摘要:

Respiratory failure is the leading cause of death in patients with amyotrophic lateral sclerosis (ALS). We review the physiology of respiratory compromise in ALS and techniques of monitoring respiratory function. Treatment options, including pharmacologic interventions, aspiration precautions, and invasive and noninvasive modes of mechanical ventilation are reviewed. Our clinical experience with respiratory failure in ALS demonstrates significantly prolonged survival in subjects who elect to receive noninvasive mechanical ventilation (19.25 vs. 80.4 days, p < 0.01). Four of 18 patients who elected to receive noninvasive ventilation decided to discontinue treatment. Four of 13 patients who were receiving mechanical ventilation elected to discontinue life support. The decision to utilize these modalities must be made with realistic considerations of the patient’s quality of lif

ISSN:0025-7931    

DOI:10.1159/000196308

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Our objective was to examine the changes in regional ventilation during hista-mine-induced bronchoconstriction in stable asthma. We measured regional ventilation by a new method which measures regional distribution of inhaled 127Xe during tidal breathing by a gated method and, by simultaneously measuring 99mTc counts from labelled macroaggregates, allowed for changes in lung shape during the breathing cycle. We studied 10 asthmatic patients [forced expiratory volume in 1 s (FEV1 2.04-4.37 litres)] and measured, in addition to the regional ventilation, oxygen saturation (SaO2), minute ventilation (Ve) and tidal volume (Vt) before and after inhaling enough histamine to lower FEV1 20% and/or SaCO2 4%. Histamine inhalation reduced FEV1 by 0.44-1.15 liters and SaO2 by 0-4%. It increased VE and functional residual capacity (FRC) in 8 of the 10 patients. The FEV1 fall did not correlate with the SaO2 fall, VE or FRC changes. Histamine inhalation increased apical ventilation in most patients, but the changes in regional ventilation in the left and right lungs were asymmetrical in 17 out of the 30 lung regions studied (upper, middle and lower paired regions in 10 patients). These results demonstrate that histamine bronchial challenge causes uneven regional ventilation. OAny resultant change in ventilation-perfusion balance may be the underlying mechanism of oxygen desaturation seen in this procedure and in spontaneous attacks of asthma.

ISSN:0025-7931    

DOI:10.1159/000196309

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Isocapnic hyperventilation with dry air is nearly as effective as with dry cold air, and appears to be a valuable screening test for bronchial hyperresponsiveness. However some incidental factors such as prechallenge bronchoconstriction, level of hyperventilation, age and smoking habits have barely been examined or were investigated in small samples of either normals or well-characterised asthmatics. In an inhomogeneous population of 186 outpatients with known asthma, 286 with suspected asthma and 32 normals, a single isocapnic hyperventilation challenge of 6-min duration was performed. There was a weak, but significant correlation between the degree of prechallenge airway function and the bronchial response, assessed by the change in forced expiratory volume in 1 s (r = 0.27, p = 0.000) in known asthmatics, but not in patients with suspected asthma and in normals. No significant relation was found between the level of hyperventilation and the bronchial response when comparing the bronchial response to the single-dose hyperventilation test between the subjects (NS). Increasing age appears to be associated with an attenuation of the response in known asthmatics (r = 0.21, p = 0.004), but not in patients with suspected asthma. Smoking habits did not affect the bronchial response in this study. In conclusion, the main finding is that there is a weak correlation between baseline airway obstruction and the subsequent response to isocapnic hyperventilation, a slow decline in response with age and no increase in responsiveness in smokers. Hence, isocapnic hyperventilation is a relatively robust test for assessing bronchial reactivity in an inhomogeneous population of outpatients like ours.

ISSN:0025-7931    

DOI:10.1159/000196310

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

It is known that pulmonary function is impaired during the course of HIV infection even in early stages. In order to estimate the resulting reduction of exercise capacity, different groups of HIV patients were investigated. Group 1 consisted of 20 patients without a history of respiratory disease and without actual lung disease, group 2 of 18 patients with a former episode of Pneumocystis carinii pneumonia (PCP) without actual lung disease, and group III of 37 patients with different broncho-pulmonary complications including PCP 20 normal subjects served as controls. Spirometry, diffusing capacity (DLCO) and exercise tests including arterial blood gas analysis (BGA) were performed in patients and controls. Compared to the controls group 1 patients revealed a decreased DLco (TCO: 83+15 vs. 67 ± 15%Pred.norm.) while spirometric data were normal. VO2 and O2 pulse at the anaerobic threshold (17.7 ± 5.1 vs. 14.3 ± 2.6 ml/kg min and 10.8 ± 4.0 vs. 8.6 ± 1.9 ml/beat, respectively) and maximum exercise (33.9 ± 9.7 vs. 22.1 ± 3.4 ml/kg min and 15.0 ± 5.0 vs. 11.3 ± 2.5, respectively) were decreased, whereas AaDO2, VD/VT, and the HR/VO2 slope were normal. The reserves of heart rate and ventilation were high. Except for a reduced maximum work rate in group 1, no significant difference was found between groups 1 and 2. Group 3 patients differed most from groups 1 and 2 with respect to spirometry, DLco and AaDO2, rather than VO2. VO2max and maximum work rate correlated with the Walter Reed classification: r = 0.72 (p < 0.0001) and r = 0.78 (p < 0.0001), respectively, suggesting that a more advanced stage of immunodeficiency leads to a decreased exercise capacity. There was also a significant correlation between maximum work rate and the Broca index: r = 0.57 (p < 0.0001).We conclude that an impairment of DLco and exercise capacity is associated with the infection of HIV-1. Analysis of gas exchange patterns suggests that the cause of exercise limitation in groups 1 and 2 is due to anemia and a neuromuscular disorder in the exercising muscles, rather than pulmonary limitations, as were observed in

ISSN:0025-7931    

DOI:10.1159/000196311

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The present study examined possible short-term effects of the heat stress during sauna bathing on gas exchange, especially in correlation with changes in cardiac output. The results obtained are as follows: (1) The heat stress of sauna bathing caused a slight but not significant increase in diffusion capacity (p = 0.239) and no change in other pulmonary function parameters. (2) Cardiac output and cardiac index increased slightly but not significantly (p = 0.2455 and p = 0.2719). We conclude that heat stress in sauna neither influences gas exchange nor does it cause a significant increase in cardiac output.

ISSN:0025-7931    

DOI:10.1159/000196312

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Lung function parameters, forced vital capacity (FVC), forced expiratory volume in 1st s (FEV1), peak expiratory flow rate (PEFR), were measured in 3,318 nonsmoking Indian women using four different types of cooking fuels (biomass, liquified petroleum gas, kerosene and mixed). Biomass fuel users had FVC values less than 75% predicted (73.42 ± 0.90; mean ± SE) whereas in other groups it was more than 75% of predicted, though less than 80% of the predicted values. However, FEV1, FEV1/FVC (%) and PEFR were within normal limits in all the four groups. The absolute values of all the three parameters of lung functions were the lowest in the biomass and mixed fuel users. A negative correlation was observed between these parameters and the duration of cooking and exposure index. Thus the present study showed that, lung function, particularly FVC, is affected by indoor air pollution due to domestic cooking more so with biomass fuel. Better housing and use of smokeless devices for cooking might be helpful to avoid this effect on lung. This ventilatory impairment seems to be more of the restrictive (parenchymal) type, since obstruction could be ruled out. A longitudinal study is needed to demonstrate whether or not these changes are variable, reversible or progressing to fibrosi

ISSN:0025-7931    

DOI:10.1159/000196313

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

We studied 84 consecutive patients referred with the suspicion of pulmonary embolism (PE) to investigate the influence of clinical and hematological profiles on the diagnosis and severity of this disease and recovery. Diagnosis of PE was confirmed in 48 out of 84 patients by perfusion scintigraphy and/or pulmonary arteriography. Severity of PE and entity of recovery were investigated by measuring standard PaO2 on blood gas analysis and the number of unperfused lung segments ULS on perfusion scintigraphy. Most common clinical predisposing conditions were more frequent, though not significantly so, in embolic patients and a very low prevalence of PE was appreciable in patients without clear predisposing conditions. Among coagulation factors, only thrombin-antithrombin (TAT) complexes were twice as high in embolic as in nonembolic patients (14.0 ± 13.6 vs. 7.0 ± 4.2 ng/ml; p < 0.02), while there was no statistically significant difference between embolic and nonembolic patients for activated partial thromboplastin time, prothrombin time, antithrombin III, protein C, fibrinogen, plasminogen, α2-plasmin inhibitor, and plasminogen activator inhibitor-1. Sensitivity and specificity of TAT complexes in diagnosis of PE were 95.8% and 30.5%, respectively. Therefore, normal values of TAT complexes may help exclude the diagnosis of PE, while abnormal values allow to reinforce the clinical suspicion of PE. No relation was found between coagulation parameters and the severity of PE. The follow-up of 48 patients with confirmed PE was favorable on the average; however, neither the presence of predisposing conditions nor abnormal coagulation parameters allow to predict the degree of functional and scintigraphic improvement during follow-

ISSN:0025-7931    

DOI:10.1159/000196314

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

The formation of reactive oxygen species (ROS) is a major factor responsible for reperfusion injury in lungs. Adult T cell leukemia derived factor (ADF), a polypeptide made of 104 amino acids, is induced by a variety of stresses including X-ray, ultraviolet, H2O2, and mitogen. ADF has a reducing activity, which catalyzes the proton transfer between thiol-radical of cystein-containing proteins. Furthermore, ADF has a protective activity of ROS which are formed by xanthine oxidase and other alternative pathways in vitro. Using a rat in vivo model of lung ischemia, we examined the protective effect of recombinant human ADF (rhADF) against ischemia reperfusion injury of the lung. Ischemia, lasting for 75 min, was induced in the left lung of rats at 23 °C. The lung was then reperfused. These animals were divided into two groups: group 1 (n = 6, treatment with normal saline) and group 2 (n = 6, treatment with 28 µg/g of rhADF). One minute after the beginning of reperfusion, arterial oxygen tension (PaO2) decreased significantly in both groups (p < 0.01), without any significant intergroup difference (55.5 ± 9.8, 49.8 ± 8.6 mm Hg, respectively). Twenty minutes after reperfusion, PaO2 was significantly higher (p < 0.05) in group 2 (113.0 ± 8.1 mm Hg) than in group 1 (72.3 ± 13.6 mm Hg). The wet/dry weight ratio was significantly higher in group 1 (7.31 ± 0.54) than in group 2 (5.82 ± 0.36). Histologically, lung injury tended to be milder in group 2 than in group 1. These results suggest that rhADF has a protective effect against ischemia reperfusion injury of the r

ISSN:0025-7931    

DOI:10.1159/000196315

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Eight patients with a thoracic malignancy inhaled single doses of 3-100 × 106 IU of human natural interferon (IFN)-beta via a dosimeter-equipped jet nebulizer. After inhalation IFN-beta was not detectable in any of the serum samples as measured using an antiviral bioassay. Except for a slight body temperature rise and an 18% decrease in peak expiratory flow rate observed in 1 patient the patients did not experience any major side effects. Inhaled natural IFN-beta in this study was tolerated better than inhaled IFN-alpha or IFN-gamma in our previous studies. IFN-beta might thus be a promising local treatment for pulmonary diseases. Further work is needed to investigate the concentrations of biologically active IFN in alveolar epithelial lining fluid after inhalation and the therapeutic effect of inhaled IFN-beta

ISSN:0025-7931    

DOI:10.1159/000196316

出版商:S. Karger AG    

年代:1994

数据来源: Karger

ISSN:0025-7931    

DOI:10.1159/000196317

出版商:S. Karger AG    

年代:1994

数据来源: Karger