Glutaraldehyde is commonly used in endoscopy labs to clean and disinfect instruments. It can cause direct irritation of the skin and the upper and lower airways. Health care workers are also at risk for the development of irritant-induced or sensitizer-induced occupational asthma when exposed to this chemical. Herein, we report on a patient who had frequent exposures to glutaraldehyde over one year while working in an endoscopy lab and developed chronic upper and lower respiratory tract symptoms. Multiple spirometric tests during her evaluation revealed variable results including restrictive pattern with a response to bronchodilators, obstructive pattern with a paradoxic bronchoconstrictive response to bronchodilators, and obstructive pattern with a partial response to bronchodilators. These results indicate that the distribution of inflammation and bronchial responsiveness can vary in a single patient with glutaraldehyde-induced occupational asthma. Therefore, the evaluation may be more difficult than might be expected in patients with occupational asthma, and some patients will need multiple pulmonary function tests to characterize their airway disease.

Background: Electromagnetic navigational bronchoscopy (ENB) is a tool used to help

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CaseThis patient presented to the emergency center with two days of fever, dyspnea, and productive cough. His chest radiographs and computed tomography scans showed significant abnormalities in the right thorax (Figures 1 and 2). He recalled having some type of surgery in Mexico as a child for tuberculosis. Since this surgery, he has lived a productive life and denied chronic respiratory limitations. He denied recurrent tuberculosis. The patient was admitted to the hospital; he decompensated and required intubation with mechanical ventilation. Bronchoscopy was performed to evaluate his right lung. The RUL orifice was noted, but the bronchoscope was unable to be passed into it. The RML bronchus was open but severely constricted. The bronchoscope was unable to be passed into this bronchus as well. The RLL

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Background: Indwelling pleural catheters (IPC) have been used increasingly in patients with recurrent pleural effusions. However, data about mortality after IPC use are limited. Objectives: We sought to determine the natural history following IPC placement in Lubbock, Texas, in terms of life expectancy and pleurodesis rates in patients with both malignant and benign effusions. Methods: A retrospective review of patients who had IPC insertion from March 2014 through December 2016 at University Medical Center in Lubbock, Texas, was performed. Patients 18 years and older who had IPC placement for recurrent pleural effusions were included. The duration of IPC placement, the type of pleural effusion, the volume of fluid, pleurodesis, complications, and mortality after IPC placement were retrieved from electronic medical records. Results: There were 45 patients included in the study; 20 patients (44%) were male, and 25 patients (56%) were female. The mean age was 63.5 years old. There were 33 patients with malignant pleural effusion and 12 patients with benign pleural effusion. No patients with malignant effusion were known to be alive at the time of mortality calculation, whereas two patients with benign effusion were known to be alive. Median survival was 468 days in the benign effusion group and 115 days in the malignant effusion group. The 30-day mortality was not significantly different between the two groups (malignant 34.5% vs. benign 25.0%). However, 1-year mortality was significantly higher in the malignant effusion group (89.7%) than in the benign effusion group (41.7%) (p < 0.005). Conclusion: The use of indwelling pleural catheters in Lubbock, Texas, has comparable results to published studies. These catheters should be considered as a bridge to a long-term treatment rather than a definitive therapy.

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