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D Köhler

Publications and source records attributed to D Köhler.

At least 37 records · Page 2Linked to original sources
PubMed2004

Is the rhesus monkey (Macaca mulatta) comparable to humans? Histomorphology of the sphincteric musculature of the lower urinary tract including 3D-reconstruction.

The physiology of the muscle systems of the human lower urinary tract is still not known in detail. To study the functional basics of this complex organ system, experiments are often performed in animal models including rhesus monkeys. To apply the results of animal model studies to the humans, a clear knowledge of the comparative anatomy of both species is necessary. However, detailed comparative studies of the lower urinary tract of the rhesus monkey and the humans are lacking. Accordingly, a detailed study on the sphincteric musculature of the lower urinary tract of the rhesus monkey was performed in order to demonstrate anatomical correspondences and differences between both species. The lower urinary tract anatomy was investigated in 18 male and female rhesus monkeys (Macaca mulatta) by serial sections. Immunohistochemical staining methods were used to differentiate striated and smooth musculature. Three-dimensional reconstructions were performed in order to demonstrate the topographical anatomy of the different muscle systems. In both man and male rhesus monkeys, a urethral sphincter muscle exists independent of the pelvic floor musculature, with a smooth and a striated muscular part. A urinary diaphragm (diaphragma urogenitale) does neither exist in the rhesus monkey nor in the human. In contrast to women, a striated muscle encircles the urethra and vagina together in the female rhesus monkey. A vesical sphincter muscle, found in the human bladder outlet, does not exist in the rhesus monkey.

Animals↗
PubMed2003

[Montelukast-free interval before inhalational bronchial allergen provocation].

BACKGROUND: Leukotrienes are potent bronchoconstrictive and proinflammatory mediators in bronchial asthma. In a previous study on 16 subjects with bronchial asthma (two randomized groups) we showed that montelukast (10 mg daily) significantly suppressed allergen provocation with specific allergens (mites and pollen) (p = 0.0005). In a follow-up study we addressed the question as to when montelukast should be discontinued in order to avoid a relevant effect on inhalational bronchial allergen provocation. METHOD: At the end of the first study montelukast (10 mg daily) was given again to both groups (2 x 8 asthma patients) for 21 days. After a montelukast-free period of one and three days allergen provocation was repeated in the same manner and the results were compared with the historic baseline values without montelukast. RESULTS: The provocation dose for allergens was reduced by 39% after a montelukast-free period of one day and by 67% after three days. Only after three days was the difference significant (p = 0.017), at which time the control value was nearly reached again. CONCLUSION: We recommend that montelukast be discontinued at least three days prior to inhalational allergen provocation.

Acetates↗
PubMed2002

Survival of mechanically ventilated patients admitted to a specialised weaning centre.

OBJECTIVE: Hospital mortality and survival rates of long-term ventilated patients.DESIGN. Retrospective cohort study. SETTING: Specialised national weaning centre. INTERVENTION: Protocol-directed liberation from ventilator. PATIENTS: Four hundred three of 640 patients with prolonged mechanical ventilation (MV) who were admitted to our respiratory intensive care unit (RICU) were studied. MV lasted longer than 2 weeks and patients had failed more than two weaning trials in the referring ICUs. The majority of patients (59.3%) had chronic obstructive pulmonary disease (COPD). RESULTS: After a mean duration of 41 days of MV prior to transfer, 68% of patients were liberated from the ventilator. In total, 98 of 403 patients (24.3%) died during the stay in our hospital, 305 patients (75.7%) were discharged. Compared to the non-survivors, the survivors were characterised by younger age, longer length of stay in our RICU, lower severity of illness scores at admission, fewer cardiac illnesses and a higher rate of weaning success. In 31.5% of the discharged patients non-invasive MV (NIV) was initiated during the stay at our unit. We gathered follow-up data on 293 patients (96.1%). Post-discharge survival rates were 67.6% at 3 months, 49.4% at 1 year and 38.1% at 3 years. Length of survival was significantly dependent on age, weaning success and main diagnosis (i.e., prognosis in COPD is worse compared to thoracic restriction, neuromuscular disease and others) in the multivariate analysis. CONCLUSIONS: Difficult-to-wean patients have a high hospital mortality rate and poor long-term prognosis. Age, main diagnosis, severity of illness, weaning success and institution of NIV predict survival.

Aged↗
PubMed2002

[Late pulmonary manifestation of ovarian and breast cancer--which contribution provide immunohistochemical techniques?].

The two case studies are describing 2 females with tumor-suspicious lung opacities including pleural effusions. Both patients have had a smoking history of more than 20 packyears and both underwent surgery for a breast respectively an ovarian cancer 10/15 years before. Conventional staining of the biopsies does not allow in most cases the differentiation between a primary lung carcinoma or the metastasis of an extrapulmonary tumor. Immunohistochemical techniques can give clues as to the origin of the primary tumor. The contribution of these methods in finding the correct diagnosis in the two presented cases is discussed. The cooperation between clinician and pathologist should be emphasized. The transfer of all important information is essential.

Aged↗
PubMed2002

[Positive pressure ventilation in Cheyne-Stokes respiration].

Cheyne-Stokes respiration (CSR) is found in patients with chronic left ventricular failure and associated with a reduced prognosis. Continuous positive airway pressure (CPAP) improves the survival rate. In this retrospective study we report on the effect of different positive pressure ventilation modes in CSR. The observation period lasted from 1995 - 1999. Inclusion criteria was CSR with a respiratory disturbance index > 10/h whereas > 50 % of the events had to be central and/or mixed. In each patient a 4 week lasting intervention with each of CPAP, Bilevel CPAP in spontan mode (i.e. BiPAP S or BiPAP ST) and BiPAP in controlled mode (i.e. BiPAP T) was performed. Responder were defined by subjective and objective criteria. In total 41 males were included. Responder were distributed as follows: CPAP: n = 13 patients (31.7 %), BiPAP S/ST: n = 9 patients (22.0 %) and BiPAP T: n = 12 patients (29.3 %). In total 7 from 41 patients (17.1 %) rejected a long-term treatment with positive pressure ventilation. The majority of patients with CSR responded to CPAP and BiPAP S/ST mode. Compared to the other responder groups the best quality was reached with BiPAP T. However the latter was performed only by 29 % of the population.

Aged↗
PubMed2002

[Overestimation of hypoxemia].

Extreme mountain climbers and patients with stable but severe ventilatory insufficiency (e.g. obesitas hypoventilation-syndrome, scoliosis) sometimes experience a state of severe hypoxemia without any or only mild subjective disturbances. Organ failure is never observed in these periods. On the other hand there are two well documented studies concerning long term oxygen therapy (LTOT) that have shown in hypoxemic COPD-patients (pO 2 lower then 55 mm Hg) a doubling the life expectancy under oxygen. This contradiction can be elucidated if the influence of oxygen on the ventilation is taken into account. These study patients treated with LTOT all had more or less hypercapnia (hypoventilation) due to an overload of their respiratory pump. Oxygen reduces the ventilation (seen as hypercapnia) which leads to an unloading of the respiratory muscles. Later studies to LTOT found a positive correlation between the extent of stable hypercapnia and life expectancy. In this article the physiopathologic background of this findings are discussed. The main parameter of the regulator for the oxygen transport is not pO 2 but the oxygen content. The oxygen content multiplied by cardiac output determines the extent of oxygen delivery. Many regulatory systems (e.g. polyglobuly or expression of oxygen resistant isoenzymes of the respiratory chain) are involved to compensate the hypoxemia associated with hypoventilation which prevents an organ threatening hypoxia. This pathophysiologic finding has important impact on intensive care medicine, which usually takes only pO 2 into account for therapeutic decisions (e. g. high FiO 2 and high pressure support). This sometimes leads to "overtreatment", with possible harm to the patient.

Altitude↗
PubMed2002

[Influence of montelukast on inhalational bronchial allergen provocation].

BACKGROUND: Leukotrienes are potent bronchoconstrictive and proinflammatory mediators in bronchial asthma. A randomized, cross-over study on 16 subjects assigned to two groups investigated whether premedication with the leukotriene antagonist montelukast (10 mg daily for 21 days) has a relevant effect on inhalational bronchial allergen provocation. METHOD: Allergens were inhaled by atomizing commercial provocation solutions in dilutions of 1 : 1000, 1 : 100, 1 : 50, 1 : 10 and 1 : 5 with a nebulizer (Pari). The allergen dose was escalated every 20 minutes until the positive criteria (20 % fall in FEV1, doubling of oscillatory resistance) were met. The provocation tests were performed on days 1, 21 and 42 of the study. RESULTS: An allergen protective effect of variable magnitude (PD20 increased by a factor of 1.6 to 21) was observed in 12 of the 16 subjects following provocation with pollen and mite allergens. The mean for all 16 patients showed a highly significant increase (p = 0.0005) by a factor of 4.3. The extent of allergen protection cannot be predicted in individual cases and is independent of the chosen allergen and the PD20 without montelukast. However, a significant correlation (p = 0.0016) was found between unspecific bronchial hyperreactivity (histamine) and the PD20. The allergen protective effect of montelukast decreases with increasing unspecific hyperreactivity. CONCLUSION: We recommend that medication with montelukast be discontinued before allergen provocation because it cannot be predicted in individual cases whether and to what extent montelukast suppresses the immediate reaction following inhalational bronchial allergen provocation.

Acetates↗
PubMed2002

[Influence of an oscillating physiotherapy device (RC-Cornet trade mark) on the regional distribution of the pulmonary aerosol deposition in patients with COPD].

BACKGROUND: The inhalation of ipratropium bromide via a jet nebulizer obtained a significantly higher bronchodilation, if the oscillating physiotherapy device RC-Cornet trade mark was integrated into the exaspiratory limb of the nebulizer. Therefore we investigated the influence of the RC-Cornet trade mark on the central pulmonary radioaerosol deposition as well as the relationship between central and peripheral lung deposition in patients with chronic obstructive lung disease in a controlled study. METHODS: Lung ventilation scintigraphy was performed routinely in 14 pat. with COPD (Nebulizer: PARI VECTOR trade mark, radioaerosol 500 MBq tin-colloid). At first all pat. inhaled a single breath from the nebulizer, afterwards the lungs were scanned with a planar gamma camera. Both groups (biometric and lung function data were identical) then inhaled another 5 breaths. In group A the RC-Cornet trade mark was inserted into the exaspiratory limb, in group B a normal exaspiratory valve. Once more lung scans were collected. Evaluation of the scans by means of a "region of interest" technique, dividing the lungs in a central and a peripheral area. Measuring of the radioactivity (impulse) per pixel and determination of the penetration index (PI). RESULTS: The following 5 breaths led to a significant increase of the central aerosol deposition (i. e. decrease of PI) in comparison with the measuring after the first breath in both groups (A 0,41 +/- 0,07 to 0,38 +/- 0,08, p = 0,04; B 0,38 +/- 0,08 to 0,34 +/- 0,11, p = 0,02). However, no difference could be recognized between the groups. No significant difference was seen with respect to the impulses per pixel. CONCLUSION: Neither the aerosol deposition in the central region of the lung nor the relation between central and peripheral deposition (PI) differs between the both groups. The effect of the RC-Cornet trade mark mentioned in the introduction seems to be caused by physiotherapeutic induced changes of the mucus transport and not by an enhanced central drug deposition.

Administration, Inhalation↗
PubMed2001

Sexuality in patients with noninvasive mechanical ventilation due to chronic respiratory failure.

In patients with chronic respiratory failure (CRF) noninvasive mechanical ventilation (NMV) improves quality of life. We studied some basic issues concerning sexuality in patients with NMV. In 383 patients with NMV for CRF (age, > 40 yr) physiologic data (lung function, blood gases, and exercise) were taken from within the 6 mo period before enrollment. The questionnaire was focused on sexuality after initiation of NMV. Of the patients, 54.3% sent back the questionnaire. NMV was used for 41.1 +/- 27.0 mo. A total of 34.1% of patients were sexually active. Compared with patients receiving NMV, control persons had a higher rate of sexual activity (84%, p < 0.0001) and masturbation rate (13 versus 40%). Sexually active patients had greater VC (2.1 versus 1.8 L), higher FEV(1) (1.4 versus 1.1 L), higher Pa(O(2)) at rest (64.0 versus 60.4 mm Hg), a higher maximal work load (72.0 versus 58.8 W), were younger, and most of them were married or had sexual partners. Changes in sexual activity after NMV initiation were reported to be as follows: "Nothing changed," 46.3%; "less active," 35.8%; "more active," 12.6%; and "fantasy increased," 10.5%. Increased sexual fantasy predominated in men. "Sexually active" patients with NMV had sexual intercourse 5.4 +/- 4.8 times per month. Sexuality in patients receiving NMV for CRF is markedly reduced compared with normal subjects. In half of the patients, sexual activity is influenced by initiation of NMV.

Analysis of Variance↗
PubMed2001

["Epidemiology" of the value of orally administered morphine as therapy of severe pulmonary emphysema of the pink-puffer type].

OBJECTIVES: Patients with severe emphysema from pink puffer type (PPT) are symptom-limited due to dyspnea even at low level of activity. In this study we investigated the clinical effect of oral morphine in this group of patients. MATERIALS AND METHODS: Based on the analysis of medical records (n = 456 patients) and a currently answered questionnaire (n = 205 patients) we analyzed data of all patients with emphysema being treated from 1995-1999. RESULTS: Dyspnea improved during the adaptation period on the ward in 59.4% of the whole population being treated with morphine and in 67.7% of the analyzed patients after discharge. Before discharge the treatment with morphine was finished by 38.9% of the population. In the group of long-term survivors approximately 50% of patients continued the treatment. In total, about 10% of the collective finished the treatment due to intolerable side effects. In the 5-year observation period morphine has been increasingly applied in an earlier stage of the disease. CONCLUSION: In patients with severe emphysema from pink puffer type a trial with morphine is justified. In particular the beneficial effect on dyspnea in the responder group and the acceptable rate of side effects underline this strategy.

Administration, Oral↗
PubMed2001

[Does the inhalation of a 1% L-menthol solution in the premedication of fiberoptic bronchoscopy affect coughing and the sensation of dyspnea?].

BACKGROUND: Inhalation of l-menthol inhibits cough and has been shown to reduce respiratory discomfort associated with loaded breathing. We investigated the effect of the inhalation of a 1% l-menthol solution in the premedication of fiberoptic bronchoscopy (FB) on the frequency of cough and the irritability of the tracheobronchial mucosa during FB in a blinded, randomized and placebo controlled study. METHODS: 64 pat. (30-78 yrs, 55 males) underwent routine FB. Premediction: atropine and hydrocodone s.c., inhalation of oxybuprocain by means of a jet nebulizer, sedation on demand. Verum-group: inhalation of 3 ml 1% l-menthol-solution. Placebo-group: 3 ml 0.05% l-menthol (to provide the typical smell). Before and after inhalation peak respiratory flow (PEF) was registered, during FB the frequency of cough was measured. The bronchoscopist scored the irritability of the tracheobronchial mucosa using a visual analog scale. The patients answered a questionnaire addressing their perception of dyspnea and cough on the day after FB compared to the day before. RESULTS: The cough counts didn't show a significant difference between the groups. The irritability of the mucosa was increased in the verum group (main bronchus verum 62.2 +/- 22, placebo 48.6 +/- 23 [mm vissual analog scale, p = 0.03]). Cough and dyspnea reported by the patients decreased on the day after FB significantly compared to the day before (no difference between the groups). The inhalation of 1% l-menthol induced a significant increase of the PEF (verum 307 +/- 103 pre, 329 +/- 84 post [l/min, p = 0.003]) compared to placebo. CONCLUSIONS: The inhalation of 1% l-menthol did not enhance the tolerability of the FB. However, l-menthol induced a significant increase of the PEF immediately after inhalation. Finally sensation of dyspnea was decreased in both groups at the day post FB.

Administration, Inhalation↗
PubMed2001

[Stabilization of two patients with brittle asthma by inhaled beclomethasone dipropionate with small particle size].

UNLABELLED: Two patients with brittle asthma whose bronchial obstruction was less variable during treatment with HFA-beclomethasone (HFA-BDP) solution aerosol than with other previous treatments are presented here. In order to evaluate whether this improvement was related to the smaller particle size of the new formulation (MMAD 1.1 mu vs 4 mu with the CFC-formulation) both patients participated in a prospective case study sequence. METHOD: During a 4 week run-in both patients inhaled 200 micrograms of HFA-BDP (Ventolair) BID from the Autohaler followed by 4 weeks of treatment with 500 micrograms CFC-BDP (Aerobec) BID from the Autohaler in study phase 1 and 4 weeks of treatment with 200 mcg HFA-BDP (Ventolair) BID from the Autohaler in study phase 2. During the entire study period other concomitant medications remained unchanged. The dose of CFC-BDP was chosen to be 2.5 times higher than the HFA-BDP dose to get approximately comparable amounts of intrabronchial deposition. During the study Peak-Flow and concomitant medications were recorded daily. RESULTS: Both patients showed significantly higher Peak-flow values during treatment with Ventolair (HFA-BDP) than during treatment with AeroBec (CFC-BDP). P-values were p < 0.0001 and p < 0.005 for patient 1 and 2 respectively. CONCLUSION: At a comparable intrabronchial dose these two cases of brittle asthma showed significant improvements in control of bronchial obstruction with a BDP-formulation of smaller particle size. This is an indicator that smaller airways in the periphery of the lung participate in the inflammatory process leading to bronchial obstruction and that deposition of inhaled steroids in this region could have therapeutic advantages.

Administration, Inhalation↗
PubMed2001

Serum levels of sulpiride enantiomers after oral treatment with racemic sulpiride in psychiatric patients: a pilot study.

Sulpiride (SULP), a substituted benzamide with high selectivity for D2-like dopamine receptors, has a chiral structure and is used in most countries as the racemate. In an open pilot study, we investigated 26 inpatients (13 female, 13 male) with schizophrenic or depressive disorder treated with SULP (mean daily dosage 64-1062 mg) administered orally, either as a monotherapy or as an add-on treatment to a stable and unchanged medication for 3-60 days. Serum levels of total SULP and of its enantiomers were measured by high-performance liquid chromatography (HPLC) procedures. Clinically relevant indicators of hepatic and renal function as well as retrospectively assessed clinical outcome parameters were correlated with serum levels of racemic SULP, L-SULP, D-SULP, and the L:D-SULP ratio. A significant correlation between mean daily dosage and serum levels of SULP, L-SULP, and D-SULP emerged (p < 0.05) which was not influenced by age, gender, diagnosis, hepatic, or renal function. The ratio of L:D-SULP serum levels was <1 (range 0.66-0.97) in all patients. A slight negative correlation between CGI improvement and the ratio of L:D-SULP (p < 0.10) and a positive correlation between racemic SULP concentrations and side-effects at endpoint was found (p < 0.05).

Adult↗