1/16. Lung volume reduction surgery combined with cardiac interventions.OBJECTIVE: Postoperative course and functional outcome were evaluated in patients who underwent lung volume reduction surgery (LVRS) or in combination with valve replacement (VR), percutaneous transluminal coronary angioplasty (PTCA), placement of a stent, or coronary artery bypass grafting (CABG). methods: patients with severe bronchial obstruction and hyperinflation due to pulmonary emphysema were evaluated for lung volume reduction surgery. Cardiac disorders were screened by history and physical examination and assessed by coronary angiography. Nine patients were accepted for LVRS in combination with an intervention for coronary artery disease (CAD). In addition, three patients with valve disease and severe emphysema were accepted for valve replacement (two aortic-, one mitral valve) only in combination with LVRS. Functional results over the first 6 months were analysed. RESULTS: Pulmonary function testing demonstrates a significant improvement in postoperative FEV1 in patients who underwent LVRS combined with an intervention for CAD. This was reflected in reduction of overinflation (residual volume/total lung capacity (RV/TLC)), and improvement in the 12-min walking distance and dyspnea. Median hospital stay was 15 days (10-33). One patient in the CAD group died due to pulmonary edema on day 2 postoperatively. One of the three patients who underwent valve replacement and LVRS died on day 14 postoperatively following intestinal infarction. Both survivors improved in pulmonary function, dyspnea score and exercise capacity. Complications in all 12 patients included pneumothorax (n = 2), hematothorax (n = 1) and urosepsis (n = 1). CONCLUSION: Functional improvement after LVRS in patients with CAD is equal to patients without CAD. mortality in patients who underwent LVRS after PTCA or CABG was comparable to patients without CAD. LVRS enables valve replacement in selected patients with severe emphysema otherwise inoperable.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/16. rhabdomyolysis triggered by an asthmatic attack in a patient with McArdle disease.We describe a patient with McArdle disease who developed rhabdomyolysis triggered by a bronchial asthmatic attack. A 64-year-old man had chronic pulmonary emphysema with asthma, and an asthmatic attack led to severe rhabdomyolysis that required continuous hemodiafiltration. After 2 years, a physical examination revealed atrophy of the extremities compared with previous examinations, especially of the intercostal muscles. During that time, he suffered two severe bronchial asthmatic attacks. His serum level of creatinine kinase remained between 4,000 and 7,000 IU/l when he did not suffer from asthmatic attacks and rhabdomyolysis had abated. Therefore, we suspected that his recent muscle atrophy was caused by asthmatic attacks, and discussed the possibility of his respiratory muscle weakness due to McArdle disease in relation to his severe bronchial asthmatic attacks as well as chronic obstructive pulmonary disease.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/16. Care of a patient with breathing difficulties.Use of the Roper model of nursing care enabled the patient's physical, social and psychological needs to be met. Identification of actual and potential problems in each activity of daily living enabled goals to be set and care plans to be implemented to alleviate the problems. It is important that nursing care addresses not only the physical side of nursing, but also the psychological needs of the patient and the patient's family. By identifying the patient's fears in each activity of daily living, we could offer practical help and reassurance which greatly facilitated her return to independent living.- - - - - - - - - - ranking = 0.44591396821533keywords = physical (Clic here for more details about this article) |
4/16. Definitions in chronic obstructive pulmonary disease.States of airflow obstruction are common disorders which span the spectrum from asthmatic-chronic bronchitis to emphysema. Asthmatic and chronic bronchitic states are at least potentially reversible by systematic, pharmacologically oriented therapy focusing on bronchodilators and corticosteroids. Both asthmatic bronchitis, particularly when it is not adequately treated, and emphysema result in the final common pathway of COPD. These are generally progressive states, unless smoking cessation can be achieved in early or mild stages of disease. The future focuses on the great challenge of early identification, classification, and intervention. Thus, all patients with cough, dyspnea, and wheeze should be carefully evaluated by health workers who understand the history, physical examination, and simple pulmonary function tests in the context of chest radiology. These clinical methods together can help define the disease states characterized by airflow obstruction. Often, a final definition of disease cannot be made until aggressive attempts at the treatment of the airflow obstruction and its attendant symptoms complex have been vigorously pursued by experienced clinicians.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/16. Psychosocial issues in chronic obstructive pulmonary disease.Chronic illnesses such as COPD require both comprehensive evaluations and multisystem treatment approaches with integration of biological, behavioral, psychological, and social systems. People function as biopsychosocial units, with complex interplay between themselves and their environments determining the degree of their illness. Illness, as distinct from disease, is a person's subjective response to the state of disease or organ pathology. Recognition and identification of the psychosocial components of a person's illness allows for far more effective therapeutic intervention. Treatment objectives include better acceptance of life changes and the development of new attitudes and goals through an increase in self-confidence and control over emotional, physical, and respiratory functioning. These rehabilitation goals can be fulfilled by the use of supportive therapies (individual, family, or marital and group) and educational behavioral techniques based upon a solid working alliance with the patient.- - - - - - - - - - ranking = 0.22295698410767keywords = physical (Clic here for more details about this article) |
6/16. Intravenous use of glycopyrrolate in acute respiratory distress due to bronchospastic pulmonary disease.A patient with acute respiratory distress secondary to emphysema and reactive airway disease had inadequate tidal volumes with and without endotracheal intubation. Because of the patient's failure to respond to maximal standard bronchodilator therapy and the physical inability to ventilate the patient by manual positive pressure, he received IV glycopyrrolate (0.2 mg) approximately 50 minutes after admission to the ED. The patient's condition immediately improved, as evidenced by the ability to manually ventilate the patient; he developed increased tidal volumes; and he began responding to inhalation therapy. This is the first reported case of IV glycopyrrolate administration for chronic obstructive pulmonary disease or asthma in the literature and demonstrates an instance in which inhalation therapy was ineffective due to low tidal volumes.- - - - - - - - - - ranking = 0.22295698410767keywords = physical (Clic here for more details about this article) |
7/16. Anaesthesia for Treacher Collins and Pierre Robin syndromes: a report of three cases.We present three patients with Treacher Collins or Pierre Robin syndromes who had historical and physical evidence of airway obstruction, difficulty feeding, and sleep disturbances. These preoperative findings correlated with difficult airway management intraoperatively. Based on this experience, we recommend that children with obstructive symptoms have laryngoscopy prior to anaesthetic induction. If the glottic opening is visualized, inhalational induction can proceed. If the glottic structures cannot be visualized, then the anaesthetist must choose between awake oral or nasal intubation, elective tracheostomy, or fiberoptic intubation. In all cases, a tracheostomy tray should be ready and a surgeon experienced in paediatric tracheostomy should be in attendance. After intubation, anaesthesia is best maintained with oxygen and a potent inhalational agent. Extubation should only be done with the patient fully awake and with emergency airway equipment immediately available. Postoperatively, these patients should be transferred to an intermediate care area or intensive care unit where they can be observed closely since delayed complications of airway obstruction are common in this group of patients.- - - - - - - - - - ranking = 0.22295698410767keywords = physical (Clic here for more details about this article) |
8/16. Clinical and physiological follow-up of severe chronic obstructive lung disease.case reports are given of 25 patients with severe chronic obstructive lung disease (COLD) and with a ventilatory capacity (MVVF) < or = 35 per cent of predicted normal values. The patients were selected among persons treated 1968-1970 at the Department of Pulmonary Diseases, University Hospital, Uppsala. Clinical and physiological follow-up studies have been made. Case histories, physical and radiological findings of the heart and lungs and in 5 patients autopsy findings are given. Arterial blood gas tensions and acid-base balance in the patients' habitual state are also reported. Changes in the electrocardiograms (ECG), in lung volumes and dynamic ventilatory function and physical working capacity, measured on a bicycle ergometer, are described. In 1970-71 the patients (39-72 years of age) were admitted to hospital for 5 days in their optimal state for the following investigations: static and dynamic spirometry, total haemoglobin, ECG, vectorcardiogram (VCG), physical working capacity, pulmonary gas exchange and central haemodynamic studies. The results of the gas exchange and central haemodynamic studies, total haemoglobin and the physical working capacity are given elsewhere. Certain comparisons were made between the two groups of patients: (R) patients who had had one or several periods of manifest respiratory insufficiency with intensive treatment (n = 14) and a comparison (C) group (n = 11), with the same ventilatory impairment in regard to MVVF, but without any corresponding periods needing oxygen treatment combined with breathing assistance by a physiotherapist or respirator. Sixteen patients had chronic bronchitis with emphysema, one chronic bronchitis without emphysema, four primary emphysema, one emphysema and bronchial asthma and three emphysema and widespread bronchiectasis. The most striking difference in the clinical history of the R-and C-group patients was a greater tobacco consumption (packets/lifetime) in the R group. The ECG was typical for right ventricular hypertrophy (RVH) in one patient from each group. Slightly delayed ventricular activation and clock-wise rotation of the QRS frontal plane axis were the most common ECG findings. VCG was typical for RVH in one C-group and 4 R-group patients, and suspected to indicate RVH in 7 R- and 5 C-group patients. Biventricular hypertrophy may be one of the reasons that ECG and VCG do not more often fulfil the typical RVH criteria. The average MVVF was about 21 per cent of predicted normal values before and about 27 per cent after administration of a bronchodilating spray. The average vital capacity (VC) was 55 per cent before and 64 per cent after the use of a spray.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 0.89182793643066keywords = physical (Clic here for more details about this article) |
9/16. Chronic respiratory failure and physical reconditioning: case study of an elderly obese woman.A case is described of a 67 year old obese white woman who had a history of multiple medical problems and who was in chronic respiratory failure but responded poorly to intermittent positive pressure breathing, chest physiotherapy, and supplementary oxygen. She was treated successfully with a 600 k.cal diet and a 26-day physical reconditioning programme. Reconditioning techniques included free and treadmill walking, stair climbing, bench stepping, light calisthenics, and breathing retraining. Improvements were noticed in blood gases, spirometry, electrocardiogram, motor coordination, and physical working capacity.- - - - - - - - - - ranking = 1.337741904646keywords = physical (Clic here for more details about this article) |
10/16. exercise training in patients with COPD.exercise is a useful therapeutic intervention for many COPD patients. The progressive stress test is the single most important means of clinical evaluation, although a thorough physical examination and preexercise ECG are also mandatory. The exercise program is prescribed according to duration of exercise and the maximal load reached by the patient during testing. As tolerance builds, exercise time, speed, and grade level are increased. patients who exercise routinely should be watched carefully for problems, such as hypoxia, hypertension, abnormal right-sided cardiac function, and air tapping. Supplemental oxygen is required for those who are hypoxic.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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