Impairment of (inspiratory and expiratory) respiratory muscles is a common clinical finding, not only in patients with neuromuscular disease but also in patients with primary disease of the lung parenchyma or airways. Although such impairment is common, its recognition is usually delayed because its signs and symptoms are nonspecific and late. This delayed recognition, or even the lack thereof, occurs because the diagnostic tests used in the assessment of respiratory muscle strength are not widely known and available. There are various methods of assessing respiratory muscle strength during the inspiratory and expiratory phases. These methods are divided into two categories: volitional tests (which require patient understanding and cooperation); and non-volitional tests. Volitional tests, such as those that measure maximal inspiratory and expiratory pressures, are the most commonly used because they are readily available. Non-volitional tests depend on magnetic stimulation of the phrenic nerve accompanied by the measurement of inspiratory mouth pressure, inspiratory esophageal pressure, or inspiratory transdiaphragmatic pressure. Another method that has come to be widely used is ultrasound imaging of the diaphragm. We believe that pulmonologists involved in the care of patients with respiratory diseases should be familiar with the tests used in order to assess respiratory muscle function.Therefore, the aim of the present article is to describe the advantages, disadvantages, procedures, and clinical applicability of the main tests used in the assessment of respiratory muscle strength.

A respiratory rate of 17 breaths/min is the parameter with the greatest accuracy for diagnosing overassistance. Respiratory rates of less than or equal to 12 or greater than or equal to 30 are useful clinical references to confirm or exclude pressure support overassistance.

A case of peripheral odontogenic keratocyst arising in a 57-year-old white female patient involving the posterior mandibular gingiva that recurred after 12 months of follow-up is presented. This reported case reinforces that patients presenting peripheral odontogenic keratocyst should be carefully followed up after conservative surgical treatment.

We report the case of a patient with severe dyspnea upon reclining. Lung disease, neuromuscular disorders and heart disease were ruled out. However, during the course of the investigation, bilateral diaphragmatic paresis was discovered. A key sign leading to the diagnosis was evidence of paradoxical respiration in the dorsal decubitus position. When the patient was moved from the orthostatic position to the dorsal decubitus position, oxygenation and forced vital capacity worsened. The orthostatic fluoroscopy was normal. Maximal inspiratory pressure was severely reduced. The responses to transcutaneous electric stimulation of the diaphragm were normal. However, electric stimulation of the phrenic nerve produced no response, leading to the diagnosis of bilateral diaphragmatic paresis.

BackgroundThoracoabdominal asynchrony is the nonparallel motion of the ribcage and abdomen. It is estimated by using respiratory inductive plethysmography and, recently, using optoelectronic plethysmography; however the agreement of measurements between these 2 techniques is unknown. Therefore, the present study compared respiratory inductive plethysmography with optoelectronic plethysmography for measuring thoracoabdominal asynchrony to see if the measurements were similar or different.Methods27 individuals (9 healthy subjects, 9 patients with interstitial lung disease, and 9 with chronic obstructive pulmonary disease performed 2 cycle ergometer tests with respiratory inductive plethysmography or optoelectronic plethysmography in a random order. Thoracoabdominal asynchrony was evaluated at rest, and at 50% and 75% of maximal workload between the superior ribcage and abdomen using a phase angle.ResultsThoracoabdominal asynchrony values were very similar in both approaches not only at rest but also with exercise, with no statistical difference. There was a good correlation between the methods and the Phase angle values were within the limits of agreement in the Bland-Altman analysis.ConclusionThoracoabdominal asynchrony measured by optoelectronic plethysmography and respiratory inductive plethysmography results in similar values and has a satisfactory agreement at rest and even for different exercise intensities in these groups.

A 55-year-old man was referred to the outpatient pulmonary department of our hospital because of dyspnoea during exertion and when bending forward, which had been present for at least 6 months. He reported experiencing severe symptoms of breathlessness and many of his daily activities had to be adapted or interrupt due to symptoms (as documented by the Baseline Dyspnea Index (BDI)) (table 1). Recent infectious episodes or episodes of neck or shoulder pain were absent. His medical history included systemic arterial hypertension, obesity (body mass index (BMI) 36 kg·m−2), and obstructive sleep apnoea for which he was treated with night-time continuous positive airway pressure therapy (8 cmH2O). He was a former smoker (18 pack-years) who quit smoking 15 years ago. 8 months ago, he underwent abdominal surgery (transabdominal epigastric hernia repair). The presence of cardiopulmonary disease and other aetiologies, such as neuromuscular disease, was excluded. Chest radiograph showed an elevated left hemidiaphragm and impaired left phrenic nerve conduction (i.e. increased latency and compound muscle action potential (CMAP) duration) after electrical stimulation (table 1) [1].

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ObjetivoAvaliar a modulação autonômica cardíaca em crianças não obesas, obesas e obesas mórbidas, por meio do estresse cardiocirculatório promovido pela mudança da postura supina para bípede. MétodosTrata-se de estudo transversal envolvendo trinta crianças, com idade entre 9 e 11 anos, divididas em três grupos: a) não-obesas (n=10), b) obesas (n=10), c) obesas mórbidas (n=10), selecionados conforme os respectivos índices de massa corpórea na tabela do National Center for Health Statistics. Todas elas foram submetidas a avaliação antropométrica e clínica, seguida de aplicação de manobra postural ativa, constituída por mudança postural supino para bípede. Foram monitorados os dados das variáveis cardiovasculares, como pressão arterial e frequência cardíaca, assim como foi analisada a variabilidade da frequência cardíaca. ResultadosTodos os grupos apresentaram significativo aumento da contribuição simpática e redução da atividade parassimpática, quando se comparou a variabilidade da frequência cardíaca na posição supina com a bípede. Houve significativa diferença na comparação dos deltas de frequência cardíaca (0 a 10s da manobra postural ativa) entre os grupos não obeso (+24,1bpm) e obeso (+21,7bpm). ConclusãoA obesidade não interferiu significativamente nos mecanismos autonômicos cardiovasculares, quando se comparou a variabilidade da frequência cardíaca nas posições supina e bípede em crianças não obesas, obesas e obesas mórbidas. Termos de indexação: Obesidade. Teste funcional autonômico. Variabilidade da frequência cardíaca.