Cost efficient management of educational material

We retrospectively examined direct and indirect costs of providing a programmed text in Respiratory Pathophysiology using World-Wide Web (WWW) technology as compared to printed paper. The direct costs were $3678 and $3988 respectively. Neither of these costs includes the substantial cost of original development of the educational material. The indirect cost of distributing printed material is $1800. The indirect cost for electronic material is $1430 but this assumes an institutional commitment to a technology infrastructure which will be used for purposes other than just educational material distribution. Given such a commitment, educational material can be managed in a way that provides efficient distribution at less cost than traditional paper distribution. The effectiveness of electronic methods is dependent on usage. A comparison study of use and satisfaction of paper and electronic versions of the material is planned.

[Detection and determination of acetone using semiconductor sensors]

Investigations to examine not only the factors of influence on evaluation of acetone by self-prepared semiconductor gas sensors, but also to prove analytical properties, were carried out using different tools. A sensor temperature of 600 degrees C and a carrier gas flow-rate of 5 l/h were found to be suitable conditions for the measurement of flow-injection apparatus. The determination of 1 microliter-samples of aqueous solutions containing 1-700 g of acetone/l yielded deviations of 4 to 33%. Using a head space method, the working temperature of 370 degrees C led to a maximum sensor response, the detection limit ranged from 37.5 to 50 mg of acetone/l. After quantifying 5 microliters-sample solutions of 40-600 mg/l, results with an accuracy of 1 to 36% were obtained. The method showed the possibility of distinguishing concentrations of acetone below and above 40 mg/l according to physiological and pathological urinary values. The tests carried out on 100 human urine samples provide a good agreement with the Legal reference method for samples containing physiological or strong pathological amounts of ketone bodies, but not for those including traces and small amounts. False-positive results might be caused by a possible presence of ethanol in urine.

Respiratory muscle dysfunction in hereditary motor sensory neuropathy, type I

Pulmonary function tests were performed on ten patients who were shown to have hereditary motor sensory neuropathy, type I. Mean values for spirometry, static lung volumes, and diffusion capacity were all greater than 80% of the predicted normal values for the group. In contrast, both inspiratory and expiratory muscle testing showed substantial reductions in function for the group. These abnormalities have not previously been reported, and they may be important in the management of these patients and in patients with other neuromuscular diseases.

Pulmonary embolism: diagnosis and treatment

Pulmonary embolism is a condition with a potentially high mortality that often goes unrecognized. Prompt diagnosis and treatment effectively reduce the mortality rate. Clinical judgment alone is insufficient for diagnosis; objective testing is needed. Once the diagnosis is made, effective treatment should be instituted. Treatments differ, based on several factors including disease severity, contraindications to treatment and pre-existing diseases. The major thrust of training should be to teach medical care workers how to prevent deep vein thrombosis and its most serious complication, pulmonary embolism.

Pulmonary embolism

It is reasonable to conclude by considering an approach to the diagnosis and treatment of pulmonary embolism. When the diagnosis is suspect, and in the absence of contraindications, or hemodynamic instability, treatment with heparin may be begun and an arterial blood gas and perfusion lung scan obtained. If the Pao2 and perfusion scan are normal, it is unlikely that significant pulmonary embolism has occurred. The presence of a perfusion scan defect and hypoxemia should suggest that a ventilation scan and/or evaluation for deep vein thrombosis is performed. A ventilation scan which shows absence of ventilation in areas where there is a perfusion defect, or failure to demonstrate deep vein disease, strongly mitigate against the diagnosis of pulmonary embolism. If the diagnosis is in doubt, pulmonary angiography should be performed. If the patient presents in shock, an angiogram should be performed, while heparin is administered and supportive measures are begun. If anticoagulants are contraindicated, or if re-embolization occurs after adequate anticoagulant therapy, consideration should be given to placement of a transcaval umbrella filter.

[Treatment of occlusive hydrocephalus with Torkilksen's drainage]

Seventy-three Torkildsen drainages are reported, of which 61 and 12 were performed on tumor patients and in the case of benign aqueduct occlusions due to congenital malformations or chronic inflammations, respectively. The results are quite satisfactory providing due consideration is given to both the basic ailment and the preoperative condition. The Torkildsen drain has proven extremely useful in the therapy of selected cases of occlusive hydrocephalus.

Severe pleural restriction: the maximum static pulmonary recoil pressure as an acid in diagnosis

Three patients with pleural restriction are presented in detail. One patient had had a right pneumonectomy and died of ventilatory failure due to left-sided restrictive pleurisy. The second patient had neoplastic pleural effusion and inactive tuberculosis. The third patient had systemic lupus erythematosus with bilateral restrictive pleuritis. The physiologic picture was similar in the three cases, with marked decrease of lung volumes, increase of the RV/TLC ratio, absence of airways obstruction, decrease of the Dco and decrease of dynamic lung compliance. In addition, each of these three patients and others with severe pleural restriction had a lower than normal maximum static pulmonary recoil pressure (Pmax). Since in pulmonary restrictive disease, the Pmax was found to be elevated, it was a useful test for distinguishing pulmonary restriction from pleural restriction.

The effect of ethanol on the cough reflex

1. Coughing was induced in ten healthy subjects with various threshold concentrations of nebulized citric acid. The citric acid aerosol method of cough induction proved a reliable and reproducible tool for assessing the cough threshold in an individual. The subjects were retested after consumption of 1 ml of ethanol/kg body weight. Coughing was significantly suppressed in nine of the ten subjects.

2. The marked suppression of the cough reflex by the moderate amounts of ethanol used in this study provides confirmatory evidence for the suspected causal links between ethanol abuse and certain pulmonary infections caused by aspiration.