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Biomedical subjects

J M Shneerson

Publications and source records attributed to J M Shneerson.

At least 19 recordsLinked to original sources
PubMed2005

Vocal fold palsy due to plombage for tuberculosis.

A 67-year-old patient, who had previously undergone Lucite ball plombage for pulmonary tuberculosis, presented with a hoarse voice, intermittent stridor and breathlessness. Direct laryngoscopy confirmed a left vocal fold palsy. A left supraclavicular mass became apparent and a computerized tomograph (CT) scan showed that a Lucite ball had migrated into her supraclavicular fossa. Subsequently she developed left arm pain and weakness. The balls were removed surgically, following which her arm symptoms improved but her voice remained unchanged. Migration of implanted material should be considered when new symptoms appear in patients who have undergone plombage treatment.

Aged↗
PubMed2003

Increased ventilation with NiIPPV does not necessarily improve exercise capacity in COPD.

Evidence that noninvasive intermittent positive-pressure ventilation (NiIPPV) improves exercise capacity in chronic obstructive pulmonary disease (COPD) is limited. The effectiveness of different ventilators in this setting has not been studied. Three bilevel pressure support ventilators (Bipap S/T 30, Nippy2 and Vpap II ST), applied via a mouthpiece, were compared during submaximal treadmill exercise in eight subjects with COPD. Subjects walked to exhaustion with each of the ventilators and while breathing through the mouthpiece alone, in random order. In addition, four unencumbered walks were performed. The unencumbered distance (mean +/- SD) walked was 259 +/- 123 m. With the mouth-piece alone this decreased to 211 +/- 96 m and fell further to 145 +/- 76 m with NiIPPV. There was no difference between the brands of ventilator. At the break-point of exercise, significant increases were seen in tidal volume and minute ventilation in the ventilator walks compared with the mouthpiece alone. Noninvasive intermittent positive-pressure ventilation increased ventilation but did not improve exercise capacity in the subjects in this study. No significant differences were seen between the ventilators. The effectiveness of this technique and the optimal method of assistance require further clarification.

Aged↗
PubMed2002

Narcolepsy and psychopathology: is there an association?

BACKGROUND: It is widely believed that patients with narcolepsy show high rates of associated psychiatric disturbance, especially schizophrenia and depression. However, surveys have produced conflicting findings and have not addressed the potential confounding effects of stimulant drug treatment. METHOD: Forty-five patients with narcolepsy attending a sleep disorder clinic and 50 matched normal controls underwent structured psychiatric interview. Using a 'lifetime' approach, psychiatric symptoms and diagnoses were established for both groups. RESULTS: Four of the narcolepsy patients but none of the controls had experienced psychotic symptoms. All four patients were taking amphetamines, and the symptoms resolved when the dose was lowered or treatment was changed to modafinil. The lifetime frequency of various depressive syndromes did not differ significantly between the groups. CONCLUSIONS: Contrary to previous claims this study found little to suggest that narcolepsy is associated with schizophrenia. Nor, despite its serious social and occupational consequences, does narcolepsy appear to be associated with an increased frequency of diagnosable depressive disorders.

Journal Article↗
PubMed2002

An overnight comparison of two ventilators used in the treatment of chronic respiratory failure.

Differences between bilevel ventilators used for noninvasive intermittent positive pressure ventilation (NIPPV) have been demonstrated during bench testing. However, there are no clinical studies comparing these machines. The authors have previously shown that the Quantum pressure support ventilator and Sullivan variable positive airway pressure II ST differ in performance during bench testing. To examine the clinical significance of this, these two machines were compared in the overnight treatment of subjects with chronic respiratory failure. Ten clinically-stable subjects with thoracic scoliosis were recruited. The subjects were already established on NIPPV, but none were using either of the ventilators to be tested. After familiarisation, the patients used the two ventilators in random order on consecutive nights. Peripheral oxygen saturation and transcutaneous carbon dioxide tension (Pt,CO2) were measured continuously, and sleep was recorded using polysomnography. There were no significant differences in arterial oxygen saturation, Pt,CO2 or sleep duration and quality between the two nights. Despite previously illustrated variation in laboratory performance, no differences were seen between the two ventilators when comparing overnight gas exchange and sleep in vivo. Further study is required to evaluate the significance of the differences found during bench testing in the clinical setting.

Adult↗
PubMed2002

Noninvasive ventilation for chest wall and neuromuscular disorders.

Neuromuscular and chest wall disorders are individually uncommon but together form an important group of conditions that can lead to chronic ventilatory failure. This is best recognised in scoliosis, kyphosis, following a thoracoplasty, in muscular dystrophies, such as Duchenne muscular dystrophy (DMD), and myotonic dystrophy, after poliomyelitis and with motor neurone disease (amyotrophic lateral sclerosis). If bulbar function is impaired, tracheostomy ventilation may be required, but in other situations, noninvasive ventilation is preferable. Positive pressure techniques using nasal and face masks are usually the first choice, but negative pressure ventilation is an alternative. There are no randomised-controlled trials regarding the indications for initiating noninvasive ventilation, but this is usually provided if there are symptoms due to nocturnal hypoventilation or right heart failure in the presence of a raised carbon dioxide tension in arterial blood (Pa,CO2) either at night or, more usually, in the daytime as well. There is no evidence that "prophylactic" ventilatory support is of benefit if this is provided before ventilatory failure has appeared. Careful selection of patients is required, especially in the presence of progressive neuromuscular disorders such as DMD and motor neurone disease. There are no randomised-controlled trials concerning the outcome of noninvasive ventilation in these conditions, but studies have shown an improved quality of life, physical activity and haemodynamics, normalisation of blood gases and slight improvement in other physiological measures, such as the vital capacity and maximal mouth pressures. Survival in chest wall disorders is approximately 90% at 1 yr and 80% at 5 yrs, and similar figures have been obtained in nonprogressive neuromuscular conditions. If, however, the underlying disorder is deteriorating, particularly if it involves the bulbar muscles, it may limit survival despite the provision of adequate noninvasive ventilatory support.

Humans↗
PubMed2001

Health-related quality of life in narcolepsy.

Narcolepsy is a chronic sleep disorder characterised by symptoms of excessive daytime sleepiness and cataplexy. The aim of this study was to describe the health-related quality of life of people with narcolepsy residing in the UK. The study comprised a postal survey of 500 members of the UK narcolepsy patient association, which included amongst other questions the UK Short Form 36 (SF-36), the Beck Depression Inventory (BDI), and the Ullanlinna Narcolepsy Scale (UNS). A total of 305 questionnaires were included in the final analysis. The results showed that the subjects had significantly lower median scores on all eight domains of the SF-36 than normative data, and scored particularly poorly for the domains of role physical, energy/vitality, and social functioning. The BDI indicated that 56.9% of subjects had some degree of depression. In addition, many individuals described limitations on their education, home, work and social life caused by their symptoms. There was little difference between the groups receiving different types of medication. This study is the largest of its type in the UK, although the limitations of using a sample from a patient association have been recognised. The results are consistent with studies of narcolepsy in other countries in demonstrating the extensive impact of this disorder on health-related quality of life.

Adolescent↗
PubMed2001

Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patients with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness.

BACKGROUND: It has been suggested that cough effectiveness can be improved by assisted techniques. The effects of manually assisted cough and mechanical insufflation on cough flow physiology are reported in this study. METHODS: The physiological actions and patient self-assessment of manually assisted cough and mechanical insufflation were investigated in 29 subjects (nine normal subjects, eight patients with chronic obstructive pulmonary disease (COPD), four subjects with respiratory muscle weakness (RMW) with scoliosis, and eight subjects with RMW without scoliosis). RESULTS: The peak cough expiratory flow rate and cough expiratory volume were not improved by manually assisted cough and mechanical insufflation alone or in combination in normal subjects. The median increase in peak cough expiratory flow in subjects with RMW without scoliosis with manually assisted cough alone or in combination with mechanical insufflation of 84 l/min (95% confidence interval (CI) 19 to 122) and 144 l/min (95% CI 14 to 195), respectively, reflects improvement in the expulsive phase of coughing by these techniques. Manually assisted cough and mechanical insufflation in combination raised peak expiratory flow rate more than either technique alone in this group. The abnormal chest shape in scoliotic subjects and the fixed inspiratory pressure used made effective manually assisted cough and mechanical insufflation difficult in this group and no improvements were found. In patients with COPD manually assisted cough alone and in combination with mechanical insufflation decreased peak expiratory flow rate by 144 l/min (95% CI 25 to 259) and 135 l/min (95% CI 30 to 312), respectively. CONCLUSIONS: Manually assisted cough and mechanical insufflation should be considered to assist expectoration of secretions in patients with RMW without scoliosis but not in those with scoliosis.

Adolescent↗
PubMed2001

Functional differences in bi-level pressure preset ventilators.

The performance of four bilevel positive pressure preset ventilators was compared. The ventilators tested were; BiPAP ST30 (Respironics); Nippy2 (B + D Electrical); Quantum PSV (Healthdyne); and Sullivan VPAP H ST (Resmed). A patient simulator was used to determine the sensitivity of the triggering mechanisms and the responses to a leak within the patient circuit, and to changes in patient effort. Significant differences (p <0.05) between the devices were seen in the trigger delay time and inspiratory trigger pressure. When a leak was introduced into the patient circuit, the fall in tidal volume (VT) was less than ten per cent for each ventilator. The addition of patient effort produced a number of changes in the ventilation delivered. Patient efforts of 0.25 s induced a variable fall in VT. An increase in VT was seen with some ventilators with patient efforts of 1 s but the effect was variable. Trigger failures and subsequent falls in minute volume were seen with the BiPAP and the Nippy2 at the highest respiratory frequency. Differences in the responses of the ventilators are demonstrated that may influence the selection of a ventilator, particularly in the treatment of breathless patients with ventilatory failure.

Humans↗
PubMed2000

Clinical and radiological characteristics of lung disease in inflammatory bowel disease.

The pulmonary associations of inflammatory bowel disease (IBD) are poorly characterized. The clinical, physiological and high-resolution computed tomographic thorax characteristics of the lung disease in patients with IBD presenting with respiratory symptoms are described. Detailed clinical information was obtained and standard pulmonary physiological tests and thorax high-resolution computed tomography performed on 14 patients with ulcerative colitis (UC) and three with Crohn's disease (CD), 10 male, aged 38-83 yrs. Respiratory symptoms had been present for 2-50 yrs and extraintestinal manifestations were present in three (17.6%). Normal pulmonary physiology (six patients) was associated with the high resolution computed tomographic changes of bronchiectasis, mosaic perfusion and air trapping suggestive of obliterative bronchiolitis and a pattern of centrilobular nodules and branching linear opacities ("tree in bud" appearance) suggestive of either cellular bronchiolitis or bronchiolectasis with mucoid secretions. Bronchiectasis was found in 13 patients (11 UC, 2 CD), 11 had air trapping and five had a "tree in bud" appearance on computed tomography. One patient had a predominantly peripheral reticular pattern at the lung bases similar to that found in cryptogenic fibrosing alveolitis and one patient had a mixed reticular and ground-glass pattern in the midzones with a patchy distribution in the central and peripheral portions of the lungs with air trapping. Eleven patients (three with alveolitis) exhibited a clinical and/or physiological response to steroids. Pulmonary abnormalities in ulcerative colitis and Crohn's disease can present years after the onset of the bowel disease and can affect any part of the lungs. Early recognition is important as they can be strikingly steroid-responsive.

Adult↗
PubMed1998

Mask intermittent positive pressure ventilation in chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease.

Noninvasive ventilation in chronic obstructive pulmonary disease (COPD) has been shown to improve arterial blood gases but its long-term role has not been established. We retrospectively studied 26 consecutive patients with hypercapnic ventilatory failure due to COPD in whom oxygen therapy caused worsening hypercapnia (defined as a rise in the daytime arterial carbon dioxide tension (Pa,CO2) to >8.0 kPa or nocturnal transcutaneous carbon dioxide tension (Ptc,CO2) to >9 kPa). All were treated with mask ventilation (15 with nasal and 11 face masks) at night and during daytime naps. Additional oxygen therapy was required in 15 patients. The mean annualized death rate was 10.8% with a 1 and 3 yr survival of 92 and 68%, respectively. After 1 yr the median daytime Pa,CO2 had fallen by 1.35 kPa and the arterial oxygen tension (Pa,O2) had risen by 2.4 kPa. In subjects not using additional oxygen the median overnight Sa,O2 rose by 12% and the Ptc,CO2 fell by 2.8 kPa after 1 yr. The haematocrit was significantly less than pretreatment at 6 months and 1 yr. Quality of life in the domain of role limitation by physical health (measured using the SF-36 questionnaire) improved significantly at 6 months. Survival in this selected group with clinically stable airflow obstruction unable to tolerate oxygen therapy and treated with noninvasive mask ventilation is better than historical controls and is comparable to those able to tolerate oxygen therapy. Poor survival was associated with a low forced expiratory volume in one second, a low body mass index and a high nocturnal transcutaneous carbon dioxide tension. No difference in survival was found between those treated with mask intermittent positive pressure ventilation alone or with mask intermittent positive pressure and supplementary oxygen therapy.

Adult↗
PubMed1998

Treatment of ventilatory failure in the Prader-Willi syndrome.

Hypercapnic respiratory failure is a common cause of death in the Prader-Willi syndrome. Its relationship to sleep-disordered breathing has not been established and there are no reports of its successful treatment. We have retrospectively reviewed the records of four patients with the syndrome, who developed ventilatory failure. Daytime arterial blood gas tensions and overnight oximetry traces before and during treatment were compared. Each patient had severe sleep-disordered breathing in association with daytime ventilatory failure. The median overnight mean arterial oxygen saturation (Sa,O2) was 82% and the median minimum was only 41.5%. Initial treatment was with nasal intermittent positive pressure ventilation, and in each case the daytime arterial blood gas tensions were normalized. The patients were maintained on nasal continuous positive airway pressure at night after discharge. Compliance has been good, and at last follow-up (after a median of 4.8 yrs) the daytime arterial gas tensions remained normal, while the median overnight mean arterial oxygen saturation was 95.5% and the median minimum was 84.5%. This study of patients with the Prader-Willi syndrome shows that daytime ventilatory failure is associated with sleep-disordered breathing. It can be reversed with nocturnal noninvasive ventilation and maintenance treatment with continuous positive airway pressure is well tolerated, with no deterioration in respiratory parameters.

Administration, Intranasal↗
PubMed1998

Rehabilitation in neuromuscular disorders and thoracic wall deformities.

The causes of neuromuscular disorders and thoracic wall deformities are often incurable, but there are a wide range of supportive treatments that have been introduced with the aim of improving the patient's quality of ife. There are very few studies evaluating these and as a result it is still uncertain what role they have. This review analyses the outcomes of and possible indications for these therapies. The importance of recognizing the needs of each individual patient is emphasized and the use of pulmonary rehabilitation programmes with a standard combination of treatments should be reconsidered.

Breathing Exercises↗