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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinical manifestations and autopsy findings on 23 patients who died of acute sepsis of Escherichia coli origin lead the authors to the conclusion on polymorphic clinical run of the disease. It varies with premorbid background (food intoxication, acute respiratory disease in decompensated diabetes mellitus, chronic somatic disorders) and risk factors (inadequate antibacterial therapy, nervous strain, fatigue). Inadequate antibacterial therapy promoting dysbacteriosis aggravated preexisting pathomorphological shifts in the intestine likely after toxic infection, diabetes-specific foci, contributed to the onset of intestinal sepsis.
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PMID:[Acute intestinal infection caused by Escherichia coli]. 208 42

Cardiopulmonary exercise testing is an objective method of assessing the functional capacity of a patient. In contrast to clinical assessment and resting investigations, exercise testing is useful in detecting early changes in patients with cardiac or respiratory disease. Although a number of different types of ergometers can be used for testing, the ones used commonly are the cycle and treadmill. Comparison of these two modes of exercise shows no significant clinical difference between them; therefore, either can be used for routine cardiopulmonary exercise testing. There are various types of exercise protocols, but generally the protocol should involve large muscle groups and should be tolerated by the population being tested. The main goal when selecting an exercise protocol is to strike a balance between workload increments that do not prematurely fatigue the subject and at the same time allow the subject to reach a maximum power output within 8 to 15 minutes. Whatever the exercise test protocol used, the intensity should be increased to a symptom-limited maximum. This procedure is safe as long as contraindications for starting a test and indications for terminating a test are adhered to strictly. The assessment of cardiorespiratory responses during exercise ranges from simple and noninvasive techniques to those that are invasive and complex. In the majority of cases all the information needed for proper assessment of the patient can be acquired with simple noninvasive techniques.
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PMID:Cardiopulmonary exercise testing. 266 Nov 23

To test the relative merits of administering questionnaires with previous responses available (the informed condition) or unavailable (the blind condition), we administered blind and informed versions of a quality of life questionnaire (the Chronic Respiratory Disease Questionnaire, or CRQ) in a randomized, double-blind trial of bronchodilators in chronic airflow limitation. The responsiveness of the two methods, as reflected in the p-values associated with salbutamol and theophylline effects were comparable for three of the four dimensions of the CRQ. The data suggested possible increased responsiveness of the informed method for the emotional function dimension of the questionnaire. Changes in the informed CRQ dyspnea and fatigue dimensions showed stronger correlations with changes in spirometry, 6 minute walk distance, and rating of dyspnea after the walk test than did blind administration. Further, changes in all four CRQ dimensions showed stronger correlations with corresponding global ratings using the informed questionnaire. These results suggest that by letting study subjects see their previous responses the validity of subjective measures of health status in clinical trials can be improved.
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PMID:Should study subjects see their previous responses: data from a randomized control trial. 277 69

Although the respiratory system is not fully developed at birth, the human newborn infant has flexible strategies to sustain breathing and defend blood gas homeostasis in both health and disease conditions. Initially the thresholds for chemoreceptor response to PO2 and PCO2 closely mimic those of the fetus, but the threshold resets to sustain ventilation adequate for blood gas homeostasis appropriate to the extrauterine milieu. The muscles of respiration have been "trained" in utero and effectively assume the function of the respiratory pump, despite their marginal reserve against fatigue. The pliable chest wall is functionally stabilized by the tonic activity of the intercostal muscles, thereby allowing effective ventilation. Finally, expiration is prolonged by the postinspiratory activity of the diaphragm and laryngeal braking as a means of maintaining an elevated lung volume and augmenting FRC. The ventilatory response of the newborn to respiratory disease is limited. The magnitude of the VE response is smaller than that of the adult, and is characterized by an increase in the respiratory rate and a limited increase in the VT. The poor effort reserve of the muscles, especially the diaphragm, predisposes the newborn to muscle fatigue and ventilatory failure. To avoid fatigue, recruitment of accessory muscles occurs, along with laryngeal braking of expiration, thereby decreasing the work of the diaphragm, recruiting new alveoli by an auto-PEEP effect, increasing the FRC volume, and improving gas exchange by an increase in the pulmonary surface area. These mechanisms help to avoid muscle exhaustion and facilitate adequate gas exchange in the presence of lung disease. We do not know precisely the postconceptual age at which the newborn is sufficiently developed to adopt these various defensive strategies of breathing, but the presence of tachypnea and grunting in 28-week-old premature infants suggests that long before term the human infant is capable of remarkable variation in the defense of breathing.
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PMID:Pulmonary and chest wall mechanics in the control of respiration in the newborn. 331 39

In patients with severe respiratory disease, the work of breathing is increased and the respiratory muscles, particularly those of inspiration, may become fatigued. Hitherto, there has been little information on the incidence of respiratory muscle fatigue in acutely breathless patients. We studied 34 patients with severe respiratory disease on admission to hospital when they were most breathless, and then, if possible, 7 to 14 days later after recovery for evidence of sternomastoid muscle fatigue or increased fatigability. Frequency/force curves, numerically expressed as the 20:50 ratio, were carried out in all patients on admission. Three of the 34 patients had evidence of low frequency fatigue (i.e., greater than 15% reduction in 20:50 ratio) in the sternomastoid muscle on admission when first studied (mean +/- SEM 20:50 ratio, 56.3 +/- 1.2%; n = 3). The mean 20:50 ratio in the remaining 31 patients on admission was 75.7 +/- 1.6% (n = 31) compared with 77.8 +/- 1.4% (n = 25) when symptomatically better (p less than 0.05). The mean 20:50 ratio on admission was also significantly lower than the mean 20:50 ratio in a group of age- and sex-matched normal control subjects (i.e., 78.5 +/- 1.4%, n = 25; p less than 0.05). Twenty-five patients were studied completely both on admission and recovery, including a fatigability test that involved the performance of 50 fatiguing head lifts with measurements of the 20:50 ratio 10 and 60 min later. Sternomastoid muscle fatigability was significantly increased on admission when the patients were most breathless, compared with recovery when they were less breathless (p less than 0.001 at both 10 and 60 min).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Sternomastoid muscle function and fatigue in breathless patients with severe respiratory disease. 367 71

Sleep and sleep loss have remarkable effects on breathing. Although sleep causes ventilatory disturbances of greater severity and variety than does sleep deprivation, the effects of sleep and sleep loss on respiration are similar. For example, both impair ventilatory drive and arousal responses to a variety of stimuli. Although the mechanism of impaired ventilation after sleep loss is not entirely understood, there is evidence to suggest that both respiratory muscle fatigue and central nervous system depression play a role. Patients who suffer from both disturbed sleep and lung disease are particularly vulnerable to the adverse effects of sleep disruption on breathing. Since sleep restoration returns many respiratory parameters to normal in sleep-deprived individuals, perhaps we should include rest in our treatment of certain patients with respiratory disease.
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PMID:Sleep, sleep loss, and breathing. 390 14

A heterogeneous group of 146 patients with chronic bronchitis and emphysema were asked to rate the frequency with which 89 symptoms and experiences occurred during their breathing difficulties. Normative values and the reported frequency of occurrence for the 11 symptom categories are presented. As expected, symptoms of dyspnea were the most frequently reported during breathing difficulties. In decreasing order, symptoms of dyspnea were followed by symptoms of fatigue, sleep disturbance, congestion, irritability, anxiety, decathexis, helplessness-hopelessness, poor memory, alienation. Separation of the patients into subgroups revealed that women reported more anxiety and helplessness-hopelessness than men. Younger patients reported more irritability and anxiety than older patients. Patients with mixed disease reported more dyspnea than those with chronic bronchitis or emphysema, although patients with emphysema reported more loss of interest in life than patients with chronic bronchitis. Self-ratings of functional incapacitation were clearly related to the symptom reports. Relationships among the symptom categories were discussed, as was the potential usefulness of symptom patterns in exploring coping styles in respiratory disease.
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PMID:Symptoms and experiences in chronic bronchitis and emphysema. 683 16

The Chronic Respiratory Disease Questionnaire (CRDQ), proposed by Guyatt et al, is a specific instrument used to assess quality of life in patients with chronic obstructive pulmonary disease (COPD). Our aim was to translate the questionnaire and validate it so that it could then be used as a measurement instrument in programs of respiratory rehabilitation. Sixty-five patients with COPD who were candidates for breathing therapy were enrolled in the study. Mean age was 64 +/- 7 years and all had severe air flow limitation, with FEV1 33 +/- 13% over reference values but not respiratory failure (pO2 70 +/- 10 mmHg). The questionnaire was subjected to a process of translation/back translation and disagreements over wording were discussed by a panel of bilingual speakers and the author himself. The validation process involved the following steps: 1) a comprehension study with a group of 5 patients, which revealed no special difficulties; 2) analysis of internal consistency or reliability by way of Crombach's alpha coefficient, which gave and overall score of 0.92 and area scores of 0.51 for dyspnea, 0.8 for fatigue, 0.86 for emotional factors and 0.84 for disease control, and 3) analysis of correlation between various lung function parameters and exercise test results (6 min of increasing effort and a stationary cycle), which showed weak but statistically significant correlations that were comparable to those found by the author of the original CRDQ.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The Spanish translation and evaluation of a quality-of-life questionnaire in patients with chronic obstructive pulmonary disease]. 778 80

A pilot study was done to evaluate criterion-related validity and test-retest reliability of the Chronic Respiratory Disease Questionnaire (CRQ). The CRQ examines how chronic obstructive pulmonary disease (COPD) effects quality of life, and evaluates four dimensions: dyspnea, fatigue, emotional function, and mastery. The pilot study did not establish validity. One of the dimensions, mastery, did not correlate with any of the criterion instruments. Reliability was demonstrated when the instrument was retested after 9 days. The recommendation, based on this research, is that the CRQ may be useful in clinical settings, but not for research.
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PMID:Validity and reliability of a quality-of-life instrument: the chronic respiratory disease questionnaire. 817 19

Lung cancer is the number one cause of cancer-related death for women in the United States, yet studies describing the experience of women living with lung cancer are nonexistent. A sample of 69 women with lung cancer described their symptom distress using the Symptom Distress Scale (SDS). The majority of the women (86%) had been diagnosed with primary or recurrent lung cancer within the 2 years previous, 78% had non-small-cell lung cancer, and 43% were currently receiving treatment. The most prevalent and most distressing symptoms included fatigue, frequent pain, and insomnia. Poor outlook, dyspnea, and appetite disruptions were other common distressing problems. Sixty-one percent of the subjects had two or more serious symptoms. Forty-one percent of those subjects with fatigue concurrently experienced frequent pain, and 31% had insomnia. Those with recurrent disease had significantly greater levels of distress (P = 0.03). Concurrent respiratory disease, previous chemotherapy, recurrent lung cancer, no surgical treatment, and low income were associated with a high level of symptom distress (P < 0.05). Treatment was not a significant factor relating to distress. Distress was strongly correlated to quality of life (r = 0.72, P < 0.001) and functional status (r = 0.71, P < 0.001). Poverty-level income was a weak predictor of distress among demographic and disease/treatment variables, accounting for 17% of the variance. Combined with recurrence, the model accounted for 26% of the variance.
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PMID:Correlates of symptom distress in women with lung cancer. 832 26


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