Chest
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A 48-year-old male patient had arrest due to rupture of a dissecting aneurysm of the thoracic aorta into the pericardial cavity with tamponade; he received treatment in a general hospital lacking the facilities to practice heart surgery. The patient was treated by means of intermittent pericardial drainage while being transferred to another hospital at 100-km distance for surgical treatment.
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Randomized Controlled Trial Comparative Study Clinical Trial
Protective effect of inhaled piretanide on the bronchial obstructive response to ultrasonically nebulized H2O. A dose-response study.
Inhaled furosemide prevents the obstructive response to several bronchoconstrictor stimuli in asthma. To verify whether this protective effect is also shared by other loop diuretics, we investigated the effect of inhaled piretanide on the bronchial obstructive response to ultrasonically nebulized distilled water (UNW) in ten patients with moderate, stable asthma. ⋯ Piretanide caused a significant, dose-dependent increase in UNW PD20 with respect to placebo, corresponding to 0.6 +/- 0.2 doubling doses (mean +/- SE) after 12 mg, 1.3 +/- 0.2 after 24 mg, and 2.0 +/- 0.2 after 48 mg, and had a remarkable diuretic effect; 40 mg of furosemide increased UNW PD20 by 2.3 +/- 0.3 doubling doses (p < 0.01), but showed only a modest diuretic activity. These data indicate that inhaled piretanide is as effective as furosemide in preventing UNW-induced asthma, and this effect is unrelated to their diuretic potency.
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Clinical Trial Controlled Clinical Trial
Effects of nebulized morphine sulfate on the exercise tolerance of the ventilatory limited COPD patient.
We have shown previously that the administration of morphine (0.8 mg/kg) to patients with COPD increases the VO2max by 19.3 percent. A recent study demonstrated that the administration of low-dose nebulized morphine (approximately 2 mg) increased the endurance time of patients with severe lung disease by 1 min (35 percent) with few systemic side effects. This double-blind crossover study evaluated the effects of various doses of nebulized morphine (0, 1, 4, and 10 mg) on the exercise tolerance and the psychologic status of COPD patients. ⋯ The mean changes (+/- SD) in the exercise test results after each of the four different regimens were as follows: [table: see text] Although there tended to be larger increases in the workload, VO2max, and VEmax after the largest dose of morphine, none of the changes was statistically significant. Likewise, there were no significant differences in spirometry, resting metabolic measurements, or psychologic test scores after the four different regimens. We conclude that aerosolized morphine in the doses used in this study has no significant beneficial effect on the exercise tolerance of patients with COPD.
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We studied whether inspiratory muscle training (IMT) changed respiratory sensation during exercise in 12 healthy women; IMT was performed twice daily, for 15 minutes, using a pressure threshold device and continued for 4 weeks. The inspiratory threshold was set to 30 percent of each individual's maximal inspiratory pressure (Pimax). Breathing effort was evaluated during a progressive exercise test using Borg scale. ⋯ The difference in the sensory score-exercise stage curves before and after IMT in the training group was not significant. No significant difference was noted in the relationship of the Borg score to minute ventilation before and after 4 weeks in either group. We concluded that IMT may not affect respiratory sensation during exercise in normal subjects, although IMT increases diaphragmatic strength.
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To define normal profiles of cardiac structure, function, and hemodynamics postcardiac transplantation using Doppler echocardiography. ⋯ Cardiac transplantation recipients commonly display the following: (1) trivial or mild degrees of mitral regurgitation; (2) as much as moderate tricuspid regurgitation; (3) septal hypokinesis; and (4) small pericardial effusions. There is an association between the presence of right ventricular enlargement and moderate tricuspid regurgitation.