Introduction: Respiratorysinusarrhythmia (RSA) has been used for assessment the cardiac modulation autonomic and measured by ratio expiration/inspiratory (E/I) and inspiration/expiration heart rate variation ( ∆IE). The RSA is lower in patients with acute myocardial infarction. Objective: To evaluate the effect of inspiratory muscle training (IMT) on the RSA magnitude and maximal inspiratory pressure (PImax) in patients with AMI after 6 days of physiotherapeutic intervention during hospitalized period. Methodology: Thirty three patients were divided in two groups: 19 patients of treatment group (TG) (14 males, 5 females, aged 50±9 years) who underwent the cardiovascular physiotherapy and 14 patients of control group (CG) (11 males, 3 females, aged 52±11 years) without physiotherapy. The intervals RR of electrocardiogram were obtained by Polar S810i during the RSA test on the 1 st and 6 th days. It was used to calculate the heart rate variability in the time (TD) and in the frequency domain and the RSA index. The PImax was obtained by manovacuometer on the 2 nd and 6 th days. The IMT (3x, 10 forced inspiration, 40% PImax, for 3 seconds each) was done from the 2 nd to 6 th days. Two-way ANOVA, Paired-t Test, Chi-square test and Pearson’s correlation (p<0.05) were used. Results: In the TD, the TG showed higher values than the CG for the SDNN (1 st day 58±37 and 33±23ms; 6 th day 49±20 and 32±17ms, respectively) and for the RMSSD (1 st day 40±32 e 21±18 ms; 6 th day 33±18 and 22±14ms, respectively). The ∆IE decreased significantly for the TG (12,8±7,5 to 9,9±4,8 bpm) and for the CG (10,8±5,3 to7,5±3,4 bpm). For the TG, the PImax increased (p<0,05) from 78±25 to 101±25. Conclusion: The IMT increased the PImax, although it did not modify the ASR magnitude in patients with acute myocardial infarction.
Objective: To evaluate the autonomic modulation of heart rate (HR) at rest in the supine position and during a respiratorysinusarrhythmia maneuver (M-RSA) among participants with chronic obstructive pulmonary disease (COPD) or with chronic heart failure (CHF). Methods: Twenty- eight men were divided into three groups: ten with COPD, aged 69±9 years; nine with CHF, aged 62±8 years; and nine healthy participants aged 64±5 years (controls). At rest, the R-R interval of the electrocardiographic signal was obtained in the following situations: 1) 15 min in the supine position; and 2) 4 min during M-RSA in the supine position. The data were analyzed in the time domain (RMSSD and SDNN indices) and the frequency domain (LFab and HFab). During M-RSA, the expiratory/inspiratory ratio (E/I) and the inspiratory/expiratory difference (∆IE) were calculated. Results: The main findings showed that the CHF patients presented lower RMSSD (12.2±2.6 vs. 20.4±6.5), LFab (99.2±72.7 vs. 305.3±208.9) and HFab (53.4±29.9 vs. 178.9±113.1), compared with the controls. The LFab band was significantly lower in the COPD group than in the controls (133.8±145.5 vs. 305.3±208.9). Additionally, both CHF patients and COPD patients showed lower E/I ratios (1.1±0.06 vs. 1.2±0.1 and 1.1±0.03 vs. 1.2±0.1) and ∆IE values (7.0±3.5 vs. 12.7±0.1 and 4.9±1.6 vs. 12.7±0.1), respectively, compared with the controls during M-RSA. Conclusion: The results from this study suggest that both COPD and CHF have a negative impact on the autonomic control of heart rate. Article registered on the Australian New Zealand Clinical Trials Registry (ANZCTR) under the number: ACTRN12609000467235
Hypothesizing that respiratory muscle weakness nega- tively influences heart rate variability during respiratory maneuvers in patients with COPD; Reis and coworkers  aimed to evaluate the influence of respiratory muscle strength on the magnitude of respiratorysinusarrhythmia. All chronic obstructive pulmonary disease patients used short-action bronchodilators, and six used long-action bronchodilators. Subjects in the control group were free of chronic pulmonary, cardiovascular, immune, and/or meta- bolic disease. The volunteers were kept at rest in the su- pine position for approximately 10 minutes to ensure that a true resting HR value was achieved. Then, the ECG sig- nal and the instantaneous HR were obtained at rest in the supine position for 15 minutes. Subsequently, the heart rate and RR intervals were recorded during the respiratorysinusarrhythmia maneuver in the supine position in the following order: for one minute at rest with spontaneous breathing; for four minutes while performing the respira- tory sinusarrhythmia maneuver; and for one minute at rest with spontaneous breathing. It was concluded that COPD patients showed evidence of impaired autonomic modulation of heart rate at rest and during respiratorysinusarrhythmia maneuver, the relationship between the maximal inspiratory pressure and heart rate variability indices during respiratorysinusarrhythmia maneuver indicates that the inspiratory muscle weakness observed in this population may be associated with cardiac auto- nomic control.
ABSTRACT | Heart rate (HR) luctuate during the respiratory cycle. This phenomenon is known as respiratorysinusarrhythmia. The deep breathing test is to keep a paced breathing in six breathing per minute and I:E relationship 1:1. The purpose of this study is to access minute volume, expired fraction of carbon dioxide (EFCO 2 ) and autonomic control of heart rate during deep breathing test longer than 90 seconds. Sixteen young healthy male (18 – 25 years old) were assessed. The subjects were instructed to perform inspirations and expirations with duration of 10 seconds per cycle, I:E = 1:1, and consequently respiratory rate of 6 cycles per minute, for about four minutes with one minute after and before, totaling six minutes. HR was recorded beat-to-beat using a cardio frequencimeter; MV and EFCO 2 was measured and recorded using a mobile ergoespirometer. To analyse statistics diferences, ANOVA one way (Tuckey post-hoc) and Kruskall Wallis (Dunn post- hoc) were used (p<0.05). When deep breathing test in course, EFCO 2 , MV and time domain heart rate variability shows no statistics diference over time. To perform deep
Humans’ ability to represent their body state from within through interoception has been proposed to predict different aspects of human cognition and behaviour. We focused on the possible contribution of interoceptive sensitivity to social behaviour as mediated by adaptive modulation of autonomic response. We, thus, investigated whether interoceptive sensitivity to one’s heartbeat predicts participants’ autonomic response at different social distances. We measured respiratorysinusarrhythmia (RSA) during either a Social or a Non-social task. In the Social task each participant viewed an experimenter performing a caress-like movement at different distances from their hand. In the Non-social task a metal stick was moved at the same distances from the participant’s hand. We found a positive association between interoceptive sensitivity and autonomic response only for the social setting. Moreover, only good heartbeat perceivers showed higher autonomic response 1) in the social compared to the non-social setting, 2) specifically, when the experimenter’s hand was moving at boundary of their peripersonal space (20 cm from the participant’s hand). Our findings suggest that interoceptive sensitivity might contribute to interindividual differences concerning social attitudes and interpersonal space representation via recruitment of different adaptive autonomic response strategies.
h ere are several factors that might af ect HRV, among them respiratory cycles. During inhaling, heart rate (HR) tends to augment due to the vagal, while during exhaling there oc- curs the vagal retake and, therefore, HR tends to decrease. In this context, it is possible, by means of the RespiratorySinusArrhythmia Maneuver (RSA-M) to evaluate the integrity of the cardiorespiratory system 6 . h us, the goal of the present case
The CT scans (n ¼ 5) showed disease extending from the pyriform sinus apex through the strap muscle layer to the thyroid or perithyroid tissue in all patients. In all patients, abnormal soft-tissue swelling and enhancement along the course of the disease were evident on the CT scans. In two patients, the lesions ended at the perithyroid level. There were no cases involving the mediastinums below the sternal notch. The involved pyriform sinus fossae were deformed by adjacent soft-tissue inﬂammation in all patients. One patient had cutaneous opening in the left anterior portion of the neck. One patient had thyroid gland involvement, including swell- ing of the thyroid gland, poor deﬁnition of the thyroid margin, and loss of high attenuation of the affected lobe on CT scans after contrast enhancement. MR images, obtained from two patients, showed the same disease course as did the CT scans. The patients continue to be under follow-up even after two years. There has been no evidence of recurrence in any of the patients (►Table 1).
OBJECTIVE: To evaluate the role, especially of computed tomography, in the staging of maxillary sinus carcinomas. MATERIALS AND METHODS: Ten cases of carcinoma treated in Hospital Heliópolis Department of Diagnostic Imaging and Head and Neck Surgery, São Paulo, SP, Brazil, in the period between 1988 and 2002, were evaluated. RESULTS: Nine patients presented with tumor extension to the cheek, eight to the masticator space, seven to the mouth floor and hard palate, five to the pterygoid fossa, five to the orbit, three to the ethmoid bone, and one to the skull base. Three of the patients were staged T3, and seven T4. Two patients had lymph nodes metastases at their initial presentation, and were staged T4. All of the cases were histopathologically confirmed. CONCLUSION: The accurate analysis of the tumor local extent and dis- semination by means of computed tomography and magnetic resonance imaging plays a relevant role in the surgical planning, besides influencing the therapeutic conduct and prognosis.
the pterygopalatine fossa, the pterygoid fossa, sphe- noidal sinus, cavernous sinus and temporal lobe. Angiography showed a major vascular component coming from the petrous and cavernous branches of the internal carotid artery (ICA), after embolization of external carotid artery branches.
Comments: NF1 is a common autosomal dominant disorder caused by mutations in the NF1 gene. Among the NF1 findings, congenital heart defects are considered unusual. In the literature review, there was no association between NF1 and unroofed coronary sinus, which is a rare cardiac malformation, characterized by a communication between the coronary sinus and the left atrium, resultant from the partial or total absence of the coronary sinus roof. It represents less than 1% of atrial septal defect cases. More reports are important to determine if this association is real or merely casual, since NF1 is a common condition.
Oral cavity manipulation or swallowing of a cold liquid caused episodes of typical pain, radiating down to the left ear, with a temporary relief after a lingual nerve block with Marcaine. The quantity and severity of pain episodes became progressively worse with several episodes on the same day followed by a seizure leading to the need for mechanical ventilatory support. Due to severe sinus bradycardia and asystole, during the pain episode, atropine and isoprotere- nol were used unsuccessfully (fig. 2). After the insertion of a temporary pacemaker through dissection of the right basi- lar vein, bradyarrhythmia and seizures were controlled (fig. 3 and 4). He was treated by alcohol injection through the ju- gular foramen, due to the severity of his clinical condition and because anesthetic block, at this level, caused signifi- cant improvement in the symptoms.
, 1998, were included in the study. Subsequently, an independent arbiter (pediatrician) revised all information collected, from the medical chart and a questionnaire of symptoms filled by the mother or responsible and, based on criteria proposed by the WHO, decided on the child’s respiratory diagnosis (1) . The children whose available clinical data were considered insufficient
Globally, RSV is the most common cause of childhood acute lower respiratory infection and is responsible for annual outbreaks worldwide [1-4]. RSV infection usually results in upper respiratory tract illness characterized by profuse rhinorhea, however 25 – 40% of children experiencing infections in their first year of life may develop severe respiratory disease requiring hospitalization [1, 5, 6]. This may result in long-term respiratory disorders such as abnormal pulmonary function, asthma, recurrent cough, and bronchitis [7, 8]. RSV has two Groups, A and B, which are distinguished largely by antigenic and genetic characteristics. During epidemics, either Group A or B may predominate, or both Groups may circulate concurrently [7, 9]. Evidence for RSV infection has been found in every geographic area studied and the predominant occurrence changes according to the region´s climates. In temperate countries RSV outbreaks coincide with winter and in tropical climates the pattern varying with most literature associating RSV with rainy season [10-13].
Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 4/ January 28, 2013 Page-350 like processes. Bits were given, processed and stained with routine hematoxylin & eosin. Histologically, showed small round to oval cells, having hyperchromatic nucleus with scant cytoplasm (Fig.1). These tumor cells were arranged in sheets, ribbons, nests and also in gland like pattern. Focal areas showed spindle like cells & hemorrhagic spaces. These tumor cells also showed infiltration to the bony spicules &stroma. A diagnosis of Small cell undifferentiated carcinoma- Right Maxillary sinus was made.
Abstract Paranasal sinus mucoceles are benign cystic lesions, ﬁlled with mucus, occurring due to an obstruction of involved sinus ostium. They are indolent, locally expansive, and destructive. Surgical treatment must be performed and, when done at the correct time, may prevent sequelae. We present a case of ethmoid sinus mucocele with orbit involvement and permanent optical nerve injury.
The aim of the surgery is to remove all the sinus tissue. Leaving hair containing tracts without excision may be one cause of recurrent disease. Some surgeons therefore dye the nest with methylene blue intra-operatively to completely visualize tracts for subsequent curative excision. In some cases, sinus nests can rupture, and methylene blue can spread into the operation field and prevent the visualization of the pilonidal sinus tissue. Healthy tissue can also be stained, thereby leading to larger excisions.
Physical assessment of the patients at admission revealed that pulse oximetry values lower than 90% was a risk factor for RSV infection. While some researchers consider that clinical signs of respiratory discomfort, cyanosis and a compromised general condition are sufficient for establishing tissue hypoxia , others believe that this assessment is limited, especially in previously-healthy children with low risk for mechanical ventilation . In general, risk factors at one location may not be considered important in another due to different criteria applied at hospital admission and discharge [18,20].
Objective: To measure the intra-sinus pressure and the maxillary sinus functional efficiency (MSFE) in individuals with chronic facial pain after conservative or conventional endoscopic maxillary surgery, as well as in controls. Method: Sinus manometry was performed 5 times during inhalation. Results: The resemblance of pressure values comparing those treated with minimally invasive surgery and controls was remarkable, while traditional surgery significantly decreased intrasinusal pressures. The MSFE was 100% in the three tested times for controls, close to that in those submitted to minimally invasive surgery (98.3%, 98.8%, and 98.0%) and significantly impaired after conventional surgery (48.8%, 52.1%, 48.5 %, p,0.01). All patients submitted to minimally invasive surgery remained pain-free after three months of surgery, relative to 46.7% of the submitted to conventional surgery (p,0.05). Conclusion: Minimally invasive sinus surgery is associated with functionality of the chambers that resemble what is found in normal individuals.
In the current scenario, with high-definition video sys- tems and next-generation endoscopic instruments and equipment, the question is: does the open or classic tech- nique still have a place in the surgical arsenal of paranasal sinus surgery? Surely, the answer is ‘‘yes’’, for it is not