ABSTRACT, Seventeen subjects with chronic severe asthma completed a 48 week prospective, double blind study with crossover of treatment at 24 weeks, in which triamcinolone acetonide 80 mg intramuscularly every four weeks was compared with oral prednisolone 10 mg daily. Spirometry, twice daily measurements of peak expiratory flow rate, and self assessment of asthma symptom scores showed significant improvement during triamcinolone treatment; less extra prednisolone was required and there was significant weight loss. Two patients withdrew, one because of dissatisfaction with prednisolone and one because of side effects while taking triamcinolone. Three were withdrawn, one with proximal muscle weakness and two because of intercurrent illness. Adrenal suppression, bruising, and hirsuitism were worse with triamcinolone, other side effects being comparable. On completion of the study 16 of the 17 patients opted to continue taking triamcinolone acetonide. This treatment is an important addition to the therapeutic options available for chronic severe asthma.
This report describes such a case. The diagnosis of renal vein thrombosis was suspected from the renal histopathology and radioisotope renography and was confirmed by inferior vena cavography.CASE REPORTA 19-year-old youth who worked in a grain shop was referred to us for puffiness of the face and swelling of the feet of five months' duration. The onset was insidious and was not preceded by pain in the loins. There was no history of respiratory symptoms suggestive of pulmonary embolism.
A sequence of questions was designed to quantify the within subject variation of exercise tolerance limited by breathlessness, to serve as a guide to variation in airflow limitation for epidemiological purposes. The questions seek answers about breathlessness in relation to various levels of attempted activity when the subjects are at their best and at their worst. The difference between exercise tolerance at best and exercise tolerance at worst (variation in exercise tolerance) was expressed on a scale ranging from 0 (no variation) to 6 (greatest variation). The effectiveness of these questions has been assessed in 68 patients with airflow limitation attending a chest clinic, by comparing the results with variation in peak expiratory flow rate (PEF). Variation in PEF was expressed as the standard deviation of the first 24 PEF recordings from each patient (equivalent to four days' recordings). There. was a highly significant relation between the measure of variation in exercise tolerance obtained from the questionnaire and PEF variation, though each point on the scale of variation in exercise tolerance covered a wide range of variation in PEF. The questions give some guide to the variation in airflow limitation and in combination with other questions may be helpful in epidemiological studies.
A 59-year-old man was diagnosed with a massive pulmonary embolism. Despite thrombolysis there were two episodes of cardiac arrest and following recovery of spontaneous circulation profound cardiorespiratory failure ensued. An extracorporeal membrane oxygenation retrieval team initiated veno-venous extracorporeal membrane oxygenation on site to facilitate transfer to the extracorporeal membrane oxygenation centre. An excellent outcome is reported in the short term. This represents one of the few published cases of veno-venous extracorporeal membrane oxygenation for a massive pulmonary embolism following thrombolysis.
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