British journal of diseases of the chest
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Case Reports
'Atypical pneumonia' due to parakeet sensitivity: bird fancier's lung in a 10-year-old girl.
p6trinsic allergic alveolitis is rare in childhood, with most of the cases reported due to exposure to avian precipitins (Stiem et al. 1966; Dinda et al. 1969; Chandra & Everly Jones 1972; El-Hefny et al. 1980). We report a 10-year-old girl with bird fancier's lung, and suggest that environmental antigens should be sought in children presenting with non-resolving chest disease.
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Pulmonary function changes were studied following bronchoalveolar lavage (BAL) in a group of mild to moderate asthmatic patients and in control subjects. After BAL significant decreases in FEV1 and FVC which were not inhibited by atropine and a consistent decline in PaO2 were seen in both groups. The magnitude of changes in these asthmatics was similar to that in control subjects.
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Case Reports
Assessment of proximal airway obstruction in children by analysis of flow-volume loops.
The usefulness of maximal expiratory and inspiratory flow-volume (F-V) loops was assessed in ten children with clinical evidence of tracheal or laryngeal obstruction. Normal values from 514 healthy children are presented. ⋯ F-V loop analysis is a valuable technique in the assessment of the child with proximal airway obstruction. Unlike endoscopic and radiological investigation, it measures the functional rather than the anatomical degree of obstruction, and provides a simple non-invasive way of monitoring the response to treatment.
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Recent interest in the benefits of long-term oxygen therapy for patients with chronic airflow obstruction and hypoxaemia should lead to an increased use of nasal prongs for prolonged (15 hours/day) oxygen administration. Because some patients find nasal prongs uncomfortable and since they may slip out of position during use, we have devised a new nasal oxygen mask and compared both its performance and comfort with conventional nasal prongs. Changes in end-tidal oxygen concentration were measured after administering oxygen at 2 litres/min through each device for 10 minutes in 15 normal subjects and for 1 hour in patients with chronic airflow obstruction and hypoxaemia. ⋯ There was also no difference in the improvement in arteriolized capillary oxygen tensions (mask 3.5 kPa; prongs 4.0 kPa). In a separate study of prolonged (22 hours) use there was no difference in reported comfort. The new mask is a useful alternative to conventional nasal prongs.
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We describe a case of bronchocentric granulomatosis in a young woman with several unusual features. She developed spontaneous pneumothoraces, diffuse interstitial infiltrates and the adult respiratory distress syndrome during the course of her illness. A pathological diagnosis was not made until treatment with corticosteroids had led to a marked improvement in the patient's condition and an open lung biopsy was performed.