Revue des maladies respiratoires
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Radon is a natural radioactive gas, with worldwide distribution, deriving from uranium decay products, which can be inhaled, weather in mining condition (extraction and management of uranium ores) or in domestic condition (in some high risk homes or geographic areas). The main epidemiologic studies on uranium mining workers have all confirmed an excess in relative risk of primary lung cancer. Epidemiologic studies on indoor exposure suggest a role of radon in the genesis of a certain number of primary lung cancer, although these results remain controversial and need to be confirmed. An overview of the main actual problems related to this bronchial carcinogen is presented in this paper.
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We have studied the survival of 49 patients suffering from neuromuscular disease, who were hospitalised in the Respiratory Intensive Care Unit between 1981 and 1990 (29 males and 20 females with a mean age of 49.3 +/- 17 years with a range of 15 to 79). The neuromuscular diseases consisted of 8 with multiple sclerosis, 9 with amyotrophic lateral sclerosis, 8 with Steinert's disease, 11 myopathies, and 10 suffering from miscellaneous neurological diseases. Initially 27 of the 49 patients had been intubated and ventilated. ⋯ The other factors which influence survival are age (p < 0.01), the presence of false route (p < 0.01), and the reason for hospitalisation (acute as opposed to chronic progressive deterioration, p < 0.05). In a multivariate analysis the most significant factors associated with the diagnosis were age, the reason for hospitalisation, and the existence of false routes. The initial treatment (intubation) and the prescription of long-term ventilation did not bring with it any significant further information as to prognosis, compared to the model which included these four factors.
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The techniques of non-invasive ventilation have reappeared in force as an assortment of therapeutic techniques since the end of the 1980's. At the same time there was a transient renewed interest in perithoracic ventilation favouring the use of new methods of connection to the patient (e.g. poncho). ⋯ The concept of resting the respiratory muscles has been the basis for techniques of ventilatory assistance and in part the nasal route has now replaced home ventilation using a tracheotomy. Also in certain types of acute respiratory failure, nasal ventilation widely preferred over endotracheal ventilation.
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The aim of this work was to study the relationship between dynamic hyperinflation and dyspnoea perception on exercise in patients with chronic obstructive pulmonary disease (COPD). Seven men and three women with COPD (mean FEV1 45.9 +/- 9.8% predicted) were studied. The upper end of the visual analogue scale was anchored on a preliminary test on a cycle ergometer (day 1). ⋯ At maximal exercise, IC decreased in 8 out of 10 subjects (delta IC range -150 to -900 ml). A negative relationship was found between delta IC and the rate of increase in dyspnoea on exercise, measured as the dyspnoea/PIFT slope (r = 0.844, p < 0.01). Our results suggest that dynamic hyperinflation on exercise observed in most patients with COPD allows these subjects to minimize the rate of increase in dyspnoea on exercise.