Chest
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Comparative Study
Sensitivity and specificity of early diagnostic tests of lung function in smokers.
What are the relative sensitivities and specificities of the "early" tests of lung dysfunction? We describe the findings from a study of virtually the entire population of a rural pollution-free community. Using abnormal spirometry as a marker of obstructive disease, we evaluated the two tests obtained from the single-breath nitrogen curve, closing volume (CV/VC) and the slope of the alveolar plateau (delta N2/L), as well as combinations of the two tests. ⋯ The group of smokers with abnormal delta N2/L did include fair numbers with abnormal spirometry (20.7 percent in male and 16.1 percent in female subjects). A combination of the two tests (abnormal in either delta N2/L and/or CV/VC) has good sensitivity (68.4 and 80.0 percent for male and female subjects, respectively) and specificity (74.3 and 69.0 percent for male and female subjects, respectively).
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Edema fluid and a coagulation profile were obtained in 45 patients (17 to 87 years) during fulminant pulmonary edema. Left ventricular failure and/or volume overload accounted for edema in 18 patients. In another 27 patients, edema developed in association with other features that typify the adult respiratory distress syndrome (ARDS). ⋯ ARDS is characterized by permeability pulmonary edema that usually stems from a combination of multisystemic disorders. Permeability pulmonary edema and coagulation changes appear to be interrelated. However, it is not clear the extent to which the coagulation disturbances are a cause or a result of the alterations in the alveolar-capillary membrane.
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Case Reports
Pulmonary embolism in the patient with chronic obstructive pulmonary disease. A diagnostic dilemma.
It is often difficult to distinguish pulmonary embolism from worsening underlying disease in the setting of severe chronic obstructive lung disease. We describe three patients with severe COPD and angiographically documented pulmonary embolus to stress that standard clinical and radioisotopic studies were of little value in establishing a diagnosis. All patients had acute increases in alveolar ventilation immediately following the embolus with a reduction in previously elevated levels of PaCO2, as well as hypoxemia. Such changes in arterial blood gases in the patient with severe COPD should suggest pulmonary embolus rather than increased obstruction.
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Case Reports
Extensive aortic dissection from combined-type cystic medial necrosis in a young man without predisposing factors.
A 33-year-old man with no predisposing factors had a DeBakey type 1 aortic dissection requiring surgical intervention. Microscopic examination showed combined-type cystic medial necrosis. This is the first report of extensive aortic dissection associated with combined-type cystic medial necrosis in a person younger than 40 years with no predisposing factors.