Chest
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We studied the spontaneous, uninstructed description by 40 health care professionals of breath sounds in asthmatic patients, and their use of lung sound terminology following current recommendations. Tape play-back auscultation of recorded tracheal and lung sounds was performed by ten observers in each group of residents, nurses, staff physicians and physiotherapists. They repeated the test after two weeks to three months. ⋯ We found significant differences in the preferred terms for description of adventitious lung sounds between the groups of health care professionals. There was considerable intraobserver variability, with less agreement when suggestions for a more complex characterization were followed. Our observations indicate the importance of teaching a standardized nomenclature for lung sounds to health care professionals, using only terms which are clearly informative of pulmonary disease.
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The incidence of scleroderma (systemic sclerosis) was found to be increased in a population of black men who were gold miners. Ten men with scleroderma were detected during a five-year period. The annual incidence of the disease in this population in the group aged 33 to 57 years was estimated to be 81.8 per million. ⋯ Not all of the subjects with scleroderma had silicosis, but all had been occupationally exposed to silica dust. There was a significant increase in the prevalence of tuberculosis in the past in the group with scleroderma, compared with a group of men with silicosis from the same population. The nature of the association of tuberculosis with scleroderma has not been defined.
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In a prospective study of the complications of cardiac resuscitation, 705 cases were autopsied to identify the cause of death and the pathologic findings attributable to cardiac resuscitation. Thoracic complications were observed in 42.7 percent of the cases. ⋯ Abdominal visceral complications were noted in 30.8 percent of the cases, and pulmonary complications occurred in 13 percent of the resuscitation population. Life-threatening complications, such as heart and great vessel injuries, occurred in less than .5 percent of the cases.
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Recent reports suggest adrenal insufficiency in critically ill patients is common. We found only one case of de novo adrenal insufficiency using admission ACTH injection in 70 selected intensive care unit (ICU) patients. ⋯ Based on our results, routine screening for adrenal insufficiency in ICU patients is not warranted. If it is suspected, the cosyntropin test should be performed since low random cortisol levels (even to 5 micrograms/dl) are not diagnostic of adrenal insufficiency.