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3.
BMJ Case Rep ; 11(1)2018 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-30567185

RESUMO

Patent foramen ovale (PFO) is a congenital abnormality present in 25%-30% of healthy adults and rarely leads to any sequelae. 1 2 It is associated with a left-to-right shunt which usually does not lead to any haemodynamic compromise. Occasionally, the shunt can get reversed; that is, right-to-left shunt occurs due to worsening pulmonary hypertension and can lead to persistent hypoxia. It is rare for the shunt reversal to happen in the absence of pulmonary hypertension. Here, we present an exceedingly rare case in a 61-year-old man presenting with hypoxia, was found to have shunt reversal due to unilateral diaphragmatic paralysis. He was successfully treated with PFO closure. The purpose of this report is to consider rare possibilities of PFO shunt reversal when the right-sided heart pressure is normal and to highlight that a simple chest X-ray can be a clue to the diagnosis.


Assuntos
Forame Oval Patente/diagnóstico , Paralisia Respiratória/diagnóstico , Adulto , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/cirurgia , Humanos , Hipertensão Pulmonar/etiologia , Hipóxia/etiologia , Masculino , Paralisia Respiratória/complicações , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/cirurgia
4.
Can J Cardiol ; 34(12): 1688.e21-1688.e23, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30527167

RESUMO

Diaphragmatic eventration in old age is a rare phenomenon. Typically, it is thought to originate as a result of failure of development of the muscles of the diaphragm. Less commonly, it can occur secondary to acquired conditions resulting from spinal cord or phrenic nerve injury and is only detected incidentally when the patient presents with dyspnea, chest infection, or cardiac compression symptoms. Herein, we report a case of right diaphragmatic paralysis in a 58-year-old man with a presentation of marked elevation of the right hemidiaphragm and ascites causing a picture compatible with cardiac tamponade.


Assuntos
Tamponamento Cardíaco/etiologia , Eventração Diafragmática/complicações , Paralisia Respiratória/complicações , Ascite/diagnóstico por imagem , Tamponamento Cardíaco/diagnóstico por imagem , Eventração Diafragmática/diagnóstico por imagem , Ecocardiografia Transesofagiana , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
5.
Tex Heart Inst J ; 45(4): 270-272, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30374244

RESUMO

Charcot-Marie-Tooth disease comprises a vast array of defects in myelin integrity that causes progressive peripheral sensorimotor neuropathy. It is the most prevalent inherited peripheral neuropathy, and it can affect the management of coexisting medical conditions. We report the case of a 25-year-old woman who had undergone successful Fontan surgery during childhood, but her Fontan circulation failed as a result of diaphragmatic paresis caused by Charcot-Marie-Tooth disease type 1A. This diagnosis precluded cardiac transplantation.


Assuntos
Doença de Charcot-Marie-Tooth/complicações , Técnica de Fontan/efeitos adversos , Doenças do Sistema Nervoso Periférico/complicações , Complicações Pós-Operatórias , Atresia Pulmonar/cirurgia , Insuficiência Respiratória/etiologia , Paralisia Respiratória/complicações , Adulto , Feminino , Humanos , Doenças do Sistema Nervoso Periférico/diagnóstico , Radiografia Torácica , Insuficiência Respiratória/diagnóstico , Paralisia Respiratória/diagnóstico
6.
Khirurgiia (Mosk) ; (3. Vyp. 2): 4-14, 2018.
Artigo em Russo | MEDLINE | ID: mdl-29652316

RESUMO

AIM: To develop examination algorithm and to determine the indications for various options for surgical treatment. MATERIAL AND METHODS: It is presented analysis of surgical treatment of 25 patients with unilateral diaphragm relaxation for the period from 1963 to 2016. There were 15 men and 10 women aged from 39 to 65 years. Diagnosis included predominantly radiological methods. All patients were operated openly through thoracotomy. Procedure consisted of creation of new diaphragmatic cupola at the usual level with two flaps of diaphragm and prosthesis between them. In 12 (48%) patients who were operated before 1990 xenopericardial patch was used. Further, synthetic materials (Teflon, polypropylene) were preferred. RESULTS: Postoperative morbidity and mortality was 20% (n=6) and 4% (n=1) respectively. Long-term results were followed-up within terms from 8 months to 12 years. Recurrent relaxation was absent. Most of patients had improved dyspnea, increased vital capacity and FEV1 in long-term period. Certain and general values of SF-36 life quality questionnaire were high in long-term postoperative period and similar to those in general population.


Assuntos
Diafragma/cirurgia , Paralisia Respiratória/cirurgia , Adulto , Idoso , Algoritmos , Dispneia/etiologia , Dispneia/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paralisia Respiratória/complicações , Retalhos Cirúrgicos , Toracotomia
8.
Heart Lung Circ ; 27(3): 371-376, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28473213

RESUMO

BACKGROUND: Topical cooling with ice slush as an adjunct for myocardial protection during cardiac surgery has been shown to cause freezing injury of the phrenic nerves. This can cause diaphragmatic dysfunction and respiratory complications. METHODS: Twenty (n=20) male patients between the ages of 40 and 60 years were equally randomised to undergo elective coronary artery bypass grafting (CABG) with either cold cardioplegic arrest with topical ice slush cooling or cold cardioplegic arrest without the use of ice slush. The sniff nasal inspiratory force (SNIF) was used to compare inspiratory muscle strength. RESULTS: There was no difference in the preoperative SNIF in the two randomised groups. In the immediate postoperative period, the ice slush group had worse SNIF (33.5±9.6cm H2O versus 47.8±12.2cm H2O; p=0.009). The pre-home discharge SNIF was still significantly lower for the ice slush group despite a noted improvement in SNIF recovery in both groups (38.3±10.6cm H2O versus 53.5±13.2cm H2O; p=0.011). Two patients in the ice slush group had left diaphragmatic dysfunction with none in the control group. CONCLUSION: The use of topical ice slush is associated with freezing injury of the phrenic nerves. This will adversely affect the inspiratory muscle force which may lead to respiratory complications after surgery.


Assuntos
Ponte de Artéria Coronária , Diafragma/inervação , Hipotermia Induzida/efeitos adversos , Capacidade Inspiratória/fisiologia , Nervo Frênico/lesões , Insuficiência Respiratória/etiologia , Paralisia Respiratória/complicações , Administração Tópica , Adulto , Doença da Artéria Coronariana/cirurgia , Humanos , Hipotermia Induzida/métodos , Gelo , Masculino , Pessoa de Meia-Idade , Nariz , Período Pós-Operatório , Insuficiência Respiratória/fisiopatologia , Paralisia Respiratória/fisiopatologia
9.
Med Intensiva ; 42(1): 50-59, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28619528

RESUMO

Cough is a fundamental defense mechanism for keeping the airway free of foreign elements. Life-threatening situations may arise when cough proves ineffective as a result of muscle weakness or altered mucociliary function. When a patient is unable to cough effectively, techniques are required to either reinforce or replace cough capacity. The use of mechanical systems that facilitate or substitute cough function is increasingly common in Intensive Care Units, where it is relatively frequent to find situations of ineffective cough due to different clinical causes. This review examines the current clinical practice recommendations referred to the indication and use of mechanical cough assist and intrapulmonary percussive ventilation systems.


Assuntos
Obstrução das Vias Respiratórias/prevenção & controle , Tosse , Depuração Mucociliar , Terapia Respiratória/métodos , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/terapia , Tosse/fisiopatologia , Humanos , Unidades de Terapia Intensiva , Depuração Mucociliar/fisiologia , Debilidade Muscular/complicações , Percussão , Respiração Artificial , Testes de Função Respiratória , Paralisia Respiratória/complicações , Terapia Respiratória/efeitos adversos , Terapia Respiratória/instrumentação , Traqueotomia
11.
Rev Port Pneumol (2006) ; 23(4): 208-215, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28499810

RESUMO

Pompe disease is a rare autosomal recessive neuromuscular disorder caused by acid α-glucosidase enzyme (GAA) deficiency and divided into two distinct variants, infantile- and late-onset. The late-onset variant is characterized by a spectrum of phenotypic variation that may range from asymptomatic, to reduced muscle strength and/or diaphragmatic paralysis. Since muscle strength loss is characteristic of several different conditions, which may also cause diaphragmatic paralysis, a protocol was created to search for the diagnosis of Pompe disease and exclude other possible causes. METHODS: We collected a sample size of 18 patients (10 females, 8 males) with a median age of 60 years and diagnosis of diaphragmatic paralysis of unknown etiology, followed in the Pulmonology outpatient consultation of 9 centers in Portugal, over a 24-month study period. We evaluated data from patient's clinical and demographic characteristics as well as complementary diagnostic tests including blood tests, imaging, neurophysiologic and respiratory function evaluation. All patients were evaluated for GAA activity with DBS (dried blood test) or serum quantification and positive results confirmed by serum quantification and sequencing. RESULTS: Three patients were diagnosed with Pompe's disease and recommended for enzyme replacement therapy. The prevalence of Pompe, a rare disease, in our diaphragmatic paralysis patient sample was 16.8%. CONCLUSION: We conclude that DBS test for GAA activity should be recommended for all patients with diaphragmatic paralysis which, despite looking at all the most common causes, remains of unknown etiology; this would improve both the timing and accuracy of diagnosis for Pompe disease in this patient population. Accurate diagnosis will lead to improved care for this rare, progressively debilitating but treatable neuromuscular disease.


Assuntos
Doença de Depósito de Glicogênio Tipo II/epidemiologia , Doença de Depósito de Glicogênio Tipo II/etiologia , Paralisia Respiratória/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Prevalência
12.
Curr Opin Pulm Med ; 23(2): 129-138, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28079615

RESUMO

PURPOSE OF REVIEW: Chronic obstructive lung disease affects the lung parenchyma and airways leading to well described effects in respiratory function. This review describes the current knowledge and advances regarding neuromuscular function and chest wall mechanics, which are affected in chronic obstructive pulmonary disease (COPD). RECENT FINDINGS: In COPD, progressive lung hyperinflation becomes constrained by a chest wall with decreasing capacity to expand, resulting in respiratory muscle inefficiency. There is evidence of neuromuscular uncoupling, that is, the respiratory muscle is unable to increase its output in proportion to increasing neural signals. COPD patients also have evidence of altered peripheral muscles function. The end effect of all these pathological changes is neuromuscular weakness. SUMMARY: Respiratory and peripheral muscles dysfunction is found in patients with COPD. This manifests clinically as dyspnea, poor exercise capacity, and decreased quality of life. We have clear evidence that rehabilitation helps several aspects of patients with COPD. Further understanding of the physiopathology is needed to improve our therapeutic and rehabilitation strategies.


Assuntos
Diafragma/fisiopatologia , Doenças Neuromusculares/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Parede Torácica/fisiopatologia , Fenômenos Biomecânicos , Dispneia/fisiopatologia , Humanos , Pulmão/fisiopatologia , Debilidade Muscular/fisiopatologia , Doenças Neuromusculares/complicações , Doenças Neuromusculares/reabilitação , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida , Respiração , Músculos Respiratórios/fisiopatologia , Paralisia Respiratória/complicações , Paralisia Respiratória/fisiopatologia , Paralisia Respiratória/reabilitação
13.
Lung ; 195(1): 29-35, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27803970

RESUMO

PURPOSE: The change in vital capacity from the seated to supine position (∆VC-supine) is used to screen for diaphragm dysfunction (DD), but some individuals are unable to tolerate the supine position. Since expiratory muscle function is often preserved in patients with isolated DD and inspiratory strength is reduced, the purpose of this study was to examine if the ratio of maximal expiratory pressure to maximal inspiratory pressure (MEP/MIP) may provide an alternative to ∆VC-supine when screening patients for DD. METHODS: We performed a cross-sectional analysis on 76 patients referred for evaluation of unexplained dyspnea and possible DD. MEP and MIP were measured in the seated position as well as the percent change in VC from the seated to supine position (∆VC-supine %). The presence of unilateral diaphragm paralysis (UDP), bilateral diaphragm paralysis (BDP), or normal diaphragm function (N) was confirmed by ultrasound. RESULTS: Of the 76 patients, 23 had N, 40 had UDP, and 13 had BDP. MEP/MIP was significantly greater for UDP compared to N (2.1(1.2-5.7) and 1.5(0.7-2.2), respectively) (median and interquartile range) and for BDP compared to UDP (4.3(2.3-7.5) and 2.1(1.2-5.7), respectively) (p < 0.001). The area (AUC) under the receiver-operating characteristic curve for MEP/MIP between N and UDP was 0.84 (95% confidence interval (CI) 0.74-0.94) and between UDP and BDP was 0.90 (95% CI 0.80-0.99). MEP/MIP had a strong monotonic relationship with ∆VC-supine % (Spearman's ρ = 0.68, p < 0.001). CONCLUSIONS: The MEP/MIP ratio provides a method with comparable sensitivity and specificity to ∆VC-supine % that can be used to screen patients with suspected isolated phrenic neuropathy and alleviates the need for measuring supine pulmonary function.


Assuntos
Diafragma/fisiopatologia , Pressões Respiratórias Máximas , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/fisiopatologia , Capacidade Vital , Idoso , Área Sob a Curva , Estudos Transversais , Diafragma/diagnóstico por imagem , Dispneia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Paralisia Respiratória/complicações , Decúbito Dorsal/fisiologia , Ultrassonografia
14.
Rev. cuba. anestesiol. reanim ; 15(3): 249-254, sept.-dic. 2016. ilus
Artigo em Espanhol | LILACS, CUMED | ID: biblio-830451

RESUMO

Introducción: la anestesia regional ha experimentado importantes cambios en los últimos años, debido, principalmente, al uso de la electroestimulación y la ecografía. La parálisis unilateral del diafragma es una complicación secundaria al bloqueo del plexo braquial por vía supraclavicular con una incidencia del 50 al 67 por ciento. La introducción de la ecolocalización no está exenta de esta. Dar a conocer todos los pormenores a su alrededor para que sirvan de guía a generaciones futuras es un deber de cada investigador. Objetivo: incrementar el conocimiento del manejo de pacientes con bloqueos periféricos bajo el uso de la ultrasonografía y la importancia de su seguimiento. Caso clínico: paciente de 60 años con 82 kg de peso, el que se planificó operación electiva para retirar tumor del antebrazo. Antecedentes de cardiopatía isquémica hipertensiva tratada con la colocación de dos stent. Se decidió realizar bloqueo del plexo braquial por vía supraclavicular y se obtuvo un correcto bloqueo, pero se produjo una parálisis del diafragma unilateral con repercusión para el bienestar del paciente. Conclusiones: a pesar de usar la ultrasonografía para los bloqueos periféricos, se debe seguir una vigilancia estricta de cada paciente durante todo el acto quirúrgico(AU)


Introduction: Regional anesthesia has experienced major changes in recent years, particularly due to the use of electrostimulation and ecogram. The unilateral paralysis of the diaphragm is a secondary complication after blocking the supraclavicular brachial plexus, with an incidence of 50 to 67 percent. The introduction of echolocation is not exempt from this. Every scholar should provide all the details related to it, so that they can serve as a guide to the coming generations. Objective: To increase knowledge on the management of patients with peripheral nerve blocks under the use of ultrasound and the importance of following them. Clinical case: 60-year-old patient with 82 kg of weight, which was planned elective surgery to remove tumor from the forearm. The patient had antecedents of hypertensive ischemic heart disease treated with the placement of two stents. It was decided to lock the supraclavicular brachial plexus, obtaining a correct locking, but there was a unilateral paralysis of the diaphragm with implications for the patient's welfare. Conclusions: despite using ultrasound for peripheral nerve blocks, you must follow a strict monitoring of each patient throughout the surgical act(AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Paralisia Respiratória/complicações , Bloqueio do Plexo Braquial/efeitos adversos , Ultrassonografia/métodos
15.
Rev. cuba. anestesiol. reanim ; 15(3): 249-254, sept.-dic. 2016. ilus
Artigo em Espanhol | CUMED | ID: cum-65512

RESUMO

Introducción: la anestesia regional ha experimentado importantes cambios en los últimos años, debido, principalmente, al uso de la electroestimulación y ecografía. La parálisis unilateral del diafragma es una complicación secundaria a la realización de bloqueo de plexo braquial por vía supraclavicular con una incidencia del 50 al 67 por ciento. La introducción de la ecolocalización no está exenta de esta. Dar a conocer todos los pormenores a su alrededor para que sirvan de guía a generaciones futuras es un deber de cada investigador. Objetivo: incrementar el conocimiento del manejo de pacientes con bloqueos periféricos bajo el uso de la ultrasonografía y la importancia de su seguimiento. Caso clínico: paciente de 60 años con 82 kg de peso, el que se planificó operación electiva para retirar tumor del antebrazo. Antecedentes de cardiopatía isquémica hipertensiva tratada con la colocación de dos stent. Se decidió realizar bloqueo del plexo braquial por vía supraclavicular, obteniéndose un correcto bloqueo, pero se produjo una parálisis del diafragma unilateral con repercusión para el bienestar del paciente. Conclusiones: a pesar de usar la ultrasonografía para los bloqueos periféricos, se debe seguir una vigilancia estricta de cada paciente durante todo el acto quirúrgico(AU)


Introduction: Regional anesthesia has experienced major changes in recent years, particularly due to the use of electrostimulation and ecogram. The unilateral paralysis of the diaphragm is a secondary complication after blocking the supraclavicular brachial plexus, with an incidence of 50 to 67 percent. The introduction of echolocation is not exempt from this. Every scholar should provide all the details related to it, so that they can serve as a guide to the coming generations. Objective: To increase knowledge on the management of patients with peripheral nerve blocks under the use of ultrasound and the importance of following them. Clinical case: 60-year-old patient with 82 kg of weight, which was planned elective surgery to remove tumor from the forearm. The patient had antecedents of hypertensive ischemic heart disease treated with the placement of two stents. It was decided to lock the supraclavicular brachial plexus, obtaining a correct locking, but there was a unilateral paralysis of the diaphragm with implications for the patient's welfare.Conclusions: despite using ultrasound for peripheral nerve blocks, you must follow a strict monitoring of each patient throughout the surgical act(AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Paralisia Respiratória/complicações , Traumatismos do Antebraço/cirurgia , Bloqueio do Plexo Braquial , Ultrassonografia/métodos
18.
BMJ Case Rep ; 20142014 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-24473427

RESUMO

A 65-year-old woman, treated for non-ST segment elevation myocardial infarction and unexplained type 2 respiratory failure, was referred to our hospital in view of difficulty in weaning off the ventilator. She was evaluated in detail for persistent hypercapnia. Ultrasound of the diaphragm showed minimal excursion of diaphragm while she was off the ventilator and fluoroscopy confirmed bilateral diaphragmatic palsy. As extensive radiological, immunological and microbiological workup ruled out other possible aetiologies, a diagnosis of idiopathic Bell's palsy of the diaphragm was made. She was treated with valacyclovir and steroids after which she gradually recovered and was weaned off the ventilator.


Assuntos
Aciclovir/análogos & derivados , Glucocorticoides/uso terapêutico , Insuficiência Respiratória/etiologia , Paralisia Respiratória/complicações , Valina/análogos & derivados , Aciclovir/uso terapêutico , Idoso , Antivirais/uso terapêutico , Quimioterapia Combinada , Feminino , Fluoroscopia , Humanos , Pró-Fármacos , Insuficiência Respiratória/diagnóstico , Paralisia Respiratória/diagnóstico , Valaciclovir , Valina/uso terapêutico , Desmame do Respirador
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