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Biomedical subjects

H Mal

Publications and source records attributed to H Mal.

63 records · Page 4Linked to original sources
PubMed1989

Unilateral lung transplantation in end-stage pulmonary emphysema.

Patients with end-stage pulmonary emphysema are usually proposed for either heart-lung or double-lung transplantation. The single-lung transplantation is reversed for patients with pulmonary fibrosis. Patients with emphysema are thought to be unsuitable for single-lung transplantation because of the ventilation-perfusion imbalance that is supposed to occur, the ventilation being preferentially distributed to the native lung when the perfusion is distributed to the transplanted lung. We now report a preliminary success with single-lung transplantation in two consecutive patients with end-stage pulmonary emphysema. Despite the persistence after transplantation of an obstructive syndrome, the clinical status was good, the blood gases were markedly improved, and ventilation-perfusion imbalance did not occur on lung scans. After discharge from the hospital, the patients could return to an almost normal life. Thus, our data support the feasibility of single-lung transplantation in patients with end-stage pulmonary emphysema, and we consider that single-lung transplantation could be the optimal form of lung transplantation in these patients.

Humans↗
PubMed1987

Effects of theophylline and enprofylline on diaphragmatic contractility.

Experimental data suggest that theophylline (T) enhances diaphragmatic contractility by increasing the influx of calcium at the cell membrane level through an inhibition of adenosine receptors (Aubier et al., J. Appl. Physiol. 54: 460-4, 1983). Enprofylline (E) is a xanthine drug that has poor ability to antagonize physiological actions of adenosine. The aim of this study was to compare the effects on diaphragmatic contractility of T and E in order to determine whether antagonism of adenosine receptors was the underlying mechanism of the inotropic effect of T on diaphragmatic contractility. Ten normal subjects were studied in the sitting position. The contractile properties of the diaphragm were assessed by measuring the transdiaphragmatic pressure (Pdi) generated at functional residual capacity during bilateral electrical stimulation of the phrenic nerves. The subjects were randomized, and after control measurements were performed, they received T or E. This was a double-blind crossover study, the measurements being repeated with the second drug after one week. Both drugs were administered intravenously with a loading dose of 6 and 2 mg/kg administered in 30 min for T and E and a maintenance dose of 0.9 and 0.075 mg.kg-1 X h-1 for T and E, respectively. Measurements were performed before and 60 min after T or E administration. Plasmatic levels of both drugs were also analyzed. In all the subjects, therapeutic levels of T or E were reached (14.8 +/- 0.6 and 3.9 +/- 0.42 mg/l for T and E, respectively, at 30 min).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

High frequency jet ventilation in acute respiratory failure: which ventilator settings?

Seven hypoxaemic patients with acute respiratory failure were ventilated with HFJV (Ventilator VS 600). Arterial oxygenation was improved in each patient by the increases induced in mean airway pressure (PAW) (to 20 cm H2O) using three different ventilatory settings applied in a random order: technique A: I:E ratio 0.43, driving pressure 2.9 bar, no PEEP; technique B: I:E ratio 1.0, driving pressure 1.9 bar, no PEEP; technique C: I:E ratio 0.43, driving pressure 1.8 bar, PEEP 11 cm H2O. Respiratory frequency was maintained at 250 b.p.m. throughout the study. There were no significant differences in PaO2 (FlO2 = 1) or Qs/Qt between the three techniques. In contrast, carbon dioxide elimination was markedly affected by the method used to increase PAW:PaCO2 was significantly higher during technique C (8.5 +/- 3.6 kPa) and technique B (6.6 +/- 2.1 kPa) than during technique A (4.8 +/- 0.9 kPa). Significant increases in cardiac index, heartrate, mean pulmonary arterial pressure and a decrease in the arterio-venous oxygen content difference were observed when PaCO2 increased. We conclude that, to obtain the PAW necessary to improve pulmonary oxygen exchange, more effective carbon dioxide elimination is achieved by increasing the driving pressure, rather than by increasing the I:E ratio, or using a PEEP valve.

Acute Disease↗
PubMed1986

Hemodynamic effects of high-frequency jet ventilation in patients with and without circulatory shock.

Nineteen critically ill patients with acute respiratory failure were studied to compare the hemodynamic effects of continuous positive-pressure ventilation (CPPV) and high-frequency jet ventilation (HFJV) at comparable levels of alveolar ventilation. Patients were divided into three groups: Group 1 included seven patients without circulatory shock in whom mean airway pressure (Paw) was slightly higher during CPPV than during HFJV (17.3 +/- 3.0 vs. 13.0 +/- 2.9 mmHg); Group 2 included six patients without circulatory shock in whom HFJV and CPPV were compared at the same level of Paw (19.2 +/- 5.0 mmHg); Group 3 included seven patients with circulatory shock in whom HFJV and CPPV were compared at the same level of Paw (16.0 +/- 3.9 mmHg). The following respiratory frequencies were used in HFJV: Group 1, 200 +/- 76 beats/min; Group 2, 238 +/- 103 beats/min; Group 3, 286 +/- 149 beats/min. In all patients comparable levels of PaCO2 were obtained with CPPV and HFJV. In Group 1 patients, mean arterial pressure, cardiac index, and stroke index were significantly higher during HFJV. In Group 2 patients, no significant difference was found between HFJV and CPPV. In Group 3 patients, the following hemodynamic variables were significantly higher during HFJV: mean arterial pressure (71 +/- 24 vs. 84 +/- 23 mmHg), cardiac index (3.6 +/- 1 vs. 4.1 +/- 1.41 X min-1 X m-2), and oxygen delivery (403 +/- 93 vs. 471 +/- 124 ml X min-1 X m-2).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMedDate not supplied

[Bronchiolitis obliterans after lung transplantation].

Lung transplantation has become a realistic treatment in some patients with severe respiratory impairment or severe pulmonary arterial hypertension. Immunosuppression therapy is about the same in all transplantation units and includes cyclosporin, corticosteroids and azathioprine. The diagnosis of acute rejection episodes has been greatly facilitated by the histological study of transbronchial biopsies obtained by endoscopy. Improvements in the short-term prognosis of these patients have made it possible to individualize an unusual and delayed complication: bronchiolitis obliterans. This progressive and diffuse obstruction followed by destruction of the transplant's bronchioles is interpreted as a consequence of chronic rejection. The diagnosis of bronchiolitis obliterans is difficult and rests essentially on degradation of the respiratory function resisting to increased immunosuppression. Some viral infections perhaps contribute to its development, and it may be so severe as to require another lung transplantation.

Bronchiolitis Obliterans↗