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Biomedical subjects

A Knoblauch

Publications and source records attributed to A Knoblauch.

At least 19 recordsLinked to original sources
PubMed1998

Adverse reactions to peak flow monitoring. Report of 5 patients.

Five patients with adverse reactions to peak flow monitoring are presented: 2 patients had herniation of abdominal content, while the others presented with vasovagal syncope, minor depression and neurotic preoccupation with peak flow values, respectively. As a result, 3 of the 5 patients became noncompliant. For nonpsychological somatic adverse reactions, we calculated an incidence of 1.1 cases/1,000 patients started on peak flow monitoring. Adverse reactions with a psychological background may be more frequent. Clinicians should bear in mind that patients noncompliant with peak flow monitoring may have discontinued because of adverse reactions.

Adult↗
PubMed1997

[Disseminated mycobacteriosis with M. kansasii in a case of AIDS without HIV infection].

M. kansasii is an environmental Mycobacterium that causes disease mainly in patients with local or systemic immunodeficiency. We present a case with disseminated M. kansasii infection which led to a severe febrile illness lasting for 9 months. The patient had a combined acquired immunodeficiency syndrome (AIDS) which included CD4+ and CD8+ T-lymphocytopenia, monocytopenia and a deficiency in the IgG subclasses 2 and 4. HIV testing was repeatedly negative. In the published literature only 4 of 10 similar patients (this patient included) survived a disseminated M. kansasii infection. Eleven years after the disseminated infection with M. kansasii a second opportunistic infection, disseminated mollusca contagiosa and hyperparathyroidism, developed, and 14 years later the immunologic abnormalities persist.

AIDS-Related Opportunistic Infections↗
PubMed1997

Management 1997 of chronic obstructive pulmonary disease. Working Group of the Swiss Society of Pneumology.

COPD is a disorder characterized by expiratory flow limitation that does not change markedly over periods of several months' observation. When the diagnosis is suspected, COPD patients should be submitted to full assessment and initiation of therapy. Initial assessment includes a complete history, a detailed physical examination, pulmonary function tests, a chest X-ray, and blood tests. Therapy of COPD aims at reducing symptoms, preventing exacerbations and preserving optimal lung function. Many COPD patients have a bronchospastic component and usually show some response to bronchodilator therapy. Anticholinergics, beta 2-agonists or theophylline are used as monotherapy or in combination. A subgroup of patients with COPD may benefit from oral long-term corticosteroid therapy. At prime diagnosis of COPD, a trial of oral steroid under optimal bronchodilator therapy is warranted in order to identify steroid responders early in the course of the disease. Stopping smoking is the most effective preventive measure and should be combined with complementary approaches such as eviction of environmental irritants, vaccines and prescription of antioxidants. Long-term oxygen therapy is beneficial in chronically hypoxemic patients. Respiratory rehabilitation uses a multidisciplinary approach aiming at decreasing dyspnea, increasing exercise tolerance and improving quality of life. Nocturnal home noninvasive mechanical ventilatory assistance can improve arterial blood gas tensions in patients with respiratory failure, but the long-term effect on survival is still under investigation. In selected patients, surgery (bullectomy, lung volume reduction, lung transplantation) may greatly improve pulmonary function.

Adrenal Cortex Hormones↗
PubMed1997

Sleep-related laryngospasm.

The term "sleep-related laryngospasm" refers to episodic, abrupt interruption of sleep accompanied by feelings of acute suffocation followed by stridor. The condition is included in the diagnostic and coding manual of the American Sleep Disorders Association (ASDA), but there are few references in the peer-reviewed literature. Our description of the distinct clinical picture associated with this condition is based on an analysis of the histories of a series of 10 patients. The patients and their families gave precise, uniform accounts of the dramatic attacks. Diagnostic work-up included pulmonary and gastroenterological assessment. All patients reported sudden awakening from sleep due to feelings of acute suffocation, accompanied by intense fear. Apnoea lasting 5-45 s was followed by stridor. Breathing returned to normal within minutes. Patients were left exhausted by the attacks. Nine of our 10 patients had evidence of gastro-oesophageal reflux and six responded to antireflux therapy. We conclude that the nocturnal choking attacks (and the occasional daytime attacks experienced by some of the patients) are caused by laryngospasm. The pathogenesis of the apparent underlying laryngeal irritability is unknown. The condition may be related to a gastro-oesophageal reflux.

Adolescent↗
PubMed1997

Diffuse microvascular pulmonary thrombosis associated with primary antiphospholipid antibody syndrome.

Thromboembolism is a well-known complication of the hypercoagulable state associated with antiphospholipid (aPL) antibodies. Acute respiratory failure (ARF) with diffuse pulmonary infiltrates has been reported in only a few patients with aPL antibodies. We describe a 49 year old patient with spiking fever, livedo reticularis, mild haemoptysis and ARF. Chest radiography revealed diffuse bilateral pulmonary infiltrates, and high resolution computed tomography (CT) revealed patchy distribution of areas of ground-glass attenuations. Pulmonary emboli were excluded with angiography. Lung biopsy revealed diffuse microvascular thrombosis, without capillaritis. High serum levels of anticardiolipin (aCL) antibodies were found. The patient's condition improved dramatically after intravenous infection of 1 g methylprednisolone on three consecutive days, followed by 50 mg prednisone orally. The rapid improvement following the administration of glucocorticosteroids suggests that anticardiolipin associated microvascular thrombosis, without inflammatory lesions, may depend on an interference with beta2-glycoprotein I (beta2=GPI) by anticardiolipin.

Antibodies, Anticardiolipin↗
PubMed1996

Accidents related to manure in eastern Switzerland: an epidemiological study.

OBJECTIVES: Liquid manure systems and manure pits are major hazards in the agricultural workplace. The incidence of accidents related to manure is unknown. The objective of this study was to survey the liquid manure facilities of farms in eastern Switzerland and find the incidence of accidents related to manure in the region. METHODS: Retrospective cohort study and cross sectional survey of 210 farms in eastern Switzerland. RESULTS: The incidence of accidents related to manure was found to be 10.4/1000 person-years. Most accidents were categorised as minor--that is, had a benign outcome for the people involved or involved animals only. One in 33 of the farms surveyed was the scene of an accident related to manure each year. CONCLUSIONS: The medical literature on accidents related to manure mostly reports accidents with catastrophic outcomes. This study shows that this type of accident is only the tip of the iceberg. Most of the accidents reported in this study belong to a category that has hitherto been un-noticed and unreported. The term "accident related to manure" covers a broad range of events, and those resulting in serious human illness or death represent only a small part of this spectrum. A wide variety of liquid manure systems were found on the farms surveyed. Very few liquid manure facilities conformed to published safety standards.

Accidents, Occupational↗
PubMed1995

[Dust exposure, dust-induced lung diseases and respiratory protective measures in agriculture].

Epidemiologic studies indicate a high prevalence of respiratory diseases among the farming population. Many of these diseases are responsible for disability and death and there is a considerable impact on the economy and health cost expenditure. Respirable organic dust plays a major pathogenetic role. Part I of this review discusses the diseases and syndromes caused by organic dust: organic dust toxic syndrome; chronic bronchitis and chronic obstructive pulmonary disease; asthma; and hypersensitivity pneumonitis. Part II describes preventive measures for dust control. Besides technical aspects in the process of agriculture production, special emphasis is placed on personal protective equipment systems (face-masks and air-purifying respirators). Applications, advantages and disadvantages of these systems are discussed and critically compared.

Agricultural Workers' Diseases↗
PubMed1994

Severe inflammatory upper airway stenosis in ulcerative colitis.

Severe upper airway stenosis was diagnosed in a 23 year old woman who presented with hoarseness, cough and dyspnoea 8 yrs after initial diagnosis of ulcerative colitis. The respiratory symptoms worsened over the next few months, the patient eventually developing dysphagia and ultimately severe upper airway obstruction. The narrowest site was the glottis, which was severely stenosed by inflammatory swellings. Systemic corticosteroids led to rapid clinical improvement and restoration of normal airway patency within a few months. Ulcerative colitis is frequently associated with extraintestinal inflammatory manifestations. In the respiratory tract these usually take the form of chronic bronchitis, which occasionally develops into bronchiectasis. This case confirms that the inflammation can also involve the larynx and large airways.

Adult↗
PubMed1994

Simultaneous bilateral spontaneous pneumothorax.

We describe 12 patients with simultaneous bilateral spontaneous pneumothorax (SBSP). They represent 4 percent of patients with spontaneous pneumothorax seen at our hospital from 1971 to 1990. Five of the 12 had no underlying lung disease. In the seven remaining patients, SBSP was secondary to histiocytosis X, lymphangioleiomyomatosis, osteogenic sarcoma with pleural and pulmonary metastases, Hodgkin's disease, mesothelioma, cystic fibrosis, or miliary tuberculosis. Nineteen of the 56 patients with SBSP (34 percent) described in the literature (this series included) had pulmonary disease related to disorders of cells of mesenchymal origin. Emphysema and bullous lung disease were not associated with SBSP. Long-term prognosis was a function of pulmonary status. Four of the patients described herein died during the period reviewed. All suffered from severe underlying disease. In no case was SBSP the main cause of death. With timely treatment, the short-term prognosis is benign even for patients with underlying lung disease. Surgical pleurectomy should be attempted early, especially in SBSP secondary to underlying lung disease.

Adolescent↗
PubMed1992

[Peak flow profile and expert testimony. The significance of peakflow self assessment for pneumological expert testimony].

Quantitative assessment of pulmonary obstructive diseases, such as asthma, may be difficult because of variability of obstruction. This is particularly true with regard to expert evidence pulmonary physicians deliver to insurances. Severity of obstruction, degree of impairment by an obstructive ventilatory defect, and temporal relationship of bronchial obstruction to exposure, may not be detected by physiological measurements in the pulmonary function laboratory. Much of the expert's opinion on these matters will depend on the credibility he assigns to the insured individual. The insured individual, in the other hand, has no other proof available than the description of his complaints, which puts him at a disadvantage. Serial peak flow measurements can be instrumental in clarifying such issues. They add an objective dimension to the case history. Six cases in which expert evidence was commissioned by insurances are described in detail, to exemplify how the thinking of the experts was modified by peak flow profiles. The greater usefulness of serial peak flow measurements in occupational asthma is emphasized and problems that may arise with peak flow measurements are discussed.

Adult↗
PubMed1991

[Randomized and controlled single-case study--a scientific method for individual and difficult therapy decisions in clinical practice exemplified with methotrexate use in asthma].

For various reasons, optimal individual therapies cannot always be derived from monitored, large-scale random studies. This applies particularly to delicate decisions on the treatment of chronically ill patients. In such situations, random, controlled and "double-blind" individual case studies with "cross-over" can be a solution. The procedure is adjusted to suit the individual patient. In many two-part treatment phases, the patient receives the active medication and an alternative/placebo. The sequence is adapted to the randomization. Neither patient nor doctor knows what the preparations are. The aims of the study are primarily oriented towards the wellbeing of the individual patient. The problems of individual optimization of therapy in practice are presented, as are the individual case study methods. Their potential application and limits and their value are discussed and illustrated by means of an actual case study.

Adult↗
PubMed1991

[Home mechanical ventilation in Switzerland in 1990. Future developments].

Home mechanical ventilation (HMV) was initiated in polio centers in the mid-50s (iron lung). Ten years ago, chronic respiratory insufficiency patients began to be treated with positive pressure ventilation via tracheostomy tube. Survival of kyphoscoliotic and myopathic patients was impressive in uncontrolled studies. Today it appears that similar results may be obtained with a new non-invasive technique, nasal mechanical ventilation. The present situation of HMV in Switzerland (number of patients and their location) and the results of this treatment are described. In addition, we report on a short series of 24 Swiss patients collected in 4 centers. We show that HMV is possible in Switzerland and that the results in survival and quality of life are excellent, provided that the indications for this technique are consistent with the recommendations in the literature.

Adolescent↗
PubMed1990

[Home ventilatory support--retrospective view and perspectives].

Mechanical home ventilation is a child of this centuries polio epidemics. The tank respirator, or iron lung, signaled the beginning of the new era. Improved techniques like positive pressure ventilation via tracheostoma followed soon. Hypoventilation syndromes of various origin are more and more encountered thanks to better detection methods. They benefit from a new, efficient and noninvasive technique, the positive pressure ventilation via nasal mask.

History, 20th Century↗
PubMed1989

[Amborum Special F and ASFO--2 glucocorticoid-containing herbal remedies].

Amborum Special F and ASFO are two names of a herbal remedy which is adulterated with the glucocorticoid betamethasone. Patients with asthma, rheumatic and chronic diseases import the drug direct from Burbank, California, USA. Its impressive antiasthmatic effect is reported in two patients. While under therapy the first patient developed Cushing's syndrome and the second showed suppression of adrenal cortisol production. The manufacturer, who claims that the drug contains no "western medicine" and in particular no cortisone, is unscrupulous enough to recommend it for children under two years of age. We have observed that a marked glucocorticoid effect and marked glucocorticoid side effects are achieved with small doses of betamethasone. A review of the literature and the two cases reported here suggest that the equivalence doses given in textbooks and tables of glucocorticoid equipotency are incorrect for betamethasone. Betamethasone is a more potent glucocorticoid than hitherto reported.

Adult↗
PubMed1985

[Self-monitoring of airway obstruction using the peak flowmeter].

Daily peak flow measurements provide an accurate and objective assessment of airway obstruction. The peak flow profile offers a rational basis for antiobstructive treatment. Success and failure of treatment are visualized, as are the asymptomatic beginning of an asthmatic attack, an allergen exposure or an exercise-induced obstruction. Compliance improves, and self-monitoring seems to increase patient comfort. A considerable amount of knowledge about the dynamics of airway obstruction is conveyed to the physician, and this works very much to the benefit of his patient.

Adult↗
PubMed1984

[Oculopharyngeal muscular dystrophy].

A family from eastern Switzerland with oculopharyngeal muscle dystrophy is described. The history shows seven affected persons in three generations. The inheritance pattern is autosomal dominant with complete penetrance. Bilateral ptosis and dysphagia, the hallmarks of the disorder, appear in the fourth decade and progess slowly. The late stage is characterized by ptosis, causing reclination of the head and marked upright posture. Dysphagia may be disabling, causing starvation, or, as in the index case, death by aspiration pneumonia. Surgical procedures are available to correct the ptosis and alleviate dysphagia.

Aged↗