Post-cardiac injury syndrome following dual-chamber pacemaker placement.

Post-cardiac injury syndrome (PCIS) is a well-established immune-mediated condition after cardiac injury, including myocardial infarction, direct chest trauma, or cardiac surgery. It commonly presents with unexplained fever and pericarditis, with or without recurrent pleural effusions. Here we present a case of PCIS that occurred after placement of a dual-chamber pacemaker.

An unusual presentation of pulmonary epitheloid hemangioendothelioma.

Pulmonary epitheloid hemangioendothelioma (PEHE) is a rare, often incidentally diagnosed, endothelial tumor of the lung. We present a case of a young adult who presented with acute hypoxemic respiratory failure and severe pulmonary hypertension with subsequent imaging and tissue biopsy confirming a diagnosis of PEHE. We briefly highlight the unique clinical, radiographic and histopathologic aspects of this rare disease.

Contractile fatigue of the quadriceps muscle predicts improvement in exercise performance after pulmonary rehabilitation.

Rationale: We hypothesized that among patients with chronic obstructive pulmonary disease, those who develop quadriceps contractile fatigue (QCF) after exhaustive submaximal cycle exercise would have a greater response to exercise training than those who do not develop QCF (NQCF).

Methods: Patients (N = 132) had measurement of QCF at baseline. Six-minute walk distance (6 MWD), maximal incremental cycle exercise testing, and quality of life measured by the Chronic Respiratory Questionnaire were obtained before and after pulmonary rehabilitation (PR).

Exercise capacity in hamsters with elastase-induced emphysema compared to normal controls.

The purpose of this study was to determine whether hamsters with elastase-induced emphysema (EMP) would demonstrate a reduction in exercise capacity compared to control (CON) hamsters and whether changes in activity levels, muscle function and structure could explain any changes in exercise capacity. Peak oxygen consumption and daily activity levels were measured on two occasions. Inspiratory capacity under deep anesthesia, in vitro measurements of muscle force and fatigability for the diaphragm (DIA) and extensor digitorum longus (EDL) and fiber proportions, muscle cross-sectional area and fiber specific SDH activity from the DIA, EDL and vastus lateralis (VLA) were obtained.

Community acquired pneumonia: risk factors associated with mortality in a tertiary care hospitalized patients.

Objective: To evaluate risk factors associated with mortality in patients hospitalized with CommunityAcquired Pneumonia (CAP) from a developing country.

Methods: An observational study was conducted on adult patients admitted with a diagnosis of CAP from January 2002 to August 2003 at Aga Khan University hospital, Karachi, Pakistan. Clinical records were reviewed for demographic characteristics, clinical and laboratory features, hospital course, and risk factors associated with mortality.

Hypoxemia in patients on chronic opiate therapy with and without sleep apnea.

Objective: Animal models have shown a quantal slowing of respiratory pattern when exposed to opioid agonist, in a pattern similar to that observed in central sleep apnea. We postulated that opioid-induced hypoventilation is more likely to be associated with sleep apnea rather than hypoventilation alone. Since we did not have a direct measure of hypoventilation we used hypoxemia as an indirect measure reasoning that significant hypoventilation would not occur in the absence of hypoxemia.

Central sleep apnea induced by acute ingestion of opioids.

Objectives: Three cases are presented in which patients were using opioids as required for nonmalignant pain management and significant central sleep apnea developed. Patients in the first two cases had no evidence of sleep-related breathing disorders on polysomnography until they ingested an opioid for treatment of chronic pain during the night and severe central sleep apnea developed. The patient in our third case had established obstructive sleep apnea but experienced a significant number of central events after the ingestion of an opioid analgesic, leading to worsening severity of his underlying sleep-related breathing disorder.