Lung elasticity in children and adolescents.
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Biomedical subjects
Publications and source records attributed to A Zapletal.
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During a 5-year period (1978-1983) corrective surgery for tetralogy of Fallot was performed in 114 patients, ranging in age from 2 to 24 years (mean 8.4 years). Forty-one of them (35.9%) had previously undergone a palliative operation. Insertion of a transannular patch was necessary in 48 patients (42.1%). Eleven children died in the immediate postoperative period (early mortality 9.6%); no deaths occurred later. 103 survivors were followed-up for periods ranging from 5 months to 5 years mean 2.4 years) after surgery. The condition in 91 patients was excellent (88.7%), in 11 good (10.7%) and in one poor. Residual ventricular septal defect persisted in 9 patients (8.7%). Postoperative ECG revealed complete right bundle branch block in 71 patients (59%), incomplete block in 18 (18%), 5 patients (5%) had complete RBBB with left anterior hemiblock. Postoperative dysrhythmia requiring treatment was found in 7 patients (6%). Of 82 patients thoroughly examined by echocardiography, 37 (45%) had pulmonary regurgitation, 29 (35%) pulmonary plus tricuspid regurgitation, and 3 (4%) isolated tricuspid regurgitation. 83% of the patients had impaired lung function.
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In 24 patients with cystic fibrosis (6-20 years old), divided into two groups, we studied indices of airways obstruction before, 20-30 min and 2 h after chest physiotherapy. The physiotherapy lasted for 30 min and included expectoration of 2-10 ml of sputum. In one group of 14 patients, studies were made only 30 min after chest physiotherapy. No significant improvements of the ventilatory tests occurred. In fact, Vmax at 25% of VC deteriorated (P less than 0.05) in this group as a whole. In some patients also CV/VC increased, and N2 and CO2 alveolar slopes became steeper. Only Gaw/TGV improved in 20% of the patients by more than 10% of the control value. In the second group of 10 patients, ventilatory studies were repeated 3 times at one month intervals. They did not change significantly at 20 min and 2 h after chest physiotherapy. Gaw/TGV value improved by more than 10% in 20% of the patients. During chest physiotherapy, the patients were stimulated to cough. This might contribute to the immediate negative effects on ventilatory function by causing collapse of the central airways, as documented by cinebronchographic studies in 8 patients.
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In 28 patients with cystic fibrosis aged 5--24 years the values of maximum expiratory flow rates (Vmax) at lower volume levels were assessed, as well as the "specific" conductance of the respiratory pathways (Gaw/TGV), the vital capacity (VC), total lung capacity (TLC), residual volume (RV), functional residual capacity (FRC), RV/TLC and FRC/TLC ratios and the one-second forced expiration of the vital capacity (FEV1) to evaluate obstruction of the respiratory pathways. Most markedly and most frequently abnormal were the values of Vmax, RV and of the RV/TLC ratio. These findings revealed that in almost all patients with CF there was already during the initial examination an obstruction of the peripheral respiratory pathways and hyperinflation of the lungs. During repeated measurement of the above values of lung function in 15 patients with cystic fibrosis during a period of 1--5 years when the patients increased in height by 10 cm on average, the above values did not deteriorate on average. There was, however, an individual variability of the investigated values during this period. The comprehensive treatment provided in our country prevented in patients with CF a deterioration of obstruction of the respiratory pathways during the period of investigation.
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In the article we outlined the basic principles of some recent methods of lung function testing, suitable for the assessment of airway obstruction in children and adolescents. There is also a brief description of various methods, normal values expressed in a form of regression equations, significance of different methods for the assessment of airway obstruction in patients with respiratory diseases and in children from a region with increased levels of air pollution. Among the various functional indices we found the most sensitive for the assessment of airway obstruction maximum expiratory flow rates measured at lower lung volume levels. Airway conductance appeared as the most sensitive method for the evaluation of bronchodilation following inhalation of some drugs. The measurements of airway conductance in a body plethysmography during normal quiet breathing and of maximum expiratory flow rates from flow-volume curves represent the basic methods for the detection of airway obstruction, i.e. in the larger central airways, and in the peripheral airways respectively.