Abnormalities of the respiratory function and control of ventilation in patients with anorexia nervosa.

BACKGROUND: Anorexia nervosa is a good model to study the effects of malnutrition on the respiratory system, since it excludes the consequences that some chronic diseases can have on the lung. OBJECTIVE: The objective of this study was to assess pulmonary function and alterations in the respiratory system in patients with anorexia nervosa. METHODS: Twenty-two women, 12 with anorexia nervosa and 10 healthy volunteers, were studied. Anthropometric data were gathered for all the participants. In every case, an arterial blood gas test and functional respiratory study, that included spirometry, plethysmography, measure of maximum muscular respiratory pressure and study of the ventilatory pattern at baseline and after hypercapnic stimulation, were performed. RESULTS: No significant differences were found in mean age and height in both groups of patients but there was a difference in body mass index (p < 0.05). In pulmonary function tests, an increase in residual volume (RV), RV/total lung capacity (TLC) ratio and functional residual capacity and a decrease in maximum respiratory pressure were found in patients with anorexia nervosa compared to the control group (p < 0.05). Differences were also found in the ventilatory pattern, with a reduction in minute ventilation and occlusion pressure as well as a decreased response of these parameters to hypercapnic stimulation (p < 0.05) in the patients with anorexia nervosa. CONCLUSION: In patients with anorexia nervosa, a significant elevation in RV, in the RV/TLC ratio and in functional residual capacity and a decrease in the maximum respiratory pressure were noted. In addition, they present an alteration in the central respiratory drive and a response of the respiratory system to hypercapnic stimulation. Although these alterations have no repercussion on the maintenance of gas exchange in baseline conditions, they may have in extreme situations.

Estado actual de la ventilación mecánica domiciliaria en España: resultados de una encuesta de ámbito nacional / Home mechanical ventilation in Spain today: results of a national survey

La ventilación mecánica domiciliaria constituye una modalidad de tratamiento de la insuficiencia respiratoria crónica para aquellos pacientes en situación clínica estable que precisan un soporte ventilatorio parcial o total. Con el objetivo de conocer el estado de la ventilación mecánica domiciliaria en España, se envió una encuesta a los servicios de neumología de todos los hospitales de la red sanitaria pública, cerrándose la recogida de datos en abril de 1999. Se han obtenido respuestas de 43 hospitales que pertenecen a 14 comunidades autónomas. La ventilación mecánica domiciliaria se inició en 1987 y el número total de pacientes actualmente en ventilación se eleva a 1.821. Los diagnósticos corresponden a enfermedad restrictiva toracógena en el 44 por ciento, enfermedades neuromusculares en el 25 por ciento, síndrome de hipoventilación-obesidad en el 15 por ciento, EPOC en el 9 por ciento y otras enfermedades en el 7 por ciento. De los 1.821 pacientes, 856 utilizan respiradores volumétricos y 965 diferentes modelos de soporte de presión. En cuanto a la forma de conexión al respirador, un 90 por ciento lo hacen mediante máscara nasal, un 6 por ciento a través de traqueotomía, un 2 por ciento utilizan máscaras faciales y menos de un 1 por ciento a través de piezas bucales. En conclusión, la ventilación mecánica domiciliaria se encuentra ampliamente introducida en nuestro país, siendo la forma más habitual la ventilación no invasiva mediante máscara nasal. Además de las indicaciones clásicas, enfermedades de la caja torácica y neuromusculares, otros procesos como el síndrome de hipoventilación-obesidad y la EPOC son causa de indicación de ventilación mecánica domiciliaria. (AU)

[Current status of home mechanical ventilation in Spain: results of a national survey]. / Estado actual de la ventilación mecánica domiciliaria en España: resultados de una encuesta de ámbito nacional.

Home mechanical ventilation (HMV) is used to treat chronic respiratory insufficiency in patients who are clinically stable and require partial or total support ventilation. To determine how HMV is being used in Spain, we mailed a questionnaire to the respiratory medicine departments of all hospitals in the public health system. The closing date for receipt of responses was April 1999. Forty-three hospitals in 14 autonomous communities of Spain responded. At the time of the survey, 1,821 patients were using HMV, which had been introduced in 1987. Volumetric respirations were being used by 856 patients and various models for delivering support pressure were being used by 965. Nasal masks connected to respirators were being used by 90%, while 6% were ventilated through a tracheotomy, 2% through face masks and fewer than 1% trough mouth devices. In conclusion, HMV has been widely applied in Spain and non invasive ventilation is usually provided through a face mask. HMV is prescribed for the usual reasons (chest and neuromuscular diseases) and for such conditions as hypoventilation due to obesity and chronic obstructive pulmonary disease.

[A patient with Rendu-Osler-Weber disease and pulmonary arteriovenous malformations treated satisfactorily by embolization]. / Paciente con enfermedad de Rendu-Osler-Weber y malformaciones arteriovenosas pulmonarares tratadas satisfactoriamente mediante embolización.

A 41-years-old woman with multiple arteriovenous lung malformations in a context of Rendu-Osler-Weber disease is described. The patient had a history of cutaneous and mucosal telangiectasia, frequent epistaxis and one episode of central artery embolism in the right retina. Malformations in the vascular territories of both lungs (right lower lobe and lingula) were detected by X-rays and magnetic resonance. Progressive dyspnea along with serious antecedents indicated that aggressive treatment was required. The malformations were embolized in the vascular radiology treatment center.