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Biomedical subjects

B Sanner

Publications and source records attributed to B Sanner.

At least 19 recordsLinked to original sources
PubMed2001

Prospective randomized comparison of impedance-controlled auto-continuous positive airway pressure (APAP(FOT)) with constant CPAP.

Background: The measurement of impedance permits reliable detection of obstructive apneas, hypopneas and upper airways resistance syndrome.Objective: To establish whether impedance-controlled self-adjusting positive airway pressure therapy (APAP(FOT)) is equally as good as constant continuous positive airway pressure (CPAP) in the treatment of sleep apnea syndrome (OSAS).Methods: Twenty men and five women with OSAS (age 52.8+/-9.0 years, body mass index (BMI) 31.4+/-5.0 kg/m(2), AHI 32.2+/-18.1/h (mean+/-SD)) underwent baseline polysomnography, manual CPAP titration and two nights of treatment, one with APAP(FOT), one with constant CPAP.Results: With both modes, a significant reduction in respiratory disturbances was seen (apnea/hypopnea index (AHI) baseline 32.2+/-18.1/h, constant CPAP 6.6+/-8.7, APAP(FOT) 5.5+/-3.8/h, P<0.001 baseline vs. each treatment mode). Under APAP(FOT), the sleep profile was normalized (S3/4 baseline 16.3+/-13.9% total sleep time (TST), APAP(FOT) 21.6+/-10.9% TST, P<0.05, rapid eye movement (REM) 14.2+/-6.7% TST vs. 20.3+/-7.3% TST, P<0.01), while with constant CPAP, a tendency towards improvement was found. The mean treatment pressure with APAP(FOT) was significantly lower than the constant CPAP (5.7+/-2.1 vs. 8.3+/-1.6 mbar, P<0.001).Conclusion: We conclude that APAP(FOT) is at least as effective as constant CPAP in normalizing sleep and breathing in OSAS.

Journal Article↗
PubMed2000

Self-adjusting continuous positive airway pressure therapy based on the measurement of impedance. A comparison of free pressure variation and individually fixed higher minimum pressure.

BACKGROUND: Measurement of impedance using forced oscillation technique is a sensitive means of detecting airway obstructions, including the obstructive sleep apnea syndrome (OSAS). OBJECTIVE: The present study was conducted to determine whether treatment with an automated impedance-controlled continuous positive airway pressure (CPAP) device (APAP(FOT)) is possible in patients with OSAS, and which is the best range of pressure variation in automatical CPAP treatment. We investigated two modes of APAP(FOT) with different pressure ranges: (1) the widest technically possible pressure range and (2) a range with individually defined minimum pressure. METHODS: Ten patients [9 men, age 56.6+/-10.5 years, BMI 32.0+/-4.5 kg/m(2), apnea/hypopnea index (AHI) 18.2+/-13.3 /h] had a diagnostic polysomnography (baseline). After manual titration of positive airway pressure they were submitted, in randomized order, to two modes of the APAP(FOT) device, namely pressure range of 4.0- 15.5 mbar (mode 1 free range) and an individually fixed higher minimum pressure with a maximum pressure of 15.5 mbar (mode 2). RESULTS: While the manually titrated pressure was 8.0+/-1.3 mbar, in mode 1 it was 5.6+/-2.1 mbar (p<0.01); in mode 2 7.3+/-1.6 mbar (p< 0.05). Both of these modes suppressed abnormal respiratory events (baseline AHI 18.2+/-13.3/h; mode 1: 2.5+/-1.9; mode 2: 1.8 +/-0.7, p<0.01 in each case), and increased slow wave sleep (baseline: 10.6+/-8.0%, mode 1: 20.2+/-10.4%, p<0.05; mode 2: 22.3+/-9.3%, p<0.01). In mode 1, the pressure was lower than that titrated manually in 73.2% of total sleep time, in mode 2 in 48.6%, while pressures higher than those derived manually were observed in 13.0% in mode 1 and in 19.1% in mode 2. CONCLUSIONS: The data indicate that impedance-controlled CPAP (APAP(FOT)) allows adequate treatment of OSAS patients at significantly lower pressures as compared with manually titrated pressure. Differences between the two modes are only minor.

Adult↗
PubMed2000

A test for the determination of sustained attention in patients with obstructive sleep apnea syndrome.

BACKGROUND AND OBJECTIVES: To investigate the parameter daytime sleepiness in patients with the sleep apnea syndrome (SAS), a test for measurement of sustained attention was developed. The present studies were performed on volunteers undergoing preemployment medical examinations and SAS patients to determine the extent to which test results are in agreement with the symptoms of SAS and traffic accident reports, and also with daytime sleepiness, and whether learning or therapeutic effects can be seen with repeated tests prior to and following treatment with nasal continuous positive airway pressure (nCPAP). METHODS PARTICIPANTS: 125 healthy volunteers, and two groups of 28 SAS patients each. DESIGN: Study A: The volunteers underwent a single attention test and completed a questionnaire concerned with traffic accidents and symptoms of sleep-related breathing disorders. Study B: SAS patients underwent two attention tests before treatment. Study C: SAS patients underwent one attention test before and one after nCPAP therapy. RESULTS: Study A: The error rate in volunteers without symptoms of sleep-related breathing disorders (51 persons) was 4.7 +/- 4.3% (number of errors 14.1 +/- 12.9), 95% CI: 1.2 (number of errors 3.6). No dependence of the error rate on age, BMI or sex was found. In persons with a history of apneic events (n = 10), the error rate was 10.6 +/- 10.0% (number of errors 31.8 +/- 30), in those with more than two accidents during the last 5 years (n = 4), it was increased to 15.3 +/- 9.7% (number of errors 45.9 +/- 29.1). Study B: Among SAS patients, no significant learning effect was seen, and prolongation of the test duration beyond 30 min had no effect on the test results. Study C: The error rate improved significantly with nCPAP [10.6 +/- 13.5 vs. 6.4 +/- 8.9% (number of errors 31.8 +/- 40. 5 vs. 19.2 +/- 26.7), p < 0.001]. CONCLUSIONS: The attention test can be helpful for the measurement of daytime sleepiness, and CPAP therapy can improve test performance.

Accidents, Traffic↗
PubMed1999

Multiple myeloma involving the stomach with vitamin B12 deficiency.

Involvement of the gastrointestinal tract by plasmocytoma is rare. In a 78-year-old man with IgA lambda multiple myeloma stage IIIB, the evaluation of a megaloblastic anaemia revealed a subnormal vitamin B12 level. Urinary excretion of isotope-labelled vitamin B12 was reduced. Tests for gastric parietal cell and intrinsic factor antibodies were negative. There were no clinical signs of an insufficient absorption in the ileum. Biopsy specimens of the stomach showed a dense, diffuse infiltrate of malignant plasma cells in the lamina propria of fundus and corpus. A urease test for Helicobacter pylori was positive. There was a minor haematological improvement when vitamin B12 was given parenterally. Several combinations of cytostatic drugs had no effect on the manifestations of the multiple myeloma. In our patient the vitamin B12 deficiency may be related to a displacement or destruction of parietal cells by malignant plasma cells.

Aged↗
PubMed1999

Self-adjusting nasal continuous positive airway pressure therapy based on measurement of impedance: A comparison of two different maximum pressure levels.

STUDY OBJECTIVE: Automatic titration using the forced oscillation technique (FOT) has recently been developed for the treatment of obstructive sleep apnea syndrome (OSAS). So far, it is not known if therapy with automatic nasal continuous positive airway pressure (nCPAP) using a preset upper pressure limitation or a free range (which might lead to higher mean pressure) is preferable with regard to obstructive events, sleep stages, and pressure characteristics. DESIGN: After diagnostic polysomnography, patients were randomly assigned to two settings with the self-adjusting nCPAP (APAP) device based on the FOT. In mode 1, the pressure variation ranged from 4 to 15.5 cm H(2)O, and in mode 2, the pressure variation ranged from 4 cm H(2)O to an individual upper pressure limit. PATIENTS: Eleven men, aged 53.0 +/- 6.8 years with a body mass index of 32.4 +/- 5.1 kg/m(2) and an apnea-hypopnea index (AHI) of 31.6 +/- 26.6/h. MEASUREMENTS AND RESULTS: Manually titrated pressure was at 9.3 +/- 2.1 cm H(2)O, the mean pressure in mode 1 was 5.4 +/- 1.0 cm H(2)O (p < 0.01), and the mean pressure in mode 2 was 5.1 +/- 0.7 cm H(2)O (p < 0.01). A reduction of respiratory events (baseline AHI, 31.6 +/- 26.6/h; AHI in mode 1, 3.4 +/- 4.5; AHI in mode 2, 5.0 +/- 7.2; each with p < 0.001) and an increase in the "rapid eye movement" stage of sleep (baseline, 13.0 +/- 5.5%; mode 1, 22.0 +/- 7.7 [p < 0. 05]; mode 2, 23.0 +/- 7.9 [p < 0.01]) were achieved. In mode 1, the mean pressure was below the manual pressure 91.7 +/- 9.3% of the time, and in mode 2, the mean pressure was below the manual pressure 90.4 +/- 6.3% of the time. The manual pressure was exceeded by 5.5 +/- 7.4% (mode 1) and by 5.2 +/- 3.1% (mode 2). CONCLUSION: We conclude that nCPAP therapy based on the FOT permits the adequate treatment of OSAS with significantly lower pressure than manually titrated nCPAP therapy does. A presetting of an upper pressure limit has no advantage compared to free range.

Adult↗
PubMed1998

[Obstructive sleep apnea and hypertension. Diagnostic procedure--exclusion of risk factors--nCPAP treatment].

Obstructive sleep apnea is a common illness with an estimated prevalence of 3% in the adult population. At least 50% of patients with obstructive sleep apnea also have hypertension, while approximately 30% of hypertensives also suffer from obstructive sleep apnea. This high level of coincidence together with the results of recent epidemiological studies and the frequent observation that hypertension may reverse under effective treatment for obstructive sleep apnea strongly suggest that this sleep disorder is an independent causal factor in the development of hypertension. The present paper considers the association of sleep apnea and hypertension and the resulting diagnostic and therapeutic consequences.

Adult↗
PubMed1998

Influence of tissue affinity of angiotensin-converting enzyme inhibitors on left ventricular remodeling after myocardial infarction.

BACKGROUND: The demonstration of local renin-angiotension systems has raised the question of whether angiotensin-converting enzyme (ACE) inhibitors with different tissue affinities differ with regard to their effects on postinfarction remodeling. HYPOTHESIS: The study was undertaken to investigate the influence of ACE inhibitors with different tissue affinity on morphology and function of the infarcted left ventricle. METHODS: In all, 52 patients (17 women, 35 men, 38-73 years) with large acute myocardial infarction were randomized to receive either 25-75 mg/day captopril or 10-20 mg/day fosinopril beginning on the Day 7 after infarction. Of these, 28 had anterior and 24 had posterior wall infarctions. Infarct size was determined by the creatine kinase integral method. Fifty patients were examined by cinemagnetic resonance imaging (CMRI) 1 and 26 weeks after infarction. The following parameters were determined: left ventricular end-diastolic and end-systolic volume index (LVEDVI, LVESVI), ejection fraction (LVEF), infarct weight, and muscle mass (LVMM). The volume-to-mass ratio (VMR) was calculated and the clinical status according to the guidelines of the New York Heart Association (NYHA) was documented at each examination time. The results were compared with those of a historical sample without ACE-inhibitor therapy examined in an identical manner (n = 31, 10 women, 21 men, 36-75 years). RESULTS: LVEDVI and LVESVI increased in the first 6 months after infarction by 24.9 and 36.6%, respectively, in the historical sample; by 11.0 and 7.8%, respectively, under captopril; and by 13.1 and 10.7%, respectively, under fosinopril. LVEF decreased by 14.9% in the untreated sample, by 3.7% under captopril and by 5.0% under fosinopril. Infarct weight and LVMM increased by 12.7 and 15.3%, respectively, without ACE inhibition, by 5.7 and 10.1%, respectively, in patients treated with captopril, and by 6.1 and 9.3%, respectively, in patients treated with fosinopril. The VMR increased by 7.4% in the historical sample, by 3.5% in the captopril group, and by 1.8% in the fosinopril group. The NYHA clinical status improved by 18.2% without ACE inhibition, by 42.9% in the captopril group, and by 26.3% in the fosinopril group. The differences between the two ACE-inhibitor groups and the reference group were all significant, while the differences between the captopril group and the fosinopril group were significant only for VMR (p < 0.01) and NYHA class (p < 0.05). CONCLUSIONS: Both captopril and fosinopril have a comparable positive influence on postinfarction remodeling and on clinical status. Lipophilicity and tissue affinity do not seem to play a clinically important role in ACE-inhibitor therapy after infarction.

Adult↗
PubMed1997

[Hereditary nonpolyposis colonic carcinoma with primary extra-colic manifestation].

A 62-year-old woman presented with nausea, weakness, and vasovagal attack. She had a history of a carcinoma of the endometrium 19 years prior to admission, and adenocarcinomas of the cecum, ascending colon, transverse colon, rectum and sigmoid during the subsequent years. Due to the typical history, including family history, hereditary nonpolyposis colorectal cancer (HNPCC) was diagnosed 6 months prior to admission. Physical examination was normal with the exception of pallor of the skin and the palpebral conjunctivas. Laboratory values showed hypochromic, microcytic anemia (hemoglobin: 6.5 g/dl; MCV 70.1 fl; MCH 22.8 micrograms). Esophagogastroduodenoscopy revealed an exophytic mass protruding into the lumen of the inferior part of the duodenum. Carcinoma of the duodenum as a manifestation of HNPCC was diagnosed and partial duodenectomy performed. Macroscopic and microscopic examination revealed two adenocarcinomas--next to one another--7.0 cm and 2.5 cm in diameter. HNPCC is often overlooked and its relevance underestimated. Since diagnosis of this disease has major implications, all patients with colorectal cancer, and also young women with carcinoma of the endometrium, should be screened for HNPCC.

Adenocarcinoma↗
PubMed1997

[Pronounced hypersomnia in a 13-year-old patient with periodic leg movements].

We report on a rare case of a thirteen-year old female with excessive daytime somnolence, which was caused by periodic leg movement. This underlines the necessity first to consider this diagnosis and second to record unconditionally the EMG derivation at minimum of the tibialis muscles in all patients with hypersomnolence. Even if carbamazepine is not the treatment of choice, in this case it was of remarkable effect.

Adolescent↗