SEARCH · PubMed Health

Results for “VITAL CAPACITY”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 919 records · Page 51Linked to original sources

PubMed1998

[New predictive formulas of pulmonary function in Japanese children].

Socioeconomic conditions, including nutrition, have improved dramatically over the past four decades in Japan. Those improvements have elicited significant changes in the developmental growth and average size of Japanese children. These trends suggest that predictive formulas of pulmonary function need to be revised. Our study enrolled 446 children (222 boys and 224 girls ranging in age from 5 to 16 years) who had no history of respiratory disease. The subjects were examined by spirometry. We formulated regression equations for several measures of ventilatory function by age, weight, and height, including vital capacity (VC), forced vital capacity (FVC), and forced expiratory volume in one second (FEV1.0), using data randomly selected from 70% of the children. Optimum parameters for the equations were selected by calculating Akaike information criteria (AIC) and Mallow's index C (p). The optimum regression equations were tested for their predictive value as acceptable predictive formulas by evaluating data randomly selected from 30% of the children. These new formulas are considered to be better suited for modern-day evaluations of pulmonary function in Japanese children.

Adolescent↗

PubMed1992

The effect of intermittent positive pressure breathing on lung volumes in acute quadriparesis.

Resting tidal volume and vital capacity were measured daily in 5 patients with acute quadriparesis during the first 7 to 10 days of their hospitalisation. On admission, vital capacity was significantly reduced to 26% of the predicted value (p less than 0.001). This increased significantly over the study period to 33% of the predicted value (p less than 0.02). Expiratory flow rates, measured on one occasion during the study period, showed similar decrements. Tidal volume and vital capacity were also measured immediately following administration of intermittent positive pressure breathing (IPPB). Although the lung volume achieved during IPPB was significantly higher than resting values of tidal volume and vital capacity (p less than 0.001), tidal volume returned to baseline values as soon as IPPB was ceased. Vital capacity remained significantly higher than baseline values at this stage (p less than 0.02), although the mean increase in vital capacity immediately following IPPB was only 43 mls. Acute quadriparesis is associated with a severe ventilatory impairment which includes a reduced vital capacity and expiratory flow rates. IPPB has a positive effect on lung volume whilst it is being administered. Immediately following treatment, this effect does not appear to be sustained at a level which would be considered clinically significant.

Acute Disease↗

PubMed1979

Comparison of various methods for reading maximal expiratory flow-volume curves.

To determine the best procedure for reading maximal expiratory flow-volume curves 2 sets of 5 curves were obtained one hour apart in 89 subjects and processed digitally according to 8 different methods. Four indices were considered: the forced expiratory flows at 25, 50, and 75 per cent of the forced vital capacity, and the maximal mid-expiratory flow. When selecting the curve yielding the largest forced vital capacity or the largest sum of forced vital capacity and forced expiratory volume in 1 sec, flow values were significantly lower (P less than 0.001) and were often less reproducible than those obtained with most of the other methods. Computing the mean of the indices among the curves with the 2 largest forced vital capacities also provided comparatively low values, but with with better reproducibility. In contrast, maximal flows were probably overestimated by using the highest values among the curves having forced vital capacity or a surface area within 5 per cent of the largest, or when reading the indices on a composite curve obtained by superimposing individual breaths at residual volume. More reproducible and, probably, unbiased data may be drawn from the composite curves obtained by superimposing the breaths either at total lung capacity or on the descending limb.

Adult↗

PubMed2001

Body composition analysis and changes in airways function in obese adults after hypocaloric diet.

STUDY OBJECTIVES: To determine the relationship between weight-loss and pulmonary function indexes, focusing on forced expiratory flows (ie, FEV(1), forced expiratory flow at 50% of vital capacity [FEF(50)], forced expiratory flow at 75% of vital capacity, and forced expiratory flow at 25 to 75% of vital capacity [FEF(25--75)]). Specifically, to determine the effect of losses in total and segmental fat mass (FM) and of modifications in lean body mass, after restricted hypocaloric diet, on pulmonary function among obese adults. DESIGN: Cross-sectional, observational. SETTINGS: Human Physiology Division, Faculty of Medicine and Surgery, "Tor Vergata" University, Rome, Italy. PATIENTS: Thirty obese adults (mean [+/- SD] baseline body mass index [BMI], 32.25 +/- 3.99 kg/m(2)), without significant obstructive airway disease, were selected from among participants in a weight-loss program. MEASUREMENTS AND RESULTS: Anthropometric, body composition (BC), and respiratory parameters of all participants were measured before and after weight loss. Total and segmental lean body and FM were obtained by dual-energy x-ray absorptiometry. Dynamic spirometric tests and maximum voluntary ventilation (MVV) were performed. The BC parameters (ie, body weight [BW], BMI, the sum skinfold thicknesses, thoracic inhalation circumference, thoracic expiration circumference, total FM, and trunk FM [FMtrunk]) were significantly decreased (p < or = .0001) after a hypocaloric diet. The mean vital capacity, FEV(1), FEF(50), FEF(25-75), expiratory reserve volume, and MVV significantly increased (p < or = 0.05) with weight loss. The correlation coefficient for Delta FEF(25--75) (r = 0.20) was numerically higher than Delta FEF(50) and Delta FEV(1) (r = 0.14 and r = 0.08, respectively) for the BW loss. Moreover, the correlation coefficient for Delta FEF(25--75) (r = 0.45) was significantly higher (p < or = 0.02) than those for Delta FEF(50) and Delta FEV(1) (r = 0.38 and r = 0.15, respectively) for FMtrunk loss. CONCLUSIONS: This study shows that a decrease in total and upper body fat obtained by restricted diet was not accompanied by a decrease in ventilatory muscle mass. FMtrunk loss was found to have improved airflow limitation, which can be correlated to peripheral airways function.

Adult↗

PubMed1979

Acute and chronic pulmonary function changes in allergic bronchopulmonary aspergillosis.

Pulmonary functions of patients with allergic bronchopulmonary aspergillosis were studied during an acute episode (n = 6); during a mean follow-up period of 44 months (range four months--14.8 years) (n = 16); and for any correlation between duration of ABPA and asthma with the total lung capacity (helium dilution), 1 second forced expiratory volume (FEV1), vital capacity, 1 second forced expiratory volume-forced vital capacity ratio (FEV1:FVC per cent) and diffusing capacity of carbon monoxide (DL:CO) (single breath) for the entire group (n = 22). All patients were treated with corticosteroids (intermittent or continuous) and bronchodilators. For the 16 patients, slopes using linear regression analysis were determined from the function as per cent predicted versus time in months from diagnosis and then analyzed for significance. Significant functional loss was shown in three of 16 patients for FEV1, two of 16 patients for vital capacity, one of 16 patients for FEV1:FVC per cent, none of 10 patients for DL:CO and one of 10 patients for total lung cital capacity, FEV1:FVC per cent and the duration of asthma or allergic bronchopulmonary aspergillosis was found by multiple regression analysis correcting for age and smoking (mean 4.24 years; range 0.3 to 14.8 years). Roentgenographic criteria and blood eosinophilia were used to define a "flare" of allergic bronchopulmonary aspergillosis. The six patients during a flare showed a significant reduction in total lung capacity (P less than 0.001), vital capacity (P less than 0.05), FEV1 (P less than 0.01) and DL:CO (P less than 0.001) which uniformly returned to baseline values during steroid therapy. The FEV1:FVC per cent remained unaltered. These findings, contrary to suggestions in the literature, indicate that in the majority of our patients there was no significant progressive functional deterioration after diagnosis. However, during acute episodes of allergic bronchopulmonary aspergillosis, transient reduction of volumes and DL:CO were uniformly present.

Adolescent↗

PubMed1997

Airway hyperreactivity in children with sickle cell disease.

Progressive restrictive defect with increasing age, obstructive lung disease, and bronchodilator responsiveness have been reported in sickle cell disease (SCD). Because airway hyperreactivity (AHR) can be underestimated when assessed by bronchodilator responsiveness in patients with normal baseline lung function, the aim of this study was to investigate the prevalence of AHR in SCD by cold-air bronchial provocation testing, and to assess whether AHR can be present in symptom-free patients with SCD. Forty patients aged 6 to 19 years (mean, 10.7 years +/- 3.5 SD) performed pulmonary function tests. Eighteen were known to have a history of reactive airway disease (RAD group), and 22 had no known history of RAD (non-RAD group). A control group, aged 6 to 7 years (mean, 10.5 +/- 3.1 years), consisted of 10 siblings of the non-RAD SCD group. There were no significant differences in age and height among the groups. If the forced expiratory volume in 1 second (FEV1) was greater than 70%, cold air challenge (CACh) was performed; if the FEV1 was less than 70%, aerosolized bronchodilator therapy was given. A decrease in FEV1 of more than 10% after CACh or an increase in FEV1 of 12% or greater after bronchodilator inhalation was considered evidence of AHR. In the RAD group, the total lung capacity was 88.9% +/- 14.0% of race-corrected predicted values, the forced vital capacity was 91.2% +/- 12.6%, and FEV1 was 85.3% +/- 16.2%. The mean maximal percent fall in FEV1 after CACh (n = 13) was 18.5% +/- 9.6% and was greater than 10% in 11 of 13 patients. The mean increase in FEV1 after bronchodilator therapy (n = 5) was 11.5% +/- 8.3%, and it was greater than 12% in 4 of 5 patients. In the non-RAD group the baseline total lung capacity was 101.6% +/- 11.7%, forced vital capacity was 95.5% +/- 10.2%, and FEV1 was 93.3% +/- 13.2%. The mean maximal percent fall in FEV1 after CACh (n = 19) was 14.1% +/- 8.8% and was greater than 10% in 13 of 19 patients. The mean increase in FEV1 after bronchodilator therapy (n = 3) was 14.7% +/- 11.3%, and was 12% of greater in 1 of 3 patients. In the control group the baseline total lung capacity was 105.7% +/- 12.1%, forced vital capacity was 96.2% +/- 11.1%, and FEV1 was 92.9% +/- 10.3%. The mean maximal percent fall in FEV1 was 5.0% +/- 2.5%, and was greater than 10% in none of 10 patients. The prevalence of AHR in the control group, the RAD group, and the non-RAD group was zero, 83%, and 64%, respectively (p < 0.0001). The overall prevalence in the SCD group was 73%. We conclude that there is a high prevalence of AHR in children with SCD and that airway hyperreactivity may exist in patients with SCD even in the absence of the clinical symptoms of RAD. AHR may be a significant component of sickle cell lung disease.

Administration, Inhalation↗

PubMed1993

Differences in CT density between dependent and nondependent portions of the lung: influence of lung volume.

OBJECTIVE: Lung tissue, blood, and air determine the physical density of the lung and hence the attenuation measured on CT scans. These components are not homogeneously distributed throughout the lungs, and their relative proportion changes continuously during respiration. The objective of this study was to measure densities in various areas of the normal lung with CT and to examine the influences of gravity and of the degree of lung inflation on these densities. SUBJECTS AND METHODS: The subjects in the study were six healthy male volunteers. CT scans were obtained at the level of the aortic arch and 2 cm above the expiratory level of the diaphragm with the subjects supine and then with them prone. Scans were obtained at lung volumes of 10%, 50%, and 90% vital capacity by using a respiratory gating device connected to the CT scanner. The overall density of the lungs at these two levels and the densities in the dependent (posterior in supine, and anterior in prone body position) and nondependent (anterior in supine and posterior in prone body position) areas were measured by using a semiautomatic evaluation algorithm. RESULTS: Changes in lung volume caused the same changes in lung density in the right and left lungs and in the upper and lower parts of the lungs. For both body positions (supine and prone), the difference between lung density at 10% vital capacity and that at 90% vital capacity was significantly larger (p < .05) in the dependent parts of the lung than in the nondependent parts. In both positions, differences in density between dependent and nondependent regions were significantly (p < .05) greater at 10% vital capacity than at 90% vital capacity, and the differences became small when the volume of the lung was near total lung capacity. CONCLUSION: Changes in lung volume have different effects on changes in lung density in dependent and nondependent parts of the lung. The largest changes in lung density occur in the dependent regions. The difference in density between dependent and nondependent lung regions is smallest for lung volumes near total lung capacity. These findings may be useful as a baseline for interpreting CT measurements of regional lung density in suspected cases of lung disease, which would alter the physical density of lung tissue. Our results also suggest that measurements near total lung capacity should be included.

Adult↗

PubMed1998

Normalization of respiratory sinus arrhythmia by factoring in tidal volume.

The amplitude of respiratory sinus arrhythmia (RSA) was measured in eight healthy young male students with special reference to the effect of tidal volume (Vt). Under simultaneously controlled respiratory frequency and Vt, the heart rate variability (HRV) of the subjects was measured. While the respiratory frequency was adjusted to either 0.25 or 0.10 Hz, the Vt was controlled at 13 different volumes for each frequency. Linear relationships between RSA amplitude and Vt were observed and close correlations were obtained for 0.25 Hz compared with 0.10 Hz. However, regression equations showed a marked variation among subjects. Furthermore, RSA amplitude was related to vital capacity. Subjects who had lower vital capacity tended to show higher RSA amplitudes at the same Vt. Therefore, the ratio (% Vt) of Vt to vital capacity is a more effective index in normalizing RSA than raw tidal volume. From these results, we have proposed a normalized RSA (RSA amplitude/% Vt) as a new index of autonomic activity that provides a constant value regardless of Vt.

Adult↗

PubMed1979

Determination of bronchodilation in the clinical pulmonary function laboratory. Role of changes in static lung volumes.

Improved airway resistance following bronchodilator inhalation is not always accompanied by improvement in forced expiratory flow. We studied 241 patients with airways obstruction to learn whether changes in static lung volumes (vital capacity and function residual capacity measured by body plethysmography [FRCB]) would reveal bronchodilation not demonstrated by expiratory flow rates (the ratio of forced vital capacity at one second to the total forced vital capacity [FEV1/FVC]), and the forced expiratory flow for the midportion of the forced vital capacity (FEF25--75%). A significant fall in Raw occurred in 129 patients, 46 of whom had a significant increase in vital capacity (mean of + 465 ml +/- 43, P less than 0.001) and a fall in FRCB (mean of -763 ml +/- 78 P less than 0.001) with no change in FEV1/FVC% of FEF25--75%. We interpret these data to indicate that improvement in static lung volumes can reflect bronchodilation in the absence of improved expiratory flow.

Adult↗

PubMed1986

Trachea and lung dimensions in nonsmoking twins: morphological and functional studies.

To compare genetic and environmental factors that determine lung function and dimensions, chest radiographs and pulmonary function were measured in 17 pairs of nonsmoking twin adolescent boys (12 monozygotic pairs and 5 dizygotic pairs). Genetic factors dominated in tracheal width and lung dimensions (height, width, and apicofissural and fissurodiaphragmatic distances) at residual volume. Genetic factors also affected forced vital capacity, functional residual capacity, forced expiratory volume in 1 s, maximum expiratory flow at 25% vital capacity, and maximum flow at 50% vital capacity-to-forced vital capacity ratio. Peak expiratory flow correlated with tracheal width at residual volume. Age correlated with lung dimensions (width and depth) but not with tracheal width. These results indicate that genetic factors determine the dimensions and function of central airways, peripheral airways, and lung parenchyma in adolescent males. The effects of genetic factors on some functional measurements (airway resistance, closing volume-to-vital capacity ratio, and phase III in single-breath N2 washout) may be masked because of poor reproducibility of the tests.

Adolescent↗

PubMed1990

[Influence of aging on respiratory function with emphasis on senile persons].

The change of respiratory function in senile persons was studied by determining timed vital capacity and flow volume curve, using 183 male subjects in age of 60-86 years old (66 subjected for 60-64 years old, 43 for 65-69 years, 45 for 70-74 and 29 for 75 years old or above) who are non-smoking persons and have no anamnesis of circulatory disorders. The results are as follows: 1. Each determination result by age; 1) Timed vital capacity; Both forced vital capacity (FVC) and % forced vital capacity (% FVC) were decreased with aging, where as forced expiratory volume in 1 second (FEV1.0%) remained unchanged. 2) Flow volume curve; Peak flow (PF), V75 and V50 were decreased with aging, but hardly any change was seen in V25.V50/V25 showed a tendency toward decrease with aging, but the level was 3.0 or above in each age group. It is postulated in respiratory function of senile persons aged 60 years or above that restrictive ventilation impairment goes to aggravate with age, but the severity of obstructive ventilation impairment is slight. 2. Each determination value by ventilation impairment groups; All subjects (183) were classified into 4 groups, i.e., 70 (38.3%) for normal healthy group, 43 (23.5%) for restrictive ventilation impairment group, 48 (26.2%) for obstructive ventilation impairment group and 22 (12.0%) for mixed ventilation impairment group. Normal healthy group and obstructive ventilation impairment group showed a tendency toward decrease with aging, but restrictive ventilation impairment group and mixed ventilation impairment group showed a tendency toward increase with aging. However, there were no significant differences in determination items of age and V50/V25 among the groups tested. These results suggest that ventilation impairment develops in senile persons in age of 60 years old or above regardless of their age distribution, along with the decrease in sensitivity to V50/V25. 3. Relationship among FEV1.0% and V75, V50, V25 and V50/V25 In age of 60-69 years old, there were correlations between FEV1.0% and V25, i.e., r = 0.377 (P less than 0.05) in normal healthy group; among FEV1.0% and V50 and V25, i.e., r = 0.505 and r = 0.479 (P less than 0.05) in obstructive ventilation impairment group. In senile persons in age of 70 years old, there were correlations between FEV1.0% and V50 and V25, i.e., r = 0.789 and r = 0.716 (P less than 0.01) in obstructive ventilation impairment group.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗

PubMedDate not supplied

Obstructive flow-volume loop contours after single lung transplantation.

The development of spirometric airflow obstruction may be a diagnostic dilemma in recipients of single lung allografts. The contribution of bronchial anastomotic stenosis to the observed spirometric obstruction may be clinically difficult to distinguish from that of obliterative bronchiolitis. Similarly, differentiating the "normal" obstructive defect after single lung transplantation for emphysema from obliterative bronchiolitis may be clinically challenging. We retrospectively reviewed the maximum inspiratory and expiratory flow-volume loop contours of lung transplant recipients with either obliterative bronchiolitis (n = 7) or bronchoscopically diagnosed severe bronchial anastomotic stenosis (n = 3). Five patients underwent single lung transplantation for obstructive native lung diseases and underwent observation before and after development of obliterative bronchiolitis. Bronchial anastomotic stenosis-maximum inspiratory and expiratory flow-volume loops were analyzed both before and after correction of stenosis by niobium: yttrium-aluminum-garnet laser photoresection or endobronchial silicone stent placement. Measures of airflow derived from maximum inspiratory and expiratory flow-volume loops, such as peak expiratory flow, peak inspiratory flow, forced expiratory flow at 50% vital capacity, forced inspiratory flow at 50% vital capacity, and forced expiratory volume in 1 second/peak expiratory flow ratio could not differentiate patients with bronchial anastomotic stenosis versus obliterative bronchiolitis. The most clinically useful index was the maximum inspiratory and expiratory flow-volume contour, which was characterized by terminal plateaus during exhalation and inhalation in patients with bronchial anastomotic stenosis. This index was reflected in a lower forced inspiratory flow at 75% vital capacity and forced inspiratory flow at 75% vital capacity/peak inspiratory flow ratio in bronchial anastomotic stenosis that increased after elimination of the anastomotic obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Obstruction↗

PubMed1998

Resistive inspiratory muscle training in subjects with chronic cervical spinal cord injury.

OBJECTIVE: To determine whether pulmonary function, respiratory muscle strength, and dyspnea can be improved in individuals with chronic cervical spinal cord injury (SCI). STUDY DESIGN: Ten subjects participated in an 8-week resistive inspiratory muscle training (IMT) program for 15 minutes twice daily. Spirometry, lung volumes, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and dyspnea were measured at baseline, week 4, and week 8. Six months after the study, spirometry, MIP, and MEP were re-measured in a subgroup of the original participants. RESULTS: We found that regular IMT in subjects with cervical SCI significantly improved forced vital capacity (means +/- SE) (11% +/- 2.82% increase), forced inspiratory vital capacity (21% +/- 6.91%), vital capacity (8% +/- 4.36%), total lung capacity (12% +/- 3.23%), functional residual capacity (15% +/- 5.96%), and MIP (24% +/- 6.98%) (p < .05). Furthermore, although no statistical differences were observed for the dyspnea scale, the fact that subjects reported decreased levels (43% +/- 21.30% reduction) of perceived difficulty breathing may be of greater importance. No significant differences from baseline values were found in the seven subjects whose spirometry and respiratory muscle strength were measured 6 months after the study. CONCLUSIONS: Our findings suggest that in individuals with cervical SCI regular resistive IMT may result in decreased restrictive ventilatory impairment and reported dyspnea and, thus, reduced incidence of chronic respiratory complaints, respiratory infection, and other pulmonary complications.

Adult↗

PubMed1989

[Long-term follow-up of lung function and standing height following scoliosis surgery in children and adolescents].

Previous investigations have reported conflicting results on the development of lung function and body height after operative correction of scoliosis at young age. Partly the number of patients or the duration of observation were relatively small. 120 patients were followed for at least 10 years (10-14, average 12 years) after surgical correction of scoliosis at the age of 18.2 +/- 6.8 years. Standing height and vital capacity were measured 1, 2, 5 and 10 years after operation. Height was expressed as percentile for age and vital capacity as % expected for actual height. The primary diagnoses were idiopathic scoliosis (n = 84, average Cobb angle 90 degrees), congenital scoliosis (n = 20, 83 degrees), poliomyelitis (n = 10, 128 degrees), neurofibromatosis (n = 6, 101 degrees). We found an initial decrease in lung function after 1 year, which was probably due to post-operative immobilization and increased by the gain in body height achieved by the operation. During the rest of the observation period a significant (p less than 0.05) increase of vital capacity (% of expected for actual height) was observed. The gain was maximal for idiopathic scoliosis (+6%). In congenital scoliosis body height %ile and relative vital capacity appeared fixed at the preoperative level. Interestingly patients with an initial vital capacity below 50% expected (n = 29) or preoperative Cobb angle above 90 degrees showed the best results. They also lacked the initial deterioration of lung function in the first postoperative year and had a significant gain of vital capacity (+14%) over 10 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1979

Pulmonary reaction to upper mantle radiation therapy for Hodgkin's disease.

To study the effects of upper mantle radiation therapy on pulmonary function, forced expiratory volume in one second (FEV1), vital capacity (VC), inspiratory capacity (IC), diffusing capacity for CO (DLCO) and diffusion per unit of alveolar volume (DL/VA were determined in 28 patients with Hodgkin's disease, stages 1--3, before therapy and at regular intervals thereafter. Within the first year of follow-up there were significant declines in DLCO, VC, and IC, whereas there were no significant changes in FEV1 or DL/VA. DLCO showed the greatest decline in the largest number of subjects (22/28). Eleven of the 22 had 20 to 60 percent decline of DLCO from baseline. The maximum mean decline in DLCO was -12.7 +/- 3 percent at the 87th +/- 3 days from initiation of therapy postradiation sustained through the 150th day and improving to pretreatment value (+/- 5 percent) by the 8th to 12th month. The changes in DLCO seemed to be independent of the radiation dose ranges evaluated, clinically apparent intrathoracic lymphoma, postradiation radiographic abnormalities and respiratory symptoms. We concluded that impairment in diffusing capacity and loss of vital capacity will develop in most patients receiving upper mantle radiation therapy, indicating that pulmonary reaction occurs despite lung shielding. The functional losses were prolonged and occasionally severe, but were transient and subclinical in most but not all cases. A case of fatal radiation pneumonitis affecting the lung beyond the field of irradiation is reported.

Adolescent↗

PubMed2003

Prognostic implications of physiologic and radiographic changes in idiopathic interstitial pneumonia.

Idiopathic interstitial pneumonias are a diverse group of lung diseases with varied prognoses. We hypothesized that changes in physiologic and radiographic parameters would predict survival. We retrospectively examined 80 patients with usual interstitial pneumonia and 29 patients with nonspecific interstitial pneumonia. Baseline characteristics were examined together with 6-month change in forced vital capacity, diffusing capacity for carbon monoxide, and ground glass infiltrate and fibrosis on high resolution computed tomography. Patients with usual interstitial pneumonia were more likely to have a statistically significant or marginally significant decline in lung volume, diffusing capacity for carbon monoxide, and an increase in ground glass infiltrates (p < or = 0.08) compared with patients with nonspecific interstitial pneumonia. For patients with usual interstitial pneumonia, change in forced vital capacity was the best physiologic predictor of mortality (p = 0.05). In a multivariate Cox proportional hazards model controlling for histopathologic diagnosis, gender, smoking history, baseline forced vital capacity, and 6-month change in forced vital capacity, a decrease in forced vital capacity remained an independent risk factor for mortality (decrease > 10%; hazard ratio 2.47; 95% confidence interval 1.29, 4.73; p = 0.006). We conclude that a 6-month change in forced vital capacity gives additional prognostic information to baseline features for patients with idiopathic interstitial pneumonia.

Adult↗

PubMed1995

Pulmonary sympathetic denervation does not increase airway resistance in patients with chronic obstructive pulmonary disease (COPD).

Whether or not neural blockade of pulmonary sympathetic innervation is of relevance for airway resistance in patients with chronic obstructive pulmonary disease (COPD) is unknown. Accordingly we evaluated airway resistance during sympathetic blockade by high thoracic epidural anaesthesia in patients with COPD. Before and 45 min after thoracic epidural injection of bupivacaine 0.75% (6-8 ml; n = 10) total respiratory resistance (oscillometry, ROS), vital capacity (VC), forced expiratory vital capacity in 1 s (FEV1, [%VC]), functional residual capacity (FRC; helium dilution method), and arterial blood gases were measured. Three additional patients received bupivacaine intravenously (1.2 mg.min-1 for 45 min), another three received saline epidurally. Sensory blockade covered segment C5 through T8. As an indicator of widespread sympathetic blockade including the lungs, skin temperature increased significantly on thumb and little toe. Despite pulmonary sympathetic denervation ROS, FEV1, and FRC remained unchanged, while VC decreased slightly, probably due to intercostal muscle blockade. Blood gases remained constant. Neither intravenous bupivacaine nor epidural saline evoked directional changes. Since, in contrast to beta-adrenoceptor blockade, pulmonary sympathetic denervation did not increase airway resistance in patients with COPD, neural sympathetic blockade seems to be of no relevance for airway resistance in these patients.

Airway Resistance↗

PubMed1998

[Surgery of the spine in Duchenne's muscular dystrophy].

PURPOSE OF THE STUDY: The authors present a retrospective review of 27 patients presenting a Duchenne muscular dystrophy and who were operated for spinal deformity, with special reference to functional result and postoperative evolution of vital capacity. MATERIAL AND METHODS: Age at surgery averaged 14. Mean scoliotic angulation was 42 degrees. A thoraco-lumbar kyphosis was present in 15 cases (kyphotic index less than 10 degrees). A pelvic obliquity averaging 17 degrees was associated in 19 cases. Mean pre-operative vital capacity was 56 per cent. Preoperative evolution of vital capacity was documented in 18 cases: annual rate of decrease was 4.3 per cent. Heart ejection fraction averaged 63 per cent in 23 cases, and was normal in 4 cases. Instrumentation was extended from D3, D4 or D5 to L5 (5 cases) or S1 (22 cases). Spinal fixation was done in all patients by subliminar wiring with Luque rods (5 cases) or Hartshill rectangle (22 cases). Sacral fixation was done with ilio-sacral screws linked to the rectangle by Cotrel Dubousset rods and dominos (15 cases). RESULTS: Mean blood loss was 1750 cc. Postoperatively, 25 patients were extubated on the operative day, 1 patient at D + 1, and one patient underwent a tracheostomy after one month. Scoliosis was reduced to 10 degrees after surgery and 13 degrees after 30 months follow-up. Pelvic obliquity was reduced to 4 degrees after surgery and 7 degrees after 30 months. A good spinal balance was present after surgery in 20 patients; at follow-up, a coronal or sagittal imbalance averaging 40 mm was observed in 22 patients. Postoperative evolution of vital capacity was documented in 21 cases. The annual decrease rate was 6.4 per cent. Rate was higher in patients presenting a good preoperative vital capacity (over 70 per cent) and very low in patients presenting a preoperative vital capacity under 40 per cent. 10 patients were deceased at review after a mean 53 months survival, at a mean age of 19. 17 patients were alive with a 50 months follow-up. DISCUSSION: Spinal surgery in Duchenne muscular dystrophy has a low morbidity. It allows to keep sitting position to the child and to preserve quality of life. Surgery should be considered as soon as frontal or sagittal collapse of the spine is observed. However surgery does not result in respiratory improvement nor in life duration lengthening.

Adolescent↗