Chest
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We report four cases of pleural plaques found at autopsy in individuals who resided in or near the chrysotile mining town of Thetford Mines, Quebec, and who had never been employed in the chrysotile mining and milling industry. Three of these patients were farmers, and one was a road construction worker. Lung asbestos content of these cases was compared with that of a group of nine persons living in the same vicinity who did not have pleural plaques. ⋯ Fiber sizes were the same in both groups. Also, one plaque case had an elevated level of relatively long titanium oxide fibers. These observations suggest that environmental pleural plaques in this region of Quebec are probably caused by exposure to tremolite derived from local soil and rock and that other types of mineral fibers such as titanium oxide may occasionally also be the cause of such lesions.
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Randomized Controlled Trial Comparative Study Clinical Trial
Utility of immediate postlobectomy fiberoptic bronchoscopy in preventing atelectasis.
In a prospective randomized trial, we examined the value of routine postlobectomy fiberoptic bronchoscopy (FOB) in preventing postoperative atelectasis. Twenty patients who underwent lobectomy were randomly assigned to either chest physical therapy alone (group 1) or immediate bronchoscopy (group 2). Both group 1 and group 2 were placed on a standard physical therapy regimen consisting of aerosol bronchodilator therapy, chest percussion, and incentive spirometry. It was concluded that routine postlobectomy bronchoscopy offers no advantage over the usual physical therapy measures in preventing the development of postoperative atelectasis.
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Comparative Study
Performance of a demand oxygen saver system during rest, exercise, and sleep in hypoxemic patients.
Demand oxygen systems have been shown to be effective in treating hypoxemia during seated rest and during exercise, but the performance of these systems during sleep has not been previously studied. We compared the efficacy of a new demand oxygen saver system with that of continuous flow nasal oxygen during the usual activities of daily life including sleep, seated rest, and exercise. Six hypoxemic patients were studied. ⋯ The demand oxygen system produced arterial oxygenation equivalent to continuous flow nasal cannula under all conditions while utilizing substantially less oxygen. When compared with administration of oxygen by continuous flow nasal cannula, the demand oxygen saver cannula utilized only 45 percent as much oxygen during seated rest, 44 percent as much oxygen during exercise, and 39 percent as much oxygen during sleep. Our data support the use of demand oxygen systems for treatment of hypoxemia in patients with chronic obstructive lung disease.
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Tuberculous broncho-aortic fistula has not been reported, to our knowledge. This is a case report of a 60-year-old woman with massive hemoptysis secondary to a broncho-aortic fistula. The pathologic study of the pulmonary specimens showed tuberculous granulomas with caseous necrosis and tubercle bacilli in the pulmonary tissue and the fistulous area.
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The gas exchange and hemodynamics were evaluated before, during, and after a two-hour period of prone position in 13 moderate-severe ARDS patients. Lung computerized tomography was obtained in both the supine and prone positions in two of these patients. Average arterial oxygenation improved after prone positioning (p less than 0.01). ⋯ One of these was a responder, the other a nonresponder. A brief test period in prone position is indicated in ARDS patients to identify those who may benefit from this postural treatment. The definite mechanism of the arterial oxygenation improvement observed remains to be clarified.