Ventilatory Disorders Research Articles

Association between pulmonary fibrosis and osteoporosis in the elderly people: A case-control study.

In this case–control study, we evaluated the association between osteoporosis and pulmonary fibrosis in the elderly. Participants were divided into a test group and a control group depending on bone mineral density and grid pattern changes of pulmonary fibrosis. We measured general conditions, related risk factors, serum biochemical index, grid pattern changes of double lungs, pulmonary function, arterial oxygen pressure (PO2), and bone mineral density of participates, and investigated the data through statistical analysis on SPSS 17.0 (SPSS Inc, Chicago, Illinois, USA). Significant differences were observed between groups in all collected indices except PO4. The ratio of pulmonary function disorder was higher in the test group versus the control group (12.0% vs 4.3%). Logistic regression shows that pulmonary fibrosis is a risk factor of osteoporosis, independent of age, sex, body mass index, smoking status, diabetes mellitus, alkaline phosphatase, glycosylated hemoglobin, Ca, PO4, tumor necrosis factor-α, vitamin D total, ventilation disorder, diffusive dysfunction, and hypoxemia. Senile osteoporosis is closely associated with pulmonary fibrosis, diabetes mellitus, smoking, sexuality, age, and body mass index. Pulmonary fibrosis modestly affects the incidence of osteoporosis and thus is a more promising predictor of osteoporosis.

Neurophysiological Evidence for a Cortical Contribution to the Wakefulness-Related Drive to Breathe Explaining Hypocapnia-Resistant Ventilation in Humans.

Human ventilatory activity persists, during wakefulness, even when hypocapnia makes it unnecessary. This peculiarity of human breathing control is important to speech and speech-breathing insofar as speech induces hypocapnia. This study evidences a specific respiratory-related cortical activity. This suggests that human hypocapnic breathing is driven, at least in part, by cortical mechanisms similar to those involved in volitional breathing, in breathing against mechanical constraints or with weak inspiratory muscle, and in patients with defective medullary breathing pattern generators. This fuels the notion that the human ventilatory drive during wakefulness often results from a corticosubcortical cooperation, and opens new avenues to study certain ventilatory and speech disorders.

Pseudoxanthoma Elasticum – Also a Lung Disease? The Respiratory Affection of Patients with Pseudoxanthoma Elasticum

BackgroundPseudoxanthoma elasticum (PXE) is an autosomal-recessive mineralisation disorder caused by loss of function mutations in the ABCC6 Gen. Histological findings and data of an autopsy of a PXE-patient suggest a possible pulmonal calcification. So far, there exists no clinical data whether PXE patients actually are at high risk of developing pulmonary disorder.MethodsIn a cross-sectional study, 35 PXE patients and 15 healthy controls underwent a pulmonary function testing, including spirometry, body plethysmography and carbon monoxide diffusing test. Additionally, PXE patients completed a COPD–Assessment-Test (CAT).ResultsWe observed in PXE patients normal values for predicted vital capacity (VC%; 96.0±13.0%), predicted total lung capacity (TLC%; 98.2±12.0%) and predicted forced expiration volume (FEV1%; 102.5±15.6%), whereas compared to healthy controls the PXE group showed significant diminished values for carbon monoxide diffusing capacity (DLCO, 7.2 ±1.4mmol/min/kPa vs. 8.6 ±1.5 mmol/min/kPa; p = 0.008) and predicted carbon monoxide diffusing capacity (DLCO%; 79.7±11.5% vs. 87.2±6.6%; p = 0.008). 11/35 (31.4%) PXE patients showed pathological DLCO% values under 75% (68.5%±5.4%).ConclusionPXE patients demonstrated a regular lung function testing, but nevertheless they had impaired CO diffusing parameters, which might be associated with a preclinical state of an interstitial lung disease and a risk for restrictive ventilation disorders.

Ventilatory Dysfunction in Parkinson's Disease.

In contrast to some other neurodegenerative diseases, little is known about ventilatory dysfunction in Parkinson’s disease (PD). To assess the spectrum of ventilation disorders in PD, we searched for and reviewed studies of dyspnea, lung volumes, respiratory muscle function, sleep breathing disorders and the response to hypoxemia in PD. Among the studies, we identified some limitations: (i) small study populations (mainly composed of patients with advanced PD), (ii) the absence of long-term follow-up and (iii) the absence of functional evaluations under “off-drug” conditions. Although there are many reports of abnormal spirometry data in PD (mainly related to impairment of the inspiratory muscles), little is known about hypoventilation in PD. We conclude that ventilatory dysfunction in PD has been poorly studied and little is known about its frequency and clinical relevance. Hence, there is a need to characterize the different phenotypes of ventilation disorders in PD, study their relationships with disease progression and assess their prognostic value.

Asthma-COPD overlap syndrome

Obstructive lung diseases represent a major health problem worldwide due to their high prevalence associated with elevated socioeconomic costs. Bronchial asthma and chronic obstructive pulmonary disease are chronic obstructive ventilatory disorders with airway inflammation, however they are separate nosological entities based on thedifferent development, diagnostic and therapeutic approaches, and prognostic features. However, these diseases may coexist and can be defined as the coexistence of increased variability of airflow in a patient with incompletely reversible airway obstruction. This phenotype is called asthma - chronic obstructive pulmonary disease overlap syndrome. The syndrome is a clinical and scientific challenge as the majority of these patients have been excluded from the clinical and pharmacological trials, thus well-defined clinical characteristics and therapeutic approaches are lacking. The aim of this review is to summarize the currently available literature focusing on pathophysiological and clinical features, and discuss possible therapeutic approaches of patients with asthma - chronic obstructive pulmonary disease overlap syndrome. Orv. Hetil., 2016, 157(33), 1304-1313.

Association between intracardiac hemodynamics and respiratory function in patients with coronary artery disease and respiratory comorbidity

The aim of this study was to investigate a relationship between the myocardial structure and function and respiratory parameters in patients with coronary artery disease (CAD) and respiratory disease.Methods. We performed spirometry, body plethysmography, lung diffusing capacity test and measured the left ventricle (LV) systolic and diastolic function in patients with CAD with or without respiratory diseases and ventilation disorders.Results. Patients with CAD (n = 662) participated in the study. The LV systolic dysfunction was found only in 60 patients (9.1%), while diastolic dysfunction was found in 387 patients with CAD (58.4%). Most patients with obstructive ventilation disorders had the systolic or diastolic LV dysfunction (40 patients (66.7%) and 197 patients (79.4%), respectively). Flow and volume lung function parameters and the lung diffusing capacity were associated with some echocardiographic and pulsed wave Doppler parameters.Conclusion. Comorbidity of CAD and lung obstructive disease was associated with more frequent systolic and diastolic LV dysfunction. The relationship between respiratory and cardiac parameters could indicate the cross impact that could deteriorate the course of both the diseases.

A role of pulmonary function testing for detecting ventilation and gas exchange disorders in multilobar community-acquired pneumonia convalescents

The aim of this study was to analyze lung function in multilobar community-acquired pneumonia (CAP) convalescents. Methods. Spirometry, body plethysmography, and lung diffusing capacity were measured according to the joint European Respiratory Society and American Thoracic Society standards (2005). The carbon monoxide lung diffusing capacity was evaluated using a single breath-hold technique and was adjusted for hemoglobin. Results . The complete clinical and radiological resolution of CAP did not accompanied by recovery of lung function in all cases. Obstructive ventilation disorders were diagnosed in 18.2% of patients, restrictive ventilation disorders were diagnosed in 12.1% of patients, and gas exchange abnormalities were diagnosed in 51.5% of the patients. Conclusion. Lung function and gas exchange testing is an important marker of the patient's convalescence after CAP and duration of the recovery; it also could predict the need in subsequent follow-up.

ТЕОРЕТИЧЕСКИЕ И МЕТОДИЧЕСКИЕ АСПЕКТЫ БОДИПЛЕТИЗМОГРАФИИ И ЕЕ КЛИНИЧЕСКОЕ ПРИМЕНЕНИЕ

One of the methods to evaluate lung function is body plethysmography. Body plethysmography allows to measure indicators that cannot be obtained during spirometry, that is: total lung capacity (TLC), bronchial resistance (Raw), and functional residual capacity (FRC). FRC measured by body plethysmography reflects thoracic gas volume (TGV or VTG), and includes both ventilated and poorly ventilated volume. Plethysmographic measurements are based on the principle of the relationship between pressure and volume at constant temperature and fixed amount of gas. This principle states that the absolute pressure exerted by a given mass of an ideal gas is inversely proportional to the volume it occupies if the temperature and amount of gas remain unchanged within a closed system (Boyle-Mariotte Law). In body plethysmography, the following parameters: TGV, vital capacity (VC), expiratory reserve volume (ERV), tidal volume (TV), inspiratory reserve volume (IRV), inspiratory capacity (IC), Raw are obtained. TLC, residual volume (RV) and its share in total lung capacity can be calculated. Reduced TLC allows to diagnose restrictive disorders of pulmonary ventilation. The RV and its share in TLC increase together with airway obstruction indicates air trapping. The TGV increase together with airway obstruction indicates hyperinflation. In the analysis of lung volumes predictive values, which are calculated by the formulas recommended by ATS/ERS statement, are used. The results are expressed as a percentage of the predicted value. Thus, body plethysmography is an important addition to spirometry and image methods of research, allowing to assess the functional state of the lungs more objectively; it helps to conduct the differential diagnosis and control the course of the disease.

Follow-up of the pulmonary function in long-term survival patients with acute paraquat poisoning

Objective To further study the prognosis of paraquat(PQ ) induced lung injury by means of the follow-up of the pulmonary function at 6 months poisoning in long-term survival patients with acute PQ poisoning. Methods The data of 50 PQ poisoning patients admitted from September 2010 to July 2012, and were retrospectively reviewed, and the patients were divided into the mild group and the severe group according to the manifestations and pulmonary CT. The measurement of VC%(vital capacity), FVC%(forced vital capacity), FEV1.0%(forced expiratory volume), FEV1.0/FVC%, and MMEF%(maximal mid-expiratory flow) were determined at 6 months after PQ poisoning. The comparison of pulmonary function between two groups was made by statistical analysis with SPSS 20.0 software. Results VC%, FVC%, FEV1.0%, FEV1.0/FVC% and MMEF% was(93.28±7.11)%, (94.24±7.17, 96)%.(48±8.85)%, (97.83±8.21) %and(102.82±9.52)% respectively in mild group. VC%, FVC%, FEV1.0%, FEV1.0/FVC% and MMEF% was (97.13±12.18)%, (98.94±12.22)%, (99.52±12.84)%, (90.18±7.88) %and (91.48±11.80) %respectively in severe group. The abnormal rate of restrictive or obstructive ventilatory disorder in mild group showed no significant difference with that in severe group (P>0.05). The abnormal rate of indexes of the lung function in mild group showed no significant difference with that in severe group (P>0.05). FEV1.0/FVC% and MMEF% in mild group showed statistically difference with that in severe group (P 0.05). Conclusions PQ poisoning can cause damage to a certain extend to pulmonary function in survival patients at 6 months. The extent of the damage to the small airways in severe group was more grave than that in mild group. However, this difference could not make the abnormal rate of obstructive ventilatory disorder any statistical difference. Key words: Poisoning; Paraquat; Pulmonary Function; Lung Injury; Lung Fibrosis

The level of anxiety in patients with chronic obstructive pulmonary disease: diagnosis, differential diagnosis and treatment approaches

Mental disorders including increased anxiety are comorbid conditions in chronic obstructive pulmonary disease (COPD). They have a negative influence on the general condition of patients, their quality of life, and commitment to long-term treatment, impair the effectiveness of rehabilitation. Recently, researchers devoted much attention to the study of causal relationships between increased anxiety, clinical and functional manifestations of COPD. Objective: to establish a link between clinical manifestations and the level of anxiety in patients with COPD. Methods and results. We examined 77 patients with COPD. A survey of patients included general clinical methods, evaluation of clinical symptoms, including by means of questionnaires, spirometry. Determining the level of anxiety was made using Hospital Anxiety and Depression Scale. The final evaluation of the mental state of patients was conducted by psychiatrist. COPD patients with increased anxiety and with normal levels of anxiety did not have differences in demographic parameters and the level of ventilation disorders. However, in COPD patients with increased anxiety the severity of dyspnea and the severity of symptoms is generally more severe than in patients with normal levels of anxiety. Conclusion. In identifying increased anxiety in patients should be advised to consult by psychiatrist. At the same time, the normal level of anxiety in patients with COPD by questionnaire HADS-anxiety does not exclude the possible presence of other changes in mental status.

Особенности сывороточного содержания растворимых форм дифференцировочных антигенов СD8 и их связь с нарушениями легочной вентиляции при хронической обструктивной болезни легких

Objective: to study the relationship between serum content of soluble (s-) forms of the СD8 molecules and obstructive disorders of pulmonary ventilation in patients with chronic obstructive pulmonary disease (COPD). The study involved 50 patients with COPD. All the patients underwent physical examination, spirometry. The serum levels of sCD8 antigens were investigated using ELISA method; results were compared with serum samples of 30 healthy donors. It has been shown that low level of sCD8 molecules is a risk factor for severe COPD. An analytical model of the relationship between FEV1 and sCD8 can be used in clinical practice for the purposes of the screening assessment of the immune status of the patients.

Long time enzyme replacement therapy stabilizes obstructive lung disease and alters peripheral immune cell subsets in Fabry patients.

Fabry disease is an X-linked lysosomal storage disorder, causing accumulation of globotriaosylceramid in different organs. Glycolipids are activators of different immune cell subsets the resulting inflammation is responsible for organ damage. Pulmonary involvement leads to airway inflammation; however, data on severity, as well as the effect of enzyme replacement therapy on lung function parameters and changes in peripheral immune cell subsets on lung involvement are sparse. Seven Fabry patients and four carriers underwent detailed clinical examinations screening for pulmonary manifestations. Repetitive measurements were performed on five patients on ERT (average follow-up 5 years). Patients with Fabry disease and control volunteers were included into peripheral blood cell measurements. Lung involvement was present in all patients. Symptoms suggestive for lung disease were mild, however, obstructive ventilatory disorder, dominantly affecting small airways accompanied by hyperinflation was demonstrated in all affected patients. ERT resulted in small improvement of FEV1 in most treated patients. Decreased ratio of myeloid DC, Th17 cells while increase in T helper (Th)1 cells, and no change in Th2 and regulatory T (Treg) cells were detected in Fabry patients. Fabry disease results mainly in mild symptoms related to lung involvement, characterized by moderate non-reversible obstructive ventilatory disorder. Stabilization of airway obstruction during follow-up was observed using ERT in most patients, emphasizing the importance of this treatment in respect of pulmonary manifestations. Changes of immune cell subsets in the peripheral blood might play a role in inflammatory process, including small airways in Fabry patient's lung.

Impact of Associating Tobacco to Chemicals Exposure on the Lung Function: Supply of Spirometry

Our study’s aim is to assess the impact of the combination of tobacco and chemical products (chlorine, sulphuric acid (sulphur)) on pulmonary function using the spirometry. Subjects selected were divided on 4 groups according to their smoking status and/or the exposition on chemical products. Parameters studied were: Slow Vital Capacity (SVC), Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), FEV1/VC (Tiffeneau), Peak Expiratory Flow Rate (PEFR). Ventilatory disorders were assessed in each group and comparison between groups was done. The comparative study of spirometry’s subjects who aren’t exposed on chemical products (G1vsG2), revealed that smokers (G2) had a VEMS more significantly low than the predicted standard value (P=0,003). When we compare nonsmokers (G1vsG3), exposed subjects showed a significant predominance of ventilatory disorders with CVL, VEMS and DEP weaker p=0,034(CVL), p=0,045(VEMS), p<0,001(DEP)). Among the smokers, we observed at chemical addicts, a significant reduction of CV (P=0,001(CVL); P<0,001(CVF)). Chemical addicts compared to tobacco addicts, presented a significant pre-eminence of ventilatory disorders (p=0,03(CVL), p=0,037(CVF), p=0,021(DEP)). Comparison between co-addicts(G4) and new subjects(G1), showed a variation rate more significantly low about CVL(P<0,001), CVF (P=0,003) and VEMS (P=0,021). Besides, the study of 12 co-addicts successive spirometries, on an average time of 3 years, showed in 80% of case, an evolution to ventilatory disorder. Moreover, subjects exposed on chlorine, compared with the ones exposed on sulphur, presented more ventilatory disorders (P<0,001). Then the chronic exposition on chemical products, tobacco impregnation constitutes a worsening factor of ventilatory disorders. Chlorine would be more toxic than sulphur.

Long-term follow-up after tympanostomy tube insertion in children with serous otitis media

The authors report about the efficacy of inserted tympanostomy tube in children with serous otitis media. The aim of the authors was to assess the status of eardrum, the function of Eustachian tube and hearing level 10 years after the use of tympanostomy tube. Patients filled out a questionnaire and microscopic examination of tympanic membrane, tympanometry, Eustachian tube function examination, and audiometry tests were performed. In the period of 2003-2004, ventilation tube insertion was performed in 711 patients in the ENT Department of Pediatric Health Center of University of Szeged. In 349 patients adenotomy and tympanostomy tube insertion, in 18 cases tonsillectomy and grommet insertion and in 344 patients only typmanostomy tube insertion were performed. Due to objective difficulties (address change, no phone number) 453 patients were asked for control test and 312 persons accepted the invitation. Normal hearing level was found in 84.6% of patients and normal tympanometry result occurred in 82%. Tympanic ventilation disorder, perforation of tympanic membrane, sensorineural hearing loss and sensorineural hearing loss due to noise exposure were diagnosed. Application of tympanostomy tube is effective in the treatment of serous otitis media resulting from ventilation disorder. The authors draw attention to the importance of tympanometry examination to prevent the adhesive processes and cholesteatoma in chronic ventilation disorder of the middle ear.

Clinical and genetic study on familial idiopathic pulmonary fibrosis in a Chinese family

To identify the manifestations and pathogenesis of idiopathic pulmonary fibrosis (IPF) after studying the clinical features of familial idiopathic pulmonary fibrosis (FIPF) and detecting relevant genes. Seven persons with FIPF from one family of Han nationality in northern China, which had FIPF patients in three consecutive generations, were included in this study. The incidence age of the 7 subjects (4 males and 3 females) ranged from 30 to 57 years. The propositus was II-4, while the first person attacked by FIPF was I-1. Five patients (2 males, 3 females) in the second generation and one case in the third generation were found at the time of this study. The genetic characteristics of FIPF in this study were complied with the pattern of autosomal dominant inheritance. Imaging examinations and pulmonary function tests were conducted to confirm the diagnosis of pulmonary fibrosis. Meanwhile, personal information and clinical data such as imaging examinations and pathological tests were acquired; clinical features and manifestations were analyzed and compared; and pathological tests and gene detection were performed. The average survival time was 3 years, and poor response to glucocorticoid treatment was observed. Three patients had detailed clinical information, whose interstitial pneumonia related immunologic tests were negative. Concerning pulmonary function, three patients had significant decrease of diffusion function and obvious restrictive ventilatory disorder, with DLCO value as 50%, 23% and 46%, respectively. Among the 3 patients with complete imaging data, 1 was considered as UIP, while 2 as NSIP. The 3 subjects who had different imaging findings all responded poorly to glucocorticoid treatment, and two of them died. Genetic test for TERT, TERC and SFTPC in peripheral blood and autopsy were performed for II-4 but all were negative. The average death age of family members with FIPF was 50.2 years. The patients presented various imaging features and pathological findings. Glucocorticoid treatment may be ineffective, even for persons diagnosed as NSIP by lung biopsy.

FOCUSED IMPEDANCE METHOD TO DETECT LOCALIZED LUNG VENTILATION DISORDERS IN COMBINATION WITH CONVENTIONAL SPIROMETRY

Conventional spirometry gives information on the overall ventilation of a person's lung; it cannot detect localized disorders in ventilation as occurring in pulmonary edema, pneumonia, tumor, TB, etc. Here we propose a new technique involving the recently developed focused impedance method (FIM) in combination with conventional spirometry to detect localized lung ventilation disorders. Electrical impedance of lung tissue changes as a function of air content and FIM provides a measurement of localized electrical impedance with sensitivity down to reasonable depths inside the body using a few surface electrodes; here we used a six-electrode version. At least four quadrants of the lungs in the frontal plane can be separately measured using a hand-held probe with spring backed skin surface electrodes. Firstly, spatial sensitivity distribution of the six-electrode FIM was obtained using finite element simulation which verified the focusing effect and its depth sensitivity. Percent change in impedance between maximum inspiration and expiration were measured at four quadrants of the chest of a healthy male subject giving four different values; that at the lower right quadrant was found to be the maximum, as also expected based on anatomy. Changes in impedance at this quadrant of the same subject were found to vary proportionately with exhaled air volumes, measured using a bellows-type spirometer. Similar FIM measurements at lower right lung of seven healthy subjects were found to be almost proportional (R2= 0.7) to the total exhaled air volumes (vital capacity). This was the basis of the new technique. For a healthy individual, the ratio of the local impedance change to vital capacity (VC) will fall within a certain range for each of the four lung quadrants. A lower value at any quadrant would indicate disorder within that quadrant, while a larger value would indicate disorder in a region outside the particular quadrant. The FIM electrode probe can then be moved to take measurements at the other quadrants to locate the region of disorder. This preliminary study indicates that FIM in combination with conventional spirometry could be used to detect localized ventilation defects.

Asthme et Aspergillus

There is an association between sensitisation to moulds, uncontrolled fungal infections and bad asthma control. The diagnosis of allergic broncho-pulmonary aspergillosis (ABPA) is based on three indispensible criteria: a reversible ventilatory disorder or mucoviscidosis, a total IgE > 1000 UI / ml ml and a specific Aspergillus IgE> 0,35 KUA /l, associated with two of the following: a positive Aspergillus precipintin test, a characteristic CT-scan and a blood eosinophilia > 500 cells / μ moL (without taking corticoids). The treatment is based on reduction of the local inflammation by systemic corticoids and on the decrease of mycelial proliferation during exacerbations by Itraconazole. The prevalence of severe asthma with fungal sensitisation (SAFS) is about 30 % and the use of azoles should be time-limited and reserved for refractory situations in severe asthma.

Depressed Hypoxic and Hypercapnic Ventilatory Responses (dHVR and dHCVR) Occur in Mice at the Late Stage of Lethal Avian Influenza A (H5N1) Virus Infection

H5N1 viral infection results in ~60% mortality in patients primarily due to respiratory failure, but the relevant mechanisms are unclear. Lethal H5N1 viral infection produced dHVR and dHCVR without significant changes in body weight (BW), body temperature (BT), arterial blood gases, and pulmonary inflammation 2-3 days post-infection in mice (AJRCCM 2013). Here we tested the development of dHVR/dHCVR and disorders of pulmonary functions, leading to respiratory failure at the late stage of infection. The mice were intranasally inoculated with vehicle, 100 PFU HK483 (lethal strain) or HK486 virus (nonlethal strain). At 1 day before or post-inoculation days (PID) 4, 5, 6 and 7, VE, HVR (7% O2 for 3 min) and HCVR (7% CO2 for 5 min) were measured in awake state followed by collecting arterial blood, BALF, the brain and lung after anesthesia/euthanasia. HK483 and HK486 mice showed a peak viral titer at PID4 that gradually declined thereafter. HVR and HCVR were similar in Ctrl and HK486 mice and were not changed over the infection period. At PID7, HK483 mice were very weak (all died one day later), and exhibited hypoventilation with hypoxemia and hypercapnemia; they also lacked HVR (no response) and HCVR (80%↓) with BW and BT declined by 31% and ~10 ºC, respectively. HK483 but not HK486 significantly decreased lung dry/wet ratio. Total cells in BALF increased in both infected groups, but the increase was more evident in HK483 than HK486 mice. Our data suggest that H5N1 viral infection-induced ventilatory and pulmonary disorders are viral strain-dependent and the gradual deterioration of dHVR and dHCVR may account for the mortality in HK483 mice (Supported by HL119683 and HL107462).

The epidemiology and prognostic factors of mortality in critically ill children with acute kidney injury in Taiwan

The incidence of acute kidney injury (AKI) in critically ill children varies among countries. Here we used claims data from the Taiwanese National Health Insurance program from 2006 to 2010 to investigate the epidemiological features and identify factors that predispose individuals to developing AKI and mortality in critically ill children with AKI. Of 60,338 children in this nationwide cohort, AKI was identified in 850, yielding an average incidence rate of 1.4%. Significant independent risk factors for AKI were the use of extracorporeal membrane oxygenation, mechanical ventilation or vasopressors, intrinsic renal diseases, sepsis, and age more than 1 year. Overall, of the AKI cases, 46.5% were due to sepsis, 36.1% underwent renal replacement therapy, and the mortality rate was 44.2%. Multivariate analysis showed that the use of vasopressors, mechanical ventilation, and hemato-oncological disorders were independent predictors of mortality in AKI patients. Thirty-two of the 474 patients who survived had progression to chronic kidney disease or end-stage renal disease. Thus, although not common, AKI in critically ill children still has a high mortality rate associated with a variety of factors. Long-term close follow-up to prevent progressive chronic kidney disease in survivors of critical illnesses with AKI is mandatory.

Angiostrongylosis-related restrictive pneumopathy assessed by arterial blood gas analysis in a dog

Pulmonary angiostrongylosis was diagnosed by the Baermann method and larval identification from faecal and bronchoalveolar lavage samples in a five-month- old male mongrel dog with dyspnoea and cough. Arterial blood gas analysis indicated arterial hypoxaemia and restrictive pneumopathy. In addition to the palliative treatment, fenbendazole was administered (50 mg/kg/24 h per os) for 14 days. The respiratory signs subsided within a short time clinically, but serial arterial blood gas analysis demonstrated an ongoing ventilation disorder. Repeated haematology, thoracic radiography, bronchoscopy and blood gas analysis were performed to follow the course of the disease. The most severe eosinophilia was detected after the beginning of the anthelmintic therapy, and the arterial pO2 level was permanently low. Arterial blood gas analysis provided the most adequate information about the course of the pneumopathy and it greatly facilitated the patient's medical management.