Evolution of mechanical ventilation in the last 20 yearsDr.Mahmoud Abbas
Evolution of mechanical ventilation in the last 20 years lecture presented by Dr Andres Esteban at the Egyptian Critical care Summit 2015 held at Cairo, Egypt. The Summit is the leading medical event and exhibition for critical care medicine in Egypt
Presented by Jane Dematte, MD at the Scleroderma Patient Education Conference hosted by the Scleroderma Foundation on Saturday, October 12, 2019 in Chicago, IL
Jonathan Corren, MD, discusses asthma management in this CME activity titled "Targeted Treatment in Severe Asthma: Moving Toward Precision Medicine." For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2It37Pk. CME credit will be available until June 3, 2019.
Evolution of mechanical ventilation in the last 20 yearsDr.Mahmoud Abbas
Evolution of mechanical ventilation in the last 20 years lecture presented by Dr Andres Esteban at the Egyptian Critical care Summit 2015 held at Cairo, Egypt. The Summit is the leading medical event and exhibition for critical care medicine in Egypt
Presented by Jane Dematte, MD at the Scleroderma Patient Education Conference hosted by the Scleroderma Foundation on Saturday, October 12, 2019 in Chicago, IL
Jonathan Corren, MD, discusses asthma management in this CME activity titled "Targeted Treatment in Severe Asthma: Moving Toward Precision Medicine." For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2It37Pk. CME credit will be available until June 3, 2019.
Use of Capnograph in Breathlessness Patientsnhliza
This is a research topic carried out in the Emergency Department and the abstract was presented at the International Conference In Emergency Medicine in SanFrancisco April 2008
Stephen Bernard shares his thoughts and the current evidence for using oxygen for cardiac arrest patients.
Oxygen is ubiquitous in society! You can buy it in bottles and there are even oxygen cafes.
This is especially true in hospitals where oxygen is used frequently and often without much thought.
Oxygen is a natural substance. So surely, a short time on 100% oxygen can’t be harmful, right? Stephen wants to challenge that idea.
In this talk he presents the data on why oxygen might be harmful to your patients, particularly following a cardiac arrest.
Out-of-hospital cardiac arrest (OHCA) is common and carries a high mortality rate. In Victoria, Australia, approximately 50% of patients with an initial cardiac rhythm of VF achieve a return of spontaneous circulation (ROSC) and 30% overall survive to hospital discharge.
The outcome for patients is improving. This is due mainly to faster ambulance response times and increased rates of bystander CPR. What is done in the hospital has altered the patient’s outcomes in the same way.
Currently, OHCA patients who have achieved ROSC but who remain unconscious routinely receive 100% oxygen for several hours in the ambulance, ED, cardiac catheterisation laboratory until admission to ICU. However, there is now evidence from laboratory studies and preliminary observational clinical studies that the administration of 100% oxygen during the first few hours following resuscitation may increase both cardiac and neurological injury.
Clinical trials are underway to test whether titrated oxygen to a target oxygen saturation of 90-94% in the immediate hours after ROSC results in improved outcomes compared with 100% oxygen.
Join Stephen as he makes you think twice about blindly using oxygen for patients following a cardiac arrest.
Presentation by Dr Jason Wu - resident in Critical Care at TWH, for the critical care journal club report findings of a paper by Kaukonen KM, et al. N Engl J Med. 2015 & update from the recent SMACC conference in Chicago #FOAMed #SMACC (http://www.ncbi.nlm.nih.gov/m/pubmed/25776936/)
Use of Capnograph in Breathlessness Patientsnhliza
This is a research topic carried out in the Emergency Department and the abstract was presented at the International Conference In Emergency Medicine in SanFrancisco April 2008
Stephen Bernard shares his thoughts and the current evidence for using oxygen for cardiac arrest patients.
Oxygen is ubiquitous in society! You can buy it in bottles and there are even oxygen cafes.
This is especially true in hospitals where oxygen is used frequently and often without much thought.
Oxygen is a natural substance. So surely, a short time on 100% oxygen can’t be harmful, right? Stephen wants to challenge that idea.
In this talk he presents the data on why oxygen might be harmful to your patients, particularly following a cardiac arrest.
Out-of-hospital cardiac arrest (OHCA) is common and carries a high mortality rate. In Victoria, Australia, approximately 50% of patients with an initial cardiac rhythm of VF achieve a return of spontaneous circulation (ROSC) and 30% overall survive to hospital discharge.
The outcome for patients is improving. This is due mainly to faster ambulance response times and increased rates of bystander CPR. What is done in the hospital has altered the patient’s outcomes in the same way.
Currently, OHCA patients who have achieved ROSC but who remain unconscious routinely receive 100% oxygen for several hours in the ambulance, ED, cardiac catheterisation laboratory until admission to ICU. However, there is now evidence from laboratory studies and preliminary observational clinical studies that the administration of 100% oxygen during the first few hours following resuscitation may increase both cardiac and neurological injury.
Clinical trials are underway to test whether titrated oxygen to a target oxygen saturation of 90-94% in the immediate hours after ROSC results in improved outcomes compared with 100% oxygen.
Join Stephen as he makes you think twice about blindly using oxygen for patients following a cardiac arrest.
Presentation by Dr Jason Wu - resident in Critical Care at TWH, for the critical care journal club report findings of a paper by Kaukonen KM, et al. N Engl J Med. 2015 & update from the recent SMACC conference in Chicago #FOAMed #SMACC (http://www.ncbi.nlm.nih.gov/m/pubmed/25776936/)
Distúrbios respiratórios agudos no P.S. infantil: laringite x crise asmáticaLaped Ufrn
Distúrbios respiratórios agudos no P.S infantil: laringite x crise asmática - Aula apresentada durante a Reunião Científica da Liga Acadêmica de Pediatria da UFRN - LAPED UFRN - Natal, Brasil.
Abstract— Respiratory complications are major sources of morbidity and mortality in spinal cord injury (SCI). Improvement in expiratory muscle strength may be associated with improved cough and clearance of secretions. So that expiratory muscle training are advised in SCI cases to improve expiratory muscle strength. This study was conducted to compare the effect of Resistance and Sham training on pulmonary function test in spinal cord injury cases. It was found the mean value of all the parameters of PFT of Sham training was found to increase from baseline to 1st and 2nd follow up. This difference was found significant in all the parameters of PFT at 2nd follow up, but FEV1 and PIFR of 1st follow up (p value < 0.05) only. Likewise, it is also observed that the mean value of all the parameters of PFT of test group was found to increase from baseline to 1st and 2nd follow up. This difference was found highly significant (p value <0.001) in all the parameters of PFT at 1st and 2nd follow up. So it can be concluded that however both the type of training improve PFTs but the improvement of high resistance training was significantly more than they were for sham training.
A presentation by Jon Henrik Laake at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
We present the case of a 49-year-old male who was referred from Emergency department with worsening
breathlessness, chest tightness for last 24 hours. He had a background history of Asthma and Hypertension. Initial ECG revealed symmetric T wave inversions in anterior leads and found to have raised
troponin levels. Patient was diagnosed and treated as NSTEMI. While waiting for his coronary angiogram
he underwent echocardiogram whose findings were consistent with right sided impairment. Differential
diagnosis of Pulmonary Embolism has been made and CT Pulmonary Angiogram done that confirmed
diagnosis of Pulmonary Embolism. Early advice from the Respiratory team was sought and patient was
treated with rivaroxaban. After a hospital stay, he made a remarkable recovery.
Association of Hypertension and Pulmonary Functions-Association between cardiac dysfunction and abnormal pulmonary function has remained controversial since long. The objective of this study is to find out the association of hypertension and its severity on pulmonary functions. Study was conducted on 30 hypertensive (study group) and 30 non hypertensive (control group) subjects identified from Medical OPD of SMS Hospital, Jaipur. Pulmonary functions were assessed of both hypertensive (study group) and non hypertensive (control group) subjects by Medspiror). Among pulmonary function tests, difference in means of FVC, FEV1 PEFR, FEF25-75%, MVV and FVC/ FEV1 were found less with significant difference in cases group with predominantly restrictive type of effects are observed. Female’s shows lower values than male hypertensive subjects. Furthermore, FVC, FEV1, PEFR, FEF25-75%, MVV, FVC/ FEV1 were not found to be associated with severity of illness. An inverse relation is found between hypertension and pulmonary functions predominantly restrictive type of pattern. While non significant effects are observed with severity of illness.
Presentation of Dr. Lluis Blanch at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
Mehmed 2015 - effect of vagal stimulation in acute asthmaSAIF MEHMED
vagus nerve stimulation in the carotid sheath was my interest in the past 3 years and the results was amazing that i can share my experience may be in a workshop, the results was interesting patient suffering from bronchial asthma in acute attack this papaer was the first and followed by another one with 52 participant 10 normal ,10 with asthma not in acute attack 32 in acute attack 11 of them treated with placebo and 21 treated with vagus nerve stimulation it takes time was difficult but it deseve
Patient ventilator interactions during mechanical ventilationDr.Mahmoud Abbas
Patient Ventilator Interaction during Mechanical Ventilation lecture presented by Dr.Lluis Blanch at Pulmonary Critical Care Egypt Meeting and Exhibition, January 2014. www.pccmegypt.com
Study of some Pulmonary Function Tests in Children with Sickle Cell Anemia: C...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Ponencia donde se hace una revisión superficial comparativa entre la TBC y la Covid 19.
Se describen los aspectos cronológicos, con las fechas mas resaltables que marcaron la evolución de ambas enfermedades.
Se citan también los datos epidemiológicos globales mediante mapas mundiales actualizados donde visualizamos la incidencia de ambas patologías.
Se sintetizan los costes económicos destinados a luchar contra ambas patologías o bien en forma de ayudas directas previstas como objetivo como es en la TBC, o bien como inyección monetaria al sistema económico, concluyendo que es vital la
concienciación de los gobiernos y las administraciones y la solidaridad de todos, para afrontar severa crisis sanitaria y humanitaria actual.
Se repasa la influencia de ambas enfermedades en la sociedad, en los estilos de vida, en el pensamiento, y en las manifestaciones artísticas, en el caso de la TBC referida al siglo XIX.
Enfermedades respiratorias relacionadas con la asbestosis (català)Dr. Josep Morera Prat
Causas y efectos del amianto en la Salud, diferentes enfermedades respiratorias relacionadas y la fibrosis pulmonar provocada por asbestosis. Presentación efectuada en la Jornada " El amianto y su impacto en la Salud", realizada en Parc Científic de Barcelona, 15-N-2019
Teoria higienista en la prevención de enfermedades respiratorias alérgicas.
Posición de defensa de la Teoría Higienista, en debate realizado durante la Jornada de Patología Respiratoria celebrado en el COMB, Noviembre 2019
Obesidad i asma ( coincidència o causalitat) - actualització Novembre 2019 ( ...Dr. Josep Morera Prat
presentació actualitzada del document relatiu a la relació asma bronquial i obesitat, presentat a la Jornada de Patologia Respiratoria, realitzat al COMB, el 8/11/2019
Conferencia realizada en la jornada de Fenotipos del Asma, el pasado 18 de Noviembre 2018, en el COMB.
Una visión de la magnitud del problema, causalidad vs coincidencia y los fenotipos, clínica y tratamiento.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
7. 7
Asma y Ejercicio
An
Official
American
Thoracic
Society
Clinical
PracCce
Guideline:
Exercise-‐induced
BronchoconstricCon
Jonathan
P.
Parsons,
Teal
S.
Hallstrand,
John
G.
Mastronarde,
David
A.
Kaminsky,
Kenneth
W.
Rundell,
James
H.
Hull,
William
W.
Storms,
John
M.
Weiler,
Fern
M.
Cheek,
Kevin
C.
Wilson,
and
Sandra
D.
Anderson;
Volume
187,
Issue
9(May
1,
2013)
8. 8
Asma y Ejercicio
Volume
63,
Issue
8
August
2008
Pages
953–961
Exercise-‐induced
hypersensiCvity
syndromes
in
recreaConal
and
compeCCve
athletes:
a
PRACTALL
consensus
report
(what
the
general
pracCConer
should
know
about
sports
and
allergy)
Schwartz
LB1,
Delgado
L,
Craig
T,
Bonini
S,
Carlsen
KH,
Casale
TB,
Del
Giacco
S,
Drobnic
F,
van
Wijk
RG,
Ferrer
M,
Haahtela
T,
Henderson
WR,
Israel
E,
Lötvall
J,
Moreira
A,
Papadopoulos
NG,
Randolph
CC,
Romano
A,
Weiler
JM.
9. 9
Asma y Ejercicio
Volume
63,
Issue
5
May
2008
Pages
492–505
Treatment
of
exercise-‐induced
asthma,
respiratory
and
allergic
disorders
in
sports
and
the
relaConship
to
doping:
Part
II
of
the
report
from
the
Joint
Task
Force
of
European
Respiratory
Society
(ERS)
and
European
Academy
of
Allergy
and
Clinical
Immunology
(EAACI)
in
cooperaCon
with
GA(2)LEN.
Carlsen
KH1,
Anderson
SD,
Bjermer
L,
Bonini
S,
Brusasco
V,
Canonica
W,
Cummiskey
J,
Delgado
L,
Del
Giacco
SR,
Drobnic
F,
Haahtela
T,
Larsson
K,
Palange
P,
Popov
T,
van
Cauwenberge
P;
European
Respiratory
Society;
European
Academy
of
Allergy
and
Clinical
Immunology;
GA(2)LEN.
10. 10
Asma y Ejercicio
La
broncoconstricción/hiperreacCvidad
inducida
por
ejercicio
(EIB),se
refiere
a
un
“estrechamiento”de
las
vías
aéreas
como
resultado
del
ejercicio.
Los
asmáCcos
con
gran
frecuencia
sufren
EIB
El
asma
inducido
por
ejercicio
(EIA)
es
un
concepto
que
se
solapa
con
el
de
EIB
El
asma
bronquial
en
los
Atletas
de
Elite
es
una
situación
clínica
que
se
solapa
con
las
anteriores
El
EIB
ha
recibido
otros
nombres
como“THERMALLY
BRONCHOCONSTRICTION”
An
Official
American
Thoracic
Society
Clinical
Prac5ce
Guideline:
Exercise-‐induced
Bronchoconstric5on
11. 11
Asma y Ejercicio
-‐ Clínica
suges@va(Tos,
disnea,@rantez
torácica,sibilantes
postejercicio
-‐ FEV1
pre-‐post
ejercicio(FEV
≥
al
10%)
-‐ Test
específicos
de
ejercicio
-‐ Test
de
provocación
con
Metacolina
y/o
Manitol
-‐ Otros:
PEAK
FLOW
(gráfica)
ÓXIDO
NÍTRICO
EXHALADO
(FENO)
Inhalación
hiperesmolar
de
aerosoles
4.5%
salinos
Hiperepnea
eucapníca
voluntaria
An
Official
American
Thoracic
Society
Clinical
Prac5ce
Guideline:
Exercise-‐induced
Bronchoconstric5on
12. 12
Asma y Ejercicio
An
Official
American
Thoracic
Society
Clinical
Prac5ce
Guideline:
Exercise-‐induced
Bronchoconstric5on
14. 14
Asma y Ejercicio
-‐
Muy
frecuente
-‐
Variable
según
países
y
áreas
-‐
Entre
20-‐50%
de
asmá@cos
@enen
asma
inducido
al
esfuerzo
-‐
Entre
los
depor@stas
de
Elite
varia
entre
un
15-‐75%
15. 15
Asma y Ejercicio
Exercise-‐induced
wheeze,
urgent
medical
visits,
and
neighborhood
asthma
prevalence.
Map of New York City depicting study subjects’ places of residence overlaying neighborhood asthma prevalence.
Timothy R. Mainardi et al. Pediatrics 2013;131:e127-e135
16. 16
Asma y Ejercicio
Percentage
of
athletes
no@fying
(Sydney)
or
approved
(Salt
Lake
City,
Athens,
Torino)
for
b2-‐agonist
use
and
the
percentage
of
individual
medals
won
by
these
athletes
at
the
2000
to
2006
Olympic
Games.
FITCH
ET
AL
260.e7
VOLUME
122,NUMBER
2
18. 18
Asma y Ejercicio
-‐ Enfriamiento
de
la
mucosa
-‐ Calentamiento
de
la
mucosa
-‐ Aumento
de
la
circulación
bronquial
submucosa
-‐ Atopia/Alergia
-‐ Mayor
exposición
a
polen
y
a
otros
alérgenos
-‐ Exposición
a
Cloro
-‐ Exposición
a
Ozono/otras
poluciones
ambientales
-‐
Exposición
a
PM10
por
fuel
en
hielo
ar@ficial
-‐ Inflamación
eosinovlica/neutrovlica
-‐ Remodelamiento
-‐ Otros
19. 19
Asma y Ejercicio
N
Engl
J
Med
1977;
297:743-‐747October
6,
1977
N
Engl
J
Med
1987;
317:502-‐504,
20. 20
Asma y Ejercicio
chodilator test was negative in all control subjects (change in
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
use of inhaled 2-agonists. Coughing in episodes or in rela
to exercise was reported by 26 (65%) skiers. Of 15 (38%)
ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from
subjects. Because of unavailability of cryosections, neutro
counts were not performed in control subjects and in three
ers. Data with cell counts are presented in Table 2 and Fig
1 and 2
Group analysis showed that skiers had 43-fold (p 0.0
26-fold (p 0.001), and twofold (p 0.001) greater T-
phocyte, macrophage, and eosinophil counts, respectively,
did controls. The skiers’ neutrophil count was significa
greater than that of the asthmatic subjects, whereas the lym
cyte count was not significantly different, and the macroph
eosinophil, and mast cell counts were lower. On subg
analysis by nonatopic status, the neutrophil count in skiers
not significantly different and the eosinophil count was sig
cantly lower than in asthmatic subjects. The mast cell c
was greater in skiers than in controls. There were no sig
cant differences in cell counts in nonhyperresponsive and
perresponsive skiers. Both skier groups had greater macr
age and lymphocyte counts than controls (Figure 3A), whe
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
Inhala@on
Toxicology,
15:237–250,
2003
21. 21
Asma y Ejercicio
Bronchoscopy
and
bronchoalveolar
lavage
findings
in
cross-‐country
skiers
with
and
without
ski
asthma”.Sue-‐Chu
M1,
Larsson
L,
Moen
T,
Rennard
SI,
Bjermer
L.
Eur
Respir
J.
1999
Mar;13(3):626-‐32.
23. 23
Asma y Ejercicio
AM
J
RESPIR
CRIT
CARE
MED
2000;161:1047–1050.
24. 24
Asma y Ejercicio
Exhaled
breath
condensate
cysteinyl
leukotrienes
are
increased
in
children
with
exercise-‐induced
bronchoconstricCon.
Carraro
S1,
Corradi
M,
Zanconato
S,
Alinovi
R,
Pasquale
MF,
Zacchello
F,
Baraldi
E.
2005
Apr;115(4):764-‐70.
25. 25
Asma y Ejercicio
J
Allergy
Clin
Immunol.
2005
Sep;
116(3):
586–593.
Airway
immunopathology
of
asthma
with
exercise-‐
induced
bronchoconstricCon.
Hallstrand
TS1,
Moody
MW,
Aitken
ML,
Henderson
WR
Jr.
26. 26
Asma y Ejercicio
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
VOL
161
2000
28. 28
Asma y Ejercicio
MEDICINE
SCIENCE
IN
SPORTS
EXERCISE®
2003
29. 29
Asma y Ejercicio
Role
of
MUC5AC
in
the
pathogenesis
of
exercise-‐induced
bronchoconstricCon.
Hallstrand,
Debley,
Farin,
Henderson.
CONCLUSIONS:
These
data
indicate
that
(1)
the
predominant
gel-‐forming
mucin
expressed
in
induced
sputum
of
paCents
with
asthma
with
EIB
is
MUC5AC;
(2)
an
increase
in
MUC5AC
gene
expression
and
release
of
MUC5AC
protein
occurs
acer
exercise
challenge;
and
(3)
MUC5AC
release
may
occur
through
the
cysLT-‐
associated
acCvaCon
of
sensory
airway
nerves
J
Allergy
Clin
Immunol.
2007
May;119(5):1092-‐8
30. 30
Asma y Ejercicio
The
PotenCal
Role
of
8-‐Oxoguanine
DNA
Glycosylase-‐
Driven
DNA
Base
Excision
Repair
in
Exercise-‐Induced
Asthma.
Belanger
KK1,
Ameredes
BT2,
Boldogh
I3,
Aguilera-‐Aguirre
L4.
2016
Jul
25
31. 31
Asma y Ejercicio
The
PotenCal
Role
of
8-‐Oxoguanine
DNA
Glycosylase-‐
Driven
DNA
Base
Excision
Repair
in
Exercise-‐Induced
Asthma.Belanger
KK1,
Ameredes
BT2,
Boldogh
I3,
Aguilera-‐Aguirre
L4.
2016
Jul
25
32. 32
Asma y Ejercicio
Transglutaminase
2,
a
novel
regulator
of
eicosanoid
producCon
in
asthma
revealed
by
genome-‐wide
expression
profiling
of
disCnct
asthma
phenotypes.Hallstrand
TS1,
Wurfel
MM,
Lai
Y,
Ni
Z,
Gelb
MH,
Altemeier
WA,
Beyer
RP,
Aitken
ML,
Henderson
WR.
Figure
1.
Comparison
of
lung
funcCon
and
gene
expression
between
asthmaCcs
with
EIB
and
an
asthmaCc
control
group
without
EIB.
(2010)
PLoS
ONE
5(1)
34. 34
Asma y Ejercicio
CombinaCon
of
budesonide/formoterol
on
demand
improves
asthma
control
by
reducing
exercise-‐induced
bronchoconstricCon.Lazarinis
N1,
Jørgensen
L,
Ekström
T,
Bjermer
L,
Dahlén
B,
Pullerits
T,
Hedlin
G,
Carlsen
KH,
Larsson
K.
2014
Feb;69(2):130-‐6.
35. 35
Asma y Ejercicio
Nedocromil
sodium
in
the
treatment
of
exercise-‐induced
asthma:
a
meta-‐analysis.
Spooner
C1,
Rowe
BH,
Saunders
LD.
Eur
Respir
J.
2000
Jul;16(1):30-‐7
36. 36
Asma y Ejercicio
Dietary
salt,
airway
inflammaCon,
and
diffusion
capacity
in
exercise-‐
induced
asthma.
Mickleborough
TD1,
Lindley
MR,
Ray
S.Med
Sci
Sports
Exerc.
2005
Jun;37(6):904-‐14.
37. 37
Asma y Ejercicio
Treatment
of
exercise-‐induced
asthma,
respiratory
and
allergic
disorders
in
sports
and
the
relaConship
to
doping:
Part
II
of
the
report
from
the
Joint
Task
Force
of
European
Respiratory
Society
(ERS)
and
European
Academy
of
Allergy
and
Clinical
Immunology
(EAACI)
in
cooperaCon
with
GA2LEN*
K.
H.
Carlsen1,
S.
D.
Anderson2,
L.
Bjermer3,
S.
Bonini4,
V.
Brusasco5,
W.
Canonica6,
J.
Cummiskey7,
L.
Delgado8,
S.
R.
Del
Giacco9,
F.
Drobnic10,
T.
Haahtela11,
K.
Larsson12,
P.
Palange13,
T.
Popov14,
P.
van
Cauwenberge15.
Allergy
2008:
63:
492–505
38. 38
Asma y Ejercicio
1.-‐
Disfunción
de
cuerdas
vocales
2.-‐
Anemia
3.-‐
Miocardiopa{a
hipertrófica
4.-‐
Obesidad/
no
fitness
5.-‐
Disnea
Psicógena
6.-‐
Uso
de
β-bloqueantes
7.-‐
TEP
agudo/crónico
8.-‐
Mal
de
montaña
9.-‐
Edema
agudo
de
pulmón
10.-‐
Otros
chodilator test was negative in all control subjects (change in
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
use of inhaled 2-agonists. Coughing in episodes or in rela
to exercise was reported by 26 (65%) skiers. Of 15 (38%)
ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from
subjects. Because of unavailability of cryosections, neutro
counts were not performed in control subjects and in three
ers. Data with cell counts are presented in Table 2 and Fig
1 and 2
Group analysis showed that skiers had 43-fold (p 0.0
26-fold (p 0.001), and twofold (p 0.001) greater T-
phocyte, macrophage, and eosinophil counts, respectively,
did controls. The skiers’ neutrophil count was significa
greater than that of the asthmatic subjects, whereas the lym
cyte count was not significantly different, and the macroph
eosinophil, and mast cell counts were lower. On subg
analysis by nonatopic status, the neutrophil count in skiers
not significantly different and the eosinophil count was sig
cantly lower than in asthmatic subjects. The mast cell c
was greater in skiers than in controls. There were no sig
cant differences in cell counts in nonhyperresponsive and
perresponsive skiers. Both skier groups had greater macr
age and lymphocyte counts than controls (Figure 3A), whe
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%
ers with atopy, 12 were hyperrespo
Inflammatory Cell Counts
Assessable bronchial biopsy specim
subjects. Because of unavailability
counts were not performed in contr
ers. Data with cell counts are prese
1 and 2
Group analysis showed that skie
26-fold (p 0.001), and twofold (
phocyte, macrophage, and eosinoph
did controls. The skiers’ neutroph
greater than that of the asthmatic su
cyte count was not significantly diff
eosinophil, and mast cell counts
analysis by nonatopic status, the ne
not significantly different and the e
cantly lower than in asthmatic sub
was greater in skiers than in contr
cant differences in cell counts in no
perresponsive skiers. Both skier gr
age and lymphocyte counts than con
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
39. 39
Asma y Ejercicio
Vocal
cord
dysfuncCon
in
paCents
with
exerConal
dyspnea.Morris
MJ1,
Deal
LE,
Bean
DR,
Grbach
VX,
Morgan
JA.
PATIENTS:Forty
military
paCents
with
complaints
of
exerConal
dyspnea
and
12
military
asymptomaCc
control
subjects.
CONCLUSIONS:Paradoxical
inspiratory
vocal
cord
closure
is
a
frequent
occurrence
in
paCents
with
symptoms
of
exerConal
dyspnea
and
should
be
strongly
considered
in
their
evaluaCon.
1999
Dec;116(6):1676-‐82
40. 40
Asma y Ejercicio
chodilator test was negative in all control subjects (change in
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
use of inhaled 2-agonists. Coughing in episodes or in rela
to exercise was reported by 26 (65%) skiers. Of 15 (38%)
ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from
subjects. Because of unavailability of cryosections, neutro
counts were not performed in control subjects and in three
ers. Data with cell counts are presented in Table 2 and Fig
1 and 2
Group analysis showed that skiers had 43-fold (p 0.0
26-fold (p 0.001), and twofold (p 0.001) greater T-
phocyte, macrophage, and eosinophil counts, respectively,
did controls. The skiers’ neutrophil count was significa
greater than that of the asthmatic subjects, whereas the lym
cyte count was not significantly different, and the macroph
eosinophil, and mast cell counts were lower. On subg
analysis by nonatopic status, the neutrophil count in skiers
not significantly different and the eosinophil count was sig
cantly lower than in asthmatic subjects. The mast cell c
was greater in skiers than in controls. There were no sig
cant differences in cell counts in nonhyperresponsive and
perresponsive skiers. Both skier groups had greater macr
age and lymphocyte counts than controls (Figure 3A), whe
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk fa
occurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolu
Study design. – Retrospective case study and prospective frequency study.
Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review
between 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a
auscultation and radiologic features.
Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers withou
involved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exer
Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of lo
were observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in a
resolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal
* Auteur correspondant.
Adresse e-mail : guy.cochard@chu-brest.fr (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits re´serve´s.
doi:10.1016/j.annfar.2008.05.011
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk fa
occurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolu
Study design. – Retrospective case study and prospective frequency study.
Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review
between 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a
auscultation and radiologic features.
Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers withou
involved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exer
Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of lo
were observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in a
resolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal
* Auteur correspondant.
Adresse e-mail : guy.cochard@chu-brest.fr (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits re´serve´s.
doi:10.1016/j.annfar.2008.05.011
41. 41
Asma y Ejercicio
Swimming-‐induced
pulmonary
edema:
clinical
presentaCon
and
serial
lung
funcCon.
Adir
Y1,
Shupak
A,
Gil
A,
Peled
N,
Keynan
Y,
Domachevsky
L,
Weiler-‐Ravell
D.
Chest.
2004
Aug;126(2):394-‐9.
42. 42
Asma y Ejercicio
chodilator test was negative in all control subjects (change in
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
use of inhaled 2-agonists. Coughing in episodes or in rela
to exercise was reported by 26 (65%) skiers. Of 15 (38%)
ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from
subjects. Because of unavailability of cryosections, neutro
counts were not performed in control subjects and in three
ers. Data with cell counts are presented in Table 2 and Fig
1 and 2
Group analysis showed that skiers had 43-fold (p 0.0
26-fold (p 0.001), and twofold (p 0.001) greater T-
phocyte, macrophage, and eosinophil counts, respectively,
did controls. The skiers’ neutrophil count was significa
greater than that of the asthmatic subjects, whereas the lym
cyte count was not significantly different, and the macroph
eosinophil, and mast cell counts were lower. On subg
analysis by nonatopic status, the neutrophil count in skiers
not significantly different and the eosinophil count was sig
cantly lower than in asthmatic subjects. The mast cell c
was greater in skiers than in controls. There were no sig
cant differences in cell counts in nonhyperresponsive and
perresponsive skiers. Both skier groups had greater macr
age and lymphocyte counts than controls (Figure 3A), whe
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk fa
occurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolu
Study design. – Retrospective case study and prospective frequency study.
Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review
between 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a
auscultation and radiologic features.
Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers withou
involved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exer
Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of lo
were observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in a
resolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal
* Auteur correspondant.
Adresse e-mail : guy.cochard@chu-brest.fr (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits re´serve´s.
doi:10.1016/j.annfar.2008.05.011
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk fa
occurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolu
Study design. – Retrospective case study and prospective frequency study.
Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review
between 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a
auscultation and radiologic features.
Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers withou
involved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exer
Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of lo
were observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in a
resolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal
* Auteur correspondant.
Adresse e-mail : guy.cochard@chu-brest.fr (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits re´serve´s.
doi:10.1016/j.annfar.2008.05.011
2013
Jan
19;381(9862):242-‐55.
Br
J
Sports
Med
2012;46(Suppl
I):i69–i77.
43. 43
Asma y Ejercicio
chodilator test was negative in all control subjects (change in
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
use of inhaled 2-agonists. Coughing in episodes or in rela
to exercise was reported by 26 (65%) skiers. Of 15 (38%)
ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from
subjects. Because of unavailability of cryosections, neutro
counts were not performed in control subjects and in three
ers. Data with cell counts are presented in Table 2 and Fig
1 and 2
Group analysis showed that skiers had 43-fold (p 0.0
26-fold (p 0.001), and twofold (p 0.001) greater T-
phocyte, macrophage, and eosinophil counts, respectively,
did controls. The skiers’ neutrophil count was significa
greater than that of the asthmatic subjects, whereas the lym
cyte count was not significantly different, and the macroph
eosinophil, and mast cell counts were lower. On subg
analysis by nonatopic status, the neutrophil count in skiers
not significantly different and the eosinophil count was sig
cantly lower than in asthmatic subjects. The mast cell c
was greater in skiers than in controls. There were no sig
cant differences in cell counts in nonhyperresponsive and
perresponsive skiers. Both skier groups had greater macr
age and lymphocyte counts than controls (Figure 3A), whe
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk fa
occurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolu
Study design. – Retrospective case study and prospective frequency study.
Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review
between 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a
auscultation and radiologic features.
Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers withou
involved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exer
Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of lo
were observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in a
resolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal
* Auteur correspondant.
Adresse e-mail : guy.cochard@chu-brest.fr (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits re´serve´s.
doi:10.1016/j.annfar.2008.05.011
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk fa
occurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolu
Study design. – Retrospective case study and prospective frequency study.
Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review
between 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a
auscultation and radiologic features.
Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers withou
involved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exer
Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of lo
were observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in a
resolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal
* Auteur correspondant.
Adresse e-mail : guy.cochard@chu-brest.fr (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits re´serve´s.
doi:10.1016/j.annfar.2008.05.011
[Severe
forms
of
effort-‐induced
asthma].
[ArCcle
in
French]Marotel
C1,
Natali
F,
Heyraud
JD,
Vaylet
F,
L'Her
P,
Bonnet
D,
Allard
P.Allerg
Immunol
(Paris).
1989
Feb;21(2):61-‐4.
Abstract
Severe
reacCons
in
exercise-‐induced
asthma
(EIA)
seem
to
be
underesCmated
in
the
published
literature.
We
report
two
cases
of
near-‐miss
death
from
EIA
that
occurred
acer
a
short
run.
We
review
364
exercise
tests
that
were
performed
between
September
1987
and
October
1988
by
a
standardised
protocol
on
a
treadmill,
on
paCents
with
possible
EIA.
A
posiCve
test,
defined
by
a
fall
of
FEV1
of
at
least
20%
was
found
in
173
paCents.
From
21
paCents
with
a
fall
of
greater
than
50%,
4
presented
severe
signs
of:
Cyanosis.
Intense
dyspnea
with
impediment
of
speech.
General
malaise
with
hypertension.
These
4
paCents
were
not
greatly
different
from
paCents
of
the
50%
fall
group
when
compared
for
FEV1
before
the
test
and
for
heart-‐rate
during
the
test.
They
differed
in
the
duraCon
of
the
asthma
atack,
which
was
more
protracted,
despite
the
use
of
beta-‐2
agonists.
The
onset
of
severe
reacCons
is
2.3%
of
posiCve
tests
and
seems
to
be
unpredictable.
45. 45
Asma y Ejercicio
1.-‐
Existen
ma@ces
entre
EIB
y
EIA
2.-‐
Ambos,
EIB
y
EIA
son
muy
prevalentes
con
prevalencias
variables
3.-‐
La
prevalencia
en
atletas
es
mas
alta
especialmente
en
esquí
de
fondo
y
natación
4.-‐
Los
mecanismos
fisiopatológicos
son
varios
e
históricamente
ha
predominado
la
hipótesis
de
“enfriamiento”
de
la
mucosa
5.-‐
El
tratamiento
fundamental
son
los
β-‐adrenérgicos
SABA