A systematic review of the effects of bronchodilators on exercise capacity in patients with COPD

One of the major goals of bronchodilator therapy in patients with COPD is to decrease airflow limitation in the airways and, as a consequence, improve dyspnea and exercise tolerance. The focus of this systematic review is to assess the effects of treatment with beta-agonists, anticholinergics, and theophyllines on dyspnea, and steady-state and incremental exercise capacity. Thirty-three, double-blind, randomized, placebo-controlled studies written in English were selected. This review shows that approximately half of the studies showed a significant effect of bronchodilator therapy on exercise capacity. Anticholinergic agents have significant beneficial effects in the majority of studies, especially when measured by steady-state exercise protocols. There is a trend toward a better effect of high-dose compared to low-dose anticholinergics. Short-acting beta(2)-mimetics have favorable effects on exercise capacity in more than two thirds of the studies; surprisingly, the situation is less clear for long-acting beta(2)-agents. The majority of the results of the published reports on theophyllines and their effects on exercise are negative. Direct comparisons of different classes of bronchodilators have not been made in a sufficient number of studies for a rational preference. The addition of a second bronchodilator has no proven advantage for improving exercise test results, but this has not been studied extensively and not in sufficiently large studies. The majority of studies reporting a measure of dyspnea found improvements, even in the absence of improvement in exercise capacity.     

Vascular lesion of the masseter presenting with phlebolith.

When evaluating an intramuscular soft tissue mass, a large differential diagnosis including both benign and malignant lesions must be considered. Because the treatment of these masses can range from simple observation to radical surgical excision, a minimally invasive but accurate method of diagnosis is desired. The workup should include radiographic imaging. MRI is the modality of choice for differentiating soft tissue lesions, although CT may be helpful in identifying calcifications such as a phlebolith. Although usually unnecessary, a sialogram can verify that a calcification lies within or outside the salivary ductal system. In most cases a biopsy specimen is required to confirm the diagnosis. However, if the imaging studies show characteristics consistent with a vascular soft tissue mass, the finding of a phlebolith is pathognomonic for a benign vascular lesion. If such a lesion is not causing significant cosmetic or functional disability, it can be observed without the need for invasive biopsy or treatment.     

Lung health among boilermakers in Edmonton,Alberta

Background Construction boilermakers may be exposed to a variety of substances, including asbestos and welding fumes. Past studies of boilermakers have shown increases in mortality from lung cancer and asbestosis and radiographic changes consistent with asbestos exposure. Methods Respiratory symptoms, lung function, and radiographic changes were compared for 102 actively employed boilermakers with 20 or more years of union membership and 100 telephone workers. Posteroanterior chest radiographs were evaluated by two experienced chest physicians, with a third arbitrating disagreed films. Union members were further categorized as boilermakers (n = 50) or welders (n = 52), based on longest service. Lung health was also compared with employment in a number of work sectors for time, and time-weighted exposure to dust and fumes. Results Boilermakers had more respiratory symptoms than telephone workers, but lung function did not differ. Radiographic changes were more common among the boilermakers (20% with any change, 8% circumscribed, and 9% diffuse pleural thickening). None of the boilermakers had small radiographic opacities. Several symptoms suggestive of bronchial responsiveness were associated with fume exposures in the gas and oil industry. Workers whose longest service was as a boilermaker demonstrated more symptoms than did welders. FEV₁, FEV₁/FVC, FEF_25–75, and FEF₅₀ were significantly lower among boilermakers compared with welders. Conclusion Health screening programs for these workers are warranted. Am. J. Ind. Med. 34:381–386, 1998. © 1998 Wiley-Liss, Inc.     

Beitrag zur Frage der Nephrogenen Toxine

Zusammenfassung Die VersucheBrückes und seiner Mitarbeiter werden bestätigt. Es wird gezeigt, daß bei Einleitung des Harns einer Niere in den großen Kreislauf nicht nur die Rest-N- bzw. Harnstoffwerte im Blute ansteigen, sondern auch die Indican- und Xanthoproteinreaktion im Blute — als die echte Urämie kennzeichnende Reaktionen — stark positiv ausfallen. Bei Einleitung des Harns einer Niere in die Pfortader kommt es ebenfalls zur Urämie. Die Lebensdauer dieser Tiere ist aber etwas länger als jener mit Einleitung in die Vena iliaca. Die Leber vermag also die toxischen Substanzen des Urins nur kurze Zeit abzufangen. Die histologische Untersuchung ergibt starke Leber- und Nierenverfettung; bezüglich der Leberverfettung hat sich kein Unterschied finden lassen, ob die Einleitung des Harnes in die Vena iliaca oder Vena portae erfolgte. Durch Behandeln mit Tierkohle verliert der Harn im akuten Versuch an Giftigkeit.     

A reproducibility study of corpus cavernosum electromyography in young healthy volunteers under controlled conditions

IntroductionAlthough the corpus cavernosum electromyography (CC‐EMG) has been studied already for 16 years, doubts regarding its reproducibility have remained.AimTo assess the reproducibility of CC‐EMG under controlled conditions and the influence of confounding factors.MethodsThree CC‐EMG recording sessions were performed in 13 healthy young men under the same conditions. Furthermore, the effects of potentially confounding factors, such as intake of caffeine, alcohol and smoking, and sexual activity, were investigated in the same population. Using auto‐ and cross‐correlation techniques, CC‐potentials were characterized with parameters amplitude (A), duration (D), dominant frequency (DF), maximum cross‐correlation coefficient of longitudinal and bilateral CC‐potential pairs (Rmax‐lon. and Rmax‐bi.), and propagation velocity (PV).Main Outcome MeasuresComparison of CC‐EMG parameters A, D, DF, Rmax‐lon., and Rmax‐bi. between three recording sessions and assessment of the impact of confounding factors on these parameters.ResultsDF, D, A, and Rmax‐lon. showed significant correlations among three sessions; PV showed significant correlations between two sessions performed within the same day but not between those performed on different days; Rmax‐bi. did not show significant correlations between any two sessions. Intake of caffeine, alcohol, and smoking did not affect CC‐potentials, while the recordings shortly after ejaculation showed more irregular oscillations and less CC‐potentials with smaller A.ConclusionsCC‐potential parameters DF, D, A, and Rmax‐lon. have been demonstrated to be reproducible. The results provide a basis for the clinical and scientific application of CC‐EMG. CC‐potentials are not sensitive to confounding factors such as intake of caffeine, alcohol, and smoking, while measurements shortly after ejaculation should be avoided. Jiang X, Holsheimer J, Wagner G, Mulders P, Wijkstra H, and Meuleman E. A reproducibility study of corpus cavernosum electromyography in young healthy volunteers under controlled conditions. J Sex Med 2007;4:183–190.