News about Medicine - Part 7

Association of Activated Cytolytic Lung Lymphocytes with Response to Prednisone Therapy: Clinical Laboratory Tests

Association of Activated Cytolytic Lung Lymphocytes with Response to Prednisone Therapy: Clinical Laboratory TestsBronchoscopy and Lymphocyte Isolation: Following topical lidocaine anesthesia, an Olympus BF-10 bronchoscope was passed into the airways transnasally and, after inspection of the airways, the bronchoscope was wedged into a segmental orifice of an affected lobe (as assessed by chest roentgenogram). BAL was performed by infusing approximately 150 ml of sterile 0.9 percent NaCl solution in 20- to 30-ml aliquots, with gentle aspiration until a 100-ml fluid return was achieved. At initial bronchoscopy, transbronchial biopsies were obtained from segments different from those used for BAL using standard techniques. Read the rest of this entry »

Association of Activated Cytolytic Lung Lymphocytes with Response to Prednisone Therapy: Materials and Methods

Patients
Ten consecutive patients with a diagnosis of IPF were recruited from Montefiore-North Central Bronx Hospital Center on initial presentation to enter this study. All subjects gave informed consent for the procedures, which were approved by the Institutional Review Board. The diagnosis of IPF was established by a combination of medical history, physical examination, laboratory tests, chest roentgenograms, pulmonary function tests (PFTs), arterial blood gas analyses, and the results of lung biopsies according to previously described criteria. Histologic confirmation of the diagnosis was obtained by transbronchial lung biopsy in four patients and by open lung biopsy in six patients. Here
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Association of Activated Cytolytic Lung Lymphocytes with Response to Prednisone Therapy

Association of Activated Cytolytic Lung Lymphocytes with Response to Prednisone TherapyPrevious studies have suggested that immune mechanisms may participate in the pathogenesis of certain interstitial lung diseases (eg, IPF, sarcoidosis, and hypersensitivity pneumonitis). While these diseases may have different initiating events and intermediate phases, they share a common final pathway leading to fibrosis and pulmonary insufficiency. IPF is characterized by accumulation of inflammatory cells in the lung, destruction of normal alveoli, and fibrosis. In contrast to sarcoidosis and hypersensitivity pneumonitis, IPF has not been thought to involve a local cell-mediated response. For example, sarcoidosis and hypersensitivity pneumonitis patients are known to have T-cell alveolitis with an altered distribution of lymphocyte subsets, but in IPF, lymphocyte subset ratios have been reported to be normal by Hunninghake and Crystal and to be decreased by Izumi et al. Link
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Alteration of Pulmonary Oxygenation by Pulmonary Artery Occluded Pressure Measurements in Mechanically Ventilated Patients: Conclusion

Patients with coronary artery disease or with valvular heart disease seem to be candidates for the Pa02 decrease when their resting PAP was elevated, as demonstrated in Figure 3. Both inhalational and opiate anesthetic agents also affect pulmonary oxygenation and vasoreactivity, which seem to be dependent on the existing level of vascular tone. On the other hand, sympathectomy of the pulmonary vasculatures, in this case induced by cervical epidural anesthesia, is unlikely to affect the vasoreactivity to the balloon manipulation. Thus, it remains unclear whether the Pa02 decrease during the balloon inflation was caused by purely mechanical obstruction, and/or by changes in reflex responses due to either anesthetics used or the disease per se. —Āanadianhealthcaremallinc.com
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Alteration of Pulmonary Oxygenation by Pulmonary Artery Occluded Pressure Measurements in Mechanically Ventilated Patients: Discussion

Alteration of Pulmonary Oxygenation by Pulmonary Artery Occluded Pressure Measurements in Mechanically Ventilated Patients: DiscussionIn the present study, we found that only seven of 101 patients (6.9 percent) developed more than a 100 mm Hg decrease in PaOg/FIOa during the inflation of PAC balloon; the majority of patients showed a relatively small decrease or increase in Pa02. Neither the decrease in PetC02 nor baseline PAP was correlated with the decrease in Pa02 during PAOP measurements. The maximum decrease in PaOa/FIo2 induced by the balloon inflation was 186 mm Hg in the present series of patients. Such a degree of decrease in Pa02 must be crucial and large enough to deteriorate oxygen delivery to the tissues if it occurs in patients with cardiopulmonary instability or acute respiratory failure, even though CO remained unaffected during PAOP measurements. Read the rest of this entry »

Alteration of Pulmonary Oxygenation by Pulmonary Artery Occluded Pressure Measurements in Mechanically Ventilated Patients: Results

Inflation of the PAC balloon caused a slight but statistically significant reduction in PetC02 (0 to 15 mm Hg, Table 1), but no significant differences in any variable of pulmonary and systemic hemodynamics (Table 2). However, there was a significant decrease (more than 50 mm Hg) in PaOa/FIOg in 15 patients (14.9 percent); seven of these patients (6.9 percent) showed a more remarkable decrease (more than 100 mm Hg) in PaOj/FIOg during PAOP measurement (Fig 1). On the other hand, 11 out of 101 patients (10.9 percent) showed a significant increase (more than 50 mm Hg) in PaCVFIo2. There was no significant correlation between changes in PaO/FIOg and those in PetC02 (r = 0.26), nor between changes in PkCV FIo2 and control PAP (r = 0.09, Fig 2). Read the rest of this entry »

Alteration of Pulmonary Oxygenation by Pulmonary Artery Occluded Pressure Measurements in Mechanically Ventilated Patients

Alteration of Pulmonary Oxygenation by Pulmonary Artery Occluded Pressure Measurements in Mechanically Ventilated PatientsThe measurements of PAOP using a flow-directed, balloon-tipped PAC may produce rapid onset of significant hypoxemia either by temporary cessation of mechanical ventilation or by occlusion of a major pulmonary arterial vasculature. The former has been well recognized and thus a simple electronic circuit was constructed for the measurements without separation of the patient from the ventilator. The latter decrease in Pa02 due to inflating the balloon of the PAC per se has recently been reported by us and others. Although the information obtained with inflating the PAC balloon is invaluable and contributes greatly to the management of both critically ill and anesthetized patients, the decrease in Pa02 could cause deterioration of the patients condition in some situations. Therefore, we expanded our study to know its incidence and to examine the types of patients who tend to develop a remarkable decrease in Pa02 during PAOP measurements and whether the changes in Pa02 are related to the existing level of pulmonary vascular tone. Read the rest of this entry »

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