ABSTRACT
Objective To explore the diagnostic value of CT for the vegetable stone disease in the stomach,esophagus and small intestine.Methods The clinical data and CT findings of 27 cases confirmed by endoscopy or surgery were analyzed retrospectively. Among 27 cases,6 cases performed contrast-enhanced scan.Results Among 27 cases,18 cases were the gastrolithiasis,6 cases were the intestinal stone disease,1 case was the esophagus stone disease,and 2 cases were the multiple stones of stomach and small intestine.CT missed 7 cases and misdiagnosed 1 case with the rate of missed diagnosis was 25.93%.The lesions were cylindrical or oval shape with mixed density in 27 cases,distinct boundary in 26 cases,sclerotic margin in 22 cases,ethmoid or honeycomb bub-bles in the lesion in 25 cases,no enhancement in 6 cases,and complicated small bowel obstruction in 8 cases on CT images.Conclu-sion The phytobezoars in the stomach,esophagus and small intestine have typical CT findings.Careful analyses can improve its di-agnostic accuracy.
ABSTRACT
<p><b>OBJECTIVE</b>To estimate the feasibility and the efficacy of early extubation and sequential non-invasive mechanical ventilation (MV) in chronic obstructive pulmonary disease (COPD) with exacerbated hypercapnic respiratory failure.</p><p><b>METHODS</b>Twenty-two intubated COPD patients with severe hypercapnic respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study. At the time of pulmonary infection control window (PIC window) appeared, when pulmonary infection had been significantly controlled (resolution of fever and decrease in purulent sputum, radiographic infiltrations, and leukocytosis) after the antibiotic and the comprehensive therapy, the early extubation was conducted and followed by non-invasive MV via facial mask immediately in 11 cases (study group). Other 11 COPD cases with similar clinical characteristics who continuously received invasive MV after PIC window were recruited as control group.</p><p><b>RESULTS</b>All patients had similar clinical characteristics and gas exchange before treatment, as well as the initiating time and all indices at the time of the PIC window. For study group and control group, the duration of invasive MV was (7.1 +/- 2.9) vs (23.0 +/- 14.0) days, respectively, P < 0.01. The total duration of ventilatory support was (13 +/- 7) vs (23 +/- 14) days, respectively, P < 0.05. The incidence of ventilator associated pneumonia (VAP) were 0/11 vs 6/11, respectively, P < 0.01. The duration of intensive care unit (ICU) stay was (13 +/- 7) vs (26 +/- 14) days, respectively, P < 0.05.</p><p><b>CONCLUSIONS</b>In COPD patients requiring intubation and MV for pulmonary infection and hypercapnic respiratory failure, early extubation followed by non-invasive MV initiated at the point of PIC window significantly decreases the invasive and total durations of ventilatory support, the risk of VAP, and the duration of ICU stay.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Hypercapnia , Therapeutics , Pulmonary Disease, Chronic Obstructive , Respiration, Artificial , Methods , Respiratory Insufficiency , TherapeuticsABSTRACT
<p><b>OBJECTIVE</b>To investigate the changes in respiratory and circulatory functions in chronic obstructive pulmonary disease (COPD) patients during sequential invasive-noninvasive mechanical ventilation therapy, and evaluate the effects of this new technique.</p><p><b>METHODS</b>Twelve COPD patients with type II respiratory failure due to severe pulmonary infection were ventilated through an endotracheal tube. When the pulmonary infection control window (PIC-Window) occurred, the patients were extubated and were ventilated with a facial mask using pressure support ventilation combined with positive end-expiratory pressure. The parameters of hemodynamics, oxygen dynamics, and esophageal pressure were measured at the PIC-Window during invasive mechanical ventilation, one hour after oxygen therapy via a naso-tube, and three hours after non-invasive mechanical ventilation.</p><p><b>RESULTS</b>The variation in esophageal pressure was 20.0 +/- 6 cmH(2)O during naso-tube oxygen therapy, and this variation was higher than that during non-invasive mechanical ventilation (10 +/- 6 cmH(2)O, P < 0.01). The changes in respiratory and circulatory parameters were not significantly different between invasive mechanical ventilation and noninvasive mechanical ventilation (P > 0.05).</p><p><b>CONCLUSIONS</b>The respiratory and circulatory functions of COPD patients remained stable during sequential invasive-noninvasive mechanical ventilation therapy using PIC-Window as a switch point for early extubation. The COPD patients can tolerated the transition from invasive mechanical ventilation to noninvasive mechanical ventilation.</p>
Subject(s)
Aged , Female , Humans , Male , Blood Circulation , Physiology , Pulmonary Disease, Chronic Obstructive , Therapeutics , Respiration, Artificial , Methods , Respiratory Physiological PhenomenaABSTRACT
<p><b>OBJECTIVE</b>To investigate the impact of proportional assist ventilation (PAV) on tolerance and breathlessness in ventilated chronic obstructive pulmonary disease (COPD), and to describe the patient-ventilator interaction, hemodynamic state, breathing pattern and work of breath during PAV and pressure support ventilation (PSV).</p><p><b>METHODS</b>Ten intubated COPD patients on weaning from mechanical ventilation were studied. Elastance and resistance were measured by both the inspiratory-hold technique during a brief period of volume control ventilation and runaway technique during PAV. Each assistance level of PAV (80%, 60% and 40%) and PSV was selected randomly. Patients' response, hemodynamics, blood gas and lung mechanics were monitored.</p><p><b>RESULTS</b>Tidal volume and respiratory rate didn't change in a consistent manner as the level of assist was decreased (P > 0.05). With the level of assist increasing, peak inspiratory pressure was increasing significantly (P < 0.05), while patients' work of breath had the tendency to decrease (P < 0.05). A significant difference in the Borg Category Scale was observed between PAV and PSV (0.50 [1.50] vs. 0.75 [2.00], P < 0.05) at the same degree of respiratory muscle unloading. PaCO(2) was significantly higher on PAV (54 [23] mm Hg) than on PSV (48 [23] mm Hg) (P < 0.05). Peak inspiratory pressure on PAV was significantly lower than on PSV (16 +/- 4 cm H(2)O vs. 21 +/- 3 cm H(2)O, respectively, P < 0.05). Hemodynamics and oxygenation remained unchanged.</p><p><b>CONCLUSIONS</b>PAV is a feasible method for supporting ventilator-dependent patients and was well tolerated. It can improve the breathing pattern and reduce inspiratory effort. At the same degree of respiratory muscle unloading, PAV can be implemented at much lower peak inspiratory pressure than PSV. It can also apply proportional pressure support according to the patients' ventilatory demand.</p>