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Biomedical subjects

M Decramer

Publications and source records attributed to M Decramer.

136 records · Page 8Linked to original sources
PubMed1982

Evaluation of bedside myocardial scintigraphy with 201Tl in acute myocardial infarction.

Bedside myocardial scintigraphy was performed on 149 patients admitted to the Coronary Care Unit (CCU), after IV injection of 74 MBq 201Tl, using a mobile gamma camera (Dynamo). The study was displayed on Polaroïd pictures, without any image treatment, and read by two independent readers. Clinical history, findings, and final diagnosis were assessed by an independent clinician. The following conclusions were reached: 1) The sensitivity of the study for the detection of a recent myocardial infarction (MI) was 0.84 with a specificity of 0.87. 2) There was a good correlation between scintigraphic and ECG localization. 3) No firm correlation was found between scintigraphic and enzymatic estimates of infarct size. 4) Abnormal visualization of the right ventricle was probably associated with more extensive infarction.

Aged↗
PubMed1981

Model of elasticity of the human lung.

A model of the elasticity of the human lung has been developed to evaluate the relative importance of the characteristics of the lung parenchyma, of thorax configuration, and of gravity on the vertical gradients of pleural pressure and regional volumes, and on the linear displacements of lung tissue, of various lung volumes. The predictions of the model are compared with available experimental data. It is suggested that the bulk elasticity modulus of the human lung is high with respect to that of canine lungs, that the shearing forces are low ("effective" Poison's ratio of about 0.4-0.45), and that the variations of regional pleural pressures and volumes during deflation are determined primarily by the interaction between lung weight and changes in thorax configuration.

Adult↗
PubMedDate not supplied

Diagnostic value of transesophageal echocardiography in platypnea.

Platypnea is a rare syndrome of orthostatic dyspnea frequently caused by an interatrial right-to-left shunt. The diagnosis is difficult. Assessment of arterial blood gases reveals orthostatic desaturation. In the past, definite diagnosis necessitated catheterization in the supine and upright position. Now transesophageal echocardiography on a tilt table combined with a peripheral venous contrast study provides correct diagnosis in a safe and easy way.

Aged↗
PubMedDate not supplied

Lung volume reduction surgery (LVRS) for emphysema: initial experience at the University Hospital Gasthuisberg. Leuven LVRS Group.

Emphysema is a disabling disease, for which there is no curative therapy available today. Lung transplantation offers a valuable option for a very selected number of patients, however, due to the enormous organ shortage, only few patients can be offered such a therapy. Recently there has been important resurgence of interest in lung volume reduction surgery and as a consequence, we have embarked in such a program since may 1997. We have now performed unilateral lung volume reduction surgery in 29 emphysema patients (25 on the right and 4 on the left side). Twenty-four patients were already discharged home. There has been no perioperative mortality. The mean hospital stay was 19.8 +/- 11.4 days (range, 8-47 d). Twenty patients of whom we already have follow-up data during 6 months (m) form the further basis of this report. Six weeks after the procedure the FEV1 increased from 0.82 +/- 0.28 L (28 +/- 8%) to 1.05 +/- 0.39 L, a mean increase of 28%. There was a further increase of the FEV1 to a maximum of 1.06 +/- 0.42 L at 6 m, a mean maximum increase of 29% (p = 0.0046, ANOVA). Similarly, the FVC increased from 2.80 +/- 1.10 L to 3.15 +/- 1.00 L, a mean increase of 12.5%. A further increase was also obtained at 6 m and was 19.6% (3.35 +/- 1.05 L, p = 0.014, ANOVA). The maximum decrease in RV was obtained at 3 m (from 5.91 +/- 1.37 L to 4.37 +/- 0.85 L (p = 0.0001, ANOVA), a mean decrease of 26%. The maximum TLC decrease was demonstrated at 3 m (from 8.71 +/- 1.71 L to 7.60 +/- 1.56 L (p = 0.002, ANOVA), a mean decrease of 12.8%. Afterwards there was again a gradual raise of the TLC. The six minute walking distance increased from 231 +/- 31 m to 272 +/- 34 m (p = NS) after pulmonary rehabilitation and to 416 +/- 77 m at 3 m and 415 +/- 18 m at 6 m (p = 0.0002, ANOVA) after the operation. The quality of life (measured with a standardized questionnaire, the Nottingham Health Profile) improved significantly in several domains (e.g. mobility, pain, energy, emotions and social) at 3 m postoperatively. There was one late death (at 6 m) due to an unknown cause. The actuarial survival rate was therefore 100% at 3 m and 95% at 12 m. In conclusion, unilateral thoracoscopic lung volume reduction surgery is a new and safe treatment modality for patients suffering from severe end-stage emphysema. The objective and subjective improvement is marked and the mortality is very low. Rigid selection criteria are, however, necessary to be able to guarantee an optimal result.

Actuarial Analysis↗
PubMedDate not supplied

Distribution of muscle weakness in patients with stable chronic obstructive pulmonary disease.

PURPOSE: The authors determined the degree of respiratory and peripheral muscle weakness in patients with moderate to severe chronic obstructive pulmonary disease (COPD). Differences in severity of muscle weakness among muscle groups may provide treatment options, such as selective muscle training, to adapt the exercise prescription in pulmonary rehabilitation programs. In addition, this information may add to the knowledge on the mechanisms of muscle weakness. METHODS: Respiratory and peripheral muscle force were quantified in 22 healthy elderly subjects and 40 consecutive COPD patients (forced expiratory volume in 1 second, percent of predicted value [% pred] 41 +/- 19; transfer factor for carbon monoxide, % pred 47 +/- 26) admitted to a pulmonary rehabilitation program. Lung function, diffusing capacity, isometric force of four peripheral muscle groups (handgrip, elbow flexion, shoulder abduction, and knee extension), neck flexion force, and maximal inspiratory and expiratory pressures were measured. RESULTS: Patients had reduced respiratory muscle strength (mean 64% of control subjects' value [% control]) and peripheral muscle strength (mean 75% control) compared to normal subjects. Inspiratory muscle strength (59 +/- 18% control) was significantly lower than expiratory muscle strength (69 +/- 25% control) and peripheral muscle strength (P < 0.01). Neck flexion force (80 +/- 19% control) was better preserved than maximal inspiratory pressure and shoulder abduction force (70 +/- 15% control, P < 0.01). Handgrip force (78 +/- 16% control) and elbow flexion force (78 +/- 14% control) were significantly less affected than shoulder abduction force (70 +/- 15% control, P < 0.01). Finally, shoulder abduction force and knee-extension force (72 +/- 24% control) were not significantly different. CONCLUSIONS: Muscle weakness in stable COPD patients does not affect all muscles to a similar extent. Inspiratory muscle force is affected more than peripheral muscle force, whereas proximal upper limb muscle strength was impaired more than distal upper limb muscle strength.

Aged↗
PubMedDate not supplied

Exercise training in COPD: how to distinguish responders from nonresponders.

PURPOSE: Pulmonary rehabilitation programs consistently have improved exercise capacity, quality of life, and symptoms over the past decade. Although training has been shown to be an essential component of the rehabilitation program, individual patients do not always benefit to the same extent. The present study was designed to investigate which patients were achieving significant benefit of exercise training. METHODS: Forty-nine stable outpatients with moderate to severe COPD (FEV1 37 (15)%pred) were evaluated before and after 12 weeks of exercise training (3 times per week). Responders in exercise capacity were defined as having 15% increase in maximal workload and/or 25% increase in walking distance, while responders in quality of life showed an improvement of at least 10 points on the chronic respiratory disease questionnaire. With multivariate discriminant analysis, responders were distinguished from nonresponders based upon their initial characteristics. RESULTS: Thirty-two patients were responders in terms of improved exercise capacity. Ventilatory reserve (VE/MVV), inspiratory muscle strength (Plmax), and peripheral muscle strength (handgrip force and quadriceps force) were significant predictors of the training response (P < 0.05) (accuracy 80% P < 0.001). Although the explained variance was modest, patients that were clearly ventilatory limited and had normal skeletal muscle strength were not likely to benefit from exercise training in terms of exercise capacity. No physiologic variables predicted whether a patient would increase quality of life after exercise training. CONCLUSION: Patients with reduced exercise capacity who experience less ventilatory limitation to exercise and more reduced respiratory and peripheral muscle strength are more likely to improve with exercise training. Improvements in quality of life after exercise training were significant but remained unpredictable with variables included in the present trial.

Aged↗
PubMedDate not supplied

Management of COPD according to guidelines. A national survey among Belgian physicians.

Current management of COPD by Belgian physicians was compared with the recommendations of the recently published GOLD guidelines. A random sample of 386 general practitioners and 86 pulmonologists filled in a questionnaire based on the GOLD guidelines and examining their attitudes towards COPD management. Several important deviations from the guidelines were noted. Only few GP's performed spirometry themselves and about 55% of the diagnoses were not based on spirometry. Both GP's and pulmonologists used inhaled corticosteroids considerably more often than prescribed by the guidelines, with 49% and 25% respectively, prescribing them to all COPD patients. Chronic systemic steroids were also overused in stable disease, with 55% of the GP's and 52% of the pulmonologists prescribing them in patients with repeated exacerbations. GP's did not use enough systemic corticosteroids and overused antibiotics in the treatment of exacerbations. Pulmonologists did not pay enough attention to pulmonary rehabilitation, as only 44% of them had a structured programme. Pulmonologists did not use non-invasive ventilation frequently enough in the treatment of exacerbations, as only 22% would use it in the correct indication. Both GP's and pulmonologists did not prescribe enough pharmacotherapy for smoking cessation, with 35% and 46%, respectively using it. Some interesting differences between Dutch and French speaking physicians were noted. These specific deviations from the guidelines will be addressed in a second phase implementation project.

Belgium↗
PubMedDate not supplied

Isocapnic hyperventilation with cold air in healthy non-smokers, smokers and asthmatic subjects.

Isocapnic hyperventilation with subfreezing air was performed by 15 healthy non-smokers, 10 asymptomatic smokers and 9 asthmatics. All subjects had normal ventilatory function and airway resistance (Raw) before challenge. The hyperventilation was performed twice. In one session, total respiratory resistance (Rrs) and reactance (Xrs) were measured at various frequencies, using a forced oscillation technique; in another session, vital capacity (VC), forced expiratory volume in 1 s (FEV1), maximal expiratory flow rates (FEF) and Raw were determined. In non-smokers, no changes in FEV1, FEF nor Raw were observed, whereas Rrs increased significantly (+ 20% of the prechallenge value), without change in resonant frequency nor in the Rrs-frequency relationship. This suggests a constrictory effect on central airways (possibly a narrowing of the glottis) only. In smokers, Rrs showed a similar, though longer lasting, increase than in non-smokers. Besides, a significant change of the Rrs-frequency relationship and a reduction in FEF at 50% of VC was found, suggesting an involvement of peripheral airways also. In asthmatics, bronchial reactivity was more pronounced, resulting in significant changes in all parameters: Rrs increased by about 100% of the prechallenge value, and became highly frequency dependent; Xrs decreased markedly, resulting in an increase in resonant frequency of the respiratory system. Similarly, VC, FEV1 and FEF decreased. These alterations are compatible with a more generalized constriction of the peripheral as well as central airways.

Airway Obstruction↗