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Can J Surg. 2000 Oct;43(5):377-83.
Lung volume reduction surgery: results of a Canadian pilot study. Canadian Lung Volume Reduction Surgery Study Group.

Malthaner RA, Miller JD.

Division of Thoracic Surgery, University of Western Ontario, London. richard.malthanehsc.on.ca

OBJECTIVE: To present preliminary experience with lung volume reduction surgery (LVRS) before the institution of the Canadian LVRS trial. DESIGN: A prospective case series between December 1995 and January 1997. SETTING: University hospitals in London and Hamilton, Ont. PATIENTS: Forty-nine patients who had disabling dyspnea or emphysema with hyperinflation, able to participate in respiratory rehabilitation. Twenty-three patients were excluded because of comorbid conditions precluding surgery, pulmonary hypertension, excessive steroid dependence, malnutrition, obesity, previous thoracotomy, large solitary bullae, concurrent malignant disease, chronic bronchitis, hypercapnia or psychiatric illness. INTERVENTIONS: Preoperative respiratory rehabilitation followed by LVRS via median sternotomy. MAIN OUTCOME MEASURES: Impairment, disability and handicap were assessed before and 12 months after LVRS. Impairment was assessed by changes in pulmonary function test results and blood gas measurements, disability by the 6-minute walk test and cardiopulmonary exercise test, and handicap by the disease-specific chronic respiratory disease questionnaire (CRQ), the generic medical outcomes survey short form 36 (SF-36) and the generic health utilities index mark III (HUI-III). RESULTS: Two patients died of respiratory failure while in rehabilitation. Twenty-four patients (17 men, 7 women) successfully completed rehabilitation and underwent LVRS. The mean age was 63 years (range from 49 to 78 years) and the median length of hospital stay was 12.5 days (range from 7 to 90 days). Two patients (8%) died in the early postoperative period (within 30 days) of pneumonia. One patient died of respiratory failure 8 months after LVRS after a difficult 90-day postoperative hospital stay. There were 27 major complications. There was a 36% relative increase in the mean forced expiratory volume in the first second (p = 0.01) and a 10% relative increase in the 6-minute walk test (p = 0.06). The mean CRQ dyspnea score increased 2.3 points (p = 0.01), and the SF-36 general health domain increased 20 points (p = 0.01). There was no significant change in the HUI-III (p = 0.73). CONCLUSION: LVRS appears to lessen the respiratory impairment and handicap for at least 1 year in selected patients with advanced emphysema.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11045097&dopt=Abstract

Rev Environ Health. 2000 Jul-Sep;15(3):325-36.
Effects of environmental pollutants on airways, allergic inflammation, and the immune response.

Handzel ZT.

Clinical Immunology and Allergy Unit, Kaplan Medical Center, Rehovot, Israel. handzegri.huji.ac.il

Particulate and gaseous air pollutants are capable of damaging the airway epithelial lining and of shifting the local immune balance, thereby facilitating the induction of persistent inflammation. Epidemiological studies are inconclusive regarding whether air pollution increases the incidence of asthma and chronic bronchitis in the population. Clearly, environmental pollution can, however, precipitate attacks and emergency-room admissions in those already suffering from such conditions. The catastrophic potential of airborne pollution was demonstrated in the 1960s and 1970s, when inverted atmospheric pressure conditions trapped smog over cities on the Eastern coast of the United States and over Europe. This smog resulted in thousands of hospital admissions and dozens of deaths. With the general rise in the incidence of atopy and asthma in the Western population, it is of major public health interest to reduce, as much as possible, the exposure of such populations to anthropogenic and natural sources of pollution.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11048334&dopt=Abstract

Klin Med (Mosk). 2000;78(9):32-5.
[The effectiveness of hyperbaric oxygenation in chronic obstructive bronchitis made in outpatient clinic]

[Article in Russian]

Shkol'nik MA, Butorov IV.

General clinical examination, external respiratory function investigation, antrovent pharmacological tests were performed in 68 patients aged 28-52 years with chronic obstructive bronchitis (COB) admitted to the rehabilitation center after hospital treatment. Hyperbaric oxygenation improved general condition of the patients, normalized excessive free-radical lipid oxidation and antioxidant defense. It also improves the results of combined rehabilitation treatment, bronchial permeability, sensitivity of beta-2 bronchial receptors to sympathomimetics. This allows to reduce doses or discontinue sympathomimetics.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11051737&dopt=Abstract

Crit Care. 2000;4(5):314-8. Epub 2000 Aug 21.
Do steroids prevent reintubation in children with laryngotracheobronchitis?

Rajah J, Riera-Fanego J, Keeton J, Ramjee A, Bhana R, Lasersohn L, Hon H.

University of the Witwatersrand, Johannesburg, South Africa. 092rahiron.wits.ac.za

BACKGROUND: Classic laryngotrachoebronchitis (LTB) is an inflammatory process, with oedema and secretions that involve the entire laryngotracheobronchial tree. The severity of lower airway disease in African children with LTB has previously been documented. The aim of the present study was to determine whether steroids prevent reintubation in African children with classic LTB. METHOD AND RESULTS: The study was a retrospective analysis from January 1993 to December 1996. Eighty-two black children with LTB were mechanically ventilated in the intensive care unit (ICU). By univariate regression, the estimated B coefficients for variables such as age, pneumonia, days of intubation, arterial partial oxygen tension (PaO2) : fractional inspired oxygen (FIO2) ratio, atelectasis and antibiotic use were not statistically significant (P > 0.05) as predictors for reintubation. Using multiple regression (all independent variables in combination), none of the variables acted as predictors of reintubation (P = 0.25). Steroids were shown to have no effect alone or in association with other variables in altering reintubation rates. An increase in the days of intubation showed a tendency towards reintubation (P = 0.06) in the univariate analysis (odds ratio 1.00-1.14), but showed no statistically significant difference in multivariate analysis. Of the variables used as predictors of reintubation, none acted either as a preventive factor or as a risk factor. CONCLUSION: The present results suggest that steroids should not be recommended at any stage in treatment of intubated patients with classic LTB. Prospective studies should evaluate the major risk factors for reintubation: duration of intubation, trauma to the airway at intubation and during ICU stay, and dose and timing of steroids. They should also evaluate whether upper airway disease is present alone or in association with lower airway disease.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11056758&dopt=Abstract

Hair loss is a problem in modern soceity. Examining the factors of hair growth may shed light on how hair loss might occur. How long can hair grow before it stops growing eventually if it does? Given that the hair growth rate is quite uniform and constant, somewhere between 0.3-0.5 millimeters per day, it's believed that the length of anagen, the growth phase, differs among individuals, and this is the major determinant to the maximum hair length. For some individuals, anagen may last ten years. Of course the length of the anagen is governed by genes, and the genetic background of the individuals. Non-genetic factors such as nutritional condition, weather, seasonal changes (hair may grow a bit faster during winter), taking medications, health condition may of course influence the rate of hair growth as well as hair loss. The shape of the hair, straight or curly, is dependent on the shape of the follicle. A circular or round hair follicle would generate straight hair, while the follicle with oval or elliptical shapes (in its cross-section) would produce a curly hair.

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