Reduction In Pulmonary Function Tests Research Articles

Should routine pulmonary function tests be performed in patients with left ventricular dysfunction and/or congestive heart failure undergoing cardiac surgery?

BackgroundIt is controversial whether pulmonary function testing should be performed routinely in cardiac surgery patients. The aim of our study was to focus on patients who have congestive heart failure, caused by left ventricular dysfunction or left-sided heart valve disease, and study the prognostic value of performing preoperative pulmonary function testing on their postoperative outcomes.MethodsThis is a retrospective propensity score matched study that included 366 patients with congestive heart failure who underwent cardiac surgery and had preoperative pulmonary function test. The patients were divided into two groups: Group 1 who had a normal or mild reduction in pulmonary function tests and group 2 who had moderate to severe reduction in pulmonary function tests. The postoperative outcomes, including pulmonary complications, were compared between the two groups.ResultsPulmonary function tests were normal or mildly reduced in 190 patients (group 1) and moderately to severely reduced in 176 patients (group 2). Propensity matching identified 111 matched pairs in each group with balanced preoperative and operative characteristics. Compared to group 1, Group 2 had longer duration of mechanical ventilation [12 (7.5–16) vs. 9 (6.5–13) hours, p < 0.001], higher postoperative Creatinine [111 (90–142) vs. 105 (81–128) µmol/dl, p = 0.02] and higher hospital mortality (6.31% vs. 0%, p = 0.02).ConclusionRoutine Pulmonary Function Testing should be performed in patients with Left ventricular dysfunction and/or congestive heart failure undergoing cardiac surgery since moderate to severe reduction in those patients was associated with longer duration of mechanical ventilation and higher hospital mortality.

Lung Function Indices among Marble Workers with Age Matched Healthy Individuals in Lahore

Background: Marble dust predominantly comprises of free silica which is a principal constituent of Earth’s crust. Production of toxic substances, chemicals, and respirable dust in marble industry offers an occupational threat to the workers. Free silica dust is generated during quarrying, grinding cutting and polishing of marble and is responsible for occupational pulmonary diseases. Objective: This study was conducted to compare pulmonary function test results among the workers of marble industry and healthy persons of same age in district, Lahore. Study Design: Cross-sectional study. Settings: Study was conducted in marble workshops workers, located in Township area College Road, Institute of Public Health, Lahore Pakistan. Duration: Six months from 05 May 2021 to 04 August 2021. Methods: A cross-sectional study was conducted among 225 individuals. Forty-five male persons, each were selected from cutting, grinding and polishing sections along with office workers from the marble workshop. Forty-five age matched healthy individuals selected from the same community. After getting approval from the Institutional Review board, the data was collected in a pretested standardized questionnaire after taking informed written consent by the respondents. Lung function tests were conducted by a Spiro Lab Spirometer which included forced vital capacity, forced expiratory volume in one second and ratio of forced expiratory volume to forced vital capacity. Results: The mean years of work experience of respondents was 11.58 ±5.92 and that of non-exposed healthy individuals was 11.23±5.32 years. A significant relationship of marble dust and deranged pulmonary function tests (p-value≤0.001) was noted which was normal in case of non-exposed individuals. Duration of work in marble industry and age in years had significant relationship with reduction in pulmonary function tests (p- value&lt;0.001 in each). About 83 (46%) marble workers working in different sections had reported abnormal spirometry as compared to non-exposed individuals (p-value&lt;0.001). Conclusion: According to the current study, individuals who had worked in the marble industry for more than 15 years had a steady reduction in their lung function indices, which ultimately had a detrimental effect on their health and when compared to healthy individuals of the same community, marble workers' pulmonary function tests showed significant impairments.

Changes in Lung Function Parameters after Total Intravenous Anaesthesia and Balanced Anaesthesia with Desflurane: A Prospective Randomised Study.

ObjectiveFollowing anaesthesia, there is a decrease in pulmonary function. Unlike volatile anaesthetics, propofol decreases the upper airway tone, and total intravenous anaesthesia (TIVA) with propofol may decrease coughing on emergence. Coughing may reduce postoperative atelectasis. Thus, TIVA may lead to greater decreases in lung function postoperatively as compared to balanced anaesthesia with desflurane.MethodsSixty patients of either sex, aged 18–60 years and American Society of Anaesthesiologists (ASA) status I/II, who were to undergo mastoid surgery, were randomly allocated to Group B and Group T. Anaesthesia was maintained with desflurane, nitrous oxide and oxygen in Group B, and with TIVA in Group T. Pulmonary function tests (PFT) were done preoperatively, and 1, 3 and 24 hours postoperatively.ResultsDemographic data and preoperative PFT were comparable in both groups. One hour after surgery, there was a greater decrease in FEV1 and peak expiratory flow rate (PEFR) in Group T (p=0.044 and 0.042, respectively). Three hours postoperatively, the decrease in MEFR and PEFR was again greater in Group T (p=0.005 and 0.008, respectively), while the MEFR recovered to preoperative values in Group B. By 24 hours, the forced vital capacity (FVC), MEFR and PEFR recovered to preoperative values in Group T, while FVC remained reduced in Group B (p=0.006).ConclusionBoth anaesthetic techniques cause a postoperative impairment in the lung function, but while TIVA causes a greater reduction in PFT in the early postoperative period, recovery is also earlier. On the other hand, balanced anaesthesia with desflurane was associated with a greater reduction in PFT at 24 hours.

Assessment of Pulmonary Function in Type II Diabetes Patients

Various metabolic and clinical disorders are associated with diabetes mellitus, the most prominent being vascular disease. There may be a relationship between diabetes and reduced lung function, so this study was designed to evaluate the impairment of lung function on spirometry among diabetic patients. The study included 50 type II diabetic patients and 50 healthy persons, confirmed by normal blood glucose levels, as control group. There was a significant reduction in spirometric pulmonary function tests (FEV1 and FVC) of a restrictive pattern in type 2 diabetic patients compared to control subjects. Since the diabetes affects the pulmonary vasculature and the connective tissue, therefore it can cause reduction in the pulmonary function tests. So, it is recommended that simple tests like spirometry may be performed in patients of type II diabetes as early as possible or be used as a preventive measure.

Deteriorations of pulmonary function, elevated carbon monoxide levels and increased oxidative stress amongst water-pipe smokers.

A water pipe (hookah) is a tobacco smoking tool which is thought to be more harmless than a cigarette, and there are no adequate studies about its hazards to health. Water-pipe smoking is threatening health of the youth in the world today. The objective of this study has been to investigate the carbon monoxide (CO) levels in breath, examine the changes in pulmonary function tests (PFT) and to assess the change of the oxidative stress parameters in blood after smoking a water pipe. This study is a cross-sectional analytical study that has included 50 volunteers who smoke a water pipe and the control group of 50 volunteers who smoke neither a cigarette nor a water pipe. Carbon monoxide levels were measured in the breath and pulmonary function tests (PFTs) were performed before and after smoking a water pipe. Blood samples were taken from either the volunteer control group or water-pipe smokers group after smoking a water pipe for the purpose of evaluation of the parameters of oxidative stress. Carbon monoxide values were measured to be 8.08±7.4 ppm and 28.08±16.5 ppm before and after smoking a water pipe, respectively. This increment was found statistically significant. There were also significant reductions in PFTs after smoking a water pipe. Total oxidative status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were found prominently higher after smoking a water pipe for the group of water-pipe smokers than for the control group. This study has shown that water-pipe smoking leads to deterioration in pulmonary function and increases oxidative stress. To the best of our knowledge this study is the only one that has shown the effect of water-pipe smoking on oxidative stress. More studies must be planned to show the side effects of water-pipe habit and protective policies should be planned especially for young people in Europe. Int J Occup Med Environ Health 2017;30(5):731-742.

Changes in pulmonary function tests in breast carcinoma patients treated with locoregional post-mastectomy radiotherapy: results of a pilot study.

BackgroundThe aim of present pilot study was to evaluate the changes in pulmonary function tests (PFTs) after locoregional post-mastectomy radiotherapy (PMRT) in breast cancer patients.Materials and methodsTwenty consecutive patients with histopathologically confirmed breast carcinoma stages T1–T4, N1–N2, who were treated with modified radical mastectomy with neoadjuvant or adjuvant chemotherapy underwent PFTs, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced expiratory flow at 50%, and peak expiratory flow rate, maximum mid expiratory flow (MMEF25–75), maximal oxygen consumption (VO2max), and carbon monoxide diffusing capacity (DLCO) before, at 30 days, and at 90 days after locoregional PMRT. A two-tailed paired Student’s t-test was used to compare mean values among the variables between the groupsResultsA significant drop in FVC, FEV1, and DLCO was noticed at day 90 after the completion of locoregional PMRT with P-values 0.033, 0.042, and 0.031, respectively, while MMEF25–75 and VO2max were not significantly affected (P-values 0.075 and 0.062, respectively) favoring a restrictive lung injury pattern. However, no patient was found to be symptomatic.ConclusionA significant drop in reduction in PFTs occurred at day 90 after the completion of locoregional PMRT. PFTs shall be performed in all breast cancer patients receiving locoregional PMRT for early detection of radiation-induced lung toxicity as all patients in our cohort were found asymptomatic.

Study on Effectiveness of Low Dose Theophylline as Add-on to Inhaled Corticosteroid for Patients with Sulfur Mustard Induced Bronchiolitis

Background: Theophylline may reverse steroid resistance and decrease inflammation in patients with chronic pulmonary disease and sulfur mustard (SM) induced bronchiolitis. This study was designed to assess the effects of low-dose theophylline on improvement of pulmonary function tests (PFTs) of SM exposed patients. Methods: In this comparative observational study, a group of SM-exposed victims during the Iraq-Iran war who were treated with oral slow releasing (SR) theophylline, salmetrol, fluxitide, omeprazole and NAC (study group) were compared to a group of age and gender matched SM-exposed patients who received same medications except oral SR theophylline (historical control group). PFTs were measured at the beginning of the study and after 8 weeks of the treatment. Results: In total, 33 subjects in the study group and 27 subjects in the control group were studied. Mean (SD) age of all subjects was 51 (14.1) years. In the study group, on the 8th week post-treatment, PFTs decreased, though the differences of tests between before and after treatment were not significant. In the control group, all the tests decreased in the same period and these reductions were not also significant. However, the changes in PFTs were significantly different between the two groups. The results of most PFTs in the controls decreased in greater extents compared to theophylline treated patients. This shows that despite theophylline was unable to improve the patients; it was partially able to decelerate the reductions in PFTs. Conclusion: Theophylline may not improve PFTs of SM exposed patients but it may decelerate the progress of the underlying respiratory disease. Further studies in this setting with higher doses of theophylline and longer term of evaluation are needed to better understand the pathophysiological mechanism of SM induced bronchiolitis and the effectiveness of the treatment with theophylline.

Changes in Pulmonary Function Up to 10 Years After Locoregional Breast Irradiation

To evaluate the long-term impact of locoregional breast radiotherapy (RT) on pulmonary function tests (PFTs). This study included 75 women who underwent postoperative locoregional breast RT. PFTs were performed before RT and 3, 6, and 12 months and 8 to 10 years after RT. By use of univariate and multivariate analyses, the impact of treatment- and patient-related factors on late changes in PFTs was evaluated. During the first year after RT, all PFTs significantly worsened at 3 to 6 months after RT (p < 0.05). At 12 months, forced vital capacity (FVC), vital capacity (VC), and forced expiratory volume in 1 second (FEV(1)) recovered almost to baseline values, whereas total lung capacity (TLC) and diffusion capacity of carbon monoxide (DL(CO)) recovered only slightly and were still found to be decreased compared with baseline (p < 0.05). At 8 to 10 years after RT, mean reductions in FEV(1) of 4% (p = 0.03) and in VC, DL(CO), and TLC of 5%, 9%, and 11% (all p < 0.0001), respectively, were observed compared with pre-RT values. On multivariate analysis, tamoxifen use negatively affected TLC at 8 to 10 years after RT (p = 0.033), whereas right-sided irradiation was associated with a late reduction in FEV(1) (p = 0.027). For FEV(1) and DL(CO), an early decrease was predictive for a late decrease (p = 0.003 and p = 0.0009, respectively). The time course of PFT changes after locoregional RT for breast cancer follows a biphasic pattern. An early reduction in PFTs at 3 to 6 months with a partial recovery at 12 months after RT is followed by a late, more important PFT reduction up to 8 to 10 years after RT. Tamoxifen use may have an impact on this late decline in PFTs.

The Association between RT-induced Changes in Lung Tissue Density and Global Lung Function

Radiation (RT)-induced lung injury is a common side effect following thoracic RT. The study of RT-induced lung injury is complicated by the endpoints considered (e.g., radiologic vs. symptomatic vs. functional). The association between these endpoints is not entirely clear. We herein assess the association between RT-induced changes in computed tomography (CT)-defined lung tissue density and pulmonary function tests (PFTs). As part of a prospective clinical study, patients receiving incidental partial lung irradiation underwent PFTs, CT, and single photon emission computed tomography (SPECT) scans before and repeatedly after RT. Regional lung function was assessed before and serially after RT by thoracic CT and SPECT scans and global lung function by PFTs. The percent reductions in PFTs were associated with the average changes in lung density, and perfusion for the overall group using Pearson correlations. The analyses were repeated in patient subgroups based on smoking history, tumor type (lung vs. non-lung), pulmonary symptoms (≥grade 2, i.e., requiring steroids, or worse), pre-RT surgery and chemotherapy. Comparisons were also made between the CT- and SPECT-based computations. 343 patients were enrolled between 1991 and 2004. Of these, 111 patients had a total of 203 concurrent post-RT evaluations of changes in lung density and PFTs for analyses, and 81 patients had a total of 141 concurrent post-RT SPECT scans as well. The remainders of the enrolled patients were unevaluable due to radiographic evidence of progressive tumor, pleural effusions, and/or other reasons. Patients characteristics are as follows: the majority presented with lung cancer (82%), median age was 62 (range 22-87), 83% of patients had a history of smoking with an average of 40 pack-years, 59 of the lung cancer patients had central tumors, 30% and 55% of patients had pre-RT thoracic surgery and chemotherapy respectively, the median mean lung dose was 17 Gy (range 4 ∼ 36 Gy), 27 patients had symptomatic radiation pneumonitis after RT (24%). The average increases in lung density were related to the percent reductions in PFTs, albeit with modest correlation coefficients (range, 0.20 ∼ 0.37). This was true in the overall group, as well as in most of the patient subgroups considered. The analyses also indicate that the association between lung density and PFT changes is essentially equivalent to the corresponding association with SPECT-defined lung perfusion (p = 0.25, 0.25, and 0.23 for DLCO, corrected DLCO, and FEV1, respectively). There is a quantitative association between the degree of increase in lung density as defined by CT and percent reduction in PFTs. However, the correlations are weak.

Thoracoscopic Scoliosis Surgery Affects Pulmonary Function Less Than Thoracotomy at 2 Years Postsurgery

Prospective evaluation of pulmonary function before and 2 years after surgery following anterior scoliosis instrumentation. To determine if thoracoscopic anterior scoliosis correction with instrumentation affected pulmonary function less than open thoracotomy approaches at 2 years follow-up. The thoracoscopic approach has been shown to have a smaller reduction in pulmonary function tests (PFTs) compared with an open thoracotomy approach following anterior thoracic instrumentation for adolescent idiopathic scoliosis in the immediate postoperative period; however, it is unclear if a difference remains 2 years following the procedure. A total of 107 patients in a multicenter adolescent idiopathic scoliosis database underwent an anterior instrumented fusion for thoracic scoliosis. PFTs assessing forced vital capacity (FVC), forced expiratory volume (FEV1), and total lung capacity (TLC) were obtained prospectively before and 2 years after surgery. The patients were grouped as follows: Group I, thoracoscopic instrumented fusion (n = 36); Group II, open (thoracotomy) instrumented fusion without thoracoplasty (n = 28); and Group III, open instrumented fusion with thoracoplasty (n = 43). Thoracoscopic instrumentation affected pulmonary function 2 years after surgery minimally, and on an average showed improvements in all parameters except the percent-predicted FVC, which decreased by 1% +/- 11%, and percent predicted FEV, which decreased by 2% +/- 9%. Improvements were noted in absolute FVC, FEV1, TLC, and percent-predicted TLC. This is in contrast to the patients treated with a thoracotomy, who had a greater persistent reduction in PFTs at follow-up. An added thoracoplasty to the thoracotomy approach, however, resulted in even greater residual reduction in PFTs at follow-up, with declines in percent-predicted FVC of 15%, percent-predicted FEV1 of 14%, and percent-predicted TLC of 8%. This study shows a clear advantage to the minimally invasive thoracoscopic approach with regards to pulmonary function when compared with the open thoracotomy approaches.

Tandem high-dose chemotherapy (HDCT) and peripheral stem cell rescue (PSCR) in patients (pts) with advanced soft tissue sarcomas (STS), Ewing’s/PNET (ES) and rhabdomyosarcoma (Rhabdo)

9065 Background: To improve progression-free (PFS) and overall survival (OS) a trial of HDCT was conducted in pts with primary high-risk or responding metastatic sarcomas. Methods: Thirteen pts (10 males, 3 females) with ES (7), rhabdo (4), leiomyosarcoma (1) and malignant fibrous histiocytoma (MFH) (1) were accrued from 2/95 through 9/99. Pts initially received induction or salvage chemotherapy with regimens consisting of doxorubicin (D), ifosfamide (I), cyclophosphamide (Cyc), cisplatin (P), vincristine, etoposide, dacarbazine, as well as debulking surgery (9) and radiation therapy (RT) (10). Pts received G-CSF 10μg/kg to procure 14x108 mononuclear cells/kg. Cycle (C) 1 of HDCT consisted of I 14gm/m2 and D 150 mg/m2 administered over 96 hours as an IV infusion, followed by PSCR. C2 consisted of melphalan (M) 75 mg/m2and P 100 mg/m2 on days (d) -11 and -4 followed by PSCR. Results: Eleven of 13 pts completed both cycles of HDCT; 2 pts received C1 only due to reduction in pulmonary function tests and osteomyelitis. No pt died from HDCT. All pts required narcotics for grade 3 mucositis with C1, developed grade 4 neutropenia and required platelet (plt) transfusions. All pts developed neutropenic fever with C1, and 9/11 with C2. The median number of d to neutrophil and plt recovery was 9 (5–18) and 8 (4–31) following C1 and 12 (9–15) and 9 (5–17) following C2. Of the 13 pts enrolled, 2 with advanced ES and 1 with metastatic MFH are alive and free of disease 111, 84 and 60 months post PSCR. The pt with leiomyosarcoma relapsed at 38 months, but was subsequently treated with surgery and RT and is alive at 98 months. The median PFS and OS were 8 and 12 months for pts with rhabdo, and 10 and 22 months for pts with ES. Conclusions: HDCT with D/I followed by M/P is feasible. Although HDCT is unlikely to benefit pts with rhabdo, its role as consolidation therapy in pts with other STS and ES should be assessed in prospective randomized studies. [Supported by NCI Cancer Center Support Grant CA62505] No significant financial relationships to disclose.

The challenge of predicting changes in pulmonary function tests after thoracic irradiation

In this issue of the International Journal of Radiation Oncology, Biology, Physics, Allen et al. from the University of Michigan consider methods of predicting radiation-induced changes in whole lung function. They report that they were unable to identify a relationship between three-dimensional dosimetric parameters (e.g., the mean lung dose [MLD], or the percent of lung volume receiving 20 Gy [V20]) and reductions of pulmonary function tests (PFTs) in 43 patients receiving radiotherapy (RT) for lung cancer (1). They conclude that additional work needs to be done to develop better methods of predicting RT-induced changes in PFTs. We agree. Their negative result is likely primarily the result of the tumor type studied, plus several methodologic limitations. Prospective studies at the Netherlands Cancer Institute (NKI) and Duke University Medical Center have also attempted to relate 3D dosimetric parameters to changes in quantitative pulmonary function tests (2, 3). The NKI group reported, for 81 patients with breast cancer and Hodgkin’s lymphoma, a good correlation between the mean lung dose and reductions of the diffusion capacity (TL,CO) and forced expiratory volume in 1 second (FEV1) (r 0.58 and 0.74, respectively) at 3 months postradiotherapy (2). For TL,CO, the correlation improved after excluding patients that received chemotherapy. At Duke, only weak correlations were found (r 0.2–0.4), but the study group also included patients with lung cancer (3). Predicting changes in PFTs after RT for lung cancer is complicated, because there are many confounding factors. Often, tumor-related reductions in PFTs are present at baseline (4–8). Thus, RT-induced tumor shrinkage might actually lead to an improvement in PFTs. The post-RT PFTs, therefore, reflect both improvements in function resulting from tumor shrinkage and declines in function because of damage to normal lung. It seems logical, therefore, that the correlation would be improved if patients without central lung tumors (that frequently cause adjacent hypoperfusion or atelectasis) are excluded. In the Duke study, the correlation coefficient between 3-D dosimetric parameters and declines in PFTs was improved when patients with “central tumors and adjacent hypoperfusion” were excluded (r 0.3–0.9) (3). In the study from Allen et al., their correlations did not improve when the 6 patients with pre-RT “atelectasis involving at least a lung lobe” were excluded. Twenty-four of their 43 evaluated patients had Stage III disease and, presumably, had central mediastinal disease. A large fraction of these patients would be expected to have some tumorinduced reduction in lung function, such as reduced perfusion (5, 8–10), but very few of these were excluded from their subset analysis. The absence of atelectasis of an entire lobe with routine radiography does not exclude significant tumor-induced physiologic changes within the lung. Single photon emission computer tomography (SPECT) perfusion scans are more sensitive in assessing such regional functional heterogeneities than is computed tomography (10, 11). In the series from the NKI involving patients with breast cancer and lymphoma, there were good correlations between 3-D dosimetric parameters and declines in PFTs (2). This is consistent with the concept that tumor-induced functional changes make prediction of PFTs a particularly challenging problem in patients with lung cancer. Moreover, the exacerbation of coexisting pulmonary disease in lung cancer patients undoubtedly complicates prediction of PFTs. Interestingly, several surgical series demonstrated generally excellent correlations between declines in PFTs and the estimated percent of lung resected (r 0.6 to 0.9) (12–16, review see 17). This supports the concept that the sum of the regional injuries can be used to predict changes in whole organ function in parallel-architecture type organs such as the lung. In the Duke series, the correlation between the dosimetric parameters and the subsequent decline in PFTs was strongest in patients with a larger number of post-RT PFTs (i.e.,

Relating radiation-induced regional lung injury to changes in pulmonary function tests

Purpose: To determine whether the sum of radiotherapy (RT)-induced reductions in regional lung perfusion is quantitatively related to changes in global lung function as assessed by reductions in pulmonary function tests (PFTs).Methods and Materials: Two hundred seven patients (70% with lung cancer) who received incidental partial lung irradiation underwent PFTs (forced expiratory volume in 1 s and diffusion capacity for carbon monoxide) before and repeatedly after RT as part of a prospective clinical study. Regional lung function was serially assessed before and after RT by single photon emission computed tomography perfusion scans. Of these, 53 patients had 105 post-RT evaluations of changes in both regional perfusion and PFTs, were without evidence of intrathoracic disease recurrence that might influence regional perfusion and PFT findings, and were not taking steroids. The summation of the regional functional perfusion changes were compared with changes in PFTs using linear regression analysis.Results: Follow-up ranged from 3 to 86 months (median 19). Overall, a significant correlation was found between the sum of changes in regional perfusion and the changes in the PFTs (p = 0.002–0.24, depending on the particular PFT index). However, the correlation coefficients were small (r = 0.16–0.41).Conclusions: A statistically significant correlation was found between RT-induced changes in regional function (i.e., perfusion) and global function (i.e., PFTs). However, the correlation coefficients are low, making it difficult to relate changes in perfusion to changes in the PFT results. Thus, with our current techniques, the prediction of changes in perfusion alone does not appear to be sufficient to predict the changes in PFTs accurately. Additional studies to clarify the relationship between regional and global lung injury are needed.

Prediction of overall pulmonary function loss in relation to the 3-D dose distribution for patients with breast cancer and malignant lymphoma

Purpose: To predict the changes in pulmonary function tests (PFTs) 3–4 months after radiotherapy based on the three-dimensional (3-D) dose distribution and taking into account patient- and treatment-related factors. Methods: For 81 patients with malignant lymphoma and breast cancer, PFTs ( V A, VC, FEV 1 and T L,COc) were performed prior to and 3–4 months after irradiation and dose–effect relations for early changes in local perfusion, ventilation and air-filled fraction were determined using correlated CT and SPECT data. The 3-D dose distribution of each patient was converted into four different dose–volume parameters, i.e. the mean dose in the lung and three overall response parameters (ORPs, which represent the average local injury over the complete lung). ORPs were determined using the dose–effect relations for early changes in local perfusion, ventilation and air-filled fraction. Correlation coefficients were calculated between these dose–volume parameters and the changes in PFTs. In addition, the impact of the variables chemotherapy (MOPP/ABV and CMF), tamoxifen, smoking, age and gender on the relation between the mean lung dose and the relative changes in PFTs following radiotherapy was studied using multiple regression analysis. Results: The mean lung dose proved to be the easiest parameter to predict the reduction in PFTs 3–4 months following radiotherapy. For all patients the relation between the mean lung dose and the changes in PFTs could be described with one regression line through the origin and a slope of 1% reduction in PFT for each increase of 1 Gy in mean lung dose. Smoking and CMF chemotherapy influenced the reduction in PFTs significantly for V A and T L,COc, respectively. Patients treated with MOPP/ABV prior to radiotherapy had lower pre-radiotherapy PFTs than other patient groups, but did not show further deterioration after radiotherapy (at 3–4 months). Conclusions: The relative reduction in V A, VC, FEV 1 and T L,COc 3–4 months after radiotherapy for breast cancer and malignant lymphoma can be estimated before radiotherapy based on the mean lung dose of each individual patient and taking into account the use of chemotherapy and smoking habits of the patient.

The effects and side effects of interscalene brachial plexus block by posterior approach

Background and Objectives. To investigate the use of interscalene block by posterior approach in upper extremity surgery and its effects on routine pulmonary function tests. Methods. Interscalene block by posterior approach was performed with a peripheral nerve stimulator localization in 29 ASA Physical Status I and II patients undergoing upper extremity surgery. All patients were given 20 mL of 1% lidocaine and 20 mL of 0.5% bupivacaine. Modified Bromage Scale for motor block and pinprick test for sensory anesthesia was used. Pulmonary function, measurements [forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1), and VC (vital capacity)] were done in all patients just before and 2, 5, 10, 15, and 30 minutes after the block. Results. Surgery location was the arm in four cases, and the forearm in 25 cases. General anesthesia was added in nine patients. Intravenous analgesics or sedatives were needed in four cases. Ulnar nerve was missed in 13 patients. FEV 1 decreased 11.5% in 2 minutes ( P > .05), 19.7% in 5 minutes ( P = 0.525), and FVC decreased 16.6% in 2 minutes ( P > .05), 24.5% in 5 minutes after block ( P < .05). Conclusions. Interscalene block by posterior approach did not provide a satisfactory anesthesia for forearm and hand surgery. This method also caused hemidiaphragmetic paresis and a reduction in pulmonary function tests as in the lateral approach of Winnie. We believe limitations and relative contraindications for interscalene block by lateral approach are the same for posterior approach.