PubMed Health⌕ Search

Biomedical subjects

J Festen

Publications and source records attributed to J Festen.

49 records · Page 3Linked to original sources
PubMed1990

Prevention of bacterial colonization of the respiratory tract and stomach of mechanically ventilated patients by a novel regimen of selective decontamination in combination with initial systemic cefotaxime.

A novel regimen of selective decontamination (SDD) with initial systemic cefotaxime prevented bacterial colonization of the oropharynx and stomach in mechanically ventilated patients. In a three-group study of all patients receiving prolonged mechanical ventilation, patients in control groups A and B received antibiotics only when infection was present. In group A, antibiotics that disturb colonization resistance (CR) were used. In group B, antibiotics use was restricted to antibiotics not affecting CR. Patients in group C received SDD, consisting of norfloxacin, polymyxin E and amphotericin B, administered via a gastric tube and applied to the oropharynx. Group C patients further received an initial five day course of cefotaxime, 500 mg tid. The lower respiratory tract was colonized with microorganisms on admission in about half of the patients, and this persisted in both control groups. In group C, lower respiratory tract colonization was eliminated in all patients after five days. In both control groups about 90% of the patients acquired microbial colonization of the oropharynx and stomach, mostly with Gram-negative bacilli. In group C, only 12% and 24% of the patients acquired colonization of the oropharynx and stomach respectively (P less than 0.001). The oropharynx and stomach were the major sources of microorganisms causing lower respiratory tract infection in both control groups. In group C, elimination of oropharyngeal and gastric colonization completely prevented lower respiratory tract infection from these sources.

Adult↗
PubMed1990

No effect of oral high frequency oscillation combined with forced expiration manoeuvres on tracheobronchial clearance in chronic bronchitis.

This study compared the effect of oral high frequency oscillation (OHFO) with the effect of the forced expiration technique (FET) on tracheobronchial clearance. Eight patients with chronic bronchitis were investigated (mean age 60 +/- 10 yrs, mean forced expiratory volume in one second (FEV1) 68 +/- 27% predicted, mean sputum production 33 +/- 9 g.day-1). OHFO was applied at the respiratory system resonant frequency of each patient (range 9.2-25 Hz) and combined with huffing. FET included breathing exercises, huffing and postural drainage. Duration of both OHFO and FET was 30 minutes. Tracheobronchial clearance was measured by means of a radio-aerosol technique. At 60 mins after start of the treatment mean tracheobronchial retention was 70 +/- 26% after OHFO, 54 +/- 26% after FET and 76 +/- 18% in the control run, which included huffing only. OHFO was not significantly different from control. FET was significantly different (p less than 0.02) from both OHFO and control. It is concluded that OHFO has no effect on tracheobronchial clearance in chronic bronchitis.

Adult↗
PubMed1989

Variability of tracheobronchial clearance in healthy non-smoking subjects.

Tracheobronchial clearance was measured twice in 10 healthy non-smoking volunteers to evaluate inter- and intrasubject variability, using a radio-aerosol technique (5 microns 99mTc-labelled polystyrene particles). By means of two detectors radioactivity in the lungs was measured at regular intervals for 6 h and once more 24 h after inhalation. The decrease in radioactivity after correction for background activity, isotope decay and 24-hour retention was assumed to reflect tracheobronchial clearance. Among other parameters to quantitate the results of these tests, the area under the retention curve up to 6 h after inhalation (AUC-6) was calculated. The intersubject coefficient of variation (COV) using the AUC-6 was 31%. The intrasubject COV of the AUC-6 was 11%. These results compare favourably with those reported by others using different techniques. It is concluded that the intrasubject variability of tracheobronchial clearance as measured by this technique is small.

Administration, Inhalation↗
PubMed1988

The effect of positive expiratory pressure versus forced expiration technique on tracheobronchial clearance in chronic bronchitics.

In a randomized cross-over trial, including a control measurement the effect of positive expiratory pressure (PEP) and forced expiration technique (FET) on tracheobronchial clearance was evaluated in eight chronic bronchitics with abundant sputum production (mean, 32 g/day). PEP consisted of PEP-mask breathing interspersed with breathing exercises, huffing, and coughing. FET consisted of postural drainage, breathing exercises, huffing, and coughing. Clearance was measured with a radio-aerosol technique. At 40 min after the start of therapy the mean clearance, expressed as percentage of the amount of radioactivity present at the start of therapy, was 32% after PEP, 53% after FET, and 15% in the control run. The difference between PEP, FET, and control was statistically significant (p less than 0.02). Sputum production during PEP and FET was larger than during the equivalent period of time in the control run. It is concluded that FET is more effective than PEP in enhancing tracheobronchial clearance.

Breathing Exercises↗
PubMed1988

Conventional physiotherapy and forced expiration manoeuvres have similar effects on tracheobronchial clearance.

This study compared the effect of two forms of chest physiotherapy. In the "conventional" form of physiotherapy, postural drainage was combined with percussion and directed coughing. The other, relatively new form of physiotherapy, was the forced expiration technique, i.e. huffing combined with postural drainage, breathing exercises and, if necessary, coughing. Eight patients (six with cystic fibrosis, two with agammaglobulinaemia) took part in the study. No difference was found in tracheobronchial clearance, regional lung clearance, sputum production or lung function between the two forms of treatment. The forced expiration technique can be performed without an assistant. Therefore, it is concluded that in general the forced expiration technique is preferable.

Adolescent↗
PubMed1987

Significance of screening in treatment and survival in bronchial carcinoma.

In a retrospective study, the influence of the way bronchial carcinoma was detected was evaluated with respect to the possibility of surgery and to survival rates. From the 324 patients detected through mass screening (category I) 69.8% were suitable for surgery, whereas only 41.4% of the 736 patients detected because of pulmonary symptoms (category II) were deemed surgery-eligible. In category I, the type of surgical interventions were 65% (bi)lobectomy and 22.4% pneumonectomy. In category II, these figures were 23.4% and 53.6%, respectively. During the surgery, 10.6% turned out to be unresectable in category I, whereas 22.0% were in category II. There was also a marked difference in survival after 5 and 10 years. For category I, the 5-year survival rate was 23.4%, the 10-year survival 10.9%. In category II, these figures were 8.6% and 4.2%, respectively. The 5-year survival rate of all nonsurgically treated patients was 1% regardless of the method of diagnosis.

Carcinoma, Bronchogenic↗
PubMed1987

Changing pattern of drug use in relation to disease duration of rheumatoid arthritis.

The prevalent use of antirheumatic drugs in a cohort of 311 middle aged female patients with seropositive and seronegative rheumatoid arthritis (RA) was investigated. Seropositive patients used a greater amount and more aggressive drugs during each decade of disease duration. The overall use of drugs decreased with disease duration, except for a subgroup of seropositive patients with RA who, with increased disease duration, used more aggressive drugs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1975

Intrapatient comparison of treatment with chlorthalidone, spironolactone and propranolol in normoreninemic essential hypertension.

The effects of chlorthalidone, spironolactone and propranolol in reducing blood pressure were compared in the same 11 normoreninemic hypertensive patients. All three drugs decreased the blood pressure significantly and no agent had a superior blood pressure-lowering effect. The blood pressure did not normalize. The data suggest that no one variable--volume factors, relative hyperactivity of the renin-aldosterone system or beta-adrenergic hyperactivity--is the prime mover in normoreninemic hypertension. Long-term treatment with chlorthalidone resulted in slight hyperreninism (26.3 +/- 4.9 ng-ml-1-3 hours-1) (mean +/- standard error) with concomitant changes in plasma aldosterone (23.0 +/- 3.2 ng-100 ml-1). The body weight decreased significantly (--1.8 kg, P less than 0.005). Plasma potassium concentrations were low (3.2 +/- 0.1 mEq-liter -1). Creatinine clearance was unimpaired (117 +/- 6 ml-min-1). Treatment with spironolactone resulted in more marked hyperreninism (47.0 +/- 14.3 ng-ml-1-3 hours-1) and hyperaldosteronism (61.9 +/-11.8 ng-100 ml-1). The body weight decreased significantly (--1.9 kg, P less than 0.004). Significant hyperkalemia occurred (4.4 +/- 0.1 mEq-liter-1). The glomerular filtration rate decreased significantly to 93 +/- 3 ml-min-1 (P less than 0.004). Treatment with propranolol resulted in marked suppression of the plasma renin activity (1.8 +/- 0.2 ng-ml-1-3 hours-1) and plasma aldosterone levels (8.9 +/- 1.3 ng-100 ml-1). A significant increase in body weight occurred (+2.3 kg, P less than 0.013). The plasma potassium concentration increased to a level not significantly different from the value found after treatment with spironolactone (4.2 +/- 0.1 mEq-liter-1). The creatinine clearance decreased significantly to 99 +/- 5 ml-min-1 (P less than 0.008). Hyperreninemia (by spironolactone and chlorthalidone), effective hyperaldosteronism (by chlorthalidone) and volume retention (by propranolol) are considered to represent expressions of mechanisms counteracting the depressor effects of these different pharmacologic maneuvers, leading to the maintenance of supranormal blood pressure.

Adult↗
PubMedDate not supplied

Skin vasomotor reflexes during inspiratory gasp: standardization by spirometric control does not improve reproducibility.

Arteriovenous anastomoses (AVA) in skin microcirculation are mediated by the sympathetic stimuli. The inspiratory gasp test (IG test) triggers the sympathetic nervous system, resulting in a decrease in AVA skin blood flow, as measured by laser Doppler fluxmetry (LDF). We studied the reproducibility of the IG test under carefully standardized respiratory conditions. In each of 19 healthy (young) volunteers with a mean skin temperature during the experiment above 28 degrees C 13 IG tests were performed, either under spirometric control or uncontrolled and by using a negative pressure transducer. Starting the IG test end-inspiratory results in the most pronounced absolute LDF decrease [140 PU (70-490)], median (minimum-maximum) as compared to starting end-expiratory [100 PU (40-260)] and during inspiration [110 PU (50-350)], respectively, p < 0.001 and p < 0.001. Inspiration as fast as possible results in a larger absolute LDF decrease [150 PU (40-450)], compared to inspiration in 5 s [120 PU (60-340); p < 0.02] and in 10 s [130 PU (40-350); p < 0.05]. Continuously sucking negative mouth pressure results in a larger LDF decrease [140 PU (30-420)] in comparison with taking one deep breath and holding it for 10 s [110 PU (30-270); p < 0.01]. However, standardization of the IG test did not improve its reproducibility.

Adult↗