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PubMed2000

[Positive end expiratory pressure in anesthesia].

It is well established that general anesthesia, with or without paralysis, causes profound changes in respiratory function. From a clinical point of view, the more important consequence of this impairment is a decreased efficiency of gas exchange, with a decreased blood oxygenation. The main reason of this respiratory embarrassment is the intraoperative occurrence of atelectasis, mainly in the dependent lung regions. The amount of atelectasis, computed through Computerized Tomography, correlates with the amount of intrapulmonary shunt; thus, alveolar collapse and ventilation/perfusion mismatching are considered the most important factors for poor respiratory function. This deterioration seems also to play a crucial role in obese patients, who have poorer respiratory function and gas exchange than normal subjects already in physiological conditions. Different ventilatory approaches have been tried to resolve and eventually prevent the anesthesia-induced atelectasis. In normal subjects, the sole application of positive end-expiratory pressure (PEEP) seems to be an useless tool for improving gas exchange, probably because of changes in hemodynamics functions. The only effective application of PEEP seems to be in association to an alveolar recruitment manoeuvre. As the anesthesia-induced atelectasis are also present in the postoperative period, this ventilatory approach may also be used to prevent this condition. In obese patients PEEP seems to have a major effectiveness than in normal subjects, with an improvement of lung volumes, respiratory mechanics, gas exchange and an occurrence of recruitment. However, further studies are necessary to define optimal value of PEEP and tidal volume for different types of patients.

Anesthesia, General↗
PubMed2000

[Pleural and parenchymal lung diseases from asbestos exposure. CT diagnosis].

INTRODUCTION: We report the CT findings of parenchymal and pleural diseases in a group of patients with a history of asbestos exposure, excluding lung cancer (which is not typical in this subjects) and asbestosis (which is a parenchymal fibrosis). MATERIAL AND METHODS: We retrospectively reviewed a series of CT examinations (conventional, helical and high resolution scans) of 21 patients examined from 1995 to 1999. They had pleural plaques (10), round atelectasis (2) and malignant pleural mesothelioma (9). All patients had a history of direct or indirect asbestos exposure, except one with malignant pleural mesothelioma. We evaluated the following CT findings: nodular, plaque or uniform pleural thickening; pleural calcifications; pleural thickening less or greater than 1 cm; pleural margins (regular, polycyclic, spiculated); localization (uni/bilateral hemithorax); distribution (upper, medium or lower region); pulmonary, mediastinal and diaphragmatic involvement; fissural involvement; pleural effusion; lymph node enlargement; lung mass with the comet-tail sign; lung volume (normal, reduced, increased). RESULTS: Pleural plaques were always bilateral and less than 1 cm thick, with calcifications in 80% of the cases. Margins were always regular, polycyclic in 40% of the patients and never irregular. The pulmonary pleura in the mid-chest was involved in cell cases the diaphragmatic pleura in the 50% of the cases and the upper and lower regions in 60% and 80% of the patients, respectively. Round atelectasis (3 cases in 2 patients) was always shown as a parenchymal mass in the lower lobes, posteriorly or posteromedially, with adjacent pleural thickening; its diameter ranged 4.4-6 cm and there was the comet-tail sign. In malignant pleural mesothelioma we always found pleural effusion, with unilateral pleural effusion being the only sign in 2 patients. Other findings were pleural nodules (77.7%), with spiculated (22.2%) and polycyclic (77.7%) margins, more than 1 cm in diameter. The disease was always unilateral. The parenchymal pleural was involved in 77.7% of the cases while the mediastinal and diaphagmatic pleura were involved in 44.4% of the patients. Fissural involvement was demonstrated in 66.6% of the patients. Lymph nodes were enlarged in 66.6% of the cases. The volume of the affected hemithorax was increased (22.2%), decreased (44.4%) or normal (33.3%). DISCUSSION AND CONCLUSIONS: The presence of pleural plaques is a specific sign of asbestos exposure. Round atelectasis may also indicate asbestos exposure, but it can be found in many diseases with pleural inflammation, such as tuberculous effusion, trauma, pulmonary infarct, congestive heart failure, coronary artery bypass. The CT patterns of these two diseases are typical and no other finding is necessary to confirm the diagnosis. CT-guided needle biopsy is needed only if the round atelectasis has an atypical appearance on CT images, that is without the comet-tail sign. Malignant pleural mesothelioma is strongly associated with previous occupational exposure and presents typical CT findings only in an advanced stage (irregular and nodular pleural thickening, pleural effusion, mediastinal and pulmonary contraction for tumor encasement, parenchymal and lymph node metastases), but the differential diagnosis with pleural metastatic disease can be difficult. CT plays an important role in tumor assessment but biopsy is necessary for lesion characterization.

Adult↗
PubMedDate not supplied

Risk factors of extubation failure in extremely low birth weight infants: a five year retrospective analysis.

Extubation failure is one of the most serious complications in extremely low birth weight infants (ELBWI) on mechanical ventilation therapy. We performed a 5-year retrospective analysis to realize the status of extubation failure in ELBWI. Extubation failure was defined as requirements of re-intubation within 72 hours after extubation. The extubation failure rate was 21% (29/138). The mean birth body weight was 808.3 +/- 140.4 gm. The mean gestational age was 25.8 +/- 1.2 wks. The incidence of chronic lung disease (CLD) in infants with extubation failure was 100% (29/29). Apnea of prematurity 49% (14/29) and post-extubation atelectasis 39% (11/29) were the most common reasons for reintubation. The major microbiology findings which correlated with nosocomial pneumonia in infants with extubation failure were Acinetobacter baumanni (21%), Klebsiella pneumonia (21%), Pseudomonas aeroginosa (14%), and Methicillin resistant staphylococcus aureus (14%). In conclusion, post-extubation atelectasis and apnea were the most common reasons for reintubation. ELBWI with extubation failure had higher incidences of post-extubation atelectasis, CLD, and nosocomial pneumonia. Further prospective studies are needed in order to clarify the appropriate extubation program for ELBWI and to prevent post-extubation atelectasis and nosocomial pneumonia.

Female↗
PubMed1995

[Gas exchange changes in the postoperative period of heart surgery].

We studied prospectively 59 open-heart surgical patients (CBPS) in order to evaluate postoperative arterial blood gases evolution and its predictive value of respiratory and non-respiratory post-surgical complications. Twenty-four hours after CPBS 28 over 59 patients showed left pleural effusion and/or left lower lobe atelectasis. 62.9% or pleural effusions were only blunted costophrenic angle. Chest x-ray film were normal in 38.9% (23/59) of patients. Forty-eight hours after CPBS only 5% (3/59) radiographs were normal and only 31% of pleural effusion were classified as minimal. Forty-eight hour radiographs worsened in 69.4% of the patients. (Table 1). During 48 hours period 71% of patients showed pleural effusion and 42% atelectasis. Only 1 patient showed an atelectasis up a third of hemithorax (3.5% of abnormal chest X-ray films). Twelve hours alveolo-arterial quotient (a/A) was decreased in 50/59 patients (0.51 +/- 0.16), more deeply at the second day. There was no relationship between CBP time and a/A at 12 or 48 hours. The normal chest X-ray film patients mean a/A was no different (0.54 +/- 0.17). The a/A at 48 hours was no different between patients with and without lower lobe atelectasis. Nine patients (15%) developed respiratory complications (RC) and 11 (19%) non-respiratory complications (NRC) (Table 2). There was no difference in CBP time (76.9 +/- 27.9 vs 88.1 +/- 27.7 min p = NS) nor aortic cross-clamp time (52.61 +/- 20.43 vs 59.57 +/- 19.39 min p = NS) between patients with and without RC. There were no differences in a/A at 12 hours (0.47, 0.51, 0.48 p = NS) and 48 hours (0.34, 0.32, 0.30 p = NS) between patients without complications, with RC and with NRC (Table 3). There was no correlation between 12 or 48 hours a/A and intensive care or hospital stay length. The absence of predictive value of hypoxemia could be explained from a different source of early a/A fall and important RC. It could mean that RC after CPBS are not specific of that sort of surgery nor involve mechanisms related to that special intraoperative circumstances, which is not the same for gas exchange alterations. We conclude that a/A deterioration is a very common finding after CBP and does not identify particularly risky patients.

Adult↗
PubMed1980

The reduction of postoperative chest infection by prophylactic co-trimoxazole.

A prospective randomized double-blind study was conducted to evaluate the effect of a single prophylactic dose of co-trimoxazole on the incidence of pulmonary complications following upper abdominal surgery. Of 68 patients studied, 36 were judged clinically to have no postoperative pulmonary complications, 18 to have pulmonary atelectasis and 14 to have chest infection. Serial analysis of arterial oxygen tensions supported the clinical assessment. Of 34 controls, 6 developed pulmonary atelectasis and 11 (32 per cent) chet infection. Of the 34 treated patients, 12 developed atelectasis and 3 (9 per cent) chest infection. The reduction in chest infection was significant (P < 0.05). These results support the use of prophylactic cotrimoxazole to prevent chest infection following abdominal surgery.

Cholecystectomy↗
PubMed1985

[Fiberoptic bronchoscopy in intensive care medicine--functional efficacy and methodological side effects].

A prospective study was performed to determine the side effects of fiberoptic bronchoscopy on cardiopulmonary function, the influence of bronchial lavage on cardiopulmonary function, and the functional efficacy of fiberoptic bronchoscopy in obstructive atelectasis due to retained secretions. In 17 patients endotracheal intubation was immediately followed by a significant (P less than 0.01) rise in arterial, pulmonary artery and pulmonary capillary wedge pressure, heart rate, and cardiac output. There were no statistically significant differences in arterial blood gases and intrapulmonary right-to-left shunt. Two patients showed circulatory changes indicative of a heart insufficiency on the left side. A significant increase (P less than 0.001) in intrapulmonary right-to-left shunt from 12% to 17.5%, a significant decline in arterial oxygen tension of 15 mm Hg, and a significant increase of cardiac output from 6.4 to 7.71/min following saline solution lavage (20 ml in each bronchus) were observed in nine patients. The results indicate that bronchial lavage is the essential mechanism for the decline in arterial oxygen tension induced by fiberoptic bronchoscopy. In patients with unstable cardiopulmonary status, the cardiovascular response during bronchoscopy may be hazardous and the bronchoscopist should be aware of the pathophysiologic side effects involved. Fifteen therapeutic bronchoscopies were performed in five critically ill patients with obstructive atelectasis, due to retained secretions. Following the procedure, Qs/Qt declined from 23.9% to 15%, cardiac output from 9.3 to 7.31/min, and arterial Po2 increased from 58.9 to 70.9 mm Hg. The differences were statistically significant (P less than 0.0001). The therapeutic value of fiberoptic bronchoscopy in the treatment of obstructive atelectasis is demonstrated by the significant improvement in cardiopulmonary status.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Two-dimensional ultrasonographic findings of atelectatic lung segments.

Thirteen cases with pulmonary atelectasis were examined by two-dimensional sonography in our clinics between October 1990 and April 1993. Patients' ages ranged from 2 to 16 years. Five patients revealed atelectasis with pleural effusion and eight patients had only atelectasis. Two-dimensional sonography showed a solid mass indistinguishable from lung parenchyma in patients with atelectatic lung segment without pleural effusion while atelectatic segment was readily identified in those with pleural effusion. We conclude that sonography is a useful and non-invasive technique in differentiating cardiac from extracardiac masses, because atelectatic lung segment with moderate to large pleural effusion may mimic intrapericardial masses.

Adolescent↗
PubMed1980

Incentive spirometry: its value after cardiac surgery.

Treatment with intermittent positive pressure breathing (IPPB) and incentive spirometry (I.S.) was compared in 109 patients after heart surgery with cardiopulmonary bypass. Assessment was done by measurement of vital capacity, arterial oxygen tension and identification of the radiological signs of atelectasis. All patients were instructed pre-operatively in the treatment which was to be used. Vital capacity, arterial oxygen tension while breathing air for the first three postoperative days and the incidence of atelectasis showed no significant difference between groups. Ten minutes after treatment the arterial oxygen tension fell, but this was only statistically significant after I.P.P.B. At 60 minutes the arterial oxygen tension had returned to pretreatment level in both groups. The use of the incentive spirometer four times daily is no better than I.P.P.B., in preventing atelectasis after open-heart surgery. Possibly incentive spirometer treatment given more frequently may be more effective.

Cardiopulmonary Bypass↗
PubMed2002

What can we learn from chest radiographs in hypoxemic asthmatics?

BACKGROUND: Chest radiographs (X-rays) are frequently obtained on children with asthma exacerbations who remain hypoxemic after therapy even though their utility has not been evaluated. OBJECTIVE: To compare X-rays in hypoxemic and non-hypoxemic asthmatic children. METHODS: Over 21 months, X-rays were obtained on all persistently hypoxemic asthmatics (1-17 years, oxygen saturation <93% in room air), and some non-hypoxemic asthmatics. A pediatric radiologist blinded to the patients' symptoms evaluated each X-ray for lung size, extravascular lung fluid, and atelectasis. Clinical outcomes including duration of hypoxemia, length of hospital stay, and admission to the PICU were assessed through chart audit after hospital discharge. RESULTS: A total of 445 patients were enrolled and stratified into four groups based on initial and post-treatment pulse oximetry measurements. Hypoxemic groups I and II were more likely to have large or small lungs ( P<0.05), severe interstitial fluid ( P<0.01), and atelectasis ( P<0.01) compared to non-hypoxemic group IV. Group I was more likely to have fluid in the alveolar space compared to all other groups ( P<0.01). Within hypoxemic group I, there was no association between any radiographic findings and our clinical outcomes. CONCLUSION: Large or small lung sizes, extravascular fluid, and atelectasis were more common in the X-rays of hypoxemic asthmatics.

Adolescent↗
PubMed2005

[Impact of computed tomography (CT) and 18F-deoxyglucose-coincidence detection emission tomography (FDG-CDET) image fusion for optimisation of conformal radiotherapy in non-small-cell lung cancers].

UNLABELLED: To report a retrospective study concerning the impact of fused 18F-fluorodeoxy-D-glucose (FDG)-hybrid positron emission tomography (PET) and computed tomography (CT) images on three-dimensional conformal radiation therapy (3D-CRT) planning for patients with non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: One hundred and one patients consecutively treated for stages I-III NSCLC were studied. Each patient underwent CT and FDG-hybrid PET for simulation treatment in the same radiation treatment position. Images were coregistered using five fiducial markers. Target volume delineation was initially performed on the CT images and the corresponding FDG-PET data were subsequently used as an overlay to the CT data to define target volume. RESULTS: FDG-PET identified previously undetected distant metastatic disease in 8 patients making them ineligible for curative CRT (one patient presented some positive uptakes corresponding to concomitant pulmonary tuberculosis). Another patient was ineligible for curative treatment because fused CT/PET images demonstrated excessively extensive intrathoracic disease. The gross tumor volume (GTV) was decreased by CT/PET image fusion in 21 patients (23%) and was increased in 24 patients (26%). The GTV reduction was > or = 25% in 7 patients because CT/PET image fusion reduced pulmonary GTV in 6 patients (3 patients with atelectasis) and mediastinal nodal GTV in 1 patient. The GTV increase was > or = 25% in 14 patients due to an increase of the pulmonary GTV in 11 patients (4 patients with atelectasis) and detection of occult mediastinal lymph node involvement in 3 patients. Among 81 patients receiving a total dose > or = 60 Gy at ICRU point, after CT/PET image fusion, the percentage of total lung volume receiving more than 20 Gy (VL20) increased in 15 cases and decreased in 22 cases. The percentage of total heart volume receiving more than 36 Gy increased in 8 patients and decreased in 14 patients. The spinal cord volume receiving at least 45 Gy (2 patients) decreased. After multivariate analysis, one single independent factor made significant effect of FDG/PET on the modification of the size of the GTV: tumor with atelectasis (P = 0.0001). Conclusion. - Our study confirms that integrated hybrid PET/CT in the treatment position and coregistered images have an impact on treatment planning and management of patients with NSCLC. FDG images using dedicated PET scanners with modern image fusion techniques and respiration-gated acquisition protocols could improve CT/PET image coregistration. However, prospective studies with histological correlation are necessary and the impact on treatment outcome remains to be demonstrated.

Adult↗
PubMed2005

Chronic tuberculous empyema: relationships between preoperative CT findings and postoperative improvement measured by pulmonary function testing.

AIMS: To evaluate whether preoperative computed tomography (CT) findings correlate with postoperative improvements in forced vital capacity (FVC) and forced expiratory volume during 1s (FEV1) in persons who have undergone unilateral decortication because of unilateral chronic tuberculous empyema. METHODS: A retrospective study was carried out of 67 individuals who had undergone decortication because of chronic tuberculous empyema between January 1996 and December 2000. Of these, 13 subjects who had had preoperative chest CT and preoperative and postoperative pulmonary function tests (PFTs) were included in the investigation. On preoperative CT, the degree of volume reduction of the affected side was compared with that of the contralateral normal lung. The relative volume of empyema was calculated by dividing the volume occupied by the empyema by the sum of the total volume of the ipsilateral lung and the empyema volume. The thicknesses of pleura and extrapleural fat in the involved hemithorax were measured by CT at their thickest points, and the degree of atelectasis adjacent to the empyema in the diseased lung was assessed and classified. These five CT parameters and the ages of the patients were compared with preoperative and postoperative FVC and FEV1 changes. RESULTS: A significant negative correlation was found between FVC changes and the relative volume of the affected lung (FVC: p = 0.039, RS = -0.58). FVC and FEV1 were found to be significantly and positively correlated with the relative volume of the empyema (FVC: p = 0.005, RS = 0.72; FEV1: p = 0.014, RS = 0.66) and the degree of atelectasis (FVC: p = 0.007, RS = 0.71; FEV1: p = 0.029, RS = 0.60) by Spearman's nonparametric correlation test. Other CT parameters and the ages of the patients were not found to be correlated with PFT changes. CONCLUSION: The relative volume of the affected side, the relative volume of empyema and the degree of atelectasis can predict improvements in FVC and FEV1 after decortication in patients with chronic tuberculous empyema.

Adult↗
PubMed2006

Cost-effectiveness analysis of prophylactic respiratory physiotherapy in pulmonary lobectomy.

OBJECTIVE: To evaluate the cost-effectiveness balance of implementing an intensive program of chest physiotherapy in pulmonary lobectomy. METHODS DESIGN: cross-sectional study with historical controls. Cases are 119 patients operated on during a 15-month period of time, after implementation of an intensive chest-physiotherapy program. Controls are 520 patients operated on by the same team before the program started. In these patients, only incentive spirometry was indicated besides routine nursing care. In both series, operative selection criteria and anaesthetic management were similar. Population homogeneity was assessed by comparing age, body mass index (BMI) and estimated postoperative FEV1 (ppoFEV1) of the patients in both series. Selected outcomes were as follows: 30-day mortality, prevalence of respiratory morbidity (atelectasis and pneumonia) and hospital stay. Hospital stay was estimated by Cox regression using age, ppoFEV1, BMI, diagnosis and postoperative morbidity as covariates. Costs were calculated adding chest therapists' salaries and acquisition value of specific training and monitoring devices and its consumable items. Savings from avoided hospitalisation days was discounted. RESULTS: Prevalence of atelectasis and median hospital stay decreased in physiotherapy group. Cost of the program was 48,447.81 (407.12 per treated patient). An estimated total of 151.75 hospital days was saved in the physiotherapy group. Since daily hospitalisation cost is 590.00 in our centre, 89,532.50 savings was estimated from avoided hospitalisation days. CONCLUSIONS: We have found a significant decrease in the rate of postoperative atelectasis without additional costs. In fact, the program has produced considerable monetary savings.

Aged↗
PubMed2004

Impact of FDG-PET on radiation therapy volume delineation in non-small-cell lung cancer.

PURPOSE: Locoregional failure remains a significant problem for patients receiving definitive radiation therapy alone or combined with chemotherapy for non-small-cell lung cancer (NSCLC). Positron emission tomography (PET) with [(18)F]fluoro-2-deoxy-d-glucose (FDG) has proven to be a valuable diagnostic and staging tool for NSCLC. This prospective study was performed to determine the impact of treatment simulation with FDG-PET and CT on radiation therapy target volume definition and toxicity profiles by comparison to simulation with computed tomography (CT) scanning alone. METHODS: Twenty-six patients with Stages I-III NSCLC were studied. Each patient underwent sequential CT and FDG-PET simulation on the same day. Immobilization devices used for both simulations included an alpha cradle, a flat tabletop, 6 external fiducial markers, and a laser positioning system. A radiation therapist participated in both simulations to reproduce the treatment setup. Both the CT and fused PET/CT image data sets were transferred to the radiation treatment planning workstation for contouring. Each FDG-PET study was reviewed with the interpreting nuclear radiologist before tumor volumes were contoured. The fused PET/CT images were used to develop the three-dimensional conformal radiation therapy (3DCRT) plan. A second physician, blinded to the results of PET, contoured the gross tumor volumes (GTV) and planning target volumes (PTV) from the CT data sets, and these volumes were used to generate mock 3DCRT plans. The PTV was defined by a 10-mm margin around the GTV. The two 3DCRT plans for each patient were compared with respect to the GTV, PTV, mean lung dose, volume of normal lung receiving > or =20 Gy (V20), and mean esophageal dose. RESULTS: The FDG-PET findings altered the AJCC TNM stage in 8 of 26 (31%) patients; 2 patients were diagnosed with metastatic disease based on FDG-PET and received palliative radiation therapy. Of the 24 patients who were planned with 3DCRT, PET clearly altered the radiation therapy volume in 14 (58%), as follows. PET helped to distinguish tumor from atelectasis in all 3 patients with atelectasis. Unsuspected nodal disease was detected by PET in 10 patients, and 1 patient had a separate tumor focus detected within the same lobe of the lung. Increases in the target volumes led to increases in the mean lung dose, V20, and mean esophageal dose. Decreases in the target volumes in the patients with atelectasis led to decreases in these normal-tissue toxicity parameters. CONCLUSIONS: Radiation targeting with fused FDG-PET and CT images resulted in alterations in radiation therapy planning in over 50% of patients by comparison with CT targeting. The increasing availability of integrated PET/CT units will facilitate the use of this technology for radiation treatment planning. A confirmatory multicenter, cooperative group trial is planned within the Radiation Therapy Oncology Group.

Carcinoma, Non-Small-Cell Lung↗
PubMedDate not supplied

Risk factors for postoperative respiratory complications in adult liver transplant recipients.

To determine the types and the incidence of as well as risk factors for early postoperative (<30 days) respiratory complications in adult liver transplant (LT) recipients, we reviewed The data of 44 consecutive adult LT recipients who received their grafts from January 1995 through December 2002. The data included demographic features; primary diagnosis; number of intraoperative transfusions; preoperative and postoperative laboratory values; intraoperative and postoperative characteristics; and early postoperative (<30 days) mortality. Pulmonary atelectasis, pleural effusion, pneumonia, respiratory failure, and pulmonary edema were the respiratory complications investigated. Twenty-six patients (59.1%) developed at least one respiratory complication during the early postoperative period. The most frequent complication was pleural effusion (n = 18, 40.9%), followed by atelectasis (n = 13, 29.5%), pneumonia (n = 10, 22.7%), acute respiratory failure (n = 5, 11.4%), pulmonary edema (n = 3, 6.8%), and pneumothorax (n = 2, 4.5%). Compared to the patients who did not develop these problems, the affected cohort was significantly older (27 +/- 12 years vs 36 +/- 14 years, respectively; P =.039) and required more intraoperative transfusions (P =.005). Among the overall mortality rate of 15.9%, patients who developed pneumonia showed a significantly higher mortality (40.0% vs 8.8%, respectively; P =.037). Pleural effusion, atelectasis, and pneumonia are the main respriatory complications that occur in adult LT recipients. Patient age and intraoperative transfusion requirements are important predictors of early postoperative complications. Pneumonia is associated with a poor prognosis in this patient group.

Adolescent↗
PubMed1995

Multivariate analysis of risk factors for postoperative pneumonia.

PURPOSE: Many risk factors for postoperative pneumonia have been identified, but those for the progression from atelectasis to pneumonia have been poorly examined. We undertook the present study to find risk factors for the progression from atelectasis to pneumonia. PATIENTS AND METHODS: We completed a retrospective analysis of 2,969 patients who underwent major abdominal surgery during the past 13 years. RESULTS: Pneumonia developed in 45 patients (1.5%), and postoperative atelectasis with a high risk for the subsequent infection occurred in 44 patients in whom pneumonia did not develop. A series of 13 variables was compared in the two patient categories. By multivariate discriminant analysis, we identified three independent significant correlates of the development of postoperative pneumonia: blood loss of more than 1,200 mL during surgery, age over 65 years, and preoperative utilization of inhalation therapy devices. CONCLUSION: This study shows that a substantial number of cases of postoperative pneumonia can be prevented.

Aged↗
PubMed1978

The chest film findings in 'Q' fever--a series of 35 cases.

Thirty-five cases of 'Q' fever have been admitted and confirmed serologically over the past 20 years. Thirty-two of these cases had chest films on admission, and lung changes were present in 87%. The lung changes were: 1. Multiple round segmental consolidations, 5--10 cm in diameter, of ground glass density and usually situated in the lower lobes. 2. Linear atelectasis. 3. Lobar or partial lobar consolidation, with some loss of volume in the affected lobe. 4. A slight pleural reaction in a few cases. 5. Some cases had background emphysema of the lungs. All the lesions tended to be slow to clear. The resolution time was from 10 to 70 days, with an average time fo 30 days. Some of the segmental lesions became small, round and dense during resolution. The 35 cases were almost exclusively in males. The finding of a single or multiple round segmental opacities of ground glass density, as described, especially with linear atelectasis, was found to be good evidence that the patient had 'Q' fever. The point is made that the admission chest film is in some cases a very useful early pointer to the diagnosis. This allows specific chemotherapy to be started before the serological results have come back. Plate atelectasis was helpful as a distinguishing feature from primary atypical pneumonia.

Adolescent↗
PubMed1975

Giant osmiophilic lamellated bodies after temporary ischemia of the rat lung.

Following temporary ischemia of the rat lung an atelectasis was observed after resorption of the extravasate. To determine whether changes in osmiophilic lamellated bodies (OLB) precede and perhaps cause the atelectasis the upper lobe of the right lung was in eight white Wistar-rats subjected to temporary ischemia of 10 minutes. The two axial diameters of the intracellular OLB and their precursors were measured on electron micrographs 10 minutes, 60 minutes, 1 day and 2 days after cessation of the ischemia. The mean diameters were compared by statistical methods. Already after 10 minutes the usual elliptic cut surfaces of OLB were found to be more circular presumably because of swelling caused by an osmotic insufficiency of their membranes. After 2 days, the mean diameter of OLB had doubled, while shape and structure stayed normal. At the same time, the small precursor stages were missing. Consequently, we assume that formation of new OLB--represented by small non-lamallated osmiophilic bodies--and the incorporation of lipids into existing lamellar bodies are processes independent of each other. After a short, temporary ischemia only the formation of new osmiophilic bodies seems to be interrupted and this is associated with a quick growth of existing OLB. However, apparently these cannot be excreted in due time. The result could be lack of surfactant, which would account for the postischemic atelectasis.

Animals↗
PubMed1996

Anomalies of the tracheobronchial tree in patients with esophageal atresia.

To examine associated anatomic anomalies of the tracheobronchial tree and structural abnormalities of the trachea, and their clinical consequences, bronchoscopic examination and follow-up studies were performed in 32 patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) over a 5-year period. To evaluate structural abnormalities of trachea, the ratio of circumferential length of cartilaginous trachea to circumferential length of membranous trachea (C:M ratio) was determined before surgical repair. In patients examined before and after surgical repair, the motion of the posterior tracheal wall was observed under spontaneous respiration. Fifteen of the 32 patients (47%) had abnormalities of the tracheobronchial tree such as ectopic right upper bronchus (12), congenital bronchial stenosis (4), and absence of the right upper bronchus (2). The C:M ratio of the 27 patients with EA (2.0 +/- 0.6) was significantly lower than that of controls (3.0 +/- 0.3); the ratio for the 10 cases with ectopic right upper bronchus (1.7 +/- 0.4) was significantly lower than that of other cases (2.2 +/- 0.5). The C:M ratio for the 12 patients who had atelectasis (1.7 +/- 0.3) was significantly lower than that of the 15 who did not have atelectasis (2.2 +/- 0.6). Of 24 infants, nine had bulging of the posterior tracheal wall synchronized with expiration, and their C:M ratio (1.8 +/- 0.2) was significantly lower than that of the 15 patients without bulging (2.2 +/- 0.6). These data show an association between anatomic anomalies of the tracheobronchial tree and structural abnormalities of the trachea in patients with EA. Because these abnormalities may be related to the occurrence of respiratory disorders such as tracheomalacia and atelectasis, early bronchoscopic examination, including measurement of the C:M ratio and observation of the motion of the posterior tracheal wall under spontaneous respiration, may be useful in the care of patients with EA.

Bronchi↗