HUMAN RESPIRATORY MUSCLES: SENSATIONS, REFLEXES AND FATIGUABILITY

1. Given the importance of the ventilatory ‘pump’ muscles, it would not be surprising if they were endowed with both sensory and motor specializations. The present review focuses on some unexpected properties of the respiratory muscle system in human subjects. 2. Although changes in blood gas tension were long held not to influence sensation directly, studies in subjects who are completely paralysed show that increases in arterial CO₂ levels elicit strong sensations of respiratory discomfort. 3. Stretch reflexes in human limb muscles contain a monosynaptic spinal excitation and a long-latency excitation. However, inspiratory muscles show an initial inhibition when tested with brief airway occlusions during inspiration. This inhibition does not depend critically on input from pulmonary or upper airway receptors. 4. Human inspiratory muscles (including the diaphragm) have been considered to fatigue during inspiratory resistive loading. However, recent studies using phrenic nerve stimulation to test the force produced by the diaphragm show that carbon dioxide retention (hypoventilation) and voluntary cessation of loading occur before the muscles become overtly fatigued.     

Percutaneous angioplasty in clinical management of renovascular hypertension: initial and long-term results

Between January 1980 and July 1983, percutaneous transluminal angioplasty was attempted on 137 stenotic renal arteries in 100 patients. At termination of follow-up studies (3-39 months, mean of 16 months), 70% of those treated for hypertension had benefited from the procedure. Stenosis secondary to fibromuscular dysplasia responded better than stenosis from arteriosclerosis (85% and 65% of the patients, respectively). Benefit was minimal for those with stenosis of the renal artery ostium or renal insufficiency. Determining levels of renal vein renin before angioplasty is helpful in selecting patients; following angioplasty, this has considerable significance in predicting the success of the procedure.     

Influence of the extracellular potassium environment on neurite growth in sensory neurons, spinal cord neurons and sympathetic neurons

The influence of the extracellular potassium concentration ([K+]o) on neurite growth in rat sensory neurons, spinal cord neurons and sympathetic neurons was investigated. Experiments carried out in 3-compartment culture dishes showed that although neurites from sensory and spinal cord neurons were capable of growing in both 5 mM [K+]o and 20 mM [K+]o, they were virtually unable to grow from a region of 5 mM [K+]o into a region of 20 mM [K+]o. Neurites from sympathetic neurons behaved similarly although [K+]o exceeding 20 mM was required to exclude sympathetic neurites. We suggest the possibility of a negative chemotaxis to [K+]o by growth cones in these neurons. Neurite regeneration following axotomy in sensory neurons was partially inhibited distal to a proximo-distal increase in [K+]o. The nature of this inhibition was somewhat different from that described previously in sympathetic neurons. The possibility is raised that [K+]o plays a role in the development of the nervous system.     

Larynx and hypopharynx: MR imaging with surface coils

Forty patients with disorders of the larynx or hypopharynx were studied with magnetic resonance (MR) imaging. Axial, coronal, and sagittal sections, 4 mm thick, were obtained. Twenty-eight of the patients underwent computed tomography (CT) scanning; 17 underwent surgery, and specimens were obtained for organ sectioning. Correlation was made between these three studies as well as with clinical history, physical examination, and endoscopic photography. In 13 patients who underwent all three studies, the depiction of cartilage invasion, adenopathy, and intraorgan and extraorgan spread of disease was compared. MR consistently showed superior soft-tissue definition and extent of disease compared with CT. Neither CT nor MR was able to depict histologic detail or microscopic spread of disease. Both studies were also less effective in the postoperative or postirradiated neck. The use of direct coronal and sagittal imaging planes on MR allowed the visualization of intrinsic laryngeal musculature, which was important in the recognition of subtle tumor extension. For these reasons, surface coil MR imaging is currently the imaging study of choice at our institution for disorders of the larynx and hypopharynx.