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Pulmonary Function (pulmonary + function)
Terms modified by Pulmonary Function Selected AbstractsPulmonary Function and Ventilatory Limitation to Exercise in Congenital Heart DiseaseCONGENITAL HEART DISEASE, Issue 1 2009Paolo T. Pianosi MD ABSTRACT Pulmonary function in older children and adolescents following surgical repair of congenital heart disease is often abnormal for various reasons. Many of these patients report symptoms of exercise intolerance although the reason(s) for this symptom can be complicated and sometimes interrelated. Is it simply deconditioning due to inactive lifestyle, chronotropic or inotropic insufficiency? or could there indeed be ventilatory limitation to exercise? These are the questions facing the clinician with the increasing frequency of patients undergoing repair early in life and growing into adulthood. Understanding pulmonary functional outcomes and means of determining ventilatory limitation to exercise is essential to thoroughly address the problem. This article reviews pulmonary function in patients with congenital heart disease and then describes a newer technique that should be applied to determine ventilatory limitation to exercise. [source] Osteoporosis-Related Kyphosis and Impairments in Pulmonary Function: A Systematic Review,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2007Robyn A Harrison Abstract We conducted a systematic review to examine the relationship between osteoporotic vertebral fractures, kyphosis, and pulmonary function. Findings suggest modest but predictable declines in vital capacity related to the degree of kyphosis. However, there were only four studies, and all had significant methodologic limitations. Further high-quality research is needed. Introduction: Our objective was to systematically review the extent to which osteoporosis-related vertebral fractures and kyphosis affect pulmonary function. Materials and Methods: We used a literature search from 1966 to 2006 (using Medline, EMBASE, and hand searches of references) for studies examining pulmonary function in patients without known lung disease who had vertebral fractures or kyphosis secondary to osteoporosis. Two reviewers independently abstracted data. Heterogeneity precluded formal meta-analysis. Results: Initial searches yielded 453 articles. After applying eligibility criteria, only four case-control studies of limited quality (e.g., only one study was blinded) remained. Since 1966, only 109 patients (6 men) have been studied. All four studies reported reductions in vital capacity (VC), with values ranging from 68% to 94% of predicted values. This was quantified as a 9% reduction in predicted VC per vertebral fracture in one study. The degree of kyphosis clinically (one study) or radiographically (three studies) correlated with declines in VC; impairments were most notable at kyphotic angles >55°. Statistically significant differences in percent predicted VC were obtained only when arm span or recalled height, rather than measured height, was used (two studies). Conclusions: Despite conventional teaching, the evidence relating osteoporotic vertebral fractures or kyphosis to pulmonary function is limited. On the basis of available studies, declines in VC secondary to kyphosis seem modest and directly related to the number of vertebral fractures or degree of kyphosis. Future studies need longitudinal follow-up of larger numbers of men and women, appropriate proxies for height, standardized measures for pulmonary function and kyphosis, and efforts to blind outcomes ascertainment. [source] Pulmonary Function After Pectoralis Major Myocutaneous Flap HarvestTHE LARYNGOSCOPE, Issue 3 2002FACS, Yoav P. Talmi MD Abstract Objective The pectoralis major myocutaneous flap is widely used in the reconstruction of surgical defects in the head and neck region. Pulmonary atelectasis has been reported in patients undergoing these procedures, and many of these patients are heavy smokers and drinkers and have associated cardiopulmonary disorders. Flap harvest and donor site closure may lead to impairment of pulmonary function before and after the use of pectoralis major myocutaneous (PMC) in surgical reconstruction in patients with cancer of the head and neck. Methods Patients undergoing extirpation of head and neck tumors with PMC reconstruction were prospectively evaluated. Patient age, smoking history (pack-years), anesthesia duration, percentage predicted pre- and postoperative FEV1, percentage-predicted pre- and postoperative FVC (forced vital capacity), and preoperative SaO2 (oxygen saturation) were evaluated. Preoperative FEV1/FVC ratio was calculated. Chest x-rays were reviewed. Results Only 11 patients, 5 of whom smoked, could be evaluated postoperatively. Preoperative FEV1/FVC was more than 70 and FEV1 more than 75% predicted in all patients. A decrease in FVC was observed in 7 of the 11 patients, which ranged between 2% and 27% without any clinically obvious respiratory manifestations. A baseline SaO2 of more than 96% was noted in all patients. Four of 9 postoperative chest x-rays demonstrated atelectasis. Conclusions PMC harvest and donor site closure may lead to the recorded decrease in FVC measurements. These changes did not manifest clinically. Nevertheless, alternative methods of surgical defect closure should be considered in patients with severe preexisting pulmonary disorders. [source] Pulmonary Function and Ventilatory Limitation to Exercise in Congenital Heart DiseaseCONGENITAL HEART DISEASE, Issue 1 2009Paolo T. Pianosi MD ABSTRACT Pulmonary function in older children and adolescents following surgical repair of congenital heart disease is often abnormal for various reasons. Many of these patients report symptoms of exercise intolerance although the reason(s) for this symptom can be complicated and sometimes interrelated. Is it simply deconditioning due to inactive lifestyle, chronotropic or inotropic insufficiency? or could there indeed be ventilatory limitation to exercise? These are the questions facing the clinician with the increasing frequency of patients undergoing repair early in life and growing into adulthood. Understanding pulmonary functional outcomes and means of determining ventilatory limitation to exercise is essential to thoroughly address the problem. This article reviews pulmonary function in patients with congenital heart disease and then describes a newer technique that should be applied to determine ventilatory limitation to exercise. [source] Original Article: Pulmonary function, airway cytology and bronchoalveolar lavage fluid drug concentration after aerosol administration of cefquinome to horsesEQUINE VETERINARY EDUCATION, Issue 9 2010T. Art Summary The administration of antibiotics by aerosol to horses suffering from respiratory infections may partially circumvent the limitations of antimicrobial therapy, e.g. large injection volumes, low bioavailability and risk of diarrhoea. Only injectable formulations are available currently and usually contain other substances that could irritate the mucosa and induce coughing and bronchospasm. In addition, the quality of the aerosol, particularly in terms of the delivery of antibiotics to the deep parts of the lung, is unknown. Although used under field conditions, cefquinome delivered by aerosol has never been studied in horses. This study examined the safety of cefquinome injectable solution, administered by aerosol at a dose of 225 mg/inhalation to 7 healthy horses, by assessing (1) pulmonary function before and 15 min after a single inhalation, at the first day (Day 1) and the fifth day (Day 5) of a 5 day period treatment; and (2) the inflammatory status of the lung, i.e. percentage neutrophils and myeloperoxidase concentration, based on bronchoalveolar lavage (BAL) at D1 and D5. In addition, cefquinome concentrations were measured in bronchoalveolar lavage fluid after aerosol, intravenous (i.v.) and intramuscular (i.m.) administrations. A single aerosol of cefquinome injectable solution did not induce any immediate nor delayed pulmonary side effects in healthy horses and produced cefquinome concentrations in bronchoalveolar lavage (BAL) within 30 min that were higher than the minimal inhibitory concentration of the main equine respiratory pathogens. These results should stimulate further studies, especially in horses suffering from bronchial hyper-reactivity. Aerosol delivery of antibiotics may well have a role in equine therapeutics. [source] Post-discharge health care needs of patients after lung cancer resectionJOURNAL OF CLINICAL NURSING, Issue 17-18 2010Kwua-Yun Wang Aims and objective., To determine the health care needs of patients after surgical resection of lung cancer at discharge and evaluate the significance of factors associated with such needs. Background., Other studies have found that symptom distress level, social supports and health beliefs are associated with health care needs. Design., Sixty-two participants were recruited from a thoracic surgery clinic at a medical centre in Taipei from July,December 2005. Data related to demographic variables, disease characteristics, functional status, symptom distress and social support were collected. Methods., The patients were administered the Karnofsky Performance Scale, the Symptom Distress Scale,Chinese Modified Form, the Social Support Scale (adapted from the Interpersonal Support Evaluation List), the Health Needs Scale and self-reported rating scales for pain. Data were analysed using Pearson's correlation coefficients and linear regression models. Results., Pulmonary function was found to be correlated with the level of need for health care information and physiological care. Self-perceived symptom distress and degree of distress were also correlated with levels of need for information, physiological care and psychosocial care. The level of pain was found to be correlated with the level of need for health care information and physiological care. After controlling for pain level, multivariate analysis revealed that self-perceived symptom severity (p = 0·032) and degree of distress (p = 0·043) were modestly correlated with the need for health care. Conclusions., Pulmonary function, self-perceived symptom distress, degree of distress and level of pain were correlated with the level of need for health care information and physiological care. Self-perceived symptom severity and degree of distress were independent predictors of health care needs. Relevance to clinical practice., Administration of relevant questionnaires to assess postoperative symptom distress may be necessary for optimal disease management. [source] Alcohol Consumption, Lung Function, and Quality of Life in PneumoconiosisALCOHOLISM, Issue 7 2005Wai Kwong Tang Background: To our knowledge, there are no previous data on drinking problems in patients with pneumoconiosis. The aim of this study was to examine drinking patterns and the impact of drinking on lung function and health-related quality of life (HRQOL) in Chinese patients with pneumoconiosis. Methods: Three hundred patients with pneumoconiosis were recruited from a community-based case registry. The HRQOL was measured with the St. George's Respiratory Questionnaire (SGRQ). Pulmonary function, comorbidity, and psychosocial variables were also assessed. The alcohol use of the patients was evaluated with the Alcohol Use Disorders Identification questionnaire. Results: Of the 300 patients, 72.3% (217) reported that they had not consumed any alcohol during the past year, whereas 83 patients (27.7%) did report drinking alcohol. In the drinking group, 88.0% (73) consumed <7 standard drinks per week, and none of them exceeded the safety limit of 21 standard drinks per week. The drinking group (n= 83) was younger, had less concurrent medical diseases, and lower (i.e., better) unadjusted SGRQ symptom, activity, impact, and total scores than the nondrinking group (n= 217). The SGRQ scores, which were adjusted for age, duration of occupation, concurrent medical diseases, smoking status, and forced expiratory volume in 1 sec predicted tests (FEV1%), remained significantly lower for the drinking group. Although the drinking group had a higher unadjusted FEV1% predicted, the difference between the FEV1% of the two groups, after adjustment for covariates, was of borderline significance only. Conclusions: Most Chinese patients with pneumoconiosis in this study did not consume alcohol, and among those who did, the level of alcohol consumption was low. This low level of alcohol consumption was associated with a better HRQOL and possibly with better lung function. [source] Lack of Clinical Efficacy of a Phosphodiesterase-4 Inhibitor for Treatment of Heaves in HorsesJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2006Jean-Pierre Lavoie Phosphodiesterase-4 (PDE 4) enzyme inhibitors have been shown to have anti-inflammatory properties in various animal disease processes and therefore could be effective drugs for the treatment of equine airway diseases. The purpose of this study was to evaluate the efficacy and adverse effects of the PDE 4 inhibitor L-826,141 in horses with heaves. In a blinded parallel design, horses with heaves exposed daily to moldy hay were given a placebo for 14 days and then administered either L-826,141 (n = 6; loading dose of 1 mg/kg IV followed by 0.5 mg/kg IV q48h) or dexamethasone (n = 6; 0.04 mg/kg IV q24h) from days 15 to 29 (study 1). Pulmonary function and bronchoalveolar (BAL) cytology were evaluated weekly from baseline (day 0) to 29 days. In study 2, horses were treated with L-826,141 (1.0 mg/kg IV q24h) for 8 days. Although ex vivo lipopolysaccharide-induced tumor necrosis factor (TNF)-, and LTB4 production by fresh blood were inhibited up to 90% after repeated administrations of L-826,141, this treatment failed to improve lung function. In contrast, dexamethasone (positive control) treatment resulted in significant improvement in lung mechanics and airway function in all horses. Neither drug had a significant effect on BAL total cell counts and differential cytology. Administration of the PDE 4 inhibitor L-826,141 for up to 14 days to horses with heaves was not associated with an improvement in airway function or inflammation. These findings suggest that the PDE 4 enzyme is not a key mediator of lung inflammation in heaves. [source] Pulmonary function in long-term survivors of pediatric hematopoietic cell transplantationPEDIATRIC BLOOD & CANCER, Issue 5 2006Paul A. Hoffmeister MPH Abstract Background The purpose of this study was to determine the prevalence of pulmonary dysfunction in pediatric hematopoietic cell transplant (HCT) survivors and to identify associated risk factors. Procedure In a cross-sectional study, patients surviving at least 5 years after pediatric HCT were requested to undergo pulmonary function testing (PFT). Risk factors for restrictive lung disease (RLD) and obstructive lung disease (OLD) were analyzed using multivariate analysis. Results Among 472 patients contacted, 260 (55%) participated and 215 were selected for analysis. These patients were transplanted at a median age of 8.3 (0.3,18.0) years; 175 for hematologic malignancies and 40 for non-malignant diseases. The preparative regimens for 133 patients included fractionated TBI (FTBI), 29 single-fraction TBI (SFTBI), and 53 non-TBI regimens. PFT was performed at a median of 10 (5.0,27.5) years after HCT. Forty percent of patients had either RLD or OLD (28% RLD, 9% OLD, 3% mixed RLD/OLD) and at least 15% had an isolated low-DLCO. Moderate-to-severe impairment was present in 45% of patients with RLD or OLD. In multivariate analysis, risk factors associated with RLD included transplant regimen, transplant diagnosis, scleroderma/contracture, and donor relation. Patients treated with SFTBI had the highest risk of RLD. Risk factors for OLD included chronic graft-versus-host disease, transplant regimen, and time after HCT. Patients surviving 20 or more years after HCT had the highest risk of OLD. Conclusions Fifty-five percent of long-term pediatric HCT survivors had pulmonary dysfunction. These findings stress the need for long-term follow-up to detect pulmonary dysfunction. Pediatr Blood Cancer 2006; 47:594,606. © 2005 Wiley-Liss, Inc. [source] Outcome of pulmonary function in Lemierre's disease-associated acute respiratory distress syndrome,PEDIATRIC PULMONOLOGY, Issue 4 2007Jill M. Cholette MD Abstract Pulmonary function in acute respiratory distress syndrome (ARDS) survivors typically returns to normal with the exception of a persistent reduction in carbon monoxide diffusion capacity (DLco). Septic thrombophlebitis of the internal jugular vein, (Lemierre's syndrome or postanginal sepsis) is a well-described, albeit uncommon cause of ARDS in which metastatic pulmonary thromboemboli precipitate respiratory failure requiring ventilatory support. We describe convalescent pulmonary function in two survivors of Lemierre's disease-associated ARDS, suggesting that the subset of Lemierre's syndrome induced ARDS survivors have an excellent long-term pulmonary prognosis. Pediatr Pulmonol. 2007; 42:389,392. © 2007 Wiley-Liss, Inc. [source] Effect of dexamethasone therapy on pulmonary function in chronic lung disease: A comparison of disease typesPEDIATRICS INTERNATIONAL, Issue 3 2001Masami Mizobuchi Abstract Background: In the present study, we investigated the effect of dexamethasone (DEX) therapy on extubation and pulmonary function in patients with chronic lung disease (CLD) who required long-term mechanical ventilation. In addition, we compared the effects of DEX therapy among CLD types. Methods: Twenty-two CLD patients who were ventilator dependent for 28 days or longer received DEX therapy for the purposes of extubation. A tapering dose of DEX, starting from 0.5 mg/kg per day, was administered for 7 days. Pulmonary function was measured at initiation of administration and 4 days after initiation. We evaluated static respiratory system compliance (Crs) and static respiratory system resistance (Rrs) adjusted by bodyweight. Chronic lung disease types were categorized according to the classification of the Ministry of Health and Welfare Research Project. We compared the effect of DEX therapy among CLD types. Results: Dexamethasone therapy was started at a mean (±SD) 45±11 days after birth and 32.1±1.3 weeks of postconceptional age in infants with a mean bodyweight of 939±153 g. After DEX therapy, extubation was successful in all 22 patients. Following DEX administration, Crs was significantly increased from 0.69±0.13 to 1.17±0.21 mL/cm H2O per kg. In contrast, Rrs did not show any clear changes. Comparing CLD types, no difference was observed for Crs and Rrs in each disease type. Conclusions: Dexamethasone was administered to CLD patients requiring long-term mechanical ventilation for the purposes of extubation and extubation was successful in all patients. It was found that Crs was increased in all patients following DEX, regardless of CLD type. The increase in Crs following DEX administration may have been related to successful extubation. [source] Combined Pancreatic Islet,Lung Transplantation: A Novel Approach to the Treatment of End-Stage Cystic FibrosisAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2010L. Kessler Patients with end-stage cystic fibrosis (CF) and severe CF-related diabetes (CFRD) may benefit from combined lung-pancreatic islet transplantation. In the present study, we report the long-term follow-up of four end-stage CF patients treated with combined bilateral lung and pancreatic islet transplantation from the same donor. All patients were C-peptide negative (<0.5 ,g/L) and inadequately controlled despite intensive insulin treatment. One patient was transplanted with 4 019 ± 490 islet equivalent/kg injected into the transverse colic vein using a surgical approach. In the remaining three patients, islets were cultured for 3,6 days and transplanted by percutaneous transhepatic catheterization of the portal vein. In all patients, islet allograft recovery was recognized by elevation in the plasma level of C-peptide (>0.5 ,g/L). At 6 months after transplantation, one patient showed multiple episodes of acute lung transplant rejection and a progressive decline in pancreatic islet cell function. Three out of four patients experienced an improved control of glucose levels with a HbA1c of 5.2%, 7% and 6% respectively at 1.5, 2 and 15 years follow-up. Compared with the pretransplant period, there was a 50% reduction in mean daily insulin needs. Pulmonary function remained satisfactory in all patients. In conclusion, our cases series shows that combined bilateral lung and pancreatic islet transplantation may be a viable therapeutic option for patients with end-stage CF and CFRD. [source] Plethysmography and impulse oscillometry assessment of tiotropium and ipratropium bromide; a randomized, double-blind, placebo-controlled, cross-over study in healthy subjectsBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 4 2006D. Singh Aims Spirometry, plethysmography and impulse oscillometry (IOS) measure different aspects of lung function. These methods have not been compared for their ability to assess long- and short-acting anticholinergic agents. We therefore performed a double-blind, placebo-controlled, four-way cross-over study in 30 healthy subjects. Methods Single doses of tiotropium bromide (Tio) 54 and 18 mcg, ipratropium bromide (IB) 40 mcg and placebo were administered. Specific conductance (sGaw), total lung capacity (TLC), inspiratory capacity (IC) and residual volume (RV) were measured using plethysmography, while IOS measured resistance (R5,25) and reactance (RF and X5). Pulmonary function was measured for 26 h post dose. Results Tio caused significant improvements in sGaw, forced expiratory voume in 1 s (FEV1), maximum mid-expiratory flow (MMEF) and R5,R25 at time points up to 26 h, with no clear differences between doses. IB improved the same parameters, but only up to 8 h. The weighted mean change (0,24 h) caused by Tio 54 mcg compared with placebo for FEV1 was 240 ml (95% confidence interval 180, 300), while for sGaw the ratio of geometric means (Tio compared with placebo) was 1.35 (1.28, 1.41). Neither drug caused consistent statistically significant changes in RF, forced vital capacity, TLC or IC over 26 h. RV was significantly improved from 8 to 24 h by Tio 54 mcg only. Conclusions In addition to spirometry, IOS resistance measurements and sGaw can distinguish between the effects of long- and shortacting anticholinergic effects in healthy subjects. [source] Validation of the Clinical COPD Questionnaire as a psychophysical outcome measure in adult laryngotracheal stenosisCLINICAL OTOLARYNGOLOGY, Issue 4 2009S.A.R. Nouraei Objectives:, To validate the Clinical Chronic Obstructive Pulmonary Disease Questionnaire (CCQ), a patient-administered instrument developed for bronchopulmonary disease as a disease-specific psychophysical outcome measure for adult laryngotracheal stenosis. Design:, Prospective observational study. Settings:, Tertiary/National referral airway reconstruction centre. Participants:, Thirty-three tracheostomy-free patients undergoing endoscopic laryngotracheoplasty. Main outcome measures:, CCQ and the Medical Research Council (MRC) Dyspnoea scale, a previously validated but more limited scale, were administered to patients 2 weeks before surgery, preoperatively, and 2 weeks after endoscopic laryngotracheoplasty. Pulmonary function was assessed preoperatively. Internal consistency was assessed with Cronbach , statistics and test,retest reliability was determined using intraclass correlation. Correlations between CCQ and MRC scale, and pulmonary function were used to assess convergent and divergent validity respectively. Instrument responsiveness was assessed by correlating total and domain-specific CCQ scores with anatomical disease severity and post-treatment effect size. Results:, There were 12 males and 21 females. Mean age was 44 ± 15 years. Cronbach , coefficient and intraclass correlation coefficient were 0.88 and 0.95 respectively. Total and domain-specific CCQ scores significantly correlated with the MRC scores (P < 0.001) and significant correlations between CCQ and peak expiratory flow rate and FEV1 were identified (P < 0.03). There were statistically significant changes in total and domain-specific CCQ scores when different stenosis severities were compared. Clinical COPD Questionnaire scores also changed significantly and congruently following surgery (P < 0.05 in both cases). Discussion:, Clinical COPD Questionnaire is a valid and sensitive instrument for assessing symptom severity and levels of function and well-being in adult patients with laryngotracheal stenosis and can be used as a patient-centred disease-specific outcome measure for this condition. [source] Pulmonary Function and Ventilatory Limitation to Exercise in Congenital Heart DiseaseCONGENITAL HEART DISEASE, Issue 1 2009Paolo T. Pianosi MD ABSTRACT Pulmonary function in older children and adolescents following surgical repair of congenital heart disease is often abnormal for various reasons. Many of these patients report symptoms of exercise intolerance although the reason(s) for this symptom can be complicated and sometimes interrelated. Is it simply deconditioning due to inactive lifestyle, chronotropic or inotropic insufficiency? or could there indeed be ventilatory limitation to exercise? These are the questions facing the clinician with the increasing frequency of patients undergoing repair early in life and growing into adulthood. Understanding pulmonary functional outcomes and means of determining ventilatory limitation to exercise is essential to thoroughly address the problem. This article reviews pulmonary function in patients with congenital heart disease and then describes a newer technique that should be applied to determine ventilatory limitation to exercise. [source] Original Article: Pulmonary function, airway cytology and bronchoalveolar lavage fluid drug concentration after aerosol administration of cefquinome to horsesEQUINE VETERINARY EDUCATION, Issue 9 2010T. Art Summary The administration of antibiotics by aerosol to horses suffering from respiratory infections may partially circumvent the limitations of antimicrobial therapy, e.g. large injection volumes, low bioavailability and risk of diarrhoea. Only injectable formulations are available currently and usually contain other substances that could irritate the mucosa and induce coughing and bronchospasm. In addition, the quality of the aerosol, particularly in terms of the delivery of antibiotics to the deep parts of the lung, is unknown. Although used under field conditions, cefquinome delivered by aerosol has never been studied in horses. This study examined the safety of cefquinome injectable solution, administered by aerosol at a dose of 225 mg/inhalation to 7 healthy horses, by assessing (1) pulmonary function before and 15 min after a single inhalation, at the first day (Day 1) and the fifth day (Day 5) of a 5 day period treatment; and (2) the inflammatory status of the lung, i.e. percentage neutrophils and myeloperoxidase concentration, based on bronchoalveolar lavage (BAL) at D1 and D5. In addition, cefquinome concentrations were measured in bronchoalveolar lavage fluid after aerosol, intravenous (i.v.) and intramuscular (i.m.) administrations. A single aerosol of cefquinome injectable solution did not induce any immediate nor delayed pulmonary side effects in healthy horses and produced cefquinome concentrations in bronchoalveolar lavage (BAL) within 30 min that were higher than the minimal inhibitory concentration of the main equine respiratory pathogens. These results should stimulate further studies, especially in horses suffering from bronchial hyper-reactivity. Aerosol delivery of antibiotics may well have a role in equine therapeutics. [source] Assessment of corticodiaphragmatic pathway and pulmonary function in acute ischemic stroke patientsEUROPEAN JOURNAL OF NEUROLOGY, Issue 3 2000E. M. Khedr This study investigates the effect of stroke on the corticodiaphragmatic pathway and attempts to clarify the relationship between neurophysiological data and degree of motor disability, site of infarction in computerized tomography (CT) scan, diaphragmatic excursion, blood gases and pulmonary function in stroke patients. Using magnetic stimulation of the scalp sites and cervical roots, an assessment of corticodiaphragmatic pathway was made. The study included 34 sequentially selected patients from a total of 250 patients with acute ischemic stroke. Twenty-five (age- and sex-matched) volunteers served as controls. Sixteen patients had cortical infarction, 13 had subcortical infarction and five had both cortical and subcortical infarction. The mean according to the Scandinavian Stroke Scale was 32.2. Decreased diaphragmatic excursion was observed in 41% of the patients. Twenty-four patients (70.5%) had abnormal magnetic evoked potentials (MEPs) in the affected hemisphere. In five patients MEPs could not be elicited from the affected hemisphere; the remaining 19 patients had abnormal values of both cortical latency and central conduction time (CCT). Cortical latency, CCT, amplitude of compound muscle action potentials (CMAPs) and excitability threshold of the affected hemisphere were significantly altered compared with both the unaffected hemisphere and the control group. Those patients with hemiplegia had a greater degree of hypoxia, hypocapnia and decreased serum bicarbonate level compared with the control group. Also, hemiplegic patients had different degree of respiratory dysfunction. A statistically significant association was found between neurophysiological data and disability score, diaphragmatic excursion, site of infarction in CT scan and degree of respiratory dysfunction. Central diaphragmatic impairment may occur in acute stroke and could contribute to the occurence of hypoxia in those patients. [source] Structural model for an AxxxG-mediated dimer of surfactant-associated protein CFEBS JOURNAL, Issue 11 2004Visvaldas Kairys The pulmonary surfactant prevents alveolar collapse and is required for normal pulmonary function. One of the important components of the surfactant besides phospholipids is surfactant-associated protein C (SP-C). SP-C shows complex oligomerization behavior and a transition to ,-amyloid-like fibril structures, which are not yet fully understood. Besides this nonspecific oligomerization, MS and chemical cross-linking data combined with CD spectra provide evidence of a specific, mainly ,-helical, dimer at low to neutral pH. Furthermore, resistance to CNBr cleavage and dual NMR resonances of porcine and human recombinant SP-C with Met32 replaced by isoleucine point to a dimerization site located at the C-terminus of the hydrophobic ,-helix of SP-C, where a strictly conserved heptapeptide sequence is found. Computational docking of two SP-C helices, described here, reveals a dimer with a helix,helix interface that strikingly resembles that of glycophorin A and is mediated by an AxxxG motif similar to the experimentally determined GxxxG pattern of glycophorin A. It is highly likely that mature SP-C adopts such a dimeric structure in the lamellar bilayer systems found in the surfactant. Dimerization has been shown in previous studies to have a role in sorting and trafficking of SP-C and may also be important to the surfactant function of this protein. [source] A study of the effect of a resistive heat moisture exchanger (trachinaze) on pulmonary function and blood gas tensions in patients who have undergone a laryngectomy: A randomized control trial of 50 patients studied over a 6-month periodHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2003Andrew Simpson Jones MD Abstract Background. Previous work from this department has shown that resistive tracheostomy filters increase the partial pressure of oxygen in capillary blood and also provide a significant amount of heat/moisture exchange. Until now it has not been shown whether there is any long-term beneficial effect and in particular whether raised tissue oxygenation is maintained using a practical filter device. Methods. We carried out a 6-month randomized control trial including 50 laryngectomees. Twenty-five patients were treated with the Liverpool Heat Moisture Exchange device incorporating an airway resistor (Trachinaze). Another 25 patients were treated with a placebo device. Relevant subjective and objective data were collected before and at the end of the study. The objective measurements were capillary oxygen tension (which parallels blood arterial tension), carbon dioxide tension, FEV1, FVC, and PIF. Patients were reviewed at intervals throughout the study. Data were analyzed using the Mann,Whitney U test and the paired t test to test the difference between the active device and placebo at 6 months. Results. Subjective lower airway parameters, including cough, number of chest infections, mucus production, and shortness of breath at rest, were significantly improved in the active group compared with the placebo group. The objective parameters FEV1, FVC, and PIF were not significantly different. Capillary oxygen tension, however, was highly significantly raised in the active group at 6 months. Conclusions. Trachinaze is highly superior to placebo at improving subjective pulmonary parameters, including shortness of breath. It is also superior in its ability to maintain an increased peripheral tissue oxygen tension over a 6-month period. © 2003 Wiley Periodicals, Inc. Head Neck 25: 000,000, 2003 [source] Effect of long-term nebulized colistin on lung function and quality of life in patients with chronic bronchial sepsisINTERNAL MEDICINE JOURNAL, Issue 7 2007D. P. Steinfort Abstract Recurrent Gram-negative bacterial infection is a significant cause of death in patients with bronchiectasis and severe chronic obstructive pulmonary disease (COPD). Nebulized colistin in cystic fibrosis has shown maintenance of pulmonary function and improved symptom scores. We prospectively followed 18 patients with chronic bronchial sepsis treated with nebulized colistin 30 mg daily. Mean decline in forced expiratory volume in 1 s was significantly slower following commencement of inhaled colistin (44 mL/year vs 104 mL/year, P = 0.035). Mean decline in forced vital capacity was also significantly slower following commencement of colistin (48 mL/year vs 110 mL/year, P = 0.033). Patient-reported quality of life improved following commencement of colistin (3.6 vs 6.2, P = 0.001). No patient had isolates resistant to colistin. No side-effects were reported by patients in the cohort. Use of inhaled colistin in the treatment of bronchiectasis and severe (COPD) in patients with recurrent Gram-negative infections is safe. Inhaled colistin may improve quality of life and slow decline in forced expiratory volume in 1 s and forced vital capacity. [source] How do COPD and healthy-lung patients tolerate the reduced volume ventilation strategy during OLV ventilation.ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2010P. MICHELET Background: Although a strategy of tidal volume (Vt) reduction during the one-lung ventilation (OLV) period is advised in thoracic surgery, the influence of the pre-operative respiratory status on the tolerance of this strategy remains unknown. Therefore, the aim of this study was to compare the pulmonary function between chronic obstructive pulmonary disease (COPD) and healthy-lung patients during the operative and the post-operative period. Methods: Forty-eight patients undergoing a planned lobectomy for cancer and presenting either a healthy lung function (n=24) or a moderate COPD stage (n=24) were ventilated without external positive end-expiratory pressure (PEEP) and received 9 ml/kg Vt during the two-lung ventilation (TLV) period, secondary reduced to 6 ml/kg during the OLV period. Lung function was assessed by peroperative gas exchange, venous admixture, respiratory mechanical parameters and post-operative spirometric measurements. Results: Although the PaO2 was superior in the healthy-lung group during the TLV, once the OLV was established, no difference was observed between the two groups. Moreover, the PaO2/FiO2 was proportionally more impaired in the healthy-lung group compared with the COPD group (50 ± 13 vs. 72 ± 19% of the baseline values after exclusion and 32 ± 15 vs. 51 ± 25% after the thoracotomy, P<0.05 for each) as well as the venous admixture. In the post-operative period, a higher decrease was observed in the healthy-lung group for the forced vital capacity and the forced expiratory volume. Conclusions: Reducing Vt to 6 ml/kg without the adjunction of external PEEP during OLV is associated with better preservation of lung function in the case of moderate COPD than in the case of healthy-lung status. [source] Chest physiotherapy with positive expiratory pressure breathing after abdominal and thoracic surgery: a systematic reviewACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2010J. ÖRMAN A variety of chest physiotherapy techniques are used following abdominal and thoracic surgery to prevent or reduce post-operative complications. Breathing techniques with a positive expiratory pressure (PEP) are used to increase airway pressure and improve pulmonary function. No systematic review of the effects of PEP in surgery patients has been performed previously. The purpose of this systematic review was to determine the effect of PEP breathing after an open upper abdominal or thoracic surgery. A literature search of randomised-controlled trials (RCT) was performed in five databases. The trials included were systematically reviewed by two independent observers and critically assessed for methodological quality. We selected six RCT evaluating the PEP technique performed with a mechanical device in spontaneously breathing adult patients after abdominal or thoracic surgery via thoracotomy. The methodological quality score varied between 4 and 6 on the Physiotherapy Evidence Database score. The studies were published between 1979 and 1993. Only one of the included trials showed any positive effects of PEP compared to other breathing techniques. Today, there is scarce scientific evidence that PEP treatment is better than other physiotherapy breathing techniques in patients undergoing abdominal or thoracic surgery. There is a lack of studies investigating the effect of PEP over placebo or no physiotherapy treatment. [source] Osteoporosis-Related Kyphosis and Impairments in Pulmonary Function: A Systematic Review,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2007Robyn A Harrison Abstract We conducted a systematic review to examine the relationship between osteoporotic vertebral fractures, kyphosis, and pulmonary function. Findings suggest modest but predictable declines in vital capacity related to the degree of kyphosis. However, there were only four studies, and all had significant methodologic limitations. Further high-quality research is needed. Introduction: Our objective was to systematically review the extent to which osteoporosis-related vertebral fractures and kyphosis affect pulmonary function. Materials and Methods: We used a literature search from 1966 to 2006 (using Medline, EMBASE, and hand searches of references) for studies examining pulmonary function in patients without known lung disease who had vertebral fractures or kyphosis secondary to osteoporosis. Two reviewers independently abstracted data. Heterogeneity precluded formal meta-analysis. Results: Initial searches yielded 453 articles. After applying eligibility criteria, only four case-control studies of limited quality (e.g., only one study was blinded) remained. Since 1966, only 109 patients (6 men) have been studied. All four studies reported reductions in vital capacity (VC), with values ranging from 68% to 94% of predicted values. This was quantified as a 9% reduction in predicted VC per vertebral fracture in one study. The degree of kyphosis clinically (one study) or radiographically (three studies) correlated with declines in VC; impairments were most notable at kyphotic angles >55°. Statistically significant differences in percent predicted VC were obtained only when arm span or recalled height, rather than measured height, was used (two studies). Conclusions: Despite conventional teaching, the evidence relating osteoporotic vertebral fractures or kyphosis to pulmonary function is limited. On the basis of available studies, declines in VC secondary to kyphosis seem modest and directly related to the number of vertebral fractures or degree of kyphosis. Future studies need longitudinal follow-up of larger numbers of men and women, appropriate proxies for height, standardized measures for pulmonary function and kyphosis, and efforts to blind outcomes ascertainment. [source] The effect of a pulmonary rehabilitation programme on older patients with chronic pulmonary diseaseJOURNAL OF CLINICAL NURSING, Issue 1 2008Kim Ae Kyung RN Aim., The aim of this study was to answer the question: is there an effect on the respiratory capacity and activity tolerance of older patients with chronic obstructive pulmonary disease who participate in a pulmonary rehabilitation programme? Background., Pulmonary rehabilitation is now an integral part of chronic obstructive pulmonary disease management. Evidence supports the positive effects of breath training and exercising training on quality of life, exercise tolerance and improved physical condition of individual with chronic obstructive pulmonary disease. Limited empirical documentation exists to support the effectiveness of a nurse managed rehabilitation programme for older patients with chronic obstructive pulmonary disease. The study was done to evaluate the effects of pulmonary rehabilitation provided by nurses on the pulmonary function, gas exchange and exercise tolerance in older patients with chronic obstructive pulmonary disease. Design., A one group pre-test,post-test design was used to evaluate the effects of a pulmonary rehabilitation programme. Method., The sample consisted of 20 patients with chronic obstructive pulmonary disease who participated in a pulmonary rehabilitation programme including breathing exercises, upper-limb exercises and inspiratory muscle training. Results., The findings indicated improvement in exercise performance and a decrease in dyspnea after participation in the pulmonary rehabilitation programme. Relevance to clinical practice., The clinical nurse can make a significant impact on the illness trajectory and quality of life for patients with chronic obstructive pulmonary disease. The nurse has a critical role in helping patient with chronic obstructive pulmonary disease learn to cope, adjust and adapt to life with a chronic illness. Active nurse involvement with a patient in a pulmonary rehabilitation programme can assist in the identification of factors that motivate the patient, help in establishing realistic out comes expectations and provide patient teaching opportunities. The nurse can assist the patient to develop skills of self-awareness regarding particular symptoms, self-monitoring and health status change identification. [source] Nasal administration of albuterol: an alternative route of deliveryJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 10 2004Anwar A. Hussain The use of metered-dose inhalers for the delivery of albuterol, a ,2 -selective adrenergic agonist, is associated with drawbacks, especially in children and the elderly. This investigation was designed to assess the effectiveness of albuterol delivered intranasally and to compare this delivery route with intratracheal and intravenous delivery. Three parameters of pulmonary function (peak maximal expiratory flow, maximal expiratory flow at 50% vital capacity, and total lung capacity) in anaesthetized, artificially ventilated guinea pigs were used to determine the degree of protection produced by albuterol against bronchoconstrictor responses provoked by acetylcholine. The heart rate was also measured. Although intranasal albuterol induced a slower protective action during the very initial phase of absorption, the drug was shown to be equally effective when administered either intranasally or intratracheally. In contrast, despite a significant effect initially in the case of intravenous albuterol, its ability to influence pulmonary function faded rather rapidly. No statistically significant differences in heart rate could be detected among the different treatment groups. In conclusion, intranasal albuterol may offer an alternative to metered-dose inhalers for the treatment of acute bronchospasm and for prevention of exercise-induced asthma, especially for children and the elderly. [source] Increased soluble CD40 ligand levels in cystic fibrosisJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 4 2004A. Falco Summary., Chronic inflammation represents a key pathogeneric event in the progression of lung disease in cystic fibrosis (CF). To identify novel mechanisms of the inflammatory reaction in CF and analyze its relation with coagulative activation, we carried-out a cross-sectional study to evaluate circulating levels of the inflammatory mediators soluble (s) CD40L, C-reactive protein (CRP), interleukin (IL)-1,, the coagulation markers activated factor VII (FVIIa) and prothrombin fragment (F) 1+2, as well as urinary 11-dehydro-thromboxane (TX)B2, an index of in vivo platelet activation, in 34 CF patients and 34 matched healthy subjects. We observed that CF patients displayed significantly increased circulating levels of sCD40L compared to controls [2.8 (0.4,15.6) vs 1.1 (0.2,2.7) ng mL,1 ,P = 0.0003]. sCD40L levels inversely correlated with forced expiratory volume at 1 second (FEV1) (, = ,0.788, P = 0.0001), whereas it directly correlated with CRP and IL-1, levels (, = 0.621, P = 0.0004; and , = 0.745, P = 0.0001, respectively), which were also elevated in CF patients. CF patients had also enhanced levels of FVIIa and F1+2 compared to controls [39.2 (22.6,69.8) vs 22.3 (16.2,32.4) mU mL,1, P = 0.0001; 0.60 (0.30,1.80) vs 0.17 (0.10,0.40) nmol L,1, P = 0.0001, respectively]. A direct correlation was observed between sCD40L and both plasma FVIIa (, = 0.691, P = 0.0001) and F1+2 (, = 0.545, P = 0.0017) as well as between sCD40L and urinary 11-dehydro-TXB2 (, = 0.433, P = 0.0129). Our findings suggest that in CF patients, sCD40L could represent a biochemical link between the inflammatory state, and endothelial damage and coagulative activation, leading to progressive impairment of pulmonary function. [source] MRI of the lungs using hyperpolarized noble gasesMAGNETIC RESONANCE IN MEDICINE, Issue 6 2002Harald E. Möller Abstract The nuclear spin polarization of the noble gas isotopes 3He and 129Xe can be increased using optical pumping methods by four to five orders of magnitude. This extraordinary gain in polarization translates directly into a gain in signal strength for MRI. The new technology of hyperpolarized (HP) gas MRI holds enormous potential for enhancing sensitivity and contrast in pulmonary imaging. This review outlines the physics underlying the optical pumping process, imaging strategies coping with the nonequilibrium polarization, and effects of the alveolar microstructure on relaxation and diffusion of the noble gases. It presents recent progress in HP gas MRI and applications ranging from MR microscopy of airspaces to imaging pulmonary function in patients and suggests potential directions for future developments. Magn Reson Med 47:1029,1051, 2002. © 2002 Wiley-Liss, Inc. [source] Comparison of roflumilast, an oral anti-inflammatory, with beclomethasone dipropionate in the treatment of persistent asthmaALLERGY, Issue 1 2006J. Bousquet Background:, Roflumilast is an oral, once-daily phosphodiesterase 4 inhibitor with anti-inflammatory activity in development for the treatment of asthma. Roflumilast was compared with inhaled beclomethasone dipropionate (BDP) in patients with asthma. Methods:, In a double blind, double-dummy, randomized, noninferiority study, 499 patients (forced expiratory volume in 1 s [FEV1] = 50,85% predicted) received roflumilast 500 ,g once daily or BDP 200 ,g twice daily (400 ,g/day) for 12 weeks. Lung function and adverse events were monitored. Results:, Roflumilast and BDP significantly improved FEV1 by 12% (270 ± 30 ml) and 14% (320 ± 30 ml), respectively (P < 0.0001 vs baseline). Roflumilast and BDP also significantly improved forced vital capacity (FVC) (P < 0.0001 vs baseline). There were no significant differences between roflumilast and BDP with regard to improvement in FEV1 and FVC. Roflumilast and BDP showed small improvements in median asthma symptom scores (,0.82 and ,1.00, respectively) and reduced rescue medication use (,1.00 and ,1.15 median puffs/day, respectively; P < 0.0001 vs baseline). These small differences between roflumilast and BDP were not considered clinically relevant. Both agents were well tolerated. Conclusions:, Once daily, oral roflumilast 500 ,g was comparable with inhaled twice-daily BDP (400 ,g/day) in improving pulmonary function and asthma symptoms, and reducing rescue medication use in patients with asthma. [source] Postoperative tracheal extubation after orthotopic liver transplantationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2001M. Glanemann Background: The duration of postoperative mechanical ventilation and its influence on pulmonary function in liver transplant recipients is still debated controversially. Methods: We retrospectively analyzed the incidence of immediate tracheal extubation, prolonged mechanical ventilation (>24 h following surgery), and episodes of reintubation in 546 patients who underwent orthotopic liver transplantation (OLT) at our institution. Results: Immediate tracheal extubation in the operating theater was achieved in 18.7% of patients, and prolonged mechanical ventilation was required by 11.2% of patients. In these, median time of extubation was 49.5 h, whereas the remaining 70.1% of patients required ventilation support for a median 5 h after OLT. As risk factors for prolonged mechanical ventilation we identified the indications of acute liver failure and retransplantation, as well as factors such as mechanical ventilation prior to OLT, massive intraoperative bleeding, and severe reperfusion injury of the liver graft. The incidence of reintubation was 8.8% in patients who were immediately extubated following surgery, and 13.1% in patients who underwent extubation within 24 h. The incidence was significantly increased in patients requiring prolonged mechanical ventilation (36.1%). Conclusions: Immediate tracheal extubation was safe and well tolerated. The incidence of reintubation was not increased when compared to patients in whom extubation succeeded later. However, special attention should be given to transplant recipients presenting in reduced clinical condition at the time of OLT, undergoing complicated surgery, or receiving liver allografts with severe reperfusion injury because of an increased risk for prolonged mechanical ventilation. [source] Relationship between adipokines and manifestations of childhood asthmaPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 6 2008Kyung W. Kim Although the prevalences of asthma and obesity are increasing substantially in recent decades, very little is known about the possible association between them. We evaluated the roles of leptin, adiponectin, and resistin, which are adipokines produced by adipose tissue, on childhood asthma, and their association with pulmonary function and bronchial hyperresponsiveness. We studied 149 atopic asthmatic children, 37 non-atopic asthmatic children, and 54 healthy children. Body mass index was calculated using height and weight, which were measured on the same day that pulmonary function tests and methacholine challenge tests were performed. Skin prick tests were performed, and total eosinophil count, total serum immunoglobulin E (IgE), serum eosinophil cationic protein, leptin, adiponectin, and resistin were measured in all subjects. Atopic asthmatics had lower resistin levels compared with non-atopic asthma and control groups, but leptin and adiponectin did not show any difference among these three groups. Resistin demonstrated positive correlation with methacholine PC20 and negative correlations with eosinophil count and serum total IgE. Leptin and adiponectin showed associations with forced expiratory volume in 1 s or forced expiratory flow between 25,75%. Multiple regression analysis revealed that resistin was a significant predictive factor for asthma. There was no direct association between asthma and leptin or adiponectin. Our findings suggest that resistin may play a negative predictive role in asthma. Adiponectin and leptin showed close associations with pulmonary function and may have disease-modifying effects in children with asthma. [source] | |||||||||||||||||||||||||||||||||||||||||||