placebo-controlled trial conducted from October 2003 to January 2006.

Review of oral appliances for treatment of sleep-disordered breathing.

Between 1982 and 2006, there were 89 distinct publications dealing with oral appliance therapy involving a total of 3,027 patients, which reported results of sleep studies performed with and without the appliance. These studies, which constitute a very heterogeneous group in terms of methodology and patient population, are reviewed and the results summarized. This review focused on the following outcomes: sleep apnea (i.

Acidification of distal esophagus and sleep-related breathing disturbances.

Study Objectives: To investigate whether distal esophageal acidification occurs during sleep in patients suspected of sleep-disordered breathing, and whether such acidification is related to respiratory abnormalities.

Design And Patients: Fourteen middle-aged, snoring men all complaining of daytime sleepiness and suspected of having obstructive sleep apnea.

Setting: Sleep laboratory, Pulmonary Department, Landspitali University Hospital, Reykjavik, Iceland.

Pulmonary function and sleep apnea.

The purpose of this study was to determine whether there is a relationship between pulmonary function measured during wakefulness and sleep apnea. We prospectively studied 1296 patients, who were free of any lung disease, referred to our sleep clinic for evaluation of possible sleep apnea. All patients had in-hospital nocturnal polysomnography and pulmonary function measurements, which included flow-volume curve, body plethysmography, and single-breath diffusing capacity for carbon monoxide.

Gender differences in sleep apnea: the role of neck circumference.

Study Objectives: To determine whether differences in sleep apnea severity between men and women referred to a sleep clinic are related to the differences in neck circumference (NC).

Study Design: Case series.

Setting: University hospital sleep disorders clinic.

Apnea and snoring: state of the art and future directions.

This review is intended to discuss the newer aspects of sleep apnea, and particularly where the new advances are likely to take place in the current millennium. The topics reviewed include epidemiology and clinical features of sleep apnea and snoring, adverse health consequences of sleep-disordered breathing, upper airway resistance syndrome, and treatment. Most of the work reviewed in these areas has been published since the year 2000, although whenever necessary older literature on the topic under discussion is summarized.

Upper airway pressures in snorers and nonsnorers during wakefulness and sleep.

Objective: To compare upper airway pressures in snorers and nonsnorers during sleep and wakefulness.

Design: Case series of snorers and nonsnoring controls.

Setting: Sleep clinic of a university hospital.

Comparing pressures required to abolish snoring and sleep apnea.

Objective: Snoring and obstructive sleep apnea share similar pathogenesis and similar response to treatment with continuous positive airway pressure (CPAP). The purpose of this study was to compare pressures required to abolish apneas (POSA) with pressures required to abolish snoring (PSNOR).

Design: Cross-sectional, nonrandomized cohort study.

Obstructive sleep apnea and hypertension: from correlative to causative relationship.

Sleep-disordered breathing, manifested by repetitive episodes of partial or complete cessation of breathing during sleep associated with brief arousal and autonomic activation, is estimated to affect as many as 4% of adult men and 2% of adult women. Studies conducted during the 1980s revealed a strong association between sleep-disordered breathing and hypertension. The results of these early studies, which relied on relatively small samples of patients, have been confirmed in recent years by large-scale epidemiologic studies that are controlled for all possible confounding factors.

Sleep apnea syndrome: a possible contributing factor to resistant.

Study Objectives: There is evidence supporting an association between sleep apnea and hypertension. However, it is not clear if sleep apnea interteres with the pharmacotherapy of hypertension. To investigate this question, we studied the relationship between the effectiveness of anti-hypertensive treatment in reducing blood pressure, and severity of sleep apnea in a large group of apneic patients referred to a sleep disorders centre at St.

Impact of menopause on the prevalence and severity of sleep apnea.

Study Objectives: To compare the prevalence and severity of sleep apnea between premenopausal and postmenopausal women, and to determine whether these differences are affected by the body mass index (BMI) and neck circumference.

Design: Cross-sectional study utilizing a sleep clinic patient database.

Setting: University hospital.

Predicting effective continuous positive airway pressure.

Purpose: The purpose of this study was to compare the pressure required to abolish apneas as predicted from a previously derived algorithm (Ppred) with the true effective pressure (Peff) determined during a continuous positive airway pressure (CPAP) titration study.

Setting: Sleep clinic of a university hospital.

Methods: We prospectively studied 329 patients with sleep apnea undergoing CPAP titration.

Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study.

Objective: To assess whether sleep apnoea syndrome is an independent risk factor for hypertension.

Design: Population study.

Setting: Sleep clinic in Toronto.

Evaluation of variable mandibular advancement appliance for treatment of snoring and sleep apnea.

Objective: To evaluate an adjustable mandibular positioning appliance for treatment of snoring and sleep apnea.

Methods: One hundred thirty-four patients with baseline apnea/hypopnea index (AHI) of 37 +/- 28 events/h (mean +/- SD) received the appliance. The efficacy of the appliance was assessed by the following investigations, performed at baseline and with the appliance: polysomnography, Epworth sleepiness scale, bedpartners' assessment of snoring severity, patients' assessment of side effects, and overall satisfaction.

Does nasal nitric oxide come from the sinuses?

Objective: The purpose of this study was to assess nitric oxide (NO) output by the nose and sinuses.

Method: In one volunteer, the osteomeatal complex and sphenoethmoidal recess were occluded to isolate the nose from the sinuses. The antrum and frontal sinus were each punctured by two catheters and irrigated with air at constant flow.