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Biomedical subjects

J B Wasserfallen

Publications and source records attributed to J B Wasserfallen.

17 recordsLinked to original sources
PubMed1999

Item responsiveness of a rhinitis and asthma symptom score during a pollen season.

Twenty-one asthma patients with allergic rhinitis completed a series of self-administered questionnaires (21-item symptom score for rhinosinusitis and asthma, bother scale, McMaster Asthma Quality of Life Questionnaire [MAQOL] and Euroqol) at 2-week intervals from August to November 1994. Relative responsiveness of the instruments was assessed in reference to the maximum and minimum average scores for MAQOL, with area under the curve (AUC) and correlation coefficients between the different instruments. Symptom score, MAQOL, and bother scale provided similar results for both extreme values and AUC, whereas Euroqol utilities were less responsive. These results suggest that the symptom scores and bother scales are responsive and valid, and might prove valuable in everyday practice, clinical trials, and quality assurance programs.

Adult↗
PubMed1998

Extreme hypercapnia is not a long-term prognostic factor after near-fatal asthma: a 12-year follow-up study.

QUESTION OF THE STUDY: Some patients experiencing near-fatal asthma present with extreme hypercapnia (PaCO2 > or = 100 mm Hg), whereas others do not. The influence of this factor on short- and long-term outcome and quality of life in these patients is still unknown. PATIENTS AND METHODS: A series of 39 consecutive patients who had had an episode of near-fatal asthma between 1978 and 1992 were followed up. Long-term outcome and quality of life of the 12 patients who had experienced extreme hypercapnia were compared with those of the 27 patients who had not. RESULTS: Four patients died, but only 1 from asthma. Three patients were lost to follow-up. The remaining 32 patients had a median observation period of 12.7 years. The hypercapnic patients did not significantly differ from the others in past asthma history, subsequent hospitalizations, medication needs, pulmonary function tests, quality of life and impairment/disability. In the event of subsequent near-fatal asthma attacks, they tended to present with hypercapnia levels similar to those observed during the first episode. DISCUSSION: Extreme hypercapnia in near-fatal asthma tended to recur, but is not an aggravating long-term prognostic factor. Targeted surveillance of these high-risk patients should make it possible to reduce relapses and death rates from asthma.

Adult↗
PubMed1997

[First evaluation of a year of ambulatory surgery in urology].

Day surgery in urology is in full growth actually. The present report is based on our first 120 patients. Low post-operative complication rate, patients' satisfaction and economical savings are the main factors for the important increase in this type of surgery.

Ambulatory Surgical Procedures↗
PubMed1997

Development and validation of a rhinoconjunctivitis and asthma symptom score for use as an outcome measure in clinical trials.

BACKGROUND: The measurement of health outcomes has become a priority for assessing and containing health care costs. OBJECTIVE: To develop and fully validate a simple symptom scale assessing both asthma and rhinoconjunctivitis, two interdependent conditions. METHODS: A self-administered questionnaire of 31 items was tested in 102 patients with asthma and rhinoconjunctivitis between September 1992 and December 1994. The items were rated on a six-point Likert scale ranging from none to extremely severe and included commonly recorded symptoms of inflammation such as irritation, congestion, and discharge in the skin, eyes, nose, sinus, pharynx, and chest. RESULTS: Validation included (1) responsiveness: scores for 18 patients evaluated during an emergency room visit were statistically significantly different from those recorded after recovery and in a control group of 24 patients with asthma; (2) reliability: external consistency was 0.8 at 1 week, and internal consistency was 0.8 for individual organs and 0.7 for individual symptoms; (3) validity: a five-point scale better captured the distribution of values; irrelevant and redundant items were eliminated. The optimal questionnaire included 21 items. CONCLUSIONS: The symptom score was applicable, responsive, reliable, and valid. Used with existing validated tools such as treatment needs and quality of life assessment, it may provide a comprehensive picture of allergic airway disease for quality assurance or research purposes.

Adolescent↗
PubMed1996

Comparison between incremental and single-dose allergen administration in bronchial provocation tests.

To study the effect of different schedules of allergen administration on the early (EAR) and late allergic reaction (LAR), 15 asthmatic patients with dual response after allergen challenge were submitted to two consecutive bronchoprovocation tests (BPT). BPT1 was carried out with semilogarithmic increases of allergen doses until a FEV1 drop of 20% was recorded. BPT2 was performed 2 weeks later using the highest allergen dose that had elicited the dual reaction in BPT1. Both EAR and LAR were very similar for a given patient. As the allergen dose used in BPT2 is smaller than the cumulative allergen dose administered in BPT1, this protocol takes into account a possible influence on BPT2 of bronchial hyperreactivity induced by BPT1 performed 2 weeks before.

Adult↗
PubMed1995

Acquired deficiency in C1-inhibitor associated with signet ring cell gastric adenocarcinoma: a probable connection of antitumor-associated antibodies, hemolytic anemia, and complement turnover.

BACKGROUND: Acquired deficiency in C1-inhibitor (C1-INH) associated with malignancy is often asymptomatic because clinical manifestations are not dependent on a critical complement threshold (in contrast to hereditary C1-INH deficiency). Increased complement consumption involving different kinds of antibodies is the postulated mechanism for this disease, but other factors must play an important role. CASE REPORT: A 76-year-old woman with unremarkable medical history experienced three episodes of angioedema over 6 months. Investigations revealed a complement profile characteristic of acquired deficiency in C1-INH, a hemolytic anemia, and a signet ring cell adenocarcinoma (linitis plastica). A gastrectomy and a splenectomy were performed. The postoperative course was characterized by a complete disappearance of the symptoms of angioedema and hemolytic anemia. A local recurrence of the tumor 5 months later could not be resected. The patient died 17 months after the initial surgery was performed. RESULTS: Quantitative and functional analyses of the complement factors showed persistent excessive complement consumption. Markers of hemolytic anemia disappeared after tumor removal but recurred in the second part of the disease evolution. Immunohistochemical findings in tumor tissue showed loss of normal blood group antigens but expression of Lea antigen, as well as C1q deposition. CONCLUSION: To explain the whole clinical and laboratory picture, we hypothesize a connection between tumor immunohistochemical profile, complement consumption, and hemolytic anemia. Tumor cell surface antigens might lead to a permanent but asymptomatic complement consumption that is worsened and becomes clinically manifest by superimposed hemolytic anemia caused by cross-reactive antibodies to newly expressed blood group antigens on tumor cells. This hypothesis should be confirmed by other observations.

Aged↗
PubMed1995

Long-term evaluation of usefulness of skin and incremental challenge tests in patients with history of adverse reaction to local anesthetics.

A variety of adverse reactions to local anesthetics has been described, some of which are thought to be allergic. Different protocols of prick and intradermal skin tests as well as subcutaneous challenge tests are used to select a local anesthetic which can safely be used. Their long-term effectiveness has not yet been assessed. Twenty-eight patients with a history of adverse reaction to local anesthetics were evaluated over a 3-year period. Loss of consciousness occurred in eight patients, skin reaction in nine, and vagal symptoms in eight. Various reactions were recorded in the remaining three patients. Rapid spontaneous recovery was the rule, suggesting that immediate allergic reaction and, in particular, anaphylactic reaction were unlikely. Investigation allowed the selection of a tolerated anesthetic in all cases. Reexposure occurred in 19 patients 16-50 months after evaluation and 6.8 +/- 5.5 years after the first reaction. No patient presented a second reaction. In conclusion, adverse reactions to local anesthetics seem to be, in most cases, not allergic in nature. Evaluation protocols are effective in selecting an agent susceptible to tolerance, but are time consuming. However, they probably contribute to an important reassurance effect that is likely to increase tolerance to subsequent local anesthetic administration. Simplification of the protocols and better patient selection are proposed.

Adult↗
PubMed1993

Effect of cetirizine, a new H1 antihistamine, on the early and late allergic reactions in a bronchial provocation test with allergen.

BACKGROUND: Cetirizine is a highly sensitive H1 antihistamine with particular antiallergic properties, which has been shown to be effective in the treatment of allergic rhinitis, urticaria, and hay-fever-associated asthma. METHODS: To assess the effect of cetirizine on the late allergic reaction to a specific bronchial provocation test (BPT) with allergen, we selected 25 patients with allergic asthma as determined by history, skin tests, and specific IgE levels. They were challenged with increasing doses of a cat or mite extract until a 20% drop in forced expiratory volume in 1 second (FEV1) was recorded. Sixteen patients (11 men and 5 women with a mean age of 22 years; range, 18 to 48 years) exhibited a dual response (early and late allergic reactions). These 16 patients underwent a second BPT 2 weeks later, and each again showed a dual response. They were then randomized to receive either a placebo (8 patients) or cetirizine, 15 mg twice daily (8 patients) in a double-blind fashion. After 7 days of treatment, they underwent a third BPT with the same allergen dose as given in the second BPT. RESULTS: The intensity and duration of early allergic reaction were not affected by cetirizine, whereas all parameters of late allergic reaction were statistically significantly improved in the cetirizine group when compared with those of the placebo group (maximum FEV1 decrease, p = 0.046; FEV1 [area above the curve], p = 0.027; maximum airway resistance increase, p = 0.021; airway resistance [area under the curve], p = 0.036). CONCLUSIONS: Cetirizine produced a significant protective effect against an allergen-induced late allergic reaction in a BPT. Cetirizine might therefore be effective in the treatment of asthma.

Adolescent↗
PubMed1993

Life-threatening asthma with dramatic resolution.

The speed of onset of an asthma attack can be highly variable. Recent studies have tried to characterize a subgroup of patients with life-threatening asthma that occurs suddenly but often regresses very rapidly under treatment. We had the opportunity to observe the evolution of two asthmatic women hospitalized with extremely severe respiratory acidosis. One of them required immediate orotracheal intubation and mechanical ventilation during 13 h. The results of her pulmonary function tests were normal 35 h after admission. The second woman's condition improved so rapidly under treatment that she did not require intubation and mechanical ventilation. These observations suggest that bronchospasm might play an important role in the pathophysiology of transient life-threatening asthma.

Acute Disease↗
PubMed1990

Sudden asphyxic asthma: a distinct entity?

This study analyzed the history, clinical characteristics, and acid-base data in relation to the speed of decompensation in 34 patients intubated and mechanically ventilated for severe asthma. Three patterns of decompensation were established according to the delay between the onset of symptoms and endotracheal intubation: Group I, rapid decompensation (less than 3 hours); Group II, gradual development of respiratory failure (9.2 +/- 7.7 days); Group III, acute exacerbation after unstable asthma (4.2 +/- 3.6 days). Patients who developed sudden asphyxia (Group I) showed features distinct from those with a gradual worsening. Sudden asphyxic asthma is more frequent in young men and is characterized by a severe mixed acidosis with extreme hypercapnia (mean PaCO2 = 112.8 +/- 43.9 mm Hg), a higher incidence of respiratory arrest, and silent chest upon admission. Recovery is more rapid, with a shorter duration of mechanical ventilation (33.7 +/- 25.3 h versus 91.4 +/- 64.1 h in Group II). Several arguments suggest that bronchospasm plays the primary role in the pathogenesis of sudden asphyxic asthma.

Acidosis, Respiratory↗
PubMedDate not supplied

Bronchial provocation with cat allergen: long-term outcome of the late allergic reaction and the individual IgE CRIE pattern.

In bronchial provocation tests with allergen, about 50% of the patients experienced a late allergic reaction (LAR), which has been associated with a specific IgE pattern as determined by crossed radioimmunoelectrophoresis (CRIE). Long-term outcome of this LAR is still unknown. Six patients allergic to cat, with documented LAR and specific IgE CRIE patterns were rechallenged in the same conditions after a mean interval of 2.5 years. Forced expiratory volume in one second (FEV1) and resistance results of the bronchial provocation tests (BPT) were compared, as well as specific IgE level and IgE CRIE patterns. All six patients were still suffering from asthma when exposed to a cat, although they were not being treated for asthma. Three patients (50%) had lost their LAR without specific treatment. They were older, with a longer history of asthma, but presented a very similar early allergic reaction to similar allergen doses. The other 3 were more reactive to the allergen but presented similar LAR after a slightly worse early allergic reaction (EAR). Specific IgE levels had decreased and the IgE CRIE pattern showed a diminished intensity of staining in the three patients who had lost their LAR, as opposed to the other three. These data suggest that asthmatic patients can lose their LAR over time without treatment. The occurrence of a LAR seems to be associated with a specific IgE CRIE pattern and IgE level. Further analysis of the individual antigen fractions might help to understand the mechanism of allergic reactions.

Adult↗