The severely obese patient has varying degrees of intrinsic reduction of expiratory flow rates and lung volumes. Thus, the severely obese patient is predisposed to postoperative atelectasis, ineffective clearing of respiratory secretions, and other pulmonary complications. This study evaluated the effect of bi-level positive airway pressure (Bi-PAP) on pulmonary function in obese patients following open gastric bypass surgery. Patients with a body mass index (BMI) of at least 40 kg/m2 who were undergoing elective gastric bypass were eligible to be randomized to receive either BiPAP during the first 24 h postoperatively or conventional postoperative care. Patients with significant cardiovascular and pulmonary diseases were excluded from the study. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1.0), peak expiratory flow rate (PEFR), and percent hemoglobin oxygen saturation (SpO2) were measured preoperatively, and on postoperative days 1, 2, and 3. Twenty-seven patients were entered in the study, 14 received BiPAP and 13 received conventional postoperative care. There was no significant difference preoperatively between the study and control groups in regards to age, BMI, FVC, FEV1.0, PEFR or SpO2. Postoperatively, expiratory flow was decreased in both groups. However, the FVC and FEV1.0 were significantly higher on each of the three consecutive postoperative days in the patients who received BiPAP therapy. The SpO2 was significantly decreased in the control group over the same time period. Prophylactic BiPAP during the first 12--24 h postoperatively resulted in significantly higher measures of pulmonary function in severely obese patients who had undergone elective gastric bypass surgery. These improved measures of pulmonary function, however, did not translate into fewer hospital days or a lower complication rate in our study population of other wise healthy obese patients. Further study is necessary to determine if BiPAP therapy in the first 24 postoperative hours would be of benefit in severely obese patients with comorbid illnesses who have undergone elective gastric bypass.

S100 calcium-binding protein A9 (S100A9) is elevated in plasma and bronchoalveolar lavage fluid (BALF) of patients with chronic obstructive pulmonary disease (COPD), and aging enhances S100A9 expression in several tissues. Currently, the direct impact of S100A9- mediated signaling on lung function and within the aging lung is unknown. Here, we observed that elevated S100A9 levels in human BALF correlated with age. Elevated lung levels of S100A9 were higher in older mice compared with in young animals and coincided with pulmonary function changes. Both acute and chronic exposure to cigarette smoke enhanced S100A9 levels in age-matched mice. To examine the direct role of S100A9 on the development of COPD, S100a9 -/- mice or mice administered paquinimod were exposed to chronic cigarette smoke. S100A9 depletion and inhibition attenuated the loss of lung function, pressure-volume loops, airway inflammation, lung compliance, and forced expiratory volume in 0.05 s/forced vital capacity, compared with age-matched wild-type or vehicleadministered animals. Loss of S100a9 signaling reduced cigarette smoke-induced airspace enlargement, alveolar remodeling, lung destruction, ERK and c-RAF phosphorylation, matrix metalloproteinase- 3 (MMP-3), matrix metalloproteinase-9 (MMP-9), monocyte chemoattractant protein-1 (MCP-1), interleukin-6 (IL-6), and keratinocyte- derived chemokine (KC) release into the airways. Paquinimod administered to nonsmoked, aged animals reduced age-associated loss of lung function. Since fibroblasts play a major role in the production and maintenance of extracellular matrix in emphysema, primary lung fibroblasts were treated with the ERK inhibitor LY3214996 or the c-RAF inhibitor GW5074, resulting in less S100A9-induced MMP-3, MMP-9, MCP-1, IL-6, and IL-8. Silencing Toll-like receptor 4 (TLR4), receptor for advanced glycation endproducts (RAGE), or extracellular matrix metalloproteinase inducer (EMMPRIN) prevented S100A9-induced phosphorylation of ERK and c-RAF. Our data suggest that S100A9 signaling contributes to the progression of smoke-induced and age-related COPD.

Asthma is a chronic disease of airway hyper-responsiveness, airway inflammation and episodic bronchoconstriction. With asthma forecasted to increase by an additional 100 million cases by 2025, there is a critical and immediate need to address new asthma therapies. Guidelines for asthma treatment in the emergency department conditionally recommend intravenous magnesium sulfate (MgSO4). However, some investigations have failed to demonstrate beneficial effects. Ethical constraints limit evaluation of the bronchodilatory effects of MgSO4 alone in patients with acute asthma exacerbation, independent of other conventional therapeutics. To address this ethical dilemma, this study consisted of two phases: 1) quantification of the independent pulmonary effect of three doubling doses of MgSO4 in the spontaneous equine model of asthma during naturally occurring exacerbations of bronchoconstriction, and 2) evaluation of arterial blood gas parameters in response to administration of MgSO4 at a dose identified in phase 1 that yielded greatest efficacy without deleterious side effects.

Pasture-associated severe equine asthma (EPA) is a progressive condition affecting horses in the southeastern United States. Pulmonary function testing with methacholine challenge (MC) provides a definitive diagnosis by eliciting airway hyper-responsiveness. Most horses require extensive conditioning to accept the instrumentation. Our hypothesis was that MC protocols designed to elicit airway hyper-responsiveness would yield equivalent results in the presence and absence of sedation. Sedated and unsedated MCs were performed on 8 EPA-affected horses, with each horse acting as its own control. Acepromazine was superior to xylazine/butorphanol, resulting in sedation and data collection. Based on American Thoracic Society guidelines, an acceptable ability to detect differences in lung resistance is less than a twofold difference in the provocative concentration of methacholine that elicited a 40% increase in lung resistance (PC40RL). Significant differences in PC40RL were not detected. Validation of a sedation protocol for use in MC will expand the application of this diagnostic.

Idiopathic tracheal stenosis (ITS) is a rare condition, and diagnosis of exclusion should be suspected in patients with exercise intolerance, wheezing, and dyspnea on exertion with a flow-volume loop suggestive of fixed airway obstruction. We report a case of a 32-year-old asthmatic woman with an existing diagnosis of vocal cord dysfunction and previous normal CT scan of the neck. She continued to have fixed upper airway obstruction on repeated flow-volume loops with persistent wheezing and cough along with occasional stridor and hoarseness of voice despite appropriate management of her asthma. She was finally diagnosed with ITS on a repeat CT scan of the neck for which she underwent laser surgery, steroid injection, and controlled radial expansion balloon dilation with a successful reduction of stenosis. This case illustrates the importance of clinical suspicion for early diagnosis of ITS in poorly controlled asthmatic patients and the relevance of non-surgical management of this condition.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24967号 / 医博第5021号 / 新制||医||1069(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊達 洋至, 教授 江木 盛時, 教授 川上 浩司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Tyrimo objektas: Pilateso pratimų poveikis kvėpavimo funkcijai ir energetikai. Tyrimo tikslas: Nustatyti Pilateso pratimų poveikį kvėpavimo funkcijai ir energetikai. Tiriamieji: 28(±8) metų amžiaus moterys (n=13). Tyrimo uždaviniai: 1. Nustatyti moterų kvėpavimo funkcijos ir energetikos rodiklius prieš pradedant lankyti Pilateso užsiėmimus. 2. Nustatyti moterų kvėpavimo funkcijos ir energetikos rodiklius po mėnesio trukmės Pilateso pratimų atlikimo. 3. Nustatyti mėnesio trukmės Pilateso pratimų poveikį moterų kvėpavimo funkcijai ir energetikai. Hipotezė – dėl Pilateso pratimų poveikio gerėja žmogaus kvėpavimo funkcija bei mažėja energetinių rodiklių sąnaudos pratimų metu ir po jų. Rezultatai: atlikus kiekvienos tiriamosios duomenų rezultatų palyginimą atskirai, prieš treniruočių laikotarpį ir praėjus mėnesiui po treniruočių, tiriamųjų moterų gauti duomenų rezultatai yra tokie: deguonies ventiliacija (p=0,4583), deguonies ventiliacija kiekvienam žmogaus kūno kilogramui (p=0,2951), plaučių ventiliacijos iškvėpimo laikas litrais per minutę (p=0,2413) ir paros kalorijų norma (p=0,4869) nepakito, tačiau matoma rodiklių gerėjimo tendencija, o minutinis kvėpavimo tūris (p=0,4355), kraujo tūris pratekantis per širdį ir plaučius per vieną minutę (p=0,3378), anglies dioksido ventiliacija (p=0,4033) ir kūno masės indeksas (p=0,4229), kvėpavimo pasikeitimo santykis (p=0,3358) nekito. Išvados: 1. Prieš pradedant lankyti Pilateso užsiėmimus moterų minutinis kvėpavimo tūris, plaučių... [toliau žr. visą tekstą] / Study objective: Pilates exercises effect on pulmonary function and energetics. Study aim: Find out Pilates exercises effect on pulmonary function and energetics. Subjects: 28(±8) years old women (n=13). Study objectives: 1. Set women pulmonary function and energetics rate before starting Pilates method course. 2. Set women pulmonary function and energetics rate after one month of Pilates method course. 3. Set one month Pilates method effect on women pulmonary function and energetics rate. Hypothesis – Because of Pilates exercises effect, human pulmonary function is improving and energetics are getting lower during the exercise and in daily life. Results: After compairing each objective data results separately, before training period and after one month of training period, subject women data results are: oxygen ventilation (p=0,4583), oxygen ventilation per one kilogram of persons bodyweight (p=0,2951), pulmonary ventilation exhaling time liters per minute (p=0,2413) and daily calories intake (p=0,4869) did not changed statistically, but improvement of indicators is seen, respiratory volume per minute (p=0,4355), blood flow through the heart and lungs, per one minute (p=0,3378), carbon dioxide ventilation (p=0,4033), body mass index (p=0,4229), and pulmonary change ratio (p=0,3358) showed no changes. Conclusions: 1. Before starting the Pilates workouts, women respiratory volume per minute, pulmonary ventilation exhaling time liters per minute and pulmonary change ratio... [to full text]

Motivation: The investigation of agricultural respiratory hazards has lagged behind the investigation of hazards in mining and other heavy industries. Relatively few epidemiological data are available addressing pulmonary infections in the context of the agricultural work environment, especially for the South African population. Poultry house dust was generally considered nuisance or inert, meaning it has little adverse effect on human lungs. New research shows that because poultry house dust is largely organic and contain bacteria and other bioactive substances, it cannot be considered inert. Several published research manuscripts document that the legal and recommended exposure limits for the toxic substances found in the agricultural environment are to high for concentrated animal feeding operations (CAFO's). In CAFO's there is a mixture of biologically active agents that can work synergistic to produce respiratory and systemic effects at much lower levels. Most of the current legal exposure limits used in South Africa are adopted from international limits and guidelines. Because of the influence of geography, climate and degree of industrialisation on the agricultural air quality, the relevance of the foreign exposure limits is questionable. Aim: To determine if there is a correlation between occupational exposure to poultry farm dust and the lung function of poultry farm workers in the Potchefstroom district, South Africa. Also to determine if the current legal exposure limits used for ammonia and particulate matter (PM) in South Africa, offer adequate worker protection for poultry farm workers exposed to biologically active dust. Methodology: This was an observational, cross-sectional pilot study. A target population of fifty contract workers concerned with the removal and disposal of poultry manure were identified in the Potchefstroom district and a random sample of nineteen was drawn for participation in this study. Exposure to total and respirable dust were determined by means of personal sampling for the full duration of the time averaging period (8-hour TWA). Area monitoring for ammonia and bio-aerosols were done in poultry houses in three specific demarcated areas around Potchefstroom, and weather conditions were taken into account. Lung function tests (spirometry) were conducted before and after each work shift. Interviewer administered questionnaires were used to assess occupational and exposure histories and to detect symptoms of organic dust exposure. Results and conclusions: The mean total- and respirable dust concentrations complied with the legal limits of OSHA, NlOSH and the Regulations for hazardous chemical substances of 1995. However, fifty five percent of the measured total dust concentrations and all of the respirable dust measurements exceeded Donham's recommended values for human health. The spirometric values of the subjects were normal; there was no statistical difference between the mean baseline FEV1/FVC and the mean predicted FEV1/FVC. Results also show no statistically significant cross shift changes in any of the measured variables and there is no significant correlation of the measured dust concentrations to any of the spirometric measurements. It can be concluded that occupational exposure to ammonia, particulate matter and micro-organisms on poultry farms in the Potchefsroom district, South Africa, do not have any adverse effects on the workers' lung function and the workers are adequately protected in the short term, by the legal limits that are currently used in South Africa. / Thesis (M.Sc. (Occupational Hygiene))--North-West University, Potchefstroom Campus, 2006.

Objective: The paper deals with the evaluation of the status of pulmonary and postural functions of the patients with pectus carinatum. Further, it deals with the development of pulmonary and postural functions after Welch surgery. Methods: Between the years 2010 and 2011 20 patients (19 men, 1 woman) went through Welch surgery at the Pediatric Clinic of the Faculty Hospital, Prague Motol. The average age of the group was 16,2 ± 1,2 years. Before surgery, pulmonary functions, respiratory muscle strength and posturography were evaluated. The received values were compared with the predicted, i.e. the controlled group, and in order to find mutual dependencies, also among themselves. 7 patients were repeatedly checked for pulmonary functions and posturography in the interval of 8,1 ± 3,0 months after their surgery. Pre and post - surgery values were compared. Results: Dynamic and static hyperinflation and also an increased patency of periphery respiratory tracts was found in 20 pre-surgery patients with PC. Testing of respiratory muscle strength showed significantly lower values than the predicted. Checking for posturography revealed the differences in postural system resulting, especially with complicated postural demands, in medio-lateral instability of the body. Worsening of the balance functions...

Introdução: O derrame pleural, reduzindo a capacidade funcional pulmonar, torna os pacientes incapacitados para o desenvolvimento de suas atividades habituais. A retirada do líquido pleural através da toracocentese pode reverter este quadro, porém seu impacto especialmente na capacidade ao exercício não foi totalmente estabelecido. Objetivos: Avaliar o impacto da toracocentese de alívio na capacidade funcional ao exercício, no comportamento da função pulmonar e na força dos músculos respiratórios 48 horas pós toracocentese. Casuística e Método: Foram incluídos no estudo 25 pacientes com derrame pleural unilateral, documentado por radiografia de tórax. O teste de caminhada de seis minutos (TC6M), a escala modificada de dispnéia de Borg, as variáveis espirométricas: Capacidade Vital Forçada (CVF), Volume Expiratório Forçado no Primeiro Segundo (VEF1) e as medidas de Pressão Inspiratória Máxima (Pimax) e Pressão Expiratória Máxima (Pemax) foram analisados antes e 48 horas após a retirada de volumes superiores a 600 mL. Resultados: Foram removidos 1564 + 695 mL de líquido pleural. Os valores da distância percorrida, da CVF, do VEF1, da Pimax e da Pemax aumentaram (p < 0,001) enquanto o escore de dispnéia diminuiu (p < 0,001) após o procedimento. Observaram-se correlações estatísticas (p < 0.001) entre a distância percorrida e a CVF (r = 0.725) e VEF1 (r = 0.661) avaliadas 48 horas pós toracocentese e entre a variação da distância percorrida e a variação porcentual da CVF (r = 0,450) e do VEF1 (r = 0,472), corrigidos pelo volume de líquido retirado (p < 0,05). Conclusão: Embora ocorra melhora da função pulmonar após a toracocentese, os benefícios observados são mais evidentes em situações de esforço, o que possibilita melhor readaptação dos pacientes às suas atividades rotineiras. / Introduction: Pleural effusion reducing pulmonary functional capacity hinders patients in carrying out their habitual activities. Pleural fluid removal by thoracentesis reverts the clinical situation but its impact especially on exercise capacity has not yet been determined. Objectives: To evaluate the impact of thoracentesis in functional exercise capacity on pulmonary function and on muscle strength 48 hours after thoracentesis. Methods: Twenty five patients with unilateral pleural effusion documented by chest X-ray were included. The 6 minute walk test (TC6M), Borg\'s modified dyspnea scale, spirometric variables: CVF (forced vital capacity), VEF1 (forced expiratory volume in the first second), Maximum Inspiratory Pressure (Pimax) and Maximum Expiratory Pressure (Pemax) were analyzed before and 48 hours after the removal of volumes greater than 600 mL. Results: The mean of pleural effusion removed was 1564 + 695 mL. After the procedure values of walked distance, CVF, VEF1, Pimax and Pemax covered increased (p < 0.001) while dyspnea decreased (p < 0.001). Statistical correlations (p < 0.001) between the walked distance and FVC (r = 0.725) and VEF1 (r = 0.661) were established noted measured 48 hours post thoracentesis and between the variation of the distance walked and the percentage of variation of CVF (r = 0.450) and VEF1 (r = 0.472), corrected by the volume of fluid removed (p < 0.05). Conclusions: Despite an improvement in lung function after thoracentesis, the benefits noted are more evident in effort situations of exertion, allowing a better readaptation of patients to their routine activities.