ABSTRACT
Nasal intermittent positive-pressure ventilation (NIPPV) has been showed useful for the treatment of chronic respiratory failure in patients with chest wall diseases due to sequelae of tuberculosis. We present a report of a patient with a thoracoplasty and a cavernostomy in situation of chronic respiratory failure. Nasal intermittent positive pressure ventilation improved diurnal hypoxaemia and hypercapnia.
Subject(s)
Home Care Services , Intermittent Positive-Pressure Ventilation , Postoperative Care , Postoperative Complications/therapy , Respiratory Insufficiency/therapy , Tuberculosis, Pulmonary/therapy , Aged , Chronic Disease , Female , Humans , Lung/surgery , Postoperative Complications/etiology , Reoperation , Respiratory Insufficiency/etiology , Thoracoplasty , Tuberculosis, Pulmonary/complicationsABSTRACT
La ventilación con presión positiva intermitente por vía nasal (NIPPV) se ha mostrado eficaz en el tratamiento de la insuficiencia respiratoria secundaria a alteraciones de la caja torácica, provocadas a consecuencia del tratamiento quirúrgico de la tuberculosis pulmonar. Presentamos un caso de una paciente sometida a una toracoplastia, seguida de una cavernostomía, que en la actualidad se encontraba en fase de insuficiencia respiratoria. La aplicación de NIPPV ha conseguido mejorar el intercambio de gases mejorando la hipoxemia y corrigiendo la hipercapnia (AU)
Subject(s)
Aged , Female , Humans , Chronic Disease , Lung/surgery , Postoperative Complications/etiology , Reoperation , Respiratory Insufficiency/etiology , Thoracoplasty , Tuberculosis, Pulmonary/complications , Postoperative Complications/etiology , Postoperative Complications/therapy , Respiratory Insufficiency/therapy , Tuberculosis, Pulmonary/therapy , Home Care Services , Intermittent Positive-Pressure Ventilation , Postoperative CareABSTRACT
OBJECTIVE: To carry out a comparative descriptive study of the healthcare activity of an outpatient clinic specialising in "Hearts and Lungs". Unit of analysis: care event. A procedure to construct the events was worked out. DESIGN: A prospective study of the care activity over a year, with a retrospective review at two years to construct the events. SETTING: Torreforta-La Granja Primary Care Centre, Tarragona. PARTICIPANTS: Included 1,312 patients (catchment area of 37,266 people), who consulted the doctor. MEASUREMENTS AND MAIN RESULTS: 3,467 attendances were recorded, of which 3,207 were selected, with 1,477 care events being identified on the basis of the information collected from the attendances. Daily average attendances were 13.09 +/- 3.5, by mainly male (56.3%) patients aged 53 +/- 20. Analysis by events showed a low number of visits, with an intensive use of the health resources available in the centre and low use of more complex resources. There was a low use of medical processes per event, with a high level of coverage or extent of these investigations. Hospital contacts per event identified an important amount of complementary activity concerning the emergency services and outclinics. CONCLUSIONS: The comparative analysis makes clear that the records based on attendance over-represent long events and undervalue the extent of investigations.
Subject(s)
Ambulatory Care/statistics & numerical data , Office Visits/statistics & numerical data , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
In order to analyze the mechanism of airways obstruction seen in patients with early sarcoidosis, we have studied the bronchial reactivity in 12 patients with stage I sarcoidosis. The patients were given progressively increasing doses of methacholine to inhale. A fall of more than 35% of the SGaw was taken as the index of response. In 6 out of 12 patients (responders), we observed a dose-response curve similar to that seen in subjects with highly reactive airways. We could not find any difference between responders and nonresponders that could explain the diverse responses to the methacholine. Nevertheless, the modifications in different mechanical parameters showed that the inhaled methacholine induced two types of changes: a change in lung volumes (RV and FVC), observed mainly in the nonresponders, and a change in forced expiratory flows (FEV1, MEF25, and MEF50), observed in the responders. These types of response may suggest a different site of action of the inhaled agent. We conclude that the presence of airways hyperreactivity is frequent in early sarcoidosis and could perhaps explain the incidence of airways obstruction seen in this disease.
Subject(s)
Bronchi/physiopathology , Lung Diseases/physiopathology , Sarcoidosis/physiopathology , Adult , Bronchi/drug effects , Bronchial Provocation Tests , Dose-Response Relationship, Drug , Female , Humans , Ipratropium , Male , Methacholine Chloride , Methacholine Compounds , Middle AgedSubject(s)
Adenosine Deaminase/analysis , Clinical Enzyme Tests , Nucleoside Deaminases/analysis , Tuberculosis, Pleural/diagnosis , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle AgedABSTRACT
A prospective study of 21 patients with sarcoidosis has been carried out. The patients were divided into two groups with (B) or without (A) radiological evidence of pulmonary involvement. The results show that there exists a correlation only between pulmonary restriction and the degree of radiological involvement, and that the alteration of the other measured functions (pulmonary diffusion, elasticity, peripheral airway involvement) is independent of the radiological stage of the disease. The findings are compared to those of the literature, and the relative value of the different tests in the diagnosis of pulmonary sarcoidosis are discussed.
