[How to set up a sleep laboratory in a community general hospital].

In Japan, sleep-related disorders (SRD) have been handled by only a few university teams, and mainly on a research basis, because polysomnography (PSG) is labor-intensive, expensive, and unprofitable. Although public consciousness of SRDs has been raised by mass-media campaigns, the situation is far from ore that would meet patient's demands. We have done 1476 PSG tests over about five years, and diagnosed more than 600 cases of SRDs. Therapy included nasal continuous positive airway pressure in 170 cases, prosthetic mandibular advancement in 55 cases, and uvulopalatopharyngoplasty and related operations in 97 cases. We describe how we set up a sleep laboratory and a care system, and how to circumvent problems. Several points related to the selection of patients for PSG in daily clinical practice can be clarified with our data. Computerized sleep respiratory analyser might save time and money, but their advantages and disadvantages should be studied. The approach to SRDs should be comprehensive and systematic, and polysomnographers play an important role. We need programs organized by scientific institutions to train polysomnographers. Research should continue not only on scientific aspects of SRDs but also on the way patients with SRDs are cared for. Reasonable insurance coverage of the costs of nosal continuous positive airway pressure and of PSGs is essential for widespread access to these services.

[Pulmonary emergency medicine at Okinawa Chubu Hospital, including care of patients with primary, secondary, and tertiary emergency problems].

In the emergency department of Okinawa Chubu Hospital, 32,088 patients were seen between November 1992 and October 1993. Of these patients, 19,306 were over 16 years old. About 20% of the patients seen in the emergency department had pulmonary diseases. In decreasing order of frequency, the five most commonly seen conditions were: upper respiratory tract infections (19%), bacterial pneumonia (12%), acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease, and chest trauma. Medical (i.e. nonsurgical) treatment was required by 10,034 patients. Thirty five percent of those had pulmonary disorders, and the mortality rate was 0.9%. A total of 747 patients were hospitalized, and 65 were admitted to the intensive care unit. Of those admitted to the intensive care unit, 9% died of respiratory problems. Surgical treatment was required by 5587 patients. Only 5.1% of them had pulmonary problems, and the mortality rate was 3.5%. However, the mortality rate among the 25 patients admitted to the intensive care unit for surgical pulmonary problems was 8%. Among patients with medical problems who were hospitalized via the emergency department, 36% had pulmonary disorders (mainly pneumonias, asthmatic attacks, acute bacterial bronchitis, and acute exacerbation of chronic obstructive pulmonary disease), but only 7% of patients with surgical problems had chest trauma (mainly due to traffic accidents of falls).

[Diagnosis and significance of ARDS].

Adult respiratory distress syndrome (ARDS) is defined as a syndrome of acute respiratory failure following generalized or localized catastrophic events, without a past history of underlying pulmonary diseases, which is manifested by acute onset of dyspnea, laboured breathing and non-cardiogenic lung edema. This syndrome is also characterized by preceding pulmonary or extrapulmonary insults, an almost normal lung function immediately after the catastrophic events, and acute and progressive hypoxemia, decreased pulmonary compliance with chest radiographs showing bilateral diffuse pulmonary infiltrates, associated with very poor outcome. The diagnostic modalities for obtaining pathognomonic findings indicative of ARDS are not established as yet, hence the only way to diagnose ARDS is to evaluate the pathophysiological status, as mentioned in the definition above, by various laboratory examinations. Although there are many reported modifications, the diagnostic criteria suggested by Petty, et al are still widely used in practice. However, it is unknown whether they are strictly followed or not. Nowadays, the significance of making a diagnosis of ARDS on the basis of the above criteria is questioned by some physicians. To address these questions, the authors reported on an overview of ARDS cases seen at ICU of our institute which is providing acute and emergency care services in Okinawa. In the past 10 years (1979-1988), 4500 patients were admitted to our ICU and 170 of them were diagnosed as either having ARDS or their course in ICU were complicated by ARDS. These cases were retrospectively studied.(ABSTRACT TRUNCATED AT 250 WORDS)