Data on the biomass of commercially important coral reef fishes inside and outside marine protected areas in the Philippines.

This article contains the data on fish biomass inside and outside 57 locally managed marine protected areas (MPAs) and within the nationally protected Tubbataha Reef National Marine Park (TRNMP) from 57 coastal municipalities and 20 provinces in the Philippines. It includes the seven major commercially important coral reef fishes, namely, the surgeonfish (family Acanthuridae), parrotfish (subfamily Scarinae, family Labridae), snappers (family Lutjanidae), groupers (subfamily Epinephelinae, family Serranidae), goatfish (family Mullidae), sweetlips (family Haemulidae) and emperor (family Lethrinidae). Fish visual census (FVC) surveys were done by scuba diving along 10 m × 50 m belt transects established on upper reef slope, mostly with depths ranging from 5 to 10 m. Four to twelve transects were surveyed for the locally managed MPAs, half of which were established inside MPAs and the other half outside MPAs. Thirty-three transects were surveyed for the TRNMP. FVC was performed by swimming slowly and stopping every 5 m to record all the fish within a 10 m - wide belt. All FVC surveys were conducted from 2006 to 2014 between 9:00-16:00 hours. Each fish was identified to the species level and total length (TL) was estimated to the nearest centimeter. Fish biomass was estimated using the relationship between length (L) and weight (W) with the equation W = aLb. The data we provide can be used for coral reef fisheries management and for monitoring and evaluation of coral reef fishes in the Philippines particularly for the MPAs included in this dataset. These data support the information presented in the article Muallil et al., 2019.

Sleep disordered breathing and nocturnal hypoxemia are very prevalent in a lung cancer screening population and may condition lung cancer screening findings: results of the prospective Sleep Apnea In Lung Cancer Screening (SAILS) study.

OBJECTIVE: Obstructive sleep apnea (OSA) can influence the appearance and proliferation of some tumors. The Sleep Apnea In Lung Cancer Screening (SAILS) study (NCT02764866) evaluated the prevalence of OSA and nocturnal hypoxemia in a high-risk population enrolled in a lung cancer screening program. METHODS: This was a prospective study of the prevalence of OSA in a lung cancer screening program. Subjects met the National Lung Screening Trial (NLST) age and smoking criteria (age 55-75 years; pack-years >30). Participants in the study were offered annual screening with low-dose computed tomography (LDCT) and pulmonary function testing, as well as home sleep apnea testing (HSAT) and a sleep-specific questionnaire. Sleep study-related variables, symptoms, and epidemiologic data were recorded. RESULTS: HSAT was offered to 279 subjects enrolled in our lung cancer screening program. HSAT results were available for 236 participants (mean age 63.6 years; mean tobacco exposure: 45 pack-years), of whom 59% were male and 53% were active smokers. Emphysema (74%) and chronic obstructive pulmonary disease (COPD) (62%) were common and in most cases mild in severity. OSA, including moderate to severe disease, was very common in this patient population. AHI distributions were as follows: AHI <5 (22.5%); 5-15 (36.4%); 15-30 (23.3%); and >30 (17.8%). Nocturnal hypoxemia (T90) (p = 0.003), diffusing capacity for carbon monoxide (DLCO) (p = 0.01), tobacco exposure (p = 0.024), and COPD (p = 0.023) were associated with OSA severity. Positive screening findings (nodules ≥6 mm) were associated with nocturnal hypoxemia on multivariate analysis adjusted for confounders (OR = 2.6, 95% CI = 1.12-6.09, p = 0.027). CONCLUSION: Moderate to severe OSA is very prevalent in patients enrolled in a lung cancer screening program. Nocturnal hypoxemia more than doubles the risk of positive screening findings.

Tratamiento y evolución de los empiemas diagnosticados en un estudio multicéntrico de la Comunidad de Madrid / Treatment and course of empyema diagnosed in a multicenter study of the Community of Madrid

Objetivo. Analizar las terapias utilizadas y la evolución de los empiemas incluidos en un estudio del Grupo de Pleura de Neumomadrid. Material y métodos. Estudio prospectivo y multicéntrico realizado entre 2004 y 2006, sobre los empiemas procedentes de neumología o cirugía torácica de siete hospitales de la Comunidad de Madrid. Se realizó un análisis descriptivo de los datos relacionados con el tratamiento y la evolución. Resultados. Los antibióticos iniciales más utilizados fueron levofloxacino y amoxicilina-clavulánico. Tras la toracocentesis se modificó el tratamiento en el 47% de los casos. La cobertura inicial para anaerobios se instauró en 41 pacientes (50%). El drenaje inicial se realizó mediante tubo endotorácico (89%), cirugía (9%) y toracocentesis evacuadora (2%). Se emplearon fibrinolíticos en un 51% de los casos con una eficacia del 88%. Se especificó la dosis empleada en 41 pacientes: 100.000 UI/día (39%), 200.000 UI/día (23%) y 300.000 UI/día (37%). Globalmente, requirieron cirugía 23 pacientes con evolución favorable del 91,3%. La necesidad de cirugía y la evolución de los pacientes con y sin cobertura inicial para anaerobios fue similar. La evolución final fue a la curación (84%), cronicidad (5%) o éxitus (11%) sin encontrarse diferencias entre los pacientes sometidos o no a cirugía. Conclusiones. No existió un criterio unificado para la antibioterapia y la dosis de fibrinolíticos. Los fibrinolíticos se emplearon en la mitad de los drenajes con una alta eficacia. No se observó una peor evolución en los empiemas que no recibieron cobertura para anaerobios y tampoco en aquellos que precisaron cirugía (AU)

Objective. To analyze the treatments used and course of the empyema patients enrolled in a study of the Neumomadrid Pleura Work Group. Material and methods. A prospective and multicenter study conducted between 2004 and 2006, on the empyemas from the Pneumology or Thoracic Surgery of 7 hospitals of the Community of Madrid. A descriptive analysis was made of the data related with the treatment and course. Results. The initial antibiotics used most were levofloxacin and amoxicillin and clavulanic acid. After the thoracocentesis, treatment was modified in 47% of the cases. Initial coverage for anaerobic bacteria was established in 41 patients (50%). Initial drainage was performed by endothoracic tube (89%), surgery (9%) and thoracocentesis for evacuation (2%). Fibrinolytics were used in 51% of the cases with 88% efficacy. The dose used in 41 patients was specified: 100,000 IU/day (39%), 200,000 IU/day (23%) and 300,000 IU/day (37%). Globally, 23 patients required surgery, 91.3% of whom had a favorable evaluation. The need for surgery and the course of the patients with and without initial coverage for anaerobic bacteria was similar. Final evolution was cure (84%), chronicity (5%) or exitus (11%), there being no differences found between the patients undergoing surgery or not. Conclusions. There was no unified criterion for the antibiotic treatment and dose of fibrinolytics. Fibrinolytics were used in half of the drainages with high efficacy. Worse evolution of the empyemas was not observed in those who did not receive coverage for anaerobic bacteria or in those who required surgery (AU)

Estudio multicéntrico de los empiemas en la Comunidad de Madrid / Multicenter study of empyemas in the community of Madrid

Resumen. El aumento de los microorganismos resistentes a los antibióticos, de las infecciones por anaerobios y nosocomiales, así como de los pacientes inmunodeprimidos, hacen del empiema un problema clínico frecuente con una mortalidad y morbilidad significativas. En este estudio multicéntrico y prospectivo, el Grupo de Trabajo de Pleura de Neumomadrid ha realizado un análisis descriptivo de los datos epidemiológicos, etiológicos, características del líquido pleural (LP), microbiología y evolución en función de estos hallazgos, de los empiemas de nuestro medio. Durante dos años se identificaron 82 empiemas procedentes de Servicios de Neumología o Cirugía Torácica de siete hospitales de la Comunidad de Madrid. En un tercio de nuestros pacientes se pudo identificar algún factor predisponente, destacando la diabetes, el virus de la inmunodeficiencia humana y el carcinoma broncogénico. La neumonía fue la etiología más frecuente. Las características bioquímicas del LP no mostraron diferencias significativas entre los pacientes con cultivo del LP positivo y negativo. En más de la mitad de los cultivos del LP se aisló algún germen, con predominio del género Streptococcus y de los cultivos unimicrobianos. Tras la toracocentesis diagnóstica, se modificó el tratamiento en casi la mitad de los casos. Un tercio de los pacientes requirieron cirugía, identificándose entre ellos un mayor número de mujeres, antecedentes de cirugía previa, causas extrapulmonares y gérmenes Gram positivos. Los pacientes cuyo empiema se desarrolló a raíz de procedimientos quirúrgicos recientes presentaron peor evolución (AU)

Abstract. The increase of antibiotic resistant microorganisms, of infections due to anaerobes and nosocomial infections and of immunodepressed patients is making empyema a frequent clinical problem having significant mortality and morbidity. In this multicenter and prospective study, the Neumomadrid Pleura Work Group has made a descriptive analysis of the epidemiological and etiological data that are characteristics of pleural fluid (PF), microbiology and evolution based on these findings, of the empyemas of our setting. During two years, 82 empyemas coming from the Pneumology or Thoracic Surgery Services of 7 hospitals of the Community of Madrid were identified. It was possible to identify some predisposing factors in one third of our patients, diabetes, human immunodeficiency and bronchogenic carcinoma standing out. Pneumonia was the most frequent etiology. The biochemistry characteristics of PF did not show any significant differences between the patients with positive and negative PF culture. In over half of the PF cultures, some germ was isolated, with predominance of the Streptococcus genus and of unimicrobial cultures. After the thoracocentesis diagnosis, treatment was modified in almost half of the cases. One third of the patients required surgery, identifying among them a greater number of women, background of previous surgery, extrapulmonary causes and Gram positive germs. The patients whose empyema developed due to recent surgical procedures had a worse evolution (AU)

[Non-invasive ventilation in patients with severe hypercapnic encephalopathy in a conventional hospital ward]. / Ventilación no invasiva en pacientes con encefalopatía hipercápnica grave en una sala de hospitalización convencional.

OBJECTIVE: To report our experience with non-invasive ventilation (NIV) at two levels of pressure (Bi-PAP) on a general respiratory medicine ward with patients in hypercapnic impaired consciousness and/or coma who had not previously been in an intensive care unit (ICU). METHODS: This was a prospective study of 13 patients, mean age 81 years (65-96), treated with NIV through a face mask. Ten had chronic obstructive pulmonary disease, with a mean FEV1 in stable condition of 35.2 14.6%. Glasgow scores upon admission were >/= 7. Arterial gases were monitored until suspension of NIV. RESULTS: After NIV for a mean 19 5 h/day in the first 48 hours and later of 6 1 h/day until a total of 74 9 h, 9 patients (69%) survived. The mean initial pH for these patients was 7.17 0.028 and the mean initial pCO2 was 101 9 mm Hg. In 7 cases (78%), coma was reversed in the first 48 h and a significant improvement in pH was observed in the 12-24 h analysis. Mean pH upon discharge was 7.44 0.013 and mean pCO2 was 54 2.8 mmHg. Four patients died, even though their initial or subsequent arterial gases at 12-24 h were not significantly different from those of the survivors. CONCLUSION: NIV on a general respiratory medicine ward can offer an alternative to oro-tracheal intubation for patients with hypercapnic impaired consciousness and/or coma who do not meet the criteria for admission to the ICU.

Ventilación no invasiva en pacientes con encefalopatía hipercápnica grave en una sala de hospitalización convencional / Non-invasive ventilation in patients with severe hypercapnic encephalopathy in a conventional hospital ward

OBJETIVO: Mostrar nuestra experiencia con la ventilación no invasiva (VNI) con doble nivel de presión (BIPAP) en una sala general de neumología en pacientes en estupor o coma hipercápnicos sin criterios de ingreso en unidad de cuidados intensivos (UCI).MATERIAL Y MÉTODOS: Estudio prospectivo de 13 pacientes, edad media 81 años (límites, 65-96), 10 pacientes presentaban exacerbación de enfermedad pulmonar obstructiva crónica (EPOC) con volumen espiratorio forzado en el primer segundo (FEV1) medio en situación estable de 35,2 ñ 14,6 per cent, índice de Glasgow ingreso 7, tratados con VNI mediante mascarilla facial. Se realizaron controles gasométricos hasta la suspensión de la VNI.RESULTADOS: Tras una media de ventilación de 19 ñ 5 h/día en las primeras 48 h y posteriormente 6 ñ 1 h/día hasta un promedio total de 74 ñ 9 h, sobrevivieron 9 pacientes (69 per cent).En este grupo los valores iniciales medios de pH y pCO2 fueron de 7,17 ñ 0,028 y 101 ñ 9 mmHg, respectivamente; de ellos en 7 casos (78 per cent) se revirtió el coma en las primeras 48 h y se observó una mejoría significativa en el valor de pH en el control de las 12-24 h. Los valores medios al alta de pH y pCO2 fueron 7,44 ñ 0,013 y 54 ñ 2,8 mmHg, respectivamente.Fallecieron 4 pacientes, cuyos valores gasométricos iniciales o evolutivos hasta las primeras 12-24 h no presentaron diferencia significativa con el grupo de supervivientes.CONCLUSIÓN: La aplicación de la VNI en una sala general de neumología puede constituir una alternativa a la intubación orotraqueal (IOT) en pacientes en situación de estupor o coma hipercápnicos que no cumplen criterios de ingreso en UCI (AU)

[Asymptomatic bilateral cystic lesion in the petrous apex: differential diagnosis]. / Lesión quística bilateral asintomática en la punta del peñasco: diagnóstico diferencial.

We report in this work the casual find of two bilateral and symmetrical cystic images on the apex petrosus, asymptomatic and with periodic controls. In the review of the literature we haven't found another case of this entity. The differential diagnosis of this pathology is showed. We expose the most characteristic imagings.

Lesión quística bilateral asintomática en la punta del peñasco: diagnóstico diferencial / Lesion cystic bilateral asymptomatic in the petrous apex: differential diagnosis

Presentamos en este trabajo el hallazgo casual de dos lesiones quísticas bilaterales y simétricas a nivel de la punta del peñasco, asintomáticas y sometidas a controles periódicos. En la revisión bibliográfica realizada no hemos encontrado ningún otro caso de bilateralidad de esta entidad. Hacemos el diagnóstico diferencial de su posible etiología y presentamos las imágenes más características (AU)

We report in this work the casual find of two bilateral and symmetrical cystic images on the apex petrosus, asymptomatic and with periodic controls. In the review of the literature we haven't found another case of this entity. The differential diagnosis of this pathology is showed. We expose the most characteristic imagings (AU)

Quality of Life Evaluation and Survival Study: a 3-yr prospective multinational study on patients with chronic respiratory failure.

Therapy of patients with chronic respiratory failure is mainly directed at minimizing symptoms in order to improve, or at least to prevent a deterioration of, patients' well-being. Under such circumstances, the perceived effect of therapies on patients' well-being and daily life represents the most important subjective outcome of treatment. Therefore, there is a need to provide a global estimate of health in patients on long term oxygen therapy or overnight home mechanical ventilation. The Maugeri Foundation Respiratory Failure Questionnaire (MRF28) is the first health status ("quality of life") questionnaire specifically developed for use in CRF and its items were selected to be applicable to patients with both obstructive and restrictive diseases. The Quality of Life Evaluation and Survival Study (QuESS) is a multinational study with the aim of re-evaluating the natural history of chronic respiratory failure in about 300 patients. To the authors knowledge, the Quality of Life Evaluation and Survival Study is the first study to evaluate the natural history of chronic respiratory failure in such a large number of subjects and with a complete set of data. In fact, both pathophysiologic and health status assessments will be made. Moreover, by collecting data on mortality, disease exacerbations and hospitalization, it will also be possible to verify the predictive ability of health status versus pathophysiology in terms of mortality and healthcare utilization.

[Retropharyngeal hematoma: a rare complication of coughing attacks]. / Hematoma retrofaríngeo: una rara complicación de una crisis tusígena.

OBJECTIVE: To determine the diagnosis and treatment of a retropharyngeal hematoma. MATERIAL AND METHODS: The authors report a case of retropharyngeal hematoma associated with increased intrathoracic pressure caused by coughing. DISCUSSION: Retropharyngeal hematomas are usually spontaneously resorbed so the treatment is surveillance. Surgical drainage may be necessary. The causes, clinical manifestations, diagnosis, and surgical indications are reviewed.

Hematoma retrofaríngeo: una rara complicación de una crisis tusígena / Retropharyngeal hematoma: a rare complication of coughing attacks

Objetivo: Precisar el diagnóstico y tratamiento de un hematoma retrofaríngeo. Material y métodos: Los autores presentan un caso de hematoma retrofaríngeo asociado a un aumento de la presión intratorácica por una crisis tusígena. Discusión: Los hematomas retrofaríngeos suelen reabsorberse espontáneamente por lo que su tratamiento es expectante. A veces es necesario un drenaje quirúrgico. Se revisan las causas, clínica, diagnóstico e indicaciones quirúrgicas (AU)

OBJECTIVE: To determine the diagnosis and treatment of a retropharyngeal hematoma. MATERIAL AND METHODS: The authors report a case of retropharyngeal hematoma associated with increased intrathoracic pressure caused by coughing. DISCUSSION: Retropharyngeal hematomas are usually spontaneously resorbed so the treatment is surveillance. Surgical drainage may be necessary. The causes, clinical manifestations, diagnosis, and surgical indications are reviewed (AU)

Effect of ecstasy [3,4-methylenedioxymethamphetamine (MDMA)] on cerebral blood flow: a co-registered SPECT and MRI study.

3,4-methylenedioxymethamphetamine (MDMA), an illicit recreational drug, damages serotonergic nerve endings. Since the cerebrovasculature is regulated partly by the serotonergic system, MDMA may affect cerebral blood flow (CBF) in humans. We evaluated 21 abstinent recreational MDMA users and 21 age- and gender-matched healthy subjects with brain SPECT and MRI. Ten of the MDMA subjects also had repeat SPECT and MRI after receiving two doses of MDMA. Abstinent MDMA users showed no significantly different global or regional CBF (rCBF) compared to the control subjects. However, within 3 weeks after MDMA administration, rCBF remained decreased in the visual cortex, the caudate, the superior parietal and dorsolateral frontal regions compared to baseline rCBF. The decreased rCBF tended to be more pronounced in subjects who received the higher dosage of MDMA. Two subjects who were scanned at 2-3 months after MDMA administration showed increased rather than decreased rCBF. Low-dose recreational MDMA use does not cause detectable persistent rCBF changes in humans. The lack of long-term rCBF changes may be due to a non-significant effect of serotonergic deficits on rCBF, or regeneration of serotonergic nerve terminals. The subacute decrease in rCBF after MDMA administration may be due to the direct effect of MDMA on the serotonergic system or the indirect effects of its metabolites on the dopaminergic system; the preliminary data suggest these effects may be transient.

Carcinoma de oído medio con extensión parafaringea / Meddium hearing carcinoma with parapharyngeal extension

El carcinoma de oído medio es una entidad infrecuente y, como además, su clínica inicial semeja la de una otitis crónica, su diagnóstico suele ser tardío, en estado avanzado y con mal pronóstico en la mayoría de ellos. El caso que presentamos es un carcinoma de oído medio con gran extensión que llega incluso a espacio parafaríngeo y porción superior de la parótida, irresecable y con tratamiento paliativo. Analizamos el caso y revisamos la bibliografía (AU)

Melanoptysis as a complication of fibreoptic bronchoscopy.

The case is presented of a coal miner with bilateral masses of progressive massive fibrosis, who developed acute cavitation following fibreoptic bronchoscopy and biopsies. Indeed, immediately upon bronchoscopy with transbronchial biopsy, there was expectoration of abundant melanoptysis. Three days later, the chest radiograph showed a cavity and the patient again coughed up black material, in the context of pulmonary infection. One week later, there was complete emptying of the conglomerate mass. To the authors' knowledge, this is the first reported case of a conglomerate mass of progressive massive fibrosis which cavitated as a result of bronchoscopy.

Frontotemporal dementia and early Alzheimer disease: differentiation with frontal lobe H-1 MR spectroscopy.

PURPOSE: To evaluate cerebral biochemical abnormalities in patients with frontotemporal dementia and Alzheimer disease and to determine whether proton (hydrogen-1) magnetic resonance (MR) spectroscopy can help differentiate among these two patient groups and healthy (control) subjects. MATERIALS AND METHODS: MR imaging and H-1 MR spectroscopy were performed in 14 patients with frontotemporal dementia, 12 with probable Alzheimer disease (Alzheimer), and 11 healthy (control) elderly subjects. Spectra were acquired from midfrontal and temporoparietal gray matter with a double spin-echo sequence (repetition time, 3,000 msec; echo time, 30 msec). Results were expressed in metabolite concentrations corrected for the presence of cerebrospinal fluid. RESULTS: In frontotemporal dementia patients, the frontal lobe showed reduced N-acetyl compounds (-28%) and glutamate plus glutamine (-16%), suggestive of neuron loss, and increased myo-inositol (MI) (+19%), suggestive of increased glial content. In three frontotemporal dementia patients, a lactate peak was present in the frontal lobe. In Alzheimer patients, no statistically significant abnormalities were observed in the frontal region, but MI was elevated (+8%) in the temporoparietal region. With use of linear discriminant analysis of MR spectroscopy data alone, 92% of the frontotemporal dementia patients were correctly differentiated from the Alzheimer patients and control subjects. The overall accuracy for discrimination among all three groups was 84%. CONCLUSION: H-1 MR spectroscopy demonstrated biochemical abnormalities in patients with frontotemporal dementia and aided differentiation between patients with frontotemporal dementia and Alzheimer disease.

Metabolite abnormalities in progressive multifocal leukoencephalopathy by proton magnetic resonance spectroscopy.

OBJECTIVE: To evaluate progressive multifocal leukoencephalopathy (PML) lesions using proton magnetic resonance spectroscopy (1H MRS). DESIGN: CSF polymerase chain reaction (PCR) detection for JC viral (JCV) DNA; MRI and localized 1H MRS in the PML lesions, normal-appearing contralateral brain regions (CONTRA), and in matched brain regions of normal subjects. SETTING: University-affiliated medical center. PATIENTS OR PARTICIPANTS: 20 AIDS patients with clinical diagnosis of PML, 16 had tissue and/or CSF evidence of JCV infection; 20 age-matched normal subjects. MAIN OUTCOME MEASURES: Metabolites from 1H MRS: N-acetyl aspartate (NA), creatine (CR), choline-containing compounds (CHO), myoinositol (MI), glutamine/glutamate (GLX), lactate, and lipids. RESULTS: CSF PCR for JCV DNA showed 86% sensitivity. MRI showed characteristic demyelinating lesions; commonest locations were frontal lobe and cerebellum. 1H MRS in the lesions showed decreased NA (-35%; p < 0.0001) and CR (-18%; p = 0.003), increased CHO (+28%; p = 0.0005), occasional increased MI, and excess lactate (15/20 lesions) and lipids (18/20). In the CONTRA, MRS showed trends for increased CR (+15%), CHO (+15%), MI (+13%), and lower GLX (-9%; p = 0.02). Six patients, studied longitudinally (4-18 months), showed progressive spectroscopic changes; two patients with longest survival showed the highest MI. CONCLUSIONS: These MRS findings are consistent with neuropathologic observations of neuronal loss, cell membrane and myelin breakdown, and increased glial activity in PML lesions. The CONTRA abnormalities may be due to remote effects of PML or direct HIV-1 infection. 1H MRS may be useful for characterization and follow-up evaluation of PML lesions.

Neurochemical alterations in asymptomatic abstinent cocaine users: a proton magnetic resonance spectroscopy study.

Cocaine can cause a variety of neuropsychiatric and neurobehavioral complications; however, it is uncertain whether cocaine causes persistent cerebral structural and neurochemical abnormalities in asymptomatic users. We studied 52 African-American men (26 human immunodeficiency virus-negative asymptomatic heavy cocaine users and 26 normal subjects). Ventricle-to-brain ratio (VBR) and white matter lesions (WML) were quantified on magnetic resonance imaging. N-acetyl-containing compounds (NA), total creatine, choline-containing compounds, myo-inositol, and glutamate + glutamine were measured with in vivo proton magnetic resonance spectroscopy, VBR and WML were not significantly different in the cocaine users compared to the normal controls. Elevated creatine (+7%; p = .05) and myo-inositol (+18%; p = .01) in the white matter were associated with cocaine use. NA, primarily a measure of N-acetyl aspartate and neuronal content, was normal. Normal NA suggest no neuronal loss or damage in the brain regions examined in these cocaine users. Therefore, we conclude that neurochemical abnormalities observed might result from alterations in nonneuronal brain tissue.

Lung deposition patterns of directly labelled salbutamol in normal subjects and in patients with reversible airflow obstruction.

BACKGROUND--Earlier studies of aerosol deposition in the lungs have relied on indirect labelling of Teflon spheres of a similar size distribution to the drug in question and have assumed similar aerodynamic properties. Using a modification of a new technique for directly labelling salbutamol, the deposition of salbutamol within the lungs of normal subjects and patients with asthma has been studied with the use of a metered dose inhaler (MDI) alone, an MDI with a spacer device, and a dry powder inhaler (DPI). METHOD--Salbutamol was directly labelled with technetium-99m and placed in an MDI or DPI. Ten normal subjects and 19 patients with asthma inhaled 200 micrograms of salbutamol by means of the MDI alone, the MDI with a spacer device attached, and by DPI on separate days. Deposition was assessed by a dual headed gamma camera after inhalation of the drug. RESULTS--The total mean (SD) percentage deposition of the drug in the normal subjects was 21.6% (8.9%) with the MDI alone, 20.9% (7.8%) with the MDI with spacer, and 12.4% (3.5%) with the DPI. For the patients, the mean percentage deposition was 18.2% (7.8%) with the MDI alone, 19.0% (8.9%) with the MDI and spacer, and 11.4% (5.0%) with the DPI. Bronchodilatation achieved by the patients was similar with all three techniques. Mean peripheral lung deposition was significantly greater with a spacer device than when the MDI was used alone in both normal subjects (49.4% (6.1%) v 44.1% (9.9%)) and patients (38.6% (11.1%) v 30.4% (9.4%)). CONCLUSIONS--The deposition of directly labelled salbutamol from an MDI is greater than previously estimated by indirect labelling techniques. The deposition of labelled salbutamol from a DPI, however, is little different from that measured by indirect techniques.

Value of pulse oximetry in screening for long-term oxygen therapy requirement.

Pulse oximetry, combined with spirometry, was evaluated as a method of selecting chronic obstructive pulmonary disease (COPD) out-patients requiring definitive arterial blood gas analysis for long-term oxygen therapy (LTOT) assessment. A relatively high screening arterial oxygen saturation by pulse oximetry (SaO2) level was set, in order to maximize sensitivity. All 113 COPD out-patients attending the hospital clinic over a 6 month period were screened. Sixty had a forced expiratory volume in one second < 1.5 l and 26 had an SaO2 < or = 92%. These 26 underwent arterial blood gas analysis. Nine had an arterial oxygen tension < 7.3 kPa all with an arterial carbon dioxide tension (PaCO2) > 6 kPa. A further eight had a PaO2 < 8 kPa. This produced a sensitivity of 100% and specificity of 69% for oximetry in the detection of PaO2 < 7.3 kPa determined by direct arterial puncture and 100% and 86% respectively for detecting a PaO2 < 8 kPa. Although the poor specificity of oximetry in the crucial PaO2 range makes it unsuitable, when used alone, for prescription of LTOT, it may prove valuable in selecting patients who require further definitive arterial blood gas analysis.