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 47,337 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To evaluate the reproducibility of respiratory measurements between nights we performed studies in 20 outpatients with stable, moderately severe chronic obstructive pulmonary disease. All patients had symptoms from their lung disease but had no sleep complaints. Their mean age was 61 years, mean 1-second forced expiratory volume was 42% of predicted, and mean functional residual capacity 195% of predicted. Arterial Pco2 averaged 40 +/- 1 (SEM) mm Hg and mean Po2 64 +/- 1 mm Hg. Sleep was monitored for 7 hours by standard techniques on 2 nights 1 week apart. Breathing was assessed by measuring airflow at the nose and mouth with thermistors, and rib cage and abdominal respiratory movements with inductive plethysmography. Oxygen saturation was measured with an ear oximeter. Patients slept on the average 58% of the time in the first night and 63% in the second. Arousals were common but apneas uncommon in both nights. There was no significant difference in median nocturnal O2 saturation on the 2 nights. Tidal volume and minute ventilation, but not respiratory rate, were significantly lower and more variable in rapid eye movement (REM) sleep as compared with wakefulness and non-REM sleep; however, mean values and the variance for tidal volume, respiratory rate, or minute ventilation were similar on both nights.
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PMID:Reproducibility of ventilatory measurements during sleep on different nights in patients with chronic obstructive pulmonary disease. 310 43

A nonsurgical, less aggressive, less toxic chemotherapeutic protocol for the management of nontuberculous mycobacterial (NTB) pulmonary infections has been uniformly applied to patients in our institution between 1972 and 1985. Forty-three nonimmunocompromised patients with active lung disease caused by Mycobacterium avium-intracellulare (MAI) (n = 26), M kansasii (n = 16), and M xenopi (n = 1) were identified retrospectively. Eighteen MAI patients were treated with three or four antituberculosis agents resulting in sputum conversion and clinical improvement in 12 (67 percent). Additionally, 11 out of 16 (69 percent) patients completing therapy or still undergoing therapy for persistent MAI disease, achieved sputum conversion and clinical improvement after prolonged therapy (3.6 +/- 0.5 years [SEM]). When M kansasii was identified as the etiologic agent, all patients were treated with four or fewer antituberculosis agents and 14 out of 16 patients (88 percent) achieved sputum conversion and clinical improvement throughout the follow-up period. We conclude that the use of three or four chemotherapeutic agents in the treatment of NTM lung disease provides an excellent probability of successful outcome even in MAI infections.
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PMID:Nontuberculous mycobacterial lung disease. Substantiation of a less aggressive approach. 334 64

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

Few studies have examined the response of individuals with restrictive lung disease (RLD) to respirator wear. Such information should be of theoretical and practical interest when the need to determine fitness to wear respirators is considered. Seventeen females performed progressive submaximal treadmill exercise. Twelve control subjects with total lung capacity (TLC) = 5.71 +/- .19L (mean +/- SEM) and DLCO = 25.8 +/- 1.0 mL/min/mmHg were compared to five RLD subjects with TLC = 3.70 +/- 0.22 and DLCO = 14.5 +/- 0.7. Mean age, height and weight were similar. Separate exercise trials were performed with no added resistance (NAR), and with 5 cm H2O/L/sec inspiratory and 1.5 cm H2O/L/sec expiratory resistance (R2) to stimulate widely used respiratory masks. Comparisons of exercise data were made at an oxygen consumption of 0.8 L/min. With NAR, RLD subjects had significantly higher minute ventilation (VE) (29.0 vs. 21.2 L/min for controls), higher respiratory rate (RR), and lower tidal volume (VT). Heart rate, end-tidal PCO2 (PETCO2), and mouth pressure swing (Poral) were not different from control values. With R2 compared to NAR, the controls had reduced RR and VE; and increased VT, PETCO2, and Poral. While changes with R2 for the RLD subjects were in the same directions as controls, only the increase in Poral was statistically significant. Analysis of the differences showed that none of the changes with R2 in RLD subjects was different from control changes except for the greater increase in Poral and the smaller increase in VT. The former was explained by the RLD subjects' higher VE and flow rates, and the non-linear nature of R2 at higher flow rates.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of industrial respirator wear during exercise in subjects with restrictive lung disease. 370 44

Neonatal pulmonary manifestations of prolonged (2-8 weeks) amniotic fluid leak (PAL) were evaluated in 22 neonates. The severity of respiratory insufficiency was evaluated by a profile scoring system based on arterial blood gases, ventilatory support, and evidence of "fetal compression". The spectrum included acute respiratory failure with pulmonary hypoplasia (3), pulmonary hemorrhage (2), severe bronchopulmonary dysplasia (3), subacute lung disease (5), and transient respiratory disease (2). Seven neonates were completely asymptomatic. Clinical manifestations were correlated to age of onset and duration of PAL. The onset of PAL in the asymptomatic babies had occurred after 32 weeks gestation (mean +/- SEM, 33.5 +/- 1.1 wk; duration was 4.4 +/- 1.1 wk). In symptomatic neonates the onset of PAL was 24.0 +/- 1.0 weeks; duration being 6.0 +/- 0.6 weeks. When PAL occurred before 22 weeks and the duration of leak was longer than 6 weeks, the pulmonary profile score was less than 3 and associated with severe respiratory sequelae. These manifestations culminated in neonatal demise despite aggressive conventional ventilatory techniques. Onset of PAL between 23 and 28 weeks gestation and continuing longer than 8 weeks also was associated with a similar outcome. Duration of PAL between 2 and 7 weeks in this group was associated with less severe pulmonary manifestations and higher scores. Pulmonary morbidity was significantly correlated to the initial profile score (P less than .05) and was influenced by the prenatal reduction in thoracic volume.
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PMID:Neonatal pulmonary manifestations due to prolonged amniotic leak. 371 44

It is important for the clinician who is hyperventilating infants with persistent pulmonary hypertension (PPHN) to recognize a transition phase during therapy when pulmonary hypertension is no longer the primary cause of hypoxemia, because infants who are hyperventilated develop parenchymal lung disease after 2 to 3 days. This study reports ten infants who showed PaO2 lability early in the course of PPHN, with an inverse relationship between PaO2 and PaCO2. At a mean age of 79 +/- 14 (SEM) there was a transition phase, after which PaO2 lability decreased and the infants did not require hyperventilation. The mean change in PaO2 per change in PaCO2 was significantly (p less than .05) higher pretransition (22.4 +/- 5.2) compared to during transition (5.1 +/- 1.4) or post-transition (1.9 +/- 1.2). Mean alveolar-arterial oxygen gradient was higher (p less than .05) pretransition (495 +/- 36) vs. post-transition (405 +/- 52) and was more labile relative to PaCO2 change pretransition (20.3 +/- 5.9) compared to post-transition (.3 +/- 2.4). When ventilator settings were reduced after the transition phase, PaCO2 rose by 12.2 torr.
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PMID:Transition phase during hyperventilation therapy for persistent pulmonary hypertension of the neonate. 392 53

To assess the role of changes in lung collagen in pulmonary fibrosis, the content of this protein was measured in biopsy and autopsy lung from patients with cryptogenic fibrosing alveolitis (CFA), a fibrotic lung disorder of unknown cause. The collagen concentration was measured in lung samples from 21 patients with CFA (14 autopsy and seven open-lung biopsy) and 17 normal subjects; total lung collagen was determined in the right lung of 10 patients who died from CFA and the results were compared with those from 10 normal lungs. There was a wide variation in the collagen concentrations but the mean value (+/- SEM) for patients with CFA (217 +/- 13 mg/g dry weight) was significantly higher (P less than 0.02) than that of the controls (155 +/- 15 mg/g dry weight). The mean collagen concentration of the autopsy samples (243 +/- 20 mg/g dry weight) was significantly higher (P less than 0.05) than that of the biopsy samples (165 +/- 24 mg/g dry weight). The mean total collagen was markedly raised (P less than 0.001) in right lungs of patients with CFA (32.5 +/- 4.3 g) compared with normal lungs (14.0 +/- 1.1 g). When corrected for the predicted lung volume this difference in total lung collagen remained statistically significant (P less than 0.01, mean for patients 4.7 +/- 0.7 mg/ml, controls 2.3 +/- 0.2 mg/ml). These results demonstrate an increased deposition of lung collagen in this form of pulmonary fibrosis. They also suggest that there is a greater collagen concentration in lungs of patients with later disease, indicating a progressive deposition of collagen during the course of the disease.
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PMID:Biochemical evidence for an increased and progressive deposition of collagen in lungs of patients with pulmonary fibrosis. 394 76

Endoscopic sphincterotomy (ES) was attempted in 409 patients with common bile duct stone(s) (CBDS). The mean age of patients was 72.0 +/- 0.8 years (m +/- SEM); 47 p. 100 presented risk factors; 57 p.100 had previously been cholecystectomized while 43 p. 100 had not. On an average, patients in the former group were older (80 +/- 0.7 years) than in the latter 65.4 +/- 1.0 years, p less than 0.001). The procedure was successful in 98 p. 100 of the patients, after a standard ES in 78.5 p. 100 or after different technical artifices in 21.5 p. 100. The vacuity of the CBD was obtained in 96.5 p. 100 of the cases. During the first month after the ES, 13 p. 100 of the patients had complications and 4 p. 100 died; 37 complications (9 p. 100) were related to the ES and were responsible for death in 4 patients: 18 episodes of bleeding at the site of ES, 7 acute pancreatitis, 6 cholangitis, 4 retroperitoneal perforations and 2 other complications. The occurrence of these complications was closely related to the technique of ES being more frequent after technical artifices than after a standard ES (p less than 0.001). On the other hand, these complications occurred independently of the age of patients or of previous cholecystectomy. Seventeen complications (4 p. 100) did not depend directly on ES and were responsible for death in 14 patients (3 p. 100): pneumopathy, pulmonary embolism.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Results of endoscopic sphincterotomy in common bile duct lithiasis]. 397 27

The effect on aerosol deposition from a pressurised metered dose inhaler of a 750 cm3 spacer device with a one way inhalation valve (Nebuhaler, Astra Pharmaceuticals) was assessed by means of an in vivo radiotracer technique. Nine patients with obstructive lung disease took part in the study. The pattern of deposition associated with use of a metered dose inhaler alone was compared with that achieved with the spacer used both for inhalation of single puffs of aerosol and for inhalation of four puffs actuated in rapid succession and then inhaled simultaneously. On each occasion there was a delay of 1 s between aerosol release and inhalation, simulating poor inhaler technique. With the metered dose inhaler alone, a mean (SEM) 8.7 (1.8)% of the dose reached the lungs and 80.9 (1.9)% was deposited in the oropharynx. With single puffs from the spacer 20.9 (1.6)% of the dose (p less than 0.01) reached the lungs, only 16.5 (2.3)% (p less than 0.01) was deposited in the oropharynx, and 55.8 (3.1)% was retained within the spacer itself. With four puffs from the spacer 15.2 (1.5)% reached the lungs (p = 0.02 compared with the metered dose inhaler alone, p less than 0.01 compared with single puffs from the spacer), 11.4 (1.2)% was deposited in the oropharynx, and 67.5 (1.8)% in the device itself. It is concluded that the spacer device gives lung deposition of metered dose aerosols comparable to or greater than a correctly used inhaler and oropharyngeal deposition is greatly reduced. The spacer should be used preferably for the inhalation of single puffs of aerosol but may also be used for the inhalation of up to four puffs actuated in rapid succession and then inhaled simultaneously.
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PMID:Improvement of pressurised aerosol deposition with Nebuhaler spacer device. 644 Mar 5

To test the hypothesis that asymptomatic farmers with serum precipitins to farmers' lung disease antigens also have an immune reaction involving the lungs, we did bronchoalveolar lavage (BAL) in 3 groups of dairy farmers. Group 1: 7 patients with acute farmers' lung disease. Group 2: 10 asymptomatic farmers with serum precipitins to Micropolyspora faeni. Group 3: 9 normal farmers without serum precipitins. Group 1 patients had a large number of cells (90.4 +/- 20 X 10(6)) (mean +/- SEM) with 72 +/- 5.8% lymphocytes in their lavage fluid. Their lavage also had high immunoglobulins A and G/albumin ratios. Six subjects in Group 2 had an increased number of cells (54.1 +/- 14.1 X 10(6)) and a high percentage of lymphocytes (52.5 +/- 6.6%) in their BAL. Two subjects in Group 3 had similar alterations in their lavage fluid: 60.0 and 69.6 X 10(6) cells with 20 and 37.5% lymphocytes, respectively. The other subjects in Groups 2 and 3 had normal lavages. Proliferative responses of BAL lymphocytes to phytohemagglutinin was similar in each group. Circulating immune complexes were increased only in subject with acute farmers' lung disease (Group 1). These results show that some normal farmers have signs of an alveolitis.
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PMID:Immune reactions in the lungs of asymptomatic dairy farmers. 698 47


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