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Biomedical subjects

W Vincken

Publications and source records attributed to W Vincken.

At least 91 records · Page 5Linked to original sources
PubMed1987

Determinants of respiratory muscle weakness in stable chronic neuromuscular disorders.

In neuromuscular disease, the precise relationship between general and respiratory muscle weakness is at present unclear. That relationship and the influence on respiratory muscle strength of such factors as type and duration of neuromuscular disease, distribution of general muscle weakness, and nutritional status were studied in 30 patients with stable chronic neuromuscular disease not presenting with respiratory symptoms. The degree of general muscle weakness was assessed by clinical examination of the strength of 17 muscle groups, yielding a general muscle strength index. The degree of respiratory muscle weakness was assessed by measuring maximal static inspiratory and expiratory mouth pressures. Maximal inspiratory (mean +/- SD: 68 +/- 28 percent predicted) and expiratory (66 +/- 29 percent predicted) mouth pressures were frequently reduced, but did not correlate with general muscle strength. The ability to estimate the degree of respiratory muscle weakness improved to some extent when the type of neuromuscular disease and the distribution of general muscle weakness were taken into account: thus, maximal expiratory mouth pressure was significantly lower (p less than 0.05) in myopathy than in polyneuropathy, and in proximal than in distal muscle weakness. Duration of neuromuscular disease and nutritional status did not influence respiratory muscle strength. It is concluded that in stable chronic neuromuscular disease, respiratory muscle involvement depends on a complexity of factors, in particular the type of neuromuscular disease and the distribution, rather than the degree, of general muscle weakness. In the individual patient, however, only direct measurement of maximal inspiratory and expiratory mouth pressures allows accurate assessment of respiratory muscle strength. These tests ought to complement neurologic examination.

Adult↗
PubMed1987

Urea treatment for water retention in hyponatremic congestive heart failure.

We have studied the efficiency of urea in the treatment of hyponatremia and hydrosaline retention in a 76-year-old man with chronic ischemic congestive heart failure. Since increase of furosemide worsened the hyponatremia (120 mmol/l), 30 g/day of urea was added and induced the following changes: progressive weight loss (6.5 kg in one week), increased diuresis (from 0.750 to 1.950 l/day), increased salt excretion (from 40 to 165 mmol sodium/day) and correction of the hyponatremia (120 to 136 mmol/l). Blood urea and creatinine serum concentrations rose moderately without significant change in creatinine clearance (32 to 38 ml/min). No adverse effects related to urea administration were observed. Urea intake seems to be useful in the management of hyponatremia in our patient with cardiac failure.

Aged↗
PubMed1987

Improved arterial oxygenation by diaphragmatic pacing in quadriplegia.

Despite increased alveolar ventilation, positive-pressure ventilation (PPV) reproducibly resulted in less efficient arterial oxygenation as compared to diaphragmatic pacing in a quadriplegic patient with respiratory paralysis. Volume loading acutely restored arterial oxygenation during PPV. This report emphasizes the important interaction between the cardiovascular and pulmonary systems in effecting gas exchange, particularly in quadriplegics. In this respect, diaphragmatic pacing seems to perform better than PPV.

Adult↗
PubMed1987

Inspiratory muscle activity as a trigger causing the airways to open in obstructive sleep apnea.

This report discusses mechanisms causing the airways to open during obstructive sleep apnea (OSAS). In 4 male patients with OSAS, 92 nonrapid eye movement (NERM) sleep apnea episodes and 37 rapid eye movement (REM) sleep apnea episodes were analyzed breath by breath during a one-night study. We calculated the pressure time index of the diaphragm (the product of inspiratory time/cycle duration (Tl/Ttot) and mean transdiaphragmatic pressure swing), evaluated the sleep stages via EEG, and performed frequency spectrum analysis of the EMG of the diaphragm. It was found that with each occluded inspiratory effort the tension time index of the diaphragm (TTdi) increased progressively to reach or slightly exceed the fatigue threshold, 0.15 to 0.18 (during NREM sleep the TTdi of the last occluded breath was 0.195 +/- 0.045 and during REM sleep the TTdi of the last occluded breath was 0.153 +/- 0.037); that a close time relationship was observed as well between the onset of arousal and the opening of the airways. Our data suggest that the airways may be triggered to open by a protective reflex originating in the larynx or the inspiratory muscles upon reaching a certain degree of contraction.

Adult↗
PubMed1987

Pneumomediastinum after self-dilation of the esophagus.

Pneumomediastinum following esophageal perforation is a known complication of Eder Puestow dilation for esophageal stenosis. This is the first reported case of esophageal perforation and pneumomediastinum occurring after instrumental self-dilation of a stenotic esophageal lesion. The observed 0.02 percent perforation rate in this patient (compared to the reported 0.3 percent in Eder Puestow "hetero"-dilation) makes the Eder Puestow auto-dilation procedure seem justifiable in a well-trained and well-informed patient.

Aged↗
PubMed1987

Obstructive sleep apnea caused by hemarthrosis-induced micrognathia.

A 42-year-old male hemophiliac with micrognathia caused by temperomandibular hemarthrosis was studied for obstructive sleep apnea and successfully treated without the use of a tracheostomy. Prevention of nocturnal hypoxemia by nasopharyngeal intubation was found to relieve daytime hypersomnolence while he was awaiting corrective jaw surgery. The association of obstructive sleep apnea with micrognathia secondary to hemophilia has not previously been reported to our knowledge.

Adult↗
PubMed1986

Efficacy and safety of pefloxacin in the treatment of severe infections in patients hospitalized in intensive care units.

Sixteen patients, 14 with an infection of the lower respiratory tract and two with cholangitis, were treated with pefloxacin 400 mg bid or tid. The original pathogens were eradicated in all but one patient. Pefloxacin therapy resulted in clinical cure in 11 patients, three patients were improved clinically and in two patients a clinical failure was observed. No adverse effects were noticed during or after pefloxacin administration.

Adolescent↗
PubMed1986

Rib cage motion and muscle use in high tetraplegics.

In an attempt to assess the action of the sternocleidomastoid muscles on the human rib cage, we studied the pattern of rib cage motion in 2 patients with complete transection of the upper cervical cord. Measurements of rib cage motion were obtained with magnetometers and chest roentgenograms, and concentric needle electrodes were used to record the electromyograms (EMG) of various respiratory muscles. Spontaneous quiet breathing elicited a large amount of phasic inspiratory EMG activity not only in the sternocleidomastoids, but also in the trapezii, platysma, mylohyoid, and sternohyoid muscles. This pattern of muscle use was associated with substantial rib cage deformation. During spontaneous inspiration both patients showed a clear-cut decrease in lower rib cage transverse diameter, and they both had a cranial displacement of the sternum and an increase in upper rib cage anteroposterior diameter that was disproportionately larger than the increase in lower rib cage anteroposterior diameter. Radiographic measurements confirmed these deformations but also demonstrated that the upper rib cage transverse diameter increased rather than decreased with inspiration. These results indicate that: (1) Patients with high tetraplegia use many neck muscles in addition to the sternocleidomastoids to breathe; (2) The synchronous contraction of these muscles acts to pull the sternum cranially, expands the upper rib cage, and causes paradoxical inward displacement of the lateral walls of the lower rib cage; (3) As in dogs, the motion of the upper rib cage in humans is more tightly linked to the sternum than that of the lower rib cage.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗
PubMed1986

Detection of upper airway muscle involvement in neuromuscular disorders using the flow-volume loop.

Abnormal contours of the flow-volume loop, ie, flow oscillations and inspiratory flow plateaux, have been noted in disorders affecting upper-airway muscular function. In this study, we assessed the incidence and the value of these contours as a test of bulbar and upper-airway muscular involvement in neuromuscular disease. We therefore compared flow-volume loops and pulmonary function test results between ten patients with (group 1) and 20 patients without (group 2) clinically apparent bulbar muscle involvement in neuromuscular disease. An abnormal flow-volume loop occurred significantly more often in group 1 than in group 2 (9/10 or 90 percent vs 3/20 or 15 percent, respectively; p less than 0.001) and predicted bulbar and upper-airway muscle involvement with high sensitivity (90 percent), specificity (85 percent) and efficiency (87 percent). Based on commonly used spirometric criteria, upper-airway obstruction was not more common in group 1 than in group 2 (1/10 vs 2/20); however, all three patients with upper-airway obstruction suggested by these criteria had an abnormal flow-volume loop. Following this study, three patients incurred severe respiratory complications. All three patients had previously shown an abnormal flow-volume loop. We conclude that in patients with neuromuscular disease, involvement of the bulbar and upper-airway muscles is frequently associated with an abnormal contour of the flow-volume loop. Recognition of flow oscillations or flow plateaux on flow-volume loops in these patients seems important, since they may be potential markers of severe respiratory complications.

Adult↗
PubMed1986

Upper airway dysfunction detected by respiratory flow oscillations.

In 3 patients with chronic respiratory symptoms, we identified rapid flow oscillations on flow-time and flow-volume recordings, corresponding to fluttering of lax but otherwise normal-appearing upper airway structures at cinefluoroscopy and fiberoptic endoscopy. This entity of upper airway dysfunction was responsible for, or at least contributed to, the respiratory symptoms as evidenced by dramatic relief of dyspnea following tracheostomy in one patient, and significant improvement of flow rates following helium breathing in the other 2 patients. We suggest that identification of flow oscillations on flow recordings, in particular flow-volume loops, should lead to investigation of the upper airway. When fluttering is the only abnormality observed, it should not be disregarded, but rather considered as possibly contributing to airflow limitation.

Adult↗
PubMed1985

L-dopa-induced respiratory disturbance in Parkinson's disease suppressed by tiapride.

L-dopa treatment provoked an irregular breathing pattern and dyspnea in a patient with Parkinson's disease. This side effect strongly limited adequate antiparkinsonian treatment with L-dopa. Simultaneous administration of L-dopa and tiapride resulted in improvement of parkinsonian symptoms and suppressed the respiratory side effect completely.

Benzamides↗
PubMed1984

Clinical applications of high-frequency jet ventilation.

Six patients with acute respiratory failure were treated with high-frequency jet ventilation (HFJV): 3 because they developed barotrauma while on conventional mechanical ventilation (CMV), 2 because of sedative- or PEEP-induced hypotension on CMV, and 1 because of bronchopleural fistula. In all patients, except the one with bronchopleural fistula, who was treated from the start with HFJV, gas exchange before (while on CMV) and after institution of HFJV could be compared. In these five patients, including the two with acute respiratory failure not complicated by barotrauma, gas exchange was better during HFJV than during CMV for the same levels of FIO2 and PEEP. HFJV therefore seems the method of choice for ventilatory support, not only in patients with bronchopulmonary disruption, but also in patients with hemodynamic embarrassment during CMV.

Adult↗