Respiration; international review of thoracic diseases
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The effect of pulmonary artery hypertension on right-ventricular performance in patients with chronic obstructive pulmonary disease (COPD) is unclear. Decreased values of right-ventricular ejection fraction (RVEF) have been reported, but most patients with stable COPD are not in cardiac failure and have normal or even increased cardiac outputs. We therefore hypothesized that RVEF may be afterload dependent, and thus a poor parameter of cardiac function, and that right-ventricular contractility may be normal even in COPD patients with pulmonary hypertension. ⋯ Right-ventricular end-diastolic volume index was significantly higher in patients with pulmonary hypertension, indicating increased preload as the major mechanism to maintain adequate stroke volume in the face of an increased afterload. Right-ventricular end-systolic pressure-volume relations, a good parameter to define right-ventricular contractility independent of systolic loading conditions, were not different between COPD patients with or without pulmonary hypertension, nor did the slopes of the pressure-volume lines in the 9 patients studied during exercise show any difference. From these data we conclude that (a) RVEF is a poor indicator of overall right-ventricular function; (b) right-ventricular contractility is well preserved in stable COPD patients; (c) the major mechanism of maintaining stroke volume in the face of increased right-ventricular afterload seems to be preload augmentation.
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This study was designed to compare spirometers used for human testing and to determine whether the results obtained by different spirometers meeting the American Thoracic Society (ATS) requirements are interchangeable. Water-sealed spirometer (Harvard), dry bellow wedge spirometer (Vitalograph) and computerized pneumotachograph (Gould), all of them satisfying the ATS recommendations were compared. ⋯ The Vitalograph values for FVC, FEV1 and FEV1% were significantly higher than those of the water-sealed spirometer (Harvard), but were closely similar to the values obtained by the Gould computerized pneumotachograph. Our results thus do not support the interchangeability of different spirometers and stress the importance of biological standardization of spirometers against each other.
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A case with advanced diffuse pulmonary ossification is described. The patient underwent surgical treatment of a malignant nodular melanoma of the right shoulder followed by postoperative cytostatic therapy for 6 months. He developed renal insufficiency and pulmonary infiltrates 3 years after the operation. ⋯ Morphometric measurements of ossified nodules revealed increased ossification in fibrotic lung areas. Immunohistology for differentiating immunoglobulins and lymphocytic subpopulations was insuspicious. The findings suggest that diffuse intraalveolar ossification is probably not related to pulmonary congestion.
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Comparative Study Clinical Trial Controlled Clinical Trial
Antitussive effect of dextromethorphan and dextromethorphan-salbutamol combination in healthy volunteers with artificially induced cough.
The antitussive effects of dextromethorphan (30 mg) + salbutamol (2 mg), dextromethorphan (30 mg) alone and placebo on artificial cough induced by citric acid were compared in 19 healthy non-smoking volunteers in a double-blind crossover study. The method using inhaled citric acid with increasing concentrations to establish the cough threshold level showed an acceptable reproducibility and proved to be suitable for comparison of antitussive drugs. The cough threshold level was assessed before as well as 90 and 180 min after each medication. ⋯ However, significant rises were shown following dextromethorphan (p less than 0.001) and the dextromethorphan-salbutamol combination (p less than 0.001). Between the treatments significant differences were shown in favour of the dextromethorphan-salbutamol combination. The results indicate that salbutamol has antitussive action enhancing the effect of plain dextromethorphan.
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Case Reports
Bronchoalveolar lavage during third-trimester pregnancy in patients with status asthmaticus: a case report.
Bronchial asthma is not uncommon among pregnant women. Especially, uncontrollable status asthmaticus may endanger both the lives of mother and fetus. We present a case of a late-phase pregnant woman in whom life-threatening status asthmaticus was relieved by repeated bronchoalveolar lavage (BAL) under controlled ventilation, followed by successful spontaneous vaginal delivery. This case may indicate that BAL should be considered as an option in status asthmaticus complicating pregnancy before terminating the pregnancy to save the lives of mother and fetus.