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Biomedical subjects

F J Meyer

Publications and source records attributed to F J Meyer.

At least 19 recordsLinked to original sources
PubMed2006

Bilateral long saphenous bruits: a marker of aortocaval fistula.

INTRODUCTION: The authors present a case of an aortocaval fistula manifesting clinically with bilateral long saphenous bruits. This sign has not been previously described. REPORT: An 85-year old lady presented with a 3-week history of abdominal pain radiating to her back. Examination revealed a bruit to the right of the midline associated with bilateral long saphenous bruits. A provisional diagnosis of an aortocaval fistula was confirmed on computerised tomography. The fistula was excluded by aortobiiliac bypass and the patient made an uneventful recovery. DISCUSSION: Aortocaval fistulae are rare. They should be suspected if abnormal pulsations are felt to the right of the midline in association with bruits in the region of the inferior vena cava. The presence of long saphenous bruits suggests saphenofemoral incompetence due to arterialised, reversed venous flow dynamics and strengthens the clinical diagnosis of aortocaval fistula.

Aged, 80 and over↗
PubMed2006

[Inhalative application devices for patients suffering from asthma bronchiale].

Asthma is a chronic inflammatory disorder of the airways. It is caused by infiltration of eosinophils, mast cells, and CD4+ -T-lymphocytes which leads to variable airway obstruction. The core element of therapy is to control inflammation, which is best possible with inhaled steroids, the so-called controller drugs. Cromones are only second line therapeutic agents because they are not powerful enough for optimal inflammation control. Reliever drugs like beta2-agonists or anticholinergic agents serve as a symptomatic medication because they only lead to bronchial dilatation. The inflammation in COPD is caused by neutrophils, macrophages and CD8+ -T-lymphocytes. This kind of inflammation causes an irreversible airway obstruction accompanied by destruction of the lung parenchyma. By the majority, only symptomatic medication is effective for COPD, like anticholinergic agents and beta2-agonists. About 10-20% of patients with COPD are showing improvement when treated with inhaled steroids. However, the best treatment result is only guaranteed by optimal application of the medication. The most important barrier is an insufficient coordination between manual use of the inhaling system and inhalation. Various attempts are made to solve this problem, thus leading to a huge variety of application systems. However this also leads to confusion of patients and doctors because it is difficult to choose the optimal system and to use it in the most efficient way. This article provides an overview of the different application systems and compiles important details to facilitate the optimal application of inhalation therapy by the patient.

Administration, Inhalation↗
PubMed2006

Combining inhaled iloprost with bosentan in patients with idiopathic pulmonary arterial hypertension.

Addition of inhaled iloprost to bosentan may have beneficial effects in patients with idiopathic pulmonary arterial hypertension (IPAH). A multicentre, open, randomised, controlled trial was performed to assess the safety and efficacy of inhaled iloprost in patients with IPAH who had already been treated with bosentan. The trial was terminated early after a futility analysis predicted failure with respect to the predetermined sample size. At that time, 40 patients were randomised to receive either bosentan alone (control group) or bosentan plus inhaled iloprost (combination group) for a 12-week period. The primary end-point, change in 6-min walking distance, was not met (mean changes +1 m and -9 m in the control and combination group, respectively). These results may have been skewed by three outliers in the iloprost group who presented with severe clinical worsening. None of the secondary end-points including functional class, peak oxygen uptake, and time to clinical worsening differed significantly between groups. The current study failed to show a positive effect of adding inhaled iloprost to bosentan in idiopathic pulmonary arterial hypertension patients. Further studies involving larger sample sizes and long-term follow-up are needed to determine the efficacy of adding inhaled iloprost to bosentan in patients with idiopathic pulmonary arterial hypertension.

Administration, Inhalation↗
PubMed2005

Respiratory muscle dysfunction in idiopathic pulmonary arterial hypertension.

Idiopathic pulmonary arterial hypertension (IPAH) is a pulmonary vasculopathy of unknown aetiology. Dyspnoea, peripheral airway obstruction and inefficient ventilation are common in IPAH. Data on respiratory muscle function are lacking. This prospective single-centre study included 26 female and 11 male patients with IPAH in World Health Organization functional classes II-IV. Mean+/-SD pulmonary artery pressure was 48.6+/-16.9 in females and 53.1+/-22.9 mmHg in males; cardiac output was 3.7+/-1.3 and 4.2+/-1.7 L x min(-1). Maximal inspiratory pressure (PI,max) was lower in the female patients than in 20 controls (5.3+/-2.0 versus 8.2+/-2.0 kPa). In the male patients, PI,max was lower than in 25 controls (6.8+/-2.2 versus 10.5+/-3.7 kPa). Maximal expiratory pressure (PE,max) was lower in the female patients than in controls (6.2+/-2.6 versus 9.5+/-2.1 kPa), and in male patients as compared to controls (7.1+/-1.6 versus 10.3+/-3.9 kPa). There was no correlation between PI,max or PE,max and parameters of pulmonary haemodynamics or exercise testing. The ratio of mouth occlusion pressure within the first 0.1 s of inspiration and PI,max was higher in IPAH than in controls (females 0.067+/-0.066 versus 0.021+/-0.008; males 0.047+/-0.061 versus 0.023+/-0.016). In conclusion, this study provides the first evidence of inspiratory and expiratory muscle weakness in idiopathic pulmonary arterial hypertension. The pathomechanisms and the prognostic significance should be further investigated.

Adult↗
PubMed2004

Quantitative analysis of pulmonary perfusion using time-resolved parallel 3D MRI - initial results.

PURPOSE: To assess the use of time-resolved parallel 3D MRI for a quantitative analysis of pulmonary perfusion in patients with cardiopulmonary disease. MATERIALS AND METHODS: Eight patients with pulmonary embolism or pulmonary hypertension were examined with a time-resolved 3D gradient echo pulse sequence with parallel imaging techniques (FLASH 3D, TE/TR: 0.8/1.9 ms; flip angle: 40 degrees; GRAPPA). A quantitative perfusion analysis based on indicator dilution theory was performed using a dedicated software. RESULTS: Patients with pulmonary embolism or chronic thromboembolic pulmonary hypertension revealed characteristic wedge-shaped perfusion defects at perfusion MRI. They were characterized by a decreased pulmonary blood flow (PBF) and pulmonary blood volume (PBV) and increased mean transit time (MTT). Patients with primary pulmonary hypertension or Eisenmenger syndrome showed a more homogeneous perfusion pattern. The mean MTT of all patients was 3.3 - 4.7 s. The mean PBF and PBV showed a broader interindividual variation (PBF: 104 - 322 ml/100 ml/min; PBV: 8 - 21 ml/100 ml). CONCLUSION: Time-resolved parallel 3D MRI allows at least a semi-quantitative assessment of lung perfusion. Future studies will have to assess the clinical value of this quantitative information for the diagnosis and management of cardiopulmonary disease.

Acute Disease↗
PubMed2003

Randomized clinical trial of three-layer paste and four-layer bandages for venous leg ulcers.

BACKGROUND: Both four-layer and three-layer paste bandages are widely used in the treatment of venous leg ulcers. The aim of this study was to compare the efficacy of these two bandaging regimens. METHODS: The study was a prospective, randomized, open comparison of a consecutive cohort of 133 patients with venous ulcers. Participants were stratified by ulcer size into one of three groups and were randomized within each group to receive either three-layer paste or four-layer bandages. All patients were followed for 1 year. The time taken to complete ulcer healing was the primary endpoint. The time taken to apply the bandages, comfort, tolerability and cost were also assessed. Analysis was performed on the basis of intention to treat. RESULTS: Ulcers healed completely in 51 (80 per cent) of 64 patients treated with three-layer paste bandages compared with 45 (65 per cent) of 69 patients treated with the four-layer regimen (P = 0.031). This difference developed only after 20 weeks of treatment. The median times to complete healing were 12 weeks for three-layer and 16 weeks for four-layer treatment (P = 0.040). Results of venous function tests, including half-refilling times, were similar in the two groups. CONCLUSION: Three-layer paste bandages were significantly more effective at healing venous ulcers than the four-layer regimen in this study.

Aged↗
PubMed2003

Pathophysiological aspects of cardiopulmonary interaction.

The close interaction between heart and lungs has pathophysiological and clinical implications both in cardiac and pulmonary diseases. Some aspects of ventriculo-ventricular relations are illustrated using examples of left heart failure and right heart failure or cor pulmonale. This interaction is mediated either by pulmonary vasculature or directly through interventricular septum. Furthermore, effects of chronic congestive heart failure on pulmonary function and their clinical consequences are discussed.

Heart Diseases↗
PubMed2002

Randomized clinical trial comparing the efficacy of two bandaging regimens in the treatment of venous leg ulcers.

BACKGROUND: Many venous ulcers are healed by the application of external compression. It has been suggested that bandages capable of producing greater compression enhance healing. The aim of this study was to compare the time to total healing of venous ulcers in two groups of patients treated with different compression regimens in a randomized prospective trial. METHODS: A total of 112 patients was studied and all were treated with a zinc-impregnated paste bandage applied directly to the ulcer. Fifty-seven patients had the paste covered by Tensopress and 55 by Elastocrepe bandages. Both groups had a tubular bandage applied over the top to retain the bandage in place. All ulcers were stratified and randomized within one of three size groups. The 'venous' aetiology of the ulcer was confirmed on completion by calf pump function tests. RESULTS: By 26 weeks, 58 per cent of the patients treated with Tensopress and 62 per cent of those treated with Elastocrepe bandages were healed. The median healing times were 9 and 9.5 weeks respectively. Similar numbers of patients were excluded or withdrawn from both groups. Large ulcers healed significantly more slowly than small ulcers. CONCLUSION: There was no significant improvement in venous ulcer healing using higher compression elastic bandages.

Bandages↗
PubMed2002

Peripheral airway obstruction in primary pulmonary hypertension.

BACKGROUND: As there is controversy about changes in lung function in primary pulmonary hypertension (PPH), lung mechanics were assessed with a focus on expiratory airflow in relation to pulmonary haemodynamics. METHODS: A cross sectional study was performed in 64 controls and 171 patients with PPH (117 women) of mean (SD) age 45 (13) years, pulmonary artery pressure (PAPmean) 57 (15) mm Hg, and pulmonary vascular resistance 1371 (644) dyne.s/cm(5). RESULTS: Mean (SD) total lung capacity was similar in patients with PPH and controls (98 (12)% predicted v 102 (17)% predicted, mean difference -4 (95% confidence interval (CI) -7.89 to -0.11); residual volume (RV) was increased (118 (24)% predicted v 109 (27)% predicted, mean difference 9 (95% CI 1.86 to 16.14); and vital capacity (VC) was decreased (91 (16)% predicted v 102 (10)% predicted, mean difference -11 (95% CI 15.19 to -6.80). RV/TLC was increased (117 (27)% predicted v 97 (29)% predicted, mean difference 20 (95% CI 12.3 to 27.8)) and correlated with PAPmean (r=0.31, p<0.001). In patients with PAPmean above the median of 56 mm Hg, RV/TLC was further increased (125 (32)% predicted v 111 (22)% predicted, mean difference -14 (95% CI -22.2 to -5.8)). Expiratory flow-volume curves were reduced and curvilinear in patients with PPH. CONCLUSIONS: Peripheral airway obstruction is common in PPH and is more pronounced in severe disease. This may contribute to symptoms. Reversibility of bronchodilation and relation to exercise capacity need further evaluation.

Airway Obstruction↗
PubMed2001

Respiratory muscle dysfunction in congestive heart failure: clinical correlation and prognostic significance.

BACKGROUND: In congestive heart failure (CHF), the prognostic significance of impaired respiratory muscle strength has not been established. METHODS AND RESULTS: Maximal inspiratory pressure (Pi(max)) was prospectively determined in 244 consecutive patients (207 men) with CHF (ischemic, n=75; idiopathic dilated cardiomyopathy, n=169; age, 54+/-11 years; left ventricular ejection fraction [LVEF], 22+/-10%). Pi(max) was lower in the 244 patients with CHF than in 25 control subjects (7.6+/-3.3 versus 10.5+/-3.7 kPa; P=0.001). The 57 patients (23%) who died during follow-up (23+/-16 months; range, 1 to 48 months) had an even more reduced Pi(max) (6.3+/-3.2 versus 8.1+/-3.2 kPa in survivors; P=0.001). Kaplan-Meier survival curves differentiated between patients subdivided according to quartiles for Pi(max) (P=0.014). Pi(max) was a strong risk predictor in both univariate (P=0.001) and multivariate Cox proportional hazard analyses (P=0.03); multivariate analyses also included NYHA functional class, LVEF, peak oxygen consumption (peak VO(2)), and norepinephrine plasma concentration. The areas under the receiver-operating characteristic curves for prediction of 1-year survival were comparable for Pi(max) and peak VO(2) (area under the curve [AUC], 0.68 versus 0.73; P=0.28), and they improved with the triple combination of Pi(max), peak VO(2), and LVEF (AUC, 0.82; P=0.004 compared with AUC of Pi(max)). CONCLUSIONS: In patients with CHF, inspiratory muscle strength is reduced and emerges as a novel, independent predictor of prognosis. Because testing for Pi(max) is simple in clinical practice, it might serve as an additional factor to improve risk stratification and patient selection for cardiac transplantation.

Adult↗
PubMed2000

Inefficient ventilation and reduced respiratory muscle capacity in congestive heart failure.

The extent and time-course of changes in lung volumes, ventilatory efficiency at rest and during exercise, and respiratory muscle function and their influence on exercise limitation in congestive heart failure (CHF) are unclear. It is unknown whether respiratory muscle function may predict changes in exercise limitation or may be impaired in patients with poor outcome. 145 male patients (54 +/- 1 years) suffering from CHF (NYHA class I-III, mean 2.3 +/- 0.1), with a LVEF of 23 +/- 1%, and a mean peak O2 uptake (VO2peak) 15.0 +/- 0.5 mL X min(-1) X kg(-1), were studied. They were grouped in Weber functional classes A to D according to their VO2peak. Significant increases in ventilatory equivalents for O2 and CO2 (VE/VCO2peak) and in dead space ventilation at rest and during exercise were found with increasing exercise limitation. Moreover, there was a correlation of static and dynamic lung volumes (inspiratory vital capacity, IVC, r = 0.43, P < 0.01), as well as of maximal inspiratory pressure (MIP; r = 0.46, P < 0.01) with VO2peak. Patients who died (n = 26) or were heart transplanted (n = 20) during a follow-up (mean 800 +/- 10 days) had a reduced MIP (6.4 +/- 0.4 kPa) as compared with survivors (n = 82; 9.3 +/- 0.7 kPa, P < 0.01). In a subgroup of 33 patients re-evaluated after six months, individual changes in IVC and VE/CO2peak, but not in MIP, correlated to changes in VO2peak (r = 0.69 and r = 0.72 respectively; P < 0.01). In CHF, exercise limitation is associated with reversible lung restriction and inefficient ventilation at rest and during exercise. Patients with severe CHF have a significant reduction in MIP, a finding that is associated with poor outcome.

Adult↗
PubMed1998

Acute allergic reaction and demonstration of specific IgE antibodies against alpha-1-protease inhibitor.

A 44 yr-old female with severe pulmonary emphysema and reduced alpha-1-protease inhibitor (alpha1-PI) serum levels developed an acute anaphylactic reaction following the third intravenous infusion of human alpha1-PI which was administered to prevent the progression of pulmonary emphysema. Specific immunoglobulin E-antibodies against human alpha1-PI could be demonstrated in the patient's serum using an enzyme allergosorbent test. Because of the risk of further severe anaphylactic reaction, the replacement therapy with alpha1-PI was discontinued. Physicians should be aware of this rare complication.

Adult↗
PubMed1997

[Effect of alcohol on minimal effective nCPAP pressure].

Alcohol may have an aggravating effect on sleep disordered breathing. Aim of our study was to test the effect of alcohol on the required nCPAP pressure as determined by the self-adjusting nCPAP-system AutoSet. Ten male subjects (age 54 +/- 9 yrs, body mass index 37 +/- 5 kg/m2) with moderate to severe obstructive sleep apnoea (OSA) were investigated. Full polysomnography was performed on four consecutive days (control night with and without alcohol, nCPAP pressure determination by AutoSet with and without alcohol, in randomised order). Alcohol was given in a single dose of 80 proof vodka (1.5 ml per kg of body weight) one hour prior to bedtime. Alcohol to a deterioration of the respiratory disturbance index (RDI, 56 +/- 23 without vs. 66 +/- 19 with alcohol, p = 0.02), but no significant change was observed in mean or minimal oxygen desaturation, mean or maximal event duration. The 95th percentile of the AutoSet-pressure was not different with or without alcohol (10.7 +/- 2.5 vs. 10.6 +/- 2.5 cm H2O). Moderate alcohol intake in the evening need not be taken into account for CPAP pressure determination in moderate to severe OSA.

Adult↗
PubMed1996

[Functional results of surgical lung volume reduction in severe pulmonary edema].

BASIC PROBLEM AND OBJECTIVE OF THE STUDY: Lung volume reduction (LVR) is a new surgical approach designed to relieve shortness of breath and improve exercise tolerance in patients with severe lung emphysema. The aim of this study was to analyse changes of lung function, gas exchange, exercise tolerance and degree of dyspnoea one and 3 months after LVR. PATIENTS AND METHODS: Seventeen patients (15 men and two women; mean age 53 [38-68] years) with severe emphysema (six with alpha 1-PI deficiency) underwent unilateral (n = 14) or bilateral (n = 3) LVR surgery. One week before and one and 3 months after surgery pulmonary function tests, arterial blood gas analysis at rest breathing room air, 6-minute walking distance and dyspnoea score (Medical Research Council Scale) were determined. RESULTS: There was a significant increase in forced expiratory vital capacity after one second (FEV1, P < 0.001), and a significant decrease in total lung capacity (TLC, P < 0.0001) and residual volume (RV, P < 0.0001). The mean increase in FEV1 was 39% and in PaO2 9%. The mean decrease in TLC was 20%, in RV 26% (P < 0.001; both comparisons), and in paCO2 4% (not significant). The mean 6-minute walking distance increased by 96% from 229 to 405 meters (P < 0.0001). The mean dyspnoea score on a five point scale (0-4 points) decreased by 52% from 3.4 to 1.6. With the exception of the improved inspiratory vital capacity the postoperative results at one and 3 months after LVR did not differ significantly. All patients were alive 3 months postoperatively. CONCLUSIONS: In patients with severe emphysema surgical LVR shows significantly improved pulmonary function, gas exchange, dyspnoea and walking distance as assessed one and three months postoperatively. The early mortality seems to be low.

Acute Disease↗