T Ti im me e c co ou ur rs se e oof f e ex xe er rc ci is se e c ca ap pa ac ci it ty y, , s sk ke el le et ta al l a an nd d r re es sp pi ir ra at to or ry y m mu us sc cl le e p pe er rf fo or rm ma an nc ce e a af ft te er r h he ea ar rt t--l lu un ng g t tr ra an ns sp pl la an nt ta at ti io on n N. Ambrosino*, C. Bruschi, G. Callegari, S. Baiocchi, G. Felicetti, C. Fracchia, C. RampullaTime course of exercise capacity, skeletal and respiratory muscle performance after heart-lung transplantation. N. Ambrosino, C. Bruschi, G. Callegari, S. Baiocchi, G. Felicetti, C. Fracchia, C. Rampulla. ERS Journals Ltd 1996. ABSTRACT: Recipients of heart-lung transplantation (HLT) show reduced exercise capacity due to several pre-and postsurgical factors. The aim of this study was to evaluate the time course of exercise capacity, and skeletal and respiratory muscle performance in 11 patients (5 females and 6 males; age (mean±SD) 38±13 yrs) undergoing HLT. All of the patients were admitted to our institution for a rehabilitation programme after surgery, and were followed-up for 18 months. On admission, at discharge after an in-patient rehabilitation programme, and every 6 months, patients underwent evaluation of: lung function values; incremental treadmill exercise, 6 min walking distance (6-MWD); maximal inspiratory and expiratory pressures (MIP and MEP, respectively); and peak torque of isokinetic contraction of leg flexor and extensor muscles (IFX and IEX, respectively).On admission, patients had: reduced lung volumes as assessed by vital capacity (VC) (60±15% of predicted); reduced exercise capacity as assessed by peak oxygen consumption (V ' 'O 2 ,peak) (40±12% pred); reduced skeletal and respiratory muscle performance as assessed by IEX, IFX (48±16 and 28±12 Newton-metres (N×m), respectively) and by MIP and MEP (54±21 and 58±19 cmH 2 O, respectively). Ten patients completed the rehabilitation programme. At discharge, no significant change in dynamic and static lung volumes was observed. However, nonsignificant increases in MIP, MEP, IEX, IFX, 6-MWD and V ' 'O 2 ,peak were recorded. After 6 and 12 months, indices of skeletal and respiratory muscle function and V ' 'O 2 ,peak improved further, but still remained lower than normal values.We conclude that in patients with heart-lung transplantation, skeletal and respiratory muscle function and exercise performance are reduced after surgery, that they may improve with time but are still less than normal after 18 months.

(i) Iodine levels are too low among pregnant women in our region, and particularly in foreign women. (ii) Cow's milk intake is their main source of iodine. (iii) Iodine supplementation is mandatory during pregnancy, particularly for women do not drink milk.

There have been occasional reports of acute respiratory and skeletal muscle weakness in intensive care unit patients treated with massive doses of corticosteroids. However, in this setting the concomitant use of other drugs may have influenced the finding.In this study the effects of 5 days of treatment with high doses of steroids in consecutive patients with acute lung rejection after transplantation were systematically evaluated. Maximal inspiratory pressure during phrenic nerve stimulation and peak torque of isokinetic contraction of the quadriceps and hamstring muscles were measured objectively.Compared to the pretreatment condition, ∼45% of patients showed acute generalised muscle weakness that recovered after ∼2 months.This demonstrates muscle weakness induced by steroids within patients.

Background: After undergoing a procedure of pulmonary endarterectomy (PEA), patients with chronic thromboembolic pulmonary hypertension (CTEPH) may still experience reduced exercise capacity. Data on effects of exercise training in these patients are scant. Objectives: To evaluate the effectiveness of exercise training after PEA for CTEPH and if the presence of “residual pulmonary hypertension” may affect the outcome. Methods: Retrospective data analysis of CTEPH patients undergoing inpatient exercise training after PEA. According to predefined criteria, patients were divided into those with (group 1) and without (group 2) a “good” post-surgery hemodynamic response. Assessments of the 6-min walking distance test (6-min walking distance test [6 MWT]: primary outcome) were performed before and after surgery (before training), after training and at 3-month follow-up. Hemodynamic and lung function data were also analyzed. Results: Data of 84 and 26 patients of groups 1 and 2, respectively, were analyzed. After surgery patients showed a reduction in 6 MWT, which significantly reversed after training and further improved at 3 months (p = 0.0001), without any significant difference between groups. The percentage of patients reaching the minimal clinically important difference in 6 MWT was similar between groups. The sig­nificant (p = 0.0001) post-surgery improvement in hemodynamics was maintained at 3 months without any significant difference between groups. New York Heart Association functional class improved in parallel to the hemodynamic improvement. Conclusions: Exercise training in patients with CTEPH after PEA, an inpatient exercise training program, improves exercise capacity for up to 3 months, independently of the post-surgery hemodynamic response.

Certain pathologies and variables are risk factors for early death in patients on the waiting list. This information may be used to allocate specific donor organs to patients in greater need.