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The physiology of electrical activation of the diaphragm is reviewed, with emphasis upon the respiratory mechanics of the diaphragm and its action upon other respiratory structures. The application of diaphragm pacing is discussed in terms of candidate selection, evaluation, and its future as a treatment modality for respiratory insufficiency.
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A patient with dyspnoea was found to have a complete diaphragmatic paralysis due to a bilateral phrenic nerve lesion, without evidence of a generalized neuromuscular disease. The functional sequelae of breathing with intercostal and auxiliary inspiratory muscles were studied in the patient both while awake and asleep. This we believe is the second case of idiopathic bilateral paralysis of the diaphragm described in the literature.
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Diets containing protein levels of 8, 12, and 22% were fed for 14 days to Fischer 344 male weanling rats. Enzyme activities in liver and kidney were measured using several substrates for each of the following enzyme systems: Cytochrome P-450-dependent monooxygenase, ester hydrolysis, and conjugations with sulfate, glutathione, and glucuronic acid. Enzyme activities, for the various mechanisms, decreased from 15 to 65% with decreased dietary protein, with the exception of glucuronide and sulfate conjugation, which increased with decreased dietary protein. In vivo effects were evaluated by measuring hexobarbital sleeping time, procaine paralysis time, and bromobenzene hepatotoxicity. Increased dietary protein shortened hexobarbital sleeping time and procaine paralysis time, and increased procaine lethality, whereas low protein intake protected against bromobenzene hepatotoxicity. These data suggest that typical laboratory diets (22-25% protein) may provide artificially altered activities of xenobiotic biotransformation in rats, relative to nutritionally adequate (12% protein) diets.
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We describe a patient with obstructive sleep apnea (OSA) who is unusual in two respects: 1) rapid development of severe OSA over a period of two to four months, and 2) direct temporal association between development of OSA and mediastinal surgery complicated by unilateral paralysis of the phrenic nerve and the recurrent laryngeal nerve.
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