Pulmonary embolism (PE) is a common disorder that is accompanied by significant morbidity and mortality. Although anticoagulation is the standard treatment for PE, thrombolytic therapy, with its ...ability to produce rapid clot lysis, has long been considered an attractive alternative. Although many studies have been performed over the past three decades, however, the indications for the use of thrombolytic agents in patients with PE remain controversial. In this article, we review the medical literature and provide evidence-based guidelines for the use of thrombolytic therapy. We will also discuss the practical aspects of PE thrombolysis.
We compared noninvasive positive-pressure ventilation (NPPV), using bilevel positive airway pressure, with usual medical care (UMC) in the therapy of patients with acute respiratory failure (ARF) in ...a prospective, randomized trial. Patients were subgrouped according to the disease leading to ARF (chronic obstructive pulmonary disease COPD, a non-COPD-related pulmonary process, neuromuscular disease, and status postextubation), and were then randomized to NPPV or UMC. Thirty-two patients were evaluated in the NPPV group and 29 in the UMC group. The rate of endotracheal intubation (ETI) was significantly lower in the NPPV than in the UMC group (6.38 intubations versus 21.25 intubations per 100 ICU days, p = 0.002). Mortality rates in the intensive care unit (ICU) were similar for the two treatment groups (2.39 deaths versus 4.27 deaths per 100 ICU days, p = 0.21, NPPV versus UMC, respectively). Patients with hypoxemic ARF in the NPPV group had a significantly lower ETI rate than those in the UMC group (7.46 intubations versus 22.64 intubations per 100 ICU days, p = 0.026); a similar trend was noted for patients with hypercapnic ARF (5.41 intubations versus 18.52 intubations per 100 ICU days, p = 0.064, NPPV versus UMC, respectively). Patients with ARF in the non-COPD category had a lower rate of ETI with NPPV than with UMC (8.45 intubations versus 30.30 intubations per 100 ICU days, p = 0.01). Although the rate of ETI was lower among COPD patients receiving NPPV, this trend did not reach statistical significance (5.26 intubations versus 15.63 intubations per 100 ICU days, p = 0.12, NPPV versus UMC, respectively). In conclusion, NPPV with bilevel positive airway pressure reduces the rate of ETI in patients with ARF of various etiologies.
The prognosis and optimal therapy of patients with pulmonary embolism (PE) are strongly influenced by the presence or absence of associated hemodynamic derangements. Patients with normal systemic ...arterial pressure have a relatively low risk of recurrent PE and death when treated promptly with therapeutic anticoagulation. Those who present with hypotension, shock, or cardiac arrest, however, have a much higher mortality rate and often receive thrombolytic therapy. Recent evidence indicates that the presence of right ventricular (RV) dysfunction identifies a subgroup of normotensive patients with a much more guarded prognosis who may benefit from more intensive therapy with thrombolytic agents. This article reviews our current understanding of the pathophysiology and diagnosis of RV dysfunction and its impact on the prognosis and therapy of normotensive patients with PE.
The target asymmetry
T
, recoil asymmetry
P
, and beam-target double polarization observable
H
were determined in exclusive
π
0
and
η
photoproduction off quasi-free protons and, for the first time, ...off quasi-free neutrons. The experiment was performed at the electron stretcher accelerator ELSA in Bonn, Germany, with the Crystal Barrel/TAPS detector setup, using a linearly polarized photon beam and a transversely polarized deuterated butanol target. Effects from the Fermi motion of the nucleons within deuterium were removed by a full kinematic reconstruction of the final state invariant mass. A comparison of the data obtained on the proton and on the neutron provides new insight into the isospin structure of the electromagnetic excitation of the nucleon. Earlier measurements of polarization observables in the
γ
p
→
π
0
p
and
γ
p
→
η
p
reactions are confirmed. The data obtained on the neutron are of particular relevance for clarifying the origin of the narrow structure in the
η
n
system at
W
=
1.68
GeV
. A comparison with recent partial wave analyses favors the interpretation of this structure as arising from interference of the
S
11
(
1535
)
and
S
11
(
1650
)
resonances within the
S
11
-partial wave.
J. W. Kreit, K. B. Gross, T. B. Moore, T. J. Lorenzen, J. D'Arcy and W. L. Eschenbacher
Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor 48109.
To ...compare the responses of asthmatic and normal subjects to high effective
doses of ozone, nine asthmatic and nine normal subjects underwent two
randomly assigned 2-h exposures to filtered, purified air and 0.4 ppm ozone
with alternating 15-min periods of rest and exercise on a cycle ergometer
(minute ventilation = 30 l.min-1.m-2). Before and after each exposure,
pulmonary function and bronchial responsiveness to methacholine were
measured and symptoms were recorded. Ozone exposure was associated with a
statistically significant decrease in forced vital capacity (FVC), forced
expired volume in 1 s (FEV1), percent FEV1 (FEV1%), and forced expired flow
at 25-75% FVC (FEF25-75) in both normal and asthmatic subjects. However,
comparing the response of asthmatic and normal subjects to ozone revealed a
significantly greater percent decrease in FEV1, FEV1%, and FEF25-75 in the
asthmatic subjects. The effect of ozone on FVC and symptom scores did not
differ between the two groups. In both normal and asthmatic subjects,
exposure to ozone was accompanied by a significant increase in bronchial
responsiveness. We conclude that exposure to a high effective ozone dose
produces 1) increased bronchial responsiveness in both normal and asthmatic
subjects, 2) greater airways obstruction in asthmatic than in normal
subjects, and 3) similar symptoms and changes in lung volumes in the two
groups.
Abstract
The target asymmetry
T
, recoil asymmetry
P
, and beam-target double polarization observable
H
were determined in exclusive
$$\pi ^0$$
π
0
and
$$\eta $$
η
photoproduction off quasi-free ...protons and, for the first time, off quasi-free neutrons. The experiment was performed at the electron stretcher accelerator ELSA in Bonn, Germany, with the Crystal Barrel/TAPS detector setup, using a linearly polarized photon beam and a transversely polarized deuterated butanol target. Effects from the Fermi motion of the nucleons within deuterium were removed by a full kinematic reconstruction of the final state invariant mass. A comparison of the data obtained on the proton and on the neutron provides new insight into the isospin structure of the electromagnetic excitation of the nucleon. Earlier measurements of polarization observables in the
$$\gamma p \rightarrow \pi ^0 p$$
γ
p
→
π
0
p
and
$$\gamma p \rightarrow \eta p$$
γ
p
→
η
p
reactions are confirmed. The data obtained on the neutron are of particular relevance for clarifying the origin of the narrow structure in the
$$\eta n$$
η
n
system at
$$W = 1.68\ \textrm{GeV}$$
W
=
1.68
GeV
. A comparison with recent partial wave analyses favors the interpretation of this structure as arising from interference of the
$$S_{11}(1535)$$
S
11
(
1535
)
and
$$S_{11}(1650)$$
S
11
(
1650
)
resonances within the
$$S_{11}$$
S
11
-partial wave.
The target asymmetry
T
, recoil asymmetry
P
, and beam-target double polarization observable
H
were determined in exclusive
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\begin{document}$$\pi ^0$$\end{document}
π
0
and
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\usepackage{amssymb}
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\begin{document}$$\eta $$\end{document}
η
photoproduction off quasi-free protons and, for the first time, off quasi-free neutrons. The experiment was performed at the electron stretcher accelerator ELSA in Bonn, Germany, with the Crystal Barrel/TAPS detector setup, using a linearly polarized photon beam and a transversely polarized deuterated butanol target. Effects from the Fermi motion of the nucleons within deuterium were removed by a full kinematic reconstruction of the final state invariant mass. A comparison of the data obtained on the proton and on the neutron provides new insight into the isospin structure of the electromagnetic excitation of the nucleon. Earlier measurements of polarization observables in the
\documentclass12pt{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$\gamma p \rightarrow \pi ^0 p$$\end{document}
γ
p
→
π
0
p
and
\documentclass12pt{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$\gamma p \rightarrow \eta p$$\end{document}
γ
p
→
η
p
reactions are confirmed. The data obtained on the neutron are of particular relevance for clarifying the origin of the narrow structure in the
\documentclass12pt{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$\eta n$$\end{document}
η
n
system at
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\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$W = 1.68\ \textrm{GeV}$$\end{document}
W
=
1.68
GeV
. A comparison with recent partial wave analyses favors the interpretation of this structure as arising from interference of the
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\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$S_{11}(1535)$$\end{document}
S
11
(
1535
)
and
\documentclass12pt{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
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\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$S_{11}(1650)$$\end{document}
S
11
(
1650
)
resonances within the
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\begin{document}$$S_{11}$$\end{document}
S
11
-partial wave.
We hypothesized that differences between the conditions under which a pneumotachograph (PT) is calibrated and those during data collection might lead to large errors in measured flow and volume ...during mechanical ventilation. A Fleisch No. 1 and Fleisch No. 2 and a screen PT were connected to "ideal" tubing configurations that optimized flow characteristics, and to ventilator tubing with and without a Y-connector and endotracheal (ET) tube. Each PT was also evaluated after water had accumulated in its resistive element. Air was passed through each PT configuration, using both a continuous and a pulsatile flow pattern, and collected in a water-seal spirometer. "Measured" and "true" flow and volume were determined from the PT and the spirometer, respectively. Measured flow and volume were falsely low when the PT was adapted to ventilator tubing. Addition of a Y-connector and ET tube caused measured flow and volume to increase, and, in some cases the relationship between measured and true flow became nonlinear. Water accumulation in the PT did not lead to measurement errors. We conclude that when a PT is used during mechanical ventilation, tubing geometry must be identical during calibration and data collection, and that calibration should be performed over the entire range of relevant flows.
A computer-assisted technique based on the equation of motion of the respiratory system was used to measure inspiratory work of breathing in 11 patients during pressure support ventilation (PSV) and ...assisted, volume-cycled mechanical ventilation (AMV). During both modes of ventilation, patient work of breathing was calculated as the difference between the total work performed on the respiratory system (as predicted by the equation of motion) and the work performed by the ventilator. Patient work of breathing during AMV was also calculated as the difference between ventilator work measured during assisted and controlled mechanical breaths. By either method of work calculation, patient work of breathing during AMV was less than previously reported. In addition, when equal tidal volumes were delivered, there was no significant difference between the work performed by the patient during AMV and PSV. Patient work of breathing during PSV was found, however, to vary inversely with the level of pressure support. We conclude that: (1) patient work of breathing during AMV and PSV can be calculated using a computer-assisted technique based on the equation of motion of the respiratory system, and (2) depending on the amount of pressure support provided, patient work of breathing during PSV may be greater than, less than, or equal to the work performed during AMV.
