Poor prognosis or poor sign?
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Biomedical subjects
Publications and source records attributed to M S Rothstein.
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The thoracic cage appears to be large during attacks of asthma. Lung volume measurements by body plethysmography and helium dilution have suggested that total lung capacity may be increased during an acute attack of asthma, but doubt has been cast on the accuracy of these measurements in the presence of airflow obstruction. The change in total lung capacity has therefore been investigated during and after an acute attack of severe asthma in 32 patients by a radiographic technique. There was a small decrease (0.29 l) in mean total lung capacity between admission and follow up, though a quarter of the subjects showed a slight increase. There was no correlation between change in total lung capacity and change in expiratory flow rates, arterial carbon dioxide tension on admission, body mass index, and length of stay in hospital. Our findings agree with previous reports of a decrease in total lung capacity with improving airway obstruction, but the changes were small and inconsistent.
To assess the role of bronchial hyperresponsiveness in chronic congestive heart failure (CHF), we performed standard methacholine bronchial provocation testing on nine patients with chronic CHF in New York Heart Association functional class 4. Mean pulmonary capillary wedge pressure and mean stroke volume index for the group at the time of study were 27 +/- 3 mm Hg and 27.9 +/- 8.9 ml/m2, respectively. Mean MMEFR was 71 percent of normal and mean delta to FEV1% was 76.3 percent. Only one patient, who was a 50-pack-year smoker, had a greater than 20 percent decrease in FEV1 with methacholine challenge, and this was at the highest concentration (25 mg/ml). We conclude that, in stable CHF, bronchial reactivity as assessed by standard methacholine challenge is not increased.
Stomas are artificial openings from the gastrointestinal tract or the urinary tract to the outside of the body. Patients with stomas require appliances to protect peristomal skin and contain the stomal effluent. Cutaneous problems that often arise around the stoma may be unique to these patients or may reflect more typical dermatoses and neoplasia arising in an atypical setting. Dermatologists must learn to recognize these disorders and must be aware of preventive and therapeutic techniques and the resources available to manage them. Much can be gained, in both the education of the dermatologist and in the care of the patient, by close cooperation with the specialized enterostomal therapy nurse.
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Ostomates, patient with surgical openings to their gastrointestinal or urinary tracts, are increasing in number. They require special consideration to skin care at the surgical site, beginning in the preoperative period. Physicians should understand the special appliances that ostomates must wear and should also be aware of the methods for prevention and care of skin problems associated with these patients.
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A cirsoid aneurysm, which is an abnormal arteriovenous connection, occurred in a 65-year-old man. The lesion can vary greatly in size and does not have a characteristic histologic picture. Small lesions require no treatment.