[Advances in diagnosing disorders of respiration and pulmonary circulation in post-war Czechoslovakia].
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Bronchitis↗
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[Disorders of neuromuscular function and respiration].
Neuromuscular disorders of varying aetiology frequently lead to respiratory failure. This situation contrasts with the rare application of suitable tests of pulmonary function in this group of patients. As a result, respiratory complications are not detected until they have progressed to a terminal stage. With the sequential measurement of vital capacity, and a determination of the maximum inspiratory and expiratory pressures (PImax and PEmax), we have reliable and practicable diagnostic measures available that permit the recognition of respiratory failure at an early stage. This fact is of particular importance, since the application of modern ventilation techniques in suitable patients can make a substantial contribution towards both improving the patient's quality of life and prolonging it.
Diaphragm↗
[The mechanisms of the disorder of external respiration in hypoxia].
Anesthetized rats breathed during 1 hr with gas mixtures containing 16 to 6 per cent of oxygen. At 6 per cent of oxygen, the hypoxia of pulmonary tissue and its processes of peroxide oxidation of lipids entails a sharp increase in elastic resistance against breathing. This is combined with insignificant disorders in tidal volume which is not compensated by an increase in the breathing rate. General mechanisms of external respiration disorders in various types of hypoxia and in stress, were revealed.
Animals↗
[Disorders of external respiration in severe combined trauma in an acute period of traumatic disease].
Disorders of external respiration, clinical significance and prognostical information of the gas exchange system indexes in an acute period of traumatic disease (TD) in severe combined trauma (SCT) were studied. Pronounced stable changes of the external respiration indexes in injured persons for all forms of SCT, constituting high prognostic information in dynamics of course of TD, were revealed.
Acute Disease↗
[Sudden death and mortality in epilepsy].
Mortality in epilepsy is 2-3 times higher than in the age- and sex-matched general population. It is the highest in young male epilepsy patients with generalised tonic-clonic seizures living in low socio-economical situation. The main factors of early mortality unrelated to seizures are the neurological conditions underlying epilepsy. Suicide is an important factor first of all in temporal lobe epilepsy. The group of mortality directly related to epilepsy is made up of the high-mortality grand mal status epilepticus rarely seen in treated epilepsy; the accidents related to seizures and sudden unexpected death (SUDEP). The reasons directly related to epilepsy make up about 40 per cent of epilepsy mortality. There is a 20-24-fold increase of the risk of sudden death in epilepsy compared to sudden death in the general population. The main risk of SUDEP is the "severity" of epilepsy signaled by generalized tonic-clonic seizures, resistance to antiepileptic drugs, polytherapy and frequent drug-modifications in adulthood epilepsy. Seizure-dependent autonomic changes as cardiac rhythm and breathing disturbances as well as some antiepileptic drugs and treatment modifications may contribute to the development of SUDEP. The data suggest that the main tools helping to decrease mortality in epilepsy nowadays are as follows: optimal seizure control, effective treatment of concomitant psychiatric conditions and monitoring for potentially dangerous heart dysrhythmias as well as respiration disorders.
Anticonvulsants↗
[Ammonia-gas poisoning: respiratory troubles evaluated by functional exploration].
The objective of our research is first to evaluate the defects in the respiratory function which have been noticed among patients suffering from ammonia poisoning during the accident at the SONACOS factory of Dakar in 1992. Secondly it is to set precisely the seriousness of the problem. This retrospective study is carried out on 50 patients examined at the Physiology and Functional Exploration Laboratory of the faculty of Medicine of Dakar University from March 1993 to October 1995. These patients have been submitted to at least two respiratory functional explorations. Ten of them have been treated for two years, thus benefiting from a spirographic control of these respiratory troubles already noticed. 58 % of the patients have developed an obstruction syndrome with the following specifities : fourteen patients out of 29 revealed a serious stoppage of the bronchi, twelve had a moderate bronchial obstruction, and three showed a minor bronchial obstruction. Besides, 34 % of the patients have developed a mixed syndrome with a minor restrictive component and a severe obstructive component. 8 % of the poisoned have presented a normal lung function testing. About the localisation of the respiration disorders at the level of the bronchial system, 61 % of the patients have shown an obstruction of the proximal, medial and distal bronchi. 26 % have presented obstruction of the distal bronchi, 13 % have shown an attack at their medial and distal bronchi. 5 patients out of 10 have shown any modification in their respiratory troubles while 3 of 10 have shown significant improvement. Then 2 out of 10 have shown degradation in their respiratory problems with an extension of bronchial obstruction. The ammonia poisoning has caused serious respiratory disorders related to the general and local toxic action of ammonia on the respiratory tract, its retention at their level and its effects on the respiratory function. The severity of the patent injuries incites to issue recommendations concerning the prevention of ammonia poisoning and the quick and efficient taking charge of the casualties in case of any accidental intoxication.
Adolescent↗
Successful use of the new high-dose mannitol treatment in patients with Glasgow Coma Scale scores of 3 and bilateral abnormal pupillary widening: a randomized trial.
OBJECT: The authors evaluated long-term clinical outcomes in selected acutely comatose patients with severe diffuse brain swelling and recent clinical signs of impending brain death who received a novel high-dose mannitol treatment compared with those who received conventional-dose mannitol in the emergency room. METHODS: Forty-four adult patients with traumatic, nonmissile-inflicted, acute, severe diffuse brain swelling were prospectively and randomly evaluated. All patients were selected based on the presence of recent clinical signs of impending brain death on the first emergency room evaluation. These signs included bilateral abnormal pupillary widening and lack of motor responses to painful stimulation (Glasgow Coma Scale score of 3). The study group (23 patients) received ultra-early and fast intravenous high-dose mannitol treatment (approximately 1.4 g/kg), whereas the control group (21 patients) received half that dose (approximately 0.7 g/kg). Ultra-early improvement of bilateral abnormal pupillary widening was significantly more frequent in the high-dose mannitol group than in the conventional-dose group (p < 0.02). High-dose mannitol treatment in the emergency room was also associated with significantly better 6-month clinical outcomes (p < 0.02); the best rate of favorable outcomes was 43.5%, compared with only 9.5% in the conventional-dose mannitol group. The two groups of patients were well matched with respect to all emergency room and head computerized tomography findings, as well as the timing of initial mannitol treatment (approximately 80-90 minutes after the first evaluation at the scene of the injury). Comparative evaluation of bilateral pupillary widening between the scene of the injury and the emergency room showed no significant differences between groups, whereas mannitol dose dependence was statistically significant (p < 0.05), insofar as early pupillary improvement in the emergency room was concerned. CONCLUSIONS: Ultra-early high-dose mannitol administration in the emergency room is the first known treatment strategy significantly to reverse recent clinical signs of impending brain death, and also to contribute directly to improved long-term clinical outcomes for these patients who have previously been considered unsalvageable.
Acute Disease↗
[Sleep disorders in elderly, the sleep apnea syndrome in particular: are they a cause of insomnia? A review of literature].
In this publication a review is presented based on the findings resulting from sleep-wake investigations searching for sleep disorders associated with insomnia in relatively healthy elderly. 44 Relevant journal articles published between 1980-1998 were found. The four most important sleep disorders which can be accompanied by sleeplessness in relatively healthy elderly people are periodic leg movements disorder (PLM), restless legs syndrome (RLS), REM sleep behaviour disorder (RBD) and sleep apnea syndrome (SAS). Of these disorders, sleep apnea and periodic leg movements occur most frequently, in a quarter of the elderly. The latter, however, seldom complain about sleeplessness. Within the category of older people disorders characterized by movements during sleep increase significantly with age, nightly respiration disorders do not. SAS, PLM and RBD appear most frequently in men and RLS in women. The disorders characterized by movements during sleep (especially RLS and RBD) are often accompanied by sleeplessness. SAS, however, is more closely associated with day-time sleepiness than with sleeplessness. No combination of demographic variables and symptoms allows a reliable prediction of these sleep disorders. Fortunately, these disorders are not a major threat to the health of older people.
Adult↗
[The clinical syndrome: sleeping attacks with Chenyne-Stokes respiration and hormonal disorders].
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Endocrinology↗
[German Society of Pneumology, Study Group of Disorders of Nocturnal Respiration and Circulation: recommendations for nocturnal nasal respiratory therapy in respiratory disorders].
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Carbon Dioxide↗
[New actual options in anesthesiological monitoring].
New aspects of rational monitoring in contemporary anesthesiology are discussed. Not only conventional pulsoximetric parameters of circulation and respiration disorders but also new noninvasive methods are suggested to determine blood losses (degree of its compensation), certain parameters of external respiration, gas exchange, and cardiac stroke volume (Fick's principle). Cardiac stroke volume is a cardinal parameter of oxygen transport and consumption. The level of monitoring implemented in the suggested system provides maximum patient safety during surgery. It also provides anesthesiologist with information about mechanisms of circulation and respiration dysfunction.
Anesthesia↗
[Respiratory activity of the lungs as a sign of exacerbation of a lung tuberculoma].
From the clinical and roentgenological data of 82 patients with tuberculoma (progressing 55, stationary 27) the roentgenopneumopolygraphic semiotics of regional and generalized ventilation disorders is derived. In a non-active tuberculoma lung tissue often shows a regional hyperfunction. In the progress of the tuberculous process the symptoms of "surrounding hypoventilation" near the tuberculoma is seen. After ulceration of the tuberculoma sub- and segmentary zones of reduced respiratory function appear together with biomechanic respiration disorder, indicated by reduced planimetric and amplimetric respiratory parameters. A complex evaluation of respiratory parameters can serve as an objective criterion for the early detection of a reactivation of lung tuberculosis.
Adult↗
[Review of nutritional and respiratory support in ALS].
During the evolution of amyotrophic lateral sclerosis (ALS), quality of life and survival of patients are related to respiratory and nutritional status. After diagnosis, a multidisciplinary care has to be promptly organized and coordinated by the referring neurologist. The nutritional and respiratory support imply that neurologists know their specific means of evaluation with their sensitivity and sensibility and be able to recognize clinical risk situations. The informations of patients on assisted-ventilation and nutritional support by using gastrostomy may be done early, precisely and trustfully. Well informed patient's choices must be respected. Nutritional and respiratory supports may be based on recommendations established by the American Academy of Neurology. This review will present and discuss their main aspects in patients with ALS.
Amyotrophic Lateral Sclerosis↗
Functional role for cannabinoids in respiratory stability during sleep.
STUDY OBJECTIVES: Serotonin, acting in the peripheral nervous system, can exacerbate sleep-related apnea, and systemically administered serotonin antagonists reduce sleep-disordered respiration in rats and bulldogs. Because cannabinoid receptor agonists are known to inhibit the excitatory effects of serotonin on nodose ganglion cells, we examined the effects of endogenous (oleamide) and exogenous (delta9-tetrahydrocannabinol; delta9THC) cannabimimetic agents on sleep-related apnea. DESIGN: Sleep architecture, respiratory pattern, and apnea expression in rats were assessed by polysomnography. A repeated measures, within-subjects, fully nested crossover design was used in which each animal was recorded on exactly 12 occasions. PARTICIPANTS: Eleven adult male Sprague-Dawley rats were instrumented for chronic polysomnography. INTERVENTIONS: Animals were recorded following intraperitoneal injection of various doses of delta9THC, oleamide, and serotonin, alone and in combination. MEASUREMENTS AND RESULTS: Our data show that delta9THC and oleamide each stabilized respiration during all sleep stages. With delta9THC, apnea index decreased by 42% (F=2.63; p=0.04) and 58% (F=2.68; p=0.04) in NREM and REM sleep, respectively. Oleamide produced equivalent apnea suppression. This observation suggests an important role for endocannabinoids in maintaining autonomic stability during sleep. Oleamide and delta9THC blocked serotonin-induced exacerbation of sleep apnea (p<0.05 for each), suggesting that inhibitory coupling between cannabinoids and serotonin receptors in the peripheral nervous system may act on apnea expression. CONCLUSIONS: This study demonstrates potent suppression of sleep-related apnea by both exogenous and endogenous cannabinoids. These findings are of relevance to the pathogenesis and pharmacological treatment of sleep-related breathing disorders.
Animals↗
A comparison of algorithms for estimation of a respiratory signal from the surface electrocardiogram.
We provide a quantitative comparison between two new methods for deriving a respiratory signal from a single lead electrocardiogram, and the published technique of Behbehani et al. [An investigation of the mean electrical axis angle and respiration during sleep, in: Proceedings of the Second Joint EMBS/BMES Conference Houston, TX, USA, October 2002]. We conclude that (a) single ECG lead methods for estimating the respiratory signal are well correlated with inductance plethysmographs (correlation coefficients of approximately 0.75), (b) single lead estimates are more robust than methods based on the mean electrical axis, (c) body position has little impact on measurement accuracy and (d) single lead respiratory estimates can classify epochs of sleep disordered respiration with approximately 82% accuracy.
Adult↗
Breathing abnormalities during sleep.
The purpose of this communication is to review obstructive and central breathing abnormalities that may occur during sleep, such as obstructive sleep apnea, and Cheyne-Stokes respiration. Emphasis is placed on noninvasive monitoring of the breathing pattern and intrapleural pressure swings by respiratory and surface inductive plethysmography, respectively, which establish the diagnosis of these abnormal breathing patterns.
Aminophylline↗
[Regulatory mechanisms of respiration and their disorders].
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Animals↗
Neuromuscular disease and hypoventilation.
Alveolar hypoventilation associated with neuromuscular disease can occur in acute and chronic forms. In the acute form, progressive weakness of respiratory muscles leads to rapid reduction in vital capacity followed by respiratory failure with hypoxemia and hypercarbia. Symptoms are those of acute respiratory failure, including dyspnea, tachypnea, and tachycardia. In the chronic form, impairment of the respiratory muscles affects mechanical properties of the lungs and chest wall, decreases the ability to clear secretions, and eventually may alter the function of the central respiratory centers. Symptoms include orthopnea, fatigue, disturbed sleep, and hypersomnolence. Treatment and outcome of the disease's chronic form are dependent on the underlying clinical cause of the alveolar hypoventilation. For chronic but stable diseases such as old polio, quadriplegia, or kyposcoliosis, mechanical support of minute ventilation can reverse symptoms. For chronic and progressive disease such as muscular dystrophy and amyotrophic lateral sclerosis, mechanical support of minute ventilation provides only symptomatic relief and is usually associated with deterioration to the point of complete ventilator dependency for survival. For the chronic progressive forms of alveolar hypoventilation, there is currently a need for quality randomized controlled clinical trials to define physiologic indicators and appropriate timing for mechanical support of minute ventilation.
Acute Disease↗