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Biomedical subjects

H Becker

Publications and source records attributed to H Becker.

At least 343 records · Page 19Linked to original sources
PubMed1989

Prostaglandin E1 and nitroglycerin reduce pulmonary capillary pressure but worsen ventilation-perfusion distributions in patients with adult respiratory distress syndrome.

Pulmonary artery hypertension associated with adult respiratory distress syndrome (ARDS) may increase microvascular filtration pressure by increasing pulmonary capillary pressure (PCP). To evaluate the potential to reverse this consequence of pulmonary artery hypertension, the effects of short-term vasodilator treatment were compared with prostaglandin E1 (PGE1) or nitroglycerin (NTG) on pulmonary hemodynamics and gas exchange. The two vasodilators were infused in ten patients with mild or moderate ARDS at a dosage rate achieving a 20% reduction of the mean arterial pressure. PCP was estimated by graphic analysis of the pulmonary artery occlusion curve, and continuous ventilation-perfusion (VA/Q) distributions were assessed using the multiple inert gas technique. At the given dosages both drugs induced equivalent reductions of the mean pulmonary artery pressure (PAP) from 28.2 +/- 3.6 to 23.7 +/- 3.2 with PGE1 and to 23.4 +/- 3.2 mmHg with NTG. The right atrial and pulmonary artery wedge pressure (PAWP) were also decreased to the same extent associated with the expected decrease in PCP from 17.4 +/- 2.6 to 15.1 +/- 3.3 with PGE1 and to 15.6 +/- 2.7 mmHg with NTG. The estimated PCP values were closely correlated with the values calculated according to Gaar's equation (r = 0.822. n = 23, P less than 0.001) with a regression close to the identity line. The contribution of pulmonary venous resistances to the resistance of the whole pulmonary vascular bed computed as the ratio (PCP- PAWP)/(PAP-PAWP) was 0.28 and remained unchanged during vasodilator infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Diagnosis of the function of respiratory control in patients with obstructive sleep apnea syndrome].

UNLABELLED: Twenty-five patients with OSAS were investigated and compared with an age-matched control group of 20 healthy volunteers. The ventilatory responses to pure oxygen administration, active hyperventilation, progressive hyperoxic hypercapnia and progressive isocapnic hypoxia were studied in all subjects. RESULTS: Hypoxic ventilatory response in OSAS patients was significantly diminished as compared with the control group. Hypercapnic ventilatory response, decrease in ventilation due to chemoreceptor inactivation during oxygen respiration and after hyperventilation did not differ in the two groups. The diminished response to hypoxia in OSAS patients was correlated with the increased respiration-synchronous changes in nasal resistance. Our data seem to suggest that in OSAS patients the diminished responsiveness to hypoxia may increase the likelihood of nocturnal apnea. A decrease in hypoxic inspiratory drive appears to be one mechanism initiating upper airway occlusion.

Carbon Dioxide↗
PubMed1989

[Long-term acceptance of nasal continuous positive airway pressure therapy in 70 patients with sleep apnea over a 6-month treatment period].

NCPAP therapy is considered to be an effective method of treatment in cases of obstructive and mixed sleep apnea (SA). We investigated its effectiveness during initiation of therapy, and the acceptance of the ambulatory long-term treatment. Here we present the first 70 patients (68 m, 2f) treated with nCPAP for at least six to a maximum of 20 months (on average: eleven months). Sixty-seven of the 70 patients were effectively treated with a nCPAP pressure of 5-15 mbar. The apnea index was reduced from 49 apnea episodes per hour (range 12-125) to 2 episodes per hour (range 0-8) on average. Therapy failed in one case (anatomical defect of the nasopharynx) and had to be abandoned in two cases (claustrophobia, acute rhinitis). Sixty-three patients, decided in favour of ambulatory long-term therapy. These patients were asked to complete a questionnaire about their experience with nCPAP. Four patients abandoned therapy (all within the first four weeks because of intolerance towards the apparatus), and one patient died 10 days after terminating treatment of an infection of the upper airway. Fifty-eight patients (82% of all) are still undergoing treatment. Eighty-eight per cent of these are using nCPAP for 5-7 nights a week throughout the entire sleep period, or at least for five hours. All patients report a marked reduction in or elimination of subjective symptoms. Mild local side effects occur quite frequently, but can be greatly reduced or eliminated in most cases. In individual cases they lead to a shortening of the nocturnal duration of application.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Does determination of atrial natriuretic factor have significance in the assessment of cardiac stress in apnea in sleep apnea patients?].

It has long been known that the heart is involved volume regulation. This fact took on new importance when, in 1981, de Bold discovered the existence of ANF. Apnea-associated cardiovascular changes make the treatment of apnea necessary to prevent the occurrence of cardiovascular sequelae. What is needed, however, is a parameter which, non-invasively, reflects both the cardiac loading during apnea and effects of treatment. Krieger succeeded in demonstrating that the commonly observed nycturia regresses under nasal cPAP therapy. This prompted us to consider whether the ANF factor might not be involved. In an attempt to find an answer, we have, up to now, investigated six patients prior to and during nCPAP therapy. On the basis of the results we obtained, the following conclusions may be drawn: 1. During apnea, the patients show sometimes dramatic increases in ANF plasma levels. 2. Under nasal CPAP treatment, these elevated levels decrease again, in some cases by as much as 50%. 3. The ANF plasma level correlates with pulmonary arterial pressure. This suggests to us that ANF determination is of importance for the assessment of cardiac loading during apnea, and represents a parameter that reflects the effects of therapy.

Atrial Natriuretic Factor↗
PubMed1989

Experience of a German multicenter study group with ifosfamide in small cell lung cancer.

In three German multicenter randomized trials, which included 718 patients, the activity of ifosfamide in small cell lung cancer (SCLC) was tested. In study 1, IE (ifosfamide, 1.5 g/m2, days 1 through 5; etoposide, 120 mg/m2, days 3 through 5) alternating with CAV (cyclophosphamide, 600 mg/m2, days 1 and 2; doxorubicin, 50 mg/m2, day 1; vincristine, 2 mg, day 1) was compared with a response-oriented treatment with IE therapy up to maximum response and subsequently an immediate switch to CAV. After chemotherapy, patients with limited disease received chest irradiation with 45 Gy. Prophylactic cranial irradiation (30 Gy) was given to all patients who achieved complete response (CR). A total of 324 patients were evaluable. Total response rate (CR + partial response [PR]) was 75% v 78% for the two treatment groups; the CR rate was 29% for both groups. Survival was nearly identical in both arms, with a median survival of 10.0 months for all patients, 12.0 months for those with limited disease (LD), and 7.5 months for those with extensive disease (ED). The 2-year survival rate was 11%. In study 2, IE was compared with PE (cisplatin, 90 mg/m2, day 1; etoposide, 150 mg/m2, days 3 through 5). A total of 141 patients were evaluable. Total response (CR + PR) rate was 65% for PE and 68% for IE; the CR rate for PE was 32% v 20% for IE. Survival favored PE with a median survival of 11.6 months v 9.4 months for all patients, 14.8 months v 11.0 months for LD, and 8.9 months v 7.5 months for ED. Two-year survival rates were 12% v 9% for all patients, 23% v 10% for those with LD, and 5% v 9% for those with ED. From these trials, we conclude that IE is an active and well-tolerated regimen for SCLC, and that PE may be superior to IE in limited-stage disease. Taking these results into account, we modified our chemotherapy protocols in study 3 and compared IAV (ifosfamide, 2 g/m2, days 1 to 5; doxorubicin, 25 mg/m2, days 1 and 2; vincristine, 2 mg, day 1) alternating with either PE or JE (carboplatin, 300 mg/m2, day 1; etoposide, 120 mg/m2, days 1 to 3). Interim results of 253 evaluable patients are as follows: CR + PR rate after 4 cycles was 68%; the CR rate was 28%; median survival was 11.6 months for all patients, 14.8 months for LD, and 10.2 months for ED.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1989

Neural tolerance of iotrolan 300 in ascending cervical myelography: results of a multicenter study.

This study examined the opacification, dose, and tolerance of iotrolan 300 on 231 patients in ascending cervical myelography. The contrast was rated good in 188 (81.4%) of the cases and satisfactory in 40 (17.3%) of the cases. The contrast was poor in only three (1.3%) cases. In 152 patients a dose of 10 ml or less of iotrolan 300 was administered. A good contrast quality was obtained in 84.2% of all examinations. From a total of 231 patients, 146 exhibited no concomitant effects. The intensity of the headache and neck ache was recorded by the patients themselves by means of an analog scale. The frequency and degree of the postmyelographic complaints did not increase with higher doses, i.e., they were not dose dependent. Neurologic irritation, in the form of radicular symptoms, appeared in only 2 of 231 examinations. These data demonstrate that iotrolan 300 is excellent for use in ascending cervical myelography.

Adult↗
PubMed1989

[How frequent are pathologic ENT findings in patients with obstructive sleep apnea syndrome?].

Several studies have been reported suggesting a relationship between pharyngeal obstruction due to ENT pathology and the sleep apnea syndrome (SAS). To determine the incidence of pathological ENT findings that may present symptoms similar to SAS, we performed ENT examination, fiberoptic nasopharyngoscopy, rhinomanometry and partial audiometry and electronystagmography in 431 patients who had undergone polysomnography for clinically suspected SAS. 336 patients were referred for ENT examination; 95 patients had some kind of ENT disease and therapy before polysomnography. In the first group 31% showed one or more pathological ENT finding (ears 9%, nasopharynx 2%, nose 19%, oropharynx 5%, larynx 5%, neck 1%); 10.5% had pathology in two regions and 0.7% in three regions. An ENT operation was indicated in 23%, usually for nasal obstruction. ENT findings included chronic otitis media, adenoids, enlargement of lingual tonsil and vocal cord pathology, but no patient had a malignant tumor or severe pharyngeal obstruction. We conclude that severe anatomical abnormalities or dysplastic syndromes are rare; only 2 SAS patients had acromegaly due to hypophyseal adenoma and 1 patient without SAS had craniofacial dysplasia. However, ENT examination frequently revealed severe nasal obstruction due to septal deviation, polyposis or adenoids. These findings emphasize the need for ENT examination and therapy before application of CPAP (continuous positive air pressure) therapy.

Airway Obstruction↗
PubMed1989

[Diagnosis of sleep apnea: initial experiences with a staged procedure].

The high prevalence of sleep-related breathing disturbances (SRBD), in association with cardiopulmonary disease, and the impairment by such disorders of the quality of the patients life, together with the good response of SRBD to therapy when diagnosed early on, point up the importance of incorporating the diagnostic evaluation of SRBD into the routine medical and pneumological diagnostic work-up. Since classical polysomnography requires a considerable effort, a stepwise diagnostic procedure was needed for use in practice. This includes a narrowing down of the indications, a brief questionnaire and a detailed questionnaire. For positive demonstration of a respiratory disturbance or differential diagnostic purposes, the following measures are employed on an outpatient basis in the following order: High-resolution 24-hour (Holter) ECG; analysis of heart rate and respiratory sounds, including, in particular snoring, with the MESAM system; induction plethysmography and continuous oxygen partial pressure measurement (pO2tc). Only after exhaustive use has been made of the ambulatory work-up, are the following diagnostic inhospital measures employed in the order indicated: 10-channel recording using the SIDAS system (respiration 3 channels, oxygen saturation, EOG, actogram, heart rate, intrathoracic pressure fluctuations), complete polysomnography. Once SRBD has been established, the patient is sent to the sleep laboratory to establish a baseline. Baseline measurement is accompanied by the determination of a marker, that is, a readily determined parameter capable of providing information about the success of therapy, is established. This permits complete polysomnography to be concentrated on differential-diagnostic and treatment-refractory problem cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1989

[Video-endoscopic recording of the pharynx before and following nasal continuous positive airway pressure therapy in patients with obstructive sleep apnea].

The action mechanism of nCPAP in the treatment of obstructive sleep apnea is not adequately known. We took video endoscopic pictures (chip video camera manufactured by Videotronik) of the pharynx in five patients with SA in the awake state, during apnea during sleep, and under nCPAP treatment during sleep. The patients were all in the supine position. Simultaneously with video-endoscopy, polysomnography was performed. Qualitatively good pictures were obtained in 3 patients. In the awake state, a relatively narrow pharynx was observed which, however, was completely patent during the entire respiratory cycle. During apnea and hypopnoea, a concentric collapse of the oropharynx was observed, with involvement of the lateral and posterior walls of the pharynx and the tongue, together with the soft palate over a length of several centimetres to above the epiglottis. During the hyperventilation phase following apnea, the occlusion opened up again, the diameter of the pharynx then being appreciably greater than that seen in the awake state. Under increasing CPAP pressure, occlusion became progressively less complete; when the effective pressure had been attained, the diameter of the pharynx was roughly comparable to that seen in the hyperventilation phase, that is, appreciably wider than in the awake state. During inspiration, however, even under effective nCPAP pressure, a discrete decrease in pharyngeal diameter occurred. On the basis of the visual impression, we believe that the effect of CPAP is based on a passive "pneumatic splinting" of the pharyngeal musculature.

Adult↗
PubMed1989

[Borrelia infection and systemic lupus erythematosus].

A 39-year-old woman developed transient erythema and arthralgia in spring 1987. In June she had a tick bite followed by local erythema and later migrating skin changes. Furthermore she developed pain in various joints with Raynaud's phenomenon at the fingers, swelling of the knee joints and shoulder pain. Demonstration of antibodies against B. burgdorferi antigen was shown in one institution (IFL, Western blot) while the same serum in two other institutions remained negative (IHA, ELISA). Antibiotic treatment was only temporarily successful. While the demonstration of antinuclear factors could be attributed to cross-reacting antibodies in borreliosis failing effects of absorption of serum with this antigen led to the assumption SLE as the underlying disease. Further indications were lymphopenia, increasing titers of anti ds-DNA antibodies and renal involvement as erythrocyturia and proteinuria. Sudden relief of the symptoms after treatment with steroids may be taken as further prove for this assumption. The interference of both diseases and their similarity in symptoms may impede correct diagnosis.

Adult↗
PubMed1988

[Acute abdomen in unrecognized hyperparathyroidism].

The incidence of acute abdomen in patients with unrecognised hyperparathyroidism (HPT) was investigated in 61 patients with primary and 15 patients with secondary HPT, operated on at the Surgical University Department in Düsseldorf between 4/86 and 10/87. In seven patients (9%) an acute abdomen occurred preoperatively (bleeding ulcer n = 3, ulcer perforation n = 1, acute pancreatitis n = 3). Recurrent gastrointestinal disease was observed in 20 of the 76 Patients (28%). The fast and surprising clinical recovery of patients with pancreatitis and HPT after operation of the HPT support the assumption of a causal relation between hyperparathyroidism and pancreatitis. The importance of hypercalcaemia and HPT as causative factors in gastrointestinal ulcers, remains uncertain, however. Possible acute abdominal emergencies in the clinical course of primary hyperparathyroidism support the indication for early operation.

Abdomen, Acute↗