Skeletal muscle dysfunction in chronic obstructive pulmonary disease

It has become increasingly recognized that skeletal muscle dysfunction is common in patients with chronic obstructive pulmonary disease (COPD). Muscle strength and endurance are decreased, whereas muscle fatigability is increased. There is a reduced proportion of type I fibers and an increase in type II fibers. Muscle atrophy occurs with a reduction in fiber cross-sectional area. Oxidative enzyme activity is decreased, and measurement of muscle bioenergetics during exercise reveals a reduced aerobic capacity. Deconditioning is probably very important mechanistically. Other mechanisms that may be of varying importance in individual patients include chronic hypercapnia and/or hypoxia, nutritional depletion, steroid usage, and oxidative stress. Potential therapies include exercise training, oxygen supplementation, nutritional repletion, and administration of anabolic hormones

Corynebacterium macginleyi: A cause of ventilator associated pneumonia in an immunocompromised patient

Purpose and Importance: Corynebacterium macginleyi, a lipophilic diphtheroid from the genus Corynebacteria, is a known cause of conjunctivitis. It was recently reported as a cause of serious infections in immunocompromised individuals. It has never been reported as a cause of ventilator-associated pneumonia, that which carries a high burden and risk of mortality. Our report intends to increase awareness of a potentially lethal nosocomial bacterial infection. Observations: This case reports on a 73 year old lady with metastatic lung adenocarcinoma on chemotherapy, who was hospitalized for dyspnea and diffuse pulmonary infiltrates in 2011. Trans-bronchial biopsies revealed cryptogenic organizing pneumonia. The patient improved with steroids. Failure to wean ensued with a bronchopleural fistula, increase in secretions, oxygen requirements, and appearance of new infiltrates. Two mini-BAL cultures yielded gram positive pleomorphic rods with palisade arrangement, diagnosed as C. macginleyi. Vancomycin therapy was initiated. She improved and was successfully extubated. Conclusion and relevance: Non-diphtheria Corynebacteria usually form normal flora. If isolated, they are often dismissed as contaminants. C. macginleyi has emerged as a life-threatening nosocomial infection. Prompt identification and treatment are required. It is resistant to quinolones. Thus far, vancomycin is the preferred treatment

Endobronchial hamartoma; a rare structural cause of chronic cough

Pulmonary hamartomas are rare benign tumors consisting of multiple mesenchymal cell lines like cartilage, bone and fat. We discuss an interesting case of a 53-year-old male patient, who was referred to our clinic for persistent cough. Chest X-ray revealed a left suprahilar density associated with plate like atelectasis, which on chest CT was found to be a densely calcified nodule, causing narrowing of the left upper lobe (LUL) bronchus with calcified bilateral hilar lymph nodes. A bronchoscopy revealed a smooth endobronchial mass with calcification, which was removed. Histopathology revealed pulmonary hamartoma

Endobronchial lipoma causing progressive dyspnea

We describe a 63-year-old male who presented with progressive exertional dyspnea, post-obstructive pneumonia and chest CT findings of an endobronchial lesion. Bronchoscopy revealed an endobronchial lipoma, which was resected using snare electrocautery. Complete resolution of the patient's symptoms was noted following bronchoscopic resection