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Preoperative pulmonary function as a prognostic factor for stage I non-small cell lung carcinoma.

BACKGROUND: The aim of this study was to clarify preoperative lung function as a prognostic factor for the long-term survival of, and to discuss the appropriateness of lobectomy for, patients with stage I non-small cell lung carcinoma who have poor preoperative pulmonary function. METHODS: The study group consisted of 402 lobectomized patients with stage I non-small cell lung carcinoma treated by complete resection from 1985 to 1997. Preoperative percent forced vital capacity [(forced vital capacity/predicted forced vital capacity) x 100], FEV(1)% [(forced expiratory volume in 1 second/forced vital capacity) x 100], arterial carbon dioxide tension, and smoking were statistically analyzed as prognostic factors together with other host and tumor biologic factors. RESULTS: Multivariate analysis demonstrated that tumor size (p < 0.0001) was the most significant prognostic factor for survival from primary lung cancer. Age (p < 0.0001), sex (p = 0.0036), and FEV(1)% (p = 0.0046) were found to be independent prognostic factors for survival from death by nonprimary lung cancer-related causes. Smoking was highly correlated with FEV(1)% (correlation coefficient = -0.511; p < 0.0001). The 100 patients with a preoperative FEV(1)% less than 70% included 34 patients with nonprimary lung cancer-related deaths, whereas the 302 patients with an FEV(1)% of 70% or greater included only 23 patients (p < 0.0001). CONCLUSIONS: Along with tumor size, FEV(1)% is the most significant prognostic factor for patients with stage I non-small cell lung carcinoma with regard to survival from death by other causes. Lobectomy may not be preferred as an appropriate surgical modality for patients with stage I non-small cell lung carcinoma with small peripheral nodules who exhibit poor pulmonary function, especially lowered FEV(1)%.

Adult↗

Impact of spinal anaesthesia on peri-operative lung volumes in obese and morbidly obese female patients.

Although obesity predisposes to postoperative pulmonary complications, data on the relationship between body mass index (BMI) and peri-operative respiratory performance are limited. We prospectively studied the impact of spinal anaesthesia, obesity and vaginal surgery on lung volumes measured by spirometry in 28 patients with BMI 30-40 kg.m(-2) and in 13 patients with BMI > or = 40 kg.m(-2). Vital capacity, forced vital capacity, forced expiratory volume in 1 s, mid-expiratory and peak expiratory flows were measured during the pre-operative visit (baseline), after effective spinal anaesthesia with premedication, and after the operation at 20 min, 1 h, 2 h, and 3 h (after mobilisation). Spinal anaesthesia and premedication were associated with a significant decrease in spirometric parameters. Spinal anaesthesia and premedication were associated with a significant decrease in spirometric parameters; mean (SD) vital capacities were - 19% (6.4) in patients with BMI 30-40 kg.m(-2) and - 33% (9.0) in patients with BMI > 40 kg.m(-2). The decrease of lung volumes remained constant for 2 h, whereas 3 h after the operation and after mobilisation, spirometric parameters significantly improved in all patients. This study showed that both spinal anaesthesia and obesity significantly impaired peri-operative respiratory function.

Adult↗

Pulmonary function of guinea pigs exposed to freshly generated ultrafine zinc oxide with and without spike concentrations.

Exposure of guinea pigs 3 hr/day for 5 consecutive days to freshly formed ultrafine zinc oxide (ZnO) (count median diameter: 0.05 micron; geometric standard deviation: 2.0) at a concentration of 7 mg/m3 produced a gradual decrease in total lung capacity and vital capacity over the course of the exposure period. The carbon monoxide (CO) diffusing capacity (DLCO) was not affected until the fourth day, when it dropped abruptly to 30% below control levels. Wet-lung weight/body weight ratios and wet-lung/dry-lung weight ratios increased, indicating the presence of edema. Exposures to 2.7 mg/m3 ZnO, using the same 3 hr/day, 5 day time frame, did not alter any parameters measured. In 2 experiments a single high peak of ZnO (25-34 mg/m3) occurred. In one experiment exposure was stopped, but pulmonary function measurements were made as scheduled; in the other case, exposures to ZnO were continued. In both, lung volumes were decreased abruptly and to a greater extent than when peaks were absent. Continued exposure caused greater decrements in total lung capacity (TLC) and vital capacity (VC) as well as decrements in functional residual capacity (FRC) and residual volume (RV) than were observed when exposure was stopped. Peak exposures reduced DLCO to 45%-60% below control. These values rose to 25%-30% below control with or without continued exposure. Airway resistance increased and compliance decreased following peak exposures. When exposure was stopped, these changes were reversible; with continued exposure they still were different from control levels on the fifth day.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Resistance↗

[Lung function following sleeve bronchoplastic lobectomy for bronchogenic carcinoma].

Twenty-five patients who underwent upper sleeve lobectomy for lung cancer were studied by spirometric examination to evaluate postoperative pulmonary function, including Vital Capacity (VC), %Vital Capacity (%VC), Forced Expiratory Volume in one second (FEV1.0), and Forced Expiratory Volume in one second as a percentage of the forced vital capacity (FEV1.0%). The results of the patients with bronchoplasty were compared with those of patients with lobectomy alone and of patients with pneumonectomy. Lung function was periodically examined postoperatively following bronchoplasty. VC, %VC and FEV1.0 were decreased postoperatively in the patients with upper sleeve lobectomy, while FEV1.0% was increased. There were no differences in postoperative %VC or FEV1.0% between the patients with bronchoplasty and those with upper lobectomy alone. However, the postoperative %VC of the patients with pneumonectomy was significantly decreased compared with patients who underwent postoperative %VC of the patients with pneumonectomy was significantly decreased compared with patients who underwent bronchoplasty or lobectomy alone. %VC in the patients with bronchoplasty was decreased at 3 months after operation, but it to gradually returned to the preoperative value by 13 to 24 months after operation.

Adult↗

[Recent trends and prognosis of pulmonary diseases in Japan].

To determine trends of death rates for patients with chronic pulmonary diseases the author compiled the numbers of deaths per 100,000 Japanese population per annum based on the annual reports of the Japan Vital Statistics for the past 43 years. Death rates for the newborn population as well as for the younger population decreased while those for the aged population remained unchanged. Increasing numbers of deaths from lung cancer and decreasing numbers of death from pulmonary tuberculosis were noted. The death rate from the chronic obstructive lung diseases was maintained while the death rate for diffuse fibrotic lung diseases tended to be elevated. Baseline reference values for respiratory physiology parameters, established by the Special Commission for Respiration Physiology of the Japan Society of Chest Diseases, were presented by single linear regression equations represented in terms of age covering the subject's whole age span, including the aged population. The author carried out further analyses based on the data collected in a multi-center cross-sectional survey and concerning, some parameters found consistent differences the linear regression equation calculated for the aged population from those for the younger population. A longitudinal survey conducted by follow-up observations at Keio University Hospital to determine the annual decline of parameters on respiration physiology was designed to cover healthy subjects as well as subjects with chronic pulmonary diseases. Annual declines in vital capacity, forced vital capacity, forced expiratory volume in one second, arterial oxygen tension and arterial carbon dioxide tension showed linear changes throughout the entire age span. Some parameters, such as flow max at 25% vital capacity or alveolar-arterial oxygen tension difference (AaDO2), demonstrated statistically consistent differences in annual decline between younger and older age populations. The annual decline of parameters in patients with chronic pulmonary diseases demonstrated consistently larger values compared with those for healthy subjects. In a study on the pathophysiology and prognosis of patients with respiratory failure with/or without cor pulmonale extension of the survival period for the patients with cor pulmonale was demonstrated.

Adolescent↗

[Pulmonary manifestations of lupus erythematodes visceralis].

Eight patients with SLE were found on clinical and roentgenological grounds or by respiratory function tests to have evidence of lung involvement. Great discrepancies were noted between clinical findings and the results of the respiratory function tests on the one hand and lacking or discrete radiological changes on the other hand. Four patients with pulmonary fibrosis without auscultatory signs showed decreased compliance values and decreased diffusion and vital capacities were noticed in two. In only 2 out of 4 patients with abnormal clinical signs could fibrotic changes be detected roentgenologically. Corresponding to the general diagnostic experience the measurement of compliance, diffusion capacity and vital capacity are the most appropriate methodes for assessing these visceral manifestations of SLE.

Adolescent↗

Total lung capacity in asbestosis: a comparison of radiographic and body plethysmographic methods.

The effect of asbestosis on lung volumes was studied in 46 workers by measuring total lung capacity (TLC), forced vital capacity, vital capacity, and residual volume using two standard methods: body plethysmography and radiographic lung area. Nine men had neither irregular opacities of any International Labour Office profusion category nor pleural abnormalities; 9 had pleural abnormalities only, 19 had irregular opacities only; and 9 had pulmonary asbestosis with pleural plagues. Of the 28 with irregular opacities, 18 had moderate or advanced asbestosis (category 2/1 or greater). The radiographic method gave a mean TLC of 8.11 L and the body plethysmographic mean was 8.09 L. Thus, the radiographic and plethysmographic methods produced virtually identical mean values for TLC and for residual volume 3.84 L and 3.8 L and residual volume/TLC, 47.3 and 47.3, respectively. Lung volumes measured by body plethysmography and by x-ray area were the same in each of the four radiographic categories of asbestosis. The air trapping and normal or slightly elevated TLC, which characterize asbestosis in men who have smoked cigarettes, are revealed by both methods. The radiographic method, when adequate measures are taken to obtain full inspirations, effectively duplicates the body plethysmographic method but is quicker and simpler, particularly for field studies.

Adult↗

Pulmonary and ventilatory responses to pregnancy, immersion, and exercise.

To examine the effects of pregnancy, immersion, and exercise during immersion on pulmonary function and ventilation, 12 women were studied at 15, 25, and 35 wk of pregnancy and 8-10 wk postpartum. Pulmonary function and ventilation were measured under three experimental conditions: after 20 min of rest on land (LR), after 20 min of rest during immersion to the level of the xiphoid (IR), and after 20 min of exercise during immersion at 60% of predicted maximal capacity (IE). Forced vital capacity remained relatively constant, except for a decrease at 15 wk, for the duration of pregnancy. Expiratory reserve volume decreased with a change in the pregnancy status and with the duration of pregnancy. However, the forced vital capacity was maintained by an increase in the inspiratory capacity during pregnancy. Forced expiratory volume for 1 s, expressed as percent of forced vital capacity, did not differ significantly between conditions or as a result of pregnancy. Forced vital capacity was lower during the IR trial compared with LR and IE trials. The decreased forced vital capacity of the IR trials was mediated by a decrease in the expiratory reserve volume. Whereas the inspiratory capacity increased during IR and IE compared with LR, the increase was not large enough to offset the decrease in the expiratory reserve volume. Resting immersion resulted in a significant decrease in maximal voluntary ventilation as did pregnancy. Pregnancy resulted in significant increases in minute ventilation (VE), which were related to increases in the O2 consumption.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Respiratory function in singleton and twin pregnancy.

OBJECTIVE: Singleton pregnancy causes important changes in respiratory function. The incidence of twin pregnancies is increasing, but it is not known whether affected women suffer greater respiratory compromise. The aim of this study was to determine if changes in respiratory function during pregnancy in healthy women were greater in those with a twin pregnancy compared with those with a singleton pregnancy. DESIGN: Cross sectional study. SETTING: London teaching hospital. POPULATION: Healthy pregnant women attending the antenatal clinic and ultrasound department. METHODS: A cross sectional study of respiratory function was performed in 68 women with twin pregnancies (17 examined in the first trimester, 35 second trimester, 16 third trimester) and 140 women with singleton pregnancies (28, 80, 40, respectively) and 22 non-pregnant women. Women were examined once between 7 and 40 weeks of gestation. Forced vital capacity, relaxed vital capacity, forced expiratory volume in 1 second (FEV1), peak flow, inspiratory capacity, functional residual capacity (FRC), expiratory reserve volume, pulmonary diffusing capacity and minute ventilation were measured. RESULTS: Both in twin and singleton pregnancies, the mean FRC and expiratory reserve ventilation of women studied in the third trimester and minute ventilation of women studied in each trimester differed significantly from that of the non-pregnant women. There were, however, no significant differences demonstrated in respiratory function between healthy women with twin as compared with singleton pregnancies. CONCLUSION: In healthy women, the extra demands of atwin compared with a singleton pregnancy do not compromise further the respiratory system.

Adult↗

Unilateral diaphragmatic paralysis in spinal cord injury patients.

Since the inception of the Spinal Cord Injury Center of The Institute for Rehabilitation and Research in 1961, over 1600 spinal cord injury patients have been admitted. Of these patients, approximately 51 per cent or 821 are tetraplegics. A review of the medical records shows that 22 patients had unilateral diaphragmatic paralysis. All but one of these patients are male, and they range in age from 15 to 73 years of age at onset. All cases with unilateral diaphragmatic paralysis are reviewed as to side of paralysis, incidence of tracheotomy, initial vital capacity, final vital capacity, and estimation as to the duration of diaphragmatic paralysis.

Adolescent↗

Pulmonary function abnormalities in children with sickle cell disease.

BACKGROUND: Adults with sickle cell disease (SCD) have restrictive lung function abnormalities which are thought to result from repeated lung damage caused by episodes of pulmonary vaso-occlusion; such episodes start in childhood. A study was therefore undertaken to determine whether children with SCD have restrictive lung function abnormalities and whether the severity of such abnormalities increases with age. METHODS: Sixty four children with SCD aged 5-16 years and 64 ethnic matched controls were recruited. Weight and sitting and standing height were measured, and lung function was assessed by measurement of lung volumes and forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF) before and after bronchodilator. RESULTS: Compared with the control subjects, the children with SCD had lower mean (SD) sitting height (69 (6.3) cm v 73 (7.7) cm; p=0.004), sitting:standing height ratio (0.50 (0.02) v 0.51 (0.01); p<0.0001), weight (33 (10.9) kg v 41 (14.9) kg; p=0.001), functional residual capacity measured by a helium gas dilution technique (1.2 (0.3) l v 1.3 (0.4) l; p=0.04), FEV1 (1.5 (0.5) l v 1.9 (0.7) l; p=0.0008), FVC (1.7 (0.6) l v 2.1 (0.8) l; p=0.001), and PEF (3.9 (1.3) l/s v 4.8 (1.5) l/s; p=0.0004). The effect of age on lung function differed significantly between the children with SCD and the controls for total lung capacity and vital capacity measured by plethysmography and functional residual capacity measured by helium gas dilution. CONCLUSION: Lung function differs significantly in children with SCD compared with ethnic matched controls of a similar age. Our results suggest that restrictive abnormalities may become more prominent with increasing age.

Adolescent↗

Prediction equations for lung function in black industrial workers at Palabora Mining Company.

In the course of a study on the health effects of vermiculite, 653 black rural industrial workers had their lung function measured. Since the study revealed no health effects of their industrial environment, the group was used to determine prediction equations for black men. Vital capacity, forced vital capacity, forced expiratory volume in 1 second, and peak flow were appreciably higher than the predicted values for blacks in the USA. The predicted values were, however, lower than those reported for white non-smokers but significantly higher than those reported for a non-smoking group of black miners in South West Africa/Namibia.

Adult↗

Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis.

BACKGROUND: Impaired pulmonary function due to myasthenia gravis (MG) is further compromised by thymectomy, which is necessary in most cases. Thoracoscopic thymectomy (tThx) can achieve the same resection and functional improvement of MG as median sternotomy (sThx). The possible advantage of tThx in maintaining better perioperative lung function was quantified. METHODS: In a prospective trial, 20 patients with MG were randomly allocated to undergo tThx (n = 10) by three-trocar left-sided approach or sThx (n = 10) performed as an extended procedure. Complete pulmonary function was measured at 12-hour intervals, beginning 6 hours postoperatively. Effective postoperative pain control in both groups was achieved by patient-controlled analgesia with morphine sulfate assessed by a visual analogue scale. Statistical analysis for comparison of tThx and sThx was performed using the Mann-Whitney U test. RESULTS: Postoperative vital capacity, forced vital capacity, forced expiratory volume per second, and peak expiratory flow, measured as a percentage of the individual preoperative capacity, were significantly better with tThx compared with sThx. Immediate postoperative lung function was reduced to 35% and 65% after tThx and sThx, respectively. By the third postoperative day, recovery of pulmonary function was complete after tThx but only 55% after sThx. CONCLUSIONS: Less pronounced impairment and faster recovery of pulmonary function after tThx characterize this new approach for thymectomy as minimally invasive. These results could make tThx the preferred surgical treatment of MG, which was improved to the same extent as after sThx.

Adolescent↗

Right heart haemodynamic values and respiratory function test parameters in chronic smokers.

During coronary angiography in 24 chronic smokers with coronary heart disease, cardiac function measurements were taken and correlated with respiratory function tests. Fourteen patients had evidence of chronic obstructive pulmonary disease. Cardiac output had a direct correlation with vital capacity, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and velocity at 25% of FVC (V(max)25). Pulmonary artery resistance was inversely correlated with FEV1/FVC, while pulmonary artery oxygen saturation weakly correlated with FEV1 and V(max)25. The pulmonary artery pressure had a weak correlation with the pulmonary artery resistance and an intermediate correlation with the right atrium and the right ventricular pressures. Early diagnosis and therapy of chronic obstructive pulmonary disease in smokers may be possible without using invasive methods.

Aged↗

Pulmonary function tests and thyroid hormone concentrations in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the relationship between pulmonary function tests, arterial blood gases, and thyroid gland functions in patients with chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: Thirty-two patients (mean age 64.1 +/- 7.3 years, range 53-84 years) with stable COPD (mean duration of disease 11.1 +/- 9.1 years, range 1-30 years) and 15 healthy control cases participated in the study. Pulmonary function, arterial blood gas, and thyroid hormone concentration were measured, and thyroid ultrasonography and scintigraphy were also performed. RESULTS: The values of the pulmonary function tests (vital capacity, forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow) and PaO2 were lower in the study than control group (p < 0.001), but the values of PaCO2 and concentration of free 3,5,3'-triiodothyronine (fT3) were higher in the study than control group (p < 0.01) although thyroid hormone concentrations were within normal limits in all cases. However, there was no difference between the values of thyroid-stimulating hormone and free thyroxine in both the study and control groups and therefore association could not be established between them on the one hand and pulmonary function test and arterial blood gases on the other hand. Only the values of PaCO2 and fT3 were positively associated; all other values were negatively associated with fT3. CONCLUSION: Changes in pulmonary function tests and arterial blood gases seem to be associated with fT3 concentrations in patients with COPD. Increased respiratory workload could affect thyroid functions.

Aged↗

Effect of aminophylline on respiratory muscle strength after upper abdominal surgery: a double blind study.

BACKGROUND: The effect of aminophylline on maximum respiratory muscle strength in patients undergoing upper abdominal surgery was investigated. METHODS: An open pilot study was performed in which aminophylline was administered continuously for 48 hours after surgery (protocol I). In a second group of subjects aminophylline was given for 24 hours after cholecystectomy in a double blind placebo controlled trial (protocol II). Twelve patients participated in the pilot study (group A) and 25 in protocol II of which 14 received aminophylline (group B) and 11 placebo (control, group C). Respiratory muscle strength was assessed by measuring mouth pressures during maximum static inspiratory and expiratory efforts. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), vital capacity (VC), inspiratory maximum pressures (PImax), expiratory maximum pressures (PEmax) were measured 24 hours preoperatively, PImax and serum theophylline 24 hours postoperatively, and FEV1, FVC, VC, PImax, PEmax, and serum theophylline 48 hours after surgery. RESULTS: FEV1, FVC, and VC decreased in all groups of patients at +48 hours. PImax fell at +24 hours and +48 hours but this decrease was significantly smaller in the two groups who received aminophylline than in the control group. PEmax showed a decrease at +48 hours but this reduction was similar in all three groups studied, independent of the treatment given. These data suggest that either aminophylline had a protective effect only on the inspiratory muscles or, most probably, that the effect of aminophylline was central, reducing the phrenic nerve inhibition induced by cholecystectomy and thus improving diaphragmatic function. CONCLUSIONS: Upper abdominal surgery decreases inspiratory and expiratory muscle strength and aminophylline has a protective effect only on inspiratory muscle function. This may have important clinical applications in minimising pulmonary complications after cholecystectomy.

Abdomen↗

[Glottic measurement and vocal evaluation after three surgical techniques in the treatment of bilateral vocal cord paralysis].

OBJECTIVE: To evaluate postoperative glottic area and vocal quality of three various surgical techniques for treating bilateral vocal cord paralysis, including laser arytenoidectomy (Group A, 24 cases), reinnervation of the posterior cricoarytenoid muscle by phrenic nerve (Group B, 9 cases) and arytenoidectomy accompanying lateral cordopexy by extralaryngeal approach (Woodman's procedure, Group C, 13 cases). METHODS: 46 cases suffered from bilateral recurrent laryngeal nerve injury were included in our study. The pre-postoperative glottic measurement and vocal acoustic parameters were analyzed. RESULTS: The decannulated cases in group A and group B and group C were 22, 8, 13 respectively. The post-operative mean maximal glottic area was (47.2 +/- 7.4) mm2, (78.3 +/- 16.0) mm2, (48.1 +/- 6.5) mm2 respectively. Group B cases glottic area was larger than that of group A and group C (t value were 4.46 and 3.85, P value were 0.000 and 0.001). No significant difference was found between group A and group C (t = 1.68, P = 0.101). After surgery, in group A, 17 cases voice quality was the same compared with that of before surgery, and 7 cases voice quality had become worse; In group B, the voice quality had become better in 5 cases, completely recovered in 1 case, and had not change in 3 cases; In group C, the voice quality had become deteriorated in 10 cases and no change in 3 cases. And in group B, ipsilateral diaphragm paralysis in 9 cases after surgery, whose vital capacity and forced vital capacity had decreased to 72%-84%, 76%-84% of that before the surgery respectively; and the diaphragm mobility had recovered by 35%-76% respectively, while vital capacity and forced vital capacity had become 93%-97%, 91%-98% of that before the surgery. In Group B, all cases' pulmonary function was normal half a year postoperatively. CONCLUSIONS: Reinnervation of the posterior cricoarytenoid muscle by phrenic nerve seems to be best procedure with better post-operative voice and larger glottic area. Although the sufficient airway for decannulation can be acquired in Group A and Group C, but most of patients in Group A had pre-operative vocal level and badly abnormal in Group C.

Adult↗

Assessment of pulmonary and cardiac function after high dose chemotherapy with BEAM and peripheral blood progenitor cell transplantation.

BACKGROUND: Limited information is available regarding the cardiac and pulmonary effects of high dose chemotherapy (HDCT) and autologous peripheral blood progenitor cell (PBPC) transplantation. METHODS: The authors evaluated cardiac and pulmonary function after BEAM (BCNU 300 mg/m2, etoposide 400 mg/m2/day x 3 days, cytosine arabinoside 200 mg/m2/day x 4 days, and melphalan 140 mg/m2), HDCT, and PBPC transplantation in 26 patients with non-Hodgkin's lymphoma or Hodgkin's disease. Therapy prior to BEAM included doxorubicin (25 patients), bleomycin (6 patients), and mediastinal irradiation (4 patients). All patients had pulmonary function tests (PFTs) and equilibrium radionuclide angiography before and at a median of 57 weeks after transplantation. RESULTS: Prior to high dose therapy, 8 patients had abnormal PFTs, including 6 with a diffusing capacity of the lung for carbon monoxide (DLCO) <70% of predicted value. At the time of reevaluation after HDCT, all patients included in the study were in complete remission, and none had received additional therapy after transplantation. At a median of 77 weeks after transplantation, none of the patients had cardiac or pulmonary symptoms. Moreover, there were no significant changes in total lung capacity, forced vital capacity, forced expiratory volume in 1 second/forced vital capacity, DLCO, or left ventricular ejection fraction values when compared with baseline studies. CONCLUSIONS: The authors concluded that HDCT with BEAM and PBPC transplantation did not result in significant cardiac or pulmonary toxicity, even in patients with borderline pretransplantation PFT values. Further studies of patients undergoing HDCT and PBPC transplantation are needed.

Adult↗