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International Journal of Chronic... 2020Obstructive ventilatory disturbances occur in both chronic obstructive pulmonary disease (COPD), a typical disease representative of peripheral airway obstruction, and...
BACKGROUND
Obstructive ventilatory disturbances occur in both chronic obstructive pulmonary disease (COPD), a typical disease representative of peripheral airway obstruction, and central airway obstruction (CAO). Pulmonary function tests (PFTs), which depend on patient effort, are traditionally used to evaluate lung function. The forced oscillation technique (FOT) is an effort-independent method for examining lung function during tidal breathing. The FOT is used universally to assess respiratory function in patients with COPD. Several studies have measured FOT to assess ventilatory disturbances in CAO. The results showed that FOT measurements in patients with CAO were similar to those reported in patients with COPD. However, no studies have compared FOT measurements directly between CAO and COPD. The aim of this study was to identify differences in ventilatory disturbances between peripheral and central airway obstructions in COPD and CAO, before patients received pharmacological therapy or bronchoscopic interventions, respectively.
PATIENTS AND METHODS
We retrospectively included 16 patients with CAO (10 cases of tracheal obstruction and 6 cases of bronchial obstruction) and 75 treatment-naïve patients with COPD (60 cases in Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage II and 15 cases in GOLD stage III) that were admitted from December 2013 to May 2017. Prior to treatment, patients were examined with the FOT and PFTs.
RESULTS
All parameters measured with the FOT in the inspiratory phase were significantly worse in patients with CAO than in patients with COPD. The PFTs showed that the CAO group had a significantly lower peak expiratory flow rate. In the airway wall thickening phenotype of COPD, a difference between the inspiratory and expiratory phases of the resonance frequency (ΔFres) was the best indicator for distinguishing between peripheral and central airway obstructions.
CONCLUSION
This study compared differences between CAO and COPD (mainly GOLD stage II). We found that the FOT measurement, ΔFres, was the optimal indicator of the difference between the airway wall thickening COPD phenotype and CAO. Thus, the difference might be due to mechanical changes that occur in COPD with airway wall thickening.
Topics: Airway Obstruction; Airway Resistance; Forced Expiratory Volume; Humans; Oscillometry; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests; Retrospective Studies
PubMed: 32606651
DOI: 10.2147/COPD.S246126 -
American Journal of Otolaryngology 2014Drug-induced sleep endoscopy (DISE) is used to identify the site of obstruction causing obstructive sleep apnea (OSA). However, previous studies have reported a wide...
PURPOSE
Drug-induced sleep endoscopy (DISE) is used to identify the site of obstruction causing obstructive sleep apnea (OSA). However, previous studies have reported a wide range of DISE findings, and new patterns of airway obstruction have also been observed during postoperative DISE. Therefore, we aimed to determine the features of changes in obstructive patterns during DISE.
MATERIALS AND METHODS
Forty-two patients diagnosed with OSA underwent DISE for 25 min. Sites of obstruction were determined at the levels of the velum, lateral wall of the oropharynx, tongue base, and epiglottis. The velum obstruction configuration was classified as anteroposterior, lateral, or concentric.
RESULTS
The obstructive pattern changed in 14 patients (33%). We observed a change in the site of obstruction in 9 patients (21.4%) and in the configuration of velum obstruction in 5 patients (11.9%). The changes occurred between 3 and 22 min after commencing DISE (mean, 10.6 ± 6.2 min). The proportion of obstructions in the velum, lateral wall of the oropharynx, and tongue base increased with longer DISE durations. The proportion of multiple-level obstructions increased significantly after 15 min (P<0.05). In the velum, anteroposterior obstructions in 2 patients and lateral obstructions in 3 patients changed into concentric obstructions. More configurations were observed with longer procedure durations.
CONCLUSIONS
Hence, we assume that it is possible to miss the site of obstruction during DISE if the procedure is too short, which may partly explain the discrepancies between studies.
Topics: Adult; Airway Obstruction; Endoscopy; Female; Humans; Male; Middle Aged; Oropharynx; Palate, Soft; Polysomnography; Sleep; Sleep Apnea, Obstructive; Time Factors; Tongue
PubMed: 24051233
DOI: 10.1016/j.amjoto.2013.08.017 -
Otolaryngology--head and Neck Surgery :... Apr 2010A real-time MRI "movie" during natural sleep ("Sleep MRI") allows observation of dynamic airway obstructions in obstructive sleep apnea syndrome (OSAS) patients. The...
OBJECTIVE
A real-time MRI "movie" during natural sleep ("Sleep MRI") allows observation of dynamic airway obstructions in obstructive sleep apnea syndrome (OSAS) patients. The purpose of this article was to determine the reliability of assessing these obstructions.
STUDY DESIGN
Cross-sectional diagnostic test evaluation.
SETTING
Academic referral center.
SUBJECTS AND METHODS
A total of 23 Sleep MRI sequences randomly selected from 20 consecutive OSAS patients were analyzed by two experienced sleep surgeons on two separate occasions separated by at least two weeks. Five dimensions were assessed: presence or absence of any obstruction, presence or absence of a retropalatal obstruction, presence or absence of a retroglossal obstruction, presence or absence of a swallow, and duration of an obstructive event.
RESULTS
For all dimensions measured, intra-rater reliability coefficients ranged from a low of 0.95 to a high of 1.0 for each rater. Inter-rater reliability coefficients ranged from a low of 0.85 to a high of 1.0. On two separate evaluations separated by at least two weeks, rater 1 identified a retropalatal obstruction in 100 percent of sequences, whereas rater 2 did so in 91 percent and 96 percent of the sequences, respectively. Retroglossal obstruction was identified in 57 percent (rater 1) and 65 percent (rater 2) of sequences.
CONCLUSION
Intra-rater and inter-rater reliability coefficients are very high for determination of presence or absence of any obstruction, presence or absence of a retropalatal obstruction, presence or absence of a retroglossal obstruction, presence or absence of a swallow, and duration of obstruction from Sleep MRI sequences in OSAS patients.
Topics: Adult; Airway Obstruction; Cross-Sectional Studies; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Prospective Studies; Reproducibility of Results; Sleep; Sleep Apnea, Obstructive
PubMed: 20304272
DOI: 10.1016/j.otohns.2010.01.003 -
CASE (Philadelphia, Pa.) Dec 2020• MAC may obstruct the LVOT. • This can be diagnosed using multimodality imaging. • Surgical debridement of mitral calcification can relieve obstructive physiology.
• MAC may obstruct the LVOT. • This can be diagnosed using multimodality imaging. • Surgical debridement of mitral calcification can relieve obstructive physiology.
PubMed: 33376840
DOI: 10.1016/j.case.2020.07.009 -
International Journal of Chronic... 2017According to guidelines, the diagnosis of COPD should be confirmed by post-bronchodilator (post-BD) airway obstruction on spirometry; however, in clinical practice, this...
INTRODUCTION
According to guidelines, the diagnosis of COPD should be confirmed by post-bronchodilator (post-BD) airway obstruction on spirometry; however, in clinical practice, this is not always performed. The aim of this population-based study was to compare clinical characteristics and prognosis, assessed as mortality, between subjects with airway obstruction divided into pre- but not post-BD obstruction, post-BD airway obstruction (COPD), and subjects without airway obstruction.
MATERIALS AND METHODS
In 2002-2004, four adult population-based cohorts were reexamined with spirometry and structured interview. Subjects with airway obstruction, with a ratio of forced expiratory volume in 1 s to (forced) vital capacity <0.70 (n=993), were identified together with sex- and age-matched referents (n=993). These subjects were further divided into subjects with pre- but not post-BD airway obstruction (pre- not post-BD obstruction) and subjects with post-BD airway obstruction (COPD). Mortality data were collected until December 31, 2014.
RESULTS
Out of 993 subjects with airway obstruction, 736 (74%) had COPD and 257 (26%) pre- not post-BD obstruction. Any respiratory symptoms, allergic rhinitis, asthma, exacerbations, and comorbidities were equally common among subjects with COPD and pre- not post-BD obstruction, but less common among nonobstructive subjects. Mortality was highest among subjects with COPD and higher in men than in women. In both sexes, COPD, but not pre- not post-BD obstruction, was associated with an increased risk for death compared to those without airway obstruction. When COPD was divided into Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, GOLD 2 and 3-4 had an increased risk for death when compared to the nonobstructive group, also when adjusted for common confounders and comorbidities such as heart disease, diabetes, and anxiety/depression.
CONCLUSION
Even though subjects with COPD and pre- not post-BD obstruction had fairly similar presentation of clinical characteristics, only those with COPD, specifically GOLD stage ≥2, had increased risk for death when compared with nonobstructive subjects.
Topics: Aged; Bronchodilator Agents; Female; Forced Expiratory Volume; Humans; Kaplan-Meier Estimate; Lung; Male; Middle Aged; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Pulmonary Disease, Chronic Obstructive; Risk Factors; Spirometry; Time Factors; Vital Capacity
PubMed: 28490870
DOI: 10.2147/COPD.S127923 -
Clinics in Colon and Rectal Surgery May 2022Despite an increase in screening colonoscopy, with the objective to decrease the incidence of colorectal cancer, a third of patients will present with an obstructing... (Review)
Review
Despite an increase in screening colonoscopy, with the objective to decrease the incidence of colorectal cancer, a third of patients will present with an obstructing cancer. Malignant large bowel obstructions (MLBO) pose a challenging workup and treatment paradigm where an oncologic primary tumor resection must be balanced with relieving the obstruction, functional outcomes, palliation, and consideration for adjuvant therapy. A thorough work up with cross-sectional imaging and medical optimization should be attempted; however, patients may present and require emergent intervention. The onset of MLBO can be insidious, but result in electrolyte derangements, perforation, small bowel obstruction, hemorrhage, and ischemia. Self-expandable metallic stents have been used as palliation or as a bridge to surgery and have allowed for minimally invasive surgical options as well as a decrease in stoma rates. Patients with signs of colon ischemia or perforation require emergent surgery, which is associated with an increase in stoma formation, morbidity, mortality, and a decrease in overall survival.
PubMed: 35966387
DOI: 10.1055/s-0042-1742589 -
Journal of Endourology Feb 2022Drainage of obstructed kidney attributable to extrinsic ureteral obstruction (EUO), required to prevent renal damage, is often achieved using Double-J ureteral stents....
Drainage of obstructed kidney attributable to extrinsic ureteral obstruction (EUO), required to prevent renal damage, is often achieved using Double-J ureteral stents. However, these stents fail frequently, and there is considerable debate regarding what stent size, type, and configuration offer the best option for sustained drainage. In this study, we examine the impact of stent diameter and choice of single/tandem configuration, subject to EUO and various degrees of stent occlusion, on stent failure. Computational fluid dynamics simulations and an ureter-stent experiment enabled quantification of flow behavior in stented ureters subject to EUO and stent occlusions. Various single and tandem stents under EUO were considered. In each simulation and experiment, changes in renal pressure were monitored for different degrees of stent lumen occlusion, and onset of stent failure as well as simulated distributions of fluid flow between stent and ureter lumina were determined. For an encircling EUO that completely obstructs the ureter lumen, with or without partial stent occlusion, the choice of stent size/configuration has little effect on renal pressure. The pressure increases significantly for ∼90% stent lumen occlusion, with failure at >95% occlusion, independent of stent diameter or a tandem configuration, and with little influence of occlusion length along the stent. Stent failure rate is independent of stent diameter or single/tandem configuration, for the same percentage of stent lumen occlusion, in this model. Stent failure incidence may decrease for larger diameter stents and tandem configurations, because of the larger luminal area.
Topics: Drainage; Humans; Kidney; Stents; Ureter; Ureteral Obstruction
PubMed: 34314233
DOI: 10.1089/end.2021.0426 -
Mayo Clinic Proceedings May 1975Though endometriosis is a frequent finding in females, it rarely causes obstruction of the small bowel. However, 11 patients with such obstruction were seen at the Mayo...
Though endometriosis is a frequent finding in females, it rarely causes obstruction of the small bowel. However, 11 patients with such obstruction were seen at the Mayo Clinic in the years 1950 through 1970. Their ages ranged from 27 years to 51. A portion of involved bowel had to be resected in every case, but most of the lesions were single. Generally the obstructions were subacute and did not produce surgical emergencies. But because the symptoms were neither specific nor acute, the diagnosis seldom was established prior to laparotomy and the majority of the resections were performed without bowel preparation. Nevertheless, morbidity was minor in most cases and there was no mortality. Small-bowel obstruction has not recurred. Endometriosis of the small bowel tends to be limited to the serosa and the muscular coats, not penetrating the mucosa; and obstruction is due to fibrosis and kinking of the bowel. The obstructed segment usually must be resected. If pelvic endometriosis is minimal, no further surgery is necessary. But if the pelvic lesions are extensive, or if multiple sites in the small and large intestines are involved, then more radical resection and bilateral oophorectomy are indicated.
Topics: Adult; Endometriosis; Female; Humans; Intestinal Neoplasms; Intestinal Obstruction; Intestine, Small; Middle Aged
PubMed: 1127991
DOI: No ID Found -
Computers in Biology and Medicine Sep 2019The aim of this study was to research, develop and assess the feasibility of using basic statistical parameters derived from renogram, "mean count value (MeanCV) and...
OBJECTIVE
The aim of this study was to research, develop and assess the feasibility of using basic statistical parameters derived from renogram, "mean count value (MeanCV) and "median count value (MedianCV)", as novel indices in the diagnosis of renal obstruction through diuresis renography.
SUBJECTS AND METHODS
First, we re-digitalized and normalized 132 renograms from 74 patients in order to derive the MeanCV and MedianCV. To improve the performance of the parameters, we extrapolated renograms by a two-compartmental modeling. After that, the cutoff points for diagnosis using each modified parameter were set and the sensitivity and specificity were calculated in order to determine the best variants of MeanCV and MedianCV that could differentiate renal obstruction status into 3 distinct classes - i) unobstructed, ii) slightly obstructed, and iii) heavily obstructed.
RESULTS
The modified MeanCV and MedianCV derived from extended renograms predicted the severity of the renal obstruction. The most appropriate variants of MeanCV and MedianCV were found to be the MeanCV and the MedianCV. The cutoff points of MeanCV in separating unobstructed and obstructed classes as well as slightly and heavily obstructed classes were 0.50 and 0.72, respectively. The cutoff points of MedianCV in separating unobstructed and obstructed classes as well as slightly and heavily obstructed classes were 0.35 and 0.69, respectively. Notably, MeanCV and MedianCV were not significantly influenced by either age or gender.
CONCLUSIONS
The MeanCV and the MedianCV derived from a renogram could be incorporated with other quantifiable parameters to form a system that could provide a highly accurate diagnosis of renal obstructions.
Topics: Adult; Algorithms; Female; Humans; Image Interpretation, Computer-Assisted; Kidney Diseases; Male; Middle Aged; Radioisotope Renography; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Mertiatide
PubMed: 31404720
DOI: 10.1016/j.compbiomed.2019.103371 -
International Journal of Urology :... Mar 2018To report the treatment outcomes of patients with extrinsic ureteral obstruction treated with metallic stents and to identify the factors predicting stent failure.
OBJECTIVES
To report the treatment outcomes of patients with extrinsic ureteral obstruction treated with metallic stents and to identify the factors predicting stent failure.
METHODS
A total of 52 patients with extrinsic ureteral obstruction as a result of malignancy (66 ureters) were treated with metallic stents (Resonance ) and included in the study. The median observation period was 118 days.
RESULTS
The median survival time of these patients was 210 days, and the stent patency rate was 86.0% at 6 months and 60.0% at 1 year. Eight (15.4%) patients underwent nephrostomy as a result of stent failure. The occlusion rate of bilateral ureteral obstructed cases was significantly higher than that of unilateral cases. There was no correlation between the preoperative serum creatinine level, causes of ureteral occlusions (compression by tumor, lymph node metastasis, peritoneal dissemination), obstructed site (upper, middle, lower ureter) and stent failure.
CONCLUSIONS
Metallic stents are excellent in maintaining patency compared with the conventional stents. Therefore, they can be used as first-line treatment of malignant ureteral obstructions.
Topics: Adult; Aged; Aged, 80 and over; Equipment Failure; Female; Humans; Male; Middle Aged; Neoplasms; Prosthesis Implantation; Retrospective Studies; Stents; Treatment Outcome; Ureter; Ureteral Obstruction; Urologic Surgical Procedures
PubMed: 29194771
DOI: 10.1111/iju.13500