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Biomedical subjects

E Weitzenblum

Publications and source records attributed to E Weitzenblum.

At least 163 records · Page 9Linked to original sources
PubMed1980

[Clinical and physiological post-operative course of 45 bullous emphysema (author's transl)].

45 patients exhibiting a diffuse emphysema associated with voluminous emphysematous bullae underwent surgical resection of the bullae. They were then regularly followed-up. Pulmonary function investigations were performed preoperatively in 38 patients at 6 months, 1 year and 3-7 years after resection. Postoperative subjective improvement was experienced by all patients, but diminished progressively with years. An associated chronic bronchitis was a predictor of bad prognosis. Vital capacity increased whereas plethysmographic residual volume and TLC decreased post-operatively, due to the recovery of available pulmonary parenchyma. The improvement of bronchial obstruction was probably related to the increased elastic recoil pressure. Hypoxemia also improved in most cases. In patients having undergone a second resection (controlateral lung), functional improvement progressively disappeared as the emphysematous disease progressed.

Adult↗
PubMed1980

[Indication or surgical abstention in the treatment of emphysematous bullae (author's transl)].

During a 9-year period from 1968 to 1977, in the case of bullae measuring at least 10 cm diameter, 21 surgical interventions and 31 conservative treatments were performed. The indications were either peremptory (irreductible pneumothorax, acute extension of the bullae) or spontaneously determined using a series of detailed criteria. The frequency of bronchial cancer occurring in the emphysematous bullae is noteworthy (8 cases out of 55 observations).

Bronchial Neoplasms↗
PubMed1980

Prognosis of pulmonary hypertension in chronic obstructive pulmonary disease.

Studies performed since 1968 have shown that in patients with chronic obstructive pulmonary disease (COPD) the prognosis is worse in cases with pulmonary artery hypertension (PAH), especially when the mean pulmonary artery pressure (PPA) is greater than 30 mmHg. Author's data are based on the study of a group of 175 patients with COPD, catheterized between 1968 and 1972. The fate of the patients, at least five years after the initial catheterization, was known in all the cases. The survival rate was calculated according to the "actuarial method". The results suggest that PPA has a good prognostic value, but that FEV1 and PaCO2 are as good predictors of mortality as PPA. Furthermore the influence of age is to be taken into account: prognosis is worse in patients older than 65 years. Longitudinal studies of pulmonary haemodynamics was made in 85 patients who underwent two right heart catheterizations with an interval of greater than 3 years (mean = 5 years) between them. The results indicate that PPA varies very slightly: the average increase for the whole group is 3.1 mmHg, that is less than 1 mmHg per year. There was a good negative correlation between chronological variations of PaO2 and PPA. A long survival time could be observed after the first heart failure episode or after ascertaining pulmonary hypertension.

Age Factors↗
PubMed1979

Radionuclide computerized ventilation studies.

Studies of regional lung function have developed rapidly in the last few years. Xenon -133 is the most frequently used isotope because of its physiocochemical and biologic properties. Fixed counters are being replaced by the scintillation camera interfaced to a computer allowing easy acquisition and interpretation of results and numerical data. The use of isotopes other than 133Xe, such as 81mKr, is less widespread. In this article, a method is described for studying regional ventilation in which the isotope used is 133Xe, the radioactivity is recorded by a scintillation camera, interfaced to a computer andsix (or 12) regions for both lungs are selected and investigated. The regional ventilation is expressed as an absolute value in ml/min/ml of ventilated volume as well as the relative contribution in percent of each zone to the total ventilation and volume. To illustrate this method, the results are reported for healthy subjects and for patients with chronic bronchitis and emphysema. Scintigraphs of individual cases are presented. Certain theoretic problems related to calculation of regional ventilation are discussed.

Bronchitis↗
PubMed1979

Course of pulmonary hemodynamics in patients with chronic obstructive pulmonary disease.

Eighty-five patients with chronic obstructive pulmonary disease, mainly chronic bronchitis (71 patients), who had arterial hypoxemia and moderate to severe obstruction of the airways underwent at least two right cardiac catheterizations in a clinical steady state, with a delay of three years or more between the first and the last catheterization. The average delay was 60 +/- 19 months (range, 36 to 119 months). Patients were regularly examined (quarterly clinical and functional checkups). The changes in pulmonary hemodynamic data were small. In the group of 53 patients with an initial mean pulmonary arterial pressure of 20 mm Hg or less, this pressure varied from 15.4 +/- 3.1 to 18.3 +/- 6.6 mm Hg (P less than 0.001); in the group of 32 patients with an initial mean pulmonary arterial pressure greater than 20 mm Hg, this pressure varied from 27.7 +/- 6.0 to 31.0 +/- 9.3 mm Hg (P less than 0.05). The mean pulmonary arterial pressure increased by 5 mm Hg or more in only 28 patients. In these patients with hemodynamic "worsening," the final arterial oxygen pressure (PaO2) was lower and the final arterial carbon dioxide tension was higher than in the remaining patients. A significant negative correlation (r = -0.39; P less than 0.001) was observed between changes in PaO2 and mean pulmonary arterial pressure. There was a generally good agreement between the course of pulmonary hemodynamics (mean pulmonary arterial pressure), on the one hand, and the clinical, radiologic (transverse diameter of the heart), and electrocardiographic evolution, on the other hand. In the 33 patients who died, a relatively long survival was observed after the first episode of right-sided heart failure or after ascertaining pulmonary hypertension.

Adult↗
PubMed1978

[The regional exploration of pulmonary function using xenon 133. Value of the gamma camera connected to a computer (author's transl)].

Regional isotopic exploration of ventilation and pulmonary perfusion is not yet widely applied in clinical practice, by virtue of the complexity of the equipment required, but also because of the complicated and lengthy analysis of the results. In this respect, connection of the scintillation camera to a computer represents a major advance which other authors have already emphasized. Our own experience in this area and our method of exploration are described. The results of regional exploration in a group of 43 cases of chronic obstructive lung disease (33 patients of the chronic bronchitis type, 10 patients with emphysema) are analysed and discussed. The results indicate the following : in chronic bronchitis, a very marked fall in ventilation of the bases with inversion of the normal vertical ventilation gradient, and a fall in the ventilation/perfusion ratio of the bases; in emphysema, a fall in ventilation, but also and above all in regional perfusion of all territories with preservation of normal or even increased regional ventilation/perfusion ratios. Regional exploration may also be of value in the detection of early stages of obstructive lung disease, and in pre-operative assessment in thoracic surgery.

Bronchitis↗
PubMed1977

Regional pulmonary function in sarcoidosis.

In 26 subjects with a confirmed histological diagnosis of thoracic sarcoidosis regional lung function was studied with Xenon 133. All subjects also underwent overall lung function studies including CO steady state (TCO SS) and single breath (TCO SB) diffusing capacity. Regional ventilation (Vr) was on the average increased in stages I (isolated hilar adenopathies) and II (pulmonary infiltration) and appeared normal in stage III (pulmonary fibrosis). Regional perfusion (Qr) was on the average normal in stages I and II and decreased in stage III. There were no appreciable differences between average values in stages I and II. Abnormalities of Vr and Qr were frequently found in individual cases. A distinction was made between the total number of abnormalities and deficiency abnormalities. The total number of abnormalties was high in all three stages. Deficiency abnormalities were relatively rare in stages I and II, and frequent in stage III. The correlation between radiological and regional functional abnormalities was low. TCO SB/VA was found significantly lower (P less than 0.005) in subjects with regional deficiency abnormalities (mostly perfusion abnormalities). These data probably indicate that a lowered diffusing capacity may be due to the loss of pulmonary capillaries and not only to ventilation - perfusion disparities.

Adolescent↗
PubMed1976

Comparative study of the ventilatory responsiveness to CO2 in bronchitic and emphysematous patients with chronic respiratory failure.

The comparative ventilatory responsiveness to CO2 was studied in 13 chronic bronchitics and 14 emphysematous patients, all exhibiting respiratory insufficiency and with FEV1 less than 1,500 ml. The gas inhaled was enriched with oxygen (F1O2 =0.6) and contained 6% CO2, and measurements were taken when the patients had reached a stable state. The ratio delta VE/deltaPaCO2, which represents the ventilatory responsiveness to CO2, was higher in the emphysematous patients (1.18+/-0.51 liters-min-1. Torr-1) than in the bronchitics (0.76+/-0.34, p less than 0.025), but the deviation on either side of the mean was large in each group. The ventilatory responsiveness to CO2 was proportional to the initial PaCO2, FEV1, total airways resistance, total pulmonary work and especially to inspiratory mechanical work done on the lung ( r=-0.73, p less than 0.001). The difference in ventilatory responsiveness to CO2 between the bronchitic and emphysematous patients may be explained by the difference in energy expended in breathing. It was not possible to exclude an effect due to a difference in sensitivity within the respiratory centers, since inspiratory mechanical work was not measured during CO2 inhalation. It was thought likely that mechanical factors play a triggering role, in that they cause a fall in ventilatory responsiveness to CO2 and hypercapnia, the latter causing the central hyposensitivity which maintains the retention of CO2.

Aged↗
PubMed1976

[Clinical, functional and hemodynamic course in patients with chronic bronchitis at the stage of chronic cor pulmonale].

Twenty seven patients, almost all chronic bronchitic, and with a "chronic cor pulmonale" according to the E. C. G., were followed clinically, radiologically and for E. C. G. and pulmonary functions, and also for the hemodynamics, during a minimum of 3 years, the average length of observation period being about 5 years. Twelve patients died during this observation time. Periods of right heart failure (R. H. F.) were frequent : 3.6 +/- 3.0 in average, slightly more frequent in the deceased patients than in the others. The average delay between the onset R. H. F. and death was of 49.3 +/- 30.8 months ; the survivors on average lived another 54.6 +/- 30.8 months after their first R. H. F. The mean pulmonary arterial pressure (PAP) was quite stable, going from 27.5 +/- 7.0 to 31.2 +/- 9.6 torr (an unsignificicant difference); in only 9 cases did the PAP increase of more than 5 torr during the observation period (acute attacks excepted). The PAP evolution was not significantly different in the deceased and the survivors. PAP worsening by steps after a fit of R. H. F. was observed in only 4 cases. Chronological variations of PAP were well correlated with those of Pao2 during the same period : r = -- 0.68, P less than 0.001. The hemodynamic evolution (PAP), that of the E. C. G. and the volume of the heart were reasonably parallel to the overall clinical evolution ; the E. C. G. evolution had the closest match with the overall clinical evolution (78% of cases). The E. C. G. enables only a late diagnosis of CCP but its evolution is very valuable for prognosis. Hemodynamic tests have a double value initially for diagnosis and later for the evolution.

Adult↗
PubMed1976

[Value of pulmonary hemodynamic exploration during muscular exercise in chronic bronchitis?].

The value of pulmonary haemodynamic tests during physical exercise in chronic bronchitis was shown by the comparison of two groups of patients. In the first group (n=24) the PAP during exercise is lower than 30 torr. In the second it was over 30 torr. The PAP at rest was always lower than 20 torr. The load was 40 to 50 watts, i.e. an average O2 consumption of 500-600 ml.mm-1 m-2. The cardiac output doubled on average in exercise. Both groups varied markedly in their PAP at rest: 13.6 +/- 1.7 torr for the first group and 15.8 +/- 2.4 for the second (p less than 0.001). In fact differences in pressure during exercise (I=25.0 +/- 3.4 torr; II=39.6 +/- 7.4 torr, p less than 0.001) could be explained mainly by the differences of pulmonary vascular resistances (I=0.91 +/- 0.37; II=1.47 +/- 0.61, p less than 0.005): they tended to fall during effort in the first group and increased slightly in the second; and by the much higher increase in the pulmonary "capillary" pressure during exercise in the second group (I=12.5 +/- 4.4 torr; II=19.7 +/- 72 torr, p less than 0.001). The cardiac output during rest and exercise was equal in both groups. The haemo-dynamic "recovery delay" was much higher in the second group. The spirographic shortage was on the whole identical in both groups. PaO2 on average was higher in group I (p less than 0.05) where it improved during exercise (p less than 0.01). The PaO2 of the second group did improve during exercise. The haemodynamic differences were concomitant with the differences in gas exchanges during effort, of well known prognostic significance. As the "foretelling" of PAP in effort from the PAP at rest was quite poor, it appeared that haemodynamic test in effort has a real value in contributing efficiently to the differenciation of the degree in severeness. The threshold of 30 torr for PAP in exercise (and for the load mentioned above) seemed a good discriminating factor.

Adult↗