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Biomedical subjects

B Lüderitz

Publications and source records attributed to B Lüderitz.

At least 145 records · Page 8Linked to original sources
PubMed1998

[Löffler fibroblastic endocarditis in the thrombotic stages in isolated right ventricular tissue eosinophilia].

We report on a male, 31 year old, Turkish patient with an intracardiac mass in the right ventricle, reduction of performance and weight, as well as intermittent fever. No eosinophilia was documented in the peripheral blood; cardiac function was primarily normal. Besides the differential diagnosis of Löffer's endocarditis (endomyocardial fibrosis) an inflammatory disease and a malignant cardiac tumor were suggested. The diagnosis of Löffler's endocarditis could not be confirmed morphologically by echocardiography nor histologically by right ventricular biopsy. Operative removal of the mass lesion was necessary because of fast tumor progression, fulminant pulmonary embolism, and infiltration of the tricuspid valve. Only then, histologically Löffler's eosinophilic endocarditis of thrombotic stage was diagnosed. Antiphlogistic therapy with cortisone was initially performed. With a dose reduction after 6 months, a relapse of the thrombotic mass occurred. Therefore, continuous treatment with cortisone and azathioprine was induced followed by further tumor regression and further clinical stabilization since 8 months of treatment.

Adult↗
PubMed1998

[QT syndrome: new diagnostic possibilities].

Electrocardiographic and clinical characteristics are currently used as diagnostic criteria for the long QT-syndrome. In borderline electrocardiographic findings associated with unclear syncope, it is often difficult to ensure or exclude long QT-syndrome. Schwartz and coworkers therefore created a point system as a guide in clinical decision making. In recent years genetic diagnostics have entered the arena of long-QT assessment. Aside from new insights into the pathophysiology of the long QT-disorder, it is expected that genetic diagnostics will offer substantial help to ascertain long QT-syndrome in patients with borderline electrocardiographic and clinical findings and improve risk stratification in long-QT family members. Performing linkage analysis, coupling of autosomal-dominant congenital long QT-syndrome (Romano-Ward Syndrome) to chromosomes 11 (LQT1/11p15.5), 3 (LQT3/3p21), 7 (LQT2/7q35), and 4 (LQT4/4q25-27) was demonstrated. More recently, the disease genes in long QT-syndrome 1, 2, and 3 could be identified. Analysis of the base-pair sequence allowed detection of several different mutations in different families illustrating genetic heterogeneity. Aside from diagnostic aspects, molecular genetics may also guide pharmacological therapy by identifying the specific ion-channel disorder leading to QT-prolongation and sudden death.

Chromosome Mapping↗
PubMed1998

Prospective evaluation of shoulder-related problems in patients with pectoral cardioverter-defibrillator implantation.

BACKGROUND: The pectoral approach to implantation of cardioverter defibrillators (ICDs) has become a standard in defibrillator therapy because of reduced generator size, weight, and volume. But the size of these devices is still comparable to the size of the early conventional antibradycardia pacemakers that were associated with a number of significant pocket- and shoulder-related problems after implantation in the pectoral region. In a prospective, single-center study of 50 patients with subpectoral implantation of a fourth-generation ICD, the ipsilateral shoulder joint was evaluated regarding active shoulder motility, shoulder-related pain, shoulder function, shoulder elevation, insertion tendinitis, and morphologic alterations of the shoulder. METHODS AND RESULTS: The shoulder was evaluated before implantation and at 3, 6, and 12 months after implantation. Shoulder motility was documented by evaluating active abduction, forward flexion, and external rotation. Shoulder-related pain and function were documented by the "Basic Shoulder Evaluation Form," insertion tendinitis was diagnosed by standardized palpation and the impingement test, and morphologic alterations were documented by ultrasound and radiograph of the shoulder. Three months after implantation, 20 (40%) patients had a reduced active abduction, 30 (60%) patients had an impaired active forward flexion, and eight (16%) patients had a reduced external rotation. Thirty-one (62%) patients reported shoulder-related pain or impaired shoulder function according to the "Basic Shoulder Evaluation Form." Twenty-four (48%) patients showed a shoulder elevation and 21 (42%) patients demonstrated clinical signs of insertion tendinitis. After 12 months the number of patients with reduced active abduction, forward flexion, and external rotation dropped to four (8%). Shoulder-related pain and reduced function were documented in seven (13%) patients, four (8%) patients still had shoulder elevation, and five (10%) patients still had signs of insertion tendinitis. None of the postoperatively performed ultrasounds or radiographs showed any pathologic shoulder alterations. No predictors for the occurrence of shoulder-associated problems could be found. CONCLUSIONS: (1) Decreased active shoulder motility, shoulder-related pain, reduced function, shoulder elevation, and insertion tendinitis of the ipsilateral shoulder joint are diagnosed in many patients 3 months after subpectoral ICD implantation. (2) After 12 months the number of patients with impaired shoulder motility, function, shoulder-related pain, shoulder elevation, and insertion tendinitis decreased significantly. (3) Ultrasound and radiographs of the ipsilateral shoulder showed no evidence of pathologic morphologic alterations after subpectoral ICD implantation. (4) No shoulder-associated problems required an operative revision of the subpectoral generator pocket.

Defibrillators, Implantable↗
PubMed1998

A simplified, practical echocardiographic approach for 3-dimensional surfacing and quantitation of the left ventricle: clinical application in patients with abnormally shaped hearts.

The goal of this study was to validate the quantitative accuracy of a system for 3-dimensional (3D) echocardiographic reconstruction of the left ventricle to assess its volume and function in human beings by using 3 apical views as a simplified technique to promote practical clinical application. End-diastolic and end-systolic volumes (EDV, ESV) and ejection fraction (EF) were obtained by 3D echocardiography in 50 patients with dilated or geometrically distorted left ventricles and compared with values from magnetic resonance imaging (20 consecutive patients), angiography (22 consecutive patients), and radionuclide imaging (8 consecutive patients). Three-dimensional results were also compared with 2-dimensional (2D) echocardiographic estimates. Three-dimensional left ventricular reconstruction provided values that correlated and agreed well with pooled data from the other techniques for EDV (y = 0.93x + 9.1, r = 0.95, standard error of the estimate [SEE] = 15.2 mL, mean difference = -0.5 +/- 15.4 mL), ESV (y = 0.94x + 4.3, r = 0. 96, SEE = 11.4 mL, mean difference = 0.4 +/- 11.5 mL), and EF (y = 0. 90x + 4.1, r = 0.92, SEE = 6.2%, mean difference = -0.9 +/- 6.4%) (all mean differences not significant versus 0), with greater errors by 2D echocardiography. Intraobserver and interobserver variabilities of 3D echocardiography were less than 6% for EDV, ESV, and EF. The overall time for image acquisition and 3D reconstruction was 5 to 8 minutes. Although this 3D method uses only a small number of apical views, it accurately calculates EDV, ESV, and EF in patients with dilated and asymmetric left ventricles and is more accurate than 2D echocardiography. The flexible surface fit used to combine the 3 views provides a convenient visual output as well as quantitation. This simple and rapid 3D method has the potential to facilitate routine clinical applications that assess left ventricular function and changes that occur with remodeling.

Coronary Angiography↗
PubMed1998

Failure of CPAP therapy in obstructive sleep apnoea syndrome: predictive factors and treatment with bilevel-positive airway pressure.

Continuous positive airway pressure (CPAP) is the most widely used therapy for obstructive sleep apnoea (OSA). Despite its general efficacy, oxygen desaturation due to hypoventilation persists in some patients. The present study analysed the factors which are associated with this primary failure and, moreover, examined the effect of a bilevel positive airway pressure (BiPAP) trial. In a 15-month period, 13 patients with OSA (Group A) failed to respond to initial CPAP therapy defined by a remaining apnoea/hypopnoea index (AHI) of > or = 5 or a mean nocturnal SaO2 < 90%. These patients were compared to an age- and AHI-matched control group (Group B) successfully treated by CPAP. A logistic regression analysis was performed to identify factors which are associated with initial failure to CPAP. Patients of the CPAP-failure group were treated with nasal BiPAP in the control mode. These patients were significantly more obese than patients of the control group (mean body mass index 44.2 +/- 7.7 vs 31.2 +/- 6.3 kg m-2; P < 0.001). PaO2 at rest (P < 0.001) and at exercise (P < 0.005) was significantly lower in Group A patients. PaCO2 at rest (P < 0.001) was significantly higher in Group A patients and changed for the worse during exercise, whereas it improved in the control group. Group A patients spent significantly (P < 0.0001) more time with oxygen saturation < 90%. The percentage of time spent at < 90% of SaO2 was the only factor which was independently associated with the initial failure of CPAP (OR 1.13; 95% CI 1.0-1.2). After 3 months of treatment with BiPAP, the patients' blood gas values while awake improved significantly (P < 0.05) for PaO2 as well as for PaCO2. In conclusion, patients with OSA resistant to initial CPAP are morbidly obese with impaired awake blood gas values. The percentage of time spent at < 90% of nocturnal SaO2 is independently associated with initial failure of CPAP. BiPAP in the control mode is adequate for nocturnal ventilation, and improves awake blood gas values.

Adult↗
PubMed1998

Prospective evaluation of the quality and long-term stability of atrial signals in non-thoracotomy defibrillation electrodes: comparison of four different endocardial electrograms.

UNLABELLED: Documentation of atrial signals in stored endocardial electrograms of modern implantable cardioverter-defibrillators (ICD) is a useful tool to classify the underlying arrhythmia leading to device therapy. Newest generations of ICD provide near- and far-field electrograms derived between various endocardial electrodes. The aim of this prospective study was to assess the quality and long-term stability of atrial signals in different far-field configurations including the active can housing. METHODS AND RESULTS: A total of 300 real-time endocardial electrogram recordings in 60 consecutive patients with a modern ICD in subpectoral position were analysed at the time of implant, pre-hospital discharge, 1, 3 and 12 months follow-up. Four different configurations were evaluated: right ventricular coil to can housing, can housing to pace/sense ring, right ventricular coil to pace/sense tip, and pace/sense tip to pace/sense ring. The best visibility of p-waves at an ECG-resolution of 0.5 mV/mm was seen in the can to coil configuration (77% of the patients). In the can to pace/sense ring electrogram p-waves could be observed in 58% of the patients. No p-waves were visible to pace/sense tip to pace/sense ring. At a resolution of 1.0 mV/mm p-waves were only visible in 10% of all patients exclusively in the can housing to right ventricular coil configuration. The results were stable (100% of the patients) over a follow-up of one year. CONCLUSIONS: Endocardial far-field electrograms, derived from the can housing and the right ventricular coil provide a p-wave visibility in 77% of the patients and demonstrate a long-term stability over at least one year, provided that the ECG-resolution is set at 0.5 mV/mm. Since the electrogram resolution of stored electrograms depends on the EGM-range, and the ECG-resolution at an EGM-range of 15 mV would be 1 mV/mm, the EGM-range is recommended to be programmed to 7.5 mV to ensure an ECG-resolution of at least 0.5 mV/mm for stored electrograms.

Algorithms↗
PubMed1998

Case report: inappropriate discharge of an implantable cardioverter-defibrillator caused by the combined count criterion.

We describe a rare case of an inappropriate defibrillator discharge during a sinus tachycardia with single fast sensed beats fulfilling the ventricular fibrillation rate criterion, activating the "combined count criterion," although the prevalent sinus tachycardia was inside a ventricular tachycardia rate zone, programmed to monitor only mode. The "combined count criterion" is a safety feature that ensures defibrillation therapy in case of a tachyarrhythmia inside the ventricular tachycardia detection zone, that is temporarily crossing the ventricular fibrillation detection rate. This case reports shows that there is a low but unpredictable risk of device therapy even in a zone programmed to monitor only mode. This phenomenon should be considered when a monitor only zone is installed for revelation of slower tachyarrhythmias.

Adult↗
PubMed1998

Changes in platelet size and count in unstable angina compared to stable angina or non-cardiac chest pain.

AIMS: An increase in platelet aggregability is associated with unstable angina and myocardial infarction. Platelet size and activity correlate and mean platelet volume was found to be increased before acute myocardial infarction. We measured the mean platelet volume and platelet count in patients with stable angina, unstable angina and non-cardiac chest pain. METHODS AND RESULTS: We studied 981 patients (734 men; 247 women) defined clinically as stable angina (n = 688), unstable angina (n = 108) and unstable angina requiring immediate angioplasty (n = 52). After coronary angiography the patients were subdivided into single (n = 269), double (n = 304) and triple-vessel disease (n = 311) and the control group of non-cardiac chest pain (n = 97). There was no significant difference in platelet count between the control group and patients with 1, 2, or 3-vessel disease. However, the platelet size in patients with coronary artery disease was significantly larger (single: 8.7 +/- 1.19 fl; double: 8.7 +/- 1.12 fl; triple-vessel disease: 8.8 +/- 1.18 fl) than the control group (8.2 +/- 0.95 fl) (P < 0.01). Patients with stable angina similarly had no, significant difference in platelet count compared to the control group but did have a significantly increased mean platelet volume (8.7 +/- 1.13; P < 0.01). In contrast, patients with unstable angina had a decreased platelet count (245 +/- 56 x 10/l) compared to either stable angina (262 +/- 62 x 10/l; P < 0.05) or the control group (261 +/- 58 x 10/l; P < 0.05); furthermore, the mean platelet volume (9.4 +/- 1.23 fl) was significantly greater than for stable angina (P < 0.01). Patients with unstable angina requiring immediate PTCA had an even lower platelet count (231 +/- 55 x 10/l) and higher mean platelet volume (10.4 +/- 1.03 fl) (P < 0.01) than the rest of the population with unstable angina. CONCLUSIONS: In stable angina the platelet count is unchanged compared to patients with normal coronary arteries but the platelet size is increased. However, in unstable angina there is a decrease in platelet count and an even larger increase in platelet size. We interpret this as meaning that unstable angina might be associated or preceded by an increase in platelet destruction rate that is not completely compensated for by an increase in platelet production rate. The large, more reactive platelets might be causally related to an ongoing coronary artery obstruction in unstable angina.

Adult↗
PubMed1998

Transvasal closure of interatrial defects using the Babic double-umbrella occluder system.

The purpose of the study was to assess the feasibility and safety of closure of atrial septal defects and patent foramen ovale by means of a new interventional technique. Transvasal closure of ostium secundum atrial septal defect and patent foramen ovale was performed in 18 patients using an occluder system for atrial septal defects. Two patients had undergone unsuccessful direct surgical closure years before. Implantation and follow-up were controlled using radiographic views both with and without contrast injection, transthoracic and multiplane transesophageal echocardiographic imaging, color Doppler sonography, and computed tomography. The defect was closed in 16 patients using 19 procedures. Removal of the devices through the sheath was indicated in 4 patients because of placement failure. Intraprocedural complications were ventricular fibrillation in one patient and fixation of the device in Chiari's network in an additional one. During 7-26 months follow-up occluder damage was seen in two patients and perforation of the left atrium in one patient. Thickening on the occluder surface was observed in two patients. There was no death. The system for closure of atrial septal defect is feasible and safe in patients with defects < or = 27 mm in diameter. Long-term observation of outcome is limited yet.

Adult↗
PubMed1998

[MRI diagnosis of right ventricular dysplasia].

PURPOSE: Right ventricular dysplasia (RVD) represents an important cause of sudden death and ventricular arrhythmias in young patients. The aim of this study was to describe diagnostic diagnostic criteria and the MR-tomographie aspects of the disease. METHODS: 34 patients with clinically suspected RVD were examined by 0.5-T MRI (cardiac-gated T1-weighted spin echo sequences and cine gradient echo sequences). RVD was confirmed in 16 patients and ruled out in 18 patients. MR images were evaluated for presence of: 1. right myocardial fatty infiltration, 2. dilatation of the right ventricle, 3. dilatation of the right ventricular outflow tract, and 4. localised right ventricular aneurysm. RESULTS: Right myocardial fatty infiltration was detected by MRI in 11 of 16 patients (69%) with RVD. Dilatation of the right ventricle was seen in 5 patients, dilatation of the right outflow tract in one patient, and localised right ventricular aneurysm in two patients with RVD. CONCLUSIONS: MRI is able to demonstrate fatty replacement of right ventricular myocardium in most cases and plays an important role in the diagnosis of RVD.

Adipose Tissue↗
PubMed1998

Hemodynamic sequelae of ventricular tachyarrhythmias on cerebral blood flow.

The present experiments were designed to compare the behavior of cerebral blood flow (CBF) during acute moderate and severe hypotensive episodes induced by either ventricular tachycardias (VT) or by hemorrhage. Using the microsphere method CBF was determined in 20 Sprague-Dawley rats during sinus rhythm (Group A), in 28 animals during high-rate VT (Group B) and in 10 animals after hemorrhage (Group C). According to the decrease in blood pressure and with respect to the lower threshold of cerebral autoregulation Group B was divided into 2 subgroups (B1: 80-130 mmHg; B2: 50-80 mmHg) retrospectively. While CBF remained constant in Group B1 (0.98 +/- 0.3 ml g-1 min-1 vs. 1.01 +/- 0.32 in controls, NS), CBF decreased markedly during severely hypotensive VT in Group B2 (0.52 +/- 0.2 ml g-1 min-1, p < 0.001 vs. A; p < 0.05 vs. C) and during hypovolemic hypotension in Group C (0.77 +/- 0.22 ml g-1 min-1 vs. A; NS). Cerebrovascular resistance and autoregulation indices indicated a maintenance of CBF regulation during hypovolemic hypotension and a failure during normovolemic hypotension. These findings indicate that the autoregulatory ability of the brain is substantially more stable during hypovolemic hypotension than during normovolemic hypotension. Therefore, the hemodynamic sequelae of acute hypotensive episodes on CBF depend on the underlying cause of hypotension.

Animals↗
PubMed1998

Electrical proarrhythmia: induction of inappropriate atrial therapies due to far-field R wave oversensing in a new dual chamber defibrillator.

This case report describes delivery of atrial therapies during a sinus tachycardia in a new dual chamber implantable cardioverter defibrillator inappropriately caused by far-field oversensing of ventricular beats in the atrial channel. Upon classification of the PR interval pattern, the rate criterion for an atrial tachycardia was fulfilled, and the device initiated high-frequency burst pacing as the first stage of programmed tiered atrial therapies. Atrial fibrillation subsequently was induced by high-frequency burst pacing, and eventually a programmed 10-J shock was delivered for successful termination of atrial fibrillation. The phenomenon of far-field oversensing of ventricular beats could be repeatedly observed during exercise testing and abolished by decreasing the atrial sensitivity.

Defibrillators, Implantable↗
PubMed1998

A new classification algorithm for discrimination of ventricular from supraventricular tachycardia in a dual chamber implantable cardioverter defibrillator.

INTRODUCTION: The high incidence of inappropriate therapies due to supraventricular tachycardia remains a major unsolved problem of implantable cardioverter defibrillators. We report a new detection formula for discrimination of ventricular tachycardia from supraventricular tachycardia in a patient with a dual chamber implantable cardioverter defibrillator and a new atrioventricular classification algorithm. METHODS AND RESULTS: The enhanced detection algorithm performs a stepwise arrhythmia analysis. The rhythm is first classified on the basis of cycle length. Each episode is then classified as supraventricular or ventricular on the basis of atrioventricular association, stability of circle length, and origin of acceleration. Sophisticated diagnostic information is provided by atrioventricular markers and electrogram recordings. Successful discrimination of two spontaneous episodes of ventricular tachycardia and supraventricular tachycardia is demonstrated. CONCLUSION: This new dual chamber detection algorithm may significantly improve the specificity of tachyarrhythmia detection without sacrificing sensitivity, thereby reducing the number of spurious shocks in patients with recurrent supraventricular tachycardias. Further studies are needed to assess the sensitivity and specificity of this detection algorithm.

Algorithms↗
PubMed1998

Acute and long-term effects of consecutive radiofrequency applications on conduction properties of the subeustachian isthmus in type I atrial flutter.

INTRODUCTION: Bidirectional conduction block at the subeustachian isthmus predicts long-term efficacy of atrial flutter ablation. Limited data are available on the incidence and outcome of minor conduction changes such as unidirectional or incomplete block. This prospective study sought to systematically assess discrete acute and long-term alterations of bidirectional conduction prior to a complete conduction block. METHODS AND RESULTS: In 41 patients with type I atrial flutter, pulse propagation through the subeustachian isthmus during low lateral and proximal coronary sinus pacing was documented and analyzed following each consecutive radiofrequency (RF) application. In cases of altered conduction properties and noninducibility of atrial flutter, patients were followed-up for 12 months. Three sets of results were found. First, following RF application, 23 patients presented a progressive conduction delay prior to a complete conduction block. Second, RF application did not always affect counterclockwise and clockwise conduction simultaneously or to the same extent. In 13 patients, an initial alteration of counterclockwise conduction was present before an alteration of clockwise conduction; in 5 patients, clockwise conduction was primarily affected. Third, the recurrence rate of typical atrial flutter was 9% (2/22) in patients with a complete bidirectional conduction block, 54% (7/13) in patients with unidirectional conduction block, and 100% (6/6) in patients with sole bidirectional conduction delay. CONCLUSION: In 50% of the patients, consecutive RF applications resulted primarily in a progressive conduction delay rather than a sudden conduction block. Since counterclockwise and clockwise conduction were not always affected simultaneously or to the same extent, lateral as well as septal pacing is recommended for improvement of bidirectional conduction block. Normalization of primarily altered conduction and, therefore, recurrence of atrial flutter are high in all patients without bidirectional block.

Adult↗
PubMed1998

Apoptosis in restenosis versus stable-angina atherosclerosis: implications for the pathogenesis of restenosis.

Decreases in programmed cell death (apoptosis) may contribute to restenotic hyperplasia by prolonging the life span of intimal cells. Apoptotic events were compared in restenotic versus primary lesions, by using atherectomy samples from 16 restenotic and 30 primary human peripheral and coronary lesions from patients presenting with stable angina. We used transmission electron microscopy to identify apoptosis, quantify its frequency, distinguish apoptosis from necrosis, and relate these events to cellular composition. Smooth muscle cell (SMC) density was higher in restenotic versus primary lesions (P<0.0001), whereas the number of macrophages was significantly reduced (P<0.01) and the number of lymphocytes was lower, but not significantly (P=0.06). As the main finding, restenotic lesions contained fewer apoptotic cells compared with primary lesions (3% versus 13%, P=0.002), whereas no differences were found for cellular necrosis. With regard to cell type, the lower frequency of apoptotic cells observed in restenotic tissue was attributable to both SMCs and macrophages. The key finding of less apoptosis in restenotic versus primary lesions was in agreement with terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) analysis (2% versus 9%, P<0.001). For all lesions analyzed, significant inverse correlations were observed between the density of SMCs and the frequency of apoptotic cell death (r=-0.60, P<0.001) as well as the density of SMCs and that of macrophages (r=-0.74, P<0.001). No relationship was seen between the frequency of apoptosis and the density of macrophages. In conclusion, the data of the present study indicate that a low level of apoptosis may be an important mechanism leading to restenotic intimal lesion development after interventional procedures.

Adult↗
PubMed1998

Pulmonary haemodynamics in obstructive sleep apnoea: time course and associated factors.

Changes in pulmonary artery pressure within an obstructive apnoea and elevations of transmural pulmonary artery pressure (Ppa,tm) towards the end of apnoea are well known. The purpose of our study was to examine which factors contribute to the increase of Ppa,tm in an apnoea. In addition, the time course of Ppa,tm and associated factors during a sleep study was investigated. We analysed the association of changes in arterial oxygen saturation (Sa,O2), oesophageal pressure (Poes) to estimate intrathoracic pressure, systolic blood pressure (BPsys) to estimate left ventricular afterload, apnoea duration and the change in Ppa,tm (deltaPpa,tm) during the course of obstructive apnoeas. Consecutive apnoeas in nonrapid eye movement (NREM)-sleep at the beginning, the middle and the end of the sleep study were analysed in six patients with obstructive sleep apnoea. The mean systolic Ppa,tm was 28.0+/-12.1 mmHg at the beginning of apnoea and 38.6+/-15.5 mmHg at the end (deltaPpa,tm 10.5+/-7.4 mmHg; p<0.0001). DeltaSa,O2 (p<0.0001; odds ratio (OR) 1.45; confidence interval (CI) 1.20-1.76) and deltaPoes (p<0.0001; OR 1.22; CI 1.11-1.34) were independently associated with deltaPpa,tm in a multiple regression analysis. Apnoea duration as well as deltaPoes, deltaPpa,tm and deltaSa,O2 were all significantly higher (p<0.05) in apnoeas at the middle of the sleep study than at the beginning or the end. In conclusion, hypoxaemia and mechanical factors as an increase in negative thoracic pressure contribute to elevations of the transmural pulmonary artery pressure during an obstructive apnoea. The time course of pulmonary haemodynamics within a steep study reveals that the highest transmural pulmonary artery pressure occurs in the middle of the night with no progressive increase towards the end of the sleep study.

Aged↗
PubMed1998

[Nosocomial ventilator-associated pneumonias caused by Aspergillus fumigatus in non-immunosuppressed, non-neutropenic patients].

We observed three cases of severe ventilator-associated pneumonia due to Aspergillus fumigatus in non-immunosuppressed, non-neutropenic patients. Autopsy confirmed an angioinvasive pattern of spreading with septic foci. In all cases conditions associated with temporary immunodysfunction like underlying diseases, antecedent sepsis or pneumonia, coinfections or steroid therapy were present. Although Aspergillus fumigatus was isolated in all cases in cultures of tracheobronchial secretions, the correct diagnosis was not obtained during lifetime. Our cases demonstrate that pneumonia due to Aspergillus fumigatus must be taken into account also in this patient population.

Adult↗