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This paper attempts to discuss the shape of inequalities in health in the Republic of Ireland by focusing on social class, gender and regional inequalities in health outcomes as shown in annual publications of vital statistics and in various research studies. The Republic of Ireland has a demographic profile of rapid population increase, unique in Europe. While the birth rate is the highest in Europe, the infant mortality rate is relatively low, yet the perinatal mortality rate is relatively high. Attempts are made to analyse social class variations in mortality and morbidity rates but, except for psychiatric care, Irish data on health by social class are scarce. There exist more data on gender inequalities which pinpoint the particular vulnerability of Irish women to ischaemic heart disease and certain types of cancer. Regional analysis of vital statistics reveals the vulnerability of people in urban areas (compared to rural areas) to cancer of the trachea, bronchus and lung, cirrhosis of the liver, tuberculosis of the respiratory system, pneumonia, and bronchitis, emphysema and asthma. In comparison to several European countries, Irish standardized mortality rates were the worst for urban women dying from lung cancer, and for urban men and women, Irish standardized mortality rates were the worst for non-rheumatic heart disease and respiratory tuberculosis. Various studies of morbidity of the elderly clearly reveal the hidden clinical iceberg of symptoms which are not presented to the health care system. Unfortunately, there is relatively little evidence of the health situation of disabled people, the travelling community or the long term unemployed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Health and social inequities in Ireland. 221 9

A case-control study of lung cancer involving interviews with 965 female patients and 959 controls in Shenyang and Harbin, two industrial cities which have among the highest rates of lung cancer in China, revealed that cigarette smoking is the main causal factor and accounted for about 35% of the tumours among women. Although the amount smoked was low (the cases averaged eight cigarettes per day), the percentage of smokers among women over age 50 in these cities was nearly double the national average. Air pollution from coal burning stoves was implicated, as risks of lung cancer increased in proportion to years of exposure to 'Kang' and other heating devices indigenous to the region. In addition, the number of meals cooked by deep frying and the frequency of smokiness during cooking were associated with risk of lung cancer. More cases than controls reported workplace exposures to coal dust and to smoke from burning fuel. Elevated risks were observed for smelter workers and decreased risks for textile workers. Prior chronic bronchitis/emphysema, pneumonia, and recent tuberculosis contributed significantly to lung cancer risk, as did a history of tuberculosis and lung cancer in family members. Higher intake of carotene-rich vegetables was not protective against lung cancer in this population. The findings were qualitatively similar across the major cell types of lung cancer, except that the associations with smoking and previous lung diseases were stronger for squamous/oat cell cancers than for adenocarcinoma of the lung.
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PMID:Lung cancer among women in north-east China. 225 30

Between 1980 and 1989 46 lung resections were performed in 45 children (0-9 years of age) for recurrent or persistent "atelectasis". Indications for surgery were intralobar sequestration (6), bronchial malformations and stenoses (7), chronic pneumonia following infection or aspiration (11), bronchiectases (4), pyocele associated with pulmonary artery ligation (1), upper lobe torsion (1), compression by cysts (6) or lobar emphysema (10). Overall mortality: 4/45 (2 of them within 4 weeks postoperatively) secondary to long-term artificial ventilation and associated or intercurrent disturbances.
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PMID:[Surgical indications in persistent atelectasis in early childhood]. 229 59

A 22 year-old man was brought to our hospital about twenty-three minutes following a high-speed motorbicycle accident in which he had blunt chest trauma. He was in severe respiratory distress with marked dyspnea and restless with extensive subcutaneous emphysema involving anterior chest wall, cervical and bilateral inguinal regions. A chest X-ray revealed bilateral pneumothorax involving mediastinal emphysema and also fracture of right submandibular and clavicula. In spite of orotracheal intubation and insertion of bilateral chest tube, continuous air leak and pneumothorax did not improve. Bronchoscopy revealed the disruption of mucosa of the right main bronchus at the bifurcation. Emergency right thoracotomy was performed and there was the complete disruption of the right main bronchus. Anastomosis of the right main bronchus with circumferential resection was undertaken on May 30, 1987 about two hours after trauma. About three months after reconstruction, bronchoscopic examination revealed stomal stenosis with deformation of tracheobronchial cartilage and granulation. The stenosis showed severe irregularity by deformed cartilage and thickened scar, so widening by Nd-YAG laser vaporization was inadequate in effect. Seven months after first reconstruction, we performed re-reconstructive operation, right upper sleeve lobectomy with partial resection of carcina and right wall of trachea for scar with severe deformation of cartilage. Following the operation, the patient suffered from sepsis with pneumonitis accompanied by lung edema. This complication was treated successfully. We considered that acute pneumonitis was caused by reventilation with increase of perfusion after tracheobronchial reconstruction. Consequently, we thought it important to treat such patients with long term IPPB postoperatively with adequate medication for respiratory system.
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PMID:[Successful re-reconstruction for complete disruption of the right main bronchus by blunt chest trauma]. 232 99

Neither pneumothorax or mediastinal emphysema are well recognized pulmonary manifestations of systemic lupus erythematosus (SLE). We describe a 41-year-old woman with severe lupus pneumonitis complicated by recurrent pneumothoraces and mediastinal emphysema. Other features of SLE were minimal. She died of progressive respiratory failure. Autopsy revealed innumerable blebs in both lungs responsible for the pneumothoraces and mediastinal emphysema. Both pneumothoraces and mediastinal emphysema occurred during a course of corticosteroid therapy. The course of her illness was unaffected by treatments that included high dose corticosteroids, immunosuppressives and plasmapheresis. Better medical treatment for these lupus complications should be sought in addition to surgery.
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PMID:Recurrent pneumothoraces and mediastinal emphysema in systemic lupus erythematosus. 234 34

Mixed connective tissue disease (MCTD) may result in various different pulmonary manifestations. Thus radiology may reveal pleuritis, pneumonia, pulmonary fibrosis, emphysema or cor pulmonale. Pulmonary function tests may disclose restrictive or obstructive disturbances frequently, as well as alveolar hypoventilation and impairment of diffusion. Relevant exemplary cases are discussed on the basis of chest X-rays and the results of clinical and pulmonary function tests. MCTD has a predilection for the pulmonary system and the diagnosis, course and treatment of this severe disease are largely determined by the pulmonary lesions.
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PMID:[Examples of pulmonary changes in patients with collagen diseases]. 236 27

We evaluated the therapeutic efficacy of ceftibuten (CETB, 7432-S), a new cephem antibiotic for oral use, in chronic respiratory tract infections. A daily dose of 400 mg (b.i.d.: 15 cases) or 600 mg (t.i.d.: 5 cases) of CETB was given orally for 3-14 days (mean: 10.6 days) to 20 patients: 9 with infected bronchiectasis, 3 with infection supervened on pulmonary emphysema, 3 with acute pneumonia (supervened on bronchiectasis in 2 of 3 cases), 2 with infected bronchial asthma, 1 each with infection supervened on old pulmonary tuberculosis, chronic bronchitis and pulmonary fibrosis. The clinical effects were excellent in 3, good in 11, fair in 3 and poor in 3. Eighteen strains were identified as causative organisms. Eight of 15 strains for which bacteriological responses were evaluable were eradicated by the use of CETB. Eosinophilia in 2 patients and an elevation of S-GPT value was observed in 1 patient. These adverse reactions disappeared after the completion of the therapy. From the above results, we conclude that CETB is one of the most useful antibiotics for oral use as a first choice in chronic respiratory tract infections.
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PMID:[Therapeutic efficacy of ceftibuten in chronic respiratory tract infections]. 239 48

The results of clinical and anatomical studies of acute respiratory insufficiency in patients suffering from hypotensive reactions caused by blood loss, shock, fat and thromboembolism and by acute left ventricular insufficiency are discussed. The role of impaired pulmonary circulation due to general circulatory disturbances in the development of acute respiratory insufficiency and the role of this syndrome in the onset of bilateral polysegment pneumonia after trauma and surgery are demonstrated. Acute diffuse alveolitis, interstitial intraalveolar edema, with the formation of hyalin membranes, atelectasis and emphysema are the main morphological signs of acute respiratory insufficiency. Massive infusion-transfusion therapy may aggravate acute respiratory insufficiency.
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PMID:[Clinico-anatomic characteristics of acute respiratory insufficiency occurring after trauma and surgical interventions]. 239 70

Levels of serum elastase 1 in a variety of respiratory diseases were studied. In patients with pulmonary emphysema, pulmonary fibrosis, bronchial asthma, or pulmonary infections, including pneumonia and pulmonary tuberculosis, serum elastase 1 levels were greater than those of an age-matched control group. In lung cancer patients, however, the serum elastase 1 level was within normal limits. Although alpha 1-antitrypsin levels were significantly higher in patients with pulmonary infections and lung cancer than in the normal group, they were within normal limits in patients with pulmonary emphysema, pulmonary fibrosis, and bronchial asthma. Alpha 2-macroglobulin levels were slightly increased in patients with pulmonary emphysema and pneumonia. These results suggest that the increases in serum elastase 1 levels in these respiratory diseases may be mainly caused by an imbalance of elastase/antielastase system in the lung tissue and the bloodstream.
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PMID:Elastase/antielastase systems in pulmonary diseases. 245 93

It may be difficult to decide if respiratory/ventilatory failure in patients with emphysema has resulted from a reversible process, such as pneumonia, acute on chronic bronchitis or cardiac decompensation. Therefore, we favour early institution of mechanical ventilation. Intermittent mandatory ventilation (IMV), continuous positive airway pressure (CPAP) and the new modes of pressure support (PS) help the patient to recover the strength of his musculature. Measures for bronchodilatation, antibiotics and optimal nutrition (including fat calories) allow to successfully wean most patients from the respirator. The prognosis for survival, however, is very uncertain and in general not very promising.
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PMID:[Ventilation problems in emphysema patients]. 264 29


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