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Biomedical subjects

W Karrer

Publications and source records attributed to W Karrer.

44 records · Page 3Linked to original sources
PubMed1990

[Tuberculosis--recurrence: incidence, causes, treatment].

By reducing the anti-tuberculous therapy to six to nine months and the fact that tuberculosis occurs in immunocompromised patients raises the question of relapse after treatment. In order to avoid such relapses the drug therapy has to be optimized regarding duration (minimum six months) as well as combination (bactericidal antituberculous drugs) and the patients' compliance has to be monitored carefully. Special monitoring is necessary with immunocompromised patients. The problem of resistance against antituberculous drugs (especially Isoniazid) has to be taken into consideration. The most relapses occur during the first year after termination of therapy.

Adult↗
PubMed1990

[Tuberculosis--prevention. Diagnostic and therapeutic measures].

The most effective prevention of an infectious disease is the correct treatment of patients already affected. While dealing with infected tuberculosis patients one has to take hygienic measures in order to protect doctors and nursing staff as well as relatives. However, very often neither the source of infection nor other affected persons are known. Through careful examination of the environment such patients have to be defined and treated accordingly. Other possibilities of reducing the danger of infection are BCG-vaccination and serial examination of high risk groups (especially tuberculin skin test). For newly infected patients or patients with extended residues on x-ray, chemoprophylaxis is used.

Antitubercular Agents↗
PubMed1990

Successful closure of chronic BPF by thoracoscopy after failure of endoscopic fibrin glue application and thoracoplasty.

We report a case of chronic debilitating BPF following right upper lobe resection. Despite several endobronchial applications of fibrin glue, we could not close it. Since the patient was extremely debilitated by symptoms due to the BPF, a thoracoplasty was attempted but was not successful. Finally, the BPF was definitely closed by instillation of talc into the pleura through thoracoscopy. To our knowledge, this is the first reported case of chemical closure of a recalcitrant BPF by the route of thoracoscopy. It also shows the failure of endoscopic fibrin glue application in such a condition.

Bronchial Fistula↗
PubMed1989

[Pillars of therapy of chronic obstructive bronchitis].

While bronchial asthma is defined on the basis of pulmonary function, emphysema has a patho-anatomic substrate. Chronic bronchitis on the other hand is defined clinically: productive cough of three months duration per year occurring in two successive years. Complete abstinence of smoking is a prerequisite for a meaningful anti-obstructive therapy. Beta-2-adrenergic stimulation and corticosteroids represent the treatment of choice. Beta-2-agonists are effectively complemented by anticholinergic drugs. Oral or parenteral corticosteroids should be used liberally for exacerbations. For prolonged treatment topical steroids are prescribed exclusively in order to prevent systemic side effects. The type of inhalation therapy (electric nebulizer, aerosol spray, insufflator) has to be adapted to the individual patient. Correct application of inhalation-technique is important. Topical steroids should be administered by means of a spacer chamber. Physical therapy is the most important adjuvant treatment. Selective respiration-training, a correction of breath-technique and autogenic bronchial drainage manoeuvres have to be learned in the setting of a rehabilitation program and are controlled frequently by the treating physician. The integration of all these measures into a treatment and rehabilitation plan is facilitated in a specialized clinic.

Administration, Inhalation↗
PubMed1988

[Oxygen saturation during sleep in chronic obstructive lung diseases before and after bronchodilator therapy. A controlled, prospective study in 36 patients].

In a study of nocturnal oxygen saturation by transcutaneous oximetry in 36 patients, 26 patients with chronic obstructive pulmonary disease (COPD) of varying degrees were compared with 10 patients without lung disease. The oxygen measurements were performed in all COPD patients before and after an 8-10 days' course of anti-obstructive therapy on an inpatient basis. COPD patients had more severe desaturation during night-time than those without lung disease. The severity of nocturnal desaturation correlates with severity of the obstructive lung disease. Anti-obstructive therapy significantly improves nocturnal oxygenation in patients with COPD. We conclude that strictly performed anti-obstructive therapy may diminish nocturnal oxygen desaturation and its negative sequelae, and therefore could have a positive effect on the prognosis of COPD patients.

Blood Gas Monitoring, Transcutaneous↗
PubMed1986

[Premedication in fiber optic bronchoscopy from the patient's and the physician's viewpoint--a randomized study for the comparison of midazolam and hydrocodone].

To evaluate side effects and patients' assessment of fiberoptic bronchoscopy under local anesthesia, 122 consecutive patients answered questions from an outside interviewer (an experienced psychiatrist) and not from the endoscopists themselves. The effect of premedication with midazolam (5 mg i.m.) and hydrocodonum (15 mg i.m.) was compared in a randomized study. In a multiple choice questionnaire 68% of all patients indicated considerable fear in the days before bronchoscopy. They were more afraid of the possible diagnosis of cancer (23%) than of dyspnea or asphyxiation (14%). Coughing is considered the worst side effect of bronchoscopy by 25% of patients (36% of the endoscopists) followed by dyspnea during insertion of the scope (21%) and discomfort during local anesthesia. Although the patients premedicated with midazolam are more sedated (p = 0.025 by physicians' assessment vs. p = 0.11 in patients' view), they cough more (p = 0.001 vs. p = 0.22) and usually tolerate the examination less well (p = 0.009 vs. p = 0.08) than patients premedicated with hydrocodonum. 42% of patients premedicated with midazolam had anterograde amnesia. Although they did not remember all the unpleasant side effects, only 77% said they would repeat the procedure with the same premedication, compared with 90% of patients premedicated with hydrocodonum (p = 0.08). Before and two hours after premedication the reaction times had not changed (optical sign, Wiener reaction device) and were identical in the two patient groups. At that time 37% of the patients premedicated with midazolam and 27% of those premedicated with hydrocodonum were still sleepy and could not be regarded as fit for any form of travel.

Adult↗
PubMed1985

[Which is the best drug combination for the short-term therapy of tuberculosis? A prospective randomized study with 190 patients].

190 patients with positive cultures for M. tuberculosis were treated in the initial phase as inpatients for 2-3 months at random with either pyrazinamide (Z) or ethambutol (E) in combination with isoniazid (H) and rifampicin (R). In the continuation phase as out-patients they were treated by their family doctor for a further seven months with a new randomization using either R or E combined with H. Regular controls of drug intake using urine test strips were 97% positive. The patients treated with Z showed a tendency to more rapid conversion to negative cultures despite the significantly shorter duration of initial-phase treatment. During the average observation period of 33 months after commencing therapy there were five relapses (without development of drug resistance). The distribution over the four patient groups did not allow statistical conclusions to be drawn. All of the relapses occurred during the first year after the treatment ended. All relapsing patients showed an unusually long delay (108 days) before the tuberculosis cultures proved negative, in comparison with only 48 days in all patients. The relapse rate of 3.6% equals comparable controlled studies in the literature of the last four years, in which patients were initially hospitalized for two months or received medication under direct supervision as out-patients. The family doctors treated their patients on average for ten months instead of the nine months recommended in the treatment scheme ("doctor's compliance"). This seems to be a direct consequence of the earlier recommendations in favour of a longer duration of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗