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L'objectif etait d'evaluer les etats hemodynamiques et respiratoires des operees de fistules obstetricales et rapporter nos experiences sur la prise en charge de ces malades. Il s'agit d'une etude transversale descriptive effectuee au Bloc operatoire et Reanimation du CHRR Manakara allant du 20 au 30 aout 2013. Etaient incluses les patientes operees de fistules obstetricales sous rachianesthesie. Nous avons exclu les patientes classees ASA >2 et celles ayant des tares cardio-vasculaires ou respiratoires. Apres consultations preanesthesiques, et bilans preoperatoires, nous avons administre chez les patientes 12,5mg de bupivacaine adrenalinee 0,5% isobare en intrathecal. Elles etaient mises en position de Trendelenburg 5 minutes apres l'injection du produit anesthesique et durant toute l'intervention. Le niveau sensitif, la pression arterielle, la frequence cardiaque, la frequence respiratoire et la saturation pulsee en oxygene (SpO2) etaient enregistres pendant l'intervention. Nous avons retenues 57 malades. Le bloc sensitivomoteur etait excellent pour toutes les malades. Un niveau metamerique superieur a T6 etait atteint chez 56,36% des malades. A part quelques episodes d'hypertension arterielle et tachycardie, nous n'avons trouve aucune difficulte respiratoire ni cardiovasculaire en rapport avec la position. Seuls, le niveau sensitif et la frequence respiratoire presentaient une correlation (p=0,01). Cette etude suggere que la position de Trendelenburg est realisable au cours de la rachianesthesie en utilisant un produit anesthesique approprie, en faisant attention, notamment aux changements de position et en tenant compte de l'examen preanesthesique.

Background: Protective effects of deep inspiration (DI) fail in chronic obstructive pulmonary disease (COPD). It is unknown if this reflects abnormal properties of the airway wall. Aim: To determine if the response of the airway wall to stretch is abnormal in COPD. Methods: Subjects undergoing lung surgery (65±3y) had lung function assessed before surgery and a bronchial segment was dissected from resected lung tissue for in vitro study. Subjects with COPD had a post-bronchodilator FEV 1 /FVC ratio and FEV 1 below lower limit of normal. Response to DI was assessed from maximal and partial (M/P) flow ratio. In bronchial segments, bronchodilation to simulated DI was measured from the change in airway volume after a transient stretch. Wall dimensions were measured on fixed airways. Results: The M/P ratio positively correlated with FEV 1 /FVC (%predicted, p=0.002, r=0.72) and was reduced from 0.87±0.14 (mean±SE) in the control group (n=9) to 0.50±0.08 in the COPD group (n=7, P=0.047). An M/P ratio of Conclusion: A DI produces bronchoconstriction in subjects not undergoing bronchial challenge, which is greater in subjects with COPD. While the intrinsic response of the airway wall to stretch contributes to the respiratory effect of DI, it is not different in subjects with COPD.

The aim of the study is to examine the relationship between toner-exposed work and health indices related to respiratory disorders and to confirm the baseline of a cohort study to clarify the effect of toner exposure in manufacturing plants. Subjects were 1614 male workers (809 toner-exposed workers and 805 referents) who were engaged in toner manufacturing plants in Japan (Fuji Xerox Co., Ltd). The age of subjects was from 19 to 59 years, and the average age was 40.2 years(median 40 years, SD 7.67). We conducted a pulmonary function test (PEFR, VC, FVC, FEV1.0%, V25/Ht) and a blood cell test (RBC, Hb, Hct, Plt, WBC, cell contents of WBC) and measured biochemical indices in blood (ALT, AST, γ-GTP, CRP, IgE) and 8-hydroxy-2’-deoxyguanosine (8-OHdG) in urine. Student t-test and logistic regression analysis were applied to compare between the toner-exposed workers and the referents and to analyze the relationship among indices of effects and independent factors. There was no significant difference between the two groups in blood cell count and biochemical indices. Inflammation- and allergy-related markers such as 8OHdG and IgE also showed no significant difference between toner-exposed workers and the referents. The influence of smoking on pulmonary function indices was observed, but there was no relationship between the pulmonary function and toner-exposed work. In this article, we report a preliminary cross-sectional analysis in the subjects of a cohort study. No difference in pulmonary function indices was observed between the toner-exposed workers and the referents, and there was no consistent relationship between the exposure status and examined indices; however, the prevalence of subjective respiratory symptoms was higher in the exposed workers as presented in another report. Further analysis is important in the ongoing cohort study to clarify the effect of toner exposure on respiratory systems.

Yousser Mohammad, Mouna Kakah, Yasser MohammadDepartment of Internal Medicine, Tishreen University School of Medicine, Lattakia, SyriaAbstract: Narguileh is a water pipe. Narguileh smoking is a traditional pattern of smoking among Eastern Mediterranean women, publicly considered as a harmless entertainment. We performed a survey aimed at tracking chronic respiratory symptoms and alteration in respiratory functions in 77 female narguileh smokers, 77 cigarette smokers, and controls. A questionnaire about respiratory symptoms, quantity, and duration of smoking was completed by each woman, and a flow-volume loop was performed with all women. Women were then categorized in subgroups according to a cumulative smoking duration of over 5 years, and cumulative quantity of 50 kilograms smoked. We obtained 8 subgroups for quantity and 10 for duration. Results showed a higher proportion of chronic bronchitis in narguileh smokers compared with cigarette smokers for both quantity and duration (p value < 0.001), as well as quasi-permanent alteration in maximum mid-expiratory flow (MMEF 25%–75%) in narguileh smokers compared with cigarette smokers (p value < 0.001). Forced expired volume in one second was more altered in cigarette smokers than in narguileh smokers (p value > 0.001). These results will help to raise health authority awareness that narguileh smoking is also dangerous for women.Keywords: sheesha, narguileh, narguile, COPD, MMEF, smoking in women

Background: Conducted electrical weapons (CEWs) are used by law enforcement to subdue combative subjects. Occasionally, subjects will die after a CEW has been used on them. It is theorized that CEWs may contribute to these deaths by impairing respiration. Objectives: To examine the respiratory effects of CEWs. Methods: Human volunteers received a 15-second application of electrical current from a CEW while wearing a respiratory measurement device. Common respiratory parameters were collected before, during, and after exposure. Health histories and demographic information were also collected. Results: Fifty-two subjects were analyzed. Thirty-four underwent a 15-second continuous exposure, and 18 underwent three 5-second burst exposures. In the continuous application group, the baseline mean tidal volume of 1.1 L increased to 1.8 L during application, the baseline end-tidal CO2 level went from 40.5 mm Hg to 37.3 mm Hg after exposure, the baseline end-tidal oxygen level went from 118.7 mm Hg to 121.3 mm Hg after exposure, and the baseline respiratory rate went from 15.9 breaths/min to 16.4 breaths/min after exposure. In the 5-second burst group, the baseline mean tidal volume increased to 1.85 L during application, the baseline end-tidal CO2 level went from 40.9 mm Hg to 39.1 mm Hg after exposure, the baseline end-tidal oxygen level went from 123.1 mm Hg to 127.0 mm Hg after exposure, and the baseline respiratory rate went from 13.8 breaths/min to 14.6 breaths/min after exposure. Conclusions: Prolonged CEW application did not impair respiratory parameters in this population of volunteers. Further study is recommended to validate these findings in other populations.

Over an 18-month period, the department of Forensic Medicine and Science at the University of Glasgow investigated four rather unusual drug-related deaths. In all cases, death was due to the obstruction of the airway by a foreign body after an attempt to evade arrest. In all cases, the obstruction was drug packages of various shapes and sizes. Results of toxicology revealed levels of drugs that may have had a significant respiratory effect on the deceased in three of the cases. Rupturing of the packages and hence leakage of drugs being conducive to death was obvious in only one case.

The pulmonary capillary wedge pressure (PCWP) value provides valuable assessment data to guide therapeutic interventions. Proper interpretation of PCWP becomes complicated when respiratory excursions are imposed upon the pressure waveform. Critical care nurses and advanced practice nurses who understand the mechanics of this respiratory effect can accurately interpret the PCWP.

There is conflicting evidence regarding the association between different size fractions of particulate matter (PM) and cardiac and respiratory morbidity and mortality. We investigated the short-term associations of four size fractions of particulate matter (PM(1), PM(2.5), PM(10), and PM(10-2.5)) and carbon monoxide with hospital admissions and emergency room (ER) visits for respiratory and cardiac conditions and mortality in Spokane, Washington. We used a log-linear generalized linear model to compare daily averages of PM and carbon monoxide with daily counts of the morbidity and mortality outcomes from January 1995 to June 2001. We examined pollution lags ranging from 0 to 3 days and compared our results to a similar log-linear generalized additive model. Effect estimates tended to be smaller and have larger standard errors for the generalized linear model. Overall, we saw no association with respiratory ER visits and any size fraction of PM. However, there was a suggestion of greater respiratory effect from fine PM when compared to coarse fraction. Carbon monoxide was associated with both all respiratory ER visits and visits for asthma at the 3-day lag. We feel that carbon monoxide may be serving as a marker for combustion-derived pollutants, which is one large component of the diverse air pollutant mixture. We also found no association with any size fraction of PM or CO with cardiac hospital admissions or mortality at the 0- to 3-day lag. We found no consistent associations between any size fraction of PM and cardiac or respiratory ER visits or hospital admissions.

Keywords: amoxicillin; contact urticaria; occupational; healthcare workers; nurse; respiratory effect; β-lactam antibiotics

A central sleep apnea is the absence of respiratory effect, and, thus, the absence of airflow during sleep. Central hypopnea, a related disorder, is also discussed. The sensory component of central sleep apnea; defects involving the integrative and executive neurons; non-neurologic causes of central sleep apneas, including chronic obstructive pulmonary disease and congestive heart failure; diagnosis; treatment; and other topics are reviewed in detail.

We describe an outbreak of contact dermatitis in a tulip bulb processing company Shortly after the introduction of a new pesticide, the fungicide fluazinam, employees started to complain of dermatitis of the arms and the face. 8 employees were investigated and showed positive patch tests to fluazinam. The dermatitis disappeared quickly when they stopped work, but returned as soon they restarted. Subsequent investigations showed that the fungicide had not been used according to the manufacturer's recommendations. Fluazinam was shown to be a strong; sensitizer under these circumstances.

Keywords: occupational; carpenter; construction industry; allergic contact dermatitis; chromate; epoxy; obeche; jacaranda; woods; respiratory effect

This review is an update of a previously published one on airborne-induced contact dermatoses. Because reports in the literature often omit the term 'airborne', 12 volumes of Contact Dermatitis (July 1985-April 1991) were screened, and the cases cited were classified as to history, lesion locations, causative agents, and other factors. The number of reports of airborne dermatoses has increased considerably in recent years.

The respiratory effect of progestin differs among various animal species and humans. The rat does not hyperventilate in response to exogenous progestin. The present study was conducted to determine whether administration of combined progestin and estrogen prompts ventilatory stimulation in the male rat. Ventilation, blood gases, and metabolic rates (O2 consumption and CO2 production) were measured in the awake and unrestrained male Wistar rat. The combined administration of a synthetic potent progestin (TZP4238) and estradiol for 5 days significantly increased tidal volume and minute expiratory ventilation (VE), reduced arterial PCO2, and enhanced the ventilatory response to CO2 inhalation (delta VE/delta PCO2). On the other hand, respiratory frequency, O2 consumption, CO2 production, and body temperature were not affected. The arterial pH increased slightly, with a concomitant decrease in plasma [HCO3-]. Administration of either TZP4238 or estradiol alone or vehicle (Tween 80) had no effect on respiration, blood gases, and ventilatory response to CO2. The results indicated that respiratory stimulation following combined progestin plus estradiol treatment in the male rat involves activation of process(es) that regulate tidal volume and its augmentation during CO2 stimulus.

A 17-year-old female presented because of acute erythema of the hands, oedema of the eyelids, dyspnea and cough occurring 2 months previously. Remission had rapidly been obtained with systemic corticosteroid and antihistamine. The patient had experienced these symptoms after throwing raw rice during a wedding, though she had always eaten cooked rice without problems. Further enquiry revealed a generalized acute urticaria 6 years before, after eating polenta, an Italian food made with maize flour.

The respiratory effect of diagnostic colonoscopy and upper endoscopy were studied in 32 elderly patients. Twenty-two underwent colonoscopy and 10 upper endoscopy. In the group undergoing upper endoscopy, 4 of 10 patients experienced a decrease in oxygen desaturation greater than or equal to 4% during the medication period; an additional 2 patients desaturated during the procedure. In the group undergoing colonoscopy, 12 of 22 patients experienced oxygen desaturation during the medication period; 3 other patients desaturated during the procedure. Mean SaO2 for each group was lowest (p less than 0.05) during the medication period. Central apneas occurred in 13 of the patients undergoing colonoscopy during the medication period; however, only 8 of these patients with apneas experienced desaturation greater than or equal to 4% and the periods of desaturation did not correlate with the periods of apneas. Oxygen desaturation greater than or equal to 4% occurs frequently during both upper endoscopy and colonoscopy in this elderly population. This is related to the effects of sedation; the procedure itself worsened the desaturation in only 16% of the patients. Furthermore, the desaturation did not correlate with changes in the breathing patterns of the patients. Low-flow oxygen and/or close monitoring of patients during and subsequent to administration of medication is advised.

Over a five-year period a consistent habit of smoking or nonsmoking was maintained by 302 women (aged 25 to 54 years at the beginning of the study). There were 130 nonsmokers, 40 ex-smokers, and 15 light, 46 moderate, and 71 heavy smokers. Smokers without serious disability who had stopped smoking had a very low prevalence of respiratory symptoms and showed worsening of pulmonary function over the years similar to life-long nonsmokers. Although there is a dose-related response to cigarettes, individual susceptibility also plays an important role in determining the respiratory effect of smoking. A range for change in ventilatory function over a five-year period in apparently healthy nonsmoking women is provided. Using this range, it is possible to identify susceptible smokers who show deterioration in ventilatory function that is more rapid than normal. Repeated spirometric studies may be useful in selecting a group at greatest risk of developing later disabling chronic obstructive pulmonary disease.

The aerometric results indicate significant differences between the annual means for SO2 and NO2 with the Seiberling school having the higher values. The questionnaire results indicate that the Seiberling children reported more wheezing in the chest, and shortness of breath than the Betty Jane children. Daily symptoms reported by the students indicate that the Seiberling children reported twice as many incidences of upper respiratory symptoms including rhinitis, cough, and sore throat. Baseline asymptomatic lung function testing did show that the ratio FEV1/FVC was significantly lower at the Seiberling school. For both schools there was a decrease in lung function during the symptomatic phase of an acute respiratory illness (AR!), and the tests further indicate that the ARIs in the Seiberling school were more severe and/or involved the small airways more so than the ARIs at the Betty Jane school. Recovery from the ARIs were not complete after nine days with the Seiberling children showing slower recovery than the Betty Jane children. On the basis of available aerometric information it is suggested that SO2 in combination with NO2 is primarily responsible for the reduction in lung function tests and the exacerbations seen in the children at the Seiberling school.

"The lung is connected with skin and hair" is a theory of traditional Chinese medicine. From the view of comparative physiology we researched the inter-relation of lung and skin and hair and found it in water. From living protein to fish respiration is by the structure corresponding to the skin and the organ which originated skin. Though amphibia have lung respiratory effect of skin still locate 2/3. Aves. Mammals and human beings use lungs to respire. In fact air exchanges from nature through the thin water molecular layer of the surface of the pulmonary alveoli. So the lung is derived from "skin and hair" to adapt to inter-respiration.

We measured the density variations of aortic blood from rabbits ventilated by a positive end inspiratory pressure of 6 mmHg or a negative box pressure of the same magnitude. When calculated from the density variations, the fluctuations in blood volume of the pulmonary capillaries within one cycle as induced by an intermittent positive pressure ventilation were found to be similar to the ones induced by an intermittent negative pressure ventilation. Using these volumetric fluctuations as a means to assess the transpulmonary pressure and the transmural pressure across the pulmonary capillaries, we conclude that the switching of the ventilation method did not alter the cyclic fluctuations of these pressures.

Am nichtnarkotisierten Hund wurden nach den Methoden von Schroeder vergleichende Untersuchungen uber die Atmungs- und Kreislaufwirkung von Adenosin, Muskeladenylsaure und Adenosintriphosphorsaure angestellt. Im Unterschied zu den Ergebnissen an narkotisierten Tieren fanden wir ausschlieslich eine atmungserregende Wirkung der Adenosinkorper. Der bekannte Blutdruckabfall war — im Gegensatz zur Bradykardie beim Tier in Narkose — von einer Tachykardie begleitet. Der Blutdruckabfall scheint den Kreislaufanalysen nach Wezler und Boger zufolge vor allem durch periphere Gefaserweiterung zustande zu kommen. Die Extremitatendurchblutung war jedoch nur geringgradig vermehrt. Die molaren Wirkungsstarken von Adenosin, AMP und (ATP + ADP) verhielten sich an Atmung und Kreislauf etwa wie 1 : 1,3 : 2,5. Die Befunde werden mit den Ergebnissen fruherer Arbeiten verglichen und in ihrer moglichen therapeutischen Bedeutung diskutiert.

Insulin depressed hepatic cell respiration in the presence of 2-deoxyglucose by enhancing the uptake of this glycolytic inhibitor. Sodium dodecyl sulfate (SDS) showed little to no respiratory effect in such a system. Both insulin alone and SDS alone enhanced hepatic respiratory rates in the absence of glycolytic inhibitor. In the presence of both insulin and SDS these rates were increased to an extent greater than that observed for either substance alone.

To the Editor.— It has been estimated that between 1 and 2 million pulmonary artery catheters were inserted for hemodynamic monitoring in the last decade. 1 The prevalence of the procedure has increased substantially over the past few years. It is therefore of interest that the methodology of a clinical hemodynamic measurement, cardiac output by thermodilution, which is made less frequently than blood pressure and heart rate only, be the subject of continued investigation. Some of the errors associated with the early use of this technique have been eliminated by improved technology. For example, those due to alterations in injectate temperature 2 are now minimized by the use of both a proximal and distal thermistor. The question of the importance of the respiratory effect on the measurement of cardiac output appears to have now been settled by a report inThe Journal. 3 The data presented in this article demonstrate

In Reply.— We thank Dr McIntyre for his thoughtful letter in which he states that the importance of the respiratory effect on the measurement of cardiac output appears to have now been settled by our recent article. Dr McIntyre has briefly reviewed several of the critical factors influencing pulmonary interactions with cardiac output. He would have liked data describing respiratory variables included in our article since he thought that the order of initiation of injection at the three different times during the respiratory cycle was not randomized. There is no question that lung compliance, airway pressure, and inspiratory flow wave form all interact with cardiac function. 1 However, we did not include respiratory variables since, in fact, the order of initiation of injection at the three different times during the respiratory cycle was randomized in our study. We utilized the Latin squares' technique. This is so stated in the "Methods"