The optimum duration of anticoagulation following idiopathic deep venous thrombosis and pulmonary embolism is controversial. The JRCPE is delighted to publish a debate written by three international experts. Dr Shetty and Dr Campbell recommend that three months' anticoagulation is sufficient, while Professor Hyers recommends anticoagulation for longer than three months.

The syndrome of acute respiratory failure now recognized widely as the adult respiratory distress syndrome (ARDS) has been known since World War I. It was first described as a type of acute respiratory failure that occasionally followed thoracic trauma. In reports around the time of World War II, the syndrome was identified in conjunction with severe trauma that again was usually sustained in wartime [1, 2]. In 1967, Ashbaugh and colleagues [3] first gave the syndrome a coherent framework in a clinical description of 12 patients. The mortality rate rose 58% in their patients. At that time it appeared that the majority of patients succumbed from respiratory failure or from complications directly related to it. Since that time, a number of studies have looked at survival associated with the syndrome, and all have reported a significant mortality rate ranging between 40 and 70%. Several studies have also looked at predictors of survival or mortality. The purpose of this chapter is to give information relative to the current epidemiology of ARDS. This information will include a current definition of the syndrome, discussion of clinical risk factors, complications and outcome.

This article reviews the actions of various antithrombotic agents that are useful for the treatment of established venous thromboembolic disease. Heparin and coumarin are detailed.

We sought to determine if biofeedback could reduce weaning time for the hard-to-wean patient by improving important weaning factors that are not effectively dealt with by present weaning methods. These include respiratory muscle electromyograph (EMG) efficiency, respiratory drive, and the anxiety of the ventilator-dependent patient. After the patient had received mechanical ventilation for 7 days and the day weaning began (start), the patient was randomly assigned to biofeedback or to the control group. There were 20 patients assigned to each group, with mean ages of 60.2 (biofeedback) and 59.3 (control) yr. The patients assigned to the biofeedback group received daily, until extubation or being placed on no resuscitation status (termination), frontalis electromyographic (EMG) relaxation feedback for anxiety reduction and improved respiratory muscle EMG efficiency, tidal volume/diaphragm EMG (VT/DAP), and VT feedback for increasing VT and respiratory drive defined as tidal volume/inspiratory time (VT/TI). The control group was visited daily to control for attention and reassurance. The results showed a significant (p less than 0.01) reduction in mean ventilator days for the biofeedback group of 20.6 +/- 8.9 SD compared with 32.6 +/- 17.6 SD mean days for the control group. From start to termination, there was a significant (p less than 0.01) increase in baseline VT, from 295 +/- 41 to 415 +/- 45 ml, and a significant (p less than 0.02) increase in VT/DAP, from 0.33 +/- 0.09 to 0.94 +/- 0.22 L/mV for the biofeedback group but no significant change in these parameters for the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

During the last 25 years, there has been much progress in the diagnosis, treatment, and prevention of venous thromboembolic disease. The guest editor believes that a great deal remains to be done and attempts, in this article, to outline some of the challenges remaining by developing themes put forth by the various authors of this issue.

We have demonstrated a small but statistically significant decrease in forced vital capacity and in pulmonary flow rates among 126 persons studied daily for the first three days after arrival at an altitude of 2,835 meters (9,300 ft). Nearly half of these individuals had symptoms attributable to altitude sickness, and those with the most dyspnea and worst headache also showed the greatest changes in pulmonary function studied. We suggest that there is a relationship between the symptoms of altitude sickness and pulmonary function consistent with the appearance of early interstitial or alveolar edema.