Biomedical subjects

M Heger

Publications and source records attributed to M Heger.

At least 19 recordsLinked to original sources

PubMed2006

Treatment effect and safety of EPs 7630-solution in acute bronchitis in childhood: report of a multicentre observational study.

An open post-marketing surveillance study was conducted to examine the treatment effect and safety of EPs 7630-solution in the treatment of acute bronchitis in children. This study included a total of 742 children (aged between 0 and 12 years) with acute bronchitis (83.4%) or acute exacerbations of chronic bronchitis (14.3%), who were treated with different doses of the herbal drug for up to 14 days. Five bronchitis specific symptoms (BSS) were summed up to give an overall measure of disease severity. Non-specific disease symptoms (loss of appetite, diarrhoea, headache, vomiting, and fever) were also recorded, together with adverse events and overall ratings of efficacy and tolerability. The overall BSS score decreased during treatment from 6.0+/-3.0 points at baseline to 2.7+/-2.5 points after 7 days and to 1.4+/-2.1 points after 14 days. Remission or improvement in at least 80% of patients was recorded for all the individual component symptoms. The proportion of patients suffering from non-specific symptoms also substantially improved during treatment. For example, loss of appetite was present in 65.8% of patients at study begin, but only in 27.6% at the time point of last observation visit. In 88.3% of cases, the responsible physician rated the treatment as successful. Adverse events were minor and transitory. In conclusion, EPs 7630-solution was shown to be a safe and an effective treatment option for acute bronchitis or acute exacerbations of chronic bronchitis in children.

Acute Disease↗

PubMed2006

Pelargonium sidoides preparation (EPs 7630) in the treatment of acute bronchitis in adults and children.

Acute bronchitis, although mostly caused by viral infections, is commonly treated with antibiotics. As antibiotics should only be prescribed upon strict indication, treatment options like a liquid herbal drug preparation from the roots of Pelargonium sidoides (EPs 7630) gain more and more interest. To evaluate the efficacy and safety of treatment with EPs 7630 in patients with acute bronchitis, a multi-centre, prospective, open observational study was conducted in 440 study sites located in Germany. A total of 2099 patients aged 0-93 years with productive cough for less than six days without indication for treatment with antibiotics were given EPs 7630-solution in an age-dependent dosage for 14 days. The primary outcome criterion was the mean change of the Bronchitis Severity Score (BSS: cough, sputum, rales/rhonchi, chest pain at cough, dyspnoea) from baseline to patient's individual last observation. During treatment, the mean BSS of all patients decreased from 7.1+/-2.9 points at baseline to 1.0+/-1.9 points at patients' individual last visit. Subgroup analysis for children showed a decrease of mean BSS from 6.3+/-2.8 points to 0.9+/-1.8 points and analysis of children younger than three years showed a decrease of mean BSS from 5.2+/-2.5 points to 1.2+/-2.1 points. Adverse events occurred in 26/2099 (1.2%) patients. Serious adverse events were not reported. In conclusion, EPs 7630 is an effective and well tolerated treatment of acute bronchitis in adults, children and infants outside the strict indication for antibiotic treatment.

Acute Disease↗

PubMed2006

EPs 7630-solution--an effective therapeutic option in acute and exacerbating bronchitis.

Acute bronchitis is one of the most common diagnoses in ambulatory care medicine. Although the benefit of antibiotics for acute bronchitis, which is mostly virally induced, is disputed, they are often prescribed. A therapeutic option for respiratory tract infections that do not fall within the strict indication range for antibiotic administration is the liquid herbal drug preparation from the roots of Pelargonium sidoides, EPs 7630 (Umckaloabo), which has been tested against placebo in double-blind clinical trials. EPs 7630 has both antibacterial and immuno-modulating properties. The efficacy and tolerability of EPs 7630 was investigated in a prospective, open, multicentric outcomes study with 205 patients suffering from acute bronchitis or acute exacerbation of chronic bronchitis. The main outcome measure was the change in the total score of five symptoms typical for bronchitis (cough, expectoration, wheezing/whistling on expiration, chest pain during coughing, and dyspnoea), which were each rated using a 5-point scale (from 0=not present to 4=extremely pronounced). Further symptoms (hoarseness, headache, aching limbs and fatigue) were assessed using a four-point scale (from 0=not present to 3=very pronounced). The total score of the typical bronchitis symptoms amounted to 6.1+/-2.8 points on average at the start of treatment and decreased by 3.3+/-3.8 points to 2.8+/-2.6 points by the final examination on day 7. About 60.5% of the patients assessed their health condition at the end of the study as much improved or free from symptoms. The onset of action appeared after two days on average. Adverse events occurred in a total of 16 patients. There were no serious adverse events. Altogether, 78% of the patients were satisfied or very satisfied with the treatment.

Acute Disease↗

PubMed2003

[Left ventricular dysfunction in Churg-Strauss syndrome].

Churg-Strauss syndrome is a rare disorder characterized by hypereosinophilia and a systemic vasculitis occurring inpatients with asthma and allergic rhinitis. Vasculitis commonly affects the lungs, the heart, the skin, and the peripheral nervous system. Cardiac involvement is characterized by acute and constrictive pericarditis, myocarditis and endocarditis, as well as ischemic cardiomyopathy. Endomyocardial fibrosis similar to Loeffler's syndrome has been rarely described. In the presented case, a 43 year old man with a history of allergy and asthma suffered from increasing dyspnea, fever, pulmonary infiltates and cardiomyopathy. Laboratory studies were notable for marked hypereosinophilia. In a bronchoscopic lavage and transbronchial biopsy eosinophilic infiltrates accompanied by vasculitis were found, Churg-Strauss syndrome was diagnosed. Echocardiogram showed endomyocardial deposits in the apex of the right ventricle, right ventricular function was normal particular in the basal segments. The left ventricle was slightly enlarged and left ventricular function was impaired. The diastolic mitral in-flow showed a restrictive pattern. Additionally, a pericardial effusion was observed without signs of tamponade. The patient received corticosteroids, cyclophosphamide and cardiomyopathy-specific therapy and showed a marked improvement after 4 months.

Adult↗

PubMed2003

[Efficacy of Arnica in varicose vein surgery: results of a randomized, double-blind, placebo-controlled pilot study].

INTRODUCTION: In homeopathy ARNICA is widely used as a woundhealing medication and for the treatment of hematomas. OBJECTIVE: In this pilot study the efficacy and safety of ARNICA D12 in patients following varicose vein surgery were investigated. DESIGN: Prospective, randomized, double-blind, placebo-controlled pilot trial according to ICH GCP guidelines. SETTING: The study was conducted by a surgeon at the Angiosurgical Clinic, Berlin- Buch. INTERVENTION: After randomized allocation, 60 patients received either ARNICA D12 or placebo. Start of medication occurred the evening before operation with 5 globules. On the operation day one preoperative and hourly postoperative dosages after awakening were given. On days 2-14 of the study 5 globules 3 times a day were given. OUTCOME CRITERIA: Surface (in cm(2) and using a three-point verbal rating scale) and intensity of hematomas induced by operation, complications of wound healing, and intensity of pain (five-point verbal rating scale) as well as efficacy and safety of the study medication were assessed. RESULTS: Hematoma surface was reduced (from day 7 to day 14) under ARNICA by 75.5% and under placebo by 71.5% (p = 0.4726). The comparison of hematoma surface (small, medium, large) using the verbal rating scale yielded a value of p = 0.1260. Pain score decreased by 1.0 +/- 2.2 points under ARNICA and 0.3 +/- 0.8 points under placebo (p = 0.1977). Remission or improvement of pain was observed in 43.3% of patients in the ARNICA group and in 27.6% of patients in the placebo group. Tolerability was rated as very good in all cases. CONCLUSION: The results of this pilot study showed a trend towards a beneficial effect of ARNICA D12 with regard to reduction of hematoma and pain during the postoperative course. For a statistically significant proof of efficacy of ARNICA D12 in patients following varicose vein surgery a larger sample size is necessary.

Arnica↗

PubMed2003

The IPM Wheat Model--results of a three-year study in North Rhine-Westphalia, Lower Saxony and Schleswig-Holstein.

Under the primary utilisation of phytosanitary production factors such as selection of variety, crop rotation and N fertilisation according to plant requirements, the IPM Wheat Model comprises the elements diagnosis (qualitative = type of pathogen, quantitative = disease severity), scientifically grounded treatment thresholds which, as critical values in pathogen development, can be applied to define the optimum time of fungicide application, and pathogen-specific effective fungicides and application amounts. This leads to the location and year-specific optimised control of the pathogen and of the associated yield performance. After several years of development in Bavaria (from 1985 on) and Schleswig-Holstein (1993-1999), the model was tested as part of a project involving the Universities of Bonn and Kiel and the plant protection services of the German states of Lower Saxony, North Rhine-Westphalia and Schleswig-Holstein in a three-year study (1999-2001) in interregional locations (usually nine per state) with the winter wheat variety Ritmo (interregional indicator variety) and a further variety of regional importance in different variations (untreated control, three to four times growth stage-oriented variants for the determination of the absolute damage potential, IPM-variant). In exact records (approx. 12 dates per vegetation period), the disease epidemics were recorded weekly. With the genetically uniform indicator variety Ritmo, the results documented substantially differing year- and location-specific disease and yield patterns. Interregionally, a broad wheat pathogen spectrum (Puccinia striiformis, P. recondita, Septoria tritici, Stagonospora (syn. Septoria) nodorum, Blumeria (syn. Erysiphe) graminis, Pseudocercosporella herpotrichoides, Drechslera tritici-repentis) in differing composition, disease severity and damage effect was demonstrated. The heterogeneity of the infection and damage patterns was increased in the case of the second variety, in association with the genetic variability. The epidemiologically-orientated indications (average two, reduced application amounts) according to the IPM Wheat Model in association with time-diverging progressions led, on an interregional basis, with minimum input and in association with the diverging dynamics, to a biologically and economically optimised fungicide application. In the context of economic and ecological performance, the comprehensive results of the project demonstrated the valuable functionality of the IPM Wheat Model.

Dose-Response Relationship, Drug↗

PubMed2002

Evaluation of the IPM Wheat Model in the Rhineland 2001.

The results of field trials at nine locations with two wheat cultivars in each case demonstrated the practicability of the action threshold-based fungicide strategy of the IPM Wheat Model under the intensive wheat production conditions in the Rhineland. Action thresholds used and dosage of fungicides applied are outlined. Despite using reduced rates of fungicides the epidemic development of relevant pathogens--mainly Septoria tritici and Puccinia recondita--was controlled in early stages of disease development. In plots treated according to the IPM Wheat Model disease incidence and disease severity were reduced effectively compared to untreated plots with low and high disease incidence, respectively. The effective control of pathogens using pathogen-specific action thresholds resulted in yield levels very similar to those of disease-free plots simultaneously minimising the total amount of fungicides applied. Disease control according to the IPM Wheat Model raised yields by up to 25% with monetary benefits averaging more than [symbol: see text] 100 ha-1 in 2001.

Fungi↗

PubMed2001

[Paget-von Schroetter syndrome as an occupational accident].

HISTORY AND CLINICAL FINDINGS: Two men and one woman developed typical symptoms of a thrombosis in the arms after unusual physical effort at their work place (a coal miner after a bad fall, a radiographer after having to catch a patient, a painter after jerkily moving a heavy piece of furniture). INVESTIGATIONS AND DIAGNOSIS: In all three patients a thrombosis of the subclavian vein was demonstrated by duplex scans or phlebography. In two patients tests for hypercoagulability were unremarkable. None of the patients had a thoracic outlet syndrome. TREATMENT AND COURSE: After initial local thrombolytic or heparin therapy alone, phenprocoumon treatment over several months was given in two cases, and in one case low-molecular-weight heparin was administered over several months. All three patients complained of strain-related residual symptoms in the affected arm (pain, swelling, easy fatigability). In all three cases, the accident insurer recognized the incident to be a work-related accident. CONCLUSION: Patients with a Paget-Schroetter syndrome resulting from a sudden and unusual physical effort at work, which is covered by statutory accident insurance, must be reported to the accident insurer as a work-related accident in order to safeguard individual medical claims of the patient and for general medical and epidemiological reasons.

Accidents, Occupational↗

PubMed2001

Impact of inhibition of complement by sCR1 on hepatic microcirculation after warm ischemia.

Recent observations provide evidence that complement is implicated as an important factor in the pathophysiology of ischemia/reperfusion injury (IRI). Here, we assessed the effects of complement inhibition on hepatic microcirculation by in vivo microscopy (IVM) using a rat model of warm hepatic ischemia clamping the left pedicle for 70 min. Ten animals received the physiological complement regulator soluble complement receptor type 1 (sCR1) intravenously 1 min prior to reperfusion. Controls were given an equal amount of Ringer's solution (n = 10). Microvascular perfusion and leukocyte adhesion were studied 30 to 100 min after reperfusion by IVM. Microvascular perfusion in hepatic sinusoids was significantly improved in the sCR1 group (80.6 +/- 0.6% of all observed sinusoids were perfused [sCR1] vs 67.3 +/- 1.2% [controls]). The number of adherent leukocytes was reduced in sinusoids (49.9 +/- 3.4 [sCR1] vs 312.3 +/- 14.2 in controls [adherent leukocytes per square millimeter of liver surface]; P < 0.001) as well as in postsinusoidal venules after sCR1 treatment (230.9 +/- 21.7 [sCR1] vs 1906.5 +/- 93.5 [controls] [adherent leukocytes per square millimeter of endothelial surface]; P < 0.001). Reflecting reduced hepatocyte injury, liver transaminases were decreased significantly upon sCR1 treatment compared to controls. Our results provide further evidence that complement plays a decisive role in warm hepatic IRI. Therefore, we conclude that complement inhibition by sCR1 is effective as a therapeutical approach to reduce microcirculatory disorders after reperfusion following warm organ ischemia.

Animals↗

PubMed2001

Can homeopathically prepared mercury cause symptoms in healthy volunteers? A randomized, double-blind placebo-controlled trial.

OBJECTIVE: To pilot a method for determining whether homeopathically prepared mercury causes more symptoms (a "drug proving") in healthy volunteers than placebo. METHODS: One hundred and eighteen (118) healthy volunteers ages 18 to 65 were recruited by local advertising. Subjects unfamiliar with homeopathy undertook a 1-week single-blind placebo run-in, a 1-week of double-blind, randomized treatment on either homeopathically prepared mercury 12C or placebo, and a third week of placebo run-out. Each day, symptoms were recorded on a checklist that included both true mercury symptoms and symptoms not expected to be caused by mercury (false symptoms). Additional symptoms were assessed by open reporting. Outcome was assessed by calculating a score for each day as the number of true symptoms minus the number of false symptoms. The mean score during placebo was then subtracted from the mean score for weeks two and three of the trial. RESULTS: Fourteen (14) subjects dropped out during placebo run-in. The remaining 104 completed the trial. Baseline comparability was good. Mean difference score was -0.125 (SD 3.47) for mercury and -0.221 (SD 3.01) for placebo (p > 0.2). No significant differences between groups were found for the number of subjects meeting predefined criteria for a drug-proving reaction. CONCLUSION: This pilot study failed to find evidence that mercury 12C causes significantly more symptoms in healthy volunteers than placebo. Questionnaires with a limited number of gross symptoms do not seem to be an appropriate methodological technique in drug proving research. If drug-proving phenomena exist, they appear to be rare.

Adolescent↗

PubMed2001

Homeopathy and conventional medicine: an outcomes study comparing effectiveness in a primary care setting.

BACKGROUND: Recent meta-analyses of randomized controlled trials in homeopathy have suggested that homeopathy is more than a placebo response. OBJECTIVE: Comparison of the effectiveness of homeopathy in primary care with conventional medicine in primary care for three commonly encountered clinical conditions. DESIGN: An international multicenter, prospective, observational study in a real world medical setting comparing the effectiveness of homeopathy with conventional medicine. PARTICIPANTS: Thirty (30) investigators with conventional medical licenses at six clinical sites in four countries enrolled 500 consecutive patients with at least one of the following three complaints: (1) upper respiratory tract complaints including allergies; (2) lower respiratory tract complaints including allergies; or (3) ear complaints. MAIN OUTCOME MEASURES: The primary outcomes criterion was the response to treatment, defined as cured or major improvement after 14 days of treatment. Secondary outcomes criteria were: (1) rate of recovery; (2) occurrence of adverse events; (3) patient satisfaction; and (4) length of consultation. RESULTS: Four hundred and fifty-six (456) patient visits were compared: 281 received homeopathy, 175 received conventional medicine. The response to treatment as measured by the primary outcomes criterion for patients receiving homeopathy was 82.6%, for conventional medicine it was 68%. Improvement in less than 1 day and in 1 to 3 days was noted in 67.3% of the group receiving homeopathy and in 56.6% of those receiving conventional medicine. The adverse events for those treated with conventional medicine was 22.3% versus 7.8% for those treated with homeopathy. Seventy-nine percent (79.0%) of patients treated with homeopathy were very satisfied and 65.1% of patients treated with conventional, medicine were very satisfied. In both treatment groups 60% of cases had consultations lasting between 5 and 15 minutes. CONCLUSIONS: Homeopathy appeared to be at least as effective as conventional medical care in the treatment of patients with the three conditions studied.

Adolescent↗

PubMed2001

The Paget-Schroetter syndrome: work accident and occupational disease.

INTRODUCTION: Primary thrombosis of the upper extremity (Paget-Schroetter syndrome, effort thrombosis) is usually not accepted either as a work-related accident or an occupational disease by the industrial injuries insurance authorities. This study aims to look at the circumstances under which this kind of thrombosis may be recognised as an occupational hazard. MATERIALS AND METHODS: After thoroughly studying the clinical records of 82 patients with thrombosis of the upper extremity in the outpatient department for angiology during a 10-year period, we found that in 51 cases the thrombosis was caused by secondary reasons (i.e., central venous catheterisation, malignoma, hypercoagulability, postoperative). In the remaining 31 patients, we painstakingly conducted a general and occupational history and further clinical, laboratory or technical investigations to differentiate the aetiology. RESULTS: Twenty-eight of 31 patients with suspected primary thrombosis of the axillary or subclavian vein (Paget-Schroetter syndrome) showed unusual private or occupational physical exercise as the underlying cause. Sixteen patients reported only short physical exercise up to several hours or acute trauma. Longer physical exercise periods (several days, months or even more) were found in 12 patients. Ten of the 28 patients who acquired the thrombosis doing occupational tasks covered by the industrial insurance, may be eligible for compensation. In 4 of these 10 insured cases, we found strong hints for work accidents, 6 patients of this group apparently revealed criteria of occupational diseases. Four of the 28 patients had a combination of physical effort and additional thrombogenic risk factors (cardiac pacemaker, hypercoagulability). CONCLUSION: Primary thrombosis of the upper extremity (Paget-Schroetter syndrome) should be announced to and compensated by the industrial injuries insurance either as work-related accident or occupational disease if the patient's occupational history shows close relationship between thrombosis manifestation and extraordinary physical efforts or exercises during occupational strains. For this reason, we recommend the recognition of the Paget-Schroetter syndrome in the national list of occupational diseases.

Accidents, Occupational↗

PubMed2000

In vivo microscopy reveals that complement inhibition by C1-esterase inhibitor reduces ischemia/reperfusion injury in the liver.

Complement plays a decisive role in postischemic tissue injury, a process responsible for severe damage after organ ischemia. Several pathophysiologic mechanisms initiated upon reperfusion are mediated by complement inducing microcirculatory disturbances. Here, we demonstrate the effects of complement inhibition using C1-esterase inhibitor (C1-INH) on microcirculation after liver ischemia by in vivo microscopy (IVM). In rats, the left liver lobe was clamped for 70 min. C1-INH was given 1 min prior to reperfusion. Controls received Ringer's solution. IVM was performed 30-100 min after reperfusion. Non-perfused acini decreased and sinusoidal perfusion increased substantially after treatment. Leukocyte adherence to sinusoidal and venular endothelium was markedly reduced by C1-INH. Transaminases were significantly decreased by C1-INH. Our data obtained by IVM suggest that complement activation is an early key event of ischemia/reperfusion injury. These observations demonstrate for the first time that reperfusion related microcirculatory disorders can be minimized by C1-INH. This compound should be evaluated in clinical application.

Animals↗

PubMed2000

International integrative primary care outcomes study (IIPCOS-2): an international research project of homeopathy in primary care.

OBJECTIVE: The primary objective is to evaluate the effectiveness of homeopathic treatment compared to conventional treatment for respiratory and ear complaints commonly seen in the primary care setting: runny nose, sore throat, ear pain, sinus pain, and cough. METHOD: This study is an international, multi-center, prospective, outcomes study on the effectiveness of homeopathic treatment compared to conventional treatment. The participating investigators will be divided into three groups: * Homeopathic treatment; * Homeopathic or conventional treatment according to the patient's preference, either randomized or non-randomized; * Conventional treatment. A total of 2400 patients will be recruited. Consecutive patients, age one month or older, presenting with one of the five chief complaints, and onset of symptoms less than seven days will be included into the study. Prior to enrolment into the trial each patient must provide written informed consent. Patient outcome will be measured using the Integrative Medicine Outcomes Scale (IMOS) at 7-, 14- and 28-d telephone follow-up. In addition, covariate data related to the following will be collected: patient demographics and medical history, patient preference for treatment and willingness to be randomized, health-related quality of life, primary treatment and adjunctive therapies prescribed, adverse events, type and length of consultation, follow-up recommendation, patient compliance, patient satisfaction with treatment, and patient willingness to choose therapy and health care provider again. The main outcome criterion will be the response rate according to the IMOS after 14 days of treatment. RESULTS: Preliminary interim results will be presented. CONCLUSIONS: Lessons learned from the study will be discussed.

Ear Diseases↗

PubMed1997

Evidence for the involvement of phosphatidylinositol 4,5-bisphosphate 3-kinase in CD18-mediated adhesion of human neutrophils to fibrinogen.

The CD18 integrin mediates chemotaxin-induced adhesion of neutrophils to fibrinogen. In neutrophils chemotaxins activate different intracellular pathways, which metabolize phosphatidylinositol 4,5-bisphosphate. To analyse the functional role of phosphatidylinositol 4,5-bisphosphate 3-kinase in the adhesion response, studies with the fungal metabolite wortmannin and the chemically unrelated compound LY 294002 were performed. These compounds inhibited with similar concentration dependency chemotaxin-induced formation of [32P]phosphatidylinositol 3,4,5-trisphosphate and CD18-mediated adhesion of neutrophils to fibrinogen, but did not influence expression of CD18 molecules at the cell surface. These data suggest involvement of phosphatidylinositol 4,5-bisphosphate 3-kinase in chemokine-induced avidity changes of CD18 integrins.

Androstadienes↗

PubMed1997

[Aortic coarctation--long-term follow-up in adults].

Surgical repair of coarctation of the aorta has been performed since 1945. Although surgical techniques have improved, problems such as restenosis and aneurysm at the operation site or hypertensive cardiovascular disease, still remain. To evaluate the long-term results after surgical repair of coarctation, 41 patients, 25 male and 16 female patients (mean age: 28 +/- 11 years, range 14-57 years), were studied 16 +/- 8 years after surgery (range 3-44 years). Mean age at surgery was 12 +/- 9 years (range 0.5-35 years). In 24 patients resection and end-to-end anastomosis had been performed, patch graft aortoplasty in nine patients, tube interposition graft in seven patients and one patient had undergone the subclavian flap technique. All patients were assessed by exact physical examination, the resting arm-to-leg systolic pressure gradient was measured by Doppler sonography, a bicycle exercise test and an echocardiogram were performed. Twenty-one patients reported postoperative symptoms such as dizziness (n = 12), headache (n = 3), cold legs (n = 10) and/or dyspnea (n = 8). In two patients the resting arm-to-leg pressure gradient was greater than 30 mm Hg, in two patients it was greater than 20 mm Hg. Gradient calculated by Doppler echocardiography ranged from 0 to 80 mm Hg (21 +/- 17 mm Hg) and showed poor correlation with the arm-to-leg pressure difference. The mean functional capacity was 89 +/- 18% (range 42-110%). In 18 patients exercise-induced hypertension was found, while in only eight patients arterial hypertension had already been known. To evaluate the morphology of the aorta MRI was performed in 28 patients. No aneurysm was found. In five patients a minimal lumen diameter as small as 9-11 mm was measured. Patients were divided into two groups according to their age at operation, group I: < 9 years (n = 19) and group II: > 9 years (n = 22). Resting blood pressure was significantly higher in group II (135 +/- 27 mm Hg vs 114 +/- 20 mm Hg, p < 0.009), anti-hypertensive medication (43% vs 11%, p < 0.04) and symptoms were more frequent in these patients (15/22 vs 6/19, p < 0.04). However at time of follow-up examination the age of patients of group II was significantly higher (33 +/- 12 vs 22 +/- 5 years, p < 0.0005). Between these two groups there was no difference in follow-up time and results of echocardiography or stress test. In conclusion, despite good long-term results after surgical repair of coarctation of the aorta, patients should be followed on a regular basis primarily in order to recognize systemic hypertension as early as possible and to improve the long-term outcome in these patients by antihypertensive treatment.

Adolescent↗

PubMed1997

Quantitative bronchial challenge tests with wheat flour dust administered by spinhaler: comparison with aqueous wheat flour extract inhalation.

BACKGROUND: Quantitative bronchial challenge tests with flour dust for the diagnosis of bakers' asthma may be performed by inhalation of flour delivered to the patient's respiratory tract by sophisticated equipment. OBJECTIVE: This study was carried out to assess the diagnostic value of bronchial challenge tests with flour dust inhalation from capsules administered by a Spinhaler (Fisons Inc., Loughborough, U.K.) and to compare this method quantitatively with bronchial challenge tests with a commercially available wheat flour extract. METHODS: A highly selected group of 36 bakers with work-related symptoms of rhinitis or asthma were referred to our department, a tertiary referral center, from 1992 to 1995. Thirty-four of the subjects and 10 atopic control subjects were included in this study. After the assessment of bronchial hyperresponsiveness on day 1, subjects were randomized to inhale an aqueous wheat flour extract at concentrations of 0.01, 0.1, 1, 10, and 100 mg/ml by tidal volume breathing for 10 minutes or to inhale wheat flour dust filled in capsules on days 2 and 3. One, two, and four capsules (maximum of 7 cumulative capsules) of flour dust were administered by a Spinhaler. In addition, skin prick tests were performed with a battery of environmental and occupational allergens. Total serum IgE and specific IgE to wheat flour were measured by standard procedures. RESULTS: Seventeen bakers and two control subjects demonstrated a positive skin test response to wheat flour (wheal > or = 3 mm). Fifteen bakers demonstrated a fall of 50% or more in specific airway conductance after inhalation of the commercial wheat flour extract, and 11 demonstrated such a fall in specific airway conductance after inhalation of wheat dust. Three control subjects had a positive bronchial challenge response to the extract, but dust inhalation from the capsule did not cause positive bronchial reactions in control subjects. When a 50% fall of specific airway conductance was used as criterion for a positive bronchial provocation test result, sensitivity for the extract or dust inhalation was 0.44 and 0.32, respectively, and specificity was 0.7 and 1.0, respectively. If only subjects with a positive skin test response to wheat flour were considered, sensitivity of both tests was 0.65. With more stringent criteria for the gold standard, there was a trend for a higher sensitivity but a lower specificity of the extract inhalation. Both methods were safe. CONCLUSION: The validity of bronchial challenge tests with wheat flour dust inhaled from Spinhaler capsules was superior to that of tests done with a commercially available aqueous wheat flour extract. The higher specificity of the Spinhaler method might be an advantage if bronchial challenge tests are used as confirmation tests.

Administration, Inhalation↗

PubMed1997

Gastroenteropancreatic effects of xenin in the dog.

Xenin is a 25 amino acid peptide detected in the gastric mucosa of various mammals. It has since been found in low concentrations in other tissues. Xenin plasma concentrations increase after meals. The present study reports some gastroenteropancreatic effects of this peptide in the dog. Intravenous infusion of 64 pmol/kg min synthetic xenin significantly inhibited pentagastrin-stimulated gastric acid secretion and stimulated exocrine pancreatic secretion of volume and protein. Further, intravenous infusion of xenin in a dose of 1.0 pmol/kg min stimulated jejunal motility in the anaesthetized dog. An intravenous infusion of 32 pmol/kg min xenin raised plasma concentrations of pancreatic polypeptide, vasoactive intestinal polypeptide, insulin and glucagon. The present experiments therefore indicate manifold bioactive properties of intravenously infused xenin in the dog, with jejunal motility the most sensitive target. Conclusions as to the physiological role of xenin cannot be drawn from the present experiments. The release of other hormonal peptides indicates a complex action of xenin.

Animals↗