Clinics in chest medicine
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Clinics in chest medicine · Sep 1992
ReviewUpper airway imaging in relation to obstructive sleep apnea.
A variety of imaging techniques have been used to assess upper airway size and function in patients with OSA. Each technique has certain advantages and limitations. Many of the imaging techniques study awake and upright patients, whereas OSA typically occurs while the patient is asleep in the supine position. ⋯ Nasal CPAP increases upper airway size and reduces upper airway edema. UPPP enlarges the oropharynx and reduces upper airway collapsibility. Patients with a narrow upper airway, particularly relative to tongue size, have a good response to UPPP.
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Clinics in chest medicine · Sep 1992
ReviewRight and left ventricular functional impairment and sleep apnea.
Obstructive sleep apnea may contribute to the development of pulmonary hypertension and RVF primarily through pulmonary vasoconstriction secondary to hypoxia. Several recent studies indicate, however, that intermittent apnea-related hypoxia is not sufficient to cause sustained pulmonary hypertension. These studies have been consistent in showing that pulmonary hypertension and RVF are almost invariably seen in the presence of diurnal hypoxia. ⋯ Reversal of CSR during sleep by NCPAP can lead to alleviation of these symptoms and possibly to reduced cardiac dyspnea and LV systolic function as well. Taken together, this suggests that much more extensive use of polysomnography may be warranted in the investigation of cardiovascular disease. The reasons are compelling: sleep apnea disorders are common and eminently treatable conditions whose reversal can result in improved right and left heart function and symptomatic improvement in patients with impaired myocardial function.
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Clinics in chest medicine · Mar 1992
Review Comparative StudyEvaluation and management of solitary and multiple pulmonary nodules.
The evaluation and management of a patient with an SPN is guided by principles that were derived from earlier surgical studies. Stability or no growth for at least 2 years, the presence of calcium in characteristic patterns, and age less than 35 years without any associated risk factors are reliable indicators of a benign process. Fluoroscopy and localized tomography are helpful in evaluation of an SPN. ⋯ Multiple pulmonary nodules are most commonly encountered in patients with metastatic disease to the lungs. Other less commonly encountered diseases that present as multiple pulmonary nodules include infections, arteriovenous malformations, Wegener's granulomatosis, and lymphoma. The evaluation and management of the patient with multiple pulmonary nodules are usually guided by the history, physical examination, and laboratory findings.
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Pulmonary complications represent the leading cause of postoperative morbidity. Thoracic surgical procedures carry the highest risk of such complications. Prevention of pulmonary morbidity in thoracic surgical patients depends on an understanding of expected pulmonary pathophysiologic changes, preoperative assessment of patient risk, and specific interventions aimed at minimizing the incidence and severity of these complications. This article reviews these strategies and gives recommendations concerning the use of preoperative evaluation and postoperative lung expansion techniques.
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Although tracheostomy is performed most commonly for ventilator-dependent patients who have had prolonged periods of endotracheal intubation, it is still necessary and used for other airway problems. Patient management as it relates to indications, timing, various surgical techniques, types of tubes, and complications of tracheostomy and other forms of airway maintenance and control are discussed and evaluated.