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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Restrictive lung disease patients exhibit a wide range of breathing and oxygenation abnormalities during sleep. The combination of degree of restriction, whether it is intrapulmonary or extrapulmonary, and confounding factors, such as obesity, age, and sex, will ultimately determine the degree of disturbed nocturnal physiology. The sleep literature is still sparse in most restrictive diseases. For patients with interstitial lung disease, the role of nocturnal oxygen in chronic established fibrosis, and also in acute alveolitis (e.g., farmer's lung, bird fancier's lung, etc.), has not been addressed. As fibrotic lung disease progresses, the degree of nocturnal desaturation and breathing dysrhythmias will progress. Changes in sleep architecture are likely related to the progression of the disease, but this is not known with certainty. Long-term evaluation of sleep and breathing in interstitial lung disease will give further insight into whether or not sleep changes are primary or secondary events. For kyphoscoliosis patients, again, we need more information on sleep as the thoracic deformity changes. In addition, the use of drugs (acetazolomide, medroxyprogesterone, and almitrine) and/or nasal CPAP to treat nocturnal desaturation needs to be assessed in a controlled fashion. In neuromuscular disease, the dynamics of gas exchange and sleep structure need to be defined in a larger group of patients. Factors such as degree of muscle weakness, degree of underlying lung diseases, and medications must be taken into consideration. Nocturnal hypoxemia may cause muscle weakness and fatigue, which in time, could cause more nocturnal hypoventilation and further hypoxemia. Supplemental nocturnal oxygen should be evaluated in this population.
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PMID:Sleep in restrictive lung disease. 331 24

Pulmonary complications remain the most important cause of postoperative morbidity and mortality. The many advances of modern surgical care over the last 30 years have not appreciably altered the incidence of these complications. Many risk factors have been shown to contribute to this problem, but no studies have examined the impact of preoperative protein depletion on respiratory function and related this to the development of postoperative pulmonary complications. 80 patients (42 men, 38 women, median age of 64 years, with a range of 15-91 years) awaiting major elective gastrointestinal (G.I.) surgery were divided into two categories on the basis of a direct measurement of protein depletion: nonprotein-depleted patients (n = 41, mean protein loss, 2% +/- 1.7 SEM) and protein-depleted patients (n = 39, mean protein loss, 36% +/- 3.5 SEM). There was no significant difference between these two categories in regard to age, height, sex, surgical diagnosis, the presence of chronic lung disease, smoking, proportion of upper abdominal incisions, degree of obesity, the duration of anesthesia, and the use of prophylactic antibiotics and physiotherapy. There was a significant difference between these two categories of patients in regard to respiratory muscle strength (p less than .025), vital capacity (p less than .05), and peak expiratory flow rate (p less than .005). Pneumonia developed in a significantly higher proportion of protein-depleted patients with atelectasis (p less than .05), and their stay in the hospital after surgery was longer (p less than .05). These data show that protein depletion is associated with an impairment of respiratory function, and is in itself a significant risk factor in the development of postoperative pneumonia.
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PMID:Risk factors for postoperative pneumonia. The importance of protein depletion. 340 Oct 64

We report the total clinical experience for one family medicine resident who documented every patient encounter during his three years of residency training, and compare experience with model practice patients with that in other training sites. There were 7,671 encounters with 4,449 patients, for 17,660 problem contacts and 679 procedures. Encounter and problem activity for model practice patients constituted one fifth of the total experience. Model practice patients were older than patients, and were seen more often in the office than in the hospital. Most clinical experience with acute infections, depression, and obesity was gained with model practice patients. Most experience with pneumonia, normal delivery, myocardial infarction, and chronic lung disease was acquired with other patients, and most procedures were performed on them. Personal patients of the resident within the model practice provided the greatest experience with continuity of care. These data support the value of the model practice as an important supplement to traditional hospital-based patient populations for training family physicians.
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PMID:Clinical experience during family medicine residency training. 360 11

Total respiratory resistance (R(T)) was measured by the application of a sine wave of airflow to the mouth at the resonant frequency of the respiratory system. The mean respiratory resistance of 42 normal subjects, measured at a mean functional residual capacity of 3.3 liters, was 2.3, SD +/- 0.5, cm H(2)O/liter per sec, and the resonant frequency was between 5 and 8 cycle/sec. The airway resistance measured in these same subjects with the body plethysmograph at a mean panting thoracic gas volume of 3.5 liters was 1.3, SD +/- 0.3, cm H(2)O/liter per sec. Total respiratory resistance was found to vary inversely with lung volume (V) measured plethysmographically; prediction formulae for normal subjects based on this relationship are: R(T) (mean) = 7.1/V, R(T) (range) = 4.0/V to 11.6/V where V is in liters and R(T) is in cm H(2)O/liter per sec. When these criteria were applied to subjects with thoracic disease the following results were obtained: 17 subjects with obstructive lung disease all had elevated total respiratory resistance; 9 subjects with diffuse lung disease without airway obstruction all had normal respiratory resistance; all but 1 of 5 obese subjects and all but 2 of a heterogeneous group of 9 subjects without airway obstruction had normal respiratory resistance. Failure to take lung volume into account resulted in a considerable decrease in the ability to discriminate between obstructive and nonobstructive lung disease on the basis of the forced oscillation test. The resonant frequency of the respiratory system of patients with obesity or nonobstructive lung disease was similar to that obtained in the normal group; accurate evaluation of resonant frequency in subjects with obstructive lung disease was frequently not possible. The combined resistances of lung, thoracic wall and abdominal tissues were found to account for less than 43% of the total respiratory resistance in normal subjects and were only slightly increased by the presence of obesity, restrictive diseases of the thoracic wall, and hyperinflation of the thorax. The forced oscillation method is potentially of value in the study of resistance to breathing of patients who cannot undergo body plethysmography, such as acutely ill, anesthetized, or unconscious subjects. Accurate evaluation of R(T) requires an independent measure of lung volume as well as careful attention during measurements to the airflow rate, phase of respiration, and the adequacy of cheek compression and laryngeal relaxation.
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PMID:Evaluation of the forced oscillation technique for the determination of resistance to breathing. 567 25

The pathophysiological basis of pulmonary atelectasis is reviewed and risk factors that enhance lung collapse are discussed. Management strategies to reduce or eliminate risk factors and to prevent collapse are discussed and the rational bases of these strategies are identified. Instability of lung alveoli is a consequence of surface tension and regional differences in alveolar size. The inherent tendency of alveoli to collapse is enhanced by the following risk factors; low lung volume, high closing volume, oxygen therapy, a rapid shallow ventilatory pattern, chronic lung disease, smoking, obesity, postoperative pain following abdominal or thoracic surgery, narcotic induced ventilatory depression, and neurological, neuromuscular, muscular and musculoskeletal diseases associated with mechanical impairment of respiratory function. The primary goal of perioperative respiratory management is prevention of atelectasis. Appropriate management strategies include physiotherapy and delay of elective surgery if substantial improvement in respiratory status can be achieved by specific treatments such as antibiotics, bronchodilators, steroids, and reduction of tobacco use and caloric intake. In selected cases, elective postoperative controlled ventilation may be indicated.
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PMID:Pulmonary atelectasis after anaesthesia: pathophysiology and management. 611 89

In 1978, the Centers for Disease Control initiated a multicenter prospective study to assess the safety of the various female sterilizing operations and the ways in which they could be made safer. During the first 31 months, 3500 women who underwent interval laparoscopic tubal sterilization by electrocoagulation or Silastic banding without other concurrent operations were enrolled in the study. When a standard definition of complications was used, the overall rate of an intraoperative or postoperative complication was 1.7 per 100 women. Several patients factors increased the risk of complications twofold or more: diabetes mellitus, previous abdominal or pelvic surgery, lung disease, a history of pelvic inflammatory disease, and obesity. There was a fivefold difference in complication rates between procedures performed under general anesthesia and those done under local anesthesia.
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PMID:Complications of interval laparoscopic tubal sterilization. 621 31

472 randomly selected men and women from the city of Lund were examined for disease in the heart, lungs and for hypertension. 163 men and 194 women who had no symptom or sign of disease were accepted for the further study. The prevalence of various exclusion criterias, such as symptoms and signs of heart disease, lung disease and other diseases which may possibly affect the ECG are reported as well as the distribution of blood pressures in the sample. A computer-averaged standard 12-lead ECG (leads aVL, I, -aVR, II, aVF, III, V1-V6) was recorded. All measurements of ECG-deflections have been made visually using a magnifying glass (6 times). ST-segments were classified according to the Punsar code by independent visual observers as well as by the computer. The mean frontal QRS-axis shifted to the left with advancing age, but the shift was statistically significant only in men. In both men and women there was a leftward shift of the mean frontal QRS-axis with increased weight, increased chest circumference and increased obesity index. The normal range of axis was found to be 0 degrees to 90 degrees in men and +15 degrees to 90 degrees in women. The problems concerning the definition of the electrical heart position is discussed. The concept of a Q-axis is introduced as an alternative way to indicate electrical heart position. There is a statistical significant relationship between the Q-axis and the QRS-axis in the frontal plane, although this relationship is not always apparent in the individual ECG. The presence or absence of a Q-wave in an individual lead was used to denote a lead as being a left ventricular lead or not. Using the Q-wave as a marker of heart position in the individual lead is more practical than to use the QRS-axis or the transitional zone. Duration and amplitude of the Q-wave have been measured. The upper limit of normal duration exceeded 0.03 s in leads aVL and aVF in men but not in women. The R-wave amplitudes proved to vary with age and heart position in men. In women variation of the R-wave amplitude was found with heart position but not with age.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:On the normal scalar ECG. A new classification system considering age, sex and heart position. 624 Jan 93

Vigorous respiratory therapy can prevent the development of postoperative pulmonary complications which occur with increased frequency after upper abdominal surgery. Obesity poses an additional risk factor. To study the effects of postoperative chest percussion with postural drainage (CPT), 53 consecutive patients undergoing Roux-en-Y gastric stapling procedures for treatment of morbid obesity were randomized to two groups. Both received identical postoperative respiratory care, except the study group received additional CPT. It was concluded that the addition of CPT to patients without prior chronic lung disease undergoing upper abdominal surgery caused patient discomfort, increased hospital cost, and failed to affect the incidence of postoperative pulmonary complications.
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PMID:Postoperative chest percussion with postural drainage in obese patients following gastric stapling. 649 53

Forced vital capacity (VC) and forced expiratory volume at 0.75 s (FEV) were measured in 592 Cretan island men aged 25 to 74 in 1960, 1965, and 1970. Vital capacity and FEV were directly correlated with height, but percentage changes were unrelated to height. A prominent accelerating decrease with age was also observed, the longitudinal decrement becoming more marked with advancing age. Chronic obstructive lung disease at entry significantly accelerated the loss of lung capacity, more so for emphysema than for chronic bronchitis. Among heavier men, body weight gains intensified the age-dependent loss of vital capacity and FEV. Borderline statistically significant differences in FEV decreases (adjusted for age, height and entry FEV) were seen between cigarette smoking groups. Heavy smokers had more diagnoses of chronic bronchitis and emphysema. Modifiable factors in minimizing the decrease of lung capacity with age include obesity, obstructive lung disease, and smoking, the last through development of chronic obstructive lung disease.
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PMID:Longitudinal versus cross-sectional vital capacity changes and affecting factors. 661 Jun 99

Obesity, because it alters the relationship between the lungs, chest wall, and diaphragm, has been expected to alter respiratory function. We studied 43 massively obese but otherwise normal, nonsmoking, young adults with spirometry, lung volume measurement by nitrogen washout, and single-breath diffusing capacity for carbon monoxide (DLCO). Changes in respiratory function were of two types, those that changed in proportion to degree of obesity--expiratory reserve volume (ERV) and DLCO--and those that changed only with extreme obesity--vital capacity, total lung capacity, and maximal voluntary ventilation. When compared with commonly used predicting equations, we found that mean values of subjects grouped by degree of obesity were very close to predicted values, except in those with extreme obesity in whom weight (kg)/height (cm) exceeded 1.0. In 29 subjects who lost a mean of 56 kg, significant increases in vital capacity, ERV, and maximal voluntary ventilation were found, along with a significant decrease in DLCO. Because most subjects fell within the generally accepted 95% confidence limits for the predicted values, we concluded that obesity does not usually preclude use of usual predictors. An abnormal pulmonary function test value should be considered as caused by intrinsic lung disease and not by obesity, except in those with extreme obesity.
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PMID:Effects of obesity on respiratory function. 661 44


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