Thorax
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Two hundred and fifty one cases of penetrating wounds of the chest were studied prospectively. Clinical evidence is presented to show that: basal intercostal drains are adequate to remove both air and fluid from within the pleural cavity; frequent chest radiographs are unnecessary and intercostal drains may be removed on clinical grounds alone; long term antibiotic prophylaxis is unnecessary; eight per cent of those undergoing initial observation will develop a delayed haemothorax or pneumothorax of sufficient size to require drainage; subcutaneous emphysema is of no prognostic significance in the symptomless patient with minimal intrapleural damage on admission; and outpatient follow up is not required.
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We evaluated the effect of posture on the sensitivity and specificity of abnormalities in the flow-volume loop in 30 patients with suspected obstructive sleep apnoea. Flow-volume loops were judged as abnormal if the FEF50/FIF50 ratio was greater than 1 or if the sawtooth sign was judged to be present by at least two of three chest physicians. Detailed nocturnal recordings confirmed the presence of obstructive sleep apnoea in 17 of the 30 patients. ⋯ Furthermore, there was a greater fall in oxygen saturation in patients with apnoea who had sawtoothing than in those without sawtoothing. The presence of the sawtooth sign should increase the suspicion of sleep apnoea and suggest the need for further investigation. The effect of posture on the occurrence of abnormalities in the flow-volume loop suggests that position alters the configuration of the upper airway.
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The effect of thoracentesis on pulmonary gas exchange was studied in 33 patients with unilateral pleural effusions of various causes. Arterial blood gases were measured before thoracentesis and at 20 minutes, two hours, and 24 hours after the procedure. In 13 patients alveolar arterial oxygen gradient (PA-ao2), physiological dead space:tidal volume ratio (VD/VT), physiological shunt, and "anatomical" shunt were also determined before and two hours after thoracentesis. ⋯ A concurrent significant decrease of PA-ao2 was observed (mean (SD) 1.72 (0.77) kPa; 12.92 (5.78) mm Hg). This was accompanied by a small but significant decrease of "anatomical" shunt (2.4% (1.5%] and a greater decrease of the physiological shunt (6.5% (4.3%], while VD/VT did not change. The results are probably due to improved ventilation perfusion relationships with, in particular, an increase in the ventilation of parts of the lung previously poorly ventilated but well perfused.