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The pulmonary complications remain the prime cause of morbidity and mortality in sickle cell disease. The pathogenetic mechanisms consists both of an alteration of the rheological properties of the blood, the existence of a hypercoagulability state and above all specific interactions between the abnormal sickle cells and the vascular endothelium and a dysregulation of the vascular reactivity in which nitrous oxide intervenes. The acute chest syndrome (ACS) is characterised by chest pain with dyspnoea and recent radiological abnormalities and it is an acute lung complication whose problem is one of aetiology. The infectious pneumonias are rarely documented. On the other hand, alveolar hypoventilation linked to infarcts of the thoracic ribs, thoracoabdominal trauma, subdiaphragmatic pain, the administration of analgesics causing respiratory depression, obesity or sleep disturbance are frequent causes of ACS. Bronchoalveolar lavage has revealed a frequency of fat emboli following infarcts in the long bones. Pulmonary emboli is rarely a cause. Pulmonary thrombosis is a serious complication, the diagnosis is difficult and is seen in a predisposed clinical setting. The treatment of ACS rests on controlled hydration and antibiotic therapy, oxygen therapy and controlled analgesic therapy. The indications for blood transfusion and for exchange transfusion merits a better evaluation. In the long term patients with sickle cell disease present with a failure of normal thoracopulmonary growth with a restrictive ventilatory defect and progressive diminution in the transfer factor of carbon monoxide with age. A history of ACS favours chronic lung disease. Pulmonary arterial hypertension is less frequent.
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PMID:[The sickle cell anemia lung from childhood to adulthood]. 960 86

Ten boys and 15 girls below the age of 16, were referred to the National Hospital in Norway for evaluation for heart or lung transplantation 1990-97. 24 of the children and their families went through a thorough psychosocial assessment in order to assess the supportive measures the children and their families might need for coping with stress during the evaluation and the follow-up period. The patients were divided into three diagnostic groups: Two had cystic fibrosis and one an obstructive lung disease, heart-lung group, eight had congenital heart disease and 13 cardiomyopathy. 15 children were accepted for transplantation and placed on the waiting list. The others were rejected for medical reasons. Seven children (29%) filled the criteria for a psychiatric diagnosis (six anxiety disorders and one depression). Five others had considerable anxiety symptoms. The cardiomyopathy group had fewer problems than the heart-lung and congenital heart disease groups. The study shows that families with children suffering from life-threatening disease live with a great deal of stress and are in need of help and support. Many families are either not aware of their rights or too exhausted to seek help.
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PMID:[Chronic heart or lung disease and psychosocial stress]. 1008 52

Inverse ratio ventilation (IRV) differs from other ventilatory techniques in that it employs a prolonged inspiratory time. In theory, pressure-control IRV allows you to maintain ventilation and oxygenation with lower peak airway and end-expiratory pressures; this may reduce the potential for lung damage secondary to shearing forces. Consider pressure-control IRV for patients with acute lung disease characterized by low lung compliance, diffuse microatelectasis, and increased intrapulmonary shunting. Currently, the chief limitation of this technique is that the patient cannot breathe spontaneously during its use. The best inspiratory to expiratory ratio is the shortest inspiratory time that improves oxygenation with minimal hemodynamic compromise; depression of cardiac output will negate any potential improvement in arterial oxygenation.
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PMID:The technique of inverse ratio ventilation. Steps to improve oxygenation and decrease dead space ventilation. 1014 55

The 30 patients who underwent lung transplantation between 1990 and 1996 were included in this study, and data were analyzed to find predictors of 1-year survival posttransplantation. All patients were followed throughout the posttransplantation period. Fifteen patients had a pretransplantation diagnosis of an anxiety and/or depressive disorders. Of the 30 patients transplanted, 19 survived 12 months or more, and 11 died less than 12 months posttransplantation. The > 12-month survival group had a mean age of 45.2 years at transplantation, compared with a mean age of 43.0 years in the < 12-month group (NS). The mean Psychosocial Assessment of Candidates for Transplant score and premorbid history of smoking did not differ between the groups. The > 12-month survival group had more psychiatric illness pretransplantation than the < 12-month survival group (56% vs. 27%, P < 0.05). The recipients with a psychiatric history (N = 15) were more likely to survive 1 year posttransplantation than the recipients without a psychiatric history (80% vs. 47%, P < 0.05) and were not significantly different from the recipients without a psychiatric history in terms of episodes of rejection, bronchiolitis obliterans, or noncompliance with treatment. Depression and anxiety are treatable disorders that occur frequently in patients with end-stage lung disease, and a premorbid history of either did not predict a worse outcome posttransplantation in this study of lung transplantation recipients.
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PMID:Psychiatric disorders and survival after lung transplantation. 1040 73

The symptoms associated with chronic lung disease can impair quality of life and psychosocial functioning. The purpose of the present study was to provide a thorough baseline assessment of quality of life in patients with end-stage lung disease and being evaluated for transplant; and to assess potential differences in quality of life between patients with cystic fibrosis (CF) and those with other types of end-stage lung disease (e.g., chronic obstructive pulmonary disease (COPD), interstitial pulmonary fibrosis (IPF)). We evaluated 58 patients with CF and 52 patients with other types of end-stage lung disease who were recruited for this study during an assessment of their candidacy for lung transplant. Subjects completed a battery of questionnaires that assessed demographic factors (including work and educational status), the presence of psychological distress (anxiety and depression), availability of social support, coping styles, and physical functioning. Despite significant impairment in physical functioning in the areas of recreation, household activities, sleep, and ambulation, other indices of life quality suggested good adaptation in the majority of patients. Also, quality of life differed for patients with CF and for those with other types of end-stage lung disease. Patients with CF were more likely to be working, had lower levels of anxiety and higher levels of social support, and used more functional coping strategies than did patients with other end-stage lung disease. These results highlight the fact that patients with different types of lung disease may require different psychosocial services as they await transplant. These findings also raise the question of whether there is a difference in quality of life after transplant between patients with CF and those with other types of lung disease.
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PMID:Quality of life in patients awaiting lung transplant: cystic fibrosis versus other end-stage lung diseases. 1110 56

It has been hypothesised that there is a relationship between depression and mortality rate. Some earlier studies have confirmed this relationship, but others have not. In the present study the association was examined between depressive symptoms and mortality in the inhabitants of ten residential homes for the elderly in The Netherlands. Four hundred and twenty-four subjects who were not cognitively impaired, and who participated in an intervention study, were included. One year after the initial interview, they were contacted again and it was found that 69 (16.3%) had died. In the initial interview, depressive symptoms and psychological distress were assessed with the Geriatric Depression Scale and the mental health subscale of the MOS-SF-20. The following correlates of depression were assessed: functional impairment, earlier depression, pain, social support, loneliness, and the presence of seven common chronic illnesses. In bivariate analyses no significant relationship was found between depression and mortality, while controlling for living in an experimental or control home. In logistic regression analyses with mortality as the dependent variable and depressive symptoms, demographic variables, and correlates of depression as predictors, no significant relationship between depression and mortality was found either. It is concluded that no evidence was found in this population for a significant relationship between depression and mortality. Mortality was related to measures of social support, to activities of daily living, and to the presence of chronic non-specific lung disease.
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PMID:Mortality and depressive symptoms in inhabitants of residential homes. 1124 17

We explored change in mothers' evaluations of their caregiving through the first postterm year for full-term infants and for prematurely born, very low birth-weight infants with a history of lung disease, and we examined the contribution to this evaluation of infant, family, and mother conditions. Fifty-four mothers of premature infants and 49 mothers of full-term infants evaluated their caregiving relationship, performance, and satisfaction at 1, 4, 8, and 12 months infant postterm age. In addition, at the same intervals-1, 4, 8, and 12 months-mothers rated their symptoms of depression, infant responsiveness, and satisfaction with help from husband or partner. Positive and negative feeding behaviors of mother and of infant were rated from videotapes. Regression analysis, which included all rated variables, infant birth maturity/lung health status, and number of children in the mother's care, showed that the 1-month assessment differed significantly from the assessments at 4, 8, and 12 months. All conditions, except for infant birth maturity/lung health status and mother's positive feeding behavior, were significantly associated with caregiving evaluation. Findings support inclusion of infant, family, and mother conditions in a caregiving evaluation model. Infant responsiveness may be particularly salient to a mother's caregiving evaluation.
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PMID:Mothers' evaluation of their caregiving for premature and full-term infants through the first year: contributing factors. 1152 15

We report 6 patients in whom diffuse alveolar damage (DAD) was found on 1 or more lung biopsy specimens and who experienced recurrent episodes of acute respiratory failure. The patients ranged in age from 43 to 55 years. Two to five episodes of respiratory failure occurred in each over a period of 4 months to 2 years. One patient developed evidence of chronic lung disease; while the others remained well between episodes. Lung biopsies showed the acute stage of DAD in 3, overlapping acute and organizing stages in 3, and the organizing stage in 2. A definite cause was not identifiable in any. However, 4 had been treated with narcotics for chronic pain before the first episode, and 1 received this treatment before the recurrent episode. Three also were receiving psychotropic drugs for anxiety and depression. Five patients had evidence of gastroesophageal reflux disease (GERD) and/or hiatal hernia, 2 of whom underwent Nissen fundoplication in hopes of preventing future recurrences. Although a definite cause of the recurrent DAD was not identified, the findings suggest the possibility of a reaction to narcotics and/or psychotropic drugs in some patients, with a possible additional effect of GERD. A drug history should be carefully elicited in patients with recurrent DAD, and all potentially toxic drugs should be stopped.
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PMID:Diffuse alveolar damage and recurrent respiratory failure: report of 6 cases. 1177 76

Individuals with moderate-to-severe psoriasis perceive that the disease exerts profound emotional, social and physical effects on their lives, and a significant percentage report that they do not consider their treatment sufficiently aggressive. A survey of individuals with a variety of chronic diseases reveals that those with psoriasis have the lowest estimation of their health-related quality of life, lower than that of patients with arthritis, congestive heart failure, chronic lung disease or depression. Although psoriasis can be treated effectively, many treatments are associated with long-term risks. Toxicity-sparing treatment strategies that include combination, rotational and sequential regimens can help to control moderate-to-severe psoriasis while reducing risk. Algorithms for the treatment of moderate-to-severe psoriasis detail possible options for specific types of psoriasis and for patients with specific needs. The purpose of the algorithms is to make optimum use of phototherapy, traditional cytotoxic and immunosuppressive agents, retinoids, and newer biologic agents.
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PMID:Case studies in severe psoriasis: A clinical strategy. 1457 96

Acute respiratory failure is a common complication of drug abuse. It is more likely to develop in the setting of chronic lung disease or debility in those with limited respiratory reserve. Drugs may acutely precipitate respiratory failure by compromising respiratory pump function and/or by causing pulmonary pathology. Polysubstance overdoses are common, and clinicians should anticipate complications related to multiple drugs. Impairment of respiratory pump function may develop from central nervous system (CNS) depression (suppression of the medulla oblongata, stroke or seizures) or respiratory muscle fatigue (increased respiratory workload, metabolic acidosis). Drug-related respiratory pathology may result from parenchymal (aspiration-related events, pulmonary edema, hemorrhage, pneumothorax, infectious and non-infectious pneumonitides), airway (bronchospasm and hemorrhage), or pulmonary vascular insults (endovascular infections, hemorrhage, and vasoconstrictive events). Alcohol, cocaine, amphetamines, opiates, and benzodiazepines are the most commonly abused drugs that may induce events leading to acute respiratory failure. While decontamination and aggressive supportive measures are indicated, specific therapies to correct seizures, metabolic acidosis, pneumothorax, infections, bronchospasm, and agitation should be considered. Drug-related respiratory failure when due to CNS depression alone may portend well, but in patients with drug-related significant pulmonary pathology, a protracted course of illness may be anticipated.
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PMID:Acute respiratory failure from abused substances. 1529 19


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