Thorax
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The case is reported of a 28 year old woman with status asthmaticus unresponsive to three days of maximal medical treatment. Resolution of bronchospasm was achieved with an infusion of the intravenous anaesthetic agent ketamine.
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Most survivors of ARDS have persistent mild reductions of TLCO even as long as a year after their episode. The lung volumes and flows return to normal in most instances, although a subset of patients will have persistent impairment. Both obstructive and restrictive deficits may be seen. ⋯ The possibility that conventional management may augment the degree of acute injury and worsen outcome must be considered. The effects of chronic hyperoxia in humans with acute lung injury or those of high levels of PEEP compared with low levels are not known. Exploring new ventilator management strategies while we await more specific treatment directed at the primary problem of acute lung inflammation will hopefully reduce acute mortality as well as acute and chronic morbidity.
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Multiple nodules of AA (reactive systemic) amyloid were identified at necropsy in the lungs of a patient with Crohn's disease. No other organs were involved. Nodular pulmonary amyloidosis is usually caused by deposition of AL (primary) amyloid.
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A triaxial alveolar gas diagram to depict fractional concentration of oxygen, carbon dioxide and nitrogen is described, in which the R = 1 line is always implicit. Although it is not claimed that this representation leads to new insights into respiratory physiology, a method of plotting on a triaxial coordinate system has been found to be well suited to many applications when a direct display of fractional nitrogen concentration is required.
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The aim was to establish a continuing district based confidential enquiry into deaths from asthma. ⋯ This study has shown the feasibility of organising a confidential enquiry into asthma deaths within a health district. The distinguishing features of such an enquiry are that it is continuing, that the quality of care given to those patients who died is compared against a recognised standard, and that there is a structured system for feeding back the conclusions of the enquiry to the local medical community.