PubMed Health⌕ Search

Biomedical subjects

M Solèr

Publications and source records attributed to M Solèr.

At least 73 records · Page 4Linked to original sources
PubMed1995

Lung scanning and exercise testing for the prediction of postoperative performance in lung resection candidates at increased risk for complications.

OBJECTIVE: To analyze the value of preoperative lung scanning and exercise testing for the prediction of postoperative complications and of the short- as well as long-term performance in lung resection candidates at increased risk for complications. DESIGN: Prospective clinical trial. SETTING: Clinical pulmonary function laboratory in a university teaching hospital. PATIENTS: Twenty-five (mean age, 63 years; 17 men) of 84 consecutive lung resection candidates were considered at increased risk for postoperative complications due to impaired pulmonary function (FEV1 < 2 L or diffusion of carbon monoxide [DCO] < 50% predicted, or FEV1 and DCO < or = 80% predicted combined with New York Heart Association dyspnea index > or = 2). INTERVENTIONS: Candidates underwent radionuclide ventilation/perfusion scans and exercise testing to predict postoperative (= ppo) values for FEV1, DCO, and maximal O2 uptake (VO2max). They all underwent thoracotomy for neoplastic lesions; 7 had pneumonectomies, 18 lobectomies. Six patients had postoperative complications (within 30 days), of whom three died. Three and 6 months postoperatively, pulmonary function tests and VO2max were repeated. MEASUREMENTS AND RESULTS: In the 22 survivors, the observed values were then compared with the predicted values. At 3 months, there were excellent correlations (absolute/predicted values): for FEV1 r = 0.78 and 0.81; for DCO, r = 0.77 and 0.74; and for VO2max, r = 0.71 and 0.83. The means of FEV1 and VO2max did not differ from the predicted values, whereas the predicted DCO was lower than the observed value (mL/min/mm Hg: 15.1 vs 17.9; percent predicted: 59.6 vs 70.9) (p < 0.05). At 6 months, correlations remained very good for FEV1 (r = 0.81 and 0.84) and for DCO (r = 0.76 and 0.74), but had decreased for VO2max to 0.56 and 0.65, respectively. All means were higher than predicted (p < 0.05) owing to recovery in the lobectomy group. Patients with postoperative complications (group B) had a lower preoperative VO2max in percent predicted (62.8 +/- 7.5% vs 84.6 +/- 19.7%) (p < 0.01) and also a lower VO2max-ppo (10.6 +/- 3.6 vs 14.8 +/- 3.5 mL/kg/min and 44.3 +/- 13.5 vs 68.0 +/- 20.7% predicted) (p < 0.05) than patients without complications (group A). A VO2max-ppo < 10 mL/kg/min was associated with a 100% mortality. Although FEV1-ppo and DCO-ppo were lower in group B, the difference did not reach significance. CONCLUSIONS: Radionuclide-based calculations of postoperative VO2max are predictive of operative morbidity and mortality: a VO2max-ppo of < 10 mL/kg/min may indicate inoperability. Further, short-term postoperative performance is accurately predicted by FEV1-ppo and VO2max-ppo, but long-term function is underestimated after lobectomy.

Aged↗
PubMed1994

[Therapy of primary pulmonary arterial hypertension: current status].

Primary pulmonary hypertension is a rare disease with a median survival of only 2.8 years after diagnosis. In this review article the minimal diagnostic workup is summarized and pathophysiological concepts are discussed. Therapeutic options today include oral anticoagulation, which has a proven survival effect. Furthermore, in a selected subgroup of patients, vasodilators may be effective in lowering pulmonary vascular resistance and pulmonary arterial pressure. Among these, prostacyclin and the calcium antagonists nifedipine and diltiazem are the most promising treatments. It is mandatory to perform an acute drug trial under close monitoring of pulmonary and systemic pressures as well as cardiac output before starting vasodilator treatment. In the majority of patients there will be no improvement, but possibly deleterious hemodynamic effects. Long term trials with both nifedipine and prostacyclin indicate a significant survival effect in those patients who initially respond to this treatment. Lung transplantation remains the only treatment option for patients with uncontrollable pulmonary hypertension.

Humans↗
PubMed1994

Evaluation of high-risk lung resection candidates: pulmonary haemodynamics versus exercise testing. A series of five patients.

We compared the value of exercise testing and measurement of pulmonary haemodynamics (PH) in the pre-operative assessment of 5 patients (mean age: 64 years, 3 men) with clinical stage I or II bronchogenic carcinoma and severe chronic obstructive pulmonary disease. They were considered at high risk due to poor pulmonary function tests (PFT); (one or more of the following): (1) radionuclide calculated postlobectomy FEV1 < 30% predicted, (2) diffusion capacity or transfer factor < 60% predicted, combined with a fall in PaO2 on maximal exercise of > 5 mm Hg, (3) a PaCO2 at rest of > 45 mm Hg. Maximal oxygen uptake (VO2max) during symptom-limited cycle ergometry and PH were measured in these 5 patients. They were considered eligible for lobectomy if they fulfilled at least one of the two criteria: (1) mean pulmonary artery pressure (PAP) of < 35 mm Hg and pulmonary vascular resistance of < 190 dyn.s.cm-5 at moderate exercise (40 W), (2) a VO2max of > or = 15 ml/kg/min. Six months postoperatively PFT and VO2max were measured again. PAP40W was 21, 38, 38, 46 and 52 mm Hg, respectively, which would have excluded 4/5 patients from surgery. VO2max was 21.7, 14.9, 13.4, 19.2 and 18.6 ml/kg/min, respectively, which would have excluded 2/5 patients. Expressed in percent predicted, however, VO2max was > or = 69% in all 5 patients, indicating only mild impairment of exercise capacity in the 2 patients with < 15 ml/kg/min VO2max. Therefore all 5 patients were offered surgery and underwent lobectomy. Apart from 1 prolonged air leak no complications occurred, the mean hospital stay was 16 days (13-21).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Bronchoprotection by salmeterol: cell stabilization or functional antagonism? Comparative effects on histamine- and AMP-induced bronchoconstriction.

Salmeterol provides bronchoprotection against a number of constrictor stimuli for more than 12 h after a single dose. This effect could be due either to functional antagonism at the level of airway smooth muscle or to cell-stabilizing effects of the compound. In this study, we attempted to clarify this mechanism by comparing the effects of salmeterol (50 micrograms), salbutamol (200 micrograms) and placebo on the airway responsiveness to histamine (to assess functional antagonism), and to adenosine 5'-monophosphate (AMP) (to assess additional cell-stabilizing effects), 14 h after drug treatment. Thirteen patients with mild allergic asthma were studied in a double-blind, randomized protocol on 6 days, at least 48 h apart. Forced expiratory volume in one second (FEV1) was measured before and 15 min after inhalation of the study medication. Then, 14 h later (8 a.m. the following morning), a bronchoprovocation test with histamine or AMP was performed. We found that 14 h after inhalation, salmeterol still had a significant effect on FEV1 in comparison to placebo and salbutamol. The provocative dose producing a 20% fall in FEV1 (PD20histamine) was significantly increased after salmeterol, whilst the increase in PD20AMP did not reach significance. The shift in PD20 (in doubling dose steps) induced by salmeterol pretreatment was not different between histamine and AMP. We conclude that the prolonged protective effect of salmeterol occurs via an extended bronchodilating and functional antagonistic action and not via a cell-stabilizing effect.

Adenosine Monophosphate↗
PubMed1993

[Severe hemoptysis in pulmonary vasculitis].

A 27-year-old man, in good health but a moderate smoker, suddenly had two episodes of haemoptysis. Routine clinical examination was unremarkable. Erythrocyte sedimentation rate was increased to 34 mm/h. The chest radiography showed ill-defined, contrast-poor infiltrations bilaterally, as well as left hilar enlargement. Lung scintigraphy and pulmonary arteriogram suggested pulmonary embolism, possible from a "pelvic vein spur", i.e. an intimal proliferation due to crossing of the common iliac artery over the pelvic vein. He was placed on oral anticoagulants. Three months later he had another severe haemoptysis, providing the indication for an exploratory thoracotomy. This revealed the left pulmonary artery wall to have inflammatory changes with aneurysmal dilatation. The aneurysm was plicated. Histological examination demonstrated chronic vasculitis as seen in Behçet's syndrome, a diagnosis confirmed by the findings of ulcers of the oral mucosa and the presence of HLA B5 allo-antigens. Immunosuppressive treatment was given with prednisone (1 mg/kg), azathioprine (2.5 mg/kg) and ciclosporin (5 mg/kg). Over the next 12 months there has been only one further haemoptysis.

Adult↗
PubMed1993

[Asthma mortality: consequences for therapy?].

Reports on an increase in asthma deaths in New Zealand in the late 1970s have led to a series of case-control studies aimed at identifying possible reasons for increased asthma mortality. The most intriguing finding was association of the use of beta 2-agonists as metered dose inhalers with death from asthma. Although these epidemiologic studies cannot definitely identify the cause of the increased asthma mortality, they have stimulated widespread discussion and reevaluation of therapeutic strategies. The reliability of the mortality data and the role of beta 2-agonists in this context are discussed.

Adolescent↗
PubMed1993

Inhibition of receptor-mediated platelet activation by nedocromil sodium.

BACKGROUND: Platelet activation by platelet activating factor (PAF) seems to be involved in the inflammatory process in asthma and may serve as a possible target for the antiinflammatory drug nedocromil sodium, which is known to inhibit cell activation by different stimuli. METHODS: We investigated the effect and the mode of action of nedocromil sodium on platelet activation by PAF. In a set of healthy volunteers (n = 45) we investigated seven different parameters of platelet activation by PAF, thrombin, and Ca(2+)-ionophore. RESULTS: Nedocromil sodium inhibited: (1) PAF-induced "shape change" reaction up to 78% (50% inhibitory concentration [IC50]: 3 x 10(-9) mol/L), thrombin-mediated "shape change" up to 80% (IC50 2 x 10(-8) mol/L), but not the Ca(2+)-ionophore-dependent reaction, (2) platelet aggregation by PAF up to 85% (IC50 2 x 10(-9) mol/L); (3) release of thromboxane B2 up to 82% (IC50 5 x 10(-9) mol/L); (4) formation of inositol 1,4,5-triphosphate by PAF (IC50 3 x 10(-7) mol/L), by thrombin (IC50 1 x 10(-7) mol/L), but not by Ca2+ ionophore; (5) increase of intracellular free calcium (IC50 4 x 10(-7) mol/L); (6) formation of diacylglycerol (IC50 9 x 10(-9) mol/L), and (7) translocation of protein kinase C (IC50 1 x 10(-7) mol/L). CONCLUSIONS: In the concentration range of the IC50 values found in these experiments, nedocromil sodium reduced PAF binding to platelets by only 10% to 20%, such that this interference cannot explain the observed effects of the compound. Inhibition of receptor-mediated platelet activation at an early stage in the signal transduction pathway, and without effect on Ca(2+)-ionophore-induced platelet activation, suggests an action of nedocromil sodium at the level of the cell membrane.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1993

Silicone stents in the management of inoperable tracheobronchial stenoses. Indications and limitations.

BACKGROUND: Various stent models have been developed for the treatment of inoperable stenoses of the central airways caused by external compression. Increasing use is made of the silicone stents designed by Dumon. We tested their technical feasibility, tolerance, and long-term efficacy in relieving respiratory symptoms in patients referred for endoscopic palliation of malignant disease. METHODS: All procedures were performed under general anesthesia with the use of the rigid bronchoscope. We inserted 38 stents in 31 patients (median age, 67 years; 25 men and 6 women) whose airways showed residual obstruction of > 50 percent of the lumen after laser resection of endobronchial tumor and/or mechanical dilatation of extrinsic compressions. RESULTS: Stent placement and removal--where necessary--were easy in all patients, but five stents inserted in three patients with short (< or = 2.5 cm) and conical stenoses migrated, necessitating emergency removal. In 27 of the remaining 28 patients, stent tolerance was excellent; 1 proximal tracheal stent (< 1 cm below the vocal cords) had to be removed because of otalgia and dysphagia. One lethal hemoptysis occurred within hours after a repeated laser therapy and removal of an indwelling stent. No other serious complications occurred. Immediate and lasting relief of dyspnea and improvement in performance status (Karnofsky scale, activity index) was achieved in 90 percent (28/31) of patients (p < 0.01). The influence of adjuvant radiotherapy on local tumor recurrence and survival was analyzed in a subgroup of ten patients with stage IIIB squamous cell carcinoma with comparable performance status. Five did not undergo adjuvant radiotherapy (group A) and five did (group B). In group A, four of five stents were occluded by tumor recurrence above or below the stent after a median follow-up of 2 months; in group B, zero of five were occluded (p < 0.05) after 4 months. Median survival was 4 months in group A and 6 months in group B; the difference did not reach significance. CONCLUSIONS: The silicone stents designed by Dumon are easily inserted and removed; they are also well tolerated and very efficacious in relieving respiratory symptoms caused by extrinsic airway compression. Short and conical stenoses present limitations for their use due to increased risk of migration. Combined treatment with laser resection, stent insertion, and subsequent radiotherapy is necessary to prevent local tumor recurrence and may improve survival.

Adult↗
PubMed1992

[Asthma therapy: are bronchodilators obsolete?].

Short acting beta 2-agonists, such as salbutamol, fenoterol and terbutaline, are the most potent bronchodilating agents in the treatment of acute asthmatic attacks. In chronic asthma, however, they must be viewed as purely symptomatic treatment compared to antiinflammatory agents (inhaled corticosteroids, cromoglycate and nedocromil sodium), prophylactic agents which can also decrease airway hyperresponsiveness and thereby stabilize the disease. Modern asthma treatment are based on the present understanding of asthma pathophysiology and take into account the new therapeutic options with high dose inhaled steroids and long acting beta 2-agonists. Patients with only occasional asthma symptoms should receive inhaled short acting beta 2-agonists as needed. These agents continue to be central to the treatment of any asthmatic attack. If asthma symptoms occur more than 4-6 times a week a regular inhalative antiinflammatory regimen should be initiated (e.g. inhalative corticosteroids b.i.d.). In cases with frequent symptoms or persisting airway obstruction, regularly administered inhalative bronchodilators (beta 2-agonists, possibly long acting) should be added to high dose inhaled steroids. Treatment of severe acute asthma should always include systemic glucocorticosteroids (e.g. prednisone 30-60 mg/day). Special emphasis should be placed on self-management plans, encouraging patients to monitor and treat their disease themselves in close cooperation with the physician.

Acute Disease↗
PubMed1992

Cell cultures from cryopreserved human lung tissue.

To assess gene induction in primary human fibroblasts, we have developed a method for cryopreservation of lung biopsies in liquid nitrogen. Fresh biopsies (n = 10) were chopped into 5 x 5 mm pieces and transferred into an ice-cold freezing medium. Biopsies were kept on ice for 15 min, followed by further cooling of the tissue to -70 degrees C. With this method, lung biopsies were preserved for more than 1 year before they were used for generating cell cultures. There was no significant difference in the biological responsiveness of fibroblasts generated from immediately cultured lung biopsies compared with those from cryopreserved tissue. The doubling rate of fibroblasts from fresh tissue was 23.6 +/- 1.1 hr; compared to 23.5 +/- 1.5 hr for fibroblasts generated from cryopreserved tissue. PDGF-BB enhanced de novo synthesis of DNA 100 times, in both the immediately cultured fibroblasts and those generated from cryopreserved biopsies. Macrophages, dendritic cells and endothelial cells could also be recovered from cryopreserved lung tissue. This method permits long-term storage of lung tissue and the possibility of establishing primary cell lines from the same tissue at later times without appreciable changes in their cellular biological characteristics.

Cell Cycle↗
PubMed1992

Transbronchial needle aspiration in routine fiberoptic bronchoscopy.

The objective of this study was to evaluate the yield of transbronchial needle aspiration (TBNA) in a clinical routine setting of a teaching hospital for the diagnosis and staging of bronchogenic carcinoma in comparison to the results of controlled clinical studies. We reviewed our results with Wang retractable needle catheters during a 9-month period. The needle catheters were used in 72 patients. 43 patients had a final diagnosis of bronchogenic carcinoma. Classical bronchial washes, brushings and forceps biopsies led to the diagnosis in 28 patients (65%). The addition of TBNA increased the diagnostic yield by 14% (6 patients) to 79% overall. In 32 patients staging of mediastinal lymph nodes was attempted. Positive TBNA proved inoperability in 9 patients. In 7 patients TBNA was used to investigate peripheral masses. Two patients had a malignant tumor, of which one was diagnosed by TBNA. Overall, TBNA revealed important information with clinical consequences in 16 of 72 patients (22%). There were no complications. We conclude that TBNA significantly increases the diagnostic yield of fiberoptic bronchoscopy and carries only a minimal risk. Our results, obtained in the clinical routine setting of a teaching hospital, are comparable to the reported results of controlled studies.

Biopsy, Needle↗
PubMed1991

[Silicone endoprosthesis in the treatment of tracheobronchial stenosis. Report of the first 12 patients treated with this method].

Inoperable tracheobronchial stenoses are most often due to malignant disease. Apart from systemic therapy, various local treatment modalities such as laser resection, cryotherapy and endobronchial radiation therapy have been designed to maintain airway patency. Recently, various models of tracheobronchial stents (or endoprostheses) have been designed to maintain airway patency. They prevent recurring endobronchial tumor growth or progressive extrinsic compression of dilated airways. Silicone stents are highly suitable for this purpose. We treated 12 patients (11 males, 1 female, median age 68,5 years) suffering from bronchial carcinoma (6), esophageal carcinoma (4), metastatic colon carcinoma (1) and metastatic osteosarcoma (1). One stent per patient was inserted at the following sites: 6 in the right main bronchus, 4 in the trachea, 1 in the left main bronchus and 1 tracheobronchial left. We observed 2 complications: one obstruction of a bronchial stent by secretions which could be managed by fiberbronchoscopy and one short fire to a bronchial stent on repeat laser therapy. Rapid and lasting relief of dyspnea was observed in all patients. Our initial experience with a median follow-up of 2 months confirmed the easy insertion technique, the excellent effect and tolerance as well as the simple postoperative care of these silicone stents. Their use immediately after relief of a tracheobronchial obstruction by local means can be recommended.

Aged↗
PubMed1991

Initial staging of non-small cell lung cancer: value of routine radioisotope bone scanning.

The exclusion of bone metastases is important in the initial staging of non-small cell lung cancer, though there is debate about whether bone scans should be performed routinely or restricted to patients who present with clinical or laboratory indicators suggesting skeletal metastases. In a prospective study of 110 consecutive patients referred for initial staging of non-small cell lung cancer, we assessed the sensitivity of a group of clinical indicators (chest pain, skeletal pain, bone tenderness on physical examination, serum alkaline phosphatase, and serum calcium) for the presence of skeletal metastases as determined by bone scanning. The final staging result was validated with follow up data over at least three years. At the initial staging 37 of 110 bone scans (34%) showed areas of increased uptake, of which only nine were confirmed to be metastases (by tomography, computed tomography, or biopsy). Half the patients (55) had at least one clinical indicator suggesting skeletal metastases, including all patients with proved skeletal metastases. Thus the sensitivity of these clinical indicators was 100% and the specificity 54%. Within one year three of 27 patients with non-confirmed positive bone scans had skeletal metastases, one of which was in the area that had shown increased uptake initially. All these patients had clinical indicators for skeletal metastases and all had inoperable advanced tumours. Four of 69 patients with an initially negative bone scan developed skeletal metastases within one year. It is concluded that in non-small cell lung cancer bone scanning can be restricted to patients with clinical indicators for skeletal metastases. This approach reduces the number of bone scans and consecutive investigations without loss of sensitivity in the detection of skeletal metastases.

Adult↗
PubMed1991

Long-term oxygen therapy for cor pulmonale in patients with chronic obstructive pulmonary disease.

Besides smoking cessation, antiobstructive therapy, and the treatment of intercurrent infections, long-term oxygen therapy has had the most impressive impact on survival in patients with chronic obstructive pulmonary disease (COPD). COPD leads to a functional and anatomical obstruction of the pulmonary vascular bed, with the development of pulmonary arterial hypertension and cor pulmonale. In these patients, survival benefit from long-term oxygen therapy (LTOT) stems mainly from improved hemodynamics. However, this improvement is limited: hypoxemic COPD patients treated by LTOT have the same life expectancy as nonhypoxemic COPD patients. Practical aspects concerning the prescription and application of LTOT are discussed, with special emphasis on ambulatory oxygen and oxygen-saving techniques.

Humans↗
PubMed1990

A bradykinin-antagonist blocks antigen-induced airway hyperresponsiveness and inflammation in sheep.

The effects of a new bradykinin-antagonist, NPC-567 (D-Arg [hydroxyproline3, D-phenylalanine7] bradykinin) were studied on antigen-induced airway hyperresponsiveness and inflammation in allergic sheep (n = 7). Specific lung resistance (sRL) was used to assess airway responses to inhaled Ascaris suum-antigen. Airway responsiveness was determined from slopes of cumulative dose-response-curves (DRC) to inhaled carbachol. DRCs were performed at baseline and 2 h after an inhalation challenge with antigen. Bronchoalveolar lavage, performed before antigen-challenge and after the post-challenge DRC was used to assess antigen-induced inflammatory changes. For these studies NPC-567 was given as an aerosol (20 breaths, 10 mg/ml) 30 min before antigen challenge and (400 breaths, 2 mg/ml) co-administered with the Ascaris suum antigen. The immediate increase in specific lung resistance (sRL) after antigen challenge was not different with (232 +/- 152% increase) or without drug pre-treatment (148 +/- 129% increase). In the control trial, antigen challenge led to an increase in slope of the post-challenge DRC by 123 +/- 118% compared to baseline (p less than 0.05). This hyperresponsiveness was almost completely prevented by NPC-567 (increase in slope 32 +/- 64%, p less than 0.05 vs. control). Similarly, the antigen-induced inflammatory response, characterized by a significant 3.3-fold increase over baseline in the percentage of neutrophils in the control-experiment, was blocked by the bradykinin-antagonist. These results suggest that bradykinin may be involved in the pathogenesis of antigen-induced airway inflammation and the consequent development of airway hyperresponsiveness in sheep.

Administration, Inhalation↗
PubMed1990

Severe acute asthma. Pathophysiology, clinical assessment, and treatment.

Bronchial asthma is characterized as a disease with recurrent, reversible, and generalized airway obstruction and an increased airway responsiveness to nonspecific stimuli. Besides symptoms of airway hyperresponsiveness, episodic asthmatic attacks, and chronic airway obstruction, severe acute asthma, or 'status asthmaticus', is an important and life-threatening manifestation of the disease. This paper gives an overview of the pathophysiology, clinical risk assessment, and treatment of severe acute asthma.

Emergencies↗