Chest
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Cardiac tamponade, a potentially lethal complication following cardiac surgery, may present either early or late postoperatively and may be difficult to diagnose due to atypical clinical, hemodynamic, or echocardiographic findings. To determine the frequency and clinical features of postoperative cardiac tamponade, we performed a review of 510 consecutive patients who underwent cardiac surgery. The incidence of postoperative cardiac tamponade was 2.0 percent (10/510 patients) and occurred following valvular, bypass, and aortic surgery. ⋯ Eight of ten patients survived; all of these patients underwent surgical removal of fluid and/or hematoma in the operating room. We conclude that postoperative tamponade after cardiac surgery may have varied clinical and hemodynamic presentations, often due to selective chamber compression by loculated fluid or clot. Due to its frequently atypical features and presentation that may simulate other disorders, the diagnosis of tamponade should be considered whenever hemodynamic deterioration or signs of low output failure occur in the postcardiotomy patient.
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We studied whether inspiratory muscle training (IMT) changed respiratory sensation during exercise in 12 healthy women; IMT was performed twice daily, for 15 minutes, using a pressure threshold device and continued for 4 weeks. The inspiratory threshold was set to 30 percent of each individual's maximal inspiratory pressure (Pimax). Breathing effort was evaluated during a progressive exercise test using Borg scale. ⋯ The difference in the sensory score-exercise stage curves before and after IMT in the training group was not significant. No significant difference was noted in the relationship of the Borg score to minute ventilation before and after 4 weeks in either group. We concluded that IMT may not affect respiratory sensation during exercise in normal subjects, although IMT increases diaphragmatic strength.
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A 27-year-old, 37-weeks' primigravida survived an acute myocardial infarction. Coronary angiography 25 days after infarction demonstrated multiple dissections in the left coronary artery. She had no vascular risk factors or connective tissue disease. This is a rare case of spontaneous, multiple coronary artery dissections that were diagnosed by coronary angiography.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative evaluation of three heat and moisture exchangers during short-term postoperative mechanical ventilation.
This study compared performance of three heat and moisture exchangers (HME) during short-term postoperative mechanical ventilation. Temperature and absolute humidity (AH) were measured at various points of the ventilatory circuit. There was no statistical difference between the groups, regarding ambient and body To, body weight, fraction of inspired oxygen, tidal volume, and respiratory rate. ⋯ Indirect evaluation (variations of inspiratory gases and tracheal temperatures, AH of the expired gases) confirmed the superiority of the hygroscopic HME. These data suggest that humidification of inspiratory gases with a hygroscopic HME is a defensible practice during short-term postoperative mechanical ventilation. Performance of hydrophobic HME may be weak and can expose the patient to an unacceptable risk of endotracheal tube occlusion.
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Randomized Controlled Trial Comparative Study Clinical Trial
Protective effect of inhaled piretanide on the bronchial obstructive response to ultrasonically nebulized H2O. A dose-response study.
Inhaled furosemide prevents the obstructive response to several bronchoconstrictor stimuli in asthma. To verify whether this protective effect is also shared by other loop diuretics, we investigated the effect of inhaled piretanide on the bronchial obstructive response to ultrasonically nebulized distilled water (UNW) in ten patients with moderate, stable asthma. ⋯ Piretanide caused a significant, dose-dependent increase in UNW PD20 with respect to placebo, corresponding to 0.6 +/- 0.2 doubling doses (mean +/- SE) after 12 mg, 1.3 +/- 0.2 after 24 mg, and 2.0 +/- 0.2 after 48 mg, and had a remarkable diuretic effect; 40 mg of furosemide increased UNW PD20 by 2.3 +/- 0.3 doubling doses (p < 0.01), but showed only a modest diuretic activity. These data indicate that inhaled piretanide is as effective as furosemide in preventing UNW-induced asthma, and this effect is unrelated to their diuretic potency.