Nocturnal asthma and urinary adrenaline and noradrenaline excretion

Soutar, C. A., Carruthers, M., and Pickering, C. A. C. (1977).Thorax, 32, 677-683. Nocturnal asthma and urinary adrenaline and noradrenaline excretion. Urinary adrenaline and noradrenaline excretion, heart rate, and peak expiratory flow rate have been measured every two hours for 24 hours in seven asthmatic patients suffering from nocturnal or early morning exacerbations of dyspnoea. The excretions of these catecholamines were normal or slightly raised, this being consistent with a normal response to asthma or the conditions of the test.     

Nonhypersomnolent patients with obstructive sleep apnea

Until recently, snoring had been considered both a medical enigma and a psychosocial problem. Snoring is now considered to be an acoustic phenomenon produced by vibration of the soft palate and the tonsillar pillars. We describe 20 patients with a clinical complaint of excessive snoring who were referred to rule out obstructive sleep apnea. All patients were without symptoms of daytime sleepiness and failure of the right heart. Twenty subjects were studied, 18 of whom were males. All subjects were monitored for one full night in the Sleep Laboratory. The apnea rate ranged from 9.0 to 94.0 incidents an hour with a mean of 30.0. Eight of the 20 subjects had obstructive episodes longer than 1 minute and three others had episodes longer than 55 seconds. Hypersomnolence, long thought to be a cardinal symptom, is not present in all patients with an ostensibly significant degree of obstructive sleep apnea.     

Health status in patients with disturbed sleep and obstructive sleep apnea.

The health status of 435 consecutive patients with sleep disturbances necessitating polysomnography was investigated. Patients underwent overnight polysomnography and health status assessment, including the Medical Outcomes Study SF-36 Health Survey and the Pittsburgh Sleep Quality Index. Based on a respiratory distress index (RDI) greater than 10 to define apnea, patients with apnea were significantly (P < 0.05) more likely to be male, be older, and have higher body mass index and lower oxygen saturation levels than patients without apnea. Multiple domains of the SF-36 Health Survey and the Pittsburgh Sleep Quality Index were significantly worse (P < 0.05) for this population when normative data were compared. Although few differences were observed between the apneic and nonapneic patients when a cutoff point for apnea was defined as an RDI greater than 10 or 20, increasing RDI was significantly associated with worsening physical functioning scores. Overall, decrements in health status measures were more strongly correlated with the number of oxygen desaturations below 85% than with increasing RDI. We conclude that patients with sleep disturbances demonstrate significant decrements in general and sleep-specific health status, but these decrements are more closely associated with oxygen desaturation than RDI.     

Relationship of renal lesions with urinary protein excretion in patients with overt diabetic nephropathy]

We investigated the relationship of renal lesions with the degrees of proteinuria in 57 type 2 diabetic patients with overt proteinuria (urinary protein excretion rate (UP) > 0.5 g/day). Creatinine clearance (Ccr) ranged from 25.4 to 131.0 ml/min/1.73 m2. Kidney specimens were obtained and the diagnosis of diabetic nephropathy was made in all patients. The degree of each of the following histologic changes were evaluated: diffuse or nodular lesion, the type of nodular change, mesangiolysis, arteriolar hyalinosis and interstitial damage. We divided the patients into the following 4 groups according to Ccr and UP: group A with Ccr > 60 and UP > 3 g/day (n = 10), group B with Ccr > 60 and UP < 3 g/day (n = 10), group C with Ccr < 60 and UP > 3 g/day (n = 23) and group D with Ccr < 60 and UP < 3 g/day (n = 14), and compared the histologic parameters among the 4 groups. Diffuse index in group A was greater than those in group B (p = 0.05), while those in groups C and D were not different. Nodular index, percentage of patients with nodular lesion did not differ among the 4 groups, however the percentage of glomeruli with complicated nodules (nodular lesion with mesangiolysis and/or microaneurysm) in group C was greater than those in group D (p < 0.05). Hyalinosis index did not differ between group A and B, nor between group C and D, respectively. Interstitial index in group A and B did not differ, however that in group C was greater than in group D (p < 0.05). In addition, the rate of Ccr decrease between renal biopsy and after 12 months was significantly greater in group A and C than in group B and D, respectively (both p < 0.01). These results suggest that 1) mesangial expansion was associated with the degree of proteinuria in patients with slight impaired renal function, 2) tubulointerstitial involvement was associated with the degree of proteinuria in patients with advanced impaired renal function, and 3) these structural changes might be associated with decrease in renal function in diabetic nephropathy.     

Difficult endotracheal intubation in patients with sleep apnea syndrome

Although sleep apnea syndrome (SAS) is common, studies assessing the anesthetic management of these patients are rare and consist mainly of case studies. We performed a retrospective case-control study to determine the incidence of difficult intubation in SAS patients and to determine the relationship between the severity of SAS and the occurrence of difficult intubation. Among 113 patients included (36 and 77 in the SAS and control groups, respectively), difficult intubation occurred more often in SAS patients than in controls (21.9% versus 2.6%, respectively; P < 0.05). No relationship was found between the severity of SAS and the occurrence of difficult intubation. Disappointingly, no single factor was associated with the occurrence of difficult intubation in SAS patients. We conclude that SAS is a risk factor for difficult intubation. IMPLICATIONS: Because patients with sleep apnea syndrome have an increased risk of difficult endotracheal intubation and may present with cardiovascular disease, preoperative preventive measures should be undertaken to avoid untoward events.     

Effects of low-dose nifedipine on urinary protein excretion rate in patients with renal disease

Background: The observation that proteinuria is an important determinant of the progression of renal disease has prompted numerous studies on the effects of antihypertensive agents on protein excretion. Reports on the proteinuria effects of calcium-channel blockers are quite controversial. It has been suggested that the short-acting dihydropyridine calcium-channel blocker nifedipine increases protein excretion by interference with tubular protein reabsorption. Methods: In a randomized controlled trial 10 patients with renal disease and proteinuria were treated with a dose of 10 mg nifedipine o.d. (slow release formulation) for 1 week. The acute effects on renal and systemic haemodynamics and on urinary albumin, IgG, and {beta}2-microglobulin excretion were investigated during a clearance study in the supine position after the first dose. After 1 week of treatment urinary protein excretion rates were measured in 24-h urine samples collected in the ambulatory patient in consecutive fractions of 4-8 h during normal daily activities. Results: After the first dose nifedipine lowered mean arterial blood pressure in the supine position by 7±1 mmHg (<0.01), attenuated proximal tubular sodium reabsorption (fractional excretion of sodium 3.48±0.49 vs 2.62±0.35% during control, P<0.02), but did not affect proximal tubular protein reabsorption (fractional urinary excretion of {beta}2-microglobulin (0.97±0.30 vs 0.98±0.32% during control, NS). The decrease in blood pressure was not accompanied by decreases in urinary albumin or IgG excretion rates. The selectivity index as well as GFR, RPF, and FF did not change. Continued treatment for 1 week with nifedipine did not influence 24-h protein excretion. However, we observed a rise of proteinuria during daily activities in the first 4 h after drug intake compared to the start of the study with the patients in supine position. During nifedipine the increase in proteinuria was more marked and correlated with the selectivity index. Conclusions: (1) Nifedipine 10 mg orally did not impair tubular protein reabsorption. (2) Nifedipine had no immediate antiproteinuric effect despite the observed blood pressure reduction. (3) Nifedipine increased proteinuria in ambulatory urine collections. This latter observation might explain the seemingly different effects of dihydropyridine calcium-channel blockers as reported in previous studies.     

Acoustic rhinometry findings in patients with mild sleep apnea.

BACKGROUND: Nasal obstruction may contribute to the development of obstructive sleep apnea (OSA). Acoustic rhinometry (AR) measures nasal patency and congestion, which are useful parameters in objectively evaluating nasal obstruction. The nasal obstruction produced by allergic rhinitis may contribute to the development of OSA and can be easily assessed with AR. OBJECTIVE: This study was undertaken to assess the degree of nasal obstruction seen in allergic patients with and without OSA. STUDY DESIGN AND SETTING: This study was a retrospective data analysis from a tertiary referral center. The AR data from 10 patients with and 40 patients without mild OSA were compared. RESULTS: The mean congestion factors at the first cross-sectional area (CSA1) on the AR graph were found to be significantly higher in the OSA group than in the non-OSA group (P = 0.03). The classification of change in congestion factors demonstrated significant differences at CSA1, CSA2, and CSA3 and in volume (t distributions <0.001, 0.0312, <0.001, and <0.001, respectively). The non-OSA patients noted a significant subjective improvement in nasal congestion after topical nasal decongestion, whereas the OSA patients did not (P 相似文献   

Enhanced urinary adiponectin excretion in IgA-nephropathy patients with proteinuria

Adiponectin is secreted specifically by adipose tissue. It was reported that the serum adiponectin level was markedly increased in patients with end-stage renal disease and was positively associated with abnormal renal function in type 2 diabetes. Recently, we found that urinary adiponectin level was significantly increased in type 2 diabetic patients with overt diabetic nephropathy, but not in those without nephropathy. The aim of the present study was to evaluate whether the urinary adiponectin level is increased not only in diabetic patients with macroalbuminuria but also in IgA-nephropathy patients with macroalbuminuria. We measured urinary adiponectin levels in 24 healthy control subjects, 12 IgA-nephropathy patients, and 19 type 2 diabetic nephropathy patients, and they were, in medians, 2.24 microg/g creatinine (ranges of 0.85 to approximately 3.70), 59.2 microg/g creatinine (4.95 to approximately 186), and 33.1 microg/g creatinine (4.69 to approximately 114), respectively. In the two patient groups, urinary adiponectin levels were significantly higher than in control subjects (P<0.01). Moreover, positive correlations between urinary adiponectin levels and albumin-to-creatinine ratios were observed in IgA-nephropathy (R2=0.53, P<0.01) and diabetic nephropathy patients (R2=0.61, P<0.01), but not in control subjects. Serum adiponectin levels were unchanged in these three groups. These findings suggested that the increase of urinary adiponectin levels partly results from enhanced filtration of circulating adiponectin through the changes of glomerular permselectivity and intraglomerular hydruric pressure. However, clinical implication of urinary adiponectin excretion in healthy control remains to be elucidated.     

Obstructive sleep apnea patients voice analysis

It is generally considered that obstructive sleep apnea may associate larynx abnormalities--either anatomic or functional in nature; considering the vocal tract as a series of uniform loss cylindrical pipes the idea of non-invasively exploring this by means of spectral analysis emerged. The aim of our study is to evaluate potential changes in acoustic features of voice in sleep apnea patients as compared to matched controls in order to develop a potential screening test. Material and method: Sleep apnea subjects and controls were asked to produce sustained vowels such as "a" and "i" which were recorded and analyzed. Some parameters were estimated--average of fundamental frequency, peak amplitude variation and compared and others are still to be developed.     

Postoperative considerations for patients with obesity and sleep apnea

Sleep apnea and obesity are prevalent and often coexisting conditions that challenge medical, anesthetic, and surgical treatment. It is essential to possess knowledge of the magnitude of the sleep disorder as well as concomitant medical comorbidities. Management of obese patients requires a thorough preoperative evaluation and appraisal of anesthetic and operative risks. Postoperatively, these patients can present an additional challenge.     

Anesthetic management of patients with obesity and sleep apnea

An increasing number of obese patients in the operating room is inevitable due to the well-known associated chronic health problems such as cardiovascular disease, diabetes mellitus, arthritis and cancer. Further, bariatric surgery is also likely to be increasingly performed. This article discusses the intraoperative issues in the care of patients with obesity, including airway management, pharmacokinetics, perioperative positioning, regional anesthesia, the intensity of monitoring required, laparoscopy, and minimizing hypoxia during anesthesia.     

Simplified quantification of urinary protein excretion in children

The protein/creatinine ratio (Up/Uc) measured in 71 early morning urine samples (EMU) correlated closely with timed overnight urine (ONU) protein excretion rates (r = 0.96). The relationship was linear throughout the entire range of normal and abnormal protein excretion, an ONU rate of 1 mg/h/m2 body surface area being proportional to an EMU Up/Uc of 5 mg/mmol. Using the Coomassie Blue dye-binding method the upper limit of Up/Uc in 377 apparently healthy children and adolescents aged 3-19 years was shown to be 20 mg/mmol. Albumin/creatinine ratios (Ua/Uc) were also determined in the 377 healthy subjects, yielding a normal working upper limit of 3 mg/mmol. Although in normal individuals studied longitudinally the day-to-day variation of both Up/Uc and Ua/Uc was appreciable, all measurements remained within the cross-sectional normal range. While the determination of Ua/Uc has a role in the study of "microproteinuria", it is comparatively costly for routine use. The measurement of the EMU Up/Uc avoids errors and difficulties associated with timed urine collection, simplifies sample handling by the laboratory and is inexpensive. In clinical practice this is the method of choice for the quantification of proteinuria in patients with renal disease.