Thorax
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Anatomical dead space was measured in 72 normal children aged from 5 to 16 years, using the single breath method. There was a linear increase in this measurement with height, weight, and end-inspiratory lung volume. Physiological dead space was measured in 52 normal children using the Bohr equation and substituting a rebreathing PCO2 for alveolar PCO2. ⋯ The effect of airways obstruction on the dead space volumes was studied in 36 children with asthma and 28 with cystic fibrosis. Physiological dead space increased with increasing airways obstruction. Anatomical dead space remained constant in spite of marked increases in lung volume associated with the airways obstruction.
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Since 1970 we have stabilized the ribs to correct paradoxical movement of the chest wall in chest injuries, using an original technique, in order to avoid as far as possible the need for long-term chest wall stabilization by intermittent positive pressure respiration (IPPR). The technical details of surgical stabilization are described, and the different types of stainless steel struts are shown. Type I was originally used either as an intramedullary nail or as an external brace. ⋯ We conclude that surgical stabilization of the paradoxial movement of the chest wall can avoid the use of the respirator or at least reduce the interval of IPPR to a short period during the initial recovery from trauma. Using type III struts, we have obtained stabilization of the flail chest in all cases even in patients with severe anterior paradoxical movement. The patients' tolerance of surgical stainless steel struts was good.
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A woman aged 46 was found to have severe tricuspid valve disease 14 years after the diagnosis of a malignant carcinoid tumour of the ileum and 33 years after the onset of symptoms attributable to the disease. Increasing ascites requiring repeated paracentesis had not responded to chemotherapy including infusion of 5-fluorouracil and vincristine into the coeliac artery. The tricuspid valve was replaced by a Björk-Shiley prosthesis. ⋯ She remains well one year and 11 months later. It is suggested that valve replacement surgery should be considered more often in patients with carcinoid heart disease. Hepatomegaly and ascites sould not be attributed too readily to advancing malignant disease without careful consideration of the role of right-sided valvar lesions in the production of these signs.
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Four cases of intramural diverticulosis of the oesophagus are described, and the findings are reviewed in 12 previously reported cases. Evidence is presented that this condition is a true pulsion diverticulosis due to deranged motor activity and raised intraluminal pressure. It may occur in cases of diffuse oesophageal spasm, or it may follow inflammation, stricture or surgery. The course is benign, complications being those of the underlying disorder.
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Breath holding was used as the basis of a simple test of respiratory chemosensitivity. Breath holding was begun at selected degrees of hypercapnia produced by CO2 rebreathing. In 16 healthy control subjects there was a linear regression of the log of breath-holding time on the PCO2 at the start of breath holding. ⋯ However, in 17 patients with chronic airways obstruction, breath-holding time was never prolonged and the log BHT/Pco2 relationship was normal, even though 13 had a diminished ventilatory response to CO2 and four had chronic CO2 retention. It is concluded that the BHT/Pco2 relationship provides a useful index of respiratory chemosensitivity which is not influenced by airways obstruction. This may be helpful in the detection of impaired chemosensitivity as a cause of CO2 retention even when the ventilation CO2 response is reduced non-specifically by coexisting airways obstruction.