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S Nava

Publications and source records attributed to S Nava.

At least 73 records · Page 4Linked to original sources
PubMed1997

Human and financial costs of noninvasive mechanical ventilation in patients affected by COPD and acute respiratory failure.

STUDY OBJECTIVES: It has been suggested that noninvasive mechanical ventilation (NIMV) may be a time-consuming procedure for medical and paramedical personnel. We carried out a prospective trial in 10 consecutive COPD patients aimed at assessing the human and economic resources needed to ventilate patients by NIMV and we compared these with those needed by a group of six patients receiving invasive mechanical ventilation (InMV). DESIGN: The daily cost and the minutes spent by medical doctors (MDs), respiratory therapists (RTs), and nurses (Ns) were recorded during the first 48 h of ventilation in 10 patients during NIMV (group A) and in six who received InMV (group B) after an initial unsuccessful attempt with NIMV. In two subgroups of patients (five for group A and four for group B), the analysis was also performed, except for RTs, for the total length of mechanical ventilation. SETTING: A respiratory ICU. PATIENTS: At hospital admission, the two groups of COPD patients did not differ for blood gas values (PaCO2 = 88.2+/-9.8 mm Hg for group A vs 90.5+/-12.8 mm Hg for group B, and pH = 7.21+0.08 vs 7.20+0.08, respectively) or for clinical and neurologic status, but patients of group B had not tolerated NIMV. MEASUREMENTS AND RESULTS: The total time spent at the bedside in the first 6 h did not differ between group A and B (group A = 72.3 min [MD], 87.2 min [RT], and 178.8 min [N] vs 98.8 min [MD], 12.5 min [RT], and 197.6 min [N] for group B). In the following 42 h, a plateau was reached so that there was a significant reduction for both groups in the time of assistance given by Ns (p<0.001) but not by MDs or RTs. The total costs were also not different between the two groups ($806+/-73 [US dollars per day] vs $864+/-44 for group A and B, respectively). In the subgroups monitored for the entire period of ventilation, a significant reduction in the time of assistance, for both MDs and Ns, was observed after approximately the first half. CONCLUSIONS: We conclude that in the first 48 h of ventilation, daily NIMV is neither more expensive nor time-consuming and staff demanding than InMV. After the first few days of ventilation, NIMV was significantly less time-consuming than InMV, for MDs and Ns, so that medical and paramedical time expenditure seems not to be a major problem during NIMV.

Acute Disease↗
PubMed1997

Scoring of severity in patients admitted to a respiratory intensive care unit.

A number of attempts have been made to develop measures of severity of illness for patients in the intensive care unit (ICU), but the impact of these indices in a Respiratory Intensive Care Unit (RICU) has not really been studied. At present, outcome can be accurately predicted in approximately 85% of ICU patients, while no data are available for the RICU. These indices will be reviewed in the article. The sophisticated Mortality Probability Model (MPM) II is used to predict the outcome of ICU patients. This technique is based on statistically-derived weights for its variables. The "most popular" indices are the Acute Physiology and Chronic Health Education (APACHE), the Simplified Acute Physiological Score (SAPS) and the Therapeutic Intervention Scoring System (TISS). Overall, the predictive accuracy of the latest APACHE III equation and score is rather good, but there are important limitations concerning its use in the RICU. The SAPS includes 17 variables, and can be considered as a simplified version of APACHE sharing with it the same problems of application. The TISS requires data on approximately 70 treatment variables and assigns each a score ranging 1-4. A high score represents serious intervention, while a low score illness requires much less medical or nursing intervention. The sum of these scores indicates severity of illness because more critical patients are presumed to require higher levels of interventions. The RICU is also characterized by the use of noninvasive mechanical ventilation (NMV) in the treatment of acute respiratory failure. Some indices able to predict the success of NMV, have been developed recently during a brief trial of NMV, and included the level of acidosis and hypercapnia.

APACHE↗
PubMed1997

[Hypokinetic arrhythmia, paradoxical chronotropic reaction and hypotension during dobutamine stress test].

AIM: The aim of this study was to evaluate the incidence of hypokinetic arrhythmias, bradycardiac (BR) and hypotensive reactions in a population of 775 patients during dobutamine stress test (DST): 281 patients (36.2%, group I) were symptomatic for thoracic pain without any history of coronary artery disease (CAD); 494 patients (63.8%, group II) were evaluated 3-4 weeks after an acute myocardial infarction (AMI) to stratify ischemic risk. None of these patients was receiving coronarodilating therapy. MATERIALS AND METHODS: DST was performed using an infusion of 5, 10, 20, 40 micrograms/kg/min for 5 minutes during the first two stages and for 3 minutes during subsequent stages, and was accompanied by EKG and echocardiographic monitoring. BR was defined as severe when heart rate diminished more than 40 b/min, moderate when the decrease ranged between 20 and 39 b/min, and mild when the decrease was less than 20 b/min. RESULTS: A total of 34 (4.38%) BR were observed, 19 (55%) in group I and 15 (45%) in group II. BR were severe in 12 patients (35.9%), 3 with recent AMI (2 inferior and 1 anterior) and 9 without a history of CAD. Fifteen (45%) presented moderate BR, 8 with recent AMI (6 inferior and 2 anterior); 7 cases were in group I. Mild BR was observed in 7 patients (20%), 2 with recent AMI (1 inferior, 1 anterior), of which 5 were in group I. Episodes of junctional rhythm were also observed in 10 patients (29.4%) and 1 patient (2.9%) presented 2nd degree AV block during DST positive for ischemia. The mean duration of bradycardic episodes was 89.6 seconds (+/- 29.8) and only 3 patients (8.8%) presented significant hypotension. In 13 patients (38.2%) arrhythmia was observed during dobutamine-induced ischemia. In spite of the often severely diminished heart rate, no significant hypotension was evident during the bradycardiac episode in 19 patients (55%). Only one patient (2.9%) showed a decrease of more than 40 mmHg. CONCLUSIONS: In conclusion, we found that the incidence of BR during DST (4.38%) is higher than that reported in the literature; moreover, patients with recent inferior AMI showed a higher incidence of BR compared to patients with AMI in other sites (9 vs 4, p = n.s.). We feel that ischemia alone may not be responsible for hypokinetic arrhythmia during DST, but that dobutamine-induced neurovegetative reflexes may also contribute to the pathophysiological mechanisms underlying the phenomenon.

Adult↗
PubMed1997

A possible defective estimation of antineutrophil cytoplasmic antibodies in systemic lupus erythematosus due to the coexistence of periodontitis: preliminary observations.

The objectives of this study is to determine if periodontitis-related ANCA hinder the accurate estimation of this kind of autoantibodies in systemic lupus erythematosus (SLE), due to the frequent coexistence of SLE and periodontitis, and the high incidence of antineutrophil cytoplasmic antibodies (ANCA) in this periodontal condition. Thirty SLE, thirty periodontitis lacking systemic involvement patients, and twenty healthy controls were utilized in this study. The periodontal condition and the presence of ANCA in sera of all individuals was carefully evaluated. For ANCA determination an EIA assay was utilized, directed to a neutrophil granular extract and six neutrophil granule proteins. Sixty percent of SLE patients had periodontitis, and sixty-five percent were ANCA positive. Eighty three percent of all ANCA cases were coexisting with periodontitis. A significant association (p > 0.005) between periodontitis and ANCA was found (Chi Square Test). Fifty percent of the patients with periodontitis lacking systemic involvement were ANCA positive. The results obtained in this study suggest that the figures of ANCA previously reported for SLE, might be overestimated due to the inadvertent presence of periodontitis.

Adolescent↗
PubMed1996

Concurrent preoperative chemotherapy with 5-fluorouracil and mitomycin C and radiotherapy (FUMIR) followed by limited surgery in locally advanced and recurrent vulvar carcinoma.

To prospectively evaluate the feasibility and efficacy of neoadjuvant chemoradiotherapy locally advanced or recurrent vulvar carcinoma, 58 patients referring for primary (41) or recurrent (17) disease received preoperative external radiotherapy to a dose of 54 Gy, divided into two courses with an interval of 2 weeks. 5-Fluorouracil (750 mg/m2 daily for 5 days) and mitomycin-C (15 mg/m2 single bolus) were given at the start of each cycle. Wide local excision and inguinal lymphadenectomy were planned after treatment. Eighty-nine percent of patients completed the chemoradiotherapeutic treatment, whereas 72% underwent surgery. Objective responses were observed in 80% of vulvar diseases and in 79% of groin metastases. Pathologic complete response of both the vulvar and inguinal disease was confirmed in 13 patients (31%). Early severe toxicity was recorded in 3 patients and severe worsening of performance status in 3. Three deaths occurred shortly after treatment and at least one is directly related to toxic effects. This treatment allows good control of locally advanced and recurrent vulvar cancer with acceptable side effects. Further follow-up is required to determine the long-term outcome and the effectiveness of the surgical procedure.

Antibiotics, Antineoplastic↗
PubMed1996

Non-invasive mechanical ventilation in severe chronic obstructive lung disease and acute respiratory failure: short- and long-term prognosis.

OBJECTIVE: To evaluate the short- and long-term prognosis of patients with chronic obstructive lung disease (COLD) who had noninvasive mechanical ventilation (NMV) for acute respiratory failure (ARF). DESIGN: Retrospective study. SETTING: Two respiratory intermediate intensive care units. PATIENTS: Two groups of patients suffering from COLD and an ARF episode requiring mechanical ventilation. Group 1 (30 patients) was given NMV using face masks (aged 64 +/- 9 years; pH = 7.28 +/- 0.05; PaCO2 = 83 +/- 18 mmHg; PaO2/FIO2 = 141 +/- 61). Group 2 (27 patients) was composed of control patients (aged = 65 +/- 8 years; pH = 7.26 +/- 0.05; PaCO2 = 75 +/- 17 mmHg; PaO2/FIO2 = 167 +/- 41) given MV using endotracheal intubation (EI) when clinical and functional conditions had further deteriorated because the medical therapy failed and NMV was not available at the time. Causes of ARF were in group 1 and 2 respectively: pneumonia in 8 (27%) and 11 (41%), acute exacerbation of COLD in 19 (63%) and 14 (52%) and pulmonary embolism in 3 (10%) and 2 (7%) patients. MEASUREMENTS AND RESULTS: Success rate, mortality during stay in ICU (at 3 months and at 1 year), and the need for rehospitalization during the year following ARF were measured in this study. Group 1 showed a success rate of 74%, only 8/30 patients needing EI and conventional MV. In group 2, the weaning success was 74% (20/27 patients). The mortality for group 1 was 20% in IICU, 23% at 3 months and 30% at 1 year; and 26% for group 2 in ICU, 48% at 3 months and 63% at 1 year. Within each group 1-year mortality was greater (p < 0.01) in patients with pneumonia. The number of new ICU admissions during the follow-up at 1 year was 0.12 versus 0.30 in groups 1 and 2 respectively (p < 0.05). CONCLUSION: For patients suffering from COLD who have undergone ARF, avoiding EI by early treatment with NMV is associated with better survival in comparison to patients bound to invasive MV. Pneumonia as a cause of ARF may worsen the prognosis in both groups of patients.

Acute Disease↗
PubMed1996

Aspects of fetal physiology from 18 to 37 weeks' gestation as assessed by blood sampling.

OBJECTIVE: To construct reference ranges for fetal pH, oxygen pressure (PO2), and hematologic and biochemical blood constituents, which can be used to analyze changes with gestation and differences with maternal values, thus elucidating some aspects of fetal biology and the effects of the maternal and placental environments. METHODS: We assayed venous pH, PO2, hematocrit, glucose, uric acid, urea, creatinine, total protein, total and direct bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, alkaline phosphatase, lactic dehydrogenase, amylase, pseudocholinesterase, creatine kinase, triglycerides, and cholesterol concentrations in 157 fetuses and 134 mothers who underwent fetal blood sampling from 18 to 37 weeks' gestation. None of the fetuses was infected or had chromosomal, hematologic, or hormonal abnormalities. RESULTS: All the variables analyzed were similar in fetuses sampled at the placental cord insertion (n = 125) or at the intrahepatic vein (n = 32). Maternal and fetal concentrations of glucose (r = 0.79, P < .001), urea (r = 0.96, P < .001), creatinine (r = 0.83, P < .001), and uric acid (r = 0.94, P < .001) correlated significantly, and their differences exhibited significant changes: the maternal-fetal differences of glucose and urea increased, whereas those of uric acid and creatinine decreased with advancing gestation. Fetal pH and PO2 decreased with gestational age, whereas hematocrit increased, similar to what has been described previously. All of the other variables, with the exception of amylase and cholesterol, changed significantly during the investigated period of pregnancy. Gestational age explained at least 40% of the variance in values of fetal total protein, pseudocholinesterase, alanine aminotransferase, creatine kinase, and triglycerides, but only 3-25% of the variation in the remainder. Most enzymes were higher in the fetus than in the maternal circulation, and all except alkaline phosphatase increased with gestational age. The maternal-fetal glucose difference correlated significantly with hematocrit, pH, and PO2, independent of gestational age and independent of each other. CONCLUSION: With the exception of aspartate aminotransferase, all of the analyzed fetal variables were different from the maternal values, and most changed with gestational age. The mechanisms leading to these fetal specificities remain mostly uncertain, but the provision of reference ranges for several blood constituents may be useful in the differential diagnosis of fetal disease.

Adolescent↗
PubMed1996

Helicobacter pylori infections in IgA deficiency: lack of role for the secretory immune system.

During the last years considerable attention has been focused on the possibility of the development of an oral vaccine against Helicobacter pylori. However, Helicobacter infection is known to be life-long, despite a vigorous immune response, and the hypothesis that an increased local production of secretory IgA in the gastric mucosa, due to vaccination, should protect against the colonization of the bacterium may therefore be questioned. In this study, when comparing the seropositivity and titre against H. pylori in IgA-deficient patients and age-related normal blood donors, it appears that lack of secretory IgA does not seem to have any major influence on the prevalence of the infection, nor is it reflected in titres of specific IgG antibodies. These results many argue against a pivotal role for IgA in the defence against Helicobacter, and raise questions about current strategies for the development of an oral vaccine against H. pylori and may point to a need for alternative therapeutic strategies.

Adult↗
PubMed1996

The tension-time index of the diaphragm revisited in quadriplegic patients with diaphragm pacing.

The fatigue threshold of the human diaphragm, index of its endurance and fatigability, corresponds, during spontaneous breathing, to a tension-time index (TTdi = Pdi/Pdimax x T1/Ttot (i.e., the inspiratory time over the total breath duration) of 0.15 to 0.18. We studied three quadriplegic patients with diaphragm pacing in order to reassess this threshold in patients in whom the contribution of the other respiratory muscles is lacking. Transdiaphragmatic pressure (Pdi) was obtained from the difference between gastric (Pga) and esophageal (Pes) pressures while the electromyograms (EMG) of both hemidiaphragms were recorded with surface electrodes. Four runs at different TTdi were performed on different days in each subject, varying either the Pdi developed per breath, changing the frequency of stimulation, or the T1/Ttot. The time of fatigue was defined when Pdi decreased during the trials by 35% from baseline. No evidence of transmission fatigue (i.e., decline in action potential amplitude) was observed. The TTdi at which fatigue occurred in all the quadriplegic patients was around 0.10 to 0.12, well below the values previously described. After fatigue had occurred, the force recovery during the force-frequency curve was not complete after 2 h at low frequencies, whereas at high frequencies it was fully complete at 30 min. We conclude that when respiration is accomplished only by the diaphragm, without the contribution of the other respiratory muscles, the fatigue threshold is lower than previously reported.

Action Potentials↗
PubMed1996

Effects of acute steroid administration on ventilatory and peripheral muscles in rats.

Occasional case reports have shown that acute myopathy may occur in patients treated with massive doses of corticosteroids. The mechanism of this myopathy is poorly understood. Therefore, 60 male rats were randomly assigned to receive daily injection of saline (C), methylprednisolone (M), or triamcinolone (T) 80 mg/kg/d for 5 d. Nutritional intake, measured daily in 15 animals, showed a significant reduction of food intake in the steroid-treated groups (-50 and -79% in M and T, respectively). This was associated with a similar loss in body weight. In the 45 remaining animals, diaphragm contractility and histopathologic features of several muscles were studied. Weights of respiratory and peripheral muscles were similarly decreased after steroid treatment. Maximal twitches of the diaphragm were lower in the C group (653 +/- 174 g/cm(2)) than in the M group (837 +/- 171 g/cm(2); p < 0.05) and the T group (765 +/- 145 g/cm(2), NS). Half-relaxation time was prolonged in both steroid groups, and time to peak tension was longer with M, whereas tetanic tensions were similar. Steroid treatment also induced a leftward shift of the force-frequency curve at 25 and 50 Hz when compared with saline treatment (p < 0.05). ATPase staining of the diaphragm, scalenus medius, and gastrocnemius showed type IIb fiber atrophy in the steroid groups and also diaphragmatic type IIa atrophy with T, whereas histologic examinations revealed a normal muscular pattern with absence of necrosis. Finally, a pair-fed (PF) study, performed in 18 rats (C, T, and PF), showed that muscle atrophy was considerably less pronounced in PF animals than in T-treated animals. We conclude that (1) short-term treatment with massive doses of steroids induced severe respiratory and limb muscle wasting; (2) both types of steroids induced predominantly type IIb atrophy, resulting in the expected alterations in diaphragm contractile properties; (3) neither steroid caused muscle necrosis; (4) type IIb atrophy was not caused by acute nutritional deprivation alone.

Adrenal Glands↗
PubMed1996

Noninvasive mechanical ventilation improves the immediate and long-term outcome of COPD patients with acute respiratory failure.

Noninvasive positive pressure ventilation (NPPV) has been proposed in COPD patients with acute on chronic respiratory failure (ACRF) in order to avoid endotracheal intubation and to improve immediate outcome, but long-term outcome of this therapeutic approach is still undefined. We evaluated short- and long-term (1 year) outcome of early administration of NPPV in 24 patients with ACRF due to exacerbated COPD (Group A) in comparison with 24 matched historical-control patients treated conventionally (Group B). Patients of Group A were initially treated with NPPV via nasal mask in the presence of pH < or = 7.32, and/or Pa,O2 < 7.98 kPa, and/or Pa,CO2 > 7.18 kPa, plus signs of respiratory distress. In-hospital survival rate was not significantly different in Group A vs Group B, but the patients treated with NPPV showed an earlier improvement in blood gases and a better pH and respiratory rate at discharge. Only 2 patients of Group A needed endotracheal intubation as compared with 9 of Group B. Hospital stay was significantly reduced in survivors of Group A vs Group B. Further severe relapses of ACRF in Group A were treated using NPPV. The number and length of further hospitalizations for pulmonary exacerbations were significantly higher in Group B compared with Group A. The survival rate at 12 months was significantly lower in Group B than in Group A (50% vs 71%). In conclusion, NPPV administration in patients with ACRF due to exacerbated COPD improves not only immediate but also long-term outcome.

Acute Disease↗
PubMed1995

Elevated static compliance of the total respiratory system: early predictor of weaning unsuccess in severed COPD patients mechanically ventilated.

OBJECTIVE: To assess in a group of COPD patients mechanically ventilated for an episode of acute respiratory failure the respiratory mechanics with a simple and non invasive method at the bedside in order to evaluate if these parameters may be predictive of weaning failure or success. DESIGN: A prospective study. SETTING: Intensive care and intermediate intensive care units. PATIENTS: 23 COPD patients ventilated for acute respiratory failure and studied within 24 hours from intubation. METHODS: Using end-expiratory and end-inspiratory airway occlusion technique, we measured PEEPi, static compliance of the respiratory system (Crs, st) maximum respiratory resistance (Rrsmax) and minimum respiratory resistance (Rrsmin). MEASUREMENTS AND RESULTS: The weaned group (A) and the not weaned group (B) were not different regarding to static PEEPi (group A 8.5 +/- 4.0 vs group B 8.9 +/- 2.6 cmH2O), TO Rrsmax (22.4 +/- 5.3 versus 22.2 +/- 9.0 cmH2O/1/s) and to Rrsmin (17.6 +/- 5.5 versus 17.9 +/- 8.0 cmH2O/1/s), while a significant difference (p < 0.001) has been found in Cst, rs (62.7 +/- 17.% versus 111.6 +/- 18.0 ml/cm H2O). The threshold value of 88.5 ml/cmH2O was identified by discriminant analysis and provided the best separation between the two groups, with a sensitivity of 0.85 and a specificity of 0.87. CONCLUSION: Cst, rs measured non invasively in the first 24 h from intubation, provided a good separation between the patients who were successfully weaned and those who failed.

Acute Disease↗
PubMed1995

Respiratory response and inspiratory effort during pressure support ventilation in COPD patients.

OBJECTIVE: Pressure Support Ventilation (PSV) is now widely used in the process of weaning patients from mechanical ventilation. The aim of this study was to evaluate the effects of various levels of PS on respiratory pattern and diaphragmatic efforts in patients affected by chronic obstructive pulmonary disease (COPD). SETTING: Intermediate intensive care unit. PATIENTS: We studied ten patients undergoing PSV and recovering from an episode of acute respiratory failure due to exacerbation of COPD. METHODS: Three levels of PSV were studied, starting from the lowest (PSb) one at which it was possible to obtain an adequate Vt with a pH > or = 7.32 and an SaO2 > 93%. Then, PS was set at 5 cmH2O above (PSb + 5) and below (PSb-5) this starting level. Ventilatory pattern, transdiaphragmatic pressure (Pdi), the pressure-time product of the diaphragm (PTPdi), the integrated EMG of the diaphragm, static PEEP (PEEPi, stat), dynamic PEEP (PEEPi, dyn), and the static compliance and resistance of the total respiratory system were recorded. RESULTS: Minute ventilation did not significantly change with variations in the level of PS, while Vt significantly increased with PS (PS-5 = 6.3 +/- 0.5 ml/kg vs. PSb = 10.1 +/- 0.9 [p < 0.01] and vs. PS + 5 = 11.7 +/- 0.6 [p < 0.01]), producing a reduction in respiratory frequency with longer expiratory time. The best values of blood gases were obtained at PSb, while at PSb-5, PaCO2 markedly increased. During PSb and PSb + 5 and to a lesser extent during PSb-5, most of the patients made several inspiratory efforts that were not efficient enough to trigger the ventilator to inspire; thus, the PTPdi "wasted" during these inefficient efforts was increased, especially during PS + 5. The application of an external PEEP (PEEPe) of 75% of the static intrinsic PEEP during PSb caused a significant reduction in the occurrence of these inefficient efforts (p < 0.05). Minute ventilation remained constant, but Vt decreased, together with Te, leaving the blood gases unaltered. The PTPdi per breath and the dynamic PEEPi were also significantly reduced (by 59% and 31% of control, respectively, p < 0.001) with the application of PEEPe. CONCLUSION: We conclude that in COPD patients, different levels of PSV may induce different respiratory patterns and gas exchange. PS levels capable of obtaining a satisfactory equilibrium in blood gases may result in ineffective respiratory efforts if external PEEP is not applied. The addition of PEEPe, not exceeding dynamic intrinsic PEEP, may also reduce the metabolic work of the diaphragm without altering gas exchange.

Acute Disease↗
PubMed1995

Quantitative analysis of IgA-subclass antibodies against tetanus toxoid.

Sera were analysed for levels of IgA- and IgG-class and IgA-subclass antibodies against tetanus toxoid and synthesized, tetanus-toxoid, beta-chain peptides. Forty-five peptides, deduced from the amino-acid sequence of the tetanus-toxoid beta-chain, were synthesized, in order to analyse epitope-binding of antibodies. Monoclonal, human, anti-tetanus antibodies were used to evaluate the synthesized peptides. Five synthesized peptides, bound by high, medium or low levels of IgA antibodies, were selected for the quantification of IgA1 and IgA2 antibodies. A set of chimeric, IgA-subclass antibodies with NP-specificity were used to quantify the antigen-specific IgA-subclass antibodies in a novel assay. Antibodies against the synthesized peptides were predominantly of IgA1 subclass.

Adult↗
PubMed1995

Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success.

BACKGROUND: Non-invasive mechanical ventilation is increasingly used in the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to identify simple parameters to predict the success of this technique. METHODS: Fifty nine episodes of acute respiratory failure in 47 patients with COPD treated with non-invasive mechanical ventilation were analysed, considering each one as successful (78%) or unsuccessful (22%) according to survival and to the need for endotracheal intubation. RESULTS: Pneumonia was the cause of acute respiratory failure in 38% of the unsuccessful episodes but only in 9% of the successful ones. Success with non-invasive mechanical ventilation was associated with less severely abnormal baseline clinical and functional parameters, and with less severe levels of acidosis assessed during an initial trial of non-invasive mechanical ventilation. CONCLUSIONS: The severity of the episode of acute respiratory failure as assessed by clinical and functional compromise, and the level of acidosis and hypercapnia during an initial trial of non-invasive mechanical ventilation, have an influence on the likelihood for success with non-invasive mechanical ventilation and may prove to be useful in deciding whether to continue with this treatment.

Aged↗
PubMed1995

Hemidiaphragm dysfunction due to megacolon: functional recovery after colectomy.

We describe an uncommon case of hemidiaphragm dysfunction in a man with megacolon. The patient complained of exertional dyspnoea associated with a restrictive ventilatory impairment, a reduction in respiratory muscle force, and a left hemidiaphragm elevation on roentgenogram. During maximal inspiratory manoeuvre, the electromyograph (EMG) showed an abnormal pattern in the time of recruitment of the left hemidiaphragm, associated with a rapid decline in force. After abdominal surgery (total colectomy) a significant improvement in lung volumes was observed, together with a resolution of dyspnoea. Respiratory muscle force returned to normal values with a normal EMG, whilst the elevation of the left hemidiaphragm at radiography was still present, though to a lesser extent.

Colectomy↗
PubMed1994

Significance of sonographically detected second-trimester choroid plexus cysts: a series of 211 cases and a review of the literature.

A retrospective analysis of all fetuses with prenatally detected choroid plexus cysts, identified at our institution between 1988 and 1993, was performed. Cytogenetic data, associated sonographic findings, obstetric outcome and pediatric follow-up was obtained to determine the incidence of aneuploidy and the rate of associated congenital anomalies in second-trimester fetuses with this finding. There were 211 second-trimester fetuses identified with a choroid plexus cyst. Amniocentesis was performed in 175 (83%) and postnatal chromosome analysis was performed in one newborn. Follow-up data are available on 203 (96%). Of the 176 cytogenetically studied fetuses, eight (4.5%) were aneuploid (including four cases of trisomy 18). In four of the aneuploid fetuses, the choroid plexus cyst was the only abnormal sonographic finding identified (including one case of trisomy 18). From this study and a review of the literature, we confirm that choroid plexus cysts are a sonographic marker for trisomy 18, even when identified as an isolated finding in an otherwise normal-appearing fetus. We conclude that the detection of a choroid plexus cyst merits further careful evaluation of fetal anatomy and consideration of cytogenetic evaluation.

Journal Article↗