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R Thurnheer

Publications and source records attributed to R Thurnheer.

32 records · Page 2Linked to original sources
PubMed1998

Exercise performance and gas exchange after bilateral video-assisted thoracoscopic lung volume reduction for severe emphysema.

Lung volume reduction surgery (LVRS) improves dyspnoea and pulmonary function in selected patients with severe emphysema. The purpose of this study was to assess the effects of LVRS on exercise performance and gas exchange in relation to changes in pulmonary function. In 40 patients (63.2+/-1.4 yrs, mean+/-SE) with severe emphysema (forced expiratory volume in one second (FEV1) 29+/-1% predicted, residual volume/total lung capacity (RV/TLC) ratio: 0.63+/-0.01) we assessed dyspnoea, pulmonary function and exercise performance before and 3 months after bilateral video-assisted thoracoscopic LVRS. The Medical Research Council dyspnoea score fell from 3.5+/-0.1 to 1.4+/-0.1 (p<0.0005); FEV1 increased by 55+/-9% to 44+/-2% pred (p<0.0005), RV/TLC decreased from 0.63+/-0.01 to 0.51+/-0.02 (p<0.0005). The diffusing capacity remained unchanged. Maximal work load during bicycle ergometry increased from 34.3+/-2.0 to 48.9+/-2.4 W (p< 0.0005), maximal oxygen uptake (V'O2max) from 10.0+/-0.4 to 12.8+/-0.3 mL x kg(-1) x min(-1) (p<0.0005). The increase in maximal ventilation during exercise (V'Emax) from 29.5+/-1.5 to 38.6+/-1.8 L x min(-1) (p<0.0005) was associated with increases in tidal volumes at isowatt and maximal exercise while corresponding breathing frequencies remained unaltered. The increases in V'O2max and V'Emax correlated with the increases in FEV1 and the decreases in RV/TLC. We conclude that the improvement in pulmonary hyperinflation and airflow obstruction after bilateral thoracoscopic lung volume reduction surgery may reduce ventilatory limitation, thereby increasing exercise capacity.

Adult↗
PubMed1997

Salvage therapy with mycophenolate mofetil for lung transplant bronchiolitis obliterans: importance of dosage.

BACKGROUND: Bronchiolitis obliterans (BO) is the most important long-term complication of lung transplantation. Treatment of this condition is often unsuccessful. METHODS: A patient presented with early BO. Despite OKT3 and the addition of methotrexate, the patient needed persistently high doses of prednisone to maintain lung function at a moderate level. Only the substitution of azathioprine by mycophenolate mofetil (MMF, 3 g/day) made it possible to reduce the dose of prednisone. RESULTS: Reduction of the dose of MMF to 2 g/day resulted in a deterioration of lung function, which improved impressively after MMF was increased again to 3 g/day. CONCLUSIONS: MMF may be a valuable therapy for lung transplant BO. However, the use of a high dose, i.e., 3 g/day, may be crucial.

Adult↗
PubMed1997

Radiologic emphysema morphology is associated with outcome after surgical lung volume reduction.

BACKGROUND: Lung volume reduction surgery is known to alleviate dyspnea and to improve pulmonary function, performance in daily activity, and quality of life in selected patients with severe pulmonary emphysema. We investigated the role of radiologically assessed emphysema morphology on functional outcome after a lung volume reduction operation. METHODS: The preoperative chest computed tomograms in 50 consecutive patients who had undergone surgical lung volume reduction were retrospectively reviewed by 6 physicians blinded to the clinical outcome. Emphysema morphology was determined according to a simplified classification (ie, homogeneous, moderately heterogeneous, and markedly heterogeneous; lobe predominance). We studied the impact of these morphologic aspects on functional outcome at 3 months. RESULTS: We found a fair interobserver agreement applying our classification system. Functional improvement after surgical lung volume reduction was best in markedly heterogeneous emphysema with an increase in forced expiratory volume in 1 second of 81% +/- 17% (mean +/- standard error, n = 17) compared with 44% +/- 10% (n = 16) for intermediately heterogeneous emphysema. But also in patients with homogeneous emphysema clinical relevant improvement of function could be observed (increase in forced expiratory volume in 1 second = 34% +/- 6%; n = 17). CONCLUSIONS: The morphologic type of emphysema, assessed by a simplified surgically oriented classification, is an important predictor of surgical outcome. Lung volume reduction surgery may also improve dyspnea and lung function in homogeneous emphysema.

Adult↗
PubMed1997

Thoracoscopic bilateral lung volume reduction for diffuse pulmonary emphysema.

OBJECTIVE: In a prospective study, we investigated the functional results, complications and survival of bilateral video-assisted thoracoscopic (VAT) lung volume reduction (LVR) in a selected group of patients with severe, nonbullous pulmonary emphysema. From January 1994 to September 1996, 42 of 143 candidates (13 female, 29 male, 42-78 years) were operated. They were short of breath on minimal exertion due to severe airflow obstruction and hyperinflation (FEV1 < 30%) pred., TLC > 130% pred., RV > 200% pred.). METHODS: LVR was performed bilaterally by VAT using endoscopic staplers without buttressing the staple lines. Pulmonary function test (PFT), MRC dyspnea score and 12 min walking distance were assessed preoperatively, at 3, 6 and 12 months. In addition lung function was measured at hospital discharge. RESULTS: The patients reported a marked relief of dyspnea, which persisted at all follow-up visits (P<0.001). FEV1 increased from 0.80 +/- 0.24 (L) to 1.14 +/- 0.41 (L) postoperatively, a 43% gain (P < 0.001). A relevant increase of FEV1 persisted for at least 1 year. The residual volume to total lung capacity ratio decreased from 0.64 to 0.56 at hospital discharge. The mean 12 min walking distance increased from 500 +/- 195 (m) to 770 +/- 222 (m) after 1 year (P < 0.001). The mean hospital stay was 13 +/- 5.5 days (median 12.0), drainage time was 9 +/- 4.3 (median 8.0) days. There was no 30 day mortality. Three patients died between 2 and 15 months postoperatively by non surgery related reasons. One patient underwent lung transplantation 5 months after surgical lung volume reduction. CONCLUSIONS: In a selected group of patients with severe, nonbullous pulmonary emphysema, bilateral LVR by VAT results in instantaneous postoperative improvement in pulmonary function and dyspnea. These favorable effects, including an amelioriation in exercise performance, lasted for at least 1 year.

Adult↗
PubMed1997

Hyperthyroidism and pulmonary hypertension.

OBJECTIVES: To identify patients with hyperthyroidism and coincidental pulmonary hypertension and to document reversibility of pulmonary hypertension after treatment of hyperthyroidism. DESIGN: Patients with hyperthyroidism referred for transthoracal echocardiography for any reason that showed elevated pulmonary arterial pressures were collected. After therapy for the thyreotoxic state with documented normalization of thyroid hormone (IT4), pulmonary arterial pressure was measured again noninvasively. SETTING: An out-patient tertiary referral centre. SUBJECTS: The medical records were used to identify, retrospectively, patients with hyperthyroidism and pulmonary hypertension over a three-year period (April 1993 to April 1996). INTERVENTIONS AND MAIN OUTCOME MEASURES: Systolic pulmonary artery pressure (PAPs) was determined by adding up right ventricular systolic pressure (RVSP) and mean right atrial pressure (RAP) measured by continuous-wave Doppler echocardiography according to standard techniques. All patients were treated for hyperthyroidism to normal IT4 levels. After successful therapy. Doppler echocardiography was repeated. RESULTS: Four patients with pulmonary hypertension showing elevated PAPs of 40 +/- 11 mmHg were identified. After therapy. PAPs decreased in all patients to a mean of 25 +/- 6 mmHg. CONCLUSION: The observation of four patients with pulmonary hypertension and hyperthyroidism is striking and suggests a possible pathogenetic link of these disorders.

Adult↗
PubMed1997

Video-assisted thoracoscopic volume reduction surgery in patients with diffuse pulmonary emphysema: gas exchange and anesthesiological management.

Arterial blood gases were studied prospectively using continuous intraarterial blood gas monitoring during thoracoscopic volume reduction surgery (VRS) in 24 patients with advanced diffuse pulmonary emphysema. Additionally, the early postoperative course (48 h) of arterial blood gases was studied retrospectively. Twenty-six operations were performed using a combination of thoracic epidural and general anesthesia with left-sided double-lumen intubation for one-lung ventilation (OLV). Arterial blood gases were determined awake, during two-lung ventilation prior to surgery, during OLV (extreme values), and after tracheal extubation. Additionally, the extremes during the whole procedure were determined: avoiding excessive peak inspiratory pressures (26.4 +/- 7.0 cm H2O), minimum PaO2 was 77 +/- 39 mm Hg (mean +/- SD), maximum PaCO2 65 +/- 14 mm Hg (P < 0.0001 versus preoperative values), and minimum pHa 7.22 +/- 0.08 (P < 0.0001). One tension pneumothorax occurred during OLV. Immediate postoperative extubation was performed in 25 of 26 cases, reintubation was necessary in two cases. One patient with coronary artery disease died 36 h after surgery. Hypercapnia (maximum PaCO2 49 +/- 8 mm Hg, minimum pHa 7.37 +/- 0.04, P < 0.01) was still observed 48 h after surgery. These results demonstrate that adequate oxygenation can be preserved during OLV for VRS, but CO2 elimination is impaired. However, intraoperative hypercapnia and immediate postoperative tracheal extubation are well tolerated.

Adult↗
PubMed1997

Sleep-related laryngospasm.

The term "sleep-related laryngospasm" refers to episodic, abrupt interruption of sleep accompanied by feelings of acute suffocation followed by stridor. The condition is included in the diagnostic and coding manual of the American Sleep Disorders Association (ASDA), but there are few references in the peer-reviewed literature. Our description of the distinct clinical picture associated with this condition is based on an analysis of the histories of a series of 10 patients. The patients and their families gave precise, uniform accounts of the dramatic attacks. Diagnostic work-up included pulmonary and gastroenterological assessment. All patients reported sudden awakening from sleep due to feelings of acute suffocation, accompanied by intense fear. Apnoea lasting 5-45 s was followed by stridor. Breathing returned to normal within minutes. Patients were left exhausted by the attacks. Nine of our 10 patients had evidence of gastro-oesophageal reflux and six responded to antireflux therapy. We conclude that the nocturnal choking attacks (and the occasional daytime attacks experienced by some of the patients) are caused by laryngospasm. The pathogenesis of the apparent underlying laryngeal irritability is unknown. The condition may be related to a gastro-oesophageal reflux.

Adolescent↗
PubMed1997

Coronary artery disease in patients undergoing lung volume reduction surgery for emphysema.

OBJECTIVES: Most patients with severe pulmonary emphysema referred for lung volume reduction surgery (LVRS) have a long-standing history of cigarette smoking. Coronary artery disease (CAD) predisposes to perioperative cardiac complications. Since symptoms and signs of myocardial ischemia are often absent in patients with severe ventilatory impairment even during exercise, we investigated the prevalence of CAD in candidates for LVRS by angiography. DESIGN: We prospectively studied the prevalence of CAD by angiography and assessed the CAD risk factor profile in 41 candidates for LVRS (26 men, 15 women; mean age, 66+/-6.8 years; range, 52 to 76 years), who had no current symptoms or a history of myocardial ischemia. RESULTS: In six patients (15%), asymptomatic but significant coronary lesions (> 70% stenosis) were detected. In five patients, these findings altered the clinical management. Patients with CAD had significant higher cholesterol levels, tended to have smoked more, and had more often additional vascular risk factors. CONCLUSIONS: We found a high prevalence of angiographically significant but clinically silent CAD in this particular population of heavy smokers with advanced emphysema.

Aged↗
PubMed1997

[Bilateral video-assisted thoracoscopic volume reduction surgery for treatment of advanced pulmonary emphysema].

In a prospective study, we investigated the functional results, complications, and survival of patients who underwent bilateral video-assisted thoracoscopic (VAT) lung volume reduction surgery (VRS) for severe, diffuse pulmonary emphysema (FEV1 0.77 +/- 0.03 [1], RV/TLC 0.65, 12' walking distance 482 +/- 26 [m]). From January 94 to March 97, 67 of 179 candidates underwent the operation, and 58 patients (mean age 64 +/- 1.1, range 42-78 years; 17 women) fulfilled the study criteria. There was no 30-day mortality; hyperinflation decreased to an RV/TLC ratio of 0.52 +/- 0.01 after 3 months; FEV1 increased to 1.2 +/- 0.08 [1]; and the 12' walking distance was 687 +/- 29 [m].

Adult↗
PubMed1996

Recurrent brain abscesses in an HIV-positive patient with hereditary hemorrhagic telangiectasia and arteriovenous malformations of the lung.

Patients with hereditary hemorrhagic telangiectasia are at risk for the development of brain abscesses. The history of a 47-year-old man infected with the human immunodeficiency virus and with hereditary hemorrhagic telangiectasia is reported. Within eight months, the patient presented twice with life-threatening cerebral abscesses at different sites. On both occasions, Streptococcus anginosus was cultured from the abscess material. Treatment consisted of parenteral antibiotics and neurosurgical drainage. After treatment of the second occurrence, the patient was placed on a prophylactic regimen of clindamycin. He remains relapse-free and is clinically stable 24 months after the second episode.

Anti-Bacterial Agents↗
PubMed1993

[Giant cell arteritis and aortic dissection in 2 siblings].

We present the case of two female siblings with temporal arteritis, polymyalgia and type B aortic dissection. Aortic aneurysms in families are well known in Marfan's and Ehlers-Danlos syndrome; they can, however, occur without signs of a collagen disorder. In patients with arteritis temporalis the incidence of aortic aneurysms is higher than normal. In a retrospective survey of 20,591 autopsies there were 443 aortic aneurysms (2%), 30 (7%) being a consequence of arteritis. Arteritic processes caused 15% of the thoracic and 5% of the abdominal aneurysms. This is the first description of temporal arteritis, polymyalgia and aortic dissection in siblings. The observation illustrates the danger of aneurysmatic aortic dilatation and/or dissection at a later or chronic stage of arteritis.

Aged↗