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Biomedical subjects

J Shneerson

Publications and source records attributed to J Shneerson.

At least 19 recordsLinked to original sources
PubMed2001

Lifestyle modification for obstructive sleep apnoea.

BACKGROUND: Obstructive sleep apnoeas are due to transient closure of the upper airway during sleep and merge into hypopnoeas in which the airway narrows, but some airflow continues. They are due to the forces compressing the airway overcoming those which stabilise its patency. The commonest association is obesity in which fatty tissue is deposited around the airway. Exercise has been recommended as a method of losing weight, but other techniques which achieve this are also thought to improve symptoms due to sleep apnoeas. Sleep hygiene may alter the sleep structure and the control of the upper airway during sleep and thus promote its patency. OBJECTIVES: The objectives of this review are to determine whether weight loss, sleep hygiene and exercise are effective in the treatment of obstructive sleep apnoeas. SEARCH STRATEGY: The Cochrane Airways Group Trials Register, MEDLINE, EMBASE, CINAHL and reference lists of review articles have been searched. SELECTION CRITERIA: Randomised, single or double blind placebo controlled, either parallel group or crossover design studies of any of these interventions were to have been included. DATA COLLECTION AND ANALYSIS: No completed trials have been identified. MAIN RESULTS: No randomised trial data were available for analysis. REVIEWER'S CONCLUSIONS: There is a need for randomised controlled trials of these commonly used treatments in obstructive sleep apnoeas. These should identify which sub groups of patients with sleep apnoeas benefit most from each type of treatment and they should have clear and standardised outcome measures.

Exercise↗
PubMed1998

An evaluation of the use of concentrators for domiciliary oxygen supply for less than 8 h day-1.

Since their introduction in 1985, oxygen concentrators have only been recommended when domiciliary oxygen is used for over 8 h day-1. Subsequent changes in the prices of oxygen merit a reappraisal of the prescribing of concentrators and cylinders when oxygen is used for less than 8 h day-1. Twenty-six patients in two health districts who used oxygen for less than 8 h day-1 completed a crossover study in which each group received oxygen from each source for consecutive 3-month periods. The patients were visited at home before and during the study, and on each visit they completed a questionnaire asking about their use of oxygen, how acceptable they found the two sources and about several dimensions of their quality of life. The theoretical minimum cost of cylinder supply, the actual cost of cylinder supply and the average concentrator costs were assessed. The patients found the concentrators to be more acceptable, more useful and less obtrusive than cylinders. They used more oxygen in more rooms of the home during treatment with concentrators, and there were improvements in the quality-of-life measurements. The costing information showed that, both in theory and in practice, oxygen concentrators are cheaper than cylinders when oxygen is used for more than about 1.4 h day-1. These results suggest that the provisions for the supply of domiciliary oxygen should be reviewed and that concentrators should be recommended for patients who use more than around 1.4 h day-1.

Aged↗
PubMed1998

Bronchiectasis in association with coeliac disease.

A 48 year old woman presented with a history of fatigue, regular sputum production, and wheeze. High resolution computed tomographic scanning of the thorax demonstrated widespread bronchiectasis. Coeliac disease was diagnosed on the basis of an iron deficiency anaemia, subtotal villous atrophy on small bowel biopsy, and raised anti-gliadin and antiendomysial antibodies. The temporal relationship of the bronchiectasis and coeliac disease, and the subsequent stabilisation of her clinical symptoms and improvement in pulmonary physiology following treatment with inhaled corticosteroids, suggests a relationship between the two conditions which may be due to immunological mechanisms.

Albuterol↗
PubMed1997

Vasculitis and bronchiectasis in a patient with antibodies to bactericidal/permeability-increasing protein and alpha1-antitrypsin deficiency.

A patient with alpha1-antitrypsin deficiency is reported herein; this subject developed aggressive bronchial disease and recurrent cutaneous vasculitis after pulmonary infection with Pseudomonas aeruginosa. Autoantibodies to neutrophil cytoplasmic antigens were detected, which produced granular cytoplasmic staining by indirect immunofluorescence with specificity for a newly characterized antigen: bactericidal/permeability-increasing protein (BPI). The bronchial disease and vasculitis improved, and the IgA anti-BPI titer fell after antipseudomonal treatment. This raises the possibility that anti-BPI antibodies contributed to both the bronchial disease and vasculitis.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed1994

Long term non-invasive domiciliary assisted ventilation for respiratory failure following thoracoplasty.

BACKGROUND: Ventilatory failure is a well recognised complication of patients who have had a thoracoplasty for tuberculosis, but there are few data regarding the value of long term non-invasive assisted ventilation in this situation. METHODS: Thirty two patients who had had a thoracoplasty 20-46 years previously and who had developed respiratory failure were treated with nocturnal cuirass assisted ventilation or nasal positive pressure ventilation. Their survival and changes in arterial blood gases, nocturnal oximetry, and pulmonary function tests were assessed. RESULTS: The actuarial survival rates at one, three, five, and seven years after starting treatment were 91%, 74%, 64%, and 55%, respectively. Only seven of the 13 deaths were directly attributable to chronic respiratory or cardiac failure. The arterial PO2, PCO2, mean nocturnal oxygen saturation, vital capacity, and maximal inspiratory and expiratory pressures had all improved at the time of the initial post-treatment assessment (mean 12 days after starting treatment), but no subsequent improvements were seen after up to 48 months of follow up. Neither survival nor physiological improvements were correlated with the patients' age, the interval since thoracoplasty, or the pretreatment arterial blood gas tensions or results of pulmonary function tests. CONCLUSIONS: These results show that, even when ventilatory failure has developed, the prognosis with non-invasive assisted ventilation is good and the physiological abnormalities can be partially reversed. Patients who develop respiratory failure after a thoracoplasty should be considered for this type of long term domiciliary treatment.

Adult↗
PubMed1993

Multiple recurrent intrapulmonary and endobronchial mesenchymomas (hamartomas).

A patient is described with multiple, benign, chondromatous intrapulmonary and endobronchial mesenchymomas of the lung, which recurred after resection on two occasions over a period of 30 years. In such a patient presenting at a young age or with a history of previous recurrence, a wedge excision may be necessary to prevent further recurrence.

Adult↗
PubMed1993

The effects of five years of nocturnal cuirass-assisted ventilation in chest wall disease.

We investigated the long-term effectiveness of cuirass-assisted ventilation, and examined whether mortality and morbidity could have been predicted at the time of admittance. Twenty five patients were commenced on nocturnal cuirass-assisted ventilation between 1983 and 1985, 10 with scoliosis or kyphosis, 8 with a thoracoplasty and 7 with neuromuscular disease. Mean pretreatment vital capacity was 30% of predicted, and arterial carbon dioxide tension (Paco2) was 8.2 kPa (62 mmHg). Fifteen patients were alive 5 yrs later. Two had discontinued assisted ventilation, both dying soon afterwards, and three had been changed to intermittent positive pressure ventilation. Survival could not have been predicted from age, severity of disease, lung volumes or arterial blood gases at presentation. Paco2 in the survivors had risen from a mean of 6.1 kPa (46 mmHg) after one year to 6.8 kPa (52 mmHg) after 5 yrs (p < 0.05), but remained significantly less than at presentation. There were no significant change in arterial oxygen tension (Pao2), lung volumes, respiratory muscle strength, haemoglobin, right heart failure, exercise tolerance, mental function and symptom scores after 5 yrs, compared to after 1 yr. The median amount of time spent in hospital declined from 15 days per patient in the first year after initial discharge with cuirass-assisted ventilation, to between 3-5.5 days per patient in subsequent years. We conclude that nocturnal cuirass-assisted ventilation has a role in long-term management of patients with neuromuscular and skeletal chest wall disorders. A randomized comparison with nasal intermittent positive pressure ventilation is now indicated.

Adolescent↗
PubMed1992

Massive hemothorax due to enlarging arteriovenous fistula in pregnancy.

A 37-year-old woman with hereditary telangiectasia suffered a life-threatening hemothorax due to an enlarging pulmonary arteriovenous malformation in pregnancy. This was treated by emergency right lower lobectomy and excision of arteriovenous malformations in the right middle and upper lobes, with no postoperative complications, and the subsequent delivery of a normal infant. Women with hereditary telangiectasia contemplating pregnancy should be screened for the presence of PAVM to anticipate complications.

Adult↗
PubMed1991

Home ventilation.

Home ventilation has become practical recently because of improvements in the equipment available to support respiration in the long term. It is especially effective in neuromuscular and skeletal disorders, but may also have a limited place in chronic lung diseases. Both positive- and negative-pressure ventilators may be suitable for home ventilation.

Durable Medical Equipment↗
PubMed1988

Assisted ventilation using cuirass respirators.

The effects of cuirass-assisted ventilation have been studied in 25 subjects with chest wall disease. Cuirass respirators increase ventilation in proportion to the peak negative pressure within the cuirass shell and the respiratory rate. Positive pressure applied during expiration produces little additional ventilation. During cuirass-assisted ventilation end-expiratory volume increases, arterial carbon dioxide tension (PaCO2) falls and arterial oxygen tension (PaO2) rises. Cardiac output is unchanged. Paradoxical chest wall motion is corrected by cuirass-assisted ventilation and restriction of chest wall expansion by the cuirass shell is minimal. Jacket-type respirators can produce larger tidal volumes than the cuirass at the same peak negative pressure, but are associated with greater air leakage.

Adult↗
PubMed1988

The effects of one year of nocturnal cuirass-assisted ventilation in chest wall disease.

The effects of one year of nocturnal cuirass-assisted ventilation using individually designed cuirass respirators have been investigated in twenty-five patients with chest wall disease. After one year, 22 (88%) of the patients were alive. Daytime arterial blood gases had improved. Functional residual capacity (FRC) had increased but there was no significant change in other lung volumes. Maximum inspiratory pressure (MIP) improved in the subjects with a scoliosis but not in those with a thoracoplasty or neuromuscular disease. Maximum expiratory pressure (MEP) was unchanged. Maximum voluntary ventilation (MVV), the ventilatory response to carbon dioxide and six minute walking distance had all increased. There was no improvement in respiratory symptoms, but a decrease in depression scores and in the time taken to complete a trail test. The mean (SD) number of days spent in hospital over the year was 21.5 (15.1) per patient, with patients consulting their general practitioners less frequently than in the year prior to commencing nocturnal cuirass-assisted ventilation. The cost of commencing a patient on domiciliary nocturnal cuirass-assisted ventilation is estimated as 2470 pounds, and of maintaining them at home for one year as 3302 pounds.

Female↗