PubMed Health⌕ Search

Biomedical subjects

J Behr

Publications and source records attributed to J Behr.

At least 19 recordsLinked to original sources
PubMed2007

Safety and tolerability of bosentan in idiopathic pulmonary fibrosis: an open label study.

Idiopathic pulmonary fibrosis (IPF) is a fatal disease for which no effective treatment exists. In the present study, 12 IPF patients underwent analysis of gas exchange properties using the multiple inert gas elimination technique on day 1 before and after the administration of 125 mg bosentan, a dual endothelin antagonist. Following this, patients received chronic administration for 12 weeks (62.5 mg b.i.d. in week 1, 125 mg b.i.d. thereafter). The primary objective was to determine the effect of bosentan on gas exchange (day 1) and on oxygen saturation and minute ventilation (week 2). With one exception, where redistribution of total pulmonary blood flow from normal ventilation/perfusion (V'/Q') areas (93% before, 72% after bosentan) to low V'/Q' areas (0% before, 22.2% after) was encountered, no patient showed any change in gas exchange (mean+/-SD shunt flow (% of cardiac output) 8.5+/-3.4% before, 6.1+/-2.3% after bosentan; day 1) or oxygen saturation and minute ventilation (week 2). Similarly, none of the secondary parameters was significantly changed either at week 2 or at the end of the study period (week 12). Five patients developed respiratory infections and two died because of pneumonia; this was judged as being unrelated to bosentan intake. In conclusion, bosentan administration does not seem to induce clinically relevant gas exchange abnormalities in idiopathic pulmonary fibrosis patients.

Administration, Oral↗
PubMed2006

Nuclear charge radii of 9,11Li: the influence of halo neutrons.

The nuclear charge radius of 11Li has been determined for the first time by high-precision laser spectroscopy. On-line measurements at TRIUMF-ISAC yielded a 7Li-11Li isotope shift (IS) of 25 101.23(13) MHz for the Doppler-free [FORMULA: SEE TEXT]transition. IS accuracy for all other bound Li isotopes was also improved. Differences from calculated mass-based IS yield values for change in charge radius along the isotope chain. The charge radius decreases monotonically from 6Li to 9Li, and then increases from 2.217(35) to 2.467(37) fm for 11Li. This is compared to various models, and it is found that a combination of halo neutron correlation and intrinsic core excitation best reproduces the experimental results.

Journal Article↗
PubMed2006

Interventional embolization of a giant pulmonary arteriovenous malformation with right-left-shunt associated with hereditary hemorrhagic telangiectasia.

A 46-year old woman experienced an episode of arterial desaturation despite administration of 100% oxygen during anesthetization for an elective laparoscopy. Further evaluation revealed a giant pulmonary arteriovenous malformation (PAVM) with right-left shunt associated with previously undiagnosed hereditary hemorrhagic telangiectasia (HHT, Morbus Osler- Weber-Rendu). The PAVM was treated interventionally with an Amplatzer duct occluder. Transcatheter embolization of the PAVM was well tolerated with symptomatic and hemodynamic improvement. CT scan after six months demonstrated correct position of the duct occluder in the left pulmonary artery with nearly complete occlusion of the feeding vessel.PAVMs are rare direct communications between pulmonary arteries and veins, associated with HHT in the majority of cases and often presenting with dyspnea or major neurological complications due to paradoxic embolism. In this case report, we present a rational and stepwise diagnostic workup for this rare medical condition and show that transcatheter embolization is an appropriate treatment for larger malformations.

Arteriovenous Malformations↗
PubMed2006

[A 52-year-old patient with positive troponin, iron deficiency anemia and known sarcoidosis].

We report on a 52-year-old female patient with recurrent neurosarcoidosis and an "atypical" course of celiac disease, with mild clinic features, positive IgA-antibodies and histology. In our patient, the IgA-antibodies led to a false positive troponin I test, and we initially suspected an acute coronary syndrome. With dietary treatment of the celiac disease, the antibodies decreased and the troponin I test became negative. The coincidental occurrence of sarcoidosis and "potential" celiac disease (positive antibodies only) has been reported. The coincidence of an "atypical" celiac disease and sarcoidosis is rare.

Alanine Transaminase↗
PubMed2006

Combining inhaled iloprost with bosentan in patients with idiopathic pulmonary arterial hypertension.

Addition of inhaled iloprost to bosentan may have beneficial effects in patients with idiopathic pulmonary arterial hypertension (IPAH). A multicentre, open, randomised, controlled trial was performed to assess the safety and efficacy of inhaled iloprost in patients with IPAH who had already been treated with bosentan. The trial was terminated early after a futility analysis predicted failure with respect to the predetermined sample size. At that time, 40 patients were randomised to receive either bosentan alone (control group) or bosentan plus inhaled iloprost (combination group) for a 12-week period. The primary end-point, change in 6-min walking distance, was not met (mean changes +1 m and -9 m in the control and combination group, respectively). These results may have been skewed by three outliers in the iloprost group who presented with severe clinical worsening. None of the secondary end-points including functional class, peak oxygen uptake, and time to clinical worsening differed significantly between groups. The current study failed to show a positive effect of adding inhaled iloprost to bosentan in idiopathic pulmonary arterial hypertension patients. Further studies involving larger sample sizes and long-term follow-up are needed to determine the efficacy of adding inhaled iloprost to bosentan in patients with idiopathic pulmonary arterial hypertension.

Administration, Inhalation↗
PubMed2005

[Unusual infection with pulmonary round foci obtained through "hay packs"].

A 71-year-old female, who has been treated with steroids for 3 weeks, developed a severe pneumonia with septic shock and acute respiratory distress syndrome (ARDS). Despite broad antibiosis due to the detection of pseudomonas aeruginosa (blood culture) the inflammatory markers remained high and the respiratory situation went critical. No proof of a malignoma or autoimmune process was found, despite multiple round foci in x-ray and computer tomography. Finally the delayed diagnosis of pulmonary nocardiosis was adjusted, due to the long incubation period of the pathogen Nocardia farcinica. The infectious origin may be assumed in so called "hay packs" used during the patient's residence at a health resort. After adequate change of the antibiotic regimen stabilization was achieved and the patient meanwhile recovered from the disease.

Aged↗
PubMed2005

Entorhinal cortex entrains epileptiform activity in CA1 in pilocarpine-treated rats.

Layer III neurons of the medial entorhinal cortex (mEC) project to CA1 via the temporoammonic pathway and exert a powerful feed-forward inhibition of CA1 pyramidal neurons. The present study evaluates the hypothesis that disrupted inhibition of CA1 pyramidal neurons causes an eased propagation of entorhinal seizures to the hippocampus via the temporoammonic pathway. Using a method to induce a confined epileptic focus in brain slices, we investigated the spread of epileptiform activity from the disinhibited mEC to CA1 in control and pilocarpine-treated rats that had displayed status epilepticus and spontaneous recurrent seizures. In pilocarpine-treated rats, the mEC showed a moderate layer III cell loss and an enhanced susceptibility to epileptiform discharges compared to control animals. Entorhinal discharges propagated to CA1 in pilocarpine-treated rats but not in controls. Disconnecting CA3 from CA1 did not affect the spread of epileptiform activity to CA1 excluding its propagation via the trisynaptic hippocampal loop. Mimicking the invasion of epileptiform discharges by repetitive stimulation of the temporoammonic pathway caused a facilitation of field potentials in CA1 that were contaminated by population spikes and afterdischarges in pilocarpine-treated but not control rats. Single cell recordings of CA1 pyramidal neurons revealed a dramatic loss of feed-forward inhibition and the occurrence of strong postsynaptic excitatory potentials in pilocarpine-treated rats. Excitatory responses in CA1 were characterized by multiple NMDA receptor-mediated afterdischarges and a strong paired-pulse facilitation in response to activation of the temporoammonic pathway. Our results suggest that, irrespective of the enhanced seizure-susceptibility of the mEC in epileptic rats, the loss of feed-forward inhibition and the enhanced NMDA receptor-mediated excitability CA1 pyramidal cells ease the spread of epileptiform activity from the mEC to CA1 via the temporoammonic pathway bypassing the classical trisynaptic hippocampal loop.

Animals↗
PubMed2005

[A role for combination therapy in pulmonary arterial hypertension].

For patients with pulmonary arterial hypertension (PAH) two first line therapies - iloprost inhalation (Ventavis) and bosentan (Tracleer) -- are available in Germany. A third substance, sildenafil, is already approved in the US and will be approved for this indication in the European Union soon. Patients with PAH can be stabilized or improved with a specific mono-therapy for a limited period of time only. Therefore, the question arises when and how to initiate treatment escalation. The available data from controlled clinical trials are insufficient to give a definite answer to these questions. Moreover, it is still unclear which combination of the above mentioned substances may be superior in the treatment of PAH. On the other hand, combination therapy is already reality in clinical practice. Based on this background experts from specialized centers dealing with PAH discussed the scientific basis of the role of combination therapy in PAH patients during a workshop held on April 22/23. 2005 in Wiesbaden. The goal of this workshop was to formulate a common position with regard to combination therapy of PAH on the basis of the available scientific data and clinical experience.

Administration, Inhalation↗
PubMed2005

Human herpesvirus 6 in bronchalveolar lavage fluid after lung transplantation: a risk factor for bronchiolitis obliterans syndrome?

Bronchiolitis obliterans syndrome (BOS) is the limiting factor to long-term survival after lung transplantation. Previous studies suggested respiratory viral tract infections are associated with the development of BOS. To identify the impact of virus detection in bronchoalveolar lavage (BAL) fluid, we analyzed BAL samples from 87 consecutive lung transplant recipients for human herpesvirus (HHV)-6, Epstein-Barr virus, Herpes simplex virus 1/2, Cytomegalovirus, respiratory syncytical virus and adenovirus by PCR. Acute rejection, BOS and death were recorded for a mean follow-up time of 3.27 +/- 0.47 years. Results of PCR analysis and other potential risk factors were entered into a Cox regression analysis of BOS predictors and death. Only acute rejection was a distinct risk factor for BOS of all stages, death and death from BOS. HHV-6 was detected in 20 patients. Univariate and multivariate analysis revealed that HHV-6 was associated with an increased risk to develop BOS > orb = stage 1 and death, separate from the risk attributable to acute rejection. Identification of HHV-6 DNA in BAL fluid is a potential risk factor for BOS. Our results warrant further studies to elucidate a possible causal link between HHV-6 and BOS.

Adenoviridae Infections↗
PubMed2004

Extrinsic allergic alveolitis with IgA deficiency.

Up to now only 3 cases of extrinsic allergic alveolitis (hypersensitivity pneumonitis) with IgA deficiency have been published worldwide. We had the opportunity to detect two additional cases which will be presented here. Summarizing all cases IgA deficiency is a risk factor for a severe course of the disease and an increased susceptibility to acquire allergic alveolitis by low dose antigen exposure.

Adult↗
PubMed2004

[Might it be allergic bronchial asthma?].

The prevalence of allergy and asthma in our population is on the increase, as also, it is presumed, is the number of unrecognized cases. In the diagnostic evaluation of patients with respiratory problems, therefore, the question "might it be allergic bronchial asthma?" should be asked more frequently. The central diagnostic mainstays are the finding of reversible bronchial obstruction on pulmonary function testing, and the differential allergologic investigation. Once the diagnosis has been established, comprehensive management comprising pharmacotherapy, training and preventive measures can make it possible for the patient to enjoy a largely symptom-free life. The hope for the future is that an ever deeper understanding of the pathogenesis of asthma will enable effective preventive measures to be taken in childhood.

Anti-Asthmatic Agents↗
PubMed2004

Influence of inflammatory mechanisms on the redox balance in interstitial lung diseases.

This study investigated the hypothesis that inflammatory, regulatory and antioxidant systems control the redox balance in interstitial lung diseases. Spontaneous mRNA expression of inflammatory cytokines and redox-active enzymes was examined in bronchoalveolar lavage (BAL) cells from patients with idiopathic pulmonary fibrosis (IPF) and sarcoidosis (SARC) using RT-PCR analysis. Pulmonary oxidative stress was characterized by carbonyl-levels in the soluble BAL-fluid protein. Protein carbonyls were normal in SARC, but 2.4-fold increased in IPF. Here, the protein carbonyls correlated inversely with glutathione peroxidase mRNA. The message for IL-8 increased 14-fold in IPF and was accompanied by a marked influx of PMN, while these parameters were not altered in SARC. Levels of IL-10 transcripts increased in both diseases, but stronger in SARC (33-fold) than in IPF (22-fold), contributing to a high IL-10/IL-8 mRNA ratio in SARC (0.86) in comparison to IPF (0.07) and controls (0.04). In SARC but not in IPF, IFN-gamma mRNA was expressed at high levels and correlated inversely with the carbonyl levels. In both diseases, IL-1beta, TNF-alpha, and IL-6 mRNA transcripts remained at baseline level. In summary, a low IL-10/IL-8 mRNA ratio was paralleled with significant oxidative stress in IPF, while a high IL-10/IL-8 ratio and enhanced IFN-gamma expression went along with a physiological redox-balance in SARC.

Adult↗
PubMed2003

[Rare cause of a chest pain].

HISTORY AND ADMISSION FINDINGS: A 42-year-old woman was admitted because of a newly perceived pain localized in the ventral part of the fifth left rib. The physical examination was normal except for a palpable nodular thyroid and pain on palpation of this rib. The patient history contained a serious car accident and severe cigarette abuse. DIAGNOSTIC PROCEDURES: The chest x-ray in "bone technique" showed an osteolysis in the fifth left rib, which was confirmed by computer tomography and bone scan. The high resolution CT scan of the lung revealed a discrete interstitial reticular pattern with minor cystic alterations without lymph node enlargement. DIAGNOSIS, THERAPY AND CLINICAL COURSE: Transbronchial biopsy, bronchoalveolar lavage and a malignancy screening did not lead to a diagnosis. Therefore, the patient was submitted to partial rib resection and open lung biopsy. Histological examination revealed a Langerhans cell histiocytosis. The initial therapeutic approach was a strict smoking cessation. CONCLUSION: The differential diagnosis of a lytic bone lesion in a heavy smoker should include Langerhans cell histiocytosis. On smoking cessation a remission of the disease may be achieved.

Adult↗
PubMed2003

[Therapy of exacerbated COPD. How long ambulatory treatment?].

Acute exacerbation of COPD impacts negatively on the prognosis, and is associated with a significant motality rate. Accordingly, every case of COPD exacerbation requires intensified treatment of the underlying disease. This usually ecompasses the use of inhalative and possibly also systemic bronchodilators, and systemic glucocorticosteroids at appropriate doses. Evidence of infection (purulent sputum) indicates the need for an antibiotic, the choice of which must be determined by the severity of the underlying disease. Respiratory insufficiency requires the additional use of oxygen and, where necessary, mechanical ventilation. In such cases, non-invasive ventilation via a mask has resulted in an appreciable reduction in the complications associated with invasive ventilation, and a significant reduction in the associated high mortality rates. Successful treatment of COPD exacerbation must be followed by suitable measures aimed at reducing future episodes of exacerbation. These includes smoking cessation, optimal medical treatment and vaccination against influenza, together with appropriate patient instruction.

Ambulatory Care↗