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K Rasche

Publications and source records attributed to K Rasche.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Obstructive sleep apnea syndrome: a cardiovascular risk factor?].

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is frequently associated with cardiovascular disease. We investigated endothelium-dependent and endothelium-independent nitric oxide-mediated vasodilatory function in normotensive patients with OSAS using the hand vein compliance technique. PATIENTS AND METHODS: Dose-response curves to the endothelium-dependent vasodilator bradykinin were obtained in 23 male subjects with OSAS and 12 male control subjects of comparable age, height, and weight. RESULTS: Mean (+/- SD) maximum dilation (Emax) to bradykinin was significantly lower in OSAS patients than in controls (59.8 +/- 26.0 vs. 94.8 +/- 9.5%, p < 0.0001). Mean vasodilation with nitroglycerin was not diminished in the OSAS group (90.7 +/- 30.5 vs. 100.3 +/- 12.9% in controls; n.s.). In 11 OSAS patients, a follow-up investigation was performed after at least 2 months of treatment with nasal continuous positive airway pressure (CPAP): Emax to bradykinin rose from 54.5 +/- 19.2% to 111.5 +/- 25.1% after treatment (p < 0.001). Mean vasodilation to nitroglycerin was unchanged. CONCLUSIONS: These results suggest that endothelium-dependent nitric oxide-mediated vasodilation is impaired in patients with OSAS due to an impaired function in the endothelial cells. This impairment is reversible with CPAP treatment.

Bradykinin↗
PubMed2001

Respiratory monitoring in neuromuscular disease - capnography as an additional tool?

Daytime complaints like fatigue, sleepiness and cognitive dysfunction in neuromuscular disease can be due to nocturnal hypercapnia and hypoxemia. Daytime respiratory diagnostics does not reflect sleep disordered breathing. Nocturnal pulse oxymetry and capnography were performed in 11 patients (15-75 years old) with different slowly progressive neuromuscular diseases. Only four patients complained of dyspnea. Pulmonary function was abnormal in three patients. Blood gas samples showed a hypoxemia in three patients. Pulse oxymetry results were pathological in six patients. Nine patients presented abnormal capnographies. According to these results either nocturnal oxygen application was initiated or ventilatory parameters were modified. Daytime symptoms and muscular strength improved markedly. Capnography and pulse oxymetry should be performed during the course of neuromuscular disease to detect respiratory insufficiency. Capnography seems to be a more sensitive indicator for respiratory impairment especially when artificial ventilation has been initiated.

Adolescent↗
PubMed2001

[The impact of different definitions of hypoxemia on the relation between awake pulmonary pressure and hypoxemia during sleep in patients with COPD].

BACKGROUND: Sleep related hypoxemia (SRH) in chronic obstructive pulmonary disease (COPD) can be easily detected by pulse-oximetry and may contribute to the development of pulmonary hypertension (PH). Since several parameters for the quantification of SRH are in use, we investigated which of these parameters has the strongest relation to the awake pulmonary arterial pressure (PAP) and is able to distinguish between patients without and with PH. PATIENTS AND METHODS: 44 COPD-patients (awake PaO2 > or = 60 mm Hg) were investigated. PAP at rest (PAP; pathological threshold > 20 mm Hg) and under physical exercise (PAPB; p.t. > 28 mm Hg) were determined during daytime by Swan-Ganz-catheter. To quantify the degree of SRH the following parameters of nocturnal pulse-oximetry were used: mean nocturnal oxygen saturation (SaO2 m; p.t. < 90%), nadir SaO2 (SaO2 min; p.t. < 85%), and mean time of SaO2 < or = 90% in relation to total time of registration (t90; p.t. > 30%). Linear correlations and regressions as Chi 2-respectively Fisher-test were used for statistical analysis (p < 0.05). RESULTS: Generally there was only a weak relation between PAP and SRH. The best linear correlation at rest respectively under physical exercise was found between PAP and SaO2 min (r = -0.529 resp. -0.541, p < 0.001). Using the above defined thresholds for PAP and SaO2 patients could be most precisely separated into those without and with PH using SaO2 min with a threshold for the pathological range of < 85% (p = 0.030 resp. 0.002). t90 with a threshold > 30%, however, had a much worse selectivity (p = 0.487 resp. 0.057). CONCLUSIONS: In COPD-patients with SRH the closest relation can be found between nadir SaO2 and PAP resp. PAPB. Furthermore nadir SaO2 (< 85%) could more precisely separate patients into those without and with pulmonary hypertension than t90. The overall weak relation between nocturnal oxygenation and pulmonary hypertension shows, however, that other factors such as daytime PaO2, hypercapnia or emphysema are involved in the development of pulmonary hypertension in COPD.

Blood Pressure↗
PubMed2000

[Blood gas analysis in bronchiolo-alveolar carcinoma].

A 44-year old patient is presented with bronchiolo-alveolar carcinoma which had set multiple metastases into the lung. Basic lung function was normal. It is of interest that only blood gases were borderline. There was a huge discrepancy between the extension of the pulmonary tumour and the impairment of lung function. Hence, blood gas analysis at rest and under exercise is a necessary tool in such cases.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1999

[Lymphomatoid granulomatosis: differential diagnosis and therapy].

CASE REPORT: In a 59-year-old patient presenting with fever, malaise and pulmonary masses the diagnosis of lymphomatoid granulomatosis was established histologically by open lung biopsy. Despite an immunosuppressive therapy with cyclophosphamide and prednisolone partial remission was achieved for no longer than 8 weeks. Five months later he died in a septic condition. CLINICAL PRESENTATION: In our paper we discuss the present case and give a short review of the literature. Lymphomatoid granulomatosis is a rare angiocentric and angiodestructive condition which shows characteristics of both a lympho-proliferative and a necrotizing aseptic granulomatous process. It involves most frequently lungs, central nervous system and skin. The clinical course is variable, but mortality is high. Malignant lymphoma is a frequent fatal complication. Immunologic dysfunction and EBV-associated B-cell transformation seem to play an important role in the pathogenesis of this disease. TREATMENT: As optimal therapy is unknown, attempts have been made with immunosuppressive therapy according to the Fauci scheme as well as with combined chemotherapy according to the CHOP scheme and radiation. In a recent trial, promising results have been reported for interferon alpha 2b.

Antineoplastic Agents↗
PubMed1999

[Intermittent positive pressure ventilation after sternectomy].

BACKGROUND: The indication for intermittent positive pressure ventilation (IPPV) is the symptomatic hypercapnic ventilatory insufficiency. Beside the improvement of life quality and extension of life time the aim of IPPV is a reduction of the secondary effects of chronic hypoventilation in order to stabilize the symptoms. PATIENTS AND METHODS: We examined 2 patients after sternectomy because of osteomyelitis who developed a symptomatic ventilatory insufficiency together with recurrent dys- and atelectasis and pneumonia, resistant against to antibiotic treatment. After initiation of IPPV the patients turned to a clinically stable condition. The nocturnal oxygen saturation improved as well as the daytime blood gas analysis. In these patients the indication for IPPV was not only the symptomatic hypercapnic ventilatory insufficiency but also the prophylaxis of recurrent dys- and atelectasis and pneumonia. Antibiotic therapy after sternectomy is often not successful, therefore in case of recurrent infections in patients with unstable thorax the early initiation of IPPV seems to be useful.

Aged↗
PubMed1999

[Effect of acupuncture on quality of life, mouth occlusion pressures and lung function in COPD].

BACKGROUND: There are few data concerning the effect of acupuncture in patients suffering from COPD. We conducted a prospective randomized and placebo-controlled pilot study to analyze the effect of acupuncture according to the rules of traditional chinese medicine on quality of life, pulmonary function testing and inspiratory mouth occlusion pressures (MOP). PATIENTS AND METHODS: We randomised 10 patients with stable COPD to a 2-week treatment of 7 verum acupuncture or placebo acupuncture sessions. Before and after treatment we performed pulmonary function tests as well as an interview with the chronic respiratory disease questionnaire. MOP were taken on day 1, 5 and 7 before and after punction to assess function of the respiratory pump. RESULTS: Patients receiving verum acupuncture improved significantly with FEV1 and RV/TLC. There was an improvement of large magnitude in quality of life and a trend of lower demand of the respiratory pump. In the placebo group we saw only a slight improvement of quality of life, a deterioration of lung function parameters and a trend of higher demand of the respiratory pump. CONCLUSION: Although the small number of subjects allows no further conclusions this pilot study proves feasibility of acupuncture in COPD and shows that acupuncture is worthy for further investigation in patients suffering from COPD.

Acupuncture Therapy↗
PubMed1998

Neuropsychological investigations and event-related potentials in obstructive sleep apnea syndrome before and during CPAP-therapy.

Patients with obstructive sleep apnea syndrome (OSAS) suffer from daytime sleepiness and a decline of cognitive functions. The study evaluated whether special cognitive disabilities predominate in OSAS. Besides the number connection test (ZVT), judging information processing and working velocity, computer-assisted (Wiener Testsystem and Zimmermann Testbatterie) neuropsychological testing was performed in 31 OSAS patients (50.1 +/- 9.4 years) before starting nasal continuous positive airway pressure (nCPAP) therapy. Identical test battery was performed in 10 male healthy volunteers (48 +/- 9.9 years). In addition visual evoked event-related potentials (ERPs) were recorded, the P3-component was evaluated. Impairment of alertness (P < 0.001), selective attention (P < 0.001) and continuous attention (P < 0.001) could be revealed, vigilance was not altered. Cognitive deficits were correlated with the degree of nocturnal hypoxemia. They were not linked to the apnea/hypopnea-index (AHI), arousal index or vigilance parameters. During 6 months of nCPAP-therapy (15 patients) alertness and continuous attention improved significantly (P < 0.01), intra-individual different pathological results persisted however. P3 latencies also remained prolonged. Chronic intermittent nocturnal hypoxemia in OSAS-patients obviously leads to cognitive deficits. ERP partially generated in subcortical cerebral structures represent a neurophysiological tool indicating brain dysfunction which cannot be evaluated by neuropsychological tests. Objective neuropsychological testing is needed in revealing therapeutic effects in OSAS-patients. Remaining deficits during sufficient nCPAP-therapy may reflect irreversible hypoxic cerebral damage.

Attention↗
PubMed1998

[Effect of salmeterol in obstructive sleep apnea syndrome].

The effect of inhaled long-acting beta 2-agonists on obstructive sleep apnoea syndrome (OSAS) is unknown, though from the pharmacological point of view both therapeutic and adverse effects might be discussed. The purpose of this study was to obtain data on the efficacy and safety of Salmeterol in patients with OSAS. In a randomised, double-blind, placebo-controlled, crossover study effects of Salmeterol were investigated in 20 patients with OSAS: 4 female, 16 male; age 53.0 +/- 7.8 years, body mass index (BMI) 28.0 +/- 3.0 kg.m-2; apnoea hypopnoea index (AHI) 35.6 +/- 17.8 h-1. Patients with asthma, chronic obstructive pulmonary disease (COPD), and left heart failure were excluded. Placebo or verum (50 micrograms Salmeterol) were administered at 7 p.m. by metered dose inhaler and spacer device. All patients underwent full polysomnography during baseline, placebo, and verum night. Statistical analysis was performed by Student's t-test (p < 0.05). Between placebo and verum there were no differences in total sleep time, sleep stages, apnoea index (AI), AHI, and nadir SaO2. There was, however, a significant deterioration of mean SaO2 (placebo 93.1 +/- 2.0 vs Salmeterol 92.5 +/- 2.2%) and of relative time spent with SaO2 < or = 90% (placebo 13.1 +/- 14.5 vs Salmeterol 19.5 +/- 20.8%), as well as a significant increase in heart rate (placebo 63.1 +/- 9.2 vs Salmeterol 65.6 +/- 9.3 h-1). Thus, in patients with OSAS Salmeterol had no adverse effect on quality of sleep, AI or AHI. The slight increase in heart rate and the deterioration of oxygen saturation are clinically irrelevant. The latter might be due to ventilation-perfusion-mismatch. This study demonstrates that Salmeterol has no influence on obstructive sleep apnoea and hypopnoea, but on the other hand provides an acceptable safety profile in OSAS. This might be of special importance in patients suffering from both OSAS and obstructive airway disease.

Adrenergic beta-Agonists↗
PubMed1998

[Dyspnea and lung function. Results of a multicenter study].

UNLABELLED: In seven pneumological centres 266 patients with different pneumological diseases were investigated. After having clarified several questions regarding the severity of the dyspnoea, cough intensity and the volume of sputum, as well as basic clinical investigation and after an x-ray of the thorax, the diagnosis was arrived at. Subsequently the lung function investigation with the flow-volume curve (including IVC, FVC, PEF, FEV1, MEF50%) and the body plethysmographic Rt and IGV were carried out. Different quality control procedures at and between the different centres ensured comparable results. All centres agreed to using methods well compatible with each other. The question as to which kind of parameters of lung function would agree best with the amount of the dyspnoea, was resolved. The causes for the large scatter of the results are described. Cough and sputum exercise an influence even on the degree of dyspnoea, but not by deteriorating the lung function. The results are shown for the entire collective (Part I) in respect of the different diagnoses (Part II). With different diagnosis the same significant correlations exist but the curves are positioned at different levels of the coordinate system. CONCLUSION: Significant correlations exist between the dyspnoea scale and function parameters. There are individual differences between the dyspnoea scale and disturbances of the function parameters. Carefully performed lung function analyse definitely important in any case.

Adult↗
PubMed1997

[Reproducibility of inspiratory mouth occlusion pressure with a mobile computer-assisted measuring system].

BACKGROUND: The measurement of mouth occlusion pressure is an easy method to assess respiratory drive and muscle function. In addition to a variety of stationary systems, recently a mobile computer assisted system became available. In this study the repeatability of inspiratory mouth occlusion pressures with such a mobile system was examined. METHOD: Maximal inspiratory mouth occlusion pressure (PImax), mouth occlusion pressure 100 ms after onset of normal inspiration (P0,1), and PImax after 100 ms (P0,1max) were investigated 4 times in 12 healthy subjects. Measurements were performed with a mobile system (resPImax). Criteria of repeatability were analysis of variance, intraindividual standard deviation, variation coefficient and intraclass correlation coefficient. RESULTS: Of all analyzed parameters PImax was most reproducible with a 5.3% share of variance due to measurement methods of the total variance. P0,1 was least reproducible. There was no statistically significant difference between the results of each day. The variance due to measurement methods varied between 5.3% and 30%. CONCLUSION: The repeatability of mouth occlusion pressures with this mobile device was good and partly superior to stationary systems. The concept of a mobile measuring unit simplifies getting results of bed-bound and mechanically ventilated patients.

Adult↗
PubMed1997

Oxidant scavenger function of ambroxol in vitro: a comparison with N-acetylcysteine.

Highly reactive oxygen metabolites play an important role in inflammatory processes in the lung. Ambroxol (2-amino-3,5-dibromo-N-[trans-4- hydroxycyclohexyl]benzylamine) has been shown to reduce oxidant-mediated cell damage. However, the mechanism of this effect remains unclear. In order to evaluate oxidant scavenger function increasing concentrations of ambroxol (0-10(-3) mol/l) were compared with equimolar concentrations of N-acetylcysteine (NAC) and glutathione (GSH) in vitro to reduce OH. (hydroxyl radical), HOC1 (hypochlorous acid), O-2 (superoxide anion) and H2O2 (hydrogen peroxide). OH. was measured spectrophotometrically (deoxyribose assay); O-2 (xanthine/x-oxidase), H2O2 and HOC1 (HOC1/OC1-) were determined by chemiluminescence. Ambroxol, NAC and reduced GSH scavenged OH. significantly at 10(-3) mol/l, while HOC1 was inhibited at concentrations > or = 10(-4) mol/l completely (P < 0.01). NAC and GSH had no anti-O-2 function, while ambroxol (10(-4) mol/l) reduced O-2 by 14.3 +/- 6.7%. In contrast, GSH and NAC scavenged H2O2 at > 10(-6) mol/l (P < 0.01), while ambroxol had no anti-H2O2 effect. Our data demonstrate direct oxidant-reducing capabilities of ambroxol, which may be directly related to the aromatic moiety of the molecule. However, high concentrations (micromolar concentrations) are needed. Due to differences in direct oxidant scavenger function, a combination of ambroxol and NAC could be beneficial in antioxidant therapy.

Acetylcysteine↗
PubMed1997

Quantitative bronchial challenge tests with wheat flour dust administered by spinhaler: comparison with aqueous wheat flour extract inhalation.

BACKGROUND: Quantitative bronchial challenge tests with flour dust for the diagnosis of bakers' asthma may be performed by inhalation of flour delivered to the patient's respiratory tract by sophisticated equipment. OBJECTIVE: This study was carried out to assess the diagnostic value of bronchial challenge tests with flour dust inhalation from capsules administered by a Spinhaler (Fisons Inc., Loughborough, U.K.) and to compare this method quantitatively with bronchial challenge tests with a commercially available wheat flour extract. METHODS: A highly selected group of 36 bakers with work-related symptoms of rhinitis or asthma were referred to our department, a tertiary referral center, from 1992 to 1995. Thirty-four of the subjects and 10 atopic control subjects were included in this study. After the assessment of bronchial hyperresponsiveness on day 1, subjects were randomized to inhale an aqueous wheat flour extract at concentrations of 0.01, 0.1, 1, 10, and 100 mg/ml by tidal volume breathing for 10 minutes or to inhale wheat flour dust filled in capsules on days 2 and 3. One, two, and four capsules (maximum of 7 cumulative capsules) of flour dust were administered by a Spinhaler. In addition, skin prick tests were performed with a battery of environmental and occupational allergens. Total serum IgE and specific IgE to wheat flour were measured by standard procedures. RESULTS: Seventeen bakers and two control subjects demonstrated a positive skin test response to wheat flour (wheal > or = 3 mm). Fifteen bakers demonstrated a fall of 50% or more in specific airway conductance after inhalation of the commercial wheat flour extract, and 11 demonstrated such a fall in specific airway conductance after inhalation of wheat dust. Three control subjects had a positive bronchial challenge response to the extract, but dust inhalation from the capsule did not cause positive bronchial reactions in control subjects. When a 50% fall of specific airway conductance was used as criterion for a positive bronchial provocation test result, sensitivity for the extract or dust inhalation was 0.44 and 0.32, respectively, and specificity was 0.7 and 1.0, respectively. If only subjects with a positive skin test response to wheat flour were considered, sensitivity of both tests was 0.65. With more stringent criteria for the gold standard, there was a trend for a higher sensitivity but a lower specificity of the extract inhalation. Both methods were safe. CONCLUSION: The validity of bronchial challenge tests with wheat flour dust inhaled from Spinhaler capsules was superior to that of tests done with a commercially available aqueous wheat flour extract. The higher specificity of the Spinhaler method might be an advantage if bronchial challenge tests are used as confirmation tests.

Administration, Inhalation↗
PubMed1997

[Stress test blood gas analysis in chronic obstructive lung diseases].

This study was conducted to investigate the clinical value of blood gas analysis during exercise in patients with COPD and healthy controls using the new criteria of the Deutsche Gesellschaft für Pneumologie (DGP) for performance and interpretation of blood gas analysis during exercise. A total of 64 patients with COPD (age: 63.7 +/- 10.1 years) and 35 healthy controls (age: 35.0 +/- 14.3 years) exercised on a bicycle ergometer to their submaximal capacity under steady state conditions (patients: 44.4 +/- 24.6 watt vs. 102.4 +/- 32.1 watt; p < 0.01). A pathological response for PaO2 occurred in 3 of 35 controls (8.6%) and 14 of 64 patients (21.9%; p < 0.01). A decrease in PaO2 yielded a sensitivity of 28% and a specificity of 92% in respect of patients with emphysema. Significant associations of lung function parameters at rest and blood gases under exercise were found by linear regression analysis (airway resistance (Rt): beta = -0.48; p < 0.001) and PaCO2 (FEV1: beta = -0.27; p < 0.05). This study demonstrates that in patients with COPD parameters of lung function and blood gas analysis at rest are already good predictors of gas exchange under exercise conditions. In individual cases, however, prediction may not be possible. This underlines the importance of the exercise test to investigate gas exchange under diagnostic (i.e. dyspnoea, medical opinion) and therapeutic aspects (i.e. therapy control). For COPD patients, the rule of the DGP yielded a poor sensitivity, but an excellent specificity in the diagnosis of emphysema, which yields confirmation of the diagnosis only in conjunction with, and complementary to, other methods.

Adult↗
PubMed1997

[Event related potentials and neuropsychological studies in sleep apnea patients].

Patients with obstructive sleep apnoea syndrome (OSAS) commonly complain about daytime sleepiness and a decline of cognitive functions. Several diagnostic tools have been established to judge objectively vigilance and cognitive impairment. Forty OSAS patients aged between 34 and 74 years were examined via several neuropsychological tests (e.g. vigilance test of the Wiener Testsystem, number connection test ("Zahlenverbindungstest-ZVT") to assess working velocity and information processing, d2-test to rate concentration on exertion) before starting continuous positive airway pressure (CPAP) therapy. In addition, visual evoked event-related potentials (ERPs) were recorded; the P3-component was evaluated. All patients subjectively stated daytime sleepiness and cognitive dysfunctions to variable degrees. Each patient showed at least one pathological result in the neuropsychological tests; vigilance impairment could be revealed only in 7 patients. P3-latencies were increased in OSAS patients when compared to age-matched controls (408.1 +/- 44.4 ms versus 373.4 +/- 32.5 ms; p < 0.03). P3-latencies and concentration on exertion showed a significant correlation with respect to the relative part of the total sleep time in which the patient's oxygen saturation was below 90% (p < 0.05). Thus it could be demonstrated that cognitive deficits in OSAS patients are a result of chronic intermittent oxyhaemoglobin desaturation rather than of a decline in daytime vigilance. ERPs represent an objective neurophysiological tool in neuropsychological examination. As they are also generated in subcortical cerebral structures they may indicate cognitive dysfunctions which cannot be evaluated by neuropsychological tests. If lead of ERPs is possible in special sleep centres they should be additionally used in the assessment of cognitive functions in OSAS patients.

Adult↗