Thesis (M.S.)--University of Texas at El Paso, 2009. / Title from title screen. Vita. CD-ROM. Includes bibliographical references. Also available online.

Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

Thesis--Helsinki. / At head of title: University of Helsinki Central Hospital, Surgical Clinic II. Bibliography: p. [128]-134.

Thesis (Ph. D.). University of Lund. Depts. of Anasthesia and Clinical Physiology.

Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.

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.

INTRODUÇÃO: Linfangioleiomiomatose (LAM) é uma doença rara, caracterizada pela proliferação de células musculares lisas atípicas ao redor de vias aéreas, vasos sanguíneos e linfáticos, com formação de cistos pulmonares difusos. Na prova de função pulmonar (PFP), a doença se caracteriza por padrão obstrutivo, aprisionamento aéreo e redução da capacidade de difusão do monóxido de carbono (DLCO), podendo haver resposta positiva ao teste de broncodilatação. No teste de exercício cardiopulmonar (TECP), a menor tolerância ao esforço é frequente e secundária a múltiplas causas, com maior destaque para a limitação ventilatória. Entretanto, nem todos os fatores potencialmente limitantes foram investigados. Os principais objetivos do estudo foram avaliar a prevalência e os preditores de hiperinsuflação dinâmica (HD) em pacientes com LAM, em comparação a mulheres saudáveis (controles), investigando-se adicionalmente a resposta ao broncodilatador. METODOLOGIA: Realizou-se avaliação transversal de 42 pacientes com LAM utilizando-se questionário de qualidade de vida, PFP e TECP incremental no ciclo-ergômetro, com medida seriada da capacidade inspiratória (CI) para definir HD, comparando-se aos controles. As pacientes foram ainda submetidas ao teste de caminhada de seis minutos (TC6M). A seguir, elas foram incluídas em uma avaliação randomizada, cruzada, placebocontrolada, duplo-cega (salbutamol inalatório vs. placebo). PFP e TECP com carga constante, com medida seriada da CI, foram realizadas após cada intervenção. RESULTADOS: Comparando-se aos controles, as pacientes com LAM apresentaram pior qualidade de vida, principalmente nos domínios físico e emocional, e padrão obstrutivo, aprisionamento aéreo e redução da DLCO na PFP. As pacientes demonstraram ainda menor capacidade de exercício, associada com limitação ventilatória, dispneia mais intensa e maior dessaturação no esforço. HD ocorreu em 55% das pacientes, mesmo naquelas com alteração funcional leve, e não foi observada nos controles, correlacionando-se com obstrução ao fluxo aéreo, aprisionamento aéreo, comprometimento da DLCO e dispneia. Em comparação ao subgrupo que não teve HD (subgrupo não HD), as pacientes que desenvolveram HD (subgrupo HD) tinham maior tempo de diagnóstico, caracterizando-se por obstrução ao fluxo aéreo, aprisionamento aéreo e DLCO reduzida. Apesar da capacidade de exercício semelhante, observou-se que o subgrupo HD apresentou limitação ventilatória, além de maior dessaturação e maior grau de dispneia no TECP e no TC6M. Não houve redução da HD ou aumento do tempo de exercício após utilização de salbutamol inalatório, mesmo no subgrupo HD. CONCLUSÕES: HD é frequente nas pacientes com LAM, mesmo naquelas com alteração leve na espirometria, associando-se com duração e gravidade da doença, maior grau de dispneia e menor saturação de oxigênio. Limitação ventilatória e alteração da troca gasosa são importantes fatores para interrupção do exercício em pacientes com LAM. HD também se associa com maior dessaturação e dispneia mais intensa no TC6M. Salbutamol inalatório não reduz HD ou aumenta duração do exercício no ciclo-ergômetro. / BACKGROUND: Lymphangioleiomyomatosis (LAM) is a rare disease that is characterized by the proliferation of atypical smooth muscle cells around the airways, blood vessels and lymphatics, with diffuse pulmonary cyst formation. An obstructive pattern, with air trapping, and a reduction in the diffusion capacity of the lungs for carbon monoxide (DLCO) are found in pulmonary function tests (PFTs), and there may be a positive response to the bronchodilation test. In the cardiopulmonary exercise testing (CPET), a lower exercise tolerance is frequent, secondary to multiple causes, with a greater emphasis on ventilatory limitation. However, not all potentially exercise limiting factors were evaluated. The aims of this study were to evaluate the prevalence and predictors of dynamic hyperinflation (DH) in patients with LAM in comparison with healthy women. The response to bronchodilator was also evaluated. METHODS: A cross-sectional study with 42 patients with LAM was conducted, with evaluation of a quality of life questionnaire, PFTs and a ramp CPET on cycle, with serial measurements of inspiratory capacity (IC) to establish DH. Data were compared with the healthy control subjects. The patients also performed the six-minute walk test (6MWT). Then, the patients were included in a randomized, placebo-controlled, doubleblind, crossover evaluation (inhaled salbutamol vs. placebo). After each intervention, they performed PFTs and endurance CPET with serial measurements of IC. RESULTS: In comparison with the healthy individuals, the patients with LAM experienced an impaired quality of life, mainly in the physical and emotional domains. They also had obstructive pattern, air trapping and lower DLCO in the PFTs. LAM was associated with diminished exercise performance, in association with ventilatory limitation, greater dyspnea intensity and exercise desaturation. DH occurred at a higher prevalence (55%) in patients with LAM, even in those with mild spirometric abnormalities, compared with no occurrence in the normal subjects. DH correlated with airflow obstruction, air trapping, DLCO impairment and dyspnea. The patients who developed DH (DH subgroup) had a longer duration since diagnosis and were characterized by airflow obstruction, air trapping and reduced DLCO, compared with those who did not have DH (non-DH subgroup). Although there was no difference in the exercise performance, DH subgroup had ventilatory limitation, with a higher desaturation and greater dyspnea intensity in the CPET and in the 6MWT. There was no reduction of DH or increase in exercise duration after use of inhaled salbutamol, even in the DH subgroup. CONCLUSIONS: DH is frequent in patients with LAM, even in those with mild spirometric abnormalities, and it is associated with the duration since diagnosis, the severity of disease, augmented dyspnea and lower oxygen saturation. Ventilatory limitation and gas exchange impairment are important reasons for exercise cessation in patients with LAM. DH is also associated with desaturation and greater dyspnea intensity in the 6MWT. Inhaled salbutamol does not reduce DH or improve exercise duration on cycle.

A acromegalia é uma doença multissistêmica decorrente da hipersecreção do hormônio do crescimento (GH) e do fator de crescimento semelhante à insulina tipo I (IGF-I), o que resulta no crescimento somático exagerado e alterações nas proporções corporais, estando associada à considerável aumento da morbidade e mortalidade. Estima-se ainda que os problemas respiratórios contribuam com 25% de todas as mortes encontradas neste grupo de pacientes. Diferenças metodológicas entre os diversos estudos levaram ao surgimento de dados inconsistentes sobre o papel do crescimento alveolar no desenvolvimento do aumento do volume pulmonar em acromegálicos, o que reforça a importância de novos trabalhos e outras abordagens sobre o tema. Ao mesmo tempo, com o desenvolvimento tecnológico, os métodos de imagem propostos em alguns estudos foram substituídos por outros mais sensíveis como a tomografia computadorizada (TC) multislice (Q-MDCT) que garante adequada mensuração do volume pulmonar, o que proporciona diferentes tipos de comparação e análise e, ainda, permite o estudo anatômico do tórax e vias pulmonares. Nossos objetivos foram identificar os principais achados da tomografia computadorizada (TC) em pacientes acromegálicos, determinar por meio da TC de tórax o volume pulmonar e comparar os achados da densitometria pulmonar com os da função pulmonar entre pacientes acromegálicos com doença ativa e doença controlada e, secundariamente, correlacionar estes achados. Foi realizado um estudo transversal com 29 portadores de acromegalia que tiveram diagnóstico da acromegalia suspeitado por características clínicas e confirmado por níveis elevados de GH não suprimido ou com níveis de IGF-I acima do limite normal. Posteriormente, os pacientes foram subdivididos nos grupos doença ativa(11 indivíduos) e doença controlada(18 indivíduos), segundo os níveis séricos de IGF-I. Houve ainda um grupo controle (17 indivíduos) em que os pacientes, após já terem realizado TC de tórax por alguma razão, foram convidados à realizar os testes de função pulmonar. A Q-MDCT e os testes de função pulmonar apresentaram excelente correlação: o volume total do pulmão (VTP) medido na TC inspiratória apresentou correlação significante com a capacidade pulmonar total (rs=0,742, p=0,0001), enquanto VTP medido na TC expiratória apresentou correlação significante com a capacidade residual funcional (rs=0,606, p=0,0005). Os pacientes acromegálicos com doença ativa apresentaram pulmões mais pesados em relação aos controles [885 (723994) vs. 696 (599769) g, p=0.017]. Os pacientes com acromegalia ativa também apresentaram maiores quantidades de compartimentos pobremente aerados em relação aos outros dois grupos, sendo esta diferença observada em %VTP [3,25 (2,553,46) vs. 2,24 (1,702,56) vs. 1,70 (1,452,15), p = 0,001] e g [82,6 (75,4 100,2) vs. 63,9 (49,180,3) vs. 54,2 (42,259,2), p = 0,0001]. O compartimento pobremente aerado medido na TC inspiratória apresentou correlação significante com os níveis de GH e IGF (rs=0,407, p=0,029; rs=0,467, p=0,011, respectivamente). Em conclusão, a Q-MDCT mostra que os pacientes acromegálicos com doença ativa apresentam pulmões mais pesados e maiores quantidades de compartimentos não aerados e pobremente aerados. Há relações entre os achados da densitovolumetria pulmonar e os parâmetros dos testes de função pulmonar na acromegalia.

Background: Measurements of lung function are routinely used in patients with cystic fibrosis (CF) to provide information that may be clinically relevant. Spirometry is the conventional lung function measurement used, however young children find spirometry difficult to perform and often cannot achieve the strict acceptability criteria for the test. The forced oscillation technique (FOT) is a lung function measurement that only requires tidal breathing and is easy for young children to perform. However, there is limited information about the utility of this technique in the clinical assessment of young children with CF who are unable to perform spirometry. Aims: The aim of this project was to evaluate the FOT for clinical assessment in 2 to 7 year old children with CF. Specifically this involved: 1. Technical assessment of the FOT in children with CF; 2. Comparisons of lung function using the FOT in children with CF and healthy children; 3. Evaluation of associations with factors known to be associated with lung disease including: i) inflammation ii) infection and iii) structural damage. Methods Lung function was measured in a cohort of 59 children between the ages of 2 and 7 years with CF at the time of quarterly clinic visits. Resistance and reactance at 6, 8 and 10Hz (Rrs6, Rrs8, Rrs10, Xrs6, Xrs8, Xrs10, respectively) were reported and expressed as Z scores. Children were classified as asymptomatic or symptomatic based on a respiratory questionnaire and physical examination at the time of testing. Bronchoalveolar lavage and high resolution computed tomography (HRCT) were performed annually under general anaesthesia annually. BAL fluid was assessed for the presence of micro-organisms and quantification of a range of inflammatory markers and HRCT used to determine the extent of structural abnormalities. Results: The between test repeatability (n=25) for lung function was within limits previously described in healthy children. No systematic bias was observed and repeatability was not affected by the presence of respiratory symptoms. Children with CF (n=57) had significantly increased Rrs6-10 (p<0.0001) and decreased Xrs6-10 (p<0.004) compared to healthy children. Rrs6 and Xrs6-10 were significantly worse in the presence of respiratory symptoms, and Rrs6-10 progressively worsened from an asymptomatic to a symptomatic clinic visit. Children with CF (n=48) had no greater bronchodilator response (BDR) compared to healthy children. BDR was not influenced by the presence of an infection or respiratory symptoms. No relationships between inflammatory markers and lung function (n=39) were identified when the presence of an infection was adjusted for. Children with a current infection (n=20) had increased Rrs6-10 (p<0.01) and decreased Xrs6-10 (p<0.04) compared to children who were uninfected (n=23). These relationships were most marked for children infected with Pseudomonas aeruginosa, with children having a reduced lung function between 0.95 and 1.47 of a Z score. No relationships with the presence or absence of mild structural abnormalities (bronchiectasis, bronchial wall thickening and air trapping) and lung function at the time of HRCT were identified (n=34). Conclusion: The FOT is a repeatable measurement of lung function in children with CF and reliable results can be obtained in children as young as 2 years old. Young children with CF exhibit altered respiratory function which was affected by the presence of factors known to be associated with lung disease. The FOT has the potential to provide useful information about changes in clinical status in young children with CF and may be used to direct management of patient lung disease.

Thesis (M.S.)--University of Texas at El Paso, 2007. / Title from title screen. Vita. CD-ROM. Includes bibliographical references. Also available online.