RESUMO
Convolutional Neural Networks (CNN) have performed extremely well for many image analysis tasks. However, supervised training of deep CNN architectures requires huge amounts of labelled data which is unavailable for light field images. In this paper, we leverage on synthetic light field images and propose a two stream CNN network that learns to estimate the disparities of multiple correlated neighbourhood pixels from their Epipolar Plane Images (EPI). Since the EPIs are unrelated except at their intersection, a two stream network is proposed to learn convolution weights individually for the EPIs and then combine the outputs of the two streams for disparity estimation. The CNN estimated disparity map is then refined using the central RGB light field image as a prior in a variational technique. We also propose a new real world dataset comprising light field images of 19 objects captured with the Lytro Illum camera in outdoor scenes and their corresponding 3D pointclouds, as ground truth, captured with the 3dMD scanner. This dataset will be made public to allow more precise 3D pointcloud level comparison of algorithms in the future which is currently not possible. Experiments on the synthetic and real world datasets show that our algorithm outperforms existing state-of-the-art for depth estimation from light field images.
RESUMO
We gave increasing doses of metoprolol intravenously to seven subjects with stable chronic obstructive pulmonary disease (COPD) who were also receiving their usual bronchodilators. Six of the seven tolerated up to 0.2mg/kg metoprolol without adverse effects, although there were declines in forced expiratory volume in 1 sec (FEV1). At 0.15 mg/kg mean FEV1 fell 12% (p less than 0.025), and at 0.2 mg/kg mean decline in FEV1 was 15% (p less than 0.01). These findings suggest that 0.2 mg/kg metoprolol may be given intravenously to most patients with COPD in addition to previously administered bronchodilators without precipitating clinically significant adverse effects. Any side effects that develop can be reversed by beta agonists.
Assuntos
Pneumopatias Obstrutivas/fisiopatologia , Metoprolol/farmacologia , Propanolaminas/farmacologia , Respiração/efeitos dos fármacos , Adulto , Idoso , Gasometria , Pressão Sanguínea/efeitos dos fármacos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Infusões Parenterais , Masculino , Metoprolol/administração & dosagem , Pessoa de Meia-Idade , Testes de Função RespiratóriaRESUMO
In a retrospective study of 49 cases of asbestosis, a steady increase in the frequency of diagnosis of asbestosis and asbestos-related neoplasia is documented from a major urban hospital since 1960. Although in the majority of cases the subjects were exposed to asbestos in a neighboring shipyard, in 20 per cent of the cases, asbestos exposure was in industries not related to shipbuilding, reflecting its widespread use. This selective population of patients with asbestosis more often than not had an associated neoplasm. The most likely accompanying tumor was pleural mesothelioma, and among cell types of lung cancer, adenocarcinoma was notably frequent.
Assuntos
Amianto/efeitos adversos , Neoplasias Pulmonares/etiologia , Mesotelioma/etiologia , Doenças Profissionais/etiologia , Adenocarcinoma/complicações , Adulto , Idoso , Asbestose/complicações , Asbestose/diagnóstico , Humanos , Neoplasias Pulmonares/complicações , Mesotelioma/complicações , Pessoa de Meia-Idade , OcupaçõesRESUMO
Thirty-four fiberoptic bronchoscopies employing various bronchoscopic technics were carried out in 33 immune-compromised patients for the evaluation of new pulmonary lesions. Transbronchial biopsy was performed only with fluoroscopic guidance and was omitted in patients with a bleeding tendency. Bronchial brushing and bronchial washing were successfully carried out despite the presence of contraindications to biopsy. Brushing and washing were diagnostically useful in 66 and 74 per cent of the cases, respectively, compared to 71 per cent for forceps biopsy. The combined over-all yield was 88 per cent, with no serious complications encountered. The most common etiology of new infiltrates was opportunistic infection. Among bacterial infections, gram-negative organisms were the most common, and among fungal etiologies, Coccidioides immitis was the predominant pathogen in this series from Tucson, Arizona. Although the roentgenographic pattern was not helpful in predicting the etiology of the new infiltrates, diffuse lesions were more frequently evaluated correctly by fiberoptic bronchoscopy than localized lesions. The low incidence of complications and the high over-all yield indicate that fiberoptic bronchoscopy, employing bronchial brushing and washing as supplements to transbronchial biopsy (and as a replacement to biopsy in patients with a bleeding diathesis), can be very useful in evaluating new pulmonary lesions in the immune-compromised patient. When used together, these technics significantly increase the diagnostic yield and eliminate the risks associated with performing more invasive diagnostic procedures in the compromised host.
Assuntos
Broncoscopia , Pneumopatias/diagnóstico , Adulto , Idoso , Broncoscopia/efeitos adversos , Complicações do Diabetes , Feminino , Tecnologia de Fibra Óptica , Humanos , Terapia de Imunossupressão/efeitos adversos , Infecções/complicações , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Neoplasias/complicaçõesRESUMO
Platelet aggregation and fibrin deposition in the pulmonary circulation may contribute to the pathogenesis of lung injury in the adult respiratory distress syndrome (ARDS). We evaluated the effect of two antiplatelet drugs (forskolin & dipyridamole) on pulmonary responses to intravenous infusion of 100 NIH units of thrombin per kg bw in anesthetized, and ventilated rabbits treated with fibrinolysis inhibitor. Thrombin infusion resulted in pulmonary hypertension and increased arterial CO2 tension (PaCO2) and dead space ventilation (VD/VT). Arterial oxygen tension (PaO2) and numbers of circulating leukocytes and platelets dropped after thrombin infusion. These early hemodynamic changes correlated with histological evidence of entrapped leukocytes in the pulmonary microcirculation and transient alveolar edema. Microthrombi were rarely observed in animals that received thrombin. There was little evidence for endothelial damage or progressive lung water accumulation. Treatment with forskolin or dipyridamole reversed thrombin-induced changes in pulmonary artery pressure, PaCO2, VD/VT and systemic oxygenation. Moreover, forskolin and dipyridamole blunted the drop in circulating leukocytes and prevented the development of alveolar edema following thrombin. The beneficial actions of these agents may be due to interference with the release of mediators from leukocytes or platelets.
Assuntos
Pulmão/metabolismo , Inibidores da Agregação Plaquetária/farmacologia , Trombina/farmacologia , Animais , Colforsina/farmacologia , Dipiridamol/farmacologia , Feminino , Pulmão/efeitos dos fármacos , Coelhos , Síndrome do Desconforto Respiratório/etiologiaRESUMO
We evaluated the effects of oral metoprolol, 200 mg daily, on cardiac and pulmonary function in 6 patients with chronic reversible airways obstruction and no cardiac dysfunction. The patients were clinically stable. In all patients, baseline forced expiratory volume in 1 second (FEV1) was less than 60% predicted, and increased at least 15% after isoproterenol inhalation. Resting control first pass right and left ventricular radionuclide ejection fractions were normal or only slightly depressed. Compared to placebo, metoprolol did not significantly affect FEV1 or forced vital capacity. Metoprolol did not significantly alter left or right ventricular ejection fraction, measured by first pass radionuclide technique. On patient experienced increased dyspnea on metoprolol, which was not accompanied by changes in clinical exam, spirometry, or ejection fraction. We conclude that metoprolol may be safely administered to a subset of stable patients with chronic reactive airways disease.
Assuntos
Pneumopatias Obstrutivas/fisiopatologia , Metoprolol/farmacologia , Propanolaminas/farmacologia , Adulto , Doença Crônica , Feminino , Ventrículos do Coração/efeitos dos fármacos , Humanos , Medidas de Volume Pulmonar , Masculino , Pessoa de Meia-Idade , EspirometriaRESUMO
Following acute exposure to chlorine gas, 18 asymptomatic subjects were evaluated for early pulmonary dysfunction. Airway obstruction was evident in all exposed individuals immediately after chlorine exposure. The severity, course of the obstructive defect, and clinical picture correlated with the chief complaint on admission. The obstructive abnormalities resolved within 1 wk after exposure to chlorine in 12 subjects whose chief complaint was cough. A slower resolution of the physiologic changes, clinical signs, and symptoms was noted in 6 subjects whose initial chief complaint was dyspnea. In this group, maximum mid-expiratory flow rate (FEF25-75%), and forced expiratory flow after exhaling 50% and 75% of the vital capacity (FEF50% and FEF25%, respectively) were still diminished 2 wk after chlorine exposure. The slow rate of resolution in the dyspnea group is best explained by increased individual susceptibility since a past medical history of smoking or asthma and "wheezing" was more prevalent in this group.
Assuntos
Obstrução das Vias Respiratórias/induzido quimicamente , Cloro/intoxicação , Adulto , Alcalose Respiratória/induzido quimicamente , Dispneia/induzido quimicamente , Feminino , Fluxo Expiratório Forçado , Humanos , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Masculino , Fluxo Máximo Médio Expiratório , Pessoa de Meia-Idade , Ventilação Pulmonar/efeitos dos fármacos , Capacidade Vital/efeitos dos fármacosAssuntos
Beriliose , Pneumopatias Obstrutivas/induzido quimicamente , Doenças Profissionais/induzido quimicamente , Adulto , Idoso , Aeronaves , Berílio/análise , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Pulmão/análise , Pneumopatias Obstrutivas/diagnóstico , Pneumopatias Obstrutivas/diagnóstico por imagem , Pneumopatias Obstrutivas/epidemiologia , Pneumopatias Obstrutivas/fisiopatologia , Neoplasias Pulmonares/complicações , Doenças Linfáticas/diagnóstico por imagem , Masculino , Mediastinoscopia , Pessoa de Meia-Idade , Reatores Nucleares , Doenças Profissionais/diagnóstico , Doenças Profissionais/diagnóstico por imagem , Doenças Profissionais/epidemiologia , Doenças Profissionais/fisiopatologia , Radiografia , Respiração , Estados UnidosAssuntos
Pneumopatias Obstrutivas/diagnóstico , Testes de Função Respiratória , Adulto , Resistência das Vias Respiratórias , Brônquios/anatomia & histologia , Feminino , Fluxo Expiratório Forçado , Humanos , Pulmão/fisiopatologia , Pneumopatias Obstrutivas/fisiopatologia , Medidas de Volume Pulmonar , Pessoa de Meia-Idade , Oxigênio/sangue , Alvéolos Pulmonares/fisiologia , Fumar/fisiopatologia , Capacidade VitalRESUMO
Regulation of CSF HCO3-in respiratory acidosis was studied in light of the "dual contribution theory," which proposed that there were two sources for the CSF HCO3-increase: 1) HCO3-by diffusion from plasma and 2) HCO3-generated in the CNS and catalyzed by the local carbonic anhydrase (J. Appl. Physiol. 38: 504-512, 1975). In anesthetized dogs with an increase in Paco2 of 30 mmHg for 4 h the plasma HCO3 increased 2 meq/1 and CSF 6 meq/1. In combined respiratory and metabolic acidosis, plasma HCO3-did not increase but CSF HCO3-increased 6 meq/1. In combined acidosis and intraventricular injections of acetazolamide no increase in plasma or CSF HCO3-occurred. In combined respiratory acidosis and metabolic alkalosis and intraventricular acetazolamide, plasma HCO3-increased 15 meq/1 but CSF HCO3-increased 6 meq/1. Brain and CSF ammonia increased linearly and selectively with the increase in the relative contribution of CNS HCO3-increase. Therefore regulation of CSF HCO3-in respiratory acidosis depends on both components of the dual contribution theory, where each component can provide the total CSF HCO3-increase under appropriate experimental conditions. The control mechanism may be sensitive to changes in [H+] on the brain side of the blood-brain barrier.
Assuntos
Acidose Respiratória/líquido cefalorraquidiano , Bicarbonatos/líquido cefalorraquidiano , Equilíbrio Ácido-Base , Amônia/metabolismo , Animais , Bicarbonatos/sangue , Encéfalo/metabolismo , Dióxido de Carbono/sangue , Dióxido de Carbono/líquido cefalorraquidiano , Anidrases Carbônicas/metabolismo , Líquido Cefalorraquidiano/enzimologia , Cães , Concentração de Íons de HidrogênioRESUMO
The use of bleomycin sulfate as an antineoplastic agent has been limited by its substantial pulmonary toxic effects. The exact incidence and prognosis of bleomycin-pneumonitis is unresolved. Although bleomycin pulmonary toxicity is thought to be dose-related, recent reports have emphasized severe reactions at low doses. Furthermore, severe pulmonary toxicity has been suggested to be progressive, irreversible, and ultimately, fatal. We report clinical, roentgenographic, and pathophysiologic recovery after severe, bleomycin-induced pneumonitis.
Assuntos
Bleomicina/efeitos adversos , Fibrose Pulmonar , Fibrose Pulmonar/induzido quimicamente , Bleomicina/administração & dosagem , Carcinoma de Células Escamosas/tratamento farmacológico , Feminino , Humanos , Pulmão/patologia , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Fibrose Pulmonar/tratamento farmacológico , Neoplasias Retais/tratamento farmacológico , Remissão EspontâneaRESUMO
A continued increase in the incidence of diffuse mesothelioma has been attributed to greater industrial use of asbestos but is also due in part to wider acceptance of this tumor by pathologists. In this retrospective study, the epidemiology, clinical presentation, and pathology of asbestos and non-asbestos-related mesothelioma from a major urban hospital were reviewed. Of the 36 cases of mesothelioma on file, 19 were not associated with exposure to asbestos. Although a retrospective study raises the possibility of inadequate occupational histories, the lack of history of asbestos exposure correlated with postmortem histology by light microscopy. When postmortem material was reviewed, evidence of asbestos exposure was present in all cases of mesothelioma with history of exposure to asbestos, and in no cases in which the patient denied history of asbestos exposure. Using strict histologic and histochemical criteria, the diagnosis of mesothelioma was confirmed in 8 of 9 patients with asbestos-related mesothelioma but in only 4 of 13 cases of non-asbestos-related mesothelioma. The diagnosis of diffuse methelioma is often difficult to make even wtih complete autopsy examinations. It should be entertained only with adherence to strict clinical and pathologic criteria, especially in women with no history to exposure to asbestos dust.
Assuntos
Amianto/efeitos adversos , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Adulto , Idoso , Asbestose/complicações , Exposição Ambiental , Feminino , Humanos , Neoplasias Pulmonares/induzido quimicamente , Masculino , Mesotelioma/induzido quimicamente , Pessoa de Meia-Idade , Medicina do Trabalho , Estudos Retrospectivos , NaviosRESUMO
A case of North American blastomycosis acquired outside the American continent and presenting with a left hilar mass is reported. The progressive hilar enlargement, despite adequate antifungal treatment, raised the possibility of drug resistance, concomitant tuberculosis and carcinoma. Non-invasive diagnostic studies including cultures, cytology and fibreoptic bronchoscopy were negative. On thoracotomy, both blastomy cosis and a poorly undifferentiated adenocarcinoma were evident.
Assuntos
Adenocarcinoma/complicações , Blastomicose/complicações , Neoplasias Pulmonares/complicações , Adulto , Blastomicose/patologia , Humanos , Libéria , MasculinoRESUMO
Two potential errors of pulmonary artery wedge pressure measurement that have received little attention are improper anatomic referencing of the transducer and nondependent placement of the pulmonary artery catheter tip. Transducers are often referenced to the midaxillary line of the supine patient. We utilized CT of the chest to determine accurately the topographic location of the left atrium to evaluate the accuracy of referencing the transducer in this position and to investigate atrial location in the lateral decubitus positions vis-à-vis external landmarks, so that more accurate referencing could be performed with a pulmonary artery catheter tip in the dependent lung. A prospective group consisting of ten patients referred for chest CT as well as retrospective review of 40 chest CT scans served as the study population. This study demonstrated a discrepancy between the perceived midaxillary line and the true location of the midleft atrium. Lateral decubitus CT scanning revealed a more readily localizable surface anatomic landmark which consistently and accurately predicts midleft atrial location. In addition, the appropriate decubitus position guarantees dependent catheter tip placement (Zone 3).
Assuntos
Cateterismo de Swan-Ganz/normas , Átrios do Coração/diagnóstico por imagem , Pressão Propulsora Pulmonar , Tomografia Computadorizada por Raios X , Calibragem , Átrios do Coração/anatomia & histologia , Humanos , Estudos Prospectivos , Estudos RetrospectivosRESUMO
The correlation between pulmonary artery wedge pressure (Pw) and left atrial pressure (Pla) requires a continuous fluid column between the catheter tip and the left atrium. We hypothesized that lung injury may protect the fluid column from the collapsing effects of increased airway pressure. Correlation between Pw and Pla would then depend on catheter tip location in injured versus normal lung regions. In 7 anesthetized dogs with unilateral acid pneumonitis, we compared Pla and simultaneous Pw measurements from pulmonary artery catheters located in injured and normal lungs at different levels of positive end-expiratory pressure (PEEP). Studies were repeated in 10 dogs with normal lungs and 5 dogs with bilateral acid pneumonitis. In supine dogs with unilateral lung injury, Pw from the injured lung more accurately reflected Pla than did Pw obtained from the normal lung at PEEP levels of 7 mmHg or higher, in contrast to data from dogs with normal lungs or equally injured lungs. Discrepancies between Pw and Pla at PEEP levels of 7 and 11 mmHg from the normal lung were corrected when that lung was placed in the dependent position to increase venous pressure at the catheter tip. A good Pw-Pla correlation was not guaranteed by catheter tip location below the level of the left atrium during PEEP ventilation. We conclude that the continuity of the fluid column was protected by lung injury. Although Pw-Pla differences from the normal lung were modest at the levels of PEEP that are usually optimal for gas exchange in uneven lung injury, it is recommended that the injured lung should not be avoided during insertion of the balloon-tipped catheter.
Assuntos
Pneumonia/fisiopatologia , Respiração com Pressão Positiva , Pressão Propulsora Pulmonar , Animais , Função Atrial , Cateterismo Cardíaco/métodos , Cães , Ácido Clorídrico , Pneumonia/induzido quimicamente , Postura , Pressão , Troca Gasosa PulmonarRESUMO
We compared CVP and pulmonary capillary wedge pressure (WP) measurements with left atrial pressure (LAP) in postcoronary bypass surgical patients with preserved cardiopulmonary function. Measurements were obtained under normal conditions and conditions likely to induce WP-LAP discrepancies (PEEP and catheter tip malposition). Patients were in both supine and lateral positions; the catheter tip was placed vertically below (tip down; n = 12) or above (tip up; n = 5) the left atrium. Our data showed that both CVP and WP correlated well with LAP at all PEEP levels in the supine and tip down lateral positions. However, in the tip up lateral position, WP overestimated LAP (13.3 +/- 3.4 vs. 8.0 +/- 2 mm Hg; p less than .01) at 20 cm H2O of PEEP, whereas CVP (8.8 +/- 2.1 mm Hg) closely reflected LAP. Thus, by placing the catheter tip vertically below the left atrium in supinely and laterally positioned patients, CVP and WP both produced reliable estimates of LAP despite an acute increase in alveolar pressure. When the pulmonary artery catheter tip was vertically above the left atrium, WP overestimated LAP. Under these conditions, CVP remained a reliable estimate of LAP. We conclude that CVP measurement as an estimate of LAP in this patient population could be used and not ignored. This is true in patients with previously documented good LAP-CVP correlation who are subjected subsequently to conditions which may produce an LAP-WP discrepancy (high PEEP and catheter tip malposition).
Assuntos
Função Atrial , Cateterismo , Pressão Venosa Central , Respiração com Pressão Positiva , Pressão Propulsora Pulmonar , Idoso , Cateterismo Cardíaco , Cateterismo Venoso Central , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , PressãoRESUMO
Diffuse pulmonary infiltrates and hypoxemia are common in immunocompromised patients. We describe a patient with lymphoma who developed hypoxemia and diffuse pulmonary infiltrates during treatment with corticosteroids. Open lung biopsy and postmortem examination indicated that the cause of the infiltrates was nontraumatic fat embolization (NTFE). Most previous cases of NTFE have implicated a fatty liver as the source of emboli; however, this patient had no fatty changes of the liver. The diagnosis of NTFE in an immunocompromised patient is difficult to make because its distinguishing features, such as hypoxemia, petechiae, and altered mental status, are nonspecific in this setting.
Assuntos
Embolia Gordurosa/diagnóstico , Linfoma/complicações , Embolia Pulmonar/etiologia , Corticosteroides/uso terapêutico , Adulto , Embolia Gordurosa/patologia , Feminino , Humanos , Linfoma/tratamento farmacológico , Masculino , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/patologia , RadiografiaRESUMO
Positive end-expiratory pressure (PEEP), by increasing lung volume in acute lung injury, may recruit terminal air spaces in the involved regions, but may also distend noninvolved regions increasing extravascular lung water and worsening gas exchange. We investigated the effect of increasing levels of PEEP on arterial oxygenation in 26 anesthesized dogs with unilateral acid pneumonitis and studied the influences of gravity and distribution of the injury on this effect. Arterial PO2 was consistently higher when the noninjured lung was dependent than in the supine or injured lung-dependent positions. Low levels of PEEP (5, 10 cmH2O) improved arterial oxygenation and reduced intrapulmonary physiological shunt. However, 15 cmH2O PEEP resulted in worsening of gas exchange, increased dead space ventilation, and diminished static compliance. The adverse effects of high levels of PEEP on arterial oxygenation were similar whether the injured lung was dependent or not and were evident a lower levels of PEEP in one group of dogs in which the unilateral injury was more diffuse and in which the upper and middle lobes were also involved. Thus, the compressive effects of high levels of PEEP on alveolar capillaries in the noninjured lung are influenced by the extent and distribution of injury in the injured lung, but not by local forces governing regional blood flow distribution.
Assuntos
Lesão Pulmonar , Respiração com Pressão Positiva , Postura , Animais , Artérias , Cães , Gravitação , Pulmão/patologia , Oxigênio , Pressão Parcial , Atelectasia Pulmonar/patologiaRESUMO
The percentage of eosinophils (%EOS), determined from a differential blood smear, was measured in 2,311 subjects enrolled in a general population study in Tucson, Arizona. A subgroup of 290 subjects was tested in more detail during a later evaluation in which absolute eosinophil counts, leukocyte counts, and nasal smears for eosinophils were obtained. In men, but not in women, there was a significant tendency for the %EOS to decrease with age. The highest %EOS was noted during the months of February through May, the time when most plants in this region are in bloom. Blood eosinophils were significantly related to allergy skin test reactivity, circulating IgE concentrations, several respiratory symptoms and disease diagnoses, as well as to reduced ventilatory function. Among subjects younger than 55 yr of age, however, ventilatory function was significantly low, and symptom rates increased only when there was allergy skin test reactivity in addition to eosinophilia. Neither allergy skin test reactivity nor eosinophilia alone was related to ventilatory function in this age group. Among older subjects, blood eosinophilia was associated with definite impairment of ventilatory function, regardless of skin test reactivity and independent of smoking habits. The presence of eosinophilia identified a predominantly female group of elderly nonsmokers with markedly impaired ventilatory function. These subjects appeared to fall into the clinical category of "asthmatic bronchitis".
Assuntos
Eosinofilia/etiologia , Infecções Respiratórias/sangue , Adolescente , Adulto , Idoso , Asma/sangue , Bronquite/sangue , Criança , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Enfisema Pulmonar/sangue , Hipersensibilidade Respiratória/sangue , Sons Respiratórios/fisiopatologia , FumarRESUMO
PEEP may decrease regional perfusion to nondependent lung regions, thereby creating different zones of thermal dissipation in dependent and nondependent zones of the lung. Under these conditions, the measurement of cardiac output by thermodilution may, thus, be influenced by the vertical position of the pulmonary artery catheter in the lung. We investigated this hypothesis in 7 healthy, anesthetized pigs by comparing cardiac output measurements from thermistors located in dependent and nondependent lung regions at varying levels of PEEP. Our data from thermistors in these 2 positions were similar, suggesting that the measurement of cardiac output by thermodilution is not influenced by the vertical position of the thermal sensor with respect to the left atrium.