Sternomastoid muscle size and strength in patients with severe chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) imposes a major strain on the respiratory muscle pump, and it is conventionally thought that the inspiratory muscles of the neck adapt to this chronic overload by developing hypertrophy. Yet previous anthropometric studies have shown atrophy of the sternomastoid muscles. To solve this discrepancy, we have measured the cross-sectional area of these muscles by computed tomography. Ten stable patients with severe airflow obstruction (FEV1 = 0.76 +/- 0.12 L) and hyperinflation (FRC = 210 +/- 29% of predicted) and 10 control subjects matched for age, sex, and height were studied. The sternomastoid cross-sectional area in the patients averaged (mean +/- SD) 4.29 +/- 1.48 cm2, and that in the control subjects was 3.96 +/- 0.82 cm2. This small difference could be entirely accounted for by hyperinflation, and it was not statistically significant. Sternomastoid muscle torque in patients was also similar to that in the control subjects. In patients with severe COPD, therefore, the sternomastoid muscles are essentially normal. As a corollary, their frequent prominence on clinical examination is only apparent.     

The effect of selective agonist beta-adrenergic receptors on lung ventilation function in patients with chronic obstructive pulmonary disease

The aim of the research was to show the influence of Salmeterol on the ventilatory parameters in patients with chronic obstructive pulmonary disease (bronchitis chronica spastica). In all the patients full lung function test was made with the MasterLab-Transfer of the firm Jaeger contains spirometry, flow-volume and airway resistance. The examination have shown that the average values off all analysed indices were higher in the particular examinations than in the initial one. Estimating these differences with the test "t Student" it has been demonstrated that referring to basic indices the differences were statistically essential. We can observe from the comparison of the obtained data that the growth of the indices took place in the substantial majority of patients.     

慢性阻塞性肺疾病稳定期脏虚与肺功能关系的临床观察

目的 探讨慢性阻塞性肺疾病(COPD)稳定期的中医脏虚证候与肺功能第1秒用力呼气容积占用力肺活量比值(FEV1/FVC)、第1秒用力呼气容积实测值占预计值百分比(FEV1%)及严重程度分级的关系.方法 将95例符合诊断标准的COPD稳定期患者按照证候表现分为单肺虚(25例)、两脏虚(肺脾两虚15例、肺肾两虚18例)、三脏虚(肺脾肾虚37例)3组,以中医证型为导向,同步检测肺功能,观察该证型与肺功能的相关关系.结果 3组FEV1/FVC及FEV1%之间的差别具有显著性的意义(P<0.001),单肺虚组指标高于两脏虚组和三脏虚组(均P<0.001),两脏虚组指标高于三脏虚组(均P<0.001).3组在CODP严重程度分级中的分布差别亦具有显著性的意义(P<0.001),单肺虚组轻于两脏虚组、三脏虚组(P<0.01,P<0.001),两脏虚组轻于三脏虚组(P<0.01).结论 CIOPD稳定期以肺脾肾虚为本,涉及脏腑从肺及脾,由脾及肾,且受累脏腑及病变程度亦随着FEV1/FVC及FEV1%预计值的下降、COPD分级降低而逐渐增多、加重,故应强调早期综合治疗.     

Predictors of functioning of patients with chronic obstructive pulmonary disease

The subcellular distribution of soluble and membrane-bound Arg-beta-naphthylamide-hydrolyzing activities was studied in the left and right rat brain during development and aging. During development, the soluble activity was heterogeneous, whereas adult animals showed the highest activity in the synaptosomal fraction. However, except in fetuses, membrane-bound activity was greatest in the microsomal fraction. Except in microsomal and myelin fractions, soluble and membrane-bound activities showed a decrease in 1-wk-old rats compared with fetuses and a subsequent increase to adult levels in 1-mo-old rats. This profile differed in the microsomal fraction, which increased steadily throughout development. In the synaptosomal fraction, both activities were lower in 24-mo-old rats than in 5-mo-old animals. No differences between the hemispheres were observed in soluble or membrane-bound fractions at any age tested.     

Patterns of hospitalization in elderly patients with asthma and chronic obstructive pulmonary disease

The purpose of this study was to describe the impact of asthma and chronic obstructive pulmonary disease (COPD) in the elderly on health care utilization. The Health Care Financing Administration (HCFA) file for the year 1984 through 1991 involving beneficiaries < or = 65 yr were searched for the diagnoses of asthma and COPD by ICD-9 codes. The study groups were created by determining the first admission for an exacerbation of either disease during each year from 1984 through 1991. Patients were identified by their social security number. The 1984 cohort consisted of 56,692 patients with asthma exacerbation and 162,899 with COPD exacerbation. The 1991 cohort consisted of 67,758 patients with asthma exacerbation and 131,974 patients with COPD exacerbation. In addition, the 1984 cohort was tracked by social security number for evidence of rehospitalization for either asthma or COPD through 1991. Length of hospitalization increased as patients grew older. The discharge rate to an independent living facility diminished as age increased. The use of convalescent and nursing homes or home health care after discharge more than doubled from 1984 through 1991. The utilization of health care resources by elderly patients with asthma and COPD is immense, both during hospitalization and after discharge.     

Functional outcome of patients with chronic obstructive pulmonary disease and exercise hypercapnia

Chronic hypercapnia is associated with a poor prognosis in chronic obstructive pulmonary disease (COPD). Some patients are normocapnic at rest but retain CO2 during exercise. The significance of this abnormality on the course of the disease is unknown. Sixteen stable COPD patients (13 males and 3 females, aged 60 +/- 5 yrs, mean +/- SD) who had previously undergone pulmonary function tests and progressive exercise testing with arterial blood sampling at rest and maximal capacity, entered the study. At first evaluation (E1), subjects were normocapnic at rest (arterial carbon dioxide tension (Pa,CO2): 4.9-5.7 kPa, (37-43 mmHg)) and all presented exercise-induced hypercapnia (end-exercise Pa,CO2 > 5.7 kPa (43 mmHg) with a minimal 0.5 kPa (4 mmHg) increase from resting value). The subjects were re-evaluated 24-54 months later (34 +/- 8 months) (second evaluation (E2)). At E2, forced expiratory volume in one second (FEV1) had decreased from 42 +/- 13 to 38 +/- 15% of predicted values, and mean resting Pa,CO2 had increased from 5.2 +/- 0.3 to 5.7 + 0.4 kPa. Maximal exercise capacity (Wmax) decreased between E1 and E2 from 76 +/- 30 to 56 +/- 22 W. Even if Wmax was lower at E2, end-exercise, Pa,CO2 was higher than at E1 (6.6 +/- 0.8 vs 6.4 +/- 0.5 kPa). At E2, eight subjects presented resting hypercapnia (group H), whilst the others remained normocapnic (Group N). Group H subjects had higher Pa,CO2, at Wmax than Group N and lower Wmax than Group N at E2.(ABSTRACT TRUNCATED AT 250 WORDS)     

Quality of life in patients with chronic obstructive pulmonary disease and bronchial asthma

Review of data in the literature on the quality of life and its assessment in chronic obstructive lung disease and in bronchial asthma. The authors mention the most frequently used types of questionnaires and results achieved when using them. General questionnaires include the Sickness Impact Profile or the short version of a very detailed questionnaire which has 36 questions with sub-questions (SF-36 = Short Form-36). Specific questionnaires are focused on certain questions concerning different diseases. These questionnaires include SGRQ (St. George's Respiratory Questionnaire) which is used mainly in chronic obstructive lung disease. For this disease also the CRQ was developed (Chronic Respiratory Questionnaire) but its section on dyspnoea is not standardized. For evaluation of the quality of life of asthmatic patients several questionnaires exist, in particular for children. Several questions call for further standardization. The value of questionnaires is, however, beyond dount. They elucidate the situation which does not ensue even from detailed functional examination of the lungs or immunological examination. It appraises bodily and mental functions of man, restriction of his activity, the sensation of comfort and general evaluation of his health. Thus "classical" evaluation methods are extended by now non-traditional ways of appraisal of diseases which have a high prevalence and thus also great impact in the population.     

Evolution of nocturnal pulse-oximetry results in patients with chronic obstructive pulmonary disease

The aim of this study was to evaluate if results of overnight pulse-oximetry (PO) change with time and progression of the disease. We studied 39 COPD patients. Majority of them (33 pts) were treated with long-term oxygen therapy (LTOT). Fifty pairs of PO were performed in the whole group separated from 1 to more than 3 years. Pulmonary function tests were performed at the same time as PO. Results of these tests showed progressive deterioration in the lung function-decrease of FEV1 and PaO2. Despite of that there were no statistically significant changes in any variable of PO in any studied group. This phenomenon is difficult to explain. It may resulted from the improvement in the cardiac output observed in COPD patient undergoing LTOT. May be that studied groups were not large enough or time of observation was too short to reveal differences. Stabilization of PO results in spite of deterioration in the lung function in COPD patients needs more studies.     

Measurement of respiratory muscle performance in patients with chronic obstructive pulmonary disease

Respiratory muscle performance is measured in terms of strength and endurance. A RMSE-1 type measuring system for evaluation of respiratory muscle strength (RMS) and endurance (RME) has been developed and tested in normal subjects and patients with stable chronic obstructive pulmonary disease (COPD). The results showed that there was no significant difference between normal subjects and stable COPD patients in RMS measured as maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). The maximum load (Load(m)), mean mouth pressure at maximum load (Pmean), and the maximum sustainable inspiratory pressure (SIP(m)) as % MIP (SIP(m)/MIP) were taken as measure of RME. All measures of RME in COPD group were much lower than those in the normal. The measurement of RME can be used to evaluate the effect of respiratory muscle training and direct the respiratory rehabilitation in COPD patients.     

Relationships between blood oxygen parameters in patients with chronic obstructive lung disease

The hemoglobin-oxygen dissociation curve and the relationships between the parameters of tension, saturation, capacity, affinity and concentration of oxygen in the course of respiratory failure in chronic obstructive lung diseases (COLD) were studied. The study included 141 patients divided into four basic groups according to the value of pO2 (a): patients with normoxia, mild, moderate and severe arterial hypoxia. The blood-gas status was determined using the ABL-330 and OSM-3 analyzers (Radiometer A/S, Denmark). It is concluded that: 1. Presence of normoxia (pO2 and sO2 in norm) in COLD patients does not exclude abnormalities in their arterial blood oxygen transport and increased risk of tissue hypoxia. 2. Total oxygen concentration in respiratory failure is relatively stable and "independent" from the stepwise decrease of the arterial pO2, which results from the compensatory increase of the total and effective hemoglobin. 3. There are phase fluctuations of the ctO2/pO2 dissociation curve in the reference interval, expressed in the "lowering" of P50 and p90 in mild hypoxia and the "centering" or "raising" of their values in severe hypoxia. Such fluctuations are more pronounced in the p90 than in the p50. 4. The oxygen extraction tension lowers progressively (without reaching the anaerobic threshold) and the oxygen compensation factor elevates with the pO2 (a) reduction and the arising of hypercapnia and acidemia. 5. The calculated 2,3-diphosphoglycerate (2,3-DPG) concentration values are significantly higher in hypercapnics with COHb > 1% than in those with COHb < 1%. The relationships between hypoxia, oxygen affinity, hemoglobinemia and oxygen affinity as well as the dissociation curve properties in chronic respiratory failure are discussed.     

Functional performance in people with chronic obstructive pulmonary disease

The extent to which individuals with a chronic physical illness perform their day-to-day activities and maintain the independence and autonomy they desire is both an indicator of adaptation and an important clinical outcome criterion. Yet the concept of functional performance is not well understood. Studies of people with chronic obstructive pulmonary disease (COPD) have attempted to identify physiologic and psychosocial factors that contribute to functioning in this population. These studies have used a melange of terms, including functional status, functional ability, quality of life, and health status interchangeably. They have also employed a variety of instruments to operationalize functional performance and an assortment of predictors to understand the phenomena. Perhaps as a result of this disarray, no attempt has been made to synthesize the literature for nursing research and practice. The purpose of this paper is to summarize the research on functional performance in people with COPD, indicate areas of understanding and quandary, suggest possible flaws, and propose several new directions for practice and research.     

Respiratory effects of pharingeal gas insufflation in patients with chronic obstructive pulmonary disease

In the cranio-facial region the giant-cell reparative granuloma (GCRG) is a typical lesion of the maxillary bones. Because giant-cell reparative granuloma is not strictly a granuloma, clinically and histologically, many authors prefer call it giant-cell lesion (GCL). A review of the literature have along with our experiences is reported. Authors present 17 patients with giant-cell lesion and their results, treated at the Maxillo-Facial Department of Parma. Clinical, radiographic and pathologic features were evaluated and differential diagnosis was considered, showing the real great difficulty in differential diagnosis also and especially for surgical treatment.     

Effect of flurenizide on adaptive reactions in patients with chronic obstructive pulmonary disease

Studies on the wake-sleep cycle with participation of eight female volunteers were performed before, during, and after a 120-day bed rest with the head-end of bed tilted down at 6 degrees (HDT). Methods of polysomnography and actography were applied. The test-subjects were assigned into 2 groups. Group A was prescribed to use countermeasures throughout the experiment; no countermeasures was administered by group B. Evidence of significant alteration in sleep structure at different time points in HDT is given in comparison with data about females of the control group under the conditions of everyday activity. Sleep deviations in the subjects were reordered at each of the three points of investigation and differed from those in control. HDT was shown to modify the sleep structure in experimental groups A and B. A supposition is made that under these conditions the dynamics of physical activity during night sleep had an adaptive character.     

Ventilatory response to positive and negative work in patients with chronic obstructive pulmonary disease

The consequences of extreme violence such as war torture affect children in different ways and may immediately manifest at the physical and/or psychologic level, or may remain hidden and unrecognized for years. The victims are usually very reluctant to speak about their traumatic experiences, and try to deny the existence of psychological disturbances. They often seek help for somatic problems. Taking these physical complaints seriously helps to progressively reach the psychological effects of violence. Therefore, identification of such children should be directed to more complete evaluation of their symptomatology and functioning. This can be done by: a) individual evaluation to get enough information on the historical events, functioning and symptoms of these children; and b) standardized instruments which may allow the children to disclose more about their psychological experiences during the war. In this study rating scales and assessment instruments for children aged < 15, such as CPRS with General Scoring Sheet (Fish, 1985), were used to assess the broad spectrum of psychopathology in this age group. These questionnaires were used in a large group of school children (N = 1888), 989 girls and 899 boys aged 7-16 years. The sample was divided into 3 groups: 843 non-displaced, 377 displaced and 669 refugee children. Results of statistical analysis (arithmetical mean and standard deviation of discriminative variables transformed in Z-values with F-ratio) showed the three groups of children (non-displaced, displaced and refugees) to significantly differ in 13 out of 15 psychopathologic clusters. Discriminative cannonic analysis of the 3 groups of children (non displaced, displaced and refugees) also showed significant differences. The first discriminative function (80.24% of total variance) indicated depression, violence and antisocial behavior to be rare in non-displaced children, more pronounced in displaced, and most pronounced in refugee children. The second discriminative function (19.76% of total variance) showed hyperactivity, anxiety and psychosomatic disturbances to be rare in non-displaced children; more frequent in refugee, and most expressed in displaced children. According to the results, the authors concluded that war is very painful for a large group of children, among whom the displaced and refugee children are most affected by psychopathologic disturbances.