ABSTRACT
BACKGROUND: The authors studied changes in the upper airway in morbidly obese women and the relationship to sleep apnea-hypopnea syndrome (OSAS). METHODS: Patients underwent a cardiorespiratory polygraphic study, respiratory function test (spirometry, plethysmography, maximum inspiratory pressures and arterial blood gas analysis), and computed tomographic studies of the upper airway. RESULTS: 40 morbidly obese women being evaluated for bariatric surgery (mean age 39.6 +/- 9.6 years old, BMI 48.7 +/- 5.6 kg/m2) were studied. 37 women had OSAS, and 14 had severe OSAS. Results on respiratory function tests were normal. BMI and weight had a positive correlation with apnea-hypopnea index (AHI), apnea index (AI), desaturation index (DI), lowest oxygen saturation and CT90. Uvula diameter had a negative correlation with FEV1, FVC, VC IN and a positive correlation with TLC. Retropharynx soft tissue at the retropalatal level had a negative correlation with FEV1, FVC and VC IN. The oropharynx area at maximal inspiration (total lung capacity) obtained a negative correlation with the AHI (r = - 0.423, P = 0.044), AI (r = - 0.484, P = 0.042) and DI (r = - 0.484, P = 0.019). CONCLUSIONS: Prevalence of OSAS in morbidly obese women is very high. Our results show the significant correlation between BMI and AHI in morbidly obese women. Uvula diameter and retropharynx soft tissue are the upper airway parameters with higher relationship with pulmonary function. A reduction in the cross-sectional area of the airway at the level of the oropharynx could be related to the severity of OSAS in morbidly obese women.
Subject(s)
Obesity, Morbid/diagnostic imaging , Obesity, Morbid/physiopathology , Respiratory System/diagnostic imaging , Respiratory System/physiopathology , Sleep Apnea, Obstructive/epidemiology , Adult , Body Mass Index , Cohort Studies , Female , Humans , Middle Aged , Obesity, Morbid/complications , Prevalence , Radiography , Respiratory Function Tests , Respiratory Mechanics/physiology , Severity of Illness IndexSubject(s)
Biliopancreatic Diversion , Gastric Bypass , Gastroplasty , Adolescent , Adult , Biliopancreatic Diversion/methods , Body Mass Index , Contraindications , Evaluation Studies as Topic , Follow-Up Studies , Gastric Bypass/methods , Gastroplasty/methods , Humans , Length of Stay , Middle Aged , Time FactorsABSTRACT
The course of pregnancy in three patients with portal hypertension is described. The cause of portal hypertension was cirrhosis in one and portal vein obstruction in two (one of these had previous shunt surgery). The patient with cirrhosis had an episode of encephalopathy at week 27, the rest of the patients had an uneventful pregnancy. All three had preterm vaginal deliveries at week 33, 31 and 37 of pregnancy. The clinical features of pregnancy in women with portal hypertension was reviewed in the literature. There is agreement that the risk of preterm delivery increases and pregnancy does not influence maternal prognosis. Vaginal delivery can be anticipated in most women and cesarean section is reserved for obstetric indications. Pregnancy in these women should be managed in tertiary care centers with close collaboration between perinatologists, internists and surgeons.
Subject(s)
Hypertension, Portal/diagnosis , Pregnancy Complications, Cardiovascular/diagnosis , Adolescent , Adult , Child, Preschool , Esophageal and Gastric Varices/surgery , Female , Humans , Hypertension, Portal/etiology , Liver Cirrhosis/complications , Portal Vein , Pregnancy , Pregnancy Complications, Cardiovascular/etiology , Prognosis , Vascular Diseases/complicationsABSTRACT
Ryanodine (0.03-10 microM) abolished the phasic component of the contractile response to noradrenaline in the rat vas deferens but had less effect on the tonic component of this response. In contrast, nifedipine and methoxyverapamil (D600, 0.3-0.8 microM) blocked only the tonic component of the noradrenaline, adrenaline or phenylephrine-induced contractions. These results suggest that the phasic component of the noradrenaline-induced response is related to the release of intracellular calcium whereas the tonic phase of the contraction involves calcium influx via membrane channels sensitive to dihydropyridine and diphenylalkylamine calcium channels blockers.