PubMed Health⌕ Search

Biomedical subjects

H Hein

Publications and source records attributed to H Hein.

At least 19 recordsLinked to original sources
PubMed2004

[The sleep apnoea syndromes: alternative therapies].

Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome. However, further steps are often necessary. If there is a postural component in mild cases sleeping on the side can help. Recent developments are a range of operations that increase the size of the pharynx. There is a good relief in snoring but the reduction in apnea rate is less successful. Oral appliances are are indicated for primary snoring or mild obstructive sleep apnea. The are no data that support the use of drugs as a therapy for obstructive sleep apnea. Different nonprescription therapies are available (internal and external nasal dilators, nasal and oral lubricants, dietary supplements, magnetic pillows and matresses) but their usefulness for the treatment has not been demonstrated. The treatment of choice for sleep-related obstructive breathing disorders is nCPAP.

Complementary Therapies↗
PubMed2004

[Cardiovascular diseases and sleep-disordered breathing].

About 1.9 % of the population suffer from an obstructive sleep apnea syndrome (OSAS). At the age of between 30 and 60 years it occurs in 3 %. Patients with OSAS develop more frequently such disorders as arteriosclerosis, cardiac arrhythmias and arterial hypertension. A host of pathophysiological changes can be diagnosed. The elevated sympathic activity, recurrent hypoxemias, stress, disturbances in the microvascular milieu, endothelial dysfunction, elevated oxidative capacity as well as a reduced vascular reagibility are deemed to be factors connected to arteriosclerosis. Different biochemical markers, which are seen as risk factors or as markers of cardiovascular diseases, are altered in patients with OSAS (high-sensitive CRP, Interleukin(IL)-6, IL-8, IL-10, TNF-alpha, VGEF, ICAM-1, VCAM-1 and L-Selectin). Patients with OSAS exhibit signs of an impaired insulin sensitivity. Disturbances in microcirculation are also evident. Patients with OSAS have, compared to patients without sleep apnea, elevated blood pressure measurements, even given other common risk factors. The incidence of coronary heart diseases is increased in patients with OSAS. Morbidity and mortality, especially of arteriosclerotic diseases are elevated. Many of the aforementioned disturbances can be improved by a CPAP-therapy.

Adult↗
PubMed2001

Risk of endotoxemia during the initial phase of gut decontamination with antimicrobial agents.

Decontamination of the digestive tract with antimicrobial agents has been used for prevention and therapy of bacterial translocation. With regard to the well-described endotoxin-releasing properties of these agents, the question arises as to whether their enteral administration might result in an increased amount of intestinal endotoxins entering the circulation. Immunocompromised Wistar rats were intraduodenally challenged with live E. coli. Control animals received saline solution, decontaminated rats were treated with either tobramycin plus polymyxin B or ciprofloxacin alone through the duodenal tube. Plasma endotoxin activity and blood bacteria count were measured hourly over an observation period of 5 h. The intestinal bacterial count was determined at the end of the experiment. Gut decontamination in both groups receiving antimicrobial agents resulted in elevated plasma endotoxin levels compared with nondecontaminated controls. Maximum endotoxin levels were found to be 5-6 times higher in the ciprofloxacin group than in the control group and 2 times higher than in the tobramycin/polymyxin group. No positive blood cultures were detected. Intestinal bacterial count was similar in both treatment groups. Enterally applied antimicrobial agents bear an elevated risk of endotoxemia during the initial phase of gut decontamination. The amount of endotoxin translocating from the digestive tract to the circulation varies with the agents used. Polymyxin only partially reduced the observed endotoxin leakage from the gut.

Animals↗
PubMed2000

The therapeutic effect of theophylline in mild obstructive sleep Apnea/Hypopnea syndrome: results of repeated measurements with portable recording devices at home.

Theophylline has been recommended in the literature as a therapeutic option in mild OSAHS. In mild obstructive sleep apnea/hypopnea syndrome (OSAHS), night-to-night variability of parameters of sleep-disordered breathing has been determined rarely, we therefore compared the results of serial measurements of sleep apnea/hypopnea parameters under the effects of placebo and theophylline. To this end, we measured the individual variability of the apnea-hypopnea index (AHI) for seven consecutive nights using a portable sleep apnea recording device, in 14 subjects (2 women, 12 men, mean age +/- [standard deviation] 50 +/- 8 years), treated with placebo or theophylline in a double blind, randomized crossover fashion, whose polysomnographically measured AHI was 13 +/- 5 /hour. Under theophylline treatment in comparison with placebo we observed a small but significant decrease in mean (of seven days) AHI at home (9.2 +/- 7.7 to 6.7 +/- 6.1 /hour), which was independent of body position. The night-to-night variability of AHI at home was high (9. 2 +/- 8.9 /hour; range: 0-31.4 /hour) and proved to be independent of body position and alcohol consumption. - In mild OSAHS, repeated measurements of sleep related breathing events should be performed. Theophylline showed a small but clinically insignificant potencial to reduce AHI.

Adult↗
PubMed2000

[nCPAP therapy does not affect respiratory mechanics of patients with sleep-related respiratory disturbances].

We investigated in patients with sleep disordered breathing the influence of long-term nCPAP-therapy on airway mechanics and capillary blood gases. 109 patients (19 women, 90 men, age [mean +/- standard deviation] 59 +/- 10 years, apnea-hypopnea-index 34 +/- 24/h) were treated for 27 +/- 33 months, with a mean pressure of 7.7 +/- 2 mbar, mean usage 5.6 +/- 1.9 h/night. Vital capacity, FEV1, thoracic gas volume and capillary blood gases did not change during therapy, irrespective of the smoking history. However, in a subgroup of 6 patients who were hypoxemic before therapy, there was a significant increase of PaO2 from 63 +/- 4 to 70 +/- 6 mm Hg (p < 0.01). Neither the height of the pressure nor the duration of therapy did influence the course of lung function data.

Female↗
PubMed1999

Genomic organization, sequence analysis and transcriptional regulation of the human MCP-4 chemokine gene (SCYA13) in dermal fibroblasts: a comparison to other eosinophilic beta-chemokines.

The eosinophil chemotactic beta-chemokine MCP-4 is assumed to be involved in the accumulation of eosinophils characteristic for eosinophilic inflammatory diseases. We here describe the genomic organisation (3 exons of 138, 115 and 578 bp, 2 introns of 867 and 437 bp and 1.4 kb of regulatory sequences from the immediate 5' upstream region), sequence (genomic and transcribed) and mRNA expression of the human MCP-4 gene in dermal fibroblasts. Among the promoter elements potentially regulating MCP-4 gene expression and/or mediating the effects of anti-inflammatory drugs we identified consensus sequences known to interact with nuclear factors like NF-IL6, AP-2, a NF-kappaB like consensus sequence, gamma-interferon- response and YY-1 elements as well as glucocorticoid response elements. Like MCP-3, MCP-4 mRNA expression in dermal fibroblasts is upregulated by TNF-alpha, IL-1alpha, IFN-gamma or IL-4 and differs from RANTES and eotaxin mRNA expression in its response to IFN-gamma and/or IL-4.

5' Untranslated Regions↗
PubMed1999

[Acceptance and long-term results of home mechanical ventilation in various thoracic diseases].

BACKGROUND: Home mechanical ventilation (HMV) is an important therapy for patients with respiratory insufficiency on the basis of neuromuscular diseases (NMD), chest wall deformities (CWD) and chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: We retrospectively analyzed the long-term results of all 144 patients (CWD = 47, COPD = 54, NMD = 43) who underwent a trial of non-invasive HMV from March 1990 to September 1997. RESULTS: Twenty-eight patients did not accept the HMV (19%), 7 with CWD (15%), 17 with COPD (32%) and 4 with NMD (9%). Thirty-nine of 113 patients, who accepted HMV, completed nasal ventilation for a minimum of 1 year. For all 3 groups the hypercapnia improved significantly (CWD 58 +/- 6 to 48 +/- 4 mm Hg, p < 0.001, COPD 61 +/- 7 to 46 +/- 6 mm Hg, p < 0.001, NMD 53 +/- 8 to 42 +/- 6 mm Hg, p < 0.001). CONCLUSION: HMV improves the hypercapnic ventilatory failure independent of the underlying disease. The rate of acceptance is lower in patients with COPD in comparison to CWD and NMD.

Home Nursing↗
PubMed1999

[The role of non-invasive positive pressure ventilation in lung volume reduction surgery of pulmonary emphysema--a survey of German hospitals].

BACKGROUND: Since the first publication by Cooper et. al. in 1994 of lung volume reduction surgery (LVRS) of emphysema a marked respiratory failure with hyperkapnia (PaCO2 > 55 Torr) has been regarded as an exclusion criterion for LVRS. PATIENTS AND METHOD: In a survey in German hospitals the question was asked whether non-invasive nasal ventilation (NIPPV) has a role in the management of LVRS. Of 12 hospitals 6 had experience with NIPPV and LVRS in a total of 19 patients with a mean FEV1 of 0.64 +/- 0.101. RESULTS: LVRS improved FEV1 by 0.20 +/- 0.181. Preoperative NIPPV was short (< 6 months) in 8 patients and resulted in improvement of physical condition and getting the patient used to NIPPV for better perioperative management. In 5 cases NIPPV was used on a long-term basis in order to allow the patient to be included in the LVRS program. In fact 7 of these 13 patients needed ventilation perioperatively, and 4 had to continue long-term NIPPV after surgery. In further 3 patients NIPPV was applied only perioperatively. One patient had to resume NIPPV after 15 months. Two patients started NIPPV 1 resp. 12 months after surgery. Two patients had bronchial cancer which was resected. Four patients died: 1 perioperatively after intubation, 2 after 3 resp. 13 months due to respiratory failure, 1 for cancer relapse after 20 months. CONCLUSION: NIPPV may be helpful in the planning and management of LVRS in patients with ventilatory failure with hypercarbia.

Female↗
PubMed1999

[Quality of life of various patient groups during home mechanical ventilation].

BACKGROUND: During home mechanical ventilation quality of life depends on improvement of ventilation and progress of the underlying disease. PATIENTS AND METHODS: Patients with chronic obstructive pulmonary disease (COPD; n = 11), neuromuscular diseases (NMD; n = 8) and scoliosis (n = 8) answered before and after 306 +/- 232 (64 to 910) days home mechanical ventilation a standardized and validated questionnaire (SF 36, Medical Outcomes Trust, Boston, USA). RESULTS: For all patients together physical functioning (16 +/- 22 to 24 +/- 26%), general health (33 +/- 15 to 41 +/- 20%) and vitality (25 +/- 16 to 45 +/- 22%) improved significantly (p < 0.05). For COPD vitality (22 +/- 15 to 46 +/- 22%), for patients with NMD mental health (62 +/- 9 to 70 +/- 10%) and for patients with scoliosis vitality (35 +/- 15 to 59 +/- 22%) and mental health (61 +/- 11 to 74 +/- 4%) improved. CONCLUSION: Home mechanical ventilation improves quality of life, but the improvement depends on the underlying disease.

Female↗
PubMed1999

[Intermittent assisted ventilation in neuromuscular diseases: course and quality of life].

Intermittent non-invasive home ventilation is expected to improve the quality of life, but progression of underlying neuromuscular diseases may lead to a deterioration. We observed after 82-1085 days of such home mechanical ventilation (7 patients with muscular dystrophy (age [mean/std.) 33 +/- 15 years), 8 patients with amyotrophic lateral sclerosis (ALS. age 60 +/- 8 years) a nonsignificant decrease of vital capacity (1.6 +/- 0.4 rp. 1.2 +/- 0.4 l) and an improvement of hypercapnia (49.3 +/- 8.5 rp. 43 +/- 18.5 mmHg). Quality of life (SF-36, Medical Outcomes Trust, Boston, USA) increased significantly only for mental health in patients with ALS (55 +/- 13 rp. 64 +/- 17%). Despite progression of the underlying disease the quality of life remained stable under home mechanical ventilation and mental health improved.

Adult↗
PubMed1999

[Use of home mechanical ventilation in patients with high grade chronic obstructive lung disease (COPD)].

UNLABELLED: Nasal intermittent positive pressure ventilation (NIPPV) ist well established in the treatment of chronic hypercapnic ventilatory failure in patients with scoliosis or neuromuscular diseases. It has been introduced in acute respiratory failure in patients with COPD. The role of NIPPV in the long term treatment in severe stable hypercapnic COPD patients has not been well established (Thorax 1996; 51: 455-7). PATIENTS AND METHODS: We analysed the results of blood gases and lung function in all stable chronic hypercapnic COPD patients (PaCO2 59 +/- 6 mmHg), who underwent a trial of NIPPV from 11/95 to 1/98 (n = 25; 12 f/13 m; mean age 62 +/- 10 years). Patients with acute respiratory failure or an additional obstructive sleep apnoea syndrome were excluded. NIPPV was performed over an individual hand-molded nasal mask in the assisted/controlled mode (4 volume-, 21 pressure-cycled). At the time of discharge (25 +/- 15 days after the initiation of NIPPV) patients were able to apply the ventilator during night for al least 6 h. At the time PaCO2 during NIPPV was 43 +/- 6 mmHg. RESULTS: 5 patients failed to continue NIPPV for long-term treatment, so it was discontinued after a period of 6 weeks. 20 patients (80%) continued NIPPV for 13 +/- 8 months (range 1-27 months), 2 patients died during NIPPV (after 1 and 13 months). NIPPV had no significant influence on lung function (FEV1 predicted 28 +/- 13 vs. 30 +/- 11%; intrathoracic lung volume 6.9 +/- 2.5 vs. 6.2 +/- 1.7 l) or respiratory muscle strength (Pimax 4.2 +/- 0.9 vs. 4.5 +/- 1.6 kPa). However, we observed a significant improvement in PaCO2 during spontaneous breathing (59 +/- 6 vs. 48 +/- 8 mmHg; p < 0.001) and in case of base excess (7.4 +/- 4.1 vs. 3.4 +/- 2.4 mmol/l; p < 0.003). CONCLUSION: NIPPV can improve hypercapnic ventilatory failure in a subgroup of severe stable COPD, provided patients are motivated and home mechanical ventilation is adequately performed.

Adult↗
PubMed1998

Pathophysiologically correlated deficits of information processing in obstructive sleep apnea patients.

In obstructive sleep apnea patients, who intermittently stop breathing at night for some seconds, functions of vigilance and attention seem to be impaired. The aim of our study was to investigate if nocturnal hypoxia as one possible detrimental factor is associated with the degree of modality shift effect expressing attention function at a very basic level of information processing. For the first time an experimental approach was applied to examine attention deficits in sleep apnea patients. Correlation analyses between pathophysiological parameters and attention function revealed a stronger association for the modality shift effect than for simple reaction times.

Cognition Disorders↗
PubMed1997

Genomic organization, sequence, and transcriptional regulation of the human eotaxin gene.

Eotaxin is an eosinophil specific beta-chemokine assumed to be involved in eosinophilic inflammatory diseases such as atopic dermatitis, allergic rhinitis, asthma and parasitic infections. Its expression is stimulus- and cell-specific. We here describe the genomic organisation (3 exons of 132, 112 and 542 bp and 2 introns of 1211 and 378 bp) and sequence including 3 kb of DNA from the immediate 5' upstream region of the human eotaxin gene. Among the regulatory promoter elements potentially regulating eotaxin gene expression and/or mediating the effects of anti-inflammatory drugs we identified consensus sequences known to interact with nuclear factors like NF-IL6, AP-1, a NF-kappa-B like consensus sequence and gamma-interferon- as well as glucocorticoid response elements.

Amino Acid Sequence↗
PubMed1997

[Problems in adjustment to negative pressure ventilation].

We tried to establish a nasal intermittent positive pressure ventilation for a 54-year old patient with post-polio kyphoscoliosis. Due to intractable rhinitis the patient stopped the treatment. A negative pressure ventilation via a cuirass exhibited an inverse ventilation: during the inspiratory cycle of the ventilator the diaphragm was elevated and the patient was forced to exhale, afterwards he needs to inhale by himself. The ventilatory support is now done via a combined nasal-mouth mask and intermittent positive pressure ventilation.

Combined Modality Therapy↗
PubMed1997

[Prospective study of the quality of life in intermittent self-ventilation].

PATIENTS AND METHOD: We assessed quality of life for 17 patients (age 14 to 74 years) before and during intermittent (nightly) nasal home mechanical ventilation with a standardized questionnaire (SF 36, Medical Outcomes Trust, Boston, USA). Underlying diseases were amyotrophic lateral sclerosis, bronchiectasis, kyphoscoliosis, pulmonary emphysema, muscular dystrophy and sequelae of tuberculosis. Blood gas and lung function data were collected during every examination. RESULTS: We observed statistically significant increases for items of general health, mental health, vitality and capillary oxygen partial pressure. CONCLUSION: The SF 36 allows to assess quality of life for patients under intermittent mechanical ventilation at home.

Adolescent↗
PubMed1997

[Do patients with obstructive sleep apnea syndrome treated with nCPAP therapy lose weight?].

A simple therapy for obstructive sleep apnoea syndrome is weight reduction, which we always recommend before initiating and maintaining nCPAP-therapy. We documented the body weight of 123 patients (9 women, 114 men; age 53.8 +/- 10 years, initial apnoea-hypopnoea-index 40.7 +/- 22.6/hour) before and after 582 +/- 391 days nCPAP-therapy. Absolute and relative (Broca Index: weight [kg]/[height [cm] -100] x 100) body weight was 97.8 +/- 19.4 kg resp. 128.3 +/- 24.3 units before and 97.3 +/- 18.2 kg resp. 127.8 +/- 23.5 units during therapy (not significant). Body weight changes ranged from +22 to -26 kg. Only a subgroup of patients with a Broca index between 100-119 exhibited a significant weight change from 86.8 +/- 10.4 to 88.5 +/- 10.4 kg. We conclude that our recommendations to lose weight were unsuccessful in patients with obstructive sleep apnoea, although nCPAP-therapy generally improved well-being.

Adult↗