Thorax
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Comparative Study
Haemodynamic effects of pressure support and PEEP ventilation by nasal route in patients with stable chronic obstructive pulmonary disease.
Intermittent positive pressure ventilation applied through a nasal mask has been shown to be useful in the treatment of chronic respiratory insufficiency. Pressure support ventilation is an assisted mode of ventilation which is being increasingly used. Invasive ventilation with intermittent positive pressure, with or without positive end expiratory pressure (PEEP), has been found to affect venous return and cardiac output. This study evaluated the acute haemodynamic support ventilation by nasal mask, with and without the application of PEEP, in patients with severe stable chronic obstructive pulmonary disease and hypercapnia. ⋯ In patients with severe stable chronic obstructive pulmonary disease and hypercapnia, pressure support ventilation with the addition of PEEP delivered by nasal mask may have short term acute haemodynamic effects in reducing oxygen delivery in spite of adequate levels of SaO2.
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Pain associated with hypertrophic pulmonary osteoarthropathy (HPOA) may be extremely disabling and resistant to treatment. The successful use of ketorolac, a new non-steroidal anti-inflammatory drug, given by subcutaneous infusion is reported in two patients with uncontrolled pain caused by HPOA.
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Comparative Study
Diagnosis of asbestosis by a time expanded wave form analysis, auscultation and high resolution computed tomography: a comparative study.
Crackles are a prominent clinical feature of asbestosis and may be an early sign of the condition. Auscultation, however, is subjective and interexaminer disagreement is a problem. Computerised lung sound analysis can visualise, store, and analyse lung sounds and disagreement on the presence of crackles is minimal. High resolution computed tomography (HRCT) is superior to chest radiography in detecting early signs of asbestosis. The aim of this study was to compare clinical auscultation, time expanded wave form analysis (TEW), chest radiography, and HRCT in detecting signs of asbestosis in asbestos workers. ⋯ Mid to late inspiratory crackles in asbestos workers are detected by TEW more frequently than by auscultation. Signs of early asbestosis not apparent on the plain radiograph are detected by TEW and HRCT with similar frequency. off
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Single lung function is usually assessed by radioisotopes or, more rarely, by bronchospirometry in which a double lumen catheter is used to separate ventilation of the two lungs. The latter is more precise but less comfortable. An alternative bronchoscopic method is described for determining the volume of a single lung. ⋯ Temporary occlusion of a mainstem bronchus in normal subjects is safe, relatively simple, and allows fairly precise and accurate measurements of unilateral static lung volumes. Occlusion at TLC, however, probably prevents proper emptying of the non-occluded lung.
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Randomized Controlled Trial Clinical Trial
Large volume spacer devices and the influence of high dose beclomethasone dipropionate on hypothalamo-pituitary-adrenal axis function.
The systemic effects of the inhaled corticosteroid beclomethasone dipropionate are reduced if the drug is inhaled through a large volume spacer. Use of spacers may therefore permit higher doses to be given without causing hypothalamo-pituitary-adrenal suppression. ⋯ There is wide interindividual variation in the dose of beclomethasone dipropionate causing hypothalamo-pituitary-adrenal suppression. Whether or not a spacer is used, doses higher than the currently accepted maximum of 2 mg/day can be taken by many adults with asthma without causing subnormal function of the hypothalamo-pituitary-adrenal axis. Whether these higher doses are more effective in controlling asthma remains to be established.