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Biomedical subjects

M Scherrer

Publications and source records attributed to M Scherrer.

At least 37 records · Page 2Linked to original sources
PubMed1981

[Allergic alveolitis as a result of mold on the bedroom wall].

A 23-year-old woman patient became seriously ill with the typical signs and symptoms of allergic alveolitis and with deep hypoxemia during exercise. A broad spectrum of positive precipitating antibodies was found in the serum, mainly against Penicillium casei and Aureobasidium pullulans. Although she was intensively questioned on hobbies and on possible antigens at home and at work, it was only possible to trace an antigen source after a controlled antigen free period away from home in another environment and after a controlled reexposure experiment at home: it proved to be a patch of mould of 0.5 m2 on the bedroom wall. The filaments and the spores of the fungi of the mould were shown directly by microscope. Precipitating antibodies were also present against these fungi. After several antigen-free months (the patient moved into a dry and sunny new apartment) the threatening respiratory failure (severe hypoxemia during exercise) disappeared completely together with the clinical signs and symptoms. Thus, mould on bedroom walls may constitute a threat and should be considered in cases of allergic alveolitis of apparently unknown origin.

Adult↗
PubMed1981

[Accumulation of eosinophils in the nasal secretion in patients with bronchial asthma].

From October 1977 to September 1979 69 out of 500 asthmatic patients were selected in whom case histories, skin tests and IgE blood-levels formed a sub-group with more or less pure allergic asthma and a sub-group with more or less pure intrinsic asthma. All the patients exhibited a large quantity of granulocytes in the bronchial and nasal secretions. Special attention was paid to the contents of eosinophils in the nasal smear and in the bronchial mucus. The intrinsic subgroup had a (non significantly) greater incidence of 100% eosinophils in the bronchial secretion than the allergic sub-group (p less than 0.1). Unexpectedly, the reverse was found in the nasal secretions: only 33% of the intrinsics (9 cases) and as many as 67% of the allergics (28 cases) exhibited 100% eosinophils in the nasal mucus (p less than 0.025). Thus, when discussing the two forms of asthma, allergic and intrinsic, it is always necessary to bear in mind the possible paradoxical behaviour between nasal and bronchial mucus: pure eosinophilia in the lower respiratory tract may often be found concomitantly with pure neutrophilia in the upper respiratory tract, when some of the criteria for intrinsic asthma are fulfilled.

Asthma↗
PubMed1981

[Klinefelter's syndrome associated with precocious puberty due to tumoral secretion of chorionic gonadotropins].

A 8 and a half year-old boy presented with precocious puberty related to a malignant thoracic teratoma. He was also shown to have a Klinefelter syndrome. Precocious puberty related mainly to the liver, intracranial or thoracic tumors is rare. It seems to be exclusively observed in boys. The slight testicular enlargement is the main clinical sign. The contrast between high LH and low FSH levels is the most striking biological data. The diagnosis is proved by plasma HCG, beta-HCG and alpha-foetoprotein determination. Our patient is the third one with Klinefelter syndrome; this this association is certainly not fortuitous.

Child↗
PubMed1980

[Euphyllin retard and "exercise-induced" asthma].

In a double blind crossover experiment the protective effect of theophylline slow-releasing coated tablets (Euphyllin retard) on exercise-induced asthma has been compared with that of a placebo. Sixteen patients with bronchial asthma (mean age 23 years, range 16-49 years) who were selected in a preliminary test exhibited an FEV1 decrease greater than 15% 10 minutes after an exhausting 6 minute run on the treadmill. Euphyllin retard and placebo were given 6 hours before the exercise test. Venous blood was sampled 6 hours prior to and immediately before exercise in order to determine the plasma concentrations of theophylline by a tritium radioimmunoassay method. FEV1 was measured prior to and immediately after exercise, 10 and 20 minutes later and after a final orciprenaline inhalation. A group of 9 patients (group 1) has plasma concentrations of theophylline lower than 6.2 microgram/ml (4.8 +/- 0.9 microgram/ml), and a group of 7 patients (group 2) had concentrations higher than 10.0 microgram/ml (13.8 +/- 3.3 microgram/ml). Compared with placebo, a protective effect of Euphyllin retard could be observed in group 2 only (p < 0.025). In group 1 the asthma protection was indistinguishable form that of placebo. Hence, plasma concentrations higher than 10 microgram/ml appear to be required to protect asthmatics from exercise-induced asthma. Although in some patients an effective concentration can be achieved by the recommended dose of one tablet of Euphyllin retard (350 mg aminophylline) every 12 hours, the importance of measuring plasma concentrations must be emphasized in view of the variable absorption and elimination of theophylline. Side effects may occur at concentrations higher than 15 microgram/ml.

Asthma↗
PubMed1980

[The new anticholinergic bronchospasmolytic oxitropium bromide. Is long lasting protective effect through the night].

Oxitropium bromide (Ba 253, Boehringer, Ingelheim) is a scopolamine-like atropine derivate with a mode of action approximating to that of ipratropium bromide (Atrovent, Sch 1000). The peak effect and duration of bronchodilatation with oxitropium bromide appears to be better than that of ipratropium bromide. Fifteen patients with a stable chronic bronchial obstruction were investigated in a double blind cross-over study. The obstruction was partially reversible by beta-stimulation. The patients inhaled 0.2 mg oxitropium bromide or placebo at 9.30 p.m. after two controls of FEV1 at 9 p.m. and 9.15 p.m. We re-examined the patients at 7 a.m. and 7.15 a.m. the following day and observed a significant parasympathetic additional obstruction under placebo, whereas, under the medication with oxitropium bromide overnight, significant bronchodilation was observable. When 0.2 mg oxitropium bromide was given at 7.30 a.m. to all patients, those pretreated with placebo showed significantly better bronchodilation than those pretreated with oxitropium bromide. It is concluded that oxitropium bromide is a long-acting (10 hours) overnight bronchodilator. The bronchodilation is probably due to prolonged parasympathicolysis in the airways.

Adult↗
PubMed1980

[Problems of indication and execution of long-term steroid therapy in advanced disabling bronchial asthma].

In the management of severe chronic asthma, extensive avoidance of known precipitating factors and optimum betastimulation supported by theophylline have pride of place. In combination with sodium cromoglycate they sufficiently relieve symptoms and lung function disturbances in most cases of adult extrinsic allergic asthma. The cases with chronic disabling intrinsic asthma need, in our experience, additional long-term use of corticosteroids. The intrinsic type (late onset, severe perennial course, aspirin intolerance, nasal polyps) is in many cases recognised only with difficulty. Detailed history-taking, reversibility of the lung function disturbances and eosinophilia in the sputum may in general differentiate it from chronic obstructive bronchitis and extrinsic asthma. The aim of the long-term use of steroids in asthma is to achieve the best effect with minimal risk. In this respect the following treatment schedule has proved its worth: daily administration of prednisone in a single morning dose, beginning with high doses of 40 to 50 mg with rapid reduction by 5 to 10 mg every 4 days to a dose of 15 mg, then gradual withdrawal in steps of 1 mg at longer and longer intervals with becotide support to achieve a daily maintenance dose of 2 to 6 mg prednisone or complete withdrawal. The response to the treatment under discussion is often excellent and the dangerous side effects are low. However, too rapid reduction of cortisone inhibits the success of this treatment plan. High doses of steroids over a long time (more than 10 mg prednisone daily), prescriptions in daily divided doses, depot administrations, self-medication, and repeated high pushes are the most common causes of the dangerous cortisone side effects and are therefore to be avoided.

Adrenal Cortex Hormones↗
PubMed1979

[Protection from exertion-induced bronchial asthma with disodium cromoglycate (DSCG) (cromolyn, lomudal, intal) and with ketotifen (zaditen). Doubly crossed double-blind study ].

16 cooperative asthmatic patients with exercise-induced asthma (with more than 15% decrease in FEV1 after strenuous work on a treadmill with 10% upward; pulse rates over 180 per minute during the work-phase) were selected to take part in a double-blind crossover trial. The 8 women and 8 men, with ages ranging from 15 to 57 years (mean 25) underwent 4 exercise tests. The effects on exercise-induced asthma of 20 mg disodium cromoglycate (DSCG) inhaled with a spinhaler 30 minutes before exercise were compared to 2 mg of ketotifen taken orally 3 hours before exercise, and likewise DSCG was compared to a placebo powder inhaled with a spinhaler, and ketotifen with placebo tablets. The whole study lasted from January to March. Ten minutes after exercise the following changes in FEV1 (in percent of control value measured before exercise) were seen: after inhalation of a placebo powder the FEV1 decreased to 66% with an almost equal decrease after taking placebo tablets (67%) (0.45 greater than p greater than 0.40) whereas, in comparison, the decrease in FEV1 after DSCG (84%) is smaller than that after inhalation of a placebo powder (66%) (p less than 0.0025). In contrast to these results was the equal decrease in FEV1 after ketotifen (70%) (0.35 greater than p greater than 0.30) and placebo tablets (67%). Although a relatively high chosen dosage of ketotifen was given, it does not seem capable of inhibiting mediator release from the bronchial mast-cells as DSCG does. It is concluded that ketotifen given orally 3 hours before the exercise test is not effective against exercise-induced asthma.

Adolescent↗
PubMed1979

[Cross-over double-blind study using neophylline oral (proxyphylline and diprophylline) in bronchial asthma].

In a double-blind crossover trial 16 asthmatic patients were given placebo or 4 or 8 tablets of Neophyllin (each tablet containing 56 mg proxyphylline and 84 mg diprophylline) on two consecutive days. Very slight bronchodilatation independent of the oral dose and plasma level was observed 90 minutes after taking Neophyllin. However, when a betastimulator was inhaled (0.5 mg salbutamol) prior to taking 8 tablets of Neophyllin, surprisingly marked Neophyllin-induced bronchodilatation was observed after 60 and 90 minutes (p less than 0.05 and p less than 0.025). This bronchodilatation was about half that with 4 slow release coated tablets of Neo-Biphyllin (75 mg teophylline in each tablet). When Neophyllin was taken only proxyphylline caused bronchodilatation (no correlation between plasma diprophylline levels and bronchodilatation). The threshold value of plasma proxyphylline was about 13 microgram/ml plasma. Below this level proxyphylline is ineffective (likewise no correlation between plasma proxyphylline levels and bronchodilatation). An oral dose of about 600 mg proxyphylline (in Neophyllin) is needed to reach an effective plasma level within 90 minutes.

Administration, Oral↗
PubMed1979

[The rate of isometric inspiratory pressure change as a measure for the CO2 sensitivity of the respiratory center in patients with obstructive lung disease].

In healthy persons with and without loaded breathing, in asthmatics, and in patients with chronic obstructive lung disease (COLD) the rate of isometric inspiratory pressure development ([dp/dt]max) has been measured in order to assess the clinical significance of (dp/dt)max as an index of the motor output of the respiratory center in response to increased levels of carbon dioxide. During unloaded breathing normal subjects showed an excellent correlation between the ventilatory and the (dp/dt)max responses to CO2. Normal persons breathing through an external expiratory flow resistance, the asthmatics, and the patients with COLD had not only a blunted ventilatory response, but also a reduced (dp/dt)max response. The parallel changes observed in both variables indicate that under conditions of mechanical loading the (dp/dt)max does not exclusively reflect the motor output of the respiratory center, but is influenced by other factors such as the work of breathing and the mechanical efficiency of the respiratory pump. Accordingly, measurements of (dp/dt)max are of little help in deciding whether the development of CO2 retention in patients with obstructive airway disease is primarily due to increased mechanical load or to decreased sensitivity of the respiratory center.

Adult↗
PubMed1979

[Functional and oncologic results after bronchial or blood vessel anastomosis in the resection therapy of bronchogenic carcinoma].

In treatment of bronchogenic carcinoma twelve selected patients had economical resections. To avoid a pneumonectomy, lobectomies or bilobectomies were associated twice with bronchial excision, 8 times with bronchial resection (sleeve resection) and twice with resection and anastomosis of pulmonary artery. Nine patients underwent clinical, radiologic and szintigraphic control. Except one case all patients showed good functional results. The anastomosed lobes were perfused and ventilated proportionally to the number of segments. The quality of life after partial pulmonary resections had deteriorated only to a small extent compared with the preoperative state. These results were emphasized by the only poor result which (after atelectasis of the anastomosed lung) corresponded functionally to a pneumonectomy. --The two cases of anastomosis of pulmonary artery showed a short survival. Both corresponded to a stage II of tumor classification. Of the other patients (all stage I) three are alive more than five years.

Aged↗
PubMed1978

[The bronchospasmolytics salbutamol, fenoterol, terbutaline and reproterol. Their effects and side effects in asthmatics after inhalation with an electric nebulizer].

A double-blind crossover trial was conducted in 10 asthmatic patients for comparison of fenoterol with salbutamol, in 12 other asthmatic patients for comparison of reproterol with salbutamol, and in 15 other asthmatic patients for comparison of terbutaline with salbutamol. The following doses were given: 1.25 mg fenoterol, 2.5 mg reproterol, 2.5 mg terbutaline and 1.25 mg salbutamol. 5 drops of each of the inhalation solutions (in 2 ml of saline) were aerosolized by a powered machine and inhaled for 15 min. FEV1 was measured before, and 15 and 45 min after inhalation. Immediately before FEV1 the following parameters for side effects were also determined: 1. heartbeats per min, systolic and diastolic blood pressure; 2. minute ventilation, arterial PCO2 and oxygen consumption; 3. arterial SO2, PO2 and the alveolar-arterial O2-gradient (AaDO2). To estimate the selectivity of each of the 3 betastimulators the ratio (formula: see text) was established for each parameter and compared to that obtained with salbutamol. In further steps the ratio of all parameters for side effects was shown, then only that of the 3 most important side effects tachycardia, hypocapnia (PaCO2) and hypoxemia (PaO2). The following order of selectivity was found: 1. salbutamol, 2. fenoterol, 3. terbutaline, 4. reproterol.

Adult↗
PubMed1978

[Programming of freely written anamnesses for the computer].

The case histories of more than 5000 outpatients with respiratory diseases were stored in free text from 1974 untill 1977. The retrieval efficiency was tested using STAIRS-IBM program product with the syntax operators "or", "and", "not", "with", and "adj". Chronic bronchitis in lung cancer patients was chosen as an example. The first word constellation was compiled as a retrieval argument for chronic bronchitis. The second word constellation was used as a retrieval argument for chronic bronchitis subsisting for more than 5 years before the diagnosis of lung cancer. The third word constellation retrieved documents without clear time relationship between chronic bronchitis and lung cancer. The review of each history of the 473 lung cancer patients issued a first group of 219 cases composed of lung cancer patients with histories of chronic bronchitis for more than 5 years. A second group of 180 patients had no history of preexisting chronic bronchitis. This manual selection of cases (reading of all 473 case histories) took 3 months compared to 4 h by computer dialogue selection. 87% of the first group (preexisting chronic bronchitis for more than 5 years) and 74% of the second group (no history of chronic bronchitis) were correctly obtained by the brief computer dialogue. This efficiency of the computer dialogue was further improved without difficulty by slight modifications of the dialogue strategy, so that only approximately 10% of documents remained falsely classified. It can be seen that free text analysis of case histories is possible by the STAIRS-IBM program and enables a doctor to observe new clinically important correlations in a very short time. Final deductions, however, must be followed by careful checking of all individual histories.

Computers↗
PubMed1978

[Smoking, chronic bronchitis, bronchiolar obstruction and bronchial carcinoma].

The case histories of 474 patients with lung cancer were screened. Chronic bronchitis was assumed to precede lung cancer if chronic cough and sputum had been present for more than five years. Daily consumption of cigarettes, cigars (= 5 cigarettes) or pipes (= 1 cigarette) and the number of pack-years were noted. FEV1 in percent of the slowly inspired vital capacity (FEV1 %VC) was regarded as a sensitive index for the degree of bronchial obstruction. Group 1 included 221 lung cancer patients with a clear history of preexisting chronic bronchitis. Group 2 included 175 cases without such history. Heavy smokers and severely obstructed patients were found more often in group 1 than in group 2 (p less than 0.0005). A lack of correlation was evident between smoking habits and FEV1 %VC when group 1 was fused with group 2: r= -0.071, p greater than 0.20. Indeed, light, heavy, and very heavy smokers were evenly distributed in group 1 among severely and slightly obstructed patients. However, in group 2 heavy and very heavy smokers were found more frequently in patients with slight bronchial obstruction than in patients with severe bronchial obstruction (p less than 0.01). It appears that an important subgroup of heavy and very heavy smokers with lung cancer are protected from chronic bronchitis as well as from bronchial obstruction. The reasons for this protection are not clear.

Adult↗