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Biomedical subjects

R Buhl

Publications and source records attributed to R Buhl.

152 records · Page 9Linked to original sources
PubMed1986

[Lung compliance in man is impaired by the rapid injection of alfentanyl].

To demonstrate opioid-induced muscular rigidity, compliance was measured in patients after induction of anaesthesia with etomidate (0.3 mg/kg) and N2O/O2 (2:1) ventilation. Alfentanil was given subsequently to two groups of patients: either as a bolus injection (n = 15) over 3 s, or as a slow injection (n = 15) over 30 s. Significant reduction of compliance (max. 30%) was observed after rapid injection in the following 4 min. This effect was promptly reversed by succinylcholine (25 mg i.v.). The slow injection of the opioid over 30 s, was followed by a small insignificant reduction in compliance. Alfentanil is increasingly used for short-term anaesthesia where no muscle relaxants are administered. Thus slow injection of the opioid is advised in order not to impair adequate ventilation.

Adult↗
PubMedDate not supplied

Newly diagnosed chronic obstructive pulmonary disease. Clinical features and distribution of the novel stages of the Global Initiative for Obstructive Lung Disease.

BACKGROUND: The new guidelines of the Global Initiative for Obstructive Lung Disease (GOLD) propose a novel staging system for COPD. This study describes the frequency distribution of GOLD stages in newly diagnosed COPD patients in a large city pulmonary practice. METHODS: All patients newly admitted between 1995 and 1996 were analyzed retrospectively. Incident COPD cases were classified according to GOLD criteria. RESULTS: Among 1,434 patients, 210 were diagnosed with chronic obstructive pulmonary disease (COPD) (60% males, age 55 years, range 20-82 years). 67.5% of the patients were current smokers, 27% ex-smokers, and 5.5% nonsmokers. Based on GOLD criteria, 37% had stage 0, 5% stage I, 46% stage II, and 12% stage III COPD. Symptoms leading patients to seek medical advice were cough (84%), exertional dyspnea (70%), and sputum (45%), with a median symptom duration of 12 months (range 1-240 months). Compared with patients with GOLD stages 0-1, those with stages 2-3 were older (60 vs. 47 years, p < 0.001), heavier smokers (40 vs. 20 pack-years, p < 0.001), had a longer duration of symptoms (24 vs. 6 months, p < 0.001), and elevated IgE (stage 3 only, p < 0.04 vs. stages 0-2). Interestingly, stage 0 COPD patients did not have 'normal' spirometry, as indicated by significantly lower FEV(1) (% predicted) and FEF(25-75) (% predicted), compared with age-matched nonsmoking controls (93.1 +/- 1.8 vs. 99 +/- 1.6, p = 0.004; and 76.2 +/- 2.8 vs. 91.2 +/- 2.9, p = 0.0003, respectively). CONCLUSIONS: The majority of COPD patients seek medical advice at advanced disease stages, and smoke actively despite severe symptoms and functional impairment. However, nearly every second patient presents at stages 0-1, thus opening a window for therapeutic or behavioral intervention. GOLD guidelines are a useful basis to reinforce screening programs aimed at early detection and prevention of progressive COPD in individuals at risk and smoking cessation.

Adult↗
PubMedDate not supplied

Platinum-based, leukocyte-depleting chemotherapy does not alter induced sputum markers of neutrophilic inflammation in COPD patients with unresectable non-small cell lung cancer.

BACKGROUND: Neutrophilic inflammation is a major feature of chronic obstructive pulmonary disease (COPD), and several novel therapies aim at the suppression of neutrophils in COPD. Due to the abundance and redundancy of mediators involved in neutrophilic inflammation, there is an ongoing controversy about the feasibility of such anti-neutrophilic approaches. Systemic chemotherapy has broad side effects, including neutrophil toxicity. OBJECTIVES: In this observational study, we have measured cellular and neutrophil-related inflammatory markers in induced sputum of COPD patients with unresectable non-small cell lung cancer (NSCLC) undergoing platinum-based chemotherapy. METHODS: 15 COPD/NSCLC patients were followed during their first course of chemotherapy with cisplatin (60 mg/m(2) days 1 and 7) and etoposide (100 mg/m(2) days 3, 4, and 5). Sputum induction was performed before, and 3 weeks after chemotherapy. Peripheral blood count, sputum total cells and differentials, and the concentrations of the inflammatory markers interleukin (IL)-8, and matrix metalloproteinase (MMP)-9 in sputum supernatant were analyzed. RESULTS: Similar to COPD controls (n = 12), COPD/NSCLC patients had increased levels of absolute and relative sputum neutrophils, IL-8, and MMP-9 at baseline, when compared with healthy controls (n = 14, p < 0.001, all comparisons). After chemotherapy, there was a significant reduction in peripheral blood leukocytes (pre: 10,736 +/- 550, post: 6,536 +/- 1,064 cells/microl, p = 0.002) and log neutrophils (pre: 8.9 +/- 0.09, post: 8.1 +/- 0.2 cells/microl, p = 0.004), whereas log sputum neutrophils (pre: 0.3 +/- 0.37, post: 0.18 +/- 0.3 cells x 10(6)/ml, p = 0.1), IL-8 (pre 15.9 +/- 3.8, post: 17.7 +/- 3.6 ng/ml, p = 0.7), and log MMP-9 (pre: 5.3 +/- 0.57, post: 5.6 +/- 0.7 ng/ml, p = 0.33) remained unchanged. CONCLUSION: A single course of platinum-based chemotherapy markedly decreases peripheral blood neutrophils, but has no effect on inflammatory patterns of induced sputum in COPD patients with unresectable NSCLC.

Adult↗
PubMedDate not supplied

Stability of glutathione in induced sputum: impact of freezing.

BACKGROUND: Oxidative stress has repeatedly been linked to the pathogenesis of pulmonary disorders like asthma and chronic obstructive pulmonary disease. Measuring glutathione (GSH) in induced sputum (IS) offers a noninvasive tool to study oxidative stress in airway diseases. OBJECTIVES: This study assessed the stability of GSH in sputum supernatant under varying conditions. METHODS: GSH in IS of 14 (7 healthy, 4 chronic obstructive pulmonary disease, 3 allergic rhinitis) nonsmoking subjects was quantified spectrophotometrically. The stability of GSH in supernatant was analyzed over 24 h under different ambient conditions (room temperature and cooling at 4 degrees C). Reproducibility of GSH measurements in immediately processed and frozen supernatant (+72 h) was expressed by intraclass correlation coefficient (R(i)) and coefficient of repeatability (CR). RESULTS: GSH recovery in supernatant decreased in a time- and temperature-dependent manner. Samples stored at 4 degrees C and room temperature showed a rapid decline of stability after 2 h. Mean GSH concentrations in IS after freezing (-20 degrees C) and thawing after 72 h were not significantly different from GSH values measured immediately after processing of the samples (immediate processing: 17.9 +/- 13.9 microM; 72 h freezing: 16.4 +/- 12.9 microM, p = 0.2). The reproducibility between immediately processed and frozen samples was excellent (R(i) = 0.97; CR = 5.7 microM). CONCLUSIONS: Storage of sputum supernatant at room temperature or 4 degrees C leads to a rapid decline of GSH recovery compared with baseline values. Immediate freezing of samples is a suitable and valid alternative to rapid processing and allows collection and shipment of samples for subsequent analysis.

Freezing↗
PubMedDate not supplied

Somatosensory-evoked potentials (SEPs) are affected differently by mu- and kappa-selective opioids in the dog.

Alfentanil, a mu-opioid receptor ligand, induced a dose-related suppression of the early N50 peak and an increase in latency of the late N140 peak. The highest dose blocked all potentials. These effects were reversible by naloxone. The kappa-ligand bremazocine, induced a dose-related increase in latency of the late P150 peak which was, however, reversed by the specific kappa-antagonist Mr2266, not by naloxone. Continuous blockade of the mu-receptor with low-dose naloxone topped with cumulative doses of nalbuphine, a mixed narcotic analgesic, resulted in a Mr 2266-reversible increase in latency of the late N100 peak. Influences of the opioids on the SEP may account for their difference in clinical effects.

Alfentanil↗