Chest
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Muscle nerve sympathetic activity (MSA) was recorded during wakefulness in 11 patients with obstructive sleep apnea (OSA) and in 9 sex- and age-matched healthy control subjects. Plasma levels of norepinephrine (NE) and neuropeptide Y were analyzed. Five patients had established hypertension (resting supine systolic BP/diastolic BP > or = 160/95 mm Hg). ⋯ It is concluded that neurogenic sympathetic activity as well as circulating plasma NE is increased in patients with OSA. This increased sympathetic activity during awake supine rest may reflect a pathophysiologic adaptation to hypoxia and hemodynamic changes occurring at repetitive apneas during sleep. The correlation between MSA and systolic BP implies that this mechanism may be directly or indirectly involved in the development of cardiovascular complications in OSA.
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Randomized Controlled Trial Clinical Trial
Effects of inhaled anticholinergic drug on dyspnea and gas exchange during exercise in patients with chronic obstructive pulmonary disease.
To elucidate the effect of oxitropium bromide (OTB), an anticholinergic drug, on dyspnea and gas exchange during exercise in patients with chronic obstructive pulmonary disease (COPD), we performed the cycle exercise test on 19 patients with COPD (mean age, 72.0 +/- 1.9 years; mean FEV1, 1.28 +/- 0.07 L) before and after inhalation of OTB, 300 micrograms, or placebo, 300 micrograms, in randomized fashion. Spirometry was performed immediately before and 30 min after inhalation of either OTB or placebo. Dyspnea during exercise was evaluated using the Borg scale (BS) and the slope of the regression between BS and oxygen uptake (VO2) during exercise (Borg scale slope: BSS). ⋯ Although the SaO2 at rest and during exercise did not differ with or without either OTB or placebo, the recovery time after OTB (77.3 +/- 6.8 s) was significantly shorter than that before administration (98.4 +/- 14.6 s) (p < 0.01). We conclude that the inhaled OTB produces small but significant improvement both in dyspnea during exercise and in exercise performance in stable COPD and may contribute to improve the quality of life in some patients with COPD. However, gas exchange during exercise of COPD patients is little affected by OTB.
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Randomized Controlled Trial Comparative Study Clinical Trial
Norepinephrine or dopamine for the treatment of hyperdynamic septic shock?
To compare the ability of dopamine and norepinephrine to reverse hemodynamic and metabolic abnormalities of human hyperdynamic septic shock. ⋯ At the doses tested, norepinephrine was found, in the present study, to be more effective and reliable than dopamine to reverse the abnormalities of hyperdynamic septic shock. In the great majority of the study patients, norepinephrine was able to increase mean perfusing pressure without apparent adverse effect on peripheral blood flow or on renal blood flow (since urine flow was reestablished). At the same time, oxygen uptake was increased.
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Randomized Controlled Trial Clinical Trial
The effect of pyridostigmine on bronchial hyperreactivity.
We examined the effect of pyridostigmine (PY) at a dose of 30 mg orally three times a day on nonspecific bronchial hyperreactivity in ten normal nonsmokers (NNS), ten smokers (SM), and ten mild asthmatics (AS). We conducted a double-blind, placebo-controlled, crossover trial, randomly assigning subjects to receive either placebo (PL) or PY before undergoing bronchoprovocation challenge with eucapnic voluntary hyperventilation (EVH) using dry gas. Compliance with PY was confirmed by measuring red blood cell acetylcholinesterase (Achase) levels during both days of testing. ⋯ The mean decreases in FVC and FEV1 while taking PY were as follows: NNS, 1.8 percent (+/- 0.7) FVC and 4.3 percent (+/- 0.8) FEV1; SM, 3.8 percent (+/- 1.4) FVC and 5.2 percent (+/- 1.6) FEV1; AS, 4.4 percent (+/- 1.3) FVC and 11.8 percent (+/- 2.8) FEV1. Within each category, using a paired t test to compare the results on each day of testing, no statistically significant differences were noted. Pyridostigmine at the tested dose has no significant effect on nonspecific bronchial hyperreactivity in normal NNS, SM, or AS.
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Osteomyelitis in uncommon locations can present unusual diagnostic difficulties. A patient with primary sternal osteomyelitis who presented with pain over the right supraclavicular area and a radiologic picture of a pleural-based right upper lung mass is discussed. A triple-phase bone scan was consistent with the diagnosis, and a needle aspiration of the mass revealed a staphylococcal abscess. Percutaneous drainage of the contiguous abscess and a prolonged course of antibiotic therapy cured the infection.