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CPAP offers benefits in heart failure
Residual
CPAP offers benefits in heart failure ontinuous
positive airway pres(CPAP) seems to improve heart function in patients with cardiovascular disease and sleep
sure apnoea.
Douglas Bradley, associate professor of medicine at the University of Toronto, and colleagues, studied 17 men with congestive heart failure (CHF) and sleep apnoea. Nine received CPAP nightly for 6 h over a 3-month period; the 8 controls CPAP greatly did not. "The overall heart function, as improved measured by the left ventricle ejection fraction [LVEF]," said Bradley. in the treated LVEF group increased from 24% (SEM 4) to in 3 months. The 32-6 (6-6) (p<0.02)
corresponding values in the control group were 20-6% (3-2) and 19-5 (2-8) (Am J Resp Crit Care Med 1996; 153: 277-82). Respiratory muscle strength also showed improvement when measured by changes in maximum
The Toronto researchers say as many as 40% of heart failure patients have sleep apnoea, compared with 6% of people who have not had heart failure. At least one research centre in the USA and another in Europe have also found sleep apnoea in 40-50% of CHF
should still be included in the differential diagnosis in a patient with convincing signs and symptoms of appendicitis even if he has had a laparoscopic appendicectomy warn A A Milne and A W Bradbury (Br J Surg 1996; 83: 217), adding that open surgery should not be delayed. They describe a man who presented 18 months after laparoscopic appendicectomy with typical features of appendicitis. Laparotomy revealed copious purulent peritoneal fluid and an inflamed, perforated appendiceal stump. Milne and Bradbury cite another report of residual appendicitis and point out that the complication is avoidable if the base is clearly identified. Otherwise residual appendicitis is not surprising, they say, since with conservative management of acute appendicitis, there is a 35% chance of
patients.
recurrence.
Mark
Vivien Choo
inspiratory and expiratory pressures (MIP and MEP). Among the CPAP group, MIP increased from 79-3 (SEM 8-1) to 90-7 (10-4) cm H2O (p<0.02), whereas among the controls MIP was 69.8 (7-5) at baseline and 65-8 (7-5) after 3 months. "The most important and novel finding of our study was that nightly administration of CPAP to patients with CHF and central sleep apnoea resulted in improved inspiratory muscle strength as evidenced by an increase in MIP",
they wrote.
Quinn
Dutch report calls for standard definition of
Pcalculating oor hearing, life-years,
a
factor used for
disability-adjusted
affects about 10% of the Dutch population, according to a TNO (the Dutch network of research institutes) report commissioned by the Minister of Public Health. Only one in three people with impaired
hearing
uses a
hearing-aid. Many
are
that such an appliance The main conclusion of help. might the report is that there are no not
aware
appendicitis
A ppendicitis
hearing impairment
international definitions of hearing impairment or codes for classifying the disorder. The report is a review of surveys, some based on objective audiometric measurements and others on self assessments. The TNO researchers, A M J Chorus, A Kremer, W J Oortwijn, and K Schaapveld, had thought that objective measurements would be preferable but found that
but more data are needed before preventive measures can be defined. In a survey of the general working population, 250 000 to 350 000 people claimed to have impaired hearing. But are these complaints taken any further? Hospital and clinic records indicate that in 1 year hearing impairment is the main diagnosis at admission into hospital on 1300 occasions, and the reason for 40 000 outpatient
subjective
treatments.
assessments
corresponded
better
with
social
impact. The researchers that estimate between 675000 and 1-3 million people (4-5 to 11-4% of the general population) have a hearing
impairment (panel). A difficulty was the absence of reliable data for the 20-60 age-group, years whereas babies, schoolchildren, and conscripts are tested routinely. Some surveys related severe hearing loss to use of personal stereo
headphones sure
to
or
Audiological
centres treat
about 30 000 people annually. The report also says that since a large survey in 1990, the number of hearingimpaired students has risen. Without a standard definition, international comparisons are difficult, but the prevalence of impairment among those aged above 15 years is in keeping with information from other countries, as is the rise in prevalence with age among the
elderly. The TNO researchers have suga follow-up of their study, to primarily on the social conseof hearing impairment. quences Comparison with data form other
gested focus
countries would also be desirable. Quality of life, of which hearing is an element, is a European Union research priority.
expo-
loud music
Marjanke Spanjer
385
CPAP offers benefits in heart failure ontinuous
positive airway pres(CPAP) seems to improve heart function in patients with cardiovascular disease and sleep
sure apnoea.
Douglas Bradley, associate professor of medicine at the University of Toronto, and colleagues, studied 17 men with congestive heart failure (CHF) and sleep apnoea. Nine received CPAP nightly for 6 h over a 3-month period; the 8 controls CPAP greatly did not. "The overall heart function, as improved measured by the left ventricle ejection fraction [LVEF]," said Bradley. in the treated LVEF group increased from 24% (SEM 4) to in 3 months. The 32-6 (6-6) (p<0.02)
corresponding values in the control group were 20-6% (3-2) and 19-5 (2-8) (Am J Resp Crit Care Med 1996; 153: 277-82). Respiratory muscle strength also showed improvement when measured by changes in maximum
The Toronto researchers say as many as 40% of heart failure patients have sleep apnoea, compared with 6% of people who have not had heart failure. At least one research centre in the USA and another in Europe have also found sleep apnoea in 40-50% of CHF
should still be included in the differential diagnosis in a patient with convincing signs and symptoms of appendicitis even if he has had a laparoscopic appendicectomy warn A A Milne and A W Bradbury (Br J Surg 1996; 83: 217), adding that open surgery should not be delayed. They describe a man who presented 18 months after laparoscopic appendicectomy with typical features of appendicitis. Laparotomy revealed copious purulent peritoneal fluid and an inflamed, perforated appendiceal stump. Milne and Bradbury cite another report of residual appendicitis and point out that the complication is avoidable if the base is clearly identified. Otherwise residual appendicitis is not surprising, they say, since with conservative management of acute appendicitis, there is a 35% chance of
patients.
recurrence.
Mark
Vivien Choo
inspiratory and expiratory pressures (MIP and MEP). Among the CPAP group, MIP increased from 79-3 (SEM 8-1) to 90-7 (10-4) cm H2O (p<0.02), whereas among the controls MIP was 69.8 (7-5) at baseline and 65-8 (7-5) after 3 months. "The most important and novel finding of our study was that nightly administration of CPAP to patients with CHF and central sleep apnoea resulted in improved inspiratory muscle strength as evidenced by an increase in MIP",
they wrote.
Quinn
Dutch report calls for standard definition of
Pcalculating oor hearing, life-years,
a
factor used for
disability-adjusted
affects about 10% of the Dutch population, according to a TNO (the Dutch network of research institutes) report commissioned by the Minister of Public Health. Only one in three people with impaired
hearing
uses a
hearing-aid. Many
are
that such an appliance The main conclusion of help. might the report is that there are no not
aware
appendicitis
A ppendicitis
hearing impairment
international definitions of hearing impairment or codes for classifying the disorder. The report is a review of surveys, some based on objective audiometric measurements and others on self assessments. The TNO researchers, A M J Chorus, A Kremer, W J Oortwijn, and K Schaapveld, had thought that objective measurements would be preferable but found that
but more data are needed before preventive measures can be defined. In a survey of the general working population, 250 000 to 350 000 people claimed to have impaired hearing. But are these complaints taken any further? Hospital and clinic records indicate that in 1 year hearing impairment is the main diagnosis at admission into hospital on 1300 occasions, and the reason for 40 000 outpatient
subjective
treatments.
assessments
corresponded
better
with
social
impact. The researchers that estimate between 675000 and 1-3 million people (4-5 to 11-4% of the general population) have a hearing
impairment (panel). A difficulty was the absence of reliable data for the 20-60 age-group, years whereas babies, schoolchildren, and conscripts are tested routinely. Some surveys related severe hearing loss to use of personal stereo
headphones sure
to
or
Audiological
centres treat
about 30 000 people annually. The report also says that since a large survey in 1990, the number of hearingimpaired students has risen. Without a standard definition, international comparisons are difficult, but the prevalence of impairment among those aged above 15 years is in keeping with information from other countries, as is the rise in prevalence with age among the
elderly. The TNO researchers have suga follow-up of their study, to primarily on the social conseof hearing impairment. quences Comparison with data form other
gested focus
countries would also be desirable. Quality of life, of which hearing is an element, is a European Union research priority.
expo-
loud music
Marjanke Spanjer
385