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Biomedical subjects

J H Ficker

Publications and source records attributed to J H Ficker.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Abscesses, endophthalmitis and retinopathy as "initial manifestations" of type 2 diabetes].

The case of a 42 year old female patient is described, who presented with abscesses in the lung, the left kidney, the perspiratory glands of the axillae and endophthalmitis as well. Staphylococcus aureus could be isolated from sputum, urine, bronchoalveolar lavage and excisates of the abscesses in the right axilla. After long-term antibiotic and antimycotic treatment, restitutio ad integrum could be achieved. Since the further course excluded underlying malignancy, the septic course of Staphylococcus aureus infection must be regarded as an effect of immunosuppression in long-standing and untreated diabetes mellitus.

Abscess↗
PubMed2000

[New trends in therapy of diabetes. More freedom, fewer risks, comfortable insulin administration].

The incidence of diabetes mellitus is increasing worldwide. Strict metabolic control can prevent late sequelae of this disease. For this purpose, not only more potent drugs with fewer side effects are needed, but also user-friendly techniques and devices for self-monitoring of blood glucose and the less painful application of insulin (jet application, inhalable insulin). More user-friendly insulins are the rapid- and short-acting human insulin analogues, which do away with the bothersome injection/meal interval, and improve the postprandial glycemic response. New long-acting insulins reduce the frequency of injections and the occurrence of nocturnal hypoglycemia. Type 2 diabetics will presumable benefit from the use of the rapid, short-acting glinides, for example, by enabling a greater measure of eating freedom during the course of the day. The thiazolidinediones, a group of agents that enhance the effects of insulin in target tissue, reduce insulin resistance and improve insulin sensitivity.

Diabetes Mellitus↗
PubMed2000

Detection of obstructive sleep apnea by analysis of phase angle using the forced oscillation signal.

Pharyngeal collapse in patients with obstructive sleep apnea syndrome (OSAS) is linked to decreased upper airway muscle activity. We hypothesised that decreased muscle activity causes decreased stiffness of the upper airway wall and assumed that a decrease in wall stiffness would result in a change point (CP) of the morphology of phase angle time series phi(t) obtained by forced oscillation technique (FOT). We developed an algorithm to detect CPs in φ(t) and investigated phi(t) data measured in parallel to all-night polysomnography in seven patients. A total of 2724 CPs were detected by algorithm. The CPs were marked on the polysomnograms and compared with polysomnogram scoring performed jointly by three sleep expert physicians. A total of 791 (67%) of the 1172 handscored respiratory events showed a CP in phi(t) within a time interval of 8 sec before and 6 sec after the marked onset. A total of 672 (57%) respiratory events were detected at an earlier time by algorithm, and 119 (10%) were algorithmically detected later. The average detection time by the CP algorithm was 4.0+/-1.1 sec earlier than the manual scoring. We conjecture that a CP in phi(t) indicates a change in upper airway collapsibility and that phi(t) might be a potentially useful parameter for detection of impending upper airway obstruction.

Adult↗
PubMed2000

In vivo efficacy of heated and non-heated humidifiers during nasal continuous positive airway pressure (nCPAP)-therapy for obstructive sleep apnoea.

Upper airway dryness is a frequent side-effect of nasal continuous positive airway pressure therapy (nCPAP) in obstructive sleep apnoea (OSA). In this situation, heated or non-heated passover humidifiers are often added to the nCPAP-therapy. The efficacy of these two modes in terms of increasing the absolute humidity of the inspired air in vivo has so far not been established. The present investigation was therefore designed to compare various heated and non-heated passover humidifiers in terms of the their ability to increase the absolute humidity in the inspired air during nCPAP. In six healthy test individuals, nCPAP-therapy at pressures of 5 mbar and 10 mbar was simulated, and the relative humidity and temperature of the air within the tube at the junction between CPAP tube and mask were measured. In each test person, measurements were carried out both with and without the two heated (HC 100, Fischer&Paykel Inc., New Zealand and HumidAire, ResMed Ltd., Australia) and two non-heated (Oasis and Humidifier, both from Respironics Inc., U.S.A.) passover humidifiers under steady-state conditions. The absolute humidity was calculated from the relative humidity and temperature measurements. The mean (SD) absolute humidity (gm(-3)) in the steady-state was significantly (P<0.05 higher with each of the humidifiers than that calculated when no humidifier was used. The relevant figures were as follows: no humidifier: 10(-2) (1.8) gm(-3) (at 5 mbar)/9.8 (1.8) gm(-3) (at 10 mbar); Humidifier: 16.4 (0.97)/15.6 (1.26); Oasis: 17.3 (0.97)/ 16.7 (0.93); HC100: 26.5 (1.40)/26.2 (1.23); HumidAire: 31.8 (2.50)/30.9 (2.64). The mean increase in absolute humidity (in gm(-3)) with the aid of the heated humidifiers was 16.3 (5 mbar) gm(-3)/16.4 (10 mbar) gm(-3) with HC100 and 21.6/21.1 with HumidAire, and in both cases was clearly and significantly (P=0.028) higher in comparison with the non-heated humidifiers--6.2/5.8 with Humidifier and 7.2/6.9 with Oasis. In terms of the absolute humidity achieved within the CPAP tube system, the heated humidifiers were clearly superior to the non-heated humidifiers. These results were, however, obtained under laboratory conditions, and therefore cannot be translated unreservedly to the situation represented by long-term CPAP-treatment. Furthermore, it is possible that the smaller humidification capacity of the non-heated humidifiers may still suffice to meet the requirements of clinical use in terms of effectively preventing dry airways under CPAP treatment. This point, however, needs further investigation on the basis of long-term clinical studies.

Adult↗
PubMed2000

An auto-continuous positive airway pressure device controlled exclusively by the forced oscillation technique.

The forced oscillation technique (FOT) has been demonstrated to be a very sensitive tool for the assessment of upper airway obstruction during nasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA). The present study was designed to evaluate the therapeutic efficacy of a novel auto-CPAP device based exclusively on the FOT. Following manual CPAP titration, 18 patients with OSA (mean apnoea/hypopnoea index (AHI) 48.0+/-28.1) were allocated to conventional CPAP and auto-CPAP treatment under polysomnographic control in randomized order. The patients were asked to assess their subjective daytime sleepiness using the Epworth Sleepiness Scale (ESS). The mean AHI during auto-CPAP treatment was 3.4+/-3.4 and was comparable with that obtained during conventional CPAP treatment (4.2+/-3.6). The analysis of sleep architecture, the arousal index (6.6+/-2.1 versus 7.3+/-4.4) or the ESS (5.6+/-1.8 versus 7.3+/-4.4) did not reveal any significant differences. However, the mean CPAP pressure during auto-CPAP treatment (0.84+/-0.26 kPa) and in particular the pressure applied in the lateral body position (0.74+/-0.35 kPa), was significantly lower than that employed in conventional CPAP treatment (0.93+/-0.16 kPa, both comparisons: p<0.05). The auto-continuous positive airway pressure device proved equally as effective as conventional continuous positive airway pressure. However, the mean treatment pressure was significantly reduced, especially when patients were sleeping in the lateral position.

Adult↗
PubMed1999

Are snoring medical students at risk of failing their exams?

STUDY OBJECTIVES: To compare the examination results of self-reported snoring and nonsnoring medical students DESIGN: We studied the examination scores obtained by medical students answering a multiple-choice test forming part of their final examinations. The students were asked to classify themselves as "nonsnorers," "occasional snorers," or "frequent snorers," and to state their age, sex, height and weight. SETTING: University Hospital, Erlangen, Germany PARTICIPANTS: 201 medical students (61% males/39% females; mean age 24.6 +/- 2.1 years; BMI 22.4 +/- 2.5 kg/m2) taking their final examinations in internal medicine. MEASUREMENTS AND RESULTS: Seventy-eight students (38.8%) claimed to be nonsnorers, 99 (49.3%) occasional snorers and 24 (11.9%) frequent snorers. The mean examination scores (adjusted for age, sex, and BMI) were 69.6 +/- 9.9% for the nonsnorers, 65.3 +/- 10.0% for the occasional snorers and 62.0 +/- 8.2% for the frequent snorers (p < 0.0001). 12.8% of the nonsnorers failed the exam, compared with 22.2% of the occasional snorers and 41.7% of the frequent snorers (p < 0.001). Logistic regression analysis showed an association between failing the exam and snoring (p = 0.013), but not between failure and age, BMI, or sex (relative risk for snorers adjusted for age, sex and BMI: 1.26; 95%--CI 1.01-1.57). CONCLUSIONS: In medical students, snoring seems to be associated with an increased risk of failing exams in a dose-response manner, even after controlling for age, sex and BMI. For the present, the mechanisms underlying this association must remain a matter of speculation. Snoring-related sleep fragmentation ("upper airway resistance syndrome") might be a causal factor.

Achievement↗
PubMed1999

A heated humidifier reduces upper airway dryness during continuous positive airway pressure therapy.

Upper airway dryness is a frequent side-effect of nasal continuous positive airway pressure (nCPAP) therapy in obstructive sleep apnoea (OSA). In this situation, heated humidification is often used. Alternatively, oily nose drops are frequently applied to relieve dryness. The present study aimed to investigate the efficacy of a heated humidifier in comparison with oily nose drops. Twenty-four OSA patients complaining of serious nCPAP-related upper airway dryness were randomized to 6 weeks of treatment either with heated humidification (HC 100, Fischer & Paykel, Inc., Auckland, New Zealand) or oily nose drops (Colda-Stop, Desitin, Inc., Germany). The patients completed questionnaires on the degree and frequency of upper airway dryness, compliance with nCPAP, intention to terminate nCPAP and comfort during the nCPAP therapy. All 12 patients treated with heated humidification improved in terms of the degree and frequency of upper airway dryness, and reported greater comfort when using the nCPAP device. All patients in the heated humidification group intending to terminate nCPAP therapy because of upper airway dryness persisted with nCPAP on addition of humidification. In contrast, only five out of 12 patients (42%) in the oily nose drops group reported their degree of upper airway dryness to be improved (P = 0.003), only three patients (25%) reported an improvement in the frequency of upper airway dryness (P < 0.001), and only five patients (42%) reported greater comfort when using the nCPAP device with oily nose drops (P < 0.001). In the group using oily nose drops none of the three patients who intended to terminate nCPAP therapy persisted with nCPAP. Heated humidification is highly effective and superior to oily nose drops in reducing the symptoms of upper airway dryness during nCPAP.

Aged↗
PubMed1998

[Secondary obstructive sleep apnea syndrome in a patient with tracheal stenosis and bilateral recurrent paresis. Successful treatment with nasal continuous positive airway pressure therapy].

HISTORY AND ADMISSION FINDINGS: A 67-year-old woman complained of marked daytime sleepiness, as well as loud snoring and apnoeas during sleep. She was known to have had 3 thyroidectomies for goitre 41, 23 and 12 years ago, with known tracheal stenosis and recurrent nerve palsy for 11 years. Physical examination revealed marked stridor, hoarse voice and slightly enlarged and palpable recurrent right thyroid. INVESTIGATIONS: Polysomnography demonstrated a clearly elevated obstructive sleep apnoea activity (apnoea index: 34/h, apnoea-hypopnea index: 40/h, desaturation index: 31/h, minimal saturation: 63%). Selective tracheal imaging showed subglottic tracheal stenosis with an inspiratory luminal diameter of 4 mm and an expiratory luminal diameter of 8 mm. Lung function analysis revealed marked flattening of the flow-volume curve as sign of a functionally effective tracheal stenosis. These findings indicated a secondary obstructive sleep apnoea (OSA) due to tracheal stenosis and bilateral recurrent nerve palsy. The patient declined further studies, such as bronchoscopy. TREATMENT AND COURSE: As the patient did not want any surgical treatment, nasal continuous positive airway pressure therapy (CPAP) was instituted as a trial. No apnoea occurred at a pressure of 12 mm H2O and this was well tolerated. She has now continued CPAP at home for 12 months and her vigilance was markedly improved. CONCLUSIONS: Tracheal stenosis or recurrent nerve palsy is a rare cause of OSA which can be effectively treated by nasal CPAP.

Aged↗
PubMed1998

Evaluation of an auto-CPAP device for treatment of obstructive sleep apnoea.

BACKGROUND: Auto-CPAP machines used in the treatment of obstructive sleep apnoea (OSA) are designed to vary the treatment pressure automatically in order always to apply the actually needed pressure. Consequently they should be able to achieve at least identical therapeutic effects as conventional constant pressure CPAP with a lower mean treatment pressure. The present study was designed to evaluate the therapeutic efficacy and the treatment pressure of an auto-CPAP machine (REM + auto, SEFAM) in comparison with a conventional CPAP device. METHODS: Following CPAP titration, 16 patients with OSA were allocated to receive conventional CPAP and auto-CPAP treatment under polysomnographic control in a randomised order. After each treatment the patients were asked to assess the therapy using a questionnaire; a vigilance test was also carried out and subjective daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). RESULTS: The mean (SD) apnoea/hypopnoea index (AHI) during auto-CPAP treatment was comparable with that during conventional CPAP treatment (4.2 (5.1) versus 3.6 (4.0)). Neither an analysis of sleep architecture nor the arousal index (7.4 (4.1) versus 7.0 (4.3)) revealed any significant differences. Daytime sleepiness measured with the ESS was also comparable (5.3 (3.4) versus 6.5 (4.2)). The vigilance test showed normal values after both treatments in all patients with no significant differences. The mean pressure during auto-CPAP treatment (8.1 (2.9) mbar), however, was significantly higher than that employed in conventional CPAP treatment (7.6 (2.7) mbar; mean difference 0.5 mbar; 95% CI 0.1 to 0.9 mbar; p < 0.05). CONCLUSIONS: Auto-CPAP was equally as effective as conventional CPAP with respect to therapeutic efficacy. The aim of reducing the treatment pressure with auto-CPAP, however, was not achieved.

Adult↗
PubMed1998

Obstructive sleep apnoea and diabetes mellitus: the role of cardiovascular autonomic neuropathy.

Knowledge of conditions associated with an increased prevalence of obstructive sleep apnoea (OSA) may help to identify patients with OSA and might give some insight into the pathogenesis of OSA and its sequelae. A number of earlier, smaller studies hinted at an association between diabetic cardiovascular autonomic neuropathy (AN) and OSA. The present study was, therefore, conducted with the aim of establishing the prevalence of OSA in diabetics with AN and of determining whether OSA is more prevalent in diabetics with AN, than in those without. We studied two groups of diabetic patients: 23 with and 25 without AN. All patients were evaluated for possible OSA (apnoea/hypopnoea index > or = 10) using initial ambulatory screening followed by polysomnography. Six patients with AN (26%) were found to have OSA, but none of the patients without AN met the diagnostic criteria (p<0.01). When the patients with OSA were compared to those without, no differences were found in terms of age, sex, body mass index or diabetes type or duration. In conclusion, about one in four diabetic patients with autonomic neuropathy suffers from OSA. Thus, obstructive sleep apnoea is more prevalent in diabetic patients with autonomic neuropathy, than in those without.

Autonomic Nervous System Diseases↗