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Category Archives: Polymyositis

Exercise Limitation in Patients with Polymyositis: Discussion (3)

The Vd/Vt ratio may be increased at end-exercise due to either parenchymal or pulmonary vascular disease. Although Jones and Goodwin have reported abnormal increases in the Vd/Vt ratio during exercise in patients with pulmonary vascular disease, D’Alonzo et al found that the typical response observed in nine of 11 patients with pulmonary hypertension was a fall in the Vd/Vt ratio during exercise. We failed to observe a consistent response in the patients with pulmonary hypertension in the present study and their Vd/Vt ratio at end-exercise was not significantly different from that of the patients without pulmonary hypertension.
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Exercise Limitation in Patients with Polymyositis: Discussion (2)

The clinical recognition of pulmonary hypertension in the absence of overt right heart failure may be difficult. Prior to the development of echocardio-graphic techniques right heart catheterization was the only method of establishing the diagnosis. However, echocardiography, particularly with the Doppler study, has been shown to be a sensitive, noninvasive technique for determining the presence of pulmonary hypertension. The results of the present study in which seven of 11 patients with polymyositis had echocardiographic evidence of pulmonary hypertension suggests that pulmonary vascular involvement is common in this disorder. Ventilation and perfusion scans were obtained in the first three patients with pulmonary hypertension to exclude possible pulmonary embolism. All three patients had normal or low probability scans so that further scanning was not thought to be clinically indicated. buy ortho tri-cyclen online
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Exercise Limitation in Patients with Polymyositis: Discussion (1)

Exercise Limitation in Patients with Polymyositis: Discussion (1)Pulmonary hypertension was first reported as a consequence of dermatomyositis in the late 1950s. The pulmonary hypertension was thought to be the result of degenerative and occlusive changes in the smaller branches of the pulmonary artery tree. In an autopsy series, Denbow et al examined the lungs and cardiovascular system of 20 patients with polymyositis. Four of 20 patients had small vessel disease characterized by smooth muscle hyperplasia of the medial portion of the blood vessel wall which was confined to the myocardium and lungs without involvement of other organs. More recently, another case report emphasized the severity of pulmonary hypertension in a patient with polymyositis. Postmortem examination of the pulmonary vasculature revealed fibrous intimal proliferation of the small pulmonary arteries. The pulmonary parenchyma revealed focal interstitial fibrosis. flovent inhaler
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Exercise Limitation in Patients with Polymyositis: Results (3)

Resting pulmonary function is illustrated in Figure 1. All patients had normal maximum inspiratory pressures. Only one patient (No. 10) had an abnormally low maximum expiratory pressure. Patient 3 had a mild reduction in the TLC, and patients 2 and 10 had mild reductions in diffusing capacity. No patient had evidence of obstructive ventilatory impairment.
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Exercise Limitation in Patients with Polymyositis: Results (2)

Exercise Limitation in Patients with Polymyositis: Results (2)A routine 12-lead electrocardiogram was normal in only two of 11 patients. Nonspecific ST segment changes were present in seven patients, one patient had right atrial enlargement, one had left atrial enlargement with evidence of a previous myocardial infarction, one had left ventricular hypertrophy, and another had right bundle branch block. Echocardio-graphic data revealed all patients to have normal left ventricular ejection fractions (mean, 60 ± 11 percent). In contrast to normal left ventricular function, seven patients had echocardiographic evidence of pulmonary hypertension (Table 1). The diagnosis of pulmonary hypertension was based on a reduced acceleration time with associated pulmonic valve motion abnormalities in five patients and on the basis of secondary criteria in two patients (No. 5 and 8) in whom technically adequate Doppler studies could not be obtained. All Doppler studies were performed at heart rates between 60 to 100 beats per minute except for patient 1 (54 beats per minute) and patient 7 (56 beats per minute). Correcting the acceleration time for heart rate would not have changed the results in either patient. buy flovent inhaler
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Exercise Limitation in Patients with Polymyositis: Results (1)

A total of 19 patients with polymyositis were identified at the three institutions. Six patients were excluded because they were unable to exercise (one with aseptic necrosis of the hip, one with retinal detachment, two with acute myopathy which precluded their exercise ability, one with hepatic encephalopathy, one with Graves’ disease/atrial fibrillation). Thirteen patients were eligible for the study. Two patients refused to participate. The data from the remaining 11 patients are reported.
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Exercise Limitation in Patients with Polymyositis: Methods (4)

Exercise Limitation in Patients with Polymyositis: Methods (4)Expiratory flow was determined with a heated linear pneumotachograph, shock-mounted variable pressure transducer (± 2-0 cm HaO) and a carrier demodulator while the patient breathed through a high flow, low-resistance, low-dead-space valve (Hans-Rudolph No. 3800). The concentration of COa and Os in expired air was determined by a rapid responding infrared absorption analyzer and zirconia fuel cell sensor, respectively (Cad/Net System 2001, Medical Graphics Corp, St. Paul, MN). All gas and flow measurements were corrected for ambient temperature, barometric pressure and water vapor.

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Exercise Limitation in Patients with Polymyositis: Methods (3)

Pulmonary evaluation included posteroanterior and lateral chest radiographs with subjects erect and complete PFTs. All chest radiographs were reviewed by two authors (C.H., G.K.). Pulmonary hypertension was diagnosed by chest radiograph when the hilar to thoracic ratio exceeded 0.36.® Pulmonary function tests performed included spirometry, and the measurement of lung volumes and Dsb. The FVC, FEV1? FEV,/FVC, and MW were determined with a pneumotachograph spirometer (Medical Graphics Corp, St. Paul, MN). Functional residual capacity was determined by open-circuit nitrogen washout technique, and TLC, KV, and RWTLC ratio were calculated. The Deo was determined and corrected for carboxyhemoglobinemia. Maximum inspiratory and expiratory pressures were measured at TLC and KY£ respectively, using a water-filled manometer. All values obtained were also expressed as percent predicted using standard prediction formulas.

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Exercise Limitation in Patients with Polymyositis: Methods (2)

Exercise Limitation in Patients with Polymyositis: Methods (2)Cardiac evaluation included a routine 12-lead electrocardiogram and an echocardiogram with Doppler flow studies; M-mode and two dimensional echocardiography with Doppler were performed by the cardiologist (T.B.) using a General Electric Pass II echocar-diographic machine (General Electric, Inc., Rancho Cordova, CA). Particular attention was directed to the pulmonic valve for evidence of pulmonary hypertension. The diagnosis of pulmonary hypertension was determined via: (1) measurement of the depth of the a-dip, (2) the presence or absence of systolic notching of the pulmonic valve, and (3) measurement of the acceleration time by Doppler flow studies. Reduction of the a-dip (less than 2 mm) or systolic notching of the pulmonary valve were considered suggestive of pulmonary hypertension. Pulsed Doppler echocardiograms were obtained with either a 2.5 or 3.5 kHz transducer in the parasternal and four-chamber views. Pulsed Doppler was employed in the right ventricular outflow tract to record the flow signal just proximal to the pulmonic valve. ventolin inhaler

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Exercise Limitation in Patients with Polymyositis: Methods (1)

All patients with polymyositis hospitalized or seen in the rheumatology clinics at Louisiana State University Medical Center in Shreveport and two university-affiliated medical centers during the period of July 1987 to June 1988 were eligible for inclusion in the study. Subjects were identified by review of discharge diagnoses and clinic records at those institutions. The diagnosis of polymyositis was made by the established criteria of Bohan and Peters. Derma-tomyositis was diagnosed when the above criteria were satisfied and the characteristic heliotrope rash also was present. Patients were excluded if they had associated collagen vascular disease at the time of the study or if they were unable to exercise. asthma inhalers
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