By Stephen Chapman, Grace Robinson, John Stradling, Sophie West
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Extra resources for Oxford Handbook of Respiratory Medicine, 2nd edition (Oxford Handbooks Series)
Consider plasma exchange and IV immunoglobulin. 62 Causes Normal physiological changes of pregnancy • Elevated serum progesterone levels stimulate respiratory drive and lead to an increased tidal volume and raised minute ventilation, with only a modest increase in oxygen consumption. The subsequent fall in maternal pCO2 facilitates fetal CO2 transfer across the placenta; any cause of maternal hypercapnia leads quickly to fetal respiratory acidosis. Respiratory rate is unaffected by pregnancy. Elevation of the diaphragm occurs due to the enlarging uterus, leading to a reduced functional residual capacity, although diaphragm function is normal and vital capacity is unaffected.
CT chest is useful in looking for evidence of respiratory disease in patients with symptoms but a normal CXR, and may be helpful in directing invasive diagnostic procedures. CT is also of benefit in the diagnosis and staging of Kaposi's sarcoma and lymphoma. Immune reconstitution inflammatory syndrome (IRIS) [immune restoration disease (IRD) or paradoxical reaction] is a fairly poorly defined clinical syndrome resulting from restored immunity to infectious or non-infectious antigens, following the introduction of HAART.
G. g. g. g. repeat BAL or lung biopsy); diffuse alveolar damage or interstitial pneumonitis on biopsy; mortality >70% • Engraftment syndrome comprises fever, ARDS, and erythematosus rash during marrow recovery post-HSCT • Chronic airflow obstruction (bronchiolitis obliterans) following allogeneic HSCT (from non-identical sibling or unrelated individual; occurs only extremely rarely following autologous procedure); typically associated with chronic graft-versus-host disease (GVHD); gradual onset dry cough, dyspnoea, wheeze, obstructive spirometry; CXR often normal; air-trapping and bronchial dilatation on HRCT; TBB low sensitivity; may be complicated by Aspergillus infection; variable course • Post-transplant lymphoproliferative disease most common following lung transplant (p 317); may also follow other solid organ or allogeneic HSC transplant • Pulmonary alveolar proteinosis (p 630) • Pulmonary veno-occlusive disease • Pulmonary metastatic calcification may complicate chronic renal failure and rarely progress after transplantation; usually asymptomatic, rarely causes restrictive ventilatory defect; CXR shows single or multiple nodules or patches of consolidation, may not appear calcified; CT typically diagnostic, although biopsy occasionally needed • Right hemidiaphragm dysfunction is common after liver transplant, and usually not relevant clinically.
Oxford Handbook of Respiratory Medicine, 2nd edition (Oxford Handbooks Series) by Stephen Chapman, Grace Robinson, John Stradling, Sophie West