Biomedical subjects
Publications and source records attributed to A Perruchoud.
An isolated left lower lobe was used as a left graft, during a bilateral single lung transplantation procedure, in a patient with infected fibrosis. This technique is suitable for patients with small lung volume (especially cystic fibrosis) or asymmetric retraction.
For double lung transplantation, lung volume matching is easier comparing the predicted total lung capacities of the donor and recipient and the recipient's true TLC. The major concern in the inability to close the chest when the donor lungs are too large. The technique reported of left lower lobe implantation during bilateral single lung transplantation might be of great value in patients with small lung volume.
HIV infects susceptible T-cell and mononuclear phagocyte targets. Unlike the dramatic changes that occur with T-cells during HIV disease, changes in monocyte and macrophage phenotype and function are qualitatively minimal. The aim of the study was to quantitatively analyze the morphology of macrophages in broncho-alveolar lavages in patients without AIDS, with AIDS, with AIDS complicated by Pneumocystis carinii and in carcinoma patients. In patients with AIDS, the nuclei of macrophages demonstrate a higher integrated optical density (2P less than 0.10), are bigger in size (2P less than 0.05) and have less notches (2P less than 0.02).
The definition, causes and some pathophysiological aspects of acute respiratory failure are discussed and a systematic clinical workup for these patients is proposed. The clinical and functional parameters for intubation and artifical ventilation are described. Finally, some special problems of therapy in some diseases leading to acute respiratory failure are mentioned. The basic disease not only indicates the criteria for intubation but also determines modifications in ventilatory support.
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90 out of 202 lung cancer patients hospitalized for preoperative investigations were scheduled for radical surgery. 15 patients were not operated on because of insufficient lung function data. The operation was performed in 75 patients. The complication rate was 11% and mortality 8%. 7 out of 8 patients who subsequently developed severe complications had fulfilled the criteria for lung resection only after intensive antibronchitic treatment. Nearly all the survivors showed the predicted preoperative minimal lung function values after the operation. The limit of 1000 ml for postoperative FEV1 is justified, since patients with these or larger functional reserves nearly all had a favourable early and late postoperative course, and also because lung function values continuously deteriorate in chronic obstructive lung disease.
The effect of three different doses of somatostatin on splanchnic blood flow (SBF) and on arterial plasma insulin, glucagon and glucose was determined. 125, 250 and 500 microgram/h of somatostatin was infused during 60 minutes in 3 groups of 6 patients undergoing arterial-hepatic-venous catheterization; no patient had clinical evidence of metabolitic or hepatic disease. Continuous infusion of 125 microgram/h somatostatin was without significant effect on SBF, whereas 250 microgram/h resulted in a mean 28% reduction of SBF (p less than 0.05). Doubling the dose to 500 microgram/h affected SBF similarly (21% reduction of SBF). In contrast, administration of all three doses of somatostatin suppressed the circulating insulin and glucagon levels significantly. In a recent report somatostatin had been administered in a dose of 250 microgram/h to control gastric ulcer hemorrhage. The present studies demonstrate that this dose results in a significant reduction of SBF which cannot be further depressed by increasing the dose.
The dose-response relationship of the new bronchodilator Clenbuterol (NAB 365, Boehringer Ingelheim) was tested in 12 patients with chronic obstructive lung disease. Clenbuterol is a beta-2-sympathicomimetic, from a series of substituted phenylethanolamines, and it is characterised by good absorption and prolonged action after systemic administration. The action of four different doses of Clenbuterol inhalation solution (6, 12, 24, and 48 microgram corresponding to 2, 4, 8 and 16 drops of a 0.006% solution) was assessed after a single inhalation on 4 successive days. The parameters monitored were bronchial resistance and FEV. The effect of all four doses was the same, both in respect of improvement in FEV and of decrease in bronchial resistance. The increase in expiratory volume and the decrease in bronchial resistance lasted for 6 h. The results show that for inhalation therapy Clenbuterol is a potent, selective bronchodilator, which is largely free of sideeffects. It has still to be determined whether a maximal effect could be achieved with a lower dose 6 microgram.
Thoracoscopy is a method involving little discomfort for the patient but of high diagnostic effectiveness for pleural alterations. A histological diagnosis was established in 56 cases out of a total of 60 pleural effusions of unknown origin. In 10 pleural or pleuropulmonary diseases, anatomical classification was possible in all cases. In cases of pneumothorax (21 patients) the bronchopleural fistula could very often be seen and closure by detaching of pleural adhesions or cauterization was possible. These manipulations are usually followed by insufflation of sterile talcum powder through the thoracoscope. Suspicion of ruptured diaphragm due to accident was easily and quickly verified. No complications occurred in our 100 thoracoscopic examinations.
The treatment of spontaneous pneumothorax is still controversial. To evaluate pleural drainage with a chest tube the therapeutic results in 73 patients with benign pneumothorax were reviewed. Benign spontaneous pneumothorax treated with a thick chest tube size Charrière 18-22 disappeared within an average of only 6.6 days. On the other hand, the high recurrence rate of 24% after the initial pneumothorax and 37% after the first recurrence is comparable with the results of conservative management in other pneumothorax series in the literature. Small pneumothorax without severe symptoms should therefore be supervised conservatively on an outpatient basis. The more extended forms of pneumothorax should be treated with thick chest tubes. Failure of therapeutic effect, second ipsilateral relapse or the first contralateral pneumothorax are indications for parietal pleurectomy.
Previous reports dealing with cardiac herniation following intrapericardial pneumonectomy illustrate the critical and often lethal hemodynamic sequelae of this complication. In the case presented here, the first and nearly exclusive sign of cardiac herniation after left-sided pneumonectomy with extensive resection of the pericardium was systemic arterial hypoxemia. Subsequent investigations suggested inter-atrial right-to-left shunt in the presence of a patent foramen ovale, caused by slight right-ventricular outflow obstruction with consecutively reversed pressure relationships at atrial level. This explanation was supported by the operative findings, and reversibility was achieved by pericardial reconstruction with parietal pleura. When the patient died 8 months later due to general progression of a mucoepidermoid carcinoma, autopsy confirmed a large patent foramen ovale.
The effects of smoking and inhalation of carbon monoxide on the systolic time intervals and blood pressure were examined in ten healthy smokers with a mean age of 24.3 years. Each subject smoked a low-nicotine cigarette with a ventilated filter (0.1 mg nicotine, 1.1 vol percent CO), and a high-nicotine plain cigarette (2.6 mg nicotine, 4.5 vol percent CO), as well as a cigar in random sequence and in a standardized way. Cigar smoke was not inhaled. The product heart rate x blood pressure was increased and the left ventricular ejection time index (LVETc) prolonged following smoking the high-nicotine cigarette, whereas changes after smoking the low-nicotine cigarette and the cigar were not as pronounced. These changes are presumably caused by nicotine-induced catecholamine release. Inhalation of CO did not affect cardiac performance acutely as shown by unchanged systolic time intervals. When a high-nicotine cigarette was smoked after the subject received a beta blocker, a significant prolongation of the pre-ejection period index (PEPc) occurred as a result of the increased afterload. Thus, the effects of catecholamines on parameters of myocardial contractility (PEPc, PEP/LVET) were presumably offset by the increased afterload. We conclude that the acute hemodynamic changes of smoking in healthy subjects depend upon the amount of nicotine absorbed.
Recently, tumoral calcinosis was found in a patient who had been undergoing haemodialysis in this hospital. The tumor was partially removed and subsequently regressed. The tumoral calcinosis of hemodialysis patients seems to be different from classical tumoral calcinosis.
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Explore the source record for details and available documents.