摘要:

The relation of postural changes to the diffusing capacity of the lung for carbon monoxide (DLCO) was investigated in 12 normal nonsmokers in order to evaluate the influence of body position on several components of lung resistance to gas diffusion. The well-known increase in CO diffusing capacity in the supine position was obtained only for data corrected for alveolar volume (KCO: 6.18 ± 0.75 vs. 5.45 ± 0.67 ml/min/ mm Hg/l; p < 0.005). Moreover, only the membrane component (Dm) increased significantly in supine subjects (KDm = 2.81 ± 1.32 vs. 1.82 ± 0.54 ml/min/mm Hg/l; p < 0.05), the increase in capillary blood volume (Vc) being not significant (KVc = 12.54 ± 4.22 vs. 11.17 ± 3.79 ml/l; NS). These data could be interpreted as a demonstration of a more homogeneously distributed ventilation with respect to diffusion surface in healthy young people in a supine position. The amount of surface available for diffusion seems therefore to be a limiting factor to gas flow across the lungs in these subjects. Thus a straightforward attribution of posturally influenced changes in CO diffusing capacity exclusively to factors affecting Vc is not recommended, particularly in pathological conditions, if information about variation in distribution of ventilation is unava

ISSN:0025-7931    

DOI:10.1159/000195937

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Thirty-eight neodymium yttrium aluminium garnet (Nd-YAG) laser sessions have been performed in 26 patients under local anaesthesia. The majority of patients had recurrences of inoperable non-small-cell lung cancer after radiotherapy. At evaluation, a subjective improvement of dyspnoea was noticed in 70% (18/ 26) of the patients, and in 54% (14/26) of the cases, a > 50% improvement of the airway lumen diameter was assessed at bronchoscopy. Haemoptysis subsided in 4 out of the 5 patients. On 2 occasions, the rigid scope was introduced to provide optimal control of minor bleeding during the laser performance. Neither respiratory failure, nor any treatment-related death has occurred. In our hands, Nd-YAG treatment under local anaesthesia was a feasible, effective and safe procedure

ISSN:0025-7931    

DOI:10.1159/000195938

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

In two groups (A and B) of patients with severe chronic obstructive pulmonary disease (COPD), matched for age and routine pulmonary function testing, we evaluated inspiratory muscle strength (MIP), breathing pattern, mouth occlusion pressure (P0.1), inspiratory neural drive, assessed in terms of electromyographic activity of both diaphragm (EMGd) and intercostal (EMGint) muscles, and P0.1/EMGd ratio, an index of inspiratory neuromuscular coupling. Group A (8 patients) was studied before and after a 7-day period of a new oral xanthine derivative (bamiphylline, 1.2 g daily), and group B (7 patients) was given a placebo. Under control conditions, compared with an age-matched normal control group, groups A and B both exhibited a decrease in MIP, more rapid (increase in respiratory frequency RF) and shallower (decrease in tidal volume; Vτ) breathing (RSB), a marked increase in both EMGd and EMGint and a lower P0.1/EMGd ratio. With bamiphylline FEV1 and PaO2 significantly increased, while a substantial increase in MIP was found in 5 out of the 8 patients. Vτ and inspiratory time (Ti) also significantly increased, and RF decreased. Both EMGd and EMGint significantly decreased, whereas P0.1/EMGd exhibited a substantial increase in 5 out of the 8 patients. Conversely, no significant changes were observed in group B during the study period. From these data we conclude that in patients with COPD, clinical manifestations, probably associated with inspiratory muscle overloading (decrease in muscle strength, RSB, increase in respiratory neural drive, and derangement in neuromuscular coupling) may benefit from a short-term treatment with bamiphylli

ISSN:0025-7931    

DOI:10.1159/000195939

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The increasing use of air-driven nebulised bronchodilators by patients with airflow obstruction has raised concern about the safety of this practice. We have investigated the effects of 10 mg salbutamol, nebulised in air, on blood gas tensions, heart rate and plasma potassium (K+), when administered alone to 9 patients with severe chronic obstructive airway disease and then in combination with a therapeutic dose of oral sustained-release theophylline to 5 of them on 2 separate occasions. No significant reductions in PaO2 were observed with either treatments. Heart rate increased significantly from 77.8 ± 3.7 beats/min (mean ± s.e.m.) at baseline to a peak of 87.1 ± 4.4 beats/min at 45 min (p < 0.001) with salbutamol alone and there was a similar trend of increase after combined therapy. K+ decreased significantly from a baseline of 4.0 ± 0.3 to a minimum of 3.6 ± 0.2 mmol/l at 90 min (p < 0.001) with combined therapy but did not change significantly with single therapy. No subject developed any significant cardiac arrhythmias on either occasion. Although the number of subjects studied is small, our data suggest that air-driven nebulised high-dose salbutamol may be safe in the treatment of severe chronic obstructive airway disease but when combined with oral theophylline, a significant fall in plasma potassium may occur. This could be of clinical significance in hypokalaemic patients. When combination treatment is used, monitoring of plasma potassium is recomm

ISSN:0025-7931    

DOI:10.1159/000195940

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Bronchoalveolar lavage studies in 33 patients with acute untreated tropical eosinophilia have demonstrated intense eosinophilic alveolitis. Following treatment with a standard 3-week course of diethylcarbamazine, there was a significant fall in lung eosinophils (p < 0.001). However, a mild alveolitis characterised by hypercellular lavage fluid due to a significant increase in absolute alveolar macrophages (p < 0.001) and due to an increase in both the absolute number (p < 0.01) and percentage of eosinophils (p = 0.02) was persisting at 1 month despite treatment. Long-term follow-up is essential to know the fate of alveolitis

ISSN:0025-7931    

DOI:10.1159/000195941

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Although it is accepted that thoracic structures are enlarged in supine chest radiographs, it is not known whether the lying posture may also influence the radiographic detection of abnormalities, such as those suggestive for pulmonary embolism (PE). For this purpose, we performed planar chest radiographs both in the seated and supine positions, keeping the target-to-film distance at 2 m, in 20 patients with acute PE. Chest radiograph was then repeated 1 month later in either position with the radiological conditions unchanged to investigate the effect of posture on the detection of resolution of signs. The detection of signs due to modifications of preexisting thoracic structures (elevation of the diaphragm and enlargement of the heart, right descending pulmonary artery and azygos vein) in acute PE was different between films taken in the supine and seated positions: both hemidiaphragms were more elevated (p < 0.001), heart and central vessels were wider (p < 0.05 or less) when patients were supine. On the contrary, the detection of signs of new occurrences (‘sau-sage’-like appearance of the descending pulmonary artery, linear atelectasis, densities compatible with pulmonary infarction, pleural effusion and focal hyperlucency) was not influenced by the patient’s position. During recovery, both kinds of abnormalities were reduced concomitantly in seated and supine radiographs. In conclusion, in acute PE, chest radiographs should be obtained in the seated position since the supine posture may overestimate signs due to modifications of preexisting thoracic structures even though it does not influence the detection of signs of new occurrences. On the contrary, films taken in either position are useful to follow the evolution of PE, provided the film is obtained in the same position and with the same technique as in the acute

ISSN:0025-7931    

DOI:10.1159/000195942

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

In a study of 41 consecutive patients with bacteraemia-associated community-acquired lobar pneumonia due to Streptococcus pneumoniae and Klebsiella pneumoniae an attempt was made to determine whether distinguishing criteria of disease due to these organisms could be identified according to demographic features and the results of initial clinical and laboratory investigations. Such information would aid in the early initiation of appropriate antimicrobial therapy. The most significant difference between the two groups of patients was the lower platelet count in the K pneumoniae group (p < 0.005). In addition leucopenia (p < 0.05), higher serum albumin (p < 0.05), and the male sex (p < 0.05) featured with an increased frequency in patients with pulmonary infection due to K. pneumoniae. Initial antimicrobial therapy in critically ill patients with community-acquired lobar pneumonia and thrombocytopenia, particularly when associated with leucopenia and in male patients, should include agents effective against K. pneumoniae

ISSN:0025-7931    

DOI:10.1159/000195943

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The ventilatory capacities of 195 tobacco factory workers exposed to tobacco dust and 190 Libyan men not exposed to tobacco dust were measured. In both groups, the forced vital capacity (FVC) and forced expiratory volume in 1 s were found to be correlated with age, stature, sitting height and body surface area. Those exposed to tobacco dust have decreased ventilatory capacity values as compared with age-matched unexposed workers. The duration of exposure to tobacco dust does not appear to have any significant effect on the ventilatory function. There was no significant difference in the lung function test values between the smokers and nonsmokers in both groups. The flow-volume curves were constructed for the unexposed and exposed groups of workers. At 25% FVC, in the group exposed to tobacco dust, there was a decrease in air flow by 20.8% as compared to age-matched normal unexposed Libyans. This indicates that the small airways are affected by exposure to tobacco dust. Flow-volume curves are useful in the assessment of lung function status

ISSN:0025-7931    

DOI:10.1159/000195944

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The study aimed at investigating pulmonary function in uremic patients, emphasizing the lung diffusing capacity for CO (DLCO) and its membrane and pulmonary capillary blood volume (Vc) components. The study sample comprised 25 uremic patients without clinical/radiological evidence of lung disease. They were enrolled in a chronic hemodialysis (HD) program and had anemia requiring transfusions. The subjects were tested for their lung function before and after both a first HD and a HD with blood transfusion (BT) that followed a few days later. After HD-induced removal of body fluid, and increase in pre-HD reduced forced vital capacity, alveolar volume and mid-expiratory flow rate (FEF25-75%) was observed. HD-induced DLCO decrease (p < 0.005) was observed and was related to decreased Vc. The second HD with BT increased DLCO, due to partially normalized Hb. On average, a 7.2% DLCO increase corresponded to each 10-g/l Hb rise. In conclusion, (1) the beneficial effect of HD in uremic patients reverts the small-airway obstruction; (2) the lower values of DLCO in these patients are due to reduced Hb and HD causes further DLCO reduction via decrease of Vc, and (3) HD with BT still increases DLCO because improvement of Hb predominates

ISSN:0025-7931    

DOI:10.1159/000195945

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

We assessed the respiratory effects of the number of cigarettes smoked daily (CIGD) in 748 male smokers of a general population sample living in the unpolluted area of the Po Delta (Italy). A standardized questionnaire, flow-volume curves (V/V), the diffusing capacity of carbon monoxide (DLCO) and the slope of the alveolar plateau of nitrogen (DN2%/1) were used. Subjects were divided according to the median value of the observed distribution of CIGD (1–19, 20+) and according to the tertile values of the observed distribution of pack-years (an index representing lifetime cigarette consumption; 1–7, 8–21, 22+). In those with a higher CIGD, the prevalence rate of chronic phlegm was always significantly increased, while the prevalence rate of wheeze was significantly higher if they had smoked 8+ pack-years. Using analysis of variance, adjusted for pack-years, DLCO indexes, FEF75-85 and Vmax75 were significantly reduced in those with higher CIGD. When multiple logistic models, accounting for the independent effects of age and pack-years, were used, significantly increased odds ratios (ORs) for symptoms (e.g. OR = 2.0 for phlegm, OR = 1.8 for cough, OR = 1.6 for wheeze) and abnormal DLCO (OR = 1.9) or DN2%/1 (OR = 1.6) were associated with a daily consumption of 10 cigarettes. In conclusion, the amount of cigarettes currently smoked may add a negative effect to that caused by lifetime cigarette consumption on respiratory symptoms and lung function. Moreover, the use of diffusing capacity in general population surveys is advi

ISSN:0025-7931    

DOI:10.1159/000195946

出版商:S. Karger AG    

年代:1991

数据来源: Karger