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Correlation between standing height, sitting height, and arm span as an index of pulmonary function in 6-10-year-old children.

The present study evaluates the relationships of pulmonary volumes and flows and the anthropometric variables of standing height, sitting height, and arm span in 100 6-10-year-old children. To be included in the study, all children were required to be healthy and above the 3rd percentile of the curve of Tanner et al. (Arch Dis Child 1966;41:454-471; Arch Dis Child 1966;41:613-635) for height and weight. Standing height, sitting height, and arm span were measured according to standard protocol. The pulmonary function measurements were: tidal volume, minute respiratory volume, respiratory rate, expiratory reserve volume, inspiratory capacity, vital capacity, residual volume (RV), functional residual capacity, total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in 1 sec of FVC (FEV(1)), forced expiratory flow measured between 25-75% of FVC, and FEV(1)/FVC and RV/TLC ratios. Simple linear regression best expressed the correlation between pulmonary function and the anthropometric variables. Significant correlations between anthropometric and pulmonary function measurements were observed, with FVC and FEV(1) showing the highest and RV the lowest r(2) values. There was a significant positive correlation between standing height and arm span according to linear regression and Bland-Altman comparison (Bland and Altman, Lancet 1968;8:307-310). Our results suggest that when an accurate determination of standing height cannot be obtained, arm span could be used interchangeably, using the same regression equation. However, for patients with limb deformities, regression equations of pulmonary function measurements in relation to sitting height may be a better choice for estimating pulmonary function.

Anthropometry↗

Pulmonary responses during cold induced acute pain.

Cold induced acute pain is associated with many autonomic responses of the cardiovascular system, skin conductance and pupil size. However, there are few reports suggesting changes in pulmonary function. Hence present study reports preliminary data on this. Acute pain was induced in 30 non-smoker males, 30-50 yrs of age by immersing hand in cold water and their respiratory rate (RR), tidal volume (TV), inspiratory and expiratory reserve volumes (IRV, ERV) and respective capacities, vital capacity (VC), force vital capacity (FVC), FEV1%, peak flow and flow rates at 75%, 50% and 25% of expired volume (V75,50,25) were measured. Acute pain parameters like pain threshold, tolerance and sensitivity were also recorded. Besides these, heart rate, blood pressure (systolic and diastolic), skin temperature of forehead and opposite palm were also measured. Comparisons were made between values recorded before, during and after cold induced pain. An increase in RR, RV, IC, EC, FVC, FVC%, FEV1 was observed during cold induced pain reflecting an acute state of sympathetic dominance. Positive correlations between heart rate and respiratory rate, and other respiratory with pain parameters were seen during period of induction of acute pain. Hence the study indicates that alterations in pulmonary profile form a part of multidimensional responses observed during cold induced acute pain.

Acute Disease↗

NTP Toxicology and Carcinogenesis Studies of Talc (CAS No. 14807-96-6)(Non-Asbestiform) in F344/N Rats and B6C3F1 Mice (Inhalation Studies).

Talc ore may contain several other minerals including calcite, dolomite, magnesite, tremolite, anthophyllite, antigorite, quartz, pyrophyllite, micas, or chlorites. Talc products are sold in a multitude of grades which have physical or functional characteristics especially suited for particular applications, so occupational and consumer exposures to talc are complex. Epidemiology studies have suggested an association between non-fibrous talc and lung cancer risk. Talc was nominated by the National Institute of Occupational Safety and Health (NIOSH) for study by the NTP because of widespread human exposure and because of the lack of adequate information on its chronic toxicity and potential carcinogenicity. Toxicology and carcinogenicity studies of talc (non-asbestiform, cosmetic grade), a finely powdered hydrous magnesium silicate, were conducted by exposing groups of F344/N rats to aerosols for 6 hours per day, 5 days per week for up to 113 weeks (males) or 122 weeks (females). Groups of B6C3F1 mice were exposed similarly for up to 104 weeks. LIFETIME STUDY IN RATS: Groups of 49 or 50 male and 50 female rats were exposed to aerosols of 0, 6, or 18 mg/m(3) talc until mortality in any exposure group reached 80% (113 weeks for males and 122 weeks for females). These exposures were selected based on 4-week inhalation studies of the terminal lung talc burden in F344/N rats; concentrations greater than 18 mg/m(3) were expected to overwhelm lung clearance mechanisms and impair lung function. These exposure concentrations provided a dose equivalent of 0, 2.8, or 8.4 mg/kg per day for male rats and 0, 3.2, or 9.6 mg/kg per day for female rats. In a special study, additional groups of 22 male and 22 female rats were similarly exposed and examined for interim pathology evaluations or pulmonary function tests after 6, 11, 18, and 24 months and lung biochemistry and cytology studies after 24 months. The talc aerosols had a median mass aerodynamic diameter of 2.7 mm in the 6 mg/m(3) chamber and a median diameter of 3.2 mm in the 18 mg/m(3) chamber, with geometric standard deviations of 1.9 mm. However, there was a 7-week period beginning at study week 11 during which the chamber concentration for the 18 mg/m(3) rats varied from approximately 30 to 40 mg/m(3) because of difficulties with the aerosol concentration monitoring system. Further, there was a 12-week period beginning at approximately week 70 during which there were difficulties in generating the talc aerosol, and the chamber concentrations for rats and mice were substantially lower than the target concentrations. Survival, Body Weights, and Clinical Findings: The survival of male and female rats exposed to talc was similar to that of the controls. Mean body weights of rats exposed to 18 mg/m(3) were slightly lower than those of controls after week 65. No clinical findings were attributed to talc exposure. Pathology Findings: Absolute and relative lung weights of male rats exposed to 18 mg/m(3) were significantly greater than those of controls at the 6-, 11-, and 18-month interim evaluations and at the end of the lifetime study, while those of female rats exposed to 18 mg/m(3) were significantly greater at the 11-, 18-, and 24-month interim evaluations and at the end of the lifetime study. Inhalation exposure of rats to talc produced a spectrum of inflammatory, reparative, and proliferative processes in the lungs. Granulomatous inflammation occurred in nearly all exposed rats and the severity increased with exposure duration and concentration. Hyperplasia of the alveolar epithelium and interstitial fibrosis occurred in or near foci of inflammation in many exposed rats, while squamous metaplasia of the alveolar epithelium and squamous cysts were also occasionally seen. Accumulations of macrophages (histiocytes), most containing talc particles, were found in the peribronchial lymphoid tissue of the lung and in the bronchial and mediastinal Iymph nodes. In female rats, the incidences of alveolar/bronchiolar adenoma, carcinoma, and adenoma or carcinoma (combined) in the 18 mg/m(8 mg/m(3) group were significantly greater than those of controls. The incidences of pulmonary neoplasms in exposed male rats were similar to those in controls. Minor alterations attributed to talc exposure were also observed in the upper respiratory tract. Hyperplasia of the respiratory epithelium of the nasal mucosa in males and accumulation of cytoplasmic, eosinophilic droplets in the nasal mucosal epithelium in male and female rats occurred with a concentration-related increased incidence in the exposed groups. Adrenal medulla pheochromocytomas [benign, malignant, or complex (combined)] occurred with a significant positive trend in male and female rats, and the incidences in the 18 mg/m(3) groups were significantly greater than those of controls. Although adrenal medulla hyperplasia occurred with similar frequency among exposed and control females, the incidences of hyperplasia in exposed males were significantly lower than in controls. Lung Talc Burden: Lung talc burdens of male and female rats exposed to 6 mg/m(3) were similar and increased progressively from 6 to 24 months. Lung talc burdens of females exposed to 18 mg/m(3) also increased progressively from 6 to 24 months, while those of males exposed to 18 mg/m(3) remained about the same after 18 months. Lung burdens were generally proportional to exposure concentration at each interim evaluation. Pulmonary Function, Bronchoalveolar Lavage, and Lung Biochemistry: In exposed male and female rats there was a concentration-related impairment of respiratory function which increased in severity with increasing exposure duration. The impairment was characterized by reductions in lung volume (total lung capacity, vital capacity, and forced vital capacity), lung compliance, gas exchange efficiency (carbon monoxide diffusing capacity), and nonuniform intrapulmonary gas distribution. After 24 months, males exposed to 6 mg/m(3) talc had a significant increase in beta-glucuronidase and polymorphonuclear leukocytes; males exposed 18 mg/m(3) had significant increases in b -glucuronidase, lactate dehydrogenase, alkaline phosphatase, and total protein in bronchoalveolar lavage fluid. All exposed females had significantly increased a-glucuronidase, lactate dehydrogenase, alkaline phosphatase, total protein, and polymorphonuclear leukocytes; 18 mg/m(3) females also had significantly increased glutathione reductase. Viability and phagocytic activity of macrophages recovered from lavage fluid were not affected by talc exposure. Total lung collagen was significantly increased in rats at both exposure concentrations after 24 months, while collagenous peptides in lavage fluid and the percentages of newly synthesized protein from females, but not males, were also significantly increased at the 6 or 18 mg/m(3) levels. In addition, lung proteinase activity, primarily cathepsin D-like activity, was significantly greater in exposed males and females. Rats exposed to talc also had significant increases in collagenous peptides and acid proteinase in lung homogenates. 2-YEAR STUDY IN MICE: Groups of 47 to 49 male and 48 to 50 female mice were exposed to aerosols containing 0, 6, or 18 mg/m(3) talc for up to 104 weeks. These exposures were selected based on 4-week inhalation studies of the terminal lung talc burden in B6C3F1 mice; concentrations greater than 18 mg/m(3) were expected to overwhelm lung clearance mechanisms and impair lung function. These exposure concentrations provide a dose equivalent of 0, 2, or 6 mg/kg per day for male mice and 0, 1.3, or 3.9 mg/kg per day for female mice. In a special study, additional groups of 39 or 40 male and 39 or 40 female mice similarly exposed were examined for interim pathology evaluations, lung biochemistry, and cytology studies after 6, 12, and 18 months of exposure. The talc aerosols had a median mass aerodynamic diameter of 3.3 mm with a geometric standard deviation of 1.9 mm in the 6 mg/m(3) chamber, and a median diameter of 3.6 mm with a geometric standard deviation of 2.0 mm in the 18 mg/m(3) chamber. Further, there was a 12-week period beginning at approximately week 70 during which there were difficulties in generating the talc aerosol, and the chamber concentrations for rats and mice were substantially lower than the target concentrations. Survival, Body Weights, and Clinical Findings: Survival and final mean body weights of male and female mice exposed to talc were similar to those of the controls. There were no clinical findings attributed to talc exposure. Pathology Findings: Inhalation exposure of mice to talc was associated with chronic active inflammation and the accumulation of macrophages in the lung. In contrast to rats, hyperplasia of the alveolar epithelium, squamous metaplasia, or interstitial fibrosis were not associated with the inflammatory response in mice, and the incidences of pulmonary neoplasms in exposed and control groups of mice were similar. Accumulations of macrophages (histiocytes) containing talc particles were also present in the bronchial Iymph node. In the upper respiratory tract, cytoplasmic alteration, consisting of the accumulation of cytoplasmic eosinophilic droplets in the nasal mucosal epithelium, occurred with a concentration-related increased incidence in exposed male and female mice. Lung Talc Burden: Lung talc burdens of mice exposed to 6 mg/m(3) were similar between males and females and increased progressively from 6 to 24 months, except for males at 18 months. The lung talc burdens of mice exposed to 18 mg/m(3) were also similar between the sexes at each interim evaluation. Although the talc burdens of males and females increased substantially from 6 to 24 months, the values at 12 and 18 months were similar. Generally, lung burdens of mice exposed to 18 mg/m(3) were disproportionately greater than those of mice exposed to 6 mg/m(3), suggesting that clearance of talc from the lung was impaired, or impaired to a greater extent, in mice exposed to 18 mg/m(3) than in mice exposed to 6 mg/m(3). Bronchoalveolar Lavage and Lung Biochemistry: Increases in total protein, beta-glucuronidase, lactate dehydrogenase, glutathione reductase, total nucleated cells, and polymorphonuclear leukocytes in bronchoalveolar lavage fluid were observed primarily in mice exposed to 18 mg/m(3), although some parameters were also increased in mice exposed to 6 mg/m(3). The amount of collagenous peptides in lavage fluid and total lung collagen were increased in male and female mice exposed to 18 mg/m(3). Acid proteinase activity, principally cathepsin D-like activity, of lung homogenate supernatant fluid was also significantly increased in mice at the 18 mg/m(3) exposure concentration. CONCLUSIONS: Under the conditions of these inhalation studies, there was some evidence of carcinogenic activity of talc in male F344/N rats based on an increased incidence of benign or malignant pheochromocytomas of the adrenal gland. There was clear evidence of carcinogenic activity of talc in female F344/N rats based on increased incidences of alveolar/bronchiolar adenomas and carcinomas of the lung and benign or malignant pheochromocytomas of the adrenal gland. There was no evidence of carcinogenic activity of talc in male or female B6C3F1 mice exposed to 6 or 18 mg/m(3). The principal toxic lesions associated with inhalation exposure to the same concentrations of talc in rats included chronic granulomatous inflammation, alveolar epithelial hyperplasia, squamous metaplasia and squamous cysts, and interstitial fibrosis of the lung. These lesions were accompanied by impaired pulmonary function characterized primarily by reduced lung volumes, reduced dynamic and/or quasistatic lung compliance, reduced gas exchange efficiency, and nonuniform intrapulmonary gas distribution. In mice, inhalation exposure to talc produced chronic inflammation of the lung with the accumulation of alveolar macrophages. Synonyms: talcum; agalite; emtal 596; non-asbestiform talc; non-fibrous talc; steatite; hydrous magnesium silicate

Journal Article↗

Perfluorocarbon induced alterations in pulmonary mechanics.

Perfluorocarbon (PFC) compounds induce pulmonary hyperinflation and respiratory distress in some animals following intravenous administration. This study was designed to quantify the effects of two PFC emulsions on lung volumes and compliance and to identify the mechanism of pulmonary hyperinflation. New Zealand White rabbits received isotonic saline (3 ml/kg), Fluosol (15 ml/kg) or Oxygent (90% perfluorooctyl-bromide emulsion, 3 ml/kg). After seven days we measured functional residual capacity, vital capacity, lung compliance and thoracic gas volume. Gross and microscopic histologic examination of the lungs was performed. Functional residual capacity after Fluosol administration was 16.0 +/- 4.0 ml/kg, significantly greater than after saline (3.4 +/- 1.0 ml/kg) or Oxygent (4.0 +/- 1.4 ml/kg). Vital capacity was lower with Fluosol (30 +/- 5.0 ml/kg) than after saline (37 +/- 3.0 ml/kg) or Oxygent (37 +/- 2.0 ml/kg). Thoracic gas volume increased from 9 +/- 1.0 ml/kg (saline) to 16 +/- 13 ml/kg (Oxygent) and 33 +/- 7.0 ml/kg (Fluosol). Lung compliance was the same after saline (1.6 +/- 0.5 ml.cm H2O-1.kg-1) and Oxygent (1.5 +/- 0.3 ml.cm H2O-1.kg-1) but lower after Fluosol (0.9 +/- 0.1 ml.cm H2O-1.kg-1). Gross pathology demonstrated foam exudation from airways of animals receiving PFCs and intra-alveolar foam was identified by light microscopy. These results show intra-airway foam formation causes gas trapping and shifts tidal breathing to a less compliant region of the pressure-volume curve.

Animals↗

Effect of systemic venous hypertension on pulmonary function and lung water.

We studied the effects of systemic venous hypertension (SVH) of 25 cmH2O, with and without fluid overload (100 ml.kg-1.h-1 x 4 h), on the lung water content and pulmonary function of anesthetized dogs. SVH was produced by inflating a balloon in the right atrium. Pulmonary extravascular water (PEW) was measured by gravimetric techniques taking the water content of trapped blood into consideration. Subdivisions of lung volume, pulmonary resistance, dynamic compliance, and the single-breath nitrogen washout curve were performed in a body plethysmograph. Vascular pressures, serum oncotic pressure, and arterial blood gases were also measured. Systemic venous hypertension alone produced no change in lung water content (control PEW = 3.46 +/- 0.16; SVH PEW = 3.44 +/- 0.18 g H2O/g dry tissue, mean +/- SD) or alterations in pulmonary function. Fluid overload alone produced an insignificant increase in PEW (4.24 +/- 0.72 g H2O/g dry tissue) and decreases in vital capacity and functional residual capacity. SVH in combination with fluid overload resulted in a significant increase in lung water (4.78 +/- 1.03 g H2O/g dry tissue) and decreases in functional residual capacity, vital capacity, dynamic compliance, and arterial blood oxygen tension as well as increased pulmonary resistance. We conclude that SVH favors the formation of pulmonary edema under conditions of increased pulmonary transcapillary fluid exchange and may particularly augment airway edema.

Airway Resistance↗

Childhood sequelae of infant lung disease: exercise and pulmonary function abnormalities after bronchopulmonary dysplasia.

To determine the long-term pulmonary sequelae and effect on exercise tolerance of bronchopulmonary dysplasia (BPD), we studied 10 children at a mean age of 10.4 years, who had been born prematurely, survived respiratory distress syndrome, and subsequently developed BPD, and compared them with eight age-matched normal children born at term. Pulmonary function tests and graded exercise stress tests were performed. Residual volume, the ratio between residual volume and total lung capacity, vital capacity, forced expiratory volume in 1 second, forced expiratory flow between 25% and 75% of vital capacity, and maximal expiratory flows at 80%, 70%, and 60% of total lung capacity were all abnormal (P less than 0.02) in the children with BPD, compared with control values. Pre-exercise transcutaneous CO2 tension was higher (P less than 0.05) in the BPD group than in the control group. At maximal workload, tcPCO2 remained high in patients with BPD compared with control values (P less than 0.05). Arterial oxygen saturation at maximal workload fell below pre-exercise levels in the BPD group (P less than 0.05) but not in control children. There were no differences in maximal oxygen consumption between the BPD group and control children. Exercise-induced bronchospasm occurred in 50% of the BPD group, but not in the control group. We conclude that long-term survivors of BPD have evidence of airway obstruction, hyperinflation, and airway hyperreactivity, compared with a control group. Aerobic fitness was not significantly different in the BPD and control groups, but was achieved in the BPD group at the expense of a fall in SaO2 and a rise in tcPCO2.

Asthma↗

Lung volumes and respiratory muscle strength in adult patients with childhood- or adult-onset growth hormone deficiency: effect of 12 months' growth hormone replacement therapy.

We have described impairment of the respiratory function in adult patients with childhood-onset growth hormone (GH) deficiency. The aim of the present study was to evaluate lung volumes and respiratory muscle strength in patients diagnosed as GH deficient before and after 6 and 12 months of recombinant GH treatment. Ten adults diagnosed as GH deficient in childhood, ten adults diagnosed as GH deficient in adulthood and ten healthy subjects entered the study. For each subject, evaluation of respiratory function followed the same standard approach, consisting of respiratory muscle strength assessment, record of flow-volume curves, measurement of static lung volumes and lung diffusing capacity. Childhood-onset GH-deficient patients had a significant reduction of maximal inspiratory (p < 0.01) and maximal expiratory (p < 0.05) mouth pressures. Total lung capacity, vital capacity and functional residual capacity were significantly reduced compared to healthy subjects (p < 0.05). Conversely, residual volume and diffusing lung capacity did not show any significant change. No significant change of the ratio between the percentage forced expiratory volume in 1 s and the forced vital capacity was observed. The decrease of respiratory mouth pressures was not correlated to the decrease of lung volumes. Adult-onset GH-deficient patients had only a significant reduction of maximal expiratory pressure compared to healthy subjects (p < 0.05). After 6 months of treatment no significant differences in any of the evaluated parameters were found. After 12 months of treatment patients with childhood-onset GH deficiency show a significant improvement of lung volumes (p < 0.01) and maximal respiratory mouth pressures (p < 0.005), whereas adult-onset GH-deficient patients show a significant improvement of maximal expiratory pressure (p < 0.05). In conclusion, the results of this study showed that adult patients affected with childhood-onset GH deficiency suffer from an impairment of the ventilatory function due to a reduction of lung volumes and a decrease of respiratory pressures probably due to a reduction of respiratory muscle strength. This impairment was reversed after 12 months of treatment with recombinant GH. Conversely, adult-onset GH-deficient patients had only an impairment of the maximal expiratory pressure, probably due to respiratory muscle weakness re-established after 12 months of GH therapy.

Adult↗

Thoracic kyphosis, rib mobility, and lung volumes in normal women and women with osteoporosis.

STUDY DESIGN: Lung volumes and rib mobility were measured in 15 women with kyphosis resulting from spinal osteoporosis and in 15 healthy women. OBJECTIVES: The study first sought to determine the relationship between thoracic kyphosis and rib mobility and then sought to determine the effect of kyphosis and associated changes in rib mobility on respiratory function. SUMMARY OF BACKGROUND DATA: Spinal deformity in ankylosing spondylitis and scoliosis is associated with alterations in respiratory function. The effect of thoracic kyphosis on respiratory mechanics has not been investigated in an osteoporotic population. METHODS: Lung volumes were measured using a spirometer, and rib mobility, during maximal inspiratory and expiratory maneuvers, was monitored with four motion sensors placed anteriorly, posteriorly, and laterally on the thorax. RESULTS: Vital capacity, inspiratory capacity, total lung capacity, and lateral expansion of the thorax were lower in the osteoporotic group (P < 0.05). There was a significant negative correlation between kyphosis angle and inspiratory capacity, vital capacity, and lateral expansion of the thorax. CONCLUSIONS: Lung volumes and rib mobility were significantly impaired in women with thoracic kyphosis.

Aged↗

A survey into the respiratory effects of prolonged exposure to pulverised fuel ash.

Previous studies of respiratory disorders in workers exposed to pulverised fuel ash (PFA) have been confined to radiological effects that were found to be minimal. The present survey included 268 men (88% of the defined population) with a history of more than 10 years exposure to PFA in six power stations in the south east of England. Respiratory questionnaires with full occupational histories were obtained from all of these subjects, of whom 207 were actively employed and 61 had retired; 243 had lung function tests and 208 had chest x ray examinations. The men were grouped, using their occupational histories, into high, medium, and low exposure categories. Dust concentrations were obtained by personal sampling on a representative sample of men from the three exposure categories. Lung function tests showed that a modest effect on forced vital capacity, vital capacity, forced expiratory volume in one second, peak flow, and gas transfer (DCO) was associated with prolonged heavy exposure to PFA. The men with prolonged heavy exposure also showed higher prevalences of respiratory symptoms. No definite relation between exposure and x ray changes was established. The results of this cross sectional survey indicate that exposures to PFA should not exceed the limits recommended by the Health and Safety Executive for low toxicity dusts.

Adult↗

Effect of short and long term antibiotic response on lung function in bronchiectasis.

In a study designed to show whether purulent bronchial secretions damage the lung reversibly or irreversibly, 18 patients with bronchiectasis underwent lung function tests before and after two weeks' antibiotic treatment to convert their sputum from purulent to mucoid, and 10 of them also after four months' treatment. After two weeks FEV1, forced vital capacity, vital capacity, functional residual capacity, and total lung capacity showed small but statistically significant (though not clinically useful) improvements. In the 10 patients studied after four months only FVC (of the four indices with significant improvements at two weeks in this group) was still higher than before treatment. These results contrast with those of an earlier study, in which large acute changes were found, perhaps because of differences in the patients studied. It is concluded that the absence of major changes in lung function points to physiological abnormality that is largely irreversible in these patients with chronic bronchial sepsis.

Adult↗

Influence of weight on pulmonary function in the adult guinea pig.

We examined a group of 63 adult female Hartley strain guinea pigs with weight ranging from 625 to 1,200 g in order to ascertain whether pulmonary function tests including lung volumes, pressure-volume curves, and flow-volume curves were affected by the weight of the animal. We found that there was a weight effect on total lung capacity, vital capacity, residual volume, and the forced expiratory flow between 25 and 75% of total lung capacity, although there was no effect on other parameters of airflow. Flow-volume curves for each animal could be accurately fitted to a mathematical equation, and this equation did not vary with the animals' weight. Pressure-volume curves were affected by animal weight, but could be accurately fitted to a weight-corrected equation. We conclude that when pulmonary function tests are performed on adult guinea pigs, lung volumes may be altered in proportion to the weight of the animal. When pressure-volume or flow-volume curves are being considered, although weight can either be corrected for or has no bearing on the shape of the curve, there is a large between-animal variation, and it may be necessary to use large experimental groups when it is impossible to use the same animal as its own control.

Animals↗

Pulmonary function thirteen to twenty-six years after repair of tetralogy of Fallot.

Lung function was evaluated in 68 patients 13 to 26 (median 19) years after repair of tetralogy of Fallot. Age at repair was 7 years (9 months to 42 years) and 51% had a palliative shunt. An outflow patch was inserted in 56%. Median vital capacity was 84% of predicted, forced expiratory volume in 1 second 83%, maximal voluntary ventilation at 40 breaths/min 70%, and diffusing capacity for carbon monoxide 77% of predicted. Scintigraphy demonstrated abnormal pulmonary perfusion in 86%. Average right lung perfusion was 57% (predicted 52%). Regional hypoperfusion could in some patients be explained by previous palliative shunt, pulmonary artery obstruction, or presence of aortopulmonary collaterals. Median symptom-limited work capacity was 82% (95% confidence limits 78% to 90%) of predicted. Twenty-eight physically active patients had high values for symptom-limited work capacity, vital capacity, forced expiratory volume in 1 second, and maximal voluntary ventilation at 40 breaths/min compared with those of inactive patients. Lung function variables were related to physical exercise and previous palliative shunt. Moderate or severe pulmonary valve incompetence had negative but not significant influence on lung function. There was no significant influence of acyanosis before repair, use of transannular patch, duration of follow-up, or smoking. We found moderately reduced work capacity and lung function late after repair of tetralogy of Fallot that did not cause symptoms. Lung function variables were high in young active male patients and low in patients with previous palliative shunt. A better lung function in active patients indicates that physical activity should be encouraged after repair of tetralogy of Fallot.

Adolescent↗

Respiratory monitoring in an intermediate intensive unit.

The major goal of monitoring is continuous recording of indices that enhance our understanding of the underlying pathophysiology, in order to improve diagnosis and guide management, and identify trends that assist in assessing the therapeutic response and predicting prognosis. Nowadays, technology has made it possible to automatically sense and display a wide variety of physiological indices. An ideal monitoring system should be pertinent to patient management, propose interpretable data, show high technical accuracy, high sensitivity, good reproducibility, be practical to use. The international literature, our personal experience, and cost considerations have proposed the following monitoring standards as the best for a noninvasive respiratory intermediate intensive care unit (RIICU): 1) mandatory indices: respiratory rate, oxygen saturation, haemogas-analysis, tidal volume, minute ventilation, maximum voluntary ventilation, forced expiratory volume in one second, forced vital capacity, vital capacity, maximal inspiratory pressure, heart rate and blood pressure; 2) second choice indices: capnometry, respiratory inductive plethysmography, transcutaneous monitoring of gases, haemodynamic monitoring, mechanics data by means of an oesophageal balloon, and central drive. Pulmonary monitoring devices shorten the time for patients who remain on mechanical ventilators; a reduction both in the risk of associated complications and the costs involved is a natural consequence. Continuous monitoring of significant physiological indices has the potential for predicting a critical event, and providing an opportunity for the institution of lifesaving measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗

[Mechanisms of diurnal hypercapnia in sleep apnea syndromes associated with morbid obesity].

OBJECTIVES: The prevalence and mechanisms of diurnal hypercapnia in subjects with sleep apnea syndrome are not well known, particularly in the morbidly obese. METHODS: We studied a group of 24 subjects with sleep apnea syndrome and morbid obesity defined as a body mass index greater than 40 kg/m2 and free of chronic respiratory disease. RESULTS: Hypercapnia (PaCO2 > 42 mmHg) was found in 50% of the subjects. Age, body mass index, waist/hip ratio, apnea index, ratio of maximum forced expiratory volume in one second (FEV1) to vital capacity and expiratory reserve volume were not significantly different between hypercapnic and normocapnic subjects. Total pulmonary capacity, vital capacity and FEV1 were significantly lower in hypercapnic subjects than in normocapnic subjects. CONCLUSION: These findings suggest that ventilatory restriction plays an important role in the development of diurnal alveolar hypoventilation in subjects with sleep apnea syndrome and morbid obesity.

Adult↗

Effect of concurrent radiation therapy and chemotherapy on pulmonary function in patients with esophageal cancer: dose-volume histogram analysis.

PURPOSE: The pulmonary effects of concurrent radiation therapy and chemotherapy were studied in patients enrolled in a phase I trial for esophageal cancer. MATERIALS AND METHODS: Pulmonary function tests were performed prospectively before and after combined-modality therapy (oxaliplatin, 5-fluorouracil, and radiation therapy) in 20 patients with esophageal cancer. Cumulative and differential lung DVH analysis from 0 to 5400 cGy in 25-cGy intervals was performed for the last 15 patients. Correlation between radiation exposure in various dose ranges and percent reduction in pulmonary function tests was calculated as an exploratory analysis. RESULTS: Significant reductions in carbon monoxide diffusion capacity corrected for hemoglobin (12.3%) and total lung capacity (2.5%) were evident at a median of 15.5 days after radiation therapy. DVH analysis revealed that the single dose of maximum correlation between lung volume radiation exposure and lung function reduction was less than 1000 cGy for all pulmonary functions. The percent lung volume that received a total dose between 700 and 1000 cGy maximally correlated with the percent reductions in total lung capacity and vital capacity, and the absolute lung volume that received a total dose between 700 and 1000 cGy maximally correlated with the percent reductions in total lung capacity, vital capacity, and carbon monoxide diffusion capacity. DISCUSSION: Significant declines in carbon monoxide diffusion capacity and total lung capacity are evident immediately after the administration of conformal radiation therapy, oxaliplatin, and 5-fluorouracil for esophageal cancer. Other lung functions remain statistically unchanged. The percent or absolute lung volume that received a total dose between 700 and 1000 cGy may be significantly correlated with the percent decline of carbon monoxide diffusion capacity, total lung capacity, and vital capacity. These associations will be evaluated further in a follow-up study.

Antineoplastic Combined Chemotherapy Protocols↗

Pulmonary capacities of different groups of sportsmen in India.

Pulmonary functional capacities, vital capacity (VC) maximum voluntary ventilation (MVV), forced expiratory volume in 1 second and FEV 1.0 (per cent VC) of 168 sportsmen belonging to different sports activities and of 10 sedentary individuals have been studied. It was observed that all these pulmonary functional capacities of different groups of sportsmen were higher than those of the sedentary group. The mean VC of the basketball, boxing, cricket, football, hockey and the table tennis groups, the mean MVV of all the groups except the athletic, badminton and football groups, and the mean FEV 1.0 of football, hockey, swimming and volleyball groups were significantly higher than those of the sedentary group. The mean values of all the three pulmonary functional capacities of only the hockey group were found to be significantly higher than those of the sedentary individuals. The available reported pulmonary capacity values, except FEV 1.0 of a few groups of sportsmen studied abroad, were higher than those of their counterparts studied here. These might be due to the ethnic variation as well as the variation in age, body size and level of physical fitness which influence the different pulmonary capacities.

Forced Expiratory Volume↗

Resting lung function in children after repair of tetralogy of Fallot.

Children with tetralogy of Fallot had pulmonary function tests (PFT) after intracardiac repair (ICR). According to the age at time of ICR and to the existence or not of palliative surgery preceding ICR, they were divided into three groups. Group 1 had ICR at a mean of one year one month of age (range four months to one year seven months), that is, during the active period of postnatal lung growth. Groups 2 and 3 had ICR later in childhood, that is, respectively, at four years seven months (range two years nine months to 11 years 9 months) and at five years four months (range two years seven months to 11 years five months). In group 3, ICR was preceded by palliative surgery. The PFT at rest included measurement of lung volumes (functional residual capacity), vital capacity (VC), dynamic or static compliance (CL), total pulmonary resistance, lung transfer factor for CO (TLCO) and blood gases. Group 1 had normal lung function suggesting that early repair of TOF saves lung development. In groups 2 and 3, significant decrease in VC(p less than 0.01) and CL (p less than 0.01) were found suggesting impaired alveolar growth. Additional defect in TLCO (p less than 0.01) in group 3 suggested that palliative surgery induces abnormal vascular growth. Thus, the present functional results suggest repair of TOF during the two first years of life, ie, the active period of postnatal lung growth.

Adolescent↗

Human physiological adaptability through the life sequence.

Changes in organ function from birth to old age were investigated from published data. In essence, the observations of Shock and colleagues on maximal breathing capacity, vital capacity, glomerular filtration rate, renal plasma flow, basal metabolic rate (BMR), ulnar nerve conduction velocity, cardiac index, and intracellular water (ICW) for the age period 30 to 85 years were extended to the time of birth. There were two principal findings. First, with the exception of BMR and ICW, these functional indices increased from a low point at birth to a maximum between 3 and 20 years of age and then after 30 years declined progressively to 85 years; BMR declined from a maximum in infancy and ICW peaked at about 30 years and then declinded. Second, the coefficient of variation increased regularly from birth to old age. Because the peak of organ function coincided with the period of minimal mortality, the curve of organ function across the life sequence was considered to represent changes in adaptive capacity. Supporting evidence from studies of physical fitness, thermoregulation, and seasonal change of mortality was considered. It was concluded that these shifts in adaptive capacity between birth and old age were fundamental baselines for investigations of the epidemiology of health.

Adaptation, Physiological↗