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1.
Microvasc Res ; 94: 90-5, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24990822

RESUMO

OBJECTIVES: Postocclusive reactive hyperemia is mediated by two major mediators: sensory nerves and endothelium-derived hyperpolarizing factors. We hypothesized that the skin microvascular response to 5 min ischemia would differ depending upon the hand location in patients with systemic sclerosis (SSc), primary Raynaud's phenomenon (PRP) and healthy controls. METHODS: Fifteen patients with SSc, 15 sex- and age-matched patients with PRP and healthy controls were enrolled. Their right hands were subjected to 5 min ischemia followed by a postocclusive hyperemia test, with local microcirculation monitoring by laser speckle contrast imaging on the dorsal face of the hand. RESULTS: Postocclusive reactive hyperemia was abnormal in terms of peak and area under the curve (AUC) on all fingers except the thumb in patients with SSc and PRP compared with controls. In contrast, the kinetics of the response was longer only in SSc patients, with mean (SD) time to peak on the index, middle and ring finger were respectively 72 (58), 73 (51) and 67 (47) s for SSc; 40 (20), 40 (20) and 36 (19) s for PRP; and 34 (30), 34 (30) and 29 (24) s for controls (P=0.009 for interaction). CONCLUSIONS: We observed decreased distal digital microvascular perfusion following 5 min of ischemia in patients presenting with PRP or SSc, while the kinetics was prolonged only in SSc. A dynamic assessment of digital skin blood flow using laser speckle contrast imaging following 5 min ischemia could be used as a tool to assess microvascular abnormalities in patients with Raynaud's phenomenon secondary to SSc.


Assuntos
Endotélio Vascular/patologia , Hiperemia/fisiopatologia , Doença de Raynaud/fisiopatologia , Escleroderma Sistêmico/patologia , Escleroderma Sistêmico/fisiopatologia , Idoso , Área Sob a Curva , Pressão Sanguínea , Estudos de Casos e Controles , Feminino , Dedos/irrigação sanguínea , Mãos/irrigação sanguínea , Humanos , Isquemia , Cinética , Fluxometria por Laser-Doppler , Microcirculação/fisiologia , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional/fisiologia , Projetos de Pesquisa , Pele/irrigação sanguínea , Fatores de Tempo
2.
Microvasc Res ; 82(3): 333-8, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22001188

RESUMO

OBJECTIVE: Laser speckle contrast imaging (LSCI) can be used to assess real-time responses of skin microcirculation to pharmacological interventions. The main objective of this study was to determine whether intradermal or subdermal microdialysis fiber insertion, coupled with skin flux recording using LSCI, can be used to assess baseline cutaneous flux and the post-occlusive reactive hyperemic response. The microdialysis sites were compared to control area without microdialysis fibers. METHODS: One dermal and two subdermal microdialysis fibers were randomly inserted in the right forearm skin of six healthy volunteers. We performed consecutively tests of post-occlusive hyperemia, infusion of 29 mM sodium nitroprusside (SNP), local thermal hyperemia at 43°C and a second 29 mM SNP infusion at the end of the experiment. RESULTS: Two hours after fiber insertion, cutaneous vascular conductances (CVC) at the subdermal fiber sites were not different from their respective control regions of interest, while at the dermal site CVC remained higher (0.48+/-0.15 versus 0.37+/-0.1 PU.mm Hg(-1), P=0.003). The peak CVC and area under the curve observed during post-occlusive reactive hyperemia were similar at all fiber sites and their respective controls. We observed a similar increase in CVC using 29 mM SNP infusion, 40 min local heating at 43°C, and their combination. Finally, physiological and pharmacological responses of the subdermal sites were reproducible in terms of amplitude, whether expressed as raw CVC or as % CVCmax. CONCLUSIONS: We showed that studying skin microvascular physiological or pharmacological responses using inserted subdermal microdialysis fibers coupled with LSCI is feasible and reproducible, and provides two-dimensional information. This technique will be useful for future mechanistic studies of skin microcirculation.


Assuntos
Hipertermia Induzida , Fluxometria por Laser-Doppler , Microcirculação/efeitos dos fármacos , Microdiálise , Microvasos/efeitos dos fármacos , Nitroprussiato/administração & dosagem , Pele/irrigação sanguínea , Vasodilatadores/administração & dosagem , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Estudos de Viabilidade , Feminino , França , Humanos , Hiperemia/fisiopatologia , Masculino , Microvasos/fisiopatologia , Projetos Piloto , Fluxo Sanguíneo Regional/efeitos dos fármacos , Fatores de Tempo , Adulto Jovem
3.
Transplant Proc ; 41(2): 687-91, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19328957

RESUMO

Lung transplantation (LT) is a recognized procedure for selected patients with end-stage respiratory failure. We performed 123 LT, including 32 single lung, 84 double lung, and 7 heart-lung transplantations in 48 patients with chronic obstructive pulmonary disease (COPD), 13 patients with pulmonary hypertension (PH), 33 with cystic fibrosis (CF), and 29 with interstitial lung disease (ILD) between July 1990 and January 2008. Survival was compared for periods before and after December 2001. The mean age of patients was 44.4 years (range 16-66.5 years); 84 (69%) were men. Before LT, 1 second forced expiratory volume was 28.7% +/- 18.1% and PaCO(2) = 6.3 kPa. Fifty-five patients were on noninvasive ventilation. Cold ischemia time was 320 +/- 91 minutes. Cardiopulmonary bypass (CPB) was used in 77 patients (64%). There were 18 early surgical reinterventions, 8 extracorporeal membrane oxygenations, and 38 bronchial stent insertions among 206 at-risk bronchial sutures. Crude survivals were 69%, 58%, 41%, and 18% at 1, 2, 5, and 10 years, respectively. Comparing before (n = 70 with 15 CF) vs after December 2001 (n = 53 with 17 CF), survivals were 63% vs 78%, 51% vs 71%, and 33% vs 60% at 1, 2, and 5 years, respectively (P = .01) and for CF patients, 52% vs 100%, 52% vs 94%, and 25% vs 94% at 1, 2, and 5 years, respectively (P = .005). There was significant improvement in survival before and after 2001 in 123 LT and particularly among CF patients. Improvement in survival after LT may be related to the sum of numerous changes in our practice since December 2001, including the use of pulmonary rehabilitation pre-LT, extracellular pneumoplegia, statins, macrolides for chronic rejection, monitoring of Epstein-Barr blood load, changes in maintenance immunosuppressants, as well as position movement up the coordinator nurse and learning curve.


Assuntos
Sobrevivência de Enxerto/fisiologia , Transplante de Pulmão/fisiologia , Fibrose Cística/cirurgia , Feminino , Transplante de Coração-Pulmão/mortalidade , Transplante de Coração-Pulmão/fisiologia , Humanos , Hipertensão Pulmonar/cirurgia , Pneumopatias/cirurgia , Transplante de Pulmão/mortalidade , Masculino , Doença Pulmonar Obstrutiva Crônica/cirurgia , Estudos Retrospectivos , Análise de Sobrevida , Sobreviventes
4.
J Mal Vasc ; 23(1): 3-6, 1998 Feb.
Artigo em Francês | MEDLINE | ID: mdl-9551347

RESUMO

Deep venous thrombosis (DVT) is a frequent and potentially serious complication in severely burned patients. We report the case of a burned patient (40% of total body surface burned), who had right femoral deep venous thrombosis and severe pulmonary embolism, although a prophylaxis was conducted with low molecular weight heparin, graduated compression stockings and rotating bed. This case shows that DVT early diagnosis and prophylaxis is difficult in severely burned patients. Systematic screening of DVT by duplex scan is possible only for femoral veins, which renders duplex scan more suitable for femoral catheter follow up than for systematic DVT screening. Computed tomography venography seems to be a valuable tool in the diagnosis of proximal thrombosis. Prophylaxis is best achieved with the use of preventive low molecular weight heparins, graduated compression stockings, and early mobilisation when possible. However, the place of low molecular weight heparins at high doses and external pneumatic calf compression needs to be evaluated by prospective studies.


Assuntos
Queimaduras/complicações , Embolia Pulmonar/etiologia , Tromboflebite/etiologia , Adulto , Humanos , Masculino , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/prevenção & controle , Fatores de Risco , Tromboflebite/diagnóstico , Tromboflebite/prevenção & controle
5.
J Mal Vasc ; 22(4): 268-70, 1997 Oct.
Artigo em Francês | MEDLINE | ID: mdl-9411013

RESUMO

Prompt diagnosis of a large pulmonary embolus is essential in order to initiate appropriate treatment early. We report a case of a large pulmonary embolus in which management was aided solely by noninvasive investigations. Transthoracic echocardiogram showed elevated right heart pressures which together with the patient symptoms suggested a major pulmonary embolus. Spiral computed tomography of the chest confirmed the diagnosis. The source of the embolus was shown by echodoppler. This case illustrates that a diagnosis of a major pulmonary embolus can be made using noninvasive techniques. Pulmonary angiography should be reserved for those rare cases in which diagnostic uncertainty remains rather than being used as a routine examination prior to consideration of therapeutic decision.


Assuntos
Embolia Pulmonar/terapia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Humanos , Masculino , Embolia Pulmonar/diagnóstico , Tomografia Computadorizada por Raios X
6.
Rev Mal Respir ; 21(6 Pt 1): 1137-43, 2004 Dec.
Artigo em Francês | MEDLINE | ID: mdl-15767959

RESUMO

CURRENT SITUATION: Pulmonary arterial hypertension (PAH) is a serious disease. Its prognostic is based on the functional status quantified by the NYHA class and the 6-min walking test, and the hemodynamic data. The algorithms of treatment are solely based on the hemodynamic data and the functional status. The main objective is to test whether basal concentrations of isoprostanes, Big endotheline 1, ADMA, high sensitivity CRP, NT-Pro-BNP and cardiac troponin T are a 3-year prognostic factor in PAH using a combined criterion: death from any cause and pulmonary or cardiopulmonary transplantation. MATERIALS AND METHODS: This is a multicenter, prospective, prognostic, single blinded study (plasma and urinary samples being blinded). The study started in november 2003, running for 2 years, with a 3 year follow-up for each patient. The main inclusion criterion is PAH. The data analysis will use a multivariable Cox model, taking into account the functional and hemodynamic parameters. EXPECTED RESULTS: This study will determine whether any of the biomarkers tested provides additional prognostic information in PAH in addition to the functional and hemodynamic parameters.


Assuntos
Hipertensão Pulmonar/sangue , Biomarcadores/sangue , Seguimentos , Humanos , Prognóstico , Estudos Prospectivos , Método Simples-Cego
7.
Rev Mal Respir ; 31(9): 822-30, 2014 Nov.
Artigo em Francês | MEDLINE | ID: mdl-25433587

RESUMO

INTRODUCTION: Peripherally inserted central catheters (PICC) are more and more used for intravenous antibiotic infusions in cystic fibrosis (CF) patients in the Grenoble area (France). The aim of this study was to assess the use of this technique in this indication. METHODS: 1. Retrospective evaluation of 102 consecutive PICC insertions over 3years and the incidence of adverse events during the therapy. 2. Prospective evaluation of 12 patient's satisfaction and their nurses over a 3-month period. 3. Comparative analysis of single domiciliary treatment costs using PICC versus peripheral catheter (PC). RESULTS: 102 PICC insertions were attempted in 31 patients. Seven failures and 7 complications occurred during the treatment requiring removal of the PICC, i.e. an overall success rate of 86.2% (88/102). Pain during PICC introduction was 4.2/10 (visual analogical scale). Mean satisfaction levels during therapy were 9.3/10 for patients and 8.7/10 for nurses. Compared with PC, all the patients said that PICC was "more comfortable". Differential costs of treatment with PC and with PICC at home were estimated at 57.15€ and 590.16€ respectively. CONCLUSION: PICC is an alternative to CP for intravenous antibiotherapy in CF patients, providing better safety and comfort. PICC use should be promoted in this indication.


Assuntos
Antibacterianos/administração & dosagem , Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Fibrose Cística/tratamento farmacológico , Adolescente , Adulto , Atitude do Pessoal de Saúde , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/enfermagem , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/enfermagem , Cateteres de Demora/efeitos adversos , Fibrose Cística/epidemiologia , Feminino , França/epidemiologia , Humanos , Incidência , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Adulto Jovem
8.
Clin Pharmacol Ther ; 95(4): 439-45, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24458011

RESUMO

Ischemic digital ulcer (DU) is a serious complication of systemic sclerosis (SSc). Intravenous prostanoids are the only approved treatment for active DUs, but they induce dose-limiting side effects and require hospitalization. Our objective was to evaluate the effect of iontophoresis (a noninvasive drug delivery method) of treprostinil in SSc patients. Three studies were conducted: a pharmacokinetic study in 12 healthy volunteers showed that peak dermal concentration was reached at 2 hours, whereas plasma treprostinil was undetected. Then, a placebo-controlled, double-blind incremental dose study assessed the effect of treprostinil on digital skin blood flow in 22 healthy subjects. The effect of the highest dose was then compared with that of placebo in 12 SSc patients. Treprostinil significantly increased skin blood flow in healthy subjects (P = 0.006) and in SSc patients (P = 0.023). In conclusion, digital iontophoresis of treprostinil is feasible, is well tolerated, and increases digital skin perfusion. It could be tested as a treatment for SSc-related DUs.


Assuntos
Anti-Hipertensivos/farmacocinética , Epoprostenol/análogos & derivados , Iontoforese , Escleroderma Sistêmico/tratamento farmacológico , Úlcera Cutânea/prevenção & controle , Administração Cutânea , Adolescente , Idoso , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/farmacologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Epoprostenol/administração & dosagem , Epoprostenol/farmacocinética , Epoprostenol/farmacologia , Estudos de Viabilidade , Feminino , Dedos/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional/efeitos dos fármacos , Escleroderma Sistêmico/complicações , Pele/irrigação sanguínea , Úlcera Cutânea/etiologia , Distribuição Tecidual , Adulto Jovem
9.
Clin Pharmacol Ther ; 91(5): 813-9, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22453196

RESUMO

Digital skin vasoconstriction on local cooling is exaggerated in primary Raynaud's phenomenon (RP) as compared with controls. A significant part of such vasoconstriction relies on the inhibition of the nitric oxide (NO) pathway. We tested the effect of the phosphodiesterase 5 (PDE5) inhibitor sildenafil, which potentiates the effect of NO, on skin blood flow. We recruited 15 patients with primary RP, performing local cooling without sildenafil (day 1), after a single oral dose of 50 mg (day 2), and after a dose of 100 mg (day 3). Skin blood flow, skin temperature, and arterial pressure were recorded, and data were expressed as cutaneous vascular conductance (CVC). Sildenafil at 100 mg, but not 50 mg, significantly lessened the cooling-induced decrease in CVC. It also increased resting CVC and skin temperature. These data suggest that 100 mg sildenafil improves digital skin perfusion during local cooling in primary RP. The benefit of sildenafil "as required" should be confirmed in a randomized, controlled trial.


Assuntos
Inibidores da Fosfodiesterase 5/farmacologia , Piperazinas/farmacologia , Doença de Raynaud/tratamento farmacológico , Pele/irrigação sanguínea , Sulfonas/farmacologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Fosfodiesterase 5/efeitos adversos , Piperazinas/efeitos adversos , Purinas/efeitos adversos , Purinas/farmacologia , Doença de Raynaud/fisiopatologia , Fluxo Sanguíneo Regional/efeitos dos fármacos , Citrato de Sildenafila , Temperatura Cutânea/efeitos dos fármacos , Sulfonas/efeitos adversos
10.
Rev Mal Respir ; 27(3): 219-25, 2010 Mar.
Artigo em Francês | MEDLINE | ID: mdl-20359613

RESUMO

BACKGROUND: Current guidelines for referring cystic fibrosis (CF) patients for lung transplantation, based on resting parameters, are insufficient to predict 3-year mortality. The aim of this study was to determine the prognostic value of cardiopulmonary exercise testing (CPET) in adult CF patients. METHODS: A multicenter retrospective study on 3-year outcomes was made on 51 adult CF patients who underwent CPET with blood gas analysis. Demographic data, resting pulmonary function and CPET parameters were collected to perform a univariate survival analysis by Kaplan-Meier curves and log-rank tests. To estimate prognosis, a multivariate logistic regression analysis was performed. RESULTS: The survival log-rank analysis indicated that lower FEV(1), lower body mass index (BMI), diabetes mellitus, lower work rate and higher alveolar-arterial gradient for oxygen (P[A-a]O(2)) at peak exercise were associated with a significantly higher risk of death. The logistic regression analysis showed that BMI (<19.8) and P(A-a)O(2) peak (>43 mmHg) were independently associated with a lower chance of survival. CONCLUSION: CPET with blood gas analysis may have a prognostic value in adult CF patients. Further larger prospective clinical studies are warranted to confirm these preliminary results.


Assuntos
Fibrose Cística/diagnóstico , Teste de Esforço , Adulto , Fibrose Cística/mortalidade , Feminino , Humanos , Masculino , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
11.
Rev Mal Respir ; 27(4): 301-13, 2010 04.
Artigo em Francês | MEDLINE | ID: mdl-20403541

RESUMO

In France patients with cystic fibrosis benefit from a multidisciplinary follow-up in Cystic Fibrosis Centres. In this follow-up, despite the numerous therapeutic benefits of exercise in this disease, little emphasis is placed on the promotion of physical activity. The aim of this article is to improve this aspect of management, giving advice from a working group of experts, based on the medical literature and clinical experience. These proposals include quantification of physical activity, evaluation of exercise, training and rehabilitation programs and finally, modification of behaviour to include physical activity in the overall cystic fibrosis treatment strategy. It is intended to set up multicentre studies to evaluate the impact of these proposals.


Assuntos
Fibrose Cística/reabilitação , Atividade Motora/fisiologia , Educação Física e Treinamento , Terapia Comportamental , Exercícios Respiratórios , Fibrose Cística/fisiopatologia , Fibrose Cística/terapia , Exercício Físico/fisiologia , Seguimentos , Humanos , Cooperação do Paciente , Educação Física e Treinamento/métodos , Testes de Função Respiratória , Terapia Respiratória , Esportes/fisiologia
12.
Pediatr Pulmonol ; 43(9): 908-15, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18680182

RESUMO

Patients with cystic fibrosis (CF) experience repeated infectious respiratory exacerbations leading to a continuous decline in lung function. The exacerbations are treated in hospital or at home. Our aim was to compare the clinical outcome for patients undergoing intravenous antibiotic treatment either in hospital or at home. A retrospective 10-year study was performed in four regional CF Centers. The outcome measures were percentage changes in forced expiratory volume in 1 sec (FEV(1)), forced vital capacity (FVC) and weight for age z-score (WZS). FEV(1), FVC, and WZS changes were calculated for the entire study period and for each course. A total of 1,164 courses were analyzed. For each course, the mean improvement in FEV(1) and FVC was significantly higher when performed in hospital than when performed at home (P < 0.05). FEV(1) and FVC values were 10.2%, 9.5% respectively in the hospital group and 7.3%, 6.8% in the home group. A total of 153 patients were analyzed (51 inpatients matched to 102 patients treated at home). The two groups had no significant differences in any outcome variable at baseline. The mean variation per year in FEV(1) was greater in the hospital group versus the home group (-0.4% vs. -1.8%; P = 0.03). The mean variation per year in WZS was greater in the hospital group versus the home group (P < 0.01). Clinical outcome, as defined by spirometric parameters and body weight, was better after a course of treatment in hospital than after a home treatment. This benefit was maintained throughout of the study period.


Assuntos
Antibacterianos/administração & dosagem , Fibrose Cística/complicações , Serviços de Assistência Domiciliar , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/etiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Injeções Intravenosas , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
Eur Respir J ; 12(5): 1130-6, 1998 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9864009

RESUMO

Lung function abnormalities in thalassaemia major are various and complex; however, patients still die from cardiac lesions. This study aimed to investigate pulmonary and cardiac involvement at an early stage in thalassaemic patients and study their respective implications at rest and during exercise. Ten patients (five adults and five children) with thalassaemia major were investigated by echocardiography, lung function and exercise testing a few days after transfusion. All have had regular transfusions and chelation with deferoxamine and none had chronic pulmonary disease symptoms. Minor lung function abnormalities were found: two patients had moderate obstructive syndrome and two had a decreased carbon monoxide transfer factor. Hypoxaemia was never found at rest and no desaturation was observed at the end of exercise. Echocardiographic abnormalities were also moderate. Peak oxygen consumption (V'O2) was decreased in three adults and was lower in adults than children (means 27.7+/-4.6 and 41.1+/-4.8 mL.kg(-1).min(-2) respectively). The V'O2/cardiac frequency slope was lower in adults than children (0.25+/-0.06 versus 0.42+/-0.10 mL.kg(-1).min(-2)), whereas end-exercise breathing reserve was >40% maximal voluntary ventilation for all patients. In conclusion, none of the patients had ventilatory limitations but older patients had cardiac limitations assessed by the relationship between oxygen consumption and cardiac frequency. Exercise testing may detect cardiac impairment in thalassaemia major earlier than investigations at rest.


Assuntos
Tolerância ao Exercício , Mecânica Respiratória , Talassemia beta/fisiopatologia , Adolescente , Adulto , Dióxido de Carbono/sangue , Débito Cardíaco , Criança , Ecocardiografia , Teste de Esforço , Capacidade Residual Funcional , Frequência Cardíaca , Humanos , Pneumopatias/complicações , Pneumopatias/diagnóstico , Medidas de Volume Pulmonar , Oxigênio/sangue , Consumo de Oxigênio , Troca Gasosa Pulmonar , Função Ventricular , Talassemia beta/sangue
14.
Am J Respir Crit Care Med ; 164(6): 944-8, 2001 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-11587975

RESUMO

Obstructive nonapneic respiratory events (ONAREs, i.e., obstructive hypopneas [OHs] and respiratory effort related arousals [RERAs]) are clinically important as producing sleep fragmentation but are much more difficult to detect and classify than obstructive apneas. We characterized 1,061 ONAREs in 15 unselected patients with moderate sleep apnea-hypopnea syndrome (OSAHS) according to the 1999 American Academy of Sleep Medicine (AASM) Task Force recommendations concerning accurate skills for respiratory measurements (i.e., pneumotachograph and esophageal pressure [Pes]) and definitions of respiratory events. OHs were defined as > or = 50% decrease in flow or < 50% but > or = 30% decrease in flow associated with either a desaturation of > or = 3% or a cortical arousal. RERAs corresponded to a less than 30% decrease in flow associated with an arousal. OHs represented a large majority of the events (79.9%, n = 848). Among the events demonstrating a 30 to 50% reduction in flow (n = 392), the occurrence of a cortical arousal permitted the classification of 246 events as OHs (62.8%). RERAs represented only 5.3% of the events. Finally 14.8% of the events were classified as indeterminate owing to a < 50% and > or = 30% airflow decrease without arousal or desaturation or an airflow decrease less than 30% without arousal. The same level of DeltaPes was observed at the end of OHs and RERAs (21.9 +/- 5.5 versus 18.9 +/- 5.7 cm H(2)O respectively [NS]) whereas the reduction in flow was as expected, higher for OH (57.9 +/- 10.7 versus 21.3 +/- 4.9%). In a population of moderate OSAHS, OH represented the dominant type of ONAREs when RERAs should be considered as specific but relatively rare respiratory events. The occurrence and the recognition of a microarousal represented the key associated factor for classifying respiratory events as hypopneas. The high rate (15%) of unclassified events demonstrated some limitations in the AASM Task Force recommendations for definitions of respiratory events. Similar levels of DeltaPes found at the end of RERAs and OHs, although the reduction in flow was higher for OHs, suggest that different levels of collapsibility can exist throughout the night in a given patient.


Assuntos
Síndromes da Apneia do Sono/diagnóstico , Interpretação Estatística de Dados , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Respiração , Transtornos Respiratórios/diagnóstico
15.
Am J Respir Crit Care Med ; 164(6): 1038-42, 2001 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-11587993

RESUMO

Isoprostanes are chemically stable lipid peroxidation products of arachidonic acid, the quantification of which provides a novel approach to the assessment of oxidative stress in vivo. The main objective of this study was to quantify the urinary levels of isoprostaglandin F(2alpha) type III (iPF(2alpha)-III), an F(2)-isoprostane, in patients with pulmonary hypertension (PHT) in comparison with healthy controls. The secondary objective was to test whether baseline iPF(2alpha)-III levels correlate to the reversibility of pulmonary hypertension in response to inhaled NO challenge. Urinary iPF(2alpha)-III levels were measured by gas chromatography-mass spectrometry in 25 patients with PHT, 14 of whom were investigated for response to inhaled NO challenge. Urinary iPF(2alpha)-III levels in PHT patients (225 +/- 27 pmol/mmol creatinine) were 2.3 times as high as in controls (97 +/- 7 pmol/mmol creatinine, p < 0.001). The mean pulmonary arterial pressure variation and the pulmonary vascular resistance variation in response to inhaled NO were correlated to basal iPF(2alpha)-III levels. This study shows that oxidative stress is increased in patients with pulmonary hypertension. Furthermore, iPF(2alpha)-III levels inversely correlate to pulmonary vasoreactivity. These observations are consistent with the hypothesis that free radical generation is involved in PHT pathogenesis.


Assuntos
Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/metabolismo , Peroxidação de Lipídeos , Estresse Oxidativo , Adolescente , Adulto , Idoso , Análise de Variância , Biomarcadores , Cromatografia Gasosa , Interpretação Estatística de Dados , Dinoprosta/urina , Feminino , Radicais Livres , Hemodinâmica , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Óxido Nítrico/administração & dosagem , Caminhada
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