A randomized controlled trial of early physiotherapy for high-risk infants

The potential therapeutic applications of encapsulated cells are enormous. In the US alone, it has been estimated that nearly half-a-trillion dollars are spent each year to care for patients who suffer tissue loss or dysfunction. Over 6 million patients suffer from neurodegenerative disorders such as Alzheimer's disease and Parkinson's disease, over 14 million patients suffer from diabetes, and millions more from liver failure, hemophilia, and other diseases caused by the loss of specific vital cellular functions. It appears likely that by the end of the decade clinical trials of encapsulated cells to treat many of these diseases will become a reality. The Food and Drug Administration has already authorized studies to evaluate the safety and biological activity of several types of systems. A number of issues will have to be addressed, including the sourcing of raw materials, the design and building of manufacturing facilities, the scale-up and optimization process, storage and distribution of the product, and quality control.     

Chest wall motion in preterm infants using respiratory inductive plethysmography

Preterm infant tidal breathing may be different from that of healthy full-term infants because of various features of the premature thorax. The purpose of this project was to describe chest wall motion in the preterm infant (gestational age <37 weeks) and compare it with chest wall motion data in a group of healthy, full-term infants. We wanted to use an objective bedside method for assessment with minimal disruption to the infant. The study population consisted of 61 preterm human infants whose mean(+/-sD) postconceptional age at time of study was 35.3+/-2.1 weeks. During the study, the infants were quietly awake in a prone position. Preterm infants had initially been admitted to a level III neonatal intensive care unit for acute management and had been transferred to a step-down area, where they were in stable condition for study. Data were collected with a semiquantitatively calibrated, noninvasive respiratory inductive plethysmograph. Mean(+/-SD) phase angle was significantly greater in preterm infants than in full-term infants (60.6+/-39.8 degrees versus 12.5+/-5.0 degrees, respectively, p < or = 0.0001). The laboured breathing index was significantly greater in preterm infants than in full-term infants (1.35+/-0.35 versus 1.01+/-0.01, respectively, p = 0.001). The ribcage contribution to breathing did not differ significantly between preterm and full-term infants (25.5+/-17.7% versus 36.3+/-14.4%, respectively, p = 0.11). These results indicate a significant increase in the degree of ribcage and abdomen asynchrony in the preterm subjects compared to the full-term infants. Plethysmography provided a time-efficient and objective method of assessing chest wall motion in this fragile population.     

Decimeter-wave physiotherapy in viral hepatitis

Effectiveness was evaluated of magnetotherapy, inductothermy, UNF electric field and electromagnetic waves of decimetric wave band (460 MHz) on the projection of the liver, adrenals and thyroid gland in controlled trials enrolling a total of 835 patients with viral hepatitis (type A, B, associated forms). A conclusion is reached that optimum effectiveness of decimetric field on the projection of the adrenals and thyroid gland can be achieved through the application of minimum power and everyday alternation of exposures. It has been estimated that as many as 69 percent of the patients derive benefit from the above treatment.     

Treatment and prognosis of lobar and segmental atelectasis in cystic fibrosis

Studies are presented of the effect of procaine group anesthetics on rat brain synaptosome stability to dodecyl sulfate and on catalytic properties of the membrane bound alkaline phosphatase. The dose curves of detergent stability are characterized by two maxima, one at 3.10(-4) M for tetracaine, 2.10(-6) M for lidocaine and 5.10(-5) M for procaine; the other being at 10(-3) M for all anesthetics. The curves of Vmax and KM versus procaine concentration to exhibit the minimum at 5.10(-7) M and maximum at 3,2.10(-6) M. Procaine at 5.10(-7) M increases enthalpy and enthropy of membraneous alkaline phosphatase. It is suggested that interactions between anesthetics and centers of high affinity lead to synaptosome structural rearrangements, which affect the properties of membraneous enzymes.     

Hemilateral hydrothorax and atelectasis during laparoscopic Nissen fundoplication

A 57-year-old woman, weighing 75 kg, with gastroesophageal sliding hernia, received laparoscopic Nissen fundoplication under general anesthesia. Although artificial ventilation was carried out uneventfully when the surgery started, sudden decreases in SpO2 and thoraco-pulmonary compliance were noted after insufflation of CO2. Breath sound was not audible on the left lung. We suspected that inadvertent pneumothorax was produced, but chest X-ray and transesophageal echocardiography at the end of surgery revealed the presence of left hemilateral hydrothorax with pulmonary atelectasis. She was ventilated artificially and given diuretics and albumin solution for 3-days before extubation. We speculated on two reasons for the event: a possibility of perforation of the diaphragm manipulated by surgeons, and that of transition of fluid used for irrigation just below the diaphragm. Pulmonary atelectasis could be induced with hemilateral lung ventilation because cephalad shifting of the diaphragm might follow the intraperitoneal insufflation. We conclude that laparoscopic surgery with insufflation of gas and irrigation with fluid requires careful attention if the laparoscopic surgery is sustained with insufflation and irrigation.     

Chest imaging in AIDS

A review of imaging in the acquired immune deficiency syndrome (AIDS) is presented. The imaging features can be conveniently categorized according to whether the presenting complications are infective (bacterial, protozoal, or fungal), bronchiectasis, neoplastic (Kaposi's sarcoma, AIDS-related lymphoma, or lymphoproliferative disease), or a miscellaneous group (non-specific interstitial pneumonitis, persistent generalized lymphadenopathy, or bronchogenic carcinoma).     

Immuno-prevention in newborn infants and infants

The author describes two cases of ambulatory iliac phlebitis occurring in young women, one pregnant, the other taking synthetic oestrogen-progestogen drugs. Anti-coagulants were contraindicated because of the pregnancy in the first case, and because of practical obstacles to their correct use in the second. In consequence both cases were treated as outpatients by physical compression (Nard's method), without any anticoagulant medication : the results were striking and lasting.     

The use of physiotherapy and antibacterial preparations in urogenital infections

335 patients with obliterative diseases of arteries of the low extremities were examined. Results of motor rehabilitation depend on the severity of post-amputation defect of the extremity and functional condition of the stump. The lower is the level of the amputation the higher is the effectiveness of the rehabilitational measures. Ischemia of femoral stump springs up rarely but its course is mare severe than ischemia of the stump of the shin, which is confirmed by the data of clinical examination, investigation of biochemical parameters of the blood and mortality rate. For prophylaxis of ischemia of the stump it is suggested simultaneously with the amputation of the extremity to perform reconstructive procedures on the arteries, aimed at restoration of blood flow through the profound femoral artery. This policy provides the possibility to form a long functional stump of the extremity and to improve results of motor rehabilitation.     

Chest radiography in the ICU

Proper positioning and assessment of abnormalities and complications of the above-mentioned devices have a significant impact on the management of critically ill patients in the intensive care unit (ICU). The timely assessment of new or rapidly evolving findings is critical. Optimal radiographic technique, availability of images to the clinicians, and rapid reporting by the radiologist all serve to maximize the efficacy of bedside chest radiography in the ICU. Sometimes, changes in cardiopulmonary status may only be appreciated on chest radiographs (CXRs). Complications from ventilatory assistance, such as barotrauma, occur frequently and must be detected promptly. The position of monitoring devices, an important component of critical care management, is best checked radiographically. Indications for CXRs and the recommended frequency for repeat follow-up CXRs are based on the existing literature and the consensus of an expert panel formed by the American College of Radiology.     

Chest wall mechanics in sustained microgravity

We assessed the effects of sustained weightlessness on chest wall mechanics in five astronauts who were studied before, during, and after the 10-day Spacelab D-2 mission (n = 3) and the 180-day Euromir-95 mission (n = 2). We measured flow and pressure at the mouth and rib cage and abdominal volumes during resting breathing and during a relaxation maneuver from midinspiratory capacity to functional residual capacity. Microgravity produced marked and consistent changes (Delta) in the contribution of the abdomen to tidal volume [DeltaVab/(DeltaVab + DeltaVrc), where Vab is abdominal volume and Vrc is rib cage volume], which increased from 30.7 +/- 3. 5 (SE)% at 1 G head-to-foot acceleration to 58.3 +/- 5.7% at 0 G head-to-foot acceleration (P < 0.005). Values of DeltaVab/(DeltaVab + DeltaVrc) did not change significantly during the 180 days of the Euromir mission, but in the two subjects DeltaVab/(DeltaVab + DeltaVrc) was greater on postflight day 1 than on subsequent postflight days or preflight. In the two subjects who produced satisfactory relaxation maneuvers, the slope of the Konno-Mead plot decreased in microgravity; this decrease was entirely accounted for by an increase in abdominal compliance because rib cage compliance did not change. These alterations are similar to those previously reported during short periods of weightlessness inside aircrafts flying parabolic trajectories. They are also qualitatively similar to those observed on going from upright to supine posture; however, in contrast to microgravity, such postural change reduces rib cage compliance.     

Tracheal bronchus: a cause of prolonged atelectasis in intubated children

Tracheal bronchus is a common anomaly that occurs in approximately 2% of people. Two children with multiple medical problems which led to endotracheal intubation are described. The hospital course for each child was complicated by persistent right upper lobe atelectasis. The presence of a tracheal bronchus was not recognized in either case initially; identification of this anatomic variant allowed appropriate changes in airway management. The potential for tracheal bronchus to cause, or be associated with, localized pulmonary problems is reviewed. The diagnosis of tracheal bronchus should be considered early in the course of intubated patients with right upper lobe complications.     

Chest pain in the presentation of sarcoidosis

The cases of six patients are reported illustrating that chest pain may be a prominent feature of sarcoidosis. It may be severe and be the chief presenting symptom. In the cases described it was mostly retrosternal and had few consistent aggravating factors. In each case there was bilateral hilar lymph node enlargement and it is suggested that htis was chiefly responsible for this relatively uncommon symptom of sarcoidosis. It is also suggested that undue persisting pain may respond to corticosteroid administration.     

Influence of inflation and atelectasis on the hypoxic pressor response in isolated dog lung lobes

Apnoeic left lower lobes of dog lungs were inflated by increasing alveolar pressure or decreasing pleural pressure, or the lobes were collapsed and exposed to decreasing pleural pressure with the bronchus occluded. Under each of these conditions the lobe could be made 'hypoxic' by perfusion with mixed venous blood or 'normoxic' by perfusion with systemic arterial blood. Inflation of the lobes diminished the hypoxic presor response. The relative influence of decreasing pleural pressure on inflated and collapsed lobes was such that at low pleural pressures resistance to flow through the hypoxic atelectatic lobe was no greater than that through the inflated normoxic lobe. The results indicated that the level of lung inflation can alter the effectiveness of the hypoxic pressor response in reducing perfusion to underventilated regions.