Pancreatic cystosis in cystic fibrosis. Sometimes a bike ride can help you decide

Pancreatic cystosis (PC) is an uncommon manifestation of pancreas involvement in cystic fibrosis (CF), characterized by the presence of multiple macrocysts partially or completely replacing pancreas. Only few reports are available from literature and management (surgery vs follow up) is commonly based on the presence of symptoms or complications due to local mass effect, although evidence-based recommendations are still not available. We here report the case of a young adult CF patient with PC, in which cardiopulmonary exercise testing (CPET) provided important information to be integrated to the radiological finding of inferior vena cava compression by the multicystic pancreas complex. Through the analysis of oxygen kinetic cardiodynamic phase pattern, CPET may be helpful to safely exclude significant mass effects on blood venous return and to improve the decision-making process on whether to consider surgery or not in patients with PC

The clinical value of cardiopulmonary exercise testing in the modern era

Cardiopulmonary exercise testing (CPET) has long been used as diagnostic tool for cardiac diseases. During recent years CPET has been proven to be additionally useful for 1) distinguishing between normal and abnormal responses to exercise; 2) determining peak oxygen uptake and level of disability; 3) identifying factors contributing to dyspnoea and exercise limitation; 4) differentiating between ventilatory (respiratory mechanics and pulmonary gas exchange), cardiovascular, metabolic and peripheral muscle causes of exercise intolerance; 5) identifying anomalies of ventilatory (respiratory mechanics and pulmonary gas exchange), cardiovascular and metabolic systems, as well as peripheral muscle and psychological disorders; 6) screening for coexistent ischaemic heart disease, peripheral vascular disease and arterial hypoxaemia; 7) assisting in planning individualised exercise training; 8) generating prognostic information; and 9) objectively evaluating the impact of therapeutic interventions. As such, CPET is an essential part of patients’ clinical assessment. This article belongs to the special series on the “Ventilatory efficiency and its clinical prognostic value in cardiorespiratory disorders”, addressed to clinicians, physiologists and researchers, and aims at encouraging them to get acquainted with CPET in order to help and orient the clinical decision concerning individual patients

Clinical use of Heliox in Asthma and COPD

Heliox is a low density gas mixture of helium and oxygen commonly used in deep diving (> 6 ATM). This mixture has been also used for clinical purposes, particularly in the critical care setting. Due to of its physical proprieties, Heliox breathing reduces air flow resistances within the bronchial tree; in patients with obstructive lung diseases Heliox may also reduce the work of breathing and improve pulmonary gas exchange efficiency. Beneficial effects have been documented in severe asthma attacks and in patients with chronic obstructive pulmonary disease. A reduction in WOB during mechanical ventilation and an increase in exercise endurance capacity have also been described in COPD. Heliox has been also used in the treatment of upper airways obstruction, bronchiolitis and bronchopulmonary dysplasia. Despite the encouraging results, Heliox use in routine practice remains controversial because of technical implications and high costs

Physical activity, nutritional status and systemic inflammation in COPD

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Respiratory Effects of Exposure to Traffic-Related Air Pollutants During Exercise

Traffic-related air pollution (TRAP) is increasing worldwide. Habitual physical activity is known to prevent cardiorespiratory diseases and mortality, but whether exposure to TRAP during exercise affects respiratory health is still uncertain. Exercise causes inflammatory changes in the airways, and its interaction with the effects of TRAP or ozone might be detrimental, for both athletes exercising outdoor and urban active commuters. In this Mini-Review, we summarize the literature on the effects of exposure to TRAP and/or ozone during exercise on lung function, respiratory symptoms, performance, and biomarkers. Ozone negatively affected pulmonary function after exercise, especially after combined exposure to ozone and diesel exhaust (DE). Spirometric changes after exercise during exposure to particulate matter and ultrafine particles suggest a decrease in lung function, especially in patients with chronic obstructive pulmonary disease. Ozone frequently caused respiratory symptoms during exercise. Women showed decreased exercise performance and higher symptom prevalence than men during TRAP exposure. However, performance was analyzed in few studies. To date, research has not identified reliable biomarkers of TRAP-related lung damage useful for monitoring athletes' health, except in scarce studies on airway cells obtained by induced sputum or bronchoalveolar lavage. In conclusion, despite partly counteracted by the positive effects of habitual exercise, the negative effects of TRAP exposure to pollutants during exercise are hard to assess: outdoor exercise is a complex model, for multiple and variable exposures to air pollutants and pollutant concentrations. Further studies are needed to identify pollutant and/or time thresholds for performing safe outdoor exercise in cities

A simplified approach to the interpretation of arterial blood gas analysis

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ers school first educational research seminar weathering the winds of change through medical education

In this uncertain time of fast-moving societal, economic and technological changes reshaping the medical profession in general, the respiratory specialty is presented with significant challenges and, at the same time, distinct and valuable opportunities. The movement of both patients and doctors within the European Union has focused even greater attention on the competence of doctors and their fitness to practice. Horsley et al . [1] describe the variation between continuing professional development systems across EU countries and argues for harmonisation of accreditation systems to simplify this process. At the same time, technological changes have introduced new concepts and challenges in how we conduct medical education both by instruction and assessment, such as in e-learning, simulators and simulation scenarios. These trends will particularly impact on the practice of respiratory medicine and it is therefore crucial that theprofession keeps pace. This requires particular efforts in education and training. Medical education reforms then become relevant, and calls for: 1) standardising learning outcomes and individualising the learning process; 2) promoting multiple forms of integration; 3) methods of self-reflection and self-improvement; and 4) focusing on the progressive formation of the physician's professional identity [2]. These reforms will need to be supported appropriately by the EU and member states. The European Respiratory Society (ERS) is in a unique position to propose EU-wide principles, values and measures. For this reason, the ERS has engaged in a critical self-reflection of the current state of educational policies within the society as well as determining future directions by organising the first ERS educational research seminar. The ERS School organised an educational research seminar on June 3–4, 2011 in Dublin, Ireland. International experts in medical education and respiratory medicine attended, including colleagues from the American College of Chest Physicians and the American Thoracic

Functional outcome of locking anatomical plate in extra articular fractures of the distal humerus

Background: Extra articular distal humerus fractures are difficult to treat with conventional implants like intra medullary nail, 4.5 DCP and dual plate. The present study aims to study the functional outcome of the extra articular distal humerus plate (EADHP).Methods: 48 patients with displaced extra articular distal humerus fractures were included in the study. Inclusion criteria were age more than 18 years, closed fractures with or without radial nerve palsy and less than 3 weeks old trauma. Patients aged less than 18 years, those having open fractures, fractures more than 3 weeks old, non – unions and pathological fractures were excluded from the study. All patients were operated with EADHP. Clinically, the outcome was assessed by the disability of arm, shoulder and hand (DASH) score and elbow range of motion radiologically, union was evaluated on anteroposterior and lateral radiographs.Results: Out of 48 patients, 12 had AO type 12 A1 fracture, 26 patients had type B1 fractures and remaining 10 had type C1 fractures. Mean DASH score at final follow up was 18.1; range being 12.6 to 35.7 points. The mean elbow range of motion was 0 to 130 degrees (range: 120 to 140 degrees). The mean duration for complete radiological fracture union was 14 weeks, range being 12 to 18 weeks.Conclusions: The extraarticular distal humerus plate is an ideal implant for the fixation of distal humerus fractures since it provides good stability of fracture and enables early return to function

Exercise respiratory cycle time components in patients with emphysema

Background: We have recently demonstrated that in patients with COPD the severity of emphysema (E) measured by high resolution computed tomography (HRCT) correlated with: ratio VTpeak/FEV1; VE/VCO2 slope and PETCO2 values at peak exercise. The aim of this study was to further investigate if exercise respiratory cycle time components correlated with % of E measured by HRCT. Method: Twelve patients (age = 65±8 yrs; FEV1 = 55±17%pred) with moderate to severe E (quantified by lung HRCT as % voxels < −910 HU) were evaluated with incremental cardiopulmonary exercise testing (CPET). Mean inspiratory time (TiM), mean total respiratory cycle time (TtotM), mean expiratory time during exercise (TeM) and mean expiratory time during the last third of exercise (TeM-end), has been calculated. Results: Both TeM and TeM-end had a good linear correlation with % of E (r = 0,61; p = 0,004 and r = 0,63; p = 0,003). Moreover, by dividing the patients in two groups based on the % of E (>50% and <50%), we observed that patients with higher % of E had longer TeM (TeM: 1,72±0,26sec vs 1,34±0,27sec, p = 0,005) and TeM-end. A good linear correlation has been observed also between TeM and PETCO2 and VE/VCO2 (r = 0,64; p = 0,002 and r = 0,7; p = 0,0005). TeM did not correlated with resting lung function values or inspiratory capacity (IC). Conclusion: The data confirm that distinct physiologic response pattern can be detected at CPET in these patients