Chest
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Pulmonary function and arterial blood gases were measured in 35 patients undergoing routine diagnostic flexible fiberoptic bronchoscopy (FFB) either through an 8-mm endotracheal tube (ETT) or transnasally in order to investigate whether FFB changes lung function in a way which may explain why hypoxemia commonly occurs during this procedure. In these patients with moderate airway obstruction, functional residual capacity (FRC) increased significantly after inserting the ETT, after placing the FFB in the airway through the ETT, and after inserting the flexible bronchoscope transnasally. The mean increase in FRC was 30 percent in the intubated group before FFB insertion and 17 percent in the transnasal group. ⋯ Insertion of the ETT-FFB combination or transnasal FFB did not change PaO2 substantially, although following the examination, PaO2 was decreased significantly in the transnasal group but not in the intubated group. The PaO2 decreased significantly in both groups following removal of the ETT and transnasal FFB. These results suggest that placement of an FFB or ETT-FFB combination in the airway in spontaneously breathing subjects elevates FRC.
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Comparative Study
Early prediction of outcome of respiratory failure. Comparison of high-frequency jet ventilation and volume-cycled ventilation.
Data from a prospective randomized investigation comparing volume-cycled ventilation and high-frequency jet ventilation were reexamined to determine whether improvement of respiratory and hemodynamic function, as well as ultimate outcome (death or survival), could be predicted early in the course of the disease. End points were selected for the ratio of the arterial oxygen pressure over the fractional concentration of oxygen in the inspired gas (PaO2/FIO2), the arterial oxygen saturation (SaO2), the arterial carbon dioxide tension (PaCO2), and the cardiac index. Patients were assigned to "success" or "failure" groups, according to the values recorded for those end points 24 hours after institution of mechanical ventilation. ⋯ With both types of ventilator, patients who reached the end point of oxygenation at 24 hours survived in far greater numbers than those who did not. On the basis of this investigation, it appears justified to attempt high-frequency jet ventilation in patients who do not rapidly improve on volume-cycled ventilation. Institution of high-frequency jet ventilation as the initial support method may not be advisable, since failure does not become apparent for many hours.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of lorcainide and quinidine in the treatment of ventricular ectopy.
Lorcainide, a new type I antiarrhythmic agent, was compared to quinidine in respect to antiarrhythmic efficacy and clinical safety. Thirteen subjects completed an open, randomized, crossover study with analysis of 24-hour ambulatory ECG monitoring and drug blood levels. The QRS and Q-T intervals increased with both lorcainide and quinidine. ⋯ No relationship could be established between drug level and arrhythmia suppression in this small population. Some CNS effects were reported in both groups, but no significant hematologic, chemical, or urinary adverse effects were seen with either drug. Thus, lorcainide compares favorably to quinidine in regard to arrhythmia suppression, but was limited in its clinical utility by CNS side effects.
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Randomized Controlled Trial Clinical Trial
Screening for early lung cancer. Results of the Memorial Sloan-Kettering study in New York.
The Memorial Sloan-Kettering lung cancer screening program was begun in 1974 to evaluate sputum cytology as a supplement to the annual chest x-ray examination for early detection and diagnosis. The 10,040 adult, male cigarette smokers who enrolled were randomly assigned to receive annual chest x-ray examinations only or a dual screen with annual chest x-ray examination and four monthly sputum cytology evaluation. ⋯ The same number of cancers developed in the x-ray screen only group, and were diagnosed at a later date. Despite the delay, survival and mortality were the same, suggesting that the squamous carcinomas detected by cytologic examination alone are very slow growing and tend to remain localized until detectable by x-ray examination.