Chest
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To determine the impact of transesophageal echocardiography (TE) on the treatment of patients with aortic dissection, the clinical course and outcome of 18 patients with TE diagnosis of dissection were analyzed. Ascending aortic dissection was present in nine patients, of whom six had surgery with confirmation of TE findings. Angiography was performed in only two of these patients and was falsely negative in one patient. ⋯ In the nine patients who had descending aortic dissection, angiography was performed in seven patients, of whom two underwent surgery. Information provided by angiography did not change the treatment of these patients. Thus, TE provides a prompt and accurate diagnosis in aortic dissection obviating the need for angiography in most patients.
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The effect of continuous positive-pressure ventilation (CPPV) on extravascular lung water volume has been investigated, but there is only one report which studied the effect of continuous negative extrathoracic pressure ventilation (CNETPV). The effect of CNETPV on central blood volume (CBV) has not been studied. Changes in intrathoracic pressure by CNETPV may alter lung water volume and CBV. ⋯ The EVTV increased during CNETPV but did not change during CPPV. The CBV decreased during CPPV but did not change during CNETPV. An increase of transmural pulmonary microvascular pressure was thought to be one of the reasons for the increase in EVTV with CNETPV.
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Comparative Study
A comparison of the effects of bid and qid dosing on compliance with inhaled flunisolide.
Noncompliance with inhaled steroids is a well-recognized problem in asthma therapy. We compared compliance with bid and qid regimens of inhaled flunisolide in 16 asthmatic subjects. Patients were instructed to take four inhalations bid for T1 to establish baseline compliance. ⋯ Concomitantly, the number of daily inhalations decreased from 7.9 +/- 2.5 to 6.8 +/- 3.1 (p less than 0.01). Reduced compliance with qid dosing was due in large part to an increase in frequency of six inhalations per day, resulting from tid use. Compliance with inhaled flunisolide, therefore, was worse with qid than bid dosing.
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Use of continuous transtracheal oxygen delivery systems combined with rhythmic chest compressions can provide excellent oxygenation and ventilation during cardiopulmonary resuscitation. However, occasional displacement of the transtracheal catheter results in life-threatening pneumomediastinal complications. We investigated using the pharyngeal lumen of a pharyngeal-tracheal lumened airway (PtL) as an alternative delivery system for continuous oxygen flow in 21 large mongrel dogs. ⋯ Successful resuscitation was achieved in 8 of 11 (73 percent) animals, which is similar to the results in historical controls with endotracheal intubation. No pneumomediastinal complications were seen with use of the PtL. We conclude that using the pharyngeal lumen of the PtL for continuous delivery of oxygen combined with external chest compressions can provide a safe and effective mode of oxygenation and ventilation during cardiac arrest.
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An abnormal chest roentgenogram is essential for the diagnosis of ventilator-associated pneumonia. The diagnostic accuracy of various roentgenographic signs of pneumonia has not been assessed previously in the portable anteroposterior roentgenograms obtained in ventilated patients. Seven roentgenographic signs (air bronchograms, alveolar infiltrates, silhouette sign, cavities, fissure abutment, atelectasis, and asymmetric infiltrates superimposed on diffuse bilateral infiltrates) were evaluated for their accuracy in predicting pneumonia alone, in combination with other signs, or in combination with clinical parameters. ⋯ We conclude that in intubated patients with diffuse bilateral roentgenographic infiltrates, no roentgenographic sign correlates well with pneumonia. No clinical parameter added to the accuracy of either an alveolar infiltrate or an air bronchogram in patients without diffuse infiltrates. Pulmonary hemorrhage and/or infarction are frequent autopsy findings in intubated patients and may be confused radiologically with pneumonia.