[Home mechanical ventilation in Iceland.].

OBJECTIVE: To describe the users of home mechanical ventilation treatment in Iceland. MATERIAL AND METHODS: Records for all patients in Iceland using noninvasive ventilatory support at home on April 30th 1999 were analysed. RESULTS: A total of 54 patients were using ventilatory support at home. There were 33 males and 21 females. The mean age for the group was 61 years. The mean treatment time was 3.5 years. The majority were using pressure controlled ventilators that were connected to a nose mask or full face mask. The most common reason for treatment was decreased respiratory muscle function. In 11 patients this was secondary to muscle- or neurological diseases, in nine from TBC sequelae and in six post polio or from idiopathic kyphoscoliosis. In addition there were 21 patients that had a combination of chronic obstructive pulmonary disease and sleep-related breathing disorder. Cheyne-Stoke breathing secondary to congestive heart failure was the reason for home ventilatory treatment in five males and two females. These patients had relatively normal spirometric and bloodgas results, which is in contrast to the rest of the group, where spirometric values were on the average less than 50% of predicted. Arterial blood gases commonly showed hypoxia and 16 of the patients had long-term oxygen therapy (over 16 hrs/day). CONCLUSIONS: Home ventilatory treatment has become part of medical treatment in Iceland and benefits patients with decreased ventilatory function, especially during sleep.

Pneumonia caused by penicillin-non-susceptible and penicillin-susceptible pneumococci in adults: a case-control study.

The objective of this study was to investigate the observation that patients with pneumonia due to penicillin-non-susceptible pneumococci (PNSP) in many instances present with milder disease than patients with pneumonia caused by penicillin-susceptible pneumococci (PSP) and to compare the cost of treatment. The clinical data, APACHE II score and laboratory features of hospitalized adults with pneumonia caused by PNSP or PSP were compared, along with antibiotic and hospital costs. Each patient with PNSP pneumonia (n = 36) was matched to a control with PSP pneumonia of the same age and gender. There was no difference in smoking history, but PNSP pneumonia patients had received prior antibiotics more frequently (p < 0.007). The mean APACHE II score was not different, but when broken down into acute vs. chronic scores those with PSP pneumonia had a significantly higher acute score (p = 0.005). Bacteraemia was present in 9 of 31 (29%) patients with PSP compared to 2 of 25 (8%) with the PNSP pneumonia (p = 0.09). The majority of isolates in the PNSP group were of serotype 6B (minimum inhibitory concentration range 0.125-2.0 mg/l), whereas serotypes 7, 9, 14, 18 and 19 were noted among the 9 PSP isolates. Compared with the control group, patients with the PNSP strains had a significantly longer hospital stay, 26.8 vs. 11.5 days (p = 0.001) and higher average antibiotic cost, $736 vs. $213 (p < 0.0001). In conclusion, pneumonia in adults caused by PNSP is associated with a milder clinical presentation than infection caused by PSP, suggesting either that resistance carries a price or that the serotypes of PNSP are less virulent. Pneumonia due to PNSP resulted in increased cost because of prolonged hospitalization and the use of more expensive antibiotics.

Snoring, hypertension, and the sleep apnea syndrome. An epidemiologic survey of middle-aged women.

The lower limit of the prevalence of sleep apnea syndrome (SAS) was estimated among women 40 to 59 years old by a two-stage procedure. In the first stage 2,016 questionnaires were mailed. The response rate was 75.6 percent. Daytime sleepiness was reported by 8.2 percent, habitual snoring by 11.2 percent, and intermittent snoring by 21.7 percent. There were altogether 128 women described with systemic hypertension and these women were more than twice as often habitual snorers. Logistic multiple regression analyses showed almost a threefold increase in the predicted prevalence of hypertension among intermittent and habitual snorers compared with nonsnorers in the age group 40 to 49 years old and a 60 percent increase in the 50- to 59-year-old age group. In the second stage, a group of 97 women highly suspected of SAS were selected because of their habitual snoring and daytime sleepiness. Eventually, 35 of these came for night studies and 14 were found to have SAS. Among the 35 women, 12 were hypertensive and nine of these had SAS. We estimated the lower limit of the prevalence of SAS to be 2.5 percent for women 40 to 59 years old. It is concluded that SAS is a relatively common occurrence among women, especially postmenopausal ones, and it is strongly related to hypertension.

Comparison of the oral and intravenous routes for treating asthma with methylprednisolone and theophylline.

To compare intravenous and orally administered corticosteroids and theophylline in treating acute episodes of airways obstruction, patients with recent worsening of obstructive symptoms were randomly divided into two groups. Group A received methylprednisolone, 80 mg/24 h, and aminophylline by continuous infusion. Group B received a comparable dose of a sustained-release theophylline and methylprednisolone, 80 mg in two equally divided doses, by mouth. Assessment of response was based on daily spirometric tests and evaluation of dyspnea and wheezing. Arterial blood gas and serum theophylline levels were also measured. The groups were comparable with respect to age, sex distribution, smoking history, and spirometric evidence of obstruction. Initial spirometric test results showed moderate obstruction, equal in the two groups. Obstruction improved markedly by both spirometric and clinical criteria in the four-day study period. The improvement in FEV1 and dyspnea index was slightly greater for group B, but the differences were not significant. We conclude that oral administration of steroids and theophylline is as effective as intravenous use in treating hospitalized patients with moderate exacerbations of airways obstruction.