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Biomedical subjects

K Rasche

Publications and source records attributed to K Rasche.

At least 19 recordsLinked to original sources
PubMed2007

[Pulmonary diseases and heart function].

The most severe cardiac sequel to lung disease is the load on the right ventricle due to pulmonary hypertension with the development of a cor pulmonale. This is characterized by hypertrophy and/or dilatation of the right ventricle because of a primary impairment of lung function and/or lung structure. The most important pathomechanisms for the development of pulmonary hypertension are vessel obliteration, mechanical lesions, primary vascular or extra-vascular inflammation and hypoxic vasoconstriction. Chronic obstructive pulmonary disease (COPD) is one of the most important reasons for chronic cor pulmonale. A further very common reason is obstructive sleep apnea syndrome, especially if combined with a COPD. In this case, the prevalence of cor pulmonale can reach 80%. The development of a chronic cor pulmonale is the most striking negative prognostic factor for these patients. Only 30% of COPD patients with cor pulmonale survive longer than 5 years, and only early detection of the disturbances to respiration which might potentially lead to cor pulmonale and their subsequent therapy are able to improve the patient's prognosis. Furthermore, pulmonary diseases may also have an impact on the left heart side in terms of an impairment of left heart function or by inducing severe arrhythmias . Thus, lung diseases may have both a significant impact on right and left heart performance.

Arrhythmias, Cardiac↗
PubMed2006

[Long-term compliance of cpap-therapy--update, predictors and interventions].

CPAP (continuous positive airway pressure) is the therapy of choice for obstructive sleep apnea syndrome (OSAS). About 70 % of patients on CPAP use their device for at least 70 % of nights with an application-time of at least 4 hours per night. Severity of breathing disorder respectively disturbance of sleep architecture, degree of daytime sleepiness and patients' satisfaction with diagnostic and therapeutic procedures are good predictors of long-term CPAP-compliance. CPAP-compliance can be increased by intensive patient education. Alternative devices like for example Bilevel or auto-CPAP respectively cannot augment CPAP compliance.

Continuous Positive Airway Pressure↗
PubMed2006

[Cognitive deficits in patients with chronic obstructive pulmonary disease (COPD)].

INTRODUCTION: Patients with COPD present with impairments of their cognitive performance. The present study compares intelligence and memory performance as well as different aspects of attention in COPD patients and healthy controls. Additionally, potential factors influencing daytime performance are analyzed. PATIENTS AND METHODS: Neuropsychological testing was performed in 32 patients with COPD and 10 normal controls. The following aspects were evaluated: memory, intelligence, simple, selective and divided attention, sustained attention under stress and under monotonous conditions. RESULTS: There were no differences between COPD patients and normals with regard to divided attention, vigilance and memory. Patients with COPD demonstrated significantly worse results in terms of intelligence (p < 0.01) as well as simple (p < 0.01), selective (p < 0.05) and sustained attention (p < 0.01). No correlation existed between the severity of the disease (lung function, blood gas analysis, nocturnal oxygen saturation) and neuropsychological findings. Merely a relationship between memory function and slow-wave sleep or REM sleep was demonstrated. CONCLUSION: Impairments of cognitive performance in patients with COPD cannot be predicted on the basis of the severity of the disease. Therefore neuropsychological testing is recommended, especially when impairment of daytime function has to be quantified.

Adult↗
PubMed2006

[Interactions of chemosensitive and vagal afferents in respiratory motor activity and work of breathing].

BACKGROUND: The central interaction of intracranial and arterial chemoreceptors plays an important role for the generation of respiratory motor activity. Whereas the inspiratory inhibitory effect of lung stretch receptors is largely described, relatively little is known about their influence on expiration and on the pathomechanisms of obstructive airway disease. MATERIAL AND METHODS: In anaesthetised cats, electrical activity of inspiratory and expiratory muscles (IM, EM) has been studied along with tidal volume and the position of breathing in eupnoea and increased respiratory drive before and after bilateral vagotomy. In order to mimic slowly adapting lung stretch receptor activity (SAR), the distal ends of vagal nerves (VN) were stimulated electrically using a frequency modulated signal derived from the respiratory alterations in oesophageal pressure. RESULTS: With intact VN, electrical stimulation of carotid sinus nerves or inhalation of 5 % CO (2) in O (2) resulted in an increased activation of IM in inspiration and activation of EM in expiration. Elimination of lung stretch receptor activity during quiet breathing resulted in prolongation and increase in IM activity without much effecting EM, since expiration is passive in eupnoeic breathing. After bilateral vagotomy, the electrical activity of the expiratory muscles was effectively reduced and the activity of the inspiratory muscles was largely enhanced. The effects of vagotomy could be completely reversed by electrical VN stimulation. Simulating an increased tidal volume by increasing the end inspiratory stimulation frequency to more than 100 Hz resulted in a decrease in IM activity and tidal volume. On mimicking an increased end expiratory lung inflation by end expiratory frequencies up to 50 Hz, expiration was prolonged and expiratory muscles activated. In consequence the position of breathing shifted to below the functional residual capacity (FRC). CONCLUSION: The results of these acute investigations show, that besides terminating inspiration, lung stretch receptors cause a facilitation of expiration during increased respiratory drive and expiratory airflow limitation by activation of expiratory muscles.

Afferent Pathways↗
PubMed2006

Sleep disordered breathing in the elderly: a three year longitudinal cohort study.

The objective of this investigation was to assess the association between the presence of sleep disordered breathing (SDB) and daytime sleepiness, body mass index, hospitalisation, and survival. To this end, a prospective longitudinal study was conducted in the elderly population consisting of 80 patients of either sex over the age of 65 years admitted to a city hospital in Germany without any history of SDB. All patients met the following exclusion criteria: age <65 yr, heart failure, and chronic obstructive lung disease. Baseline anthropometric and cardiorespiratory (one-night portable polygraphic recording) data, and a standardized sleep and sleepiness-questionnaires (Epworth Sleepiness Scale, ESS) were obtained in 1999. A second screening was conducted in 2003. Thirty one women and 34 men completed the follow-up after 3 years. These patients were divided into two subgroups: (i) no clinically relevant SDB and (ii) SDB (apnea-hypopnea index, AHI, >or=5 plus excessive day time sleepiness, ESS, >9). Six men and 3 women fulfilled the criteria of SDB. Thirty three percent of patients with SDB and 20% of patients without SDB died during the follow-up period. Duration of hospital stay was 35 days for the SDB patients and 20 days for patients without it. Body weight and sleepiness did not change significant over the 3-year period between the two cohorts. We conclude that the presence of SDB was associated with a 1.5-fold higher mortality and longer hospital stay in elderly patients over a period of 3 years even in persons without previous history of SDB. Daytime sleepiness was a better predictor than AHI or BMI for death.

Aged↗
PubMed2005

Driving simulator and neuropsychological [corrected] testing in OSAS before and under CPAP therapy.

Patients with obstructive sleep apnoea syndrome (OSAS) have an increased car accident rate. Investigations on accident frequency are based on case history, insurance reports and driving simulator studies. The present study combines neuropsychological testing of different attention aspects engaged in driving a car and driving simulation to evaluate a suitable instrument for assessing therapeutic effects of continuous positive airway pressure (CPAP). Driving simulator investigation and neuropsychological testing of alertness, vigilance and divided attention were performed in 31 patients with polysomnographically confirmed OSAS (apnoea-hypopnoea index 24.8+/-21.5.h(-1)) before, and 2 and 42 days after initiation of CPAP. Divided attention and alertness improved significantly during CPAP, whereas vigilance remained unchanged. However, accident frequency (OSAS before therapy: 2.7+/-2.0; 2 days after CPAP: 1.5+/-1.4; 42 days after CPAP: 0.9+/-1.3) and frequency of concentration faults (OSAS before therapy: 12.4+/-5.1; 2 days after CPAP: 6.5+/-3.9; 42 days after CPAP: 4.9+/-3.3) decreased in the simulated driving situation after 2 and 42 days of therapy. There was no relation between accident frequency, concentration faults and daytime sleepiness, as measured by the Epworth Sleepiness Scale, and polysomnographic or neuropsychological findings, respectively. In conclusion, the present results suggest that driving simulation is a possible benchmark parameter of driving performance in obstructive sleep apnoea syndrome patients.

Accidents, Traffic↗
PubMed2005

Sleep disordered breathing in the elderly: comparison of women and men.

The prevalence of obstructive sleep apnea syndrome in patients up to the age of 60 is known to be two times higher in men then in women. Hormonal changes during menopause might underlie changes in this relationship in the elderly. This study was designed to detect differences in the type and frequency of sleep-disordered breathing between women and men over the age of 65 years, having the same body mass index. The study was conducted using a matched-pair approach consisting of a sample population of 40 pairs of patients over the age of 65. All patients met the following exclusion criteria: age below 65, heart failure, chronic obstructive lung disease. Polygraphy was conducted by means of a portable recorder. All measured indices were higher in men than in women. The apnea index was 2.8 +/-4.1 in men and 0.6 +/-1.4 in women. The apnea/hypopnea index was 10.2 +/-11.4 and 4.8 +/-3.9, respectively. These differences were significant (P<0.05). Significant differences also were observed when central (men 8.1 +/-13.1, women 3.1 +/-8.2), mixed (men 5.1 +/-11.4, women 0.4 +/-1.3), and obstructive (women men 8.6 +/-20.1, 1.0 +/-4.3) apnea indices were compared. In conclusion, the study demonstrates that elderly patients showed gender-dependent differences in the type and frequency of sleep-related breathing disorders. Men suffered from all kinds of apnea more frequently than women.

Aged↗
PubMed2004

[Acute severe asthma in older adults].

The underlying causes of acute severe or life threatening asthma are infections with respiratory viruses or Mycoplasma pneumoniae, rather than bacterial infections. In addition, exposure to various agents such as allergens, non-specific irritants or drugs, and inadequate long-term treatment may be responsible. High flow oxygen therapy, high dose topic beta(2)-agonists and systemic glucocorticosteroids should be used as baseline therapy in outpatients. In hospital, intravenous therapy-eventually including sedatives-can be administered under controlled or intensive care conditions. In patients with increasing respiratory pump weakness and alveolar hypoventilation, non-invasive and/or invasive mechanical ventilation may be required. In ventilated asthma patients permissive hypercarbia has been shown to reduce complications such as pneumothorax. Bronchoscopy and bronchial lavage are recommended for patients ventilated with increasing pressures or when atelectasis occurs.

Acute Disease↗
PubMed2004

[Does nCPAP-therapy change the lung function of patients with obstructive sleep apnea syndrome?].

BACKGROUND: nCPAP-therapy is standard for patients with obstructive sleep apnea syndrome (OSAS). This study investigated, if nCPAP changed the patients lung function. PATIENTS AND METHODS: Lung function of 228 OSAS patients without co-prevalent lung disease, who received nCPAP for the first time, was examined (whole body plethysmography, spirometry, and blood gas analysis). After 1, 2, and 3 years the results of the re-examined patients were compared with their individual starting results. RESULTS: The results of the patients in the basic and in the follow-up examinations was within standard range. During reexamination, an improvement of inspiratory vital capacity was registered repetitively, especially in smokers. On the other hand, MEF 50 decreased within the first two years and FEV (1) %VC, but not FEV (1), decreased after 2 and 3 years of reexamination. CONCLUSIONS: Neither obstructive nor restrictive lung diseases were diagnosed under nCPAP-therapy within three years. This study with a retrospective design showed significant improvements of vital capacity (VC) in patients with OSAS, especially in smokers, under nCPAP-therapy. This increase can be explained by an effect of practice in the examination and by recruitment of formerly hypoventilated lung areas. As MEF 50 and FEV (1) %VC depend on VC, the decrease of both parameters may be caused by the increase of VC. In summary, nCPAP did not cause negative effects of lung function in the investigated patients over a period of 3 years.

Continuous Positive Airway Pressure↗
PubMed2004

Non-invasive ventilation in chronic obstructive pulmonary disease.

Non-invasive ventilation (NIV) via nasal or full face mask can be applied in respiratory failure due to chronic obstructive pulmonary disease (COPD) both in the acute and long-term settings. In acute exacerbation of COPD with respiratory failure it may be considered as a standard treatment. There is strong evidence that NIV might reduce intubation, complication, and mortality rate in patients with acute hypercapnia (PaCO(2) >45 mmHg). The method is cost effective and reduces hospital stay. NIV might be also useful in the weaning of COPD patients from invasive ventilation. On the other hand, for severe stable disease the data concerning a positive effect of NIV are less convincing. Preliminary evidence suggests that NIV improves gas exchange, sleep quality and quality of life and might reduce the need for hospitalization. Especially, COPD patients with substantial chronic hypercapnia (PaCO(2) >55 mmHg) and/or nocturnal hypoventilation, and those with repeated exacerbations may profit from NIV. In any case, NIV is a very valuable and effective tool in the non-pharmacological treatment of COPD. Every clinician who is involved in the management of COPD patients with respiratory insufficiency should be able to apply this technique.

Humans↗
PubMed2003

[Accidents caused by sleepiness--prediction by neurophysiologic/psychologic testing and simulated driving studies].

Daytime sleepiness is a leading symptom of various diseases, and is an important cause of accidents at the workplace and on the road. For the evaluation of accident frequency, the medical history, neurophysiological and neuropsychological tests, and driving simulator performance are applied. The present paper describes these different methods, and assesses their value in predicting accidents. In the last resort, no single test suffices to evaluate the accident risk of patients suffering from daytime sleepiness--rather, a combination of the methods described is needed, in particular when an expert opinion on a patient's ability to drive is required. To date, no controlled studies have been done to compare the predictive value of the methods considered herein. Our results suggest that the nearness of driving simulation to reality makes it a suitable additional test method, in particular for the monitoring of results under treatment.

Accidents, Traffic↗
PubMed2002

[Estimation of accident risk in obstructive sleep apnea syndrome (OSAS) by driving simulation].

Abstract. Patients with obstructive sleep apnea syndrome (OSAS) have an accident rate between two and seven times higher than normals. Investigations on accident frequency are based on case history, insurancy reports, and driving simulator investigations. The present controlled study was planned to test whether an increased accident risk could be demonstrated in patients with OSAS before and on CPAP (continuous positive airway pressure)-therapy using the driving simulator C.A.R. Driving simulator performance was investigated in 31 patients with polysomnographically confirmed OSAS (apnea-hypopnea-index 24.8 +/- 21.5/h) before, 2 and 42 days after initiation of CPAP and was compared to 10 healthy controls in whom OSAS was excluded by polysomnography. Driving simulator performance was significantly worse in OSAS as compared to normals especially in terms of accident frequency (OSAS: 2.7 +/- 2.0, controls: 1.3 +/- 1.5, p < 0.05) and concentration faults (OSAS: 12.4 +/- 5.1, controls: 7.1 +/- 3.2, p < 0.01). On CPAP accident frequency (OSAS before therapy: 12.4 +/- 5.1, 2 days CPAP: 1.5 +/- 1.4, p < 0.01; 42 days CPAP: 0.9 +/- 1.3, p < 0.001) and frequency of concentration faults (OSAS before therapy: 12.4 +/- 5.1, 2 days CPAP: 6.5 +/- 3.9, p < 0.001; 42 days CPAP: 4.9 +/- 3.3, p < 0.001) could be lowered significantly both in the short and medium term of therapy. The driving simulator C.A.R. is an adequate tool for the evaluation of an increased accident risk in OSAS-patients and demonstrates the efficiency of CPAP-therapy.

Accidents, Traffic↗
PubMed2002

[Inflammatory pseudopapilloma after recurring aspiration of fruit stones as rare differential diagnosis of bronchogenic cancer].

We present the case of a 51-year old man with drug-resistant pneumonia in the upper right lobe, weight loss and a 50-pack year history of cigarette smoking who underwent bronchoscopy. By clinical and radiological findings bronchogenic cancer was assumed. Fiberbronchoscopy showed an exophytic tumor-like mass obliterating the right upper lobe. Biopsies revealed an epithelial pseudopapillomatous tumor with multiple mucosal dysplasia and metaplasia. A second bronchoscopy in order to remove the lesion revealed a foreign body embedded in the tissue which could be removed easily. The foreign body proved to be a cherry stone, after its removal pneumonia resolved completely. In the same patient this lesion was recurrent one year later after aspiration of a grape seed. We present this case to emphasize the relationship between foreign body aspiration and inflammatory pseudopapilloma as a sequela of the inflammatory insult provoked by foreign bodies. Bronchoscopy is mandatory and may obviate misdiagnosis and thoracotomy. The use of inhaled and systemic steroids can be used to facilitate successful endoscopic extraction.

Carcinoma, Bronchogenic↗
PubMed2002

Biofilm formation in endotracheal tubes. Association between pneumonia and the persistence of pathogens.

Nosocomial pneumonia is still a common problem, especially in intubated and mechanically ventilated patients. The endotracheal tube contributes substantially to the pathogenesis of pneumonia in these patients, because it facilitates microaspiration and impairs host defences. Common nosocomial pathogens like Pseudomonas aeruginosa are known to produce exopolysaccharide and generate the complex biofilm structure, which allows adhesion to abiotic surfaces and protection against antibiotic action. Multiple studies have identified bacterial biofilm on the inner lumen of endotracheal tubes, which represents a permanent source of infectious material. Endotracheal tubes, removed from patients with ventilator-associated pneumonia are covered more frequently with biofilm than those of uninfected controls. It remains unclear whether this represents a source of infection or contamination. Bacterial biofilm, however, may play an important role in recurrent pulmonary infections of the intubated and mechanically ventilated patient.

Biofilms↗
PubMed2001

[Pleural mesothelioma. I: History, epidemiology, clinical aspects (symptoms, diagnosis)].

EPIDEMIOLOGY: Although production and processing of asbestos have been prohibited for years, the incidence of mesothelioma of the pleura will rise in Western Europe. The incidence of mesothelioma will peak between the years 2010 and 2020. It will cause an estimated 250,000 deaths within the next 35 years. PATHOGENESIS: The fact that exposure to asbestos fibers may result in mesothelioma was first described in 1960. The risk of developing mesothelioma depends mainly on the type of asbestos fibers and the way asbestos is manufactured. Environmental eronite fibers in Central Turkey are the cause of endemic mesothelioma. The pathogenetic role of infection with simian virus 40 is still not determined. Thoracic radiation is of minor importance in the etiology of pleural mesothelioma. DIAGNOSIS: Between first symptoms of disease and diagnosis of mesothelioma often more than 6 months pass as clinical symptoms are rarely typical. Detection of early stages by invasive procedures and imaging is often very difficult. Histopathological distinction between adenocarcinoma and mesothelioma requires experienced pathologists. This implies that management of mesothelioma should only be performed in multidisciplinary cooperation in specialized centers.

Asbestos↗