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PubMed2000

Neurophysiological tests of respiratory function by compound muscle action potentials from the diaphragm. Detection of lesions in the higher cervical cord.

We recorded compound muscle action potentials (CMAPs) from the diaphragm in 15 normal volunteers, nine patients with lesions of the lower cervical cord (C5 to C8), one completely quadriplegic patient (C6) and seven patients with lesions at a higher cervical level (C1 to C4). Transcranial magnetic stimulation and electrical stimulation of the phrenic nerve were carried out. When the centre of the coil was placed on the interauricular line at a point 3 cm lateral to the vertex on the scalp, the CMAPs from the diaphragm had the largest amplitude and the shortest latency. There was no difference in the mean latency of the CMAPs recorded by transcranial magnetic stimulation in the normal volunteers and in the patients with lesions of the lower cervical cord. In the quadriplegic patient, the latency of the CMAPs was not delayed, but was prolonged in the patients with lesions at a higher level. Those evoked by electrical stimulation of the phrenic nerve were not prolonged in the patients with higher lesions. Our findings suggest that the prolongation of the latency by transcranial magnetic stimulation reflects dysfunction of the higher cervical cord. The combination of transcranial magnetic stimulation and electrical stimulation of the phrenic nerve can detect the precise level of the lesion in the motor tract to the diaphragm.

Action Potentials↗
PubMed1988

[Occupational asthma: methods of diagnosis and principle etiologies].

The diagnosis of occupational asthma requires the integration of a multiplicity of data; the history, cutaneous skin tests, respiratory function tests and non-specific tests of bronchial hyper-reactivity and specific bronchial provocation tests. The history remains fundamental in the investigation of occupational asthma. It should particularly search for the presence of an atopic trait, the occurrence of similar disorders in members of the same firm and also the timing of symptoms in relation to the occupational activities. Cutaneous tests are particularly helpful in IgE-mediated asthma in relation to the inhalation of animal or vegetable materials of glycoprotein origin. For haptens, the need for their prior coupling to a protein carrier causes problems which have not been entirely resolved. Laboratory tests (RAST, histamine liberation, TDBH...) run into the same snags. Respiratory function and non specific bronchial provocation tests confirm the diagnosis of asthma and enable the medium and long term progress to be assessed. Specific bronchial provocation tests are the most appropriate tests to establish an aetiological diagnosis in occupational asthma. Different technical methods are possible: quantitative administration of allergen, aerosols, and realistic tests using exposure chambers to achieve true test doses and to obtain dose dependent responses. The products responsible for occupational asthma are multiple and are gathered into two tables. The different substances are characterised in a simplified manner. First animal matter (mammalian and arthropod allergens), secondly substances of vegetable origin (roots, leaves, flowers, grain and flour, wood and its derivatives) and finally chemical products. The chemical products are primarily from the pharmaceutical and metal industries and above all from the plastics industry.

Allergens↗
PubMed1992

[Occupational asthma].

The diagnosis of occupational asthma requires the integration of a multiplicity of data; the history, cutaneous skin tests, biological tests, respiratory function tests and non-specific tests of bronchial hyperreactivity and specific bronchial provocation test. The history search for the presence of an atopic state, the occurrence of similar disorders in members of the same firm and also the timing of symptoms in relation to the occupational activities. Cutaneous tests are particularly helpful in IgE-mediated asthma in relation to the inhalation of animal or vegetable materials of glycoprotein origin. For haptens, the need for their prior coupling to a protein carrier causes problems which have not been entirely resolved. Laboratory tests run into the same snags. Respiratory function and non-specific bronchial provocation tests, confirm the diagnosis of asthma and enable the medium and long term prognostic to be assessed. Specific bronchial provocation tests are the most appropriate tests to establish an aetiological diagnosis in occupational asthma. Different technical methods are possible: quantitative administration of allergen aerosols, realistic tests, and tests using exposure chambers to achieve true test doses. The products responsible for occupational asthma are multiple. The different substances are characterised in a simplified manner: first animal matter (mammalian and arthropod allergens), secondly substances of vegetable origin (roots, leaves, flowers, grain and flour, wood and its derivates) and finally chemical products. The chemical products are primarily from the pharmaceutical and metal industries and above all from the plastics industry.

Allergens↗
PubMedDate not supplied

[Mechanical ventilation by nasal mask in children with cystic fibrosis. Initial results of a non-invasive method].

BACKGROUND: Chronic respiratory failure (CRF) with hypoxia and hypercapnia is the last ineluctable phase in cystic fibrosis (CF). Nasal positive pressure ventilation (NPPV), a non-invasive method, may be given to CF children with CRF, especially to patients accepted for transplantation (T). This method improves ventilatory function by resting the chronically exhausted respiratory muscles, facilitates bronchial drainage by physiotherapy, prevents the exacerbations of the illness and prepares patients for T. METHODS AND PATIENTS: NPPV was used in 6 CF patients (mean age 13 years 6 months). One of them was transplanted 15 days later, two of them were accepted for T. All had hypoxia. Five of them had hypercapnia. RESULTS: NPPV was given to four patients for 3 to 14 months. The preliminary results were positive. One patient gained weight, two had more fluid sputum. One patient showed an increase in functional respiratory tests (FRT: PaO2, vital capacity, FEV-1) while these tests were stabilized in the others. CONCLUSIONS: NPPV in an effective non-invasive method for use with CF children. It is indicated for CF patients accepted for T and also earlier, for CF patients with CRF in order to prevent acute exacerbations and functional respiratory deterioration.

Adolescent↗
PubMed1990

Respiratory muscle insufficiency in acute respiratory failure of subjects with severe COPD: treatment with intermittent negative pressure ventilation.

Nine subjects with severe chronic obstructive pulmonary disease (COPD) in acute respiratory failure (ARF) and with marked weakness of the respiratory muscles (Group A) underwent intermittent negative pressure ventilation by means of an iron lung (8 h daily for 7 days). Seven subjects with COPD in stabilized chronic respiratory failure (Group B) were studied as controls and submitted to the same medical therapy without ventilator treatment. Functional respiratory tests were performed before and after 7 days of treatment. After ventilatory treatment, Group A showed an increase of maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax), vital capacity (VC), arterial oxygen tension (PaO2), pH and a decrease of residual volume (RV), total lung capacity of (TLC) and arterial carbon dioxide tension (PaCO2) (all statistically significant). No improvement was ascertained in the functional parameters of Group B. The expiratory muscles seem to play a determining role in ARF. We conclude that the iron lung is a useful therapeutic defence in removing muscular fatigue and in restoring a good level of respiratory compensation of ARF in severe COPD.

Female↗
PubMed1979

[Epidemiological studies on the symptoms due to strawberry culture in the vinyl-house. 2. An analysis of clinical examinations with emphasis on allergic response (author's transl)].

Clinical mass surveys were carried out on the residents to whom questionnaires on symptoms with reference to strawberry culture in the vinyl-house had been delivered. Two hundred and eleven persons attended at the first survey in September, 1976 (off the season of strawberry culture) and the 58 attended at the second survey in March, 1977 (within the season). The participants of the first survey consisted of three groups, i.e. farmers with and without strawberry culture and people without farming. The participants of the second survey consisted only of farmers with strawberry culture. Results are summarized as follows. 1) There were no difference of incidence of various clinical findings detected by an ophthalmologist and otolaryngologists among the three groups. 2) There were also no difference of incidence of abnormal findings in urine tests, liver functions, respiratory test, blood examinations and blood pressure test among the three groups. However, the comparison of persons in charge of strawberry culture and attended at both tof the first and the second surveys, such changes were detected as increases in the value of GOT (within normal limits), of stab neutrophiles, lymphocytes and of monocytes within the season of strawberry culture. 3) Increases of positive rates in skintest by extracts of house dust and Candida sp. were observed in the farmers with and without strawberry culture. Positive rates of skintest by strawberry pollen and honey bee extracts among the farmers with strawberry culture were markedly higher than the allergic patients in Dokkyo Hospital having no relation to this culture. This positive rate was markedly elevated among the persons who complained the symptom of rhinorrea within the season.

Adult↗
PubMed2000

Interstitial lung disease in children: a multicentre survey on diagnostic approach.

Chronic interstitial lung disease (ILD) is a rare disorder in the paediatric age group, with a poor prognosis. The diagnostic approach to ILD is based on more or less invasive methods. This study was implemented to verify which methods are the most often used in children. Questionnaires (333) were sent to members of the European Respiratory Society Paediatric Assembly belonging to 187 European and non-European centres. Questions concerned the use of noninvasive diagnostic methods, e.g. history taking, physical examination, routine laboratory tests, respiratory function tests and radiology (chest radiography, high-resolution computed tomography (HRCT)), and the use of invasive techniques such as bronchoalveolar lavage (BAL), transbronchial biopsy (TBB), open lung biopsy (OLB), video-assisted thoracoscopic biopsy (VAT) and HRCT with fine-needle aspiration biopsy (FNAB). Thirty eight centres returned the questionnaires and 131 children with ILD were studied. A diagnosis of ILD was achieved in five (3.8%) patients using noninvasive techniques alone. Using the various biopsy methods, histological assessment was performed on a total of 98 (74.8%) children. The most frequently used invasive technique both alone and in combination was BAL (83, 63.3%), followed by OLB (64, 48.8%), TBB (26, 19.8%) and VAT (11, 8.4%); FNAB was used in one patient. In conclusion a diagnosis of interstitial lung disease was reached on the basis of aetiological and/or histological findings in 117 (89%) of the 131 patients studied.

Adolescent↗
PubMed2001

Genetic, andrological and clinical characteristics of patients with congenital bilateral absence of the vas deferens.

The possibility of retrieving spermatozoa from the epididymis allows patients with congenital bilateral absence of the vas deferens (CBAVD) to father a child by means of assisted reproduction techniques. This has, however, increased the chance of transmitting a mutated allele of the cystic fibrosis transmembrane conductance regulator (CFTR) gene which increases the risk of generating offspring with cystic fibrosis (CF). Because of the increased heterogeneity of the CFTR locus, the study of a discrete number of mutations, as usually carried out in a diagnostic work-up, is unable to ascertain the presence of a mutation in a relatively high proportion of the patients screened. In an attempt to increase the chance of detecting the presence of CFTR gene abnormalities, 37 patients with CBAVD and one patient with congenital unilateral agenesis of the vas deferens (CUAVD) underwent an enlarged diagnostic protocol, which included screening for the most expected mutations of the CFTR gene in our population, evaluation of the five thymidine (5T) allelic variant, sweat test, respiratory function tests, evaluation of steatocrit, and an accurate evaluation of the history of the patient to search for symptoms commonly found in patients with CF. A single CFTR gene mutation was found in 18 patients (48.6%) with CBAVD and in the patient with CUAVD. The most frequent mutation observed was the Delta F508. Eleven patients (45.8%) had the 5T variant and in five of them it was not associated with any detectable mutation of the CFTR gene. Two female partners were found to be carriers of a mutation, whereas 5 (18.5%) had the 5T variant. As many as 71% of CBVAD patients had the simultaneous presence of at least two signs and/or symptoms suggestive of CF, albeit they were of mild intensity and the patients felt fit and healthy. In conclusion, these results suggested that some patients with CBAVD without CFTR gene mutation or 5T variant, even when their sweat test is negative, may show clinical suspicion of carrying a CFTR gene mutation and therefore are at risk of generating children affected by CF if the partner carries a mutation as well. The screening for mutations and a careful clinical examination may contribute to better identification of patients with CFTR-related CBAVD.

Adult↗
PubMed1989

[Sarcoidosis in Catalonia: analysis of 425 cases].

In a retrospective cooperative study carried out in three Barcelona hospitals, 425 patients in whom a diagnosis of sarcoidosis had been made during a 15-year period were evaluated. Several parameters were evaluated and compared with those from the longest series in the literature. Remarkable epidemiological and clinical features included the female predominance, explained by the high frequency of clinical presentations with erythema nodosum; the high incidence of other skin lesions, and, by contrast, the low frequency of eye involvement. It was also remarkable that in a few cases the diagnosis was made in a routine chest radiogram. In diagnostic procedures there was a good diagnostic yield from mediastinoscopy and muscle and pre-scalene fat biopsies The results of Kveim's test, functional respiratory testing and such current activity markers as 67-gallium pulmonary scintigraphy, serum levels of angiotensin converting enzyme and bronchoalveolar lavage were analyzed, and no differences with other series from the literature were found. The presence of the B8 allele and the A1 B8 haplotype was highly significant in subacute sarcoidosis. It is concluded that sarcoidosis is not an uncommonly found condition in this country if the suspicion index is high and an appropriate diagnostic workup is carried out. Its features are not different, as a rule, from those in other European series.

Adolescent↗
PubMed1995

[Chronic hyperventilation syndrome].

Hyperventilation syndrome is a frequent, but poorly understood clinical entity. The clinical expression is a rich combination of respiratory, cardiac and neurological signs which can simulate various organic diseases. Hypocapnia remains the primum movens for most authors although the relationship with psychiatric situations, in particular in anxious patients, is increasingly emphasized. The diagnosis is currently based on the elimination of diseases associated with hyperventilation, then on Nijmegen's questionnaire and is confirmed by the reproduction of the same clinical picture in a voluntary hyperventilation test. Respiratory function tests offer little information. Treatment is based on combining rehabilitation therapy focused on the diaphragm and on relaxation. Specialized care may be needed in psychiatric patients.

Chronic Disease↗
PubMed1997

Maximal inspiratory pressure and inspiratory muscle endurance time in asthmatic children: reproducibility and relationship with pulmonary function tests.

Respiratory muscle strength, assessed by maximal inspiratory mouth pressure (PImax), and endurance, assessed as the length of time a subject could breathe against inspiratory resistance with a target mouth pressure > or = 70% of PI,max (Tlim), were measured in 20 symptomless asthmatic children, in order to assess the reproducibility of such measurements and their relationship to traditional pulmonary function tests or tests of bronchial hyperresponsiveness. After recording lung volumes and bronchial response to methacholine, PI,max and Tlim were measured twice in the same morning, with a 30-minute interval between each experimental trial. Mean (+/-SD) values of PI,max were 72.2 +/- 20.6 cmH2O in the first and 75.8 +/- 22.9 cmH2O in the second trial. Tlim was 154 +/- 65 and 164 +/- 66 seconds in the first and in the second trial respectively. A lack of agreement between different measurements was seen for both PI,max and Tlim. The coefficient of repeatability was 24.8 for PI,max and 92.3 for Tlim. A significant correlation between age and PI,max as well as between body mass index and PI,max were shown; no similar correlation was found for Tlim. No correlation was found between PI,max and Tlim in either of the two successive runs or between either PI,max or Tlim and lung volumes or bronchial response to methacholine. Our study shows that at this time the reproducibility of PI,max or Tlim in children with asthma in remission seems to be poor, although PI,max has a better reproducibility than Tlim. A standardized procedure to measure PI,max, should be obtainable in the near future. This would improve its clinical usefulness since PI,max is the only noninvasive test to assess respiratory muscle strength that can identify subjects at risk to develop respiratory muscle fatigue during an acute asthmatic attack.

Adolescent↗
PubMed1995

[Pulmonary function abnormalities and respiratory manifestations in Sjögren's syndrome].

The respiratory system is the target organ of many autoimmune collagen diseases. In patients with Sjögren's syndrome (SS), the respiratory disorders are also common manifestations. Tracheal and pleural manifestations have been described (Strimlan 1976; Constantopoulos 1985). In the older literature (Shearn 1979), pneumonia and pleurisy were often reported but did not seem to constitute any serious problem. The symptoms are frequent and clinically important. They can present in different ways from dry cough secondary to desiccation of tracheobronchial mucosa (xerotrachea) to dyspnea from airway obstruction or hypersensitivity of trachea. The common respiratory manifestation of SS is small airway disease, and the detection of this involvement requires clinical, roentgenological and respiratory functional tests. In particular, the respiratory functional test is useful for the diagnosis of respiratory disorders in patients with SS.

Humans↗