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Biomedical subjects

H Worth

Publications and source records attributed to H Worth.

At least 55 records · Page 3Linked to original sources
PubMed1999

Repetitive hemodilution in chronic obstructive pulmonary disease and pulmonary hypertension: effects on pulmonary hemodynamics, gas exchange, and exercise capacity.

BACKGROUND: In cor pulmonale associated with severe chronic obstructive pulmonary disease (COPD), disturbances of pulmonary microcirculation may contribute significantly to hypoxemia, pulmonary hypertension, and exercise intolerance. OBJECTIVE: It was tested whether reduction of blood viscosity induced by repetitive hemodilution might improve pulmonary hemodynamics and oxygen uptake. METHODS: Seven patients with stable COPD (forced expiratory volume in 1 s 33 +/- 3 % of predicted, means +/- SE) and pulmonary hypertension were phlebotomized 5-6 times over a period of 3 months with substitution of 6% hydroxyethyl starch (molecular weight 40, 000). This resulted in a stepwise reduction of the hematocrit from 53.3 +/- 2.6 to 45.8 +/- 3.1% and a reduction of whole blood viscosity from 9.8 +/- 0.6 to 8.8 +/- 0.7 mPa x s at a shear rate of 2.0 s-1. Before and after the treatment period, patients underwent cardiopulmonary exercise testing and right heart catheterization. RESULTS: Mean pulmonary artery pressure (PAm) decreased from 30 +/- 3 to 22 +/- 2 mm Hg and arterial oxygen partial pressure (PaO2) increased from 63.2 +/- 2.2 to 71.8 +/- 3.7 mm Hg at rest. During peak exercise, PAm decreased from 59 +/- 7 to 53 +/- 7 mm Hg and PaO2 increased from 54.0 +/- 5.7 to 63.2 +/- 2.4 mm Hg after hemodilution. Peak oxygen consumption rose from 573 +/- 84 to 750 +/- 59 ml x min-1, corresponding to an increase in cardiac index from 4.25 +/- 0.5 to 5.88 +/- 0.76 liters x min-1 x m-2. Pulmonary vascular resistance fell from 345 +/- 53 to 194 +/- 32 dyn x s x cm-5. The patients' peak exercise capacity increased from 9.2 +/- 2. 0 before to 13.5 +/- 3.2 kJ at the end of the study (p < 0.05 for all differences, paired t test). CONCLUSION: The findings suggest that a prolonged improvement of pulmonary microcirculation by reducing blood viscosity may improve pulmonary gas exchange, central hemodynamics, and exercise tolerance in patients with severe COPD and pulmonary hypertension.

Aged↗
PubMed1997

[Noninvasive ventilation in the acute care hospital--a cost factor?].

BACKGROUND: Noninvasive ventilation as well established in treatment of chronic respiratory failure. Many announcements and our own experience give evidence that this method of treatment is useful for patients with acute respiratory failure too. Also the actual situation of our health system requires increasing attention to financial points of view. PATIENTS AND METHOD: We analyzed a number of 185 patients who needed mechanical ventilation in our intensive care unit in 1995. 80 of these 185 needed mechanical ventilation due to pulmonary and cardiopulmonary diseases (e. g. cardiac failure, exacerbation of chronic obstructive lung disease, pneumonia and status asthmaticus). 61 received invasive, 19 noninvasive ventilation. RESULTS: Nineteen of 61 patients with invasive and 1 of 19 with noninvasive ventilation died. The mean duration of ventilation was 8.9 (1-50) days in the invasive ventilated group and 2.9 (1-8) days in the noninvasive ventilated group. A cost reduction of nearly 10000 Marks per patient can be calculated, using noninvasive ventilation due to the shorter duration of treatment. CONCLUSION: So noninvasive ventilation is a cost reducing and gentle alternative compared to conventional invasive mechanical ventilation for many patients with acute respiratory failure. It is also practicable in regional hospitals. Further investigation is needed to specify those groups of patients who receive the most benefit from noninvasive ventilation.

Cost-Benefit Analysis↗
PubMed1997

Self management in COPD: one step beyond?

On the basis of the beneficial health effects of self-management in the treatment of other chronic diseases like asthma it might be expected that the active participation of COPD-patients in the management of their disease may reduce the burden of the disease. Self-management of COPD includes sufficient coping behaviour, compliance with inhaled medication, attention to changes in the severity of the disease, adequate inhalation technique, and self adjustment of the medication in case of exacerbations. The results of a pilot study on the effects of self-management in COPD suggest a reduction of morbidity due to COPD. The definite place of self-management in the treatment of COPD has to established by larger, prospective, controlled trials.

Adaptation, Psychological↗