Revue des maladies respiratoires
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Self-adjusted Continuous Positive Airway Pressure or autoCPAP machines have been engineered to automatically adjust the pressure to maintain the upper airway patency. They can be used for titration or long-term home therapy. They have been developed to improve efficiency and compliance of CPAP treatment and the cost-effectiveness of titration and also to decrease the long waiting lists for manual titration. ⋯ In general, optimal CPAP determined automatically are identical or lower than evaluated manually by experienced technicians. However, the long-term benefits of auto-CPAP on compliance have not been determined and require further controlled clinical studies taking account not only compliance, but also sleep quality, quality of life, alertness and cognition for each autoCPAP. The cost-effectiveness of auto-titration versus conventional titration remains also to be established.
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Besides increasing the work of ventilation, emphysema increases lung volume which in itself has a deleterious effect on the inspiratory muscles. We review here the effects of an acute change in lung volume on the configuration of the rib cage and muscle function. ⋯ We also analyze the activation pattern of inspiratory and expiratory muscles during the breathing process in patients with emphysema. Finally, we discuss the effects of single-lung transplantation and reduction surgery on chest distension and improved inspiratory muscle function.
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Pulmonary pseudocysts (PPC) classically relate to chest trauma. It is a rare entity in adults, with multiple differential diagnosis. PPC most often evolve favorably. ⋯ CT patterns of PPC relate to single or numerous cavities surrounded by air space consolidations. The physiopathological mechanisms of PPC remains uncertain. The histological study of this reported case affords some worth data to highlight the pathogenesis of this acquired abnormality.
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Review Comparative Study
[Acute circulatory failure caused by primary pulmonary hypertension or pulmonary embolism].
Patients with acute massive pulmonary embolism or primary pulmonary hypertension may develop acute circulatory failure and are therefore admitted in the intensive care. The mortality rate of patients with pulmonary embolism and shock varies between 25 and 35% whereas the corresponding figure in patients with submassive embolism is less than 10%. Spiral computed tomography may be the most convenient test for diagnosing pulmonary embolism in the setting of acute circulatory failure. ⋯ Symptomatic treatment combines oxygen, inotropic drugs, as well as the optimisation of right ventricular filling pressure. Specific treatment includes inhaled nitric oxide or intravenous epoprostenol followed by anticoagulants with either calcium channel blockers in patients responding acutely to vasodilators or a continuous infusion of epoprostenol in those who do not respond to acute challenge or who are not improving with calcium channel blockers. Although the long term survival has markedly improved as a result of epoprostenol treatment, some patients with refractory primary pulmonary hypertension remain candidates for lung transplantation.
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Eosinophils are the most characteristic inflammatory cells in the airway mucosa in asthma. Eosinophils release highly toxic products and cytokines which may influence the immune system, amplify the inflammatory response and participate in damaging and remodeling processes that occur in the airway mucosa. Eosinophilic inflammation in asthma is related to the blunted perception of bronchoconstriction. ⋯ The number and activation of eosinophils in the airway mucosa are related to the magnitude of airway hyperresponsiveness to bradykinin but not to an agonist acting directly on smooth muscle such as methacholine. Inhaled corticosteroids reduce eosinophil inflammation in asthma whereas beta 2-agonists appear to increase the magnitude of eosinophilic inflammation induced by allergen exposure. The eosinophilic inflammation can be assessed by non-invasive methods using sputum analysis and, indirecly, by measuring the airway reactivity to bradykinin.