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Biomedical subjects

J Lebzelter

Publications and source records attributed to J Lebzelter.

8 recordsLinked to original sources
PubMed2001

Pulmonary function in patients with diabetes mellitus.

BACKGROUND: Pulmonary complications of diabetes mellitus have been poorly characterized. Although some authors have reported normal pulmonary function, others found abnormalities in lung volumes, pulmonary mechanics, and diffusing capacity. SUBJECTS AND METHODS: We studied pulmonary function in a group of patients with diabetes using a combined cardiopulmonary exercise test. Twenty-seven patients with diabetes aged 48 +/- 13 years participated in the study. RESULTS: Overall, forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow, midexpiratory phase, were within the predicted values, but the residual volume/total lung capacity ratio was slightly elevated. Comparison by diabetes type showed nonsignificant differences in forced expiratory volume in 1 second and forced expiratory flow, midexpiratory phase. Residual volume/total lung capacity ratio was significantly elevated in type 1 patients compared with type 2. Carbon monoxide diffusion capacity (DLCO) was normal in both groups. There was no correlation between the results on pulmonary function test and duration of disease, presence of microangiopathy, or glycemic control. The DLCO was significantly lower in patients with microangiopathic changes, but not when DLCO was corrected for alveolar volume. On the cardiopulmonary exercise test, maximal workload, maximum oxygen uptake, and maximal heart rate were less than predicted, whereas anaerobic threshold and ventilatory reserve were normal. No significant differences were noted in diabetes type, and there was no correlation between parameters of cardiopulmonary exercise test and the other variables. CONCLUSION: Spirometric values are preserved in patients with diabetes mellitus, and there are no defects in diffusing capacity. Cardiovascular factors may account for impaired physical performance. There is no need for routine screening of pulmonary function among diabetic patients.

Adult↗
PubMed2001

Relationship between pulmonary function and unsupported arm exercise in patients with COPD.

UNLABELLED: In patients with chronic obstructive pulmonary disease (COPD) the limitation on unsupported arm exercise (UAE) is predominantly respiratory muscle function-dependent. It is characterized by neuromechanical dysfunction (thoracoabdominal dyssynchrony) of the inspiratory muscles (diaphragm, accessory), superimposed by lung mechanics dysfunction. The undergoing mechanism is probably multifactorial. To study the relationship of resting pulmonary function and UAE performance in patients with COPD. Twenty-one patients, mean age 63 +/- 7 years, with COPD [forced expiratory volume in the first second (FEV1) 42 +/- 12% of predicted] underwent assessment of resting lung function (inspiratory capacity 57 +/- 17%; functional residual capacity 204 +/- 38% of predicted), maximal inspiratory pressure (67 +/- 14 cmH2O), upper arm circumference (30 +/- 2 cm), and symptom-limited cardiopulmonary UAE assessments. UAE consisted of bilateral anterior arm elevation to shoulder level at a rate of 40 arm strokes.minute-1. A series of stepwise multiple regression models were fitted to the data to predict exercise time from resting pulmonary function indices. RESULTS: Statistically significant correlations (r) were found between exercise time and inspiratory capacity (% of predicted) (r = 0.67, p = 0.0008), maximal inspiratory pressure (cmH2O) (r = 0.47, p = 0.03), upper arm circumference (r = 0.74, p = 0.0001), FEV1 (% of predicted) (r = 0.62, p = 0.0026), oxygen uptake (r = 0.56, p = 0.0085) and functional residual capacity (% of predicted) (r = -0.41, p = 0.06, borderline). Inspiratory capacity (% of predicted), functional residual capacity (% of predicted), upper arm circumference (cm) and FEV1 (% of predicted) explained 77% of the variance in exercise time. Therapeutic strategies that aim to increase inspiratory capacity or decrease functional residual capacity, or increase inspiratory muscle strength and upper arm/torso muscle endurance are likely to alleviate symptoms and improve UAE performance in patients with COPD.

Aged↗
PubMed2000

[Preflight assessment by hypoxic inhalation test in cardiopulmonary patients].

Flying may expose passengers to hypoxic conditions, which may induce hypoxemia, particularly in those with chronic heart and/or lung disease. Onset of dyspnea, wheezing, chest pain, cyanosis and right heart failure can lead to urgent need for oxygen during flight. The hypoxia inhalation test (HIT) provides a safe and simple means of identifying those who may develop hypoxemia during flight. We report our experience with 48 self-reporting patients who underwent HIT prior to pre-planned air travel. They inhaled for 15-minute periods a reduced oxygen concentration (F1O2 15%) under normobaric conditions, during which O2 saturation was monitored by pulse oximeter; electrocardiogram, blood pressure and symptoms were also monitored. O2 saturation of < 85% (PaO2 50 mm Hg) was considered a positive test. In the 8 cases (17%) with a positive test, 5 had chronic obstructive pulmonary disease and 3 had cardiovascular and/or combined heart-lung disease. We calculated predicted O2 partial pressure in altitude (PaO2ALT) and compared it to actual results in the 8 patients with a positive HIT. In 5, use of the predicted formula would have under-diagnosed the hypoxemia that developed during the HIT. Thus, the results of the HIT changed treatment strategy in these patients. We recommend that patients with positive tests use O2 (2LPM or 4LPM) during flight. HIT is practical and of potential benefit in the objective assessment of patients with various degrees of heart, lung or combined heart-lung disease. Clinicians should be aware of the relative risk of hypoxia during flight in such patients, and of the value of HIT in identifying them, leading to increase in its use.

Aerospace Medicine↗
PubMed1999

Quantitative 15 steps exercise oximetry as a marker of disease severity in patients with chronic obstructive pulmonary disease.

BACKGROUND: Hypoxemia is a common complication of chronic obstructive pulmonary disease and a major factor in patients' prognosis and quality of life. The response to exercise has been evaluated by various means but no standardization has been accepted. OBJECTIVES: To suggest a simple outpatient technique for evaluating the response of arterial oxygen saturation to exercise for use as a marker of disease severity. PATIENTS AND METHODS: Ninety-six patients with various degrees of COPD were divided into three groups: mild (forced expiratory volume in 1 sec > 65%), moderate (FEV1 between 50 and 65%), and severe (FEV1 < 50%). Using continuous oximeter recording we measured oxygen saturation during 15 steps of climbing, and quantified oxygen desaturation by measuring the "desaturation area," defined as the area under the curve of oxygen saturation from the beginning of exercise through the lowest desaturation point and until after recovery to the baseline level of oxygen percent saturation. Desaturation was correlated to spirometry, lung gas volumes, blood gas analysis, and 6 min walking distance. RESULTS: A good correlation was found between severity of COPD and baseline SaO2, lowest SaO2, recovery time, and desaturation area. A negative correlation was found between desaturation area and FEV1 (r = -0.65), FEV1/forced vital capacity (r = -0.58), residual volume to total lung capacity (r = 0.52), and diffusing lung capacity for carbon monoxide (r = -0.52). In stepwise multiple regression analysis only FEV1 correlated significantly to desaturation area. A good correlation was noted between 6 min walking distance and desaturation area with the 15 steps technique (r = 0.56). CONCLUSIONS: In patients with severe COPD, arterial hypoxemia during exercise can be assessed by simple 15 steps oximetry. This method can serve both as a marker for disease severity and to determine the need for oxygen supplementation.

Adult↗
PubMed1998

Significance of prominent atrial-wave and diastasis deflection in radionuclide diastolic volume curve during exercise in detection of coronary artery disease.

BACKGROUND: Exercise testing with multigated acquisition technetium radionuclide cineangiography (MUGA) is a useful modality that can discriminate systolic and diastolic performance in patients with ischemic heart disease. However, some patients may have abnormal left ventricular filling dynamics with normal regional and global systolic function. HYPOTHESIS: The purpose of the study was to assess exercise-induced diastolic dysfunction as expressed by a prominent atrial (A) wave or diastasis deflection at the left ventricular volume curve, in patients with different degrees of ischemic heart disease. METHODS: In all, 32 men and 7 women aged 35-70 years (mean 54 +/- 8.6 years) underwent MUGA at rest and during exercise for analysis of the radionuclide volume curve. Within 6 weeks, thallium-201 scintigraphy and coronary angiography were performed and the patients were categorized into three groups: (1) disease-free (n = 10), (2) single-vessel disease (> 50% stenosis) (n = 19), and (3) double-vessel disease or more (n = 10). A waves or diastasis deflections were compared among the groups. RESULTS: Significant differences (p < 0.01) were noted in A-wave deflection relative to peak diastolic volume curve during exercise (Aexe/T) between Group 1 and Groups 2 and 3. Group 1 manifested only a mild rise in A-wave deflection from rest (20.20 +/- 8.49%) to exercise (25.85 +/- 8.49%), whereas Groups 2 and 3 exhibited a significant increase from 25.89 +/- 9.55% and 28.40 +/- 12.6%, respectively, to 60.21 +/- 22.5% and 63.0 +/- 22.86%, respectively. Group 2 had a significantly (p < 0.05) higher maximal heart rate than Group 3. CONCLUSIONS: The addition of prominent A-wave or diastasis deflection to a normal systolic response during exercise testing with multigated radionuclide cineangiography might be a sensitive marker of coronary artery disease. The A wave represents diastolic dysfunction of the left ventricle, considered an early event in the ischemic cascade.

Adult↗
PubMed1998

Pulmonary function threshold for distinguishing ventilatory- and nonventilatory-limited patients with airflow obstruction.

Patients with chronic obstructive pulmonary disease (COPD) may demonstrate great variability between results on the pulmonary function test (PFT) compared to those on the cardiopulmonary exercise test (CPXT). The purpose of this study was to correlate PFT and CPXT indices and to identify PFT threshold values for predicting exercise capacity in patients with airflow limitation. Fifty-seven patients (48 men and 9 women) of mean age 66.4 +/- 4.8 years with COPD and 40 age-matched control patients underwent PFT and CPXT. Based on the CPXT results, the patients were divided into ventilatory-limited (VL) and nonventilatory-limited (NVL), and the findings were correlated with the PFT indices. Linear regression analysis was used to determine the relationship between dyspnea index (VEmax/MVV) and forced expiratory volume in one second (FEV1). The cutoff value for VL was FEV1 < 38% and for NVL FEV1 > 68%. The prominent limiting symptom (61%) in the VL group was dyspnea sensation, with leg discomfort presenting in only 14%; corresponding rates in the NVL group were 38% and 31%. We conclude that the FEV1 is a reliable index for distinguishing VL from NVL COPD patients during CPXT at two extremes: below 38% of the predicted value (VL) and above 68% of the predicted value (NVL).

Aged↗
PubMed1998

Assessment of functional results after percutaneous transluminal coronary angioplasty by cardiopulmonary exercise test.

Twenty-nine patients with documented coronary artery disease underwent cardiopulmonary exercise tests before and following a percutaneous transluminal coronary angioplasty (PTCA). The patients medication regimen and exercise protocols remained the same in both cases. Following PTCA, significant improvement (p < 0.001-0.0001) was noted in oxygen consumption (1,526.8 +/- 470.0 vs. 1,686.2 +/- 390 ml/min), oxygen pulse (12.40 +/- 2.73 vs. 13.44 +/- 2.9 ml/beat), oxygen pulse score (7.62 +/- 1.29 vs. 8.85 +/- 1.26 points) and in the ventilatory anaerobic threshold (993.1 +/- 177.6 vs. 1,089.8 +/- 150.9 ml/min) but not (p > 0.05) in maximal heart rate (128.7 +/- 16.9 vs. 132.0 +/- 17.2 beats/min). Thus, a cardiopulmonary exercise test is an effective method to assess functional results following PTCA.

Adult↗