Respiratory Medicine CME RSS feed: Current Issue. Respiratory Medicine CME publishes articles relevant to the continuing medical and professional development of researchers and practitioners with an interest in adult and paediatric medicine, epidemiology, immunology and cell biology, physiology, occupational disorders, and the role of allergens and pollutants. Respiratory Medicine CME publishes commissioned CME related articles and Case Reports . The journal is published online only on a quarterly basis. Access the journal online at http://www.resmedcme.com/ Click here to take a CME test . Respiratory Medicine CME tests are accredited by The European Board for Accreditation in Pneumology (EBAP).http://www.resmedcme.com/?rss=yesElsevier Inc.en © 2009 Elsevier Ltd. All rights reserved. Respiratory Medicine CME1755-0017242009 © 2009 Elsevier Ltd. All rights reserved. healthpermissions@elsevier.comhttp://www.resmedcme.com/article/PIIS1755001709000840/abstract?rss=yesAbstract: Because of the low sensitivity of sputum smears and the delay in cultures (2–4 weeks for a result), a variety of new technologies have been developed for the more rapid and sensitive detection of PTB. This article address the new diagnostic techniques for Tuberculosis. These techniques help in early daignosis of tuberculosis.Newer diagnostic techniques for tuberculosisNazish Fatima10.1016/j.rmedc.2009.09.015Respiratory Medicine CME 2, 4 (2009)Respiratory Medicine CME24S1755-0017(09)X0005-9151154http://www.resmedcme.com/article/PIIS1755001709000839/abstract?rss=yesAbstract: The last 30 years, high frequency ventilation (HFV) has found its way from the neonatal to the paediatric and adult ICU. With its small tidal volumes, strict intrathoracic pressure variations and disengagement of ventilation from oxygenation, HFV fits in our insights nowadays in lung protective ventilation. This review provides you with an understanding of the different modes of HFV, gas exchange mechanisms during HFV which uses tidal volumes below dead space volume, and some information on nursing and weaning a child on HFV. Focus will be on the clinical use of high frequency oscillatory ventilation with a practical overview of the strategies used: the high-volume strategy designed to rapidly recruit and maintain optimal lung volume in diffuse alveolar disease and lung haemorrhage, the low volume strategy in airleak, and the open airway strategy in small airway disease where the continuous distending pressure is used to recruit and stent the airways.High frequency oscillatory ventilation in children: an overviewE.L.IM. Duval, D.G. Markhorst, A.J. van Vught10.1016/j.rmedc.2009.09.014Respiratory Medicine CME 2, 4 (2009)Respiratory Medicine CME24S1755-0017(09)X0005-9155161http://www.resmedcme.com/article/PIIS1755001709000177/abstract?rss=yesAbstract: Congenital lobar emphysema (CLE) is classically a disease of infants, in which pneumothorax is a rare complication. We present a 14-year-old girl with a spontaneous pneumothorax, which persisted on thorax drainage and was caused by a newly diagnosed CLE.Congenital lobar emphysema in a teenager presented by a persisting pneumothoraxJ.M. Douwes, R.F.H.M. Tummers, A.G. Hensens, M. Wagenaar, B.J. Thio10.1016/j.rmedc.2009.01.015Respiratory Medicine CME 2, 4 (2009)Respiratory Medicine CME24S1755-0017(09)X0005-9162163http://www.resmedcme.com/article/PIIS175500170900013X/abstract?rss=yesAbstract: Tracheobronchomegaly (TBM) (Mounier–Kuhn syndrome) is dilatation of the trachea and major bronchi because of atrophy or absence of elastic fibers and smooth muscle cells. We present a case of TBM with refractory lower respiratory infection and haemoptysis.The patient was a 53-year-old man with recurrent haemoptysis and without fever, wheezes, chest pain, weight loss or any respiratory disease. Chest helical computed tomography (CT) scan showed tracheomegaly with transversal diameters of the trachea of 50mm. A bronchoscopy was performed and revealed markedly enlarged airways and traces of bleeding arising from the right airways. The haemoptysis was stopped only after bronchial artery embolization.Mounier–Kuhn syndrome: A rare cause of bronchial dilatation: A case reportA. Abdelghani, H. Bouazra, A. Hayouni, S. Slama, A. Garrouche, S. Mezghani, N. Klabi, M. Benzarti10.1016/j.rmedc.2009.01.007Respiratory Medicine CME 2, 4 (2009)Respiratory Medicine CME24S1755-0017(09)X0005-9164166http://www.resmedcme.com/article/PIIS1755001709000128/abstract?rss=yesAbstract: Here we report an interesting case of airway obstruction secondary to blood clot formation after an episode of massive hemoptysis in a pregnant lady and removal of clot with rigid bronchoscopy after an attempt of faliure with flexible bronchoscopy with review of literature.A case of an airway obstruction secondary to blood clot formation after an episode of massive hemoptysis in a smear positive pulmonary tuberculosis pregnant ladySameer Singhal, S.N. Mahajan, S.K. Diwan10.1016/j.rmedc.2009.01.006Respiratory Medicine CME 2, 4 (2009)Respiratory Medicine CME24S1755-0017(09)X0005-9167169http://www.resmedcme.com/article/PIIS1755001709000116/abstract?rss=yesAbstract: Negative pressure pulmonary edema is a well-described complication of acute upper airway obstruction. It occurs as a result of a markedly negative intrathoracic pressure generated by forced inspiration against a closed glottis, leading to extravasation of fluid into the alveolar spaces. Capillary blood-gas barrier stress failure may ensue resulting in alveolar hemorrhage. We report a case of negative pressure pulmonary hemorrhage secondary to partial strangulation. The patient's symptoms rapidly abated within 48h with supportive therapy.Negative pressure pulmonary hemorrhageKhalil Diab, Aliya Noor10.1016/j.rmedc.2009.01.018Respiratory Medicine CME 2, 4 (2009)Respiratory Medicine CME24S1755-0017(09)X0005-9170172http://www.resmedcme.com/article/PIIS1755001709000104/abstract?rss=yesAbstract: We report the successful use of high-frequency oscillatory ventilation without recruitment maneuvers in a patient with ARDS and severe hypoxemia who developed a pneumomediastinum during conventional mechanical ventilation. High-frequency ventilation is an attractive modality for the treatment of pneumomediastinum, especially when the airway pressures cannot be reduced by variation in the settings of the conventional mechanical ventilator.Successful use of high-frequency oscillator ventilation for acute respiratory distress syndrome with pneumomediastinumAdriano R. Tonelli, Orlando I. Ruiz-Rodriguez, Edgar J. Jimenez10.1016/j.rmedc.2009.01.011Respiratory Medicine CME 2, 4 (2009)Respiratory Medicine CME24S1755-0017(09)X0005-9173175http://www.resmedcme.com/article/PIIS1755001709000098/abstract?rss=yesAbstract: Rituximab, a chimeric anti-CD20 IgG1 monoclonal antibody, is an effective treatment for haematological autoimmune diseases such as idiopathic thrombocytopenic purpura (ITP). A 72-year-old man was diagnosed with idiopathic thrombocytopenic purpura (ITP). After receiving 4 cycles of rituximab in one month complete response was achieved. However, three weeks after the last infusion he presented to the haematology department with fever, productive cough and dyspnea and severe hypoxemia. HRCT of the thorax revealed patchy areas of ground glass opacities throughout both lungs and small peripheral consolidations were seen. Transbronchial biopsy showed interstitial thickening and type II pneumocyte activation with interstitial pneumonia. Bronchoalveolar lavage showed increased eosinophils. The patient was treated with three pulses of 1 gr iv methylprednisolone and then gradually switched to 15mg of prednisolone for 3 months. The dyspnea and tachypnea gradually improved, in addition to blood oxygenation and a follow up HRCT 3 months later showed a significant resolution of lesions.Severe lung toxicity like acute respiratory distress syndrome, cryptogenic organizing pneumonia, pneumonitis, and interstitial lung disease are very rare, with most of the knowledge coming from case reports. Rituximab-induced interstitial lung disease (R-ILD) is a rare complication. To the best of our knowledge, 23 cases of R-ILD have been reported in the literature; 22 of them were treated with R-CHOP for NHL and only one was receiving rituximab for ITP. We report the second case to develop this complication for a non-malignant disorder.Rituximab-induced nonspecific interstitial pneumonia like reaction in a patient with idiopathic thrombocytopenic purpuraCharalambos Protopapadakis, Katerina M. Antoniou, Argiro Voloudaki, Katerina Samara, Athanasia Proklou, Giorgos Margaritopoulos, Nikolaos M. Siafakas10.1016/j.rmedc.2009.01.010Respiratory Medicine CME 2, 4 (2009)Respiratory Medicine CME24S1755-0017(09)X0005-9176178http://www.resmedcme.com/article/PIIS1755001709000086/abstract?rss=yesAbstract: Urinothorax is a rare cause of pleural effusion, and is typically the result of either obstructive uropathy or injury to the kidney or urinary tract. We report a case of a man who developed a right-sided urinothorax following percutaneous nephrolithotomy, and briefly discuss the pathophysiology, diagnosis, and management of this uncommon problem.Urinothorax: An uncommon cause of pleural effusionBenjamin Wei, Hiroo Takayama, Matthew D. Bacchetta10.1016/j.rmedc.2009.01.009Respiratory Medicine CME 2, 4 (2009)Respiratory Medicine CME24S1755-0017(09)X0005-9179180http://www.resmedcme.com/article/PIIS1755001709000074/abstract?rss=yesAbstract: Like sirolimus, everolimus is an inhibitor of mTOR (mammalian target of rapamycin), used as an immunosuppressant in solid organ transplantation and as an antineoplastic agent. Its usage increases. Many cases of sirolimus-induced hypersensitivity pneumonitis were reported. To our knowledge only four cases of everolimus-associated interstitial pneumonitis have been reported in transplant recipients, three in heart and the other in kidney transplantation, with a favourable outcome after discontinuation. We report herein three cases of hypersensitivity pneumonitis due to everolimus.Everolimus associated interstitial pneumonitis: 3 Case reportsG. Bouvier, L. Cellerin, B. Henry, P. Germaud, M. Hourmant, C. Sagan, A. Magnan10.1016/j.rmedc.2009.01.008Respiratory Medicine CME 2, 4 (2009)Respiratory Medicine CME24S1755-0017(09)X0005-9181184http://www.resmedcme.com/article/PIIS1755001709000049/abstract?rss=yesAbstract: Multidrug-resistant tuberculosis has been a serious medical and epidemic problem all over the world. Management of patients suffering from multidrug-resistant tuberculosis is complicated and therapy is successful in 60–70% of cases only. Therapeutic strategies recommend the application of standardized or an individual treatment regimen based on the results of susceptibility drug tests for second-line antituberculous drugs. The case study describes treatment for multidrug-resistant tuberculosis with individual drug regimen adjusted according to the results of susceptibility tests. Although smear and culture negativity was reached, course of disease was changed in the seventh year of the individual regimen, the disease progressed and the patient died.Situation of multidrug-resistant tuberculosis in the Czech Republic, unusual case studyVaclava Bartu, Emilie Kopecka10.1016/j.rmedc.2009.01.003Respiratory Medicine CME 2, 4 (2009)Respiratory Medicine CME24S1755-0017(09)X0005-9185188http://www.resmedcme.com/article/PIIS1755001708001139/abstract?rss=yesSummary: A 79-year-old woman was admitted after a fall at home. Crepitations were detected on palpation of the chest, neck, and face. A chest X-ray film and Computed tomography revealed massive subcutaneous emphysema and pneumomediastinum. Very rarely, as in the present case, rib fracture results in laceration of the pleura, causing subcutaneous emphysema.Minor trauma resulting in massive subcutaneous emphysema and pneumomediastinumGideon Berger, Oren Fruchter10.1016/j.rmedc.2008.12.009Respiratory Medicine CME 2, 4 (2009)Respiratory Medicine CME24S1755-0017(09)X0005-9189190http://www.resmedcme.com/article/PIIS1755001708001115/abstract?rss=yesSummary: Background: Endobronchial metastasis from an extrapulmonary malignancy is relatively rare. There have been no previous reports of airway stenting to salvage right upper lobe airway patency.Case report: This report describes a 76-year-old male who suffered from a huge endobronchial tumor with a history of renal cell carcinoma (RCC). The endobronchial tumor was thought to have invaded the right main bronchus from a metastasis of the lung parenchyma and the tumor was estimated to have considerable vascularity by contrast enhanced computed tomography. The patient underwent external irradiation, endobronchial tumor reduction with a flexible bronchoscope, transcatheter bronchial arterial embolization and then a successful endobronchial tumor resection by rigid bronchoscopy. The endobronchial tumor resection was mainly achieved using an electrosurgical snare. Furthermore, a Y-shaped Dumon stent was implanted at the bifurcation of the right upper lobe bronchus and bronchus intermedius for the management of complete right airway patency.Conclusions: The tumor was successfully resected using a multidisciplinary approach and a novel method of silicone stent placement using the usual rigid bronchoscopic technique was employed to maintain complete right airway patency.Management of right upper airway patency by a silicon stent in a case of endobronchial metastasisRan Shioi, Masanori Yasuo, Atsuhito Ushiki, Tsuyoshi Tanabe, Kenji Tsushima, Masayuki Hanaoka, Keishi Kubo, Hideaki Moteki, Yutaka Takumi, Satoshi Kawakami, Masahiro Kurozumi, Yoshiki Hirose10.1016/j.rmedc.2008.12.002Respiratory Medicine CME 2, 4 (2009)Respiratory Medicine CME24S1755-0017(09)X0005-9191196http://www.resmedcme.com/article/PIIS1755001708001103/abstract?rss=yesSummary: Peritoneal dialysis is a rare cause of pleural effusion. It appears, as a complication of continuous ambulatory peritoneal dialysis (CAPD), in approximately 2% of all CAPD patients.We describe three patients with pleural effusions secondary to CAPD. Because of the late onset of pleural effusion and pulmonary symptoms, i.e. months after CAPD treatment was initiated, the pleural effusion was not directly regarded as a complication of CAPD.After thoracocentesis with biochemical analysis of crystal clear pleural fluid and in two patients Tc-99 peritoneal scintigraphy/contrast enhanced CT-scanning, which demonstrated pleuroperitoneal communication, we concluded that pleural effusion was secondary to CAPD in these three subjects.All patients were treated with hemodialysis after cessation of CAPD and because two of them wanted to continue with CAPD, video-assisted thoracoscopic surgery with talc poudrage (chemical pleurodesis) was performed in order to prevent recurrence.Pleural effusions secondary to CAPD is not a frequent complication of CAPD though a very important one because CAPD must be stopped if it appears. Diagnostic thoracentesis (high glucose concentration) may be the simplest way to make a diagnosis but a contrast enhanced CT-scanning is essential for diagnosis of bigger diaphragmatic defects.Peritoneal dialysis – An unusual cause of pleural effusion (“sweet hydrothorax”)I. Krivokuca, J.-W.J. Lammers, J. Kluin10.1016/j.rmedc.2008.12.001Respiratory Medicine CME 2, 4 (2009)Respiratory Medicine CME24S1755-0017(09)X0005-9197200