Respiration; international review of thoracic diseases
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Pertinent historical, clinical, and laboratory findings were recorded for 37 consecutive patients who presented to the emergency room complaining of shortness of breath and chest pain but without evidence of coronary insufficiency, pneumonia, or musculoskeletal injury. 13 had pulmonary embolism suggested by lung scan with or without pulmonary angiogram, or, in 2 cases, by right heart catheterization. As a group, these patients in whom embolism was judged probable approached fairly closely the profiles of previous studies of patients with documented pulmonary emboli. ⋯ In the population served by this emergency room, which has a high morbidity from chest diseases and putative predisposing conditions to pulmonary embolism, screening patients for high and low probability groups for this diagnosis cannot be done on clinical grounds alone. Six-projection ventilation-perfusion lung scanning may be the only acceptable screening examination, and should be available directly from the emergency room in hospitals with an active emergency service.
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The acute effects of thoracentesis on arterial oxygenation were observed in 19 studies on 17 patients. Arterial blood samples were obtained prior to, immediately after, and 1 h after thoracentesis. ⋯ It was concluded that significant hypoxemia may result from thoracentesis due to aberration of ventilation-perfusion relationships. It is further suggested that oxygen therapy be routinely administered during and immediately after the procedure.
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Reasoning from known effects of salbutamol on the bronchial smooth muscle cell and their enhancement in asthmatics through steroids, this communication proposes a method employing these substances in such a way as to prevent bronchospasm during fiberoptic bronchoscopy. Following split-dosage administration of 100 mg prednisolone prior to bronchoscopy, a total of 3.75 mg salbutamol in a diluted saline solution is instilled intrabronchially through the biopsy channel. ⋯ In a control group of 17 chronic bronchitics showing an improvement of 15% in flow rates after bronchodilators, no significant change was seen in FEV1 and FVC following fiberbronchoscopy. This procedure not only renders the diagnostic bronchofiberscopy relatively safe in asthmatics, but may be of use within the context of intensive care in serious bronchospasm refractive to conventional therapy.
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This work deals with a modification of a thromboelastograph which enables to measure both in vitro and in vivo effectiveness of mucolytic substances. A simple method is described for building up a comparative diagram of the effectiveness of several drugs; a diagram which is of interest from both a pharmacological and a clinical point of view.