text: Health blog | - Part 5
  Health Blog News - Part 5
  Posted in Alveolitis
  Comments Off on From Subclinical Alveolitis to Granulomatosis
  Sequential Evaluation of Pulmonary Involvement in Extrathoracic Sarcoidosis
  Follow-up of patients with subclinical inflammatory alveolitis associated with systemic diseases may represent the best opportunity to study the mechanisms responsible for the development of interstitial lung disease. We report a seven-year sequential pulmonary evaluation of one patient with clinically isolated gastric sarcoidosis, treated by gastrectomy, without evidence of clinical, radiologic or functional lung impairment and with chronic subclinical lymphocyte alveolitis. Five years later, she developed an overt interstitial lung disease characterized by fine crackles, diffuse parenchymal opacities and impaired diffusing capacity, preceded by an expansion of polymorphonuclear neutrophils in the lower respiratory tract, raising the hypothesis that these cells may be implicated in the pathogenesis of pulmonary derangement in sarcoidosis. This observation illustrates the importance of pulmonary follow-up of unaffected patients with systemic diseases and with subclinical inflammatory alveolitis, and the potential predictive value of neutrophil alveolitis in the pulmonary outcome of these patients. generic paxil [Read More…]
  Tags: alveolitis, granulomatosis, lung, pulmonary involvement, sarcoidosis
  Comments Off on Effect of Sternotomy and Coronary Bypass Surgery on Postoperative Pulmonary Mechanics: Conclusion
  Whether there is a role for routine PFTs prior to sternotomy and the results of such tests should determine the use of an IMA graft requires further study. We believe that preoperative PFTs are useful to quantify the degree of respiratory impairment in patients who already have evidence of poor respiratory function, and that the choice of the bypass conduit, specifically, the denial of an IMA graft, should not be based on the results of preoperative PFTs. The more favorable patency rate of IMA grafts is the factor that should be weighed against the possibility of postoperative impairment in pulmonary function. It should also be noted that the effectiveness of PFTs to identify patients likely to have respiratory complications has not been established. [Read More…]
  Comments Off on Effect of Sternotomy and Coronary Bypass Surgery on Postoperative Pulmonary Mechanics: Discussion
  The differences in postoperative PFTs between the two study groups could also be related to differences in the preoperative clinical condition of the patients in each of the groups. However, we believe that the clinical condition of each patient would have been reflected in a number of intraoperative factors such as number of vessels requiring bypass, longer bypass runs, and higher postbypass fluid gradients. However, there were no statistically significant differences in intraoperative factors between any of the study groups, which suggest that the sample was homogeneous prior to assignment to the study groups. In addition, as differences in intraoperative factors could have also determined different postoperative PFTs, we explored the associations between PFTs and intraoperative factors without finding significant differences between the two study groups and no significant association with preoperative or postoperative PFTs. [Read More…]
  Comments Off on Effect of Sternotomy and Coronary Bypass Surgery on Postoperative Pulmonary Mechanics: Results
  All patients that were entered on the study were available for postoperative follow-up. Demographic data showed that the patients in group 1 were younger than the patients in group 2 (57.4 vs 69.0, p<0.0001). This finding probably reflects the personal preference of the surgeons involved in the study, which is not to use the IMA in elderly patients. The percentage of men was higher in group 1 than in group 2 (98 vs 40 percent, p<0.001). Intraoperative variables of number of vessels bypassed, bypass and cross-clamp time, postbypass fluid gradient and other intraoperative factors (Table 1) were not significantly different between the two study groups. [Read More…]
  Comments Off on Effect of Sternotomy and Coronary Bypass Surgery on Postoperative Pulmonary Mechanics: Methods
  All patients had arterial blood gas determinations preoperatively and as part of routine postoperative care. Coronary bypass grafting was carried out under hypothermic cardiopulmonary bypass with blood-potassium cardioplegia and topical hypothermia. The decision to use either or both IMAs or the SV was that of the operating surgeon at the time of the procedure. The IMA was mobilized from the posterior sternal table with a pedicle of intercostal muscle. No effort was made to avoid entering the pleural cavity during IMA harvesting. The saphenous vein was harvested from the inner thigh. Use of either or both IMAs, the SV, the number of vessels bypassed, the duration of the bypass run, the aortic cross-clamp time, and the fluid gradient after CPB were recorded and entered into a computerized database. Graft-coronary artery anastomoses were performed using standard techniques. All patients were weaned from CPB without difficulty. Postoperative care included endotracheal intubation for the first 24 h and routine hemodynamic monitoring of left ventricular filling pressures and cardiac output. No patients had prolonged requirements for ventilatory support and all were discharged from the hospital without complications. Spirometry was repeated postoperatively using the same technique. [Read More…]
  Comments Off on Effect of Sternotomy and Coronary Bypass Surgery on Postoperative Pulmonary Mechanics
  Comparison of Internal Mammary and Saphenous Vein Bypass Grafts
  A median sternotomy incision is the standard approach for coronary artery bypass grafting. Usually, the bypass conduit consists of a SV graft or the IMA. It is assumed that little or no significant lung injury is sustained durng sternotomy and that poststernotomy changes in pulmonary function are related to changes in the mechanics of the thoracic cavity itself. However, the combination of sternotomy and IMA harvesting may impair respiratory function. First, it may interfere with sternal stability and decrease chest wall compliance. fully [Read More…]
  Comments Off on Efficacy of a Pulsed Oxygen Delivery Device during Exercise in Patients with Chronic Respiratory Disease: Conclusion
  The reasons for the few discrepancies in Pa02 between the COS-5 and continuous flow of oxygen in our study are not readily apparent. There were six instances (in four patients) out of the 31 comparisons of the two modes of delivery in which the Pa02 differed by more than ±5 mm Hg (the accuracy of the electrodes), or the saturations differed by more than 2 percent. The Pa02 was more than 5 mm Hg greater with continuous 02 delivery at two flow rates in a patient with COPD (No. 1) and at one flow rate in a patient with IPF (No. 11). Of interest, patient No. 1 employed pursed lip breathing during exercise, and it is possible that the pursed lip breathing caused buildup of a reservoir of oxygen that was inhaled during the subsequent inspiration. Conversely, the Pa02 was higher with the COS-5 at two flow rates in one patient with IPF (No. 12) and at one flow rate in one patient with COPD (No. 5). There was no apparent explanation for the higher Pa02 during COS-5 oxygen delivery in these patients, but it is of interest that patient 12 was breathing at the highest respiratory rate observed. further
  Comments Off on Efficacy of a Pulsed Oxygen Delivery Device during Exercise in Patients with Chronic Respiratory Disease: Discussion
  Previous studies of pulsed demand oxygen delivery systems have reported equivalent oxygenation at rest in patients with pulmonary disease when oxygen is delivered by pulsed and continuous modes. However, since ambulation is essential for all patients with chronic pulmonary disease, it is important to ensure that these devices provide adequate oxygenation during exercise. We have previously found that the level of oxygenation achieved during exercise by another demand system that delivers pulsed oxygen was less than that found with continuous oxygen delivery, particularly at flow rates of 3 L/min. Although the mechanism for these differences during exercise was not investigated, it was suggested that they might be due to the breathing pattern, or a switch from nose to mouth breathing, with resultant failure to trigger the demand valve consistently. Such conditions would be particularly prevalent under conditions of stress in patients who breathe rapidly and shallowly, or through their mouths, or if they are unable to develop sufficient inspiratory force to trigger a demand oxygen device because of respiratory muscle fatigue. We therefore also studied patients with IPF because they generally breathe at high respiratory frequencies, particularly during exercise. Source