British journal of diseases of the chest
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Serial arterial blood gases were measured during fibreoptic bronchoscopy in 26 patients with diffuse interstitial lung disease. All those having transbronchial biopsy with or without bronchoalveolar lavage, performed breathing room air, showed significant falls in PaO2, at the time of passage of the bronchoscope through the vocal cords both at the beginning and end of the procedure. ⋯ Cessation of the supplementary oxygen 30 minutes after withdrawal of the bronchoscope did not result in rebound hypoxaemia. Bronchoalveolar lavage and transbronchial biopsy can be performed safely in patients with diffuse interstitial lung disease without significant hypoxaemia developing, if oxygen is started before the procedure and continued for 30 minutes after withdrawal of the bronchoscope.
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Pulmonary function changes were studied following bronchoalveolar lavage (BAL) in a group of mild to moderate asthmatic patients and in control subjects. After BAL significant decreases in FEV1 and FVC which were not inhibited by atropine and a consistent decline in PaO2 were seen in both groups. The magnitude of changes in these asthmatics was similar to that in control subjects.
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Case Reports
Assessment of proximal airway obstruction in children by analysis of flow-volume loops.
The usefulness of maximal expiratory and inspiratory flow-volume (F-V) loops was assessed in ten children with clinical evidence of tracheal or laryngeal obstruction. Normal values from 514 healthy children are presented. ⋯ F-V loop analysis is a valuable technique in the assessment of the child with proximal airway obstruction. Unlike endoscopic and radiological investigation, it measures the functional rather than the anatomical degree of obstruction, and provides a simple non-invasive way of monitoring the response to treatment.
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Recent interest in the benefits of long-term oxygen therapy for patients with chronic airflow obstruction and hypoxaemia should lead to an increased use of nasal prongs for prolonged (15 hours/day) oxygen administration. Because some patients find nasal prongs uncomfortable and since they may slip out of position during use, we have devised a new nasal oxygen mask and compared both its performance and comfort with conventional nasal prongs. Changes in end-tidal oxygen concentration were measured after administering oxygen at 2 litres/min through each device for 10 minutes in 15 normal subjects and for 1 hour in patients with chronic airflow obstruction and hypoxaemia. ⋯ There was also no difference in the improvement in arteriolized capillary oxygen tensions (mask 3.5 kPa; prongs 4.0 kPa). In a separate study of prolonged (22 hours) use there was no difference in reported comfort. The new mask is a useful alternative to conventional nasal prongs.
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We describe a case of bronchocentric granulomatosis in a young woman with several unusual features. She developed spontaneous pneumothoraces, diffuse interstitial infiltrates and the adult respiratory distress syndrome during the course of her illness. A pathological diagnosis was not made until treatment with corticosteroids had led to a marked improvement in the patient's condition and an open lung biopsy was performed.