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Biomedical subjects

J Barandun

Publications and source records attributed to J Barandun.

At least 19 recordsLinked to original sources
PubMed2000

[Atopic neurodermatitis--therapy in high altitude climate].

Climatotherapy of atopic dermatitis in a high alpine climate is a well-established therapy that meets the currently growing demand for a holistic approach in the treatment of this skin condition. The effectiveness of climatotherapy was evaluated in 97 patients with atopic dermatitis who were treated at the Zürich High Mountain Clinic in Davos during the period 1990-1994. The period of hospitalisation averaged 32 days. Upon discharge, 89% of patients were symptom-free or much improved. According to the patients' subjective recollection after a time interval of at least one year, 70% recalled being symptom-free or much improved at discharge. In the first year after climatotherapy, 81% of patients suffered a relapse. Nevertheless, in 56% the severity of the atopic dermatitis was reduced, and 74% of the patients who had previously been unable to work were able to resume their occupation. Before treatment, 73% of the patients were on corticosteroids, 14% systemically. The latter could be discontinued in all but one case; local steroids could be discontinued in 71% of cases. 62% of the patients had also tried "alternative" medical treatments and remedies, the majority with no measurable success. Thus, climatotherapy is a successful treatment for atopic dermatitis, but a mild relapse is to be expected. The popular, but less successful "alternative" medical treatment of atopic dermatitis needs to be evaluated scientifically according to international medical standards.

Adult↗
PubMed1998

Effect of high-frequency oral airway and chest wall oscillation and conventional chest physical therapy on expectoration in patients with stable cystic fibrosis.

STUDY OBJECTIVE: To compare the effect of high-frequency oral airway oscillation, high-frequency chest wall oscillation, and conventional chest physical therapy (CPT) on weight of expectorated sputum, pulmonary function, and oxygen saturation in outpatients with stable cystic fibrosis (CF). DESIGN: Prospective randomized trial. SETTING: Pediatric pulmonary division of a tertiary care center. PATIENTS: Fourteen outpatients with stable CF recruited from the CF center. INTERVENTIONS: Two modes of oral airway oscillation (1: frequency 8 Hz; inspiratory to expiratory [I:E] ratio 9:1; 2: frequency 14 Hz; I:E ratio 8:1), two modes of chest wall oscillation (1: frequency 3 Hz; I:E ratio 4:1; 2: frequency 16 Hz; I:E ratio 1:1, alternating with frequency 1.5 Hz, I:E ratio 6:1), and CPT (clapping, vibration, postural drainage, and encouraged coughing) were applied during the first 20 min of 4 consecutive hours. MEASUREMENTS AND RESULTS: Sputum was collected on an hourly basis for a total of 6 consecutive hours. During the first and the last hour, patients collected sputum without having any treatment and underwent pulmonary function tests (PFTs). Oxygen saturation was measured at 30-min intervals during hours 1 to 6. For the first 20 min of the second to the fifth hour, patients received one of the treatments. To assess the effect of the intervention, the weight of expectorated sputum during hours 2 to 6 was averaged and expressed as percentage of the weight expectorated during the first hour (baseline). For the five treatment modalities, mean sputum dry and wet weights ranged between 122% and 185% of baseline. There was no statistically significant difference among the treatment modalities. As measured by sputum wet weight, all oscillatory devices tended to be less effective than CPT (p=0.15). As measured by dry weight, oral airway oscillation at 8 Hz with an I:E ratio of 9:1 and CPT tended to be more effective than the other treatment modalities (p=0.57). None of the treatment modalities had an effect on PFTs and oxygen saturation and all were well tolerated. CONCLUSION: In outpatients with stable CF, high-frequency oscillation applied via the airway opening or via the chest wall and CPT have comparable augmenting effects on expectorated sputum weight without changing PFTs or oxygen saturation. In contrast to CPT, high-frequency oral airway and chest wall oscillations are self-administered, thereby containing health-care expenses.

Adolescent↗
PubMed1997

[Value and costs of pulmonary rehabilitation].

Pulmonary rehabilitation (PR) is nowadays a recognized discipline for stabilisation and improvement of chronic pulmonary diseases. According to epidemiologic data the number of patients with chronic obstructive bronchitis and asthma is on the rise. Aim and components of a modern stationary PR-program are defined and benefit and costs discussed according to data from recent publications. Necessity of an individual, stepwise, multidisciplinary and holistic approach to physical and psychic symptoms based on an exact diagnostic workup is shown. Data from selected studies on benefits of PR such as reduced frequency and/or cost of hospitalisations, improved quality of life or reduced symptoms, improvement of pulmonary function and effects on mortality and working capacity are discussed. Since controlled studies are unavailable from Switzerland so far, data from American and European literature are used. In the most severe terminal stages of pulmonary failure individual complementary surgical measures have to be evaluated, i.e. volume-reducing surgery for emphysema or transplantation of the lung. The peri- and postoperative risks and arising costs have to be weighted against the expected improvement of pulmonary function and quality of life by exhaustive conservative measures.

Cost-Benefit Analysis↗
PubMed1997

Necrotizing granulomatosis of the breast.

We describe a case of necrotizing granulomatosis of Wegener's type involving the breasts of a 40-year-old man. There were no signs of generalized disease. Involvement of the breast is rare in Wegener's granulomatosis (WG). To date, 17 cases have been reported, and all were women. They predominantly presented with a unilateral breast mass, and mammary malignancy was the principal concern. In the majority of cases, breast lesions of WG have been a presenting sign of, or preceded, disseminated disease. Our patient is unusual in that the necrotizing granulomas developed as an isolated finding in a site remote from those usually affected by WG, and, as far as we are aware, represents the first case of Wegener's type granulomatosis involving the male breast.

Adult↗
PubMed1996

[Inhalation therapy in chronic obstructive bronchial diseases].

A number of different inhalation appliances are available for the inhalation treatment of chronic obstructive bronchial diseases. Electrical aerosol appliances, aerosols providing measured dosage and dry powder inhalers all show good physical properties for creating aerosol particles with an average aerodynamic mass diameter of 2-9 microns, which is a prerequisite for optimum bronchial deposition. Advantages and disadvantages of the principal appliances available on the market are compared. In an overview the action, indications and side effects of beta-2 sympathomimetics, ipratropium bromide, anti-allergens and inhaled steroids are discussed. Both in chronically obstructive pulmonary diseases (COPD) and in chronic asthma, precise patient instructions and the correct use and combination of bronchial dilating medicines and inhaled steroids in asthma, and of beta-2 sympathomimetics and ipratropium bromide in COPD, are important for optimum effect of inhalation treatment. The literature shows that the widespread fear of side effects of steroids applied in inhalant form is unfounded.

Adrenergic beta-Agonists↗
PubMed1996

Expansion of cytokine-producing CD4-CD8- T cells associated with abnormal Fas expression and hypereosinophilia.

The mechanisms of sustained overproduction of eosinophils in the idiopathic hypereosinophilic syndrome and in some human immunodeficiency virus (HIV)-1-infected individuals are largely unknown. We hypothesized that T cells may release soluble products that regulate eosinophilia in these patients, as has been previously shown in bronchial asthma. We identified one patient with idiopathic hypereosinophilic syndrome and one HIV-1-infected individual with associated hypereosinophilia who demonstrated high numbers of CD4-CD8- T cells in peripheral blood. CD4-CD8- T cells from both patients, although highly activated, did not express functional Fas receptors. In one case, the lack of functional Fas receptors was associated with failure of Fas mRNA and protein expression, and in another, expression of a soluble form of the Fas molecule that may have antagonized normal signaling of Fas ligand. In contrast to the recently described lymphoproliferative/autoimmune syndrome, which is characterized by accumulation of CD4-CD8- T cells and mutations within the Fas gene, this study suggests somatic variations in Fas expression and function quite late in life. Both genetic and somatic abnormalities in regulation of the Fas gene are therefore associated with failures to undergo T cell apoptosis. Furthermore, the expanded population of CD4-CD8- T cells from both patients elaborated cytokines with antiapoptotic properties for eosinophils, indicating a major role of these T cells in the development of eosinophilia. Thus, this study demonstrates a sequential dysregulation of apoptosis in different cell types.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Effect of mouthpiece breathing on cardiorespiratory response to intense exercise.

Use of mouthpiece and noseclips after breathing pattern at rest and during moderate exercise. Our purpose was to extend observations on mouthpiece breathing to its effects on the cardiorespiratory response to intense exercise and to develop and validate an algorithm for computer-assisted analysis of breathing pattern recorded with respiratory inductive plethysmography. Six normal men performed incremental bicycle exercise to volitional exhaustion on two occasions with and without mouthpiece and noseclip. ECG and breathing pattern recorded with a respiratory inductive plethysmograph were analyzed manually and with computer assistance. Mouthpiece breathing increased tidal volume and respiratory cycle time by up to 63 and 33% respectively (p < 0.02) during mild exercise, but it did not alter performance, heart rate, or breathing pattern at maximal exercise. Mean differences between inductive plethysmographic and spirometric tidal volumes were < 5% during validation at rest and maximal exercise. Application of the proposed algorithm for semiautomatic breathing pattern analysis provided significant time savings with no loss in precision compared with manual analysis. In conclusion, in normal men, performance and breathing pattern during maximal exercise are not altered by a mouthpiece and noseclip, and accurate computer-assisted measurement of ventilation from external transducers may be performed even during intense exercise.

Adult↗
PubMed1994

Differential cytokine profiles in peripheral blood lymphocyte supernatants and skin biopsies from patients with different forms of atopic dermatitis, psoriasis and normal individuals.

There is increasing evidence that the activation of a selected T helper cell population producing a Th2-related cytokine pattern with IL-4 and IL-5 but not IL-2 and interferon-gamma (IFN-gamma) may be involved in the pathogenesis of IgE-mediated atopic diseases and in particular of atopic dermatitis (AD). However, the existence of a 'nonatopic' (intrinsic) form of AD (NAD) with normal serum IgE levels, negative RAST tests, negative immediate type skin reactions towards environmental allergens and a negative patients and family history for IgE-mediated allergies raised the question whether this form may be explained by a different T cell activation and cytokine pattern. In the present study we compared the distribution of peripheral blood leukocyte and lymphocyte subpopulations, their activation state and cytokine production in peripheral blood lymphocyte supernatants and skin biopsies of patients with AD (n = 19), NAD (n = 14), psoriasis (n = 6) and normal individuals (n = 13). A characteristic eosinophilia was present in AD and NAD but not in psoriasis and normal controls. The three patient groups showed significantly increased numbers of activated CD4+ and CD8+ cells as measured by IL-2R and HLA-DR expression. Determination of spontaneously released IL-2, IL-4, IL-5 and IFN-gamma from peripheral blood lymphocytes demonstrated a Th2-related cytokine pattern with elevated levels for IL-4 and IL-5 in AD patients only. Increasingly enough, patients with NAD displayed high IL-5 but low IL-4 levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytokines↗
PubMed1991

[Diagnosis and treatment of pulmonary infection due to Mycobacterium malmoense].

To date more than 150 patients with Mycobacterium malmoense disease have been reported. These infections are rare and only in one case, so far not published, is this species associated with Aids. Most reported cases were seen in northern Europe. We present three pulmonary cases from Switzerland. M. malmoense causes lung disease resembling tuberculosis clinically and in chest X-ray. Disease is considered to be present when two and more sputums or bronchial washings are acid-fast bacilli smear-positive and culture-positive. M. malmoense grows slowly on egg-based bacteriological media; the incubation time is at least 6 weeks and the use of special solid or liquid media is recommended. Person-to-person transmission is rare and, in contrast to tuberculosis, isolation of the patient is not necessary and subsequent close contact persons do not need to be evaluated. It seems that a combination of isoniazid, rifampicin and ethambutol given for more than 12 months is the best regimen.

Adult↗
PubMed1991

[Interlocking intramedullary nailing of the femur: is the advantage of early mobilization gained by risking a malposition?].

We report a follow-up of 57 consecutive femoral fractures treated by internal fixation with the AO Universal Interlocking Nall. All fractures (91% follow-up) had healed within a mean of 22 months (range 9-50) after operation. Full weight-bearing was possible after an average of 9 weeks (range 2-20). The only infection occurred after a secondary open lengthening osteotomy. In 5 cases a rotational malposition or length discrepancy had to be corrected shortly after initial surgery. Rotational malposition in excess of 10 degrees occurred in 26% of cases (mostly external rotation) and length discrepancy exceeding 1 cm in 13% (mostly shortening). The frequency of malposition is explained by the absence of rotational or length control during operation. We recommend that malposition be correlated without delay by reoperation.

Adolescent↗
PubMed1991

[Talus fracture. Injury pattern, treatment tactics and results of operation (1980-1989)].

The results of 25 operated talus fractures are presented. 7 of these were peripheral fractures with excellent results, 18 central fractures with only satisfying or even bad outcome. Although we didn't see any avascular necrosis of the talus, almost all patients had pain and slight or even severe signs of arthrosis in the ankle or subtalar joint.

Follow-Up Studies↗
PubMed1989

[Febrile status].

We report the case of a 55-year-old woman with intermittent fever of unknown origin of several weeks duration. The past medical history was uneventful, as was the review of systems. After an extensive work-up, which did not produce the cause of the fever, the patient developed abdominal pains with signs of sub-ileus. In further examinations, a large stenotic carcinoma of the colon was found.

Adenocarcinoma↗
PubMed1989

[Initial results with the new tibial interlocking nail of the Orthopedic Study Group].

The new AO universal tibia nail with interlocking possibility has several new features. The wall thickness has been increased from 1.0 to 1.2 mm. In order to give the stiffer nail smoother insertion properties and better cortical contact, the overall design has been altered with the help of computer calculation. Proximally there are 3 holes for locking purposes in the frontal plane, while distally we find two holes in the frontal and one in the sagittal plane to accommodate the locking bolts. The new nail has been applied in 17 clinical cases with overall good results. The indications were deliberately pushed to the extremes and even 5 open fractures were nailed after minimal remaining. There were 2 major perioperative complications: one proximal blow-out of the anterior cortex due to a wrong point of insertion and several other technical mistakes. The situation was salvaged with an external fixator. In an 85-year-old multiple injured lady with a 3-degree open tibia, the initial fixateur externe was replaced after 3 weeks by a 10 mm universal nail. Due to severe porosis and rather proximal extensive cortical comminution, the locking bolts and therefore the nail did not find a good hold in the tibia plateau. After uneventful healing of the soft tissues and additional splinting, the fracture, however, consolidated within 4 months. There were two superficial soft tissue infections early postoperatively, but no cases of osteitis. Healing of the fractures seems to progress without delay.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-Up Studies↗
PubMed1986

[Transfusion-associated LAV/HTLV-III infections in Switzerland. Report of 2 cases].

Two patients developed signs of LAV/HTLV-III infection one and two years respectively after a blood transfusion. The leading symptom in one patient was generalized lymphadenopathy, while the other patient presented with Candida stomatitis. In both cases, blood transfusions administered in 1983 were found to be the only possible source of infection; one blood donor of each patient was anti-LAV/HTLV-III positive. Family members and sexual partners of the two were negative for antibodies against LAV/HTLV-III. Our findings document the first two cases of LAV/HTLV-III associated disease most probably related to blood transfusions in Switzerland.

Acquired Immunodeficiency Syndrome↗