A 67-year-old man with a history of chronic obstructive pulmonary disease (COPD) underwent F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for staging of gastric cancer. The projection images of F-18 FDG PET/CT showed intensely increased F-18 FDG uptake in the anterior neck, chest wall, and upper abdomen. We suspected distant metastases of cervical lymph nodes, ribs, and peritoneum in gastric cancer. However, the transaxial images of F-18 FDG PET/CT showed abnormal F-18 FDG uptake in scalene muscles of anterior neck, intercostal muscles of chest wall, and diaphragm of upper abdomen. Patients with COPD use respiratory muscles extensively on the resting condition. These excessive physiologic use of respiratory muscles causes increased F-18 FDG uptake as a result of increased glucose metabolism. The F-18 FDG uptake in respiratory muscles of gastric cancer patient with COPD mimicked distant metastases in cervical lymph nodes, ribs, and peritoneum.
Abdomen ; Aged ; Diaphragm ; Electrons ; Glucose ; Humans ; Intercostal Muscles ; Lymph Nodes ; Metabolism ; Muscles ; Neck ; Neoplasm Metastasis* ; Peritoneum ; Positron-Emission Tomography and Computed Tomography ; Pulmonary Disease, Chronic Obstructive ; Respiratory Muscles* ; Ribs ; Stomach Neoplasms* ; Thoracic Wall

Mechanical ventilation (MV) is an effective treatment for respiratory failure. In recent years, it has been found that MV can not only cause ventilation-associated lung injury (VALI), but also cause ventilation-induced diaphragmatic dysfunction (VIDD). Although the injury site and etiology are not the same, they are interrelated and mutually causal, and eventually lead to weaning failure. Studies have indicated that diaphragmatic function protection strategy should be implemented in patients on MV. That is, the entire process from assessing the ability of spontaneous breathing before MV, to the initiation of spontaneous breathing and to weaning during MV. For patients on MV, continuous monitoring of respiratory muscle strength should be conducted. Early prevention, early intervention and timely detection of VIDD may reduce the occurrence of difficult weaning, resulting in improved prognosis. This study mainly discussed the risk factors and pathogenesis of VIDD.
Humans ; Respiration, Artificial ; Respiratory Muscles ; Respiration ; Diaphragm ; Cognition

Mechanical ventilation has, since its introduction into clinical practice, undergone a major evolution from controlled ventilation to diverse modes of assisted ventilation. Conventional mechanical ventilators depend on flow sensors and pneumatic pressure and controllers to complete the respiratory cycle. Neurally adjusted ventilatory assist (NAVA) is a new form of assisted ventilation in recent years, which monitors the electrical activity of the diaphragm (EAdi) to provide an appropriately level of pressure support. And EAdi is the best available signal to sense central respiratory drive and trigger ventilatory assist. Unlike other ventilation modes, NAVA breathing instructions come from the center. Therefore, NAVA have the synchronous nature of the breaths and the patient-adjusted nature of the support. Compared with traditional ventilation mode, NAVA can efficiently unload respiratory muscles, relieve the risk of ventilator-induced lung injury (VILI), improve patient-ventilator coordination, enhance gas exchange, increase the success rate of weaning, etc. This article reviews the research progress of NAVA in order to provide theoretical guidance for clinical applications.
Humans ; Interactive Ventilatory Support ; Respiration, Artificial ; Positive-Pressure Respiration ; Diaphragm/physiology* ; Respiratory Muscles/physiology*

OBJECTIVE: To determine the effect of respiratory muscle training in patients with chronic obstructive pulmonary disease (COPD) by pulmonary function test and fluoroscopy- guided diaphragm movement. METHOD: The respiratory muscle training program included breathing retraining, self-exercise and electromyography- assisted biofeedback therapy. 22 COPD patients underwent training program for 177+/-47.8 (84~259) days and were followed up regularly. To evaluate the effect of respiratory muscle training, we tested pulmonary function test before and after training. We also evaluated difference of area at full inspiratory and full expiratory time by fluoroscopy- guided diaphragm motion. RESULTS: Parameters in pulmonary function test showed no significant differences before and after respiratory muscle training. In fluoroscopic examination, the difference in the diaphragm movement area at full inspiration and expiration time showed significant improvement after respiratory muscle training (p<0.05). CONCLUSION: Diaphragm movement increased in patients with COPD after respiratory muscle training, although pulmonary function test did not.
Biofeedback, Psychology ; Breathing Exercises ; Diaphragm ; Fluoroscopy ; Humans ; Pulmonary Disease, Chronic Obstructive ; Respiration ; Respiratory Function Tests ; Respiratory Muscles

No abstract available.
Dermatomyositis* ; Respiratory Muscles*

A six-month old boy and a thirty-month old girl who suffered from dyspnea were admitted to our hospital. Their primary disease was congenital myopathy, and both of them had a history of recurrent pneumonia. Chest X-ray scan showed unilateral diaphragmatic eventration. To minimize the injury of weakened respiratory muscle in children with myopathy, VATS plication was performed under double lung ventilation. Each of the two patients were discharged on the 17th and 24th postoperative day. We report two cases of successful VATS plication in children with diaphragmatic eventration associated with congenital myopathy.
Child* ; Diaphragm* ; Diaphragmatic Eventration* ; Dyspnea ; Female ; Humans ; Lung ; Male ; Muscular Diseases* ; Pneumonia ; Respiratory Muscles ; Thoracic Surgery, Video-Assisted ; Thorax ; Ventilation

Herpes zoster is a varicella-zoster virus reactivation that is characterized by pain and rash. It can cause motor paresis on affecting muscles, but diaphragmatic paralysis is a rare complication. Methods of evaluation of diaphragmatic paralysis include plain radiography, fluoroscopy and electroneurography. The direct movement of diaphragmatic muscles on ultrasound can also be used to diagnose diaphragmatic paralysis. We reported a case of a 72-year-old woman who developed left hemidiaphragmatic paralysis after herpes zoster. The diaphragmatic paralysis occurred 3 weeks after appearance of a typical skin rash on the left C4-5 dermatomes. We diagnosed diaphragmatic paralysis using ultrasound.
Aged ; Diagnosis* ; Diaphragm ; Exanthema ; Female ; Fluoroscopy ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Muscles ; Paralysis ; Paresis ; Radiography ; Respiratory Paralysis* ; Ultrasonography*

PURPOSE: Frequent desaturation due to immature incoordination of suck-swallow-breathing in preterm infants can influence multiple organs such as the heart, lungs, and brain, which can then affect growth and development. Most notably in preterm infants, feeding desaturation may even affect pulmonary function during gavage feeding. Because respiratory muscle activities may reflect the work required during respiration, we evaluated the differences in these activities between full-term and preterm infants with feeding desaturation, and investigated the correlations with clinical variables. METHODS: Nineteen preterm infants with feeding desaturation (group 1) and 19 age-matched full-term infants (group 2) were evaluated. Oromotor function was evaluated using video recording. The root-mean-squre (RMS) envelope of the electromyography signal was calculated to quantify the activities of muscles involved in respiration. The differences in RMS between both groups and the correlation with clinical variables including gestational age (GA), birth weight (BW), and Apgar scores (AS) at 1 and 5 minutes after birth were evaluated. RESULTS: The RMS values of the diaphragm (RMS-D) and rectus abdominis (RMS-R) were significantly greater in group 1 compared to group 2, and the 1- and 5-min AS were significantly lower in group 1 compared to group 2. RMS-D and RMS-R were inversely correlated with GA, BW, 1- and 5-min AS in all infants. CONCLUSION: This study showed that respiratory muscle activities were augmented during feeding in preterm infants compared to full-term infants. Additionally, respiratory muscle activities were inversely correlated with all clinical variables.
Ataxia ; Birth Weight ; Brain ; Diaphragm ; Electromyography ; Gestational Age ; Growth and Development ; Heart ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Lung ; Muscles ; Parturition ; Rectus Abdominis ; Respiration ; Respiratory Muscles* ; Video Recording

In order to improve synchrony between a ventilator and its patient, a new method for triggering a ventilator based on diaphragmatic electromyogram (EMG) is introduced. The methods to extract and process diaphragmatic EMG signals are studied. It has been shown that the characteristic parameters of a respiration activity, such as inspiratory beginning point, expiratory beginning point and respiration period, can be detected from diaphragmatic EMG envelop instead of traditional flux curve. A new parameter, designated as diaphragmatic "Intensity of EMG" for short "IEMG", is defined. Repeat respiration tests have disclosed that there is relatively high correlation between the diaphragmatic IEMG curve and its corresponding cubage curve. These results primarily demonstrate that the new synchronization method may be feasible.
Diaphragm ; physiology ; Electromyography ; Humans ; Positive-Pressure Respiration ; methods ; Respiration ; Respiration, Artificial ; methods ; Respiratory Insufficiency ; therapy ; Respiratory Muscles ; physiology ; Work of Breathing ; physiology

BACKGROUND: Respiratory muscle interaction is further profoundly affected by a number of pathologic conditions. Hyperinflation may be particularly severe in chronic obstructive pulmonary disease(COPD) patients, in whom the functional residual capacity(FRC) often exceeds predicted total lung capacity(TLC). Hyperinflation reduces the diaphragmatic effectiveness as a pressure generator and reduces diaphragmatio contribution to chest wall motion Ultrasonography has recently been shown to be a sensitive and reproducible method of assessing diaphragmatic excursion. This study was performed to evaluate how differences of diaphragmatic excursion measured by ultrasonography associate with normal subjects and COPD patients. METHODS: We measured diaphragmatic excursions with ultrasonography on 28 healthy subjects(16 medical studentz 12 age-matched control) and 17 COPD patientc Ultrasonographic measurements were performed during tidal breathing and maxima] respiratory efforts approximating vital capacity breathing using Aloka KEC-620 with 3.5 MHz transducen Measurements were taken in the supine posture. The ultrasonograpbic probe was positioned transversely in the midclavicular line below the right subcostal margin After detecting the right hetnidiaphragm in the B-mode the ultrasound beam was then positioned so that it was approximately parallel to the movement of middle or posterior third of right diaphragm. Recordings in the M-inodc at this position were made throughout the test Measurements of diaphragmatio excursion on M-mode tmcing were calculated by the average gap in 3 times-respiration cycle. Pulmonary functicn test(SensorMedics 2800), maximal inspiratory(Plmax) and expiratory mouth pressure(PEmax, Vitalopower KH-101, Chest) were measured in the seated posture. RESULTS: During the tidal breathing, diaphragmatic excursions were recorded 1.5 +/-0.5cm, 1.7+/-0.5cm and 1.5 +/- 0.6cm in medical students, age-matched control group and COPD patients, respectively. Diaphragm excursions during maximal respiratory efforts were significantly decreased in COPD patients (3.7+/-1.3cm) when compared with medical students, age-matched control group(6.7+/-1.3cm, 5.8+/-1.2cm, p<0.05). During maximal respiratory efforts in control subjects, diaphragm excursions were cowelatal with FEV1, FEV1/FVC, PEF, PIF, and height. In COPD patients, diaphragm excursions during maximal respiratory efforts were correlated with PEmax(maxinIal expiratory pressure), age, and %FVC. In multiple regression analysis, The combination of PEmax and age was an independent marker of diaplngnt excursions during maximal respiratory efforts with COPD patients. CONCLUISON: COPD subjects had smaller diaplragmatic excursions during maximal respintoty efforts than control subjects. During maximal respiratory efforts in COPD patients, diaphragm excursions were well correlated with PEmax. Those results suggest that diaphragm excursions during rnaximel respiratory efforts with COPD patients may be valuable at predicting the pulnionmy function.
Diaphragm ; Humans ; Lung ; Mouth* ; Posture ; Pulmonary Disease, Chronic Obstructive* ; Respiration ; Respiratory Function Tests* ; Respiratory Muscles ; Students, Medical ; Thoracic Wall ; Ultrasonography* ; Vital Capacity