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Copyright of Acta Medica Colombiana is the property of Acta Medica Colombiana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

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Copyright of Salud, Ciencia y Tecnología is the property of Fundacion Salud, Ciencia y Tecnologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Pulmonary congestion is a strong predictor of mortality and cardiovascular events in chronic kidney disease (CKD); however, the effects of the mild form on functionality have not yet been investigated. The objective of this study was to assess the influence of mild pulmonary congestion on diaphragmatic mobility (DM) and activities of daily living (ADL) in hemodialysis (HD) subjects, as well as compare ADL behavior on dialysis and non-dialysis days. In parallel, experimentally induce CKD in mice and analyze the resulting pulmonary and functional repercussions. Methods: Thirty subjects in HD underwent thoracic and abdominal ultrasonography, anthropometric assessment, lung and kidney function, respiratory muscle strength assessment and symptoms analysis. To measure ADL a triaxial accelerometer was used over seven consecutive days. Twenty male mice were randomized in Control and CKD group. Thoracic ultrasonography, TNF-α analysis in kidney and lung tissue, exploratory behavior and functionality assessments were performed. Results: Mild pulmonary congestion caused a 26.1% decline in DM (R2 = .261; P = .004) and 20% reduction in walking time (R2 = .200; P = .01), indicating decreases of 2.23 mm and 1.54 min, respectively, for every unit increase in lung comet-tails. Regarding ADL, subjects exhibited statistically significant differences for standing (P = .002), walking (P = .034) and active time (P = .002), and number of steps taken (P = .01) on days with and without HD. In the experimental model, CKD resulted in increased levels of TNF-α on kidneys (P = .037) and lungs (P = .02), attenuation of exploratory behavior (P = .01) and significant decrease in traveled distance (P = .034). Thoracic ultrasonography of CKD mice showed presence of B-lines. Conclusion: The mild pulmonary congestion reduced DM and walking time in subjects undergoing HD. Individuals were less active on dialysis days. Furthermore, the experimental model implies that the presence of pulmonary congestion and inflammation may play a decisive role in the low physical and exploratory performance of CKD mice. Resumen: Antecedentes: La congestión pulmonar es un fuerte predictor de mortalidad y eventos cardiovasculares en la enfermedad renal crónica (ERC); sin embargo, aún no se han investigado los efectos de la forma leve sobre la funcionalidad. El objetivo de este estudio fue evaluar la influencia de la congestión pulmonar leve en la movilidad diafragmática (MD) y las actividades de la vida diaria (AVD) en sujetos en hemodiálisis (HD), así como comparar el comportamiento de las AVD en los días de diálisis y no diálisis. Paralelamente, inducir de forma experimental la ERC en ratones y analizar las repercusiones pulmonares y funcionales resultantes. Métodos: Treinta sujetos en HD fueron sometidos a ecografía torácica y abdominal, evaluación antropométrica, función pulmonar y renal, evaluación de la fuerza de los músculos respiratorios y análisis de síntomas. Para medir las AVD se utilizó un acelerómetro triaxial durante 7 días consecutivos. Se aleatorizaron 20 ratones machos en el grupo control y con ERC. Se realizó ecografía torácica, análisis de TNF-α en tejido renal y pulmonar, comportamiento exploratorio y evaluaciones de funcionalidad. Resultados: La congestión pulmonar leve provocó una disminución del 26,1% en la MD (R2 = ,261; P = ,004) y una reducción del 20% en el tiempo de caminata (R2 = 0,200; P = ,01), lo que indica disminuciones de 2,23 mm y 1,54 minutos, respectivamente, por cada unidad de aumento de las colas de cometa pulmonares. En cuanto a las AVD los sujetos mostraron diferencias estadísticamente significativas para estar de pie (P = ,002), caminar (P = ,034) y tiempo activo (P = ,002) y número de pasos dados (P = ,01) en los días con y sin HD. En el modelo experimental la ERC resultó en un aumento de los niveles de TNF-α en los riñones (P = ,037) y los pulmones (P = ,02), la atenuación del comportamiento exploratorio (P = ,01) y una disminución significativa en la distancia recorrida (P = ,034). La ecografía torácica de ratones con ERC mostró la presencia de líneas B. Conclusión: La leve congestión pulmonar redujo la MD y el tiempo de marcha en sujetos sometidos a HD. Los individuos eran menos activos en los días de diálisis. Además, el modelo experimental implica que la presencia de congestión e inflamación pulmonar puede desempeñar un papel decisivo en el bajo rendimiento físico y exploratorio de los ratones con ERC.

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]

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

RESUMEN Introducción. La anestesia regional es una técnica importante, innovadora y popular para el manejo anestésico y analgésico. En el bloqueo supraclavicular del plexo braquial existe incidencia 50-60% de parálisis diafragmática. La presentación clínica es variable de acuerdo con factores externos e internos del paciente. Existen múltiples técnicas radiológicas en el diagnóstico, siendo de gran utilidad la ecografía por su fácil acceso. El objetivo es determinar la incidencia de parálisis diafragmática secundaria a bloqueo supraclavicular del plexo braquial guiado por ecografía en una institución de cuarto nivel. Metodología. Estudio analítico, longitudinal, prospectivo; se seleccionaron 110 pacientes. Criterios de inclusión: pacientes mayores de 18 años sometidos a cirugía de miembro superior con bloqueo supraclavicular de plexo braquial. Criterios exclusión: pacientes ASA (American Society of anesthesiologist) 4 y 5, gestantes, IMC >35 kg/m2, pacientes con antecedentes neuromusculares, enfermedad pulmonar restrictiva u obstructiva, parálisis nervio frénico o disfunción diafragmática. Se realizó un análisis mediante test estadísticos, describiendo los diferentes grados de parálisis diafragmática. Resultados. En los pacientes que cumplieron con los criterios de inclusión, la incidencia de parálisis diafragmática fue de 65% (37% parálisis total y 28% parcial), el 1.81% presentó síntomas respiratorios sin cambios hemodinámicos. Discusión. El bloqueo del plexo braquial por vía supraclavicular es una técnica relacionada con parálisis diafragmática, la ecografía ha permitido reducir la incidencia de esta complicación, es un método útil en el diagnóstico postoperatorio. Conclusiones. La parálisis diafragmática post bloqueo plexo braquial supraclavicular es una complicación observada principalmente en pacientes con previo compromiso pulmonar, por lo cual es de importancia la vigilancia estricta. ABSTRACT 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. RESUMO Introdução. A anestesia regional é uma técnica importante, inovadora e popular para o manejo anestésico e analgésico. No bloqueio supraclavicular do plexo braquial há uma incidência de 50-60% de paralisia diafragmática. A apresentação clínica é variável de acordo com fatores externos e internos do paciente. Existem múltiplas técnicas radiológicas no diagnóstico, sendo a ultrassonografia muito útil devido ao seu fácil acesso. O objetivo é determinar a incidência de paralisia diafragmática secundária ao bloqueio supraclavicular do plexo braquial guiado por ultrassom em uma instituição de quarto nível. Metodologia. Estudo analítico, longitudinal, prospectivo; 110 pacientes foram selecionados. Critérios de inclusão: pacientes maiores de 18 anos submetidos à cirurgia de membro superior com bloqueio supraclavicular do plexo braquial. Critérios de exclusão: pacientes ASA (American Anesthesiology Society) 4 e 5, gestantes, IMC>35 kg/m2 pacientes com história neuromuscular, doença pulmonar restritiva ou obstrutiva, paralisia do nervo frênico ou disfunção diafragmática. Foi realizada uma análise por meio de testes estatísticos, descrevendo os diferentes graus de paralisia diafragmática. Resultados. Nos pacientes que atenderam aos critérios de inclusão, a incidência de paralisia diafragmática foi de 65% (37% paralisia total e 28% parcial), 1.81% apresentavam sintomas respiratórios sem alterações hemodinâmicas. Discussão. O bloqueio do plexo braquial supraclavicular é uma técnica relacionada à paralisia diafragmática, a ultrassonografia tem reduzido a incidência dessa complicação e é um método útil no diagnóstico pós-operatório. Conclusões. A paralisia diafragmática após bloqueio do plexo braquial supraclavicular é uma complicação observada principalmente em pacientes com envolvimento pulmonar prévio, pelo que é importante vigilância rigorosa.

Resumo. A ruptura diafragmática traumática é uma afecção de urgência frequente em pequenos animais, o presente trabalho reuniu estudos que apontam os gatos machos, jovens e não castrados como os mais suscetíveis, principalmente os que possuem acesso à rua. Traumas diretos ou indiretos causam a ruptura do diafragma, fazendo com que os órgãos abdominais migrem para a cavidade torácica, danos graves à cavidade e aos órgãos torácicos podem ocorrer como consequência do trauma. Os sinais clínicos podem incluir dispneia, cianose e abafamento dos sons cardiopulmonares à ausculta; entretanto, podem ser inespecíficos dependendo do acometimento e tempo da ruptura. O tratamento é cirúrgico, sendo indicado uma técnica de herniorrafia diafragmática, que consiste na síntese do diafragma no local onde foi rompido para recompor a estrutura anatômica do mesmo, restituindo sua função na respiração e reestabelecendo a pressão negativa do tórax.

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Konjenital diafragma evantrasyonu nadir görülen bir hastalık olup, klinisyen hekimlerce ayırıcı tanısı uygun şekilde yapıldıktan sonra gerekirse cerrahi tedavi uygulanan bir hastalıktır. Beş gündür prodüktif öksürük ve son 2 aydır geceleri yarım saatte bir uyanma şikâyeti ile çocuk polikliniğine başvuran 10 aylık erkek hasta sunulmaktadır. Hastanın dış merkezde çekilen akciğer grafisinde diyafragma elevasyonu görülmesi üzerine çocuk allerji ve immünoloji polikliniğine getirildi. Özgeçmişinde doğum sonrası 1. gününde morarma öyküsü ile yenidoğan yoğunbakım ünitesinde 2 gün takip edilme öyküsü mevcut. Son 2 aya kadar herhangi bir şikâyeti olmamış. Akciğer tomografisi ve batın ultrasonu ile herniasyon, subdiafragmatik kitle ve tümöral oluşum dışlandı. Yenidoğan dönemindeki grafisine de ulaşılan hastaya konjenital diafragma evantrasyonu tanısı konuldu. Asemptomatik seyrettiğinden cerrahi düşünülmedi ve takip önerildi. Nadir görülen bu olgu farkındalığı artırmak amacıyla burada sunulmaktadır.

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Se describe la técnica de la vaguectomía sector mediastinal inferior por abordaje abdominotransdiafragmático. Se dan los fundamentos anatomoquirúrgicos que posibilitan su fácil ejecución y evitan los accidentes operatorios. Se enfatizan sus ven tajes: sector troncal de los vagos, conservación de las estructuras esofagohiatusdiafragmáticas ( aparato cardial), método· que evita las hernias hiatales. Técnica factible a pesar de ser reintervención abdominal con secuelas peritoneales y adherencias, cumpliendo además con el procedimient:o de drenaje gástrico.

Presentado en sesión de 2 de agosto de 1961

Presentado en sesión de 22 de mayo de 1957

Presentado en sesión de 25 de mayo de 1949

Presentado en sesión de 4 de junio de 1952

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]

Copyright of Fisioterapia Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Mediante el presente estudio retrospectivo se revisaron 466 historias clínicas de pacientes atendidos por el servicio de urgencias quirúrgicas del Hospital San Juan de Dios de Bogotá, durante el periodo entre el 1° de marzo de 1981 y el 28 de febrero de 1986. Los pacientes en la serie estudiada fueron en su mayoría de sexo masculino (92%); se estableció una relación hombre/mujer de 11:1. El grupo de edad más afectado estuvo entre los 10 y 29 años (58%). La mayoría de los pacientes sufrió trauma penetrante (96,3%); 17 pacientes (3,7%) sufrieron trauma cerrado. El hemidiafragma más comprometido fue el izquierdo. Las manifestaciones clínicas más sobresalientes fueron: dolor abdominal, hipoventilación del hemitórax afectado, disnea, hemoneumotórax y defensa abdominal. Los métodos paraclínicos demostraron un bajo grado de especificidad diagnóstica. Las lesiones asociadas en su orden de frecuencia estuvieron localizadas en nivel del hígado, estómago, bazo, colon, intestino delgado, pulmón, páncreas, sistema vascular y óseo. El acceso quirúrgico en 413 casos se efectuó por laparotomía, en 37 por toracolaárotomía, y en los 13 restantes por toracotomía. La hernia diafragmática se presentó, en el 6%; y la mortalidad global fue del 10,5%.

Varón de 68 años con EPOC y adenocarcinoma de pulmón derecho tratado con quimioradioterapia. Acude a urgencias por dolor epigástrico intenso de 12 horas de evolución, sin traumatismos previos. En TC urgente se objetiva herniación diafragmática anterior izquierda con abundantes asas de yeyuno intratorácicas junto al ángulo esplénico colónico (fig.1, 2 y 3). Presentan marcada dilatación, líquido interasas y cambio de calibre, compatible con torsión del pedículo mesentérico, obstrucción y sufrimiento intestinal. Fue intervenido urgentemente evidenciándose anillo herniario no traumático (congénito, probablemente de Bochdalek) que comprime y necrosa yeyuno y ángulo esplénico. Se realizó reparación herniaria con resección intestinal y segmentaria de colon. La reparación de la hernia diafragmática incluyó exposición del defecto y sutura continua del mismo con material reabsorbible, evitándose la colocación de malla protésica debido al alto riesgo de fuga de anastomosis intestinal e infección posterior. Evolución postoperatoria favorable, actualmente en seguimiento en consultas.

Presentado en la Sesión del miércoles 23 de abril de 1946.

Presentado en la Sesión del miércoles 23 de abril de 1946.

Presentado en la Sesión del 29 de Septiembre de 1948.

Avaliar se há relação entre a mobilidade diafragmática com o tempo de trânsito oral e faríngeo, pontuação do índice preditor de mortalidade Body mass index, airflow Obstruction, Dyspnea and Exercise capacity (BODE), dispneia e o estado de saúde em pacientes com doença pulmonar obstrutiva crônica (DPOC). Estudo transversal com avaliação dos seguintes desfechos: mobilidade diafragmática (ultrassonografia), tempo de trânsito oral e faríngeo (videofluoroscopia), preditor de mortalidade (pontuação no índice BODE), dispneia (escala do Medical Research Council modificada - mMRC) e estado de saúde (COPD Assessment Test). Participaram do estudo 19 pacientes com diagnóstico clínico de DPOC estágios II e III da GOLD (65,95±7,9 anos; 11 homens; VEF1 47,76±21,91% predito). Houve correlação negativa e forte entre a mobilidade diafragmática e o índice BODE (r=-0,822; p

La ventilación mecánica invasiva (VMI) es una terapia de soporte vital que no está exenta de complicaciones, como la disfunción diafragmática inducida por la ventilación mecánica, que se caracteriza por atrofia y debilidad de dicho musculo. El interés en esta patología parece estar basado en la asociación encontrada con resultados clínicos negativos. La prevalencia oscila entre 29 y 80%, probablemente debido a la variabilidad entre los diferentes métodos diagnósticos y el momento de la evaluación. El patrón de oro continúa siendo la presión negativa transdiafragmática generada por la estimulación bilateral de los nervios frénicos, aunque por la falta de practicidad, se comenzó a utilizar la ecografía diafragmática. Si bien cuenta con varias modalidades, no todas tienen análisis de correlación con el patrón de oro. Otra problemática surge al momento de analizar la asociación independiente entre la patología y la VMI, ya que los factores confusores no son sencillos de aislar.

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]

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Introducción: la parálisis diafragmática se produce por interrupción en la transmisión de los impulsos nerviosos a través del nervio frénico o por pérdida de la contractilidad del músculo. Conlleva a atrofia muscular progresiva y distensión de la cúpula. Puede presentarse bilateral o unilateralmente, siendo esta última más común; sin embargo, es una afección de baja incidencia. Las causas son invasión tumoral del nervio frénico, lesiones quirúrgicas, traumáticas, infecciones, idiopáticas, entre otras. Su corrección quirúrgica es necesaria cuando hay compromiso respiratorio. Varias técnicas y abordajes están descritos para realizar reparación. No se conocen publicaciones de plicaturas diagramáticas realizadas por videotoracoscopia por dos puertos. Caso clínico: se presenta caso clínico de paciente femenina de 50 años de edad con parálisis diafragmática idiopática. Disnea progresiva, con datos espirométricos sugestivos de patrón restrictivo severo. Se realizó satisfactoriamente y sin complicaciones plicatura diafragmática vía toracoscópica por dos puertos. Se comprobó mejoría anatómica y clínica. Conclusión: la plicatura diafragmática es la técnica quirúrgica de elección para la corrección de la parálisis diafragmática. Se propone la videotoracoscopia por dos puertos como abordaje favorable que permite realización del procedimiento operatorio. Rev.cienc.biomed.2013;4(1):142-146

INTRODUÇÃO: O diafragma é o principal músculo respiratório e desempenha um papel importante na respiração e na regulação fisiológica. Uma terapia que visa melhorar essas condições referentes ao diafragma, é a técnica de liberação manual diafragmática. OBJETIVO: O objetivo deste estudo foi verificar a aplicabilidade clínica das técnicas manuais de liberação diafragmática e identificar as principais técnicas, populações investigadas, variáveis avaliadas e seus desfechos. MÉTODOS: Foram pesquisadas as seguintes bases de dados: PubMed, Scielo e Science Direct, com os descritores “Diaphragm [Mesh]” e “Musculoskeletal Manipulations [Mesh]” com seus correspondentes no mesmo idioma. Foram incluídos ensaios clínicos randomizados, não randomizados, estudos semi, quase-experimentais e estudos pilotos ou de caso, que abordaram técnicas de liberação manuais diafragmáticas. RESULTADOS: Há variadas técnicas de liberação diafragmática, sendo as mais mencionadas: normalização dos pilares do diafragma, alongamento e estiramento do diafragma, relaxamento dos pilares do diafragma. Além disso, as técnicas de liberação diafragmática vêm sendo associadas a protocolos de terapia manipulativa osteopática (TMO). As principais populações estudadas foram de pacientes saudáveis, com lombalgia, cervicalgia, osteoartrite, asmáticos, doença pulmonar obstrutiva crônica, constipados, cardiopatas e com refluxo gastroesofágico. Os principais desfechos avaliados são variáveis musculoesqueléticas (dor, flexibilidade, amplitude, espessura diafragmática), variáveis cardiorrespiratórias (pressão inspiratória/expiratória máxima (PImax e Pemax), mobilidade torácica, frequência cardíaca e respiratória), qualidade de vida e disfunções gastrointestinais/gastroesofágicas. CONCLUSÃO: A aplicabilidade clínica das técnicas de liberação diagramática está sendo investigada associado com outras técnicas osteopáticas, em protocolos de TMO em pacientes saudáveis, pneumopatas, cardiopatas, gestantes, em cicatriz pós-cirúrgica, constipados, com refluxo gastroesofágico, osteoartrite, cervicalgia e com lombalgia. Evidencia-se: diminuição ou eliminação das dores musculoesqueléticas, aumento da flexibilidade, ADM, Pimáx e Pemáx, aumento da mobilidade torácica, aumento da qualidade de vida, diminuição do inchaço e dor abdominal e sem efeito em cardiopatas.

Tyrimo tikslas – įvertinti diafragminio kvėpavimo lavinimo poveikį sėdimą darbą dirbančių žmonių apatinės nugaros dalies skausmui mažinti. Tyrimo metu buvo siekiama palyginti tiriamųjų juosmeninės stuburo dalies skausmą, diafragmos aktyvumą, juosmeninės stuburo dalies mobilumą, apatinės nugaros dalies skausmo ir negalios rodiklius prieš ir po kineziterapijos, įvertinti gautų rezultatų funkcinius ryšius. Tyrime dalyvavo 12 sėdimą darbą dirbančių žmonių, kurie skundėsi apatinės nugaros dalies skausmu. Tirimieji buvo pasirinkti netikimybiniu tiksliniu atrankos būdu ir suskirstyti į dvi grupes. I grupei taikyti stabilumo, tempimo pratimai, II – stabilumo, tempimo ir diafragminio kvėpavimo pratimai. Tyrimo metodai: anketavimas (Roland –Morris klausimynas), testavimas (SAS, diafragmos aktyvumo vertinimas naudojant aparatą – pneumotonometrą „Micro RPM“, juosmeninės stuburo dalies mobilumo vertinimas naudojant Šoberio testą), statistinė duomenų analizė. Po kineziterapijos gautas I ir II grupių skausmo, diafragmos aktyvumo bei negalios ir skausmo rodiklių pagerėjimas. II grupės tyriamųjų skausmo, diafragmos aktyvumo Rolland-Moris rezultatai gauti geresni lyginant su I grupės rezultatais. Tyrimas parodė, kad atlikti stabilizavimo pratimai kartu su diafragminiais kvėpavimo pratimais turėjo didesnį poveikį funkciniams rodiklių rezultatams nei vien tik stabilumo ir tempimo pratimai.

Comparar a efetividade do Threshold IMT e do Voldyne no fortalecimento muscular respiratório de jovens saudáveis através de um protocolo estruturado. A pesquisa envolveu jovens saudáveis, divididos aleatoriamente em grupo threshold (GT) e grupo voldayne (GV), e submetidos a um protocolo de treinamento, realizado em 10 sessões, duas vezes por semana. O protocolo consistiu em inspirações com dispositivos realizados em 3 séries de 15 repetições partindo do volume residual e alcançando a capacidade pulmonar total. Adotou-se para o grupo GT uma carga de 40% da pressão inspiratória máxima (Pimáx). Foram submetidos a avaliação e treinamento 20 jovens distribuídos nos grupos (GT n-10 e GV n-10). Houve aumento relevante da força muscular respiratória em ambos os grupos, amostra apresentou um alto aumento de 15,43% e 35,45% no pós intervenção na Pimáx, em GT (p

RESUMO Avaliar o músculo diafragma é importante para verificar suas possíveis alterações ou disfunções. Existem várias formas de avaliar a mobilidade diafragmática, mas poucos estudos que comparam a mobilidade do hemidiafragma direito com o esquerdo. O objetivo deste estudo é avaliar se existem diferenças entre a mobilidade diafragmática das hemicúpulas direita e esquerda em indivíduos saudáveis e em indivíduos com Doença Pulmonar Obstrutiva Crônica (DOCP), bem como comparar a mobilidade diafragmática entre homens e mulheres, e entre pacientes saudáveis e com DPOC. Foram avaliados 40 indivíduos saudáveis e 40 indivíduos com diagnóstico clínico de DPOC. Utilizaram-se os parâmetros antropométricos, cardiopulmonares e avaliação da mobilidade diafragmática pelo método radiográfico. Os dados foram analisados estatisticamente e tratados com análise descritiva (média e desvio-padrão) e análise inferencial. Para comparar a mobilidade das hemicúpulas diafragmáticas direita e esquerda, utilizou-se o teste t pareado. O nível de significância adotado para o tratamento estatístico foi de 5% (p

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]

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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]

Copyright of Fisioterapia Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

RESUMO Na doença pulmonar obstrutiva crônica (DPOC), os pacientes podem apresentar redução da mobilidade diafragmática e uma série de compensações na coluna torácica, nas cinturas escapular e pélvica. No entanto, não está clara a relação da mobilidade diafragmática com alterações posturais na coluna vertebral e na pelve desses indivíduos. Objetivou-se verificar se existe relação entre a mobilidade diafragmática com as curvaturas da coluna vertebral de pacientes com DPOC e em indivíduos aparentemente saudáveis. Foram avaliados 22 pacientes com DPOC e 22 indivíduos aparentemente saudáveis. As avaliações foram: antropometria, espirometria, mobilidade diafragmática e avaliação postural. Foram analisadas quatro alterações posturais: lordose cervical, cifose torácica, lordose lombar, posição pélvica. Não houve diferença estatisticamente significativa entre os grupos, em relação às variáveis idade, massa corporal, estatura e IMC, confirmando que os grupos foram pareados. Não houve diferença estatisticamente significante em nenhuma das variáveis referentes às curvaturas da coluna vertebral e à posição da pelve entre os grupos estudados. No grupo DPOC houve correlação da mobilidade diafragmática com a cifose torácica (r=-0,543; p=0,009). Já em relação ao grupo de indivíduos aparentemente saudáveis, não houve correlação da mobilidade quanto os indivíduos aparentemente saudáveis apresentaram os mesmos ângulos de curvatura da coluna vertebral e a mesma posição da pelve. Contudo, os pacientes com DPOC apresentaram relação entre a mobilidade diafragmática e o ângulo da curvatura torácica.

Introdução: A eficácia do treinamento da musculatura inspiratória (TMI) com alta e baixa intensidade na obesidade mórbida precisa ser elucidada. Objetivo: Analisar os efeitos do treinamento de alta e baixa intensidade na musculatura inspiratória em indivíduos com obesidade mórbida. Método: Participaram 32 homens, divididos em dois grupos (G1 e G2). As avaliações do grau de dispneia, prova de função pulmonar, PImáx, DP e MD foram realizadas no pré-treinamento e após 12 semanas de treinamento. Discussão: Protocolos de treinamento nesse estudo, com resistor de carga linear Power Breather®, têm efeitos positivos nesses indivíduos tanto em alta quanto em baixa intensidade, mas com efeitos mais prolongados no TMI de alta intensidade. Resultados: O G1 obteve aumento significante da VVM, PImáx, DP, MD e diminuição significantes na MRCm em 12 semanas de treinamento, os quais se mantiveram após 12 semanas sem treinamento. O G2 apresentou o mesmo comportamento quando comparado com o G1 em 12 semanas de treinamento, porém os valores voltaram aos iniciais na VVM, MRCm e MD, e as variáveis PImáx e DP apresentaram valores abaixo da avaliação inicial após 12 semanas sem treinamento. Na análise intergrupo (12-12 semanas), G1 apresentou valores maiores na VVM, PImáx, DP e MD quando comparado com G2. Na comparação das 24-24 semanas, G2 apresentou valores menores na VVM, PImáx, DP e MD aumentos significantes na MRCm quando comparados com G1. Conclusão: O TMI de alta e baixa intensidade proporcionou efeitos benéficos aos indivíduos, os quais se mantiveram após 12 semanas do treinamento de alta intensidade. ABSTRACT Effects of high and low intensity training in inspirational musculature in morbid obesian individuals: controlled randomized study 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.