"Open lung ventilation optimizes pulmonary function during lung surgery".

BACKGROUND: We evaluated an "open lung" ventilation (OV) strategy using low tidal volumes, low respiratory rate, low FiO2, and high continuous positive airway pressure in patients undergoing major lung resections. MATERIALS AND METHODS: In this phase I pilot study, twelve consecutive patients were anesthetized using conventional ventilator settings (CV) and then OV strategy during which oxygenation and lung compliance were noted. Subsequently, a lung resection was performed. Data were collected during both modes of ventilation in each patient, with each patient acting as his own control. The postoperative course was monitored for complications. RESULTS: Twelve patients underwent open thoracotomies for seven lobectomies and five segmentectomies. The OV strategy provided consistent one-lung anesthesia and improved static compliance (40 ± 7 versus 25 ± 4 mL/cm H2O, P = 0.002) with airway pressures similar to CV. Postresection oxygenation (SpO2/FiO2) was better during OV (433 ± 11 versus 386 ± 15, P = 0.008). All postoperative chest x-rays were free of atelectasis or infiltrates. No patient required supplemental oxygen at any time postoperatively or on discharge. The mean hospital stay was 4 ± 1 d. There were no complications or mortality. CONCLUSIONS: The OV strategy, previously shown to have benefits during mechanical ventilation of patients with respiratory failure, proved safe and effective in lung resection patients. Because postoperative pulmonary complications may be directly attributable to the anesthetic management, adopting an OV strategy that optimizes lung mechanics and gas exchange may help reduce postoperative problems and improve overall surgical results. A randomized trial is planned to ascertain whether this technique will reduce postoperative pulmonary complications.

The Effect of High Intensity Interval Run Training on Cross-sectional Area of the Vastus Lateralis in Untrained College Students.

Aerobic cycling has been repeatedly shown to induce hypertrophy in skeletal muscle across a variety of populations, while there has been a lack of investigation into the impact of running upon hypertrophy. An increasingly popular model of aerobic exercise is high-intensity interval training (HIIT); in addition to its positive impact upon cardiovascular health, HIIT may be sufficient for inducing significant muscular hypertrophy. Therefore, the purpose of this investigation was to examine the influence of a high-intensity interval running protocol upon hypertrophy of the vastus lateralis in an untrained, young population. Twelve recreationally active university students (Male: 2; Female: 10; 19.9±0.5 yr.; 169.8±1.9 cm; 63.8±2.3 kg; VO2max: 42.1±1.6 ml•kg-1min-1) completed 24.5±0.6 sessions of high-intensity interval run training over 10 weeks. The protocol consisted of four sets of 4 minutes running at 90-95% HRmax followed by 3 minutes active rest at 70% HRmax. Relative and absolute aerobic capacity increased 5.2±2.2% and 6.0±2.3% respectively as a result of the intervention (p< 0.05). Cross-sectional area (CSA) of the vastus lateralis was measured via panoramic ultrasound imaging pre- and post-intervention. Following the protocol, CSA of the intervention group was 10.6±2.7% greater (p< 0.05), while that of the control group did not change. This is the first data to demonstrate hypertrophy of the vastus lateralis in a young population following a running protocol. These data support the existing body of evidence suggesting aerobic exercise to be an effective mode of improving cardiorespiratory fitness as well as increasing whole muscle size of the quadriceps.

Radiation-induced brachial plexopathy in women treated for carcinoma of the breast.

OBJECTIVES: To study the clinical presentation and natural history of radiation-induced brachial plexopathy in 33 women treated for carcinoma of the breast. METHODS: All of the patients were referred to a single consultant neurologist. Details of surgical procedures, radiotherapy, symptoms at presentation and follow-up and neurological findings were recorded. Patients were reviewed at six or 12 monthly intervals for 2-19 years (median 9.5 years). Investigations included blood tests, chest X-ray, bone scan, neurophysiological studies, computerized tomography (CT) or magnetic resonance imaging (MRI) of the cervical spine and cerebrospinal fluid examination. RESULTS: Symptoms began from six months to 20 years after radiotherapy (median time 1.5 years). Progressive weakness was universal and resulted in loss of any useful hand function in all but three patients. The time taken to loss of useful hand function ranged from six weeks to five years (median 1.25 years). Three patterns of upper limb weakness were identified, distal limb weakness only (13 patients), global limb weakness that was more marked distally (11 patients), and completely flaccid arm (10 patients). Seventeen patients required long-term morphine to palliate pain. A chemical sympathectomy benefited three patients. CONCLUSIONS: Most patients developed symptoms within three years, but late presentations 8-20 years later were encountered. Symptoms were progressive in all patients, though the rate did vary. Pain was common and persisted indefinitely in all but one patient. Morphine was effective and should be used early and in adequate doses. Chemical sympathectomy provided sustained relief in three of six patients.