Snoring as a cause of nocturia in men with lower urinary tract symptoms.

OBJECTIVES: Snoring increases with increasing age and body mass, and repeated periods of hypoxia cause nocturnal polyuria. Accordingly, we examined the occurrence of snoring problems in patients scheduled for transurethral prostatic resection. METHODS: Of 171 men scheduled for TUR-P, 41 were excluded due to cardiac disease, diabetes, or prostatic malignancy. Of the remaining 130 patients, 12% were troubled by snoring that disturbed their sleep. The severity of their snoring was evaluated by questionnaires, micturition charts, and determination of nocturnal capillary oxygen saturation (SaO(2)) and pulse rate. Plasma levels of cortisol, arginine vasopressin (AVP), and atrial natriuretic peptide (ANP) were measured in the morning and at 2 p.m. Fifteen non-snoring patients also scheduled for TUR-P served as controls. RESULTS: Compared to controls, the snoring patients had a significantly higher body mass index (BMI), voided more frequently, and produced more urine at night. They also had a significantly larger number of hypoxic episodes at night, which, along with low SaO(2) levels, correlated with the nocturnal diuresis. Snorers did not differ significantly from controls in regard to excretion of cortisol and AVP, but they did have higher plasma levels of ANP. CONCLUSIONS: We recommend that elderly obese men with urgency at night be questioned about snoring, and that micturition frequency and volume charts be completed before deciding to operate.

Home mechanical ventilation in Sweden, with reference to Danish experiences. Swedish Society of Chest Medicine.

The Swedish Society of Chest Medicine has started a national register of patients on home mechanical ventilation, to establish reliable national prevalence data and to accurately document patient and treatment characteristics to enable a scientific evaluation of this treatment. In this first collection of retrospective register data, covering patients on home mechanical ventilation at the register start on 1 January 1996, we found 541 patients, corresponding to 6.1/100000 inhabitants, using home mechanical ventilation. Non-invasive ventilation, night-time ventilation and volume controlled ventilation dominated. We found four diagnosis categories of approximately equal size, namely post-polio, chest wall deformities, neuromuscular diseases and 'other diseases'. The age distribution was bimodal, with one small peak in the 20-29 year group and a large peak in the 60-69 year group. A survey of Danish patients on home mechanical ventilation showed that they were considerably younger and that almost half of them suffered from neuromuscular diseases. Further work will be done to follow the situation in Sweden and in Denmark to elucidate the obvious differences in the selection of patients for home mechanical ventilation.

Diaphragm pacing with a quadripolar phrenic nerve electrode: an international study.

We sought to determine the international experience with the quadripolar diaphragm pacer system and to test two hypotheses: the incidence of pacer complications would be (1) increased among pediatric as compared to adult patients; and (2) highest among active pediatric patients with idiopathic congenital central hypoventilation syndrome (CCHS). Data were collected via a questionnaire coupled with the Atrotech Registry data for a total of 64 patients (35 children and 29 adults) from 14 countries. Thoracic implantation of electrodes and bilateral pacer use each occurred in 94% of all subjects. Tetraplegic (vs pediatric CCHS) patients were more typically paced 24 hours/day (P = 0.001). Pacing duration averaged 2.0 +/- 1.0 years among children and 2.2 +/- 1.1 years among adults. Infections occurred among 2.9% of surgical procedures, all in pediatric CCHS patients (vs pediatric tetraplegic patients, P = 0.01). The incidence of mechanical trauma was 3.8%, without significant differences among patient groups. The incidence of presumed electrode and receiver failure were 3.1% and 5.9%, respectively, with internal component failure greater among pediatric CCHS than pediatric tetraplegic patients (P < 0.01). Intermittent or absent function of 0-4 electrode combinations occurred among 19% of all patients, with increased frequency among pediatric CCHS than pediatric tetraplegic patients (P < 0.03). Complication-free successful pacing occurred in 60% of pediatric and 52% of adult patients. In all, 94% of the pediatric and 86% of the adult patients paced successfully after the necessary intervention. Although pacer complications were not increased among pediatric as compared to adult patients, the incidence of complications was highest among the active pediatric patients with CCHS. Longitudinal study of these patients will provide invaluable information for modification and improvement of the quadripolar system.

Respiratory tract colonization and infection in patients with chronic tracheostomy. A one-year study in patients living at home.

The high rate of complications, especially respiratory tract infection (RTI), reported in patients with chronic tracheostomy (CT) has discouraged physicians from using this method. However, previous studies of CT have concerned mainly hospitalized patients. We have followed the bacterial colonization patterns of the upper and lower respiratory tract and recorded all RTIs in 39 outpatients with CT during a 12-mo period. Patients were colonized with one or more potential pathogens at the stomal site and in the trachea in 95% and 83%, respectively, of all sampling occasions. Staphylococcus aureus, gram-negative enteric bacteria (GNEB), and Pseudomonas aeruginosa were the most common colonizing bacteria at these sites. Seventy percent of bronchial-protected brush cultures were negative, despite simultaneous heavy colonization of the stomal site or the trachea. Only 18 of 39 (46%) patients were treated with antibiotics because of RTIs on a total of 30 occasions during the study year. Of these, only five episodes of pneumonia in four patients were registered, corresponding to an incidence of about 10 per 100 person years. We conclude that outpatients with chronic tracheostomy can be managed with a low risk for developing severe RTIs, despite massive airway colonization with potentially pathogenic bacteria.

[Home respiratory therapy becomes more and more frequent. Increased quality of life via a simplified technique]. / Respiratorbehandling i hemmet allt vanligare. Okad livskvalitet genom förenklad teknik.

Long-term domiciliary ventilation is an effective treatment for chronic hypoventilation due to neuromuscular disease or thoracic deformity. As the majority of patients require assisted ventilation only at night, it is a simple means of improving quality of life, and even sometimes of prolonging life. According to a nationwide enquiry organised by the Swedish Thoracic Society in 1993, 460 patients (5.5 per 100,000 of the population) were using domiciliary ventilation (almost a doubling of the figure of 250 patients reported from a similar survey in 1990). The most prevalent indications were poliomyelitis sequelae (30%), followed by myopathy (21%), idiopathic scoliosis (13%) and tuberculosis sequelae (13%). Eighty per cent of the patients used assisted ventilation only at night, and 60 per cent used non-invasive devices such as a nasal mask.

Total intravenous anaesthesia with single-lumen endotracheal intubation for thoracoscopic sympathectomy.

The aim of this paper was to discuss the stress applied to the circulatory and respiratory systems by the combination of general anaesthesia and thoracoscopic sympathectomy and to show the benefits of an intravenous anaesthetic technique together with a single-lumen endotracheal tube as a safe method of anaesthesia for this procedure. In a retrospective study, 125 cases of thoracoscopic sympathectomy were reviewed. The anaesthesia was a totally intravenous technique with propofol, alfentanil, and atracurium and a gas mixture of 40% oxygen in air. The degree of hypoxaemia during inflation of carbon dioxide into the thorax was assessed. The results showed that hypoxaemia caused no problems in any of the patients. Three patients with severe angina pectoris were also studied using the same anaesthetic technique and they showed marked haemodynamic instability throughout the procedure requiring inotropic support. Haemodynamic values obtained through a Swan-Ganz catheter in one patient showed marked changes during the procedure, but values returned to normal after the operation. Although these patients were haemodynamically unstable there was no problem with hypoxaemia.

[Chronic respiratory insufficiency--a death sentence?]. / Kronisk respiratorisk svikt--en dödsdom?

Chronic respiratory deficiency is a complication in a number of diseases and results in poor quality of life and increased mortality. Notwithstanding that the long-term prognosis is poor the patient should be offered respiratory support via a nasal mask or a tracheotomy tube; this issue was discussed at an international meeting on ventilation at home held in Lyons in France.