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PubMed1995

Ventilatory response to arm elevation. Its determinants and use in patients with chronic obstructive pulmonary disease.

During arm elevation, normal individuals predominantly recruit the diaphragm, whereas chronic obstructive pulmonary disease (COPD) patients use more the accessory inspiratory and abdominal expiratory muscles. To test that arm elevation is useful to study the ventilatory muscle response in COPD, and to define the factors that determine this response, we studied 34 patients (FEV1 0.95 +/- 0.08 L) during 2 min of arm elevation. Transnasal balloons were used to determine end-inspiratory and end-expiratory gastric (Pg), pleural (Ppl) and transdiaphragmatic (Pdi) pressures. The slope of delta Pg/delta Ppl (= Pgi - Pge/Ppli - Pple) was used to infer respiratory muscle recruitment. With linear regression, the delta Pg/delta Ppl during arm elevation significantly correlated with resting delta Pg/delta Ppl (r = 0.68), hyperinflation (FRC/TLC, r = 0.52), and diaphragmatic tension time index (TTIdi) (r = 0.47). With multiple regression, resting delta Pg/delta Ppl, percentage predicted FRC (FRC %pred) and TTIdi influenced delta Pg/delta Ppl during arm elevation (r = 0.84). Over the 2 min of arm elevation, the dependency upon resting breathing pattern decreased, while hyperinflation and TTIdi became increasingly important. Higher resting TTIdi values were associated with a faster and shallower breathing pattern (f/VT > or = 38) during arm elevation. We conclude that the pattern of respiratory muscle recruitment during arm elevation depends primarily on the resting breathing pattern. Over 2 min, the degree of hyperinflation and the force reserve of the diaphragm increasingly impact on the ability to recruit the diaphragm. Measurement of f/VT during arm elevation is useful to determine functional reserve of the diaphragm in severe COPD.

Arm↗

PubMedDate not supplied

[Diaphragm rupture caused by closed trauma. A more and more frequent condition].

The Authors report a case of rupture of the diaphragm in blunt trauma of the abdomen, to examine the more significant features of this condition whose incidence proves to be increasing, after a review of the literature data, parallel to the increase of accidents on the road and at work. They examine the most important pathogenic problems and these related to the mechanism leading to diaphragmatic lesion and they highlight the deeper pathophysiological changes suffered from the patient with such a condition. They draw attention to what they consider to be the most important aspect, and therefore the diagnosis. In fact, in accordance with the various series of cases reported in the literature, it is crucial in the diagnostic problem is when the possible cause of the rupture is suspected and necessary diagnostic cascade (Rx, echotomography, TC) is activated so to highlight the lesion. Therefore a quick diagnostic fitting is necessary for the survival of the acute patient with hernia of the thorax cavity, as well as quick surgical correction of the lesion that, as in the case described, serves to achieve the best possible anatomic-functional results.

Diaphragm↗

PubMed1990

Short term effect of intermittent negative pressure ventilation in COPD patients with respiratory failure.

Ten patients with stable chronic obstructive pulmonary disease (COPD) and hypercapnic respiratory failure were randomly submitted to intermittent negative pressure ventilation (INPV) 6 h per day for 5 consecutive days by either a cuirass or pneumo wrap ventilator. The effects were assessed by measurements of spirometry, blood gases, maximal inspiratory (MIP) and expiratory (MEP) pressures, 12 minutes walking distance test (12 mwd), sensation of dyspnoea by a visual analogue scale (VAS) and diaphragmatic electromyographic activity (Edi). Edi was recorded during INPV sessions in only 7 patients. The same measurements apart from Edi were also performed in 8 matched control patients randomly submitted to conventional physiotherapy. During INPV, Edi activity was reduced, at least temporarily down to 50% of baseline values. Comparison of baseline with post INPV values showed no changes in thoracic gas volume (TGV), forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC), arterial oxygen partial pressure (Pao2) and MEP; significant improvements were seen in MIP, vital capacity (VC), VAS, and 12 mwd only in patients submitted to INPV. A significant improvement in PaCO2 was observed in both groups of patients. We conclude that INPV may be effective in improving the functional reserve of the inspiratory muscles in selected COPD patients with hypercapnic respiratory failure and signs of inspiratory muscle dysfunction.

Breathing Exercises↗

PubMed1992

Alterations in diaphragmatic oxidative and antioxidant enzymes in the senescent Fischer 344 rat.

We investigated age-related changes in antioxidant, glycolytic, beta-oxidation, and tricarboxylic acid cycle enzyme activity in the diaphragm and plantaris muscle of female Fischer 344 rats. Tissue samples from the costal and crural diaphragm and plantaris muscle were obtained from 30 animals in the following age groups: 1) 6 mo old (n = 10), 2) 26 mo old (n = 10), and 3) 30 mo old (n = 10). Aging had no effect (P greater than 0.05) on the activities of citrate synthase (CS) and 3-hydroxyacyl-CoA dehydrogenase (HADH) in the costal or crural diaphragm. Similarly, no age-related differences existed (P greater than 0.05) in the crural diaphragm in lactate dehydrogenase (LDH) or glutathione peroxidase (GPX) activity. In contrast, the activities of LDH and GPX were significantly (P less than 0.05) higher in the costal diaphragm in the 30- than in the 6-mo old animals. In addition, the ratio of LDH to CS activity increased (P less than 0.05) as a function of age in the costal diaphragm. Conversely, the ratio of CS to GPX activity in the costal diaphragm was lower (P less than 0.05) in the 30- than in the 6-mo old animals. No significant (P greater than 0.05) age-related differences existed in LDH-to-CS or CS-to-GPX activity ratios in the crural diaphragm. Finally, aging resulted in a significant decrease (P less than 0.05) in the activities of LDH, CS, and HADH in the plantaris muscle. These data demonstrate that, unlike many hindlimb locomotor muscles, the oxidative capacity of the Fischer 344 rat diaphragm does not decrease in old age.

3-Hydroxyacyl CoA Dehydrogenases↗

PubMedDate not supplied

[Specific features of the motor function of the digestive organs in persons with different degree of resistance to motion sickness].

The effect of three exposures to Coriolis acceleration on the frequency and amplitude of fasting stomach contractions was investigated in 6 resistant and 16 susceptible to motion sickness test subjects. After tests all of them underwent gastroduodenoscopy and 4 subjects from each group were subjected to echography to measure gall bladder contractility in response to glucose-milk loads. After tests the motor activity of the stomach increased slightly in resistant subjects due to an increase of the amplitude and a slight decrease of biopotential frequency. During gastroscopy antral and pyloric sphincters were closed. In the stomach there was an insignificant amount of contents without gall. In the susceptible group, the motor activity was, on the contrary, inhibited due to a significant decline of the wave amplitude and frequency (by 40% and 11%, respectively). In the stomach, one or both sphincters were widely open; it also contained a large amount of gastric juice and gall. In 36% of susceptible and 17% resistant subjects, diaphragmatic hernia (at the esophageal opening) was found. Ultrasonic examination of the gall bladder showed that susceptible subjects developed its faster and stronger contraction when compared to resistant subject in response to glucose-milk loading. This pointed to a more prolonged duration of the gall excretion phase. Reactive changes of the gastroduodenal zone in response to motion tests facilitated duodenal-gastric reflux and major gastrointestinal symptoms of motion sickness.

Adult↗

PubMed1989

Weighted ventriculographic wall motion score for improved survival prediction in patients with coronary artery disease. Coronary Artery Surgery Study.

Global ventricular function parameters such as the ejection fraction and the sum of wall motion scores for segments of the left ventricle are excellent predictors of long-term survival in patients with coronary heart disease. These are usually determined from a monoplane right anterior oblique view. It was hypothesized that a biplane weighted wall motion score that included the left anterior oblique projection might better predict survival. A new score (BISCORE) was derived for 1,433 Mayo Clinic ventriculograms coded by the methods of the Coronary Artery Surgery Study (CASS). Weighting coefficients for each left ventricular segment were derived by the proportional hazards technique, and this resulted in the equation BISCORE = 120 - (8.6 x anterobasal + 3.4 x basal septum + 2.9 x apical + 2.7 x posterolateral + 2.4 diaphragmatic), which yielded a score from 0 (all segments aneurysmal) to 100 (all segments normal). This score stratified the original 1,433 patients into distinct groups by survival. As a single variable it was better than previous wall motion scores and ejection fraction at predicting survival. When prospectively applied to 5,172 Coronary Artery Surgery Study patients, this new score again proved to be a better predictor of survival than previous unweighted scores. Since the new score contains terms from the left anterior oblique ventriculographic projection, it is concluded that this projection adds information to that of the right anterior oblique projection regarding survival. Furthermore, this weighted score appears more highly associated with survival than unweighted scores.

Coronary Disease↗

PubMed2004

Allelic heterogeneity of SMARD1 at the IGHMBP2 locus.

Spinal Muscular Atrophy with Respiratory Distress (SMARD) is an autosomal recessive disorder characterized by neurogenic muscular atrophy due to progressive anterior horn cell degeneration and early life-threatening respiratory failure ascribed to diaphragmatic dysfunction. SMARD is clinically and genetically heterogeneous. SMARD type 1 is characterized by onset of respiratory failure within the first weeks of life and has been ascribed to mutations in the immunoglobulin mu-binding protein 2 (IGHMBP2) gene on chromosome 11q13-q21. We report here the identification of nine novel IGHMBP2 mutations in five SMARD1 patients, including seven missense [ c.587A>G (p.Gln196Arg), c.647C>T (p.Pro216Leu), c.752T>C (p.Leu251Pro), c.1693G>A (p.Asp565Asn), c.1730T>C (p.Leu577Pro), c.1807C>T (p.Arg603Cys), c.1909C>T (p.Arg637Cys)] and two nonsense mutations [ c.1488C>A (p.Cys496X), c.2368C>T (p.Arg790X)]. Interestingly, 7 of 9 mutations occurred at highly conserved residues of the putative DNA helicase domain. The identification of novel IGHMBP2 variants will hopefully help diagnosing SMARD1 and contribute to a better functional characterization of IGHMBP2 gene product.

Alleles↗

PubMed1984

Pleural liquid pressure measured by micropipettes in rabbits.

Pleural liquid pressure (Ppl) was measured by the micropipette servo-nulling method. In anesthetized, paralyzed, and mechanically ventilated rabbits, windows were made by dissecting away the intercostal muscle layers, exposing the parietal pleura over the right caudal lung lobe. Repeated measurements of Ppl were made at the windows by puncturing the parietal pleura with micropipettes during apnea at functional residual capacity. In five supine rabbits, Ppl relative to atmospheric pressure averaged -3.32 +/- 1.22 (SD) cmH2O at a distance of 5.64 +/- 0.34 (SD) cm above the lung base and -1.64 +/- 0.79 cmH2O at a distance of 2.35 +/- 0.64 cm above the lung base; the vertical Ppl gradient was 0.51 cmH2O/cm height. Ppl interpolated to midlung height was equal in absolute magnitude to mean lung static recoil (Pst) of 2.00 cmH2O. In prone rabbits, Ppl measured near the dorsal surface, 3.9 cm above the lung base, averaged -1.32 +/- 0.46 cmH2O on the costal surface, not statistically different in magnitude from mean Pst of 1.59 +/- 0.09. In contrast, Ppl measured at the same vertical height off the edge of the caudal lung in the costo-diaphragmatic recess was -4.64 +/- 0.65 cmH2O. We concluded from these data that Ppl was equal to pleural surface pressure over the costal surface and that the vertical gradient in Ppl was not hydrostatic, except in large fluid spaces off the sharp edges of the lung.

Animals↗

PubMed2000

Twitch transdiaphragmatic pressure depends critically on thoracoabdominal configuration.

We measured the effect of thoracoabdominal configuration on twitch transdiaphragmatic pressure (Pdi, t) in response to supramaximal, transcutaneous, bilateral phrenic nerve shocks in three thin normal men. Pdi, t was measured as a function of lung volume (VL) in the relaxation configuration, at functional residual capacity (FRC), and at the same end-tidal VL 1) during relaxation; 2) with the abdomen (Ab) expanded and the rib cage (RC) in its relaxed FRC configuration; 3) with RC expanded and Ab in its relaxed FRC configuration; and 4) in configuration 3 with an active transdiaphragmatic pressure similar to that required to produce configuration 2. In increasing VL from FRC to configuration 1, Pdi, t decreased by 3.6 cmH(2)O; to configuration 2 by 14.8 cmH(2)O; to configuration 3 by 3.7 cmH(2)O; and to configuration 4 by 2.7 cmH(2)O. We argue that changes in velocity of shortening and radius of curvature are unlikely to account for these effects and suggest that changes in diaphragmatic fiber length (L(di)) are primarily responsible. If so, equivolume displacements of Ab and RC change L(di) in a ratio of approximately 4:1. We conclude that Pdi, t is exquisitely sensitive to abdominal displacements that must be rigorously controlled if Pdi, t is to be used to assess diaphragmatic contractility.

Abdomen↗

PubMed1988

Metabolic enzymatic activities in the intercostal and serratus muscles and in the latissimus dorsi of middle-aged normal men and patients with moderate obstructive pulmonary disease.

The glycolytic and oxidative enzyme activities (lactate dehydrogenase (LDH), hexokinase (HK), citrate synthase (CS) and 3-hydroxyacyl-CoA-dehydrogenase (HAD] were measured in the fifth internal and external intercostal muscles, in the vertical and horizontal parts of the serratus, an accessory inspiratory muscle, and in a non-respiratory muscle, the latissimus dorsi (LD) of twenty middle-aged men: nine subjects with normal lung function and eleven patients with moderate chronic obstructive pulmonary disease (COPD). In the normal subjects the enzyme activities of the respiratory muscles were similar to those of the LD, and there were no differences between the internal and the external intercostal muscles. In the COPD patients the metabolic activities of HK, CS and HAD were higher in both intercostals than in LD. Furthermore, there was a significant increase in these enzymatic activities as compared to the intercostals of the normal subjects. These data support the hypothesis that the internal and external intercostal muscles play a more important role in COPD patients than in normal subjects. They are consistent with the hypothesis that COPD has an endurance training effect on both intercostal muscles which could compensate for diaphragmatic disuse.

3-Hydroxyacyl CoA Dehydrogenases↗

PubMed1979

[Diagnostic problems in chest injuries (angiography) (author's transl)].

Roentgenography is the simplest and most reliable means to arrive at the diagnosis of chest injury. General roentgenograms are difficult to interpret as they tend to be technically imperfect. Fractures, emphysema, pneumothorax, accumulation of fluid can usually be ascertained directly; but the traumatic origin of changes in the pulmonary parenchyma or of an enlarged heart shadow cannot be reliably deduced from the X-ray appearance. It may provide some differential-diagnostic information but the correct interpretation of the findings depends on further observation. In 6-7% of severe chest trauma with vascular injuries and rupture of the diaphragm angiography is indicated. The evidence to be obtained from chest radiography should not be overestimated: fractures of ribs are sometimes overlocked, even by the expert; parenchymatous lesions may manifest themselves as shadows but their nature remains obscure until they have been related to the clinical and subsequent radiological findings. The same applies to rupture of the diaphragm, bronchi or vessels, if only the immediate posttraumatic roentgenographs are examined. A tent-shaped heart shadow is considered characteristic of the presence of fluid in the pericardium; this is valid only for chronic hydropericardium, but not for the potentially fatal cardiac tamponade; if the pericardium has lost its elasticity a haemorrhage of not more than 150 ml may prove fatal. Nor does the roentgenogram provide information about pulmonary function. Especially in cases of pulmonary shock minor changes in the chest roentgenogram may give a false sense of security when, in fact, blood gas analyses show that a life-endangering situation has developed. The radiologist who is aware of the limititations of the method will derive maximum diagnostic benefit from a chest angiography. No other method is capable of supplying information of such great importance in such a short time.

Angiography↗

PubMed1998

The effects of prenatal intraamniotic surfactant or dexamethasone administration on lung development are comparable to changes induced by tracheal ligation in an animal model of congenital diaphragmatic hernia.

BACKGROUND/PURPOSE: Lung surfactant deficiency contributes to the pathophysiology of congenital diaphragmatic hernia (CDH) and the high neonatal mortality rate. Acceleration of lung surfactant system maturation by prenatal administration of hormones has been described in animal models of CDH. However, in utero tracheal ligation (TL) is the best method to accelerate lung growth and reverse the pulmonary hypoplasia associated with CDH. Although this method offers promise, its application in humans is limited. The aim of this study was to investigate a new noninvasive therapeutic strategy, that is, the prenatal intraamniotic administration of exogenous porcine surfactant or dexamethasone, and compare it with the effects of TL in an animal model of CDH. METHODS: Twenty-four pregnant New Zealand rabbits underwent surgery on gestational day 24 or 25 to create CDH in 26 fetuses. Five groups of animals were studied: (1) Control, nonoperated fetuses (n=14), (2) CDH (n=6), (3) CDH plus TL (n 6), (4) CDH plus intraamniotic administration of Curosurf (40 mg; n=6), and (5) CDH plus intraamniotic infusion of dexamethasone (0.4 mg; n=8). On gestational day 30, the fetuses were delivered by cesarean section. Functional studies (lung hysteresis curves and lung distensibility), weight and volume of lungs, histopathologic and histomorphometric analysis of lungs were performed. RESULTS: The authors demonstrated that the hysteresis curve of CDH animals was shifted downward in comparison with controls. The analyses of curves standardized for lung weight indicated that intraamniotic administration of surfactant or dexamethasone improved lung compliance in comparison with controls and CDH fetuses, but TL had no effect on this parameter. Lung distensibility (maximum lung volume at 32 cm of water pressure per gram of lung) was reduced by CDH, but this parameter was increased by intraamniotic administration of drugs and not by TL (P< .05). CDH decreased the weight and volume of lungs (P< .05), and these changes were reversed only by TL, which prevented the herniation of the liver from the abdomen to the thorax. Histologically, CDH lungs treated with TL or intraamniotic administration of drugs demonstrated structural patterns similar to those of controls. Histomorphometric studies proved that CDH promoted significant thickening of septa walls (P< .05), and all the therapeutic methods could reverse this alteration to control values. The alveolar number per area in control lungs, CDH, and CDH plus TL lungs were similar, but in CDH plus surfactant and CDH plus dexamethasone lungs, the decreased number per area (P< .05) demonstrated that the alveolar airspace was increased. CONCLUSION: From these data the authors conclude that intraamniotic surfactant or dexamethasone administration is capable of preventing pulmonary hypoplasia in fetuses with CDH, and thus, this method may be a substitute for TL.

Analysis of Variance↗

PubMed2003

Pharmacokinetic changes during extracorporeal membrane oxygenation: implications for drug therapy of neonates.

Extracorporeal membrane oxygenation (ECMO) is a prolonged form of cardiopulmonary bypass used to support patients with life-threatening respiratory or cardiac failure. In neonates, ECMO is used for a variety of indications, including sepsis and pulmonary diseases such as meconium aspiration syndrome, persistent pulmonary hypertension or congenital diaphragmatic hernia. In recent years, ECMO has been increasingly used after surgery to correct congenital cardiac defects. Despite the need for numerous drugs to maintain the ECMO circuit and treat the patient's underlying illness, relatively little is known of the disposition of drugs in this patient population. To date, the largest number of pharmacokinetic studies have been conducted with gentamicin and vancomycin. Both drugs have been found to have an increased volume of distribution, probably as a result of the addition of a large exogenous blood volume for circuit priming. Elimination half-lives for both drugs are prolonged during ECMO, with several studies demonstrating a return to expected values after decannulation. The reason for this prolonged elimination is probably multifactorial, with a reduction in renal function as the primary determinant. This same pattern of an increased volume of distribution and prolonged elimination has been found for several other drugs, including tobramycin, bumetanide and ranitidine. Other factors that affect drug disposition during ECMO include loss of the drug from adhesion to the circuit components and loss in the circulating blood volume during changes in the equipment. The benzodiazepines and propofol are largely sequestered within the circuit. Serum concentrations of heparin, morphine, fentanyl, furosemide, phenytoin and phenobarbital are also reduced by these mechanisms. The addition of haemofiltration or dialysis in up to a quarter of ECMO patients further complicates the determination of population pharmacokinetic parameters. The literature published to date on the pharmacokinetic changes associated with ECMO provide preliminary support for dosage adjustment; however, more research is needed to identify optimal administration strategies for this patient population.

Animals↗

PubMed1992

Intrinsic properties of pharyngeal and diaphragmatic respiratory motoneurons and muscles.

Breathing is a complex act requiring the coordinated activity of multiple groups of muscles. Thoracic and abdominal respiratory muscles expand and contract the lungs, whereas pharyngeal and laryngeal respiratory muscles maintain upper airway patency and regulate upper airway resistance. An appreciation of the importance of the latter muscle group in maintaining ventilatory homeostasis and in the pathophysiology of sleep apnea has led to extensive studies examining the neural regulation of pharyngeal dilator muscles. The present review examines the role of heterogeneity in motoneuron and muscle properties in determining the diversity in the electrical and mechanical behaviors of thoracic compared with pharyngeal muscle groups. Specifically, phrenic and hypoglossal motoneuron electrophysiological properties influence whether and the extent to which these neurons will fire in response to a given synaptic input arising from chemo- and mechanoreceptors and from respiratory and nonrespiratory pattern generators. Furthermore, thoracic and pharyngeal muscle properties determine the mechanical response to motoneuronal activity, including the speed of contraction, relationships between motoneuron firing frequency and force production, and whether force is maintained during repetitive activation. Heterogeneity in the functional capabilities of these motoneurons and muscles is in turn determined by diversity of their structural and biochemical properties. Thus, intrinsic properties of respiratory motoneurons and muscles act in concert with neuronal drives in defining the complex electrical and mechanical behavior of pharyngeal and thoracic respiratory motor systems.

Animals↗

PubMed1992

Effect of chronic renal failure on skeletal and diaphragmatic muscle contraction.

The changes in muscle mechanical properties caused by the myopathy of chronic uremia was examined in the soleus and the diaphragm muscles of rats in which chronic uremia was produced by subtotal nephrectomy. Using an in vitro muscle preparation in two groups of rats (moderately and severely uremic), we determined that uremia had a significant detrimental effect on both muscles with respect to the force-frequency relationships. In the diaphragm it decreased by 15% in the moderate group and by 43% in the severe group. In the soleus it decreased by 20% in both groups. Twitch characteristics behaved differently in the soleus and the diaphragm muscles in that 1/2 RT and TPT increased significantly (p < 0.05) in the soleus (severely uremic group) but not in the diaphragm. Fatigability was increased in both muscles in the moderately uremic rats and in the diaphragm in the severely uremic rats; however, the fatigability of the soleus in the severely uremic group was not different from that in the control group. Our findings suggest that the myopathic changes occurring in chronic uremia affects the function of the soleus and the diaphragm in different ways. Other findings in the severely uremic group indicate that additional factors such as marked electrolyte imbalances may also affect the excitation-contraction coupling in different ways.

Animals↗

PubMed2004

The aerobic capacity and ventilatory efficiency during exercise in Qigong and Tai Chi Chuan practitioners.

The objective of this study was to compare cardiorespiratory responses to exercise among older Qigong participants, Tai Chi Chuan (TCC) practitioners and normal sedentary controls during cycle ergometry. Thirty-six community-dwelling men with a mean age of 59.1 +/- 6.6 years participated in this study. Each group (Qigong, TCC and control) included 12 subjects with matched age and body size. The Qigong group practiced Qigong regularly for 2.3 +/- 1.5 years; the TCC group practiced Yang TCC for 4.7 +/- 2.3 years. Heart rate (HR) responses were measured during the practice of Qigong and TCC. Additionally, breath-by-breath measurement of cardiorespiratory function was performed during the incremental exercise of leg cycling. The mean HR during Qigong and TCC practice was 91 +/- 5 bpm and 129 +/- 7 bpm, respectively. At the peak exercise and the ventilatory threshold (VeT), TCC group displayed highest oxygen uptake (VO2), O2 pulse and work rate among the three groups. The Qigong group also showed higher oxygen uptake and O2 pulse than the control group. At the same relative exercise intensity, the Qigong group had the highest tidal volume among the three groups. In conclusion, Qigong and TCC show a beneficial effect to aerobic capacity in older individuals, but TCC displays a better training effect than Qigong due to its higher exercise intensity. However, Qigong can enhance breathing efficiency during exercise due to the training effect of diaphragmatic breathing.

Aging↗

PubMed1998

Thoracoscopic diaphragmatic plication.

We report on thoracoscopic plication of the the paralyzed right hemidiaphragm of a 33-year-old woman with a history of reactive airway disease. The paralysis was secondary to transection of the phrenic nerve during right first rib resection for thoracic outlet syndrome 1 year prior to evaluation. By use of video-assisted thoracoscopic surgery (VATS), the diaphragm was plicated as with open thoracotomy. Postoperative recovery was uneventful, with minimal pain and early discharge. Preoperative symptoms of exertional dyspnea and orthopnea were significantly improved.

Adult↗

PubMed1984

Respiratory muscle weakness in uremic patients under continuous ambulatory peritoneal dialysis.

The increasingly frequent use of continuous ambulatory peritoneal dialysis (CAPD) as substitutive therapy in terminal renal failure has induced the investigation of the advantages and disadvantages of this therapeutic modality. The effects of CAPD on pulmonary function are one of the aspects currently under study. Based on previous data suggesting the existence of extrapulmonary ventilatory restriction in uremic patients under CAPD, we have studied in these patients the respiratory muscle function as expressed in the maximal inspiratory pressure (MIP) and assessed the impact of the infusion of 2 liters of dialysis fluid into the peritoneal cavity on both MIP and the pulmonary volumes. Uremic patients evidenced significantly lower MIP values as compared with healthy controls. The filling of the peritoneal cavity induced, both in the supine and in the sitting position, a restrictive effect and an increase in the inspiratory capacity. We conclude that uremic patients under CAPD evidence a respiratory muscle dysfunction of as yet unclear cause. Our findings further suggest that the infusion of 2 liters of dialysis fluid into the peritoneal cavity induces not only a restrictive effect, but also an increase in the strength of the respiratory muscles, the latter effect being probably due to increased diaphragmatic contractility.

Adult↗