Síndrome de infusión de propofol y COVID-19. Reporte de caso / Propofol and COVID-19 infusion syndrome. Case report

Resumen: La forma grave de neumonía por SARS-CoV-2 (COVID-19) cursa en la mayoría de los casos con un síndrome de dificultad respiratoria aguda (SDRA). Es necesario emplear sedación durante su ventilación mecánica, el propofol es el que más de utiliza por su farmacocinética y farmacodinamia. El propofol es un anestésico que se usa ampliamente en las unidades de cuidados intensivos. Su empleo puede provocar un efecto adverso poco frecuente, pero en extremo grave, conocido como síndrome por infusión de propofol (SIP), el cual se encuentra estrechamente asociado a la velocidad de infusión aunado a factores de riesgos propios del paciente. Se caracteriza principalmente por inestabilidad hemodinámica, acidosis láctica y por progresión a disfunción multiorgánica. Se presenta un caso de SIP en paciente con síndrome de dificultad respiratoria aguda (SDRA) secundario a SARS-CoV-2 que desarrolla esta complicación asociada a la sedación. Se discute fisiopatológica clínica y consideraciones que deberán tomarse en cuenta al momento de su utilización en infusión continua.

Abstract: The severe form of SARS-CoV-2 pneumonia (COVID-19) occurs in most cases with acute respiratory distress syndrome (ARDS), requiring the use of sedation during mechanical ventilation, with propofol being the most widely used for its pharmacokinetics and pharmacodynamics. Propofol is a widely used anesthetic in intensive care units (ICU). Its use can cause an infrequent but extremely serious adverse effect, known as propofol infusion syndrome (PRIS), which is closely associated with the speed of infusion coupled with risk factors specific to the patient, the clinical features of PRIS are hemodynamic instability, lactic acidosis and with progression to multi-organ dysfunction. We present a case of SIP in a patient with acute respiratory distress syndrome (ARDS) secondary to SARS-CoV-2 who develops this complication associated with sedation, discusses clinical pathophysiology and considerations that should be taken into account when using it in continuous infusion.

Differences of CT pulmonary function indexes in asbestosis patients engaged in different types of work / 国际生物医学工程杂志

Objective To evaluate the changes and characteristics of pulmonary function in asbestosis patients engaged in different types of work by multi-slice spiral CT imaging.Methods Total 30 asbestosis patients were equally divided into three groups,who engaged in the work of raw asbestos processing,fiber combing and pressure molding,respectively.The pulmonary volume,pulmonary density and pulmonary small airway indexes were measured by a whole lung scanning at maximum inspiratory and maximum expiratory efforts.The pulmonary volume indexes include maximum inspiratory volume,maximum expiratory volume,pulmonary volume difference and pulmonary volume ratio.The mean pulmonary density indexes include the mean pulmonary densities after inspiratory and expiratory activities,pulmonary density difference and pulmonary density ratio.The small airway indexes include the diameter ratios of the wall after inspiratory and expiratory activities and the percentage of bronchial wall area after inspiratory activity.Results The differences of the gender,age,stage,and contact history of the patients are not statistically significant for all the groups (all P＞0.05).The differences of the mean pulmonary densities after expiratory activity,the left and right pulmonary densities after expiratory activities,pulmonary density ratio,diameter ratios of the wall after inspiratory and expiratory activities,and the percentage of bronchial wall area after inspiratory activity are statistically significant among the three groups (all P＜0.05).Further pairwise comparison showed that the differences of between the combing group and the raw material processing group in the above indexes are statistically significant (all P＜0.05),while not statistically significant between the molding group and the raw material processing group (all P＞0.05).The differences among the three groups in other indexes are not statistically significant (all P＞0.05).Conclusions The emphysema with fibrous thickening in the alveolar septum and small airway wall is more severe in the workers who engaged in asbestos fiber combing comparing with in raw asbestos processing and asbestos pressure molding.Therefore,the medical protection of these groups of patients should be strengthened.

Differences of CT pulmonary function indexes in asbestosis patients engaged in different types of work / 国际生物医学工程杂志

Objective To evaluate the changes and characteristics of pulmonary function in asbestosis patients engaged in different types of work by multi-slice spiral CT imaging.Methods Total 30 asbestosis patients were equally divided into three groups,who engaged in the work of raw asbestos processing,fiber combing and pressure molding,respectively.The pulmonary volume,pulmonary density and pulmonary small airway indexes were measured by a whole lung scanning at maximum inspiratory and maximum expiratory efforts.The pulmonary volume indexes include maximum inspiratory volume,maximum expiratory volume,pulmonary volume difference and pulmonary volume ratio.The mean pulmonary density indexes include the mean pulmonary densities after inspiratory and expiratory activities,pulmonary density difference and pulmonary density ratio.The small airway indexes include the diameter ratios of the wall after inspiratory and expiratory activities and the percentage of bronchial wall area after inspiratory activity.Results The differences of the gender,age,stage,and contact history of the patients are not statistically significant for all the groups (all P＞0.05).The differences of the mean pulmonary densities after expiratory activity,the left and right pulmonary densities after expiratory activities,pulmonary density ratio,diameter ratios of the wall after inspiratory and expiratory activities,and the percentage of bronchial wall area after inspiratory activity are statistically significant among the three groups (all P＜0.05).Further pairwise comparison showed that the differences of between the combing group and the raw material processing group in the above indexes are statistically significant (all P＜0.05),while not statistically significant between the molding group and the raw material processing group (all P＞0.05).The differences among the three groups in other indexes are not statistically significant (all P＞0.05).Conclusions The emphysema with fibrous thickening in the alveolar septum and small airway wall is more severe in the workers who engaged in asbestos fiber combing comparing with in raw asbestos processing and asbestos pressure molding.Therefore,the medical protection of these groups of patients should be strengthened.

Evaluation of respiratory dysfunction in patients with asbestos lung based on pulmonary function indexes utilizing CT / 国际生物医学工程杂志

Objective To evaluate the changes and characteristics of respiratory function and pulmonary function in patients with asbestosis by multi-slice spiral CT imaging.Methods 61 asbestosis patents and 30 healthy subjects were enrolled and divided into normal re spiratory function group,mild injury group and moderate/severe injury group according to forced vital capacity and forced expiratory volume in one second.The lungs were scanned at the end of inspiratory and expiratory phase,and the lung volume,lung density and small airway index were measured.Results There were significant differences in lung volume (inspiratory and expiratory volume,volume difference,and volume ratio) among the normal group,the mild injury group and the moderate/severe injury group (all P＜0.05).There were statistically significant differences in the mean lung density (lung density at the end of inspiratory and expiratory phase,lung density difference,lung density ratio) among the three groups (all P＜0.05).There were significant differences in the small airway indexes (tracheal wall thickness ratio at the end of inspiratory and expiratory phase,bronchial wall area ratio) among the three groups (all P＜0.05).Conclusions CT lung function imaging techniques can be used to assess the degree of respiratory dysfunction in asbestosis patients.With the development of pulmonary respiratory dysfunction,the total lung volume decreased,the amount of lungs gradually increased,emphysema gradually increased,and the thickness of small airway wall and alveolar fibrous hypertrophy gradually increased.

Characteristics of ultrasonic patterns of problem based critical care ultrasound examination in patients in intensive care unit / 中华医学超声杂志（电子版）

Objective To provide epidemiological data as a reference for the coming research and clinical practice by analyzing the problem based critical care ultrasound (CCUS) examination database in Department of Critical Care Medicine,West China Hospital, Sichuan University. Methods A retrospective study of the database was performed. The clinical problems prompting the CCUS examination were classified, the ultrasonnic findings representing the pathophysiological changes were collected and gathered into categories, and the pathophysiological etiology for each classification of clinical problems was stated after referring to the clinical information. Results In the 135 cases with a mean age of (51±18) years, 386 times of problems based examinations were performed (2.85 times per patient). The problems prompting the examinations were acute circulatory dysfunction (271 times, 70.2%), acute respiratory dysfunction (34 times, 8.8%), acute circulatory dysfunction combined with acute respiratory dysfunction (76 times, 19.7%), and suspected diaphragm disorder and others (5 times, 1.2%). In the 347 times of examination for acute circulatory dysfunction, the pathophysiological changes discovered by the CCUS examination included hypovolemia (55 times, 15.9%), hypervolemia (85 times, 24.5%), decreased systemic vascular resistance index (22 times, 6.3%), and increased right ventricular (RV) afterload (15 times, 4.3%). In the 246 times of examination for cardiac dysfunction, the underlying etiology detected included left ventricular (LV) systolic dysfunction (31 times, 12.6%), LV diastolic dysfunction (108 times, 43.9%), LV systolic dysfunction associated with diastolic dysfunction (49 times, 19.9%), RV dysfunction (23 times, 9.4%), and whole heart failure (35 times, 14.2%). Acute respiratory disorders was identified 110 times in total, which consisted of lung consolidation (40 times, 36.4%), diffuse ultrasonic interstitial syndrome (DIS; 27 times, 24.5%), consolidation associated with DIS (18 times, 16.4%), focal interstitial syndrome (17 times, 14.6%), and others (9 times, 8.2%). Causes of deterioration of the cases were cardiogenic pulmonary edema, diastolic dysfunction, RV failure, acute valve insult or chronic valve insufficiency and so on. Conclusions The main problems prompting the CCUS examinations are acute circulatory dysfunction and acute respiratory dysfunction. CCUS examination can provide physicians with valuable information on the full picture of the pathophysiology characteristics of hemodynamics and lung pathology to help diagnose the causes of the deterioration and guide clinical treatment.

Risk Factors Analysis on Acute Respiratory Dysfunction Caused Death in Patients After Type A Aortic Dissection Surgery / 中国循环杂志

Objective: To analyze the risk factors on acute respiratory dysfunction caused death in patients after type A aortic dissection surgery. Methods: A total of 223 patients who received aorta replacement surgery in our hospital from 2010-01 to 2012-12 were retrospectively studied. 80 patients suffered from post-operative acute respiratory dysfunction including 61 male and 19 female with the mean age of (49.2 ± 11.6) years. Those patients were divided into 2 groups as Death group, n=18 and Survival group, n=62. We analyzed the most relevant risk factors for death, such as gender, age, histories of smoking, diabetes, hypertension, Marfan syndrome;pre-operative acute or chronic dissection, hypoxemia, mal-perfusion, LVEDD and LVEF;CPB time, aortic-clamping time;post-operative ICU retention time, mechanical ventilation time, permanent neurologic dysfunction, pulmonary infection, MACE, renal failure, hypohepatia, septicemia and wound mal-healing, et al. Results: The early post-operative ( Conclusion: The occurrence and mortality were high in patients after type A aortic dissection surgery especially in those with female gender and post-operative renal failure.

Low Blood Selenium Concentrations in Critically Ill Children with Systemic Inflammatory Response Syndrome and Respiratory Dysfunction / 대한구급학회지

BACKGROUND: Selenium is an essential trace-element with antioxidant and immunological function. We studied the relationship between blood selenium concentrations, systemic inflammatory response syndrome (SIRS) and organ dysfunctions in critically ill children. METHODS: This was a retrospective, observational study of the blood selenium concentrations of critically ill children at the time of a pediatric intensive care unit admission. RESULTS: A total of 62 patients with a median age of 18 (5-180) months were included in this study. The mean of blood selenium concentration (microg/dl) was 8.49 +/- 2.42. The platelet count (r = -0.378) and PaCO2 (r = -0.403) showed negative correlations with blood selenium concentration, while PaO2/FiO2 (r = 0.359) and PaO2 (r = 0.355) showed positive correlations (p 300 (7.90 +/- 2.43 vs. 9.54 +/- 2.17, p = 0.018). Blood selenium concentrations were significantly lower in patient with PaO2/FiO2 300 (7.64 +/- 2.76 vs. 9.54 +/- 2.17, p = 0.018). CONCLUSIONS: Patients with systemic inflammatory response syndrome or respiratory dysfunction showed significantly low blood selenium concentrations.

Risk factors of acute respiratory dysfunction after a type aortic dissection surgery / 中华胸心血管外科杂志

Objective Acute respiratory dysfunction (ARD) can occur after aortic surgery with the use of cardiopulmonary bypass and deep hypothermic circulation arrest, but relatively little is known about acute respiratory dysfunction in the patients with type A aortic dissection. This study aims to analyze the independent risk factors of acute respiratory dysfunction after A type aortic dissection surgery and to assess possible prevention and treatment option in the future. Methods Clinical data of the 252 patients including 193 male patients and 59 female patients who underwent type A aortic dissection surgery from February 2009 to October 2010 were collected. The mean age was 47 years. Postoperative acute respiratory dysfunction was defined as oxygenation impairment (PaO2/FiO2 ＜ 150) that occurred within 72 h of surgery except pleural effusion, cardiogenic pulmonary edema, pneumonia, pulmonary embolism and haemato-/ pneumothorax. There were 187 acute A type aortic dissection patients and 65 chronic type A aortic dissection patients. Clinical characteristics including age, gender, weight, height, history of hypertension, history of smoking, preoperative complications such as preoperative shock and acute renal failure, pericardial effusion, previous cardiac surgery, time from event to surgery, malperfusion syndrome, cardiopulmonary time, cross-clamp time,deep hypothermia circulation arrest time, surgical procedure, duration of intensive care unit stay and postoperative complications including tracheotomy, dialysis dependent renal failure and hospital mortality were gathered. Arterial blood analysis, chest X ray, ventilator parameters, number of blood transfusion and flood balance were assayed after operation. All the factors were evaluated by means of univariate and multivariate logistic regression analysis to identify relative risk factors of ARD. Results Acute respiratory dysfunction occurred in 32 (12.7% ) patients. The in-hospital mortality was significant difference between acute respiratory dysfunction group and non- acute respiratory dysfunction group (P ＜ 0.05). The value of BMI, incidence of acute aortic dissection, preoperative SBP level, cardio-pulmonary bypass time, aortic clamp time and total arch replacement in acute respiratory dysfunction group were significantly higher than the values in non- acute respiratory dysfunction group. Multivariate Logistic regression analysis showed blood transfusion more than 10 units and cardio-pulmonary bypass time more than 160 minutes were independent risk factors of early stage acute respiratory dysfunction after type A aortic dissection surgery.Conclusion Acute respiratory dysfunction after type A aortic dissection was a severe early stage postoperative complication and was associated with in-hospital mortality. The patients in acute aortic dissection were prone to have acute respiratory dysfunction. The independent risk factors of acute respiratory dysfunction included blood transfusion more than 10 units and cardio-pulmonary bypass time more than 160 minutes.

The Application of G5 percussive mobilizer in bronchial purification treatment of repiratory failure / 中国基层医药

ObjectiveTo investigate the clinical value of G5 Percussive Mobilizer in respiratory failure.Methods76 patients with respiratory failure were randomly divided into the treatment group (38 cases) and control group (38 cases). The treatment group were treated with G5 Percussive Mobilizer made in America,and the control group were treated with knock expectoration. The daily sputum volume, clinical symptoms, thoracic signs and arterial blood gas analysis changes were observed. ResultsThe daily sputum volume,clinical symptoms,thoracic signs and arterial blood gas analysis changes of the treatment group (31 cases effective,81.6% ) has significant difference compared with the control group (23 cases effective ,60.5% ) ( P < 0. 05 ). ConclusionG5 Percussive Mobilizer can eliminate the bronchial secretion rapidly and effectively,and it can help improve the ventilation and oxygenation function. It is safe, effective and easy to practice in bronchial purification treatment.

The feasibility of laparoscopic radical resection for colorectal cancer in patients with respiratory dysfunction / 肿瘤研究与临床

Objective To investigate the feasibility of laparoscopic radical resection for colorectal cancer in patients with respiratory dysfunction. Methods A total of 64 patients with colorectal cancer with respiratory dysfunction simultaneously admitted in our hospital. Following the principles of en-bloc resection, thirty-six patients underwent laparoscopic radical resection, and 28 underwent open resection. Results The time of postoperative oxygen inhalation was shorter in laparoscopic group than that in open resection group (3.5 d vs 4.6 d) (P<0.05), and independently expectorating was better in laparoscopic group than that jn open resection group (P <0.05). The time to endotracheal intubation removal (21.2 min vs 23.9 min) and oxygen saturation were no significant difference between laparoscopic group and open resection group. One case got lung infection in open resection group, both groups had no atelectasis, respiratory failure and urinary infections case. Conclusion Laparoscopic surgery is feasible for colorectal cancer in patients with respiratory dysfunction.

Tuberculose pulmonar: associação entre extensão de lesão pulmonar residual e alteração da função pulmonar / Pulmonary tuberculosis: association between extent of the residual pulmonary lesion and alteration in the lung function

OBJETIVO: Descrever as alterações nas variáveis da espirometria e seus distúrbios; estudar a existência de associação entre a extensão da lesão pulmonar residual ao final do tratamento da tuberculose e a alteração da função pulmonar aferida pela espirometria. MÉTODOS: Estudou-se uma série de 96 pacientes com diagnóstico de tuberculose pulmonar, atendidos em três unidades de saúde de Região Metropolitana do Recife, durante o período de janeiro de 2003 a novembro de 2005. Foram analisados pacientes de ambos os sexos, com idade a partir de 15 anos, cujas radiografias do tórax do final do tratamento foram classificadas pelo critério da National Tuberculosis Association (NTA). Os pacientes responderam questionário, no início da pesquisa, e foram submetidos à prova de função pulmonar, após o término do tratamento. RESULTADOS: Dos 96 pacientes estudados, concluímos que 89,6 por cento apresentavam seqüelas radiográficas; 54 por cento apresentavam seqüelas moderadas a graves. Estas alterações radiográficas correspondiam a 24,6 por cento e 73,8 por cento, respectivamente, de alterações na função pulmonar. CONCLUSÃO: Foram identificadas 89,6 por cento de lesões residuais radiográficas, enquanto 66,7 por cento das disfunções respiratórias alertam para o fato de que a assistência ao paciente com tuberculose pulmonar não deve se restringir apenas à cura baciloscópica da doença. A identificação de lesões pulmonares residuais e disfunções respiratórias em pacientes que concluem o tratamento da tuberculose permitirão instituir medidas precoces de tratamento dessas seqüelas para uma melhor qualidade de vida.

OBJECTIVE: To describe alterations in spirometric variables and its disturbances and to study the existence of a relationship between extent of the residual lung lesion at the end of treatment for tuberculosis and alteration of the lung function measured by spirometry. METHODS: Analyzed were 96 patients with diagnosis of pulmonary tuberculosis, treated in three health centers in the metropolitan area of Recife, from January, 2003 to November, 2005. Patients of both genders, 15 years of age or older were included, whose chest x-rays at end of the treatment were classified according to criteria of the National Tuberculosis Association (NTA) for extent of lung lesion. Patients replied to a questionnaire at the beginning of the survey, and were submitted to spirometry after conclusion of treatment. RESULTS: Of the 96 patients, 89.6 percent presented with radiographic sequels. About 54 percent had moderate to severe sequels. These radiographic alterations correspond to 24.6 percent and 73.8 percent respectively of alterations in the pulmonary function. CONCLUSION: The large number of residual radiographic lesionss (89.6 percent) and breathing dysfunction (66,7 percent) identified in this survey call attention to the fact that treatment of a patient with pulmonary tuberculosis must not be restricted to bacteriological healing of the disease. Identification of the residual lung lesions and of the breathing dysfunction in patients who conclude treatment will promote early actions to treat these sequels, improving the quality of life of these patients.

Analysis of factors of impacting on the outcomes of patients with ALI/ARDS / 中华急诊医学杂志

Objective To investigate the factors influencing the outcomes of patients with ALI/ARDS.Method Data of 63 patients with ALI/ARDS in ICU,Cancer Hospital,Chinese Academy of Medical Science,from January 2005 to December 2006,were retrospectively analyzed.Patients were divided into survivor group(n=39)and non-survivor group(n=24)according to different outcomes,and equally,patients were classified in the rcspect of different causes as pulmonary origin and extra-pulmonary origin.Results The incidence of ALI/ARDS was 5.2%(63/1201)in ICU.The univariate analysis showed that the differences in the length of mechanical ventilation(P=0.028),blood creatinine level(P=0.031),oxygenation index(P=0.023),between survivor group and non-survivor group.In addition,the differences in acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores and sequential organ failure assessment(SOFA)on the admission day were significant between survival group and non-survival group(P<0.001,respectively).Logistic regression analysis showed that APACHE Ⅱ scores was the only independent predictor of the mortality in patients with ALI/ARDS(P=0.015,OR:3.809,95%CI:1.295～11.203).There was no significant difference in one-year survival between pul-monary origin cause of ALI/ARDS group and exwa-pulmonary origin cause of ALI/ARDS group(63.9% vs.55.4%).There was significant difference in one-year survival between ARDS and ALI group(44.9% vs.88.9%,P<0.05).Conclusions APACHE Ⅱscores on the admission day of patients is the only independent predictor of the mortality in patients with ALI/ARDS,whereas the underlying cause of ALI/ARDS does not matter to the survival of patients.

Catastrophic Respiratory Failure Associated with Unilateral PICA Infarction Involving Lateral Medullar Region

Medullar respiratory centers are composed of ventral and dorsal groups. A direct infarction to their structure could lead to a complete loss of respiratory drive, despite unilateral brainstem lesion is rarely associated with central respiratory dysfunction. A 70-year-old man was admitted with sudden dizziness and disequilibrium without motor weakness. Brain MRI (diffuse weight image) shows high signals intensities on left PICA territory of cerebellum and medulla oblongata including reticular formation, nucleus of tractus solitarius, nucleus ambiguus, and nucleus retroambiguus but sparing corticospinal and corticobulbar pathway. On 3rd hospital day, he had a complete loss of respiratory drive involving both autonomic and voluntary components. He didn't get the respiratory drive during CO2 retention while his consciousness and motor power were preserved.

Transient Repiratory Dysfunction after Percutaneous Cordotomy: A case report / 대한통증학회지

Percutaneous cordotomy is a useful method for cancer pain management. Candidates for cervical cordotomy include those patients with unilateral cancer pain below the shoulder, with a life expectancy of less than 1 year, who can not be adequately treated by other less invasive methods. However, various complications can occur following a cordotomy, with the most serious being respiratory dysfunction. Herein, we report a case of transient respiratory dysfunction following a percutaneous cervical cordotomy.

Application of pressure support ventilation on cervical spinal cord injured patients / 中国康复理论与实践

@#ObjectiveTo summarize the application of pressure support ventilation (PSV) on cervical spinal cord injured patients with respiratory dysfunction.MethodSixteen patients were studied.Respiratory rate (RR),tidal volume (VT), minute ventilation (VE),peak inspiration pressure (PIP), dynamic lung conpliance (Cdyn), blood pH value, PaO2 and PaCO2 were measured under the different pressure levels of PSV. ResultAll parameters correlated with the level of PSV. Conclusion Appropriate PSV levels can make the respiratory parameters close to the reasonable level and respiratory functional status for the cervical cord injured patients with respiratory dysfunction.

Clinical Utility of the Diaphragmatic Needle Electromyography in Patients with Respiratory Dysfunction

OBJECTIVE: To confirm the clinical utility of diaphragmatic needle electromyography (EMG) in patients with respiratory dysfunction. METHOD: Needle electorode was inserted into the muscle just above the lower costal margin between anterior axillary and medial clavicular lines. Case 1 who showed no response bilaterally in a phrenic NCS and a complete denervation of the diaphragm on needle EMG was unable to be weaned off from the ventilator. Case 2 who showed normal electrodiagnostic findings was successfully weaned off from the ventilator. Case 3 who showed a respiratory insufficiency from organophosphate intoxication had normal electrodiagnostic findings and was able to be successfully weaned off from the ventilator with a psychiatric support. RESULT: We ruled out the possibility of lack in central respiratory drive and weaned off patients from the ventilator, based on a normal firing pattern of motor unit potentials. CONCLUSION: Phrenic nerve conduction study (NCS) alone is not sufficient to find out the nature of respiratory dysfunction. Needle EMG of the diaphragm can be helpful in determining the pathogenesis, but its utility has been limited due to its potential risks. However we have confirmed that the needle EMG of diaphragm is a safe and easy study to perform and can provide a valuable information in the evaluation and management of respiratory dysfunction.

Effect of adenoidectomy on dentofacial skeleton in naso-respiratory dysfunction children / 영남의대학술지

This study was made to investigate the effect of adenoidectomy on dentofacial skeleton in naso-respiratory dysfunction children. The clinical material compromised the 24 children in a previous study who had naso-respiratory dysfunction and 24 children who were the nasal breathing with normal occlusion. The cephalograms were taken at the initial examination and 1 year later for the control group and experimental group the paired sample statistical analysis was performed. The results were as follows. 1. In cranial base variable, difference between two groups were not statistically significant. 2. In craniofacial variables, experimental group showed brachyfacial pattern but control groups didn't show significant growth pattern. 3. In maxillary variables, experimental group showed flattening the plane. 4. In mandibular variables, experimental group showed the decrease of mandibular plane angle and gonial angle. 5. In facial height variables, experimental group showed horizontal growth rotation.

Two cases of mitochondrial myopathy with predominant respiratory dysfunction

Although it is well known that the respiratory failure is a major cause of death in most patients with chronic neuromuscular disease, predominant respiratory dysfunction without severe involvement of limb muscles is an unusual complication of mitochondrial myopathy in adult age. We experienced two cases of mitochondrial myopathy with severe involvement of respiratory function and only mild involvement of limb muscles. One is a 16 year old female and another is a 22 year old male. The diagnosis is based on morphologic characteristics of "ragged red fibers" under the light microscope and abnormal mitochondrias on the electron microscope in the muscle biopsy.