Clinical and investigative medicine. Médecine clinique et experimentale
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Considerations for analgesic or anaesthetic intervention during labour and delivery are reviewed. The amelioration of maternal discomfort must be safe for both mother and fetus. ⋯ Maternal stress resulting from pain can adversely affect fetal oxygen supply. The pros and cons of systemic and regional analgesia are discussed.
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A major nonrespiratory function of the mammalian lung is that of a polymorphonuclear leukocyte reservoir. Within this reservoir, granulocytes are distributed between marginating and circulating pools. Under normal conditions these cells release little, if any, toxic metabolites. ⋯ Nevertheless, adult respiratory distress syndrome does arise under conditions facilitating chemotactic factor release from macrophages (e.g. hyperoxia), in situations where widespread activation of complement occurs (e.g. sepsis, trauma, microemboli), and in shock conditions where pulmonary blood flow is often lowered. Correlations exist between adult respiratory distress syndrome and activation of complement, acute neutropenia, sequestration of polymorphonuclear leukocytes and enhanced functional and metabolic activity of granulocytes. Although these findings suggest that polymorphonuclear leukocytes are an important factor in the pathogenesis of adult respiratory distress syndrome, its precise role remains to be determined.
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Pressure-vol. (PV) curves of the lung were obtained in 2 groups of normal subjects using different esophageal balloon vols. and balloon positions. The PV curves were fitted to the exponential V = A - Be-KP. Transpulmonary pressures at different %S of total lung capacity and specific compliance were calculated. ⋯ With the balloon positioned at 8 or 12 cm from the gastro-esophageal junction there was no change in PV curve parameters but transpulmonary pressures and K were significantly altered at the 4 cm position. We conclude that, for clinical purposes, exact positioning of the esophageal balloon and use of the precise resting balloon vol. are not critical. Highly reproducible measurements of the elastic properties of the lung may be obtained using an esophageal balloon with a vol. of 0.6-1.0 ml and a position 8-12 cm from the gastro-esophageal junction.