Pneumomediastinum, subcutaneous emphysema, and pneumothorax after a pulmonary function testing in a patient with bleomycin-induced interstitial pneumonitis / Pneumomediastino, enfisema subcutâneo e pneumotórax após prova de função pulmonar em paciente com pneumopatia intersticial por bleomicina

Spontaneous pneumomediastinum is an uncommon event, the clinical picture of which includes retrosternal chest pain, subcutaneous emphysema, dyspnea, and dysphonia. The pathophysiological mechanism involved is the emergence of a pressure gradient between the alveoli and surrounding structures, causing alveolar rupture with subsequent dissection of the peribronchovascular sheath and infiltration of the mediastinum and subcutaneous tissue with air. Known triggers include acute exacerbations of asthma and situations that require the Valsalva maneuver. We described and documented with HRCT scans the occurrence of pneumomediastinum after a patient with bleomycin-induced interstitial lung disease underwent pulmonary function testing. Although uncommon, the association between pulmonary function testing and air leak syndromes has been increasingly reported in the literature, and lung diseases, such as interstitial lung diseases, include structural changes that facilitate the occurrence of this complication.

O pneumomediastino espontâneo é um evento incomum, cujo quadro clínico inclui dor pleurítica retroesternal, enfisema subcutâneo, dispneia e disfonia. O mecanismo fisiopatológico implicado é o surgimento de uma diferença de pressão entre os alvéolos e estruturas adjacentes, ocasionando ruptura alveolar com posterior dissecção da bainha peribroncovascular e infiltração do mediastino e do tecido subcutâneo pelo ar. Desencadeantes conhecidos incluem exacerbação aguda de asma e situações que exigem a realização de manobra de Valsava. Descrevemos e documentamos por imagens tomográficas a ocorrência de pneumomediastino após a realização de prova de função pulmonar em um paciente com pneumopatia intersticial induzida por bleomicina. Apesar de incomum, a associação entre provas de função pulmonar e síndromes de vazamento de ar tem sido relatada cada vez mais na literatura, e doenças pulmonares, como as pneumopatias intersticiais, contemplam alterações estruturais que facilitam a ocorrência da complicação. .

Upper airway collapsibility evaluated by a negative expiratory pressure test in severe obstructive sleep apnea

OBJECTIVES: To investigate the usefulness of measuring upper airway collapsibility with a negative expiratory pressure application as a screening test for severe obstructive sleep apnea (OSA). INTRODUCTION: OSA is a risk factor for cardiovascular disease, and it may have serious consequences. Its recognition may have important implications during the perioperative period. Increased upper airway collapsibility is one of the main determinants of OSA, and its evaluation could be useful for identifying this condition. METHODS: Severe OSA and normal subjects (24 in each group) were matched by body mass index and referred to our sleep laboratory. The subjects were enrolled in an overnight sleep study, and a diurnal negative expiratory pressure test was performed. Flow drop (DV) and expiratory volume were measured in the first 0.2 s (V02) of the negative expiratory pressure test. RESULTS: DV ( percent) and V02 ( percent) values were statistically different between normal and OSA subjects. OSA patients showed a greater decrease in flow than normal subjects. In addition, severely OSA patients exhaled during the first 0.2 s of the negative expiratory pressure application was an average of only 11.2 percent of the inspired volume compared to 34.2 percent for the normal subjects. Analysis of the receiver operating characteristics showed that V02 ( percent) and DV ( percent) could accurately identify severe OSA in subjects with sensitivities of 95.8 percent and 91.7 percent, respectively, and specificities of 95.8 percent and 91.7 percent, respectively. CONCLUSIONS: V02 ( percent) and DV ( percent) are highly accurate parameters for detecting severe OSA. The pharyngeal collapsibility measurement, which uses negative expiratory pressure during wakefulness, is predictive of collapsibility during sleep.

Is the addition of intrathecal fentanyl to hyperbaric bupivacaine affecting maternal spirometric function during ceasarean section?

Subarachnoid blockade with local anesthetics induces may respiratory depression. Although the addition of fentanyl to bupivacaine has become popular in subarachnoid blockade for Cesarean section, there is no information on the effect of intrathecal fentanyl on maternal spirometic respiratory function in parturients undergoing elective cesarean section. We studied the effects of the addition of intrathecal fentanyl to hyperbaric bupivacaine on maternal spirometic respiratory function in 60 partuirents undergoing elective cesarean section. The parturients were randomized into two groups: those receiving 2.0 ml of hyperbaric bupivacaine 0.5% and 0.4ml of saline intrathecally [control group] and those receiving 2.0 ml of hyperbaric bupivacaine and 0.4ml of fentanyl [25microg] intrathecally [patients group]. We performed spirometry on arriving at the operation room and 15 min after subarachnoid blockade. Subarachnoid blockade with bupivacaine significantly decreased the peak expiratory flow rate, but did not induce significant changes in vital capacity and forced vital capacity. The addition of intra-thecal fentanyl to bupivacaine improved the quality of subarachnoid blockade, but did not lead to deterioration in respiratory function compared with intrathecal bupivacaine alone. The addition of intrathecal fentanyl to hyperbaric bupivacine did not lead to deterioration in maternal spiromatric respiratory function in parturients undergoing Caesarean section

Pulmonary function tests in acute pancreatitis: an experimental study in the rat

As complicacoes respiratorias da pancreatite aguda sao bem conhecidas e relacionadas a mau prognostico. Usando-se um modelo de pancreatite aguda por injecao de acido taurocolio a 2,5 por cento no ducto hepatico de ratos, estudaram-se as alteracoes das funcoes pulmonares por pletismografia de corpo inteiro apos a intubacao dos animais. Vinte e nove animais foram divididos em tres grupos: grupo controle - 10 ratos (laparotomia); grupo 2 horas apos a pancreatite aguda - 10 ratos; grupo 8 horas apos a pancreatite aguda - nove ratos. Os parametros pulmonares medidos foram: volume de reserva inspiratorio; volume de reserva expiratorio; capacidade vital forcada; volume expiratorio forcado 1/4 segundo; fluxo expiratorio forcado medio de 0 a 50 por cento da capacidade vital forcada; fluxo expiratorio forcado medio de 50 a 75 por cento da capacidade vital forcada; fluxo expiratorio forcado medio de 75 a 100 por cento da capacidade vital forcada...

Estudo da celularidade do parenquima pulmonar distal em ratos pelo metodo do lavado bronco-alveolar na pancreatite aguda / A study of the distal pulmonary cells obtained by broncho alveolar lavage in rats with acute pancreatitis

Alteracoes celulares do lavado bronco-alveolar (LBA) em ratos com pancreatite aguda necro-hemorragica (PANH) foram estudadas nos tempos de duas e oito horas apos indicao de PANH por injecao de solucao de acido taurocolico a 2,5 por cento no ducto hepatico. Grupo controle-dez ratos, Grupo PANH-nove ratos (2hs) Grupo PANH (8hs)-oito ratos. A comparacao entre os grupos mostrou aumento significativo no numero de Macrofagos/ml, segmentados/ml e linfocitos/ml no LBA (p<0,05). Assim os autores concluem que a PANH aumenta o numero de celulas inflamatorias principalmente dos neutrofilos segmentados no LBA de ratos o que e compativel com uma pneumopatia inflamatoria aguda