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A patient with chronic lung disease became cyanotic following right pneumonectomy for cancer. He was found to have right-to-left shunting through a patent foramen ovale in the absence of pulmonary hypertension, and he improved remarkable after surgical therapy. This case vividly illustrates the subtlety with which acquired right-to-left shunting may appear in the setting of chronic hypoxemia. The frequency of patent foramen ovale in the general population (20 percent) and the ease and efficacy of treatment for this lesion underscore the need for general awareness of this potential problem in the chronically or critically ill.

Glucocorticoid therapy has long been advocated for treatment of pulmonary dysfunction in sarcoidosis. No controlled prospective study in current medical literature establishes the efficacy...

In three obese patients with sleep disturbance and somnolence, upper airway obstruction appeared to play the primary pathophysiologic role. The somnolence in these patients was caused by s...

During an investigation of pulmonary dysfunction in 41 consecutive patients with classical or definite rheumatoid arthritis, it was found that 41.4 percent had abnormalities of pulmonary diffusion. Generally the physiologic profile was one of decreased vital capacity, decreased total lung capacity, and arterial hypoxemia; these abnormalities were supported by the pathologic findings of percutaneous lung biopsy. All patients showed changes of interstitial fibrosis. Usually, the patients were not symptomatic, and 47.0 percent had normal chest roentgenograms. The type of treatment received, level of rheumatoid factor, duration of disease, and American Rheumatism Association (ARA) stage of disease failed to correlate with the presence or absence of pulmonary dysfuntion. The clinical significance of pulmonary fibrosis in rheumatoid patients is unknown, and the disease seems to be mild clinically and only slowly progressive. It is concluded that pulmonary fibrosis is common in rheumatoid disease and should be regarded as an expected manifestation, rather than an unusual complication, of the systemic process connoted by the term rheumatoid disease.

• The effect of intravenous sedation on oxygen saturation and ventilation was studied in 11 patients undergoing peritoneoscopy. Oxygen saturation (mean ± SD) decreased from baseline (94.7% ± 1.7%) to nadir (78.6% ± 10.7%) after sedation. Respiratory depression was evident in these patients by concomitant decreases in minute ventilation and tidal volume. Baseline to nadir arterial blood gas changes in eight patients were consistent with hypoventilation and also suggested a superimposed ventilation perfusion mismatch. Mean respiratory rate did not significantly change during peritoneoscopy. Peritoneal gas insufflation stimulated increased ventilation and oxygen saturation, but no further changes in Pco 2 or pH. We conclude that serious arterial oxygen desaturation and possibly some ventilation perfusion mismatch occur after sedation with intravenously administered meperidine-diazepam for peritoneoscopy with resultant hypoxemia, hypercarbia, and acidosis. ( Arch Intern Med . 1989;149:1029-1032)

A method for simulating speech in a tracheotomized individual includes providing a source of compressed air, regulating the air pressure, and controlling the flow of air from the source between a condition in which airflow is stopped and a condition in which airflow is allowed in response to actuation by the individual. The air flow is supplied to a reed to vibrate it, and the resulting vibration-modulated air flow is introduced into the pharynx of the individual, permitting the individual to articulate audibly comprehensible speech. Apparatus for carrying out this method is also described.

Excerpt Steroid therapy has long been advocated for treatment of pulmonary dysfunction in sarcoidosis. Current medical literature, however, reveals no controlled prospective study which establishes...

Excerpt Forty-one consecutive patients with classical or definite rheumatoid arthritis were studied in an attempt to determine the prevalence of pulmonary dysfunction in rheumatoid disease. Routine...

Seven patients had central airway obstruction of varied causes. The diagnosis was established early in some, but in others, because of either atypical clinical or physiological features or the lack of suspicion, the diagnosis was delayed. These cases emphasize that central airway obstruction may simulate asthma or chronic obstructive pulmonary disease and is not a rare clinical problem. Prime suspects are patients with dyspnea and wheezing without a well-defined cause.