Latest News - Part 31
Inspiratory Muscle Training in Patients With Duchenne Muscular Dystrophy: Protocol
The catheters were perfused with distilled water at a constant flow of 25 ml/h. The proximal ends were coupled to pressure transducers (Could-Statham, P23ID, Cleveland). The catheter-pressure transducer system was described in detail previously. The Pdi was calculated by subtracting esophageal pressure (Pes) from the gastric pressure (Pga) by an electronic subtraction circuit. The Pes, Pga, and Pdi were displayed on-line on a four-channel paper recorder (Beckman 511 A, Fullerton, Calif). The Pes, Pga, and Pdi were arbitrarily assigned zero at the start of each sniff trial. Thus, only the change in pressure from the initial position was determined for each sniff. An interval of 30 to 40 s was allowed between e ach sniff and the best of a total of ten maneuvers was used for analysis. buy allegra
Inspiratory Muscle Endurance: The patients were instructed to breathe continuously in cycles at a certain level of inspiratory resistance for 1 min, followed by 20 s of rest. The test was terminated when the Pdi could not be sustained at the target level for three consecutive breaths or when a total of 20 resistive breathing cycles were completed by the patient. The cumulative time of these maneuvers (Те) served as a parameter for inspiratory muscle endurance. A single-lead ECG was monitored throughout the maneuvers. The blood gas values assessed immediately after the resistive breathing cycles showed no worsening in oxygen tension or increase in C02 tension in any patient.
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Inspiratory Muscle Training in Patients With Duchenne Muscular Dystrophy: Inspiratory Muscle Training at Home
At home, patients had to perform both resistive breathing maneuvers and maximal static inspiratory efforts against the almost occluded resistance. Training was done in the sitting position and a noseclip was used. The inspiratory resistive breathing training consisted of ten loaded breathing cycles of 1-min duration each, with 20-s intervals between them, twice daily. The level of the inspiratory resistance was adjusted in the hospital. During the 1-min resistive breathing cycle, if the minimal airflow value was not achieved more than two times, a warning signal on the training apparatus would be shown to the patient and the cycle had to be repeated. The same happened if the desired Ve was not achieved. Thus, each patient had to correctly complete ten resistive breathing cycles twice a day. The number of correctly and incorrectly performed exercises was stored in the apparatus. Fifteen minutes after the resistive breathing training, the patients had to perform ten maximal static inspiratory efforts and reach a certain minimal pressure value, which was determined in the hospital. A 20-s interval between the maneuvers was allowed. When the minimal pressure value was not achieved, this maneuver had to be repeated, until a total of ten maneuvers were performed correctly. The number of correctly and incorrectly performed efforts was stored in the apparatus. canada health and care mall
Inspiratory Muscle Training in Patients With Duchenne Muscular Dystrophy: Training Apparatus
For this study, a special training apparatus was constructed to enable the patient to actually adhere to the prescribed training intensity. In addition, the number of correctly and incorrectly performed exercises was stored by the apparatus to give the physician the possibility to control the training of the patient.
The training apparatus enabled the patient to do resistive breathing maneuvers against a variable inspiratory resistance or maximal static inspiratory efforts against the almost occluded resistance. Room air was breathed through a mouthpiece, a twoway non-rebreathing valve of low resistance, a 3-cm-long plastic tube, a pneumotachograph, and a variable alinear inspiratory resistance. Inspiratory flow was measured with the pneumotachograph connected to a differential pressure transducer (Honeywell 163 PC, Freeport, III). The training equipment was kept in a small collapsible case. In the bottom half of the case, the mouthpiece, the two-way valve, and the short plastic tube were kept. The pneumotachograph and the alinear resistor were fixed in this part of the case. In addition, there was a slot for a videogame cassette that could be opened if the training was successful. The possibility to play a videogame as a reward could motivate the patients not to interrupt the training prematurely. mycanadianpharmacy
Inspiratory Muscle Training in Patients With Duchenne Muscular Dystrophy: Methods
One of the main problems in the treatment of patients with neuromuscular diseases is the progressive impairment of inspiratory muscle function. Since chest wall and pulmonary compliance are reduced in neuromuscular diseases, the mechanical load on the weakened respiratory muscles is increased. Imbalance between load and capacity of the respiratory muscles may lead to fatigue and respiratory failure, which is the most important cause of death in these patients. Therefore, the treatment of diseased respiratory muscles to improve their strength and endurance presents a great challenge in the treatment of patients with neuromuscular diseases. Pharmacologic therapy was reported to possibly strengthen the respiratory muscles and make them less susceptible to fatigue. Also, periodic respiratory muscle rest and training were used to prevent the decline in respiratory muscle function. canadianfamilypharmacy
Previous studies have shown that strength and endurance of the respiratory muscles can be improved through specific training programs in normal subjects, patients with COPD, patients with cystic fibrosis, and quadriplegics. However, the role of inspiratory muscle training remains controversial in patients with neuromuscular diseases. On the one hand, it is alleged that inspiratory muscle training is potentially hazardous, since it may accelerate fatigue in the already very weak respiratory muscles by overwork and therefore cannot be recommended. On the other hand, improvement of inspiratory muscle function by specific training programs has been reported, but these studies were uncontrolled. The question of whether the use of inspiratory muscle training is sensible remains unanswered. And if the answer is yes, when should we intervene in the course of the patient’s disease?
The goal of our study is to answer the following questions: (1) Does respiratory muscle training in patients with Duchenne muscular dystrophy (DMD) improve inspiratory muscle function or does it do more harm? (2) Does the severity of the existing pulmonary function impairment affect the obtainable training effects?
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Mucosa-Associated Lymphoid Tissue Lymphoma of the Lung With Cold-reacting Autoantibody-mediated Hemolytic Anemia – Discussion
The concept of MALToma was first described bv Isaacson and Wright2 in a patient suffering from immunoproliferative intestinal disease and low-grade primary В cell lymphoma of the stomach in 1983. The distinct clinicopathologic entity was later extended to include low-grade В cell lymphoma arising from other mucosal organs including the bronchus, salivary gland, thyroid gland, thymus, orbital organs, bladder, and female genital tract. Pulmonary MALToma is very rare and often difficult to diagnose. It may have a mixed population of small lymphocytes and plasma cell infiltration at the submucosal area, even associated with germinal center formation. Usually it is misdiagnosed as a pseudolymphoma. However, demonstration of typical angulated centrocyte-like lymphoid cells and lymphoepithelial lesions would be characteristic for histologic diagnosis of a MALToma. The dominant component is a diffuse infiltrate of small-to-intermediate-sized В lymphoid cells with irregular nuclei and pale to clear cvtoplasma, which are called “centrocytelike cells” or “monocytoid В cells.” Lymphoid follicles are scattered throughout the infiltrate, which may be distorted or even overrun by the surrounding centrocyte-like cells. Immunohistochemical staining establishes the presence of \ or к light chain restriction within the infiltrate of mono-typic В cells.
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Mucosa-Associated Lymphoid Tissue Lymphoma of the Lung With Cold-reacting Autoantibody-mediated Hemolytic Anemia – Case Report
The primary mucosa-associated lymphoid tissue lymphoma (MALToma) of the lung is a rare low-grade В cell lymphoma arising from bronchus-associated lymphoid tissue which had been regarded as pseudolymphoma. It has characteristic histologic findings with monoclonal В cells of centrocytelike lymphoid cells and a lymphoepithelial lesion. This is a case report of MALToma of the lung and cold-reacting autoantibody-mediated hemolytic anemia. To our knowledge, there is no other report of such an association in the English-language medical literature. A morphologic and immunohistologic analysis of the case demonstrates the variety of distinctive histologic features ascribed to low-grade lymphoma of pulmonary MALT, which is consistent with the histologic details of MALToma arising from a variety of other glandular epithelial tissues.
A 39-year-old Chinese woman was admitted to National Taiwan University Hospital in May 1992 with a 2-year history of chronic productive cough accompanied by yellowish sputum. The chest radiograph showed diffuse alveolar consolidations in both lungs (Fig 1). The patient had received antituberculosis therapy for 1 year without improvement in 1991. She had been hospitalized elsewhere without a definite diagnosis, even by transbronchial lung biopsy, 1 year prior to admission. Dyspnea and intermittent fever gradually developed in addition to the productive cough.
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Comparison of Cardiac Pacing Modes in Patients With Chronic Obstructive Pulmonary Disease – Discussion
Dyspnea with exertion is a commonly recognized complaint in patients with lung disease. An increasing perception of shortness of breath with exercise is consistent with severe lung disease and frequently results in a fear of exertion that not only limits any activity requiring exertion, but daily living activities as well. The limitation of physical activities also leads to deconditioning, which then further compromises the patient’s ability to exercise. It has been shown that individual perceptions of dyspnea are very subjective and correlate better with work of breathing rather than level of hypoxemia. Due to the relative subjectivity of the complaint, “I feel short of breath with exercise” and the fact that most patients will modify their life-styles to accommodate increasing dyspnea with exertion, providing medical management that will keep these patients active and clinic ally stable is a challenge. Any adjunct that can help to optimize oxygen delivery is valuable in the treatment and rehabilitation of these patients. buy birth control
In this study, those patients with chronic lung disease who required cardiac pacing performed significantly better with a DDRR as compared with WIR. There was a significant improvement in exercise duration as well as a decrease in the ventilatory equivalents for oxygen at all levels of exercise. The improvement in exercise duration is important as it suggests an increased exercise tolerance. One must also be careful not to overlook the significance of the decreases seen in the ventilatory equivalent for oxygen at all levels of exercise. This decrease is consistent with a trend toward improvement in AT, suggesting a decrease in lactic acid production throughout exercise and an improvement in the efficiency of oxygen delivery with this mode. Perhaps even more important is that decreases in ventilator)’ effort or work of breathing will affect the patient’s perception of dyspnea. All of the patients with COPD we tested stated that they felt less short of breath during exercise with the DDDR pacing mode compared with the WIR mode, which is consistent with the decreases noted in ventilatory equivalents for oxygen at all levels of exercise.
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