[Pulmonary manifestations in connective tissue diseases (author's transl)].
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to F Kummer.
Explore the source record for details and available documents.
Maximal work endurance of heart and circulation measured by submaximal work load on an ergometer can be estimated with reasonable accuracy by means of the physical working capacity 170 (PWC 170) only in healthy individuals aged 30 years or below. Limitation of exercise by pulmonary factors does not appear to bias the results essentially. In healthy people aged 40 or over, the risk of miscalculating maximal working ability based on PWC 170 increases considerably despite maintenance of high statistical correlation to maximal work load. In patients with coronary heart disease, there is no statistical correlation between PWC 170 and maximal work load; therefore, symptom-limited ergometry is required in these patients. For the assessment of quality in follow-up tests, the watt-pulse at submaximal work load appears to be the most adequate parameter. It is recommended that submaximal tests be also carried out in a rectangular-triangular manner, for the purpose of comparison with symptom-limited tests and for evaluation of changes in the dynamics of pulse and blood pressure regulation.
Airway resistance was measured by body plethysmography and also by an oscillographic method for assessment of the impedance of the respiratory tract. The results were compared in 42 unselected patients. The correlation between the two values for airway resistance was satisfactory (r = 0,804 p less than 0,001). However, when correlation was sought between each type of resistance-value and other lung function data (FEV1, IGV), the resistance measured by plethymography correlated better than the one measured by the oscillation method. This difference was even more pronounced when 21 patients with manifest bronchospasm were reevaluated after bronchodilatation. Nevertheless, the oscillation method for assessment of the resistance of the respiratory tract serves as a new and practicable tool for bed-side lung function testing, as well as for testing of patients who are unable to cooperate for routine spirography.
Serum angiotensin converting enzyme (ACE) activity was studied in 50 patients with sarcoidosis (39 active, 11 inactive sarcoidosis), as well as in 50 control patients (34 chronic lung diseases, 9 Hodgkin-disease, 7 rheumatoid arthritis). There is a significant difference (p less than 0.001) of ACE-activity between sarcoidosis patients and controls, and between active (without steroid treatment) and inactive sarcoidosis. Steroid treatment apparently lowers ACE-activity in sarcoidosis, however, without evidence for clinical improvement. Increased ACE-activity was also found in a patient with primary biliary cirrhosis.
In 4 patients with juvenile idiopathic thoracic scoliosis an atelectasis as part of the convex-sided lungs was found. In all cases there was a small sagittal diameter of the chest; the atelectases were situated in the right lower and middle lobe and caused by the close topographical relation of large bronchi and scoliotic spine (sometimes compression of the bronchus) demonstrable by tomography, bronchoscopy and bronchography. The therapeutic approach of these atelectases is discussed. Thoracic casting either for conservative correction and treatment of scoliosis or as postoperative immobilisation after fusion was done. In all cases, it may influence the occurrence of an atelectasis.
Exercise tests were performed in 21 competition rowers, before and after a 4 month training period. The significance of differences in VO2, VT, and specific ventilation (Sp. V) at equal work loads, were tested. The influence of the relative VO2 Trel VO20 = VO2/kg BW) on the correlation between maximal workload (Wmax) and VO2 max, was investigated. The VO2 at all workloads, showed a highly significant increase after the period of training. Multiple linear regression analysis, demonstrates an increase of the correlation coefficient from r = 0,65 (single) to R = 0,95 (multiple). The precision of estimation concerning maximal exercise, improves considerably when rel. VO2 is taken into account, as well as, Wmax. The rel. VO2max as a parameter for the state of training can be estimated from an exact training history (total amount of training with direct cardiopulmonary influence = endurance type of training). Combined with Wmax this training history can be included into the multiple regression equation VO2max - 1060 + 6.3 Wmax + 57.3 rel. VO2max. By these means, including ergometry and the training history, even a practicing internist can to a fair estent estimate the capacity for sport.
Radiology is the basic factor in diagnosis of emphysema. Further differentiation is possible by assessment of the concomitant cardio-vascular changes. By these means, the type of emphysema (accompanying emphysema in chronic bronchitis, or primary emphysema) can be established.
We can conclude that the combination of high FEV2/1 index and a "peak-flow-less" flow-volume loop is characteristic for the presence of proximal airway stenosis and is a reliable means for differentiation against bronchospasm and emphysema. In comparison, the measurement of airway resistance, FEV1 alone, inspiratory shift of mid-breathing level etc., indicate only the presence of airway obstruction, but fail to give specific information for functional differentiation of bronchial obstruction and morphological evidence of proximal airway stenosis.
Detailed pulmonary function analysis was performed in 20 patients with juvenile-onset diabetes mellitus and in 20 age- and sex-matched control subjects. No significant differences were found in comparisons of all lung function data obtained from these two groups. Even the parameters of lung recoil, which recently have been reported to be decreased in juvenile-onset diabetes, were within the normal range. These data indicate normal pulmonary function in patients with juvenile-onset diabetes mellitus, a finding that is in accordance with clinical experience.
In a retrospective study in 91 patients an attempt was made to differentiate the primary and/or predominating disorder "emphysema" or/and "chronic bronchitis" by independent evaluation of a number of X-ray signs and lung function criteria in routine diagnosis. Good congruency of the diagnosis from these two different aspects, could be established. Patients with 3 or more X-ray signs of emphysema were found to have larger lung volume and smaller diffusing capacities than those without. Vice versa, patients with functional diagnosis of predominant emphysema more often showed the full X-ray pattern of emphysema, than those with predominant "chronic bronchitis". In either method of diagnostic procedure, the occurence of the "small heart of emphysema" was obviously much more frequent in patients believed to have predominant or primary emphysema. Assessment of X-ray signs of changes of the lesser circulation can be obtained in a stage of the disease, when structural changes have become irreversible. Considering the different pathophysiologic pattern of predominant panacinar emphysema, the destruction of alveolar walls and, consequently of the capillary bed, is more likely to reduce DCO as well as cardiac output before pulmonary hypertension can develop. The X-ray signs resulting from this effect on the lesser circulation, exist in widened right hilar branch and abrupt narrowing of peripheral vessels, with a small heart and lack of prominence of the pulmonary trunk. In chronic bronchitis, however, signs of pulmonary hypertension are expected to occur early in the disease. The relevance of the X-ray changes of the heart size and the pulmonary circulation in both types of lung disease, could be confirmed by lung function data.
In kyphoscoliosis, a rotation of the convex-sided lung around a vertical axis, can be observed. In comparison of "pure" scoliotics with kyphoscoliotics, the degree of kyphosis seems to counteract the rotating effect of scoliosis. This effect is possibly related to the duration of the deformity, insofar as, rotation increases primarily due to scoliosis and then tends to disappear with age-related development of accompanying kyphosis. The clinical relevancy and the kyphosis-dependent changes lf lung function, are discussed.
A brief survey is given on the current theories and knowledge of therapy of bronchospasm. The results, obtained in 11 patients with proven atopy, regarding their response to the anticholinergic inhalant ipratropium-bromide (Atrovent) after artificial bronchospasm induced by specific allergen and acetylcholin, respectively, are being discussed. The therapeutic response was largely dependent on the level of preceding bronchospasm, quantitated by airway resistance. This phenomenon was more pronounced in allergen than in acetylcholin-induced asthma. The differences were of statistical significance by means of covariant analysis. The clinically relevant aspects of this finding are being discussed.
Sixty-two patients with classical or definite rheumatoid arthritis were subjected to lung function analysis. The various parameters--spirography, plethysmography, blood gas analysis, measurement of lung compliance, and diffusion capacity--were correlated with duration and stage of disease, and with rheumatoid factor titres. A statistically significant correlation was found to exist between Rose-Waaler titre and specific diffusion capacity. Similar results between Rose-Waaler titre and lung compliance, however, were not statistically significant.
Explore the source record for details and available documents.
The "asthma programme", the product of teamwork between the 1st Department of Dermatology and the 2nd Department of Medicine is presented. It contains all examinations necessary for the diagnosis of bronchial asthma: case history, skin test, IgE, RAST, lung function test, inhalative provocation test. The value of each is discussed. Finally, the results of hyposensitation treatment are presented.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
12 patients with chronic bronchitis were treated with two different doses (0.02 and 0.08 mg) of Sch 1000 (Atrovent) administered by metered dose inhalation and the results compared with those following administration of a placebo in a cross-over double-blind study. The airway resistance and thoracic gas volume fell significantly after treatment with the drug, with no appreciable difference in effect between the dosages. The bronchodilatory action of the drug lasted about 4 hours and differed markedly from that of the placebo. No anticholinergic side effects or specific effects on the circulation were encountered at the administered dosage.