A comparison of maximum cystometric bladder capacity with maximum environmental voided volumes

The aim of the study was, to determine whether maximum cystometric capacity accurately reflects the maximum functional bladder volume in women with urinary incontinence. We performed a retrospective chart review involving 85 women between the ages of 22 and 89 with primary complaints of urinary incontinence. The maximum cystometric capacity as determined by cystometry was compared with the maximum environmental voided volumes as recorded in a 24-hour voiding diary, using Pearson's correlation coefficients and pairedt-tests. Patients diagnosed as having a small bladder capacity (<300 ml maximum volume) based on cystometry were also examined with contingency table analysis to determine whether the bladder volumes in the voiding diaries supported the diagnosis of a small bladder. In 85 subjects the average maximum cystometric capacity was 14.7% less than the maximum volume recorded in the voiding diary. The correlation between the maximum cystometric capacity and maximum functional bladder volume wasr=0.473 (P<0.001). However, there was a statistically significant difference between the two volumes by pairedt-test analysis (P=0.006). Using cystometry to diagnose small bladder capacity showed a sensitivity of 62.9% and a specificity of 71.2% when using voiding diary volumes as the criterion standard. The positive predictive value was 51.4% and the negative predictive value was 84.0%. These results suggest that whereas the maximum bladder capacity measured by cystometry correlates with maximum environmental bladder capacity as determined by 24-hour voiding diaries, there is a statistically significant difference. The diagnosis of a small bladder should not be based on office cystometry alone.Editorial Comment: Although voiding diaries provide a wealth of information regarding daily intake and voiding habits, including episodes of incontinence, they can be difficult to obtain from all patients. The authors question whether a cystometrogram can provide adequate information regarding bladder capacity, and in particular identify low-capacity bladders which would require further evaluation. The answer in their population seems to be no. That this would be the case is not completely surprising, given the artificial environment of the urodynamic laboratory from many standpoints, as enumerated by the authors. The voiding diary should be used to establish functional bladder capacity and cystometry to evaluate bladder sensation, compliance and uncontrolled detrusor activity.     

Pattern of lung volumes in patients with sighing breathing.

BACKGROUND--Sighing breathing is observed in subjects suffering from anxiety with no apparent organic disease. METHODS--Lung volumes and expiratory flow rates were measured in 12 patients with a sighing pattern of breathing and in 10 normal subjects matched for age, gender, and anthropometric data. In both groups the measurements were made by spirographic and plethysmographic techniques. In normal subjects functional residual capacity (FRC) and residual volume (RV) were measured during normal breathing and again during simulated sighing breathing to exclude technical artifacts resulting from hyperventilation during measurement by the helium closed circuit method. RESULTS--Patients with a sighing pattern of breathing had a normal total lung capacity (TLC) but significantly different partitioning of lung compartments compared with normal subjects. The vital capacity (VC) was lower when measured by both spirographic and plethysmographic methods and RV was higher. The forced expiratory volume in one second (FEV1) was also lower in patients with sighing breathing. The FEV1/VC and the maximal expiratory flow rates at 50% and at 25% of the forced vital capacity (V50 and V25) were normal and similar in both groups. In normal subjects there were no differences in RV when measured during quiet or simulated sighing breathing. CONCLUSIONS--Subjects with sighing breathing have a normal TLC with a higher RV and lower VC than normal subjects. There was no obvious physiological or anatomical explanation for this pattern.     

Surgery for synchronous primary lung cancers and intrapulmonary metastases]

Between 1988 and 2000, 1,040 patients with primary lung cancer underwent pulmonary resection at Nagaoka Red Cross Hospital. Thirty-one (2.9%) patients had synchronous primary lung cancer (group A) and 78 patients (7.5%) had intrapulmonary metastases (group B). The 5-year and 10-year survival rate for group A was 64% and 56% respectively and for group B 37% and 32% respectively. The patients in group A showed a better survival rate in the different lobes (80% at 5 years) than in the same lobe (55%), while those in group B gave reverse results (31% and 42%). In group A, the patients had a better survival rate in the different histology (73% at 5 years) than in the same histology (45%). The 5-year survival was 65% for 20 patients with stage I disease, 75% for 4 patients with stage II disease, 43% for 75 patients with stage III and 25% for 10 patients with stage IV. These data suggest that synchronous primary lung cancer had a better prognosis than primary lung cancer with satellite nodules, but the histological discrimination between multiple lung cancers and intrapulmonary metastases was uncertain.     

Stair-climbing test to evaluate maximum aerobic capacity early after lung resection.

BACKGROUND: The aim of this study was to investigate the extent of reduction in maximum oxygen consumption in the early postoperative period after lung resection for lung carcinoma. METHODS: A total of 115 patients who underwent lung resection (95 lobectomies, 20 pneumonectomies) performed a maximal stair-climbing test the day before operation and the day of discharge from the hospital (8 +/- 3.3 days after the operation). RESULTS: The postoperative test showed a 15% reduction in maximum oxygen consumption (VO2max) with respect to the preoperative test (Student's t test, p < 0.0001). This reduction was greater after pneumonectomy (21.4%) than after lobectomy (14%) (Student's t test, p < 0.05). A multiple regression analysis showed that the only significant independent predictors of both preoperative and postoperative VO2max were the age of the patient and the level of arterial oxygen content. CONCLUSIONS: The early postoperative reduction in VO2max was greater after pneumonectomy than after lobectomy and the exercise performance was significantly influenced by the level of arterial oxygen content both before and early after the operation.     

Automated system for the measurement of airways resistance, lung volumes, and flow-volume loops.

Using a digital computer and body plethysmograph measurements of airways resistance, lung volumes, and flow-volume loops may be obtained from a single manoeuvre performed by the patient. All the measurements together with a display of the flow-volume loop are displayed within 10 seconds of the patient completing the manoeuvre. The system appears to offer considerable advantages in speed, objectivity, and reproducibility when compared with conventional methods.     

Differential ethnic standards for lung functions, or one standard for all?

The multiple regression equation predicting lung function values for a study population of South African Blacks is compared with equations predicting normal values for Blacks elsewhere, and in almost all cases is found to predict higher values. This is so despite the study population's high prevalence of respiratory disease and long history of exposure to crocidolite asbestos dust. This anomalous finding is explored in terms of some problems with studies generating normal values. In particular, the confounding effect of social class status on ethnic determinants of lung function is considered. Low 'normal' values for Blacks reported from South Africa and elsewhere are examined. The disadvantages to workers of being evaluated in relation to low norms are discussed in terms of preventive medicine and workmen's compensation. The application of a universal standard for all is proposed.