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Biomedical subjects

C Witt

Publications and source records attributed to C Witt.

At least 109 records · Page 6Linked to original sources
PubMed1997

[Multiple sleep latency test in patients with obstructive snoring].

The objective of our study was to examine the effect of the n-CPAP on day tiredness of patients suffering from obstructive snoring. This effect was objectified by means of the Multiple Sleep Latency Test (MSLT). The MSLT was performed with optimal pressure at 8.00, 10.00, 12.00 and 14.00 hrs. subsequent to the control night and the third CPAP night. The latencies of falling asleep and the sleep stages were determined in accordance with the criteria of Rechtschaffen and Kales. The average latency of falling asleep before therapy was: at 8.00 hrs 9.0 +/- 14.2 min, at 14.00 hrs. 7.2 +/- 6.3 min. The following latencies of falling asleep were observed after the third CPAP night: 8.00 hrs. 14.2 +/- 6.3, 10.00 hrs. 13.4 +/- 6.4, 12.00 hrs. 13.7 +/- 6.4 hrs. 13.7 +/- 6.0 min. This means that after the therapy there was a marked tendency to longer latencies at all 4 points of measurement with significant differences at 12.00 and 14.00 hrs. A comparison of the quality of sleep before and after the therapy yielded an increase in deep sleep and a significant increase in REM density during dream sleep. MSLT enabled objectivation of improved sleep quality and of subjective decrease in day tiredness after CPAP therapy in patients with obstructive snoring. The latency in falling asleep increased at all the points of measurement. Nevertheless, interindividual differences are great, compared with the uniform subjective success of CPAP therapy achieved with these patients.

Adult↗
PubMed1996

Expression of adhesion molecules in peripheral pulmonary vessels from smokers and nonsmokers.

INTRODUCTION AND RATIONALE: An accumulation of intraalveolar cells, especially of macrophages and granulocytes, can be observed in smokers. Since adhesion molecules are involved in the process of cell accumulation, in this study we investigated the hypothesis that the expression of endothelial adhesion molecules on pulmonary vascular endothelial cells is different in smokers and nonsmokers. METHODS: We investigated lung biopsies from 26 patients who underwent thoracic surgery for localized malignancies (smokers: 15; nonsmokers: 11). Cryostat sections were stained by using immunohistochemistry (APAAP method) with antibodies against E- and P-selectin, the vascular adhesion molecule-1 (VCAM-1), and the intercellular adhesion molecule-1 (ICAM-1). The number of adhesion molecule-positive stained vessels was compared to the total number of vessels identified by the expression of von Willebrand's factor (vWF) and anti-CD31. RESULTS: The two groups investigated showed no differences in the expression of E-, and P-selectin and of VCAM-1. In contrast, the expression of ICAM-1 was significantly increased in smokers (median 25 vessels/section, CI95%: 19-31) compared to nonsmokers (median 16 vessels/section, CI95%: 9-21) (p = 0.030). In smoking subjects, we were also able to demonstrate a positive correlation between the duration of smoking expressed as pack years and the expression of ICAM-1 on pulmonary vessels (Spearman rank coefficient of correlation 0.857; p = 0.0002). CONCLUSION: The observed increased expression of ICAM-1 on pulmonary vascular endothelial cells in smokers compared to nonsmokers may be involved in the increased recruitment of inflammatory cells to the alveolar space of smokers.

Adult↗
PubMed1996

Preoperative two- and three-dimensional transesophageal echocardiographic assessment of heart tumors.

BACKGROUND: Two-dimensional transesophageal echocardiography is the most widely used diagnostic approach in the rare entity of heart tumors. The aim of this study was to assess the diagnostic usefulness of three-dimensional echocardiography in comparison with the two-dimensional technique in a rare clinical setting. METHODS: Twenty-seven patients (18 women; mean age, 49.7 +/- 14 years) with a histologically proven diagnosis of a cardiac tumor were studied. The primary diagnosis was done by a two-dimensional transthoracic echocardiography (n = 9) and transesophageal echocardiography (n = 18). In addition, we performed three-dimensional transesophageal assessment in 5 patients with left atrial myxomas. The echocardiographic findings were compared with the intraoperative appearance and pathologic diagnosis. RESULTS: The echocardiographically suspected diagnosis of a heart tumor in 29 cases was histologically correct in 27 patients (myxomas, 20; epicardial lipoma, 1; malignant epicardial mesothelioma, 1; metastatic processes of hypernephromas, 2; and undifferentiated tumors of the pericardium, 3). Only the combination of multiplane transesophageal and three-dimensional echocardiography was able to demonstrate the shape, dimensions, location, origin, surface, three-dimensional movement, and involvement of valves and was most useful in the preoperative diagnosis and planning. CONCLUSIONS: Three-dimensional transesophageal echocardiography yields important additional clinical information and improves the operative planning. Three-dimensional echocardiography may become the best approach to study the anatomy and pathology of the heart as it provides an objective display of cardiac size and shape in heart tumors.

Adult↗
PubMed1996

Increase in the expression of alpha E beta 7, characteristic of intestinal intraepithelial lymphocytes, on T cells in the lung epithelium of patients with interstitial lung diseases and in synovial fluid of patients with rheumatic diseases.

The intestinal epithelium contains a distinct group of lymphocytes (iIEL). The majority of iIEL are T cells characterized by a phenotype different from PBL. This phenotypic peculiarity has led to the hypothesis that iIEL, develop in a thymus-independent fashion, that they may develop locally in the gut epithelium itself and that they have the distinct function of providing a first line of defense in the gut. We looked at the expression of the gut-associated surface molecule alpha E beta 7 on T cells in inflamed tissues outside the gut epithelium. The already high frequency of 41.8% alpha E beta 7+ T cells in bronchoalveolar lavage from healthy lungs rises to a median of 61% in a fibrotic lung. In synovial fluid the percentage of T cells expressing alpha E beta 7 was diverse; it was not as high as in the lung but was elevated compared to PBL levels. In both tissues, the increase in alpha E beta 7 expression correlated with an increase in CD8+ cells. We discuss our data in the context of a model in which iIEL can leave the gut epithelium and become involved in inflammatory processes, possibly related to autoimmune disease.

Arthritis, Rheumatoid↗
PubMed1996

Antibody reactivity profiles following immunization with diverse peptides of the PERB11 (MIC) family.

PERB11 (MIC) is a gene family possessing multiple copies located within the MHC. Structurally, PERB11 is related to the MHC class I, neonatal IgG Fc receptor (FcRn) and Zn-alpha 2-glycoprotein molecules. The MHC class I family is complex in terms of its genomic arrangement, expression and function, and available evidence suggests that the PERB11 family may be similarly complex. We have adopted an approach to study the expression of such complex gene families by immunizing with multiple peptides and by screening the resulting antibodies against a large range of tissues. The amino acid sequences of PERB11.1 and PERB11.2 as well as those of other related molecules were analysed and compared. Peptides were chosen for immunization based upon (i) loop formation within the equivalent known structure of the MHC class I molecules; (ii) immunogenicity by computer analysis; and (iii) evolutionary relationships. Antibodies in serum from immunized rabbits bound to three out of six peptides used for immunization. ELISA and immunoprecipitation demonstrated binding both to the peptides and to the PERB11.2 recombinant protein. By immunofluorescent staining of various tissues of several species, the three antisera generated overlapping profiles of activity. These included reactions with kidney, small and large intestine, oesophagus, testis, ovary and human neutrophils. This is the first description of antibodies induced by the PERB11 peptides. The extreme complexity of these profiles requires further investigation, but may be explained in terms of antibodies against diverse products of the PERB11 gene family and/or related molecules.

Amino Acid Sequence↗
PubMed1996

Multiple fistulas and tracheobronchial stenoses require extensive stenting of the central airways and esophagus in squamous-cell carcinoma.

We report here on two cases of double airway and esophageal stenting in patients with multiple esophagotracheal fistulas and stenoses of the airways and esophagus due to squamous-cell carcinoma. Dumon stents and a Strecker device were used for tracheobronchial stenting. Covered Gianturco Z-stents were implanted into the esophagus. In one case, extrinsic compression of the trachea and tumor progression required recanalization by Nd:YAG laser. Clinical improvement led to discharge of the patients within two weeks after the procedure. The results show that simultaneous implantation of stents in the central airways and covered Gianturco Z-stents in the esophagus is an effective therapeutic strategy in patients with tracheal and esophageal obstructions and esophagorespiratory fistulas. Further systematic studies evaluating double stenting are warranted.

Aged↗
PubMed1996

Behet's syndrome with pulmonary involvement-combined therapy for endobronchial stenosis using neodym-YAG laser, balloon dilation and immunosuppression.

We present a case report of a patient suffering from Behet's syndrome with pulmonary involvement. The development of endobronchial granulomatosis in the bronchus intermedius and right upper lobe bronchus led to severe bronchial stenosis and dyspnoea. Also aphthous ulcerations in the bronchial mucosa occurred. Treatment of the granulomatous stenosis consisted of Neodym-YAG laser resection and immunosuppression. On follow-up there was a recurrence of the stenosis, characterised by fibrotic strictures. Therefore a balloon dilation was performed and immunosuppression instituted, which led to an increase in airway diameter and a reduction in dyspnoea. These clinical results suggest that recanalisation therapy with Neodym-YAG laser and/or balloon dilation with additional immunosuppression is suitable in benign stenosis (granulomatous or fibrotic), caused by Behet's disease.

Adult↗
PubMed1996

Diagnosis of alveolitis in interstitial lung manifestation in connective tissue diseases: importance of late inspiratory crackles, 67 gallium scan and bronchoalveolar lavage.

The diagnostic relevance of bronchoalveolar lavage (BAL) and associated non-invasive findings in connective tissue diseases (CTD) has not been established regarding alveolitis so far. The goal of the study was to determine the relations between BAL cell differential count and findings of non-invasive diagnostic procedures for alveolitis to predict the clinical value of BAL in CTD. One hundred-five patients (92 non-smokers; 13 smokers) with CTD (73 patients with systemic sclerosis, 19 with systemic lupus erythematosus, 13 with primary Sjögren's syndrome) had symptoms or signs of lung involvement and were further examined (lung function test, chest radiography, thoracic computed tomography, 67 gallium scintigraphy and BAL). The relations between BAL in middle lobe and cell count differentiation to non-invasive investigations were analyzed by logistic regression. In all CTD patients investigated a pulmonal involvement occurred based on non-invasive methods. Regarding non-invasive methods, alveolitis determined by BAL cell differential count was significantly associated with an increased 67-gallium uptake and late inspiratory crackles (P < 0.01), and to a lesser extent with an abnormal interstitial pattern in CT (P < 0.055). Parameters of lung function and laboratory parameters were related to alveolitis using multivariate testing. Considering the alveolitis subtype (granulo- or lymphocytosis), only a reduced FEV1 showed a relationship to granulocytic alveolitis (P < 0.01). Late inspiratory crackles and increased 67 gallium uptake as non-invasive diagnostic findings point out alveolitis in CTD remarkably. Therapeutic and prognostic aspects necessitate BAL to specify the type of alveolitis (lymphocytosis or granulocytosis or mixed forms) in CTD patients with lung manifestation. Non-invasive diagnostic procedures cannot predict the type of alveolitis sufficiently.

Adult↗
PubMed1996

[Interventional pneumology: procedures for pulmonary hemorrhage and tumor-induced superior vena cava syndrome].

Interventional pneumology includes both bronchological and vascular methods of diagnostic and therapy, especially in case of pneumological emergency, such as pulmonary hemorrhage and superior vena cava syndrome. In massive pulmonary hemorrhage bronchological diagnosis is needed to determine the location and activity of the bleeding, as well as angiography of bronchial arteries, and of pulmonary arteries, respectively. Bronchus occlusion by aid of balloon catheter or double lumen tube are intermediate methods to bridge over till defenitive surgery or embolisation of bronchial or pulmonal arteries as complementary methods in patients with pulmonary hemorrhage. In patients suffering from superior vena cava syndrome caused by neoplasms venous angioplasty and Wallstent implantation provide immediate clinical improvement.

Angioplasty, Balloon↗
PubMed1995

[Venous angioplasty and Wallstent implantation in emergency treatment of superior vena cava syndrome caused by tumor].

HISTORY AND CLINICAL FINDINGS: A 58-year-old man was hospitalized because of threatened asphyxia resulting from massive obstruction to neck vein flow and increased venous markings over the ventral and dorsal thorax. The previous year he had received radiotherapy (total of 55.8 Gy) for squamous cell carcinoma in the right upper lobe of the lung (primary stage T2 N2 M0). The signs of venous congestion had developed over several months. TESTS: Emergency phlebography demonstrated obstruction to superior vena cava (SVC) flow by tumour compression. TREATMENT AND COURSE: It was possible to pass the SVC obstruction with a hydrophilic guide-wire and then perform a balloon angioplasty, followed later by implantation of two intraluminal expandable stents ("Wallstent"). The dyspnoea quickly improved after the successful recanalization. The day after the intervention palliative radiotherapy of the SVC obstruction was begun. But increased venous markings over the thorax recurred, but without dyspnoea, after 4 1/2 months free of signs of venous congestion. Repeat phlebography again demonstrated complete obstruction of the SVC by the tumour. Recanalization by balloon angioplasty was again achieved. CONCLUSIONS: This case underlines the value of percutaneous balloon angioplasty with stent implantation as supplementary treatment in the late stages of SVC obstruction by tumour.

Angioplasty, Balloon↗
PubMed1995

Experimental models of tracheobronchial stenoses: a useful tool for evaluating airway stents.

BACKGROUND: Stent implantation is a conservative alternative to open operation for treating benign tracheobronchial strictures. Most of the presently available stents were primarily designed for endovascular use. Their respiratory use entails a risk of iatrogenic complications. From a scientific and from an ethical point of view these risks justify preclinical evaluation of new respiratory stents in experimental models of central airway stenoses. Therefore, an attempt was made to develop such models in piglets and adult minipigs. METHODS: Tracheal stenoses were obtained by creating first a segmental tracheomalacia through extramucosal resection of cartilaginous arches. The fibrous component of the stenoses was then obtained through bronchoscopic application of a caustic agent causing progressive deep mucosal and submucosal injury. Stenoses of the main bronchi were created by topical application of the caustic agent only. RESULTS: These models demonstrated the typical features of benign fibromalacic tracheobronchial stenoses with constant recurrence after mechanical dilation. Preliminary experiments showed that short-term problems of tolerance of stent prototypes are easily demonstrable in these models. CONCLUSIONS: These experimental models, which simulate quite realistically human diseases, offer the opportunity to perfect new tracheobronchial stents specifically designed for respiratory use and to evaluate their long-term tolerance before their use in humans.

Animals↗
PubMed1995

[Differentiation of arousal in sleep before and after CPAP therapy in patients with pronounced sleep apnea syndrome].

The sleep apnea syndrome is often associated with the syndromes of daytime exhaustion and involuntary daytime sleeping fits. The cause is assumed to be fragmentary sleep resulting from night-time arousal. The central nervous activation reactions caused by apnea or hypopnea, respectively, and not the movement arousal determine the sleep structure. We have examined 10 male patients in the age range 40-55 years (48 +/- 6 SD) before and during the first 3 nights of CPAP therapy. Cardiorespiratory polysomnography was performed in all four nights. Sleep way analyzed visually and differentiation was made between respiratory (RA) and movement arousal (MA). All 10 patients had a pronounced sleep apnea syndrome. Deep and dream sleep were reduced, significantly more respiratory arousals occurred than movement arousals. The SWS latency was shortened in the first therapy night, the deep and dream sleep proportions increased and the RA decreased significantly. No further significant changes in the sleep parameters occurred during the second and third nights. We found that the number of apnea/hypopnea was not equal to the number of RA. When less arousal was recognized it was suggestive of a deficit of the diversion function while more RA was indicative of additional respiratory events, e.g. pharyngeal obstructions and hyperventilations which were not recognized as apnea or hypopnea. In addition to its role in the differential diagnosis of sleeping disorders, in particular sleep apnea, arousal differentiation is also an important criterion for estimating the efficiency of CPAP therapy.

Adult↗
PubMed1995

[Obstructive snoring--diagnosis and therapy].

Obstructive snoring belongs to the sleep-related breathing disorders. The characteristics of this disorder is described, following the case report about two young snorers, complaining of excessive day-time sleepiness, involuntary falling asleep in monotoneous situations. Ambulatory monitoring using the four-channel system MESAM-IV showed a Respiratory Disturbance Index of < 5 during a predominantly continuous snoring episode without significant drops in oxygen saturation. Clinical cardio-respiratoric polysomnographic monitoring showed a normal architecture of sleep interrupted by respiratory arousals. Under nasal CPAP treatment these arousals, as well as the complained excessive daytime sleepiness disappeared. The latter fact becomes evident, when comparing the sleep latencies before therapy to those under CPAP-treatment, estimated by the Multiple Sleep Latency Test (MSLT). Thus, this therapy proved to be very effective in patients suffering from obstructive snoring.

Adult↗
PubMed1992

[The accidental aspiration and ingestion of petroleum in a "fire eater"].

A 26-year-old man, practicing for a variety performance as "fire-eater", accidentally inhaled and ingested about 10 ml petroleum. Soon afterwards he developed dyspnoea, an urge to cough, fever up to 39 degrees C and loss of retentiveness. He was treated as an out-patient with doxycycline, 100 mg daily, and aspirin, 500 mg three times daily. While this reduced the dyspnoea, the elevated temperature persisted and he had haemoptysis. Chest x-ray and computed tomography 12 days after the aspiration revealed areas of atelectasis and of liquefaction necroses. Bronchoscopic and cytological examinations showed eosinophilic alveolitis and mucosal necrosis in both main bronchi. The symptoms were improved by two inhalations of beclomethasone four times daily, and systemic treatment with prednisolone, 50 mg daily, together with parenteral antibiotic administration (cefotaxime, 1.0 g twice daily). The focal lung lesions regressed completely within a few weeks. Five months after the aspiration computed tomography merely demonstrated discrete scarring of the previously necrotic lesions. This case illustrates that, even with extensive necrotic lung changes after petroleum aspiration, conservative treatment is justified and likely to be effective.

Adult↗