Biomedical subjects
W T Ulmer
Publications and source records attributed to W T Ulmer.
[The inhalation 1 concentration test for the assessment of bronchial reactivity].
An unspecific bronchial provocation challenge with a 1-concentration test is a reliable method to distinguish between normal and hyperreactive persons. The patient inhales a bronchoconstricting substance such as methacholine. A significant change of lung function, for example an increase of airway resistance, characterizes a hyperreactive bronchial system. The continuous registration of transcutaneous oxygen pressure is helpful concerning a strong reaction or a peripheral airway obstruction. An exaggerated increase of airway resistance after provocation test can be treated rapidly by inhalation of sympathicomimetics. No complications were registered. Comparative studies showed a good reproducibility of this method. Summarizing, the 1-concentration test is simple, easy to perform and suitable especially for investigations in occupational medicine or epidemiology.
[Diagnostic parameters for the evaluation of work capacity: the bronchopulmonary system].
The bronchial pulmonary system can be effected by obstructive diseases with and without emphysema. The onset of these affections may be an airway allergy. In case of other mechanisms, fibrotic processes can be observed accompanied by a lung compliance decrease. Lung circulation itself is rarely affected by the development of Cor pulmonale in a state after pulmonary embolism and after the so-called primary pulmonary high pressure. These disorders can be diagnosed properly without or scarcely straining the patient by spirometry which requires the patient's cooperation, however, and by body plethysmography which does not depend on cooperation, lung compliance measurements, arterial blood gases and inhalative provocation tests. If applied by experience staff, these reliable basic methods supply qualitative and quantitative information for the assessment of working capability that scarcely can be obtained on another organ.
[Obstructive airway diseases--emphysema. Diagnosis and therapy].
Spirometric examinations are suitable for the diagnosis of airway obstruction, but not of pulmonary emphysema. Whole body plethysmography, in contrast, is the most reliable diagnostic procedure for both conditions, both qualitatively and quantitatively. The basic treatment of any form of airway obstruction consists in the inhalation of beta-2-sympathomimetic drugs; theophyllines are also good bronchodilators, but are less powerful than beta-2-sympathomimetics. Glucocorticoids must always be given when bronchitis also presents, which is only rarely treatable with antibiotics alone. Although regression of pulmonary emphysema is not possible, progression of the destructive process would appear to be inhibited by intensive treatment of the inflammatory bronchitis. Only in the case of patients with congenital alpha-1-antitrypsin deficiency is it possible to administer such causal treatment in the form of substitution therapy. Surgical treatment can be considered only in the case of bullous pulmonary emphysema.
[Inhalation therapy with selective beta 2-sympathomimetic drugs. Effect of pirbuterol administered via the Autohaler and salbutamol administered via the Diskhaler in obstructive respiratory tract disease].
The therapeutic success of salbutamol inhalation with the powder inhalator (Diskhaler) and of pirbuterol with an inhalation-triggered metered aerosol (Autohaler) was determined by comparing the degrees of bronchodilation in 13 patients suffering from chronic obstructive airways disease. Rt and IGV were determined by whole-body plethysmography and FEV1, peak flow and MEF50 by spirometry, and pulse rates were also measured. On average, Rt values decreased by 40 per cent; the other lung function parameters responded correspondingly. Duration of action extended to 4 hours after dosage. Pulse rates and lung functions measured after administration of the products did not differ, either. In such studies as this, whole-body plethysmographic results are superior to those obtained by spirometry.
[Current therapy for chronic respiratory tract diseases].
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[Current diagnosis of chronic respiratory tract diseases].
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Peripheral neuropathies in patients with chronic obstructive pulmonary disease: a multicenter prevalence study.
To investigate the prevalence and type of peripheral neuropathies (PNP) in patients with chronic obstructive pulmonary disease (COPD), we studied lung function and blood gases, clinical signs of PNP, and neurophysiological function in 151 patients with COPD without known risk factors for PNP. Mean (SD) age was 65 (10) years, mean arterial PO2 was 59 (9) mmHg, mean ratio of forced expiratory volume in the first second to vital capacity (FEV1.0/VC) was 42 (12%). Thirty patients (20%) had clinically detectable and 6 (4%) had subclinical PNP of mild degree. Fourteen (9%) of the patients with clinically detectable PNP had symptoms due to PNP. Prevalence of PNP increased with severity of hypoxemia (p less than 0.05) and was more pronounced in the lower than in the upper limbs. Age and the degree of hypoxemia were predictors to differentiate between COPD patients with and without PNP. Although the cause of PNP in COPD patients remains unknown, our observations suggest that chronic hypoxemia may contribute to PNP.
Treatment of severe chronic bronchitis with ceftazidime.
The aim of this study was to determine whether ceftazidime is more effective than other antibiotics in the treatment of severe acute exacerbation of chronic bronchitis, particularly when other antibiotics have previously failed. Our investigations showed that ceftazidime is effective and well tolerated in patients with severe chronic bronchitis and purulent sputum. The effectiveness of ceftazidime was seen in a reduction of the volume of sputum produced daily and in a colour change from yellow-green to clear-white. The absence of an effect on parameters of lung function was not unexpected since our patients had long-lasting chronic bronchitis.
Western blot analysis of water-soluble wheat flour (Triticum vulgaris) allergens.
Water-soluble wheat flour allergens were analyzed using the western blot technique. The sera of 130 bakers (42 with wheat flour allergy, 88 without allergy) were analyzed for IgE, IgG, and IgG4 binding towards wheat flour allergens. Three major allergens with molecular weights of 47, 17, and 15 kD were identified (Tri v Bd 47, Tri v Bd 17, and Tri v Bd 15; IUIS allergen nomenclature) by their ability to bind IgE from approximately 50% of the allergic sera. The specificity of the IgG was mostly directed against three high molecular weight components (134, 122, and 98 kD). In contrast, IgE and IgG4 was found frequently against the major allergens. 40% of healthy donors versus 12% of the asthmatic bakers had no detectable IgG4 against wheat flour extract. The biological activity of the water-soluble wheat flour components has been shown by their ability to induce histamine release from basophil leukocytes obtained from patients with bakers' asthma. The release of histamine from basophil leukocytes significantly correlated with the presence of IgE antibodies against wheat flour components of 47, 17 and 15 kD. A regulatory role of wheat flour specific IgG4 in allergic diseases could not be evaluated by western blot analysis.
[Pathophysiologic principles of obstructive respiratory tract diseases].
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[The physician and his patient].
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[Diagnosis of lung function: what do we need?].
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[Functional disorders in obstructive respiratory tract diseases].
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[Function analytic control of therapy of obstructive respiratory tract disease].
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[Reproducibility of the bronchospasmolytic effect of anticholinergic drugs and beta-sympathomimetics].
The bronchodilator effect of an anticholinergic and beta-adrenergic drug in the same patient was tested at 3 different times to study the reproducibility. There is a good average reproducibility: the curves concerning the bronchodilation are nearly identical or parallel. On the other hand there is a greater difference in the individual curves at different times: the patients with the most severe airway obstruction show the greatest difference in the bronchodilator effect at different times.
[The bronchospasmolytic test with anticholinergic drugs and sympathomimetics: differences between body plethysmography and spirometry measuring procedures].
The different bronchodilator effects after inhalation of anticholinergic and beta-adrenergic drugs due to the different methods of measurement (i.a. body plethysmography vs. spirometry) were studied in 43 patients with COLD and in 20 healthy subjects. The greatest changes occur when the body plethysmographic value Rt was chosen. The spirometric values FEV1 and PEF show the greatest bronchodilator effect. The patients with COLD have the best bronchodilation after inhalation of the beta-adrenergic drug, whereas the healthy subjects show the greatest effect after anticholinergic drugs.