RESUMEN
A comparison was made between metabolic parameters during exercise in patients with implanted dual sensor VVIR pacemakers. We analyzed two groups of patients with implanted dual sensor responsive pacemakers. The first group was composed of 14 patients (mean age 37.7 years) who had implanted Topaz pacemakers. The second group of 9 patients had a Legend Plus (mean age 44.7 years). A control group consisted of 54 healthy individuals (mean age 40.4 years). Testing was performed on treadmill, using a stepwise staircase loading CAEP protocol. Directly measured and mathematically calculated parameters used in assessment of metabolic impact of pacemaker function were: minute ventilation (MV), MV/body surface, MV/body mass unit, oxygen consumption, oxygen consumption/body surface, oxygen consumption/heart rate (oxygen pulse), oxygen consumption/body mass unit, carbon dioxide production, respiratory index. The majority of the observed parameters revealed no statistically significant difference between the control group and the patients with dual sensor or single sensor controlled rate response. However, oxygen pulse showed a statistically significant difference when comparing the group with single sensor controlled rate response with dual sensor controlled rate response and control group (p < 0.05). Other parameters indicating an advantage of dual sensor controlled rate were the time period of reaching anaerobic threshold (respiratory index) and exercise duration. They both displayed a statistically significant difference between dual sensor controlled rate response and single sensor rate response (p < 0.05) with no significant difference compared to control group (p > 0.05).
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Prueba de Esfuerzo , Frecuencia Cardíaca , Consumo de Oxígeno , Marcapaso Artificial , Respiración , Adulto , HumanosRESUMEN
UNLABELLED: Hepatopulmonary syndrome (HPS) is defined by liver disease, hypoxaemia, increase of alveolar-arterial gradient, when inhaling room air, and intrapulmonary vascular dilatation. Pathoanatomical substrate of intrapulmonary vascular dilatation consists of dilated precapillary network, direct arterio-venous communication and dilated pleural blood vessels, "pleural spiders" [2]. Recently, hepatopulmonary syndrome gained clinical significance. Deterioration of arterial oxygenation in patients with liver disease indicates a very poor prognosis, because of which there are suggestions to classify hepatopulmonary syndrome as a new indication of liver transplantation [4]. AIM OF THE STUDY: The aim of the study was to examine the clinical and pathogenetic significance of intrapulmonary shunts in the development of respiratory disorders, and determination of correlation between intrapulmonary shunts and clinical, biochemical parameters in patients with liver cirrhosis. METHOD: In a prospective study over the period 1996-1999, we observed 50 patients with liver cirrhosis who were examined and treated at the Department of Gastroenterology and Hepatology of the Clinical Centre of Serbia in Belgrade. Hepatic examinations were based on medical history, physical examination, laboratory tests, ultrasound, duplex Doppler ultrasound, and histopathological findings. Hepatic failure was classified into 3 stages according to Child's classification. In this study we used 2 groups of pulmonary functional tests: analysis of arterial blood gas exchange and ventilation tests (spirometry, flow-volume curve and body pletismography). Arterial blood gas analysis was performed in supine and sitting positions while inhaling room air and after 15 min of inhaling hyperoxic mixture. RESULTS: Patients were classified according to the generally accepted Child's classification into 3 stages: Sixteen patients (32%) were in Child's A stage, 20 patients (40%) in Child's B stage, and 14 (28%) in stage Child's C. HPS was diagnosed in 9 (18%) patients with liver cirrhosis. The majority of patients with HPS (6) were in Child's C stage, while the other 3 patients were in Child's B stage. Biochemical parameters were considerably worse in patients with shunts in comparison to those without shunts. However, t-test shoved no significant difference. Hypoxaemia caused by intrapulmonary arterio-venous shunt in supine position was found in 7 (14%) patients. Mean value of PaO2 was 8.72 kPa (SD = 1.02). Hypoxaemia caused by arterio-venous shunt in sitting position was found in 9 (18%) patients. The mean PaO2 value was 7.41 kPa, SD = 1.81. Orthodeoxia was confirmed in all patients with intrapulmonary shunt. Hypoxaemia without shunt in supine position was found in 18 (36%) patients, while 12 (24%) patients had hypoxaemia without shunt in sitting position. Comparing groups of patients with shunt and without shunt in supine position, we found a borderline statistically significant difference in PaO2 values (p = 0.057, t-test). In sitting position the difference in PaO2 values between these groups was statistically very significant (p = 0.001, t-test). DISCUSSION: It is supposed that approximately 50% of patients with indication for liver transplantation have some form of arterial oxygenation disorder and 13-47% of these patients may have HPS [6, 7]. In our study, HPS was diagnosed in 18% of patients. We explain this high incidence by the fact that our study included the patients with advanced liver cirrhosis (stages Child's B and C). In studies performed up to date, there was neither correlation between biochemical liver function parameters and intrapulmonary shunts, nor any strong relation between severity of hepatic failure and degree of hypoxaemia [12, 13]. We noticed no correlation between hepatic functions (synthetic, excretory, transaminases) and PaO2 and/or intrapulmonary shunts. Some authors suggested that ventilation-perfusion disorder (Va/Q) is an important cause of hypoxaemia in
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Síndrome Hepatopulmonar/etiología , Cirrosis Hepática/complicaciones , Femenino , Síndrome Hepatopulmonar/fisiopatología , Humanos , Masculino , Estudios Prospectivos , Circulación PulmonarRESUMEN
The study concerned 37 adults patients with miliary tuberculosis, who were treated at the Institute for Lung Diseases and Tuberculosis in Belgrade, over the period from 1987 to 1990. This number of patients is 1.37% of the total number of hospitalized patients with TB. The average age was 51 yrs (21-78). The sex distribution was equal. Associated diseases and predisposing conditions existed in 28 (76%) patients, most often haematologic diseases, systemic diseases of the connective tissue, and alcoholism. Classical X-ray finding of the lungs was present in 89% of the patients, and poor and atypical in 11%. The accompanying pleural exudation was observed in 13.5% of the patients, smaller cavernae in 5.4%, and enlarged mediastinal lymph nodes in one patient. The diagnosis of miliary TB was bacteriologically or pathohistologically confirmed in 31 (84%) patients, on autopsy in 2 cases and by antituberculotic test in 4 cases. Positive Loewenstein culture media were obtained in 62% of patients, from sputum in 64% of cases, in the liquor in 5.4%, and from the pleural fluid in 2.7% of patients. (BK was found by direct sputum microscopy in 6 pts - 16%). Positive pathohistological findings was obtained in 18 (49%) patients: by pleural biopsy in 2 cases, lung biopsy in 8 (bronchoscopy in 5 pts, aspiration needle biopsy in 2 pts), and by biopsy of extrathoracic tissues and organs in 8 pts. Early diagnosis was established in 62% patients.
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Tuberculosis Miliar/diagnóstico , Tuberculosis Pulmonar/diagnóstico , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Pulmonary alveolar microlithiasis is a rare disease of unknown cause and pathogenesis, where the pathological substrate is composed of calcium microconcrements inside the alveoli. The lungs are endured with deterioration of respiratory mechanics, ventilation and perfusion disorders and finally pulmonary hypertension and chronic cor pulmonale. The disease follows a slow course extending approximately over 20 years. The authors present two cases of pulmonary alveolar microlithiasis affecting two brothers aged 14 and 19 years respectively. Radiographic findings were typical and impressive. Lung changes were discovered on recruitment in the elder brother and on examination of family members in the younger brother. Both has no complaint and normal respiratory findings. The histopathological diagnosis was made from a sample obtained by bronchoscopic-parabronchial lung biopsy. This report is completed with data from the literature.