Chest
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Unlike most pneumonias, the diagnosis of Pneumocystis carinii pneumonia is based solely on identifying organisms by stain, usually with methenamine-silver. Because of technical problems involved with adequate staining, control samples usually are done concurrent with tissue specimens to be examined. ⋯ We recently observed false-negative biopsy specimens in a case of P carinii pneumonia where the Pneumocystis organism failed to stain with methenamine-silver on several occasions, although fungal controls were positive. This report emphasizes the importance of using P carinii as a control whenever attempting to diagnose P carinii pneumonia.
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Letter Case Reports
Unilateral diaphragmatic paralysis in association with Erb's palsy.
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This study was undertaken to determine if the production of pulsatile flow by the intra-aortic balloon pump during cardiopulmonary bypass has any beneficial effect on coronary flow, regional myocardial flow, myocardial metabolism, and left ventricular function. Thirty-six conditioned dogs were subjected to one hour of total normothermic cardiopulmonary bypass. They were divided into the following five groups: (1) controls, beating heart and femoral inflow; (2) balloon, beating heart, and femoral inflow; (3) balloon, beating heart, and aortic inflow; (4) control, fibrillating heart and femoral inflow; and (5) balloon, fibrillating heart, and femoral inflow. ⋯ This increase in flow may have been in part due to increased resistance to flow in the descending aorta by the balloon. No differences in flow were noted in the other groups, all of which were perfused via the femoral artery. No significant differences in myocardial metabolism or left ventricular contractility could be demonstrated between balloon-treated and control groups in these normal hearts.
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Comparative Study
The esophageal obturator airway: a clinical comparison to ventilation with a mask and oropharyngeal airway.
We compared controlled ventilation with the esophageal obturator airway to ventilation with a conventional rubber mask and oropharyngeal airway in ten anesthetized patients. Measurements of exhaled tidal volume, mask-to-face fit (leakage of mask), supraglottic obstruction, and the operator's effort were all inferior using the esophageal obturator airway. ⋯ Placement of the device was difficult in three of ten patients, and two of ten had inadvertent tracheal intubations. Edentulous patients were difficult to impossible to ventilate using the esophageal obturator airway.