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H Wirtz

Publications and source records attributed to H Wirtz.

At least 19 recordsLinked to original sources
PubMed2006

[Health significance of inhaled particles].

Particulates refer to particles, dust, dirt, soot and aerosol mists that has suspended in the surrounding air. They may consist of solids of various forms including fibres or liquids. Long term exposure to silicon dioxide containing dusts (crystalline silica: quartz, tridymite, cristobalite, coesite, stishovite) may cause pneumoconiosis in the form of acute or/either chronic silicosis. Asbestos refers to a divers family of crystalline hydrated fibrous siliates typically exhibiting a greater tha 3:1 length ot diameter ratio. It is subdivided into serpentine (Chrysotile) and amphibole (crocidolite, amosite, anthophyllite, tremolite, actinolite). Exposure to asbestos fibres may cause lung fibrosis and promote cancer of the lung or the pleura. Besides the induction of malignant diseases dust exposure may result in obstructive as well as restrictive lung diseases which may be compensate in case of the recognition as a occupational diseases. Other occupational exposures leading to pneumoconiosis are caused be talc, or metals including aluminium containing dusts. Also the group of man-made mineral (MMMFs) or vitreous fibres (MMVFs), including glass wool, rock wool, slag wool, glass filaments, microfibres, refractory ceramic fibres are bioactive under certain experimental conditions. Although it has been shown that MMMFs may cause malignancies when injected intraperitoneally in high quantities in rodents, inhalation trials and human studies could not reproduce these results in the same precision. Fine particles (particulate matter = PM) comprise one of the most widespread and harmful air pollutants in the industrialized world. PM may cause worsening of asthma and other respiratory diseases, reduce lung function development in children, potentially increased the risk of premature death in the elderly and enhance mortality from cardiac diseases. Because of the small size PM2.5 is seen to be even more hazardous than PM10.

Administration, Inhalation↗
PubMed2006

[Acute bronchitis: when are antibiotics, and when is symptomatic treatment indicated?].

Acute bronchitis is usually caused by a virus, while the chronic form is due to inhalative noxae (in most cases decades of cigarette smoking). Both varieties are diagnosed on a clinical basis. Treatment of acute bronchitis is symptomatic. A sore throat is treated locally, and a troublesome, in particular nocturnal, cough with antitussive agents applied for a limited period (14 days). If bronchial mucus is viscous and difficult to clear, short-term treatment with a secretolytic or mucolytic substance is justified. Management of chronic bronchitis consists primarily in the elimination of the noxae. Treatment with antibiotics (usually oral) makes good sense only when there is a bacteriological infection of the upper or lower airways in an acute stage, such as infection-driven exacerbation of chronic obstructive bronchitis (COPD).

Adult↗
PubMed2006

[Talc pleurodesis in malignant pleural effusions].

Pleural effusions associated with malignancy--either malignant or paramalignant diseases--were found in ca. 20% of these patients. Large pleural effusions cause mainly dyspnoea but also cough and chest pain. The presence and degree of dyspnoea depend on the size of the effusion and the patient's underlying pulmonary function. In acute cases and large effusions immediate chest drainage is indicated in symptomatic patients, followed by the treatment of the underlying disease, e. g. chemotherapy. The most effective therapy for controlling reiterated malignant pleural effusions is the thoracoscopic talc poudrage (2.5-10 g) which has been shown to have a success rate of > 90%. Talc induces a broad inflammatory reaction involving mesothelial cells of the pleura, coagulation parameters, fibroblast proliferation eventually leading to symphysis of the pleura. This procedure is reserved for patients who are in good general conditions, who are expected to have a reasonably long survival, and who failed chemical pleurodesis. A good predictor for longer survival time is a Karnofsky Performance Scale > or = 40 indicating a survival time > 30 days, which therefore should be considered prior to the procedure. The adult respiratory distress syndrome (ARDS) is the most important complication initially observed in the US in up to 9% of all cases. ARDS incidence was strongly related to high number (50%) of small talc particles < 15 microm. In summary, talc poudrage or slurry (talc particle size > 10 microm) in malignant pleura effusions is a safe and effective method to induce pleura symphysis. Complaints and complications such as chest pain, transient fever, and empyema are rare or very are which are almost exclusively related to the therapeutic procedure itself.

Dyspnea↗
PubMed2006

Anti-TNF effects on destructive fibroblasts depend on mechanical stress.

Joint destruction in rheumatoid arthritis (RA) starts typically at sites of mechanically stressed inserts of the synovial membrane near the cartilage/bone border. In the therapy of RA, tumour necrosis factor (TNF) antagonists have rapidly emerged as a valuable class of anti-rheumatic agents that reduce joint destruction. The aim of this study was to investigate and profile genes involved in the interaction between articular movement and anti-TNF therapy in an in vitro model. Murine LS48 cells, an established substitute for invasive RA synovial fibroblasts, were cultured, stretched and/or treated with anti-TNF-alpha antibody for 24 h. RNA was isolated and gene transcript levels were determined using U74Av2 Affymetrix GeneChips to identify transcriptional events. Positive findings were verified by polymerase chain reaction (PCR). We identified 170 differentially regulated genes, including 44 of particular interest. Gene expression fell into different functional groups that can be explained by RA pathogenesis and experimental conditions. For 21 genes of the 44 of particular interest, regulation could be confirmed by real-time PCR. Remarkably, we found structural as well as functional genes differently regulated between stretched cells, anti-TNF-treated cells, and stretched cells treated with anti-TNF antibody. Additionally, we also found a large number of genes that are apparently not related to the experimental conditions. Mechanical exertion modulates gene expression and subsequently cellular response to anti-TNF therapy. Results in exerted cells correspond to current knowledge regarding RA pathogenesis and underline the relevance of our experimental approach. Finally, the central function of the interleukin-18 system in joint destruction could be confirmed by our findings.

Animals↗
PubMed2005

[Rare cause of pectangina after coronary artery surgery].

The coronary subclavian-steal-syndrome is a rare cause for angina pectoris following A. mammaria interna bypass operation. A 72-year-old male patient presented with vertigo and angina pectoris. A three vessel coronary artery disease was known and coronary artery surgery with three aortocoronary bypasses had been performed a year prior to presentation. A difference in peripheral arterial pressure between the right (150/80 mmHg) and the left (125/75 mmHg) arm was noted at physical examination. Color Doppler sonography of the left vertebral arteria exhibited a retrograde flow suggesting a coronary subclavian-steal-syndrome. Angiography revealed a significant stenosis of the left arteria subclavia. The stenosis was successfully treated with percutaneous transluminal angioplasty and stent implantation.

Aged↗
PubMed2005

Exhaled breath condensate: methodological recommendations and unresolved questions.

Collection of exhaled breath condensate (EBC) is a noninvasive method for obtaining samples from the lungs. EBC contains large number of mediators including adenosine, ammonia, hydrogen peroxide, isoprostanes, leukotrienes, nitrogen oxides, peptides and cytokines. Concentrations of these mediators are influenced by lung diseases and modulated by therapeutic interventions. Similarly EBC pH also changes in respiratory diseases. The aim of the American Thoracic Society/European Respiratory Society Task Force on EBC was to identify the important methodological issues surrounding EBC collection and assay, to provide recommendations for the measurements and to highlight areas where further research is required. Based on the currently available evidence and the consensus of the expert panel for EBC collection, the following general recommendations were put together for oral sample collection: collect during tidal breathing using a noseclip and a saliva trap; define cooling temperature and collection time (10 min is generally sufficient to obtain 1-2 mL of sample and well tolerated by patients); use inert material for condenser; do not use resistor and do not use filter between the subject and the condenser. These are only general recommendations and certain circumstances may dictate variation from them. Important areas for future research involve: ascertaining mechanisms and site of exhaled breath condensate particle formation; determination of dilution markers; improving reproducibility; employment of EBC in longitudinal studies; and determining the utility of exhaled breath condensate measures for the management of individual patients. These studies are required before recommending this technique for use in clinical practice.

Biomarkers↗
PubMed2004

[Unexpected cause of a tarsal destruction in a diabetic patient].

HISTORY: A 56-year-old male patient has suffered from increasing pain in the left foot which limited the ability of walking since 18 months. There was a soft and painful swelling below the left inner ankle. In addition the patient reported back pain, but no neurological symptoms. Insulin dependent diabetes type II was known for 20 years, and a diabetic foot syndrome was suspected. 6 months prior the patient consulted his physician because of repeated acute bronchitis with expectoration and no improvement following antibiotic therapy. INVESTIGATIONS: Osteolytic destruction of the left middle foot and the tarsal with soft tissue infiltration according to MR, a spondylodiscitis of the lumbar vertebra I and II (MR) and mixed interstitial/alveolar infiltrates throughout the lung with a predominance in both upper lobes were found. The microbiological examination of sputum and biopsy of inflamed soft tissue of the left ankle revealed infection with mycobacterium tuberculosis. DIAGNOSIS: Open lung tuberculosis with concomitant bone tuberculosis and tuberculous arthritis of the left middle foot and spondylodiscitis. THERAPY AND CLINICAL COURSE: The antibiotic therapy consisted of a combination of five antibiotic drugs for 2 weeks and of a four drug combination for further 3.5 months. After that there will be a consolidation therapy with a two drug regime for 6 months. An orthopaedist is also involved. Surgical procedures with respect to the left foot will not be considered as long as the antibiotic therapy has not been finished. CONCLUSION: A combination of symptoms resulting from inflammatory bone processes and pulmonary symptoms is always suspicious for a hematogenic dissemination of a pulmonary tuberculosis.

Diabetes Mellitus, Type 2↗
PubMed2004

[Alternating electric heart axis in a patient with small cell lung cancer].

HISTORY AND ADMISSION FINDINGS: A 62-year-old man was admitted because of recurrent abdominal pain 18 months after small cell lung cancer (SCLC) had been diagnosed and remission achieved with chemotherapy and radiotherapy. The abdomen was soft on palpation, but pressure on the epigastric region was painful. Symptomatic treatment brought improvement, but 16 hours after admission the patient complained of severe diffuse abdominal pain. Abdominal findings were unchanged. He was pale and in a cold sweat. Heart sounds were decreased, while auscultation and percussion of the lung were unremarkable. INVESTIGATION: Lactate dehydrogenase and aspartate-aminotransferase concentrations were markedly raised and the serum creatinine was increased, while the Quick value was decreased. The electrocardiogram (ECG) showed low voltage and alternating electrical heart axis. Chest radiogram demonstrated a double-contour cardiac silhouette suggesting a large pericardial effusion, confirmed on echocardiography, which also showed a pendulum-like cardiac motion. The needle aspirate of the pericardial fluid contained malignant cells. DIAGNOSIS: These findings indicated malignant, hemodynamically significant pericardial effusion due to a recurrence of SCLC, with pronounced abdominal symptoms and advanced right heart failure. TREATMENT AND COURSE: Pericardiocentesis brought about marked improvement. 30 mg cisplatin was injected into the pericardial sac and chemotherapy resumed. The ECG became normal. There was no tumor progression over the following 4 months when the pericardial effusion recurred, chemotherapy (4 cycles of carboplatin and etoposide) was restarted and another infusion of cisplatin undertaken. CONCLUSION: This case report illustrates a not uncommon manifestation of lung cancer, malignant pericardial effusion, first becoming symptomatic as severe abdominal pain. Characteristic changes in the chest radiogram and the ECG provided the diagnosis, confirmed histologically.

Abdominal Pain↗
PubMed2004

[Pulmonary Infiltrate, Pleural Effusion and IgM Macroglobulinaemia].

We report a 71-year-old mam with known IgM- Macroglobulinemia, who developed infiltrative pulmonary changes and a pleural effusion. Both, the pleural effusion and bronchoalveolar lavage revealed monoclonal IgM positive B-lymphocytoes. Transbronchial biopsies showed tissue infiltrates of lymphoplasmocytic cells, consistent with a pleuropulmonary manifestation of Morbus Waldenstroem. Bone marrow and gastrointestinal involvement could be excluded, and the diagnosis of a primary pulmonary immunocytoma was made. The patient underwent partial lung resection with removal of the affected lung tissue. Pleuropulmonary changes in patients with IgM-Macroglobulinaemia or Morbus Waldenstroem may be due to pulmonary involvement by the hematological disease.

Aged↗
PubMed2004

[Apoptosis and necrosis induced by cyclic mechanical stretching in alveolar type-II-cells--influence of captopril and L-Arginine].

BACKGROUND: Alveolar type-II(ATII)-cells are exposed to mechanical stretch during breathing and mechanical ventilation. Increased stretch may contribute to lung injury. METHODS: The influence of three stretching patterns (characterized by frequency [min (-1)] - increase in surface area [%]: S40 - 13, S60 - 13, S40 - 30) on parameters of apoptosis, necrosis and membrane integrity in rat ATII cells was compared with that in static cultures. The S40 - 13 stretching pattern simulated normal breathing. The other patterns were chosen to study increased amplitude and frequency. RESULTS: There were no significant differences between the S40 - 13 group and static cultures. LDH release and early apoptotic cells were significantly increased in S60 - 13 and S40 - 30 in comparison with static cultures (LDH: 0.089 +/- 0.014 microg/ml and 0.177 +/- 0.050 microg/ml versus 0.050 +/- 0.011 microg/ml; early apoptosis: 17 +/- 3.5 % and 23 +/- 3.1 % versus 9.7 +/- 1.4 %) at 24 h. Necrosis was significantly increased only in the S40-30 group (13 +/- 2.4 % versus 6.1 +/- 0.9 % in static culture at 24 h). Captopril as well as L-Arginine prevented apoptosis and reduced apoptotic cells to static culture levels in the S40 - 30 group but did not influence necrosis and LDH release. CONCLUSION: Increased mechanical stretch may contribute to lung injury by induction of apoptosis and necrosis in ATII cells. Apoptosis induced by high amplitude mechanical stretch is prevented by captopril and L-Arginine.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2004

[Expired diagnosis?--the potential of exhaled breath analysis].

Analysis of breath condensate is an innovative approach to biochemical information from the lung. It provides a new tool to estimate and characterize the burden of oxidative and inflammatory processes in the airways/lung. Clinical applications in asthma, COPD and CF can be envisioned as well as determining organ-specific inflammation in mechanically ventilated patients or monitoring patients with transplanted lungs. However, besides inflammation other important areas have begun to be evaluated, such as the demonstration of p53 mutations in NSCLC patients or an increased ratio of EBC nitrite to tidal volume in mechanically stressed lungs. Of course a careful validation of each and every parameter is paramount to the use in clinical applications. The comparison to BAL is oftentimes called for but at the same time is not the comparison to a gold standard because of the well-known problems of BAL. The scope of this review is a summary of facts and theories concerning exhaled breath condensate generation, collection and analysis but at the same time the representation of the many aspects that remain to be resolved.

Breath Tests↗
PubMed2004

[Correlation of TEI Index and invasive parameters of rightheart function in PAH].

BACKGROUND: The reduction of right ventricular function characterizes patients with severe pulmonary hypertension (PAH). Monitoring right ventricular function therefore is important. Echocardiography is the method of choice for this purpose. The so called Tei-Index seems to be an adequate diagnostic tool with prognostic relevance. We here compared Tei-Index with parameters of right heart catheterization in patients with PAH. PATIENTS AND METHODS: Tei-Index was calculated in 42 patients from the sum of isovolumetric contraction time and relaxation time divided by ejection time. A right heart catheter was performed the same day and pulmonary arterial mean pressure (PAPm) as well as pulmonary arterial resistance (PAR), central venous saturation (SVO (2)), central venous pressure (ZVD) stroke volume (SV) and right ventricular ejection fraction (RVEF) were recorded. RESULTS: Correlation were observed between in each case Tei-Index and RVEF (r = - 0.72; p < 0.001), SV (r = - 0.52; p < 0.001), ZVD (r = 0.65; p < 0.001) and SVO (2) (r = - 0.58; p < 0.001). Tei-index did not correlate with PAPm and PAR. CONCLUSION: Correlations of Tei-Index with parameters of right ventricular function derived from right heart catheterization support the usefulness of 2D-doppler echocardiography for monitoring right heart function in PAH patients.

Blood Pressure↗
PubMed2003

[Febrile respiratory infection and erythema in a 25-year-old man].

HISTORY AND CLINICAL FINDINGS: A 26-year-old man fell acutely ill with fever (39 degrees C), rigor, dry cough, headache and pain in the neck and limbs. Ambulant treatment with amoxycillin, later cefuroximaxetil, worsened his general condition. At admission to hospital he had, over his trunk and limbs, cocarde-like, erythematous efflorescences up to 2 cm in diameter with central elevations and blisters. Additional acute bronchitis, pharyngitis, stomatitis, tonsillitis, conjunctivitis and urethritis indicated extensive mucosal involvement. INVESTIGATIONS: Significant findings were: 9900/microl WBC, ESR 57 mm at one hour, C-reactive protein 160 mg/l, capillary pO2 6.4 kPa, pCO2 4.2 kPa. Mycoplasma serology (days 1, 8, 15) took a typical course. Chest radiogram showed an interstitial infiltrate on day 5. DIAGNOSIS: Respiratory Mycoplasma infection with interstitial pneumonia and exudative erythema multiforme. TREATMENT AND COURSE: Because infection with an atypical pathogen was suspected, antibiotic treatment was changed to erythromycin and, at the suggestion of the dermatologist and ophthalmologist, local treatment (erythromycin, dexamethasone and dexpanthenol) was begun. Mycoplasma serology was first positive on day 3. The fever had disappeared on day 6 and the rash had regressed. Blood gases and blood picture were normal by day 8. The patient was discharged on day 18, after marked improvement of the skin and mucosal changes. CONCLUSION: The occurrence of a rare dermatological complication of a relatively common respiratory Mycoplasma infection can, when the erythema precedes positive Mycoplasma serology, aid in the differential diagnosis.

Administration, Topical↗
PubMed2003

[62-year-old patient with progressive dyspnea and positional left-sided thoracic pain].

A 62-year-old male patient presented with left-sided chest pain experienced in a lying position and progressive dyspnea. He had a history of thyroid carcinoma treated 22 years ago and a nodular shadow in the left lung first identified 9 years ago. He refused any further diagnostic and therapeutic measures for the nodular shadow as he had been free of symptoms. The clinical findings at presentation included labial and acral cyanosis. Breathing sounds over the lower left lung were diminished. A chest X-ray revealed a 9 x 8-cm cloudiness lateral to the left border of the heart, which was confirmed in a contrast thoracic CT evidencing a smooth surface and a wall absorbing contrast medium. Staging diagnostics indicated no further tumor manifestations. Needle biopsy showed fibrous tissue. Thoracotomy with tumor extirpation exhibited a solitary fibrous tumor of the pleura. Solitary fibrous tumor of the pleura is a rare cause for a nodular shadow of the lung. Clinical findings are rather nonspecific. Complete resection is the therapy of choice. Resection of functional lung tissue has to be avoided because the tumor often is pediculated.

Biopsy, Needle↗
PubMed2002

[A hemodynamically active type II atrial septal defect in a 78-year-old patient. Indications for interventional catheter occlusion?].

HISTORY AND ADMISSION FINDINGS: A 78-year-old woman presented with a first episode of syncope. She reported increasing fatigue and dyspnoea upon exertion over a period of 20 years and chest pain 2 months prior to admission. Auscultation revealed fixed doubling of the second heart sound. INVESTIGATIONS: Laboratory tests showed increased troponin I. Transaminases were moderately elevated. Chest X-ray showed an enlarged right heart and a dilated pulmonary artery (2 cm). Echocardiography discovered a large secundum atrial septal defect with a diameter of 3 cm but no right to left shunt (no Eisenmenger reaction). Cardiac catheterization revealed a stenosis of the right coronary artery and severe systolic pulmonary hypertension of 80 mmHg. DIAGNOSIS, TREATMENT AND COURSE: A significant stenosis of the right coronary artery was successfully dilated. The ASD was closed by interventional implantation of a commercial closure device (Amplatzer). One month later, echocardiography indicated in an estimated systolic pulmonary pressure of 30 mmHg. The patient's condition improved considerably. CONCLUSION: This case is remarkable in that a very large ASD was asymptomatic up into old age and without the development of an Eisenmenger reaction. Also, large ASD can be by catheterization with the appropriate closure device. Fixed pulmonary hypertension is not obligatory. Non-invasive closure is a good alternative of surgery in elderly patients with risk factors.

Aged↗
PubMed2002

BALF N-acetylglucosaminidase and beta-galactosidase activities in idiopathic pulmonary fibrosis.

The lysosomal enzymes N-acetylglucosaminidase (N-ACGA) and beta-galactosidase (beta-gal) are involved in cellular collagen metabolism and may, therefore, be markers of fibrosis in idiopathic interstitial pneumonias, such as idiopathic pulmonary fibrosis (IPF). N-ACGA and beta-gal were analyzed in the bronchoalveolar lavage fluid (BALF) of patients with the histologic pattern of usual interstitial pneumonia (UIP, n=10) and controls (n=9). Cellular distribution in BALF as well as the concentration of TGF-beta a well-known mediator of fibroblast matrix deposition were correlated to the enzyme activities in both groups of patients. We found that both, N-ACGA (UIP: 25.2 nmol/l s +/- 3.4; controls: 73 nmol/l s +/- 1.3) and beta-gal (UIP: 4.7 nmol/l s +/- 0.5; controls: 2.4 nmol/l s +/- 0.3) were elevated significantly in BALF of patients with IPF compared to that of control patients (P<0.003). This increase was paralleled by an increase in neutrophils (IPF: 17.9% +/- 21.8; controls: 5.4% +/- 6.3; P=0.03) and eosinophils (IPF: 2.0% +/- 1.5; controls: 0.2% +/- 0.45; P=0.002) in BALF fluid. In addition, N-ACGA activity correlated closely with lung function (FVC, TLC, and DLCO), transforming growth factor-beta (TGF-beta) in BALF (r=0.77, P=0.008) and activated lymphocytes (r=0.66, P=0.0021). Our findings suggest that measurement of lysosomal enzymes such as N-ACGA may represent a useful indicator of fibrotic activity in IPF.

Acetylglucosaminidase↗
PubMed2002

[Invasive pulmonary aspergillosis--CT findings in context with the clinical course].

PURPOSE: To investigate the impact of chest radiographs and CT in patients suffering from invasive pulmonary aspergillosis (IPA) compared to the clinical course. PATIENTS AND METHODS: Twenty-three patients with confirmed diagnosis of IPA between January 1996 and September 1999 were included in this study. Signs of inflammatory infiltrates on chest radiographs and CT were retrospectively evaluated in relation to the onset of the clinical symptoms. Infiltrates on CT were analyzed in detail with respect to number, morphology, and localization. RESULTS: Seventy-six infiltrates were found on the CT of 22 patients; one patient had diffuse areas of lung infiltrates. Both lungs were affected by infiltrates in 14 patients. Pleural effusions were confirmed in 12 patients. Twelve patients had typically round foci with halo and nine patients crescent air signs. The preferred localization of lung infiltrates was segment 6. The median interval between the onset of clinical symptoms and the first radiographic changes was 5.5 days, with an additional interval of 4.5 days until confirmation by CT. Localization, number of infiltrates, and clinical course were not related. CONCLUSION: In immune-compromised patients with fever, a CT of the chest should be carried out as soon as possible to detect signs indicative of IPA. Morphological changes on CT like a round focus with halo and crescent air sign support the diagnosis of IPA. In this context, special attention should be directed to pulmonary segment 6.

Aspergillosis↗