Vital Capacity Index Research Articles

Vital prognosis in intrathoracic sarcoidosis with special reference to pulmonary function and radiological stage

A follow-up of 254 patients with intrathoracic sarcoidosis has been carried out after a median of 27 yrs from the diagnostic admission. All patients could be traced. At the end of follow-up there was no excess mortality (80 deaths observed versus 65.5 expected). However, during the first 20 yrs of follow-up a slight excess mortality was seen. Thirty three out of the 80 deaths were related to sarcoidosis. No excess number of deaths from lung cancer or lymphoma was observed. Erythema nodosum was of no prognostic significance concerning survival. X-ray stage was related to survival with a significant excess mortality for stage 3. Early clearing of X-ray changes gave a favourable vital prognosis. Survival was related to lung function, and for forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC) index and total lung capacity (TLC) this relationship reached levels of statistical significance. In multivariate Cox regression models, with age and sex entered as covariates, the same parameters were found to be significant predictors of mortality. Patients with FEV1 < or = 50% predicted had an increased mortality risk of 4.2 (95% confidence interval 1.8-9.6) when compared to patients with FEV1 > 80% predicted. Likewise, patients with TLC < or = 80% predicted had a mortality risk of 2.6 (1.5-4.5) when compared to patients with TLC > 80% predicted. In conclusion, a modest excess mortality was observed during the first 20 yrs of follow-up. Furthermore, both X-ray staging and lung function at the time of diagnosis influenced long-term mortality in patients with intrathoracic sarcoidosis.

Risk Factor Dynamics, Mortality and Life Expectancy Differences between Eastern and Western Finland: The Finnish Cohorts of the Seven Countries Study

Prior studies have not accounted for male mortality being higher in east than west Finland. Efforts to identify the mechanisms producing higher mortality in the east, due primarily to cardiovascular diseases (CVD), initially focused on a search for new risk factors. An alternate approach is to examine the assumptions of the analysis. This was investigated using a model which described (a) changes in risk factors over time, (b) dependency of risk factor effects on age, and (c) interactions and nonlinear effects of risk factors on mortality. The model was applied to 25-year follow-up data from cohorts of eastern (N = 823) and western (N = 888) Finnish men using pulse pressure, diastolic blood pressure, body mass index, total cholesterol, vital capacity index, cigarette smoking, and heart rate as risk factors. At age 40, men in the west had a life expectancy 2.4 years higher. Of the difference 29% (0.7 years) was associated with area differences in risk factor means, variances, and their change with age. The remainder, 1.7 years, was associated with age differences in the relation of risk factor interactions to CVD mortality. Possible reasons for these differences, such as joint elevation of several risk factors inducing rapid progression of atherogenesis, are discussed. No significant area differences were observed for mortality from either cancer or other causes.

Alterations in Pulmonary Function Following Pneumonectomy for Bronchogenic Carcinoma

Twenty-one patients who underwent pneumonectomy for bronchogenic carcinoma at the Nashville Veterans Administration Hospital from November, 1977, to March, 1980, were evaluated with standard pulmonary function tests preoperatively and postoperatively. Twelve patients had Stage I disease, 4 patients had Stage II, and 5 patients had Stage III disease. The interval between the operative procedure and postoperative testing ranged from 2 to 33 months (mean, 12.4 months). Mean functional loss of pulmonary capacity after pneumonectomy was based on analysis of preoperative and postoperative forced vital capacity (FVC) and initial-second forced expiratory volume (FEV 1) indices. The mean functional loss as expressed by FVC was 41.5% after right pneumonectomy and 34.0% after left pneumonectomy. The mean functional loss as expressed by FEV 1 was 40.2% after right pneumonectomy and 38.3% after left pneumonectomy. The postoperative functional status of each patient was classified according to the New York Heart Association criteria. Nineteen of the 21 patients were in Class I or II preoperatively. Postoperatively, 10 patients were in Class I or II and 11 in Class III or IV. The results indicate that a postoperative FVC less than 2.5 liters and FEV 1 less than 1.5 liters are not compatible with active life.

Some biochemical indices of nutrition in treated cystic fibrosis patients

Postprandial levels of copper, ceruloplasmin, iron, total iron binding capacity, cholesterol, vitamin A, carotene, folic acid, vitamin C, albumin, and total globulins in plasma, of 25-OH-vitamin D in serum, and of glutathione reductase activity, an index of riboflavin status, in erythrocytes were determined in a group of 18 juvenile cystic fibrosis patients receiving specialized outpatient care with attention to diet, vitamin supplementation, and pancreatic enzyme replacement. Bone mineralization was assessed by radiographic and photon beam technique. In the plasma of cystic fibrosis patients, levels were elevated for copper, ceruloplasmin, total globins, and total proteins and were depressed for iron, vitamin D, vitamin A, carotene, and albumin. Cortical thickness was diminished in the patients, but bone density was not. For patients with cystic fibrosis, a relation was established between forced vital capacity and certain biochemical indices in plasma. As forced vital capacity decreased, plasma levels increased for copper, total globulins and total proteins and decreased for albumin.

Pulmonary Function Studies in Pulmonary Tuberculosis

Pulmonary function studies were made on 292 patients with pulmonary tuberculosis. All patients were divided into four groups, namely, those with normal ventilation (NV) restrictive ventilatory insufficiency (RVI) obstructive ventilatory insufficiency (OVI) and mixed ventilatory insufficiency(MVI) based upon vital capacity, timed vital capacity and air velocity index , and the functional characteristics of each group were compared.The incidence of NV has progressively decreased and that of MVI has progressively increased as the extent of the disease process progressed, as expected, and this was particularly true in female patients. However, the incidence of OVI was higher among male patients whereas that of RVI was higher among female patients regardless of the extent of the disease process. Vital capacity was within normal range in patients with NV and OVI but it was significantly decreased in those with RVI and MVI. Timed vital capacity in those with NV and RVI showed no deviation from that of normal value but significant decrease was noted in those with OVI and MVI. Air velocity index was within normal range or even higher than normal in patients with NV and RVI but it was lower in those with OVI and MVI. However, even in patients with OVI and MVI the mean values of air velocity index were well above the lower Iimit of the normal, suggesting that this test is not a very sensitive one for the detection of air trapping. Maximal breathing capacity was within normal limits in patients with NV but modcrately decreased in the remaining groups, particularly in those with MV I. Also notcd was a greater decrease in maximal breathing capacity in patients with RVI in comparison to those with OVI. thus suggesting that a decrease in the vcntilating area of the lung rather than airway obstruction playcd a more significant role in the production of ventilatory insufficiency in pulmonary tuberculosis. Changcs in breathing reservc ratio and ventilatory factor according to each type of ventilation were very similar to those of maximal breathing capacity.And the decreases in breathing reserve ratio and ventilatory factor were caused in most of cases by a decrease in maximal breathing capacity. Air trapping index and Leslie’s index not only showed no close correlation to timed vital capacity and air velocity index but even some controversy was present. lt was felt that air trapping index andLeslie's s index were not valuable tests for the diagnosis of air trapping. Changes in capacity ratio according lo each type of ventilation were very similar to those of air velocity index. Minute ventilation, oxygen consumption, ventilation equivalent and oxygen diffusion were approximate of the same range regardless of the type of ventilatory insufficiency.

Studies on the Effects of Various Types of Collapse Therapy and Pulmonary Resection upon Cardiopulmonary Function in Patients with Pulmonary Tuberculosis (1) : Pneumothorax and its Intrapleural Complications.

The effects of pneumothorax upon pulmonary function have been studied since long time ago, and many authors have reported their observations with spirometry and blood gas analysis. Some data have been reported upon the effects of pneumothorax on pulmonary circulation by the simple indirect methods; since venous catheterization was introduced in this field, a few authors have reported their studies using this method. But the author can not find a report in which the effects of pneumothorax upon cardiopulmonary function have been generally studied, nor studies on the pulmonary circulation in patients with intrapleural complications caused by pneumothorax. So this paper reports the present author's results upon these points.Methods : The venous catheterization was performed according a modified method of Cournand and Ranges. Pressures were recorded by means of Hamilton's optical manometer or Sanborn strain gauge electromanometer, and the arbitrary zeropoint of all pressures was the midpoint between the second cost-sternal angle and the corresponding point of back. Cardiac output was determined by the direct Fick principle. Alveolar O2 tension and arterial O2 and CO2 tension were determined by O2-CO2 Diagram reported by Rahn & Fenn. Alveolar ventilation was calculated by the following formula, provided that arterial CO2 tension was equal to alveolar CO2 tension. VA=VCO2/FAO2 and the work of right ventricle against pressure was calculated both by Riley's formula and by the present author's following formula.WR (Watanabe)=(mPAP-dRVP)×CO×0.1332 (joules/min) where mPAP=mean pulmonary arterial pressure (mmHg), dRVP=right ventricular enddiastolic pressure (mmHg), CO=cardiac output (1/min). Measurement of lung volume was carried out by means of Gebauer's spirometer, predicted vital capacity was calaulated by the Ebina's vital capacity index. Predicited maximum breathing capacity was calculated by multiplying predicted vital capacity by vital capacity-maximum breathing capacity ratio (VC/MBC) obtained by the present author's measurement of those who are free from cardiopulmonary diseases. The degree of lung collapse caused by pneumothorax was estimated by the dorso-ventral X ray film. When the collapsed area remained within one third of one lung, it was classified as slight ; when it was from one-third to two-thirds of one lung, moderate, and when it became over two-thirds of one lung, high. Patients were classified according to N T A criteria. Muscular exercise was performed with bicycle ergometer.The subjects were 18 patients under pneumothorax (group I) and 5 patients with its intrapleural complications (group II). And group 1 was divided into two groups, the one (group a) consisting of 11 patients under unilateral pneumothorax, and the other (group b) of 7 patients under bilateral pneumothorax (Table II).Results : 1. Group 1 : The decrease in vital capacity was relatively slight, alveolar ventilation ratio (VA/VE), diminished, and the latter decreased remarkably in group b (Table III). Arterial O2 tension showed negative correlation with A-a O2 tension gradient (Fig 1). Cardiac index was increased in most cases in group a, showing only slight decrease after air refill, while in group b it was decreased in many cases and decreased markedly again after air refill (Table V). The intrathoracic pressure during cardiac catheterization was almost similar to that during the first pneumothorax in 5 cases whereinformation was available on the first pneumothorax (Table VII).Right auricular pressure was normal in general, and in a few patients it even dropped clearly, while on the other hand it was elevated slightly after the air refill. [the rest omitted]

肺手術に関する心電図の臨床的研究 (第6報) : 肺切除術後1ヵ年間に於ける心電図変化の推移と肋膜の病変及び肺能力との関係

In this report the relations of postoperative changes in ECGs to adhesion and thickening of the surgically-attacked pleura, and to decrease of lung capacity were investigated periodically.METHODS Electrocardiographic examinations were done in the manner described in Report V. Postoperative pleural lesion was examined through X-ray pictures. Non-existence and very mild forms of pleural adhesion and thickening were taken as negative findings, while moderate and advanced forms as positive findings. Calculation of lung capacity was based on Ebina's vital capacity index, and decrease within (-) 50% of the standard vital capacity was regarded as negative, and that over (-) 50% as positive. The cases who were negative on the above-mentioned two points were recorded as having Pathologic Item (-); those who were positive on either of the two as having Pathologic Item (+1); and those who were positive on the both points as having Pathologic Item (+2).RETSULS AND CONCLUSIONS(1) Cases who preoperatively gave normal ECGs in a rest perisod and after exercise.i) In most cases of segmental resection rapid normalization of ECGs occurred together with improvement of pleural lesion and lung capacity in the 6th postoperative month.ii) In cases of lobar resection ECGs showed gradual improvement parallel to that of pleural lesion and lung capacity 6 months after operation.iii) In cases of total resection no significant improvement was noted in ECGs and clinical symptoms. Also with ECGs taken after exercise the same relationship was demonstrated to exist between ECGs and clinical symptoms.(2) The cases who before operation were electrocardiographically normal in a rest period, but not after exercise, and those who were abnormal in a rest period as well as after exercise continued to show the same electrocardiographic abnormalities even 6 months after operation in spite of improvement of pleural lesion and lung capacity. That is, in these cases no parallel relationship was established between improvement of clinical symptoms and that of ECGs. In a few cases of segmental resection, however, the parallel relationship was noted.