Postoperative FVC Research Articles

Sigara içen hastalarda ameliyat sonrası üç top solunum egzersiz uygulamasının solunum fonksiyon testleri üzerine etkisi

Aim:Incentive spirometry is used to reduce pulmonary complications after surgical interventions under general anesthesia. In this study, we aimed to investigate the effect of postoperative incentive spirometry on pulmonary function tests in patients who smoke and undergo extremity surgery under general anesthesia. Study design: Eighty patients with ASA I-II physiological score, aged 18-61 years, who underwent extremity operation in a 3rd level hospital were included in the study. After the patients were divided into two groups as 40 patients in each group, smokers of 10-20 cigarettes per day for at least 5 years and non-smokers and the groups were once more randomized according to whether they would use incentive spirometry (three balls of breathing exercise) or not. Group K (n=20):Non-smoker and not using incentivespirometry, Group T (n=20): Non-smoker and using incentivespirometry, Group S (n=20): Smoker of 10-20 cigarettes per day for at least 5 years andnot using incentive spirometry, Group ST (n=20): Smokers of 10-20 cigarettes per day for at least 5 years and using incentive spirometry. Results:The demographic data similar between the groups. When the groups were compared in terms of preoperative and postoperative FVC and FEV1 values, the postoperative FVC values in Group K and Group S were found to be significantly lower than the preoperative values (p=0.001, p=0.002, respectively). Postoperative PEF values were significantly lower than preoperative values (p=0.024, p=0.024, p=0.001, respectively). When compared within groups, postoperative VC values in Group K and Group S were found to be significantly lower than preoperative values (p=0.037, p=0.012, respectively). When the groups were compared statistically in terms of preoperative and postoperative FEV1/FVC values, no significant difference was found (p>0.05). Conclusion:It was found that postoperative worsening of respiratory function test values in smokers who received general anesthesia has improved with the use of incentive spirometry. For this reason, it is assumed that the use of incentivespirometry in the postoperative period in extremity operations performed under general anesthesia will be helpful in preventing postoperative respiratory complications.

Preoperative respiratory muscle training combined with aerobic exercise improves respiratory vital capacity and daily life activity following surgical treatment for myasthenia gravis

ObjectiveThe effects of preoperative respiratory muscle training (RMT) on postoperative complications in patients surgically treated for myasthenia gravis (MG) remain unclear. The present study therefore evaluated the effects of preoperative moderate-to-intense RMT and aerobic exercise, when added to respiratory physiotherapy, on respiratory vital capacity, exercise capacity, and duration of hospital stay in patients with MG.MethodsEighty patients with MG scheduled for extended thymectomy were randomly divided into two groups. The 40 subjects in the study group (SG) received preoperative moderate-to-intense RMT and aerobic exercise in addition to respiratory physiotherapy, whereas the 40 subjects in the control group (CG) received only chest physiotherapy. Respiratory vital capacity (as determined by VC, FVC, FEV1, FEV1/FVC, and PEF) and exercise capacity (as determined by the 6-min walk test [6 MWT]) were measured pre- and postoperatively and before discharge. The duration of hospital stay and activity of daily living (ADL) were also determined.ResultsDemographic and surgical characteristics, along with preoperative vital capacity and exercise capacity, were similar in the two groups. In the CG, VC (p = 0.001), FVC (p = 0.001), FEV1 (p = 0.002), PEF (p = 0.004), and 6MWT (p = 0.041) were significantly lower postoperatively than preoperatively, whereas the FEV1/FVC ratio did not differ significantly. Postoperative VC (p = 0.012), FVC (p = 0.030), FEV1 (p = 0.014), and PEF (p = 0.035) were significantly higher in the SG than in the CG, although 6MWT results did not differ. ADL on postoperative day 5 was significantly higher in the SG than in the CG (p = 0.001).ConclusionRMT and aerobic exercise can have positive effects on postoperative respiratory vital capacity and daily life activity, and would enhance recovery after surgery in MG patients.

Outcomes of Single vs. Bilateral Lung Transplant in Patients with Chronic Obstructive Pulmonary Disease

There are contradictory reports on outcomes after bilateral lung transplant (BLT) vs. single lung transplant (SLT) in patients with COPD, which may be confounded by differences in allocation preferences and patient care between programs. We report outcomes of SLT vs. BLT for COPD at our center. We retrospectively analyzed COPD patients who underwent SLT and BLT between Jan 2008 and Dec 2018. Pre- and post-transplant characteristics were compared between groups with chi-square and t-tests. Unadjusted Kaplan-Meier survival estimates were used to compare differences in freedom from CLAD (2019 ISHLT criteria) and allograft survival with log-rank tests. 276 patients with COPD underwent LT (233 BLT and 43 SLT). SLTs were older than BLTs [median 63y (IQR 59-69) vs. 61y (IQR 57-67) p=0.04]. There were no other differences in baseline characteristics. SLTs had younger donors [median 27y (IQR 23-49) vs. 36y (IQR 22-53) p=0.01] and more often underwent EVLP [49% vs. 29% p=0.01]. BLTs required more intraoperative ECMO [14% vs. 2.3% p=0.03] and blood transfusion [40% vs. 19% p=0.02]. Mean post-transplant hospital and ICU length of stay was similar between groups [BLT 29.1d (95%CI 27.1-34.9) vs. SLT 23.5d (95% CI 19.6-27.5) p=0.11], and [BLT 6.8d (95%CI 5.3-8.1) vs. SLT 5.4d (95% CI 3.7-7.1) p=0.36]. Postoperative FEV1 and FVC were better in BLT [2.75L (95% CI 2.2-3.39) vs. 1.63L (95% CI 1.39-1.92) p <0.0001] and [3.28L (95% CI 2.73-4.05) vs. 2.55L (95% CI 2.11-3.30) p<0.0001]. DLT resulted in higher gains in 6MWD (159m +/-106 vs. 106m +/-105, p=0.03). There was no significant difference in freedom from CLAD (Fig. 1A) or allograft survival between SLT and BLT recipients, but BLT recipients showed a trend towards improved survival after 5 years (Fig.1B). BLT for COPD resulted in better postoperative lung function and exercise capacity, but no significant differences in freedom from CLAD and allograft survival. There was a trend toward improved longer-term survival with BLT for COPD.

The effects of maxillomandibular fixation on ventilatory functions in adult Nigerians

Background: Maxillomandibular fixation (MMF) is a routine procedure in maxillofacial surgery in developing countries. Aim: The aim of this study was to determine the pulmonary functions (forced expiratory volume in 1 min [FEV1], forced vital capacity [FVC], and peak expiratory flow rate [PEFR]) of adult Nigerian patients who had MMF and to find the associated changes in pulmonary functions in the postoperative period vis-a -vis pulmonary function tests among healthy adult Nigerians. Settings and Design: The study setting was the Oral and Maxillofacial Surgery Department of a Teaching Hospital in Northern Nigeria, and the study design was prospective hospital based. Materials and Methods: One hundred and six patients and 106 controls were recruited between January 2011 and December 2012. Information was obtained using a questionnaire. All study participants had their baseline lung functions measured; the treatment group in addition had their postoperative daily lung function parameters measured for the 1st week and then weekly for the next 5 weeks. Statistical Analysis: Statistical analyses were performed using the Statistical Package for Social Sciences (version 16, SPSS Inc., Chicago, IL, USA). The mean and standard deviation values of physical characteristics and ventilatory functions were determined in both men and women. The mean values were compared using Student's t-test. Statistical significance was inferred at P ≤ 0.05. Results: One hundred and seventy males and 42 females participated in the study. The control group had a mean age of 30.25 ± 9.05, weight 64.08 ± 9.90, height 1.67 ± 0.10, body mass index (BMI) 23.32 ± 3.07, basal FVC 3.70 ± 0.71, basal FEV13.16 ± 0.54, and basal PEFR8.35 ± 1.62. For the treatment group, the mean age was 30.68 ± 8.23, weight 64.91 ± 9.96, height 1.66 ± 0.10, BMI 23.21 ± 3.14, basal FVC 3.72 ± 0.69, basal FEV13.14 ± 0.51, and the basal PEFR8.18 ± 1.61. Conclusion: The postoperative mean FVC, FEV1, and PEFRvalues drop significantly by more than 50% when compared to the preoperative values in the first postoperative week with the nadir on the second postoperative day in the patients with MMF.

(351) - Interleukin 12-Dependent CMV-Specific CD4+ T Cell Proliferation, T-bet Induction and Effector Function During Primary Infection Are Key Determinants for Early Immune Control in Lung Transplant Recipients

s S137 recipients) were divided into two groups, the flat chest (FC) group and the normal chest (NC) group. The thoracic shape was defined by the measurement of anteroposterior and transverse dimensions of the thorax. Pulmonary function was assessed perioperatively. Results: Twenty donor grafts were in the FC group and 12 were in the NC group. There were no significant differences in FVC size matching between the FC and NC groups (p= 0.94). In the FC group, postoperative FVC ratio to the preoperatively estimated FVC of the donor graft (FVCR post/pre) was 0.67 ± 0.24, 0.82 ± 0.39, and 0.86 ± 0.45, at 3 months, 6 months, and 1 year, respectively. In the NC group, FVCR post/pre was 0.99 ± 0.44, 1.03 ± 0.59, and 1.14 ± 0.42, at 3 months, 6 months, and 1 year, respectively. There was a significant difference in FVCR post/pre between the groups at 3 months after LDLLT (p= 0.01). This trend existed even 1 year after LDLLT between the groups (p= 0.08). Conclusion: Postoperative pulmonary function in a patient with flat chest was significantly worse in the early phase after bilateral LDLLT. Preoperative thoracic shape might be important for estimating the postoperative pulmonary function in lung transplantation.

(348) - Risk Factors and Impact of Bronchial Stenoses after Lung Transplantation: Ten Year Single Center Experience with over 1,100 Patients

s S137 recipients) were divided into two groups, the flat chest (FC) group and the normal chest (NC) group. The thoracic shape was defined by the measurement of anteroposterior and transverse dimensions of the thorax. Pulmonary function was assessed perioperatively. Results: Twenty donor grafts were in the FC group and 12 were in the NC group. There were no significant differences in FVC size matching between the FC and NC groups (p= 0.94). In the FC group, postoperative FVC ratio to the preoperatively estimated FVC of the donor graft (FVCR post/pre) was 0.67 ± 0.24, 0.82 ± 0.39, and 0.86 ± 0.45, at 3 months, 6 months, and 1 year, respectively. In the NC group, FVCR post/pre was 0.99 ± 0.44, 1.03 ± 0.59, and 1.14 ± 0.42, at 3 months, 6 months, and 1 year, respectively. There was a significant difference in FVCR post/pre between the groups at 3 months after LDLLT (p= 0.01). This trend existed even 1 year after LDLLT between the groups (p= 0.08). Conclusion: Postoperative pulmonary function in a patient with flat chest was significantly worse in the early phase after bilateral LDLLT. Preoperative thoracic shape might be important for estimating the postoperative pulmonary function in lung transplantation.

Effects of transcutaneous electrical acupoint stimulation at different frequencies on perioperative anesthetic dosage, recovery, complications, and prognosis in video-assisted thoracic surgical lobectomy: a randomized, double-blinded, placebo-controlled trial.

Transcutaneous electrical acupoint stimulation (TEAS), a non-invasive and non-pharmacological adjunctive intervention for perioperative analgesia, may also reduce the incidence of postoperative pulmonary complications. The effect of TEAS on video-assisted thoracic surgical (VATS) patients is still unknown, however. The purpose of this study was to investigate the effects of TEAS of different frequency on perioperative anesthetic dosage, recovery, complications, and prognosis for patients undergoing VATS lobectomy. Eighty VATS lobectomy patients with no previous experience of TEAS or acupuncture were randomly assigned to four groups: control (con), 2/100, 2, and 100Hz. The last three experimental groups received TEAS at the indicated frequencies for 30min before induction, during the operation, and for another 30min 24 and 48h after surgery. 2/100Hz is a type of alternating frequency which goes between 2 and 100Hz every 3s. TEAS was administered over acupoints Neiguan, Hegu, Lieque, and Quchi on the sick lateral. Electrodes were applied to the patients in the control group, but no TEAS was used. Anesthetic dosage, blood gas analysis results, lung function indexes FEV1 and FVC, post-anesthesia care unit (PACU) status, postoperative complications, and quality of life scores were recorded and analyzed statistically. Intraoperative opioid consumption was lowest in the 2/100Hz group, with statistical significance (con, P≤0.001; 2Hz, P≤0.001; 100Hz, P=0.026). Compared with preoperative FEV1 and FVC, postoperative FEV1 and FVC were significantly lower in all groups; during one-lung ventilation, arterial oxygen partial pressure (PaO2) decreased more slowly in the 2/100Hz group than in the con group (P=0.042). Moreover, in the 2/100Hz group extubation time was shorter (P=0.038), visual analgesia scale score lower (P=0.047), and duration of PACU stay shorter (P=0.043) than in the con group. In the 100Hz group incidence of postoperative nausea and vomiting (PONV) was lower than the con group (P=0.044). In all groups mean postoperative physical component scores were significantly lower than mean preoperative scores. TEAS is a safe noninvasive adjunctive intervention for anesthesia management among patients undergoing VATS lobectomy. TEAS at 2/100Hz can reduce intraoperative opioid dosage and slow the decrease of PaO2 during one-lung ventilation. It can also effectively reduce pain score, extubation time, and PACU stay immediately after surgery. Further, 100Hz TEAS can reduce PONV morbidity.

Cough impairment and risk of postoperative pulmonary complications after open upper abdominal surgery.

Cough impairment is often described as part of the pathophysiological basis of postoperative pulmonary complications (PPCs). However, there have been few studies examining cough effectiveness and its relationship with PPCs following open upper abdominal surgery. The goal of this study was to estimate (1) changes in cough efficacy after upper abdominal surgery through the assessment of peak cough flow and (2) the extent to which cough impairment is associated with postoperative pain, FVC, and risk of PPCs. This prospective cohort study assessed 101 subjects (45% male, 56 ± 16 y old) admitted for elective upper abdominal surgery. Measurements of peak cough flow and FVC were performed on the day before surgery and repeated on postoperative days 1, 3, and 5. PPCs were assessed daily by a pulmonologist blinded to the cough measurement results. Peak cough flow dropped to 54% of the preoperative value on postoperative day 1 and gradually increased on postoperative days 3 (65%) and 5 (72%) (P < .05). On all postoperative days, peak cough flow was strongly correlated with FVC (P < .001) and weakly correlated with pain (P = .006). Six subjects (6%) developed PPCs. The association between peak cough flow and risk of PPCs was not statistically significant (unadjusted odds ratio of 0.80, 95% CI 0.45-1.40, P = .44; adjusted odds ratio of 0.66, 95% CI 0.32-1.38, P = .41). Cough effectiveness is impaired after upper abdominal surgery. Postoperative restrictive lung dysfunction seems to be associated with this impairment. There is no significant association between peak cough flow and PPCs; however, cough impairment might result in clinically important consequences in a high-risk population.

Endoscopic Sinus Surgery in Adults With Cystic Fibrosis

To ascertain the effect of endoscopic sinus surgery (ESS) on lung function, intravenous (IV) antibiotic use, and hospitalization in adults with cystic fibrosis (CF). Retrospective analysis. Tertiary care center. Fifteen adults with a diagnosis of CF undergoing ESS between March 1, 2006, and June 31, 2008. Twelve-month preoperative and 12-month postoperative pulmonary function testing (forced vital capacity [FVC] and forced expired volume in 1 second [FEV1]), number of IV antibiotic courses, total number of days of intravenous antibiotic use, and number of inpatient hospital days (IHDs) were assessed. Twenty-two adults with CF underwent ESS; 15 patients had adequate data for evaluation. No significant differences were found between mean preoperative and postoperative FEV1 (61.3% vs 59.5%; P = .41) or FVC (76.4% vs 76.1%; P = .97) or between best preoperative and postoperative FEV1 (67.4% vs 67.0%; P = .95) or FVC (84.2% vs 83.0%; P = .86) (paired samples t test). The number of IV antibiotic courses and the total number of days of IV antibiotic use did not differ between the preoperative and postoperative periods (Wilcoxon signed rank test P = .61 and P = .10, respectively). However, the number of IHDs was significantly lower in the 1-year postoperative period (36.7 days) vs the 1-year preoperative period (59.1 days) (Wilcoxon signed rank test, z = -2.20, P = .03). This preliminary study of ESS in adult CF patients indicates significant reduction in the number of IHDs in the postoperative period. However, there is no evidence that ESS improved lung function or the need for IV antibiotics.

The effect of crystalloid versus medium molecular weight colloid solution on post-operative nausea and vomiting after ambulatory gynecological surgery - a prospective randomized trial

BackgroundIntravenous fluid is recommended in international guidelines to improve patient post-operative symptoms, particularly nausea and vomiting. The optimum fluid regimen has not been established. This prospective, randomized, blinded study was designed to determine if administration of equivolumes of a colloid (hydroxyethyl starch 130/0.4) reduced post operative nausea and vomiting in healthy volunteers undergoing ambulatory gynecologic laparoscopy surgery compared to a crystalloid solution (Hartmann’s Solution).Methods120 patients were randomized to receive intravenous colloid (N = 60) or crystalloid (N = 60) intra-operatively. The volume of fluid administered was calculated at 1.5 ml.kg-1 per hour of fasting. Patients were interviewed to assess nausea, vomiting, anti-emetic use, dizziness, sore throat, headache and subjective general well being at 30 minutes and 2, 24 and 48 hours post operatively. Pulmonary function testing was performed on a subgroup.ResultsAt 2 hours the proportion of patients experiencing nausea (38.2 % vs 17.9%, P = 0.03) and the mean nausea score were increased in the colloid compared to crystalloid group respectively (1.49 ± 0.3 vs 0.68 ± 0.2, P = 0.028). The incidence of vomiting and anti-emetic usage was low and did not differ between the groups. Sore throat, dizziness, headache and general well being were not different between the groups. A comparable reduction on post-operative FVC and FEV-1 and PEFR was observed in both groups.ConclusionsIntra-operative administration of colloid increased the incidence of early postoperative nausea and has no advantage over crystalloid for symptom control after gynaecological laparoscopic surgery.

Long-term respiratory functional results after pneumonectomy

The aim of this study is to evaluate the long-term respiratory outcome of patients who underwent pneumonectomy for non-small cell lung cancer (NSCLC), analysing functional tests. Twenty-seven consecutive patients who were candidates for pneumonectomy performed spirometry before and at least 24 months after surgery in the same laboratory. Diffusion of carbon monoxide and the most common dynamic and static lung volumes were evaluated in percentage of predicted and compared. A significant inverse correlation was observed between the preoperative FEV1 (%) and FVC (%) and their postoperative loss, respectively r=-641 (p<0.0001) and r=-789 (p<0.0001). Also the correlation between the RV/TLC ratio and the FEV1 loss confirmed a better postoperative outcome in patients with major airway obstruction (p=0.02). To investigate these data, the series were divided into two groups: group A included BPCO patients with a FEV1 lower than 80%, the others were considered group B. Group B showed a significant major postoperative FEV1 (%) and FVC (%) impairment, 31% versus 12%, p=0.005, and FVC (%) loss, 37% versus 16% (p=0.02), meanwhile group A showed a significant major postoperative RV (%) reduction, 43% versus 17%, p=0.03. Despite being significantly higher preoperatively in BPCO patients, the RV% becomes similar between the two groups in the postoperative. In our experience patients with major preoperative airway obstruction who underwent pneumonectomy had lower impairment in FEV1% at almost one year after surgery than those with normal respiratory function. The resection of a certain amount of non-functional parenchyma associated with the mediastinal shift, with an improvement of the chest cavity for the remaining lung, could give a reduction volume effect in BPCO/emphysematous patients.

Actual and Predicted Postoperative Changes in Lung Function After Pneumonectomy: A Retrospective Analysis

Little is known about long-term effects of pneumonectomy on lung function and exercise tolerance. We evaluated the long-term validity of two formulas frequently used to predict postoperative lung function, as well as trends in postoperative lung function and late postoperative exercise capacity. Nonuniversity teaching hospital of Eindhoven, the Netherlands. Patients who underwent pneumonectomy between 1993 and 1998 and survived for > 1 year after the operation. Lung function and exercise test data of 32 patients were analyzed. Postoperative FVC and FEV1 according to Kristersson/Olsen (split function of resected lung) and Juhl and Frost (number of segments to be resected) were calculated and compared with observed values measured in the third postoperative year. Calculated values correlated well with observed values, whereas Kristersson/Olsen appeared to be more accurate than Juhl and Frost. When considering trends in FEV1, we found a mean decline of 44 mL/yr; only three patients (12%) showed a rapid decline of > 100 mL/yr. Of 14 patients (44%), postoperative maximal exercise capacity was impaired due to ventilatory limitation. The Kristersson/Olsen formula was more accurate in predicting postoperative lung function in the third postoperative year in pneumonectomy patients. Although the annual decline in FEV1 in these patients is almost the same as in healthy patients without COPD, pneumonectomy has serious implications on exercise capacity in many patients.

Intraoperative 125I brachytherapy for high-risk stage I non-small cell lung carcinoma

Purpose: Preliminary assessment of feasibility, efficacy, acute and chronic side effects associated with permanent intraoperative placement of 125I vicryl mesh brachytherapy in a select group of high-risk Stage I NSCLC who have undergone video-assisted thoracoscopic resection (VATR). Methods and Materials: From January 8, 1997 to March 16, 1998, 23 patients with Stage I NSCLC at high risk for conventional surgery due to cardiopulmonary compromise underwent combined VATR and intraoperative placement of 125I seeds embedded in vicryl mesh. Seeds embedded in vicryl suture were attached with surgical clips to a sheet of vicryl mesh, and thoracoscopically inserted over the target area (tumor bed and staple line) with nonabsorbable suture or surgical clips. A total dose of 100–120 Gy prescribed to the periphery of the target area (defined as the staple line and tumor bed with a 1-cm margin) was delivered. Results: The mean target area covered was 48 cm 2 (range 40–72) and mean total activity was 22 mCi (range 17.2–28.2). The median length of postoperative stay was 7 days. The median follow-up was 11 months (range 2–20). Postoperative CT scans of the chest revealed no dislodgement of the seeds and no local recurrence in any patient.Three patients developed distant metastasis (1 died 6 months postoperatively; the other 2 are currently alive with disease). One patient developed an ipsilateral recurrence in the right lower lobe after having had a right upper lobe resection. There were 3 postoperative deaths due to medical comorbid conditions or surgical complications (1 in the immediate postoperative period). Pulmonary function testing performed 3 months after implantation revealed no significant difference between preoperative and postoperative values: mean preoperative FVC was 2.3 L (range 1.31–3.0) and postoperative FVC was 2.2 L (range 1.1–3.9), p = 0.42; mean preoperative FEV 1 was 1.2 L (range 0.71–2.2 ), and postoperative FEV 1 was 1.5 L (range 0.8–2.9), p = 0.28. Conclusion: Review of early data suggests that intraoperative 125I vicryl mesh brachytherapy in high-risk Stage I NSCLC is potentially effective and well tolerated, with no significant decline in measurable pulmonary function studies and no increase in postoperative complications. Longer follow-up is needed to determine ultimate local control and survival.

Anaesthesia for liver transplantation in cystic fibrosis patients.

Cystic fibrosis (CF) is a disease caused by an inherited genetic defect. While pulmonary and pancreatic abnormalities predominate the clinical spectrum, other organ involvement is common, including liver. The severity of liver disease does not appear to be related to the severity of exocrine pancreatic or lung function. We discuss anaesthesia in four CF patients undergoing liver transplantation. We studied haemodynamic and oxygenation modifications during anaesthesia in four patients affected by CF with end-stage liver disease and mild to moderate pulmonary abnormalities. The patients received pancreatic enzyme prior to transplantation and two had insulin-dependent diabetes mellitus. All patients were treated with broad-spectrum antibiotic therapy. After a waiting time ranging one week to three months, all patients were successfully transplanted. General anaesthesia was induced with fentanyl, thiopental and pancuronium, and maintained with isoflurane supplemented by fentanyl in O2:air. Haemodynamic and oxygenation evaluations were made during the main phases of the transplant. After the intubation and at the end of the procedure all patients received a broncho-alveolar toilet through fiberoptic bronchoscopy. During anaesthesia for liver transplantation, PaO2 increased proportionally to the decreasing of Qs/Qt. In postoperative follow-up, Fev1 and FVC improved from preoperative time in all patients. In conclusion, even if cystic fibrosis is a multisystem disease, liver transplantation can be offered to CF patients with endstage liver disease and mild to moderate pulmonary function abnormalities. The four patients are still alive, enjoying good health. The improved respiratory function and quality of life of these children is remarkable.

Transcylindrical cholecystectomy: new technique for minimally invasive cholecystectomy.

Minilaparotomy cholecystectomy presents exposition difficulties, and laparoscopy requires expensive equipment and additional training. Laparotomy is more painful, causes trauma to the abdominal wall, and requires a longer convalescence; it is also less aesthetic. We present a new technique for minilaparotomy cholecystectomy, transcylindrical cholecystectomy (TC), based on the introduction of a 3.8- or 5.0-cm diameter cylinder (10.0 cm long). The cylinder serves the purpose of separating and isolating the hepatocystic triangle from the surrounding structures, thereby providing a stable surgical field and adequate vision of the hepatocystic triangle so the technique can be performed safely. Patients who have been diagnosed with symptomatic cholelithiasis, who are convalescent from biliary pancreatitis, or who have acute cholecystitis have been treated consecutively by TC. We have carried out the procedure on 116 occasions, 94 using the 3.8-cm cylinder and 28 with the 5.0-cm cylinder; both cylinders were used in 6 cases. The indications for using the 5.0-cm cylinder were mainly cholecystitis, pancreatitis, choledocholithiasis, and difficulty with the 3.8-cm cylinder. The result is a 4.5- or 7.0-cm incision. We had difficulty recognizing the anatomy in 11 dissections so we had to enlarge the incision. We have not had accidents related to placement of the cylinder, hemorrhage, or bile duct injuries. The median operating time was 43 minutes, and the mean postoperative stay was 1.8 days. Postoperative FVC and FEV, reductions were 21.7% and 27.4%, respectively. The technique has proved fast, safe, and practicable using conventional material. The cost of TC is $701 (US).

Predicting Postoperative Pulmonary Function in Patients Undergoing Lung Resection

Our aim was to determine the effect of lung resection on spirometric lung function and to evaluate the accuracy of simple calculation in predicting postoperative pulmonary function in patients undergoing lung resection. We reviewed preoperative and postoperative pulmonary function test results on patients who were followed in the multidisciplinary lung cancer clinic between July 1991 and March 1994 and who underwent lung resection. The predicted postoperative FEV1 and FVC were calculated based on the number of segments resected and were compared with the actual postoperative FEV1 and FVC. This study was conducted at a university, tertiary referral hospital. All patients were evaluated at a multidisciplinary lung cancer clinic and underwent lung resection by one surgeon (L.A.L.). Sixty patients undergoing 62 pulmonary resections were reviewed. The predicted postoperative FEV1 and FVC were calculated using the following formula: predicted postoperative FEV1 (or FVC) = preoperative FEV1 (or FVC) x (1-(S x 0.0526)); where S = number of segments resected. The actual postoperative FEV1 and FVC correlated well with the predicted postoperative FEV1 and FVC for patients undergoing lobectomy (r = 0.867 and r = 0.832, respectively); however, the predicted postoperative FEV1 consistently underestimated the actual postoperative FEV1 by approximately 250 mL. For patients undergoing pneumonectomy, the actual postoperative FEV1 and FVC did not correlate as well with the predicted postoperative FEV1 and FVC (r = 0.677 and r = 0.741, respectively). Although there was considerable variability, the predicted postoperative FEV1 consistently underestimated the actual postoperative FEV1 by nearly 500 mL. Of the patients undergoing lobectomy, eight also received postoperative radiation therapy. When analyzed separately, patients receiving combined therapy lost an average of 5.47% of FEV1 per segment resected. This contrasts with a 2.84% per segment reduction in FEV1 for patients who did not receive radiation therapy. This simple calculation of predicted postoperative FEV1 and FVC correlates well with the actual postoperative FEV1 and FVC in patients undergoing lobectomy. The predicted postoperative FEV1 consistently underestimated the actual postoperative FEV1 by approximately 250 mL. The postoperative FEV1 and FVC for patients undergoing pneumonectomy is not accurately predicted using this equation. The predicted postoperative FEV1 for patients undergoing pneumonectomy was underestimated by an average of 500 mL and by greater than 250 mL in 12 of our 13 patients. Thus, by adding 250 mL to the above calculation of predicted postoperative FEV1, we improve our ability to we identify a minimal postoperative FEV1 for patients undergoing pneumonectomy. Finally, combined modality treatment with surgery followed by radiation therapy may result in additive lung function loss.

Fonction respiratoire postopératoire et cholécystectomie par voie cœlioscopique

Open cholecystectomy is associated with characteristic changes in pulmonary function showing a restrictive pattern. Laparoscopic cholecystectomy without opening of the peritoneal cavity could be an alternative in reducing postoperative respiratory dysfunction. Having given their informed consent, 13 healthy ASA1 patients (age : 41 ± 18 yrs) undergoing laparoscopic cholecystectomy were enrolled in this study, in order to assess their postoperative pulmonary function tests (forced vital capacity [FRC], forced expiratory volume [FEV 1], functional residual capacity [FRC]) before operation (T0) and 4 h (T4), 24 h (T24), 48 h (T48) after surgery. Anaesthesia technique was the same associating propofol-atracurium-fentanyl, 50 % N 2O/O 2. Ventilation was adapted to maintain end-tidal carbon dioxide pressure up to 30–35 mmHg. Postoperative analgesic regimen consisted of paracetamol-ketoprofen. Mean length of surgery was 84 ± 15 min ; mean duration of anaesthesia was 110 ± 24 min. An immediate and harmonious restrictive breathing pattern developed postoperatively. Postoperative FVC measured 65 % (T4), 63 % (T24), 72 % (T48) of preoperative function (p < 0.025) ; postoperative FEV 1 measured respectively 60, 66 and 75 % of preoperative function (p > 0.001), without change in FEV 1/CV and FRC ; a significant hypoxia occurred (T0 : 86 mmHg, T4: 80 mmHG, T24 : 75 mmHg, T48 : 81 mmHg [p < 0.05]). Laparoscopic cholecystectomy resulted in less postoperative respiratory dysfunction than conventional cholecystectomy, as previously reported ; this restrictive pattern observed without changes in FRC was similar to that following lower abdominal surgery.

Effectiveness of Transcutaneous Electrical Nerve Stimulation Following Cholecystectomy

Summary A randomised study was undertaken to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in relieving post-operative incisional pain. Thirty patients undergoing elective cholecystectomy through a right upper paramedian incision were randomly allocated to one of two groups, to receive different regimens of post-operative analgesia. Fifteen patients in one group received a conventional regimen of on-demand intramuscular papaveretum and 15 patients in the other group received TENS, supplemented by intramuscular papaveretum, if required. The effectiveness of TENS was evaluated by measuring both the analgesic and pulmonary effects on the first, second and fifth post-operative days. Pain was subjectively measured at rest, following deep breathing, and following coughing, using linear analogue pain scales. Pulmonary function was assessed by measuring FVC and FEV1 with a Vitalograph spirometer. The study found no significant difference between the two groups on comparing post-operative FEN1 and FVC values, FEV1/FVC ratio, opiate analgesia requirements, post-operative pulmonary complications or mean number of days before either mobilisation or hospital discharge. Analysis of subjective pain measurements revealed similar pain scores for both groups on all but the second post-operative day where a significant decrease (p The limited benefits of TENS, following this particular surgical procedure, do not justify the additional cost or time required for its implementation.

Open Versus Laparoscopie Cholecystectomy A Comparison of Postoperative Pulmonary Function

Upper abdominal surgery is associated with characteristic changes in pulmonary function which increase the risk of lower lobe atelectasis. Sixteen patients undergoing open cholecystectomy and 20 patients undergoing laparoscopic cholecystectomy were prospectively evaluated by pulmonary function tests (forced vital capacity [FVC], forced expiratory volume [FEV-1], and forced expiratory flow [FEF] 25% to 75%) before operation and on the morning after surgery to determine if the laparoscopic technique lessens the pulmonary risk. Fraction of the baseline pulmonary function was calculated by dividing the postoperative pulmonary function by the preoperative pulmonary function and multiplying by 100%. Postoperative FVC measured 52% of preoperative function for open cholecystectomy and 73% for laparoscopic cholecystectomy (p = 0.002). Postoperative FEV-1 measured 53% of baseline function for open cholecystectomy and 72% for laparoscopic cholecystectomy (p = 0.006). Postoperative FEF 25% to 75% measured 53% for open cholecystectomy and 81% for laparoscopic cholecystectomy (p = 0.07). It is concluded that laparoscopic cholecystectomy offers improved pulmonary function compared to the open technique.

Successful surgical treatment of synchronous bilateral double primary lung cancers in a patient with chronic obstructive pulmonary disease

A 66-year-old man was found to have a nodular shadow, 35 × 30mm, in the right middle lung field on a chest x-ray film during treatment for chronic obstructive pulmonary dinease. Fiberoptic bronchoscopy revealed a mass obstructing the right B6 with irregular mucosa extending to the right lower bronchus, and another small mass was detected on the left B3. Endobronchial biopsies of both lesions showed squamous cell carcinoma. The left lung tumor was not visible on chest x-ray films. Spirogram results were : FVC, 2.61 L; percent predicted FVC, 78.4 %; FEV1.0, 1.56 L; FEV1.0/FVC ratio, 59.8 %. Predicted postoperative FVC of 1.4-1.5 L and FEV1.0 of 0.8-9L after resection of the right lower lobe and left S1+2+S3 were determined by preoperative spirometry and quantitative 99mTc-MAA perfusion scan.Both tumors were resected, first by right lower sleeve lobectomy, with preservation of the middle lobe, for squamus cell carcinoma in the right S6 with superficial infiltration extending to the lower lobe bronchus. Two months later left S1+2 +S3 segmentectomy was performed for the early hilar squamous cell carcinoma of the left B3. Histological exmaination showed that the B3 lesion was composed, for the most part, of carcinoma in situ. Regional lymph nodes obtained during both operations were free of metastasis. Our diagnosis was multiple primary lung cancers according to the criteria suggested by Martini et al.The paient underwent curative resection without postoperative respiratory embarrassment. Spirogram and 99mTc-MAA perfusion and 81mKr ventilation lung scans were performed serially after operation. Spirometric results improved with time and have been stable since about six months after operation. Although a discrepancy was found between the distribution of perfusion and ventilation in the early postoperative period, it diminished several months after operation. The patient is at present disease-free with a adequate pulmonary function.