Chest
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Case Reports
Bilateral ductus arteriosus in d-transposition of the great arteries with right aortic arch.
The rare anomaly of a right aortic arch, distal origin of the left subclavian artery, and posterior left ductus arteriosus (forming a vascular ring) plus a right ductus arteriosus is described in an infant with d-transposition of the great arteries with an intact septum. The presence of a right aortic arch and distal left subclavian artery with bilateral ductus arteriosus has not been described previously.
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A new cannula with a system of intermittent nasal flow was evaluated and compared with a standard constant-flow nasal cannula in 15 patients with chronic obstructive pulmonary disease. The intermittent-demand cannula released oxygen only when a negative pressure was detected in the nose (negative mode) or when a a positive pressure ceased to be detected in the nose (positive mode). At rates of flow varying from 0.63 to 5.60 L/min, the continuous-flow mode used 9 percent more oxygen than the negative mode and 31 percent more oxygen than the positive mode to achieve comparable improvement in arterial oxygen tension. The system using the intermittent-demand cannula was sensitive and reliable in over 150 hours of testing.
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After abdominal surgery, 64 patients were managed with one of the following two techniques of respiratory care: (1) deep breathing by way of a new device, an incentive spirometric three-ball, flow-measuring device (Triflo); and (2) standard episodic intermittent positive-pressure breathing (IPPB) every four hours. Both series of patients received therapy with a bronchodilator drug by nebulization. All patients had preoperative spirometric measurements followed by five consecutive days of therapy and spirometry. ⋯ There were no significant differences between the two methods of respiratory care, but 57 percent (17/30) in the group receiving therapy with IPPB developed pneumonia, atelectasis, or bronchitis, while only 29 percent (10/34) did so in the group using the incentive spirometric device (P less than 0.05). Spirometric differences were minimal, although the trend favored the incentive spirometric device. Principal conclusions were as follows: (1) deep breathing under the conditions of this investigation was equal to episodic therapy with IPPB; and (2) from an economic standpoint, IPPB, as it is currently practiced, may be disadvantageous when compared with the incentive spirometric device.