RESUMEN
STUDY OBJECTIVES: Upper-airway obstruction (UAO) may be present in patients with Parkinson's disease (PD), and its reversibility after levodopa therapy has been suggested. To investigate the effects of oral intake of levodopa on pulmonary function and UAO criteria in patients with PD, we studied 22 patients with PD. DESIGN: Pulmonary function tests were performed after a 12-h withdrawal of levodopa therapy, and 1 h after oral intake of placebo or levodopa, according to a double-blind, placebo-controlled, crossover study. Six UAO criteria were recorded to detect UAO in patients. UAO was found in 5 of 21 patients on baseline conditions (1 patient could not perform all tests). RESULTS: Among the patients with UAO, after levodopa therapy three of five patients did not meet the four of six required criteria for defining UAO. Levodopa produced its effects on UAO criteria by means of a saw-tooth pattern improvement and/or a decrease below the defined thresholds of the peak inspiratory flow and the FEV(1)/peak expiratory flow (PEF) and FEV(1)/forced expiratory flow after 50% of the FVC (FEV(0.5)) ratios. Levodopa PEF increased by 0.85 L/s in patients with UAO and by 0.24 L/s in patients without UAO, while after placebo it increased by 0.03 L/s in patients with UAO and decreased by 0.16 L/s in patients without UAO (p = 0.02). Whereas in patients without UAO an increase of the FEV(1)/PEF and FEV(1)/FEV(0.5) ratios was observed after placebo and levodopa intake, these ratios decreased after levodopa and increased after placebo in patients with UAO. CONCLUSIONS: These results show that levodopa administration in patients with PD induces significant variations in PEF and UAO ratios (FEV(1)/PEF and FEV(1)/FEV(0.5)).
Asunto(s)
Antiparkinsonianos/farmacología , Levodopa/farmacología , Enfermedad de Parkinson/fisiopatología , Mecánica Respiratoria/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Obstrucción de las Vías Aéreas/complicaciones , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/complicaciones , Pruebas de Función Respiratoria , EspirometríaRESUMEN
We report two episodes of cardiorespiratory arrest immediately after measurement of peak expiratory flow in two young asthmatic subjects during an attack of asthma. Various mechanisms could be involved, particularly airway inflammation.
Asunto(s)
Asma/diagnóstico , Paro Cardíaco/etiología , Ápice del Flujo Espiratorio , Adolescente , Adulto , Asma/fisiopatología , Broncoconstricción , Tos/fisiopatología , Humanos , MasculinoRESUMEN
OBJECTIVE: To evaluate the diagnostic value of clinical features, pulmonary function testing, blood gas tensions, and oximetric data for case finding of obstructive sleep apnea (OSA) before polysomnography (PSG) in a series of consecutive overweight patients. METHODS: We studied a population of 102 consecutive patients referred by an obesity clinic for suspected OSA, in whom body mass index was > or = 25 kg/m(2). The following tests were performed: clinical score (CS), pulmonary function tests (PFTs), measurement of arterial blood gas tensions, nocturnal oximetry, and full-night PSG. RESULTS: Six of 34 women and 34 of 68 men had OSA, defined by an apnea-hypopnea index > or = 15. CS and the cumulative time spent below 80% arterial oxygen saturation (SaO(2)) were higher, and PaO(2), minimal SaO(2), and mean nocturnal SaO(2) (mSaO(2)) were lower in OSA patients than in non-OSA patients. Logistic regression showed that sex, CS, and the ratio of FEV(1) over forced expiratory volume in 0.5 s (an index of upper airway obstruction on flow-volume curves) and mSaO(2), expressed as categorical variables, were independent predictors of OSA. None of these individual variables had a satisfactory diagnostic value for the diagnosis of OSA. A logistic regression model including sex and all continuous variables would have allowed us to predict the presence or absence of OSA confidently in 72.5% of the population, in whom the positive predictive value of the model was 94% and the negative predictive value was 90%. CONCLUSION: In obese patients referred to a respiratory sleep laboratory and evaluated by CS, PFTs, arterial blood gases, and oximetry, no individual sign or symptom may accurately predict the presence or absence of OSA. Provided that it is validated in prospective studies, a logistic regression model using these variables may be useful for the prediction of OSA.
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Obesidad/complicaciones , Apnea Obstructiva del Sueño/etiología , Adulto , Índice de Masa Corporal , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oximetría , Polisomnografía , Valor Predictivo de las Pruebas , Curva ROC , Pruebas de Función Respiratoria , Apnea Obstructiva del Sueño/fisiopatologíaRESUMEN
Musical performance, especially in singers and wind instrument players, depends on an effective pulmonary function. Performing artists may be seriously impaired by respiratory diseases that, comparatively, may produce only modest inconvenience for non-musicians. The report of two cases of respiratory diseases occurring in musicians herein provides an introduction to a review of the interactions between music and the human respiratory system. The following points are considered: epidemiological data; pulmonary function in musicians; favorable effects of music on the respiratory system; description of the main respiratory problems that may affect musicians.
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Enfermedades Pulmonares/complicaciones , Música , Asma/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/complicaciones , Pruebas de Función Respiratoria , Infecciones del Sistema Respiratorio/complicaciones , EspirometríaRESUMEN
Dilated cardiomyopathy was observed in 2 patients with chronic obstructive lung disease. This association raises first a diagnostic problem: the low specificity of clinical, radiographic and electrocardiographic signs makes it difficult to diagnose a left ventricular failure in such patients. Echocardiography is useful, but right and left heart catheterization and coronary arteriography are needed to establish the diagnosis of dilated cardiomyopathy and exclude other causes of left cardiac failure. The cause-effect relationship between the 2 diseases is not easy to evaluate. It is studied here in the light of the different mechanisms suggested to explain the repercussions function and notably the interactions between ventilation and right and left ventricular function. However, the association of the 2 diseases seems to be fortuitous. Their reciprocal repercussions, notably in the field of haemodynamics, are unquestionable and make the overall prognosis worse.
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Cardiomiopatía Dilatada/complicaciones , Insuficiencia Cardíaca/etiología , Enfermedades Pulmonares Obstructivas/complicaciones , Anciano , Cateterismo Cardíaco , Cardiomiopatía Dilatada/diagnóstico , Ecocardiografía , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Función RespiratoriaRESUMEN
This report describes the development of a pleuroperitoneal fistula complicating pleural aspergillosis in a 63-year old non-immunocompromised man treated with itraconazole. The patient presented a confluent granuloma of the abdomen while an abscess of the abdominal wall was disclosed. Skin involvement, usually described in disseminated aspergillosis, has not been reported in pleuropulmonary aspergillosis.
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Aspergilosis/complicaciones , Aspergillus fumigatus , Dermatomicosis/complicaciones , Fístula/etiología , Enfermedades Pulmonares Fúngicas/complicaciones , Enfermedades Peritoneales/etiología , Enfermedades Pleurales , Fístula del Sistema Respiratorio/etiología , Músculos Abdominales , Aspergilosis/diagnóstico , Dermatomicosis/diagnóstico , Diagnóstico Diferencial , Empiema Pleural/complicaciones , Empiema Pleural/diagnóstico , Fístula/diagnóstico , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico , Masculino , Persona de Mediana Edad , Enfermedades Peritoneales/diagnóstico , Enfermedades Pleurales/complicaciones , Enfermedades Pleurales/diagnóstico , Enfermedades Pleurales/etiología , Radiografía Abdominal , Fístula del Sistema Respiratorio/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Respiratory education by singing may be considered in the course of pulmonary rehabilitation to help control breathing and reduce dyspnoea. METHODS: We have undertaken singing training during pulmonary rehabilitation in 45 patients, mean age 60.1 ± 10.0 years, suffering from COPD (n=37) or other chronic respiratory disorders (n=8). The parameters measured at the beginning and end of course of rehabilitation were: forced vital capacity, FEV1, total lung capacity, residual volume, 6 min walking distance, VO2max, maximum pressure, MRC dyspnoea score, Cincinnati questionnaires and VSRQ (simplified visual respiratory questionnaire). RESULTS: The following were the principal significant variations observed (initial value, % variation, significance): 6 minutes walk (326 ± 114 m, +13.8%, P=0.006); VO2max (18,1 ± 6.1 ml/kg/min, +8.3%, P=0.01); P max (75 ± 31 W, +14.7%, P=0.001); MRC score (2.3 ± 0.6, -21.7%, P<10(-4)); VSRQ score (34 ± 13, +50.0%, P<10(-6)). There was no significant change in the level of dyspnoea evaluated by the Cincinnati score. CONCLUSION: These results are in favor of a beneficial effect of singing during pulmonary rehabilitation.
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Ejercicios Respiratorios , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Canto/fisiología , Anciano , Disnea/etiología , Disnea/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Consumo de Oxígeno , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Calidad de Vida , Trastornos Respiratorios/fisiopatología , Trastornos Respiratorios/rehabilitación , Pruebas de Función Respiratoria , Músculos Respiratorios/fisiopatología , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Resultado del TratamientoAsunto(s)
Antituberculosos/uso terapéutico , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/patología , Quimioprevención , Diagnóstico Diferencial , Progresión de la Enfermedad , Humanos , Huésped Inmunocomprometido , Radiografía Torácica , Factores de Riesgo , Tuberculosis Pulmonar/complicacionesRESUMEN
The goal of this study was to compare outcomes and costs of two management strategies for non-ventilator-associated nosocomial pneumonia (NP) in a medical ward. In this single-centre study, NP patients (n = 68) were randomized to receive non-invasive management (NIM) with immediate empirical antibiotic treatment (n = 34), or invasive management (IM) based on protected brush sampling of specimens (n = 34). The economic analysis adopted the hospital's perspective and took into account only direct costs. Baseline characteristics did not differ significantly between the two patient groups. The most frequently isolated organisms were Staphylococcus (25.4%), Streptococcus (23.7%) and Pseudomonas (18.6%) species. The 28-day clinical cure rate did not differ notably between the two groups (NIM, 79.4%; IM, 73.5%). Mortality at 28 days tended to be lower in the NIM group (10.0% vs. 21.8%). Mean antibiotic costs were lower in the IM group (euro194 +/- 355 vs. euro300 +/- 335, p <0.001) but overall management costs were similar (respectively, euro367 +/- 355 and euro346 +/- 363 in the IM and NIM groups, p = 0.08). With respect to both outcome and cost, this study does not support routine management of NP in medical wards using invasive procedures.
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Antibacterianos/uso terapéutico , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/tratamiento farmacológico , Costos de la Atención en Salud , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/tratamiento farmacológico , Anciano , Infección Hospitalaria/economía , Infección Hospitalaria/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/economía , Neumonía Bacteriana/mortalidad , Pseudomonas/aislamiento & purificación , Staphylococcus/aislamiento & purificación , Streptococcus/aislamiento & purificación , Resultado del TratamientoRESUMEN
Based on a review of two cases of cancer of prostate revealed by prevalent lymphnode metastases, a succinct but very clear summary is presented of current diagnostic and therapeutic options in stage D cancer of prostate, and the place of hormone therapy emphasized.
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Adenocarcinoma/patología , Metástasis Linfática/patología , Neoplasias de la Próstata/patología , Adenocarcinoma/terapia , Anciano , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias de la Próstata/terapiaRESUMEN
Asplenic patients are at high risk for the development of fulminant pneumococcal bacteremia. The mortality rate in those infected patients remains high. Therefore pneumococcal polysaccharide vaccine has been recommended, but despite penicillin prophylaxis pneumococcal sepsis can occur in vaccinated patients. We have observed two cases (one fatal) of overwhelming postsplenectomy pneumococcal sepsis in vaccinated patients who received long-term antibiotic prophylaxis. Both exhibited a poor antibody response to polyvalent vaccine.