European journal of respiratory diseases最新文献

In the present study the response of the pulmonary circulation to a vasodilator agent (nifedipine) and to low-flow oxygen (FiO2 35%) has been studied both at rest and during exercise (steady state, 25 W) in nine patients with severe scoliosis (spinal curve + 100 degrees, FVC 38%). All patients were dyspneic on exertion and had had at least one episode of right heart failure. The mean pulmonary artery pressure (Pap) ranged from 13 to 37 mmHg at rest and ranged from 30 to 75 mmHg during exercise. Standard exercise, performed 60 min after 20 mg sublingual nifedipine, was associated with a reduction in mean Pap (49 mmHg) as compared with exercise performed during the control period (58 mmHg, p less than 0.001). Pulmonary vascular resistance (PVR) on exercise decreased more on nifedipine (28.9%) than on oxygen (13.9%) (p less than 0.05). Our results suggest that nifedipine improves pulmonary haemodynamics in patients with severe scoliosis complicated by cor pulmonale.

All patients seen in 1975 to 1984 with benign asbestos pleural effusion (BAPE) were studied. In all, 73 exudates occurred in 60 patients, 40 on the left side and 33 on the right. Relapses occurred on the same side in two patients; 11 had bilateral exudates, three of them concomitantly, in the other patients with a free interval of 1-15 years. The mean latency time from the first exposure to asbestos was 30 years, with a range of 1 to 58 years. The effusions lasted from 1 to 10 months, with a median of 3 months. The most common symptoms were pain, fever, cough, and/or dyspnoea; however, 46% of the episodes were symptomless. The total number of thoracocenteses was 66, with removal of 50 to 2000 ml (mean 460) each time. Fifty-three per cent of the pleural fluids were macroscopically haemorrhagic and 26% eosinophilic. Two findings contribute to a better understanding of the entity: first, even a comparatively slight occupational exposure can be sufficient; secondly, BAPE can occur many years after exposure to asbestos, and not only in the first one or two decades.

Data are presented on the relationships between air flow rates and pressures generated by 15 brands of domiciliary compressor currently used in the United Kingdom to drive jet nebulisers. Since compressor brands vary widely in power, care must be taken in the selection of appropriate models for efficient respiratory therapy.

We compared samples obtained using a fine-needle with those made using a screw-needle (Rotex) of equal diameter in 28 patients. The biopsies were performed with the aid of computed tomography. All patients had lesions suggesting primary lung neoplasia or metastatic disease located in the lung parenchyma, pleura and in the ribs (17, 9 and 2 patients, respectively). Diagnostic material was obtained from 25 patients. There was no statistically significant difference in the yield of diagnostic material produced by the two procedures. Malignancy was found in 12 patients. Pneumothorax was the most common complication, occurring in 7 patients. CT-guided diagnostic needle biopsies have high diagnostic accuracy and a low complication rate. The diagnostic yield of the fine-needle and the screw-needle is equal.

In 12, symptom-free, asthmatic children, aged 5-10 years, responses (increases in FEV1) were measured to cumulative doses of inhaled terbutaline delivered by two methods: a) 5 breaths from a 750 ml spacer (Nebuhaler) attached to a metered dose aerosol (doses were 0.5, 1, 2 and 4 mg); and b) by face mask attached to a Bennett twin-jet nebuliser containing terbutaline solution (doses were 1, 2, 4 and 8 mg in 2 ml). Responses were dose-related by both methods and the log dose-response lines were parallel. Twice the dose of nebulised terbutaline was required to give responses equivalent to those seen with the Nebuhaler (significant difference between the lines, ANOVA, P = 0.05). The highest doses given by either method resulted in achievement of at least 80% of the maximum possible improvement in respiratory function (i.e. predicted FEV1 (50th centile) minus basal FEV1) with no effects on pulse rate. Thus, the use of the Nebuhaler with terbutaline metered dose aerosol is at least as effective as administration of the same total dose by nebuliser in children who are not in acute respiratory difficulty. Also, it produces a dose-related bronchodilator effect, without pulse-rate effects, for doses of terbutaline between 0.5 to 4 mg (2 to 16 puffs of the metered dose (0.25 mg) aerosol).