Revue des maladies respiratoires
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Review Randomized Controlled Trial Clinical Trial
[Non-invasive ventilation in acute respiratory insufficiency in chronic obstructive bronchopneumopathy].
At the time of acute exacerbations of chronic airflow obstruction (BPCO) non-invasive ventilation represents an alternative to endotracheal intubation. In patients with respiratory distress, the use of a face mask is often preferable to a nasal mask alone, by avoiding the escape of oxygen which occurs around the mouth in nasal ventilation. ⋯ The consequences were a significant reduction of the complications of acute respiratory failure which were linked to artificial ventilation (p < 0.05) with a reduction of the hospital stay (p < 0.05) and finally a significant reduction in mortality (29 per cent - 9 per cent, p < 0.005). From now on, this technique could be used in many centres as the first treatment in acute exacerbations of BPCO patients to avoid the use of endotracheal intubation.
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A young man without any past history of note had taken isotretinoin for disfiguring acne before the summer season. He presented with a severe bilateral pneumonia, associated with dyspnoea two months after the start of treatment. ⋯ The elevated level of eosinophils (54% in 564,000 cells/ml) in the alveolar lavage lead to a diagnosis of allergic pneumonia. The rapidly favourable outcome following the cessation of the medication and with the addition of corticosteroids seemed to us a supplementary argument in favour of a diagnosis of eosinophilic pneumonia, due to isotretinoin which seemed the primary initiating factor.
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After having invented the stethoscope, Laennec published his treatise on auscultation in 1819, describing the acoustic events generated by ventilation and linking them with anatomopathological findings. The weak points of his semiology lay in its subjective and interpretative character, expressed by an imprecise and picturesque nomenclature. Technical studies of breath sounds began in the middle of the twentieth century, and this enabled the American Thoracic Society to elaborate a new classification of adventitious noises based on a few physical characteristics. ⋯ Technology development raises hope for the design, in near future, of automatic processes for respiratory noise detection and classification. Systematic research into the production mechanisms and sites of these noises has progressed equally. It should, in time, reinforce their semiological value and give to auscultation, either instrumental or using the stethoscope or instrumentally, an increased diagnostic power and the status of respiratory function test.
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The main primary pollutants released into the atmosphere are sulfur dioxide (SO2), nitrogen monoxide and dioxide (NOx), particulate dust and in a less important part carbon monoxide (CO), hydrocarbons and heavy metals (Pb, Cd). Sulfur and nitrogen oxides are released from combustion of coals and fuels. Sulfates, nitrates and ozone are secondary pollutants resulting from chemical reactions within the atmosphere. ⋯ Since most of these studies do not include bacteriologic and virologic confirmation, it is unclear whether this respiratory morbidity is due to respiratory irritation or infection. In conclusion, we think that high concentrations of air pollutants are very likely to increase sensibility to respiratory infections in humans. There are however no sufficient data to clearly establish whether air pollution constitutes a risk factor for respiratory infections at usual ambient concentrations.
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The measure of dead space (VD) has been at the centre of a controversy in the diagnosis of pulmonary emboli. We present an unusual case report because we had measured the dead space before the acute incident. The improvement in the result only occurred after the imposition of a vena caval filter and this supplied the discussion on the specificity of scintigraphy to appreciate the functional state of the pulmonary vascular bed.