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At least 937 records · Page 52Linked to original sources
PubMed1990

Effects of Buscopan on gastro-oesophageal reflux and hiatus hernia.

This prospective study was undertaken to establish whether Buscopan (hyosine butyl bromide) interferes with the detection of a hiatus hernia or induces gastro-oesophageal reflux. One hundred and four consecutive patients were included in the study who came for barium meal and swallow examinations over a period of 3 months. Ten patients were excluded from the study. The examinations were performed by the author. The manoeuvres to detect gastro-oesophageal reflux and hiatus hernia were performed before and after intravenous Buscopan. It was found that Buscopan does not induce gastro-oesophageal reflux in the majority of patients, or interfere with detection of a hiatus hernia. The conclusion of this study is that Buscopan can be given early on in the barium meal examination without a significant effect on hiatal function.

Adolescent↗
PubMed1993

Inspiratory muscle training and respiratory sensation during treadmill exercise.

We studied whether inspiratory muscle training (IMT) changed respiratory sensation during exercise in 12 healthy women; IMT was performed twice daily, for 15 minutes, using a pressure threshold device and continued for 4 weeks. The inspiratory threshold was set to 30 percent of each individual's maximal inspiratory pressure (Pimax). Breathing effort was evaluated during a progressive exercise test using Borg scale. After IMT, both Pimax and maximal transdiaphragmatic pressure increased by 30 percent in the training group (p < 0.05) but did not change in the control group. Prior to IMT, the Borg score increased in proportion to exercise grade. The difference in the sensory score-exercise stage curves before and after IMT in the training group was not significant. No significant difference was noted in the relationship of the Borg score to minute ventilation before and after 4 weeks in either group. We concluded that IMT may not affect respiratory sensation during exercise in normal subjects, although IMT increases diaphragmatic strength.

Adult↗
PubMed2003

Diaphragmatic defect with peritoneopericardial communication.

An 81-year-old man had a congenital defect of the central tendon of the diaphragm, including a peritoneopericardial communication with herniation of the omentum to the pericardial sac in front of the heart. In addition, he had a critically stenosed congenital bicuspid aortic valve and severe coronary artery disease. The patient underwent reduction of the herniated omentum into the abdominal cavity, coronary artery bypass grafting, aortic valve replacement, and closure of the peritoneopericardial communication with a synthetic patch. Three years later, the patient was doing well, with a normally functioning pericardial valve in the aortic position and no sign of omentum around the heart.

Aged↗
PubMed1999

Morphology of the lymphoid organs of the bottlenose dolphin, Tursiops truncatus.

The anatomy of the lymphoid organs was studied during the course of detailed dissections of 50 beach-stranded bottlenose dolphins, Tursiops truncatus. Constant lymph nodes occur in 4 groups, based on their location and structure. These groups are somatic, including nodes of the cervical region and pelvic recess; lung-associated, included marginal, diaphragmatic and hilar nodes; visceral, including the mesenteric, pancreatic, pericolic and porta hepatis nodes; and aortic arch nodes. Lymphatic drainage of the lung is primarily to the marginal and diaphragmatic nodes. The mesenteric node mass is well-endowed with capsular and trabecular smooth muscle, and a network of muscle fascicles within the organ implies an important contractile function in the circulation of lymph. In addition to constant nodes, occasionally nodes are found in relation to the thoracic aorta, the kidney, and under the scapula. Gut-associated structures include dorsal and ventral oropharyngeal tonsils, mucosal aggregates in the straight segment of the intestine (colon) and anal tonsils; this gut-associated lymphoid tissue tends to involute with age, being greatly reduced by puberty. Formed lymphoid organs include the thymus and the spleen, the latter being relatively small in relation to body size. None of these structures is unique among cetaceans, but the anal tonsils are particularly well developed in T. truncatus. The lymphoid aggregates in the colon resemble the arrangement in the vermiform appendix, which is lacking in most cetaceans, and may have functions analogous to that organ.

Animals↗
PubMed1979

Oxygenation of pulmonary vein blood in conscious and anaesthetised ponies.

Catheters were implanted through the left atrium into large veins drawing blood from regions of the diaphragmatic lobes in five ponies. Measurement of oxygen and carbon dioxide tensions in blood samples drawn through these catheters showed that in laterally recumbent conscious and anaesthetised animals the function of the lowermost lung is progressively impaired while in the supine position the function of both lungs is adversely affected.

Anesthesia↗
PubMed2001

[Risks of pharmacotherapy in heart diseases in pregnancy].

Normal physiological changes in the cardiovascular system in pregnancy such as increase in cardiac output, vasodilatation and hypervolemia are of clinical relevance as they are able to aggravate, mask or even imitate cardiovascular diseases. There is an increase of cardiac size and volume during pregnancy; furthermore hormonal changes lead to diaphragmatic elevation and barrel-shaped thorax followed by a rotation of the cardiac axis to the left (15 degrees-30 degrees). Cardiac topography and size, changes in cardiac functioning and physiology as well as hemodynamic changes lead to auscultatory and ECG changes (i.e. S1-Q3-type, ST-depression, T wave flattening). In addition there is a high incidence of functional systolic and diastolic sounds during pregnancy, which are also able to imitate cardiovascular diseases. The physiological changes in pregnancy are similar to those under heavy exercise. This results in continuous cardiac stress during the whole pregnancy. This stress is specifically high from the 28th to the 34th week of pregnancy and in the post-partum period; the maximum of cardiac stress is reached during labor. Important for the specific cardiac risk during pregnancy is not the type of heart disease but cardiac functioning and the severity of complaints before pregnancy. Principally it has to be expected that preexisting heart diseases will experience an aggravation of one grade according to NYHA during pregnancy. In cases of heart diseases with shunt defects, with shunt defect and injured myocardium, with continuous arrhythmia or atrial fibrillation, patients are at extremely high risk of cardiac death. A termination of pregnancy should be considered in all patients with heart diseases grade III or IV according to NYHA, severe pulmonary hypertension, Eisenmenger's syndrome, severe aortic or pulmonary stenosis, Marfan's syndrome, and severe continuous cardiac insufficiency. The drug therapy of cardiac diseases during pregnancy depends on the specific type of heart disease. Prescription of most drugs is principally possible during pregnancy and breast feeding. However, for most drugs there is only very limited therapeutic experience during this period. Definitively contraindicated during pregnancy and breast feeding are ACE inhibitors, angiotensin I and II blocking agents, vasopeptidase inhibitors and molsidomin, a NO-prodrug. In life-threatening conditions, however, sometimes it will be necessary to administer drugs with only poor experiences in pregnancy.

Cardiovascular Agents↗
PubMedDate not supplied

Cardiovascular function and serum catecholamine concentrations after anesthesia and surgery in the dog.

Peripheral vasoconstriction and plasma catecholamine concentrations were studied in 37 dogs after cervical disc fenestration and salivary gland excision, laparotomy for intestinal anastomoses and cystotomy, or laparotomy for repair of diaphragmatic rupture, gastrotomy, and pyloromyotomy. Meperidine (4.4 mg/kg) was administered before extubation of 12 dogs undergoing laparotomy. Heart rate, respiratory frequency, indirect blood pressure, rectal temperature, toe web temperature, and plasma concentrations of epinephrine and norepinephrine were determined before induction of anesthesia, after intubation, after extubation, at sternal recumbency, and at standing. All dogs were hypothermic during surgery. After surgery, peripheral hypothermia (large rectal-toe web temperature gradients) increased from a mean of 4.6 degrees C after intubation to a mean of 10.4 degrees C when the dogs initially stood. Heart and respiratory rates and blood pressures during recovery were similar to those before anesthesia. Mean plasma catecholamine concentrations were neither significantly higher during recovery than before surgery nor were they increased in any surgical group, including the dogs not treated with meperidine. After anesthesia, 15% of the epinephrine and 12% of the norepinephrine samples were more than two standard deviations above the mean of the preanesthetic concentrations of all dogs. The ratio of all dogs with an epinephrine concentration more than two standard deviations above the mean of baseline epinephrine concentrations was greater at sternal recumbency than before anesthesia and the ratio of dogs with an increased epinephrine concentration at sternal recumbency was greater in the laparotomy dogs (9 of 24) than in the cervical surgery dogs (0 of 12).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMed1991

Corticosteroid therapy and respiratory muscle function in humans.

We examined the effects of prednisone administration on respiratory muscle function in humans using a double-blind study with a placebo control group. A total of 16 normal subjects were randomized to receive 20 mg prednisone daily (n = 8) or placebo daily (n = 8) for 2 wk. Inspiratory muscle strength (Pimax), expiratory muscle strength (PEmax), diaphragmatic strength (Pdimax), and inspiratory muscle endurance were measured at the beginning and end of the study. There was no significant change with treatment for Pimax (-145 +/- 7 to -138 +/- 6 cm H2O), PEmax (171 +/- 17 to 169 +/- 14 cm H2O), Pdimax (194 +/- 11 to 196 +/- 12 cm H2O), or endurance (76 +/- 3 to 77 +/- 4%) for the prednisone group and no significant difference between the two groups. We conclude that prednisone in moderate dosage has no significant effect on respiratory muscle function in humans, at least in the short term.

Adult↗
PubMed1990

Effect of body position on regional diaphragm function in dogs.

The in situ lengths of muscle bundles of the crural and three regions of the costal diaphragm between origin and insertion were determined with a video roentgenographic technique in dogs. At total lung capacity (TLC) in both the prone and supine positions, the length of the diaphragm is not significantly different from the unstressed excised length, suggesting that the diaphragm is not under tension at TLC and that there is a hydrostatic gradient of pleural pressure on the diaphragmatic surface. Except for the ventral region of the costal diaphragm, which does not change length at lung volumes greater than 70% TLC, all other regions are stretched during passive deflations from TLC. Therefore below TLC the diaphragm is under passive tension and supports a transdiaphragmatic pressure (Pdi). The length of the diaphragm relative to its unstressed length is not uniform at functional residual capacity (FRC) and does not follow a strict vertical gradient that reverses when the animal is changed from the supine to the prone position. By inference, the length of muscle bundles is determined by factors other than the vertical gradient of Pdi. During mechanical ventilation, regional shortening is identical to the passive deflation length-volume relationship near FRC. Prone and supine FRC is the same, but the diaphragm is slightly shorter in the prone position. In both positions, during spontaneous ventilation there are no consistent differences in regional fractional shortening, despite regional differences in initial length relative to unstressed length.

Animals↗
PubMed1997

Immunohistochemical distribution of surfactant apoprotein-A in congenital diaphragmatic hernia.

The high mortality for congenital diaphragmatic hernia (CDH) has been attributed to a combination of pulmonary hypoplasia and persistent pulmonary hypertension. Recent experimental studies suggest that surfactant deficiency may also contribute to CDH pathophysiology. In this report, the authors immunohistochemically and morphometrically examined whether or not the hypoplastic lungs of CDH are associated with the immaturity of the surfactant system, especially alveolar type II cell function. Nine autopsy cases with CDH were immunohistochemically examined for the expression of surfactant apoprotein, using anti-IgG against human surfactant apoprotein A (SP-A), and the findings were compared with those in a gestational and postnatal age-matched control group. The lung/body weight ratio in the CDH was less than that in the controls (0.010 +/- 0.005 versus 0.021 +/- 0.013, P < .01). The radial alveolar count (RAC) of the CDH cases were also significantly less than that of the control cases (2.10 +/- 0.52 versus 3.48 +/- 0.39, P < .01). In the CDH cases, the RAC of the lung on the affected side were also significantly less than that of the lung on the unaffected side (1.71 +/- 0.34 versus 2.50 +/- 0.26, P < .01). In the immunohistochemical distribution of SP-A, compared with the control cases, the number of SP-A-positive cells on the alveolar septa of the CDH cases decreased in number, and this immunohistochemical reaction was weak even in positive type II cells. In addition, the immunoreaction observed in the alveolar type II cells of the unaffected side lungs in the four CDH cases was stronger than that of the unaffected side lungs. These results suggest that in the lungs of the CDH cases, especially on the affected side, there is a possible delay in both the structural growth and functional maturation or development of SP-A synthesis by alveolar type II cells, and this retardation of the functional maturation in alveolar type II cells is also considered to play a role in postnatal respiratory insufficiency in CDH patients.

Apolipoproteins A↗
PubMed1981

Congenital posterolateral diaphragmatic hernia: a retrospective study.

Congenital posterolateral diaphragmatic hernia continues to be associated with a high mortality from ventilatory failure. To evaluate the malformation and factors associated with survival, 43 children with congenital diaphragmatic hernia seen in the neonatal period were studied; 20 survived. The male:female ratio was 2.1. No consistent antenatal factors could be implicated, and, except for intestinal malrotation and lung hypoplasia, associated anomalies were uncommon. The most common cause of death was ventilatory failure and marked bilateral lung hypoplasia was a common autopsy finding. Most of those died were admitted within 8 hours of birth. Tolazoline has been used in 10 patients since 1975 and, of these, 4 survived. Postoperatively a transient period of satisfactory lung function correlated well with response to vasodilators, which may be of value in future therapy.

Child, Preschool↗
PubMed1985

Effects of hypocalcemia on diaphragmatic strength generation.

We studied the effects of hypocalcemia on diaphragmatic force and diaphragm blood flow (Qdi) in 12 anesthetized dogs. The diaphragm was electrically stimulated with intramuscular electrodes surgically implanted in the ventral surface of each hemidiaphragm. The transdiaphragmatic pressure (Pdi) during supramaximal (50 V) 2-s stimulations applied over a frequency range of 10-100 Hz was measured with balloon catheters during tracheal occlusion at functional residual capacity. A catheter was placed via the femoral vein into the left inferior phrenic vein, and Qdi was measured by timed volume collections of left inferior venous effluent. A catheter was introduced in a femoral artery to monitor blood pressure (BP). In five additional dogs, the force generated by the sartorius muscle during electrical stimulation was also studied concomitantly to diaphragmatic force. The animals were mechanically ventilated throughout the experiment, and the arterial blood gases and pH were maintained constant. Hypocalcemia was induced by a continuous infusion of EGTA (70 mg X kg-1 X h-1), which led to a progressive decrease (P less than 0.0001) of ionized calcium plasmatic level from 2.21 +/- 0.4 meq/1 during control to 1.69 +/- 0.06, 1.25 +/- 0.5, and 1.07 +/- 0.5 meq/1 after 30, 60, and 120 min, respectively. Hypocalcemia decreased progressively Pdi, which amounted to 84 +/- 3 (P less than 0.001) and 98 +/- 2% of control values for the low frequencies (10 and 20 Hz) and the high frequencies (50 and 100 Hz), respectively, after 30 min of EGTA infusion and to 74 +/- 5 and 79 +/- 6% for the low and high frequencies, respectively, after 120 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1976

Acute blunt traumatic rupture of the diaphragm in children.

Two patients had acute rupture of the diaphragm from blunt trauma. One was a 10 1/2-month-old infant, the youngest yet reported with this condition to our knowledge. He required emergency repair because of increasing encroachment on respiratory function by the hernial contents during the early hours of observation. The second patient, a ten-year-old boy with an associated fractured femur, underwent successful repair of a diaphragmatic laceration that included the pericardium. In this case the approach via the abdomen, used to rule out associated intraperitoneal injuries, actually facilitated the repair, particularly that of the diaphragmatic pericardium.

Abdominal Injuries↗
PubMed1998

Application of M-mode sonography to functional evaluation in pediatric patients.

To assess the feasibility and advantages of functional motion-mode (M-mode) sonography in pediatric patients with various non-cardiac M-mode applications, 50 patients aged 6 days to 14.5 years with megaureter, diaphragmatic palsy and spinal cord malformation were studied. In addition to initial conventional brightness-mode gray-scale ultrasound. M-mode sonography was performed for evaluation of motion and possible impairment. The findings were compared with other imaging results. The impact of the sonographic results on clinical management was evaluated retrospectively. Impaired motion was demonstrated by conventional sonography in all cases. Only M-mode sonography enabled adequate documentation for comparison with follow-up examinations, but allowed only semiquantitative assessment. Thus even gradual improvement or deterioration can be followed in an unbiased way by using a better-documented investigation for comparison, though an objective 'ranking', especially of diaphragmatic movement, could not be achieved. M-mode sonography enables a non-invasive and non-ionizing evaluation and documentation of motion impairment in pediatric patients. It improves documentation of motion and enables a better comparison with previous findings. It is especially useful for follow-up in evolving disease.

Adolescent↗
PubMed1998

Prediction of outcome in congenital diaphragmatic hernia.

The case records of 59 patients with congenital diaphragmatic hernia (CDH) who presented between 1984 and 1997 were studied retrospectively. Included in the study were infants born with CDH who required respiratory support within the first 6 h of life. Twenty-three were excluded from the study for various reasons; 36 were enrolled in the study; the male-to-female ratio was 18:18. Twenty-nine hernias were left-sided and 7 were right-sided. All patients were ventilated using conventional techniques. Arterial blood gases were measured on average 1.76 h following admission and the initial period of resuscitation (range 1-4 h). Three formulae were applied in an attempt to predict outcome: ventilation index against PCO2, alveolar-arterial oxygen gradient, and a newly derived formula from this institution (Red Cross formula) that comprises respiratory rate x PCO2 x FiO2 x mean airway pressure/PaO2 x 6000. Seventeen patients (47.2%) survived and 19 died (52.8%); 21 became stable enough to undergo surgery. The average time from presentation until surgery was 1.98 days (range 6 h to 4 days). The Red Cross formula, with a 100% predictive value for mortality, 85% predictive value for survival, and an overall predictive value of 91.6%, appeared to be superior to the other formulae studied. The availability of a highly accurate predictive formula may facilitate management of this frequently lethal disease.

Blood Gas Analysis↗