Category Archives: Pulmonary Function : Part 11

A Survey of the Current Use and Methods of Analysis of Bronchoprovocational Challenges (3)

A Survey of the Current Use and Methods of Analysis of Bronchoprovocational Challenges (3)After 15 min the subject underwent an empty run in which aerosol delivery was mimicked and again paired spirograms were obtained (empty run). Buffer and subsequent histamine solutions were nebulized and delivered by a DeVilbiss 646 nebulizer (DeVilbiss Co, Somerset, PA) as previously described. The nebulizer was connected to a breath-activated model 2A Rosenthal-French nebulization dosimeter (Laboratory of Applied Immunology, the Good Samaritan Hospital, Baltimore, MD). The nebulizer was connected to a breath-activated model 2A Rosenthal-French nebulization dosimeter (Laboratory of Applied Immunology, the Good Samaritan Hospital, Baltimore, MD). The dosimeter was powered by compressed air at 20 psi and was activated for 0.6 s with inhalation. The subject inhaled a total of 5 breaths of buffer solution. Inspiratory and expiratory time were maintained between 4.5 and 5 s. Three minutes after this inhalation paired spirograms were obtained (postbuffer baseline). proventil inhaler
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A Survey of the Current Use and Methods of Analysis of Bronchoprovocational Challenges (2)

Methods
A questionnaire was sent to a total of 94 investigators worldwide, 40 of whom were currently practicing in the United States. Each respondent had recently published, in English, in a major pulmonary journal or text, an article in which a bronchoprovocational challenge technique had been utilized. Each was asked specific questions about the number and type of challenges that they usually performed, the methods that they used in preparing the solutions for inhalation challenges, the methods of collecting the data and the means used in the final analysis.
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A Survey of the Current Use and Methods of Analysis of Bronchoprovocational Challenges (1)

A Survey of the Current Use and Methods of Analysis of Bronchoprovocational Challenges (1)Patients with asthma, as compared with normal subjects, can be characterized by the presence of an increase in airway responsiveness to inhaled pharmacologic bronchoconstricting agents. Bronchial provocation testing with histamine or methacholine aerosols can be helpful in correctly diagnosing asthma in patients with mild symptoms or with an atypical presentation of the disease. Airway responsiveness to these agents has been shown to correlate with the severity of the disease and the requirement for bronchodilator therapy. Bronchial provocation testing also has a well-defined role in clinical pharmacology as a tool to evaluate the efficacy of investigational pharmacologic compounds.
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Postpericardiotomy and Postmyocardial Infarction Syndrome (14)

Since then a Dressler-like syndrome has also been described after pacemaker implantation (as possibly occurred in our first case), blunt trauma to the chest, percutaneous puncture of the left ventricle, and pulmonary embolism. None of these describe the acute findings of our three patients. Cheap Diskus Advair
In summary, three cases are described suggesting an acute noncardiogenic alveolitis or capillary leak syndrome occurring two-three days after cardiac injury. Two had a history of distant myocardial or pericardial injury, and the third had an acute anteroseptal myocardial infarction occurring two-three weeks before cardiac surgery. All three patients reponded dramatically to therapy with corticosteroids, suggesting an autoimmune etiology.
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Postpericardiotomy and Postmyocardial Infarction Syndrome (13)

Postpericardiotomy and Postmyocardial Infarction Syndrome (13)The postcardiotomy syndrome (PPS) and its possible relationship to a hypersensitivity reaction was first described in 1961. The authors described a delayed pericardial reaction following 30 of 100 consecutive congenital heart operations in which the pericardium was widely incised, and they believed that the syndrome probably represented a hypersensitivity response to blood in the pericardial sac that had already undergone traumatic pericarditis. birth control yasmin
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Postpericardiotomy and Postmyocardial Infarction Syndrome (12)

The noncardiogenic fulminating pulmonary edema occurring during or after cardiopulmonary bypass is described as occurring within 6 hours of surgery, with the probable cause believed to be an unknown type of allergic reaction secondary to blood or blood products. This “post pump syndrome,” however, is not applicable to our cases, and the present use of membrane oxygenators and improved tubing has made this a rare surgical complication. Rarely, this syndrome is described as not recognized immediately postoperatively, during which time the chest roentgenogram appears normal only to show pulmonary edema 48 to 72 hours later. proventil inhaler

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Postpericardiotomy and Postmyocardial Infarction Syndrome (11)

Postpericardiotomy and Postmyocardial Infarction Syndrome (11)Discussion
The cases reported suggest an acute autoimmune mechanism precipitated by acute myocardial or pericardial injury in the presence of already existing antiheart antibodies. Unfortunately, measurements of antibody as originally described by Van DerGeld were not available to us, so such considerations remain theoretical. Nevertheless, the history of prior myocardial or pericardial damage associated with the marked elevation of the sedimentation rate and the dramatic response to corticosteroid therapy strongly supports this notion.
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Postpericardiotomy and Postmyocardial Infarction Syndrome (10)

On the third postoperative day; there was further deterioration with bilateral pulmonary edema and pleural effusions and a normal heart size on the chest roentgenogram. The Po2 was 41 mm Hg on 40 percent oxygen. No S3 gallop, JVD, heart murmur, or peripheral edema was observed.
By the fourth postoperative day, pulmonary edema had worsened. Because of unexplained pulmonary edema in the presence of good left ventricular function and the elevated sedimentation rate, an acute postpericardiotomy syndrome was considered. Accordingly, the patient was started on a regimen of prednisone 80 mg daily. Within 24 hours there was significant improvement and after 48 hours the Po2 was 62 mm Hg (94 percent saturation) on room air, and there was clearing of the pulmonary edema on chest roentgenogram.
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Postpericardiotomy and Postmyocardial Infarction Syndrome (9)

Postpericardiotomy and Postmyocardial Infarction Syndrome (9)There were no operative complications, and the patient came to the intensive care unit in stable condition. The immediate postoperative chest roentgenogram showed no cardiomegaly or pulmonary edema. Transient hypertension was treated for 4 hours with nitroprusside. The left atrial pressure remained 10 to 15 mm throughout the first postoperative day, and the blood pressure and pulse were stable. The ECG showed no evidence of further damage. Fostextubation blood gases showed a pH of 7.44 Pco2 of 34 mm Hg, and Po2 of 70 mm Hg (saturation of 94 percent) on 4 L oxygen by nasal cannula. antibiotic levaquin
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Postpericardiotomy and Postmyocardial Infarction Syndrome (8)

Case 3
A 56-yeai^old man was seen in the emergency department of a community hospital on June 6, 1989, because of recurring anterior chest and back pains. The ECG showed QRS and T wave changes compatible with an acute anteroseptal MI. Seventeen days later, the patient was referred to Presbyterian Hospital because of recurring chest pain and strongly abnormal results of a treadmill stress test. ventolin 100 mcg
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