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We compared body composition, biochemical parameters, motor function, and brain neural activation in 27 adults with Prader-Willi syndrome and growth-hormone deficiency versus age-and sex-matched controls and baseline versus posttreatment values of these parameters after one year of recombinant human growth hormone (rhGH) treatment. To study body composition, we analyzed percentage of fat mass, percentage of lean mass, and muscle-mass surrogate variables from dual X-ray absorptiometry. Biochemical parameters analyzed included IGF-I, glucose metabolism, and myokines (myostatin, irisin, and IL6). To explore muscle function, we used dynamometer-measured handgrip strength, the Timed Up and Go (TUG) test, and the Berg Balance Scale (BBS). To study brain activation, we acquired functional magnetic resonance images during three motor tasks of varying complexity. After one year of treatment, we observed an increase in lean mass and its surrogates, a decrease in fat mass, improvements in TUG test and BBS scores, and increased neural activation in certain cerebellar areas. The treatment did not significantly worsen glucose metabolism, and no side-effects were reported. Our findings support the benefits of rhGH treatment in adults with Prader-Willi syndrome and growth-hormone deficiency on body composition and suggest that it may also improve balance and brain neural activation.
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The phenotypic characteristics of chronic obstructive pulmonary disease (COPD) in individuals younger than 50â years of age (early COPD) are not well defined. This prospective, multicentre, case-control study sought to describe these characteristics and compare them with those of smokers (≥10â pack-years) of similar age with normal spirometry (controls). We studied 92 cases (post-bronchodilator forced expiratory volume in 1â s (FEV1)/forced vital capacity (FVC) <0.7) and 197 controls. Results were contrasted with participants with similar inclusion criteria recruited into the ECLIPSE and COPDGene cohorts. Cases had moderate airflow limitation (FEV1 71.3±20.8%) but were often symptomatic, used healthcare resources frequently, had air trapping (residual volume 150.6±55.5% ref.), had reduced diffusing capacity (84.2±20.7% ref.) and had frequent evidence of computed tomography (CT) emphysema (61%). Of note, less than half of cases (46%) had been previously diagnosed with COPD. Interestingly, they also often reported a family history of respiratory diseases and had been hospitalised because of respiratory problems before the age of 5â years more frequently than controls (12% versus 3%, p=0.009). By and large, these observations were reproduced when available in the ECLIPSE and COPDGene cohorts. These results show that early COPD is associated with substantial health impact and significant structural and functional abnormalities, albeit it is often not diagnosed (hence, treated). The fact that a sizeable proportion of patients with early COPD report a family history of respiratory diseases and/or early-life events (including hospitalisations before the age of 5â years) renders further support to the possibility of early-life origin of COPD.
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Adenocarcinoma de Pulmão/prevenção & controle , Carcinoma de Células em Anel de Sinete/secundário , Tumor de Krukenberg/secundário , Neoplasias Ovarianas/secundário , Tomografia Computadorizada por Raios X , Adenocarcinoma de Pulmão/diagnóstico por imagem , Biomarcadores Tumorais , Neoplasias Ósseas/secundário , Carcinoma de Células em Anel de Sinete/diagnóstico por imagem , Feminino , Humanos , Tumor de Krukenberg/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico por imagem , Derrame Pleural Maligno/diagnóstico por imagemAssuntos
Broncoscopia , Osteocondrodisplasias/diagnóstico por imagem , Nódulo Pulmonar Solitário/diagnóstico por imagem , Doenças da Traqueia/diagnóstico por imagem , Idoso , Feminino , Humanos , Achados Incidentais , Osteocondrodisplasias/diagnóstico , Nódulo Pulmonar Solitário/etiologia , Doenças da Traqueia/diagnósticoRESUMO
INTRODUCTION: Morbid obesity and obstructive sleep apnea (OSA) interact at an inflammatory level. Bariatric surgery reduces inflammatory responses associated with obesity. Heme oxygenase-1 (HO-1) is an enzyme with anti-inflammatory properties, which might be increased in morbid obesity or OSA. We studied morbidly obese patients with OSA to determine: (a) HO-1 plasma concentrations according to OSA severity and their relationship with insulin resistance and inflammation and (b) the impact of bariatric surgery on HO-1 and parameters of insulin resistance and inflammation. MATERIAL AND METHODS: We analyzed the homeostasis model insulin resistance index (HOMA) and plasma concentrations of HO-1, tumor necrosis factor alpha, interleukin-6, interleukin-1-beta, C reactive protein (CRP), and adiponectin according to polysomnography findings in 66 morbidly obese patients before bariatric surgery and 12 months after surgery. RESULTS: Before surgery, HO-1 plasma concentrations were similar in three groups of patients with mild, moderate, and severe OSA, and correlated with HOMA (r = 0.27, p = 0.02). Twelve months after surgery, low-grade inflammation and insulin resistance had decreased in all the groups, but HO-1 plasma concentration had decreased only in the severe OSA group (p = 0.02). In this group, the reduction in HO-1 correlated with a reduction in CRP concentrations (r = 0.43, p = 0.04) and with improved HOMA score (r = 0.37, p = 0.03). CONCLUSIONS: Bariatric surgery decreases HO-1 concentrations in morbid obesity with severe OSA, and this decrease is associated with decreases in insulin resistance and in inflammation.
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Cirurgia Bariátrica , Heme Oxigenase-1/sangue , Inflamação , Resistência à Insulina , Obesidade Mórbida/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Adiponectina/sangue , Adulto , Proteína C-Reativa/metabolismo , Feminino , Humanos , Inflamação/sangue , Inflamação/complicações , Inflamação/metabolismo , Inflamação/cirurgia , Insulina/sangue , Resistência à Insulina/fisiologia , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/metabolismo , Polissonografia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/metabolismo , Fator de Necrose Tumoral alfa/sangueRESUMO
Almost all the information about the effect of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnoea (OSA) comes from clinical trials involving only middle-aged patients. The objective of this study was to assess the effect of CPAP treatment in elderly patients with severe OSA on clinical, quality-of-life and neurocognitive spheres. We performed an open-label, randomised, multicentre clinical trial in a consecutive clinical cohort of 224 elderly (≥70â years old) patients with confirmed severe OSA (apnoea-hypopnea index ≥30) randomised to receive CPAP (n=115) or no CPAP (n=109) for 3â months. A sleep study was performed by either full polysomnography or respiratory polygraphy. CPAP titration was performed by an autoCPAP device. The primary endpoint was quality of life (Quebec Sleep Questionnaire) and secondary endpoints included sleep-related symptoms, presence of anxiety/depression, office-based blood pressure and some neurocognitive tests. The mean±sd age was 75.5±3.9â years. The CPAP group achieved a greater improvement in all quality-of-life domains (p<0.001; effect size: 0.41-0.98), sleep-related symptoms (p<0.001; effect size 0.31-0.91) as well as anxiety (p=0.016; effect size 0.51) and depression (p<0.001; effect size: 0.28) indexes and some neurocognitive tests (digit symbol test (p=0.047; effect size: 0.20) and Trail Making Test A (p=0.029; effect size: 0.44)) in an intention-to-treat analysis. In conclusion, CPAP treatment resulted in an improvement in quality of life, sleep-related symptoms, anxiety and depression indexes and some neurocognitive aspects in elderly people with severe OSA.
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Pressão Positiva Contínua nas Vias Aéreas/métodos , Apneia Obstrutiva do Sono/terapia , Idoso , Ansiedade/complicações , Pressão Sanguínea , Índice de Massa Corporal , Cognição , Transtornos Cognitivos/complicações , Estudos de Coortes , Depressão/complicações , Feminino , Seguimentos , Humanos , Masculino , Polissonografia , Qualidade de Vida , Sono , Espanha , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Home single-channel nasal pressure (HNP) may be an alternative to polysomnography (PSG) for obstructive sleep apnea (OSA) diagnosis, but no cost studies have yet been carried out. Automatic scoring is simpler but generally less effective than manual scoring. OBJECTIVES: To determine the diagnostic efficacy and cost of both scorings (automatic and manual) compared with PSG, taking as a polysomnographic OSA diagnosis several apnea-hypopnea index (AHI) cutoff points. METHODS: We included suspected OSA patients in a multicenter study. They were randomized to home and hospital protocols. We constructed receiver operating characteristic (ROC) curves for both scorings. Diagnostic efficacy was explored for several HNP AHI cutoff points, and costs were calculated for equally effective alternatives. RESULTS: Of 787 randomized patients, 752 underwent HNP. Manual scoring produced better ROC curves than automatic for AHI < 15; similar curves were obtained for AHI ≥ 15. A valid HNP with manual scoring would determine the presence of OSA (or otherwise) in 90% of patients with a polysomnographic AHI ≥ 5 cutoff point, in 74% of patients with a polysomnographic AHI ≥ 10 cutoff point, and in 61% of patients with a polysomnographic AHI ≥ 15 cutoff point. In the same way, a valid HNP with automatic scoring would determine the presence of OSA (or otherwise) in 73% of patients with a polysomnographic AHI ≥ 5 cutoff point, in 64% of patients with a polysomnographic AHI ≥ 10 cutoff point, and in 57% of patients with a polysomnographic AHI ≥ 15 cutoff point. The costs of either HNP approaches were 40% to 70% lower than those of PSG at the same level of diagnostic efficacy. Manual HNP had the lowest cost for low polysomnographic AHI levels (≥ 5 and ≥ 10), and manual and automatic scorings had similar costs for higher polysomnographic cutoff points (AHI ≥ 15) of diagnosis. CONCLUSION: Home single-channel nasal pressure (HNP) is a cheaper alternative than polysomnography for obstructive sleep apnea diagnosis. HNP with manual scoring seems to have better diagnostic accuracy and a lower cost than automatic scoring for patients with low apnea-hypopnea index (AHI) levels, although automatic scoring has similar diagnostic accuracy and cost as manual scoring for intermediate and high AHI levels. Therefore, automatic scoring can be appropriately used, although diagnostic efficacy could improve if we carried out manual scoring on patients with AHI < 15. CLINICAL TRIALS INFORMATION: Clinicaltrials.gov identifier: NCT01347398.
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Custos e Análise de Custo , Nariz/fisiologia , Pressão , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia/economia , Curva ROC , Apneia Obstrutiva do Sono/economia , Adulto JovemRESUMO
BACKGROUND: Maximal oxygen uptake ((V)O(2max)) obtained from incremental exercise testing is a useful indicator of limited exercise capacity. Several prediction equations have been developed to estimate (V)O(2max) in patients with chronic obstructive pulmonary disease (COPD), but agreement studies between estimated and measured (V)O(2max) are lacking. This study aims to assess agreement between the 6 estimated (V)O(2max) evaluated during maximal incremental exercise testing in male COPD patients. METHODS: Patients with stable COPD, in accordance with GOLD guidelines, were included in the study. Agreement between (V)O(2max) obtained during incremental exercise testing and (V)O(2max) obtained from 6 prediction equations were studied. To estimate (V)O(2max) from anthropometric prediction equations, lung function variables and submaximal exercise testing were used. RESULTS: Of the 60 male patients in the study, 12 were GOLD stage II, 24 GOLD stage III, and 24 GOLD stage IV. Five prediction equations underestimated the value of (V)O(2max) in relation to measured (V)O(2max) : equations 1, 2, 3, 4, and 6, by 14%, 66%, 42.2%, 35%, and 23.3%, respectively. Conversely, prediction equation 5 overestimated measured (V)O(2max) by 76.9%. Agreement between all (V)O(2max) prediction equations and measured (V)O(2max) was poor. Discrepancy between (V)O(2max) prediction equations and measured (V)O(2max) varied from 20.857 to 0.736 L/min. CONCLUSIONS: The use of lung function at rest and submaximal exercise testing is inaccurate for determining (V)O(2max) , which cannot be estimated by prediction equations in patients with stable COPD.
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Tolerância ao Exercício/fisiologia , Pulmão/fisiologia , Consumo de Oxigênio/fisiologia , Doença Pulmonar Obstrutiva Crônica/patologia , Testes de Função Respiratória , Descanso/fisiologia , Idoso , Análise de Variância , Estudos Transversais , Teste de Esforço , Indicadores Básicos de Saúde , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/reabilitação , Índice de Gravidade de Doença , Caminhada/fisiologiaRESUMO
INTRODUCTION: The interviewer-administered chronic respiratory questionnaire (CRQ-IA) is widely used and has demonstrated excellent properties for measuring health-related quality of life (HRQL) in patients with chronic obstructive pulmonary disease (COPD). However, the self-administered version (CRQ-SAS) in Spanish has not been validated. The aim of this trial was to evaluate the validity and the sensitivity of the Spanish version of the CRQ-SAS in patients with COPD. MATERIAL AND METHODS: We randomized 40 patients with COPD (33 treated with pulmonary rehabilitation and 7 with liquid oxygen therapy) to one of the two methods of administration of CRQ (SAS vs. IA) both before and 8 weeks after the treatment. In addition, patients completed the SF-36 questionnaire, pulmonary function tests, and six-minute walk test. RESULTS: The CRQ-SAS demonstrated good longitudinal construct validity on all domains with a range of correlations, for the change scores, between 0.46 (P=.05) and 0.71 (P=.01). Regarding sensitivity to change, we observed a minimal clinically significant change in most domains (fatigue 0.71 [P=.02], emotional factor 0.62 [P=.04], control of the disease 0.83 [P=.06]). CONCLUSIONS: The Spanish version of CRQ-SAS is valid for evaluating HRQL in COPD patients. The correlations of the CRQ-SAS with other tools provide construct validity and show good sensitivity to change.
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Doença Pulmonar Obstrutiva Crônica , Qualidade de Vida , Inquéritos e Questionários , Idoso , Feminino , Humanos , Idioma , Masculino , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
We present the case of a 48-year-old woman suffering from fatal familial insomnia (FFI)--a rare prion disease--who developed Biot's breathing and secondary respiratory failure during the early stages of the illness. Once hypercapnia was detected a trial of nocturnal noninvasive ventilation (NIV) was offered with important improvement of arterial blood gases (ABG), and subjective good quality of sleep. To our knowledge, this is the first report in the medical literature of the use of NIV in the management approach of this devastating disease. Its impact on the prognosis and survival of these patients, however, is yet to be elucidated.
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Hipercapnia/diagnóstico , Insônia Familiar Fatal/diagnóstico , Insônia Familiar Fatal/terapia , Insuficiência Respiratória/complicações , Autopsia , Progressão da Doença , Evolução Fatal , Feminino , Humanos , Hipercapnia/etiologia , Hipercapnia/terapia , Insônia Familiar Fatal/genética , Pessoa de Meia-Idade , Polissonografia/métodos , Troca Gasosa Pulmonar , Doenças Raras , Respiração Artificial , Testes de Função Respiratória , Insuficiência Respiratória/diagnóstico , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Unattended home sleep studies have been implemented to minimize the cost and delay in establishing obstructive sleep apnoea syndrome (OSAS) diagnosis and therapy. However, their accuracy and validity remain disputed. The purpose of our study is to assess their effectiveness (i.e. their technical reliability in real life conditions). SETTING: Private sleep unit attending to private and social security patients. POPULATION: Consecutively admitted patients, aged over 18 years, referred to our clinic for confirmation or treatment of OSAS without co-morbidities. METHODS: A clinical history was obtained for each patient with special attention to sleep, smoking habit, educational level and type of insurance. Chest X-ray and forced spirometry were performed. For the portable respiratory recording device an eight-channel polygraph was used and for continuous positive airway pressure (CPAP) titration an automatic positive airway pressure device was applied; both instruments were previously validated. Patients were instructed how to use the devices at the clinic and then applied them at home by themselves. RESULTS: For diagnostic sleep studies, 145 out of 150 (96.7%: CI: 92.4-98.9) and for CPAP titration 42 out of the 61 patients (69%: CI: 56.4-81.3) performed the sleep study correctly according to the pre-established criteria. No statistically significant differences were found between correct performance and educational level, sex, smoking habit or type of health insurance. CONCLUSIONS: (1) Unattended home sleep studies appear as effective as in-hospital studies for diagnosis of OSAS without co-morbidities; (2) for CPAP titration, the effectiveness was slightly lower; and (3) factors such as patients' educational level or type of health insurance do not appear to influence outcome.
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Assistência Ambulatorial , Projetos de Pesquisa , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Idoso , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
OBJECTIVES: To determine the optimal clinical reading time for the transcutaneous measurement of oxygen saturation (SpO(2)) and transcutaneous CO(2) (TcPCO(2)) in awake spontaneously breathing individuals, considering the overshoot phenomenon (transient overestimation of arterial PaCO(2)). EXPERIMENTAL SECTION: Observational study of 91 (75 men) individuals undergoing forced spirometry, measurement of SpO(2) and TcPCO(2) with the SenTec monitor every two minutes until minute 20 and arterial blood gas (ABG) analysis. Overshoot severity: (a) mild (0.1-1.9 mm Hg); (b) moderate (2-4.9 mm Hg); (c) severe: (>5 mm Hg). The mean difference was calculated for SpO(2) and TcPCO(2) and arterial values of PaCO(2) and SpO(2). The intraclass correlation coefficient (ICC) between monitor readings and blood values was calculated as a measure of agreement. RESULTS: The mean age was 63.1 ± 11.8 years. Spirometric values: FVC: 75.4 ± 6.2%; FEV(1): 72.9 ± 23.9%; FEV(1)/FVC: 70 ± 15.5%. ABG: PaO(2): 82.6 ± 13.2; PaCO(2): 39.9.1 ± 4.8 mmHg; SaO(2): 95.3 ± 4.4%. Overshoot analysis: overshoot was mild in 33 (36.3%) patients, moderate in 20 (22%) and severe in nine (10%); no overshoot was observed in 29 (31%) patients. The lowest mean differences between arterial blood gas and TcPCO(2) was -0.57 mmHg at minute 10, although the highest ICC was obtained at minutes 12 and 14 (>0.8). The overshoot lost its influence after minute 12. For SpO(2), measurements were reliable at minute 2. CONCLUSIONS: The optimal clinical reading measurement recommended for the ear lobe TcPCO(2) measurement ranges between minute 12 and 14. The SpO(2) measurement can be performed at minute 2.
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Gasometria/instrumentação , Gasometria/métodos , Orelha , Pele/metabolismo , Transdutores , Vasodilatação/fisiologia , Adulto , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Pele/irrigação sanguíneaRESUMO
INTRODUCTION: Primary hyperhidrosis is characterized by excessive sweating of the palms, soles, and axillae due to overactivity of the sympathetic nervous system at the level of the second and third sympathetic thoracic ganglia. The treatment of choice is bilateral dorsal sympathectomy performed using video-assisted thoracic surgery (VATS). The objective of our study was to determine whether lung function changes observed in a group of patients prior to bilateral dorsal sympathectomy performed using VATS were still evident 3 years after surgery. PATIENTS AND METHODS: Of the 20 patients studied at baseline, we were able to obtain data for 18 (3 men and 15 women; mean age, 35 y). They underwent spirometry and a bronchial challenge test with methacholine, and the fraction of exhaled nitric oxide (FE(NO)) was measured. The results were compared with those of the tests performed before surgery. RESULTS: At 3 years from baseline, we detected a statistically significant increase in forced vital capacity from a mean (SD) of 96% (10%) to 101% (11%) (P=.008), and a statistically significant decrease in midexpiratory flow rate from 3.8 (0.9)L/s to 3.5 (0.9)L/s (P=.01). The results of the bronchial challenge test with methacholine and the FE(NO) remained unchanged. CONCLUSIONS: The lung function changes detected point toward minimal, clinically insignificant small airway alterations due to sympathetic denervation following bilateral dorsal sympathectomy performed 3 years earlier.
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Hiperidrose/fisiopatologia , Hiperidrose/cirurgia , Pulmão/fisiopatologia , Simpatectomia/métodos , Cirurgia Torácica Vídeoassistida , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espirometria , Fatores de TempoRESUMO
OBJECTIVE: To determine the effect of an intervention in secondary schools on visible tobacco use, the prevalence and intensity of smoking, and the attitudes and behaviors of teachers and students. METHODS: We performed a quasiexperimental study in 18 public secondary schools that carried out the program and in 18 that did not (control group). Information was obtained on visible tobacco use and the number of ashtrays and smokefree posters through direct observation. Data were collected on tobacco use, the number of heavy smokers, smoking in schools, opinions on smokefree schools, smoking in front of the students, and attempts to quit smoking through questionnaires to teachers and students in the third year of compulsory secondary education (15-year-olds) and in the final year of secondary school (18-year-olds). RESULTS: Visible tobacco use was lower in the intervention group (27.9 vs. 45.6%) and twice as many posters were displayed. No differences were found in the prevalence of daily tobacco use, but the percentage of heavy smokers was lower in teachers and students in the intervention group. Smoking was lower in students in the third year of compulsory secondary education in schools carrying out the program. Opinions about smokefree schools were favorable in both groups. CONCLUSIONS: The program contributed to reducing visible tobacco use and in decreasing the number of heavy smokers among teachers and students.
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Instituições Acadêmicas , Prevenção do Hábito de Fumar , Adolescente , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: In spontaneously breathing patients, the differences between arterial PaCO2 and end-tidal CO2 (EtCO2) and the influence of bronchial obstruction have not clearly established. MATERIAL/METHODS: This was a prospective observational study. Patients (n=120) were classified according to spirometric criteria into groups with normal, mild, moderate, and severe obstruction. Arterial blood gases and capnography were performed in two ways: with a tidal volume (Vt) and a non-forced maximal expiration maneuver. Pearson correlation coefficients (r) between PaCO2 and capnographic values were determined for the entire cohort and the subgroups. A concordance study was performed with Bland-Altman analysis. RESULTS: Comparison of PaCO2 and EtCO2 measured at Vt showed a significant correlation (r=0.722, p<0.01) for the entire cohort, but with a significant mean infra-estimation: P(a-et)CO2=5.2+/-4.4 mmHg, p<0.05. Analysis of subgroups: At Vt, P(a-et)CO2 was 1.7+/-2.9 mmHg (p=ns) in patients with normal spirometry, being maximal in the group with greater obstruction (8.2+/-5.6 mmHg, p<0.05). At maximal expiration, the comparison between PaCO2 and EtCO2 showed a significant correlation (r=0.88, p<0.001), but a significant lack of concordance for the entire cohort (P(a-et)CO2=-4.8+/-4 mmHg, p<0.05) and subgroups. Finally, comparison of PaCO2 and mean EtCO2 values showed a significant correlation (r=0.74, p<0.001) and concordance (P(a-et)CO2= 0.2+/-3.3 mmHg, p=ns) for the entire cohort and subgroups. CONCLUSIONS: Capnographic results at Vt are accurate predictors of true PaCO2 only in patients without bronchial obstruction. The maneuvers of slow maximal expiration overestimate PaCO2 in all groups. The best concordance was obtained comparing PaCO2 with mean EtCO2.
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Capnografia/métodos , Dióxido de Carbono/sangue , Expiração , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Respiração , Idoso , Gasometria , Feminino , Humanos , Pessoa de Meia-Idade , Pressão Parcial , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/patologia , Estatística como Assunto , Volume de Ventilação PulmonarRESUMO
BACKGROUND: Essential hyperhidrosis is characterized by overactivity of the sympathetic fibers passing through the upper-dorsal ganglia (second and third thoracic ganglia [D2-D3]), and the treatment of choice is video-assisted thoracoscopy sympathectomy. Alterations in cardiopulmonary function after treatment have been reported. STUDY OBJECTIVE: To evaluate cardiopulmonary function impairment after sympathectomy in patients with essential hyperhidrosis. DESIGN AND SETTING: Prospective controlled trial at a pulmonary function unit of a university hospital. PATIENTS: Twenty patients (2 men and 18 women) with essential hyperhidrosis. MEASUREMENTS AND RESULTS: Pulmonary function tests, including spirometry and thoracic gas volume, bronchial challenge with methacholine, and maximal exercise, were performed before and 3 months after D2-D3 sympathectomy. Video-assisted sympathectomy was performed using a one-stage bilateral procedure with electrocoagulation of D2-D3 ganglia. Pulmonary function values (spirometrics and volumes) were not statistically different in the two groups. The maximal midexpiratory flow was the only variable that showed significant changes, from 101% (SD, 26%) to 92% (SD, 27%) [p < 0.05]. Ten patients had positive bronchial challenge test results that remained positive 3 months after surgery, and 2 patients whose challenge test results were negative before surgery became positive after sympathectomy. Significant reductions in maximal heart rate (HR) and oxygen and carbon dioxide uptakes were observed during the maximal exercise test. CONCLUSIONS: Video-assisted thoracoscopy is a safe treatment, and the observed modifications in cardiopulmonary function only suggest a minimal small airway alterations in the presence of positive bronchial hyperresponsiveness and mild sympathetic blockade in HR. The clinical importance of these findings is not significant.