Dyspnea: the heart or the lungs? Differentiation at bedside by use of the simple Valsalva maneuver.

Thirty-seven patients with dyspnea, clinical chronic obstructive pulmonary disease and abnormal pulmonary function tests demonstrating an obstructive airways pattern underwent six-foot posteroanterior chest radiography, radionuclide ventriculography and sphygmomanometer-monitored arterial pressure response during a bedside Valsalva maneuver. Patients could be separated into three groups (square wave, absent overshoot, sinusoidal) on the basis of their Valsalva response which corresponded to left ventricular ejection fractions on radionuclide ventriculography of 0.19 +/- 0.05, 0.42 +/- 0.20, 0.64 +/- 0.13 (p less than 0.005 for differences between all group means). Pulmonary function test results and a detailed patient history could not accurately separate patients with primary pulmonary dyspnea from those with concomitant left ventricular dysfunction (ejection fraction less than 0.50). In this population of patients, however, both the sensitivity (88 percent) and predictive value (88 percent) for the presence of left ventricular dysfunction of an abnormal (square wave or absent overshoot) systolic arterial pressure response during Valsalva maneuver were high. Thus, in dyspneic subjects with clinical evidence of chronic obstructive airways disease, concomitant left ventricular dysfunction can be accurately diagnosed using the simple Valsalva maneuver without sophisticated equipment or highly trained personnel.

Yersinia enterocolitica septicaemia.

Septicaemia from Yersinia enterocolitica carries a mortality of up to 80%. We report the successful management of a case who required intensive therapy, including inotropic and ventilatory support.

Anaesthetic rooms: current practice in one British health region.

In Britain it is traditional that each operating theatre has an adjacent anaesthetic room (1). The implications for equipping current theatre suites and the design of new theatres are wide-ranging. There are no data available on the attitudes of anaesthetists in this country towards the necessity for anaesthetic rooms and the extent of the anaesthetic equipment found in them. This survey in the North West region suggests that all consultant anaesthetists regard the availability of an anaesthetic room as a necessity, and most consider that the current level of vital-signs monitoring equipment in the anaesthetic room is inadequate.

The use of flumazenil (Anexate, Ro 15-1788) in the management of drug overdose.

This is a report of a large selfadministered overdose of temazepam and meprobamate. The administration of flumazenil (Ro 15-1788) led to the partial antagonism of the depressant action of the drugs which was sufficient to avoid the need for invasive respiratory and cardiovascular support.