Biomedical subjects

Edward Ingenito

Publications and source records attributed to Edward Ingenito.

3 recordsLinked to original sources

PubMed2005

Pulmonary function tests versus computed tomography in sheep with experimental emphysema.

The authors explored the relative utility of pulmonary function tests (PFTs) and computed tomography (CT) to characterize the progression of papain induced emphysema in sheep (n = 12). PFT included plethysmography (FRC(pleth)), helium dilution (FRC(He)), and expired reserve volume (ERV). Following papain, FRC(pleth) and FRC(He) were unchanged; ERV decreased hence residual volume increased significantly (RV + 270 mL, +86%, P = .02). In contrast, FRC by CT increased in 10 of 12 sheep (+264 mL +21%, P = .008). We conclude that plethysmography was insensitive to emphysema, but the effect on ERV (i.e., trapped gas volume) and FRC by CT were very similar, and in line with the morphologic changes in this animal model.

Animals↗

PubMed2003

Physiologic responses of sheep to two different methods of papain exposure.

Human emphysema is a progressive, destructive lung disease that produces morphologic and functional heterogeneity throughout its course. Consequently, the mature form of the disease is described by a broad range of anatomic, radiological, and physiologic patterns. This report describes the development and characterization of a sheep model of emphysema that represents many of the essential features of both homogeneous and heterogeneous emphysema. Emphysema was produced by two different techniques of papain exposure: (1) aerosol (75 IU/kg) given weekly for 4 treatments (HM) or (2) aerosol (75 IU/kg) weekly for 3 treatments following subsegmental intrabronchial instillations, 75 IU (in 10 saline) per lobe in 6 lobes (HT). Dexamethasone (0.06 mg/kg iv) was administered prior intrabronchial instillations only. On computed tomography, the HM group had homogeneous emphysema, the HT group gross nonuniformity of disease and bullae formation. Both groups demonstrated a significant (p < 0.05) increase in residual volume (HM, +38%; HT, +30%). There was a significant increase (p = 0.002) in total lung capacity per kilogram for the HM group. Emphysema had no effect on active or passive chest wall compliances. Diffusion capacity was significantly (p < 0.05) reduced in both groups. Both elastic (p = 0.066) and resistive (p = 0.025) components of impedance were increased in the HT, and airway resistance increased significantly in the HM groups. The HM model demonstrated gas trapping, a characteristic feature of emphysema, but failed to replicate the alterations in lung dynamics observed in the human form of this disease. The HT model demonstrated less static hyperinflation but significant frequency dependence and hence appeared to better represent the dynamic characteristics of human emphysema.

Administration, Inhalation↗

PubMed2002

Power of outcome measurements to detect clinically significant changes in pulmonary rehabilitation of patients with COPD.

STUDY OBJECTIVES: Several validated instruments are used to measure outcomes, such as exercise performance, dyspnea, and health-related quality of life after pulmonary rehabilitation (PR) in patients with COPD. However, no study has simultaneously compared the responsiveness of the most frequently used outcome measurements after PR. We designed this study to investigate the capacity of several of the most frequently used outcome measurements to detect changes after PR in a population of patients with severe COPD who qualified for lung volume reduction surgery. DESIGN, PATIENTS, AND INTERVENTIONS: We evaluated 37 patients with severe COPD (FEV(1) < 40%) before and after 6 to 8 weeks of outpatient PR. The following frequently used tools were evaluated: the 6-min walk distance (6MWD); functional dyspnea with the Medical Research Council (MRC) scale; baseline and transitional dyspnea index (BDI/TDI); resting and 6MWD visual analog scale (VAS); quality of life with a generic tool (the Short Form-36 [SF-36]); and two disease-specific tools, the Chronic Respiratory Disease Questionnaire (CRQ) and the St. George's Respiratory Questionnaire (SGRQ). RESULTS: After PR, mean +/- SD 6MWD increased in 33 of 37 patients (89%), from 285 +/- 97 to 343 +/- 92 m (p = 0.009). Improvements were seen also in the MRC scale in 23 of 37 patients (62%; from 2.27 +/- 0.8 to 1.86 +/- 0.6; p = 0.01); in CRQ dyspnea in 25 of 37 patients (67%; from 3.25 +/- 0.9 to 3.90 +/- 1.4; p = 0.02); in CRQ mastery in 22 of 37 patients (60%; from 4.37 +/- 1.4 to 5.14 +/- 1.3; p = 0.01); and in BDI/TDI functional in 24 of 37 patients (64%; from 1.4 +/- 0.8 to 0.7 +/- 1.1; p = 0.002). There were smaller improvements in the SGRQ in 18 of 37 patients (48%) and in the SF-36 in 19 of 37 patients (51%), but they were not statistically significant. There were good correlations between the dyspnea components of all the tools. The 6MWD change did not correlate with the changes in the other outcomes. Clinically significant changes in the values for those outcome tools were detected in > 50% of patients for the BDI/TDI, 29% of patients for the MRC scale, in 37% of patients for the 6MWD, in 48% of patients for the VAS at peak exercise, in > 50% of patients for the CRQ, and in 40% of patients for the SGRQ. CONCLUSIONS: We conclude that the VAS peak exercise, BDI/TDI, and CRQ adequately reflect the beneficial effects of PR. The 6MWD evaluates a unique domain not related to quality of life. Due to their simplicity and sensitivity, VAS at peak exercise, 6MWD, and CRQ may be the best practical tools to evaluate responsiveness to PR.

Aged↗