[Routine preoperative ECG of younger patients is not justified].
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Adult↗
Biomedical subjects
B Bake
Publications and source records attributed to B Bake.
Reduction of alveolar-capillary diffusion after inhalation of endotoxin in normal subjects.
Normal subjects were exposed to an aerosol of Escherichia coli endotoxin. Carbon monoxide diffusion (Dco), spirometry, blood neutrophils, white blood cells, and platelets were determined at various times thereafter. A significant decrease in Dco and an increase in blood neutrophils was found, with a maximum effect 4 to 8 h after exposure. Exposure to distilled water caused a tendency for Dco to decrease and a significant increase in blood neutrophils. No effect on spirometry or body temperature was detected. It is suggested that the changes observed represent an inflammation at the alveolar level that appears at dose levels of endotoxin below those which cause bronchoconstriction and fever.
Administration, Inhalation↗
Post-polio lung function.
Post-polio patients sometimes complain about the occurrence of breathing difficulties decades after the polio infection. We have examined 40 post-polio patients who have had respiratory or non-respiratory poliomyelitis for at least 30 years in an attempt to elucidate whether hypoventilation is common and to what extent certain symptoms and simple lung function tests are related to hypoventilation or incipient hypoventilation. We measured arterial blood gases, vital capacity (VC), maximal expiratory and inspiratory pressures (MEP, MIP) and CO2 rebreathing response. Symptoms were assessed by a yes/no questionnaire. Six patients required respiratory assistance at the onset of the disease. At present, two require nocturnal assisted ventilation. Two patients showed manifest hypoventilation; one of which required night-time ventilator, whereas the other patient had not required ventilatory assistance even at the onset of the disease. Significant correlation (p less than 0.05) was found between arterial carbon dioxide tension (a-PCO2) and VC, MEP and ventilation increase during CO2 rebreathing. A significantly higher a-PCO2 was found among those who required respiratory assistance at the onset of the disease, who admitted headache and who felt the cough ineffective. Low VC and low ventilatory increase during CO2 rebreathing and the presence of headache explained 45% of the variation in a-PCO2 in a multiple regression analysis. We conclude that manifest hypoventilation is rare in this unselected material of post-polio patients and that a vital capacity below 45-50% of predicted normal and the presence of frequent headaches indicate an increased risk to develop hypoventilation.
Adult↗
Lung function in adult idiopathic scoliosis: a 20 year follow up.
Severe idiopathic scoliosis may lead to respiratory failure, which can be treated by assisted ventilation. Twenty four patients with surgically untreated idiopathic scoliosis who had been examined in 1968 were re-examined in 1988 to assess changes in lung function and risk factors for respiratory failure. The patients were aged 15-67 years in 1968 and had a scoliotic angle of 10-190 degrees and a vital capacity of 1.0-6.0 litres. Spirometric values and scoliotic angles were determined in 1968 and 1988, and arterial blood gas tensions in 1988. The decline in spirometric values over the 20 years was of the same magnitude as the predicted decline due to aging. Arterial blood gas tensions in 1988 were strongly correlated with the scoliotic angles and spirometric indices recorded in 1968. Hypoxaemia and hypercapnia was seen in four patients in 1988 (then aged 43-67 years) and these were the four patients who had a vital capacity below 43% predicted in 1968. The remaining 20 patients had blood gas values within normal limits. Two further patients had died from respiratory failure before 1988, so a total of six patients had developed respiratory failure. In a multiple logistic analysis vital capacity expressed as % predicted in 1968 was the strongest predictor of the development of respiratory failure, followed by the scoliotic angle. Respiratory failure occurred only in patients who had a vital capacity below 45% predicted in 1968 and an angle greater than 110 degrees. Thus respiratory failure develops in adults with scoliosis with a large angle and a low vital capacity when normal aging reduces the ventilatory capacity further. Such individuals merit close follow up.
Adolescent↗
Swallowing problems in rheumatoid arthritis.
Twenty-nine female patients with definite or classical rheumatoid arthritis (RA) and 30 controls were investigated in order to evaluate oral symptoms, particularly xerostomia, and swallowing difficulties in RA by means of a questionnaire, physical examination, stimulated saliva secretion, labial salivary gland biopsy, esophageal manometry and laboratory blood tests. Xerostomia was reported by 6 patients (21%), compared with no-one in the control group. Four of these 6 patients had decreased stimulated saliva secretion, compared with 2 of the remaining 23 patients. Dysphagia was experienced by 8 patients (28%), compared with one control subject. Dysphagia was associated with disease severity. Esophageal manometry revealed a decrease of the amplitude of the peristaltic pressure complex in the proximal part of esophagus in the RA group, indicating dysfunction of the striated muscles. No correlation was found between dysphagia and esophageal manometry results.
Arthritis, Rheumatoid↗
Laryngeal involvement in rheumatoid arthritis.
Twenty-nine female patients with definite or classical rheumatoid arthritis (RA) and 30 controls were studied in order to assess the prevalence of laryngeal involvement in patients with RA and the occurrence of extrathoracic airway obstruction. Laryngeal involvement was assessed by physical examination including direct fiberoptic laryngoscopy, respiratory function tests and low-voltage radiography. Physical examination revealed laryngeal involvement in 17 RA patients (59%), extrathoracic airway obstruction was indicated by spirometry in 4 (14%) and radiography revealed pathological findings in 3 patients (10%). One or more signs of laryngeal involvement were found in 20 patients (69%). Symptoms of breathing difficulties were common (75%) among patients with laryngeal involvement. The erythrocyte sedimentation rate and class-specific rheumatoid factors were not correlated to laryngeal involvement.
Adult↗
The ability of noninvasive methods to detect and quantify laryngeal obstruction.
The ability of the noninvasive methods forced oscillation technique (Rosc), spirometry and flow-volume curves to detect and quantify laryngeal obstruction, using assessment of orolaryngeal (upper) airway resistance (Rol) as reference, was compared in 55 patients with various laryngeal diseases. Statistical analysis was performed by means of sensitivity/specificity, simple regression, stepwise regression and stepwise logistic regression. The results showed that the ability to detect a laryngeal obstruction was acceptable and that Rosc-Insp, peak inspiratory flow (PIF) and forced inspiratory volume in one second (FIV1) seemed to be the best variables for detection of a laryngeal obstruction. None of the studied noninvasive methods appeared to be adequate for quantification of laryngeal obstruction.
Airway Obstruction↗
[Light-caliber spirometers are preferred in physical check-ups].
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Calibration↗
Vascular effects of topically applied bradykinin on the human nasal mucosa.
To evaluate the vascular effects of topically applied bradykinin on the human nasal mucosa, 13 asymptomatic hay fever patients and 11 non-allergic subjects were challenged with diluent or bradykinin in three increasing doses. Mucosal blood flow was determined with the 133Xenon wash-out method and expiratory peak flow measurements used to assess nasal airway resistance before and after challenge. Nasal symptoms were recorded. Nasal secretion quantity was measured from preweighed paper handkerchiefs. Bradykinin induced a slight increase in nasal airway resistance which was similar in both allergic and non-allergic subjects. Nasal secretion was clearly increased after challenge with bradykinin compared with challenge with diluent in both allergic and non-allergic subjects. Bradykinin did not, however, induce any change in mucosal blood flow in either group. The present findings could be explained by direct effects of bradykinin on the vascular bed without reflex activity. Bradykinin would then induce an increase in vascular permeability with subsequent oedema formation and increased amounts of fluid on the mucosal surface. In contrast to allergen challenge, bradykinin challenge had no effect on the resistance vessels, changes of which had previously been shown to be largely reflex-mediated.
Administration, Topical↗
Long-term results with a simple surgical treatment of bilateral vocal cord paralysis.
Since 1979, we have treated patients suffering from bilateral vocal cord paralysis with laterofixation of one vocal cord, a simple and comparatively atraumatic method. To evaluate the long-term results of this method of laterofixation, 11 consecutive patients were examined at least 5 years postoperatively regarding breathing capacity, voice function, and swallowing ability. Breathing capacity was assessed by determination of orolaryngeal (upper) airway resistance and spirometry. Voice function was judged by two listening panels. Swallowing ability was studied by barium contrast radiography. Postoperative improvement of breathing capacity was, in most cases, found to be long lasting. Furthermore, there was no deterioration of voice function, nor were there aspiration problems during the postoperative follow-up period. We suggest this method of laterofixation as the treatment of choice in patients suffering from breathing difficulties due to bilateral vocal cord paralysis.
Aged↗
Respiratory function in chronic primary fibromyalgia.
Since patients with severe chronic primary fibromyalgia (CPF) report effort dyspnoea, respiratory function was studied in 87 consecutive women with CPF according to Yunus' criteria. Bernstein spirometry, maximum inspiratory (MIP) and expiratory (MEP) pressures were obtained in patients, and in a reference group of 61 healthy women. MIP was considerably lower in patients than in controls (3.6 +/- 2.0 vs. 8.0 +/- 2.2 kPa, p less than 0.0001), as was MEP (3.1 +/- 2.1 vs. 8.3 +/- 2.2 kPa, p less than 0.0001). Patients who had previously reported dyspnoea at a bicycle exercise test showed significantly lower values of respiratory pressures than patients without dyspnoea. Respiratory pressures were reproducibly low in CPF patients. Spirometric values were normal among patients and controls. We conclude that maximum expiratory and inspiratory pressures are low in CPF, a finding which may indicate respiratory muscle dysfunction in this syndrome.
Adult↗
Lung function and respiratory symptoms among workers in a soft paper mill.
The aim of the present cross-sectional study was to investigate whether long-term exposure to soft paper dust causes impairment of lung function. Exposed workers (n = 287) and referents (n = 79) were investigated, using spirometry and questionnaires. Personal samplings of total dust showed that the actual mean concentrations did not exceed 3 mg/m3. The exposed subjects were divided into three categories according to historical and present exposure to paper dust; low exposure, moderate exposure and high exposure. The study did not show any lung function impairment due to exposure to paper dust. However, the exposed subjects had a significantly increased prevalence of symptoms from both the upper and lower airways as well as an increased prevalence of reported asthma. On the basis of our study, we conclude that lung function impairment does not occur among workers exposed to mean levels of soft paper dust below 5 mg/m3.
Cross-Sectional Studies↗
The effect of topical nasal anaesthesia on allergen-induced symptoms, obstruction and blood flow.
The effect of topical anaesthesia on the nasal mucosa before and after allergen challenge was evaluated in 12 subjects with strictly seasonal allergic rhinitis. A single-blind randomized placebo-controlled design was used. The nasal challenge was carried out after pre-treatment of the nasal cavity with 52 mg of lidocaine/nasal cavity, or placebo applied topically in spray form. The number of sneezes was counted. The amount of nasal secretion was estimated by weighing used paper handkerchiefs. The capacitance and resistance vessel reactions were monitored by determining nasal peak flow and 133Xe wash-out respectively. After placebo pre-treatment the two doses of allergen induced moderate symptoms and vascular changes. Pre-treatment with local anaesthesia did not affect any of the symptoms nor did it affect the decrease in the tone of the capacitance vessels. It was found that topically applied lidocaine per se did not have any effect on nasal mucosal blood flow as measured using the 133Xe wash-out technique. However, the local anaesthesia did block the allergen-induced increase in the tone of the resistance vessels. In conclusion, a redundancy of systems appears to be involved in nasal allergic reactions. Although a reflex-induced mechanism may well play a significant role in the induction of the signs and symptoms of nasal allergic reactions, the redundancy of systems involved may well override any reduction in one single system, as appears to be the case in the present study. Lidocaine per se did not influence the nasal mucosal blood flow.
Administration, Topical↗
Dyspnoea in chronic primary fibromyalgia.
We investigated the prevalence of dyspnoea, according to a 5-grade score proposed by the World Health Organization (WHO), among 87 consecutive women (age 44.0 +/- 8.4, range 26-65 years), with severe chronic primary fibromyalgia (CPF). In total 73 women (84%) were dyspnoeic, 47, 17, six and four patients reported dyspnoea corresponding to WHO grades 1, 2, 3 and 4, respectively. In multivariate analysis WHO dyspnoea grade was the most important determinator of exercise capacity. The higher WHO dyspnoea grade reported, the lower exercise capacity and heart rate were reached at graded bicycle exercise tests (r = -0.48, P less than 0.001 and r = -0.40, P less than 0.001). WHO dyspnoea grade correlated directly to breathing frequency at rest (r = 0.45, P less than 0.001) and inversely to maximum inspiratory pressure (r = -0.29, P less than 0.01). It did not correlate with maximum expiratory pressure, nor with spirometric measurements of pulmonary function. It is concluded that dyspnoea is common among CPF patients and is not explained by cardiac or pulmonary causes, but may partly be due to diaphragmatic muscular insufficiency and physical inactivity.
Adult↗
Mucosal blood flow in the human nose following local challenge with histamine.
Nasal blood flow was measured using the 133Xe wash-out method in 10 non-allergic subjects and 13 asymptomatic hay fever patients. Determinations were made before and 15 min after challenge with diluent, 0.13 mg, 1.3 mg and 13 mg of histamine/nasal cavity. Nasal symptom scores were recorded. The nasal inspiratory peak flow was determined simultaneously in the hay fever patients. No differences in blood flow or symptom score recordings were found between the normal subjects and allergic patients under basal conditions or after histamine challenge. The nasal blood flow increased after challenge with the highest histamine dose. The increase was 34% (P less than 0.05) from baseline in normals and 47% (P less than 0.05) in allergics. There was a dose-dependent increase in nasal symptom scores following histamine challenge, again with no difference between normal and allergic subjects. The nasal peak flow decreased in a similar manner with a maximum decrease of 74% (P less than 0.001). The present study gives further support to the notion that histamine is not the only mediator involved in vascular reactions during allergic rhinitis.
Adult↗
Effects of topical treatment with H1 and H2 antagonists on clinical symptoms and nasal vascular reactions in patients with allergic rhinitis.
Fifteen asymptomatic subjects with allergic rhinitis participated in a double-blind, randomized, crossover, placebo-controlled study. The subjects were pretreated intranasally with a single dose of a selective H1 receptor antagonist, levocabastine, and/or selective H2 receptor antagonist, ranitidine, prior to a nasal allergen challenge. The nasal symptoms obtained at the challenge were assessed using a scoring technique 15 min after the allergen exposure. The nasal airway resistance was determined twice prior to and once after the allergen challenge using anterior rhinomanometry. The nasal mucosal blood flow was determined before and 15 min after allergen challenge using the 133Xe wash-out technique. After pretreatment with the H1 antagonist there was a statistically significant reduction in the number of sneezes and rhinorrhea compared to pretreatment with placebo. Pretreatment with the H2 receptor significantly decreased the rhinorrhea but not the sneeze. The nasal blockage was unaffected by both the H1 and the H2 antagonists. Pretreatment with the H1 and/or the H2 antagonists inhibited the reduction in the nasal mucosal blood flow induced by the allergen challenge to a significant degree. The present findings suggest that topical treatment with the highly selective histamine antagonist, levocabastine, inhibits allergen-induced reflex-mediated symptoms. H1 and H2 receptors do not appear to be involved in the regulation of the tone of the capacitance vessels. This indicates that a more complex mechanism participates in the induction of nasal blockage than the direct effect of histamine on H1 and H2 receptors on the capacitance vessels of the nasal mucosa alone. Both H1 and H2 receptors are of importance for the regulation of nasal mucosal blood flow during the allergic reaction.
Administration, Topical↗
Pulmonary function and symptoms after inhalation of endotoxin.
In previous experiments, a good relationship was demonstrated between the amount of airborne bacterial endotoxin and acute reactions after exposure to organic dusts. In the present study, 77 naive subjects were exposed to isolated endotoxin (IE) or endotoxin attached to bacterial cells (CE). Both preparations were obtained from Enterobacter agglomerans, which is a major bacterial species in many organic dusts. The major physiologic effect caused was a dose-related decrease in transfer factor, as measured by carbon monoxide diffusion. Half of the subjects reported fever and about one-third a subjective feeling of chest tightness. The exposure also caused a dose-related but small decrease in FEV1. A slightly increased bronchial reactivity was demonstrated at 4 h after endotoxin exposure. The minute volume after CO2 exposure was marginally affected. The results further support the conclusions from epidemiologic and experimental studies that the bacterial endotoxin is responsible for the acute reactions seen after exposure to many organic dusts, including that derived from cotton.
Aerosols↗
Lung function in workers exposed to soft paper dust.
In a cross-sectional study, 13 nonsmoking men with heavy exposure to paper dust were compared with 14 unexposed men, mainly office workers, employed at the same paper mill. They were studied using questionnaires, physical examinations, pulmonary function studies, and chest radiographs. Among those exposed there was an increased lung elastic recoil pressure (Pel) compared with controls which was significant (p less than 0.05) at the maximal level of total lung capacity (100% TLC). Furthermore, among the exposed workers there was also a significantly (p less than 0.05) decreased residual volume (RV). Two of the exposed men underwent lung biopsies, one of which showed fibrotic alveolar walls. Among the exposed there was also a significant (p less than 0.05) predominance of symptoms from the lower respiratory tract. We suggest that the observed pulmonary function impairment taken together with the histological examination of the lung biopsies are signs of a nonspecific reaction to high levels of paper dust.
Adult↗