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1.
Ann Vasc Surg ; 62: 70-75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31207398

RESUMO

BACKGROUND: The objective of this study was to characterize phrenic nerve and brachial plexus variation encountered during supraclavicular decompression for neurogenic thoracic outlet syndrome and to identify associated postoperative neurologic complications. METHODS: A multicenter retrospective review was performed to evaluate anatomic variation of the phrenic nerve and brachial plexus from November 2010 to July 2018. After initial characterization, the following two groups were identified: variant anatomy (VA) group and standard anatomy (SA) group. Complications were analyzed and compared between the two groups. RESULTS: In total, 105 patients were identified, and 100 patients met inclusion criteria. Any anatomic variation of the standard course or configuration of the phrenic nerve and/or brachial plexus was encountered in 47 (47%) patients. Phrenic nerve anatomic variations were identified in 28 (28%) patients. These included 9 duplicated nerves, 6 lateral accessory nerves, 8 medial displacement, and 5 lateral displacement. Brachial plexus anatomic variation was found in 34 (34%) patients. The most common variant configuration of a fused middle and inferior trunk was identified in 25 (25%) patients. Combined phrenic nerve and brachial plexus anatomic variation was demonstrated in 15 (15%) patients. The VA and SA groups consisted of 47 and 53 patients, respectively. Transient phrenic nerve injury with postoperative elevation of the ipsilateral hemidiaphragm was documented in 3 (6.4%) patients in the VA group and 6 (11.3%) patients in the SA group (P = 0.49). Permanent phrenic nerve injury was identified in 1 (2.1%) patient in the VA group (P = 0.47) and none in the SA group. Transient brachial plexopathy was encountered in 1 (1.9%) patient in the SA group (P = 1.0) with full recovery to normal function. CONCLUSIONS: Anatomic variability of the phrenic nerve and brachial plexus are encountered more frequently than previously reported. While the incidence of nerve injury is low, surgeons operating within the thoracic aperture should be familiar with variant anatomy to reduce postoperative complications.


Assuntos
Neuropatias do Plexo Braquial/etiologia , Plexo Braquial/anormalidades , Descompressão Cirúrgica/efeitos adversos , Traumatismos dos Nervos Periféricos/etiologia , Nervo Frênico/anormalidades , Síndrome do Desfiladeiro Torácico/cirurgia , Adulto , Plexo Braquial/lesões , Plexo Braquial/fisiopatologia , Neuropatias do Plexo Braquial/fisiopatologia , Feminino , Humanos , Masculino , Maryland , Traumatismos dos Nervos Periféricos/fisiopatologia , Philadelphia , Nervo Frênico/lesões , Nervo Frênico/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/fisiopatologia , Resultado do Tratamento
2.
Sleep ; 42(11)2019 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-31634407

RESUMO

STUDY OBJECTIVE: To evaluate long-term efficacy and safety of phrenic nerve stimulation (PNS) in patients with moderate-to-severe central sleep apnea (CSA) through 3 years of therapy. METHODS: Patients in the remede System Pivotal Trial were observed every 3 months after implant until US Food and Drug Administration approval. At the time of approval and study closure, all patients completed 24 months of follow-up; 33 patients had not reached the 36-month visit. Sleep metrics (polysomnography) and echocardiographic parameters are reported at baseline, 12, 18, and 24 months, in addition to available 36-month sleep results from polygraphy. Safety was assessed through 36 months; however, analysis focused through 24 months and available 36-month results are provided. RESULTS: Patients were assessed at 24 (n = 109) and 36 (n = 60) months. Baseline characteristics included mean age 64 years, 91% male, and mean apnea-hypopnea index 47 events per hour. Sleep metrics (apnea-hypopnea index (AHI), central apnea index, arousal index, oxygen desaturation index, rapid eye movement sleep) remained improved through 24 and 36 months with continuous use of PNS therapy. At least 60% of patients in the treatment group achieved at least 50% reduction in AHI through 24 months. Serious adverse events (SAEs) related to the remede System implant procedure, device, or therapy through 24 months were reported by 10% of patients, no unanticipated adverse device effects or deaths, and all events resolved. No additional related SAEs were reported between 24 and 36 months. CONCLUSION: These data suggest beneficial effects of long-term PNS in patients with CSA appear to sustain through 36 months with no new safety concerns. TRIAL REGISTRATION: NCT01816776.


Assuntos
Terapia por Estimulação Elétrica/métodos , Nervo Frênico/fisiopatologia , Apneia do Sono Tipo Central/terapia , Idoso , Terapia por Estimulação Elétrica/efeitos adversos , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Prospectivos , Qualidade de Vida , Apneia do Sono Tipo Central/fisiopatologia , Resultado do Tratamento
3.
J Peripher Nerv Syst ; 24(3): 283-293, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31393643

RESUMO

Diaphragm weakness in Charcot-Marie-Tooth disease 1A (CMT1A) is usually associated with severe disease manifestation. This study comprehensively investigated phrenic nerve conductivity, inspiratory and expiratory muscle function in ambulatory CMT1A patients. Nineteen adults with CMT1A (13 females, 47 ± 12 years) underwent spiromanometry, diaphragm ultrasound, and magnetic stimulation of the phrenic nerves and the lower thoracic nerve roots, with recording of diaphragm compound muscle action potentials (dCMAP, n = 15), transdiaphragmatic and gastric pressures (twPdi and twPgas, n = 12). Diaphragm motor evoked potentials (dMEP, n = 15) were recorded following cortical magnetic stimulation. Patients had not been selected for respiratory complaints. Disease severity was assessed using the CMT Neuropathy Scale version 2 (CMT-NSv2). Healthy control subjects were matched for age, sex, and body mass index. The following parameters were significantly lower in CMT1A patients than in controls (all P < .05): forced vital capacity (91 ± 16 vs 110 ± 15% predicted), maximum inspiratory pressure (68 ± 22 vs 88 ± 29 cmH2 O), maximum expiratory pressure (91 ± 23 vs 123 ± 24 cmH2 O), and peak cough flow (377 ± 135 vs 492 ± 130 L/min). In CMT1A patients, dMEP and dCMAP were delayed. Patients vs controls showed lower diaphragm excursion (5 ± 2 vs 8 ± 2 cm), diaphragm thickening ratio (DTR, 1.9 [1.6-2.2] vs 2.5 [2.1-3.1]), and twPdi (8 ± 6 vs 19 ± 7 cmH2 O; all P < .05). DTR inversely correlated with the CMT-NSv2 score (r = -.59, P = .02). There was no group difference in twPgas following abdominal muscle stimulation. Ambulatory CMT1A patients may show phrenic nerve involvement and reduced respiratory muscle strength. Respiratory muscle weakness can be attributed to diaphragm dysfunction alone. It relates to neurological impairment and likely reflects a disease continuum.


Assuntos
Doença de Charcot-Marie-Tooth/fisiopatologia , Debilidade Muscular/fisiopatologia , Nervo Frênico/fisiopatologia , Músculos Respiratórios/fisiopatologia , Adulto , Doença de Charcot-Marie-Tooth/diagnóstico por imagem , Diafragma/diagnóstico por imagem , Diafragma/fisiopatologia , Estimulação Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico por imagem , Nervo Frênico/diagnóstico por imagem , Músculos Respiratórios/diagnóstico por imagem , Ultrassonografia
5.
Rev. esp. anestesiol. reanim ; 66(6): 342-345, jun.-jul. 2019.
Artigo em Espanhol | IBECS | ID: ibc-187544

RESUMO

La colecistectomía laparoscópica supone hoy en día el tratamiento gold estándar de la patología aguda de la vía biliar. A pesar de las numerosas ventajas que presenta respecto a la cirugía abierta clásica, no está exenta de complicaciones. Presentamos el caso de un paciente varón de 82 años que tras el diagnóstico de colecistitis gangrenosa es intervenido de urgencia de colecistectomía laparoscópica, presentando en las primeras 24h del postoperatorio un episodio de insuficiencia respiratoria aguda, motivo por el cual ingresa en reanimación. Los estudios realizados a posteriori mostraron una parálisis del hemidiafragma derecho, probablemente relacionada con la cirugía


Laparoscopic cholecystectomy is currently the gold standard treatment for acute biliary tract pathology. Despite its many advantages compared to open surgery, it is not without complications. We present the case of an 82-year-old man who, after a diagnosis of gangrenous cholecystitis, underwent urgent laparoscopic cholecystectomy. During the first 24hours after the surgery, he had an episode of acute respiratory failure, for which he was admitted to the critical care unit. Studies performed later showed paralysis of the right diaphragm that was probably related to the surgery


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Paralisia Respiratória/etiologia , Colecistectomia Laparoscópica/efeitos adversos , Colecistite/cirurgia , Insuficiência Respiratória/etiologia , Reanimação Cardiopulmonar , Nervo Frênico/fisiopatologia , Pneumoperitônio/complicações , Apraxias/etiologia
6.
Clin Chest Med ; 40(2): 331-342, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31078213

RESUMO

We examine 2 means by which the healthy respiratory system contributes to exercise limitation. These include the activation of respiratory and locomotor muscle afferent reflexes, which constrain blood flow and hasten fatigue in both sets of muscles, and the excessive increases in pulmonary vascular pressures at high cardiac outputs, which constrain O2 transport and precipitate maladaptive right ventricular remodeling in endurance-trained subjects.


Assuntos
Exercício Físico/fisiologia , Insuficiência Cardíaca/fisiopatologia , Pulmão/irrigação sanguínea , Nervo Frênico/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Músculos Respiratórios/fisiopatologia , Feminino , Humanos , Masculino
7.
Laryngoscope ; 129(11): 2669-2673, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30756404

RESUMO

OBJECTIVE: To evaluate the extent of airway improvement and voice quality in patients with bilateral vocal fold paralysis (BVFP) who underwent selective laryngeal reinnervation surgery. METHODS: Seven patients with BVFP caused by thyroid surgeries were enrolled. They underwent selective laryngeal reinnervation surgery. Videostroboscopy data, voice perceptual data (grade [G]), acoustic data, laryngeal electromyography data, and pulmonary function test data were obtained preoperatively and postoperatively. RESULTS: Videostroboscopic videos showed that six patients could achieve moderate-to-maximal abduction in the bilateral vocal folds during inspiration, whereas all patients achieved adduction in the bilateral vocal folds during phonation at 4 to 7 months postoperatively. G score was decreased significantly versus preoperative values (P < 0.05), and vocal functional parameters were improved significantly at 12 months postoperatively (P < 0.05). The aerodynamic parameter of maximum phonation time was significantly longer than the preoperative value (P < 0.05). Most parameters in pulmonary function test recovered to normal reference levels as early as 3 months postoperatively, whereas maximal inspiratory pressure (PImax) values were still slightly lower than normal levels 12 months after surgery. All of these parameters improved significantly versus preoperative values. Electromyographic data at 12 months postoperatively showed full interference potentials in bilateral posterior cricoarytenoid muscles during inspiration and full interference potentials in bilateral thyroarytenoid muscles during phonation in all patients. Moderate electric potentials were seen in left interarytenoid muscle in one failed patient. CONCLUSION: This new selective laryngeal reinnervation procedure can achieve physiological movements of the bilateral vocal folds in selected patients with BVFP. LEVEL OF EVIDENCE: 4. Laryngoscope, 129:2669-2673, 2019.


Assuntos
Nervo Hipoglosso/cirurgia , Regeneração Nervosa , Nervo Frênico/cirurgia , Complicações Pós-Operatórias/cirurgia , Traumatismos do Nervo Laríngeo Recorrente/cirurgia , Paralisia das Pregas Vocais/cirurgia , Adulto , Feminino , Humanos , Nervo Hipoglosso/fisiopatologia , Músculos Laríngeos/inervação , Músculos Laríngeos/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fonação , Nervo Frênico/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Período Pós-Operatório , Período Pré-Operatório , Nervo Laríngeo Recorrente , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Traumatismos do Nervo Laríngeo Recorrente/fisiopatologia , Estroboscopia , Tireoidectomia/efeitos adversos , Resultado do Tratamento , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/fisiopatologia , Prega Vocal/inervação , Prega Vocal/fisiopatologia , Qualidade da Voz
8.
Medicine (Baltimore) ; 98(1): e13993, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30608443

RESUMO

Respiratory failure is common during acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). Phrenic nerve conduction (PNC), transcranial magnetic stimulation (TMS), and cervical magnetic stimulation (CMS) are of great value in identifying the feature and site of AE-COPD.PNC, TMS, and CMS were performed in 20 AE-COPD patients with respiratory failure, and re-examined after weaning. Latencies and amplitudes of the diaphragmatic compound muscle action potential (dCMAP), motor evoked potential of the diaphragm (dMEP) evoked by TMS and CMS, and central motor conduction time (CMCT) were measured. Blood gas analysis and serum electrolyte levels were also evaluated. The results were compared with those from 20 healthy subjects.AE-COPD patients showed prolonged CMCT and latencies of dCMAP and dMEP, decreased amplitudes of dCMAP and dMEP evoked by CMS, while CMCT and the latency of dMEP evoked by TMS were shortened after weaning. Significant correlation was identified between arterial blood gas analysis, serum electrolyte levels, disease duration, the duration of mechanical ventilation and the electrophysiological findings in AE-COPD patients prior to weaning.The central and peripheral respiratory pathway is involved in AE-COPD. Central respiratory pathway function is improved after weaning in AE-COPD patients with respiratory failure.


Assuntos
Eletrofisiologia/instrumentação , Potencial Evocado Motor/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Respiratória/etiologia , Estimulação Magnética Transcraniana/métodos , Idoso , Idoso de 80 Anos ou mais , Gasometria/métodos , Diafragma/inervação , Diafragma/fisiopatologia , Progressão da Doença , Eletrólitos/sangue , Feminino , Humanos , Masculino , Condução Nervosa/fisiologia , Nervo Frênico/fisiopatologia , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações
9.
J Neurotrauma ; 36(3): 448-459, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29943656

RESUMO

The present study was designed to investigate laryngeal function responses to chemoreceptor activation after unilateral high-cervical spinal cord contusion in rats. Adult male Sprague-Dawley rats received laminectomy or unilateral contusion at the C2 spinal cord. Both respiratory airflow and subglottal pressure were measured in spontaneously breathing rats at three days, two weeks, or six weeks after spinal surgery. Laryngeal closure responses were evoked via intrajugular capsaicin (1.5 µg/kg) administration and hypoxia (12.5% O2, 3 min) to activate bronchopulmonary C-fibers and chemoreceptors, respectively. High cervical contusion resulted in long-term reductions in tidal volume without changes in laryngeal resistance at baseline. Alternatively, capsaicin-induced increased subglottal pressure was significantly attenuated in contused rats at three days post-injury. Contused rats regained the ability to increase laryngeal resistance after capsaicin treatment at two and six weeks post-injury, whereas this recovered response remained weaker than uninjured animals. Notably, hypoxia-induced laryngeal closure was not altered during the acute injured stage, but instead was blunted at six weeks post-injury. These data suggest that cervical spinal cord injury not only influences the breathing pattern, but it also impacts upper airway function through modulation of laryngeal resistance. An attenuated laryngeal closure response may negatively impact the ability to prevent irritant inhalation and maintenance of the functional residual capacity. This may contribute to the provocation of pulmonary disease after cervical spinal cord injury.


Assuntos
Resistência das Vias Respiratórias/fisiologia , Medula Cervical/fisiopatologia , Laringe/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Animais , Medula Cervical/lesões , Masculino , Nervo Frênico/fisiopatologia , Ratos , Ratos Sprague-Dawley , Volume de Ventilação Pulmonar/fisiologia
10.
Pulmonology ; 25(4): 223-235, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30509855

RESUMO

The diaphragm is the main breathing muscle and contraction of the diaphragm is vital for ventilation so any disease that interferes with diaphragmatic innervation, contractile muscle function, or mechanical coupling to the chest wall can cause diaphragm dysfunction. Diaphragm dysfunction is associated with dyspnoea, intolerance to exercise, sleep disturbances, hypersomnia, with a potential impact on survival. Diagnosis of diaphragm dysfunction is based on static and dynamic imaging tests (especially ultrasound) and pulmonary function and phrenic nerve stimulation tests. Treatment will depend on the symptoms and causes of the disease. The management of diaphragm dysfunction may include observation in asymptomatic patients with unilateral dysfunction, surgery (i.e., plication of the diaphragm), placement of a diaphragmatic pacemaker or invasive and/or non-invasive mechanical ventilation in symptomatic patients with bilateral paralysis of the diaphragm. This type of patient should be treated in experienced centres. This review aims to provide an overview of the problem, with special emphasis on the diseases that cause diaphragmatic dysfunction and the diagnostic and therapeutic procedures most commonly employed in clinical practice. The ultimate goal is to establish a standard of care for diaphragmatic dysfunction.


Assuntos
Diafragma/fisiopatologia , Nervo Frênico/fisiopatologia , Paralisia Respiratória/terapia , Ultrassonografia/métodos , Diafragma/diagnóstico por imagem , Diafragma/inervação , Diafragma/cirurgia , Eventração Diafragmática/complicações , Eventração Diafragmática/diagnóstico por imagem , Eventração Diafragmática/fisiopatologia , Fluoroscopia/métodos , Humanos , Microcirurgia/métodos , Nervo Frênico/lesões , Nervo Frênico/patologia , Nervo Frênico/cirurgia , Radiografia/métodos , Respiração Artificial/métodos , Respiração Artificial/tendências , Testes de Função Respiratória/métodos , Paralisia Respiratória/etiologia , Estimulação Elétrica Nervosa Transcutânea/métodos
11.
Rev. esp. anestesiol. reanim ; 65(10): 593-596, dic. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-177213

RESUMO

El bloqueo del nervio frénico es una complicación que puede producirse tras la anestesia del plexo braquial por encima de la clavícula. La principal consecuencia de este bloqueo es la parálisis diafragmática ipsolateral, que en ocasiones puede suponer aparición de complicaciones respiratorias postoperatorias. Presentamos un caso clínico de una mujer que tras ser intervenida de una prótesis total de hombro presentó disnea en la unidad de recuperación posquirúrgica. Se realizó una ecografía diafragmática que permitió un diagnóstico rápido de parálisis completa del hemidiafragma ipsolateral. Ante la sospecha de bloqueo del nervio frénico, la ecografía ha demostrado ser una herramienta diagnóstica rápida con alta sensibilidad y especificidad. Su empleo puede anticipar el posible desarrollo de complicaciones inmediatas, y orientarnos para escoger la estrategia terapéutica adecuada para cada caso de una manera precoz. En nuestro caso nos permitió tratar de forma precoz mediante oxigenoterapia, retirada de catéter interescalénico y vigilancia intensiva


Phrenic nerve block is a complication that can occur after brachial plexus anaesthesia above the clavicle. The main consequence of this blockage is ipsolateral diaphragmatic paralysis, which can sometimes lead to the appearance of post-operative respiratory complications. A case is presented on a woman, who after having undergone a total shoulder prosthesis, presented with dyspnoea in the post-operative recovery unit. A diaphragmatic ultrasound was performed that enabled a rapid diagnosis to be made of a complete paralysis of the ipsolateral hemi-diaphragm. Given the suspicion of phrenic nerve block, ultrasound has proven to be a rapid diagnostic tool with high sensitivity and specificity. Its use can anticipate the possible development of immediate complications, and act as a guide in choosing the appropriate therapeutic strategy for each case in an early manner. In this case it enabled us to treat early with oxygen therapy, interscalene catheter removal, and intensive surveillance


Assuntos
Humanos , Feminino , Idoso , Nervo Frênico/fisiopatologia , Paralisia Respiratória/prevenção & controle , Bloqueio Nervoso/efeitos adversos , Transtornos Respiratórios/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Diagnóstico Precoce
12.
J Comp Neurol ; 526(18): 2973-2983, 2018 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-30411341

RESUMO

Structural plasticity in motoneurons may be influenced by activation history and motoneuron-muscle fiber interactions. The goal of this study was to examine the morphological adaptations of phrenic motoneurons following imposed motoneuron inactivity while controlling for diaphragm muscle inactivity. Well-characterized rat models were used including unilateral C2 spinal hemisection (SH; ipsilateral phrenic motoneurons and diaphragm muscle are inactive) and tetrodotoxin phrenic nerve blockade (TTX; ipsilateral diaphragm muscle is paralyzed while phrenic motoneuron activity is preserved). We hypothesized that inactivity of phrenic motoneurons would result in a decrease in motoneuron size, consistent with a homeostatic increase in excitability. Phrenic motoneurons were retrogradely labeled by ipsilateral diaphragm muscle injection of fluorescent dextrans or cholera toxin subunit B. Following 2 weeks of diaphragm muscle paralysis, morphological parameters of labeled ipsilateral phrenic motoneurons were assessed quantitatively using fluorescence confocal microscopy. Compared to controls, phrenic motoneuron somal volumes and surface areas decreased with SH, but increased with TTX. Total phrenic motoneuron surface area was unchanged by SH, but increased with TTX. Dendritic surface area was estimated from primary dendrite diameter using a power equation obtained from three-dimensional reconstructed phrenic motoneurons. Estimated dendritic surface area was not significantly different between control and SH, but increased with TTX. Similarly, TTX significantly increased total phrenic motoneuron surface area. These results suggest that ipsilateral phrenic motoneuron morphological adaptations are consistent with a normalization of motoneuron excitability following prolonged alterations in motoneuron activity. Phrenic motoneuron structural plasticity is likely more dependent on motoneuron activity (or descending input) than muscle fiber activity.


Assuntos
Neurônios Motores/patologia , Plasticidade Neuronal/fisiologia , Paralisia Respiratória/patologia , Paralisia Respiratória/fisiopatologia , Animais , Diafragma/inervação , Modelos Animais de Doenças , Nervo Frênico/patologia , Nervo Frênico/fisiopatologia , Ratos , Ratos Sprague-Dawley
13.
Eur J Heart Fail ; 20(12): 1746-1754, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30303611

RESUMO

AIMS: The presence of central sleep apnoea (CSA) is associated with poor prognosis in patients with heart failure (HF). The aim of this analysis was to evaluate if using phrenic nerve stimulation to treat CSA in patients with CSA and HF was associated with changes in HF-specific metrics. METHODS AND RESULTS: All patients randomized in the remede System Pivotal Trial and identified at baseline with HF were included (n = 96). Effectiveness data from treatment and former control groups were pooled based on months since therapy activation. Changes from baseline to 6 and 12 months in sleep metrics, Epworth Sleepiness Scale, patient global assessment health-related quality of life, Minnesota Living with Heart Failure Questionnaire (MLHFQ), and echocardiographic parameters are reported. HF hospitalization, cardiovascular death, and the composite of HF hospitalization or cardiovascular death within 6 months are reported by the original randomized group assignment for safety assessment. Sleep metrics and quality of life improved from baseline to 6 and 12 months. At 12 months, MLHFQ scores changed by -6.8 ± 20.0 (P = 0.005). The 6-month rate of HF hospitalization was 4.7% in treatment patients (standard error = 3.3) and 17.0% in control patients (standard error = 5.5) (P = 0.065). Reported adverse events were as expected for a transvenous implantable system. CONCLUSIONS: Phrenic nerve stimulation reduces CSA severity in patients with HF. In parallel, this CSA treatment was associated with benefits on HF quality of life.


Assuntos
Terapia por Estimulação Elétrica/métodos , Insuficiência Cardíaca/terapia , Nervo Frênico/fisiopatologia , Qualidade de Vida , Apneia do Sono Tipo Central/terapia , Idoso , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Polissonografia , Estudos Prospectivos , Apneia do Sono Tipo Central/etiologia , Apneia do Sono Tipo Central/fisiopatologia , Resultado do Tratamento
15.
Am J Physiol Lung Cell Mol Physiol ; 315(5): L891-L909, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30188747

RESUMO

The retrotrapezoid nucleus (RTN) contains chemosensitive cells that distribute CO2-dependent excitatory drive to the respiratory network. This drive facilitates the function of the respiratory central pattern generator (rCPG) and increases sympathetic activity. It is also evidenced that during hypercapnia, the late-expiratory (late-E) oscillator in the parafacial respiratory group (pFRG) is activated and determines the emergence of active expiration. However, it remains unclear the microcircuitry responsible for the distribution of the excitatory signals to the pFRG and the rCPG in conditions of high CO2. Herein, we hypothesized that excitatory inputs from chemosensitive neurons in the RTN are necessary for the activation of late-E neurons in the pFRG. Using the decerebrated in situ rat preparation, we found that lesions of neurokinin-1 receptor-expressing neurons in the RTN region with substance P-saporin conjugate suppressed the late-E activity in abdominal nerves (AbNs) and sympathetic nerves (SNs) and attenuated the increase in phrenic nerve (PN) activity induced by hypercapnia. On the other hand, kynurenic acid (100 mM) injections in the pFRG eliminated the late-E activity in AbN and thoracic SN but did not modify PN response during hypercapnia. Iontophoretic injections of retrograde tracer into the pFRG of adult rats revealed labeled phox2b-expressing neurons within the RTN. Our findings are supported by mathematical modeling of chemosensitive and late-E populations within the RTN and pFRG regions as two separate but interacting populations in a way that the activation of the pFRG late-E neurons during hypercapnia require glutamatergic inputs from the RTN neurons that intrinsically detect changes in CO2/pH.


Assuntos
Núcleo Celular/fisiologia , Expiração/fisiologia , Neurônios/fisiologia , Sistema Nervoso Simpático/fisiopatologia , Animais , Dióxido de Carbono/metabolismo , Núcleo Celular/metabolismo , Concentração de Íons de Hidrogênio , Hipercapnia/metabolismo , Hipercapnia/fisiopatologia , Masculino , Neurônios/metabolismo , Nervo Frênico/metabolismo , Nervo Frênico/fisiopatologia , Ratos , Ratos Wistar , Receptores da Neurocinina-1/metabolismo , Sistema Nervoso Simpático/metabolismo
16.
BMC Pulm Med ; 18(1): 126, 2018 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-30068327

RESUMO

BACKGROUND: Most patients with unilateral diaphragm paralysis (UDP) have unexplained dyspnea, exercise limitations, and reduction in inspiratory muscle capacity. We aimed to evaluate the generation of pressure in each hemidiaphragm separately and its contribution to overall inspiratory strength. METHODS: Twenty-seven patients, 9 in right paralysis group (RP) and 18 in left paralysis group (LP), with forced vital capacity (FVC) < 80% pred, and 20 healthy controls (CG), with forced expiratory volume in 1 s (FEV1) > 80% pred and FVC > 80% pred, were evaluated for lung function, maximal inspiratory (MIP) and expiratory (MEP) pressure measurements, diaphragm ultrasound, and transdiaphragmatic pressure during magnetic phrenic nerve stimulation (PdiTw). RESULTS: RP and LP had significant inspiratory muscle weakness compared to controls, detected by MIP (- 57.4 ± 16.9 for RP; - 67.1 ± 28.5 for LP and - 103.1 ± 30.4 cmH2O for CG) and also by PdiTW (5.7 ± 4 for RP; 4.8 ± 2.3 for LP and 15.3 ± 5.7 cmH2O for CG). The PdiTw was reduced even when the non-paralyzed hemidiaphragm was stimulated, mainly due to the low contribution of gastric pressure (around 30%), regardless of whether the paralysis was in the right or left hemidiaphragm. On the other hand, in CG, esophagic and gastric pressures had similar contribution to the overall Pdi (around 50%). Comparing both paralyzed and non-paralyzed hemidiaphragms, the mobility during quiet and deep breathing, and thickness at functional residual capacity (FRC) and total lung capacity (TLC), were significantly reduced in paralyzed hemidiaphragm. In addition, thickness fraction was extremely diminished when contrasted with the non-paralyzed hemidiaphragm. CONCLUSIONS: In symptomatic patients with UDP, global inspiratory strength is reduced not only due to weakness in the paralyzed hemidiaphragm but also to impairment in the pressure generated by the non-paralyzed hemidiaphragm.


Assuntos
Diafragma/diagnóstico por imagem , Diafragma/fisiopatologia , Pressão , Paralisia Respiratória/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Volume Expiratório Forçado , Capacidade Residual Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Frênico/fisiopatologia , Paralisia Respiratória/patologia , Ultrassonografia , Capacidade Vital
17.
J Neurosurg Spine ; 29(4): 470-480, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29979142

RESUMO

The authors studied restoration of respiratory function in rabbits, using the recurrent laryngeal nerve to restore function after the phrenic nerve had been severed. The results of this animal study are encouraging and suggest that a similar technique could possibly be used to help patients with severe cervical spinal cord injuries.


Assuntos
Nervo Frênico/cirurgia , Recuperação de Função Fisiológica/fisiologia , Traumatismos do Nervo Laríngeo Recorrente/cirurgia , Nervo Laríngeo Recorrente/cirurgia , Anastomose Cirúrgica/métodos , Animais , Diafragma/fisiopatologia , Eletromiografia/métodos , Nervo Frênico/fisiopatologia , Coelhos , Nervo Laríngeo Recorrente/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia
18.
Rev Esp Anestesiol Reanim ; 65(10): 593-596, 2018 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30033043

RESUMO

Phrenic nerve block is a complication that can occur after brachial plexus anaesthesia above the clavicle. The main consequence of this blockage is ipsolateral diaphragmatic paralysis, which can sometimes lead to the appearance of post-operative respiratory complications. A case is presented on a woman, who after having undergone a total shoulder prosthesis, presented with dyspnoea in the post-operative recovery unit. A diaphragmatic ultrasound was performed that enabled a rapid diagnosis to be made of a complete paralysis of the ipsolateral hemi-diaphragm. Given the suspicion of phrenic nerve block, ultrasound has proven to be a rapid diagnostic tool with high sensitivity and specificity. Its use can anticipate the possible development of immediate complications, and act as a guide in choosing the appropriate therapeutic strategy for each case in an early manner. In this case it enabled us to treat early with oxygen therapy, interscalene catheter removal, and intensive surveillance.


Assuntos
Artroplastia do Ombro , Diafragma/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/diagnóstico , Nervo Frênico/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Paralisia Respiratória/diagnóstico , Idoso , Anestésicos Locais/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Remoção de Dispositivo , Dispneia/etiologia , Dispneia/terapia , Diagnóstico Precoce , Feminino , Humanos , Levobupivacaína/efeitos adversos , Oxigenoterapia , Doenças do Sistema Nervoso Periférico/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/etiologia , Ultrassonografia
19.
Neurology ; 91(9): e843-e849, 2018 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-30054437

RESUMO

OBJECTIVE: To describe the clinical phenotype and recovery of diaphragm dysfunction caused by neuralgic amyotrophy in a large cohort of patients, to improve accurate awareness of this entity, and to encourage adoption of a standardized approach for diagnosis and treatment. METHODS: This observational cohort study recruited adult patients with neuralgic amyotrophy and symptoms of idiopathic phrenic neuropathy from the database of the Dutch expert center for neuralgic amyotrophy and the Dutch centers for home mechanical ventilation. Demographic and clinical information on diagnosis, symptoms, and recovery was obtained from chart review. We attempted to contact all patients for a follow-up interview. RESULTS: Phrenic neuropathy occurs in 7.6% of patients with neuralgic amyotrophy. Unilateral diaphragmatic dysfunction and bilateral diaphragmatic dysfunction are frequently symptomatic, causing exertional dyspnea, orthopnea, disturbed sleep, and excessive fatigue. Diagnostic practices varied widely and were often not optimally targeted. The majority of patients experienced at least moderate recovery within 2 years. CONCLUSION: We recommend screening every patient with neuralgic amyotrophy for diaphragm dysfunction by asking about orthopnea and by performing upright and supine vital capacity screening and diaphragm ultrasound in cases of suspected phrenic neuropathy to optimize diagnosis and care.


Assuntos
Neurite do Plexo Braquial/complicações , Neurite do Plexo Braquial/patologia , Diafragma/fisiopatologia , Nervo Frênico/fisiopatologia , Paralisia Respiratória/etiologia , Adolescente , Adulto , Idoso , Neurite do Plexo Braquial/epidemiologia , Neurite do Plexo Braquial/terapia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Recuperação de Função Fisiológica , Respiração Artificial/métodos , Adulto Jovem
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