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Biomedical subjects

V Schulz

Publications and source records attributed to V Schulz.

At least 37 records · Page 2Linked to original sources
PubMed1999

[High dose St. John's wort extract as a phytogenic antidepressant].

In 1998 a special standardized high-dose hypericum extract has been approved in Austria and Germany for treatment of mild and moderate depression. The efficacy has been already recognized since 1984 from the German Health Authorities based on traditional knowledge. However, this has been substantiated in the subsequent years in controlled clinical trials. 20 of these studies including a total of 1,787 patients have been filed, among them 10 older studies in which hypericum was extracted with ethanol compared to newer studies in which the extract was methanol (LI 160). In the past 10 years several controlled clinical trials have been conducted compared with placebo as well as synthetic antidepressants. These studies have shown that the effective dosage is within a range of 600 to 900 mg extract. The side effects are substantially fewer than with synthetic antidepressants and range within 3%. The most important risk is photosensitization, which is however without clinical relevance in the recommended dosages. Recent pharmacological studies revealed that hypericum extracts have a similar mechanism of action like the selective serotonin reuptake inhibitors (SSRI), however, very likely to a smaller extent.

Antidepressive Agents↗
PubMed1999

Outpatient use of low molecular weight heparin (Dalteparin) for the treatment of deep vein thrombosis of the upper extremity.

Upper extremity deep vein thrombosis (DVT) is now recognized as a major cause of morbidity and mortality. There is little information regarding the most effective treatment of this condition. We report a prospective cohort study of the use of low molecular weight heparin (LMWH) in the outpatient management of upper extremity DVT. Forty-six patients were managed as outpatients for objectively documented upper extremity DVT with dalteparin (200 aXa u/kg), for a minimum of five days. Warfarin was usually initiated on the first day with a target INR of 2.0-3.0. Most patients had an underlying malignancy or a history of a central line. All patients were followed for 12 weeks from diagnosis. Only one patient had a major bleed. No patients developed pulmonary emboli. One patient had a recurrence of DVT during the treatment with LMWH with extension of the existing thrombus. Seven patients died, all due to their underlying disease. This study supports the safety and effectiveness of dalteparin in the treatment of upper extremity DVT. Given that these patients were treated as outpatients, there is a potential for huge cost savings.

Adolescent↗
PubMed1999

[Ventilatory failure in COPD: follow-up under intermittent positive pressure ventilation (IPPV)].

Effectiveness of IPPV in COPD is controversial. We examine the course of 29 patients with longterm IPPV (19 male, 10 female, age 60.3 years, BMI 23.7, FEV1 mean 22% predicted, PaCO2 mean 67 mmHg). PaCO2 is significantly by IPPV reduced. Patients are followed for 2 to 48 months (mean 16.5). Five stop IPPV (1 bilateral lung transplantation, 1 lung volume reduction surgery, 3 non-compliance), 8 die of respiratory failure, 5 of non-respiratory causes (non-RI) (3 tumor, 2 cardiovascular), and 10 survive (SV, 20.5 months). No difference in survival is observed between non-RI and SV. Weight increase by +5% is seen in SV more frequently, lung function is worse in RI, especially in weaning pts., hospital days are less frequent in SV and non-RI. Probability of survival is 70% at 1 year, 57% at 2 years, and 23% at 3 years, and is seriously influenced by non-RI. Our results are influenced by the high number of non-RI, the quitting of IPPV, and the primary inclusion of tumour pts. Still a high number of deaths by RI leads us to the conclusion that IPPV may be helpful for palliation, bridging before surgery and in subgroups who still have to be defined.

Female↗
PubMed1999

[Intermittent positive pressure ventilation in post tuberculosis syndrome].

Pulmonary tuberculosis sequelae with chronic respiratory failure is a clinical picture that is often mentioned, but seldom separately described, in connection with noninvasive ventilation in the case of acute or chronic respiratory failure. We report on the functional data and the ventilation of 26 patients. The patient group is characterized by great chronological latency between the start of pulmonary tuberculosis and the development of respiratory illness. Acute or chronic respiratory failure with this clinical entity should be treated in the form of noninvasive positive pressure ventilation.

Adult↗
PubMed1999

[Course of pulmonary hemodynamics in intermittent ventilation].

Patients with chronic respiratory failure often show an elevated pulmonary vascular resistance. We examined in a prospective study with the follow-up of patients with intermittent non-invasive ventilation (nISB) and pulmonary hypertension using dobutamine stress echocardiography. The data show that ISB lowers the pressure in all patients, more in patients with restrictive diseases, due to thoracic deformities, than in patients with COPD.

Adolescent↗
PubMed1998

Segmental hyperhidrosis as a manifestation of spinal and paraspinal disease.

BACKGROUND: Segmental hyperhidrosis is an uncommon finding which is usually associated with irritation or infiltration of pre-ganglionic sympathetic fibres or the sympathetic chain. METHODS: We report two cases of segmental hyperhidrosis with striking clinical features. RESULTS: In one case, a mesothelioma produced ipsilateral simultaneous underactivity and overactivity of sympathetic outflow and in the other case a thoracic central disc herniation was probably responsible for a band of sweating which clearly extended beyond the segmental level of injury. CONCLUSION: Segmental hyperhidrosis should trigger a search for structural disease in the spinal and paraspinal region.

Humans↗
PubMed1997

[Follow-up of intermittent self-ventilation (ISB). Mortality and causes].

BACKGROUND: Intermittent positive pressure ventilation (IPPV) has an impact on morbidity and survival in patients with chronic respiratory failure. We analyse the causes of death in relation to the disease, the age, the effectiveness of and the compliance with IPPV. PATIENTS: The course of 108 patients, who were on IPPV for a mean of 24 (SD +/- 21) months, is analysed. RESULTS: Twenty-seven patients die (7/7 AIS, 2/17 muscular dystrophy, 8/45 kyphoskoliosis and TB sequelae, 2/7 other neurological diseases, 6/16 COPD bronchiectasis, 1/1 fibrosis of the lang). The cause of death is in 21 hypoventilation or respiratory infection due to progressive disease (9 patients), air leakage after occlusion of tracheostoma (2 patients), bronchitis (6 patients), discontinuation of IPPV (3 patients). Two patients develop pulmonary failure (atypical mycobacteriosis and asbestosis, pulmonary embolism). Non-pulmonary causes of death are present in 2 (rupture of aortic aneurysm, pleural carcinosis). CONCLUSIONS: A safe interface for IPPV is needed for longer survival. An efficient system of home-care has to be developed.

Adolescent↗
PubMed1997

Fetal heart rate (FHR) pathology in labor related to preceeding Doppler sonographic results of the umbilical artery and fetal aorta in appropriate and small for gestational age babies. A longitudinal analysis.

The aim of this study was to ascertain the value of serially performed Doppler sonographic measurements of fetal vessels for the prediction of FHR alterations in labor a longitudinal analysis was conducted. 24 patients with SGA fetuses as the only risk factor and 38 patients without any risk factor were recruited for the study. Flow velocity waveforms of the fetal aorta and the umbilical artery were analyzed for systolic diastolic (S/D) ratio weekly at 20-39 weeks gestation and from 30 weeks gestation onwards twice weekly. Courses were related to complications during labor reflected by alterations of FHR tracings. The more numerous pathologie S/D ratios of both fetal vessels were recorded the more frequently complications in labor occurred (Chi Square test, p < 0.05). The mean value of the S/D ratios in fetuses with FHR pathology in labor differed significantly compared to the uncomplicated group (Wilcoxon rank sum test, p < 0.05). The fluctuation of S/D ratios was greater in the complicated than in the normal group (Wilcoxon rank sum test, p < 0.05). A combination of parameters describing S/D ratios showed a sensitivity of 86% and a specificity of 19% for the fetal aorta and a sensitivity of 71% and a specificity of 91% for the umbilical artery. Serial Doppler measurements of the fetal aorta and the umbilical artery aid in predicting pathologic FHR alterations in labor and may be of benefit in antenatal care to ensure fetal well being particularly in cases of IUGR.

Aorta↗
PubMed1996

[Quality of life and long-term survival with intermittent self-ventilation in respiratory insufficiency caused by thoracic restrictive diseases].

BACKGROUND: Mortality and quality of life are to be assessed in patients with respiratory failure due to restrictive chest wall disease. Neither specific questionnaires, nor perspective studies are available. PATIENTS AND METHOD: In a retrospective analysis records of mortality and morbidity, physical and social activity, and duration of IPPV are reviewed. RESULTS: The group consists of 35 patients (mean age 56 +/- 12 years; 22 female, 13 male; 11 post tuberculosis, 24 kyphoskoliosis; IPPV duration 28.5 +/- 20.7 months). Five patients died, 3 of which during the first 4 months: In 3 death is related to respiratory symptoms, 1 is due to pulmonary embolism, 1 to disruption of aortic aneurysm. Hospitalisation is required by 12 patients in 20 instances with a mean duration of 14.2 days. Respiratory symptoms are the cause in 13 instances, special difficulties are met with occlusion of tracheostoma in 3 patients. Professional activity is performed by 14 of the 21 patients < 60 years old. Physical activity is severely reduced in 4 patients, while it is mildly to moderately compromised in 26. Seven of all patients need supplemental oxygen. CONCLUSION: In respiratory failure due to restrictive chest wall disease treatment with IPPV seems to improve long-term survival and to enhance quality of life.

Adult↗
PubMed1996

[Intermittent self-ventilation in neuromuscular diseases. Comparison of lung function parameters in ventilated and non-ventilated patients].

BACKGROUND: Based on neuromuscular-disease patients in our case, we investigate the possibility of elaborating criteria by which to judge when home intermittent mechanical ventilation should be commenced and to access its consequences over an extended period. PATIENTS AND METHODS: Out of 24 patients with neuromuscular diseases (6 female, 18 male, mean age 32 years), 14 were treated with IPPV. They were suffering from hypercapnic respiratory failure with heavy sleep disruption and corresponding daily symptoms. RESULTS: The aim was to calculate significant examination parameters to facilitate indication for IPPV. The clinical situation of patients dependent on respiratory support improved under IPPV. We witnessed a "ventilation-saving effect" and--despite progression of the basic disease within the monitoring period--no deterioration of the blood-gas situation. CONCLUSIONS: It is possible to elaborate criteria for the indication of IPPV based on our group of neuromuscular-disease patients.

Adolescent↗
PubMed1996

[Value of pulsatile Doppler ultrasound in diagnosis of suspected placental insufficiency in comparison with other examination parameters].

In order to determine the diagnostic value of various methods for placental insufficiency, the following parameters were obtained from 108 patients with intrauterine growth retardation (IUGR) as the only risk factor: A/B-ratio, resistence index (RI), pulsatility index (PI) of the umbilical artery (UA) and descending fetal aorta (FA), maternal serum estriol, grading of the placental maturity according to Grannum, amount of amniotic fluid, and fetal heart rate tracings. All Doppler indices showed the same efficacy as regards prediction of neonatal growth retardation. With a value of 8.0 for the A/B ratio of the FA and 4.5 for the UA neonatal dystrophy may be recognized with a precision of 72.2% (sensitivity 65.2%, specificity 77.4%). Maternal serum estriol has an accuracy of 64% (sensitivity 50%, specificity 74%), fetal heart rate tracings are able to predict neonatal growth retardation with a precision of 63% (sensitivity 43.5%, specificity 77.4%) determination of the amount of amniotic fluid has an accuracy of 58% (sensitivity 69%, specificity 50%) and grading of placental maturity 61% (sensitivity 17%, specificity 95%). The parameters combined yield in an accuracy of 75% (sensitivity 72%, specificity 74%). The fetal outcome of neonates with preceeding pathologic Doppler indices differed significantly from those with normal Doppler indices as regards indication for cesarean section, necessity of therapy in the intensive care unit, and preterm labor rate (chi square test, p < 0.05). This result could be improved to 2-4% by obtaining additional parameters. Pulsed Doppler sonography of fetal vessels is an additional tool in diagnosing intrauterine growth retardation.

Amniotic Fluid↗
PubMed1995

[Systemic lupus erythematosus and silicosis].

A 60-year-old stonemason, suffering for many years from joint pains and exertional dyspnoea, developed a high fever with weight loss. Physical examination revealed reddening of light-exposed skin areas, fine rales and overly warm and reddened hand and knee joints. Abnormal laboratory findings were increased erythrocyte sedimentation rate of 66 mm/h, C-reactive protein concentration of 1 mg/dl, haemoglobin of 9.4 g/dl and white cell count of 3300/microliters. Urine contained albumin (100 mg/dl) and cylinders. Titres of both antinuclear and anti-ds-DNA antibodies were elevated (1:2560 and > 97 U/ml, respectively). The chest radiography showed enlarged hili, as well as reticular and nodular shadows which histologically showed silicosis. Systemic lupus erythematodes was diagnosed and the patient was treated with prednisone (2 mg/kg daily), the dosage being reduced to 12 mg daily within 3 months. When the joint pains recurred, azathioprine (50 mg daily) was added for 24 months. At present he is receiving prednisone (12 mg daily) and there has been no recurrence for 4 years.

Diagnosis, Differential↗
PubMed1995

Necrotizing bronchitis, angiitis, and amyloidosis associated with chronic Q fever.

The authors report the clinical, radiological and histological findings in a 63-year-old male patient who developed severe necrotizing bronchitis, necrotizing angiitis, and secondary amyloidosis of the right upper love and intermediate bronchus. The patient expired due to respiratory insufficiency. At the age of 27 years, the patient had had radiotherapy of the mediastinum because of suspected Hodgkin's disease. Acute pneumonia suggestive of Q-fever infection was diagnosed at the age of 48. Progressive restrictive lung disease developed during the last decade. Serological evaluation revealed IgM and IgA high titers against Coxiella burnetii. IgA, complement and amyloid deposits were detected in the walls of small arteries. Bronchial lavage and pleural effusions displayed numerous activated T lymphocytes. Analysis of endogenous lectins revealed alterations of the pulmonary defense system. The clinical history, histological and immunological findings suggest that chronic Q fever may induce remarkable changes in the immune system, comparable to autoimmune-reactive diseases.

Amyloidosis↗
PubMed1995

[Diaphragmatic paralysis and respiratory insufficiency].

BACKGROUND: Phrenic nerve palsy leads to disfunction of the main respiratory muscle. With bilateral palsy dyspnoea in the supine body position will typically occur. With one-sided lesion symptoms will only appear when a second pulmonary disease is present. PATIENTS: We refer of 6 patients with bilateral and 5 with unilateral diaphragmatic paresis. In 3 patients neuralgic shoulder-arm-amyotrophy was diagnosed, in further 4 there was suspicion of it. Amyotrophic lateral sclerosis developed in 2 after 4 respectively 8 months. In 1 case a cervical operation led to palsy, mediastinitis in 1 case. Lung function tests showed a restrictive pattern, especially in bilateral palsy. RESULTS: Vital capacity was reduced by almost 50% respectively 25% in the supine body position. Mouth occlusion pressure reduction was apparent. Near normal to marked hyperkapnia developed in bilateral paresis. In 5 cases non-invasive intermittent ventilation is instituted (2 volume controlled, 3 pressure supported). Two patients died (1 patient with amyotrophic lateral sclerosis after 13 months, 1 with malignant pleurisy after 4 months). Three patients continued non-invasive intermittent ventilation since 14 to 64 months.

Adult↗
PubMed1994

Elastinolytic activity of alveolar macrophages in smoking-associated pulmonary emphysema.

Current concepts of pathomechanisms leading to acquired emphysema suggest that alveolar macrophages (AM) activated by cigarette smoking may cause an elastase/antielastase imbalance localized to the microenvironment formed by phagocytes and lung tissue. A functional cell assay was used to evaluate the cell-associated elastinolytic activity of AM. AM were obtained by bronchoalveolar lavage from patients with emphysema and from patients with non obstructive chronic pulmonary diseases (non-COPD) and cultured under serum-free conditions in direct contact with 3H-labeled elastin particles. Elastinolytic activity was calculated from the released radioactivity in culture supernatants and expressed as micrograms of 3H-elastin degraded x 10(-5) AM x 72 h-1. AM of patients with emphysema had significantly higher elastinolytic activity compared to that of non-COPD patients (median: 10.8 versus 4.1 micrograms; P < 0.01). Further differentiation of patients revealed the lowest median activity in sarcoidosis (2.3 micrograms). In respect to smoking habits there was a major difference between smokers with emphysema degraded more than twice the amount of elastin than smokers in the non-COPD group (median:11 versus 3.9 micrograms, P = 0.01). From these data we conclude that AM-derived elsatinolytic proteases may be involved in the destruction of lung elastin, which is thought to be the key event occurring in the pathogenesis of pulmonary emphysema.

Adult↗
PubMed1994

The pulmonary artery acceleration time determined with the MR-RACE-technique: comparison to pulmonary artery mean pressure in 12 patients.

The goal of our study was to evaluate a rapid noninvasive MR technique for quantification of the pulmonary artery acceleration time (PAT) and other parameters of pulmonary hemodynamics and to correlate with pulmonary artery mean pressure (mPAP). The PAT known as "time-to-peak" out of Doppler echocardiographic measurements normally shows significant inverse correlation with mPAP. With the MR-RACE-Technique (RACE: Real time ACquisition and Evaluation of motion) blood velocity measurements can be obtained with a total acquisition time of a few seconds. The application of this technique to the pulmonary artery has not been reported before. Out of the RACE velocity wave form PAT can be obtained with a temporal resolution of about 15 ms. To explore the relationship between PAT and mPAP, right heart catheterization and MR-RACE measurements were performed in 12 patients with different pulmonary vascular abnormalities. Results of MR-RACE were compared with those of mPAP measured by right heart catheter and showed significant inverse correlation (r = -0.82, p = .0011, n = 12). The ability of MR-RACE to enable measurements of blood flow with profiles may be important for characterizing pulmonary and cardiovascular abnormalities.

Aged↗
PubMed1994

Clinical investigation of the antidepressant effectiveness of hypericum.

To date, 25 controlled therapy studies have investigated the antidepressive effectiveness of hypericum extracts. A total of 1592 treatment cases have been included. The dosage was typically 300 to 900 mg total extract daily; the therapy duration was 2 to 6 weeks. Fifteen studies were performed comparing hypericum extracts with placebo, 10 studies as comparative studies. This paper presents an overview of their results.

Antidepressive Agents↗