Chest
-
Comparative Study
Altered exercise gas exchange and cardiac function in patients with mild chronic obstructive pulmonary disease.
Patients with advanced COPD have significantly reduced gas exchange and pulmonary function; however, little is known regarding physical work capacity and exercise gas exchange in patients with mild COPD. A total of 39 individuals (20 men and 19 women) without evidence of COPD (controls) and 51 individuals (29 men and 22 women) with mild COPD (FEV1 > or = 60 percent of predicted; and ratio of FEV1 over forced vital capacity of 60 to 70 percent) were tested to determine resting pulmonary function and resting and peak exercise gas exchange in response to progressive maximal cycle ergometer testing. In general, those with mild COPD had similar smoking histories and essentially equivalent resting gas exchange studies as compared to the controls. ⋯ The reduction in functional work capacity is secondary to a loss of pulmonary function, as well as chronic deconditioning. Increased dyspnea may be responsible for the premature cessation of exercise observed in patients with mild COPD. Thus, early intervention with exercise training may be warranted to counter the deleterious effects of deconditioning and declining pulmonary function in patients with mild COPD.
-
Two cases of airway foreign bodies involving the aspiration of component parts of commonly used respiratory therapy equipment are described. The first case demonstrated the accidental introduction of a washer from a closed catheter suction system into the airway of a patient. The second case involved the accidental introduction of a part of an intubating stylet into the lung. Improper use of this equipment can result in airway foreign bodies and potential respiratory compromise.
-
Case Reports
Massive hemothorax associated with intrathoracic extramedullary hematopoiesis involving the pleura.
Intrathoracic extramedullary hematopoiesis rarely involves the pleura and is usually asymptomatic. We report a 73-year-old woman with myelofibrosis who had pleural involvement with extramedullary hematopoietic tissue that produced a massive hemothorax. Before the diagnosis of extramedullary hematopoietic tissue was established, sclerosis with tetracycline was attempted, which accelerated pleural bleeding and required surgical evacuation. The bleeding was ultimately controlled by low-dose radiation therapy.
-
Comparative Study
Effect of body position on gas exchange in patients with unilateral central airway lesions. Down with the good lung?
In this study, we evaluated the effect of body position (erect, supine, and two decubitus positions) on gas exchange (alveolar-arterial PO2 difference [AaPO2]) in 35 patients who had various degrees of lung collapse roentgenographically caused by unilateral central airway lesions, with special reference to the difference in AaPO2 between two lateral decubitus positions. The patients were divided into two groups. Group 1 was composed of 23 patients with FEV1/FVC > 70 percent. ⋯ Unlike previous reports, the present study showed that AaPO2N was not exclusively less than AaPO2L in our patients. AaPO2N was higher than AaPO2L in 11 of 23 in group 1 and in 5 of 12 in group 2 patients. In summary, our results indicated that positional changes did not significantly affect gas exchange in the patients with lung collapse roentgenographically caused by unilateral central airway lesions and the dogma "Down with the good lung" could not be applied to these patients flawlessly.
-
Advances in cytokine biology and molecular biology have led to the development of novel immunologic approaches to the treatment of septic shock, ARDS, and MOF. These advances are necessary since improvements in supportive care clearly fall short of the hoped-for reductions in mortality associated with these disorders. As noted in this review, these new therapies are directed at three distinct levels of the inflammatory cascade: (1) the inciting event or insult (eg, endotoxin); (2) the mediators (eg, TNF, IL-1); and (3) the effector cells (eg, neutrophils). ⋯ That is, due to the complexity and redundancy of the inflammatory network, it is doubtful that a "magic bullet" will be found. However, it is also clear that advances in our understanding of the pathogenesis of ARDS, septic shock, and MOF at the molecular level have provided clinicians with powerful weapons with which to do battle. It remains to be seen which ones will work the best.