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Biomedical subjects

N Konietzko

Publications and source records attributed to N Konietzko.

At least 19 recordsLinked to original sources
PubMed1992

[The current role of thoracoplasty in treatment of chronic pleural empyema].

To demonstrate the indication for surgery, the preoperative and postoperative course, and to assess the influence of thoracoplasty on respiratory physiology, the data of patients subjected to thoracoplasty during the past 30 years at our hospital were evaluated. Final assessment was performed separately for patients with and without preceding pulmonary resection. In 21 cases there was an unspecific empyema of the pleura and in 6 cases a specific one; in 14 cases there was also a concomitant bronchopleural fistula. After a washing-out period of 92 days (24-283) and after surgery had been unsuccessful in 9 patients, standard thoracoplasty was performed, complemented by a "jalousie" ("Venetian blind") plasty after Heller. Postoperative lethality was 11.1%. 5 patients developed pleuro-cutaneous fistulas that healed by local treatment; in one patient, a small residual cavity remained that required an additional plasty for correction. In 94% of the patients who had been operated upon, scoliosis occurred convex to the thoracoplasty; this was more marked in patients in whom lung resection had been performed than in patients without resection. Restrictive ventilatory disorders were seen in the lung function of 55% of the patients, whereas mixed restrictive-obstructive disorders occurred in 45%. Ergospirometry resulted under load besides in an increased respiratory minute volume (AMV), in a proportionate dead space of the AMV which was significantly higher than preoperatively. Despite the considerable functional and aesthetic consequences resulting therefrom, thoracoplasty still has its justification in refractory pleura empyemas as an ultimate means of cleaning up.

Adenocarcinoma↗
PubMed1978

[Differential diagnosis of stenoses of the large airways by means of lung function tests (author's transl)].

The different pathophysiological mechanisms involved in producing airflow obstruction at different sites in the tracheobronchial tree enable their differentiation by means of pulmonary function tests. These tests include volume-time measurements at forced in- and expiration, flow-volume measurements forced in- and expiration and flow-pressure measurements in the bodyplethysmograph during quiet breathing. In 23 patients with localized stenosis of the central tracheobronchial tree (12 with extra-thoracic tracheal stenosis, 4 with intrathoracic tracheal stenosis and 7 with main bronchus stenosis) the following parameters proved to be of diagnostic value: In the differential diagnosis of intra-extra-thoracic tracheal stenosis the forced in-expiratory flow-volume curve, in main bronchus stenosis the plethysmographically obtained flow-pressure curve with a large phase lag at zero flow ("trapped air"). In extreme cases the qualitative analysis of the spirogram in connection with the static lung volumes can be diagnostic.

Airway Obstruction↗
PubMed1977

Problems in evaluating the effect of secretolytic agents on the mucociliary system by means of radioactive particles.

In a double-blind cross-over study the effect of two secretolytic agents on the mucociliary clearance was tested in 8 patients with mild chronic obstructive bronchitis. Clearance was assessed from the removal rate of previously inhaled sulfur colloid particles, tagged with 99Tcm. For the interpreatation of the results, obtained by this method, it is essential to take into account the pattern of particle deposition. For example there was a faster clearance under placebo compared to the secretolytic drugs because of a more central deposition. To overcome this problem different approaches were therefore tested. The following constellations proved to be useful in assessing the effect of secretolytic drugs: (1) change in deposition patter; (2) clearance rate, if no change in deposition takes place; (3) clearance rate from a peripheral area of the lung. An attempt to apply a simple three compartment model proved to be unpracticable probably becuase of the complexity of the mechanism involved. One of these mechanisms could be a reversal in mucus transport, observed at least in one patient, a finding which might be of pathophysiological relevance.

Airway Obstruction↗
PubMed1977

[Ventilation and gas-dynamic work of breathing during CO2 stimulation in patients with airways obstruction prior to and following bronchodilation with reproterol (author's transl)].

A new, non-invasive method for measuring chemo-sensitivity of the respiratory center is described, one that may sensibly be applied in patients with airways obstruction. It is used for measurement of ventilation and gas-dynamic work of breathing in body plethysmography during a modified unsteady state of CO2 rebreathing technique. In 9 patients suffering from chronic obstructive bronchitis, a linear correlation between the end-expiratory CO2 partial pressure and the respiratory work rate vs. the airways resistance was established while between the end-expiratory PCO2 and the respiratory minute volume as well as the respiratory minute volume and the respiratory work rate vs. airways resistance, a non-linear correlation exists. In tests with 7-(3[2-(3 5-dihydroxyphenyl)-2-hydroxy-ethyl-amino]-propyl)-theophylline (reproterol, Bronchospasmin), a beta-phenylethyl-amino alkylxanthine, with known bronchodilating effects and a preparation for which pharmacological considerations of central-analeptic effects cannot definitely be excluded, this method revealed in patients with airways obstruction no breathing stimulation. In contrast, however, specific airways resistance in patients afflicted with bronchitis was statistically significantly reduced.

Adult↗
PubMed1976

[Cardiopulmonary adaptation to acute hypoxia (author's transl)].

The most important adaptive mechanism to acute hypoxia is alveolar hyperventilation which improves the oxygen uptake in the lung. The delivery of oxygen to the particular organs is regulated according to their vital function. An essential adaptive mechanism can not be observed above an inspiratory O2 partial pressure of 100 mm mercury, corresponding to an altitude of about 3000 m in normals. In contrast, in patients with cardio-pulmonary disturbances adaptive mechanisms take place at far lower altitudes. Especially in patients with arterial hypoxemia, pulmonary hypertension and occlusive vascular disease moderate hypoxia may lead to decompensation of an a priori unstable equilibirum.

Acclimatization↗
PubMed1976

[Functional scintigraphic radiospirometry. First clinical results in patients with lung diseases].

First clinical results of patients with diseases of the lungs. The previous experiences on patients with diseases of the lungs reveal that the regional function diagnostics of the lungs may be extended and improved by functional scintigraphic radiospirometry. Because of the determination of regional lung volumes restrictive lung diseases can be differentiated and analysed more exactly than it has been possible before by the examinations of perfusion and ventilation alone. A further advance of the determination of lung volume is that the question of functional operability can be cleared up exactly. In our opinion the routine use of the functional scintigraphic radiospirometry is justified. A contraindication for this kind of examination should only be pregnancy.

Adult↗
PubMed1975

[Investigation of the mucociliary clearance by means of 99mTc-labelled sulfur colloid (author's transl)].

The mucociliary system of the lung was studied in eight normal subjects and ten patients with chronic bronchitis, using sulfur colloids, labelled with 99mTechnetium. By recording the radioactive impulses over the lung with a scintillation camera and analysing the data with a computer, we were able to exclude extrapulmonary artefacts and to select central areas of the tracheobronchial tree. Time activity curves obtained over the central airways were interpreted by means of a model. In bronchitics the disappearance rate of the radioactive particles was found to depend upon the pattern of deposition and the degress of airway obstruction. Because of the good reproducibility in one and the same subject, the effect of drugs, influencing the mucociliary system, can be tested. We used a newly developed vagolytic substance which did not influence the mucociliary system and which reduced little the airway resistance in patients with chronic bronchitis at the administered dose.

Adult↗
PubMed1975

[Rapidly debilitating disease with generalized lymphadenopathy, skin involvement and interstitial pulmonary infiltration (report of three cases)].

Generalized but well-circumscribed lymphadenopathy and rash-like skin changes were observed in three men, aged 58 to 75 years. There was a reticular appearance in the chest X-ray. Dyspnoea, weakness, marked weight loss, changing but marked lymphopenia, markedly increased blood-sedimentation rate, and an always negative Tine test were present in all three. Despite antibiotics, cytostatic drugs and prednisolone the disease quickly ended fatally with high fever, general debilitation and pneumonia. Post-mortem examination revealed diffuse lymphatic hyperplasia with plasma-cell infiltration in the lymph nodes, tonsils and lymphatic tissue of the intestines, and diffuse hyperplasia of the endothelial venules, together with basophilic blast cells, eosimophilic granulocytes and reticulum cells with broad nucleoli. The spleen was normal or enlarged. Spleen, lung tissue and lymphatics, the skin in the area of the small vessels, hair follicles and sweat glands contained lymphocytes, plasma cells and eosinophilic leucocytes. The spleen, if enlarged, also had focal necroses in its periarteriolar septa. In two cases electrophoresis revealed beta-globulin poorly demarkated from gamma-globulin, doubling and increase. In the third case, IgA was markedly increased with one each monoclonal IgG1 und IgA, and corresponding shift in the chi/lambda relationship in serum. Immunohistologically, lymphocytes were made up of about 20 percent IgG-containing and about 25 percent IgA-containing cells. Lymphopenia, if present, was associated with markedly reduced blast transformation of peripheral lymphocytes to phytohaemagglutinin. The granulocytes were defective (intracellular killing of Candida albicans and Staphylococcus aureus), while the nitrobluetetrazolium test was normal. There was RBC phagocytosis in the macrophages of bone marrow and in Kupffer cells of all three cases.

Aged↗
PubMed1975

Effect of isosorbide dinitrate on hemodynamics and respiration of patients with coronary artery disease and of patients with chronic cor pulmonale.

The influence of isosorbide dinitrate on hemodynamics and gas exchange was studied in 10 patients with coronary artery disease and 10 patients with chronic cor pulmonale. A significant decrease in total pulmonary vascular resistance was found in both groups. This effect seemed mainly to be due to improved conditions for the left ventricle in the patients with coronary heart disease, while it could be explained by vasodilatation of the precapillary pulmonary resistive vessels in the patients with cor pulmonale. In the latter group, there was also a significant increase in the alveolo-arterial PO-2 gradient.

Adult↗