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Background: Extubation is a critical process in the ICU. Pulmonary USG has different applications, those that predict success in extubation, such as the diaphragmatic excursion time index (DEIT). Objective: To determine the diaphragmatic excursion time index is a predictor of the success of weaning off mechanical ventilation in patients in the intensive care unit. Material and methods: Diagnostic performance study in patients in the ICU and in the extubation protocol. Diaphragmatic measurement by USG, evaluating DEIT; cut-off point of 2.42 ± 1.55 cm/s. In the hypothesis test, a JI square was carried out between the two qualitative variables, in order to accept or reject H0, with a statistical significance of p < 0.05 to determine if there is dependence between the dependent and independent variables. Results: Total of 200 patients from the population, with successful extubation in 52.5% and extubation failure in 47.5%. Prognostic values of the DEIT were: S: 77.1% (68.2-84.1%), E: 56.8% (46.8-66.3%). ROC curve for ITED, AUC of 0.665 (0.58-0.74; p = 0.001). In secondary objectives, a correlation was made between ventilatory and demographic variables for successful extubation; with FvT (Rho: 0.680, p = 0.0001). Conclusions: The DEIT for withdrawal of mechanical ventilation has low sensitivity and specificity as a result of successful extubation. The finding that DEIT is not an adequate predictor determining the outcome of successful extubation. [ABSTRACT FROM AUTHOR]

The description of anastomosis of the phrenic nerve has been little studied and even controversial at present. Classical authors such as Testut have briefly described this anastomosis. 13 anatomical preparations formalized at 10% were used, identifying 26 phrenic nerves from their location in the neck and being dissected to their terminal distribution in the diaphragm muscle. A distribution of the phrenic nerve was observed in 3 terminal branches, anterior, lateral and posterior. These branches penetrate the muscle and run initially between the muscle fibers and then on the underside of the muscle and the fascia. In monitoring the anterior branch of the phrenic nerve, it was found that it divided into several branches. 2 constantly stood out, one anterior towards the sternum and another medial that borders the pericardium, which was of interest to us. In 38% of the cases, anastomoses were found between the right and left phrenic nerves, located mainly anterior to the pericardium, which would indicate a justification for reinnervation due to damage to the phrenic. This anatomical description is of utmost importance in cases of bilateral injury to the phrenic nerve and explains the recovery of the denervated diaphragm. [ABSTRACT FROM AUTHOR]

Introduction: one of the main effects of invasive mechanical ventilation is injury to the respiratory muscles, specifically the diaphragm. In which structural and functional alterations can occur that partially or totally modify its function. During mechanical ventilation, a process of disuse atrophy of said muscle occurs. Therefore, the clinical utility of measuring diaphragmatic muscle strength is important to know if the patient has the ability to activate the protective mechanisms of the airway to achieve successful extubation and removal of the mechanical ventilator in the shortest time possible. Objective: describe the measurement of muscle strength as a predictor of extubation in intensive care units. Material and methods: a literature review was carried out, carried out between 2011 and 2022. Results: patients who are subjected to prolonged mechanical ventilation generally develop a diaphragmatic muscle disorder, becoming a problem for the weaning, for it is important know the methods of measuring muscle strength. [ABSTRACT FROM AUTHOR]

Introduction: Diaphragmatic surface electromyography is a procedure designed to assess the diaphragm. The physiological values of the electrical activity may have potential use in rehabilitation, sports training, ventilatory support withdrawal in critical care units and follow-up of respiratory disease. Objective: To assess and describe the diaphragmatic function through surface electromyography in a population of individuals during spontaneous and forced breathing. Methods: Observational, exploratory cross-sectional study including subjects with no comorbidities. Diaphragmatic surface EMG was performed measuring the mean quadratic root during tidal volume and vital capacity breathing. The body composition of the participants was also assessed. Results: 28 males and 22 females were included in the study. The mean quadratic root of the tidal volume for two minutes was 13.94 µV for females and 13.31 µV for males. The vital capacity was 23.24 µV for males and 22.4 µV for females. A correlation was identified between the mean quadratic root, weight, and body surface. Conclusions: Mean quadratic root values of tidal volume in two minutes in healthy females and males have been documented. The mean quadratic root values are correlated with the physiological and functional characteristics of the participants. [ABSTRACT FROM AUTHOR]

Objective: To verify the relationship between the rectus femoris crosssectional area and diaphragmatic excursion with successful weaning from mechanical ventilation in chronic critically tracheostomized patients. Methods: This was a prospective observational cohort study. We included chronic critically ill patients (those who underwent tracheostomy placement after 10 days under mechanical ventilation). The rectus femoris cross-sectional area and diaphragmatic excursion were obtained by ultrasonography performed within the first 48 hours after tracheostomy. We measured rectus femoris cross-sectional area and diaphragmatic excursion to assess their association with weaning from mechanical ventilation, including their potential to predict successful weaning and survival throughout the intensive care unit stay. Results: Eighty-one patients were included. Forty-five patients (55%) were weaned from mechanical ventilation. The mortality rates were 42% and 61.7% in the intensive care unit and hospital, respectively. The fail group in relation to the success group at weaning presented a lower rectus femoris cross-sectional area (1.4 [0.8] versus 1.84 [0.76]cm2, p = 0.014) and lower diaphragmatic excursion (1.29 ± 0.62 versus 1.62 ± 0.51cm, p = 0.019). When rectus femoris cross-sectional area = 1.80cm2 and diaphragmatic excursion = 1.25cm was a combined condition, it had a strong association with successful weaning (adjusted OR = 20.81, 95%CI 2.38 - 182.28; p = 0.006) but not with intensive care unit survival (adjusted OR = 0.19, 95%CI 0.03 - 1.08; p = 0.061). Conclusion: Successful weaning from mechanical ventilation in chronic critically ill patients was associated with higher measurements of rectus femoris cross-sectional area and diaphragmatic excursion. [ABSTRACT FROM AUTHOR]

Introduction. Regional anesthesia is an important, innovative, and popular technique for anesthetic and painkiller management. In supraclavicular brachial plexus blockade, there is a 50-60% rate of diaphragmatic paralysis. Clinical presentation is variable according to the patient's internal and external factors. There are multiple radiological techniques in diagnosis, with ultrasounds being very useful due to their easy access. The objective is to determine the incidence of diaphragmatic paralysis secondary to supraclavicular brachial plexus blockade guided by ultrasound in a fourth level institution. Methodology. Prospective, longitudinal, analytical study. 110 patients were selected. Inclusion criteria: patients over 18 years of age subject to upper limb surgery with supraclavicular brachial plexus blockade. Exclusion criteria: ASA (American Society of Anesthesiologists) 4 and 5 patients, pregnant women BMI >35 kg/m² patients with neuromuscular background, restrictive or obstructive pulmonary disease, phrenic nerve paralysis, or diaphragmatic dysfunction. An analysis was carried out via statistical tests, describing the different degrees of diaphragmatic paralysis. Results. In patients who met the inclusion criteria, the incidence of diaphragmatic paralysis was 65% (37% with total and 28% with partial paralysis), 1.81% showed respiratory symptoms without hemodynamic changes. Discussion. Supraclavicular brachial plexus blockade is a technique related to diaphragmatic paralysis. Ultrasound has allowed for the incidence of this complication to be reduced. It is a useful method in post-operative diagnosis. Conclusions. Diaphragmatic paralysis after supraclavicular brachial plexus blockade is a complication mainly observed in patients with previous pulmonary problems. Therefore, it must be strictly monitored. [ABSTRACT FROM AUTHOR]

The main purpose of this study was to examine the correlation between the aerobic and anaerobic performance of diaphragm thickness in athletes. That study was conducted with 15 team athletes (TA) (age 21.80 ± 2.40 years), 15 individual athletes (IA) (age 18.93 ± 2.31 years) and the control group (CON) 10 people living sedentary lifestyles (age 23.60 ± 2.91 years). In this study, diaphragm muscle thickness (B-mode ultrasonography), respiratory function (spirometry and maximum inspiratory (MIP) and expiratory pressures (MEP), aerobic capacity yo-yo intermittent endurance Test 1 (YYIET-1), and anaerobic power by Monark 834 E were assessed. The diaphragm thickness was determined from the intercostalspace between the 8th and 9th ribs at the expiration time by ultrasound and from the intercostal space between the 10th and 11th ribs at inspiration and then, the thickness of the diaphragm was measured from the diaphragm is seen best. There was a positive correlation between DiTins(r= 0.477) and DiTins-ex(r= 0.473) parameters of TA. In IA, there was a significant correlation between DiTins and DiTins-ex parameters and Peak Power (r= 0.495 and 0.435, respectively) and average power (r= 0.483 and 0.446, respectively). No significant correlation in all parameters of the CON group (p<0.05). As a result, it was determined that athletes with high diaphragm thickness had higher anaerobic performance, and athletes with thinner diaphragm thickness had better VO2 Max capacity. The diaphragm thickness of the athletes in individual branches was thicker than the team athletes, and their anaerobic performance was also higher. [ABSTRACT FROM AUTHOR]

The growing acceptance of ultrasound in the evaluation of the thorax has allowed us to be more accurate in the diagnosis of patients with thoracic pathology; thus, ultrasound in the evaluation of the diaphragm, as the main respiratory muscle, facilitates an easy and reproducible diagnosis, with a short learning curve. So this review provides the ultrasound imaging characteristics of the diaphragm in terms of its anatomical and functional description. [ABSTRACT FROM AUTHOR]

Aim: The aim of study was verify if respiratory training program the influenced of nitrite/ nitrate (NO-2/NO-3 ) levels in Exhaled Breath Condensate (EBC) in candidate of cardiac surgery. Materials and Methods: 21 volunteers of both sexes, 50 years old, with weakness of inspiratory muscles and with indication of coronary artery bypass and/or heart valve surgery admitted in the Clinical Hospital of the Medical School of Ribeirão Preto of São Paulo University (FMRP/USP). Were randomized group training (TG=10) underwent a minimum of 9 days of inspiratory muscle training using an incentive spirometry "Threshold IMT", with progressive daily increase of load according to patient tolerance; and training control (CG=11) received only conventional physiotherapy without respiratory muscle training goal. We compared spirometric values, maximal inspiratory pressure, as well as the values of NO-2/NO3 in EBC before and after intervention in each group. Results: It was observed the increased muscle strength in inspiratory breath in the group control (p <0.03) and trained group (p <0.004), but just in trained group the NO-2/NO-3 levels in CEP was significant (p <0.05). Conclusion: Both conventional phisicaltherapy and inspiratory training protocol, even in the very short term, promoted an improvement in inspiratory muscle strength, but just inspiratory training influenced the concentration of NO-2/NO-3 mediators in CEP, which may suggest that the training may exert some influence on airway inflammation. Further studies with larger samples are needed to determine the benefit of mediator reduction with respiratory muscle strength training. [ABSTRACT FROM AUTHOR]

Direct piezoelectric conversion is very popular in generating power from mechanical stress. There is continuous progress in power harvesting from mechanical vibration. In this article, experimental tests on a piezoelectric circular plate, to evaluate the electric power produced by the piezoelectric conversion at low acceleration over a wide range of ambient vibration frequency, are presented. The experimental analysis is presented and discussed. The results demonstrate the potentiality of using low-cost piezoelectric diaphragms to harvest energy from ambient vibration. Under low acceleration (5.36 m/s2), the vibration frequency was varied in the range of 10– 200 Hz and the generated power was measured. Under a very small dynamic force (less than 0.06 N), the output power of 1.5 mW was obtained with an 8.5 mm drum harvester across a load resistance of 17.8 kΩ at a frequency of 173 Hz. [ABSTRACT FROM AUTHOR]

BACKGROUND: The diaphragm is the main respiratory muscle and plays an important role in breathing and physiological regulation. A therapy that aims to improve these conditions regarding the diaphragm, is the manual diaphragmatic release technique. OBJECTIVE: The aim of this study was to verify the clinical applicability of manual diaphragmatic release techniques and searching the main techniques, population, evaluated variables and outcomes. METHODS: The following electronic databases were searched: PubMed, Scielo and Science Direct, with the descriptors "Diaphragm [Mesh]" and "Musculoskeletal Manipulations [Mesh]" with their correspondents in the same language. There were included randomized clinical trial, non-randomized clinical trials, semi and quasiexperimental studies and pilot or case studies, which addressed manual diaphragmatic release techniques. RESULTS: There are various diaphragmatic release techniques, the most mentioned are: normalization of the diaphragm pillars, stretching of the diaphragm, relaxation of the diaphragm pillars and protocols for osteopathic manipulative therapy (OMT) for the diaphragm. The main populations studied were healthy patients, with low back pain, asthmatics, chronic pulmonary obstructive disease, constipated, cardiac patients and with gastroesophageal reflux. The main outcomes assessed are musculoskeletal variables (pain, flexibility, range of motion, diaphragmatic thickness), cardiorespiratory variables (maximal inspiratory/expiratory pressure (MIP and MEP), chest mobility, heart and respiratory rate), quality of life and gastrointestinal/gastroesophageal disorders. CONCLUSION: The clinical applicability of diagrammatic release techniques is being investigated in association with other osteopathic techniques, in protocols of OMT in healthy subjects, patients with lung diseases, heart disease, pregnant women, scar tissue, constipated, with gastroesophageal reflux, osteoarthritis, cervicalgia and with low back pain. There is evidence of reduction and elimination of musculoskeletal pain, increased MIP, increased chest mobility, increase on health quality, decrease of bloating and abdominal pain related to constipation and decrease of reflux symptoms. [ABSTRACT FROM AUTHOR]

Prescribing the Diaphragm explains the cultural understandings of contraception on the eve of the FDA approval of the birth control pill. Using fictional depictions of unmarried women seeking diaphragms and a debate about whether diaphragms should be available in public hospitals, it explains how society understood contraception in the late 1950s. Taken together, they show how different public debates framed the disciplinary technology of the diaphragm. These conversations demonstrate that the diaphragm, and its acceptability, were firmly linked to marriage, such that liberal clergy could present contraception as functionally a marital and medical right that should not be limited by class. That linkage to marriage proved so strong that the decision to acquire a diaphragm had the potential to take on a veneer of commitment more significant than the decision to have sex itself. [ABSTRACT FROM AUTHOR]

Extensive periods of hypoxic cause adaptive changes that make it possible to respond to the demands imposed by the environment. However, there are cases where this exposure is intermittent, as is the case of workers in andean areas. The objective of this communication was to verify the morphological and mechanical effects on diaphragm and lungs of rats subjected to intermittent hypoxic. Four 6-monthold Sprague Dawley rats were used. Two rats were subjected to 10 cycles of intermittent hypobaric hypoxic (IHH) of 96 h (~428 torr, PO2 90 mm Hg), followed by 96 h of normobaric normoxia, for 80 days. Uniaxial traction and staining tests were performed with Hematoxylin-Eosin and Picrosirius red de Junqueira. When comparing the curves of the diaphragms, those subjected to hypoxic slightly reduce their effort with respect to the condition of normoxia, in the lung tissue the hypoxic negatively affects its resistance, these show a lower slope with respect to the normoxics. In the histological analysis, the pulmonary parenchyma had a lower number of blood vessels and cellularity, such as a greater area fraction of alveolar spaces and amount of total collagen in IHH group. In the diaphragm, IHH group had a lower number of irregularly distributed myocytes and a lower amount of total collagen. In conclusion, the main findings indicate that the diaphragm and lung tissue subjected to IHH undergo structural changes, which result in a decrease in tensile strength. [ABSTRACT FROM AUTHOR]

Anamnesis: paciente SRD de 4 meses e historial clínico de trauma por automotor con evolución de 8 días‚ el tutor manifiesta que lo llevaron a otro centro médico donde le administraron tratamiento analgésico‚ desde entonces presenta dificultad para respirar‚ consume alimento y toma agua con normalidad‚ realiza deposiciones y orina sin dificultad. Hallazgos clínicos y ayudas diagnosticas: al examen físico inicial presenta marcado distrés respiratorio‚ saturación de oxígeno 80 %‚ en la auscultación se perciben estertores pulmonares y crepitaciones‚ moderado dolor a la palpación abdominal‚ en las pruebas de laboratorio se observaron; Hemograma: MCH bajo 29,2 pg‚ MCHC 27‚ Químicas: ALT 123 U/L‚ CRP 10,00 mg/<‚ coprológico: eritrocitos +‚ leucocitos ++‚ moco ++‚ microbiota bacteriana aumentada‚ células epiteliales +++‚ celulosa ++‚ grasa +‚ toxocara sp +‚ en el estudio ultrasonográfico protocolo VetBLUE no se evidencia sliding‚ presencia de líneas B y aumento de espacio pleural ventana CdL‚ venta PhL - MdL parénquima hepático y vejiga biliar distendida‚ ventana CrL parénquima hepático ausencia de sliding líneas B. Hallazgos ecográficos sugestivos de hernia diafragmático peritoneal. Plan terapéutico: se inicia manejo hospitalario con: dipirona 30 mg/kg/ IV‚ furosemida 1 mg/kg/IV‚ ampicilina 30 mg/kg/ IV‚ dexametasona 0,5 mg/kg/IV‚ se procede a una toracostomía en hemitórax izquierdo‚ se indica celiotomía preumbilical y herniorrafia diafragmática. Resultados: intraoperatorio se observa pérdida de continuidad a nivel de la cúpula diafragmática izquierda‚ en el manejo post quirúrgico intrahospitalario se observa resolución clínica del neumotórax presentándose una recuperación total del paciente 72 horas después de la intervención quirúrgica‚ determinando el alta hospitalaria. Conclusión: es frecuente encontrar que los pacientes con trauma de tórax presentan marcado distrés respiratorio para someterse al estrés que se produce en la radiografía torácica. Existen diversos estudios que describen la ecografía torácica como una técnica acertada y segura en el diagnostico de diferentes patologías‚ por tal motivo se sugiere el protocolo ecográfico VetBLUE como método práctico. [ABSTRACT FROM AUTHOR]

Background: Diaphragmatic eventration is characterized by weakness of the diaphragmatic muscle, which leads to cranial dislocation of the affected diaphragm and, ultimately, in dyspnea. This condition is rare in humans and even rarer in animals, and may be congenital or acquired. The acquired form is less commom and may be induced by trauma or inflammation and neoplastic invasion of the phrenic nerve. Here, we report a case of acquired diaphragmatic eventration in a dog, with the aim of increasing the knowledge of this condition in animals and helping others to recognize and treat future cases. Case: A 12-year-old male dachshund presented with severe dyspnea, exercise intolerance and episodes of coughing. Based on a physical examination and imaging, the main suspicion was a diaphragmatic hernia, and surgery was performed. When the surgeon entered the thoracic cavity, an extremely thin - yet, intact - right hemidiaphragm was observed. The left side of the diaphragm was normal. A polypropylene mesh was sutured to the affected diaphragm in an attempt to strengthen the hemidiaphragmatic muscles and prevent further insinuations of viscera into the thoracic cavity. The dog developed bronchopneumonia, postoperatively, and was hospitalized and treated with antibiotics, analgesics and support medication. However, the dog died five days after surgery. A postmortem examination revealed that the right side of the diaphragm was markedly thin and flaccid. Diaphragm samples were collected for histopathological examination. For comparison, a sample of normal diaphragm was collected from a same age, matched dachshund that died due to an unrelated condition. This tissue was called "diaphragm control", and it was collected in order to compare the histologic features of a normal diaphragm muscle with the affected one. Histopathology revealed a marked reduction of muscle fibers. In the affected sample, replacement of these fibers by fibrous connective tissue and a marked infiltration of fat were seen among the remaining muscle fibers. Multifocal areas of necrosis were also observed affecting some muscles fibers. Microscopic comparisons of both diaphragm samples (affected vs. control) revealed a drastic difference in the amount of muscle fibers and fat, corroborating the intense diaphragmatic atrophy observed in the diaphragm from the affected dog. Based on clinical presentation, the gross lesions observed during surgery and later during the post mortem examination, and histopathological findings, a definitive diagnosis of acquired diaphragmatic eventration was established. Discussion: Diaphragmatic eventration is rarely reported in small animal clinics and thus may be confused with other conditions. It must be mainly differentiated from diaphragmatic hernia and should be considered as a differential diagnosis when an animal, regardless of age, presents with dyspnea, apathy and coughing episodes. On suspecting diaphragmatic eventration, surgical intervention should be carried out as soon as possible. The recommended treatment is plication of the affected hemidiaphragm. However, in the present case, a polypropylene mesh was sutured to the affected area to support the atrophic muscles. It is thought that, trauma injured the dog's phrenic nerve, affecting right hemidiaphragmatic innervation, and generating progressive atrophy of diaphragmatic muscle fibers. Subsequently, the dog developed diaphragmatic eventration due to diaphragmatic fragility. Diaphragmatic eventration is a very rare disorder in small animals and can be difficult to diagnose based solely on physical and radiographic examinations. [ABSTRACT FROM AUTHOR]

Over time and throughout all regions, history has been a discipline allowing an established order of knowledge, legacies and complex historical experiences of human beings. Consequently, knowing the history of civilizations, cultures and societies allows us to understand and rationalize this information and use the information to continue building a new reality. In this context, the objective of this work was to analyze the origin and meaning of the term diaphragm, and knowledge of the anatomy and functions of this muscle. Based on this knowledge and its path throughout history its current definition was constructed. In Homer's writings, the diaphragm was recognized as an anatomical structure that was not linked to any particular function and in the early physiological explanations of breathing, and did not play a role in the breathing process. Hippocrates and Plato marked a point of inflection in the definition of the term, since they described it as a structure that separated the thorax from the abdomen, relating it correctly with the meaning of the term diáphragma (diafragma), "separation". However, in the classical period of Greece, it was more frequently associated with Greek mythology and human spirituality, considering the diaphragm as the seat of thought. Another important milestone in the history of this muscle were the studies Galen through dissection in animals, and Vesalius in humans, where both describe the diaphragm and its functions in great detail, approaching the detail of the breathing process more closely. Finally, Testut structures the information in a manner that has been maintained to this day, and the only change has been in the dissemination of the information. [ABSTRACT FROM AUTHOR]

Introduction: The efficacy of high and low intensity inspiratory muscle training (IMT) in morbid obesity needs to be elucidated. Objective: To analyze the effects of high and low intensity training on the inspiratory muscle in morbidly obese individuals. Methods: 32 men were divided into two groups (G1 and G2). The assessments of dyspnea, pulmonary function test, PImax, DP and MD were performed in pre-training and after 12 weeks of training. Discussion: Training protocols in this study, with Power Breather® linear load resistors, have positive effects in these individuals both in high and low intensity, but with longer effects in high intensity IMT. Results: The G1 obtained a significant increase of the VVM, PImax, DP, MD and significant decrease in the MRCm in 12 weeks of training, which were maintained after 12 weeks without training. G2 presented the same behavior when compared to G1 at 12 weeks of training, but values returned to baseline in VVM, MRCm and MD, and the PImax and DP variables presented values below the initial evaluation after 12 weeks without training. In intergroup analysis (12-12 weeks), G1 presented higher values in VVM, PImax, DP and MD when compared to G2. In the comparison of 24-24 weeks, G2 presented lower values in VVM, PImax, DP and MD significant increases in MRCm when compared to G1. Conclusion: High and low intensity IMT provided beneficial effects to individuals, which were maintained after 12 weeks of high intensity training. [ABSTRACT FROM AUTHOR]

Background: The diaphragm is a fibromuscular organ whose primary function is related to ventilation. It also serves as a barrier between pleural and abdominal cavities. This organ is rarely affected by pathologic entities, but eventration is among the primary diseases of this structure. Case Report: We present the case of a 21 year old female with no relevant personal history. She arrived to the emergency room with thoracic blunt trauma. Chest radiography is indicated, showing elevation of the left hemidiaphragm. This study was complemented with a computed tomography making a presumptive diagnosis of diaphragmatic eventration. As part of the treatment, we proposed surgical therapy but the patient refused and now she is under surveillance in her clinic. Discussion: Diaphragmatic eventration is caused by the weakness of the muscular part of the organ. It is thought that is caused by functional or congenital absence of the diaphragmatic musculature. The clinical presentation is variable but, in most of the cases, the patients are asymptomatic. The diagnosis is made by radiologic studies such as chest plains and computed tomography. Treatment could be conservative or surgical. The prognosis will depend on the degree of pulmonary hypoplasia and the coexistence of other malformations. Conclusion: Diaphragmatic eventration is rarely diagnosed in adults and the treatment will depend on the surgeon's and the patient's joined decision. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Obstructive Pulmonary Disease (COPD) causes injuries in the thoracic-pulmonary mechanics. Studies show that diaphragmatic electrical stimulation is able to generate benefits for patients with COPD. Objective: to evaluate the influence of transcutaneous electrical diaphragmatic stimulation by Russian current in chest expansion in COPD. Methods: a prospective quasi-experimental study with COPD, classification grade III and IV, drug stability, smoking cessation, and maintain of the lifestyle. The style of life, anthropometry -- BMI, dyspnea -- Borg scale, respiratory rate (RR) and thoracic-abdominal cirtometry were evaluated. The Endophasys R ET 9701 was used with time and attendance of the 18 min. (20 to 30 Hz) and 12 min. (70-100 Hz), with 1-6 sec of contraction and relaxation time (2x of contraction, with the percentage of the current 20-50% to 30 sessions (2x / week). Data were expressed descriptively as absolute and relative frequency, and comparisons were made by "t" test. Results: 13 COPD, 11 (84.6%) males, age 68.46 ± 11.11 years, BMI 25.13 ± 4.61 kg / m2, BORG: initial:2.46 ± 1.66 and end:2.23 ± 1.30 and the RR: initial: 17 ± 5 bpm and end:16 ± 4.3 ipm. There were changes in cirtometry (cm): axillary expiratory of 103 ± 4.24 to 97.69 ± 10, 18; thoracic of 98.25 ± 2.47 to 96.38 ± 9.97; inspiratory thoracic of 99.25 ± 3.88 to 98.73 ± 9.93; expiratory umbilical 99 ± 2.82 to 93.54 ± 13.83. Conclusion: diaphragmatic electrical stimulation through the Russian current promotes benefits in the components of respiratory mechanics as chest expansion and breathing pattern in patients with COPD. [ABSTRACT FROM AUTHOR]

The structural alterations that occur in the muscle fibers of denervated rat diaphragms were studied. Fifteen adult male albino rats (Rattus norvegicus) with a mean weight of 200 g and about 60 days of age were used. Chronically denervated diaphragms were obtained and the animals were sacrificed after 4, 8 and 12 weeks of denervation. The left antimere of the diaphragm was denervated by sectioning of the phrenic nerve and the right antimere served as control. Each antimere was divided into fragments, which were used for analysis transmission electron microscopy. During the initial phase of denervation (4 weeks), ultrastructural muscle modifications appeared in scattered fibers and in foci along these fibers. Muscle fibers with foci of less dense and loosely arranged myofibrils, disorganized Z line, displaced T tubules, and central nucleus exhibiting reentrances and fragmented aspect were observed. After 8 weeks, formation of large aggregates of small elongated mitochondria showing altered cristae, matrix inclusions and increased electron density was noted. At 12 weeks of denervation the alterations were found to be more drastic. Nuclei with internal deposits of myofibrillar or amorphous material were observed. In these fibers, vacuoles harbored enormous myeloid structures in the subsarcolemmal or intermyofibrillar region. [ABSTRACT FROM AUTHOR]

Introduction: Diaphragmatic hernias (DH) are a rare condition in adult patients. Most of the cases are asymptomatic findings in imaging studies. Rarely do they present as complicated cases. Clinical cases: We report two clinical cases of complicated DH, one of Bochdalek and another with history of a penetrating thoracic trauma two years before, both with hollow viscus rupture in the thoracic cavity. [ABSTRACT FROM AUTHOR]

The diaphragm muscle plays a role in respiration, so fundamental to physiotherapy intervention when it proves ineffective. The aim of this study was to analyze the effect of diaphragmatic release in respiratory pressures in healthy young and sedentary. The study was conducted with 20 healthy sedentary volunteers, aged 18 to 25 years, 10 men and 10 women. The protocol consisted of evaluation of respiratory pressure through the manometer before and after the release maneuver diaphragm for 3 minutes. The values of maximal respiratory pressures that showed statistical significance in men and women before and after diaphragmatic release, p <0.05, when comparing the values of MIP and MEP between men and women was not significant before the MIP and then, and in between MEP before, yet found himself statistically significant difference in MEP after the maneuvers, demonstrating that the maneuver was more effective in women than in women. The protocol was efficient diaphragmatic release to promote increase in maximal respiratory pressures, suggesting that it may be used as a physical therapy resource for the development of better functioning of respiratory mechanics [ABSTRACT FROM AUTHOR]

Background: Diaphragmatic evaluation is crucial in clinical practice, and no studies have reported the intra- and interobserver reproducibilities of the radiographic method to evaluate diaphragmatic mobility. Objective: To analyze the reliability of radiographic measurement as a method for assessing the mobility of the left and right hemidiaphragms. Method: Forty-two patients, who were waiting for cholecystectomy surgery, were evaluated relative to the following parameters: physical examination, pulmonary function and radiographic evaluation. The measure of mobility of each hemidiaphragm was randomly determined by two physical therapists at two different times. The intra- and interobserver reproducibilities of the measurements were determined by the intraclass correlation coefficient (ICC[2,1]) and the 95% confidence interval (Cl). The Bland-Altman plot was also used. The level of significance was 5%. Results: In the analysis of intra-observer reproducibility in radiographic evaluations of the left and right hemidiaphragms, ICC[2,l] indicated a "very high correlation" for both observer A (ICC[2,1] = 0.99, p <0.001 and ICC[2,1] = 0.97, p <0.001, respectively) and observer B (ICC[2,1] = 0.99, p <0.001 and 1CC[2,1] = 0.99 p <0.001, respectively). In the analysis of interobserver reproducibility, the ICC[2,1] indicated a "very high correlation" for the 1st and 2nd radiographic evaluations of the right hemidiaphragm (ICC[2,1 ] = 0.98 and ICC[2,1] = 0,99, respectively, p <0.001) and left hemidiaphragm (ICC[2,1] = 0.98 and ICC[2,1] = 0.99, respectively, p <0.001). Conclusion: The intra and interobserver tests of the radiographic measure of mobility of the left and right hemidiaphragms showed high reliability. [ABSTRACT FROM AUTHOR]

The morphological alterations that occur in the muscle fibers of denervated rat diaphragms were studied. Fifteen adult male albino rats (Rattus norvegicus) with a mean weight of 200 g and about 60 days of age were used. Chronically denervated diaphragms were obtained and the animals were sacrificed after 4, 8 and 12 weeks of denervation. The left antimere of the diaphragm was denervated by sectioning of the phrenic nerve and the right antimere served as control. Each antimere was divided into two fragments, which were used for histological (H.E.) and histoenzymological (NADH-TR and myofibrillar ATPase). After 4 weeks, denervated muscle fibers showed important light microscopic alterations: atrophy with angular profiles in cross-sections, cytoplasm containing vacuoles, enlarged interstitial space with increased connective tissue, cellular infiltration, and muscle fibers without defined contours. The most marked alterations being observed for type lib and Ha fibers. Eight and 12 weeks after denervation, the NADH-TR reaction showed that it was impossible to characterize the muscle fibers based on their metabolic profile. [ABSTRACT FROM AUTHOR]

The aim was to detect the presence of bundles of collagen fibers in the margins of the esophageal hiatus and establish if there is any relationship of these bundles with the anatomy of the hiatus. Ten adult male cadavers, with no gross anatomical alteration caused by trauma, surgery or disease, upon the esophageal hiatus were used in the study. A piece of anatomical structure comprising the diaphragm with the esophageal hiatus and adjacent tissues was removed, dissected and 10% formol embedding. With the aid of a digital caliper, measurements of the perimeter of the esophageal hiatus were done both in the abdominal and thoracic sides. For the structural study each margin was divided in six sections. Staining techniques of Masson and Picrosirius-hematoxilin were used. Collagen fibers bundles had been found in 8/10 studied cadavers, distributed in 13 margins of the hiatus, of which 7 to left and 6 to the right. The muscle fibers originating from the right pillar had participated in forming both margins of the esophageal hiatus in 60% of cadavers, while in 40%, the fibers of the left pillar had formed the medial side of the right margin. The right margin was statistically thicker than the left. It did not have a correlation between the measures of the vertices of the angles superior/inferior and the transversal measure of the esophageal hiatus. The measures between the vertices of the angles superior/inferior, respectively, with the central tendon and median arcuate ligament, had presented thoracic values that tended to the double, in relation to the abdominal ones, and had been statistically significant. These distances were smaller in cadavers who possessed bundles of collagen fibers in the margins of the esophageal hiatus. Bundles of collagen fibers bundles were found in 65% of the 20 margins of the esophageal hiatus. The margins of the esophageal hiatus were predominantly formed by muscles fibers originated of the right pillar of the muscle diaphragm. The anatomical and morphometric data presented statistically significant values regarding: thickness of the right arm in relation to the left; distance between the vertex of the superior angle and the central tendon; and distance between the vertex of the inferior angle and the median arcuate ligament. [ABSTRACT FROM AUTHOR]

We prepared 161 anatomical pieces to study the peripheral diaphragmatic insertions on the thoraco-abdominal wall. The anterior sterno-costal part and the posterior lumbo-costal regions of the diaphragm exhibit the highest anatomical variability, while the lateral costal part is more constant. The multiple mechanical forces which act upon the diaphragm and the forces exerted by the muscular parts of the diaphragm lead to various architectural dispositions in the diaphragm and especially at the level of it's peripheral insertions. The anatomy of the peripheral diaphragmatic insertions can be better understood by comparison with architectural elements. The diaphragm inserts at the periphery on skeletal anatomical structures (procesus xifoideus, ribs, vertebrae) as well as on soft structures (posterior lamina of the theca of the musculus rectus abdominalis, endothoracal fascia of the intercostal spaces, fasciae of the quadratus lombae m. and the psoas m.) in a generally alternative manner. From an architectural point of view, the peripheral insertion of the diaphragm is a successive sequence of pillars and arcades (the pillars are the muscular fascicules and the arcades are arcade-shaped structures of connective tissue). The validity of the classical anatomical descriptions of the peripheral diaphragmatic insertions remain unaltered, however, the reconsideration from an architectural point of view allows a better understanding of the disposition, variants and alterations under the action of various mechanical forces, under the dynamic influence of general anatomical changes like obesity and aging. [ABSTRACT FROM AUTHOR]

Purpose: to analyze the definition of breath support, as well as the strategies used to achieve it and their benefits according to both singing teachers and Speech Language Pathologists (SLP). Methods: six professionals experienced in singing voice answered an interview on issues pertaining to singing breath support. The answers were submitted to content analysis from where four categories were derived: definition of breathing support, type of support, strategies and benefits. Results: the aspects that were most often reported by the professionals are: the definition of breath support is related to the participation of the diaphragm and intercostal muscles; the most adequate type of support is intercostal and diaphragmatic; among the strategies used to improve breathing support, the most commonly mentioned were body perception, awareness of the muscles involved in the process, air flow balance, tension relief and posture alignment. There are discrepancies as for the abdominal contraction, use of different objects as guidelines, mental imagery, and use of singing exercises - vocalizes. According to the interviewed subjects, the greatest benefit of breath support lies in the relief of laryngeal tensions and improvement of respiratory coordination. There was a low level of agreement about the benefits of support, especially with regards to the improvement of the singing voice. Conclusion: the results point out to a convergence of opinions as for most of the interviewed subjects when considering the definition, approach strategies and benefits of breathing support, however, still with no consensus on the subject. [ABSTRACT FROM AUTHOR]

The morphological and structural alterations that occur in the neuromuscular junctions of the denervated rat diaphragm were studied. Fifteen adult male albino rats (Rattus norvegicus) aged about 60 days and with a mean weight of 200 g were used. Chronically denervated diaphragms were obtained and the animals were sacrificed after 4, 8 and 12 weeks of denervation. The left antimere of the diaphragm was denervated by section of the phrenic nerve and the right antimere was used as control. Each antimere was divided into three fragments: one was used for histochemical (nonspecific esterase) and morphometric study of neuromuscular junctions, and the other two were used for transmission and scanning electron microscopy (SEM) analysis. Histochemical analysis of the diaphragm neuromuscular junctions after denervation showed only small changes in junction morphology. However, these junctions became smaller and elongated and presented less visible contours with increasing time of denervation. Ultrastructural analysis of neuromuscular junctions after 12 weeks showed more or less organized junctional folds on the muscle fiber surface. The junctional cytoplasm exhibited important alterations such as mitochondrial degeneration and the presence of numerous filaments. SEM revealed the presence of deep primary synaptic grooves with peripheral excavations which housed the nerve terminal boutons and exhibited internally the secondary synaptic clefts present among the junctional folds of the sarcolemma. This study showed that some of the morphological changes demonstrated in other denervated striated skeletal muscles are not repeated at the same intensity or in the same temporal pattern in the rat diaphragm. [ABSTRACT FROM AUTHOR]

Background: Prolonged mechanical ventilatory support (MVS) combined with high oxygen concentrations has a negative impact on diaphragm function. However, the acute effects of MVS with hyperoxia have not been elucidated. Objective: To analyze the acute effects of mechanical ventilation with hyperoxia on the morphometry of the rat diaphragm. Methods: An experimental, prospective study was conducted with Wistar rats (weight: 400±20 g), which were randomly allocated to two groups. The control group (n=4) was anesthetized, tracheostomized and kept spontaneously breathing room air for 90 minutes. The experimental group (n=5) was also anesthetized, curarized, tracheostomized and kept in controlled mechanical ventilation for the same amount of time. Both groups were submitted to median thoracotomy for sample collection of costal fibers from the diaphragm muscle, which were sectioned every µm and stained with hematoxylin and eosin for the morphometric study. Independent Student's t tests were employed to investigate differences between groups, with a significance level of p<0.05. Results: There were no signs of acute muscle lesions, however the blood capillaries became dilated in the experimental group. The mean morphometric data related to the maximum cross-sectional diameter of the diaphragm costal fibers were 61.78±17.79 µm and 70.75±9.93 µm (p=0.045) for the control and experimental groups, respectively. Conclusions: Short-term mechanical ventilation with hyperoxia led to significant microvascular and muscle changes, which may reflect the onset of an inflammatory process. [ABSTRACT FROM AUTHOR]

The pericardium is a fibrous and serous membrane that surround the heart and the juxta- cardiac portion of the great vessels. We studied the pericardium and diaphragm and we recorded different measurements, relations and connection between both. We dissected 142 mediastinal regions from 10% formaldehyde - fixed or fresh individual cadavers, Brazilian adults, of both sexes, from 18-70 years of age. For the histology study from both structures were sectioned five fragments of different regions: anterior, next to sternum (region 1), left lateral, next to heart apex (region 2), posterior (region 3), right lateral, next to course of inferior vena cava (region 4) and central(region 5). The average of transversal and anterior-posterior diameters of pericardium were 103.3 + 6.7 mm and 66.0 ± 2.3 mm, respectively; the same diameters of diaphragm were 309.4 ± 27.4 mm and 152.5 ± 24.9 mm, respectively. The diaphragm area was 37,260 ± 2,324 mm2 and the area of pericardium base over the diaphragm was 6,042 ± 367 mm2 . The thickness of diaphragm was 2.42 ± 0.34 mm in right part, 2.38 ± 0.71 mm in left part and 2.52 ± 0.66 mm in anterior part. The thickness of pericardium was 0.26 ± 0.02 mm. In region 2 both structures were easily separated in 47.2 mm; in the region 4 both structures are fused. The results of this study will complement the morphologic knowledges about fibrous pericardium and its relationships with the diaphragm. [ABSTRACT FROM AUTHOR]

The objective of this study was to review some celiac trunk compression syndrome aspects such as: symptomposture relationship; absence of symptoms; syndrome-age relationship; angiographic study on anatomy of the celiac trunk stenosis; congenital or acquired origin; invasive diagnostic tests; surgical and postoperative results. [ABSTRACT FROM AUTHOR]

The function of respiratory muscles, and mainly inspiratory muscles, is impaired in COPD patients. Most of these impairments are essentially due to pulmonary hyperinflation that puts these muscles in a disadvantageous situation. The main consequence of this dysfunction is respiratory muscle fatigue that may cause shortness of breath, exertion intolerance, and hypoventilation with onset of hypercapnic respiratory failure. This function may be measured at the pulmonary function laboratory by means of unspecific (spirometry, pulmonary volumes) or specific tests (maxim respiratory pressures [MIP - M], transdiaphragmatic pressure, tension-time index of the diaphragm, electromyography, or endura tests). Therapy should aim at improving hyperinflation with bronchodilator therapy, improving muscular strength with rehabilitation, and in severe cases muscle rest with mechanical ventilation. Peripheral muscle dysfunction is a common complication in moderate-severe COPD, and it may be the result of chronic inactivity, hypoxemia, electrolytic impairments, under nutrition, steroids, oxidative stress, and systemic inflammation. Besides, it may contribute to patients' quality of life worsening, disability, and even an increase in morbimortality. It may tested by impedanciometry, muscle strength tests (dynamometry), imaging tests, and even muscle biopsy in research studies. Peripheral muscle dysfunction is potentially manageable with rehabilitation, nutritional supplementation, and anabolic drugs. However, therapeutic success is often incomplete, so that further studies with new therapeutic strategies are needed. [ABSTRACT FROM AUTHOR]

In this study to characterize the morphology of the diaphragm in Callithrix jacchus, we used 4 adult animals, two males and two females, which they died of natural causes. After the dissection of animals the diaphragm was measured for its length and width using a caliper, and the muscular portion of the collected samples for histology and stained with Hematoxylin-Eosin and Masson. The topography and presence of three openings in the diaphragm corroborate the literature for other mammals. The presence of a tendinous center "V" differs from other species such as guinea pig. There were no gender differences for measurements. The use of coloration allowed more accurate analysis of the muscular portion. [ABSTRACT FROM AUTHOR]

Introdução: A Doença Pulmonar Obstrutiva Crônica (DPOC) ocasiona prejuízos na mecânica toraco-pulmonar. Estudos comprovam que a estimulação elétrica diafragmática é capaz de gerar benefícios ao portador de DPOC. Objetivo: Avaliar a influência da estimulação diafragmática elétrica transcutânea pela corrente russa na expansibilidade torácica de indivíduos portadores de DPOC. Métodos: Os critérios de inclusão foram: estabilidade medicamentosa, cessação tabágica, Classificação da DPOC grau III e IV e manter estilo de vida. A avaliação constou de informações sobre história da moléstia pregressa e atual, hábitos de vida, avaliação física: antropometria, inspeção, palpação, FR e cirtometria. A intervenção se deu pela Endophasys R ET 9701, tempo de terapia e freqüência: foram 18 min. (20 a 30 Hz) e 12 min. (70 a 100 Hz), sendo de 1 a 6s de contração e o tempo de relaxamento duas vezes o tempo de contração, com a porcentagem da corrente de 20 a 50%, totalizando 30 sessões (2x/ semana). Os dados foram expressos de forma descritiva por frequência absoluta e relativa e as comparações foram feitas pelo teste "t" de Student (p<0,05) - SPSS 17 e apresentadas por média ± desvio padrão. Resultados: Participaram do tratamento 13 DPOC, sendo 11 (84,6%) do sexo masculino, com idade de 68,46 ± 11,11 anos e IMC de 25,13 ± 4,61 kg/m2, Escala de dispnéia de BORG: inicial 2,46±1,66 e final 2,23±1,30 e a FR: inicial 17 ± 5 ipm e final 16±4,3 ipm, houve mudanças na: cirtometria (cm) axilar expiratória de 103±4,24 para 97,69±10,18; torácica de 98,25±2,47 para 96,38±9,97; torácica inspiratória de 99,25±3,88 para 98,73±9,93; umbilical expiratória de 99±2,82 para 93,54±13,83. Conclusão: A estimulação elétrica diafragmática por meio da corrente russa promove benefícios nos componentes da mecânica respiratória como a expansibilidade torácica em pacientes portadores de DPOC. [ABSTRACT FROM AUTHOR]