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Biomedical subjects

A Perruchoud

Publications and source records attributed to A Perruchoud.

At least 37 records · Page 2Linked to original sources
PubMed1983

Traumatic aneurysm of the thoracic aorta simulating bronchogenic neoplasms.

A 70-year-old man was examined in 1977 because of hoarseness and a central opacification in the left hilus. At that time, the diagnosis of a central bronchogenic carcinoma was made based on roentgenographic findings. The patient's condition was reevaluated five years later, when an examination disclosed a chronic posttraumatic aortic aneurysm. Despite severe chronic obstructive pulmonary disease, the patient was successfully operated on.

Aged↗
PubMed1982

[Complications of bronchoscopy].

1500 bronchoscopies performed in the Department of Pneumology, University of Basle, were analyzed for frequency and severity of complications. 500 patients were investigated by rigid tube in local anesthesia, 500 patients by rigid tube in neuroleptanalgesia and 500 patients by flexible fiberbronchoscope. The rate of complication for all patients was 4.1%, which agrees well with the previously reported complication frequency of 1-11%. The complications were minor in 3.5% of patients, moderate in 0.5% and major in 0.1%. There were no deaths. The incidence of severe complications and deaths was thus lower than in other studies. There was a higher incidence of complications (p less than 0.001) in the group examined with the rigid tube in neuroleptanalgesia, due to the more frequently observed minor complications. The incidence of complications can be reduced by a careful indication for bronchoscopy, adequate yet sparing use of anesthesia, and choice of the right instrument.

Adolescent↗
PubMed1982

Theophylline serum concentration and therapeutic effect in severe acute bronchial obstruction: the optimal use of intravenously administered aminophylline.

In 20 patients with acute exacerbation of bronchial obstruction, the therapeutic effect of high (20 mg/L) and low (10 mg/L) serum concentrations of theophylline was compared in a double-blind randomized study. The theophylline dose, administered as a continuous aminophylline infusion, was individually adjusted by means of repeated measurements of serum concentrations. At 28 h after starting therapy the high concentration group showed a significantly greater improvement in pulmonary function as assessed by FEV1 (0.57 +/- 0.52 L (mean +/- SD) versus 0.1 +/- 0.18 L, p less than 0.01) and FVC (1.0 +/- 0.65 L versus 0.01 +/- 0.66 L, p less than 0.02). As a measure of the overall clinical improvement, the time during which intravenous therapy was required was also shorter in the high-dose group (61.7 +/- 25.8 h (mean +/- SD) versus 116 +/- 49.7 h, p less than 0.02). The occurrence of side effects in the two groups was not significantly different. In patients with severe acute bronchial obstruction, serum theophylline concentrations around 20 mg/L seemed to offer a definite therapeutic advantage, thus, routine serum concentration measurements and the use of accurate infusion devices for optimal dose adjustment may be justified.

Adult↗
PubMed1982

Evidence for an augmented glucagon dependence of hepatic glucose production in cirrhosis of the liver.

The role of endogenous glucagon in maintaining hepatic glucose production after an overnight fast in patients with cirrhosis of the liver was studied with arterial-hepatic-venous catheterization and using somatostatin to suppress glucagon secretion. Arterial glucagon levels were elevated in eight cirrhotics to 290 +/- 90 pg/ml (SEM) compared to 100 +/- 10 pg/ml (P less than 0.02) in five normal controls, and they were lowered during administration of somatostatin (SRIF; 250 microgram/h) by a mean of 154 pg/ml and 39 pg/ml in cirrhotics and controls, respectively. Basal net splanchnic glucose production (NSGP) was similar in patients with and without cirrhosis (approximately 100 mg/min) but declined more markedly during 30 min of SRIF in cirrhotics to a net splanchnic uptake of glucose of 30 +/- 20 ml/min, as opposed to a fall of NSGP by 44 +/- 2 mg/min in controls (P less than 0.01). To assure that NSGP declined during SRIF infusion due to the fall of glucagon levels, SRIF was combined with a glucagon infusion at 150 ng/m2 . min in four cirrhotics and in five control subjects. Arterial glucagon levels were elevated to a mean of 650 pg/ml and 559 pg/ml in cirrhotics and controls, respectively. NSGP increased after 40 min of SRIF and glucagon replacement to 179 +/- 33 mg/min in cirrhotics and significantly more, to 412 +/- 68 mg/min, in controls (P less than 0.01). Thus, hepatic glucose production during basal and elevated glucagon levels suggested hepatic resistance to glucagon in cirrhosis. Nevertheless, endogenous glucagon played an augmented stimulatory role in maintaining glucose production in the normal range since there was an exaggerated fall of hepatic glucose output during glucagon suppression.

Aged↗
PubMed1981

Effect of somatostatin on splanchnic hemodynamics in patients with cirrhosis of the liver and in normal subjects.

The effect of somatostatin on splanchnic hemodynamics was determined in 8 patients with cirrhosis of the liver and in 18 normal subjects using arterial-hepatic-venous catheterization. Estimated hepatic blood flow determined by indocyanine green infusion was 1.36 +/- 0.23 L/min (+/- SEM) in patients with cirrhosis and remained unaffected during 30 min of somatostatin (250 microgram/h) administration. Wedged hepatic venous pressure which was elevated to 23 +/- 1.8 mmHg was also uninfluenced. In contrast to somatostatin, an infusion of vasopressin (12 U/h for 30 min) given to the same patients, lowered estimated blood flow by 28% (p < 0.05) and wedged hepatic venous pressure by 18% (p < 0.02). Arterial gastrin and insulin levels were lowered during somatostatin infusion by 33% (p < 0.02) and by 75% (p < 0.005), respectively. In contrast to the cirrhosis, infusion of 250 microgram/h somatostatin into normal subjects was associated with a decrease of estimated hepatic blood flow from 1.20 +/- 0.16 to 0.88 +/- 0.12 L/min (p < 0.01) representing a 27% decline. Arterial gastrin and insulin concentrations were lower (p < 0.01) than in cirrhosis, but the basal levels were lowered by somatostatin to a similar degree in both groups of patients. A higher dose of somatostatin (500 microgram/h) administered to normal subjects resulted in a similar decrease of gastrin and of estimated hepatic blood flow as that seen with 250 microgram/h, whereas a lower dose (125 microgram/h) decreased gastrin but failed to influence estimated hepatic blood flow. Thus, somatostatin at a dose which has been used in the treatment of acute peptic ulcer hemorrhage (250 microgram/h) failed to influence estimated hepatic blood flow and wegded hepatic venous pressure in patients with cirrhosis but lowered splanchnic blood flow in normal subjects. Assuming that this effect contributes to somatostatin's therapeutic efficacy, these results cast doubt on its potential value in the treatment of upper gastrointestinal bleeding of cirrhotics with portal hypertension.

Dose-Response Relationship, Drug↗
PubMed1980

[Ambulatory treatment of chronic obstructive lung diseases].

The treatment of patients with chronic obstructive pulmonary disease has three main purposes: 1. to reduce the work of breathing, 2. to prevent exacerbation of the disease, and 3. to lessen the complications of chronic hypoxemia. The treatment of bronchospasm (beta 2-stimulators, xanthines, parasympathicolytics and possibly corticosteroids) is or primary importance. Harmful irritants, such as cigarette smoking, should be eliminated to decrease hypersecretion. Both well directed antibiotic therapy and treatment of heart failure influence the outcome of therapy. Finally, accessory measures such as physiotherapy and physical exercise are also part of the rehabilitation program for these patients.

Adrenergic beta-Agonists↗
PubMed1980

[Rehabilitation program with IPPB-home treatment in severe chronic obstructive lung disease: hospitalizations and cost analysis].

31 patients with severe chronic obstructive lung disease (FEV1 less than 45% VC) were included in a rehabilitation program with IPPB home care. The frequency and duration of hospitalizations in the three years before and the three years following institution of the program were compared. During the rehabilitation period the incidence of hospitalizations fell from 87 to 46 (p less than 0.001), and the number of days spent in hospital decreased from 2896 to 1099 (p less than 0.001). The high cost of the rehabilitation program requires careful selection and competent instruction of candidates. If these basic requirements are observed, a surprising reduction in the total cost of treatment can be achieved by shortening the expensive hospital stay.

Cost Control↗
PubMed1980

Occlusion pressure-response in patients with chronic obstructive lung disease.

Occlusion pressure (P100) at rising inspiratory CO2 concentration was measured in 9 healthy adults and in two groups of patients with chronic obstructive lung disease, of which 29 had an arterial CO2 tension (PaCO2) of less than 43 mm Hg and 15 a PaCO2 of more than 43 mm Hg. Statistically the three groups could be separated significantly from each other in terms of occlusion pressure at rising alveolar CO2 tensions (PACO2). At a standard endexpiratory PACO2 of 60 mm Hg the absolute values of P100 of the obstructive patients with a normal PaCO2 are significantly higher than those of the two other groups. The differences in ventilatory response between the three groups are discussed.

Adult↗
PubMed1979

[Acute respiratory insufficiency in internal medicine].

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.

Acid-Base Equilibrium↗
PubMed1979

[Presurgical determination of lung function in patients with bronchogenic carcinoma].

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.

Aged↗