Reduction In Vital Capacity Research Articles

Effects of laparotomy or laparoscopicprocedures for cholecystectomy on diaphragmatic and thoracoabdominal mobility

Design of the study: Observational descriptive and cross sectional study. Objective: To verify the effects of laparotomy or laparoscopicprocedures for cholecystectomy on lung function, diaphragmatic and thoracoabdominal mobility. Methods: We evaluated 18 individuals who underwent cholecystectomy by either laparotomy (CLG n=9) or by a laparoscopic procedure (LCG, n=9). The participants were evaluated in preoperative and in the 2nd postoperative day: anthropometrics measures, cardiorrespiratory parameters, intensity of pain, pulmonary function, diaphragmatic mobility and thoracoabdominal mobility. For statistical analysis, the Wilcoxon test was applied to compare the pre and postoperative of both groups, Mann-Whitney test was applied to comparison between groups (p≤0.05). Results: Diaphragmatic mobility was reduced in both groups whereas thoracoabdominal mobitity al all levels were reduced only in CLG (p<0.05). In LCG, there was a significant decrease of thoracoabdominal mobility only in the umbilical region (p<0.008). By comparing the values of thoracoabdominal mobility between groups postoperatively, there was a difference only in umbilical mobility (p=0.02). We found a significant reduction in vital capacity (VC) in LCG only (p=0.05). Conclusion: Laparotomy and laparoscopic procedures for cholecystectomy reduce the mobility of the diaphragm, but only laparotomy impairs thoracoabdominal mobility in the three levels, axillary, xiphoid and umbilical

Eight-year follow-up of airway hyperresponsiveness in patients with primary Sjögren’s syndrome

Objective: To evaluate in a longitudinal study the influence of airway hyperresponsiveness (AHR) on lung function in patients with primary Sjögren’s syndrome (pSS).Methods: Lung function was studied over an eight-year period in 15 patients who fulfilled the Copenhagen criteria for primary Sjögren’s syndrome and who were covered in our earlier published study on AHR in patients with Sjögren’s syndrome. Standard spirometry and measurements of lung volumes, diffusing capacity (DLCO), and AHR to methacholine were performed.Results: A significant decline over time was found in total lung capacity (TLC), vital capacity (VC), forced vital capacity (FVC), functional residual capacity (FRC), and expiratory midflows (FEF50). A sign of small airway obstruction (decrease in FEF50) at entry correlated with VC at follow-up (r = .8, P < .003), and the individual change in FEF50 during the observation period correlated with the individual change in VC (r = .6, P < .05). Six patients had increased AHR, and three of them had decreased DLCO. Six of the patients progressively reduced DLCO over time, and five of them had spirometric signs of increased small airway obstruction.Conclusions: During this eight-year follow-up we observed that one-third of the patients with pSS developed a significant reduction in lung function. Our findings suggest that small airways obstruction and AHR are associated with reduction of VC and development of impaired DLCO as a sign of interstitial lung disease in this group of patients.

Reduced Chest and Abdominal Wall Mobility and Their Relationship to Lung Function, Respiratory Muscle Strength, and Exercise Tolerance in Subjects With COPD.

Advanced air-flow limitation in patients with COPD leads to a reduction in vital capacity, respiratory muscle strength, and exercise capacity. However, its impact on chest and abdominal wall mobility is unknown. This study aimed to ascertain the prevalence of patients with COPD with reduced chest and abdominal wall mobility and to investigate the effect of reduced chest and abdominal wall mobility on pulmonary function, respiratory muscle strength, and exercise capacity. In 51 elderly male subjects with COPD, chest and abdominal wall mobility, FVC, FEV1, FEV1/FVC, maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), and the 6-min walk distance (6MWD) were assessed. Chest and abdominal wall mobility were measured using the breathing movement scale (0-8) at the 3 regions (upper chest, lower chest, and abdomen). Reduced mobility was defined as a value lower than the lower limit of the normal scale. The unpaired t test, Mann-Whitney test, and multiple regression analysis were performed. The percentages of subjects with reduced mobility were 78% for the upper chest, 76% for the lower chest, and 53% for the abdomen. The subjects with reduced mobility had significantly low FVC, FEV1, and 6MWD in each region and significantly low FEV1/FVC, PImax, and PEmax in the abdominal region compared with those with nonreduced mobility. FVC and 6MWD were independently associated with the scale values in each region and with the abdominal scale value, respectively. The majority of subjects with COPD had reduced chest and abdominal wall mobility, which was independently associated with FVC. Even though abdominal wall mobility was relatively preserved compared with chest wall mobility, it was also independently associated with 6MWD.

Comparative analysis of sarcoidosis treatment efficiency in clinical practice settings

Aim. To evaluate the effectiveness of different management regimens in patients with sarcoidosis in clinical practice settings.Methods. A retrospective analysis of condition of 530 patients with sarcoidosis at baseline and at the end of follow-up (at least 6 months) was conducted. The patients were divided into subgroups according to the treatment received by them: prednisolone, methotrexate, pentoxifylline, vitamin E. The fifth group consisted of patients who were under active surveillance without treatment. The dynamics of the disease clinical and laboratory manifestations, radiographic changes, and lungs forced vital capacity were evaluated.Results.. Improvement rate was the highest and amounted to 74.3% in patients with mild forms of sarcoidosis treated with vitamin E. The spirometric parameters have most commonly positive dynamics among patients treated with prednisone (56.2%). When comparing patients with equal radiographic stages and close spirometry data, methotrexate improved radiographic pattern in 70% of cases. Pentoxifylline effect was associated with the initial radiographic stages of sarcoidosis (p=0.003), its influence was insufficient in preventing of the fibrosis development and the lungs vital capacity reduction in patients with initially severe and widespread forms of sarcoidosis. After completion of treatment with methotrexate, relapse occurred in 37.2% of patients, and after pentoxifylline treatment in 31% of cases subsequent systemic glucocorticoid therapy was needed.Conclusion. In mild sarcoidosis vitamin E is quite effective and active surveillance without treatment is acceptable, in case of severe course, prednisolone and methotrexate efficacy is comparable, while pentoxifylline did not allow to prevent fibrosis development and the lungs ventilatory capacity reduction; choice of regimen is determined by the clinical presentation severity and lesion size according to the X-ray.

Progression from respiratory dysfunction to failure in late-onset Pompe disease

To identify determinants of respiratory disease progression in late-onset Pompe disease (LOPD), we studied relationships between pulmonary function, respiratory muscle strength, gas exchange, and respiratory control. Longitudinal evaluation of 22 LOPD patients (mean age 38 years) was performed at 6-month intervals for 6–24 months. Measurements included vital capacity (VC), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), tidal volume (VT), dead space (VD), and ventilatory response to CO2. Although reduction in VC correlated with MIP and MEP (p < 0.0001), some patients had normal VC despite reduced MIP and MEP (5 [23%] and 9 [41%] patients, respectively). Daytime hypercapnia was associated with reduced VC (<60% predicted) and MIP (<40% predicted). Moreover, chronic hypercapnia was associated with elevated VD/VT (≥0.44) due to falling VT (≈300 ml), compatible with reduced efficiency of CO2 clearance. The presence of hypercapnia and/or ventilatory support was associated with reduced ventilatory responsiveness to CO2 (≤0.7 l/min/mmHg). We conclude that daytime hypercapnia, an indicator of chronic respiratory failure, is tightly linked to the degree of respiratory muscle weakness and severity of pulmonary dysfunction in LOPD patients. Reductions in CO2 clearance efficiency and ventilatory responsiveness may contribute to the development of chronic daytime hypercapnia.

Pirfenidone: Clinical trials and clinical practice in patients with idiopathic pulmonary fibrosis.

Pirfenidone is an oral drug that exerts not only anti-fibrotic activity but also pleiotropic effects, such as anti-inflammatory and anti-oxidative effects. Because it suppresses reduction in vital capacity and improves progression-free survival, it was approved in October 2008 in Japan for the first time in the world as an anti-fibrotic agent for treatment of idiopathic pulmonary fibrosis (IPF). In October 2014, the agent was approved in the U.S., based on the results of the ASCEND study. Today, it is commercially available in 38 countries worldwide. In clinical practice, it is important to pay attention to the balance between the effectiveness and adverse events (such as gastrointestinal symptoms and photosensitivity reactions, among others) of treatment with pirfenidone. It is important to investigate pirfenidone׳s most cost-effective usage, and the ideal time of treatment initiation, the condition in which treatment should be initiated, and duration of treatment.

Postural alterations and pulmonary function of mouth-breathing children

Mouth-breathing children have changes in their stomatognathic system, which result in head projection, stress increase in the scapular belt muscles and postural adaptations. Although thoracic shape and posture can influence ventilatory dynamics, we didn't find studies addressing pulmonary function of mouth-breathing children.Aimsthis study aimed at analyzing the posture of mouth-breathing children, and studying the existence of correlations between posture and pulmonary volumes.Material and Methodsprospective, observational and cross-sectional study, where the posture and pulmonary function of 17 mouth-breathing children and of 17 nasal-breathing children were evaluated by means of photogrammetry and forced spirometry.Resultswhen compared to nasal-breathing, mouth-breathing subjects presented an increment in head projection and cervical lordosis, forwarded gravity center and reduced pulmonary volumes. There was an association between head projection and forced vital capacity, and between postural alterations and age.Conclusionmouth-breathing children have postural alterations which increases with age and also reduced spirometry values. The vital capacity reduction correlates negatively with head projection.

Evaluation of lung volumes, vital capacity and respiratory muscle strength after cervical, thoracic and lumbar spinal surgery.

Studies have shown that physiopathological changes to the respiratory system can occur following thoracic and abdominal surgery. Laminectomy is considered to be a peripheral surgical procedure, but it is possible that thoracic spinal surgery exerts a greater influence on lung function. The aim of this study was to evaluate the pulmonary volumes and maximum respiratory pressures of patients undergoing cervical, thoracic or lumbar spinal surgery. Prospective study in a tertiary-level university hospital. Sixty-three patients undergoing laminectomy due to diagnoses of tumors or herniated discs were evaluated. Vital capacity, tidal volume, minute ventilation and maximum respiratory pressures were evaluated preoperatively and on the first and second postoperative days. Possible associations between the respiratory variables and the duration of the operation, surgical diagnosis and smoking status were investigated. Vital capacity and maximum inspiratory pressure presented reductions on the first postoperative day (20.9% and 91.6%, respectively) for thoracic surgery (P = 0.01), and maximum expiratory pressure showed reductions on the first postoperative day in cervical surgery patients (15.3%; P = 0.004). The incidence of pulmonary complications was 3.6%. There were reductions in vital capacity and maximum respiratory pressures during the postoperative period in patients undergoing laminectomy. Surgery in the thoracic region was associated with greater reductions in vital capacity and maximum inspiratory pressure, compared with cervical and lumbar surgery. Thus, surgical manipulation of the thoracic region appears to have more influence on pulmonary function and respiratory muscle action.

Prevalence of airflow obstruction and reduced forced vital capacity in an Aboriginal Australian population: The cross-sectional BOLD study.

Mortality and hospital separation data suggest a higher burden of chronic obstructive pulmonary disease (COPD) in indigenous than non-indigenous subpopulations of high-income countries. This study sought to accurately measure the true prevalence of post-bronchodilator airflow obstruction and forced vital capacity reduction in representative samples of Indigenous and non-Indigenous Australians. This study applies cross-sectional population-based survey of Aboriginal and non-Indigenous residents of the Kimberley region of Western Australia aged 40 years or older, following the international Burden Of Lung Disease (BOLD) protocol. Quality-controlled spirometry was conducted before and after bronchodilator. COPD was defined as Global initiative for chronic Obstructive Lung Disease (GOLD) Stage 2 and above (post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1 /FVC) ratio <0.7 and FEV1 < 80% predicted). Complete data were available for 704 participants. The prevalence of COPD, adjusted for age, gender and body weight in Aboriginal participants (7.2%, 95% confidence interval (CI) 3.9 to 10.4) was similar to that seen in non-Indigenous Kimberley participants (8.2%, 95% CI 5.7 to 10.7) and non-Indigenous residents of the remainder of Australia (7.1%, 95% CI 6.1 to 8.0). The prevalence of low FVC (<80% predicted) was substantially higher in Aboriginal compared with non-Indigenous participants (74.0%, 95% CI 69.1 to 78.8, vs 9.7%, 95% CI 7.1 to 12.4). Low FVC, rather than airflow obstruction, characterizes the impact of chronic lung disease previously attributed to COPD in this population subject to significant social and economic disadvantage. Environmental risk factors other than smoking as well as developmental factors must be considered. These findings require further investigation and have implications for future prevention of chronic lung disease in similar populations.

P158 Evaluation Of Vital Capacity Changes In Spinal Injured Patients During Episode Of Sepsis

Introduction Respiratory complications have been suggested as cause of death in approximately 60% of spinal cord injured patients requiring ventilation after spinal cord injury. 1 The vast majority of these respiratory complications are due to infections i.e. pneumonias. It has been postulated that infections trigger a general inflammatory response which directly affects respiratory muscle strength and worsens respiratory function, which can cause respiratory failure. 2 All patients with a high spinal injury (> T1) or respiratory impairment have their vital capacity (VC) measured routinely at least once daily. We designed a project to assess if significant forced vital capacity (FVC) changes occur in spinal injury patients during an episode of sepsis. Methods In this retrospective review we collected data from all our spinal injury patients with an episode of sepsis (pneumonia or urinary) between March 2010 and February 2013. Results A total of 16 episodes were recorded in 14 patients (2 female, 12 male) with an average age of 61.8. Level of spinal cord injury varied from C4-T9 and the majority had ASIA (American Spinal Injury Association) grade A. Of all 16 episodes of sepsis, 6 (37.5%) were diagnosed as pneumonia. 10 (62.5%) were of urinary tract origin with positive urine culture. Blood cultures were positive in 4 cases, negative in 11 and not available in 1. FVC ranged from 4000 ml to 1200 ml. VC changes were more profound with respiratory infection as we observed an average FVC change of 1450 ml (50–77%) for the diagnosis of pneumonia and 862 ml (2.3–58%) for urinary tract infection Conclusions Systemic infection causes significant changes in vital capacity suggesting direct effect of the inflammatory process on diaphragmatic and respiratory muscle function. These VC changes are more profound with respiratory infection and in our study varied from 50%-77% reduction from the baseline. Reduction in VC is an important sign of clinical deterioration and should be routinely measured in any patient with spinal cord injury to prevent respiratory compromise and respiratory failure. References Watt J et al . Spinal Cord .2011;49:404–10 Boczkowski J. Am J Respir Crit Care Med .2004;169:662–663

Pirfenidone in Idiopathic Pulmonary Fibrosis: Real-Life Experience from a German Tertiary Referral Center for Interstitial Lung Diseases

Background: Pirfenidone is a novel antifibrotic drug for the treatment of mild-to-moderate idiopathic pulmonary fibrosis (IPF). However, adverse events may offset treatment benefits and compliance. Objectives: To assess recent course of disease, adverse events and compliance in patients who started pirfenidone. Methods: In an observational cohort study, 63 patients with mild-to-moderate IPF who started pirfenidone between May 2011 and June 2013 were reviewed. Pulmonary function, adverse events and treatment compliance were recorded at each clinic visit. Disease progression was defined as a reduction of vital capacity ≥10% and/or diffusion capacity (DLCO) ≥15%. Results: Follow-up time on pirfenidone treatment was 11 (±7) months. Sixty-six percent of the patients continued with pirfenidone monotherapy and 34% of the patients received pirfenidone combined with corticosteroids (CCS) and/or N-acetylcysteine (NAC). There was a nonsignificant reduction in mean decline of percent predicted forced vital capacity after treatment start (0.7 ± 10.9%) compared to the pretreatment period (6.6 ± 6.7%, p = 0.098). Sixty-two percent of the patients had stable disease on pirfenidone treatment. Adverse events affected 85% of the patients, leading to discontinuation of pirfenidone in 20%. Adverse events and treatment discontinuation were seen more frequently in patients with concomitant CCS and/or NAC treatment. Conclusions: Adverse events affect the majority of patients treated with pirfenidone, but are mostly manageable with supportive measures. In this heterogeneous patient group, a nonsignificant effect of pirfenidone treatment on pulmonary function was seen, underlining the need for more data on patient selection criteria and efficacy of pirfenidone, particularly in patients with coexistent emphysema and concomitant NAC/CCS treatment.

Pulmonary Function After Lobectomy Versus Segmentectomy in Patients with Stage I Non-Small Cell Lung Cancer

Several reports have shown that segmentectomy is superior to lobectomy for preservation of postoperative pulmonary function. The purpose of this study was to characterize the relationship between pulmonary function and the volume of the resected lung in patients undergoing segmentectomy or lobectomy. Patients undergoing open lobectomy (n=126) and open segmentectomy (n=52) for stage I non-small cell lung cancer were analyzed retrospectively. Pulmonary function testing, including vital capacity (VC) and forced expiratory volume in 1 second (FEV1), was performed preoperatively and at 1 and 6months postoperatively. The postoperative reduction of VC and FEV1, as indicated by the postoperative value/preoperative value, at 6months after surgery was significantly less in the segmentectomy group than in the lobectomy group. However, the standardized functional loss ratio, as expressed by [(measured postoperative value)-(predicted postoperative value)] / (predicted postoperative value)×100 (%), at 1month after surgery was significantly lower in the segmentectomy group than in the lobectomy group. No significant difference in the standardized functional loss ratio was seen at 6months postoperatively. Pulmonary function at 6months after surgery is better after segmental resection than after lobectomy. However, the absolute value of pulmonary function did not reach the predicted-postoperative value at 1month after surgery. Thus, when segmentectomy is performed, clinicians should be aware that early postoperative pulmonary function may be significantly less than the expected value.

Impact of 3D Conformal Radiotherapy on Lung Function of Patients with Lung Cancer: A Prospective Study

Background: The development of three-dimensional conformal radiotherapy (3D-RT) has enabled the restriction of the dose to normal lung, limiting radiation-induced lung injury. Objectives: This study was designed to describe the time course of lung function until 7.5 months after 3D-RT in patients with lung cancer, and assess the relationship between lung function changes and dose-volume histogram (DVH) analysis or computed tomography scan changes. Radiation doses were optimized according to recent guidelines. Methods: Sixty-five lung cancer patients treated with 3D-RT agreed to participate in this prospective, hospital-based study. Lung volumes, forced expiratory volume in 1 s (FEV₁) and diffusing capacity of the lung for carbon monoxide (DL<smlcap>CO</smlcap>) were measured before radiotherapy (RT), 10 weeks, 4 and 7.5 months after the beginning of 3D-RT. Results: Eleven lung cancer patients (17%) developed grade 2-3 respiratory symptoms after RT. At 7.5 months, vital capacity (VC) was 96 ± 2%, total lung capacity (TLC) 95 ± 2%, FEV₁ 93 ± 2% and DL<smlcap>CO</smlcap> 90 ± 2% of the initial value. Only 15% of patients showed pulmonary function reduction >20%. Patients with FEV₁ or DL<smlcap>CO</smlcap> <60% before RT did not show significant changes after RT. There were weak correlations between reduction of VC, TLC, FEV₁ or DL<smlcap>CO</smlcap> and radiation dosimetric parameters and between reduction of VC or FEV₁ and radiation-induced pneumonitis images. Conclusions: In lung cancer, the reduction of lung function within 7.5 months after 3D-RT was small and correlated, albeit weakly, with DVH parameters. Patients with initially impaired lung function showed tiny changes in spirometry and DL<smlcap>CO</smlcap> values.

Upper thoracic shape in children with pectus excavatum: Impact on lung function

Pectus excavatum (PE) can present with respiratory complaints in childhood. However severity of the PE, measured by the Pectus Severity Index (PSI), correlates only modestly with reduced vital capacity (VC). We hypothesized that another upper thoracic feature, a pectus gracilis (PG) or slender chest, co-exists with PE, and impacts lung function. We developed the Pectus Gracilis Index (PGI) based on the chest width to depth ratio at the gladiolar-manubrial sternal junction on computerized tomographic (CT) scans, and measured PGI among 316 control children 10-20 years old. PG was defined by PGI values >2 z-scores above the mean normal value. We determined the prevalence of PG in 97 children with PE and correlated PGI and PSI with VC among the 86 that performed spirometry. The mean and upper limit of normal for PGI averaged 2.73 and 3.55, respectively for control children. The prevalences of a PG among controls and children with PEs were 3.2% and 59%, respectively (OR = 45, P < 0.00001). Among the children with PEs, the PGI, and PSI correlated with one another (r = 0.77, P < 0.001). Both PSI and PGI significantly correlated inversely with VC. (r = -0.34, P < 0.001 and r = -0.38, P < 0.001, respectively). Importantly, PGI correlated with VC after adjusting for PSI among children with PE. (r = 0.20, P < 0.03). The upper thoracic feature of a PG is common among children with PE and contributes to reductions in VC. Assessment of the thorax, using the PGI, may improve the structure-function correlations previously described for children with PE.

Maintenance of vital capacity during repetitive breath‐hold in a spearfishing competition

Cough and a reduction in vital capacity have recently been reported following breath-hold dives to depths of 25-75 m. We sought to investigate whether repetitive dives to depths of less than 30 m would elicit similar effects. Participants in a single-day spearfishing competition were recruited. Subjects performed spirometry before and after the 5-h event. Demographics, medical and diving history, respiratory symptoms and competition diving statistics were collected. Twenty-five subjects (two females), age 33 years (11) (mean (SD)), were studied. During the competition each subject completed 76 (33) dives, to 10 (3) m depth, with each dive lasting 0.9 (0.3) min. Maximum depth was 17 (4) m. No respiratory symptoms were reported. There was no difference in spirometry before and after competition except for FEF(25-75%), which increased by 0.16(0.34) L (P < 0.05). Pulmonary oedema or lung injury is not common after repetitive breath-hold diving to depths to 25 m, or is too mild to be reflected in symptoms or spirometry.

Restrictive Pattern in Spirometry. Does FEV1/FVC Need to Be Increased?

Introduction: Spirometry is an excellent tool in the diagnostics of airway obstruction, but is less reliable in restrictive diseases. Diagnosis of lung restriction on the grounds of reduced forced vital capacity (FVC) is burdened with many potential errors. According to the American Thoracic Society/European Respiratory Society (ATS/ERS) 2005 guidelines, restrictive pattern in spirometry consists of a reduction in vital capacity and increase in forced expiratory volume in 1 second/vital capacity (FEV1/VC) of &gt; 85–90%. However, to our knowledge, this recommendation has not been validated. The aim of this study was to check how the inclusion of an increased FEV1/FVC as a mandatory condition affects the value of spirometry in detecting a restrictive ventilatory defect. Materials and methods: The material consisted of pulmonary test results obtained from consecutive patients referred to our lab during the year 2009, who had undergone spirometry and lung volume measurements at the same visit. Results: Out of 1739 test results, there were 1402 non-obstructive cases (679 females [48.4%] and 723 males [51.6%]) with a mean age of 49.7 ± 14.5 years, included in the analysis. ERS 1993 reference equations were applied to all parameters. The lower limit of normal (LLN) was set at –1.645 of the SR level. Restrictive ventilatory defect (TLC &lt; LLN) was found in 283 patients (20.2%). Reduced FVC only, as a condition of restrictive ventilatory defect diagnosis, was found in 202 patients (14.4%) (sensitivity 59%, specificity 97%). Reduced FVC together with increased FEV1/FVC &gt; 85% was found in only 76 patients (5.4%) (sensitivity 23%, specificity 99%). Only 14% of mild, 26% of moderate, and 64% of severe restrictions could be detected with reduced FVC and increased FEV1/FVC. Conclusions: Dual condition, i.e., reduced FVC and increased FEV1/FVC, significantly diminishes the sensitivity of the test and hampers the diagnosis of restrictive ventilatory defect in spirometry, especially in mild and moderate stages.

Voice Characteristics in Adults With Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disorder caused by mutations in the NF1 gene, which is located at the long arm of chromosome 17. Major characteristics include multiple café-au-lait spots and neurofibromas. Voice abnormalities have been reported to occur in this patient group. However, most studies relied on subjective measurements only. The present study reports the results of an objective voice assessment based on a multiparameter approach in 22 adults with NF1. Aerodynamic measurements, voice range profiles, acoustic voice quality and intonation measurements, and dysphonia severity indices were obtained and compared with data from a control group, consisting of 22 healthy adults. It was found that NF1 patients show a poorer overall voice quality compared with controls. Particularly, a reduction of vital capacity and limitations in laryngeal possibilities with respect to frequency and intensity were observed in the NF1 group.

Preservation of Phrenic Nerve Involved by Stage III Thymoma

In stage III thymoma, the involved organs are usually resected to achieve complete resection. However, inclusion of the phrenic nerve (PN) in the resection may compromise pulmonary function which may be critical for the patients with serious complications. We retrospectively analyzed 18 thymoma patients with Masaoka stage III thymoma that involved the PN to determine the effects of PN resection versus PN preservation on postoperative pulmonary function, survival, and relapse. The PN was resected in 9 patients and preserved in 9 patients. The PN resection was avoided because of severe myasthenia gravis (n = 3), myotonic dystrophy (n = 1), old age (>80, n = 2), and minimal involvement (n = 3). Resection of the PN resulted in reduction of vital capacity and forced expiratory volume in the first second of expiration to 66% and 69%, respectively, of the preoperative values. Chronic respiratory failure appeared gradually in one patient in the PN resection group and he died without relapse 28 months postoperatively. In the PN preservation group, postoperative PN paralysis appeared in 8 of 9 patients and the paralysis was recovered in 7 of 8 patients. Postoperative vital capacity and forced expiratory volume in one second recovered to 92.4% and 94.1% of the preoperative values. Although relapse was observed more frequently in the PN preservation group and relapse-free survival seems to be longer in the PN preservation group (p = 0.073), there was no difference in overall survival between the groups. It may be an option to preserve the involved PN in stage III thymoma especially in the patients with serious complications.

Cardiopulmonary involvement in Fabry’s disease

Background — Fabry’s disease is an X-linked lysosomal storage disease caused by deficiency of alpha-galactosidase A enzyme activity. Decreased enzyme activity leads to accumulation of glycosphingolipid in different tissues, including endothelial and smooth-muscle cells and cardiomyocytes.Objectives — There is controversial data on cardiopulmonary involvement in Fabry’s disease, because many reports are based on small and selected populations with Fabry’s disease. Furthermore, the aetiology of cardiopulmonary symptoms in Fabry’s disease is poorly understood.Methods — We studied cardiopulmonary involvement in seventeen patients with Fabry’s disease (20-65 years, 6 men) using ECG, bicycle stress, cardiac magnetic resonance imaging, spirometry, diffusing capacity and pulmonary high-resolution computed tomography (HRCT) tests. Cardiopulmonary symptoms were compared to observed parameters in cardiopulmonary tests.Results — Left ventricular hypertrophy (LVH) and reduced exercise capacity are the most apparent cardiac changes in both genders with Fabry’s disease. ECG parameters were normal when excluding changes related to LVH. Spirometry showed mild reduction in vital capacity and forced expiratory volume in one second (FEV1), and mean values in diffusing capacity tests were within normal limits. Generally, only slight morphological pulmonary changes were detected using pulmonary HRCT, and they were not associated with changes in pulmonary function. The self-reported amount of pulmonary symptoms associated only with lower ejection fraction (P < 0.001) and longer QRS-duration (P = 0.04) of all measured cardiopulmonary parameters, whereas cardiac symptoms have no statistically significant association with any of these parameters.Conclusion — LVH and reduced exercise capacity are the most apparent cardiopulmonary changes in Fabry’s disease but they have only a minor association to cardiopulmonary symptoms.Therefore, routine cardiopulmonary evaluation in Fabry’s disease using echocardiography is maybe enough when integrated to counselling for aerobic exercise training.

The Impact of Various Anthropometric Measurements of Obesity on Pulmonary Function in Candidates for Surgery

Obesity has proven to be associated with respiratory symptoms and impaired pulmonary function, which could increase the incidence of postoperative complications after bariatric surgery. However, the component of obesity that has the most influence on pulmonary function has not been identified, especially in Asian-Pacific populations. This cross-sectional study enrolled obese Chinese patients >or=18 years of age with a body mass index (BMI) >32 kg/m(2), who were being evaluated for bariatric surgery. All patients performed pulmonary function test, and the results were analyzed according to various anthropometric measurements. Multiple-regression analyses were also conducted and adjusted for age, sex, and smoking history to determine the factors that impaired the pulmonary function of the obese patients. A total of 150 consecutive patients were enrolled from July 2007 to August 2008. We found that body weight, BMI, waist circumference (WC), hip circumference, and waist-to-height ratio but not waist-to-hip ratio had a significant correlation with decreased forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), total lung capacity (TLC), vital capacity (VC), and increased diffusing capacity of the lung for carbon monoxide to alveolar gas volume. After multiple linear regression analysis, only WC was associated with reductions in FEV1, FVC, TLC, and VC. Obesity is associated with a restrictive pattern of impaired pulmonary function in various anthropometric parameters measured in obese Chinese adults in Taiwan. Among these parameters, WC had the greatest impact on pulmonary function, which could also implicate the rate of postoperative complication and the need of more intensive care after bariatric surgery.