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[Mediastino-pulmonary sarcoidosis in children. Clinical study, analysis of data of bronchoalveolar fluid lavage and respiratory function tests, therapeutic trends].

A series of 27 children (mean age: 12 yrs, 5 mos.) presenting with thoracic sarcoidosis is reported. This series, collected from 1961 to 1988 shows the rarity of the disease at that age. However the low rate of asymptomatic forms (22%) suggests that the frequency of the disease is underestimated, as it is not diagnosed. The histological proof is necessary for the diagnosis. When peripheral lesions available for biopsy are lacking, a liver needle biopsy is helpful (93% of positivity). This study shows the frequency of multivisceral types, the intensity of the macrophagic and lymphocytic alveolitis. The therapeutic indications depend on the comparison of the radiological stage, the results of pulmonary function tests (PFT), those of the bronchoalveolar lavages (BAL) and of the serum granulomatous activity markers, especially concerning angiotensin converting enzyme (ACE). When present at the beginning of evolution, several risk factors lead to use a corticosteroid treatment: age of onset before 4 years, multivisceral involvement, presence of functional pulmonary signs, delayed diagnosis and onset of treatment, impaired respiratory function (especially concerning the alveolo-capillary diffusion), PMN cells greater than or equal to 2% in the initial BAL, and IgG proteins greater than 4 SD. Thus sarcoidosis in children differs from that seen in adults as it has a more marked evolutive tendency and leaves severe sequelae in one third of patients.

Adolescent↗

[Changes in the parameters of respiratory function tests in Raynaud's disease].

Patients with Raynaud's phenomenon can demonstrate arterial spasm not only in hands but also in other organs. The aim of this study was to investigate pulmonary function in 15 patients with Raynaud's disease and in 8 healthy controls before and after cold pressor test. Before the cold pressor test no significant differences in pulmonary parameters between the patients and the controls were observed. After cold pressor test, a statistically significant decrease in diffusing capacity (DLCO) was observed in the study group, but not in the controls. Total lung capacity (TLC) was also slightly decreased. No significant changes of specific diffusing capacity (D/VA) and flow-volume curve parameters (FEF50, FEF25) were noticed.

Adult↗

Obstructive azoospermia: respiratory function tests, electron microscopy and the results of surgery.

Forty-five patients have been treated surgically for obstructive azoospermia. Fifteen underwent reversal of vasectomy and 40% of the wives became pregnant. Thirty had epididymovasostomy, and in only 2 (6.5%) did the sperm count become normal, although a few poorly motile sperms appeared in the ejaculate in a further 4 patients. Congenital abnormalities of the vasa in 7 cases and post-inflammatory blocks in 4 cases were examples of obstructive azoospermia due to well defined causes. However, in half of the patients (15 cases) the cause was obscure although it was associated with sinusitis, bronchitis or bronchiectasis (Young's syndrome). The results of pulmonary function tests in 30 cases, and electron microscopic studies of cilia from epididymes (10 cases) and bronchial mucosa (2 cases) indicated that the basic abnormality might be malfunction of the microtubules which appeared to be ultrastructurally normal in most cases. One case appeared to be associated with dietary deficiency, and correction of diet coincided with a successful result of surgery.

Adult↗

[Perbronchial lung biopsy and respiratory function tests].

27 patients with diffuse pulmonary disease according to X-ray findings were examined by lung function and perbronchial lung biopsy. The lung function tests are compared with the extent of impairment of lung function expected according to lung specimen obtained by perbronchial biopsy. It is shown that lung function is a good indicator if the lung specimen is representative for the disease, and that the results of perbronchial biopsy mostly are representing the disease. The use of perbronchial biopsy is discussed and shown in some cases.

Biopsy↗

[Lung transplantation and respiratory function tests. Functional outcome in the presence and absence of chronic rejection].

Between may 1988 and march 1993, twenty five double lung transplants were performed and five heart/lung transplants. Lung function tests (EFR) were performed on these patients for a period of 19.2 +/- 3.4 months. The aim of this study was two-fold. First, to report our overall results and to estimate the role of the single breath nitrogen washout test (N2 slope) in the early detection of chronic rejection (RC). Secondly, to assess the diagnostic value of EFR in the discrimination of acute rejection (RA) and of cytomegalovirus pneumonitis (PCMV). There were 41 episodes of RA and 21 episodes of PCMV and they were analysed as a function of the presence or absence of RC. In the absence of RC, RA produced no change in EFR and PCMV was accompanied by a pure restrictive ventilatory defect. On the otherhand, RA and PCMV lead to a worsening of obstruction and an hypoxaemia which characterises RC. The diagnosis of RC was made, on average, 14.4 +/- 2.9 months after surgery. However, from the sixth month the nitrogen slope was significantly increased and other parameters of EFR (particular maximal flows at low lung volume) remained normal. Thus, our results suggest that the N2 slope, measured in the absence of any evidence of acute rejection, constitutes an early test for chronic rejection. When its pathological rise is compared to the results of histology (presence or absence of RC), it shows a sensitivity of 0.94 and a specificity of 0.93.

Acute Disease↗

[Correlations between respiratory function tests and hemodynamic studies in the decision of pneumonectomy].

We report a prospective study of 50 patients with chronic pulmonary pathology of diverse etiology and various grades of abnormality in Pulmonary mechanics and blood gases. In all patients we performed pulmonary function test and hemodynamic study with a Dotter-Lucas catheter with and without unilateral occlusion of pulmonary artery, at rest and during exercise. Our objective was to define if one or more parameters of routine pulmonary function test could allow us to predict the condition of pulmonary circulation, and therefore identify those patients at risk of pulmonary hypertension in whom pneumonectomy could be contraindicated and in this way avoid cardiac catheterization. We did not find any correlation between the grade of abnormality in pulmonary mechanics and the severity of pulmonary hypertension. On the other hand, all patients with severe pulmonary hypertension, that precluded pneumonectomy, had severe hypoxemia (PaO2 less than 50 mmHg); patients with moderate hypoxemia (PaO2 50-57 mmHg) had pulmonary hypertension of diverse grade, that could preclude or not, pneumonectomy. We conclude that this group of patients need to be catheterized to evaluate the indication of pneumonectomy.

Adolescent↗

[Exposure to asbestos: role of respiratory function tests as tools for screening and follow-up].

Among pulmonary function tests, spirometries and flow-volume curves are used in occupational or environmental field. They require the compromise between simple and sufficiently performance to be useful. Limitation factors explain the low sensitivity and the absence of specificity related to asbestos (tobacco...). The wide interindividual variation compared to standards limits meaning for early detection. A significant epidemiological difference makes no sense for individual detection. The carbon monoxide diffusing capacity, even classical, has restricted uses. Unlike diffuse pleural thickening, the worst cases with circumscribed pleural plaques lead to limited lung capacity decline. If not, they are associated to pulmonary abnormalities or tobacco. The early asbestos-related parenchyma diseases are associated to restrictive ventilator disorders, small airway obstruction or isolated single breath carbon monoxide diffusing limitation, leading to great difficulties for specific early detection criteria validation. Comparative pulmonary changes over time greater than the physiological pulmonary slope should be a good alert indicator.

Asbestosis↗

[Longitudinal study of parameters of respiratory function tests and blood gas analysis in patients with progressive systemic scleroderma].

The longitudinal study encloses 53 patients with PSS followed up for a period of 6 years. The most frequent changes in the parameters of pulmonary function are: diffusing capacity impairment--reduction in DICO (86.8% of the patients), restrictive lung disease pattern (50.9% of the patients) and arterial hypoxemia (43.4% of the patients). The duration of PSS and the follow up period do not cause significant changes in the pulmonary function parameters and the arterial blood-gas analysis in the group of patients studied.

Blood Gas Analysis↗

[High-resolution computed tomography compared with the thoracic radiogram and respiratory function tests in assessing workers exposed to silica].

To compare the usefulness of high-resolution computed tomography (HRCT) and chest radiography in the functional evaluation of silica-exposed workers, 27 workers were submitted to posteroanterior and lateral chest radiographs, apex to base HRCT scans and pulmonary function tests. Two experienced readers studied plain films independently to assess small opacities profusion (ILO-UC, Geneva 1980): from 0/- to 3/+. HRCT grading and extent of silicotic nodules and associated emphysema were scored on a four-point scale. Inter-reader analysis showed better agreement for HRCT (K = 0.49) than chest radiography (K = 0.29). Poor agreement was observed between chest radiography and HRCT classes, particularly in the early stages of silicosis. No correlation was observed between chest radiography score and pulmonary function tests, while a significant correlation was observed between HRCT classes (grade and extent of the nodules) and FEV1, MEF50, MEF75, RV and FRC. In conclusion, HRCT exhibited better reproducibility and higher accuracy than chest radiography in identifying the absence of silicotic nodules and in depicting functionally important lesions. To this purpose, HRCT can be considered a useful support to conventional chest radiography.

Aged↗

[Comparison of data of respiratory function tests and pulmonary radiology images. Apropos of 106 subjects exposed to asbestos].

We have compared X-ray and lung function data in 106 asbestos workers with diverse, yet most often prolonged and important, exposure times. Based on the international B.I.T. classification, we have found a significant link between VC and type, density, opacity extent and presence of pleural thickening. The same relationship is found with alveolo-arterial ductance. On the whole, however, it is difficult to determine lung function condition with X-ray. Thus, certain criteria concerning function should be considered as well as radiography.

Adult↗

[Results of comprehensive respiratory function tests in CNSLD (author's transl)].

34 persons with CNSLD, but fit for work, were examined with the aim to record the degree of disturbance of pulmonary function and the underlying pathophysiological mechanism. The results were compared with 30 healthy subjects. The following function tests were carried out under resting conditions and bicycle ergometer exercises: Analysis of ventilation (FVC% pred., FEV1% FVC, RV% pred., RV% TLC), analysis of lung mechanic (Raw, CL) measurement of diffusion (DL, DM, Vc, DL% pred.) and analysis of lung inhomogeneity (RE/REO, V2/V1, CL6/CL100, deltaFN2/deltaV500, deltaFCO2/deltaV500,IHB). The results were analyzed and evaluated by using the digital computer C 8205. Persons suffering from CNSLD were showing among typical clinical symptoms the following disturbances of lung function: The obstructive ventilation disturbance stands in the foreground in connection with signs of inhomogeneity of lung mechanics and ventilation. While the resistance already shows the airway obstruction objectively under resting conditions, the decreased compliance is measurable at first under exercise. The disturbance of diffusion, which is pointed out, is mainly a latent decreased diffusing capacity of alveolo-capillary membrane. These disturbance of diffusion gets more importance because the inhomogeneity of lung hides the real disturbance of diffusion. The pathophysiological consequence of disturbed partial functions of respiration is the latent hypoxaemia without hypercapnia, therefore the signs of respiratory partial insufficiency.

Adult↗

[Quantitative assessment of pulmonary emphysema with computerized tomography. Comparison of the visual score and high resolution computerized tomography, expiratory density mask with spiral computerized tomography and respiratory function tests].

CT is the most accurate method to detect pulmonary emphysema in vivo. We compared prospectively two different methods for emphysema quantitation in 5 normal volunteers and 20 consecutive patients with chronic obstructive pulmonary disease (COPD). All subjects were submitted to function tests and HRCT; three scans were acquired at preselected levels during inspiration. The type and extent of pulmonary emphysema were defined, using the time-honored visual score system, by two independent observers under blind conditions. Disagreements were subsequently settled by consent. All subjects were also examined with expiratory spiral CT, using a density mask program, at two different cut-off levels (-850, -900 HU). Visual score and expiratory spiral density mask values (-850 HU) were significantly correlated (r = 0.86), but the visual extent of emphysema was always higher than shown by expiratory spiral CT. The emphysema extent assessed with both CT methods correlated with the function result of expiratory airflow obstruction and gas diffusion impairment (visual score versus forced expiratory volume in one second: r = -0.81, versus single breath carbon monoxide diffusion: r = -0.78. Spiral expiratory density mask -850 HU versus forced expiratory volume in one second: r = -0.85, versus single breath carbon monoxide diffusion: r = -0.77). When -900 HU was used as the cut-off value for the expiratory density mask, the correlation with single breath carbon monoxide diffusion worsened (r = -0.56). Visual score and expiratory density mask -850 HU gave similar results and permitted COPD patients to be clearly distinguished from normal controls (p < 0.01). Residual lung volume, measured with expiratory spiral CT correlated significantly with residual volume measured with the helium dilution technique (r = 0.66), but CT values were always higher than function results. We believe the true residual volume should lie somewhere in between the CT value and the function results with the helium dilution technique and conclude that the extent of pulmonary emphysema can be confidently assessed with CT methods. Finally, the simple visual score may be as reliable as such highly sophisticated new methods as the spiral expiratory density mask. Expiratory studies offer new insights into different normal and abnormal features of COPD and respiratory impairment.

Aged↗

Respiratory function tests after mantle irradiation in patients with Hodgkin's disease.

Pulmonary function tests were performed in 43 patients with Hodgkin's disease before mantle irradiation and at 3, 6, 9, 12 and 15 or more months thereafter. Treatment was given with a telecobalt unit to a total dose of 36 to 42 Gy, the higher dose being reserved for cases with considerable mediastinal involvement. The functional parameters explored included static and dynamic lung volumes, gas exchanges, ventilatory efficiency, and airway resistance. Measured parameters were expressed as a percentage of the pre-treatment value (PTV) in the individual patient. In the whole group, only small variations in the functional indices were observed at 3 to 6 months after mantle irradiation. In patients with normal PTVs a greater variation in static and dynamic volumes was observed at 3 to 6 months after mantle irradiation, with complete recovery thereafter. The gas exchange parameters also showed a similar variation at 3 to 6 months but no recovery was demonstrated in the subsequent examinations. No changes in ventilatory efficiency and airway resistance were observed. In patients with abnormal PTVs, usually presenting large mediastinal adenopathy, all parameters improved after mantle irradiation, and the favourable effect of tumour regression was probably more important than the radiation damage on the pulmonary parenchyma.

Adolescent↗

[So-called pocket-sized spirometry versus respiratory function tests: a comparative study of vital capacity, forced expiratory volume in 1 second and Tiffeneau's coefficient].

A simplified preoperative respiratory assessment was carried out in order to assess the reliability of a pocket-sized spirometer. 30 patients were each tested using two methods: 1) the traditional extensive laboratory lung function tests and 2) a bedside test using a pocket-sized spirometer, which measured the vital capacity (VC), the forced expiratory volume in 1 second (FEV1), the peak flow (PEF) and the ratio of FEV1 to VC. The correlation between the two series of VC and FEV1 measurements was highly significant (p less than 0.001). Therefore, these two parameters could be considered as reliable when testing was performed at the bedside. However, the sensitivity of the FEV1/VC ratio was decreased; in three of the patients, the significance of this third parameter was not the same with the two methods. Measurements of peak flow were only collected at the bedside, and a statistical comparison was not established. Analysis of this last parameter always allowed us to confirm or not an obstructive syndrome when the values of FEV1 or FEV1/VC were in disagreement. The pocket-sized spirometer would seem to be a simple and reliable means of diagnosing respiratory insufficiency, its type (obstructive or restrictive) and its seriousness.

Aged↗

Changes in respiratory function tests during pregnancy.

Anatomical, physiological and biochemical adaptations that occur during pregnancy are profound. Changes in respiratory physiology are a part of the same process. In the present study of 70 selected women, 50 pregnant and nonpregnant control, it was found that out of seven parameters studied five showed changes. There were changes in respiratory frequency, tidal volume, vital capacity, inspiratory capacity and expiratory reserve volume. Maximum voluntary ventilation and timed vital capacity did not change. RF, VT, VC and IC rose significantly while ERV had a significant fall. These changes may be affecting ante-intranatal behaviour of pregnant women and their pregnancy outcome.

Adult↗

[Bronchoalveolar lavage (BAL) in patients with pulmonary sarcoidosis. I. Correlations between cellular morphology of BAL with radiologic and respiratory function tests].

BAL, spirometric evaluation and compliance values were analysed in 51 patients (21 females, 30 males; age range 19-51 years). Basing on BAL criteria, 19 had active sarcoidosis, 32 non-active sarcoidosis. Radiological stages (I, II, III) were found in similar percentages in both forms of the disease. Mean respiratory function parameters were similar in the active and non-active stage of the disease. The most common abnormality found in 33% of the patients was decreased DLCO.

Adult↗