Respiratory mechanics were studied in 7 patients with vocal cord paralysis (Group A), 7 with laryngeal or sublaryngeal obstruction (Group B) an in 3 with intrathoracic tracheal obstruction (Group C). Group A showed decrease in FIV1.0, PIFR and VI50 when compared with corresponding expiratory parameters. Group B only showed a decrease in PIFR compared with PEFR. In all patients the high flow area near TLC in expiratory V/V curves was replaced by a flat flow pattern, extending variably into lower lung volumes. Predominant inspiratory flow reduction was present in Group A. Usually the normal expiratory plateau (IVPF curves) was absent even at very low lung volumes (about 25% VC) in the 8 patients studied (Group A, B, C). In Group B, inspiratory and expiratory resistances (IVPF curves) were similar up to about 50-60 cm H2O Palv; above this level inspiratory resistance was higher. The flow-pressure pattern (IVPF curves) of a normal subject with a relatively low resistance added at the mouth (9 mm i.d.) was very close to that of the resistance alone throughout inspiration. Above 60 cm H2O Palv expiratory resistance appeared to be lower, as in Group B. Calculated pressure drop due to convective acceleration across the resistance coincides with its pressure-flow relationship. These results do not support the hypothesis of inspiratory reduction in tracheal caliber as a contributing cause to inspiratory flow decrease. The difference PEFR-PIFR at highest Palv was inversely related to the degree of obstruction. Consequently, flow-volume curves of moderate sublaryngeal lesions may show disproportionate reductions in VI (like Group A) despite its fixed nature. Results obtained in six patients submitted to surgical treatment are discussed.

Adolescent↗

PubMedDate not supplied

[Comparison between the bacterial flora airways and of the lung tissue].

In 44 patients tracheotomized and under mechanical ventilation bacteriological studies were carried out, inmediately after death, in bronchial secretions and in a small piece of lung obtained by thoracotomy. The more frequently found bacterium in bronchial secretions or the lung was the Pseudomona aeruginosa (Table 1). In order of decreasing frequency: Klebsiella, Staphylococcus, Proteus, etc. were found in the lung while in bronchial secretions the order was inverse by predominance of Proteus. Total bacteriological coincidence was found in 14 cases while it was partial in 8 more patients where another bacterium was added in bronchial secretions. Bacteria were different in 6 cases (Table 2) in 4 of them: staphylococcus was obtained in the lung while Pseudomonae, Proteus and Klebsiellae were present in bronchial secretions (Table 3). In 16 cases cultures of the piece of lung taken were negative. Not taking into account these last ones, it is possible to conclude that from the therapeutic stand point culture of bronchial secretions was useful in antibiotic selection in 22 out of 28 cases.

Bacteria↗

PubMedDate not supplied

[Usefulness of blood cultures from central venous catheters in the diagnosis of infection of the catheter tip].

Central venous blood cultures, obtained through catheters have been used for diagnosis of tip infections. We prospectively studied in a consecutive way two blood culture techniques. In a group of 23 cases, the first 5 ml of catheter solution was discarded, and in the second group of 41 cases the first 10 ml of catheter solution and blood were used. Colony counts for true positive samples were 100 cfu/ml (median value) with a 95% confidence interval = 5-1000 cfu/ml. Test validation showed for all cases, first and second groups respectively: sensitivity 60%, 50% and 62.5%; specificity 91.1%, 100% and 94.7%; positive predictive values 94.1%, 100% and 93.8%; negative predictive values 73.3%, 85% and 64%. This study had a limited utility in the diagnosis of central venous catheter tip infections. Our results show that the most sensitive technique is culture of initial samples obtained through the venous access, and that a cut-off lower than those used in previous studies should be used.

Adult↗

PubMedDate not supplied

[Spectrum of alveolar hypoventilation].

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Humans↗

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[Identification of Streptococcus viridans in clinical specimens].

In a 4 year prospective study of "viridans" or non-groupable streptococci 100 clinically significant strains were isolated. Strains were defined as significant when found in two or more samples of blood cultures, or when seen on Gram staining together with inflammatory reaction. Fifty-two strains were speciated by 10 physiological characteristics. In 42 cases additional tests were performed. Only 16 isolates were unidentifiable by the techniques used. Sources of isolates included purulent lesions (53%) (mainly S. milleri and S. mitior); endocarditis (27%) (S. bovis I, S. sanguis, S. mutans, S. bovis II) and urinary tract infections (10%) (S. bovis II, S. milleri).

Endocarditis, Bacterial↗

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