Residual volume fraction during walking using wireless air plethysmography in patients with chronic deep venous disease.

OBJECTIVE: Traditional air plethysmography (APG) provides a quantitative measure of the residual volume fraction (RVF) after 10 tiptoe movements. The recent development of a wireless Bluetooth (Bluetooth SIG, Inc, Kirkland, Wash) APG device, the PicoFlow (Microlab Elettronica, Padua, Italy), enabled us to measure RVF during normal walking. The aim of our study was to compare the RVF obtained during tiptoeing with RVF obtained during normal walking in patients with deep venous pathology (ie, reflux and/or obstruction). METHODS: A total of 61 consecutive symptomatic patients (27 women and 34 men; median age, 46 years; range, 18-79 years) with chronic venous disease due to deep venous pathology (venous reflux or obstruction, or both) before treatment or persisting after intervention were included in the present study. Of the 122 total limbs examined, 79 were affected by deep chronic venous disease and 43 contralateral limbs were normal with normal deep veins and acted as controls. The APG examination was performed using the PicoFlow device using the standard examination technique. The RVF was calculated from the residual volume at the end of 10 tiptoe movements and also during normal walking. RESULTS: At the end of the 10 tiptoe movements, the mean ± standard deviation RVF was 27.0% ± 13.2% in the limbs with normal deep veins and 38.8% ± 16.9% in the limbs with deep chronic venous disease (P < .001). During walking, when a steady state in volume was reached, the RVF was 26.3% ± 17.8% in the limbs with normal deep veins and 43.1% ± 18.6% in limbs with deep venous disease (P < 0.001). A significant difference was found between limbs with normal deep veins and limbs with deep venous reflux, irrespective of which exercise was performed. However, the mean RVF between the limbs with normal deep veins and those with outflow obstruction in the absence of reflux was significant during walking (P = .012) but not during tiptoeing (P = .212). The mean RVF was higher in the C3 to C6 limbs than in the C0 to C2 limbs with tiptoeing (29.9% ± 14.5% vs 38.3% ± 17.0%; P < .006). Similar results were obtained with walking (29.2% ± 18.0% vs 42.4% ± 18.8%; P < .004). CONCLUSIONS: In limbs with normal deep veins and deep veins with reflux, the RVF measured during walking with wireless APG was similar to the RVF obtained during tiptoeing. However, in the limbs with outflow obstruction in the absence of reflux, the RVF during walking was higher than the RVF after tiptoeing. Our results have shown that the evaluation of RVF during walking is feasible and practical.

Pulmonary capacity of patients with total traumatic injury of the brachial plexus submitted to neurotization with the phrenic nerve: a case series / Capacidade pulmonar de pacientes com lesão traumática total do plexo braquial submetidos à neurotização com o nervo frênico: uma série de casos

Total traumatic injury often requires surgical intervention such as neurotization using the phrenic nerve with the aim to recover the elbow function. However, its repercussions on the respiratory kinematics are unknown. Objective: To evaluate the ribcage volume in tricompartments division, kinematics of Duty Cycle, and shortening velocity of the respiratory muscles after nerve phrenic transfer. Methods: Five participants (4 male), aged 18 to 40 years old (32±2), diagnosed with total brachial plexus injury and with nerve phrenic transfer. The optoelectronic plethysmography (OEP) was the instrument to evaluate volume in quiet breathing (QB), inspiratory capacity (IC) and vital capacity (VC) of the rib cage in its tricompartments division (pulmonary rib cage, abdominal rib cage and abdomen rib cage) and in each hemithorax, as well as the shortening velocity of the respiratory muscles, and respiratory rate. Assessments occurred 30 days prior and 30 days after surgery. Results: There was a decrease in the total compartmental distribution in QB with statistical difference only in the abdominal compartment (p <0.05). Four patients showed a reduction in the shortening speed of the left diaphragm muscle. It was not possible to perform a group analysis of respiratory kinematics and volumes in CV, IC due to the variation found in each patient analyzed. Conclusion: There was a reduction in volume in the rib cage as well as a change in the speed of shortening of the respiratory muscles after the transfer of the phrenic nerve one month after surgery.

A lesão traumática total freqüentemente requer intervenção cirúrgica, como neurotização usando o nervo frênico, com o objetivo de recuperar a função do cotovelo. No entanto, suas repercussões na cinemática respiratória são desconhecidas. Objetivo: Avaliar o volume da caixa torácica na divisão dos tricompartimentos, a cinemática do Duty Cycle e a velocidade de encurtamento dos músculos respiratórios após a transferência do nervo frênico. Métodos: Cinco participantes (4 do sexo masculino), com idade entre 18 e 40 anos (32 ± 2), com diagnóstico de lesão total do plexo braquial e transferência do nervo frênico. A pletismografia optoeletrônica (OEP) foi o instrumento para avaliar o volume na respiração silenciosa (QB), a capacidade inspiratória (IC) e a capacidade vital (VC) da caixa torácica em sua divisão tricompartimental (caixa torácica pulmonar, caixa torácica abdominal e caixa torácica do abdômen ) e em cada hemitórax, bem como a velocidade de encurtamento dos músculos respiratórios e a frequência respiratória. As avaliações ocorreram 30 dias antes e 30 dias após a cirurgia. Resultados: Houve diminuição da distribuição compartimental total no QB com diferença estatística apenas no compartimento abdominal (p <0,05). Quatro pacientes apresentaram redução da velocidade de encurtamento do músculo diafragma esquerdo. Não foi possível realizar uma análise de grupo da cinemática respiratória e dos volumes em CV, IC devido à variação encontrada em cada paciente analisado. Conclusão: Houve redução do volume da caixa torácica e também alteração da velocidade de encurtamento dos músculos respiratórios após a transferência do nervo frênico um mês após a cirurgia.

The usefulness of Tanita TBF-310 for body composition assessment in Judo athletes using a four-compartment molecular model as the reference method

SUMMARY Body composition assessment at the molecular level is relevant for the athletic population and its association with high performance is well recognized. The four-compartment molecular model (4C) is the reference method for fat mass (FM) and fat-free mass (FFM) estimation. However, its implementation in a real context is not feasible. Coaches and athletes need practical body composition methods for body composition assessment, and the bioelectrical impedance analysis method (BIA) is usually seen as a useful alternative. The aim of this study was to test the validity of BIA (Tanita, TBF-310) to determine the FM and FFM of elite judo athletes. A total of 29 males were evaluated in a period of weight stability using the reference method (4C) and the alternative method (Tanita, TBF-310). Regarding the 4C method, total-body water was assessed by deuterium dilution, bone mineral by DXA, and body volume by air displacement plethysmography. The slops and intercepts differed from 1 (0.39 and 1.11) and 0 (4.24 and -6.41) for FM and FFM, respectively. FM from Tanita TBF-310 overestimated the 4C method by 0.2 kg although no differences were found for FFM. Tanita TBF-310 explained 21% and 72% respectively in the estimation of absolute values of FM and FFM from the 4C method. Limits of agreement were significant, varying from -6.7 kg to 7.0 kg for FM and from -8.9 kg to 7.5 kg for FFM. In conclusion, TBF-310 Tanita is not a valid alternative method for estimating body composition in highly trained judo athletes.

RESUMO A avaliação da composição corporal ao nível molecular é relevante para a população esportiva e sua associação com o alto rendimento é bem reconhecida. O modelo molecular a quatro compartimentos (4C) é o método de referência para as estimativas de massa gorda (MG) e massa livre de gordura (MLG). No entanto, sua implementação no contexto real não é viável. Técnicos e atletas precisam de métodos práticos de composição corporal para a avaliação da composição corporal e o método de análise de impedância bioelétrica (BIA) é geralmente visto como uma alternativa útil. O objetivo deste estudo foi testar a validade da BIA (Tanita, TBF-310) na determinação de MG e MLG em atletas de elite de judô. Um total de 29 atletas masculinos foi avaliado em um período de estabilidade de peso usando o método de referência (4C) e o método alternativo (Tanita, TBF-310). Em relação ao método a 4C, a água corporal total foi avaliada pela diluição de deutério, mineral ósseo por DXA e volume corporal por pletismografia por deslocamento de ar. Os declives e interceções diferiram de 1 (0,39 e 1,11) e 0 (4,24 e -6,41) para MG e MLG, respectivamente. A MG da Tanita TBF-310 superestimou o método 4C em 0,2 kg, embora não tenham sido encontradas diferenças para MLG. A Tanita TBF-310 explicou 21% e 72%, respectivamente, na estimativa dos valores absolutos de MG e MLG do método a 4C. Os limites de concordância foram grandes, variando de -6,7 kg a 7,0 kg para MG e de -8,9 kg a 7,5 kg para MLG. Em conclusão, a TBF-310 Tanita não é um método alternativo válido para estimar a composição corporal em judocas altamente treinados.

Gas exchange and breathing pattern in women with postmenopausal bone fragility.

BACKGROUND: Little is known about the relationship between bone fragility and respiratory function. We hypothesized that women with osteoporosis or osteopenia, without cardio-pulmonary disease, have perturbations in the pattern of breathing and gas exchange. METHODS: In 44 women with bone fragility (BF, T score: < -1), and 20 anthropomorphically-matched control women (T score > -1) we compared pulmonary function tests, central respiratory drive (mouth occlusion pressure or P 0.1), pattern of breathing using optoelectronic plethysmograph and arterial blood gases at rest. RESULTS: Static pulmonary function was similar in BF subjects and controls. However, the arterial blood gas measurements differed significantly. The arterial pH was significantly higher in BF subjects than in controls (P < 0.001). The partial pressure of carbon dioxide (PaCO2) and oxygen (PaO2) in arterial blood were significantly lower in BF subjects than controls (P < 0.001 and P = 0.009, respectively). The BF subjects had a shorter inspiratory fraction compared with controls (P = 0.036). Moreover, T-scores were significantly inversely correlated with the alveolar-arterial gradient of oxygen (r = -0.5; P = 0.0003) and the arterial pH (r = -0.4; P = 0.002), and positively correlated with arterial PaO2 (r = 0.3; P = 0.01) and PaCO2 (r = 0.4; P = 0.002) among all subjects. CONCLUSION: In the absence of known cardio-pulmonary disease, BF is associated with statistically significant perturbations in gas exchange and alterations in the pattern of breathing including shortening of the inspiratory time.

Prediction of Post-interventional Outcome in Great Saphenous Vein Incompetence: The Role of Venous Plethysmography with Selective Superficial Vein Occlusion.

OBJECTIVE/BACKGROUND: To evaluate whether the outcome of radiofrequency ablation (RFA) treatment of great saphenous vein (GSV) incompetence may be predicted using strain-gauge plethysmography (SGP) with selective occlusion of the superficial venous system. METHODS: Seventeen patients (20 limbs) underwent endovenous RFA treatment for GSV incompetence (Clinical Etiology Anatomy Pathophysiology classification C2-C5; "C-group"). Duplex ultrasound (DUS) and SGP were performed with selective occlusion of superficial veins before and after RFA. Selective superficial occlusion was validated, in a control group (C-group) of 12 patients (14 legs), by ascending phlebography. In the RFA group, the time taken to reach 50% and 90% (T50, T90) of maximum venous volume was measured, as well as relative maximal reflux rates (%EV/min). The methodological error and coefficient of variation (CV) were assessed. RESULTS: Nineteen of 20 legs had complete post-operative GSV obliteration using DUS, and refilling times were improved after RFA (T50 11 ± 3 vs. 19 ± 3 s; p < .001; T90 27 ± 5 vs. 47 ± 6 s; p < .001). With SGP, the methodological error and CV for T50 were 4 s and 16%, respectively. Equivalence between pre-operative superficial occlusion and post-operative baseline measurements was achieved in 15 of 17 legs for T50, and 12 of 17 for T90 (three of the 20 legs were excluded due to treatment failure [n = 1], and untreated perforating veins [n = 2]). Mean differences (95% confidence interval) were within the equivalence ranges (T50 1 [-1 to 3] seconds; T90 -3 [-11 to 4] seconds). In the C-group superficial vein occlusion was possible in 12 of 14 legs. The remaining patient (two legs) showed incomplete superficial vein occlusion at ankle level (lipodermatosclerosis) and complete superficial vein occlusion at calf level. CONCLUSION: SGP with standardized superficial venous occlusion seems to be a reliable method for identifying venous reflux and may be useful in predicting the results of successful RFA treatment.

The clinical applicability of an automated plethysmographic determination of the ankle-brachial index after vascular surgery.

An automated ankle-brachial index device could lead to potential time savings and more accuracy in ankle-brachial index-determination after vascular surgery. This prospective cross-sectional study compared postprocedural ankle-brachial indices measured by a manual method with ankle-brachial indices of an automated plethysmographic method. Forty-two patients were included. No significant difference in time performing a measurement was observed (1.1 min, 95% CI: -0.2 to +2.4; P = 0.095). Mean ankle-brachial index with the automated method was 0.105 higher (95% CI: 0.017 to 0.193; P = 0.020) than with the manual method, with limits of agreement of -0.376 and +0.587. Total variance amounted to 0.0759 and the correlation between both methods was 0.60. Reliability expressed as maximum absolute difference (95% level) between duplicate ankle-brachial index-measurements under identical conditions was 0.350 (manual) and 0.152 (automated), although not significant (p = 0.053). Finally, the automated method had 34% points higher failure rate than the manual method. In conclusion based on this study, the automated ankle-brachial index-method seems not to be clinically applicable for measuring ankle-brachial index postoperatively in patients with vascular disease.

Non-invasive whole-body plethysmograph for assessment and prediction of radiation-induced lung injury using simultaneously acquired nitric oxide and lung volume measurements.

Radiation-induced lung injury (RILI) is a prevalent side effect in patients who undergo thoracic irradiation as part of their cancer treatment. Preclinical studies play a major role in understanding disease onset under controlled experimental conditions. The aim of this work is to develop a single-chambered optimized, non-invasive, whole-body plethysmograph prototype for unrestrained small animal lung volume measurements for preclinical RILI studies. The system is also designed to simultaneously obtain nitric oxide (NO) measurements of the expired breath. The device prototype was tested using computer simulations, phantom studies and in vivo measurements in experimental animal models of RILI. The system was found to improve resemblance to true breathing signal characteristics as measured by improved skewness (21.83%) and kurtosis (51.94%) in addition to increased overall signal sensitivity (3.61%) of the acquired breath signal, when compared to matching control data. NO concentration data was combined with breath measurements in order to predict early RILI onset. The system was evaluated using serial weekly measurements in hemi-thorax irradiated rats (n = 8) yielding a classification performance of 50.0%, 62.5%, 87.5% using lung volume only, NO only, and combined measurements of both, respectively. Our results indicate that improved performance could be achieved when measurements of lung volume are combined with those of NO. This would provide the overall plethysmography system with the ability to provide useful diagnostic and prognostic information for preclinical and, potentially, clinical thoracic dose escalation studies.

A wearable sensor system for monitoring cigarette smoking.

OBJECTIVE: Available methods of smoking assessment (e.g., self-report, portable puff-topography instruments) do not permit the collection of accurate measures of smoking behavior while minimizing reactivity to the assessment procedure. This article suggests a new method for monitoring cigarette smoking based on a wearable sensor system (Personal Automatic Cigarette Tracker [PACT]) that is completely transparent to the end user and does not require any conscious effort to achieve reliable monitoring of smoking in free-living individuals. METHOD: The proposed sensor system consists of a respiratory inductance plethysmograph for monitoring of breathing and a hand gesture sensor for detecting a cigarette at the mouth. The wearable sensor system was tested in a laboratory study of 20 individuals who performed 12 different activities including cigarette smoking. Signal processing was applied to evaluate the uniqueness of breathing patterns and their correlation with hand gestures. RESULTS: The results indicate that smoking manifests unique breathing patterns that are highly correlated with hand-to-mouth cigarette gestures and suggest that these signals can potentially be used to identify and characterize individual smoke inhalations. CONCLUSIONS: With the future development of signal processing and pattern-recognition methods, PACT can be used to automatically assess the frequency of smoking and inhalation patterns (such as depth of inhalation and smoke holding) throughout the day and provide an objective method of assessing the effectiveness of behavioral and pharmacological smoking interventions.

Detection of cigarette smoke inhalations from respiratory signals using reduced feature set.

A combination of wearable Respiratory Inductive Plethysmograph and a hand-to-mouth Proximity Sensor (PS) can be used to monitor smoking habits and smoke exposure in cigarette smokers. In our previous work, detection of smoke inhalations was achieved by using a Support Vector Machine (SVM) classifier applied to raw sensor signals with 1503-element feature vectors. This study uses empirically-defined 27 features computed from the sensor signals to reduce the length of vectors. Further reduction in the length of the feature vectors was achieved by a forward feature selection algorithm, identifying from 2 to 16 features most critical for smoke inhalations detection. For individual detection models, the 1503-element feature vectors, 27-element feature vectors and reduced feature vectors resulted in F-scores of 90.1%, 68.7% and 94% respectively. For the group models, F-scores were 81.3%, 65% and 67% respectively. These results demonstrate feasibility of detecting smoke inhalations with a computed feature set, but suggest high individuality of breathing patterns associated with smoking.

Measuring toe pressures using a portable photoplethysmograph to detect arterial disease in high-risk patients: an overview of the literature.

Lower extremity arterial disease (LEAD) is estimated to affect one third of individuals older than 65 years of age, occurs in younger individuals who use tobacco or have diabetes mellitus (DM), and often remains undiagnosed until a patient pres- ents with ischemia-related symptoms or complications. Valid and reliable noninvasive tests such as the ankle-brachial index (ABI) are recommended to detect LEAD. However, ABI results can be inconclusive or the index can be elevated (i.e., >1.3) in persons with calcified ankle arteries due to DM, renal failure, or arthritis. In these instances, obtaining toe pressure (TP) measurements, which correlate well with angiographic findings, is advised, providing the patient does not have vasoconstriction with cold toes or vasospastic disease. In such cases, TP can be obtained using a portable pho- toplethysmograph (PPG), which offers a simple and inexpensive method for healthcare providers in a variety of clinical settings to assess for the presence of LEAD. Portable PPG TP measurements have been found to have a high level of agreement with vascular laboratory PPG tests to detect LEAD, as well as good sensitivity and a high specificity. Adopting a TP measurement protocol of care to assess high-risk individuals such as patients with DM and elevated ABIs potentially can have a major impact on early identification of LEAD and reduce the risk of ischemia-related complications, including lower extremity wounds and amputations.

Reliability and concurrent validity of the perometer for measuring hand volume in women with and without lymphedema.

BACKGROUND: Lymphedema of hand after breast cancer treatment causes significant loss of hand function. Although there are several ways of assessing limb volume, measuring hand volume has been problematic due to technical difficulties associated with assessment of finger volumes. The aim of this study was to investigate the criterion validity and reliability of Perometer™ for measuring hand volume in woman with and without lymphedema. METHODS AND RESULTS: Hand volume of forty women with (n = 20) and without lymphedema (n = 20) was assessed twice by one rater and once by another rater using the Perometer, and once by one rater using the water volumetry method. Intra- and inter-rater reliability was determined from the intraclass correlation coefficients and Percent Close Agreement. Agreement between the Perometer and water volumetry was determined using a limit of agreement and Lin's concordance correlation. The Perometer had high intra [ICC(2,1) = 0.989 (95% CI: 0.98-0.99)] and inter-rater reliability [ICC(2,1) = 0.993 (95% CI: 0.99-1.0)]. Percent close agreement revealed that 80% of the measures were within 9 ml for inter-rater reliability and within 15 ml for intra-rater reliability. In addition, there was high concordance between hand volumes obtained with the Perometer and water volumetry method (R(c) = 0.88). However, the Perometer overestimated the volume of hand compared to water volumetry method (bias: 7.5%). CONCLUSIONS: The Perometer can be used with high reliability to measure hand volume but caution should be exercised when data are compared with measures derived from the water volumetry method.

Evaluation of pulmonary rehabilitation after lung resection through opto-electronic plethysmography.

The aim of this study is to evaluate the Pulmonary Rehabilitation (PR) and post-operative complications on lung cancer patients by means of opto-electronic plethysmography (OEP). FEV1 and FVC have been measured through OEP on 13 lung cancer patients, before and after lobectomy and after pulmonary rehabilitation (PR). In every patient, FEV1 decreases after surgery, whereas FVC decreases only in 8 patients. Mean FEV1 and FVC decrease in every compartment of chest wall (CW) and in CW after lobectomy and improve in post-rehabilitation phase (ΔFEV1(CW)=+31%; ΔFVC(CW) = +13%). The highest positive variation of FEV1 has been measured in rib-cage abdominal compartment (ΔFEV1(RCa) =+59%) and of FVC in abdomen (ΔFVC(AB) = +24%), after PR.

Sleep-related sweating in obstructive sleep apnoea: association with sleep stages and blood pressure.

The aim of this study was to investigate sleep-related sweating as a symptom of obstructive sleep apnoea (OSA). Fifteen otherwise healthy male non-smoking patients with untreated moderate-to-severe OSA underwent polysomnography, including measurements of skin and core body temperature and electrodermal activity (EDA) as an objective indicator of sweating. Evening and morning blood pressure was measured as well as catecholamines in nocturnal urine. All measurements were repeated after 3 months on successful continuous positive airway pressure (CPAP) treatment. The untreated OSA subjects had a mean (+/-SD) apnoea-hypopnoea index of 45.3 +/- 3.9 and a mean EDA index during sleep of 131.9 +/- 22.4 events per hour. Patients with higher EDA indices had higher systolic blood pressure in the evening and morning (P = 0.001 and 0.006) and lower rapid eye movement (REM) sleep percentage (P = 0.003). The EDA index decreased significantly to 78.5 +/- 17.7 in the patients on CPAP treatment (P = 0.04). The decrease correlated with lower evening systolic and diastolic blood pressure (P = 0.05 and 0.006) and an increase in REM% (P = 0.02). No relationship was observed between EDA and skin or core body temperature, or to catecholamine levels in urine. OSA patients who experience sleep-related sweating may have increased blood pressure and decreased REM sleep compared with other OSA patients. CPAP treatment appears to lower blood pressure and increase REM sleep to a higher extent in these patients compared with other OSA patients.

Validity for the simplified water displacement instrument to measure arm lymphedema as a result of breast cancer surgery.

OBJECTIVES: To evaluate concurrent and construct validity for the Simplified Water Displacement Instrument (SWDI), an instrument for measuring arm volumes and arm lymphedema as a result of breast cancer surgery. DESIGN: Validity design. SETTING: Hospital setting. PARTICIPANTS: Women (N=23; mean age, 64+/-11y) were examined 6 years after breast cancer surgery with axillary node dissection. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The SWDI was included for measuring arm volumes to estimate arm lymphedema as a result of breast cancer surgery. A computed tomography (CT) scan was included to examine the cross-sectional areas (CSAs) in square millimeters for the subcutaneous tissue, for the muscle tissue, and for measuring tissue density in Hounsfield units. Magnetic resonance imaging (MRI) with T2-weighted sequences was included to show increased signal intensity in subcutaneous and muscle tissue areas. RESULTS: The affected arm volume measured by the SWDI was significantly correlated to the total CSA of the affected upper limb (R=.904) and also to the CSA of the subcutaneous tissue and muscles tissue (R=.867 and R=.725), respectively (P<.001). The CSA of the subcutaneous tissue for the upper limb was significantly larger compared with the control limb (11%). Tissue density measured in Hounsfield units did not correlate significantly with arm volume (P>.05). The affected arm volume was significantly larger (5%) than the control arm volume (P<.05). Five (22%) women had arm lymphedema defined as a 10% increase in the affected arm volume compared with the control arm volume, and an increased signal intensity was identified in all 5 women on MRI (T2-weighted, kappa=.777, P<.001). CONCLUSIONS: The SWDI showed high concurrent and construct validity as shown with significant correlations between the CSA (CT) of the subcutaneous and muscle areas of the affected limb and the affected arm volume (P>.001). There was a high agreement between those subjects who were diagnosed with arm lymphedema by using the SWDI and the increased signal intensity on MRI, with a kappa value of .777 (P<.001). High construct validity for the SWDI was confirmed for arm lymphedema as a volume increase, but it was not confirmed for lymphedema without an increase in arm volume (swelling). The SWDI is a simple and valid tool for estimating arm volume and arm lymphedema after breast cancer surgery.

Psychophysiological assessment of sexual function in women after radiotherapy and total mesorectal excision for rectal cancer: a pilot study on four patients.

INTRODUCTION: The potential contribution of psychological and anatomical changes to sexual dysfunction in female patients following short-term preoperative radiotherapy (5 x 5 Gy) and total mesorectal excision (TME) is not clear. Aim. In this study we assessed female sexual dysfunction in patients who underwent radiotherapy and TME for rectal cancer. MAIN OUTCOME MEASURES: Genital arousal was assessed using vaginal videoplethysmography. METHODS: Sexual functioning was examined in four patients who had rectal cancer and underwent radiotherapy and TME. All investigations were done at least 15 months after treatment. The results were compared with an age-matched group of 18 healthy women. RESULTS: The patients and healthy controls showed comparable changes in vaginal vasocongestion during sexual arousal, though three out of four patients showed a lower mean spectral tension (MST) of the vaginal pulse compared with healthy controls. Subjective sexual arousal was equivalent between the two groups. CONCLUSIONS: In this study the changes of genital and subjective sexual arousal after erotic stimulus condition between patients and healthy controls were not different, though lower MST of the vaginal pulse was found in three out of four patients compared with healthy women. Additional work, however, must be performed to clarify the mechanisms of sexual dysfunction following treatment of rectal cancer.

Detection of pulsus paradoxus by pulse oximetry in pediatric patients after cardiac surgery.

The presence or absence of pulsus paradoxus (PP), defined as an inspiratory decrease greater than 10 mmHg in systolic blood pressure, can have significant diagnostic and therapeutic implications for many clinical conditions including acute asthma, pericardial tamponade, heart failure, hypovolemia, shock states, and the like. However, PP may be difficult to measure in children. Indwelling arterial catheters facilitate the measurement of PP, but this invasive technique generally is reserved for critically ill patients. This study aimed to assess the use of the pulse oximetry plethysmographic waveform (POPW) for the detection of PP in pediatric patients after cardiac surgery. The study enrolled 40 pediatric patients 18 years of age and younger who had invasive blood pressure monitoring with an intraarterial cannula. Systolic pressure variability (SPV) and changes in POPW amplitude (DeltaPOPW%), calculated using five consecutive snapshots from every patient's monitor, were compared using linear regression, Pearson product-moment correlation, the Spearman rank method, and receiver operating characteristic (ROC) curve analysis. A strong correlation existed between respiratory SPV and DeltaPOPW% for the detection of PP (r = 0.682; p < 0.0001). A respiratory variation in DeltaPOPW% exceeding 25.44% (about one-fourth the amplitude of the tallest POP waveform) allowed detection of PP with a sensitivity of 86.7% and a specificity of 88%. Pulse oximetry is a readily available and easily performed noninvasive means for detecting PP in children.

Validity of new child-specific thoracic gas volume prediction equations for air-displacement plethysmography.

BACKGROUND: To determine the validity of the recently developed child-specific thoracic gas volume (TGV) prediction equations for use in air-displacement plethysmography (ADP) in diverse pediatric populations. METHODS: Three distinct populations were studied: European American and African American children living in Birmingham, Alabama and European children living in Lisbon, Portugal. Each child completed a standard ADP testing protocol, including a measured TGV according to the manufactures software criteria. Measured TGV was compared to the predicted TGV from current adult-based ADP proprietary equations and to the recently developed child-specific TGV equations of Fields et al. Similarly, percent body fat, derived using the TGV prediction equations, was compared to percent body fat derived using measured TGV. RESULTS: Predicted TGV from adult-based equations was significantly different from measured TGV in girls from each of the three ethnic groups (P < 0.05), however child-specific TGV estimates did not significantly differ from measured TGV in any of the ethnic or gender groups. Percent body fat estimates using adult-derived and child-specific TGV estimates did not differ significantly from percent body fat measures using measured TGV in any of the groups. CONCLUSION: The child-specific TGV equations developed by Fields et al. provided a modest improvement over the adult-based TGV equations in an ethnically diverse group of children.

Lung function reference values in Iranian adolescents.

There is insufficient information about reference values for pulmonary volumes for Iranian populations. A study of lung function parameters was made on 302 non-smoking healthy Iranian students (152 male and 150 female). Lung function measures correlated strongly with height but not with body mass index. There were significant differences between some of the measured parameters and American Thoracic Society reference values for Caucasians (P < 0.05). Of note is the high functional residual capacity (110% higher) and low inspirational capacity (86% lower) in males compared with the reference values.