Prevalence of other autoimmune diseases in polyglandular autoimmune syndromes type II and III.

PURPOSE: Polyglandular autoimmune syndromes (PAS) are complex, heterogeneous disorders in which various autoimmune diseases can occur, affecting both endocrine and non-endocrine organs. In this meta-analysis, the prevalence of associated autoimmune disorders was investigated in PAS II and III. METHODS: A comprehensive search in MEDLINE and Embase databases identified 479 studies with the keywords of PAS II and PAS III. 18 records containing a total of 1312 patients fulfilled our inclusion criteria (original studies reporting at least 10 cases and containing the combination of other autoimmune disorders) and were selected for further analysis. A meta-analysis of prevalence was performed using the random-effects model with the calculation of 95% confidence intervals (CI). Results of each meta-analysis were displayed graphically using forest plots. RESULTS: Distinction between PAS II and PAS III was made in 842 cases, of which 177 and 665 were PAS II and III (21.1 vs 78.9%), respectively. The prevalence of Hashimoto's thyroiditis was significantly higher than that of Graves's disease (39% [95% CI 17-65%] vs. 4% [95% CI 0-10%], respectively; p = 0.001). In PAS II, Addison's disease (AD) coexisted with AITDs, T1DM or the combination of these conditions in 65, 18 and 10% of cases, respectively. In addition, one other endocrine and five non-endocrine organ-specific autoimmune disorders were reported. In PAS III, two other autoimmune endocrinopathies, six non-endocrine organ-specific, and four systemic autoimmune disorders were found in combination with AITDs. CONCLUSIONS: AITDs, T1DM and AD are the most common combinations in PAS, thus screening for these conditions seems to be reasonable.

Instant oxygen delivery system for manual resuscitators.

To help prevent the use of manual resuscitators without supplemental oxygen we developed a device that automatically starts the flow of oxygen when the resuscitators is put into use and then stops the oxygen flow when the resuscitator is returned to its assigned resting place. This instant oxygen delivery valve does not compromise oxygen flowrates from the gas source. We have used this device without problems for several months in our intensive care until.

Differential lung ventilation with PEEP in the treatment of unilateral pneumonia.

A technique for differential lung ventilation via a Carlens tube with inspiratory retardation and the application of separate levels of PEEP to each lung are described in the treatment of a patient with severe unilateral pneumonia. In addition to isolating the diseased lung, this technique permits modification of the distribution of ventilation between the two lungs to improve the ventilation-perfusion ratio and enhance arterial oxygenation. Its clinical application is influenced by the flow characteristics of available mechanical ventilators and by the limitations of the currently available double-lumen endobronchial tubes.

Continuous positive airway pressure without tracheal intubation in spontaneously breathing patients.

Indications for the use of therapy with continuous positive airway pressure (CPAP) in spontaneously breathing patients are increasing in number. The value of this technique without tracheal intubation was investigated in 14 patients with acute respiratory distress. In most patients (eight patients, or 57 percent) the technique was successful, as evidenced by avoidance of the necessity for tracheal intubation and improvements in clinical appearance, arterial oxygen pressure, and chest x-ray films. Complications were observed in three patients, but these necessitated discontinuation of therapy in only one. The use of this technique allows avoidance of endotracheal intubation and mechanical ventilation, with their attendant risks.