Pulmonary function changes in patients undergoing laparoscopic cholecystectomy

Purpose: Microwave ablation has become an alternative treatment for pulmonary ground-glass nodules (GGN) and is widely accepted by clinicians. However, its effect on lung function remains unknown. Therefore, this retrospective study aimed to explore pulmonary function changes and associated risk factors in patients undergoing computed tomography (CT)-guided microwave ablation (MWA) for treating pulmonary GGN. Materials and Methods: Thirty-five patients diagnosed with pulmonary GGN on thin-layer chest CT and enhanced CT were examined. Patients unable or unwilling to undergo thoracoscopic surgery underwent CT-guided simultaneous percutaneous core needle biopsy and MWA. Pulmonary function tests (PFT) were performed before ablation and 3 days and 6 months post-ablation. Forced expiratory volume in one second (FEV1), FEV1%, forced vital capacity (FVC), maximal voluntary ventilation (MVV), and peak expiratory flow (PEF) values pre- and post-MWA were analysed. Linear regression analysis was used to examine the correlation between ablation volume and changes in PFT findings 3 days post-ablation. Associations between patient characteristics, rates of postoperative complications, and PFT findings were analysed. Results: Forty-eight lesions were completely ablated and examined intraoperatively. There were significant differences in pre- and post-operative PFT findings on day 3 but not at 6 months. The mean ablation volume after 3 days of 11.4 ± 6.3 cm3 was positively correlated with changes in FEV1, MVV, and PEF values. Patients’ age (mean, 59.4 ± 13.0 years) positively correlated with changes in PEF values. The rates of change in FVC and MVV values were significantly higher with multiple pulmonary nodules than with isolated pulmonary nodule. PFT findings were similar between patients who experienced or did not experience complications (eg, pneumothorax and pleural effusion). Conclusions: Pulmonary function could be impaired shortly after MWA. PFT findings may correlate with age, ablation volume, and number of ablated lesions. In most patients, pulmonary function returned to the preoperative state after 6 months.

Objective To retrospectively analyze pulmonary function changes after growing rod surgery for progressive early-onset scoliosis.Methods Ten cases of progressive early-onset scoliosis treated with growing rod technique from September 2002 to July 2011 were enrolled in the study.There were 3males and 7 females,aged from 6 to 9 years (average,7.0±1.1 years).Four patients had finished the final fusion surgery (Group fusion),and 6 patients (Group non-fusion) were in the process of periodic lengthening.Forced vital capacity (FVC),FVC/predicted FVC ratio,forced expiratory volume in one second (FEV1),FEV1/predicted FEV1 ratio,Cobb’s angle,and C7-S1 distance before each surgery were recorded.Lung function changes and correlations between lung function changes and radiographic changes (Cobb’s angle and C7-S1 distance) were analyzed.Results In Group fusion,both FVC and FEV1 increased,and FVC showed a significant difference.In Group non-fusion,FVC and FEV1 also increased and both showed a significant difference.FVC/predicted FVC ratio and FEV1/predicted FEV1 ratio both changed similarly and did not show statistical differences in the two groups.There were no significant correlations between lung function changes and radiographic changes (Cobb’s angle and C7-S1 distance).Conclusion Pulmonary function improves after growing rod surgery for progressive early-onset scoliosis.The pulmonary function changes do not correlate with changes of Cobb’s angle and C7-S1 distance. Key words: Scoliosis; Internal fixators; Respiratory function tests

Pulmonary function in 42 patients with chronic myelogenous leukemia (CML) was tested before and after HLA-matched (39 related, 3 unrelated) allogeneic bone marrow transplantation (BMT) between 1985 and 1999. Pulmonary function tests (PFTs) including ventilatory capacity, lung volumes, and diffusion capacity for carbon monoxide (DLCO) were performed before and 3, 6, 12, and 24 months after BMT, and every 12 months thereafter. Possible pre- and post-BMT risk factors were evaluated for their influence on pulmonary function. Patients were divided into two groups according to their survival duration for more than 12 months or not.Pretransplant PFTs were essentially normal except for mild reduction in DLCO values in the short-term survival group. Overall pulmonary function changes revealed persistent and significant decrease of forced vital capacity (FVC) and DLCO values after BMT. The DLCO values reached abnormal levels (<80%) and showed a trend of incomplete recovery. Decrease of forced expiratory volume in the first second (FEV1) and vital capacity were also noted but the FEV1/FVC ratio remained within normal limits after BMT. Transient fall of total lung capacity after BMT was noted. However, its values did not reach abnormal levels such as to cause restrictive ventilatory impairment. Possible risk factors including gender, smoking, bronchiolitis obliterans, acute and chronic graft-versus-host disease (GVHD) were found to have significant influences on posttransplant pulmonary function changes by multiple regression analysis. Most patients except those who developed bronchiolitis obliterans were clinically asymptomatic. Development of bronchiolitis obliterans was the most important factor to cause both clinical symptoms and impaired pulmonary function.In summary, pulmonary function changes before and after HLA-matched allogeneic BMT in long-term survivors of CML only showed modest dysfunction. The primary negative presentation with the development of oxygenation defect had no clinical significance in most patients. The influences on the impairment of pulmonary function were multifactorial.

Changes in pulmonary function after definitive radiotherapy for NSCLC

Decreased lung function is related to higher cardiovascular disease (CVD) incidence and mortality. However, little is known about the relationship between the risk factors of CVD and pulmonary function. The aim of the study was to assess the relationship between the prevalence of cardiovascular risk factors, the total CVD risk, and pulmonary function. The analysis included 4104 men and women aged 45 to 69 years, participants of the Polish part of the Health, Alcohol, and Psychosocial factors In Eastern Europe (HAPIEE) Project, who provided valid measurements of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) using a Micro-Medical Microplus spirometer. The prevalence of CVD risk factors was defined as follows: hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or taking hypertension medication), diabetes (glucose ≥ 7.1 mmol/L or self-reported diabetes), and hypercholesterolaemia (total cholesterol ≥ 5 mmol/L or low-density lipoprotein-cholesterol ≥ 3 mmol/L or taking lipid lowering medication). Categories of total CVD risk were defined according to the 2016 European Guidelines on CVD prevention in clinical practice. The analysis of covariance was used to compare the lung function in the CVD risk factors and the total CVD risk categories. Mean values of FEV1 and FVC, adjusted for age and height, were significantly higher in men than in women (3.02 L; 95% confidence interval [CI] 2.96-3.08 L vs. 2.52 L; 95% CI 2.45-2.63 L for FEV1 and 3.62 L; 95% CI 3.56-3.69 L vs. 3.05 L; 95% CI 2.98-3.12 L for FVC). Obesity was significantly associated with FVC in men and women; it was associated with FEV1 only in men. Compared with participants with normal body mass index, obese men and women had 280 mL and 112 mL lower mean FVC, respectively. Men without hypertension had almost 100 mL higher mean FVC than those with hypertension. The difference in FVC in women was approximately 80 mL. Diabetes was associated with lower values of FVC in both sexes and with FEV1 in women. A significant negative trend was observed in the mean FVC and FEV1 by the considered CVD risk categories. Impaired lung function was associated with higher CVD risk, which could be explained partly by an adverse association between lung function and prevalence of obesity, hypertension, and diabetes.

Factors Influencing Noninvasive Ventilation Initiation in Amyotrophic Lateral Sclerosis

Predicted normal spirometric values have been shown to have significant geographical and ethnic variation. These variations are of epidemiological significance in determining the prevalence of disease and of clinical importance in measuring the effects on pulmonary function of various diseases. A total of 599 men were chosen from employees of a package manufacturer, a general hospital in Lahore, and a village in northern Pakistan; 94 students and staff of a women's college in Lahore were also studied. The forced vital capacity (FVC) was recorded from three satisfactory efforts, and the FVC, one second forced expiratory volume (FEV1), and maximal midexpiratory flow (MMF, or FEF25-75%) were calculated from the best FVC effort. The FVC and FEV1 in men were found to be similar to those of a group of emigrant Pakistanis and a north-western Indian population (Delhi) but higher than populations in south and eastern India. Pakistani women had values similar to those of women in northern India. None of the women smoked and, among Pakistani men, the smokers (285) averaged 6.7 pack years. While the FVC and FEV1 values did not differ between smokers and non-smokers, there was a significant difference in MMF (FEF25-75%) in the two groups. This latter finding corroborates studies on North American populations in which smokers generally have had a higher lifelong cigarette consumption. This confirms the MMF (FEF25-75%) to be a more sensitive test of subtle, asymptomatic changes in pulmonary function than the more widely used FVC and FEV1.

Changes in Pulmonary Function During the Early Years After Inpatient Rehabilitation in Persons With Spinal Cord Injury: A Prospective Cohort Study

The primary goals of this study were to evaluate early changes in pulmonary function and retrobulbar hemodynamics and to examine the correlation between these parameters in patients with type 2 diabetes during the preclinical stages of diabetic retinopathy. For the single-time point measurements, 63 subjects with type 2 diabetes without diabetic retinopathy (diabetes group) and 32 healthy subjects (control group) were selected to evaluate any early changes in pulmonary function and retrobulbar hemodynamics and to examine the correlation between these parameters. In the longitudinal follow-up study, 32 subjects who were newly diagnosed with type 2 diabetes were divided into 2 groups according to their resistivity index (≤0.7 and >0.7). Early changes in pulmonary function and retrobulbar hemodynamics were studied in these groups and compared with the previous values. For the single-time point measurements, the fasting plasma glucose, 2-h postprandial blood glucose, glycosylated hemoglobin A1c, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels as well as the pulmonary function parameters were significantly higher in the diabetes group than in the control group. The pulmonary function parameters were negatively and significantly correlated with glycosylated hemoglobin A1c and the duration of diabetes. The retrobulbar hemodynamics were positively correlated with glycosylated hemoglobin A1c and diabetes duration; in contrast, the correlation between retrobulbar hemodynamics and glycosylated hemoglobin A1c. In the longitudinal follow-up study, the pulmonary function of the 2 groups categorized by their resistivity index levels indicated that subjects with resistivity index levels ≤0.7 showed significantly better pulmonary function, and the pulmonary function of this group showed improvement and a significantly smaller decrease. The incidence of diabetic retinopathy in the group with resistivity index levels ≤0.7 (9 of 22, 40.9%) was significantly lower than that in the group with resistivity index levels >0.7. Pulmonary function and retrobulbar hemodynamics changed during the preclinical stages of diabetic retinopathy. Regulating glycemia may improve retrobulbar hemodynamics in the retrobulbar arteries (ie, central retinal artery, posterior ciliary artery, and arteria ophthalmica). By detecting the retrobulbar resistivity index and the levels of glycosylated hemoglobin A1c, we could predict future changes in pulmonary function during the preclinical stages of diabetic retinopathy as well as the degree of retinopathy. (ClinicalTrials.gov registration NCT02774733.).

Little is known on the association between cross-shift changes in pulmonary function and personal inhalation exposure to particulate matter (PM) among informal electronic-waste (e-waste) recovery workers who have substantial occupational exposure to airborne pollutants from burning e-waste. Using a cross-shift design, pre- and post-shift pulmonary function assessments and accompanying personal inhalation exposure to PM (sizes <1, <2.5 μm, and the coarse fraction, 2.5-10 μm in aerodynamic diameter) were measured among e-waste workers (n = 142) at the Agbogbloshie e-waste site and a comparison population (n = 65) in Accra, Ghana during 2017 and 2018. Linear mixed models estimated associations between percent changes in pulmonary function and personal PM. Declines in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) per hour were not significantly associated with increases in PM (all sizes) among either study population, despite breathing zone concentrations of PM (all sizes) that exceeded health-based guidelines in both populations. E-waste workers who worked "yesterday" did, however, have larger cross-shift declines in FVC [-2.4% (95%CI: -4.04%, -0.81%)] in comparison to those who did not work "yesterday," suggesting a possible role of cumulative exposure. Overall, short-term respiratory-related health effects related to PM exposure among e-waste workers were not seen in this sample. Selection bias due to the "healthy worker" effect, short shift duration, and inability to capture a true "pre-shift" pulmonary function test among workers who live at the worksite may explain results and suggest the need to adapt cross-shift studies for informal settings.

Prospective evaluation of pulmonary function before and 2 years after surgery following anterior scoliosis instrumentation. To determine if thoracoscopic anterior scoliosis correction with instrumentation affected pulmonary function less than open thoracotomy approaches at 2 years follow-up. The thoracoscopic approach has been shown to have a smaller reduction in pulmonary function tests (PFTs) compared with an open thoracotomy approach following anterior thoracic instrumentation for adolescent idiopathic scoliosis in the immediate postoperative period; however, it is unclear if a difference remains 2 years following the procedure. A total of 107 patients in a multicenter adolescent idiopathic scoliosis database underwent an anterior instrumented fusion for thoracic scoliosis. PFTs assessing forced vital capacity (FVC), forced expiratory volume (FEV1), and total lung capacity (TLC) were obtained prospectively before and 2 years after surgery. The patients were grouped as follows: Group I, thoracoscopic instrumented fusion (n = 36); Group II, open (thoracotomy) instrumented fusion without thoracoplasty (n = 28); and Group III, open instrumented fusion with thoracoplasty (n = 43). Thoracoscopic instrumentation affected pulmonary function 2 years after surgery minimally, and on an average showed improvements in all parameters except the percent-predicted FVC, which decreased by 1% +/- 11%, and percent predicted FEV, which decreased by 2% +/- 9%. Improvements were noted in absolute FVC, FEV1, TLC, and percent-predicted TLC. This is in contrast to the patients treated with a thoracotomy, who had a greater persistent reduction in PFTs at follow-up. An added thoracoplasty to the thoracotomy approach, however, resulted in even greater residual reduction in PFTs at follow-up, with declines in percent-predicted FVC of 15%, percent-predicted FEV1 of 14%, and percent-predicted TLC of 8%. This study shows a clear advantage to the minimally invasive thoracoscopic approach with regards to pulmonary function when compared with the open thoracotomy approaches.

P.11.12 Pulmonary function characteristics of boys with Duchenne muscular dystrophy: Data from the CINRG longitudinal study project

Changes in pulmonary function of residents in Sanriku Seacoast following the tsunami disaster from the Great East Japan Earthquake.

We studied the effects of unilateral hemidiaphragmatic paresis caused by interscalene brachial plexus block on routine pulmonary function in eight patients. In an additional four patients, we studied changes in chest wall motion during interscalene block anesthesia by chest wall magnetometry. Ipsilateral hemidiaphragmatic paresis, as diagnosed by ultrasonography, developed in all patients within 5 min of interscalene injection of 45 mL of 1.5% mepivacaine with added epinephrine and bicarbonate. Large decreases in all pulmonary function variables were measured in every patient. Forced vital capacity and forced expiratory volume at 1 s decreased 27% +/- 4.3% and 26.4% +/- 6.8%, respectively (P = 0.0001). Peak expiratory and maximum midexpiratory flow rates were also significantly reduced. Interscalene block caused changes in pulmonary function and chest wall mechanical motion that were similar to those published in previous studies on patients with hemidiaphragmatic paresis of pathological or surgical etiology. Interscalene block probably should not be performed in patients who are dependent on intact diaphragmatic function and in those patients unable to tolerate a 25% reduction in pulmonary function.

A prospective clinical study. To observe postoperative change in pulmonary function in patients with ankylosing spondylitis (AS) kyphosis after pedicle subtraction osteotomy (PSO). The preoperative pulmonary dysfunction in patients with AS has been reported in several literatures, whereas few research about postoperative changes in pulmonary function with AS kyphosis was published. A total of 32 (27 males and 5 females) patients with AS were eligibly involved. Twenty-nine (25 males and 4 females) patients completed the follow-up and 3 (2 males and 1 females) patients were lost. Pulmonary function tests, breath-holding time (BHT), and full-length spine radiographs in natural standing position were followed postoperatively. The global kyphosis significantly decreased from 63.0°± 20.3° preoperatively to 15.3°± 10.3° postoperatively and 17.1°± 10.9° at the 2-year follow-up. The BHT before surgery was 32.5 ± 10.1 s, whereas the postoperative BHT had increased to 43.1 ± 8.6 s (P < 0.05). Two patients with AS underwent normal pulmonary function test before operation, whereas there were 19 patients at 2-year follow-up. The clinical improvement rate was 85.2% (23/27). The percent-predicted vital capacity had increased from 68.4% ± 9.5% to 79.4% ± 6.1% at 2-year follow-up (P < 0.05). The percent-predicted forced vital capacity before PSO was 75.5% ± 6.4% and it was 81.0% ± 6.9% at 2-year follow-up (P < 0.05). The improved percent-predicted vital capacity and predicted forced vital capacity had a positive correlation with the correction of global kyphosis (r = 0.6328 and 0.8612, respectively). The postoperative pulmonary function including pulmonary volume and ventilatory function in patients with AS with kyphosis had significantly improved at 2-year follow-up. And, the improved pulmonary function had a positive correlation with the kyphosis correction. 3.