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Biomedical subjects

F Kummer

Publications and source records attributed to F Kummer.

At least 55 records · Page 3Linked to original sources
PubMed1988

Neutrophil elastase alpha 1-proteinase inhibitor complexes in pleural effusions.

Polymorphonuclear (PMN) granulocyte derived neutrophil elastase (NE) is rapidly antagonized by alpha 1-proteinase inhibitor (alpha 1 PI) in vivo. To determine the clinical value of elastase alpha 1-proteinase inhibitor complexes (E-alpha 1 PI) in pleural effusions, fluid samples of 99 patients were examined. Fifty-six had malignant effusions, 30 had non-malignant exudates (pleural protein above 3 g/dl) mainly of inflammatory origin, and 13 patients had low protein transudates (below 3 g/dl) due to congestive heart failure. Nonmalignant exudates showed significantly higher (P less than 0.001) concentrations of E-alpha 1 PI compared with malignant effusions or low protein transudates (P less than 0.001). Malignant exudates secondary to lung cancer were characterized by higher (P less than 0.001) median pleural E-alpha 1 PI concentrations compared to malignant exudates due to primarily extrathoracic malignancies. Total pleural leukocyte counts and pleural neutrophil counts were performed in 68 effusions. By this means no clear-cut differentiation between malignant and nonmalignant exudates seems possible except for marked empyema. In conclusion, E-alpha 1 PI complexes in pleural fluid may better reflect the stage of inflammation of pleural effusions rather than mere pleural leukocyte counts. Low levels of E-alpha 1 PI complexes (less than 75 ng/ml) in pleural exudates with protein values above 3 g/dl are characteristic of malignant exudates. Determination of E-alpha 1 PI in pleural exudates may serve as a sensitive marker of inflammation and useful adjunct to pleural cytology in aspects of differential diagnosis of pleural effusions.

Blood Proteins↗
PubMed1987

[Diagnosis and therapy of nocturnal asthma].

The bronchial tonus depends on circadian oscillations like all other organ functions. The tendency to increased nocturnal bronchoconstriction in some asthmatic subjects is well known. The reasons of such individual variations are different concentrations of cortisol, adrenaline, histamine, cAMP in serum as well as imbalance between vagal and sympathetic interactions. In practice, the early diagnosis of severe nocturnal bronchial constriction is important for prevention of asthma attacks and status asthmaticus. We report on our circadian measurements of airway resistance (Ros) or peak-flow. By adequate therapy an improvement of the individual bronchial tolerance could be achieved, however the biorhythm remained unchanged. Measurements of airway resistance at 2 a.m. were significantly improved by therapy, as was the mean level measurements during 4-hourly readings. High dose bedtime or slow release theophylline decreased the number of nocturnal asthma attacks.

Airway Resistance↗
PubMed1987

Nuclear medicine in diseases of the lung--present status and future. Introduction--clinical aspects.

Clinical needs for noninvasive radionuclide methods have often been an important stimulus to further progress in techniques. In disorders such as pulmonary thromboembolism, however, the correct interpretation can only be made with the help of a broad synoptic basis, formed by the treating physician, the X-ray, and the nuclear medicine specialist. This trivial statement has been of topical interest over the past 20 years in the history of ventilation-perfusion (V-P) scanning. Considerable achievements and promising results have undoubtedly been obtained in the examination of aerosol clearance (alveolar permeability and mucociliary transport), regional ventilation, workup for malignancy, identification of inflammation of the parenchyma in the absence of radiological signs, and in noninvasive diagnosis of pulmonary blood flow and volume. Future developments may be very expensive and require highly specialized equipment (PET, cyclotron, etc.), with no assurance that routine clinical application will be available in the near future.

Humans↗
PubMed1986

[Diagnostic value of the combined determination of carcinoembryonic antigen (CEA) in pleural effusion and serum with an enzyme immunoassay (EIA). Sensitivity, specificity and relation to tumor type].

Measurement of carcinoembryonal (CEA) levels in pleural fluid are suggested to improve the unsatisfactory sensitivity of pleural cytology in the differential diagnosis of malignant pleural effusions. We evaluated simultaneously determined pleural and serum CEA levels in 117 patients with pleural effusions of different aetiology (74 malignant, 30 inflammatory exudates and 13 transudates) by use of an enzyme immunoassay (EIA). Despite considerable scatter, pleural levels of CEA in malignant effusions were significantly higher (p less than 0.001) than the values in benign effusions. Using a cut off level of 5 ng/ml, 41% (= sensitivity) of malignant pleural effusions showed elevated concentrations of CEA. Only one out of 43 benign effusions showed a level of 5 ng/ml, which is equivalent to a specificity of 98%. However, malignant effusions due to small cell lung cancer, pleural mesothelioma and metastasising ovarian carcinoma never showed elevated levels of CEA. Highest pleural values of CEA were observed in cases of alveolar cell or adenocarcinoma of the lung or metastasising breast cancer. Although pleural and serum CEA levels correlated significantly (rs = 0.77), the evaluation of serum CEA levels alone yielded a lower sensitivity (36%) and specificity (93%) than pleural levels. 77% of cases with malignant pleural effusions showing elevated pleural CEA levels were characterized by an increased ratio Pleura/Serum greater than 1, particularly in effusions due to lung cancer. The CEA ratio was significantly higher (p less than 0.05) in patients with malignant than with benign effusions. EIA appears to be more specific by avoiding false positive results in benign effusions as compared with determination by conventional RIA. In conclusion, evaluation of pleural CEA levels in patients with malignant effusions by using an EIA because of its high specificity is a valuable adjunct to pleural cytology in improving the diagnosis of malignant effusions. However, a normal CEA level in either pleural effusion or in serum is of no clinical significance. Simultaneous measurement in pleural effusion and serum is of greater value.

Breast Neoplasms↗
PubMed1986

[Neurophysiologic studies in Pickwickian syndrome].

In 11 patients clinically diagnosed as Pickwickian syndrome the results of daytime and night polysomnogramm were compared. The daytime recording was very efficient in identifying apnoea and correlating various types of apnoea to different sleep stages. In polysomnogramms of night sleep we found, as did Lugaresi, a reduction of sleep stages III and IV, and a slight increase of sleep stages I and II. Patients without apnea in daytime sleep also showed a normal apnea index in night sleep. The BAEP's especially the pontomesencephalic components were pathological in six patients (55%). This might be due to a primary lesion or to hypoxic damage of the brainstem.

Adult↗
PubMed1985

Dry aerosol of monodisperse millimicrospheres for ventilation imaging: production, delivery system, and clinical results in comparison with 81m-krypton and 127-xenon.

The production of monodisperse human albumin millimicrospheres (diameter less than 1 micron) and labeling with 99mTc is described. A system constructed to nebulize and deliver a dry aerosol yielded a lung delivery efficiency of approximately 25%. In 48 patients without and with varying degrees of chronic obstructive lung disease, quantitative comparison with 81mKr (penetration index, regional distribution of activity in the lungs) demonstrated similar penetration of the particles to the lung periphery (r = 0.89 and r = 0.94, respectively). Qualitative comparison with 81mKr or 127Xe showed complete or a high degree of diagnostic agreement in all but one patient. Semiquantitative scoring of hot spots as a substrate of local turbulent airflow showed a close inverse correlation (r = -0.82) with the forced expiratory volume in 1 s (FEV 1.0%), thus providing additional information about the severity of the airway obstruction. In 24 patients with suspected pulmonary embolism, complete agreement between aerosol and 81mKr images was found in all patients studied. For same-day ventilation/perfusion studies, labeling of the millimicrospheres with 111In yielded images of comparable quality to those obtained with the 99mTc-labeled aerosol.

Aerosols↗
PubMed1985

The comparative biomechanical, histologic, and radiographic analysis of canine lumbar discs treated by surgical excision or chemonucleolysis.

Previous experimental studies on the canine intervertebral disc treated with chemonucleolysis have shown encouraging results in preserving normal histologic, biomechanical, and radiographic disc appearance. These observations suggest that chemonucleolysis may have significant advantages over surgical disc excision in preserving normal function of the lumbar vertebral motion segment. An experimental canine study was devised to examine and compare the short and long-term effects of chemonucleolysis and surgical disc excision on the entire lumbar motion segment to determine if one treatment modality is superior to the other in providing better maintenance of motion segment function. Twenty adult beagle dogs underwent anterior laparotomy. In ten dogs, Chymodiactin was injected into the L4-5 disc and in the remaining ten, routine surgical discectomies were performed on the L4-5 disc. Preoperative and presacrifice lateral radiographs were obtained. All dogs were allowed to exercise freely. Five dogs that received Chymodiactin (Group A) and five dogs that had surgical excisions (Group B) were killed six weeks postoperatively. Five months postoperatively, five dogs given Chymodiactin (Group C) and 5 having surgery (Group D) were also killed. Mechanical testing was performed on each treated disc sample with a modified MTS machine (MTS Systems Corp., Minneapolis, MN). Axial compression, bending, shear, and torsion were assessed in ten modes. Stiffness values for each mode were calculated. Following the biomechanical tests, the facet joints and the disc with the adjacent endplate were removed intact and analyzed histologically and with high resolution radiography. Six-week biomechanical testing revealed a 50% loss of torsional stiffness, as well as loss of anterior and medial-lateral shear stiffness in the chemonucleolysis group.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

Spaetlese lung.

Explore the source record for details and available documents.

Agricultural Workers' Diseases↗
PubMed1983

[Diagnosis in sarcoidosis. Sensitivity and specificity of 67-gallium scintigraphy, serum angiotensin converting enzyme levels, thoracic radiography and blood lymphocyte subpopulations].

In a prospective study in 73 patients (48 female, 25 male) with histologically proven sarcoidosis we examined the sensitivity and specificity of Gallium 67 scanning, S-ACE, chest X-ray and blood T-lymphocyte assays for assessment of activity in sarcoidosis. We found a positive correlation between 67Ga score and S-ACE (r = 0.54, p less than 0.001). S-ACE levels and 67Ga score were significantly higher (p less than 0.001) in active sarcoidosis compared to inactive sarcoidosis. However, patients characterized by bihilar active sarcoidosis proved to have higher mean S-ACE levels (p less than 0.025) and a higher 67Ga score (n. s.) compared to patients with other presentations of active sarcoidosis. 67Ga scanning had the highest sensitivity of all parameters (92%) to detect active sarcoidosis, followed by chest X-ray (79%) and S-ACE (70%). Blood T-lymphocyte assays without comparison to lavaged lung T-lymphocytes failed to give reliable results. In patients with inactive sarcoidosis S-ACE showed a higher specificity (85%) compared to 67 Ga scanning (77%). Among follow up assessments in 26 patients with recurrent sarcoidosis 67Ga scanning proved to be the most reliable means for all stages of sarcoidosis whereas in patients with interstitial pulmonary lesions chest X-ray as well as S-ACE sometimes failed to assess activity. For the clinical management of patients with pulmonary sarcoidosis we suggest the combined use of chest X-ray and S-ACE. In case of discrepant results, as well as interstitial pulmonary involvement or for difficult therapeutic decisions the use of 67Ga scanning or bronchoalveolar lavage should be considered.

Adolescent↗
PubMed1983

The assessment of cardiopulmonary function in thoracic surgery.

Cardiopulmonary function is a determinant of the utmost importance in thoracic surgery. A large battery of tests is available, however, only a relatively limited part of it is obligatory. The essential procedures include testing of global ventilation (inspiratory vital capacity, FEV1), relation of lung volumes (residual volume) and regional quantitation of perfusion (scan). Other costly and invasive tests can be regarded as complementary. This is true in planned lung resection for cancer, where the indication for surgery is of vital importance. Other types of thoracic surgery need a more precise evaluation of risk factors balanced against the expected general improvement of cardiopulmonary function, as in cardiac surgery, decortication, and resection of bullae. But since thoracic surgery is practised mainly for the purpose of lung resection with ensuing loss of function, major attention is paid to this field in order to avoid inconclusive but costly testing, and to discuss indication and use of involved technique in high-risk patients.

Blood Gas Analysis↗