Respiration; international review of thoracic diseases
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Starling's law (the energy of muscle contraction is proportional to the initial fiber length) has been applied to contraction of inspiratory muscles. Its application to the expiratory muscles is difficult because both maximal length and maximal pressure development occur at total lung capacity (TLC). We hypothesize that decrease of both inspiratory (Pimax) and expiratory (Pemax) muscle strength in chronic ascites (CA) will reflect generalized muscle weakness and stretching of both the diaphragm and abdominal wall as well. ⋯ With fluid removal, abdominal muscles shortened; diaphragmatic curvature decreased although diaphragm length was unchanged. Nevertheless, neither Pimax nor Pemax increased. Respiratory muscle strength depends upon generalized muscle strength more so than upon muscle length in CA patients.
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We describe a 49-year-old female Japanese hairdresser who presented with a 5-year history of exertional dyspnea, a nonproductive cough, and occasional febrile episodes. Histological analysis revealed interstitial fibrosis with mononuclear cell infiltration, foreign body granuloma, and numerous intra-alveolar macrophages and multinucleated giant cells of foreign body type. Arterial blood gas, pulmonary function studies and computed tomographic findings demonstrated improvement 6 months after cessation of exposure to the salon. Bronchoalveolar lavage fluid findings suggested that the development of lung disease in this case was triggered by an allergic mechanism rather than the storage of hair spray ingredients in the lung.