臂丛神经根性损伤膈神经移位术对青壮年患者早期呼吸功能的影响

目的研究臂丛神经损伤膈神经移位术对青壮年患者早期呼吸功能的影响.方法对16例接受膈神经移位治疗的患者,在术前、术后（10 d）进行肺功能指标的比较,同时定期进行门诊随访,观察呼吸系统自觉症状程度.结果13例术后出现了不同程度的供氧不足症状,16例全部出现一侧膈肌抬高,术后第10天肺活量（VC）、肺活量预计值百分数（VC%）分别比术前减少37.98%和26.88%,两者差异有统计学意义（tvc=11.532、tvc%=0,P＜0.01）.其它项目如残气量（RV）较术前轻度下降,肺总量（TLC）下降值达到术前肺总量的36.49%,残气量/肺总量比值（RV/TLC%）较术前上升了4.75%,上述各指标的差值均有统计学意义.1 s用力呼气量/用力肺活量比值（FEV1/FVC）和术前比基本无改变,但其差值有统计学意义.膈神经移位右侧（10例）与左侧（6例）术前、术后肺活量比较差异有统计学意义.术后随访8个月～2年,所有患者均无明显呼吸困难和胸闷等症状.结论膈神经移位术后对青壮年患者肺容量有较大的丧失,肺通气功能减弱和小气道阻力增加,但其丧失程度在机体自身代偿耐受范围内,不会导致急剧发生的严重呼吸功能障碍.建议对右侧臂丛神经根性损伤的患者,术前进行严格的肺、心功能检查,避免发生较为严重的并发症.     

Are reduced lung volumes in IDDM due to defect in connective tissue?

Lung volumes were measured by spirometry and helium-dilution technique in 28 young adult men with insulin-dependent diabetes mellitus (IDDM) of long duration and compared with 16 age- and height-matched adult men without diabetes. Reduced values for forced expiratory volume at 1 s, vital capacity, functional residual capacity, total lung capacity, residual volume, and single-breath carbon monoxide transfer factor were found for the IDDM patients compared to the control subjects. The results are consistent with reduced lung volumes in IDDM patients and did not correlate with the presence or absence of mild cheiroarthropathy but may relate to duration of diabetes.     

Lung function in coastal and highland New Guineans—comparison with Europeans

The lung volumes, ventilatory capacity, and transfer factor of young adult male and female New Guineans living at sea level, after standardization for age, height, and, in the case of transfer factor, the haemoglobin concentration, resemble those of people of Indian and West African descent. The inspiratory capacity and expiratory reserve volume are smaller than for comparable Europeans. The highland New Guineans have a larger total lung capacity and transfer factor than the coastal dwellers due mainly to a larger inspiratory capacity. Compared with representative Europeans, the highlanders have a similar total lung capacity but larger transfer factor. The exceptional lung function of the New Guinea highlanders is not closely related to altitude and is probably determined at least in part by their present mode of life entailing a high level of habitual activity. This factor needs to be taken into account when considering `normal values'.     

Lung volumes, ventilatory capacity, and transfer factor in healthy British boy and girl twins

Cotes, J. E., Dabbs, J. M., Hall, A. M., Axford, A. T., and Laurence, K. M. (1973). Thorax, 28, 709-715. Lung volumes, ventilatory capacity, and transfer factor in healthy British boy and girl twins. Normal values are reported for the lung volumes, ventilatory capacity, and transfer factor of 212 healthy British twin children aged 8 to 16 years. The boys and the girls share a common relationship to height for the residual volume, peak expiratory flow rate, and Kco (transfer factor per litre of lung volume). For the inspiratory capacity and the transfer factor, also its membrane component (Dm), the values for the boys exceed those for the girls by, on average, 10%. This difference may be due, at least in part, to the boys taking more exercise.     

Lung volumes in normal Cantonese subjects: preliminary studies.

Measurements of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, functional residual capacity (FRC), total lung capacity (TLC), residual volume (RV), and RV/TLC ratio have been made in 331 normal Cantonese subjects (134 male and 197 female). The results have been expressed in multiple regression equations relating the volumes to age, height, and weight and have been compared with those of other workers. Lung volumes obtained in this study are in general lower for Chinese subjects than those reported for Caucasians. Similar findings for FVC were reported by Chuan and Chia (1969) in Singapore and by Wu and Yang (1962) in Taiwan. Significant differences, however, are noted for FRC, TLC, RV, and RV/TLC between our findings and those of Chuan and Chia. Our series is unbalanced because of an uneven distribution of age groups. In fact in none of the reported studies on Chinese subjects, including that of da Costa (1971), is the series large or balanced. Clearly, further research is required in this ethnic group to get more reliable predictive formulae for lung volumes.     

Lung volume and its subdivisions in normal and asthmatic males

Measurements of lung volume and its subdivisions were made in 89 asthmatic children and adults and 58 normal subjects. The asthmatics were divided into three groups according to the classification of Jones (1966). In this the FEV₁ is used as an index of airways resistance which is divided into labile and fixed components. The compartment of lung volume showing the largest increase was the residual volume in subjects with a predominantly fixed increase of airways resistance (group 3) and this was true of both the children and adults. This compartment was also significantly enlarged in the labile subjects (groups 1 and 2). Significant increases in functional residual capacity were demonstrated in all three groups, especially in the children. Total lung capacity was significantly increased in the two labile groups of children but not in the adults. Even a low level of lability (group 1) may be associated with highly significant abnormalities in lung volume compartments which may be more evident in the child than in the adult.     

Relation between severity of mitral valve disease and results of routine lung function tests in non-smokers.

The effects of mitral valve disease on lung function have been studied in 26 non-smoking patients by relating values for lung volumes and carbon monoxide transfer factor (TLCO) to various indices of cardiac function measured at catheterisation. In general, more severe mitral disease was associated with greater abnormalities of lung function. Reductions of the one-second forced expiratory volume, vital capacity, TLCO and transfer coefficient, and increase in residual volume were all significantly related to the severity of mitral valve disease. In addition, the cardiothoracic ratio, measured radiographically, showed an inverse correlation with both vital capacity and total lung capacity. Although some of the consequences of mitral valve disease on lung function resemble those of primary airway disease, useful distinguishing points are the relative normality of the forced expiratory ratio and the absence of an increase in total lung capacity.     

Cigarette smoking and irreversible airways obstruction in the West Indies

Miller, G. J. (1974).Thorax, 495-504. Cigarette smoking and irreversible airways obstruction in the West Indies. Two communities, one in Jamaica and one in Guyana, have been surveyed in order to investigate the relationships between cigarette smoking, respiratory symptoms, and lung function in the West Indies. Cigarette consumption was less than that reported in the United Kingdom, particularly among women. Smoking was associated with cough, phlegm, increases in total lung capacity and residual volume, and reductions in FEV%, transfer coefficient (Kco), and alveolar capillary blood volume (Vc). Vital capacity (VC) and the diffusion capacity of the alveolar membrane (Dm) were normal. After allowing for differences in age and tobacco consumption, less cough, phlegm, and airways obstruction occurred in the West Indies than has been reported in the United Kingdom.     

Restrictive pattern of pulmonary functions in idiopathic and congenital scoliosis following spinal fusion

Summary This paper presents the results of pulmonary function analysis in 141 subjects. Thirty-five of these were patients with adolescent idiopathic scoliosis, 36 had congenital scoliosis, and the remaining 70 were age-, sex-, height-, weight- and arm-span-matched normal subjects used as controls for adolescent idiopathic scoliosis. The patients with adolescent idiopathic scoliosis had their pulmonary function evaluated pre- and post-operatively. At pre-operative evaluation the mean age was 13.7 years and the mean cobb angle 48°; at post-operative evaluation the figures were 17.1 years and 36° respectively. In the congenital scoliosis group the mean age was 14.5 years and the mean Cobb angle 42°, and pulmonary functions were evaluated at a minimum of 3 years after surgery. The results are as follows: Adolescent idiopathic scoliosis: (i) Marked disproportion was found in the pulmonary volumes following spinal surgery. After taking growth of the thoracic cage into account, the total lung capacity remained unchanged whilst the vital capacity was significantly reduced and there was a significant increase in residual volume. (ii) This disproportionate increase in residual volume was further confirmed by very highly significantly increased residual volume/vital capacity and residual volume/total lung capacity ratios at post-operative evaluation compared to pre-operative ratios (Mann-Whitney test, P=0.001). (iii) The residual volume was 48% of vital capacity pre-operatively compared to 35% in normal controls. The percentages increased to 70% post-operatively, whilst it was unchanged in the matched controls. Congenital scoliosis: (i) The mean residual volume was markedly increased (154% of predicted value). (ii) Vital capacity was significantly reduced in surgically treated patients (68% of predicted values). (iii) This pattern of reduced vital capacity was more marked in those patients who had multiple thoracic anomalies and were treated surgically (46% of predicted value). However, those patients with multiple thoracic anomalies who did not require surgery did not show such reduction of vital capacity. Comparison between idiopathic and congenital scoliosis: (i) In unoperated patients, the percentages of predicted values of total lung capacity, vital capacity and residual volume were significantly greater in congenital scoliosis than in adolescent idiopathic scoliosis. (ii) Post-operatively there was no significant difference in the percentages of predicted values of total lung capacity, vital capacity and residual volume between patients with congenital scoliosis and those with adolescent idiopathic scoliosis, despite the difference in pathogenesis. These findings have relevance to scoliotic patients treated with spinal fusion with regard to their capability to perform strenuous physical activities.     

Effects of mitral valve surgery on static lung function and exercise performance.

Lung function at rest was assessed in 50 patients before and six months after mitral valve surgery. There were small increases in spirometric volumes (FEV1 and vital capacity) with decreases in total lung capacity and residual volume, but no change in carbon monoxide transfer factor or transfer coefficient (KCO). Progressive exercise tests performed before and after operation in 19 of the patients confirmed an improved exercise capacity after surgery. The patients with the greatest symptomatic improvement in breathlessness were also those who achieved the greatest increase in maximum work load and the greatest decrease in ventilation for a given oxygen consumption. Depression of the ST segment of the electrocardiogram and frequent ventricular ectopic beats on exercise remained common after surgery and may have been due to digoxin treatment.     

Reference values and prediction equations for normal lung function in a non-smoking white urban population.

Prediction equations for normal lung function have been derived from tests on 179 healthy, non-smoking, white urban dwellers. The subjects, 96 women (height 1.46-1.77 m) and 83 men (height 1.61-1.96 m) aged 18-86 years, underwent measurements of spirometric flow and volume, multi-breath helium dilution lung volumes, and single breath carbon monoxide transfer factor and the single breath nitrogen washout test. Regression analysis using height, age, and weight as independent variables was used to provide predicted values for both sexes. Correlation coefficients were similar to those found in previous studies but normal ranges for spirometic measurements were narrower than in many previous studies, and spirometric flow and volume measurements were higher than those obtained in studies that included cigarette smokers, reflecting our more stringent criteria for selecting subjects and the newer standardised technical methods adopted. Multi-breath helium dilution values for total lung capacity were similar to those found in previous studies but the inspiratory vital capacity was larger and the residual volume reduced. Values for carbon monoxide transfer factor and the single breath nitrogen washout did not differ significantly from existing values. A complete set of lung function reference values and prediction equations for both sexes has been derived from a single population. The exclusion of cigarette smokers and subjects with respiratory symptoms has produced values that should have a greater sensitivity in the detection of mild lung disease.     

Effect of pleurotomy on pulmonary function after median sternotomy

To determine whether pleurotomy during median sternotomy worsens postoperative pulmonary function, patients whose pleurae remained intact (N = 7) were compared with those whose pleural spaces were entered during median sternotomy (N = 31). Thirty-eight adults performed spirometry and N2 washout to determine functional residual capacity preoperatively and 2, 24, 48, and 72 hours after extubation. Two mediastinal drainage tubes were placed in every patient; no pleural drainage tubes were inserted. Chest roentgenograms were performed preoperatively and 24 and 72 hours after extubation. Preoperatively, functional residual capacity, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC did not differ between groups. Postoperatively, in all patients developed a restrictive pulmonary defect, but mean functional residual capacity, FVC, FEV1 and FEV1/FVC did not differ between groups. In contrast to earlier reports, entering the pleural space did not worsen the restrictive pulmonary defect that results from median sternotomy when direct pleural drainage was avoided.     

Lung function in healthy British women.

The forces expiratory volume, total lung capacity, transfer factor (diffusing capacity), and their subdivisions have been measured in 113 healthy British women aged 27 to 74 years of whom 47 were current smokers and 66 were lifetime non-smokers. The results have been analysed in terms of age, stature, mass, body fat, and smoking. In addition to their relation to stature and to age, the inspiratory capacity was positively correlated with indices of body muscle while the residual volume, expiratory reserve volume, and total lung capacity were inversely correlated with the percentage of body mass that is fat or with mass divided by the square of stature. The inverse correlation between total lung capacity and age was apparently due to the quantity of body fat increasing with age. The transfer factor and its subdivisions were inversely correlated with smoking. In this study the forced expiratory volume and vital capacity were independent of both fat and smoking; the transfer factor was independent of the physiological response to exercise. The results provide reference values for lung function in British women.     

Pulmonary function after complete unilateral phrenic nerve transection

OBJECT: The status of pulmonary function following phrenic nerve transfer surgery is still largely unknown because of the high degree of variability in the accessory phrenic nerve that may be involved. In the present study, pulmonary functions were assessed in patients before and after full-length phrenic nerve transfer surgery, in whom the phrenic nerve was severed at a location just before its entry into the diaphragm. METHODS: Fifteen patients (average age 27.4 years) with complete brachial plexus palsy underwent full-length phrenic nerve transfer. The phrenic nerve was harvested from the thoracic cavity by means of video-assisted thoracic surgery and then transferred to the musculocutaneous nerve. Postoperative pulmonary functions were retrospectively analyzed. Patients underwent follow-up evaluation for 42 to 48 months; four patients were eventually lost to follow up. Although no patient experienced pulmonary problems following the surgery, all sustained varying degrees of diaphragmatic paralysis and elevation (for 1-1.5 intercostal spaces) on the surgically treated side as seen on chest x-ray films. Pulmonary functional parameters, including vital capacity, vital capacity in percentage of predicted values, residual volume, total lung capacity, forced vital capacity, and forced expiratory volume in 1 second, recovered to preoperative levels by 1 year postsurgery. In contrast, the postoperative maximal inspiratory pressure value was significantly decreased compared with the predicted values (average decrease approximately 20%) in all of the patients, even at 4 years after the surgery. CONCLUSIONS: In young patients with healthy lung function, unilateral phrenic nerve transection surgery can cause unilateral diaphragmatic paralysis and reduce the inspiration muscle force; however, most pulmonary function parameters gradually recover to preoperative levels within 1 year.     

Effects of long-term partial outflow obstruction on bladder function in the rat

The effects of chronic partial outflow obstruction in rats were investigated. The urethra of male rats was partially obstructed for 3 or 6 months and bladder function was compared with that of age-matched controls. Bladder function was studied in vivo by infusion cystometry and in vitro by measuring the response of bladder muscle strips to stimulation. Cystometrograms of outflow-obstructed bladders were categorized into three types: type 1 was equivalent to a normal bladder; type 2 was characterized by large capacity, enhanced voiding pressure, and some residual urine; type 3 had the largest capacity, an impaired voiding pressure, and considerable residual volume (overflow-type of incontinence). The type 3 bladder was the most frequently observed type in rats obstructed for 6 months. Bladder weight increased significantly in rats with outflow obstruction. When five in vivo cystometric parameters (pressure at which micturition was induced, capacity, maximum voiding pressure, voided urine volume, and residual urine volume) were analyzed according to duration of obstruction, only two parameters (capacity and residual urine volume) in rats obstructed for 6 months differed significantly from those in age-matched controls. Evaluation of these values according to cystometric type showed a significant deterioration in four of five parameters in type 3 bladders. Contractile responses of the bladder in vitro to field stimulation, bethanechol, ATP, and KCI were significantly impaired in those obstructed for 3 or 6 months. When in vitro responses were analyzed according to the classification of cystometric type, deterioration of contractility was confirmed in both types 2 and 3 bladders. The present animal model of outflow obstruction can serve as a model of benign prostatic hyperplasia in humans. © 1996 Wiley-Liss, Inc.     

Predictors of mortality among adolescents and young adults living with HIV on antiretroviral therapy in Dar es Salaam,Tanzania: a retrospective cohort study

IntroductionGlobal AIDS‐related deaths have declined by only 10% among adolescents since its peak in 2003. This is disproportionately low compared to a decline of 74% among children aged 0–9 years old. We determined the magnitude of, and predictors of mortality among adolescents and young adults living with HIV on antiretroviral therapy (ART) in Dar‐es‐Salaam, Tanzania.MethodsA retrospective cohort study was conducted among adolescents (aged 10–19) and young adults (aged 20–24) living with HIV and enrolled in care and treatment centres in Dar es Salaam, Tanzania between January 2015 and December 2019. Data were analysed using STATA version 16. Cumulative hazard curves were used to estimate and illustrate 1‐year mortality. Predictors for mortality were assessed by the Fine and Gray competing risk regression model. Sub‐hazard ratios (SHR) and 95% confidence intervals (95% CI) were then reported.ResultsA total of 15,874 young people living with HIV were included: 4916 (31.3%) were adolescents and 10,913 (68.7%) were young adults. A total of 3843 (77.5%) adolescents and 9517 (87.2%) young adults were female. Deaths occurred in 2.3% (114/4961) of adolescents and 1.2% (135/10,913) of young adults (p < 0.001). Over a follow‐up of 9292 person‐years, the mortality rate was 3.8 per 100 person years [95% CI 3.2–4.6/100 person‐years] among adolescents and 2.1 per 100 person‐years among young adults [95% CI 1.8–2.5/100 person‐years]. Independent predictors of mortality among adolescents were male sex (adjusted (SHR) aSHR = 1.90, 95% CI: 1.3–2.8), CD4 count < 200 cells/mm³ (aSHR = 2.7, 95% CI: 1.4–5.0) and attending a private health facility (aSHR = 1.7, 95% CI: 1.1–2.5). Predictors of mortality among young adults were CD4 count < 200 cells/mm³ (aSHR = 2.8, 95% CI 1.7–4.5), being underweight (aSHR = 2.1, 95% CI: 1.4–3.3) and using nevirapine‐based therapy (aHR = 8.3, 95% CI: 3.5–19.5).ConclusionsThe mortality rate for persons living with HIV and on ART in Tanzania was significantly higher in adolescents than young adults. Age‐ and sex‐specific risk factors identify targets for intervention to reduce mortality among affected adolescents and young adults.     

Spirometric changes after pleural decortication in young adults

BACKGROUND: The collection of pleural fluid and thickened pleura restrict the movement and expansion of lung. The main treatment strategy is lung decortication for the thickened pleura. The aim of this study was to investigate lung functions before and after pleural decortication in young adults. METHODS: A total of 63 patients with thickened pleura were retrospectively evaluated. Before the operation, patients with tuberculosis (n = 36) were treated with anti-tuberculosis therapy for 3-6 months. Patients with non-tuberculosis causes (n = 27) had been treated with broad-spectrum antibiotics. Forced expiratory volume in 1 s (FEV1, %), forced vital capacity (%) and vital capacity (litre) were measured before and after decortication. RESULTS: Spirometric parameters FEV1 (68.1 +/- 16.7 vs 71.01 +/- 14.4), forced vital capacity (67.6 +/- 16.4 vs 71.3 +/- 14.4) and vital capacity (2.6 +/- 0.6 vs 2.8 +/- 0.7) significantly improved after the operation (P +/- 0.01). Spirometric changes were not significantly different between tuberculosis and non-tuberculosis groups. CONCLUSION: Pleural decortication may improve the lung restoration in patients with thickened pleura and also improve lung functions significantly in young adults.     

进胸取膈神经移位术后肺功能的变化

目的　研究进胸取膈神经移位术后患者肺功能的变化。方法　对 5例进胸取膈神经移位患者术前及术后 (8～ 14个月 )肺功能的变化进行比较。结果　 5例在术后均未出现供氧不足症状。 3例出现膈肌抬高 ;术后肺活量 (VC)、肺活量预计值百分数 (VC % )分别比术前减少 17.3 %和 3 2 .3 % ,两者差异有显著性意义 (tvc=3 .49、tvc% =4.17,P <0 .0 5 )。其它项目如残气量 (RV)、肺总量 (TLC)、残气量 /肺总量比值 (RV/TLC)、用力肺活量 (FVC)、1s用力呼气量 (FEV1)、1s用力呼气量 /用力肺活量比值(FEV1/FVC)、5 0 %肺活量的最大呼气流量预计值百分数 (FEF 5 0 % )的变化 ,和术前相比均无明显差异。结论　进胸取膈神经移位术后成人的肺容量有部分丧失 ,但其丧失程度在机体可耐受范围内 ,不会导致呼吸功能障碍     

Variations in car crash-related hospitalization costs amongst young adults in New South Wales, Australia

BackgroundThis study aims to examine factors associated with variation in crash-related hospitalization costs for young adults in New South Wales (NSW), Australia with a particular focus on types of vehicle occupant, rurality of residence and socioeconomic status (SES).MethodsData on patients aged 17–25 years, admitted to public hospitals due to a crash during July 2000–June 2007 were extracted from the NSW Health Admission Collection database. The hospitalization cost of each admission was calculated based on published charges for specific Australian Refined-Diagnosis Related Groups (AR-DRG). Multivariable analyses using generalized estimating equations were used to estimate costs by vehicle occupant type (driver, passenger and other occupants), rurality of residence (urban, regional and rural areas) and SES (low, moderate and high SES areas).ResultsDuring 2000–2007, there were 11,892 crash-related hospitalizations involving young adults, aged 17–25 years, in NSW. These cost the health sector about A$87.6 million or on average, A$7363 per hospitalization (mean length of stay (LOS) 5.3 days). Compared to drivers, passengers had significantly longer LOS (<0.01) as well as higher hospitalization costs (p = 0.04). Regional and rural young adults had significantly longer LOS and higher hospitalization costs compared to urban young adults (p < 0.05). Compared with young adults from high SES areas, young adults from moderate SES areas had significantly higher costs (p = 0.02), whilst the higher costs for young adults of low SES areas was borderline significant (p = 0.06), although differences in LOS by SES were not significant.ConclusionAnnually, young adults’ crashes in NSW were estimated to cost the health sector at least A$14.6 million between 2001 and 2007. The higher hospitalization costs and LOS for young adults living in regional and rural vs. urban areas, and those living in moderate and low SES vs. high SES areas partly reflects the severity of these crashes and challenges for treatment. Based on these findings, a strong economic argument can be made for targeting prevention strategies to young people living in rural and low SES areas. The area variations in costs also suggest some scope for policy makers to consider potentially more efficient ways of targeting both treatment and preventative programmes.     

FOUR-HOUR VOIDING OBSERVATION IN YOUNG BOYS WITH POSTERIOR URETHRAL VALVES

Purpose

We evaluated 4-hour voiding observation as a method of basic assessment of bladder dysfunction in young boys with posterior urethral valves.

Materials and Methods

Voiding pattern, including number of voids, voided and residual urine volume, and bladder capacity, was determined noninvasively in 24 boys younger than 4 years with posterior urethral valves and compared to that of healthy age matched controls. Results were then compared to those of standard cystometry.

Results

The number of voids was higher, voided was smaller and residual urine volume was higher in the posterior urethral valve group. There was no difference in voiding pattern before and after removal of the anatomical obstruction. Voided and residual urine volume, and bladder capacity were higher on standard cystometry than on voiding observation.

Conclusions

Four-hour voiding observation is an easy noninvasive method that focuses on emptying difficulties and clearly detects differences in voiding patterns between boys with posterior urethral valves and healthy, nontoilet trained children. We recommend the method as a complement to standard cystometry for the diagnosis and followup of bladder dysfunction in young boys with posterior urethral valves to identify the need for treatment.