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Query: UMLS:C0034065 (pulmonary embolism)
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In 75 patients with various pulmonary disorders, ventilation and perfusion scans were obtained in multiple views with the 81mKr/99mTc technique and compared with an evaluation of regional ventilation and perfusion derived from the standard chest radiograph. In emphysema, the chest film correlated poorly with ventilation-perfusion scans, showing a trend to underestimate the functional impairment. In chronic bronchitis and asthma, large segmental defects observed on both ventilation and perfusion scans were associated with a normal chest radiograph. Typical findings in pulmonary embolism were segmental defects on perfusion scan with normal ventilation scan and clear lung fields on the chest film. In chronic left heart disease, plain films were inaccurate in predicting alteration of the base-to-apex perfusion gradient observed on the scan.
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PMID:81mKr ventilation and 99mTc perfusion scans in chest disease: comparison with standard radiographs. 41 42

In an intensive care unit an important role is assigned to respiratory physiotherapy. Its principal task is efficacious toilet of the bronchi by fluidifying the secretions, promoting their ungluing from the respiratory tree and facilitating their evacuation by cough or by aspiration with a catheter or bronchoscope. The technique comprises the inhalation of a secretolytic (e.g. Bisolvon, NaCl 9%) and, in the case of asthma, bronchospasmolytic (e.g. Ventoline) aerosol followed by breathing exercises. The other objectives of physiotherapy are to ensure a better distribution of inspired air, increase failing ventilation, ameliorate disturbed gas exchange, relax the contracted respiratory muscles and prevent bronchiolar collapse in emphysema during expiration. The field of application of respiratory physiotherapy is large; its purpose is prophylactic and therapeutic. The method is prophylactic in all patients confined to bed, where there is a risk of bronchial obstruction or ventilatory failure, especially in those with severe operation, traumatism or consciousness disorder. Physiotherapy has a therapeutic role in several, principally broncho-pulmonary diseases, such as asthma, obstructive emphysema, pneumonia, bronchiectasis, pulmonary abscess, atelectasis, and pulmonary and pleural fibrosis. Myocardial infarction and pulmonary embolism in the acute state, acute pulmonary edema, pneumothorax and pulmonary hemorrhage are contraindications for physiotherapy. If the method is to be effective the intensive care unit should have a specialized physiotherapist attached to it working there on a daily basis.
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PMID:[The role of respiratory physiotherapy in an intensive care unit]. 52 99

Postmortem chest roentgenograms in approximately 3,500 cases of a random autopsy population were reviewed. Pneumothorax was found in 77 cases (2.2%). Simple pneumothorax was present in 38 cases, and tension pneumothorax or combined simple and tension pneumothorax was present in 39 cases. Only 40 of the 77 patients had been clinically diagnosed as having pneumothorax. Pulmonary conditions most often present in cadavers with pneumothorax were bacterial pneumonia, pulmonary emphysema, and pulmonary embolism, with or without infarcts and infarct abscesses. Procedures most frequently associated with pneumothorax were mechanical ventilation and attempts at cardiorespiratory resuscitation. Rib fractures (iatrogenic and noniatrogenic) were found in 23 of the 77 cases.
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PMID:Pneumothorax in a large autopsy population. A study of 77 cases. 69 69

Objective documentation of pulmonary embolism is an essential prerequisite for appropriate treatment (Figure 7). A chest film, as well as measurement of arterial blood gases, should be obtained immediately, and if the lung fields are essentially normal, a lung scan should then be performed. If the scan shows a definite perfusion defect characteristic of embolism, this provides sufficient evidence to establish a diagnosis of pulmonary embolism. The presence of hypoxemia with a low arterial pO2, further confirms the suspicion of a ventilation-perfusion abnormality, and anticoagulant therapy with heparin should be initiated immediately. Should the chest film show abnormalities in the same anatomic areas in which perfusion defects are present on the scan, further investigation by pulmonary arteriography is required to substantiate the diagnosis. The use of pulmonary angiography for documentation of pulmonary embolism is also indicated at the outset when certain specific disorders that confuse scan interpretation are also present-chronic obstructive lung disease, emphysema, asthma, congestive cardiac failure. Assessment of the arterial blood oxygenation simultaneously with the estimated occlusion and the hemodynamic data can be used as a prognostic index as therapy progresses.
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PMID:The diagnosis of pulmonary embolism. 100 Sep 26

Left heart diseases, in particular mitral stenosis, are often associated with anatomic and functional alterations of the lung. According to the pulmonary structures involved they could be named chronic secondary intersticial and vascular lung diseases. Congenital heart diseases with pre- or post-tricuspid shunts are also often associated with anatomic and functional alterations of the lung. This condition also constitutes a chronic secondary vascular lung disease (atrial septal defect) or a chronic primary vascular lung disease ( ventricular septal defect, patent ductus arteriosus). Primary lung diseases (interstitial pulmonary fibrosis, pulmonary emphysema, recurrent pulmonary embolism) are often associated with right ventricular hypertrophy with or without dilation, a condition commonly named chronic cor pulmonale. On the whole the interrelationships between heart and lung diseases are as follows: a) anatomic and functional alterations of the lung due to left heart diseases are mediated through pulmonary venous hypertension; b) anatomic and functional alterations of the lung due to congenital heart diseases are mediated through the increased pulmonary blood flow with or without transmission of the systemic blood pressure to the pulmonary vasculature, and c) anatomic and functional alterations of the right ventricle due to primary or secondary lung diseases are mediated through arterial pulmonary hypertension. In summary, the interrelationships between heart and lung diseases are mainly mediated through the pulmonary venous or pulmonary arterial hypertension.
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PMID:Cardiac and pulmonary diseases. A pathophysiologic interelationship. 113 Sep 7

The results of 64 membranes diffusing capacity (Dm) and pulmonary capillary blood volume (Vc) estimations were analysed to assess the clinical significance of these measurements. These estimations were performed on 18 healthy subjects, 19 patients with mitral valvular involvement of rheumatic aetiology, 15 patients with chronic bronchitis and emphysema, 8 patients with chronic bronchitis alone, and 4 patients with pulmonary embolism. It was observed that Dm correlated very well with the pulmonary diffusing capacity (DLCO) measured during the inhalation of room air in all the groups of subjects. In patients with rheumatic heart disease, the DLCO was affected little by even large changes in Vc, whereas it ran closely parallel to the Dm in these subjects. In the past Dm has been considered to be an unreliable estimation, varying greatly as a result of small errors in the measurement of DLCO. This appears to be relatively true only in normal subjects having low Vc/Dm ratio. In a majority of diverse clinical conditions where the Vc/Dm ratio is increased, the Dm becomes a more reliable estimation. In these patients the DLCO itself is a good index of the membrane diffusing capacity.
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PMID:Clinical significance of the measurement of membrane diffusing capacity and pulmonary cappillary blood volume. 116 37

The bronchial pulmonary system can be effected by obstructive diseases with and without emphysema. The onset of these affections may be an airway allergy. In case of other mechanisms, fibrotic processes can be observed accompanied by a lung compliance decrease. Lung circulation itself is rarely affected by the development of Cor pulmonale in a state after pulmonary embolism and after the so-called primary pulmonary high pressure. These disorders can be diagnosed properly without or scarcely straining the patient by spirometry which requires the patient's cooperation, however, and by body plethysmography which does not depend on cooperation, lung compliance measurements, arterial blood gases and inhalative provocation tests. If applied by experience staff, these reliable basic methods supply qualitative and quantitative information for the assessment of working capability that scarcely can be obtained on another organ.
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PMID:[Diagnostic parameters for the evaluation of work capacity: the bronchopulmonary system]. 227 71

Deadspace is defined in terms of the efficiency of the lung in eliminating carbon dioxide. The airway deadspace is the volume of the airway in which gas moves chiefly by convection. The alveolar deadspace is caused by ventilation/perfusion inequalities at the alveolar level. The commonest causes of increased alveolar deadspace are airways disease--smoking, bronchitis, emphysema, and asthma. Other causes include pulmonary embolism, pulmonary hypotension, and ARDS. In addition, right-to-left shunting (cyanotic heart disease, atelectasis) causes an apparent or virtual deadspace, which, although not representing non-perfusion of any compartment, nevertheless reduces the efficiency of ventilation.
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PMID:Deadspace during anaesthesia. 229 89

The application of 99mTc-DTPA radioaerosols to a variety of clinical disorders is described. With the development of simple equipment that can deliver very small droplets, this approach has become increasingly popular for measurements of the distribution of ventilation in patients with obstructive lung disease and suspected pulmonary embolism. In addition, by determining the rate at which the radionuclide is cleared from the lung, information has been obtained concerning the permeability of the pulmonary epithelium to extracellular indicators. Accelerated clearance rates have been found in patients with a variety of chronic interstitial lung diseases indicating that epithelial permeability is increased. Accelerated clearance rates have also been found with acute inflammation of the lung such as the adult respiratory distress syndrome and pneumocystis pneumonia. Furthermore, rapidly reversible increases in 99mTc-DTPA clearance occur in smokers and may be related to the inflammatory changes that contribute to the development of emphysema.
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PMID:99mTc-DTPA aerosol deposition and clearance in COPD, interstitial disease, and smokers. 329 74

Digital subtraction radiography was used in 84 patients with suspected pulmonary embolism to obtain information about localized changes in ventilation of the lungs. Preliminary experiences in patients with carcinoma of the lung, emphysema and acute inflammatory diseases have also been obtained. Digital subtraction radiography is a simple, rapid and inexpensive method to obtain information about ventilation in the lungs. It is completely non-invasive and requires only minimal cooperation of the patient. The sensitivity appears to be as good as that of 133Xe radionuclide ventilation studies.
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PMID:Studies on pulmonary ventilation using digital subtraction radiography. A preliminary report. 354 81


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