title: Time-Trend Analysis of Pulmonary and Diaphragmatic Functionality in Patients with Diaphragmatic Palsy or with Chronic Diaphragmatic Hernia after Surgical Treatment.
abstract: BackgroundThe aim of this study was to assess long-term pulmonary and diaphragmatic function in two cohorts of patients: the first one affected by diaphragmatic palsy (DP) who underwent plication reinforced by rib-fixed mesh and the second one affected by chronic diaphragmatic hernia (TDH) who underwent surgical reduction and direct suture.Materials and MethodsFrom 1996 to 2011, 10 patients with unilateral DP and 6 patients with TDH underwent elective surgery. Preoperative and long-term (12 months) follow-up assessments were completed in all patients, including pulmonary function tests (PFTs) with diffusion of the lung for carbon monoxide (DLCO), measure of maximum inspiratory pressure (MIP) assessed both in standing and in supine positions, blood gas analysis, chest computed tomographic (CT) scan, and dyspnea score. The Pearson chi-square test, Fisher exact test, and Studentt-test were applied when indicated.ResultsAt long-term (12 months) postoperative follow-up, patients operated for DP showed a significant improvement in terms of forced expiratory volume in 1 second (FEV1%) (+ 18.2%,p< 0.001), forced vital capacity (FVC%) (+ 12.8%,p< 0.001), DLCO% (+ 8.3%,p= 0.04), and Po2(+ 9.86 mm Hg,p< 0.001) when compared with baseline values. Conversely, when considering the TDH group, only the levels of Po2were found to be significantly higher in the postoperative assessment (+ 8.3 mm Hg,p= 0.04). Although MIP increased in both the groups after surgery, a persistent and significant decrease of MIP was detected in TDH group when comparing the levels assessed in supine position with those measured in the standing position (p< 0.001). Medical Research Council dyspnea scale improved in the DP group by a factor of 0.80 (p< 0.001) and in the TDH group by a factor of 0.33 (p= 0.175).ConclusionIn patients who underwent surgery for DP, good long-term results may be predicted in terms of pulmonary flows, volumes, and DLCO. Conversely, in patients who underwent elective surgery for chronic TDH, a persistent overall restrictive pattern, lower MIP values in supine position, and paradoxical motion could be expected.
authors.affiliation: Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Rapicetta
authors.affiliation: Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Voltolini
authors.affiliation: Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Lococo
authors.affiliation: Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Vecchioni
authors.affiliation: Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Tenconi
authors.affiliation: Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy.
authors.forename: Masimiliano
authors.initials: M
authors.lastname: Paci
authors.affiliation: Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Ricchetti
authors.affiliation: Physiopatology and Respiratory Rehabilitation, University Hospital of Siena, Siena, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Rossi
authors.affiliation: Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gotti
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003964:Diaphragm / Q000294:innervation*; D004417:Dyspnea / Q000503:physiopathology / Q000601:surgery; D017558:Elective Surgical Procedures; D005260:Female; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects; D006801:Humans; D008168:Lung / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D057216:Propensity Score; D020127:Recovery of Function; D012042:Registries; D012119:Respiration; D012129:Respiratory Function Tests; D012133:Respiratory Paralysis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016683:Supine Position; D013536:Suture Techniques; D019616:Thoracic Surgical Procedures / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome