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114. Echocardiography in adult patients with cystic fibrosis
Supplement / The Netherlands Journal of Medicine 54 (1999) S3 –S84 RFTs did not differ significantly between those with new CXR changes and those without. PV and CRP were significantly higher with CXR deterioration, p , 0.025. We suggest that routine admission CXRs may not be needed and that requests could be limited to patients with a major exacerbation and those with significantly raised inflammatory markers.
114. Echocardiography in adult patients with cystic fibrosis. G. Nekludova, C. Naumenko. E. Amelina, A. Cherniaev. Pulmonology Institute, Moscow, Russia. Right ventricular disease is almost invariably secondary to pulmonary vascular disease and itself is a consequence of airflow obstruction and tissue destruction in cystic fibrosis (CF) patients. The aim of our study was to evaluate the echocardiography parameters in adult CF patients. Twelve CF patients (6 males and 6 females, aged 17–26 years) in stable state were divided into two groups. First group patients (7 patients), who had forced expiratory volume in one second (FEV1 ) more than 30% and second group patients (5 patients), who had FEV1 less than 30% were studied. Each subjects had measurements of lung function and echocardiography at the same day. There were significant differences in the echocardiography parameters between the patients of first and second groups (systolic pulmonary arterial pressure (SPAP): 21.262.4 mmHg and 38.468.2 mmHg, p , 0.05; stroke volume: 60.463.5 ml and 41.065.7, p , 0.05 respectively). Significant correlations were found between SPAP and both tricuspid and mitral diastolic flows (r 5 0.71, p , 0.05 and r 5 0.69, p , 0.05 respectively). Our data suggest that adult CF patients have right ventricle disfunction as well as have left ventricle disfunction especially for subjects with severe airflow obstruction.
115. Bronchial artery embolization in CF: a clinical point of view. F. Pardo 1 , M. Collura 1 , M.L. Furnari 1 , L. Termini 1 , D. Messana 2 , S. Salerno 3 . 1 Centro Regionale Fibrosi Cistica, 2 Radiologia Osp. Oncologico, 3 Istituto di Radiologia Universita` , Palermo. Bronchial artery embolization (BAE) is a well established treatment to control the haemoptsys in CF. We report the Palermo CF Center experience of over 10 years (1988–1998). 8 pts (4 M, 4F) underwent 11 BAE procedures for haemoptsys (8 major, 3 recurrent). Mean age of pts at presentation was 25 yrs (range 16.5–33).The mean FEV1 before all the 11 embolisation was 34.736DS 16.75 (range 11–63). No pts was in O 2 therapy. Embolization via femoral or axillary access route using 4–5Fr cobra, Sos or Simmons catheter and particles (Ivalon) or coils was successfully achieved in all pts (8 in bronchial, 6 in aberrant vessels). The 8 pts were followed up for a mean of 34.6 mths (range 7–99). 3 needed another procedure after a mean of 30.3 mths (range 9–64). Only 1 pt died for PNX after 35 mths. 2 pts had lung transplantation after 4 and 32 mths respectively. Both were O2 dependent after BAE. The mean decrease of FEV1 (%) after 2 months from the 11 embolisation was 6.7 and after 1 year was 12.8. In 7 / 8 pts alive quality of life can be considered good. BAE is an effective and a safe procedure in controlling
S53
haemoptsys in CF and provide relief of symptoms for a good period.
116. Long term results of lobar resection for focal bronchiectasis. G.J. Connett, J. Maddison, J. Fairhurst. Southampton University Hospital, UK. We have reported favourable short term benefits following lobectomy to treat severe localised bronchiectasis in 6 patients. Following surgery all cases had marked clinical improvements and maintained or improved lung function. After a minimum of 3 years follow up all except one (who suffered immediate post-op complications) have maintained or improved lung function. However an increase in symptoms requiring further antibiotics has occurred. Changes in prospective Chrispin Norman CXR scores are shown Case
Pre-Op
Post-Op
1998 score
Yrs Post-Op
1 2 3 4 5 6
7 5 10 9 10 12
7 4 5 10 3 15
9 15 14 10 14 13
3 8 4 3 6 4
New radiological changes tended to occur in zones previously occupied by resected lobes. This was demonstrated by retrospectively scoring changes in the appearance of upper, lower, left and right lung zones in each patient. Distortion of lung anatomy following lobar resection might be causally related to recurrent bronchiectasis at the site of previous resections.
117. Prevalence of urinary incontinence (UI) in women with cystic fibrosis (CF). M. Cornacchia, A. Zenorini, C. Braagion, S. Perobelli, L.M. Cappelletti, G. Mastella. CF Center, Ospedale Civile Maggiore, Verona, Italy. UI is uncommon in young women. Stress UI could be associated with chronic cough and poor nutritional status, two characteristics usually observed in young women with moderate and severe lung disease due to CF. The aim of our study was to determine the prevalence of UI in CF women aged 15 years and over. An anonymous questionnaire was administered to 176 patients (mean age: 24.665.8 yrs) at the time of a routine control as outpatients. 72 (41%) patients were classified as never incontinent. Occasional UI was reported in 61 (35%) CF women. Regular UI occurring twice or more a month for at least two consecutive months in the last year, was reported in 43 (24%) patients. The prevalence of regular UI of 16% in patients aged 15–25 yrs and of 35% in patients aged 25–45 yrs was higher than in healthy subjects (4 and 8%, respectively) (BMJ 1980;281:1243). Coughing, laughing and physical activity were associated to UI in 92, 33 and 21% of the patients, respectively. Patients with UI had lower values of FEV1 (55624% pred.) and were older (2666 yrs) than patients without the symptom (65623% pred., p , 0.01 and 2365 yrs, p , 0.01, respectively).
114. Echocardiography in adult patients with cystic fibrosis. G. Nekludova, C. Naumenko. E. Amelina, A. Cherniaev. Pulmonology Institute, Moscow, Russia. Right ventricular disease is almost invariably secondary to pulmonary vascular disease and itself is a consequence of airflow obstruction and tissue destruction in cystic fibrosis (CF) patients. The aim of our study was to evaluate the echocardiography parameters in adult CF patients. Twelve CF patients (6 males and 6 females, aged 17–26 years) in stable state were divided into two groups. First group patients (7 patients), who had forced expiratory volume in one second (FEV1 ) more than 30% and second group patients (5 patients), who had FEV1 less than 30% were studied. Each subjects had measurements of lung function and echocardiography at the same day. There were significant differences in the echocardiography parameters between the patients of first and second groups (systolic pulmonary arterial pressure (SPAP): 21.262.4 mmHg and 38.468.2 mmHg, p , 0.05; stroke volume: 60.463.5 ml and 41.065.7, p , 0.05 respectively). Significant correlations were found between SPAP and both tricuspid and mitral diastolic flows (r 5 0.71, p , 0.05 and r 5 0.69, p , 0.05 respectively). Our data suggest that adult CF patients have right ventricle disfunction as well as have left ventricle disfunction especially for subjects with severe airflow obstruction.
115. Bronchial artery embolization in CF: a clinical point of view. F. Pardo 1 , M. Collura 1 , M.L. Furnari 1 , L. Termini 1 , D. Messana 2 , S. Salerno 3 . 1 Centro Regionale Fibrosi Cistica, 2 Radiologia Osp. Oncologico, 3 Istituto di Radiologia Universita` , Palermo. Bronchial artery embolization (BAE) is a well established treatment to control the haemoptsys in CF. We report the Palermo CF Center experience of over 10 years (1988–1998). 8 pts (4 M, 4F) underwent 11 BAE procedures for haemoptsys (8 major, 3 recurrent). Mean age of pts at presentation was 25 yrs (range 16.5–33).The mean FEV1 before all the 11 embolisation was 34.736DS 16.75 (range 11–63). No pts was in O 2 therapy. Embolization via femoral or axillary access route using 4–5Fr cobra, Sos or Simmons catheter and particles (Ivalon) or coils was successfully achieved in all pts (8 in bronchial, 6 in aberrant vessels). The 8 pts were followed up for a mean of 34.6 mths (range 7–99). 3 needed another procedure after a mean of 30.3 mths (range 9–64). Only 1 pt died for PNX after 35 mths. 2 pts had lung transplantation after 4 and 32 mths respectively. Both were O2 dependent after BAE. The mean decrease of FEV1 (%) after 2 months from the 11 embolisation was 6.7 and after 1 year was 12.8. In 7 / 8 pts alive quality of life can be considered good. BAE is an effective and a safe procedure in controlling
S53
haemoptsys in CF and provide relief of symptoms for a good period.
116. Long term results of lobar resection for focal bronchiectasis. G.J. Connett, J. Maddison, J. Fairhurst. Southampton University Hospital, UK. We have reported favourable short term benefits following lobectomy to treat severe localised bronchiectasis in 6 patients. Following surgery all cases had marked clinical improvements and maintained or improved lung function. After a minimum of 3 years follow up all except one (who suffered immediate post-op complications) have maintained or improved lung function. However an increase in symptoms requiring further antibiotics has occurred. Changes in prospective Chrispin Norman CXR scores are shown Case
Pre-Op
Post-Op
1998 score
Yrs Post-Op
1 2 3 4 5 6
7 5 10 9 10 12
7 4 5 10 3 15
9 15 14 10 14 13
3 8 4 3 6 4
New radiological changes tended to occur in zones previously occupied by resected lobes. This was demonstrated by retrospectively scoring changes in the appearance of upper, lower, left and right lung zones in each patient. Distortion of lung anatomy following lobar resection might be causally related to recurrent bronchiectasis at the site of previous resections.
117. Prevalence of urinary incontinence (UI) in women with cystic fibrosis (CF). M. Cornacchia, A. Zenorini, C. Braagion, S. Perobelli, L.M. Cappelletti, G. Mastella. CF Center, Ospedale Civile Maggiore, Verona, Italy. UI is uncommon in young women. Stress UI could be associated with chronic cough and poor nutritional status, two characteristics usually observed in young women with moderate and severe lung disease due to CF. The aim of our study was to determine the prevalence of UI in CF women aged 15 years and over. An anonymous questionnaire was administered to 176 patients (mean age: 24.665.8 yrs) at the time of a routine control as outpatients. 72 (41%) patients were classified as never incontinent. Occasional UI was reported in 61 (35%) CF women. Regular UI occurring twice or more a month for at least two consecutive months in the last year, was reported in 43 (24%) patients. The prevalence of regular UI of 16% in patients aged 15–25 yrs and of 35% in patients aged 25–45 yrs was higher than in healthy subjects (4 and 8%, respectively) (BMJ 1980;281:1243). Coughing, laughing and physical activity were associated to UI in 92, 33 and 21% of the patients, respectively. Patients with UI had lower values of FEV1 (55624% pred.) and were older (2666 yrs) than patients without the symptom (65623% pred., p , 0.01 and 2365 yrs, p , 0.01, respectively).