Cardiopulmonary response to exercise in patients with different degrees of lung toxicity after radio-chemotherapy for Hodgkin's disease.

The combination of mediastinal radiotherapy (RT) and polychemotherapy (CT) regimens can produce late toxic pulmonary and cardiac effects which often remain at the subclinical level. The aim of the present study was to investigate the cardiopulmonary response to exercise in this kind of patient. Therefore, 126 patients suffering from Hodgkin's disease were investigated after a follow-up of at least 5 years from the completion of the combined treatment. Sixty-two patients had been submitted to ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)-RT, 40 to ABVD-MOPP (mechloretamine, vincristine, procarbazine, prednisone)-RT and 24 to VEBEP (vincristine, epidoxorubicin, bleomycin, cyclophosphamide, etoposide, prednisone)-RT. The patients were divided into three groups on the basis of respiratory function: group 1 (67 patients), normal spirometry and lung transfer function for carbon monoxide (DLCO); group 2 (52 patients), normal spirometry and DLCO less than 80% of predicted; and group 3 (7 patients), total lung capacity and DLCO less than 80% of predicted. The patients were submitted to respiratory function evaluation and 2D-echocardiography before exercise, and to the determination of cardiac output by the acetylene rebreathing method before and during symptom-limited exercise on a cycloergometer using an incremental protocol. The patients of group 3 and to a lesser extent the patients of group 2 showed, in comparison to patients of group 1, a lower tolerance to exercise, a lower oxygen consumption, a higher respiratory rate, a lower O2 pulse and a lower cardiac output per oxygen uptake. These data indicated an abnormal exercise physiology in the patients with persistent pulmonary impairment, especially when the reduction of DLCO was associated with a decrease of total lung capacity. The lower exercise capacity seems to be due to a combination of decreased cardiac performance and an impairment of gas diffusion capacity.

Exercise testing as a predictor of surgical risk after pneumonectomy for bronchogenic carcinoma.

The aim of the present investigation was to evaluate the predictive value of a symptom-limited exercise test in predicting postoperative morbidity and mortality in patients submitted to pneumonectomy. The study was conducted in 150 patients (mean age, 57.1). Forty-four patients (29.3%) had postoperative complications. Four patients (2.7%) died within one month of the pneumonectomy. Patients with complications had significantly lower VO2max. The incidence of complications in relation to the amount of oxygen consumption showed that with the progressive decrease of oxygen consumption there was a progressive increase in frequency of complications. In particular patients with VO2max < 50% of predicted should be considered at high risk of morbidity and mortality from cardiopulmonary causes. This predictive capacity of VO2max was more evident in patients with a preoperative FEV1 less than 70% of predicted. The present data support the suggestion that exercise testing could be a useful adjunt in the evaluation of postoperative risk for pneumonectomy, especially in patients with obstructive pulmonary disease.

Thinking about "culture": some programme pointers.

PIP: This article exhorts development workers to develop an understanding of their own cultural heritage in order to understand how cultural subjectivity influences their work. While not endorsing "cultural relativism," the authors stress that women must work within their own cultures to develop empowerment and combat culturally legitimized practices which are harmful to women. Cultural constructs must be examined in order to understand such issues as the Northern tendency to encourage personal individualism and the Southern tendency to organize along communal lines. Gender identity is also a social construction which calls for a consideration of each situation (or harmful practice) as uniquely based in a given cultural context. General agreement exists, however, that in order to tackle gender oppression, women must be empowered and their status must be improved. Thus development initiatives should support longterm investment in research and programs, illiteracy rates must be decreased, and educational opportunities must be sought in every program. Women's groups must link up to share resources with each other and with traditional nongovernmental organizations. Governments should 1) integrate a gender component into every Ministry; 2) emphasize literacy for girls and women; 3) support local women's initiatives; 4) provide gender-sensitive training for professionals in critical fields; 5) increase attention to the needs of young women; and 6) offer more women visible official posts in public service.^ieng