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Biomedical subjects

D Heimer

Publications and source records attributed to D Heimer.

At least 37 records · Page 2Linked to original sources
PubMed1991

Comparison of a B2 adrenergic agonist and an anticholinergic agent given by sequential inhalation in patients with severe chronic obstructive pulmonary disease.

We evaluated the response of 15 male patients with severe chronic obstructive pulmonary disease (COPD) to sequential inhalations of an anticholinergic agent, ipratropium bromide 0.25 mg (IB) and a B2 adrenergic agonist, terbutalin 2.5 mg (TER), in a double-blind crossover study. We found no statistically significant difference in the bronchodilatory response between the two agents when comparing the change in forced vital capacity and forced expiratory volume in 1 sec. The subsequent effect of the sequential inhalation demonstrated some additional bronchodilatory response when IB was given after TER, but not when TER was given after IB. However, the end result after the two protocols was not statistically different. The results indicate that in COPD patients the two agents are equipotent. However, in order to prescribe the best treatment schedule for each patient, it is still necessary to evaluate how each individual patient responds to each of the agents. Sequential inhalation may be beneficial in some patients.

Adrenergic beta-Agonists↗
PubMed1990

Respiratory muscle performance in patients with type 1 diabetes.

Respiratory muscle strength and endurance were examined in 31 Type 1 diabetic patients and in age, sex, and weight matched control subjects. No significant difference in respiratory muscle strength was noted between the two groups. Maximal static inspiratory pressure was 92.3 +/- 33.9 (+/- SD) and 99.5 +/- 23.0% of the predicted values in the patient and control groups, respectively. Maximal static expiratory pressures were 75.1 +/- 14.3 and 77.4 +/- 14.0% of the predicted values in the patient and control groups, respectively. Respiratory muscle endurance was significantly lower in the diabetic patients 88.9 +/- 20.7 vs 103.9 +/- 15.8% predicted in the control group (p less than 0.01). Total lung capacity, vital capacity, and maximal voluntary ventilation were also significantly lower in the diabetic group and correlated with the duration of diabetes.

Adult↗
PubMed1990

Physiological changes in respiration associated with near drowning in the Dead Sea: a canine model.

An experimental study to elucidate the physiological changes that occur in respiration during near drowning in the Dead Sea was performed in an experimental model. Findings showed that clinical signs of respiratory failure were due to aspiration rather than ingestion of Dead Sea water and occurred within 10 min of aspiration. Physiological changes included increased ventilation, tachypnea, increased resistance, decreased compliance and hypoxia.

Airway Resistance↗
PubMed1988

Effect of chronic renal failure on respiratory muscle strength.

In 10 patients with chronic renal failure (CRF), undergoing hemodialysis, we studied respiratory muscle strength and endurance. The data obtained was compared with those acquired from 10 age-, sex-, weight- and height-matched normal volunteers. Maximal static inspiratory pressures (PImax) measured at residual volume and maximal static expiratory pressure (PEmax) measured at total lung capacity were significantly lower in the CRF group, 58.2 +/- (SD)24.9 and 50.8 +/- (SD)24.2% of predicted, respectively (p less than 0.005, p less than 0.01). There was a significant correlation between PImax and PEmax (r = 0.827, p less than 0.001), indicating similar involvement of both inspiratory and expiratory muscle groups. Maximal voluntary ventilation (MVV), although 84.4% of the predicted value in the CRF group, was significantly lower than in the control group, where it was 114% of predicted (p less than 0.001). MVV also correlated significantly with PImax and PEmax (r = 0.764, p less than 0.001 and r = 0.807, p less than 0.001, respectively). All but one CRF patient had elevated erum inorganic phosphorus levels, and a significant correlation was found between the serum inorganic phosphorus levels and PImax and PEmax (r = 0.718, p less than 0.001). These data indicate that there is an impairment of respiratory muscle strength and endurance in patients with CRF which may predispose the patient to respiratory muscle fatigue.

Adult↗
PubMed1987

Extreme hypermagnesemia due to ingestion of Dead Sea water.

We describe 3 patients who developed extreme hypermagnesemia due to ingestion of water of the Dead Sea, which would have been fatal were it not for the protective effects of the accompanying hypercalcemia. We emphasize the clinical features of this condition and the importance and effectiveness of early hemodialysis as the main modality of treatment.

Aged↗
PubMed1986

Serological, clinical and radiological findings in adults with bronchopulmonary infections caused by Chlamydia trachomatis.

We report here four cases of lower respiratory tract infection caused by Chlamydia trachomatis. Three of them had clinical and radiological findings of atypical pneumonia, while one presented with an acute exacerbation of chronic obstructive pulmonary disease (COPD). None of the patients had signs of ocular or genitourinary infections. All patients had specific IgM, IgA and IgG antibodies for C. trachomatis during the acute infection, and were seronegative for C. psittaci. No specific clinical or radiological patterns were found. Two of the patients with pneumonia were laboratory workers who were exposed to the L2 (434 bu) serovar of C. trachomatis. They had a striking seroconversion and were followed up serologically for up to 30 weeks after onset of illness.

Adult↗
PubMed1985

Bronchial challenge with room temperature isocapnic hyperventilation. A comparison with histamine challenge.

We evaluated isocapnic hyperventilation with room temperature gas (IHV) as a test of bronchial hyperreactivity and compared it with histamine challenge (HC) in three groups of subjects: normal subjects, known mild asthmatic patients, and patients referred to the pulmonary clinic for a chief complaint of dyspnea. Physical examination at the time of evaluation was negative in all subjects. When the criterion for a positive reaction to IHV was a decrease in FEV1 of 10 percent or greater, and the criterion for a positive reaction to HC was a PD20 (concentration of inhaled histamine necessary to decrease FEV1 by at least 20 percent) of less than 10 mg/ml, the specificity of both tests was 100 percent. The sensitivity of both tests as evaluated from the known asthmatic patients was also 100 percent. Among the dyspneic patients, eight of 30 reacted to both IHV and HC, two of 30 reacted to HC alone, and eight of 30 reacted to IHV alone. It was concluded that IHV compares favorably with HC as a test of bronchial hyperreactivity, patients with clinical histories highly suggestive for asthma might not need to undergo bronchial challenge testing, and neither HC nor IHV when used alone is able to identify all of the hyperreactive patients.

Adolescent↗
PubMed1985

Fiberoptic bronchoscopy in patients with hemoptysis and nonlocalizing chest roentgenograms.

We reviewed retrospectively the records of 45 patients undergoing fiberoptic bronchoscopy for hemoptysis in whom chest roentgenograms either were normal or showed only nonlocalizing findings. Follow-up was available for up to three years. In none of the patients was evidence of malignant neoplasms found either at the time of the initial evaluation or at the time of follow-up. This was true for all age groups and for smokers as well as nonsmokers. We conclude that routine fiberoptic bronchoscopy for hemoptysis is not necessarily indicated in patients like ours. Indications for this procedure in this type of case should be carefully weighed.

Adult↗
PubMed1984

"Second wind" during inspiratory loading.

Five human volunteers breathed through an inspiratory register to achieve a transdiaphragmatic pressure (Pdi) of 42-45% of the maximum, until fatigue. During the period of resistive breathing all subjects experienced at least one episode of a sudden feeling of relaxation and relief from dyspnea, i.e., "second wind." These episodes were accompanied by a sudden decrease in the neural stimulation to the diaphragm as reflected in the electromyogram (EMG). Changes in lung volume or chest configuration were eliminated as was recruitment of accessory muscles of inspiration during the "second wind"; thus, there appeared to be a change in the contractile function of the diaphragm such that the same force (Pdi) was achieved with less neural input. These results indicate that the phenomenon of "second wind" has physiologic correlates and may be subject to experimental verification and manipulation.

Adult↗
PubMed1983

Sleep apnea syndrome treated by repair of deviated nasal septum.

Sleep apnea syndrome (SAS) often presents a difficult therapeutic problem to the clinician since many of the accepted modes of therapy are associated with only partial success or with a number of long-term complications. We present three patients with obstructive SAS in whom dramatic clinical improvement occurred following repair of a deviated nasal septum. The subjective improvement was associated with a diminution in the number and duration of obstructive apnea episodes as observed during a standard sleep study. Because of its simplicity and low rate of complication, we propose that repair of a deviated nasal septum be further evaluated as a mode of therapy for this condition.

Adult↗
PubMed1983

Uncomplicated pneumonia: an evaluation of determinants of length of hospitalization.

A study was carried out on the length of hospitalization of patients with uncomplicated pneumonia. Three medical wards with comparable admissions criteria and characteristics of patients had different lengths of hospitalization (5.4, 8.1 and 9.1 days). Quality of care, defined by a score based on agreed-upon criteria of patient management and scored by independent observers, was similar for the three wards. There were also no differences in the rates of rehospitalization or complications. In the ward with the shortest hospital stay, predischarge chest X-rays were not performed; in the other two wards, 19.8% of the patients had a repeat chest X-ray before discharge. The difference in the proportion of predischarge X-rays did not explain the differences in length of stay. The data suggest that hospitalization practices should be periodically reviewed to ascertain their contribution to the length of hospitalization. The shortest hospitalization period for uncomplicated pneumonia observed on one of the medical wards seems reasonable and was not associated with obvious major complications in this small group of patients. Since only a small percentage of chest X-rays return to normal by the end of the 1st wk, and in view of their questionable contribution to therapeutic decisions, the usefulness of the predischarge chest X-ray is doubtful.

Adolescent↗
PubMed1981

Pathologic and physiologic effects of aspiration of hydrocarbons in the rat.

In a series of laboratory rats, pathologic and physiologic changes of the lungs were studied for 2 wk after intratracheal instillation of kerosene. The ratio of lung weight to body weight increased, indicating pulmonary congestion. Pathologically, 2 types of changes were seen: a generalized hyperemia and a focal bronchopneumonia. Physiologically there was an upward shift to the left of the static pressure-volume curve, with increases in total lung capacity of 35 to 40%. This was true whether air or saline was used as the inflating medium. All the changes described were maximal by 24 h after kerosene instillation and tended to return to baseline within 2 wk. Although static compliance of the lung increased, when normalized for total lung capacity there was no change, indicating that the shift was functionally equivalent to opening new lung units. We speculate that the leftward shift in the pressure-volume curve was due either to a reversible effect on lung elastin, or to changes in contractile elements located in lung parenchyma.

Animals↗
PubMed1980

The effect of sequential inhalations of metaproterenol aerosol in asthma.

In 19 asthmatic patients, three inhalations of metaproterenol (0.65 mg per puff) followed by placebo at 10 and 20 min were compared with one inhalation of the drug every 10 min for the same total of three doses. Metaproterenol 0.65 mg produced just as much increase of 1-sec forced expiratory volume (FEV1) as did the much larger dose (1.95 mg), but each subsequent inhalation of the drug produced further, significant increase of FEV1 suggesting better penetration of the bronchidilator aerosol after some bronchodilation had been achieved. After completion of treatment, the FEV1 was significantly higher when the drug was given sequentially rather than all at once. These data have important implications with respect to the utilization of bronchodilator aerosols in the treatment of asthma and indicate the unsuitability of sequential inhalation for study of dose response of these agents.

Administration, Intranasal↗