Chest
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This report documents the first known case of bilateral diaphragmatic paralysis following blunt trauma to the chest. The important role of diaphragmatic function in maintaining ventilation, particularly with the patient in the supine position, is illustrated by the reduced total lung capacity, functional residual capacity, and vital capacity. Severe hypoxemia with the patient in the supine position, was markedly improved by elevation of the patient to 30 degree and was further improved by sitting the patient upright. Following an initial period of acute respiratory failure, the patient was managed acceptably by maintaining an elevated position for sleeping until diaphragmatic function returned, about nine months after the injury.
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In a double-blind study the fiberoptic bronchoscope was contaminated with five pathogenic organisms, each at a concentration of 10(9) organisms per milliliter. The shaft and inner channel of the bronchoscope were cleansed with five antiseptic regimens. ⋯ The five different regimens were as follows: (1) physiologic saline solution; (2) 70 percent solution of isopropyl alcohol, followed by physiologic saline solution; (3) alkaline glutaraldehyde, followed by 70 percent solution of isoproply alcohol, followed by physiologic saline solution; (4) benzalkonium chloride, followed by 70 percent isopropyl alcohol, followed by physiologic saline solution; and (5) povidone-iodine solution, followed by 70 percent solution of isopropyl alcohol, followed by physiologic saline solution. The four regimens involving solutions other than saline solution alone were effective in reducing the count of residual bacterial colonies to 10(4) colonies per milliliter or less.