Introduction Duchenne muscular dystrophy (DMD) results in progressive loss of respiratory muscle ... more Introduction Duchenne muscular dystrophy (DMD) results in progressive loss of respiratory muscle strength and death from respiratory insufficiency. A therapy to avoid these respiratory complications in these patients is noninvasive positive pressure ventilation (NIPPV). Spontaneous pneumothorax is the presence of air in the pleural space in the absence of thoracic trauma and it has been rarely reported among patients on chronic, intermittent NIPPV with and without DMD. Purpose To discuss the clinical presentation and management of recurrent spontaneous pneumothorax associated with NIPPV in patients with DMD and the indications and use of NIPPV in these patients by presentation of a case. Case Report A 31-year-old man with a medical history of DMD, chronic respiratory failure on NIPPV at nighttime, and allergic rhinitis presented with an apical left pneumothorax by routine chest x-ray for follow-up visits to the Pulmonary Medicine Clinic for three separate episodes over a 12-week period. He had a right pneumothorax previously 8 years before this period. During multiple hospitalizations for pneumothorax management, he received supplemental oxygen therapy, thoracostomy tube placement for percutaneous aspiration, and doxycycline pleurodesis, resulting in lung reexpansion. On the last hospitalization the patient refused further management after being thoroughly oriented. Discussion Patients with DMD have increased risk for sleep-disordered breathing. Long-term NIPPV is effective for improving the quality of life and survival of neuromuscular disease patients, especially with DMD. Serial evaluation and adjustment of NIPPV are necessary because patients' requirements change with time. Conclusion Since chronic NIPPV is widely used, patients and caregivers must be aware of the occurrence of spontaneous pneumothorax as a complication of NIPPV in DMD.
Major changes in the incidence of the most common histological types of lung and bronchus cancer ... more Major changes in the incidence of the most common histological types of lung and bronchus cancer have been observed around the world. herein we report the overall incidence, stage at diagnosis and overall mortality of lung and bronchus cancer in Puerto rico, and the incidence of the different histologic types. Methods: aggregate lung and bronchus cancer data from 1987 to 2003 were obtained from the Puerto rico central cancer registry. incidence and mortality rates were age-standardized by the direct method to the 2000 standard population of the united states. for the incidence (overall, by histologic type, and by sex), and mortality we calculated the annual percent change (aPc) using the Joinpoint regression Program. results: there were 9,886 cases of lung and bronchus cancer (6,772 men, 3,114 women), for an overall age-adjusted incidence of 18.8 per 100,000. the incidence decreased significantly for the whole group, falling from 18.9 per 100,000 in 1987 to 17.1 in 2003 (aPc:-0.74, p<0.05); for men, incidence decreased from 28.1 per 100,000 to 24.4 (aPc:-1.02, p<0.05) over the same period of time. the mortality rate has decreased overall (aPc:-0.62, p<0.05) and in men (aPc:-0.71, p<0.05). squamous cell carcinoma was the most common histologic type in 1987, but it decreased from 6.2 per 100,000 in 1987 to 3.5 in 2003 (aPc:-3.86, p<0.05), while adenocarcinoma increased from 3.7 per 100,000 to 4.6 (aPc: +1.51, p<0.05). conclusion: in Puerto rico, over the period of 1987 to 2003, squamous cell carcinoma of the lung and bronchus decreased, while adenocarcinoma increased. as of 1999, the most common type of lung and bronchus cancer is adenocarcinoma. Both the incidence and the mortality of lung and bronchus cancer decreased for men but not for women. [
Major changes in the incidence of the most common histological types of lung and bronchus cancer ... more Major changes in the incidence of the most common histological types of lung and bronchus cancer have been observed around the world. Herein we report the overall incidence, stage at diagnosis and overall mortality of lung and bronchus cancer in Puerto Rico, and the incidence of the different histologic types. Aggregate lung and bronchus cancer data from 1987 to 2003 were obtained from the Puerto Rico Central Cancer Registry. Incidence and mortality rates were age-standardized by the direct method to the 2000 standard population of the United States. For the incidence (overall, by histologic type, and by sex), and mortality we calculated the annual percent change (APC) using the Joinpoint Regression Program. There were 9,886 cases of lung and bronchus cancer (6,772 men, 3,114 women), for an overall age-adjusted incidence of 18.8 per 100,000. The incidence decreased significantly for the whole group, falling from 18.9 per 100,000 in 1987 to 17.1 in 2003 (APC: -0.74, p < 0.05); for...
Introduction Duchenne muscular dystrophy (DMD) results in progressive loss of respiratory muscle ... more Introduction Duchenne muscular dystrophy (DMD) results in progressive loss of respiratory muscle strength and death from respiratory insufficiency. A therapy to avoid these respiratory complications in these patients is noninvasive positive pressure ventilation (NIPPV). Spontaneous pneumothorax is the presence of air in the pleural space in the absence of thoracic trauma and it has been rarely reported among patients on chronic, intermittent NIPPV with and without DMD. Purpose To discuss the clinical presentation and management of recurrent spontaneous pneumothorax associated with NIPPV in patients with DMD and the indications and use of NIPPV in these patients by presentation of a case. Case Report A 31-year-old man with a medical history of DMD, chronic respiratory failure on NIPPV at nighttime, and allergic rhinitis presented with an apical left pneumothorax by routine chest x-ray for follow-up visits to the Pulmonary Medicine Clinic for three separate episodes over a 12-week period. He had a right pneumothorax previously 8 years before this period. During multiple hospitalizations for pneumothorax management, he received supplemental oxygen therapy, thoracostomy tube placement for percutaneous aspiration, and doxycycline pleurodesis, resulting in lung reexpansion. On the last hospitalization the patient refused further management after being thoroughly oriented. Discussion Patients with DMD have increased risk for sleep-disordered breathing. Long-term NIPPV is effective for improving the quality of life and survival of neuromuscular disease patients, especially with DMD. Serial evaluation and adjustment of NIPPV are necessary because patients' requirements change with time. Conclusion Since chronic NIPPV is widely used, patients and caregivers must be aware of the occurrence of spontaneous pneumothorax as a complication of NIPPV in DMD.
Major changes in the incidence of the most common histological types of lung and bronchus cancer ... more Major changes in the incidence of the most common histological types of lung and bronchus cancer have been observed around the world. herein we report the overall incidence, stage at diagnosis and overall mortality of lung and bronchus cancer in Puerto rico, and the incidence of the different histologic types. Methods: aggregate lung and bronchus cancer data from 1987 to 2003 were obtained from the Puerto rico central cancer registry. incidence and mortality rates were age-standardized by the direct method to the 2000 standard population of the united states. for the incidence (overall, by histologic type, and by sex), and mortality we calculated the annual percent change (aPc) using the Joinpoint regression Program. results: there were 9,886 cases of lung and bronchus cancer (6,772 men, 3,114 women), for an overall age-adjusted incidence of 18.8 per 100,000. the incidence decreased significantly for the whole group, falling from 18.9 per 100,000 in 1987 to 17.1 in 2003 (aPc:-0.74, p<0.05); for men, incidence decreased from 28.1 per 100,000 to 24.4 (aPc:-1.02, p<0.05) over the same period of time. the mortality rate has decreased overall (aPc:-0.62, p<0.05) and in men (aPc:-0.71, p<0.05). squamous cell carcinoma was the most common histologic type in 1987, but it decreased from 6.2 per 100,000 in 1987 to 3.5 in 2003 (aPc:-3.86, p<0.05), while adenocarcinoma increased from 3.7 per 100,000 to 4.6 (aPc: +1.51, p<0.05). conclusion: in Puerto rico, over the period of 1987 to 2003, squamous cell carcinoma of the lung and bronchus decreased, while adenocarcinoma increased. as of 1999, the most common type of lung and bronchus cancer is adenocarcinoma. Both the incidence and the mortality of lung and bronchus cancer decreased for men but not for women. [
Major changes in the incidence of the most common histological types of lung and bronchus cancer ... more Major changes in the incidence of the most common histological types of lung and bronchus cancer have been observed around the world. Herein we report the overall incidence, stage at diagnosis and overall mortality of lung and bronchus cancer in Puerto Rico, and the incidence of the different histologic types. Aggregate lung and bronchus cancer data from 1987 to 2003 were obtained from the Puerto Rico Central Cancer Registry. Incidence and mortality rates were age-standardized by the direct method to the 2000 standard population of the United States. For the incidence (overall, by histologic type, and by sex), and mortality we calculated the annual percent change (APC) using the Joinpoint Regression Program. There were 9,886 cases of lung and bronchus cancer (6,772 men, 3,114 women), for an overall age-adjusted incidence of 18.8 per 100,000. The incidence decreased significantly for the whole group, falling from 18.9 per 100,000 in 1987 to 17.1 in 2003 (APC: -0.74, p < 0.05); for...
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