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Biomedical subjects

A F Meinesz

Publications and source records attributed to A F Meinesz.

At least 19 recordsLinked to original sources
PubMed2006

[From the poliomyelitis epidemic to the founding of artificial respiration centres, intensive care units and centres for home mechanical ventilation].

In 1952, Copenhagen was confronted with a poliomyelitis epidemic that involved the respiratory musculature in large numbers of patients. The anaesthetist B. Ibsen, who established carbon dioxide intoxication due to severe hypoventilation as the cause of death, proposed that the patients be treated by tracheostomy and positive pressure respiration in order to achieve better ventilation than with an iron lung. In the Netherlands, it was decided to organise the control ofthe epidemics on a nationwide basis. Various hospitals were asked to set up artificial respiration centres. In addition, the Beatrix Fund was set up in order to collect money for combating poliomyelitis. The epidemic reached the Netherlands in 1956. In Groningen University Medical Centre, 74 patients were admitted, of whom 36 had to be ventilated. In two cases, the mechanical ventilation could not be stopped and one of these was ultimately discharged home with chronic ventilation in 1960, thus becoming the first patient in the Netherlands to be given mechanical ventilation at home. The mechanical ventilation centres developed into the intensive care units as we know them today. Most of the forms of treatment now in use are based on the techniques thought up and elaborated by the pioneers working in the mechanical ventilation centres. The latest development in this series is the development of centres for home mechanical ventilation.

Critical Care↗
PubMed2003

[Treatment of the obstructive sleep-apnea syndrome in adults].

When treating the obstructive sleep-apnoea syndrome (OSAS), conservative management and the correction of treatable stenoses in the upper airway should be considered first. If these measures are neither effective nor applicable, then continuous positive airway pressure (CPAP) is the preferred treatment. Surgical interventions should only be considered after failure of non-surgical treatment modalities. Pharmacological management of OSAS is usually only indicated as a form of supplementary treatment in specific patients. Oral-appliance therapy appears to be of value in the management of OSAS and, in specific groups of patients, seems likely to offer a good alternative to CPAP in the future.

Female↗
PubMed1999

[Dyspnea caused by bullae in a muscular dystrophy patient on chronic intermittent ventilatory support].

A 65-year-old patient, ex-smoker, with facioscapulohumeral muscular dystrophy (FSHD) had been on home non invasive ventilatory support for three years when he experienced gradual increase of dyspnoea. The chest radiograph showed large bullae occupying most of the right hemithorax, with compression of lung tissue, mediastinal shift, and compression of the left lower lobe. Bullectomy resulted in rapid clinical and radiographic improvement. This is the first report of beneficial effects of emergency bullectomy in FSHD. Bullectomy has proved most successful in patients with localized bullae and compression of surrounding lung tissue. Patients with respiratory infections and bronchiectasis benefit less.

Aged↗
PubMed1999

[Orthopnea: not always of cardiac origin].

Respiratory insufficiency developed in a man aged 68 after cardiac surgery and in a man aged 60 with COPD and a history of cigarette smoking after an attack of 'flu', while in a woman aged 70 with non insulin-dependent diabetes mellitus it had been present for years. All three had bilateral diaphragmatic paralysis. The diagnosis is based on the triad orthopnoea, paradoxical abdominal movements during respiration in the recumbent position and a decrease of the vital capacity in the horizontal as compared with the sitting position. The patients' physical condition could be improved with the aid of (noninvasive) ventilatory support.

Aged↗
PubMed1997

[Risk of respiratory insufficiency caused by thoracic rigidity].

Three patients, a man aged 71 and two women aged 47 and 54, were admitted for chronic obstructive pulmonary disease and cardiac failure. All three had thoracic deformities, owing to earlier pneumonectomy with thoracoplasty because of pulmonary tuberculosis, congenital kyphoscoliosis, and infant poliomyelitis respectively. Such patients are at risk of developing chronic respiratory insufficiency because of chronic alveolar hypoventilation: muscle power decreasing with age gradually fails to meet the increased respiratory labour. Often, the respiratory insufficiency is not noticed because the problems are ascribed to secondary chronic obstructive pulmonary disease or cardiac failure. The first sign of imminent respiratory insufficiency is nocturnal carbon dioxide accumulation. Therapy consists of respiratory assistance at night by positive air pressure ventilation via a nose mask.

Aged↗
PubMed1994

Pneumatosis intestinalis and active cytomegaloviral infection after lung transplantation. Groningen Lung Transplant Group.

Pneumatosis intestinalis occurred in a patient with a primary cytomegaloviral (CMV) infection with pneumonitis 6 weeks after single lung transplantation for primary pulmonary hypertension. The possible causal relationship between pneumatosis intestinalis, an uncommon disorder with an obscure pathogenesis, and active CMV infection has been observed before; however, to our knowledge, this is the first report of this combination after lung transplantation. The patient had no abdominal complaints, and after treatment of the CMV infection, the pneumatosis intestinalis resolved spontaneously. The early diagnosis of active CMV infection and the prevention of unnecessary abdominal surgery were essential in this case.

Adult↗
PubMed1990

Amyloid tumour resected by laser therapy.

We report a patient presenting with dyspnoea, cough and fever with a middle lobe atelectasis. Amyloid deposits in the bronchial wall caused almost complete obstruction of the middle lobe bronchus. The patient was treated with neodymium yttrium aluminium garnet (NdYAG) laser photoresection resulting in complete clearance of the middle lobe bronchus. Laser therapy has to be considered as first-line therapy for patients with endobronchial amyloidosis.

Adult↗
PubMed1989

The distribution of bronchial responsiveness to histamine in symptomatic and in asymptomatic subjects. A population-based analysis of various indices of responsiveness.

The distribution of bronchial responsiveness (BR) and the place of symptomatic subjects in this distribution was investigated in a random population sample of 339 subjects who participated in the 1984 survey of the Vlagtwedde/Vlaardingen Study. BR was assessed by a histamine provocation test. The following indices of BR were used: (1) a histamine threshold both at 10 and at 20% decreases in FEV1 (PC10 and PC20); (2) the concentration causing a 10 or a 20% decrease estimated by linear interpolation (IPC10 and IPC20), and by linear regression of all data points (PD10 and PD20); (3) the slope of the linear regression line through all data points (SAP) and the slope of the line through the origin and the last data point (SOL). Disease was defined as the self-reported presence of respiratory symptoms from a respiratory symptom questionnaire. Bronchial challenge was considered as a test to predict symptom prevalence. Receiver-operator characteristic curves were applied to define optimal cutoff points for each of the indices used to define a positive and a negative test. For each index, sensitivity, specificity, predictive value of a positive and negative test, and efficiency rate of the test were calculated. The overall distribution of BR in this population appeared to be log normal for the different continuous indices. Subjects with symptoms were on the more responsive tail of the distribution. After adjusting for age, sex, smoking habit, and level of pulmonary function, the mean log-transformed values of PD10, PD20, SAP, and SOL for the various symptom groups differed significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Benign endobronchial tumours treated by neodymium-YAG laser.

We present two patients with benign endobronchial tumours: polypi and a chondroma. Both were treated by Neodymium-YAG laser photoresection. There have been no signs of recurrence in the four years since treatment. Endobronchial resection by Neodymium-YAG laser is an effective treatment for benign endobronchial tumours.

Aged↗
PubMed1986

No response improvement after sequential chemotherapy for small cell lung cancer.

In a phase II study in patients with small cell lung cancer (SCLC) the combination of cyclophosphamide, cisplatinum and etoposide was found to be active, the response rate was 91% (30% CR, 61% PR) in the whole group. In 40 limited disease patients 19 CR (48%) and 20 PR (50%) were seen, whereas in 30 extensive disease patients only 2 CR (7%) and 23 PR (77%) were reached. Adding a second combination of doxorubicin, vincristine and procarbazine resulted in response improvement in only two patients. Median response duration was 41 weeks in CR patients and 30 in PR patients (p less than 0.01). Median survival was 66 in CR and 45 weeks in PR patients (p less than 0.002). Performance score and disease stage were found to be good prognostic factors. Four patients (6%) are disease-free at 2 1/2 years. The value of sequential chemotherapy for SCLC is probably minimal in view of the lack of response improvement.

Adult↗
PubMed1985

High-dose cyclophosphamide and high-dose VP 16-213 for recurrent or refractory small cell lung cancer. A phase II study.

In nine patients with recurrent or refractory small cell lung cancer a phase II study with high-dose cyclophosphamide and high-dose VP 16-213 with autologous bone marrow transplantation was performed. The regimen used was based on a previously reported phase I study. In eight of the nine evaluable patients a response was seen (six PR and two CR). One patient died of treatment related toxicity. Infection is the most important toxicity. The response duration was short. This combination is a suitable "late intensification' regimen for patients with minimal residual disease after standard dose induction chemotherapy.

Adult↗
PubMed1984

No narcosis for bone marrow harvest in autologous bone marrow transplantation.

A prospective study with mild general analgesia and sedation together with local anesthesia during bone marrow harvest was performed. Thirty-one patients underwent 33 bone marrow collections. Pretreatment consisted of 100 mg meperidine i.m. and 20 mg diazepam i.m. 1 h before start of procedure. Eight patients got additional meperidine and diazepam during the procedure, all patients got lidocaine 1% locally. A mean volume of 1.321 was obtained with 42.5 punctures. Twenty-two patients had no complications, 4 vomited, 4 had easily correctable hypotension of short duration, one got oxygen for cyanosis of short duration. Acceptance was good in 23 patients, in 6 reasonably well, in two bad. Only one patient experienced pain problems, due to suction. Anxiety was no major problem due to good information before the procedure and mild sedation. This form of anesthesia for bone marrow collection is a safe procedure, it is generally well accepted by the patient and it can be performed on an out-patient basis.

Adult↗