The other explanation for dyspnea: giant paraesophageal hiatal hernia repair routinely improves pulmonary function

2019 ◽  
Vol 32 (9) ◽  
Author(s):  
Andrea Wirsching ◽  
Fredrik Klevebro ◽  
Piers R Boshier ◽  
Michal Hubka ◽  
Madhan K Kuppusamy ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Respiratory Function ◽  
Surgical Repair ◽  
Pulmonary Function Tests ◽  
Gastrointestinal Symptoms ◽  
Hiatal Hernia Repair ◽  
Intrathoracic Stomach ◽  
Presenting Symptoms ◽  
Function Tests ◽  
Elective Repair

SUMMARY Paraesophageal hiatal hernias (PEHs) are most commonly associated with gastrointestinal symptoms; less widely appreciated is their potentially important influence on respiratory function. We hypothesize that surgical repair of PEH will significantly improve not only gastrointestinal symptoms, but also preoperative dyspnea and spirometry scores. A prospective Institutional Review Board-approved database was used to review all patients undergoing PEH repair from 2000 to 2016. Patients with pre- and postoperative pulmonary function tests assessed by spirometry were included. Postoperative changes in spirometry measurements were compared to PEH size as reflected by the percentage of intrathoracic stomach observed on preoperative contrast studies. Patients were stratified according to improvement in forced expiratory volume in 1 second (FEV1). Patients with >12% (‘significant’) improvement in FEV1 after surgery were compared to the remaining patient population. In total, 299 patients met the inclusion criteria. Symptomatic improvement in respiratory function was noted in all patients after PEH repair. Age, gender, BMI, presenting symptoms, Charlson comorbidity index as well as preoperative comorbidities did not significantly impact the functional outcome. Spirometry results improved in 80% of the patients, 21% of whom showed an improvement of >20% compared to the preoperative level. ‘Significant’ improvement in respiratory function was seen in 122 of 299 (41%) patients. Patients presenting with moderate and severe preoperative pulmonary obstruction demonstrated ‘significant’ improvement in FEV1 in 48% and 40% of cases, respectively. Large PEHs, characterized by a percentage of intrathoracic stomach >75%, was strongly associated with ‘significant’ improvement in FEV1 (P = 0.001). PEHs can impact subjective and objective respiratory status and surgical repair can result in a significant improvement in dyspnea and pulmonary function score that is independent of preoperative pulmonary disease. Gastric herniation of more than 75% was associated with higher possibility for improvement of pulmonary function tests. Patients with persistent and unexplained dyspnea and coexistent PEH should be assessed by an experienced surgeon for consideration of elective repair.

Continuous Ambulatory Peritoneal Dialysis and Pulmonary Function

1983 ◽  
Vol 28 (4) ◽  
pp. 355-356 ◽  
Author(s):  
W. G. J. Smith ◽  
K. R. Patel ◽  
J. D. Briggs ◽  
B. J. R. Junor
Keyword(s):  
Peritoneal Dialysis ◽  
Pulmonary Function ◽  
Lung Disease ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Respiratory System ◽  
Respiratory Function ◽  
Pulmonary Function Tests ◽  
Lung Volumes ◽  
Function Tests ◽  
Supine Posture

Pulmonary function tests were performed in ten patients established on continuous ambulatory peritoneal dialysis. A decrease in all lung volumes was observed after instillation of dialysate and a further decrease on change from the erect to the supine posture. This change was small and unlikely to have a functionally significant effect in patients with a healthy respiratory system. However, in patients with pre-existing lung disease, respiratory function might be further compromised.

scholarly journals Impact of Paraesophageal Hernia Repair on Respiratory Function: A Systematic Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Dominick Myers ◽  
Xander Jacobson ◽  
Matthew Dale ◽  
Venket Sahasranaman ◽  
Kalyana Nandipati
Keyword(s):  
Hernia Repair ◽  
Pulmonary Function ◽  
Respiratory Function ◽  
Literature Search ◽  
Paraesophageal Hernia ◽  
Surgical Repair ◽  
Paraesophageal Hernia Repair ◽  
Intrathoracic Stomach ◽  
Postoperative Pulmonary Function ◽  
The Subject

Background and Objectives: Surgical repair of hiatal and paraesophageal hernia is widely accepted for the treatment of gastroesophageal reflux symptoms. The respiratory benefit of this surgery is less clear. The objective of this review is to quantify the benefit to pulmonary function and subjective dyspnea of paraesophageal hernia repair with the aim of refining the indications and contraindications for elective paraesophageal hernia repair.Methods: Articles were gathered from systematic searches of the Medline Complete Database via the Creighton University Health Sciences Library literature search services. Publications with both pre and postoperative pulmonary function data or both pre and postoperative subjective dyspnea data with regards to surgical paraesophageal hernia repair were included.Results: Six studies were included in this review. The majority of studies in this review show improvement in pulmonary function postoperatively with regards to FEV1, FVC, and VC when stratified by % intrathoracic stomach (ITS), particularly in groups >50% ITS. No significant change was seen in postoperative DLCO or FEV1/FVC.Conclusion: Paraesophageal hernia repair has shown to improve pulmonary function both objectively and subjectively. This review was limited by the paucity of literature on the subject as well as the lack of a standardized method for measurement of %ITS.

Study of pulmonary function tests in tobacco factory workers

2018 ◽  
Vol 6 (3) ◽  
pp. 16-19
Author(s):  
Gajanan V Patil ◽  
◽  
Atish Pagar ◽  
U S Patil ◽  
M K Parekh ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Pulmonary Function Tests ◽  
Factory Workers ◽  
Function Tests

Pulmonary Function Tests in European Birth Cohorts

2013 ◽  
Vol 9 (1) ◽  
pp. 3-10
Author(s):  
Linus Grabenhenrich ◽  
Cynthia Hohmann ◽  
Remy Slama ◽  
Joachim Heinrich ◽  
Magnus Wickman ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Pulmonary Function Tests ◽  
Birth Cohorts ◽  
Function Tests

Pulmonary Function Tests Fail to Predict Exercise Intolerance in Sheep with Emphysema

2005 ◽  
Vol 37 (4) ◽  
pp. 550-556
Author(s):  
MELISSA R. MAZAN ◽  
EDWARD P. INGENITO ◽  
LARRY TSAI ◽  
ANDREW HOFFMAN
Keyword(s):  
Pulmonary Function ◽  
Pulmonary Function Tests ◽  
Exercise Intolerance ◽  
Function Tests

ISOLATED ABNORMALITIES OF DIFFUSION CAPACITY (DLCO) IN PULMONARY FUNCTION TESTS AMONG INNER CITY PATIENTS

CHEST Journal ◽  
2008 ◽  
Vol 134 (4) ◽  
pp. 49S
Author(s):  
Ibrahim H. Abou Daya ◽  
Muhammad U. Anwer ◽  
Gilda Diaz-Fuentes ◽  
Steve Blum ◽  
Latha Menon
Keyword(s):  
Pulmonary Function ◽  
Inner City ◽  
Pulmonary Function Tests ◽  
Diffusion Capacity ◽  
Function Tests

Shrinking lung syndrome in pediatric systemic lupus erythematosus

Lupus ◽  
2021 ◽  
pp. 096120332110103
Author(s):  
Alfonso Ragnar Torres Jimenez ◽  
Nayma Ruiz Vela ◽  
Adriana Ivonne Cespedes Cruz ◽  
Alejandra Velazquez Cruz ◽  
Alma Karina Bernardino Gonzalez
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Pleural Effusion ◽  
Pulmonary Function ◽  
Lupus Erythematosus ◽  
Pulmonary Function Tests ◽  
Age At Diagnosis ◽  
X Rays ◽  
Systemic Lupus ◽  
Function Tests ◽  
Restrictive Pattern

Shrinking Lung Syndrome (SLS) is a rare and little known complication associated with Systemic Lupus Erythematosus (SLE), characterized by progressive and unexplainable dyspnea, pleuritic pain, small pulmonary volumes and elevation of the diaphragm on chest X-rays as well as restrictive pattern on pulmonary function tests. Objective To describe clinical, radiological and treatment characteristics in pediatric patients with SLS. Material and methods This is a descriptive and retrospective study in patients under 16 years old with the diagnosis of SLE complicated by SLS at the General Hospital. National Medical Center La Raza. Clinical, radiological and treatment variables were analyzed. Results are shown in frequencies and percentages. Results Data from 11 patients, 9 females and 2 males were collected. Mean age at diagnosis of SLS was 12.2 years. Age at diagnosis of SLE was 11.1 years. SLEDAI 17.3. Renal desease 72%, hematological 91%, lymphopenia 63%, mucocutaneous 72%, neurological 9%, arthritis 54%, serositis 91%, fever 81%, secondary antiphospholipid syndrome, low C3 72%, low C4 81%, positive ANA 91%, positive anti-DNA 91%. Regarding clinical manifestations of SLE: cough 81%, dyspnea 91%, hipoxemia 81%, pleuritic pain 71%, average oxygen saturation 83%. Chest X-rays findings: right hemidiaphragm affection 18%, left 63%, bilateral 18%. Elevated hemidiaphragm 91%, atelectasis 18%, pleural effusion 91%, over one third of the cardiac silhouette under the diphragm 36%, bulging diaphragm 45%, 5th. anterior rib that crosses over the diaphragm 91%. M-mode ultrasound: diaphragmatic hypomotility 100%, pleural effusion 63%. Pulmonary function tests: restrictive pattern in 45% of the cases. Treatment was with supplementary oxygen 100%, intubation 18%, antibiotics 100%, steroids 100%, intravenous immunoglobulin 54%, plasmapheresis 18%, cyclophosphamide 54% and rituximab 18%. The clinical course was favorable in 81%. Conclusions SLS should be suspected in patients with SLE and active disease who present hipoxemia, pleuritic pain, cough, dyspnea, pleural effusion and signs of restriction on chest X-rays. Therefore, a diaphragmatic M-mode ultrasound should be performed in order to establish the diagnosis.

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