Telespirometry: novel system for home monitoring of asthmatic patients.

OBJECTIVES: To describe a newly developed telespirometry system consisting of a portable spirometer that transmits the lung ventilatory values by telephone from the patient's home to a remote monitoring center and to assess the ability of the telespirometry system to detect early signs of asthmatic deterioration. METHODS: Thirty-nine patients with moderate to severe asthma were monitored with the telespirometry system. The lung function testing and transmission of the spirometric data by telephone from the patient's home to a remote monitoring center were performed according to the patient's judgment. All previous transmissions of the spirometric data were analyzed retrospectively to detect early signs of asthmatic deterioration, which resulted in dispatch of the mobile intensive care unit (MICU) to the patient's home. RESULTS: In 19 patients (49%), analysis of the spirometric data detected early signs of asthmatic deterioration. Analysis of the spirometric data correlated with decisions to dispatch the MICU in 22 of 39 (56%) patients. In patients with severe asthma, the decision was made during oral communication between the patient and the operator and was based on clinical impression rather than functional results. CONCLUSION: Home monitoring of asthmatic patients with the telespirometry system may improve the management of the disease and the quality of life and reduce costly hospitalizations.     

Renovascular hypertension: a unique cause of unilateral focal segmental glomerulosclerosis.

A 48-year-old man presented with malignant hypertension and massive proteinuria. Renal angiography showed complete obstruction of the left renal artery and 99mTc-mercaptoacetylglycine (MAG3) renography showed a nonfunctioning left kidney. Percutaneous transluminal renal angioplasty of the left renal artery was unsuccessful; hence, the patient underwent left nephrectomy because of uncontrolled hypertension and proteinuria. Histological examination of a right kidney specimen revealed lesions of focal segmental glomerulosclerosis with benign nephrosclerosis. In contrast, histology of the left kidney showed typical ischemic kidney with hypertrophy of arteriolar smooth muscle cells. The patient responded favorably to the nephrectomy, as his blood pressure and urinary protein dramatically decreased with no antihypertensive medication. This case illustrates the heterogeneous effect of the renin-angiotensin system on either kidney in patients with renovascular hypertension due to unilateral renal artery stenosis.     

A review of the effects of external pressure on skin blood flow

The human foot is a complex mechanical structure consisting of bones, ligaments and joints. They act together to provide a robust system capable of absorbing and dissipating the intermitted pressure that is subjected to its plantar surface during walking to prevent soft tissue breakdown. Current studies suggest that plantar foot pressure may lead to soft tissue breakdown (e.g. neuropathic ulceration) and hence research has so far concentrated on investigating the mechanical effects of plantar foot pressure on the foot’s integrity. This has been possible through the widely available pressure and force platforms as well as in-shoe pressure systems. However, to understand how plantar foot pressure causes soft tissue breakdown it is vital to investigate both the physiological–mechanical interactions between the skin and plantar foot pressure. This review suggests that with the current advances in technology, the physiological response of skin blood flow to mechanical plantar foot pressure should be investigated and correlated further, both during static and dynamic loading, by developing a new system capable of either measuring both variables simultaneously or by synchronising two systems in real time.     

The variability of arterial pressure measured by oscillometric methods in premature newborn infants

The variability of blood pressure measured by oscillometry and the validity of this technique were studied in premature infants. Thirty premature babies whose postnatal age was six days or more had their blood pressure measured 11 times over a twenty-minute period for three consecutive days. Movements were found to have a very substantial influence on results that could not be reliably compared with values obtained invasively. No consistent pattern of variations of oscillometric results obtained during the eleven measurements of use for recommending a specific measurement time was found. Diastolic blood pressure fell gradually over the three-day study period. The most reliable of the eleven daily values was the lowest value for which good correlations were found between the three study days; this lowest value was not influenced by neonatal or postnatal factors.     

Comparative maternal, fetal, and neonatal effects of chloroprocaine with and without epinephrine for epidural anesthesia in obstetrics

The effects of epidural chloroprocaine with and without 1:200,000 epinephrine during labor and delivery on uterine activity, progress of labor, fetal heart rate, maternal blood pressure, newborn Apgar scores, neonatal acid-base status, and the Neurologic and Adaptive Capacity Scoring System (NACS) were compared in 28 parturients. Patients in group I (n = 14) received 2% chloroprocaine with 1:200,000 epinephrine and patients in group II (n = 14) received 2% plain chloroprocaine. Addition of epinephrine to chloroprocaine had no significant effects on uterine activity, duration of first or second stages of labor, or fetal heart parameters. Apgar scores, neonatal acid-base status, and the NACS were equally good in the two groups. Duration of analgesia was significantly longer in group I than in group II patients (76 +/- 3.8 vs 42.9 +/- 1 min, P less than 0.001). We conclude that addition of epinephrine to chloroprocaine during epidural anesthesia in the normal parturient has no adverse effects on mother, fetus, neonate, or the progress of labor and that it significantly prolongs the duration of anesthesia.     

Assessment of a new transtelephonic portable spirometer.

BACKGROUND: A new portable spirometer, the Spirophone, has been developed that records a subject's blow and can then transmit all the data by telephone to a receiving centre for analysis and comment. Tests of this device were undertaken to determine its accuracy and reliability. METHODS: The performance of the Spirophone was tested using computer generated wave forms, by delivering blows from calibrated syringes at different flows, and by comparing subjects' blows with those recorded with a commercial spirometer. RESULTS: Using computer generated wave forms all lung function indices were accurate to within 1% and blows delivered from calibrating syringes were accurate to within 5%. When subjects performed repeated forced vital capacity (FVC) manoeuvres there were no significant differences between lung function indices recorded with the Spirophone and with a commercial spirometer. With the Spirophone and commercial spirometer in series the FVC and forced expiratory volume in one second (FEV1) were within 5% of each other in nine out of 10 healthy subjects. CONCLUSION: The Spirophone recorded maximal forced expiratory manoeuvres with acceptable accuracy, reliability, and reproducibility, and this system offers the ability to monitor a patient's lung function at a centre remote from the patient.