Search

Author(s): Hana Serajeddini [sup.1] , Paola Rogliani [sup.2] , Marco Mura [sup.1] [sup.3] [sup.4 ] Author Affiliations: (Aff1) 0000 0004 1936 8884, grid.39381.30, Division of Respirology, Western University, , London, [...], Purpose The pathophysiology of idiopathic pulmonary fibrosis (IPF) is complex, and its clinical course is difficult to predict. Perceived dyspnea, exercise capacity, and lung physiology have all been associated with mortality outcomes in IPF, but the significance of these relationships is unclear. We sought to investigate the correlation among these variables and their independent predictive capability in determining mortality outcomes. Methods Four-hundred-thirty-seven patients diagnosed with IPF from three independent centers were included in the study. Medical Research Council Dyspnea Score (MRCDS), 6-min walk distance (6MWD), and pulmonary function tests were determined at baseline. The end-point was 18-month transplant-free survival. Results Correlations between MRCDS, 6MWD, forced vital capacity (FVC), and diffusing lung capacity for carbon monoxide were either very weak or weak. Calculation of variance inflation factors demonstrated absence of collinearity among these variables. Univariate regression analysis and c-statistics identified MRCDS, 6MWD, and FVC as significant predictors of 18-month transplant-free survival. Multivariate regression analysis retained MRCDS, 6MWD, and FVC as independent predictors of mortality. To ensure generalizability, we confirmed the results in subgroups of patients stratified according to baseline FVC, and further by considering lung transplant as a competing event to death. Conclusions In a cohort of patients with IPF encompassing a wide range of disease severity, baseline perceived exertional dyspnea, exercise capacity, and lung function are weakly correlated to each other, translating in the absence of collinearity. MRCDS, 6MWD, and FVC are significant and independent predictors of outcome, suggesting that a multi-dimensional assessment of IPF is prognostically appropriate and advantageous.

Author(s): Gabriela Leuschner [sup.1] , Fredrik Reiter [sup.1] , Florian Stocker [sup.1] , Alexander Crispin [sup.2] , Nikolaus Kneidinger [sup.1] , Tobias Veit [sup.1] , Friederike Klenner [sup.1] , Felix [...], Introduction Idiopathic pulmonary fibrosis (IPF) is considered a disease of older patients, being rare in patients [less than or equal to] 50 years. Still, IPF can occur in younger patients, but this particular patient group is not well characterised so far. The aim of this study was to compare the diagnostic certainty, clinical features, comorbidities and survival in young versus older IPF patients. Methods We reviewed our medical records from February 2011 until February 2015, to identify IPF patients, who were then classified as young ([less than or equal to] 50 years) or older IPF (> 50 years). Radiographic and histological findings, lung function parameters, comorbidities, disease progression and survival were analysed and compared between the two groups. Results Of 440 patients with interstitial lung disease, 129 patients with IPF were identified, including 30 (23.3%) [less than or equal to]50 years and 99 (76.7%) > 50 years. There were no differences between age groups in baseline demographics; younger patients were less likely to have a confirmed diagnosis by high-resolution computed tomography (p = 0.014), more likely to require a biopsy (p = 0.08) and less likely to have received antifibrotic therapy (p = 0.006). Despite an overall limited prognosis, younger patients had a significantly better median survival after diagnosis (p = 0.0375), with a significantly higher proportion of older patients dying due to respiratory failure (p = 0.0383). Conclusion IPF patients under the age of 50 years have similar features and clinical course compared to older IPF patients. These patients should be diagnosed by adopting a multidisciplinary team approach, potentially benefitting from earlier intervention with effective antifibrotic therapy.

Author(s): Tom McEnery [sup.1] , Ronan Walsh [sup.2] , Conor Burke [sup.1] , Aisling McGowan [sup.1] , John Faul [sup.1] , Liam Cormican [sup.1] Author Affiliations: (1) grid.414919.0Department of Respiratory [...], Neuralgic Amyotrophy (NA) or Parsonage-Turner syndrome is an idiopathic neuropathy commonly affecting the brachial plexus. Associated phrenic nerve involvement, though recognised, is thought to be very rare. We present a case series of four patients (all male, mean age 53) presenting with dyspnoea preceded by severe self-limiting upper limb and shoulder pain, with an elevated hemi-diaphragm on clinical examination and chest X-ray. Neurological examination of the upper limb at the time of presentation was normal. Diaphragmatic fluoroscopy confirmed unilateral diaphragmatic paralysis. Pulmonary function testing demonstrated characteristic reduction in forced vital capacity between supine and sitting position (mean 50%, range 42-65% predicted, mean change 23%, range 22-46%), reduced maximal inspiratory pressures (mean 61%, range 43-86% predicted), reduced sniff nasal inspiratory pressure (mean 88.25, range 66-109 cm H.sub.2O) and preserved maximal expiratory pressure (mean 107%, range 83-130% predicted). Phrenic nerve conduction studies confirmed phrenic nerve palsy. All patients were managed conservatively. Follow-up ranged from 6 months to 3 years. Symptoms and lung function variables normalised in three patients and improved significantly in the fourth. The classic history of severe ipsilateral shoulder and upper limb neuromuscular pain should be elicited and thus NA considered in the differential for a unilateral diaphragmatic paralysis, even in the absence of neurological signs. Parsonage-Turner syndrome is likely to represent a significantly under-diagnosed aetiology of phrenic nerve palsy. Conservative management as opposed to surgical intervention is advocated as most patients demonstrate gradual resolution over time in this case series.

Author(s): Gregory J. Schilero[sup.1] [sup.2] , Miroslav Radulovic[sup.1] [sup.2] , Jill M. Wecht[sup.1] [sup.2] , Ann M. Spungen[sup.1] [sup.2] , William A. Bauman[sup.1] [sup.2] , Marvin Lesser[sup.1] Author Affiliations: (1) [...], Traumatic spinal cord injury (SCI) is associated with significant psychological and physical challenges. A multidisciplinary approach to management is essential to ensure recovery during the acute phase, and comprehensive rehabilitative strategies are necessary to foster independence and quality of life throughout the chronic phase of injury. Complications that beset these individuals are often a unique consequence of SCI, and knowledge of the effects of SCI upon organ systems is essential for appropriate management. According to the National SCI Statistical Center (NSCISC), as of 2010 there were an estimated 265,000 persons living with SCI in the United States, with approximately 12,000 incidence cases annually. Although life expectancy for newly injured individuals with SCI is markedly reduced, persons with chronic SCI are expected to live about as long as individuals without SCI; however, longevity varies inversely with level of injury. Since 2005, 56 % of persons with SCI are tetraplegic, and due to paralysis of respiratory muscles, these individuals may be especially prone to pulmonary complications, which remain a major cause of mortality among persons with chronic SCI. We at the VA Rehabilitation Research and Development Center of Excellence for the Medical Consequences of SCI at the James J. Peters VA Medical Center have devoted more than 25 years to the study of secondary medical conditions that complicate SCI. Herein, we review pulmonary research at the Center, both our past and future endeavors, which form an integral part of our multidisciplinary approach toward achieving a greater understanding of and improving care for veterans with SCI.

Author(s): Mohamad F. El-Khatib[sup.1] , Ghassan Jamaleddine[sup.2] , Nadim Kanj[sup.3] , Salah Zeineddine[sup.3] , Hassan Chami[sup.3] , Imad Bou-Akl[sup.3] , Ahmad Husari[sup.3] , Marwan Alawieh[sup.1] , Pierre Bou-Khalil[sup.3] Author Affiliations: [...], Background This study compares the effect of heliox-driven to that of air-driven bronchodilator therapy on the pulmonary function test (PFT) in patients with different levels of asthma severity. Methods One-hundred thirty-two participants were included in the study. Participants underwent spirometry twice with bronchodilator testing on two consecutive days. Air-driven nebulization was used one day and heliox-driven nebulization the other day in random order crossover design. After a baseline PFT, each participant received 2.5 mg of albuterol sulfate nebulized with the randomized driving gas. Post bronchodilator PFT was repeated after 30 min. The next day, the exact same protocol was repeated, except that the other driving gas was used to nebulize the drug. Participants were subgrouped and analyzed according to their baseline FEV.sub.1 on day 1: Group I, FEV.sub.1 [greater than or equal to]80 %; Group II, 80 % > FEV.sub.1 > 50 %; Group III, FEV.sub.1 [less than or equal to]50 %. The proportion of participants with greater than 12 % and 200-mL increases from their baseline FEV.sub.1 and the changes from baseline in PFT variables were compared between heliox-driven versus air-driven bronchodilation therapy. Results The proportion of participants with >12 % and 200-mL increases from their baseline FEV.sub.1 with air- or heliox-driven bronchodilation was not different with respect to the proportion of participants with baseline FEV.sub.1 [greater than or equal to]80 % (20 vs. 18 %, respectively) and 80 % > FEV.sub.1 > 50 % (36 vs. 43 %, respectively), but it was significantly greater with heliox-driven bronchodilation in participants with FEV.sub.1 [less than or equal to]50 % (43 vs. 73 %, respectively; p = 0.01). Changes from baseline FVC, FEV.sub.1, FEV.sub.1/FVC, FEF.sub.25-75 %, FEF.sub.max, FEF.sub.25 %, FEF.sub.50 %, and FEF.sub.75 % were significantly larger with heliox-driven versus air-driven bronchodilation in participants with baseline FEV.sub.1 [less than or equal to]50 %. Conclusion Improvements in PFT variables are more frequent and profound with heliox-driven compared to air-driven bronchodilator therapy only in asthmatic patients with baseline FEV.sub.1 [less than or equal to]50 %.

Introduction Exertional desaturation (ED) in patients with chronic obstructive pulmonary disease (COPD) occurs frequently and may predict mortality [1]; yet there is no standard definition for ED and its exact [...], Background Dynamic hyperinflation (DH) causes exercise limitation and exertional dyspnea in patients with chronic obstructive pulmonary disease (COPD). Exertional desaturation (ED) also occurs commonly in COPD but neither routine physiologic parameters nor imaging predict ED accurately. In this study we evaluated the relationship between DH and ED during 6-min walk testing (6MWT). Methods We measured ED and DH in patients with stable COPD. Sp[O.sub.2] was measured by continuous pulse oximetry during 6MWT. ED was defined as a decline in Sp[O.sub.2] (ΔSp[O.sub.2]) [greater than or equal to]4 %. DH was determined by measuring inspiratory capacity (IC) before and after the 6MWT using a handheld spirometer. DH was defined as ΔIC >0.0 L. We correlated DH and ED with clinical and pulmonary physiologic variables by regression analysis, [chi square], and receiver operator curve (ROC) analysis. Results Thirty males [age = 65 ± 9.4 years, [FEV.sub.1] % predicted = 48 ± 14 %, and DLCO % predicted = 50 ± 21 % (mean ± SD)] were studied. ΔSp[O.sub.2] correlated with ΔIC (r = 0.49, p = 0.005) and age (r = 0.39, p = 0.03) by univariate analysis; however, only ΔIC correlated on multivariate regression analysis (p = 0.01). ΔSp[O.sub.2] did not correlate with [FEV.sub.1], FVC, [FEF.sub.25-75], RV, DLCO % predicted, BMI, smoking, BORG score, or distance covered in 6MWT. DH strongly correlated with ED (p = 0.001). On ROC analysis, DH had an area under the curve of 0.92 for the presence of ED (sensitivity = 90 %; specificity = 77 %, p < 0.001). Conclusion Routine pulmonary function test results and clinical variables did not correlate with ED in patients with stable COPD. Dynamic hyperinflation strongly correlates with exertional desaturation and could be a reason for this desaturation. Keywords COPD * Dynamic hyperinflation * Exertion * Desaturation

Cervical spinal cord injury (CSCI) typically results in impaired general respiratory function However, little is known about respiratory mechanics during speech production, with participants involved in research to date showing [...]

A study was conducted to evaluate the benefits of vitamin A supplementation given to pregnant women before during and after pregnancy in improving lung function among offsprings. Results indicated that vitamin A was very useful in improving lung function at all stages of pregnancy and after.

A multicenter, randomized, double-blind placebo-controlled trial was conducted from February 2007 to July 2009 at 40 cystic fibrosis (CF) care centers in the United States and Canada to determine if azithromycin treatment improves lung function and reduces pulmonary exacerbations in pediatric CF patients uninfected with P. aeruginosa. The treatment with azithromycin for 24 weeks did not result in improved pulmonary function in children and adolescents with CF uninfected with P. aeruginosa.

Byline: Paula W. Steimback (1), Gisele P. Oliveira (1), Andreia F. Rzezinski (1), Pedro L. Silva (1), Cristiane S. N. B. Garcia (1), Graziela Rangel (2), Marcelo M. Morales (2), Jose R. Lapa e Silva (3), Vera L. Capelozzi (4), Paolo Pelosi (5), Patricia R. M. Rocco (1) Keywords: Acute lung injury; Sigh; Ventilator-induced lung injury; Transpulmonary pressure; Apoptosis Abstract: Purpose To evaluate the effects of frequency and inspiratory plateau pressure (Pplat) during recruitment manoeuvres (RMs) on lung and distal organs in acute lung injury (ALI). Methods We studied paraquat-induced ALI rats. At 24 h, rats were anesthetized and RMs were applied using continuous positive airway pressure (CPAP, 40 cm[H.sub.2]O/40 s) or three-different sigh strategies: (a) 180 sighs/h and Pplat = 40 cm[H.sub.2]O (S180/40), (b) 10 sighs/h and Pplat = 40 cm[H.sub.2]O (S10/40), and (c) 10 sighs/h and Pplat = 20 cm[H.sub.2]O (S10/20). Results S180/40 yielded alveolar hyperinflation and increased lung and kidney epithelial cell apoptosis as well as type III procollagen (PCIII) mRNA expression. S10/40 resulted in a reduction in epithelial cell apoptosis and PCIII expression. Static elastance and alveolar collapse were higher in S10/20 than S10/40. Conclusions The reduction in sigh frequency led to a protective effect on lung and distal organs, while the combination with reduced Pplat worsened lung mechanics and histology. Author Affiliation: (1) Laboratory of Pulmonary Investigation, Instituto de Biofisica Carlos Chagas Filho, C.C.S., Universidade Federal do Rio de Janeiro, Ilha do Fundao, Rio de Janeiro, RJ, 21941-902, Brazil (2) Laboratory of Cellular and Molecular Physiology, Carlos Chagas Filho Institute of Biophysics, Rio de Janeiro, RJ, Brazil (3) Department of Pneumology, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil (4) Department of Pathology, University of Sao Paulo, Sao Paulo, SP, Brazil (5) Department of Ambient, Health and Safety, University of Insubria, Varese, Italy Article History: Registration Date: 03/02/2009 Received Date: 16/09/2008 Accepted Date: 26/01/2009 Online Date: 17/02/2009 Article note: The work was supported by Centres of Excellence Program (PRONEX-FAPERJ), Brazilian Council for Scientific and Technological Development (CNPq), Carlos Chagas Filho, Rio de Janeiro State Research Supporting Foundation (FAPERJ), Sao Paulo State Research Supporting Foundation (FAPESP). Electronic supplementary material The online version of this article (doi: 10.1007/s00134-009-1439-y) contains supplementary material, which is available to authorized users.

Byline: T. Sano (1), H. Ueda (1), H. Bando (1) Keywords: Chronic cough; Cough variant asthma; Peak expiratory flow rate; Suplatast tosilate Abstract: It is important to make a differential diagnosis of cough variant asthma in patients with chronic cough. To examine whether or not peak expiratory flow rate (PEFR) is useful for the differential diagnosis of cough variant asthma in such patients, diurnal variation rates of PEFR were calculated in 23 patients who presented with dry cough lasting four or more weeks and who showed no abnormalities on chest radiographs. None of the patients had wheezes, and pulmonary function testing at the time of visit to the hospital revealed no abnormalities. During the control period, the mean diurnal variation rate of PEFR in 23 patients was 16.3 +- 7.9%. Six, nine and eight patients had PEFR diurnal variations rates of &lt 10% (Group 1), 10--19% (Group 2), and aY= 20% (Group 3), respectively. At week 3 of treatment with bronchodilators, only Group 3 showed a significant decrease in PEFR diurnal variation rate from 25.7% to 10.1%. The cough score decreased significantly in Group 3 only. These patients had enhanced bronchial hyperresponsiveness and showed eosinophils in induced sputum, leading to the diagnosis of cough variant asthma (CVA). After making the diagnosis of CVA, an inhaled corticosteroid or a Th2 cytokine production inhibitor suplatast tosilate was administered to patients consequently, they showed no recurrence of cough. PEFR monitoring allowed the detection of morning dip and was suggested to be potentially useful for the differential diagnosis of cough variant asthma in patients with chronic cough. Author Affiliation: (1) Department of Pulmonary Medicine, Tokushima Prefectural Central Hospital, Kuramoto-cho 1-10-3, Tokushima, Tokushima, 770-8539, Japan Article History: Registration Date: 01/01/2004 Accepted Date: 29/06/2004

Byline: Nathaniel Marchetti (1), Katharine Criner (1), Gerard J. Criner (1) Keywords: Hypersensitivity pneumonitis; Mycobacterium avium intracellulare; Hot tub; Pulmonary disease; Nontuberculous mycobacterium Abstract: Hot tub lung is described as an acute pulmonary illness that is characterized by fever, dyspnea and interstitial nodular infiltrates. Although not entirely clear, the etiology may be a hypersensitivity pneumonitis, an infection secondary to Mycobacterium avium intracellulare (MAC), or possibly both. Herein we describe the most well-characterized physiologic, radiographic, and functional recovery from hot tub lung reported in the literature to date. Pulmonary function testing and CT scans of the chest were obtained after each therapeutic intervention, and the patient had the most dramatic improvement with simply avoiding the hot tub. Prednisone therapy offered minimal further improvement while anti-MAC therapy provided no further improvement. These results are suggestive of a hypersensitivity pneumonitis rather than an infectious etiology. Author Affiliation: (1) Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, 19140, USA Article History: Registration Date: 01/01/2004 Accepted Date: 22/06/2004

Byline: Jurg Hammer (1), Neal Patel (2), Christopher J. L. Newth (2) Keywords: Forced expiration; Infant pulmonary function testing; Volume recruitment; Reproducibility; Maximum expiratory flow volume curves Abstract: Objective To determine the effect of forced deflation maneuvers on respiratory mechanics and to assess the reproducibility of such measurements in intubated infants with lung disease. Design and setting Prospective study in the pediatric intensive care unit of a university children's hospital. Patients Ten clinically stable infants requiring mechanically assisted ventilation for acute pulmonary disease, mean age 5.9 months (1--18), mean weight 5.8 kg (3.2--13). Interventions Two sets of measurements of compliance (Crs) and resistance (Rrs) were obtained at 20-min intervals both before and after +40/-40 cm[H.sub.2]O forced deflation maneuvers. Forced deflation measurements were repeated at the end of the study. Results Forced deflation caused a significant increase in Crs from 0.53+-0.09 and 0.58+-0.11 ml/cm[H.sub.2]O/kg to 0.71+-0.11 and 0.68+-0.11 ml/cm[H.sub.2]O/kg. Rrs measurements did not differ. The low coefficients of variation for repeated measures of the baseline measurements (Crs 4.2+-0.5%, Rrs 7.1+-0.8%, for forced vital capacity 8.6+-2.5%, maximum expiratory flows at 25% vital capacity 16.0%+-3.3%) confirmed the good reproducibility during stable conditions. Conclusions Inflation and deflation maneuvers affect subsequent measurements of respiratory system compliance but not measurements of maximum expiratory flow-volume relationships in intubated infants, probably through recruitment of lung volume. Careful interpretation and planning of the sequence of infant pulmonary function testing is necessary to reassure that changes are not related to short-term alterations in volume history. Author Affiliation: (1) 1Division of Pediatric Intensive Care and Pulmonology, University Children's Hospital, Romergasse 8, 4005, Basel, Switzerland (2) Division of Critical Care, Children's Hospital Los Angeles, University of Southern California, Los Angeles, Calif., USA Article History: Received Date: 27/09/2002 Accepted Date: 03/06/2003 Online Date: 25/07/2003

Byline: B. P. Chattopadhyay (1), J. Alam (1), A. Roychowdhury (1) Keywords: Automobile Exhaust; Diesel bus garage; Biddies; Pulmonary function abnormalities; Restrictive and obstructive impairments Abstract: In Kolkata city the road transports are maintained by private and Government organization. A major work force belonged to the State Transport Corporation (KSTC), Government of West-Bengal. The pollution caused by these vehicles affects the workers health and caused different types of respiratory problems. This study was undertaken to assess the pulmonary function status of these workers. City KSTC garage workers were investigated and categorically divided into two group: garage mechanics and the (2) those transporting the passengers (drivers and conductors). Vital capacity (VC), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) were recorded by Spirovit-SP-10 (Schiller Ltd, Switzerland) and Wright&apos;s Peak Flow Meter (UK) on 236 workers. The different flow volumes, FEV.sub.1, FEV.sub.1%, and flow rates, FEF.sub.02--121, FEF.sub.25--75%, etc. were calculated. The administrative people had higher PFT than the other categories. Drivers and conductors have almost equal mean PFT values but mechanical workers had slightly higher. PFT values according to different age ranges and duration of exposure showed gradual decrement as age and duration of exposure increased. Non-smokers had higher lung volumes compared to smokers and ex-smokers. Restrictive, obstructive and combined types of impairments were noticed in 28.4%, 1.7% and 2.9%, respectively, workers. The restrictive impairment was found to be 30.4% in conductors, 28.9% in drivers, 27.9% in mechanics and 21.7% in administration people. Obstructive type of impairment was found to be 2.9% in both drivers and conductors. The effect of pollution by dust and fumes may be responsible for these pulmonary function impairments, restrictive impairments being greater. Author Affiliation: (1) Regional Occupational Health Centre (Eastern), Indian Council of Medical Research, Block-DP, Sector-V, Salt Lake City, Kolkata-700 091, India Article History: Registration Date: 01/01/2003

Byline: Yu. Yu. Byalovskii (1) Abstract: The role of a processional motivational factor in the tolerability of short-term resistive respiratory loads was studied. The processional motive was formed using the method of moral and material stimulation of a successful activity. The subjects with a material--monetary processional motive were shown to have the greatest tolerability of additional respiratory resistance. They demonstrated the greatest physiological expenditure during the realization of resistive loads. A dissociation between the introspective estimates of processional motives and the values of the subjects' real activity was noted: according to the data of Gerbachevskii's test, the greatest effectiveness of motivation was characteristic of subjects with mobilization of voluntary resources on the basis of moral encouragement and the maximal effectiveness of real activity was observed in subjects with material stimulation motives. Author Affiliation: (1) Ryazan State Medical University, Russia Article History: Registration Date: 12/10/2004

Byline: E.I. Mohamed (), C. Maiolo (), L. Iacopino (), M. Pepe (), N. Daniele (), A. Lorenzo () Abstract: Many studies have investigated lung function in relation to age and height among Caucasians, however, most of these studies did not consider the individual components of body weight. The objective of the present study was to study the effect of body weight components [bone-free lean body mass (BF-LBM), bone mineral content (BMC), and fat mass (FM)] measured by dual x-ray absorptiometry (DXA) on the lung-function variables (FVC, FEV1, and PEF) and to derive prediction equations for these variables in healthy adult Italians. Dynamic spirometric tests and body composition analysis by DXA were performed on 58 nonsmoking males, mean age ( +-SE) 26.72 +- 1.98 years and BMI 25.51 +- 0.64 kg/m2, and 60 nonsmoking females matched for age and BMI (29.61 +- 1.65 years and 26.45 +- 1.05 kg/m2, respectively). Bivariate linear regression analysis showed the variables age, height, BF-LBM, BMC, and the interaction term BF-LBM*Height, but not weight and FM, to correlate significantly with lung-function variables for males and for females separately. Multiple linear regression analysis showed that sex, age, height, and BF-LBM*Height were significantly associated with FVC, FEV1, and PEF. The prediction equations developed for FVC, FEV1, and PEF on the basis of the independent variables i.e. sex, age (y), height (m), and BF-LBM*Height (kg * m) had a significantly higher cumulative correlation coefficient and a lower SEE compared with those based on age and height only. The present report suggests that the BF-LBM, expressed independently from height, can be considered for predicting lung-function variables. Author Affiliation: () Division of Human Physiology, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy, IT () Division of Internal Medicine, University of Rome "Tor Vergata,", Via Montpellier 1, 00133 Rome, Italy, IT () Biophysics Department, Medical Research Institute, University of Alexandria, Alexandria, Egypt, EG Article History: Accepted Date: 23/04/2002

Byline: C.-C. Lin (), C.-T. Chang (), T.-C. Li (), A. Kao () Abstract: The alveolar integrity (AI) in 60 patients of noninsulin-dependent diabetes mellitus (NIDDM) who had normal chest X-ray findings and pulmonary function test was measured by technetium-99m (Tc-99m) diethyltriamine pentaacetic acid (DTPA) and Tc-99m hexamethylpropylen amine (HMPAO) radioaerosol inhalation lung scan (lung scan). The degree of AI damage in NIDDM was presented as the clearance rate (%/min) of hydrophilic Tc-99m DTPA and lipophilic Tc-99m HMPAO radioaerosols from the lungs. The AI of NIDDM patients was compared with the AI of 40 normal controls. The results show that (1) the clearance rate of Tc-99m DTPA radioaerosols was faster than those of Tc-99m HMPAO radioareosols in either NIDDM patients or normal controls over any portion of the lungs, (2) the clearance rates of both Tc-99m DTPA and Tc-99m HMPAO radioaerosols were faster in NIDDM patients than those in normal controls over any portion of the lungs. Our findings concluded that (1) at least two different clearance mechanisms of radioaerosols in the lungs are working and (2) the AI damage in NIDDM patients happened in both hydrophilic and lipophilic parts of the alveoli. In addition, the AI damage found by faster clearance rates of both Tc-99m DTPA and HMPAO radioaerosols may provide the other objective evidence of lung complications in NIDDM patients, which are different from the traditional studies such as chest X-ray or pulmonary function test. Author Affiliation: () Department of Family Medicine, China Medical College, No. 2, Yuh-Der Road, Taichung 404, Taiwan, TW () Division of Endocrinology and Metabolism, China Medical College, Taichung, Taiwan, TW () Institute of Chinese Medicine, China Medical College, Taichung, Taiwan, TW () Department of Nuclear Medicine, China Medical College Hospital, Taichung, Taiwan, TW Article History: Accepted Date: 16/05/2002

Byline: A. Herrejon (1), I. Inchaurraga (1), C. Vivas (1), J. Custardoy (2), J. Marin (3) Keywords: Key words: Spontaneous pneumothorax--Pleural pressure--Resolution time. Abstract: To assess whether pleural pressure (PP) measurement is helpful in evaluating the evolution of spontaneous pneumothorax (SP). To measure the inspiratory and expiratory PP at tidal volume in the SP in 85 cases. Ninety-one percent were cured with medical treatment, whereas the remaining 9% required surgery. In the cases medically resolved, the inspiratory pleural pressure (IPP) was -9 +- 5 mbar, and the expiratory pleural pressure (EPP) was -3 +- 6 mbar, whereas in the surgical cases, IPP was -7 +- 2 mbar (p= not significant), and EPP was 1 +- 3 mbar (p &lt 0.01). In the SP cases, which resolved in less than 7 days of drainage, IPP was -10 +- 5 mbar, and EPP was -3 +- 5 mbar, whereas IPP was -8 +- 3 mbar (p &lt 0.01), and EPP was 0 +- 4 mbar (p &lt 0.001) in those cases in which SP resolution required more than 7 days. The sensitivity to predict the need for surgery with an EPP aY= 2 mbar was 100%, with a specificity of 49%. The cutoff of the curve was aY= 1 mbar, with a sensitivity of 65% and specificity of 70%. The values of PP at the end of an expiration to tidal volume were negative in the SP cases, which were resolved by medical treatment, whereas they were atmospheric in those cases that required surgery. The static inspiratory and expiratory PP in the SP cases requiring thoracic drainage during &lt 7 days showed more negative PP than those that resolved in a period longer than 7 days. Author Affiliation: (1) Department of Pneumology, Dr. Peset Hospital. Valencia, Spain, ES (2) Department of Internal Medicine. La Vega Baixa Hospital, Orihuela, Alicante, Spain, ES (3) Department of Pneumology, Universitary Clinic Hospital, Valencia, Spain, ES Article note: Accepted for publication: 11 August 2000

Byline: E. T. Iversen (1), T. Sorensen (1), T. Heckscher (1), J. I. Jensen (2) Keywords: Key words: COPD--Exercise capacity--Lung function--Terbutaline--Energy expenditure. Abstract: The objective of this study was to investigate the effects of a single dose of a [beta].sub.2-agonist, terbutaline (Bricanyl Turbuhaler(r)), on resting lung function and exercise capacity in patients with chronic obstructive lung disease. Using a double-blind, placebo-controlled, randomized crossover study and outpatients from a department of pulmonary medicine at a major inner-city hospital, we examined 26 individuals with chronic obstructive lung disease who met the criteria of 40% a$? FE[V.sub.1]a$? 70% of predicted, FEV.sub.1/FVC a$? 70%, and IFE[V.sub.1]a$? 200 ml 20 min after inhalation of 1 mg of terbutaline. The patients inhaled 2.5 mg of terbutaline and matched placebo. At rest, terbutaline caused significant increases in [D.sub.L]CO, MVV.sub.12sec, and all spirometric indices derived from the flow-volume loop, the increases also being significantly larger than those after inhalation of 1 mg of terbutaline for FEV.sub.1, FVC, and PEF. The peak work rate was unchanged after terbutaline. Oxygen uptake, ventilation, and tidal volume at peak work rate increased significantly, whereas carbon dioxide elimination increased insignificantly. Cumulative oxygen uptake and carbon dioxide elimination during progressive exercise to exhaustion and 10 min of recovery were significantly higher after terbutaline. We concluded that despite significant improvements in resting lung function, inhalation of 2.5 mg of terbutaline did not increase exercise capacity, but it increased cumulative oxygen uptake and carbon dioxide elimination during exercise and recovery, presumably because of a thermogenic effect of terbutaline. Author Affiliation: (1) Department of Pulmonary Medicine, Bispebjerg Hospital, DK 2400 Copenhagen NV, Denmark, DK (2) Department of Medicine, Centralsygehuset i Esbjerg, DK-6700 Esbjerg, Denmark, DK Article note: Accepted for publication: 29 April 1999

Lung function declines more rapidly in adults with asthma than adults without asthma. This was the conclusion of a 15-year study of 17,506 participants in the Copenhagen City Heart Study. A total of 1,095 had asthma. Compared to those without asthma, those with asthma experienced greater declines in FEV1, which is a measure of how much air can be exhaled from the lungs in one second. This was true even among non-smokers, but smokers with asthma had even greater declines in FEV1.

Byline: S. M. Scharf (1), L. Rossoff (1), K. McKeon (1), L. M. Graver (1), C. Graham (1), H. N. Steinberg (1) Keywords: Key words: Lung volume reduction--Emphysema--Maximum flow rates--Elastic recoil--Work of breathing--Dyspnea. Abstract: Lung volume reduction surgery (LVRS) is a promising new treatment for emphysema and leads to increased flow rates. We investigated the mechanisms by which flow rates could increase and the correlates of lessened dyspnea in patients undergoing LVRS before and 3 months after LVRS in patients with severe emphysema. The following were done: routine pulmonary function testing, measurements of elastic recoil (Pel), tidal breathing patterns, inspiratory work of breathing (W.sub.insp), construction of static recoil-maximum flow curves, and measurement of baseline and transitional dyspnea index (TDI). There were increases in forced vital capacity (FVC: 2.24 +- 0.71 to 2.92 +- 0.63 liters p &lt 0.05), forced expired volume in 1 (FEV.sub.1: 0.64 +- .16 to 1.03 +- 0.28 liters p &lt 0.01), and decreases in all divisions of lung volume, e.g. total lung capacity (TLC: 6.86 +- 1.41 to 5.96 +- 1.49 liters p &lt 0.01). Maximum Pel increased (11.7 +- 3.7 to 19.8 +- 7.8 cm[H.sub.2]O p &lt 0.02) as did the coefficient of retraction (C.sub.R= Pel/TLC: 1.8 +- 0.7 to 3.6 +- 3.6 +- 2.2 cm[H.sub.2]O/liter). However, the individual responses in other parameters were markedly different among patients. There was no consistent trend in changes in the slope or position of the static recoil-maximum flow curve or W.sub.insp. The only positive correlate of improved dyspnea (TDI = 3.22 +- 2.22 p &lt 0.01) was improvement in C.sub.R, FEV.sub.1 being a weak negative correlate and change in lung volume not being a correlate at all. We conclude that there is a heterogeneous response of the airways to LVRS. Increased elastic recoil was the primary determinant of improved flow rates after LVRS and is the only positive correlate for improvement in dyspnea. Author Affiliation: (1) Pulmonary and Critical Care Division and Cardiothoracic Surgery Division, Long Island Jewish Medical Center, The Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY 11042 USA, US Article note: Accepted for publication: 14 July 1997

Byline: E. Kreuzfelder (1), G. Scheiber (2), K. Quabeck (3), U. W. Schaefer (3), J. Bruch (4), U. Costabel (5), H. Grosse-Wilde (1) Keywords: Key words: Alveolo-capillary leakage--BAL--BMT--Lung function--Pulmonary complications. Abstract: A prospective study was performed to identify markers predictive for the development of pulmonary complications in the early (&lt 50 days) and late (&gt 50 days) phase after bone marrow transplantation (BMT). The characterization of BMT patients with early or late pulmonary complications revealed clear-cut differences. Early and long term increase of alveolo-capillary protein permeability was associated with smoking and was found in 20 patients developing pulmonary complications within 50 days after BMT (group 1). The 22 patients who developed such complications thereafter (group 2) had more acute graft vs host disease than 66 patients who remained free of these complications for a minimum of 1 year. Concentrations of bronchoalveolar lavage (BAL) fluid albumin (alb) and serum [beta].sub.2-microglobulin (S-[bet[a].sub.2]m) were determined 10 days before BMT, on days 1, 30, and 40 after BMT, whereas lung function tests were performed before BMT, after discharge from the hospital, and 6 months as well 1 year after BMT. Using cut-off values for BAL fluid alb (&gt 2.3 mg/dl) and S-[bet[a].sub.2]m (&gt 0.8 mg/liter) we could significantly discriminate 12 patients out of 19 group 1 patients (early pulmonary complications) as well as 9 out of 21 group 2 patients (late pulmonary complications) from 12 out of 64 group 3 patients (without such complications) 1 day after BMT. Our results demonstrate that early increased alveolo-capillary protein permeability defines a patient population at risk to develop pulmonary complications later than 50 days after BMT with up to 1 year significantly decreased lung volumes (FEV1, 73% predicted, VC, 85% predicted). Author Affiliation: (1) Institut fuer Immunologie, Universitaetsklinikum Essen, Hufelandstrasse 55, D-45122 Essen, Germany, DE (2) Abteilung fur Anaesthesiologie und Intensivmedizin, Kreiskrankenhaus Ilmenau, Ilmenau, Germany, DE (3) Klinik und Poliklinik fuer Knochenmarktransplantation, Hufelandstrasse 55, D-45122 Essen, Germany, DE (4) Institut fuer Hygiene und Arbeitsmedizin, Hufelandstrasse 55, D-45122 Essen, Germany, DE (5) Abteilung fuer Pneumologie, Universitaetsklinikum Essen, Hufelandstrasse 55, D-45122 Essen, Germany, DE Article note: Accepted for publication: 12 June 1997

The evaluation and analysis of blood pressure frequencies to determine the rate of respiration is a novel technique. This method of measuring respiration involves the analysis of blood pulse waves to determine the actual frequency of inspiration and expiration. Subsequent statistical analysis indicated that there is no significant difference between the rate of respiration and blood pressure frequency. This method can be utilized as an efficient and simple alternative in determining the respiratory rate.