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1.
Anesthesiology ; 131(2): 266-278, 2019 08.
Article in English | MEDLINE | ID: mdl-31166236

ABSTRACT

BACKGROUND: Postoperative diaphragmatic dysfunction after thoracic surgery is underestimated due to the lack of reproducible bedside diagnostic methods. We used point of care ultrasound to assess diaphragmatic function bedside in patients undergoing video-assisted thoracoscopic or thoracotomic lung resection. Our main hypothesis was that the thoracoscopic approach may be associated with lower incidence of postoperative diaphragm dysfunction as compared to thoracotomy. Furthermore, we assessed the association between postoperative diaphragmatic dysfunction and postoperative pulmonary complications. METHODS: This was a prospective observational cohort study. Two cohorts of patients were evaluated: those undergoing video-assisted thoracoscopic surgery versus those undergoing thoracotomy. Diaphragmatic dysfunction was defined as a diaphragmatic excursion less than 10 mm. The ultrasound evaluations were carried out before (preoperative) and after (i.e., 2 h and 24 h postoperatively) surgery. The occurrence of postoperative pulmonary complications was assessed up to 7 days after surgery. RESULTS: Among the 75 patients enrolled, the incidence of postoperative diaphragmatic dysfunction at 24 h was higher in the thoracotomy group as compared to video-assisted thoracoscopic surgery group (29 of 35, 83% vs. 22 of 40, 55%, respectively; odds ratio = 3.95 [95% CI, 1.5 to 10.3]; P = 0.005). Patients with diaphragmatic dysfunction on the first day after surgery had higher percentage of postoperative pulmonary complications (odds ratio = 5.5 [95% CI, 1.9 to 16.3]; P = 0.001). Radiologically assessed atelectasis was 46% (16 of 35) in the thoracotomy group versus 13% (5 of 40) in the video-assisted thoracoscopic surgery group (P = 0.040). Univariate logistic regression analysis indicated postoperative diaphragmatic dysfunction as a risk factor for postoperative pulmonary complications (odds ratio = 5.5 [95% CI, 1.9 to 16.3]; P = 0.002). CONCLUSIONS: Point of care ultrasound can be used to evaluate postoperative diaphragmatic function. On the first postoperative day, diaphragmatic dysfunction was less common after video-assisted than after the thoracotomic surgery and is associated with postoperative pulmonary complications.


Subject(s)
Diaphragm/physiopathology , Point-of-Care Systems , Postoperative Complications/diagnostic imaging , Thoracic Surgery, Video-Assisted/adverse effects , Thoracotomy/adverse effects , Ultrasonography/methods , Aged , Cohort Studies , Diaphragm/diagnostic imaging , Female , Humans , Male , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Prospective Studies , Reproducibility of Results , Risk Factors
2.
Boll Soc Ital Biol Sper ; 56(12): 1226-32, 1980 Jun 30.
Article in Italian | MEDLINE | ID: mdl-7459063

ABSTRACT

The sterical requirements of dopamine (DA) receptors involved in the control of prolactin (PL) secretion have been analyzed by studying the effects of the administration of d- and l-sulpiride (25 mg i.v.) on PL serum levels in five normal male volunteers. Both d- and l-sulpiride cause a remarkable rise in PL serum levels, the only difference between the two drugs being the lower decay rate of hormone levels after the l-isomer. The results obtained are discussed in the frame of a possible low steric selectivity of DA receptors controlling PL secretion in the hyposthalamo-pituitary axis.


Subject(s)
Prolactin/metabolism , Receptors, Dopamine/physiology , Sulpiride/pharmacology , Adult , Humans , Male , Prolactin/blood , Receptors, Dopamine/drug effects , Reference Values , Stereoisomerism , Structure-Activity Relationship
3.
Neurosci Lett ; 15(2-3): 289-94, 1979 Dec.
Article in English | MEDLINE | ID: mdl-530534

ABSTRACT

The effects of (+)- and (-)-sulpiride on anterior pituitary hormone secretion (LH, FSH, PL, hGH, TSH) have been studied in five normal men. Both (+)- and (-)-sulpiride increase PL and TSH secretion and decrease LH and FSH secretion, whereas they do not seem to affect hGH secretion. These results are discussed in view of the different action of (+)- and (-)-sulpiride on DA receptors in the forebrain with respect to DA receptors involved in the control of anterior pituitary secretion.


Subject(s)
Pituitary Gland, Anterior/drug effects , Receptors, Dopamine/drug effects , Sulpiride/pharmacology , Adult , Double-Blind Method , Follicle Stimulating Hormone/metabolism , Growth Hormone/metabolism , Humans , Luteinizing Hormone/metabolism , Male , Pituitary Gland, Anterior/metabolism , Prolactin/metabolism , Stereoisomerism , Thyrotropin/metabolism , Time Factors
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