Search PubMed⌕ Search

Biomedical subjects

H Klech

Publications and source records attributed to H Klech.

35 records · Page 2Linked to original sources
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

Thoracic imaging with gallium-67.

In the past, gallium-67 imaging has undergone several ups and downs related to its clinical importance. After a period of initial enthusiasm, its role and indications are now established. At present, there are two fields of clinical interest for 67Ga-imaging: (1) mediastinal staging in bronchogenic carcinoma and the staging of malignant lymphoma; (2) assessment of activity in interstitial lung diseases, especially sarcoidosis and inflammatory lung disorders. The advantage of 67Ga-imaging is that it is highly sensitive for the detection of neoplastic and inflammatory processes, independent of anatomical barriers. Particularly with the challenge of AIDS, 67Ga-imaging will gain increasing importance in the future. The low specificity of gallium for detecting underlying disorders precludes its use as a primary diagnostic tool. Therefore, and because of the cost and radiation load, the indications for application will have to be selected very carefully.

Adenocarcinoma↗
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↗
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

[Mediastinal CT-staging of bronchial carcinomas].

Forty-three patients with proven bronchogenic carcinoma were evaluated with computed tomography (CT) to search for mediastinal and broncho-pulmonary nodal metastases. Definitive staging was achieved by thoracotomy (34 patients) and mediastinoscopy or transbronchial nodal sampling (9 patients). Three parameters of lymph node appearance on CT were studied to improve the sensitivity and specificity of CT in detecting malignancy in bronchogenic carcinoma: 1) node size, 2) node location and 3) border regularity and definition. 762 clearly defined nodes were studied by CT - 391 metastatic and 371 non metastatic. The most useful CT parameters were node size over 10 mm, and node location, which results in a sensitivity of 80% and a specificity of 88%. A combination of all 3 CT parameters increased sensitivity to 82% and specificity to 90%. These results show clearly, that size is not the only relevant CT-parameter in successful preoperative identification of mediastinal nodal metastases.

Aged↗
PubMed1985

[Cefaclor in the treatment of respiratory tract infections in children].

61 children up to the age of 14 years with respiratory tract infections underwent therapy with Cefaclor. 52 patients (89%) had satisfactory results. 4 patients (7%) experienced prolonged signs of infection. Cefaclor was very well tolerated. Because of its wide spectrum of activity particularly against ampicillin resistant strains of H. influenzae and because of its good tolerance Cefaclor is very useful in treatment of respiratory tract infections in children.

Adolescent↗
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↗
PubMed1982

67Ga scanning for assessment of disease activity and therapy decisions in pulmonary sarcoidosis in comparison to chest radiography, serum ACE and blood T-lymphocytes.

In 60 patients with histologically proven sarcoidosis, 67Ga scanning was evaluated in terms of sensitivity and specificity for assessing disease activity and compared with chest radiography, serum ACE and blood T-lymphocytes. While 67Ga scans had the highest sensitivity (94%), the specificity was only 68%. The sensitivity of chest radiography was 80%, of serum ACE and blood T-lymphocytes 77% and 48%, respectively. While in patients with radiographical type I, 67Ga scanning, chest radiography and serum ACE had a sensitivity of 92%-100%, in patients with radiographical type II-III, only 67Ga scans had a sensitivity exceeding 90%. A 67Ga score correlated significantly with serum ACE levels (r = 0.59, P less than 0.001). After effective steroid treatment, 67Ga uptake and serum ACE activities decreased markedly. While in 25% of cases, chest radiography failed to provide reliable information, 67Ga scanning and serum ACE activities always proved useful in evaluating the course of the disease and the patient's response to steroid therapy. A negative 67Ga scan together with normal serum ACE levels seem to have a high predictive value for excluding active sarcoidosis.

Adolescent↗
PubMed1982

Assessment of activity in Sarcoidosis. Sensitivity and specificity of 67Gallium scintigraphy, serum ACE levels, chest roentgenography, and blood lymphocyte subpopulations.

The value of different factors are examined to assess activity in 60 patients with biopsy-proven sarcoidosis. In patients with active sarcoidosis (n = 35), 67Gallium scans proved to be the most sensitive method (94 percent sensitivity), followed by serum angiotensin I converting enzyme (S-ACE) levels, chest x-ray films, and lymphocyte assays. In patients with peripheral pulmonary lesions, chest x-ray films failed in 32 percent of cases to document activity (68 percent sensitivity) whereas 67Ga scans and S-ACE levels remained to give reliable results. Despite poor specificity, negative 67Ga scans together with normal ACE levels have a high predictive value for exclusion of active sarcoidosis. In patients with peripheral pulmonary lesions, chest roentgenography is of doubtful value for staging lung involvement and assessment of activity including monitoring and control of therapy.

Adolescent↗
PubMed1981

[Meningitis in generalized sarcoidosis (author's transl)].

Case report on a severe meningitis in a 15 years old patient, who showed at first the clinical signs of a tuberculosis meningitis. Anamnesis, further clinical observation and investigation after subsiding of the meningitis gave convincing arguments for a generalized sarcoidosis. Preexisting diencephalic disturbances favoured the diagnosis of a meningo-encephalic type of sarcoidosis. Problems of diagnosis and therapy are discussed.

Adolescent↗