RESUMO
Crohn's disease frequently can affect the genitourinary system, mainly in the form of urinary fistulae and urolithiasis. Diagnostic evaluation of fistulae associated with Crohn's disease has improved with the increasing use of computed tomography and MR imaging, along with other diagnostic modalities. Resective surgery is the main treatment in this group of patients. Kidney stones are common because of metabolic derangements and dehydration; however, these can be treated adequately with minimally invasive procedures, such as extracorporeal shock-wave lithotripsy, ureteroscopy, and percutaneous surgery. In addition, medical therapies can prevent recurrent stones.
Assuntos
Doença de Crohn/complicações , Cálculos Urinários/etiologia , Fístula Urinária/etiologia , Doença de Crohn/imunologia , Doença de Crohn/metabolismo , Inflamação , Imageamento por Ressonância Magnética , Procedimentos Cirúrgicos Minimamente Invasivos , Tomografia Computadorizada por Raios X , Cálculos Urinários/diagnóstico , Cálculos Urinários/cirurgia , Derivação Urinária , Fístula Urinária/diagnóstico , Fístula Urinária/cirurgia , UrografiaRESUMO
We have previously shown that regional chest wall impedance increases when the chest wall muscles are tonically contracted to perform isometric, non-respiratory tasks. To test how this affects breathing, we measured respiratory frequency, tidal volume, end-tidal PCO2, electromyographic activity (EMG) at four points on the chest wall surface, and regional displacements across six planes of the chest wall during maintenance of three different postures that necessitated strong tonic respiratory muscle contraction. These postures included a static push-up, a bilateral leg-lift and a partial sit-up. The subjects (n = 8) were able to maintain the postures for 1.5-2.5 min, and strong tonic EMG activity was observed in each posture at all points measured. The rate and depth of breathing and pattern of regional chest wall displacements were variable within the group of subjects and among the three postures. However, minute ventilation increased and end-tidal PCO2 decreased in each subject during each posture (P < 0.05). In six of the eight subjects, transdiaphragmatic pressure (Pdi) was measured during 1 min of the same exercises. The ratio of the breathing fluctuation in Pdi to tidal volume was at least twice as high compared with rest, except for two subjects during the leg-lifts. We conclude that strong tonic contraction of the chest wall muscles impedes, but does not limit, breathing, and that there is no single breathing strategy used during such conditions.
