[Adenosine triphosphate in the treatment of supraventricular paroxysmal tachycardia: a comparison with verapamil]. / Trifosfato de adenosina en el tratamiento de la taquicardia paroxística supraventricular: comparación con verapamilo.

AIMS: There are multiple drugs options in the treatment of Paroxysmal Supraventricular Tachycardia (PST) after inefficacious vagal stimulus. In this study we compare two of these treatments: verapamil versus adenosin triphosphate (ATP). METHODS: Fifty patients with PST were randomly treated with either Verapamil (5 to 10 mg) or ATP (5 to 20 mg). The basal features of each group, and the efficacy and safety of the two drugs were compared. Verapamil failures were treated with ATP and vice versa. RESULTS: The characteristics of both groups of treatment were similar. 86% of PST episodes were resolved with Verapamil use, versus 83% after ATP administration. Finally all patients were successfully treated with these drugs. No adverse effects were observed with Verapamil, whereas these effects were frequent with ATP use, but in any case requiring specific intervention. CONCLUSIONS: Both Verapamil and aTP are an equally safe and effective treatment of PST, but transient and minor side effects are frequent after ATP administration.

[Effects of muscle training on breathing pattern in patients with severe chronic obstructive pulmonary disease]. / Efectos del entrenamiento muscular sobre el patrón ventilatorio en pacientes con enfermedad pulmonar obstuctiva crónica grave.

OBJECTIVE: During physical exertion, the ventilatory response of patients with severe chronic obstructive pulmonary disease (COPD) is more rapid and shallow than that of healthy subjects. There is evidence that exercise training can alter breathing pattern in COPD patients. The purpose of the present study was to observe the effects of physical training on patients with severe COPD and to determine whether or not any possible changes were maintained over time. MATERIAL AND METHODS: Patients with severe COPD without bronchial reversibility were enrolled in a randomized controlled trial of a peripheral muscle training program carried out in a hospital setting. All enrolled patients were clinically stable, without exacerbation, and were randomly assigned to a training program of high (group A) or low (group B) intensity. RESULTS: Thirty-five men with severe COPD in stable condition (mean [SD] forced expiratory volume in 1 second at 41%[7%]) were enrolled in the study. The mean age was 64(5) years. Group A underwent training at 70(22) W and group B at 35(10) W, such that the estimated total work was 8050(2882) kJ in group A and 4044(1205) kJ in group B. Breathing pattern changes were detected in exercise tests only for group A patients, but the changes were not maintained 12 months after the end of the program. CONCLUSIONS: Intense training produces changes in the breathing pattern of patients with severe COPD. The changes are not specific to the task performed, not dependent on lactate production, and not maintained over the long term.

[Training of inspiratory muscles in chronic obstructive lung disease. Its impact on functional changes and exercise tolerance]. / Entrenamiento de los músculos inspiratorios en la enfermedad pulmonar obstructiva crónica. Su impacto sobre las alteraciones funcionales y sobre la tolerancia al ejercicio.

The aim of this study was to evaluate the impact of inspiratory muscle training on lung function and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). Thirty-five patients with stable COPD were enrolled. We measured lung function variables and peak inspiratory and expiratory pressures (PImax and PEmax). Tests of progressive maximal exercise tolerance and stable submaximal exercise tolerance were administered. Two study groups were formed. Group A patients (n = 20) were enrolled in a respiratory muscle training program lasting four months. Group B (n = 15) was the control group. At the end of the study period the patients underwent testing similar to the first battery of tests. All showed moderate to severe obstruction with no significant differences between groups (FEV1: group A 37.6 +/- 13%, group B 36.6 +/- 12%; FVC: group A 80.4 +/- 15%, group B 80 +/- 12%). Nor were there any significant differences between the two groups in initial results of either maximal respiratory pressures or exercise tolerance. No lung function changes were observed in either group. PImax in group A increased significantly at the end of the study (from 54 +/- 9 to 78 +/- 16 cmH2O; p < 0.001); there were no changes in group B. No changes were seen in VO2max or ventilatory response and/or gasometry during exercise in any of the groups. The trained group, on the other hand, experienced a significant decrease in dyspnea evaluated on the Borg scale exercise in maximal (5.7 +/- 1.1 versus 4.7 +/- 1.2, p < 0.005) and submaximal (5.9 +/- 0.9 versus 4.9 +/- 1.3, p < 0.005) and an increase in time of submaximal exercise tolerance (5.5 +/- 2 versus 7 +/- 3 min, p < 0.05), changes that were not observed in the control group. Based on these results, and although specific training of inspiratory muscles does not appear to improve lung function in patients with COPD, it is accompanied by a decreased sense of dyspnea during exercise and greater tolerance.

[Role of postoperative estimate of maximum oxygen uptake in predicting cardiorespiratory insufficiency in the immediate postoperative period in thoracic surgery]. / Valor de la estimación de la captación de oxígeno máxima postoperatoria en la predicción de insuficiencia cardiorrespiratoria en el postoperatorio inmediato de cirugía de tórax.

We sought to determine if predicted post-operative maximal oxygen uptake (VO2max/kg-PPO) was associated to the occurrence of respiratory or cardiac failure within the 60 days following lung surgery and to evaluate its validity as operability criterion. We studied 47 patients with chronic air-flow limitation (COPD) with FEV1 > 0.8 1 and without hypercapnia, that underwent lung surgery. Age was 56 (SD 11) years, FEV1 = 1.8 (SD 0.5) 1 (61% predicted (SD 13%) and FEV1/FVC = 55 (SD 7.5). Ten patients presented serious cardiac or respiratory complications (3 died). Significant correlation with complications was found for RV, TL-COsb-PPO, VO2max/kg, resection size and VO2max/kg-PPO. VO2max/kg-PPO correlation (-0.73) was significantly higher (p = 0.0016) than all the pulmonary function test (PFT) correlation and than VO2max/kg correlation (p = 0.049) as well. Cut-off points, positive and negative predictive values were respectively: 12.6 ml/min/kg, 0.75 y 0.90% for VO2max/kg-PPO; 17 ml/min/kg 0.83 and 0.87 for VO2max/kg and 148%, 0.67 and 0.82 for RV (the best of the pulmonary function tests). Multivariable models did not improve discriminant power. We conclude that, out of the studied variables, VO2max/kg-PPO showed higher correlation with the complications sought than PFT or VO2max/kg. As criterion to predict cardiac or respiratory failure, with the observed prevalence, its negative predictive values is good, but its positive predictive value is relatively low. None parameter was able to predict all the complications.

[Role of bronchoalveolar lavage and transbronchial biopsy in the diagnosis of pneumonia in patients with organ transplantation]. / Papel del lavado broncoalveolar y la biopsia transbronquial en el diagnóstico de neumonías en pacientes portadores de trasplante de órganos.

Pneumonia in patients with organ transplantation constitutes a very frequent cause of mortality, as a result precocious aetiologic diagnosis is indispensable. The bronchoscopic techniques, bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB), constitute fundamental procedures for these diagnoses. We begin this study with the aim of evaluating the profitability obtained with these procedures. 36 bronchoscopies were performed on 29 patients with organ transplantation, in all of them we realized BAL and in 20 TBB. We confirm the presence of pneumonia in 30 (in 15 of them we had performed TBB), the BAL was diagnostic in 20 cases (66.6%) and the TBB in 7 (46.6%). With both, BAL and TBB, we obtained a sensitivity of 80% and a specificity of 75%. We isolated 10 bacteria, 8 Citomegalovirus (CMV), 6 Pneumocystis carinii and 2 Aspergillus fumigatus. The BAL and the TBB contributed significantly in the aetiologic diagnosis of pneumonia in patients with organ transplantation, consequently we consider them basic tools in the management of these infections.

[Comparative study of 2 diagnostic tests of aspecific bronchial hyperreactivity]. / Estudio comparativo de dos pruebas de diagnóstico de la hiperreactividad bronquial inespecífica.

Bronchial challenge test are useful in diagnosis of bronchial hyperresponsiveness (BH). To assess the sensitivity of histamine test (HT) and exercise test (ET), 45 asthmatic patients (31 men, 14 women, ages 9-34) with normal resting pulmonary function test were studied. HT and ET were performed in two different days. HT was positive in 40 (6 severe, 23 moderate and 11 mild) and ET was positive in 13 (88.8% vr 28.8%, p < 0.001). All patients with positive ET had positive HT. There is a relationship between the degree of BH severity and the response to ET (chi 2 = 5.995; p < 0.05). The HT has a high profitability the diagnosis of BH. The ET has a low sensitivity.

Efectos del entrenamiento muscular sobre el patrón ventilatorio en pacientes con enfermedad pulmonar obstructiva crónica grave / Effects of muscle training on breathing pattern in patients with severe chronic obstructive pulmonary disease

OBJETIVO: Durante el esfuerzo físico la respuesta ventilatoria de los enfermos con enfermedad pulmonar obstructiva crónica (EPOC) grave es más rápida y superficial que la de los sujetos sanos, y existen indicios de que el entrenamiento físico podría cambiar el patrón ventilatorio de estos pacientes. El propósito del presente estudio fue comprobar los efectos que el entrenamiento físico de los pacientes con EPOC grave tiene sobre el patrón ventilatorio, así como determinar o no el mantenimiento de los posibles cambios producidos en el tiempo. MATERIAL Y MÉTODO: Se realizó un estudio aleatorio y controlado con pacientes con EPOC grave sin reversibilidad bronquial. En estos pacientes se efectuó una intervención mediante entrenamiento físico. Los pacientes fueron remitidos al hospital para entrenamiento muscular periférico, todos ellos en situación clínica estable, sin exacerbación, y fueron asignados a dos programas diferentes de entrenamiento físico. RESULTADOS: Se estudiaron 35 pacientes varones con EPOC grave, estables (volumen espiratorio forzado en el primer segundo del 41 ñ 7 por ciento), con una edad media de 64 ñ 5 años, divididos en dos grupos con diferente potencia media estimada de entrenamiento (grupo A: 70 ñ 22 W; grupo B: 35 ñ 10 W) y trabajo total desarrollado (grupo A: 8.050 ñ 2.882 kJ; grupo B: 4.044 ñ 1.205 kJ). Sólo se objetivaron cambios en el patrón ventilatorio durante el ejercicio realizado durante la prueba de esfuerzo en el grupo A, que no se mantuvieron a los 12 meses de finalizado el programa. CONCLUSIONES: El entrenamiento intenso produce cambios en el patrón ventilatorio de los pacientes con EPOC grave que son inespecíficos de la tarea e independientes de la producción de lactato, y que no se mantienen a largo plazo (AU)