Chest
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An evaluation of a tuberculosis screening program for food handlers revealed an unexpectedly low cost ($45) per identifiable candidate for preventive treatment (324 of 6,090 individuals screened). Four new active cases of tuberculosis were identified, and a risk/benefit analysis projected a potential reduction of 19.4 new active cases over the subsequent ten-year period.
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The positional effect on gas exchange was studied in eight patients who had unilateral pleural fluid without clinical or radiologic evidence of parenchymal lung disease. In all eight patients, PaO2 values were higher when the lung with the pleural fluid was uppermost. The mean PaO2 in this position was 71.9 +/- 9.3 mm Hg (mean +/- SE) compared with 66.7 +/- 8.7 mm Hg in the lateral decubitus position with the pleural fluid lowermost. ⋯ Larger positional differences were found in the patients with the smallest pleural effusions. These results are probably due to perfusion of areas of unventilated lung, accentuated by gravity with a consequent increase in shunting. A large effusion also causes a decrease in perfusion, so that ventilation-perfusion mismatching is decreased and the positional effect on gas exchange diminished.
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Case Reports
Positional dyspnea and oxygen desaturation related to carcinoma of the lung. Up with the good lung.
Body position can lead to respiratory symptoms and affect gas exchange in disease states. We describe a patient with carcinoma of the left lung in whom dyspnea and oxygen desaturation developed in the right lateral position only. Fiberoptic bronchoscopic study demonstrated a tumor mass protruding into the left main-stem bronchus, which caused further narrowing when the patient turned on his right side.
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With improvement in computed tomography (CT) technology, including faster scanning and images with better detail, the indications for CT of the thorax have expanded. In many instances, data collected on earlier-generation scanners no longer apply. This report is an update of CT scanning of the thorax and includes information on the role of CT in diagnosis when specific clinical syndromes and diseases are suspected. It also addresses controversial subjects, such as the role of CT scanning in the staging of bronchogenic carcinoma and the evaluation of the solitary pulmonary nodule, as well as suggesting guidelines for deciding when a CT scan of the thorax is indicated.