Role of spirometric and arterial gas data in predicting pulmonary complications after abdominal surgery.

The aim of this study was to evaluate the predictive value of preoperative spirometric and arterial gas data on severe pulmonary complications (PC) after elective abdominal surgery. We retrospectively studied 480 patients, 254 males and 226 females, mean (SD) age 63 (11) years, at risk for PC according to standardized criteria, who underwent laparotomy for resection of gallbladder for gallstones (44% of patients), resection of colon, rectum or stomach for malignant tumours (37%), and other abdominal surgery (19%). The overall incidence of postoperative PC was 18%. In a logistic regression analysis adjusted for smoking habit and clinical history of chronic bronchitis, FEV1<61% of predicted [odds ratio (OR)=16.86, 95% confidence interval (95%CI)=5.62-50.58] and PaO2<9.33 kPa (OR=6.42, 95%CI=2.48-16.61) were the main determinants of PC. Ischaemic heart disease (OR=3.44, 95%CI=1.08-10.93), operation for malignant tumours (OR=3.24, 95%CI=1.75-6.00) and age (OR=1.04, 95%CI=1.00-1.08) were also independent predictors of PC. Patients with moderate-to-severe airway obstruction combined with hypoxaemia had a significant higher risk of PC in comparison with patients with a normal respiratory pattern. Taking into account age, type of operation, and comorbidity, a preoperative respiratory functional assessment could be useful in identifying an increased risk of major PC in selected patients.

Maximal inspiratory pressure in elite soccer players.

The respiratory muscle strength of elite athletes has been assessed only for some competitive sports and different conclusions have been reported. The aim of this study was to evaluate the inspiratory muscle strength in a group of professional soccer players in comparison with a group of sedentary subjects. Maximal Inspiratory Pressure (PImax) was measured both at Functional Residual Capacity (FRC) and at Residual Volume (RV) in 130 subjects: 27 of these were elite soccer players (all males, aged 22 +/- 3 years) and 103 were normal sedentary subjects (77 males and 26 females, aged 44 +/- 19 years). Predictive linear models were produced by a stepwise regression analysis in the whole sample of subjects. Both PImaxFRC and PImaxRV models included female gender and ageing as negative predictors, and Body Mass Index (BMI) as positive predictor of the inspiratory pressures. The model predicting PImaxFRC was slightly more accurate than the model predicting PImaxRV (r-squared: 0.38 vs 0.36, respectively). After adjustment for the variables entered in these models, PImaxFRC and PImaxRV were respectively 1.54 KPa and 1.08 KPa higher in soccer players than in sedentary subjects but this result was statistically significant (p < 0.02) only for PImaxFRC. We conclude that the inspiratory muscle strength is increased in soccer players and PImax measured at FRC seems more sensitive in order to discriminate between subjects with different level of physical activity.

[High-dose brachytherapy in endobronchial neoplastic stenoses]. / La brachiterapia con alto rateo di dose nelle stenosi neoplastiche endobronchiali.

Form March, 1991, to September, 1995, twenty-nine patients with endobronchial neoplastic stenosis were treated with high dose rate (HDR) brachytherapy at the Casa Sollievo della Sofferenza Hospital in San Giovanni Rotondo (Foggia, Italy). Fifteen patients had hemoptysis, 10 dyspnea, 6 constant cough and 6 lung atelectasis. The total dose, specified at 1 cm from the source, ranged 5 to 21 Gy and the fraction doses 5 to 15 Gy. Fourteen of 29 patients (48%) died. The mean survival is 7 months, with the follow-up ranging 1 to 22 months. Subjective responses were achieved in 78.4% of cases, with 67.6% complete and 10.8% partial remission rates. Complete remission of hemoptysis was observed in 100% of patients. Dyspnea improved in 70%, cough in 46.4% and atelectasis in 83.2%. Endoscopic findings, 1 month after the end of brachytherapy, showed a response in 79.4% of patients. The complication rate was 13.8% (1 tracheoesophageal fistula, 2 pulmonary hemorrhages and 1 cavitary necrosis). Even though the number of treated patients is small, our experience confirms the efficacy of HDR endobronchial brachytherapy in the palliation of lung cancer-related symptoms. Literature data show that brachytherapy improves the quality of life in the patients with poor prognosis who are otherwise untreatable. The HDR technique is more accurate than the LDR technique and therapy is better tolerated also because execution time is shorter. Prospective clinical trials are needed to investigate the most effective total doses and fractionations and to better define the role of brachytherapy in the curative treatment of lung cancer.