Is macroturbulence in OB Sgs related to pulsations?

As part of a long term observational project, we are investigating the macroturbulent broadening in O and B supergiants (Sgs) and its possible connection with spectroscopic variability phenomena and stellar oscillations. We present the first results of our project, namely firm observational evidence for a strong correlation between the extra broadening and photospheric line-profile variations in a sample of 13 Sgs with spectral types ranging from O9.5 to B8.Comment: 2 pages, 1 figure. Poster contribution to the proceedings of the IAU272 "Active OB stars: structure, evolution, mass loss and critical limits

Controlled expiration in patients with chronic obstructive pulmonary disease on ventilatory support

Chronic respiratory failure develops over the years in many patients with chronic obstructive pulmonary disease (COPD). During exacerbations of COPD the gas-exchange is known to deteriorate in these patients. This acute-on-chronic respiratory failure may ultimately lead to hypercapnic coma. Mechanical ventilation has to be applied to maintain gas-exchange. As this treatment does not affect the pathophysiological mechanisms leading to the respiratory failure, mechanical ventilation can only be considered as rescue therapy. Altered respiratory mechanics associated with COPD may hamper ventilatory support. For the same reasons weaning from the ventilator is considered to be a cumbersome process, in many patients requiring long-tenn ventilatory support. These altered respiratory mechanics can be elucidated in tenns of elastic recoil of the lung and airways resistance. In this chapter these features will be described with emphasis on spontaneous breathing as well as mechanical ventilation. Adaptations of equipment used for ventilatory support and weaning purposes that may improve ventilation and gas-exchange in COPD, will be reviewed. Finally an outline of the investigations described in this thesis will be given. The popUlation of patients that is the subject of this thesis consists of those who are suffering from severe chronic airways obstruction in whom loss of elasticity of lung tissue may be present. Though COPD may not be the exactly right nomenclature for the condition present in all of those patients, it was applied to all patients because destruction of elastic tissue of a minor degree is difficult to demonstrate or exclude in a living person

A Patient with Four-Year Survival after Nonsmall Cell Lung Carcinoma with a Solitary Metachronous Small Bowel Metastasis

Solitary small bowel metastasis secondary to lung cancer is very uncommon. In this report, we present a patient with NSCLC and a metachronous solitary metastasis of the jejunum. She is alive without evidence of disease and doing well four years after palliative surgery, radiotherapy, and chemotherapy. To the best of our knowledge, this is the first case report describing a prolonged survival in a patient with a symptomatic solitary small bowel metastasis treated with palliative surgery, chemo- and radiotherapy instead of complete surgical resection

Controlled expiration in mechanically-ventilated patients with chronic obstructive pulmonary disease (COPD)

In patients with severe chronic obstructive pulmonary disease (COPD), lung emptying may be affected by flow limitation. We tested the hypothesis that the airway compression leading to flow limitation can be counteracted by controlling the expiratory flow. The effects of an external resistor on lung emptying were studied in six patients with COPD, who were mechanically ventilated whilst sedated and paralysed. Respiratory mechanics were obtained during ventilatory support with and without the resistor. Airway compression was assessed using the interruptor method. For the study, a turbulent resistor was applied with the highest resistance level that did not increase the end-expiratory lung volume. At this resistance level, external positive end-expiratory pressure (PEEP) was generated in all patients. As total PEEP levels remained unchanged at both settings during the controlled expiration, the levels of intrinsic PEEP were significantly decreased from 0.96+/-0.30 to 0.53+/-0.19 kPa (mean+/-SD). Comparison of the expiratory flow-volume curves at both settings revealed that, during the controlled expiration, the flows were significantly decreased during the first 40% of the expired volume and significantly increased during the last 60%. As the end-expiratory lung volumes remained unchanged during both settings, these increments in flow indicated a decrease in effective resistance. Airway compression was observed during unimpeded expirations in all patients using the interruptor method. During the application of the resistor, airway compression was no longer detectable. In patients with chronic obstructive pulmonary disease receiving ventilatory support, the application of an external resistor could decrease effective expiratory resistance by counteracting airway compression, without increments in end-expiratory lung volume

Improving lung cancer survival; time to move on

Background: During the past decades, numerous efforts have been made to decrease the death rate among lung cancer patients. Nonetheless, the improvement in long-term survival has been limited and lung cancer is still a devastating disease.Discussion: With this article we would like to point out that survival of lung cancer could be strongly improved by controlling two pivotal prognostic factors: stage and treatment. This is corresponding with recent reports that show a decrease in lung cancer mortality by screening programs. In addition, modulation of the patient's immune system by immunotherapy either as monotherapy or combined with conventional cancer treatments offers the prospect of tailoring treatments much more precisely and has also been shown to lead to a better response to treatment and overall survival of non-small cell lung cancer patients.Summary: Since only small improvements in survival can be expected in advanced disease with the use of conventional therapies, more research should be focused on lung cancer screening programs and patient tailored immunotherapy with or without conventional therapies. If these approaches are clinically combined in a standard multidisciplinary policy we might be able to advance the survival of patients with lung cancer