Reduction In Vital Capacity Research Articles

200. COMPARISON OF SHORT-TERM OUTCOMES BETWEEN TRANSTHORACIC AND ROBOT-ASSISTED TRANSMEDIASTINAL RADICAL SURGERY FOR ESOPHAGEAL CANCER: A PROSPECTIVE STUDY

Abstract Background The present study aimed to assess the lower invasiveness of robot-assisted transmediastinal radical esophagectomy by prospectively comparing this procedure with transthoracic esophagectomy in terms of perioperative outcomes, serum cytokine levels, and respiratory function after surgery for esophageal cancer. Methods Patients who underwent a robot-assisted transmediastinal esophagectomy or transthoracic esophagectomy between April 2015 and March 2017 were included. The perioperative outcomes, preoperative and postoperative serum IL-6, IL-8, and IL-10 levels, and respiratory function measured preoperatively and at 6 months postoperatively were compared in patients with a robot-assisted transmediastinal esophagectomy and those with a transthoracic esophagectomy. Results Sixty patients with esophageal cancer were enrolled. The transmediastinal esophagectomy group had a significantly lower incidence of postoperative pneumonia (p = 0.002) and a significantly shorter postoperative hospital stay (p < 0.0002). The serum IL-6 levels on postoperative days 1, 3, 5, and 7 were significantly lower in the transmediastinal esophagectomy group (p = 0.005, 0.0007, 0.022, 0.020, respectively). In the latter group, the serum IL-8 level was significantly lower immediately after surgery and on postoperative day 1 (p = 0.003, 0.001, respectively) while the serum IL-10 level was significantly lower immediately after surgery (p = 0.041). The reduction in vital capacity, percent vital capacity, forced vital capacity, and forced expiratory volume at 1.0 s 6 months after surgery was significantly greater in the transthoracic esophagectomy group (p < 0.0001 for all four measurements). Conclusions Although further, large-scale studies are needed to confirm our findings, robot-assisted transmediastinal esophagectomy may confer short-term benefits in radical surgery for esophageal cancer.

Short-term exposure to zinc- and copper-containing welding fumes: Effects on pulmonary function in humans

Zinc- and copper-containing welding fumes typically induce a systemic inflammation indicated by increase in C-reactive protein (CRP) levels, also known as welding fume fever. It typically includes symptoms like fever, myalgia or headaches, but only a quarter of patients experience respiratory symptoms, e.g. coughing. This retrospective analysis of data of three studies with either control (filtered air) or zinc- and copper-containing welding fume exposure aims to identify and characterize the effect of the welding fumes on lung function. Spirometry and body plethysmography data of male healthy volunteers were analyzed and comparisons between different timepoints after a 6 h exposure were conducted. For controls no significant changes in spirometry were observed between baseline and 6 h, 24 h and 1 week after exposure. For volunteers exposed to zinc- and copper-containing welding fumes no significant reductions in forced expiratory volume in 1 s (FEV1) and minimal reductions in vital capacity (VC) (52 ml, 0.9%) were detected after 6 h. After 24 h significant reductions in FEV1 (147 ml, 3.2%) and VC (162 ml, 2.9%) could be observed. 1 week after exposure FEV1 was still significantly reduced (102 ml, 2.1%) and airway resistance were increased while no differences in VC were detected. The reduction of FEV1% after 24 week significantly correlated with increases in CRP levels. In conclusion, a single exposure to zinc- and copper-containing welding fumes leads not only to a systemic inflammation but could also induce slight sustained airway constrictions after 24 h and 1 week. The observed slight airway constriction is not caused by immediate effects but possibly inflammatory processes. Although welding fume fever does not necessarily present respiratory symptoms, welders exposed to zinc- and copper-containing welding fumes should be monitored for respiratory symptoms and obstructive ventilation pattern.

From UPTD to ESOT: Monitoring hyperoxic exposure in surface-oriented diving

A recent review suggested that the measure K = t2 x pO24.57 (t is exposure time in h, pO2 in Atm) should replace UPTD as an exposure index for pulmonary oxygen toxicity (POT) in surface-oriented diving. K would better predict reduction in vital capacity (VC) during exposure and allow prediction of recovery. Although K is more accurate estimating VC changes than UPTD, the calculation of K is more extensive, particularly when estimating hyperoxic exposure for dives with multiple pO2 segments. Furthermore, and in contrast with UPTD, K is difficult to interpret on its own given its non-linear dimension of time. We suggest that a new metric: ESOT (Equivalent Surface Oxygen Time) should be used to replace UPTD. ESOT = t x pO22.285 (t is exposure time in min, pO2 in Atm). ESOT=1 is thus the hyperoxic exposure reached after 1 min breathing of 100% O2 at surface pressure. Hyperoxic monitoring by ESOT is more practical than K to apply in an operational environment, with no loss of accuracy in POT prediction. In addition, it intuitively allows interpreting hyperoxic exposures on its own, analogous to UPTD. The daily hyperoxic threshold limits suggested by Risberg and van Ooij for two, five and an unlimited number of successive diving days would translate to ESOTs of 650, 500 and 420 respectively.

Evaluation of Spiro Metric Parameters in Traffic Police Men in a Metropolitan City

Introduction: Air pollution is a major environment related health threat. Air quality crisis in Indian cities is mainly due to emission from vehicles which include various particles and gases from vehicular emission. Traffic policemen who work in the busy traffic signal areas for years together are constantly exposed to this pollutant making them susceptible to its adverse effects, like respiratory and cardiovascular diseases. Objectives: To compare different parameters of pulmonary function test (PFT) between non-smoker controls and non-smoker traffic policemen, and also between smoker controls and smoker traffic policemen. Methods: This study was carried out in Department of Physiology among the government servants not exposed to traffic pollution and traffic policemen exposed to vehicular pollution. PFT was conducted in both these groups and parameters like vital capacity (VC), FEV1-force expiratory volume at the end of 1 second, ratio of forced expiratory volume at first second to forced vital capacity (FEV1/FVC%), mid-expiratory flow rate (FEV25-75%) and peak expiratory flow rate (PEFR) were measured and compared between these two groups. Results: In the present study, traffic policemen (non smoker) showed a statistically significant reduction in VC, FEV1, FEV1/FVC%, FEV25-75, and PEFR compared to controls (non smoker) whereas traffic policemen (smoker) showed a statistically significant reduction in VC, FEV1, FEV1/FVC%, FEV25-75%, and PEFR compared to controls (smoker). Conclusion: Significant reduction in all the parameters in traffic policemen compared to control group proves that preventive measures like pollution masks, regular breathing exercises, etc., have to be implemented at the workplace to reduce health hazards of continuous exposure to traffic dust.

Utility of Rectus Abdominis Ultrasound as a Respiratory Function Test for Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) causes deterioration of respiratory function. Muscle weakness of the orbicularis oris interferes with the accurate assessment of respiratory function using spirometry. Reduced forced vital capacity (FVC) is an indicator that helps determine the appropriate timing to provide noninvasive ventilation (NIV) for the survival of ALS patients. We employed ultrasonography to evaluate changes in respiratory function by measuring the thickness of the rectus abdominis (RA) muscle as a possible alternative to spirometry. Sixteen subjects with ALS were included in this study. The thickness of RA muscles was measured using ultrasonography, and respiratory fluctuations, such as vital capacity (VC), FVC, FEV1, percentage of predicted VC (%VC), percentage of predicted FVC (%FVC), percentage of predicted FEV1 (%FEV1), and FEV1/FVC, were evaluated using spirometry. Sixteen subjects underwent assessment by ultrasonography. A positive correlation was observed between the percent change in RA muscle thickness evaluated from maximal expiration to maximal inspiration and %VC (P = .001), %FVC (P = .001), FEV1 (P = .009), and %FEV1 (P = .02). RA ultrasonography was useful for predicting a reduction in VC in subjects with ALS and may help determine the best timing for introducing NIV.

Budget Impact of the Vest™ High Frequency Chest Wall Oscillation System for Managing Airway Clearance in Patients with Complex Neurological Disorders: A US Healthcare Payers' Perspective Analysis.

ObjectiveAs a recognized therapy to improve airway clearance, high-frequency chest wall oscillation (HFCWO) is used to manage reduced vital capacity in patients with complex neuromuscular disorders (cNMD). This study aimed to investigate the budget impact of HFCWO versus chest wall physical therapy (CWPT) from a US-commercial payer perspective.MethodsIn combination with a previously developed cost-effectiveness model, a budget impact model was developed to evaluate the incremental budgetary impact associated with introducing a HFCWO device over a 5-year time horizon. The model compared the cost implications associated with the commonly used CWPT procedure, as the current scenario, with a new scenario consisting of 80% of market share for HFCWO. The resource use and costs included in the analyses were costs associated with the HFCWO device (Vest™ System) and its consumables, patient training, and medical services such as hospitalization, medications, emergency room, and outpatient visits. The primary outcome measures included total and incremental budgetary impact per member per year (PMPY).ResultsIn a hypothetical plan of 1,000,000 members (men: 49.2%), 2099 patients with cNMD were estimated to be eligible to receive airway clearance services over 5 years. The new scenario (HFCWO and CWPT [US$24 PMPY]) was cost-saving compared with the current scenario (CWPT only [$34 PMPY]) with a cost reduction of US$9.46 PMPY. The model estimated a net cost-saving of US$1,594,131 and US$9,591,343 over 1 and 5 years, respectively.ConclusionThis study suggests the HFCWO technique to manage the reduction in vital capacity in patients with cNMD would lead to favorable budget impact results.

Comparison of short-term outcomes between transthoracic and robot-assisted transmediastinal radical surgery for esophageal cancer: a prospective study

BackgroundThe present study aimed to assess the lower invasiveness of robot-assisted transmediastinal radical esophagectomy by prospectively comparing this procedure with transthoracic esophagectomy in terms of perioperative outcomes, serum cytokine levels, and respiratory function after surgery for esophageal cancer.MethodsPatients who underwent a robot-assisted transmediastinal esophagectomy or transthoracic esophagectomy between April 2015 and March 2017 were included. The perioperative outcomes, preoperative and postoperative serum IL-6, IL-8, and IL-10 levels, and respiratory function measured preoperatively and at 6 months postoperatively were compared in patients with a robot-assisted transmediastinal esophagectomy and those with a transthoracic esophagectomy.ResultsSixty patients with esophageal cancer were enrolled. The transmediastinal esophagectomy group had a significantly lower incidence of postoperative pneumonia (p = 0.002) and a significantly shorter postoperative hospital stay (p < 0.0002). The serum IL-6 levels on postoperative days 1, 3, 5, and 7 were significantly lower in the transmediastinal esophagectomy group (p = 0.005, 0.0007, 0.022, 0.020, respectively). In the latter group, the serum IL-8 level was significantly lower immediately after surgery and on postoperative day 1 (p = 0.003, 0.001, respectively) while the serum IL-10 level was significantly lower immediately after surgery (p = 0.041). The reduction in vital capacity, percent vital capacity, forced vital capacity, and forced expiratory volume at 1.0 s 6 months after surgery was significantly greater in the transthoracic esophagectomy group (p < 0.0001 for all four measurements).ConclusionsAlthough further, large-scale studies are needed to confirm our findings, robot-assisted transmediastinal esophagectomy may confer short-term benefits in radical surgery for esophageal cancer.Trial registrationThis trial was registered in the UMIN Clinical Trial Registry (UMIN000017565 14/05/2015).

Assessment Of Ratio Of Peak Expiratory Flow Rate To Vital Capacity For Identifying Pulmonary Fibrosis.

Pulmonary fibrosis (PF) is associated with reduction in vital capacity (VC) and increase in expiratory flow rates, including peak expiratory flow (PEF). Full pulmonary function testing and computed tomography chest scans are limited resources in some geographic areas and a simple and sensitive screening test would be of value. We hypothesized that increase in the ratio of % predicted PEF over % predicted VC (%PEF/%VC), from spirometry alone might be sensitive to screen for pulmonary fibrosis. The %PEF/%VC from 1,000 consecutive spirometric flow volume curves was nearly normally distributed: 7.5% (approximately 1.5 standard deviations) had a ratio ≥ 1.4. We evaluated the sensitivity and specificity of this cut point for a diagnosis of PF in a retrospective chart review of 391 patients with good quality spirometry and respirologists' confirmed diagnoses. Of the 391 patients analyzed, 98 had PF, 79 were normal, 70 had a combined obstructive and restrictive processes, 57 had obstructive lung disease, 61 had extra-parenchymal restriction and 26 had non-fibrotic interstitial lung disease. A %PEF/%VC ≥ 1.4 was only 54.1% sensitive in predicting PF, however it had a specificity of 94.9%. There was a 95.1% specificity for ruling in intra-parenchymal opposed to extra-parenchymal restriction. A %PEF/%VC ≥ 1.4 was not sensitive enough to screen for PF but did demonstrate high specificity and thus may be helpful in identifying intraparenchymal restriction.

Impact of palatal coverage for maxillary implant assisted overdenture on respiratory performance. Spirometric evaluation.

Objectives: The purpose was to determine the influence of maxillary implant overdentures with and without palatal coverage on spirometric parameters. Materials and methods: 14 healthy edentulous patients were participated in this study. All patients were received 4 implants in maxillary arch in canines premolars areas and 2 implants in mandibular canines areas. All patients were received 2 maxillary implant overdentures “with and without palatal coverage” and one mandibular implant overdenture. Locator attachments were used to anchor the overdentures. Spirometry test was performed in three different oral conditions: without prosthesis , with maxillary implant overdenture with palatal coverage, and with palateless implant overdenture. The test was done after 2 months of each overdenture delivery. Spirmetric parameters as, Vital capacity (VC), Peak expiratory flow (PEF), Forced expiratory volume in 1 sec. (FEV1), FEV1/FVC (Forced vital capacity), and Maximum expiratory flow between 25% and 75% (MEF25-75) were evaluated. Results: There was statistically significant reduction in VC, FEV1/FVC, and MEF25-75 for without prosthesis compared to maxillary implant overdenture with or without palatal coverage (p 0.05). Conclusion: Covering the palate by dental prosthesis had an adverse effect on respiratory function as using the palateless implant overdenture showed improvement in respiratory performance in comparison to maxillary implant overdenture with palatal coverage.

Comparing Segmentectomy and Lobectomy for Clinical Stage IA Solid-dominant Lung Cancer Measuring 2.1 to 3 cm

IntroductionWe aimed to determine the feasibility of segmentectomy for radiologically solid-dominant clinical stage IA lung cancer measuring 2.1 to 3 cm (whole tumor size). Patients and MethodsData from 197 patients with radiologically solid-dominant clinical stage IA lung cancer measuring 2.1 to 3 cm who underwent lobectomy (n = 154) or segmentectomy (n = 43) were retrospectively analyzed. Recurrence-free survival (RFS) and overall survival (OS) at 5 years were assessed. Finally, propensity score matching was performed by age, gender, radiologic whole tumor size, consolidation to maximum tumor ratio, tumor location, maximum standardized uptake value, and preoperative forced expiratory volume in 1 second (FEV1) and vital capacity (VC). ResultsOnly 2 (4.7%) patients in the segmentectomy group were converted to lobectomy because of lymph node metastasis or inadequate surgical margins. Postoperative reductions in VC and FEV1 at 12 months were significantly less in the segmentectomy group (VC, 7.4%; FEV1, 6.9%) than in the lobectomy group (VC, 17.6%; FEV1, 14.4%). RFS was comparable between patients who underwent lobectomy and segmentectomy in both the unmatched (73.4% and 82.7%, respectively; P = .30) and the 37 propensity-matched (79.5% and 80.1%, respectively) patients. Similarly, OS was comparable between patients who underwent lobectomy and segmentectomy in the unmatched (80.0% and 90.6%, respectively; P = .42) and matched (82.9% and 89.3%, respectively) patients. ConclusionsSegmentectomy can be feasible in patients with radiologically solid-dominant clinical stage IA lung cancers measuring 2.1 to 3 cm when patients are appropriately selected.

Pirfenidone in idiopathic pulmonary fibrosis: real-life experience in the referral centre of Siena.

Background:Idiopathic pulmonary fibrosis (IPF) is the most common idiopathic interstitial pneumonia and has a median survival after diagnosis of 2–5 years. Pirfenidone is the first approved antifibrotic drug for the treatment of IPF. Here we report the functional progress, side effects and survival data of a population of patients with IPF, diagnosed at our centre and treated with pirfenidone.Methods:We enrolled 91 patients with IPF (71 males) treated with pirfenidone. Clinical, survival and functional details were collected retrospectively at start of therapy and after 12, 24, 36 and 48 months of treatment. Lung function tests at least 12 months before starting therapy were available for 40 patients and were entered in the database, as well as side effects.Results:During the observation period (922 ± 529 days), 27 patients died, 5 patients underwent lung transplant and 10 patients interrupted therapy due to adverse events or IPF progression. The median survival was 1606 days. There was a significant reduction in disease progression rate, as measured by trend of forced vital capacity, after 1 year of therapy with respect to before treatment (p = 0.0085). Forced vital capacity reduction rate was progressively higher in the subsequent years of treatment. Treatment-related side effects were reported in 25 patients and were predominantly mild. Overall, four patients discontinued therapy due to severe photosensitivity.Conclusions:Our findings confirm the efficacy of pirfenidone in reducing functional progression of IPF and its excellent safety profile in a real-life setting. This study, designed on a long-term follow up, contributes to the growing evidence on safety, tolerability and efficacy of pirfenidone in IPF. The reviews of this paper are available via the supplemental material section.

Assessment of Forced Vital Capacity and FEV1 as Pulmonary Function Tests in Males with Type-2 Diabetes Mellitus

Introduction&#x0D; Diabetes mellitus (DM) is a group of metabolic diseases. It is associated with well known complications linked to either microangiopathy, macroangiopathy or a combination of both. Some studies found that there were changes in respiratory system or pulmonary functions in diabetes so this study was planned to see the effect of type 2 DM on pulmonary functions.&#x0D; Materials &amp; Method&#x0D; The present study was undertaken in two groups. Hundred male individuals were included in the study with each group comprised of 50 individuals. For pulmonary function tests we used computerized Spirometer Statistical difference between the data obtained in various groups was evaluated by z test.&#x0D; Observations&#x0D; Reduction in FVC-Forced vital capacity reduction is statistically significant. FEV1-reduction is statistically significant. FEV1/FVC (%) reduction is statistically significant.&#x0D; Conclusion&#x0D; So it is always better to detect the respiratory damage in diabetes patient at an early stage to prevent the further complications

Weaning from mechanical ventilation in people with neuromuscular disease: protocol for a systematic review

IntroductionNeuromuscular diseases (NMD) are characterised by progressive muscular impairment. The muscle weakness is directly related to respiratory muscles weakness, causing reduction in vital capacity, especially when associated with mechanical ventilation...

Respiratory muscle power and lung function in healthy obese Sudanese medical students

There is an increasing prevalence of obesity worldwide (Body Mass Index equals or above 30kg/m2). Obesity may cause changes in pulmonary mechanics, as measured by spirometric values: mild reduction in vital capacity and proportionate reduction in Forced Expiratory volume in the first second (FEV1) depending upon the age, type of body fat distribution and severity of obesity. Changes in respiratory muscle strength in healthy obese individuals have not been widely investigated. The aim of this study is to assess the effect of obesity on respiratory muscle strength and pulmonary function in healthy obese subjects. A cross sectional study was carried out at National Ribat University, Faculty of Medicine, among ninety-five healthy male and female medical students aged 17-25 years (52 obese with BMI equals or above 30kg/m2, 43 non-obese with BMI&lt; 0.05). These results were also found to be consistent in female subjects. Significant negative correlation was also observed between % fat and lung function parameters (FVC, FEV1). Increased strengthening of respiratory muscles in healthy obese adults (as measured by elevated MEP and MIP) might be a compensatory effect to bring lung function to comparable values of the non- obese. Percent of body fat could be a good predictor for decline in lung function in obese individuals.

Maximal Respiratory Muscle Strength and Vital Capacity in Children With Early Onset Scoliosis.

Descriptive cross-sectional study. To measure respiratory muscle function in children with early onset scoliosis (EOS), determine the frequency of respiratory muscle weakness, and correlate these measures with vital capacity, body mass index, and Cobb angle. Progressive restrictive respiratory disease is common among children with moderate to severe EOS. Reduced respiratory muscle strength is associated with the loss of lung function in adolescents and adults with scoliosis. We hypothesized that reduced inspiratory and expiratory respiratory muscle strength also occur in children with EOS and correlate with reduced vital capacity, poor nutritional status, and severity of the spine deformity. We measured maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), forced vital capacity (FVC), body mass index IBMI), and Cobb angle in 49 children with EOS but with no diagnosis of underlying muscle weakness. We measured these indices in 12 children serially over 18 months to see if abnormal respiratory muscle function was sustained. FVC averaged 51% (SD 21) of predicted norms with 26 subjects having an FVC <50% predicted. The mean MIP was 57% (SD 25) and the mean MEP was 53% (SD 23) of predicted norms. Thirteen (27%) of the group had MIP values >2SD below the age and sex-based norms. BMI ranged between 1% and 99% of age-based norms. Cobb angle averaged 59° (SD27). MIP% and MEP% significantly correlated with FVC% (r =0.37, P = 0.01 and r = 0.52, P < 0.001 respectively)) but not with BMI or Cobb angle. Reduced MIP% and MEP% were sustained over 7 to 41 months. Respiratory muscle weakness is common and persistent in children with EOS and correlates with reductions in vital capacity. Mechanisms for abnormal respiratory function are unclear but must be determined to develop surgical treatment strategies that preserve respiratory muscle function in children with EOS throughout childhood. 2.

CHARACTERISTICS OF CHIlDRENS’ PHYSICAl DEVElOPMENT IN YAMAlO-NENETS AUTONOMOUS OKRUG

Physical development is one of the indicators characterizing the health of children and reflects the risk factors of the impact of its infringement. The article presents the results of a comprehensive assessment of physical development of Nenets-children (7-17 years old) born and residing on the territory of the Yamalo-Nenets Autonomous Okrug. It was found that in all age groups among boys and girls there is prevalence of persons with a harmonious physical development and normal weight. Difference from common patterns peculiar to this period of ontogenesis has been revealed, - "the first crossing of growth curves" in the Nenets-children was recorded at the age of 14 years. In (63,4 ± 4,9) % of surveyed vital capacity of lungs lags far behind the proper values. The value of life index in (86,1 ± 2,9) % of children indicates delay in a body capacity formation and in development of chest and back muscles. The suggestion about the adaptive nature of vital capacity reduction was made. Somato-typological analysis revealed among surveyed persons with asthenic somato-type. Thus, (59,8 ± 4,2) % of the Nenets-children have asthenic somato-type, (36,5 ± 4,1) % - normosthenic, (3,7 ± 1,6) % - hypersthenic somato-types. Comparative analysis showed that anthropometric indices of boys and girls under 14 years old had similar values. The research conducted demonstrates necessity to create regional tables of suite of metrics of physical development for ethnic groups of the population.

Riskfactors for acute exacerbation of idiopathic pulmonary fibrosis: A systematic review and meta-analysis.

Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive fibrotic disease limited to the lungs. The course of disease varies widely, with some patients experiencing acute respiratory deterioration, a condition called acute exacerbations of IPF (AE-IPF). The risk factors contributing to AE-IPF are unclear. This systematic review and meta-analysis investigated the risk factors for AE-IPF. Studies of risk factors for AE-IPF were identified in Medline, EMBASE and Cochrane databases. Fixed effects models were used to calculate pooled relative risks and weighted mean differences (WMD).The meta-analysis included seven articles involving 14 risk factors for AE-IPF. Risk factors for AE included reductions in vital capacity (VC; WMD - 10.58, 95% confidence interval (CI) -17.17 to - 3.99), forced vital capacity (FVC; WMD -6.02, 95%CI - 8.58 to - 3.47), total lung capacity (TLC; WMD -4.88, 95%CI -7.59 to - 2.17), and PaO2 (WMD -4.19, 95%CI -7.66 to -0.71) and a higher alveolar-arterial oxygen difference (AaDO2 ; WMD 4.4, 95%CI 0.24 to 8.57). Mechanical procedures, higher serum KL-6 concentration and secondary pulmonary hypertension, might be risk factors for AE-IPF. In contrast, age, sex, body mass index (BMI), differences in diffusing lung capacity for carbon monoxide (DLCO), exposure to seasonal variations and air pollution, and virus infection might be unrelated to AE-IPF. Poor pulmonary function, mechanical procedures, higher serum KL-6 and secondary pulmonary hypertension were associated with increased risks of AE-IPF.

Airway Resistance in Patients with Obstructive Sleep Apnea Syndrome Following Robotic Prostatectomy.

Because minimally invasive surgery can improve postoperative recovery, it became the preferred technique for patients with significant comorbidities. However, steep Trendelenburg position and abdominal CO2-insufflation can lead to a significant increase in upper airway resistance and an alteration of overall lung function. In particular, patients who already suffer from an obstructive airway disease like obstructive sleep apnea syndrome (OSAS) might be at risk for postoperative airway complications. Therefore, we perioperatively performed spirometric tests in patients with OSAS undergoing robotic surgery in steep Trendelenburg position. Twenty patients with OSAS were enrolled in the study. A day before surgery lung function measurements were performed and repeated preoperatively, 40, 120, and 240 minutes and 1 and 5 days postoperatively. We measured vital capacity (VC), forced expiratory volume in 1 second (FEV1), maximal mid expiratory and inspiratory flow (MEF50, MIF50), arterial oxygen saturation, and nasal flow. The ratio of MEF50 to MIF50, as an indicator of upper airway resistance, was increased significantly postoperatively and normalized within 24 hours (p < 0.0001), while FEV1 and VC were significantly reduced and recovered only partially as much as the fifth postoperative day (p < 0.0001). Airway resistance increased following robotic radical prostatectomy in Trendelenburg position in patients with OSAS. Two separate major effects can be observed. A significant increase of the upper airway resistance, which improved to preoperative conditions within 24 hours, and a reduction in FEV1 and VC, which recovered only partially as much as the fifth postoperative day.

Cardiovascular and respiratory effects of the neoprene wetsuit in non-immersed divers.

A neoprene wetsuit is widely used to reduce thermal dispersion during diving. Recent observations have pointed out that elastic recoil of the wetsuit might have significant compressive effects, able to affect water and electrolyte homeostasis during both dry and immersed conditions. The aim of this study was to evaluate the possible cardiovascular and respiratory effects of the neoprene wetsuit in dry conditions in a sample of experienced divers. Twenty-four (24) healthy divers were evaluated by Doppler-echocardiography and by spirometry in basal conditions and while wearing a full neoprene wetsuit. During wetsuit conditions, we observed a significant decrease in heart rate (-5%; p ⟨ 0.05) and cardiac output (-12%; p ⟨ 0.05), and a significant increase in total peripheral resistances (15%; p ⟨ 0.05). Moreover, a significant reduction of right ventricular early diastolic filling was observed (-15%; p ⟨ 0.05). As concerns pulmonary function, a significant reduction of vital capacity (-2%; p ⟨ 0.001) and expiratory reserve volume (-25%; p ⟨ 0.001), and a significant increase of inspiratory capacity (9%; p ⟨ 0.001) and tidal volume (25%; p ⟨ 0.05) were observed. These data support the hypothesis that neoprene elastic recoil, possibly due to a compression exerted on chest, might affect systemic circulation (decreasing cardiac output and impairing right ventricular filling) and respiratory function.

SMOG: Causes, Effects and Preventions

&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;Recently many cities of Pakistan have been struck by the havoc of smog. Smog is formed when pollutants like nitrogen oxide, carbon monoxide and volatile organic compounds that are released from automobiles, industries and burning of fossil fuels interact with sunlight. These photochemical reactions usually occur in summers and leads to the development of ground level ozone or bad ozone (O&lt;sup&gt;3&lt;/sup&gt;) which is an important smog causing pollutant. This ozone adversely affects human health specially respiratory and cardiovascular system and is among the cause of premature deaths.&lt;sup&gt;1&lt;/sup&gt; Fine particulates of 2.5 micrometer or less are also among the pollutants found in smog and haze.&lt;sup&gt;2&lt;/sup&gt;&lt;/p&gt;&lt;p&gt; Mechanism behind the damaging effect of ozone on cardiopulmonary system is explained to be due to high oxidizing power of ozone that forms free radicals exposing body to oxidative stress. Also, ozone and fine particulate air pollution are found to cause acute arterial vasoconstriction normally.&lt;sup&gt;2&lt;/sup&gt; Moreover, Ozone causes reduction in vital capacity and forced expiratory volume in 1s, increase in lung resistance along with worsening of asthma in summers. It increases the release of allergens from pollens leading to respiratory allergy symptoms&lt;sup&gt;3&lt;/sup&gt; and making the respiratory problems even worse. Reactive oxygen species like hydroxyl and superoxide anion radicals produced in body by ozone and other pollutants increases the susceptibility of cancer in a person due to mutagenic properties of reactive oxygen species and their damaging effect on body cells.&lt;sup&gt;3&lt;/sup&gt;&lt;/p&gt;&lt;p&gt; Knowledge about Secondary preventive measures that one should take during smog must be spread as it will help people to cope up from the situation in a better way next time. These measures are minimal exposure to outdoor air but if exposure is inescapable than a facemask should be worn. Elderly and people experiencing any cardiac or respiratory illness are more prone to harmful effects of smog. These patients should increase the dosage of medication on their physician’s advice to prevent worsening of disease. Supplements and food containing antioxidants like omega 3 fatty acids when added to diet may help against oxidative stress caused by pollutants.&lt;sup&gt;4&lt;/sup&gt;&lt;/p&gt;&lt;p&gt; Steps should be taken to avoid the recurrence of this calamity. Media campaign for public awareness regarding the sources of pollutants causing smog should be launched. Banning deforestation and promotion of tree implantation is required nationwide as trees transpire and decreases temperature by cooling effect which indirectly prevents photochemical reactions to occur and minimizing the formation of air pollutants.&lt;sup&gt;3&lt;/sup&gt; Recycling of solid waste is a good alternative to open burning of waste and garbage. Using low emission, low carbon fuels and combustion free power sources like wind and solar powerare important for primary prevention as these are safer for health and are also low cost and energy efficient.&lt;sup&gt;1&lt;/sup&gt;&lt;/p&gt;