Increase in lung size has been described in acromegalic patients, but data on respiratory muscle function and control of breathing are relatively scarce. Lung volumes, arterial blood gas tensions, and respiratory muscle strength and activation during chemical stimulation were investigated in a group of 10 patients with acromegaly, and compared with age-and sex-matched normal controls.Inspiratory muscle force was evaluated by measuring pleural (Ppl,sn) and transdiaphragmatic (Pdi,sn) pressures during maximal sniffs. Dynamic pleural pressure swing (Ppl,sw) was expressed both as absolute value and as percentage of Ppl,sn. Expiratory muscle force was assessed in terms of maximal expiratory pressure (MEP). In 8 of the 10 patients, ventilatory and respiratory muscle responses to hyperoxic progressive hypercapnia and to isocapnic progressive hypoxia were also evaluated.Large lungs, defined as total lung capacity (TLC) greater than predicted (above 95% confidence limits), were found in five patients. Inspiratory or expiratory muscle force was below normal limits in all but three patients. During unstimulated tidal breathing, respiratory frequency (fR) and mean inspiratory flow (tidal volume/inspiratory time (VT/tI)) were greater, while inspiratory time (tI) was shorter than in controls. Minute ventilation (V'E) and mean inspiratory flow response slopes to hypercapnia were normal. In contrast, four patients had reduced ∆(VT/tI)/ arterial oxygen saturation (Sa,O 2 ) and three had reduced ∆V'E/Sa,O 2 . Ppl,sw(%Ppl,sn) response slopes to increasing end-tidal carbon dioxide tension (PET,CO 2 ) and decreasing Sa,O 2 did not differ from the responses of the normal subjects, suggesting normal central chemoresponsiveness. At a PET,CO 2 of 8 kPa or an Sa,O 2 of 80%, patients had greater fR and lower tI compared with controls. Pdi,sn and Ppl,sn related both to ∆V'E/∆Sa,O 2 (r=0.729 and r=0.776, respectively) and ∆(VT/tI)/∆Sa,O 2 (r=0.860 and r=0.90, respectively). Pdi,sn also related both to ∆V'E/∆PET,CO 2 (r=0.8) and ∆(VT/tI)/ ∆PET,CO 2 (r=0.76).In conclusion, the data suggest the relative independence of pneumomegaly and respiratory muscle strength. Peripheral (muscular) factors appear to modulate a normal central motor output to give a more rapid pattern of breathing. Eur Respir J 1997; 10: 977-982 [5,7,8]. Ventilatory responses to chemical stimuli (hypercapnia and hypoxia) have been assessed [11], but the relative contribution of respiratory muscle function to indices of ventilatory control have not been specifically investigated.To obtain insight in this field, we assessed respiratory muscle function and the control of breathing in a group of patients with acromegaly both during spontaneous and chemically-stimulated breathing. Subjects and methodsThe subjects comprised five males and five females with acromegaly, referred to the section of pneumology of the Department of Internal Medicine at the University of Florence, from the Department of Endocrinology at the same University. They were studied in a clinically st...
Background Patients with coronavirus disease 2019 (Covid-19) may experience venous thrombosis while data regarding arterial thrombosis are sparse. Methods Prospective multicenter study in 5 hospitals including 373 patients with Covid-19-related pneumonia. Demographic data, laboratory findings including coagulation tests and comorbidities were reported. During the follow-up any arterial or venous thrombotic events and death were registered. Results Among 373 patients, 75 (20%) had a thrombotic event and 75 (20%) died. Thrombotic events included 41 venous thromboembolism and 34 arterial thrombosis. Age, cardiovascular disease, intensive care unit treatment, white blood cells, D-dimer, albumin and troponin blood levels were associated with thrombotic events. In a multivariable regression logistic model, intensive care unit treatment (Odds Ratio [OR]: 6.0; 95% Confidence Interval [CI] 2.8–12.6; p < 0.001); coronary artery disease (OR: 2.4; 95% CI 1.4–5.0; p = 0.022); and albumin levels (OR: 0.49; 95% CI 0.28–0.87; p = 0.014) were associated with ischemic events. Age, sex, chronic obstructive pulmonary disease, diabetes, heart failure, coronary heart disease, intensive care unit treatment, in-hospital thrombotic events, D-dimer, C-reactive protein, troponin, and albumin levels were associated with mortality. A multivariable Cox regression analysis showed that in-hospital thrombotic events (hazard ratio [HR]: 2.72; 95% CI 1.59–4.65; p < 0.001), age (HR: 1.035; 95% CI 1.014–1.057; p = 0.001), and albumin (HR: 0.447; 95% CI 0.277–0.723; p = 0.001) predicted morality. Conclusions Covid-19 patients experience an equipollent rate of venous and arterial thrombotic events, that are associated with poor survival. Early identification and appropriate treatment of Covid-19 patients at risk of thrombosis may improve prognosis.
In patients with bronchial asthma, forced expiratory flows are differently sensitive to a previous volume history. A reduced ability of a deep inhalation (DI) to dilate obstructed airways has been hypothesized to be a physiological marker for the degree of airway responsiveness and to relate to the presence and magnitude of inflammation in the lung, even in mild stable asthma. However, there are at present doubts as to whether functional changes could be used as a substitute for airway inflammation studies.In order to investigate the interrelations among airway inflammation, bronchial hyperresponsiveness and effects of volume history, 58 consecutive asthmatics with mild to moderate asthma were studied. The effects of DI were assessed as the isovolumic ratio of flows from forced expiratory manoeuvres started from maximal (M) or partial (P) lung inflation. Airway inflammation was assessed by using induced sputum. Sputum was analysed for total and differential cell counts, and levels of eosinophil cationic protein (ECP) which reflects eosinophil activation. Airway responsiveness was assessed as the provocative concentration of histamine which caused a 20% fall in forced expiratory volume in one second (FEV1) from control (PC20).The M/P ratio was significantly related to ECP (r=-0.31, p<0.03) and eosinophils (r=-0.29, p<0.03), FEV1/vital capacity (VC) (r=0.32; p<0.01), clinical score (r=-0.33; p<0.03) and age (r=-0.41; p<0.0001). In a stepwise multiple regression analysis including age, score, baseline lung function, ECP, number of eosinophils and the response to b 2 -agonist, age (p<0.037) predicted a small amount of the variance in M/P ratio (r 2 =0.12). It is concluded that volume history response is substantially independent of both sputum outcomes (inflammatory cell number and eosinophil cationic protein) and bronchial hyperresponsiveness; rather it seems to be associated with anthropometric characteristics. Functional aspects do not provide information on eosinophilic, probably central, airway inflammation. Eur Respir J 1999; 14: 1055±1060. In patients with bronchial asthma maximal expiratory flow is affected by a deep inhalation (DI) varying from an increase, to no effect, to a decrease in expiratory flow. These changes relate to the site and mechanism of the obstructive process [1]. A reduction in bronchodilation following a DI has been shown to be positively related to the severity of airway inflammation [2]. An increase in the bronchodilator effect of a DI, after corticosteroid administration, has consistently been reported [2±4]. Furthermore, the bronchodilator effect of DI is inversely related to the degree of responsiveness to a subsequent methacholine challenge in mild asthma [5]. Thus, several lines of evidence suggest that the blunting of the dilator effect of DI during obstruction could serve as a physiological marker for the degree of airway responsiveness and may relate to the presence and magnitude of inflammation in the lung even in mild stable asthma [2].This hypothesis is based eithe...
In patients with COPD, flow limitation (FL) predicts chronic exertional dyspnoea (CED) better than routine spirometry. Whether, and to what extent, FL and CED are overlapping quantities in chronic asthma has not yet been defined. Forty consecutive clinically stable asthmatic patients without smoking history or cardiopulmonary disorders, were studied. In each subject respiratory function, including static and dynamic pulmonary volumes, was evaluated; maximal (MEFV) and partial (PEFV) expiratory V'-V curves and isovolumic partial to maximal flow ratio (M/P). FL was assessed in a seated patient by comparing tidal and PEFV curves; FL was detected when tidal flows were superimposed or exceeded those obtained during PEFV curves, and was expressed as a percentage of the expired control tidal volume (V(T)) affected by flow limitation (FL% VT). Dyspnoea was assessed by both MRC scale and Baseline Dyspnoea Index (BDI) focal score. Half of the patients were found to have FL. They were older, more dyspnoeic and more obstructed (P<0.03 - P<0.000005) than the non-FL group. FEV1, vital capacity (VC), age, body mass index, FL and M/P ratio were all related to dyspnoea scores. FL was significantly related to FEV1 (r = - 0.59). Multiple regression analysis showed that FEV1 (P=0.003, r2= 15-3% and P = 0.004, r2= 20.3%) and age (P = 0.0006, r2 = 26.8% and P = 0.016, r2 = 11%) independently predicted a part of the variance of MRC (P = 0.0001, r2 = 42.1%) and BDI (P = 0.0008, r2 = 31.3%), respectively. With dyspnoea scale being the gold standard, diagnostic accuracy (sensitivity and specificity) by ROC (receiver operating characteristics) analysis was similar for FEV1 and FL. The results indicate that FL may be present in this subset of asthmatics. CED may not be easily explained by abnormalities of routine spirometry or FL, the largest part of the CED variance remained unexplained. Thus, routine spirometry, FL and CED in patients with bronchial asthma are only partially overlapping quantities which need to be assessed separately.
Recent epidemiological reports on Chinese population affected by novel coronavirus showed a wide spread of clinical and biochemical alterations, suggesting a relationship between progression of lung damage to acute respiratory distress syndrome and the systemic inflammatory response, triggering an irreversible multiple organ damage and disseminated intravascular coagulation. Bedside ultrasound assessment provides integrated information, describing a multisystemic and dynamic clinical scenario for every patient. Furthermore, this approach allows to concentrate multiple information in the hands of a single operator, also limiting the risk of exposure to infection for healthcare professionals. As per our experience, herewith reported, we described the characteristics of 10 patients with SARS-CoV-2 infection. Ultrasound findings were related to clinical information, blood test analysis, and results of instrumental tests, such as chest X-ray and chest CT. According to our ultrasound data, COVID-19 appears to be a systemic pathology even in those cases of mild to moderate disease. By this multisystem ultrasound approach, we could immediately recognize patients with a diffuse organ involvement and a more severe clinical pattern; moreover, we can protect healthcare workers and limit infection within health facilities.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.