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At least 1,063 records · Page 59Linked to original sources
PubMed1981

[The anterior subcostal transperitoneal approach to the kidney. Report on a series of enlarged nephrectomies (author's transl)].

An anterior subcostal transperitoneal approach was employed in a series of 50 operations, including 43 enlarged nephrectomies for cancer. The advantages of this technique are that it gives direct access to the aortic diaphragmatic orifice and the large vessels and upper pole of the kidney, it is simple to enlarge, and it is solid. It has only minor inconveniences. As only the abdominal cavity is opened, the patient's respiratory function is preserved, especially in the elderly and those with respiratory insufficiency. With a lower mortality and morbidity, a shorter period of hospitalisation, and lower costs, it enables the same enlarged excision to be performed as during thoraco-phrenolaparotomy. It can also be employed for other types of operation on the kidneys and renal vessels, the adrenals, or the lateral aortic glands.

Aged↗
PubMed1995

[Prenatal diagnosis of left cardiac abnormality].

We found out of 1500 prenatal cardiac ultrasound examinations very small left heart in 14 cases. Six of the 14 cases were hypoplastic left heart syndrome and eight functional-secondary left heart hypoplasia. The most important signs the echocardiography in cases of hypoplastic left heart are as follow: hypoplasia of mitral valve with or without measurable flow, absence of the anterograde flow through the aortic valve, retrograde flow in the isthmus. In cases of functional left heart hypoplasia the size of the left ventricle, aorta and mitral valves were under the 3rd percentile but there were measurable anterograde flow through the aorta. In eleven cases there were other malformations: hygroma colli, diaphragmatic hernia and omphalokele. The differentiation of the hypoplastic left heart from the secondary left heart hypoplasia has a great importance because of the therapic planning and prognosis.

Abnormalities, Multiple↗
PubMed1997

[The venous valve: non-invasive imaging of its functioning].

B Mode and TM mode Imaging are useful tools to illustrate directly the venous valve motion. Using B Mode, venous valve are echogenic with a particular kinetic as regards its topography. So it's possible to determine in TM Mode a "pseudo-cardiac" valvular motion (jugular vein) and a "pseudo-diaphragmatic" motion for the lower limbs veins. Valvular motion assures unidirectional venous flow.

Humans↗
PubMed1995

[Reconstruction of the diaphragm with various materials. An animal experiment study].

The relative merits of three methods of diaphragmatic hernia repair were evaluated in animals. Eighty Sprague-Dawley rats underwent laparotomy. The control group had an incision in the diaphragm with primary repair. The other three groups underwent partial resection of the left hemidiaphragm. The defects were repaired in 20 rats with lyophilized Dura, in 20 with polytetrafluoroethylene (PTFE) and in another 20 with absorbable serosa from a cow. Seventy-two animals survived the operation; they were followed up by electromyography (EMG) and post-mortem physical and histological examinations after 3 and 6 months. The EMG showed normal function for the absorbable material. Only scanty physiological waves were registered in the PTFE group. The examination for stretching and stress showed good results for all materials tested. The histological examinations amount to strong foreign body reactions with Dura and PTFE groups. The absorbable bovine serosa had vanished after 3 months postoperatively. It is concluded that bovine serosa can be recommended for diaphragmatic hernia.

Animals↗
PubMed1985

Temporal pulmonary function changes in cervical cord injury.

Temporal changes in pulmonary function (PF) in subjects with complete cervical cord transection occur in two stages. The first, extending from the acute to post-acute periods, is characterized by relatively rapid increases in the following: vital, inspiratory, and total lung capacities (VC, IC, and TLC, respectively), and inspiratory and expiratory airflows coupled with decreases in functional residual capacity (FRC). Second stage changes--from the post-acute period on--are more gradual, with both VC increase and FRC decrease continuing while TLC and ventilatory indices remain unchanged. The initial stage appears to be caused in part by functional respiratory muscle return coincident with resolution of inflammation and edema above the injury level. Altered respiratory mechanics also contribute to these early changes and the continuing later changes. Mechanical changes in the lung are probably both decreased compliance (which decreases FRC) and increased airway resistance (which diminishes airflow). Chest wall changes, resulting from returning spinal cord reflexes, affect PF via: (1) increased rib cage stability, leading to a more effective transduction of diaphragmatic displacement into lung volume, and (2) abdominal and expiratory intercostal spasticity, which could limit maximum inspiration. The net effect of these changes, however, may eventually lead to chronic hypoventilation.

Adolescent↗
PubMed1975

Predominantly unilateral asthma studied with 133Xe-radiospirometry.

Regional lung function in the supine position was studied with 133Xe-radiospirometry in 10 asthmatic subjects in remission, before and after inhalation of specific allergens in the right lateral decubitus position. Regional ventilation and regional lung volume showed a significant decrease in the right lung. The decrease in ventilation was most pronounced in the diaphragmatic half of the lung. The regional perfusion of the right lung decreased less than the ventilation. The change in perfusion, however, became greater with time, whereas the decrease in ventilation remained the same as shortly after the provocation. Predominantly regional asthma could thus be provoked in the regions that receive most of the allergen in the right lateral position. The asthma was easily controlled and caused little discomfort.

Adolescent↗
PubMed1977

133Xenon washout patterns during diaphragmatic breathing. Studies in normal subjects and patients with chronic obstructive pulmonary disease.

Studies of the washout of radioactive 133xenon were performed in six normal subjects and six patients with chronic obstructive pulmonary disease during normal and diaphragmatic breathing. Subjects were unable to change the distribution of ventilation with diaphragmatic breathing. In all normal subjects and in three of the six subjects with chronic obstructive pulmonary disease, overall washout improved with diaphragmatic breathing. It is suggested that this change was related to the slower, deeper tidal volumes used by these subjects during diaphragmatic breathing.

Breathing Exercises↗
PubMed1979

Morphologic aspects of bronchopulmonary dysplasia.

Some of the morphologic changes of bronchopulmonary dysplasia are frequently found in infants dying of the infantile respiratory distress syndrome, so the frequency of BPD is more frequent as determined morphologically than as determined clinically. Morphologic differences have been described between the lesions of oxygen poisoning and those of BPD, but there are probably no true qualitative differences and such differences as exist are quantitative ones. Clinical and functional studies suggest that lung damage in infancy and early childhood may result in residual functional abnormalities in older childhood, and to a predisposition to chronic airflow obstruction in later life. It is hypothesized that this may be brought about by alteration in postnatal lung growth. Two patients who had an operation for diaphragmatic hernia on the first day of life and who died 8 and 64 months later were used to illustrate this point, since both had obviously abnormal lung structure at the time of death.

Adult↗
PubMed2005

Sleep in restrictive and neuromuscular respiratory disorders.

Thoracic restrictive disorders (i.e., chest wall deformities or neuromuscular diseases), may predispose to sleep-disordered breathing, poor sleep quality, and nocturnal hypoventilation. These disorders intensify the effects of reductions in both respiratory center output and central chemosensitivity and increases in upper airway resistance that occur with the onset of sleep. Normally, rapid eye movement (REM) sleep suppresses the activity of nondiaphragmatic breathing muscles, further reducing ventilation. Diaphragmatic or upper airway muscle weakness and reduced chest wall compliance in patients with thoracic restrictive disorders enhance the severity of sleep-disordered breathing during REM sleep, worsening gas exchange abnormalities and sleep fragmentation and impairing daytime functioning. Although daytime respiratory function and nocturnal oxygen saturation are not well correlated, some markers may be useful for identifying patients with thoracic restriction at risk for sleep-disordered breathing. Although some patients may respond to continuous positive airway pressure (CPAP) alone, noninvasive positive pressure ventilation (NPPV) is a more important part of disease management for patients with restrictive thoracic disorders. This technique improves nocturnal ventilation and sleep quality but may also contribute to sleep fragmentation in some patients. If the patient is an unsuitable candidate for or fails NPPV, tracheostomy mechanical ventilation should be considered.

Contraindications↗
PubMed1997

Curtailed respiration by repeated vs. isolated hypoxia in maturing piglets is unrelated to NTS ME or SP levels.

In early development, respiratory disorders can produce recurring hypoxic episodes during sleep. To examine possible effects of daily repeated vs. isolated hypoxic hypoxia, cardiorespiratory functions and central, respiratory-related neuromodulator levels in 21- to 32-day-old, chronically instrumented, unsedated piglets were compared between a fifth sequential daily hypoxia and an isolated hypoxia (10% O2-90% N2 for 30 min). Diaphragmatic electromyographic activity, heart rate and arterial pressure, and pH and gas tensions were measured. In vivo microdialysis, via chronically implanted guides, served to sample interstitial substance P (SP) and methionine-enkephalin (ME) at the level of the respiratory-related nucleus tractus solitarii (NTS). Compared with an isolated hypoxia, repeated hypoxia resulted in 1) lower respiratory frequency (f), ventilation equivalent, and arterial pH, higher arterial PO2 during hypoxia, and lower f in recovery from hypoxia; and 2) increased SP concentrations but no change in ME concentrations. We conclude that, in these maturing swine, repeated vs. isolated hypoxic exposure curtails respiratory responses to hypoxia by a mechanism(s) unrelated to SP or ME levels at the NTS.

Aging↗
PubMed1994

Ultrasonographic signs of sliding, gastric, and hiatal hernia: their prospective evaluation.

This study was conducted to identify the sonographic findings that might be used to diagnose sliding gastric hiatal hernia. We first performed a retrospective evaluation of 12 patients known to have sliding hiatal hernia and 18 normal controls. In the controls the esophagogastric junction could be visualized clearly in all cases and the alimentary tract cross section at the diaphragmatic hiatus ranged from 7.1 to 10.0 mm. The esophagogastric junction was not visualized in any of the hernia patients, whose alimentary tract diameters measurements ranged from 16.0 to 21.0 mm. These two markers (non visualization of the function and diameter greater than 16 mm) were then evaluated for their ability to predict the occurrence of sliding hiatas hernia in a prospective study of 38 patients subsequently diagnosed by means of barium studies and endoscopy. In this group, each sign had a positive predictive value of 100%. The negative predictive value of the alimentary tract diameter was 90%; that of non-visualization of the esophagogastric junction was 94.7%. Inclusion of ultrasonography in the initial work-up of patients with symptoms of gastroesophageal reflux may reduce the need for more invasive diagnostic procedures.

Adult↗
PubMed1993

The effect of opioids on inspiratory muscle fatigue during inspiratory resistive loading.

The effect of opioids on inspiratory muscle function under high mechanical load is still unknown. Even less clear is the extent to which opioids influence the shift of the electromyographic power spectrum of the inspiratory muscles to lower frequencies during ventilatory stress. We studied seven healthy subjects breathing against high inspiratory threshold loads until exhaustion while keeping the minute ventilation constantly high. We compared runs with and without administration of 0.2 mg kg-1 of morphine sulphate intramuscularly; two subjects were given 30 mg morphine sulphate so that we could study the effect of higher opioid concentration. The endurance time (Tlim), the diaphragmatic electromyogram (EMG), the transdiaphragmatic pressures (Pdi) and the ventilatory effort sensation were analysed. Morphine did not have any effect on Tlim or on the effort sensation elicited by the inspiratory resistance in both concentrations. Analysing the spectral shifts of the diaphragmatic EMG, we did not find any significant difference in the decrease of the centroid frequency between drug and control runs. Furthermore, the activation pattern of the diaphragm and the intercostal muscles, evaluated from the percentage contribution of oesophageal and gastric pressures on the transdiaphragmatic pressure swings, did not change following the administration of morphine. Our study shows that morphine does not change the function of the inspiratory muscles during high-resistive breathing. Morphine does not affect the electromyographic power spectrum of the diaphragm during those resistive breathing runs, either. This points out that during stressful ventilatory situations, the shift of the electromyographic power spectrum is attributed to a peripheral (muscular) event consequent to muscle fatigue and not to the elaboration of endogenous opioids.

Adult↗
PubMed1994

Severe asthma complicated by bilateral diaphragmatic paralysis attributed to Parsonage-Turner syndrome.

Progressive dyspnea that developed in a 52-year-old woman with a lifelong history of asthma did not respond to high-dose orally administered glucocorticoids. Initially, a diagnosis of allergic bronchopulmonary aspergillosis or hypersensitivity pneumonia was suggested as the cause of the worsening dyspnea. Pulmonary function tests demonstrated severe airway obstruction; substantial improvement was noted after bronchodilator therapy. Maximal inspiratory pressure was decreased, and the diffusing capacity of the lungs was abnormal. Computed tomography of the chest showed no parenchymal or mediastinal abnormalities. During a sniff test, fluoroscopy of her diaphragm disclosed paradoxical motion of both hemidiaphragms during inspiration, consistent with bilateral hemidiaphragmatic paralysis. Parsonage-Turner syndrome was diagnosed. The dose of glucocorticoids was tapered. Follow-up of the patient by telephone contact in March 1994 (9 months after her initial examination at our clinic) revealed that the dyspnea was still severe.

Asthma↗
PubMed1989

Inspiratory and skeletal muscle strength and endurance and diaphragmatic activation in patients with chronic airflow limitation.

To determine whether patients with chronic airflow limitation have a specific alteration in skeletal muscle performance, the strength and endurance of inspiratory and limb muscles were compared in 11 patients with chronic airflow limitation and 11 control subjects during maximal voluntary contractions. Peak inspiratory pressure at observed functional residual capacity (FRC) was significantly less in the patients than in the control subjects (mean 72 (SD 25) v 93 (21) cm H2O), though only two patients had low maximal pressures across a wide volume range. Maximal voluntary torque of the elbow flexor muscles was also reduced in the patients but the difference was not significant (60 (17) v 72 (18) Nm). During the endurance sequence of 18 maximal voluntary contractions (10 s duration, 5 s rest interval) the decline in peak and average force was less for the inspiratory muscles than for the elbow flexors in both groups. Inspiratory muscle endurance was slightly greater in the patients with chronic airflow limitation than in the control subjects, whereas limb muscle endurance was slightly impaired in the patients. In three patients with chronic airflow limitation, two of whom had low maximal inspiratory pressures at FRC, the ability to drive the diaphragm voluntarily was examined by stimulating the phrenic nerves during maximal inspiratory efforts. Each patient was capable of full activation of the diaphragm during the maximal inspiratory efforts. These results suggest that the relative preservation of inspiratory muscle performance in patients with chronic airflow limitation may be an adaptive response to respiratory "loading."

Airway Obstruction↗
PubMed1998

[Prenatal diagnosis and therapy of congenital diaphragmatic hernia].

The diagnosis and treatment of congenital diaphragmatic hernia, CDH, is an interdisciplinary problem. The patient concentration with prenatally diagnosed CDH for comprehensive examination with subsequent decision on the type of delivery improves the prognosis of patients with CDH. Introduction of corticoid therapy in prenatally assessed CDH reduces dysfunction and surfactant deficiency and can reduce the degree of respiratory failure during delivery. In very early prenatally assessed CDH it is possible to consider the possibility of combined corticoid and TRH (thyroxin releasing hormone) treatment of CDH. The authors submit also contemporary possibilities of prenatal intervention treatment of CDH (indication criteria for reconstruction operations of foetal surgery, intrauterine closure of the trachea and artificial laparoschisis). The concentration of patients with postnatally diagnosed CDH and a severe grade of acute respiratory insufficiency in a department with conventional and non-conventional artificial pulmonary ventilation incl. inhalation of NO oe extracorporeal membrane oxygenation, ECMO, is a further step towards optimation of treatment. Continuous evaluation of parameters of pulmonary functions during the pre- and postoperative period may prove that a therapeutic protocol with delayed surgery is useful.

Female↗