The American review of respiratory disease
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Am. Rev. Respir. Dis. · Sep 1983
Enhanced tracheal mucus clearance with high frequency chest wall compression.
The clearance of mucus in the trachea during high frequency chest wall compression (HFCWC) was studied in nine anesthetized dogs. High frequency chest wall compression was applied by oscillating the pressure in a thoracic cuff such that it produced oscillatory tidal volumes of 25 to 100 cc at frequencies of 3 to 17 Hz. The tracheal mucus clearance rate (TMCR) was determined by direct observation of the rate of displacement of a charcoal particle spot by means of a fiberoptic bronchoscope. ⋯ The TMCR during 2 min of HFCWC was increased at 5, 8, 11, 13, 15, and 17 Hz but not at 3 Hz. The enhancement of clearance was most pronounced in the range of 11 to 15 Hz, reaching a peak value of 340% of control at 13 Hz. These studies suggest that HFCWC might be of considerable potential benefit as a mode of chest physiotherapy.
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Am. Rev. Respir. Dis. · Jul 1983
Case ReportsPneumocystis pneumonia: importance of gallium scan for early diagnosis and description of a new immunoperoxidase technique to demonstrate Pneumocystis carinii.
Pneumocystis pneumonia presented in a homosexual with fever, a normal chest radiograph, and pulmonary gallium uptake. Bronchial washings yielded Mycobaterium tuberculosis, but despite antituberculosis therapy he remained febrile, and gallium uptake in the lung increased. Subsequently, silver stain of transbronchial lung biopsy obtained 2 months earlier at the time that tuberculosis was diagnosed showed many Pneumocystis cysts in alveolar spaces. In contrast to Pneumocystis cysts in infected lung tissue from other humans, our patient's Pneumocystis cysts reacted more avidly with antiserum to rat Pneumocystis than with antiserum to human pneumocystis, raising the possibility that organisms that infect humans may have varied surface antigenic properties.
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Am. Rev. Respir. Dis. · Jul 1983
Case ReportsRemission of severe obesity-hypoventilation syndrome after short-term treatment during sleep with nasal continuous positive airway pressure.
Two patients with the Pickwickian syndrome and with life-threatening sleep hypoxemia were treated with continuous positive airway pressure (CPAP) applied through the nares only during sleep periods. Each patient presented with severe daytime somnolence, disturbed sleep, nocturnal confusion, and daytime awake cardiorespiratory failure (PaCO2, 63 and 55 mmHg). Both patients demonstrated grossly abnormal breathing during sleep with severe sleep hypoxemia, the arterial oxyhemoglobin saturation (SaO2%) falling repetitively to levels below 50%. ⋯ There was rapid recovery of mental function and loss of cardiorespiratory failure within 3 days of treatment. After short-term treatment with nocturnal CPAP therapy (23 days and 35 days) both patients were able to sleep, unaided, without sleep-induced upper airway occlusion with arterial oxyhemoglobin levels sustained above 80%. We conclude that nasal CPAP therapy during sleep is an effective noninvasive therapy for patients with the Pickwickian syndrome, and may lead to a stable remission of the underlying severe disordered breathing in sleep.
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Am. Rev. Respir. Dis. · Jul 1983
Comparative StudyProtein metabolism during bleomycin-induced pulmonary fibrosis in rabbits. In vivo evidence for collagen accumulation because of increased synthesis and decreased degradation of the newly synthesized collagen.
In vivo rates of synthesis and degradation of collagen and noncollagen protein were measured in normal lung and during the first 14 days of bleomycin-induced pulmonary fibrosis in rabbits. Protein synthesis rates were obtained by measuring the incorporation of labeled proline into tissue proteins after the injection of 3H-proline with a large amount of unlabeled proline. Degradation rates were assessed by several independent methods, including measurement of hydroxy-3H-proline in the tissue-free pool as an index of the degradation of newly synthesized collagen. ⋯ Six days after bleomycin administration the collagen synthesis rate almost doubled and the synthesis rate of noncollagen protein increased by about 35%. At this time the degradation rate of newly synthesized collagen had decreased by about 30%. From this study we conclude: (1) that the lung is an active tissue in terms of protein metabolism with rapid turnover for both collagen and noncollagen proteins, and (2) that an increased rate of synthesis and a decreased rate of degradation contribute to rapid accumulation of collagen in the early stages of pulmonary fibrosis.