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Biomedical subjects

J J Klein

Publications and source records attributed to J J Klein.

33 records · Page 2Linked to original sources
PubMed1994

[Poor technique in the use of inhalation drugs by patients with chronic bronchitis/pulmonary emphysema].

OBJECTIVE: To describe errors in inhaler technique of patients with chronic obstructive pulmonary disease (COPD). SETTING: Outpatient clinic, Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands. DESIGN: Descriptive. METHOD: Adult COPD patients who already used an inhaler were asked to demonstrate their inhaler technique. Using a inhaler-specific checklist errors were registered. A division was made into good, adequate and inadequate technique. For each inhaler a selection of critical actions with regard to effective inhaler technique was made. RESULTS: Inhaler technique was assessed in 123 COPD patients. Over one-third of all patients had a very poor inhaler technique, which probably resulted in little or even no drug deposition at all. 42% of the patients performed all essential inhaler actions correctly. For patients with a Diskhaler this was 86%, significantly higher than for the other inhalers, Rotahaler and Turbuhaler, which did not differ much (35% and 46%). Poor inhalation technique leads to insufficient bronchodilating or prophylactic effect, to the prescription of more or additional medication with a higher probability of side effects, and to increased costs. CONCLUSION: The inhalation technique can be improved substantially with a good instruction protocol.

Administration, Inhalation↗
PubMed1992

Local induction of tumor necrosis factor as a molecular mechanism of mucosal damage by gonococci.

Tumor necrosis factor (TNF) is an endogenously produced cytokine that plays a critical role in mediating septic shock and multi-organ failure, but previous studies of the role TNF in disease have not examined its role in mucosal disease processes. In an experimental model of acute gonococcal salpingitis, gonococcal infection of human fallopian tube mucosa resulted in increased mucosal production of TNF. Recombinant human TNF-alpha damaged fallopian tube mucosa in a dose-response manner and produced epithelial damage with the same ultrastructural features as those observed in gonococcal infection. Blocking production of TNF during gonococcal infection diminished the extent of damage to fallopian tube mucosa. In addition to mediating systemic disease, such as septic shock, TNF is also produced locally, and can play a critical role in mediating mucosal disease processes, such as acute gonococcal salpingitis.

Dexamethasone↗
PubMed1983

Topographical differences in the physiological response of canine airway smooth muscle.

The resting membrane potential (Em), electrical and contractile response were studied in three anatomically separate areas of trachealis muscle and also in bronchial muscle (2nd generation) isolated from mongrel dogs. These responses were studied before and after administration of a single dose of histamine, serotonin, carbachol and prostaglandin F2 alpha. A cross-sectional area of airway smooth muscle in each preparation was directly assessed from the histological sections. These values were used to evaluate isometric tension (in g/mm2). It was found that (1) cross-sectional area of airway smooth muscle varies with location; (2) resting membrane potential of airway smooth muscle from upper, middle and lower portions of dog trachea was similar, i.e., -60.4 +/- 0.8, -60.2 +/- 0.4 and -60.8 +/- 0.9 mV, respectively; (3) resting membrane potential of bronchial airway smooth muscle (2nd generation) was -63.4 +/- 0.5 significantly higher (P less than 0.01) than the membrane potential observed in the trachealis muscle; (4) both contractile and electrical changes after single doses of histamine and serotonin administration showed a vertical gradient response. The largest contractile and electrical responses to these two agents were found in preparations from the lower portion of trachea and the smallest response was observed in upper tracheal preparations; (5) contractile responses after a single dose of carbachol and PGF2 alpha, when expressed as isometric tension also showed vertical gradient. In contrast, membrane potential changes after carbachol and prostaglandin F2 alpha were similar in all three types of tracheal segments. Airway smooth muscle of the 2nd generation of bronchi showed large responses after single doses of histamine, carbachol and prostaglandin F2 alpha but the response after serotonin was smaller than that seen in the lower trachea.

Animals↗
PubMed1983

Relationship between serum theophylline levels and pulmonary function before and after inhaled beta-agonist in "stable" asthmatics.

In 9 "stable" adult asthmatics, the relationship between serum theophylline level and pulmonary function, as well as the interaction of aminophylline and inhaled beta2-agonist on pulmonary function, were studied. At varying levels of serum theophylline between 6 and 25 micrograms/ml, which were brought about by increasing oral doses of a slow-release theophylline preparation, the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), airway resistance (Raw), and lung volume were assessed before and after inhalation of a B2-sympathicomimetic (isoetharine). In those subjects in whom it was possible to obtain blood levels within all 3 ranges of less than 10, 11 to 15, and greater than 15 micrograms/ml, there was a significant (p less than 0.05) increase in FEV1 between a mean level of 6.4 +/- 0.9 micrograms/ml and one of 12.8 +/- 0.2 micrograms/ml, but there was no further significant improvement at a mean value of 19.2 micrograms/ml +/- micrograms/ml. Specific airways conductance (SGaw) showed no change at increasing serum theophylline levels. In addition, inhaled beta-agonist increased FEV1 and SGaw maximally at all times, irrespective of the serum theophylline level, and there was no relationship between the response to inhaled bronchodilator and the serum theophylline level. The data indicate that unlike the patient in serious difficulty, ventilatory function was not improved by maximizing serum theophylline levels in this population of stable asthmatics. This suggests that theophylline may be less useful for the stable asthmatic patient than for the acutely ill patient.

Administration, Intranasal↗
PubMed1982

Autologous bone marrow transplantation in the therapy of small cell carcinoma of the lung.

Ten patients with small cell carcinoma of the lung were entered into a chemotherapeutic treatment program consisting of cyclophosphamide, vincristine, Adriamycin, and 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea. Two courses of combination chemotherapy were administered to each patient followed by a third course with the same doses of drugs used on Course 2 but with autologous bone marrow transplantation given 24 to 48 hr after drug infusion. No differences could be detected between Courses 2 and 3 in terms of the magnitude, timing, or degree of myelosuppression. Serial bone marrow biopsies documented a progressive decline in granulocyte-macrophage colony-forming units in culture per mg bone marrow medullary core from 138 +/- 179 (S.D.) prior to chemotherapy to 7 +/- 11 after the marrow transplant recovery (p = 0.05). These data suggest that autologous bone marrow transplantation does not reduce the myelosuppression seen following the drugs used in this study at the dosages used. Autologous bone marrow transplantation may be useful only in the setting of marrow lethal therapy. Its usefulness in shortening recovery time from nonlethal therapy appears questionable.

Antineoplastic Agents↗
PubMed1976

Pulmonary function after recovery from the adult respiratory distress syndrome.

Eight adult patients with acute respiratory distress syndrome were treated with positive end-expiratory pressure (PEEP) ventilation. The results of detailed examinations of pulmonary function in these eight patients obtained after different periods of time following discharge from the respiratory care unit were analyzed to determine the degree of disturbances in pulmonary function. For comparison, examinations of pulmonary function were also performed on two patients who were treated with zero end-expiratory pressure ventilation. This follow-up study showed remarkably few abnormalities. Whe present, restrictive disturbances in pulmonary function, especially decreased static compliance and diffusing capacity, were found. No correlation was found between the pulmonary-function results of the eight patients and the duration of the PEEP treatment, nor between the results and the time interval between treatment at the respiratory care unit and the moment of the pulmonary function studies.

Adolescent↗