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PubMedDate not supplied

Atopic and non-atopic sensitivity in a large bakery.

Flour is an allergen which can sensitize either by the digestive or the inhalatory route, particularly those who work with this product. Factors involved occupational four-induced asthma also include various insects and their excreta, fungi and dermato-farinae. In this study, 1303 subjects from a number of bakeries were studied. They underwent allergological investigation by means of prick-tests with allergens and respiratory function tests for those with bronchial asthma. Also studied is the relationship with atopic syndromes or atopic family history.

Allergens↗
PubMed2001

Effects of cryoanalgesia on post-thoracotomy pain and on the structure of intercostal nerves: a human prospective randomized trial and a histological study.

OBJECTIVE: The choice of analgesia in the management of post-thoracotomy pain remains controversial. Although several alternative forms of post-thoracotomy analgesia exist, all have their disadvantages. Cryoanalgesia, localized freezing of intercostal nerves, has been reported to have variable effectiveness and an incidence of long-term cutaneous sensory changes. We carried out an animal study to assess the reversibility of histological changes induced by cryoanalgesia and a prospective randomized trial to compare the effectiveness of cryoanalgesia with conventional analgesia (parenteral opiates). METHODS: In six anaesthetized dogs, intercostal nerves were exposed to a varying duration of cryo-application (30, 60, 90 and 120 s). The nerves were biopsied and examined histologically at regular intervals over the following 6 months. In the clinical study, 200 consecutive patients undergoing thoracotomy were randomized to cryoanalgesia and conventional (parenteral opiates) analgesia groups. Postoperative pain scores, respiratory function tests and use of opiate analgesia were measured for the two groups. RESULTS: Following application of the cryoprobe, degeneration and fragmentation of the axons was evident with associated inflammatory changes. As the endoneurium remained intact, axonal regeneration took place after the resolution of axonal swelling. Over the course of weeks, recovery of the intercostal nerve occurred and was complete after 1 month for the 30 and 60 s groups. For nerves exposed to longer durations of cryoanalgesia, the time taken for complete recovery was proportionally increased. Clinically, there was a statistically significant (P<0.05) improvement in postoperative pain scores and use of opiate analgesia and an improvement (P>0.05) in respiratory function tests for patients in the cryoanalgesia group. The previously suggested cutaneous sensory changes resolved within 6 months with complete restoration of function. CONCLUSIONS: We suggest that cryoanalgesia be considered as a simple, inexpensive, long-term form of post-thoracotomy pain relief, which does not cause any long-term histological damage to intercostal nerves.

Adult↗
PubMed2005

Effects of multiple sclerosis on respiratory functions.

OBJECTIVES: To measure respiratory functions of ambulatory patients with multiple sclerosis and compare the results with expected values from healthy general population data. Further, to study the correlation of respiratory function impairment with the multiple sclerosis-induced disability level. SUBJECTS: Thirty-eight patients with definite diagnosis of multiple sclerosis from the multiple sclerosis outpatient clinic. METHODS: The Expanded Disability Status Scale (EDSS) scores (mean 4.34+/-1.39) were evaluated to measure disability level. Respiratory functions tested in the laboratory included spirometric (FVC, FEV1, FEV1/FVC), maximal inspiratory (MIP) and expiratory (MEP) mouth pressure measurements. Patients were clinically assessed using a pulmonary dysfunction index (PDI) and dyspnoea index; various breathing features were also recorded. RESULTS: With respect to expected values from healthy general population, important decreases were found in mouth pressures with MIP (77%+/-23%, p approximately equal to 0) and MEP (60%+/-13%, p approximately equal to 0) while spirometric measures were significantly but less affected (FVC 94%+/-12%, p < 0.01, FEV1 91%+/-16%, p < 0.001). FEV1/FVC ratios were normal. Notable increases in PDI (5.58+/-0.68, p approximately equal to 0) and dyspnoea index (0.32+/-0.47, p approximately equal to 0) were observed. Significant relationships (p < 0.01) between respiratory function impairment and the multiple sclerosis disability level could be detected for FVC, MEP and PDI. CONCLUSIONS: Multiple sclerosis clearly impairs respiratory functions; maximal mouth pressures are more severely reduced. This impairment increases with multiple sclerosis-induced disability level but is found to be independent from duration of disease.

Adult↗
PubMedDate not supplied

Respiratory function after esophagectomy for patients with esophageal cancer.

BACKGROUND/AIMS: Postoperative respiratory hypofunction sometime ruins quality of life of patients with esophageal cancer. From 1993, we introduced transhiatal esophagectomy without thoracotomy as a less invasive surgery to prevent postoperative respiratory complications for patients who have relatively early stage of esophageal cancer and have preoperative respiratory complication, or who are older in age. In this study, postoperative long-term evaluation of respiratory functions of patients with esophageal cancer who underwent esophagectomy was performed. METHODOLOGY: Among the patients with esophageal cancer who underwent esophagectomy in our hospital between 1993 and 1995, we selected 13 patients who underwent transhiatal esophagectomy (transhiatal group) and 9 patients who underwent transthoracic esophagectomy (transthoracic group). Conventional respiratory function tests (VC, vital capacity; FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; FEV1/FVC, ratio of FEV1 to FVC; PEF, peak expiratory flow) were compared between the two groups at 3, 6, and 12 months after operation. RESULTS: In the transhiatal group, postoperative average values of VC, FVC, and FEV1 recovered 92%, 98%, and 93% of preoperative average values at 6 months after operation, while in the transthoracic group, the average values of VC, FVC, and FEV1 were still 78%, 78%, and 72% of preoperative average values at 6 months after operation. Postoperative respiratory complications were detected in 4 patients (transhiatal: 2 and transthoracic: 2). The recovery rates of VC, FVC, FEV1, FEV1/FVC, and PEF at 6 months after operation of these 4 patients were not different from those of 18 patients without postoperative respiratory complications. CONCLUSIONS: In patients treated with transthoracic esophagectomy, postoperative respiratory hypofunctions continued over 6 months after surgery. However, postoperative respiratory complications may not be related with the long-term postoperative respiratory hypofunction in patients with esophageal cancer.

Aged↗
PubMed2000

Intraperitoneal lidocaine for postoperative pain after laparoscopy.

BACKGROUND: A controversy exists over the effectiveness and clinical value of intraperitoneal local anaesthetics for treating pain after laparoscopic cholecystectomy. The use of intraperitoneal lidocaine was evaluated in this study. METHODS: At the end of surgery, 200 ml saline containing 200 mg lidocaine, or the same volume of saline, were randomly splashed under the right diaphragmatic surface in 50 patients in a double-blind manner. Postoperative shoulder and abdominal pain intensity were recorded on a numeric grading scale and a visual analogue scale, respectively. Analgesic consumption was also recorded. Respiratory function tests were compared before and after surgery. Side effects and recovery variables were assessed by the nurses at 2-h intervals. RESULTS: The incidence, severity and duration of shoulder pain were reduced from 40% of patients scoring 3.9+/-0.2 for duration of 17.9+/-0.2 h in the control group to 12% scoring 2.5+/-0.5 for duration of 1.6+/-0.01 h in the lidocaine group. Lidocaine treated patients had significantly less abdominal postoperative pain immediately on return to the ward and during the first postoperative day (P<0.05). "No pain on deep inspiration" was reported by 72% of patients in the lidocaine group immediately on return to the ward compared to 8% of those in the control group. Analgesic consumption for 24 h after surgery was significantly less in the lidocaine group (P<0.05). There were no significant differences in respiratory function tests, recovery variables or incidence of side effects between the two groups. CONCLUSION: Intraperitoneal lidocaine is simple to use and results in a long-lasting reduction of pain after a single administration.

Adult↗
PubMed1989

[Prescribing of long-term oxygen therapy and observation of its results].

It is accepted that long-term oxygen therapy should be given for at least 15 hours per day. We have assessed the value of domiciliary oxygen therapy for a mean period of two months in 127 patients under the care of the association for Aid to Respiratory Failure Patients in Brittany (A.I.R.B.). These patients have been equipped with oxygen concentrators. The mean duration of oxygen therapy is 11.8 +/- 5 hours per day. Only 30 patients (23.6%) achieved treatment of 15 hours or more. The patients were split into two groups on the basis of their usage of oxygen: group A (n = 97 = 76.4%) whose oxygen consumption was less than 15 hours per day; group B (n = 30 = 23.6%) whose consumption of oxygen was equal to or superior to 15 hours per day. There was no difference between the two groups as regards age, sex or cause of their respiratory failure nor as regards socio-professional classification, their habitat, or on the basis of respiratory function tests and tolerance of their treatment. On the other hand, patients having the longest duration of oxygen therapy were the most severe (PaO2 56.5 +/- 9.3, in group A and 50.4 +/- 7.3 in group B), they were also the most compliant (good compliance occurred in 27.8% in group A and 76.7% in group B) and were taking the prescribed therapy for the longest time (group A 13.8 +/- 2.7 hours, group B 17 +/- 2.7 hours). Then again, it is also these patients who had the best understanding and the best evaluation of the duration of oxygen therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2001

Effects of lung metastasectomy on respiratory function.

OBJECTIVE: The effects of lung metastasectomy on respiration were evaluated. SUBJECTS: From 1961 to 1999, 203 patients underwent lung metastasectomy. Of these, 102 patients who had undergone only partial lung resection, had undergone sufficient respiratory function testing, and had not suffered from other lung disease were included. RESULTS: Unilateral thoracoscopic surgery caused less decrease in percent vital capacity than surgery through a posterolateral thoracotomy, in both the early (rate of decrease: 16.2 +/- 9.1 vs. 33.0 +/- 12.0%, p < 0.01), and the late postoperative period (2.0 +/- 4.5 vs. 17.8 +/- 6.0%, p < 0.0001). Two thoracoscopic operations caused less decrease in percent vital capacity than 2 operations through a posterolateral thoracotomy (21.3 +/- 13.8 vs. 61.1 +/- 8.1%, p = 0.02). Bilateral metastasectomy through a median sternotomy caused less decrease in percent vital capacity than that through posterolateral thoracotomies (45.5 +/- 13.7 vs. 60.8 +/- 8.8%, p < 0.05). Four (36%) of 11 patients who had undergone 3 or more metastasectomies exhibited dyspnea of degree 3 or higher on the Hugh-Jones classification. CONCLUSIONS: Thoracoscopic metastasectomy and metastasectomy through a median sternotomy caused less restrictive respiratory dysfunction than metastasectomy through a posterolateral thoracotomy. Since metastatic lung disease often necessitates repeated metastasectomy, and repeated metastasectomy often causes severe restrictive respiratory dysfunction, metastasectomy should be performed with a less invasive procedure.

Adult↗
PubMed1980

A physiologic study on respiratory handicap of the laryngectomized.

Lack of the upper airway function after laryngectomy creates unfavorable effects on the lower respiratory tract. The purpose of this study is to re-evaluate this relationship objectively. Respiratory function tests were performed on 13 laryngectomized patients. Pulmonary volumetry and ventilometry revealed increased RV and FRC, and decreased FEV1.0%, indicating evidence of obstructive changes in the lung, MEFV-recordings showed greater downward convexity than those of the normal at the lower volume level. The value of MEF50/body-height was definitely smaller than normal average in the same age group. Pulmonary resistance was in wide variety but definitely lower than normal because of lack of the upper airway resistance. If this component is added to the value, the total will be in normal range or even higher. Dynamic compliance remained mostly in the normal range when measured using a mask at the tracheostoma. The value was lower than normal when measured through a cuff-canula. The difference in static and dynamic compliances was greater than that in normal cases, which may indicate evidence of uneven distribution of air in the lung. Regular check-up and suitable respiratory care are recommended on the laryngectomized.

Airway Obstruction↗