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Thoracic Medicine

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Sleep Medicine

Latest News

The severity of obstructive sleep apnoea can contribute to high blood pressure in patients despite treatment with antihypertensive medications

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The Wall Street Journal reported recently on the topic of sleep deprivation as to which cities around the World are the most and least sleep deprived. Brisbane leads the way with the earliest bed time and earliest wake up time.

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According to new research, risk of being obese by age 21 was 20 percent higher among 16-year-olds who got less than six hours of sleep a night, compared with their peers who slumbered more than eight hours.

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As we get older there is a strong relationship between reduced amount and quality of sleep. Recent research has found specific cluster of neurons that have linked insomnia and more sleep fragmentation. The reduction of these neurons can be from normal aging but has also been seen in Alzheimers disease.

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A bedtime routine might sound like something that's only necessary for the grade-school set, but following a nightly schedule can greatly improve the sleep of adults, too. Sleep experts recommend establishing a bedtime routine, both to calm and relax you as you get ready to sleep and so you aren't inadvertently giving yourself jet lag.

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Researchers at NYU Langone Medical Center and elsewhere, using a mouse model, have recorded the activity of individual nerve cells in a small part of the brain that works as a "switchboard," directing signals coming from the outside world or internal memories. Because human brain disorders such as schizophrenia, autism and post-traumatic stress disorder typically show disturbances in that switchboard, the investigators say the work suggests new strategies in understanding and treating them.

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Chronic Obstructive Pulmonary Disease (COPD)

COPD

Chronic Obstructive Pulmonary Disease is a broad term to define airflow limitation that is not reversible. A patient usually has a component of emphysema, chronic bronchitis or a combination of the two. Diagnosis, analysis and treatment of COPD requires a range of professional medical services; including Medical Imaging, Pathology and Lung Function testing.

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Medical Imaging

pathology

Pathology

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Lung Function

 

Medical Imaging

Chest x-rays and CT scans are imaging studies that are commonly performed in patients with COPD; however, neither is required to diagnose COPD.

Chest x-rays — Plain chest x-rays have poor sensitivity for detecting COPD. COPD is identifiable on chest x-rays in only around 50% of patients with COPD.  Some features on x-rays that can be found (often in advanced disease) include:

  • Rapidly tapering vascular shadows, increased radiolucency of the lung, a flat diaphragm, and a long, narrow heart shadow on a frontal radiograph, accompanied by a flat diaphragmatic contour and an increased retrosternal airspace on a lateral radiograph. These findings are due to hyperinflation.

     

 



  • Bullae, defined as radiolucent areas larger than one centimeter in diameter and surrounded by arcuate hairline shadows. They are due to locally severe disease, and may or may not be accompanied by widespread emphysema. (See right)

 
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A C.T. Scan showing Lung Bullae




  • Prominent hilar vascular shadows and encroachment of the heart shadow on the retrosternal space. The cardiac enlargement may become evident only on comparison with previous chest radiographs. These findings are due to pulmonary hypertension and cor pulmonale, which can be secondary to COPD.

 
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Prominent Hilar Vascular Shadows



Computerised tomography — Emphysema can often be diagnosed through computed tomography (CT), but not chronic bronchitis or asthma.  High resolution CT has an even greater sensitivity and specificity for emphysema diagnosis than normal CT or plain chest x-ray.  CT can be used to determine the location and type of emphysema (centriacinar or panacinar). CT plays an important role in evaluating emphysematous patients for lung volume reduction surgery.

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Pathology

Arterial Blood Gases - Arterial blood gases are a blood test using blood taken from an artery, most commonly drawn from the wrist. Thie blood test can reveal mild or moderate hypoxemia without hypercapnia in patients with mild COPD. Hypomemia is the partial pressure decrease of oxygen in blood, decreased oxygenation in the blood is a serious condition leading to blacking out, inefficient bodily function and eventually premature death. As the disease progresses, the hypoxemia becomes more severe and hypercapnia develops.  Hypercapnia is where there is a high level of carbon dioxide in the blood, this usually causes a reflex causing increased respiration to increase oxygen and decrease carbon dioxide levels.. Hypercapnia occurs with increasing frequency as the forced expiratory volume in one second (FEV1) falls below one litre, the amount of air exhaled in one second. Blood gas abnormalities worsen during acute exacerbations and may also worsen during exercise and sleep.

Lung Function

Spirometry is the "Gold Standard" in diagnostic testing of COPD. Spirometry is a very simple test and measure inhalation and exhalation volumes of a patients breath. In COPD FEV1/FVC ratio should be below 0.7. This figure is determined from a vast number of studies which have tested lung function in healthy patient and then compared the results to patients confirmed to have COPD. The studies will compare data on sexes, ages and various other demographic variables to identify a range of "normal" functioning.

 

  • The patient with COPD has reduced peak expiratory flow, and severely decreased flows at 25%, 50% and 75% of vital capacity compared with the normal range (vertical bars), and shows minimal response to bronchodilator (BD). By comparison, the patient with chronic asthma shows incomplete, but substantial, reversibility of expiratory flow limitation across the range of vital capacity. After BD the forced expiratory volume in one second (FEV1) was within the normal range (82% predicted). Absolute and per cent predicted values for FEV1 and forced vital capacity (FVC) before and after BD are shown for each patient.

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The Wesley Lung Function Laboratory offers state-of-the-art lung function testing, including spirometry. More information on the Lab, lung function testing, lung conditions and our services can be found HERE.

Alternatively you can download our Educational Brochure about COPD below:

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Chronic Obstructive Pulmonary Disease (722KB)


Click HERE to download a referral form, these can be used by patients and doctors.

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