Biomedical subjects
W Mitlehner
Publications and source records attributed to W Mitlehner.
[Legal social status of management with portable liquid oxygen devices in Germany].
This survey is based on three successful German sociolegal court proceedings instituted against relevant statutory medical cost bearers in respect of providing pulmonary patients with portable light-weight oxygen equipment. The sociolegally relevant indications for liquid oxygen treatment are described contrasting with conventional oxygen suppliers such as concentrators or steel flasks. Also detailed are the sociolegally appropriate prescription procedures for patients suffering from chronic respiratory insufficiency who can be mobilised by treatment with oxygen.
Exercise hypoxemia and the effects of increased inspiratory oxygen concentration in severe chronic obstructive pulmonary disease.
Exercise-associated oxygen desaturation in severe chronic obstructive pulmonary disease (COPD) remains a topic of unknown prognostic and clinical relevance and of unknown therapeutic importance. Furthermore, exercise limitation in these patients is due to multifactorial interaction of respiratory, cardiac, circulatory and 'peripheral' mechanisms. For the evaluation of the role of the oxygen-dependent mechanisms of exercise limitation we studied 14 stable patients with severe COPD (FEV1 32% pred., FEV1/VC 41%, thoracic gas volume of 180% pred.) and mean Pa O2 64 mm Hg by a stage 1 cycle exercise test during breathing room air (FiO2 0.21) and hyperoxic (FiO2 0.35) air. The measurements were performed by an open system using a low dead space valve (55 ml) measuring real-time breath by breath oxygen consumption (VO2) via a differential oxygen sensor, expired carbon dioxide (VCO2), ventilation (VE), oxygen pulse and oxygen saturation in both conditions. With FiO2 0.21 the mean exercise limitation was restricted to 37 (+/- 14) W and the VO2 to 11.7 (+/- 2.4) ml/kg/min with peak oxygen desaturation of 86.4 (+/- 3.2). With FiO2 0.35 the patients achieved a significant increase of workload to 55 (+/- 12.4) W and of VO2 to 14.9 (+/- 2.9) ml/kg/min. Despite the complete abolition of exercise desaturation by FIO2 0.35 the mean peak ventilation of 261/min (+/- 5.1) vs. 27 l/min (+/- 4.1) remained unaltered and therefore the restriction of the ventilatory pump limited the exercise ability. The effects of FiO2 0.35 occurred in these patients at submaximum exercise and may be related to reduction of ventilatory cost of energy and delayed onset of metabolic acidosis.(ABSTRACT TRUNCATED AT 250 WORDS)
[Rare metabolic and cerebral complications after polychemotherapy of a testicular tumor].
In a 21-year-old patient with a tumor of the right testis, CT indicated a pathologically altered lymph node in the interaortocaval region. After high inguinal orchiectomy we performed a modified retroperitoneal lymph node dissection and monitored its success by immediate section for microscopic examination. Pathohistological investigation yielded immature teratoma. The patient was given two courses of adjuvant polychemotherapy containing cisplatin. Two days after the conclusion of the second course he was readmitted with grand mal epilepsy and visual agnosia. Two months later another grand mal epileptic fit occurred. The patient also suffered from marked metabolic disorders, such as hypokalemia, hyperreninism, hyperaldosteronism, kaliuresis, and hypertension. We consider these to be toxic side effects of cisplatin resulting in nephropathy. Evidence of cisplatin-induced encephalopathy was obtained by NMR tomography and EEG which indicated barrier disorders. Symptoms were relieved and continuous normalization of blood pressure, potassium level, and water and electrolyte balance was achieved by the administration of potassium substitution, ACE inhibition, and an aldosterone antagonist. The patient has since remained in a stable condition.
[Involvement of the lungs in neurofibromatosis].
Two patients, a 66-year-old man (case 1) and a 55-year-old woman (case 2), had been known (for 40 and 35 years, respectively) to have type 1 neurofibromatosis. Dyspnoea, recently even at rest, had developed in both over the past few years. Both were emaciated (weight 62 kg, height 180 cm; 42 kg, 166 cm, respectively). In both the chest radiography had net-like increased interstitial markings. Computed tomography in case 1 showed largely subpleural small-blister-like changes bilaterally (honeycomb lung), while there were large apical cysts bilaterally in case 2. Lung function tests demonstrated restrictive changes in case 1 (vital capacity 48% of norm, relative one-second capacity 88%) and severe ventilation abnormality in case 2 (vital capacity 42% of norm, relative one-second capacity 47%). Both had marked hypoxaemia even at rest and the walking limit was 200 m in case 1, 40 m in case 2. The pulmonary changes were most likely manifestations of the neurofibromatosis. Symptomatic treatment consisted of long-term oxygen therapy with a portable liquid oxygen system (flow rate: 1-2 l/min at rest and 3-5 l/min on exercise; duration: 24 h/d). This achieved a walking distance without hypoxaemia of 500 and 200 m, respectively, with marked improvement in the patients' condition.
[Oxygen concentrators are not ozone concentrators].
Ozone is a constituent of the natural ambient atmosphere and occurs dependent on weather and environment in concentrations that can trigger airway inflammation. Oxygen concentrators are employed in oxygen long-term therapy and produce in the room air a mixture of concentrated oxygen and residual gases of unknown ozone concentration. Hence, we studied the ozone concentration of the air supplied by the oxygen concentrator, both under normal conditions in the room air and with increased ozone concentration of the air in the room. Both under room air conditions and under increased ozone concentrations of up to 12 ppm in the surrounding air the residual gas mixture of the air produced by the oxygen concentrator did not contain any ozone concentration beyond 0.005 ppm. This prompts us to suggest that the oxygen concentrators examined by use are ozone eliminators rather than ozone concentrators.
Value of computer tomography in the detection of bullae and blebs in patients with primary spontaneous pneumothorax.
In this prospective study, the value of computed tomography (CT) in detecting bullae and bleb formation of the lung in 35 patients with primary spontaneous pneumothorax (PSP) has been determined. The ability of CT in the detection of bullae and bleb formation and fibrotic changes is compared with the chest film in PSP. CT showed pathological lung changes in 31/35 patients. In most cases, few (n < 5) and small blebs (i.e., < 2 cm in diameter) were found. In 16/35 cases, blebs (< 2 cm) and bullae (> 2 cm in diameter) occurred in the extra-apical region. Contralateral pathological changes were found in 23/35. Bullae (> 2 cm) could be detected only in 6/35. In the chest film, bullae and blebs could be detected in 11/35 cases on the ipsilateral (in 2/35 cases not confirmed by CT), in 3/35 on the bilateral and in 4/35 only on the contralateral side. Thus, CT was proved to be of high value in the assessment of bullae and bleb formation in PSP compared with chest film. Negative pressure drainage was instituted as primary therapy. In a follow-up of 9.6 (+/- 5.7 SD) months, only early recurrences were noticed (n = 35). The rate of recurrences was 6/35 patients. The longer follow-up period (mean 31.7 +/- 6.1 months) could be performed for 32 patients; 3 were lost. Additionally, 2 recurrences occurred. No correlation between recurrences and anatomical status (number, size and distribution of blebs/bullae) as assessed by CT was found. Differential treatment protocols on the basis of the initial findings do not appear to be warranted.
Effects of long-term oxygen therapy due to portable liquid oxygen tanks in disabled malnourished chronic obstructive pulmonary disease patients with borderline hypoxemia. Aim of the study and methods.
Long-term oxygen therapy by light-weight portable liquid oxygen systems may improve the degree of functional handicap in patients with severe chronic obstructive pulmonary disease (COPD), borderline hypoxemia or exertional hypoxemia, limited walking distance and malnutrition who do not fulfill the Nocturnal Oxygen Therapy Trial criteria for long-term oxygen therapy. The paper will discuss a proposal for a study plan to test this hypothesis. After a period of stabilization, the methods of measurements include functional tests (walking tests, cycle exercise test [FiO2 21, 35%], baseline measurements of pulmonary function, arterial blood gases, lactate, right heart catheterization, radionuclide ventriculography). The study is designed as a multicentric, controlled, parallel and randomized test for oxygen treatment and no treatment by oxygen. The main outcome will be tested on the results of functional tests (walking tests, VO2max) to demonstrate the possible benefit of long-term oxygen therapy in borderline hypoxemic COPD patients.
[Portable liquid oxygen sources. Technical properties and the first clinical experiences].
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[Amiodarone-induced segmental lung infiltration. Radiologic and computed tomographic aspects].
Due to pulmonary toxicity, segmental lung consolidation or diffuse interstitial pulmonary infiltrations can occur during long-term treatment of ventricular tachycardia with amiodarone (Cordarex). These infiltrations can be confused with other infectious pneumonic consolidations, dystelectasia or tumorous lung disease, and may be erroneously treated as such. Apart from the clinical symptoms (dyspnea, non-productive cough, low-grade fever), the earliest radiographic signs are segmental infiltrates or diffuse interstitial lung opacifications. Pathological pulmonary function tests can only be observed in the early stages of the diffuse alveolar-fibrosing form of the disease. In this case study of amiodarone-induced segmental pulmonary infiltration, the radiological and computer-tomographic aspects are discussed, along with other complementary diagnostic procedures such as gallium scintigraphy and bronchoscopic biopsy.
[Pseudotumorous liver tuberculosis with multiple organ abscesses. A contribution to the differential diagnosis of liver abscess].
In a patient hospitalized with the diagnosis "fever of unclear etiology", a large liver abscess with multiple organ abscesses (soft tissues of the throat, spleen) was found. The bacteriological investigation of the liver abscess punctation material and the histological investigation of material from a throat abscess did not lead to a diagnosis. The causative organism was only detected by a specific investigation for M. tuberculosis (bacteriological, ELISA). Apart from one exception, there has been no reference to the possible causation of large liver abscesses by M. tuberculosis in the review literature in this country and abroad. In the case described, the tuberculous liver abscess was caused to regress by pharmacotherapy.