Respirology : official journal of the Asian Pacific Society of Respirology
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Approximately 20% of pleural effusions remain without an established aetiology after evaluation. Thoracoscopy has a very high sensitivity for the diagnosis of both benign and malignant diseases and greatly increases the diagnostic yield for pleural effusion. We sought to evaluate the diagnostic yield and safety of medical thoracoscopy at this institution. ⋯ There were no major complications, but four patients had late tumour seeding at the thoracoscopy site. Medical thoracoscopy is a safe procedure with a high diagnostic yield. Pre-operative evaluation of the pleural collection using ultrasound or CT increases the likelihood of successful access to the pleural space and may increase diagnostic yield.
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Comparative Study Clinical Trial
Population based standards for pulmonary function in non-smoking adults in Singapore.
Ethnic differences in lung function are well recognized, hence the use of normative data should therefore be based on reference equations that are derived specifically for different ethnic groups. We have collected data (n = 406) for population-based reference values of lung function from randomly selected samples of healthy non-smoking adults of both gender (aged 20-79 years) for each of the three major ethnic groups (Chinese, Malay and Indians) in Singapore. ⋯ Ethnic differences were demonstrated, with Chinese having the largest lung volumes and flow rates, and Indians the smallest. These prediction equations provide improved and additional (TLC, RV, RV/TLC, FRC) population-based reference values for assessment of pulmonary health and disease in Singapore.
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Several methods have been used to predict successful weaning and extubation among chronic obstructive pulmonary disease (COPD) patients. The objective of this study is to determine whether carbon dioxide recruitment threshold (PCO2RT) can be used as adjunct to conventional weaning parameters to predict early weaning and successful extubation. Twelve COPD patients who were ready to be extubated based on conventional weaning parameters were divided into group A (n = 7) and group B (n = 5). ⋯ After weaning for 30 min on a T-tube, another arterial blood gas is determined and this is called the PCO2SB or the CO2 level after 30 min on spontaneous breathing. If the PCO2SB-PCO2RT difference is high with a sensitivity of 85.71% and specificity of 100% vs sensitivity of 57.14% and specificity of 60% using the conventional weaning parameters. Thus an increase in PCO2SB at 30 min T-tube is indicative of impending respiratory pump failure and that other causes of failure to wean must be investigated.
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Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability. There is now a better understanding of the pathophysiology of COPD and of the effectiveness of various treatment strategies in controlling symptoms and progression of disease. Although cessation of smoking is of primary importance, the growing realization in recent years that airflow limitation in COPD can be significantly relieved with the use of bronchodilators has changed the clinical approach to treating this disease. ⋯ The use of the combination of these two classes of inhaled bronchodilators provides superior bronchodilation than treatment with either of the individual components without added side-effects or loss of the positive effects of ipratropium bromide including reduced exacerbation frequency and lack of tachyphylaxis. The use of combination therapy also improves cost-effectiveness and patient compliance. Combination therapy should be considered as an important component of a treatment algorithm of COPD.
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The objective of this study was to present clinical and radiological data of eight women with histologically proven lymphangioleiomyomatosis (LAM) diagnosed between 1984 and 1994, and to suggest a diagnostic strategy when LAM is suspected. A review of case reports, including results of biopsies, lung function and radiological procedures was undertaken. The mean age of the women at start of symptoms was 36 years, and the mean age at time of diagnosis 42 years. ⋯ Three specimens had to be revised before the histological diagnosis was confirmed. It was concluded that the important clues to a diagnosis of LAM are recurrent episodes of pneumothoraces in fertile women, progressive air-flow limitation, markedly reduced gas transfer and characteristic findings on thoracic CT scans. A specific request to the pathologist to stain lung tissue specimens for smooth muscle cells is mandatory.