Restrictive Ventilatory Disturbances Research Articles

Acute toxicity of intratracheal arsenic trioxide instillation in rat lungs.

This study investigated the acute toxicity of different concentrations of arsenic trioxide (As2O3; ATO) on rat lungs. In total, 160 Wistar rats were randomly divided into the control, low‐, medium‐ and high‐dose groups, which were exposed to 0, 0.16, 1.60 and 16 μg/kg of ATO by intratracheal instillation, respectively. Samples were collected at 6, 12, 24, 48 and 72 hours after exposure and the dynamic changes indicative of acute lung toxicity were monitored. Compared with the control group, the exposure groups exhibited significant changes such as increased lung water content ratio and protein concentration in the bronchoalveolar lavage fluid, pulmonary interstitial thickening, cell membrane edema, increased inflammatory factor concentration, JNK and P38 were significantly activated, and the degree of phosphorylation was increased. Furthermore, all the changes in the exposure groups were exposure concentration‐dependent. ATO respiratory tract exposure can cause restrictive ventilatory disturbance in rats, and the degree of injury is exposure concentration‐dependent.

Alteração espirométrica em crianças com mielomeningocele é dependente do nível de lesão funcional

OBJETIVO: Avaliar a função pulmonar de crianças com mielomeningocele (MMC) de diferentes níveis de lesão funcional comparados a controles saudáveis pareados por idade e sexo. MATERIAL E MÉTODO: Este foi um estudo caso-controle, no qual foi selecionada apenas uma criança por nível funcional de lesão e com função cognitiva preservada, e controles de crianças saudáveis pareados por idade e gênero ao grupo de MMC. Medidas antropométricas e espirométricas de função pulmonar foram obtidas de ambos os casos e controles de MMC. RESULTADOS: Todas as crianças com MMC apresentaram reduzido estado nutricional segundo os índices recomendados pela OMS. Foi observada presença de distúrbio ventilatório restritivo leve nas crianças com nível de lesão torácica (CVF = 0,65 %prev) e lombar-alta (CVF = 0,69 %prev), e apesar de dentro dos limites da normalidade, as crianças com MMC com níveis inferiores de lesão apresentaram valores espirométricos menores do que seus respectivos controles. Houve correlação negativa perfeita entre a capacidade vital forçada e o nível de lesão funcional das crianças com MMC. CONCLUSÃO: Crianças com MMC apresentam reduzidos valores de função pulmonar quando comparados aos controles saudáveis, sobretudo os com níveis de lesão funcional elevada, os quais demonstraram distúrbio ventilatório restritivo. A fisioterapia respiratória deve ser incorporada na avaliação e segmento das crianças com MMC, coadjuvante à fisioterapia motora, especialmente naquelas acometidas com níveis de lesões mais elevadas.

Pulmonary alveolar microlithiasis

A 37-year-old patient was admitted to the hospital with severe dyspnoea and cough. Baseline investigations revealed haemoglobin of 16.2 g/dl, haematocrit of 48.8% and a total leucocyte count of 8800/mm3. Comprehensive metabolic profile and serum and urine protein electrophoresis findings were normal. Arterial blood gas analysis showed type 1 respiratory failure. Spirometry showed restrictive ventilatory disturbances (vital capacity 53%, forced expiratory volume in 1 s 91%). A posterior–anterior chest radiograph showed bilateral diffuse, nodular (‘sandstorm-like’) calcifications in both lungs (figure 1A). A high-resolution …

Função pulmonar pós-colecistectomia laparoscópica e abreviado tempo anestésico-cirúrgico

To evaluate pulmonary function after laparoscopic cholecystectomies. Prospective study, in which the post-operative spirometries of 15 patients who underwent laparoscopic cholecystectomies with abbreviated anesthetic-surgical time were analyzed. Significant differences existed for the Forced Vital Capacity variable (p=0,020) and Forced Expiratory Volume in the first second (p=0,022) between pre- and immediate post-operative, indicating restrictive ventilatory disturbances. Light restrictive laparoscopic post-cholecystectomy ventilatory disturbances were observed, with rapid recovery of pulmonary function, which may lower post-operative pulmonary morbidity.

Funktionelle 3He-MRT der Lunge

Pulmonary diseases have a high health-related and economic significance. (3)He-MRI is an alternative imaging method which can detect ventilatory disturbances with a high sensitivity. The application of different pulse sequences allows static and dynamic assessment of ventilation and bronchial gas flow, non-invasive measurement of intrapulmonary oxygen partial pressure and quantification of pulmonary parenchyma destruction and overinflation. Generally, the method is applicable for obstructive and restrictive ventilatory disturbances but initial approaches also exist for vascular pulmonary diseases. Specific clinical applications remain to be determined but (3)He-MRI is an excellent instrument for the assessment of physiologic and pathophysiologic interrelations in the distribution of ventilation.

Colectomia laparoscópica: revisão retrospectiva de 120 casos

To evaluate pulmonary function after open subcostal cholecystectomy under action of morphine in the immediate postoperative period. This was a prospective study in which the postoperative spirometric studies of fifteen patients who underwent open subcostal cholecystectomies received peridural morphine anesthesia. Preoperative and postoperative data were compared using a paired student-t test. Values of p < 0.05 were considered statistically significant. Significant differences were shown for the Forced Vital Capacity variable (p = 0.007) and Forced Expiratory Volume in the first second (p = 0.008) comparing the preoperative and immediate postoperative period, indicating restrictive ventilatory disturbances. All patients presented normal spirometric studies in the third postoperative day. Even under action of morphine peridural analgesia, in the immediate postoperative period, light restrictive post-cholecystectomy ventilatory disturbances were observed. However, it was observed a fast recovery after morphine peridural analgesia for pulmonary function, which may lower postoperative pulmonary morbidity.

Aspectos históricos da pressão arterial de oxigênio e espirometria relacionados à operação abdominal

INTRODUÇÃO: Operações, principalmente de abdome superior, cursam no pós-operatório com hipoxemia e distúrbios ventilatórios restritivos. O objetivos da presente revisão foram: a) fazer retrospecto histórico das técnicas espirométricas e da avaliação laboratorial da hipoxemia, por meio da pressão arterial de oxigênio (PaO2) e, b) rever os principais fatores responsáveis pelas alterações da função pulmonar pós-operatória. MÉTODOS: Fez-se revisão histórica sobre os principais aspectos espirométricos e da medida da PaO2, correlacionando esses exames como aferidores da função pulmonar, após operações abdominais. CONCLUSÕES: Operações em andar superior do abdome podem cursar com hipoxemia e distúrbios ventilatórios restritivos, cuja principal causa é a disfunção diafragmática, que pode ser minimizada por meio de laparoscopia e um eficaz tratamento da dor pós-operatória.

Non-invasive positive pressure ventilation improves lung volumes in the obesity hypoventilation syndrome

Our objective was to study the long-term effects of non-invasive positive pressure ventilation (NPPV) on lung function and gas exchange in patients with the obesity hypoventilation syndrome (OHS). Prospective observational study in OHS patients performing NPPV over a period of 24 months. We studied 35 clinically stable OHS patients with a mean body mass index (BMI) 45.9+/-8.8 kg/m(2) and daytime PaCO(2) at room air of 6.92+/-0.48 kPa at baseline. Nocturnal NPPV was initiated with pressure-cycled devices on IPAP 24+/-3 cm H(2)O, EPAP 6+/-2 cm H(2)O and respiratory frequency of 18.8+/-3.7/min. After 12 and 24 months of NPPV hypercapnia was persistently normalized and hypoxemia was markedly improved while no changes in calculated alveolar-arterial oxygen difference occurred. Augmented ventilation was followed by a significant reduction in hemoglobin and hematocrit (P<0.001 each). Daily duration of ventilator use significantly correlated with the decrease in PaCO(2) after 12 months (r = 0.37; P<0.05) and 24 months (r = 0.47; P<0.05). Vital capacity (VC) and expiratory reserve volume (ERV) significantly increased after 12 and 24 months NPPV compared to the baseline values, though BMI was only slightly reduced. The 2-year survival rate was 91% with three patients (9%) discontinuing NPPV during the study period. Long-term domiciliary NPPV normalizes hypercapnia and markedly improves hypoxemia as well as polycythemia in OHS patients. In addition, NPPV leads to a significant reduction in restrictive ventilatory disturbance, predominantly by increasing ERV. Application of high inspiratory pressures and good adherence to therapy are presumed to be the basis for the beneficial effects of NPPV in OHS.

Functional implications of BAL in the presence of restrictive or obstructive lung disease

Most of the complications associated to bronchoscopy are related to changes of the respiratory function during or after its performance. Prevention of complications should be achieved by understanding the effects of bronchoscopic procedures and their relation to the pulmonary function deterioration. Previous studies regarding the functional impairment caused by bronchoalveolar lavage (BAL) were mostly limited by the presence of interferent factors such as sedative drugs. Furthermore, it is not clear whether or not patients with different ventilatory disturbances present the same functional response to bronchoscopy and BAL. The aim of this study was to determine the additional effects of BAL over the respiratory function deterioration related to bronchoscopy in patients with different respiratory function profiles (normal, restrictive and obstructive). Forty patients submitted to bronchoscopy without premedication were divided into four groups: group I-normal pulmonary function submitted to basic bronchoscopy; group II-bronchoscopy in combination with BAL, subdivided according to pulmonary function: group IIa (normal function), group IIb (restrictive ventilatory disturbances) and group IIc (obstructive ventilatory disturbances). Spirometry was made before and after the bronchoscopic procedure. Baseline hemoglobin saturation was compared to the lowest level during the procedure. Functional worsening caused by the procedure was observed with a decrease in forced vital capacity (FVC), forced expiratory volume in the first second (FEV(1)) and Hemoglobin saturation in all groups. Comparison between groups showed no significant difference regarding the changes in FVC (P=0.8324), FEV(1) (P=0.6952) and hemoglobin saturation (P=0.5044). We conclude that standardized BAL, like the one used in our study, does not result in an increased risk for ventilatory impairment compared to bronchoscopy itself, independently of the presence of previous respiratory disease.

251 Diastolic heart failure and restrictive ventilatory disturbances lead to severe cardiopulmonary system failure in systemic sclerosis patients

251 Diastolic heart failure and restrictive ventilatory disturbances lead to severe cardiopulmonary system failure in systemic sclerosis patients

ポリオ後症候群に睡眠時無呼吸症候群を合併した一症例

Respiratory disturbance is one of the symptoms in post-polio syndrome (PPS), which is induced by the aging process of the respiratory muscle, scoliosis, bulbar muscle weakness and central arousal disturbance. Because of low patient activity levels resulting from progressive locomotive limitation, symptoms of progressive ventilatory insufficiency are often masked. We report a case of a 41-year old male with PPS, who was diagnosed as having sleep apnea syndrome (SAS), and was treated by continuous positive airway pressure (CPAP) ventilation using noninvasive nasal access. At the age of 11 months, he contracted spinal and bulbar poliomyelitis that involved the right arm, trunk, both legs, and bulbar muscles. At the age of 12 years, he became drowsy in the daytime, had headaches in the morning, and general fatigue with the progress of scoliosis. He visited our clinic for further examination of his PPS at the age of 41 years. At admission, his physical examination revealed severe trunk scoliosis with thoracic deformity and muscle weakness with atrophy in the right upper and both lower extremities. Spirometry demonstrated restrictive ventilatory disturbance. Pulse oximetry during the night and a further study using polysomnography (PSG) showed that he had sleep-induced hypoventilation and/or SAS. After he was treated using nasal CPAP and nocturnal ventilation, symptoms related to SAS disappeared.

Pigeon breeder's disease: allergic extrinsic alveolitis of pigeon breeders

SummaryThe term « Extrinsic allergic alveolitis » refers to a growing number of diseases of which farmer lung and birds breeder disease are classical examples.The clinical features, common to these conditions, consist of pulmonary (dyspnoea, cough, thoracic aches, fine crepitations at both lung bases) and systemic (fever, chills, loss of weight) symptoms. The functional abnormality is essentially a restrictive ventilatory disturbance with impairment of gas transfer and decrease in lung compliance.The pathology of the lung shows infiltration of the alveolar walls with polymorphs, lymphocytes and plasma cells or epitheloid granulomata. These lesions are thought to result from an immunologic reaction (type III) between precipitating antibodies and inhaled organic dusts, small enough to reach the alveolar level.The diagnosis should rely on the following findings :1. demonstration of serum precipitins against the relevant organic dust;2. occurrence of an Arthus type reaction following intracutaneous injection ...

Cardiopulmonary changes in scleroderma A physiologic study

Four patients with scleroderma were studied by means of cardiac catheterization and measurements of pulmonary function. In one case the studies were repeated after versene therapy and subjective clinical improvement. In 2 cases, a single-breath carbon-monoxide test was performed. In 2 cases, marked pulmonary hypertension was found, and in all 4 cases, reduction in the cardiac output and index was demonstrated. All patients exhibited evidence of restrictive ventilatory disturbance, but only one showed evidence of an obstructive type of pulmonary ventilatory defect. All patients exhibited a large intrapulmonary venoarterial shunt. In the 2 patients in whom the single-breath carbon-monoxide technique was performed a diffusion defect was also observed. The large A-a PO 2 gradient described in these patients when they were breathing room air was the result of the combination of a diffusion defect and pulmonary venoarterial shunts. Versene therapy resulted in marked subjective improvement, but failed to improve the pulmonary ventilation or to diminish the intrapulmonary shunt.