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Air trapping because of chronic obstructive pulmonary disease (COPD) leads to a reduction in inspiratory capacity/total lung capacity (IC/TLC) ratio. We hypothesize that COPD patients with a low IC/TLC ratio suffer more frequent COPD exacerbations.Retrospective cohort study of patients with COPD, aged 30 years or older with forced expiratory volume in 1 second70% predicted and forced expiratory volume in 1 second/forced expiratory volume (FEV1/FVC) ratio70% treated in our ambulatory care clinic for 3 years (2003-2006). Patients were divided in 2 groups, either IC/TLC ratio less than or greater than 25%.Charts of 350 patients with COPD were reviewed. Of the 77 patients who met inclusion criteria, 28 patients (20 women and 8 men) had IC/TLC ratio25% (low group) and 49 patients (25 women and 24 men) had IC/TLC ratio25% (high group). Average number of exacerbations per person in the low group was 3.5 (0-10), significantly higher than in the high group, which was 2.2 (0-10; P = 0.01). Visits for COPD exacerbations were analyzed based on treatment site namely, office, emergency room (ER), and hospital. The per person office visits were 1.96 (0-10) in the low group and 0.80 (0-3) in the high group (P = 0.002). ER visits were similar, 0.57 (0-3) in the low group and 0.38 (0-3) in the high group (P = 0.15), as were hospital visits, 0.96 (0-8) in the low group and 1.06 (0-5) in the high group (P = 0.81).COPD patients in the low group experienced significantly more unscheduled office visits because of exacerbations, suggesting they need early identification and closely monitored therapy.

Background and Objectives Cocaine inhalation has been linked to the development of pneumomediastinum. The aim of this review was to identify the clinical course and outcome of spontaneous pneumomediastinum caused by cocaine use. Material and Methods We performed a literature search in English language using PubMed. We included all case reports and case series of spontaneous pneumomediastinum caused by cocaine use. Twenty-three case reports and 7 case series describing 40 patients were identified. In addition, 2 young adults who were admitted to our teaching hospital with cocaine- induced pneumomediastinum were included in this review. Results Among 42 patients, 93% were presented with chest pain and 64% had subcutaneous emphysema. Symptoms subsided after a median of 24 hours, and radiological abnormalities abated after 2 to 30 days, with a median of 4.5 days. Pneumothorax was present in 19% of patients, and only 1 required chest tube placement. Patients were discharged with full recovery after 1 to 6 days, with a median of 2 days. Conclusions Cocaine-induced pneumomediastinum is a benign condition. A short observation period with outpatient follow-up is appropriate in the majority of patients. Invasive procedures have a low yield and should be based on a high degree of clinical suspicion for esophageal rupture or bronchial tree laceration.

This case report describes a 49 year old woman with an intra-parenchymal bronchogenic cyst masked on chest x-ray examination by a pleural effusion. The cyst was intact. It is likely that the cyst provoked the pleural effusion by repetitive mechanical irritation of the pleura. At surgery, the cyst was removed and the pleural effusion drained without recurrence. The cyst was unilocular and measured 8.5 x 7.0 x 0.8 cm with a smooth and glistening lining. It was filled with approximately 300 ml of clear fluid. Microscopic examination confirmed the bronchogenic cyst. This is the first case of an intact intra-parenchymal bronchogenic cyst associated with a pleural effusion that was not due to rupture of the cyst, infection or malignancy.

This case report describes a 49 year old woman with an intra-parenchymal bronchogenic cyst masked on chest x-ray examination by a pleural effusion. The cyst was intact. It is likely that the cyst provoked the pleural effusion by repetitive mechanical irritation of the pleura. At surgery, the cyst was removed and the pleural effusion drained without recurrence. The cyst was unilocular and measured 8.5 x 7.0 x 0.8 cm with a smooth and glistening lining. It was filled with approximately 300 ml of clear fluid. Microscopic examination confirmed the bronchogenic cyst. This is the first case of an intact intra-parenchymal bronchogenic cyst associated with a pleural effusion that was not due to rupture of the cyst, infection or malignancy.