Biomedical subjects

E Eber

Publications and source records attributed to E Eber.

52 records · Page 3Linked to original sources

PubMed1994

Management of severe congenital tracheobronchomalacia by continuous positive airway pressure and tidal breathing flow-volume loop analysis.

We report on a now 9-month-old infant with severe tracheobronchomalacia associated with campomelic dysplasia. The diagnosis of tracheobronchomalacia was suggested in the neonatal period by typical changes of the tidal breathing flow-volume loop and was confirmed by tracheobronchoscopy. Tidal breathing flow-volume loop analysis also allowed to titrate the optimal, continuous positive airway pressure for the respiratory management of the patient. Since bedside pulmonary function testing is noninvasive and rapid, it may reduce the need for frequent bronchoscopic evaluations in the management of patients with tracheobronchomalacia.

Abnormalities, Multiple↗

PubMed1994

[Measuring lung volume in the infant--problems with the nitrogen washout method].

The open-circuit nitrogen washout technique, as developed by Gerhardt et al., seems to be ideally suited for assessing functional residual capacity (FRC) in infants. By performing this measurement in over 250 infants throughout the last three years, we gathered considerable practical experience of our own, but also encountered several methodological problems, which, so far, have received only little attention by the relevant literature, or have remained unresolved altogether. Our data illustrate the importance of reproducing the infant's own breathing rate and tidal volume when calibrating the system. The choice of the O2-background-flow should be based on the individual peak tidal inspiratory flow, as derived from the tidal flow-volume loop. The importance of maintaining this O2-background-flow unchanged between calibration and measurement is also demonstrated. The question, at which N2-concentration the measurement should be terminated, has remained unresolved. Diffusion of N2 from blood and tissue into the alveolar space is responsible for considerable noise. Our own measurements resulted in widely differing FRC-values for different N2-target-concentrations; these differences seem to increase with more severe bronchial obstruction. Finally, there remains the question, how long the minimal interval between two subsequent measurements should be. In conclusion, these unresolved questions have to be answered in relevant prospective studies, before recommending this technique for routine clinical application.

Airway Obstruction↗

PubMed1994

Lung volume measurements in wheezy infants: comparison of plethysmography and gas dilution.

The accuracy both of plethysmographic measurements of thoracic gas volume (TGV) and determinations of functional residual capacity (FRC) by gas dilution techniques in infants with obstructive lung disease is subject to continued dispute. We studied 25 wheezy infants and compared TGV derived from end-expiratory airway occlusions (TGVEE), corrected TGV after end-inspiratory airway occlusions (TGVEI), and FRC determined by nitrogen wash-out (FRCN2). Group mean TGVEE and TGVEI differed significantly (25.8 +/- 8.4 versus 24.6 +/- 7.1 ml.kg-1). TGVEE and FRCN2 did not differ significantly. TGVEE and TGVEI, as well as TGVEE and FRCN2, and TGVEI and FRCN2 data, respectively, showed lack of agreement. Based on 95% confidence intervals, calculated from TGVEE data, 14 of the 25 infants showed a significantly higher TGVEI than TGVEE; only one patient had a significantly lower TGVEI. Compared to FRCN1 data, TGVEE and TGVEI measurements yielded lower values in at least one third of our patients. The present study illustrates, that there is no gold standard for the measurement of lung volume in infants with airway obstruction.

Bronchiolitis, Viral↗

PubMed1993

Rapid detection of Legionella species in bronchoalveolar lavage fluids with the EnviroAmp Legionella PCR amplification and detection kit.

A molecular assay based on a rapid DNA extraction protocol and the EnviroAmp Legionella Kits was used to detect Legionella species in bronchoalveolar fluid specimens. All Legionella strains isolated from tap water in hospitals could be detected distinctly. Both sensitivity and specificity were tested. In a prospective study, bronchoalveolar lavage fluids obtained from patients with atypical pneumonia were investigated. Three positive samples were detected with the molecular techniques and were subsequently confirmed by culture. Application of the system described may lead to safe and early diagnosis of Legionnaires' disease in patients with atypical pneumonia.

Bacteriological Techniques↗

PubMed1992

[Mucoviscidosis screening with immunoreactive trypsin].

Up to now 49,116 immunoreactive trypsin (IRT) measurements have been carried out in Austrian newborns in the first week of life. Related to provisionally chosen cut-off points, 301 newborns (0.61%) showed an elevated IRT value; 253 of them were successfully recalled. According to a direct strategy, sweat tests were done without a second IRT measurement in 101 infants; eleven of them were identified as cystic fibrosis (CF) patients. In accordance with a 2-step strategy, 152 infants were reinvestigated by a second IRT determination. Twenty-eight of them again showed an elevated IRT value, as based on provisional, age-dependent reference values; seven were subsequently identified as CF patients by sweat testing. So far two false-negative findings were obtained on IRT screening: one child was later identified as having CF on the basis of typical clinical symptoms and a positive sweat test, the other patient presenting with meconium ileus showed a normal IRT value after surgery, but was subjected to a sweat test in view of the underlying condition. These preliminary results suggest a CF incidence of 1 to 2460 newborns in Austria. Hence, IRT screening appears to be a reliable method for identifying CF patients in the newborn period, thereby facilitating early treatment and genetic counselling.

Austria↗

PubMed1992

[Mucoviscidosis screening with immunoreactive trypsin. Initial experiences in Austria].

Up to now, 16.338 IRT-measurements have been carried out on dried blood spot specimens; 15.505 of them were taken in the first week of life. Related to a provisionally chosen cut-off point of 750 ng/ml, 134 newborns (= 0.86%) showed an elevated IRT-value and subsequently were recalled between the fourth and sixth week of life for a second IRT-determination. Twenty-five out of 116 reinvestigated children again showed an elevated value, as based on likewise provisional, age-dependent reference values. Four of these children subsequently were identified as CF patients by sweat testing. So far, we did not encounter any false-negative IRT values. We also commenced to establish a profile of reference values for the first twelve weeks of life; as yet, there are not enough data for definitely defining these limits of normality. In conclusion, IRT-screening appears to be a reliable method for identifying CF patients in the newborn period. Our preliminary results indicate an incidence of CF of 1 to 3880 in the southeast of Austria.

Austria↗

PubMed1991

Cold air challenge of airway reactivity in children: a correlation of transcutaneously measured oxygen tension and conventional lung functions.

For pharmacological challenges, a correlation between the induced changes of the transcutaneously measured oxygen tension (PtcO2) and of conventional pulmonary function tests (PFTs) has been documented. We performed a 4-minute cold air challenge (CACh) in 17 children with bronchial asthma under continuous monitoring of PtcO2, and correlated observed changes with CACh-induced alterations of conventional PFTs. PtcO2 decreased significantly with CACh (from 86 +/- 10 mmHg to 66 +/- 14 mmHg, P less than 0.001), but returned to near-baseline within the next 30 minutes. PFTs changed with a similar pattern; the closest correlation was found between the CACh-induced fall of PtcO2 and Delta-FEV1 (r = 0.833, P less than 0.001). Changes of FVC, PEF, and Vmax50 correlated significantly as well. PtcO2 can complement or substitute for conventional PFTs in assessing the response to CACh in children.

Adolescent↗

PubMed1991

[Effectiveness and tolerance of aerosol disodium cromoglycate in children with bronchial asthma].

Thirteen centres studied the efficacy and safety of nebulized cromolyn solution in 53 asthmatic children (36 m., 17 f.; mean age 4.8 +/- 1.7 years). During a fiveweek treatment period a significant reduction of asthmatic symptoms was observed by investigators daily symptom scores, as assessed by the parents, also showed a significant improvement during treatment period. In addition, there was also a marked decrease in the use of other anti-asthmatic medication (beta 2-sympathomimetics, theophylline and antihistamines). There were no side effects of nebulized cromolyn solution treatment.

Aerosols↗

PubMed1990

Cold air challenge for measuring airway reactivity in children: lack of a late asthmatic reaction.

Cold air challenge (CACh) for measuring airway reactivity uses respiratory heat or water loss as a bronchoconstrictor stimulus; this stimulus is also important for the development of exercise-induced asthma, for which late asthmatic reactions (LARs) have been described. At 1200 hr on day 1, 22 children with asthma started to record their peak expiratory flow rate (PEFR) in 3 hr intervals until 0900 hr on day 2. At 1000 hr, they underwent a standardized 4 min CACh. Children then inhaled salbutamol and continued to record PEFR until 0900 hr on day 3. As a bronchodilator effect, PEFR measurements were significantly higher 2, 5, and 8 hr after CACh, but subsequently did not differ significantly from pre-CACh values. At 5 hr after CACh, individual values ranged from 95 to 137% of the corresponding pre-CACh measurements, at 8 hr from 94 to 150%, and at 11 hr from 80 to 121%. This random sample of children with asthma demonstrated no LAR after CACh.

Adolescent↗

PubMed1990

[Determination of theophylline serum level: comparison between a rapid test (enzyme-immuno-chromatography) and conventional fluorescence polarization immunoassay].

To evaluate the reliability and accuracy of a rapidly performed enzyme immunochromatography method for measuring the serum concentration of theophylline, we compared it with a conventional technique (fluorescence-polarisation immunoassay). We investigated 103 venous blood samples from children and adolescents with bronchial asthma, medicated with sustained-release theophylline preparations. There was a highly significant correlation of the measured values; with a few exceptions, the individual values scattered only narrowly around the regression line. Based on this close correlation, the investigated enzyme immunochromatography test can be recommended for rapid theophylline serum level determinations in clinical practice.

Adolescent↗

PubMed1988

Airway obstruction and airway wall instability in cystic fibrosis: the isolated and combined effect of theophylline and sympathomimetics.

Multiple aspects of lung function were measured in 17 cystic fibrosis (CF) patients on four occasions: without therapy (0); with oral theophylline medication (Th); after inhalation of salbutamol (beta 2); and with combined medication (Th + beta 2). In addition to routine measurements, partial and maximum expiratory flow-volume (MEFV) curves were superimposed, and the flow transient equivalent of the MEFV curve was determined. Its volume dimension (volume of airway contribution, VACMEFV) partially reflects airway distensibility. Changes in airway compressibility--the other consequence of airway wall instability--were assessed by observing changes in end-expiratory flow rate. Airway resistance, expired volumes, and early expired flow rates, as well as VACMEFV improved significantly after beta 2 medication. Mean end-expiratory flow also increased after beta 2; in two patients, however, it decreased significantly, indicating that enhanced airway compression dominated over the release of bronchospasm. The alone had only minor effects on lung function. Early expired volume and flow rates as well as VACMEFV showed no significant difference between beta 2 alone and Th + beta 2; airway resistance even decreased significantly with this drug combination. End-expiratory flow rate, however, was significantly lower after Th + beta 2 than after beta 2 alone. Although theophylline does not alter lung function in most patients with CF, sympathomimetics relieve bronchospasm in many, but they enhance airway compressibility and thereby decrease peripheral expiratory airflow in some.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Extralobar sequestration with unusual arterial supply and venous drainage.

We present a case of extralobar pulmonary sequestration between the left lower lobe and diaphragm with an unusual arterial blood supply and venous drainage. Angiography revealed a large systemic artery arising from the left subclavian artery. The venous return paralleled this anomalous artery and drained into the left subclavian vein. This case illustrates the wide anatomic variability of such complex bronchovascular anomalies. Careful preoperative evaluation of both the arterial supply and venous drainage is important to avoid intraoperative complications. Angiography provides clear definition of these abnormal vascular structures, which is essential for appropriate therapeutic management.

Bronchopulmonary Sequestration↗

PubMedDate not supplied

[Chronic interstitial lung diseases in childhood: bronchopulmonary dysplasia and exogenous allergic alveolitis].

Bronchopulmonary dysplasia (BPD) is a chronic lung disease that develops in preterm infants treated with oxygen and positive-pressure ventilation for respiratory distress syndrome. Despite the introduction of new treatment modalities (surfactant therapy, high-frequency oscillation) and improvements in the outcome of critically ill preterm infants, BPD has become an extremely important complication of neonatal intensive care and the most common form of chronic lung disease in infants. Specific pathogenesis, treatment modalities, prognosis, and multidisciplinary approaches to the prevention of BPD are described in detail. Extrinsic allergic alveolitis ("hypersensitivity pneumonitis") is a rare pulmonary disease in childhood due to inhaled organic dust, containing fungal antigens, thermophilic actinomycetes, or avian proteins. Diagnosis is often difficult, but it should be considered in every child with persistent and otherwise unexplained respiratory symptoms.

Alveolitis, Extrinsic Allergic↗

PubMedDate not supplied

[Peak flow measurement from the pediatric viewpoint].

With special emphasis on the paediatric aspects, the importance of peak expiratory flow rate measurements in asthma patients is reviewed. Portable peak flow meters allow for regular home monitoring of lung function. Repeated peak expiratory flow recordings by patients at home are of great value in the diagnosis and the therapeutic management of bronchial asthma. Monitoring of peak expiratory flow rates may improve the perception of compromised airway function and thereby enhance compliance in asthma patients. As a relatively simple form of pulmonary function testing, the measurement of peak expiratory flow rates, however, cannot substitute for pulmonary function testing by spirometry, flow-volume-curves or bodyplethysmography.

Adolescent↗

PubMedDate not supplied

[Chronic interstitial lung diseases in childhood--an overview].

The spectrum of chronic interstitial lung disease in children includes a large and heterogeneous group of rare disorders. This paper reviews these disorders by focussing on basic pathophysiological mechanisms, and by discussing the difficulties in the classification of these diseases. Diagnostic and therapeutic approaches are also listed. The overall prognosis is dubious and mortality remains high.

Child↗

PubMedDate not supplied

The Chocuhaler: sweet deliverance in asthma management.

OBJECTIVE: To determine the characteristics of a new cocoa-based edible spacer device for the delivery of aerosol bronchodilator. DESIGN: In-vitro comparison of two spacer devices (standard and edible) and determination of bronchodilator response using the edible spacer. SETTING: A university children's hospital in Western Australia. SUBJECTS: Two volunteers with moderate asthma. RESULTS: Compared with a standard spacer, the edible spacer delivered significantly more bronchodilator in droplets of a size likely to enter the respiratory tract. A significant bronchodilator response occurred in two out of two subjects when salbutamol was inhaled orally via the chocolate spacer. No significant bronchodilator response occurred in either subject when the spacer was eaten at the end of the study. CONCLUSION: The chocolate spacer used in this study is a suitable device to deliver salbutamol by inhalation. However, there may be potential drawbacks of weight gain in some patients and meltdown in hot climates.

Administration, Inhalation↗