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Biomedical subjects

B Juhl

Publications and source records attributed to B Juhl.

At least 19 recordsLinked to original sources
PubMed1995

[Congenital central hypoventilation--treated with nocturnal biphasic intermittent respiration via nasal mask].

A case of congenital central hypoventilation syndrome (CCHS) was undiagnosed until the girl in question was eight years old. Her development was normal, although with symptoms and signs of nocturnal hypoventilation. At the age of eight, with an interval of eight months, she suffered two attacks of acute respiratory insufficiency necessitating intubation and respiratory treatment. The episodes were considered to be pneumonia/septicaemia, but were in retrospect proven to be lung congestion as a consequence of hypercapnia and hypoxaemia. After the last episode CCHS was confirmed. The difficulties in diagnosing CCHS are discussed. After extubation she has been successfully treated with nocturnal nasal intermittent positive pressure ventilation (NIPPV) with BiPAP (Respironic), and she has in this way avoided tracheostomy.

Circadian Rhythm↗
PubMed1995

[Pregnancy and delivery in a woman with neuromuscular disease. Spinal muscular atrophy and severely reduced pulmonary function].

Pregnancy and delivery are described in a 22-year-old woman suffering from spinal muscular atrophy. In spite of severe respiratory insufficiency with a vital capacity of 0.6 litre, pregnancy and planned caesarean section in general anaesthesia went without complications. Some explanations for this are presented. Teams involving respiratory centres specialized in the treatment of patients with neuromuscular diseases, obstetricians and neurologists are recommended. These teams may carry out individual counselling, frequent controls, respiratory support and planning of delivery.

Adult↗
PubMed1995

A randomised, clinical study of the effect of low-dose dopamine on central and renal haemodynamics in infrarenal aortic surgery.

OBJECTIVE: To determine whether dopamine prevents deterioration of central haemodynamics and renal function in aortoiliac surgery. DESIGN: Prospective, randomised and placebo-controlled. SETTING: University hospital. MATERIALS: Thirty patients for elective vascular surgery with implantation of an aortobifemoral or an aortobiiliac graft due to aortoiliac arteriosclerosis had infusion of dopamine 3 micrograms/kg/min or placebo during the operation and 24 h postoperatively. Thoracic epidural analgesia and general anaesthesia were used. CHIEF OUTCOME MEASURES: Central haemodynamic measurements were registered. The effective renal plasma flow (ERPF), the glomerular filtration rate (GFR), angiotensin II, aldosterone, arginine vasopressin (AVP), atrial natriuretic peptide (ANP), endothelin and excretion of water and electrolytes were measured preoperatively, 1 h postoperatively and 24 h postoperatively. MAIN RESULTS: During the operation the dopamine group had higher cardiac index and heart rate together with lower pulmonary artery wedge blood pressure. ERPF and GFR did not differ between the groups. In the dopamine group ERPF was increased in all patients at the first postoperative clearance. The fractional excretion of sodium, the per- and postoperative diuresis and AVP were increased in the dopamine group as compared to the placebo group. Postoperatively, ANP in the placebo group was raised as compared to the preoperative level. CONCLUSIONS: Peroperatively, dopamine counteracted depression of left ventricular function. The increased ERPF at the first postoperative clearance in the dopamine group indicates either improved peroperative haemodynamics or a synergistic effect between dopamine and epidural sympathetic blockade. Dopamine also improved diuresis and natriuresis.

Aged↗
PubMed1995

Indicators of need for mechanical ventilation in Duchenne muscular dystrophy and spinal muscular atrophy.

STUDY OBJECTIVES: The purpose was to investigate a possible relationship between different parameters of physical function, spirometric measurements, and the approaching need for mechanical ventilation. DESIGN: A nonrandomized, prospective, descriptive study of 11 patients with spinal muscular atrophy type II (SMA-II) and 14 patients with Duchenne muscular dystrophy (DMD). At a home visit, the anthropometric indices of age, height, and weight were recorded, the degree of disability was scored, and measurement of the strength of eight muscle groups and spirometry was performed. The interdependence of the variables was analyzed and the intergroup differences evaluated. Eighteen months later, it was found that one of the authors (B.J.), who was blind to the results of the first examination had instituted home mechanical ventilation on seven of the patients. The data were analyzed retrospectively for their predictive value as indicators of approaching ventilator dependency. RESULTS: The seven patients who needed mechanical ventilation were the patients with DMD with the highest disability score (Egen Klassifikation [EK] sum > 20) and the smallest values for FVC < 1.2 L (FVC% < 30). We found a significant correlation (p = 0.002) between FVC% and the EK sum at the first examination and between the FVC% and the time until treatment with mechanical ventilation was instituted (p = 0.023). Although 7 of the 11 patients with SMA type II had FVC below 1.2 L and some of them had an EK sum score higher (indicating more disability) than some patients with DMD who needed mechanical ventilation, none of them required mechanical ventilation. CONCLUSION: In this investigation, a combination of EK sum and FVC% provided a better indication of the approaching need for mechanical ventilation in the patients with DMD than the variables separately.

Adolescent↗
PubMed1995

Unchanged renal haemodynamics following high dose ascorbic acid administration in normoalbuminuric IDDM patients.

The object of the study was to test whether high dose ascorbic acid (AA) could normalize glomerular hyperfiltration in insulin-dependent diabetes mellitus (IDDM) patients. A prospective, double-blind, randomized, placebo (tartaric acid, TA) controlled study design was used, with parallel treatment lasting 4 weeks. Measurements were made before and after treatment, on 24 normoalbuminuric, normotensive male IDDM patients, who were randomized to ascorbic acid (n = 12, age 35 years (18-39), diabetes duration 12 years (2-12), BP 128/82 mmHg (SD 14/6)), or to placebo (TA) (n = 12, age 30 years (19-36), diabetes duration 8 years (2-17), BP 119/75 mmHg (SD 9/7). The intervention consisted of 6 enterosoluble tablets of 500 mg AA or 213 mg TA, twice a day, being daily doses of 6 g AA or 2.55 g TA. No significant differences in any of the parameters measured were seen, when comparing results following AA or placebo treatment. The glomerular filtration rate (GFR, clearance of 125I-iothalamate) was unchanged while effective renal plasma flow (ERPF, clearance of 131I-hippuran) tended to decline in both groups. The GFRs before and after treatment in the AA-treated group were 141 (SD 15) and 134 (SD 12) ml min-1 1.73 m-2; NS (2p = 0.09). In the TA-treated group they were 142 (SD 19) and 137 (SD 16) ml min-1 1.73 m-2; NS (2p = 0.20). The ERPFs in the AA group were 584 (SD 93) and 545 (SD 47) ml min-1 1.73 m-2; (2p = 0.06). In the TA group they were 618 (SD 108) and 574 (SD 98) ml min-1 1.73 m-2 (2p = 0.03). The filtration fractions (FFs) in the AA group were 0.244 and 0.246 NS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Complications and late sequelae after nasotracheal intubation].

A total of 379 patients admitted to the Intensive Care Unit (ICU) for mechanical ventilation were prospectively investigated for lesions of the nose, nasal cavity, ears and larynx during and after nasotracheal intubation. One to two years later, the surviving patients were questioned to investigate late persisting sequelae. During intubation and up to five days following extubation, inflammatory changes and ulceration of the nostrils or nasal septum were found in respectively 76 (20%) and 110 (29%) patients. There were bleedings from the nasal cavity in 67 (19%) and fractures of the conchae in 40 patients (11%). Hoarseness was noted in 135 patients (42%). Inflammatory changes and ulcerations of the nostril and nasal septum were correlated to the duration of intubation. Among the 281 patients included in the follow-up study, 100 (35%) had symptoms from the nose and nasal cavity. Sixty-five (24%) had symptoms related to the ears, 56 (20%) to the maxillary sinus, 81 (29%) to the voice and 90 (32%) to the throat. Increasing duration of intubation was found to be correlated to persisting symptoms from the larynx. Former ulcerations of the nose were associated with a tendency toward nasal bleeding. To avoid as many complications as possible from the nose and nasal cavity, we recommend orotracheal intubation. As late sequelae from the larynx increase with the duration of intubation, perhaps tracheostomy should be performed earlier than is general practice today, but that has to be proven in forthcoming studies.

Adolescent↗
PubMed1994

Clean intermittent self-catheterization.

The pathogenesis and the symptomatology of the infrequent voiding syndrome is discussed. The acceptability of clean intermittent self-catheterization as a treatment modality for women with the infrequent voiding syndrome is documented through questionnaires and retrospective study of patient records in fifty-four women. This study is part of a study already published.

Adult↗
PubMed1993

[Is it possible to live with clean intermittent catheterization?].

In the period 1983 to 1992, 208 patients with bladder dysfunction were introduced to clean intermittent self-catheterization. Through questionnaires and retrospective study of patient records we found that 57% of the patients were very satisfied with this treatment modality. Seventy percent found it easy to learn to catheterize themselves and 39% experienced improval of everyday life. Thirty-five percent never had bacteriuria. No serious complications were seen. Conclusively we found that clean intermittent self-catheterization is a good treatment modality for patients with bladder dysfunction. It is easy to learn, easy to perform and is very well accepted by the patients.

Adolescent↗
PubMed1993

[Transesophageal echocardiography for registration of hemodynamics. A new tool in anesthesiology].

During the last ten years, transesophageal echocardiography has become an important tool for cardiac monitoring. In other countries it is widely applied, especially in cardiac surgery, but the areas of application are still expanding. Transesophageal echocardiography is a non-invasive technique in contrast to most other methods available for monitoring central haemodynamics. The complication frequency is extremely low. However, correct therapeutic decisions depend on profound experience with the equipment and image interpretation. The scope of transoesophageal echocardiography as a new tool in haemodynamic monitoring is described in this paper together with preliminary results.

Anesthesiology↗
PubMed1993

[Heroin-induced pulmonary edema].

Based on a case story and having examined the literature, we describe the incidence, symptoms, course, complications and treatment of the kind of pulmonary oedema that may arise in connection with acute heroin intoxication. A possible pathogenesis is also discussed. Heroin-induced pulmonary oedema is rather frequent and the mortality is high. It differs from cardiogenic pulmonary oedema at essential points. It is most likely due to an increased permeability of the lung capillaries. However, it is still unclarified whether this is caused by a toxic or an allergic reaction, or by hypoxia. The treatment is supportive, using a respirator and oxygen enriched breathing air until the hypoxia has been abolished, and support of the circulation with reasonable liquid supply and infusion of inotropic and vasoactive drugs.

Adult↗
PubMed1993

[Indicators for an impending need of artificial respiration in patients with muscular dystrophy].

In 1990 we examined 25 patients with Duchenne Muscular Dystrophy (DMD) or Spinal Muscular Atrophy type II (SMA-II). The purpose was to elucidate their general physical capability and find indicators for future need of artificial ventilation. We used interviews and measurements. The interviews were based on classifications described as 1) EAMDA, 2) VIGNOS, 3) BROOKE for use with DMD patients. Our own classification (called EK) is described and used. Moreover, we measured five parameters for the mechanical lung function, the strength of eight great muscle groups, and anthropometrical data. In January 1992, between two and 18 months after our examination, seven of the patients (all DMD) required artificial ventilation. Among the patients who needed artificial ventilation, we found the DMDs to have the lowest physical capability, as measured by the interview (EK and EAMDA) and the smallest values for forced vital capacity (FVC) and peak expiratory flow rate (PEF). All 11 patients with SMA-II could administer their lives without ventilator. Comparing their values with the DMD group, we would expect that several would need artificial ventilation. The reason why the SMA-II patients can manage without artificial ventilation is not clarified. Combining our classification (EK) and the value for FVC, we can predict the need for artificial ventilation among the participating DMD patients.

Adolescent↗
PubMed1993

Complications and late sequelae following nasotracheal intubation.

A total of 379 patients admitted to the ICU for mechanical ventilation were prospectively investigated for lesions on the nose, nasal cavity, ears and larynx during and after nasotracheal intubation. One to two years later, the surviving patients were questioned to investigate late persisting sequelae. During intubation and up to 5 days following extubation, inflammatory changes and ulceration of the nostrils or nasal septum were found in 76 (20%) and 110 patients (29%), respectively. There were bleedings from the nasal cavity in 67 (19%) and fractures of the conchae in 40 patients (11%). Hoarseness was noted in 135 patients (42%). Inflammatory changes and ulcerations of the nostril and nasal septum were correlated to the duration of intubation. Among the 281 patients included in the follow-up study, 100 (35%) had symptoms from the nose and nasal cavity. Sixty-five (24%) had symptoms related to the ears, 56 (20%) to the maxillary sinus, 81 (29%) to the voice and 90 (32%) to the throat. Increasing duration of intubation was found to be correlated to persisting symptoms from the larynx. Former ulcerations of the nose were associated with a tendency to nasal bleeding. To avoid as many complications as possible from the nose and nasal cavity, we recommend orotracheal intubation. As late sequelae from the larynx increase with the duration of intubation, perhaps tracheostomy should be performed earlier than is general practice today, but that has to be proven in forthcoming studies.

Adolescent↗
PubMed1992

Computer-aided analysis of gastrointestinal pressure recordings. Comparison with manual scoring.

The aim of the present study was to compare computer-based and visual/manual scoring of pressure recordings from the gastric antrum and duodenum. The computer system was based on three separate principles of recognition: moving average, tracking base line, and threshold filters. Computer scoring resulted in the detection of more contractions than visual/manual scoring, owing to inclusion of artefacts of duration and amplitude above the selected thresholds. Owing to its unreliability, visual/manual scoring led to inclusion of some contractions of below-borderline amplitude or duration. The median difference in the frequency of contractions was, however, 0 min-1. There was close agreement on amplitudes of contractions. As the differences between visual/manual analysis and computer-aided scoring by the present system are of an unimportant magnitude and as computer-based scoring is consistent, we conclude that computer-aided analysis is preferable to visual/manual analysis.

Duodenum↗
PubMed1991

Is minitracheotomy a simple and safe procedure? A prospective investigation in the intensive care unit.

Patients with imminent respiratory failure due to sputum retention were assessed for minitracheotomy (MT). MT was considered potentially useful in 79 patients but only attempted in 73, 54 men and 19 women, aged 23-81 years (median 65 years). Insertion of the cannula failed in 4 cases. Sputum retention and atelectasis were successfully treated in 87% (N = 60). Treatment by MT in medical and neurological patients seems as effective as in surgical patients (success rate 81% versus 90%). The frequency of complications was 16%. Most complications were insignificant and occurred during cannulation, but a few severe complications were seen. To minimize the number of these it is essential that MT is done only by doctors who are familiar with the procedure. MT can be recommended for treatment of sputum retention and atelectasis in surgical and medical/neurological intensive care patients with preserved cough function.

Adult↗
PubMed1991

The effect of nasotracheal intubation on the paranasal sinuses. A prospective study of 434 intensive care patients.

A total of 434 patients admitted to the intensive care unit for mechanical ventilation were followed prospectively to investigate the influence of a nasotracheal tube on the paranasal sinuses. Twenty-five patients died before the examination was completed. The rest were examined for clinical symptoms of sinusitis. If sinusitis was suspected or the patients were intubated for 5 days or more, an x-ray of the sinuses was performed. In patients intubated for less than 5 days (N = 357), sinusitis was clinically suspected in three, but radiographically verified in only one. In patients intubated for 5 days or more (N = 47), 23 (49%) had affection of the paranasal sinuses. Patients needing a nasotracheal tube should be examined for sinusitis if they are intubated for more than 5 days or if unexplained fever, sepsis or purulent nasal secretion develops. If the suspicion is confirmed, the nasotracheal tube should be removed.

Adult↗
PubMed1991

Postoperative pulmonary complications and lung function in high-risk patients: a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia.

The effect of three postoperative regimens of respiratory therapy on pulmonary complications and lung function was compared in high-risk patients. Fifty-one patients were randomized to: 1) conventional chest physiotherapy alone (PHYS), 2) chest physiotherapy and positive expiratory pressure (PEP), or 3) chest physiotherapy with both positive expiratory pressure and inspiratory resistance (RMT). Treatments were given twice daily by a physiotherapist and self-administered. The incidence of postoperative pulmonary complications (PPC) was respectively, 71%, 76% and 65% in the PHYS-, PEP- and RMT-groups. The incidence of PPC requiring treatment with antibiotic, bronchodilator or supplementary oxygen according to the existing clinical practice was 47%, 47% and 29%. The incidence of atelectasis was 65%, 64% and 60% and of pneumonia 29%, 35% and 6%. There was no difference between the groups, except for a tendency to a lower frequency of pneumonia in the RMT-group. Postoperatively forced vital capacity (FVC) decreased to mean 54%, forced expired volume in 1 s to 48% and functional residual capacity to 76% of preoperative values. Arterial oxygen tension (PaO2) declined to mean 8.1 kPa and arterial saturation (SaO2) to 89%. There was no difference between the groups except for FVC, PaO2 and SaO2 (P = 0.008, P = 0.008 and P = 0.002), which showed the least decrease in the RMT-group. None of the regimens could be considered as satisfactory concerning the prevention of PPC, but RMT seemed to be the most efficient. Insufficient self-administration of treatment was probably one of the causes of the overall high incidence of PPC in this study.

Abdomen↗
PubMed1990

[Long-term respirator treatment].

Long-term respirator treatment in the patients' own home is instituted increasingly frequently in patients with neuromuscular diseases. Positive pressure ventilation via a permanent tracheostomy is employed. Treatment is frequently commenced electively during hospitalization in particularly interested departments. Discharge to the patients' home is undertaken after thorough instruction of the patient himself, the family and the persons who help the patient with his other daily needs. Possible guidelines for establishing this form of treatment are outlined on the basis of literature from abroad.

Denmark↗