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Biomedical subjects

M Wenzel

Publications and source records attributed to M Wenzel.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Eyelid reconstruction with tarsomarginal transplant].

UNLABELLED: In the past 3 years, 85 basal cell carcinomas were treated in our clinic using eyelid reconstruction. During the same period, 54 lids were reconstructed after other diseases, mostly after chemical burns. In one of the 54 patients, the upper lid was reconstructed using a tarso-marginal graft after congenital coloboma. METHOD: In 31 of the 85 patients with basal-well carcinoma (36%), so much tarsus was lost that a transplantation of tarsus was necessary. Fifteen of the 31 patients were treated with a Hughes-plasty and 16 using a tarsomarginal graft, two in the upper lid. RESULTS: In eight of the remaining 16 cases, the defect was less than one half of length, so that the graft was taken from the second lower lid. In the remaining eight patients, the defect was two thirds of length or longer. In six cases, a 7 mm-graft was taken from the upper lid. As the tarsus from the upper lid measures 10 mm and is thus twice as big as the lower lid tarsus, it was divided into two grafts, resulting in two grafts measuring 7 x 5 mm. They were placed in the lower lid ("double tarsomarginal graft"). The former lower part with lashes was placed in the middle of the lower lid, the former upper part peripherally. In two patients, the defect was healed with three tarsomarginal grafts. A pedicle skin flap was transposed to cover the posterior grafts. Remaining defects were closed with free skin transplants. CONCLUSION: The tarsomarginal graft permits a short operation time and early rehabilitation of the patients. The disadvantage of the double tarsomarginal graft is that the more valuable upper lid tarsus is used to reconstruct the less valuable lower lid tarsus.

Adult↗
PubMed1997

A new tongue advancement technique for sleep-disordered breathing: side effects and efficacy.

We examined the efficacy and the acceptance of an oral device (SnorEx) causing a forward displacement of the tongue for the treatment of sleep-disordered breathing (SDB). Twenty-three consecutive subjects with SDB were investigated. Noncompliance (NC) of use of the oral appliance was observed in 74% (17 of 23) of the subjects. NC patients were characterized by unacceptable local side effects of the prosthesis, lacking improvement of indicators of daytime well-being, and a missing reduction of the respiratory disturbance index (RDI). The device was tolerated without side effects in 26% (6 of 23) of the subjects. In these compliant (C) subjects the RDI, EDS, and snoring improved significantly (p < 0.05) compared with baseline values. After 6 mo using the device, five of the six C patients were still using it. We conclude that the high rate of noncompliance and the low efficacy of the SnorEx prosthesis preclude large-scale use of this treatment modality in patients with SDB and snoring since the local side effects are the principal cause of NC. No useful predictive parameter of treatment compliance or treatment success was found. Thus, this dental appliance should be prescribed only for selected patients failing other treatment modalities seen by an experienced sleep-disorders specialist.

Dental Prosthesis↗
PubMed1997

[Optical stimulation method (Snore-Stop) and tongue retainer (Snore-Master) without relevance in therapy of obstructive sleep apnea and snoring].

Recently intra- und extraoral devices are increasingly used in order to treat obstructive sleep apnea and snoring. We examined the value of an optically stimulating system ("eye-cover", Snore-Stop) and a tongue-retainer (Snore-Master) as treatment of the obstructive sleep apnoe or snoring. In case of the eye-cover is a microphone integrated, which detects acoustic signals (e.g. snoring). After detection of snoring optical stimuli are generated in front of the eyes. This is intended to induce an arousal of the patient, without awaking him, causing a change of body position and this reduces the snoring or apneas. For the examination of the eye-cover in 26 patients (23 men, 55.6 +/- 10.3 years) polygraphic studies were performed while sleeping one night with the eye-cover and one night without, respectively. Visual analogue scales (VAS) were used in order to measure quality of life and sleep and the adverse effects of the device. To examine the tongue-retainer 14 patients (13 men, aged 52.9 +/- 11.8 years) were measured polygraphically. Again the subjective scores were assessed using the VAS. The principle of the tongue-retainer is to create a hollow space in front of the teeth, in which the tongue is positioned. Fixation of the tongue in this ventral position is thought to enlarge the mesopharyngeal area in order to reduce the upper airway obstruction. For both devices the index of snoring, the apnea-hypopnea-index, the index of desaturation, the mean and minimal SaO2 and SaO2 < 90 % in % of the night did not change significantly. Furthermore the subjective perception of the patients concerning their quality of sleep and life did not change. Moreover, despite of an adequate adaptation-period the use of the tongue-retainer was associated with considerable adverse effects. Neither the eye-cover nor the tongue-retainer could improve the severity of obstructive sleep apnoe or snoring.

Adult↗
PubMed1997

[Bronchial hyperreactivity and nCPAP therapy].

In patients with obstructive sleep apnoea (OSA) nCPAP may irritate the mucous membranes of the upper airways. We investigated in this study whether nCPAP can induce bronchial hyperreactivity (BHR). Forty-one patients (33 men, mean age 52.6 years) were treated with nCPAP due to OSA. All of them were tested for BHR with histamine ("pari-provo-Test") before and six weeks after initiation of the nCPAP therapy. Thirty-five of the patients showed BHR neither before nor after the beginning of CPAP. Six patients developed a BHR of moderate degree (PD20: 50-100 micrograms) during the study; four of these six patients were not symptomatic. The two other patients complained about more colds than usual or about noctumal cough. Both of them received inhaled steroids and a moistening system. Nobody of the enrolled patients was obliged to finish CPAP therapy due to BHR. Four patients had already a BHR before nCPAP therapy began. Most of the patients did not acquire a BHR during the first 6 weeks after nCPAP therapy had started. A BHR bronchial may develop, but in the majority it remains without clinical relevance. In patients with a BHR and OSA, the benefits of nCPAP therapy excel the potential adverse effects.

Airway Resistance↗
PubMed1997

[Is SnorEx also ApneaEx? A study with a new intra-oral prosthesis as a form of therapy of obstructive sleep apnea syndrome].

UNLABELLED: In recent years different kinds of dental devices have been advocated for treating sleep apnoea. In this study we report on our results with a kind of prosthesis ("Snor-Ex", DEPITA, 29336 Nienhagen) designed to relieve upper airway obstruction in sleep in pulling forward the tongue by a truss pad positioned in the posterior area of the tongue. We performed the study to test the effectiveness of the device in reducing the number of obstructive events. PATIENTS: 23 patients with OSA (22 male, age: 53.7 +/- 8.6 years, Body mass index: 31.1 +/- 3.9 kg/m2, Apnoea index: 33.5 +/- 18.4, Respiratory disturbance index: 45.6 +/- 19.7, mean apnoea duration: 20.4 +/- 4.4 sec) were included. STUDY DESIGN: Before the study was started, polysomnography was performed and the OSA associated symptoms/claims were standardised with the help of visual analogue scales (VAS). The prosthesis were made by the dental laboratory. Between the 28th and 42nd day after beginning with the study the patients had to come to the hospital for control. The effect of the therapy was documented only by a further polysomnography in patients who could sleep for at least 2.5 hours with the prosthesis. The effects of the device on changing OSA-associated symptoms and snoring were reevaluated by the above mentioned VAS. During the control the patients were divided into non-responders (NR) and responders (R) according to the results. RESULTS: The NR prevail in the study with 75% (17/23). They are characterised by inacceptable loco-regional side effects of the prosthesis, missing improvement of the state of daytime wellbeing and constant obstructive events. Only 25% of the patients are R. They locally tolerated the prosthesis, which is the precondition for long-term therapy. The severity of OSA diminished. Snoring also diminished significantly. CONCLUSION: According to our results the insufficient acceptance and the low effectivity of the SnorEx-prosthesis preclude large-scale indication for OSA patients. The prosthesis should not be prescribed without contacting a sleep lab.

Adult↗
PubMed1997

[Predictive value of laryngoscopy with reference to the severity of obstructive sleep apnea].

The diagnosis of sleep-related breathing disorders is based primarily upon targeted history-taking and upon night-time polysomnography. Diagnostic measures should be completed by laryngopharyngoscopy (LPS). Frequently in cases of relevant obstructive sleep-related breathing disorders, a collapse of the pharyngeal lumen may be detected already in the waking state: either during spontaneous breathing or through adequate provocation (snoring manoeuvre). Furthermore, endoscopy of the upper airways will yield indirect clues as to nocturnal snoring and possible obstructive apnoeas. Although the predictive value of LPS regarding the degree of obstructive sleep-related breathing disorders seems low compared with polysomnography, it appears reasonable to perform it to exclude further relevant ENT findings. With LPS, local and regional obstacles of the kind of the intended positive pressure ventilation (narrowing of the nasal ducts, septum deviation and hyperplasia of the turbinates) are demonstrable which may warrant surgical correction. LPS, which has a low complication rate, facilitates interdisciplinary cooperation in the care for patients suffering from obstructive sleep-related breathing disorders.

Airway Obstruction↗
PubMed1997

[Work of breathing in differentiation of various forms of sleep-related breathing disorders].

BACKGROUND: In contrast to the obstructive sleep apnoea syndrome (OSA) the obesity-hypoventilation syndrome (OHS) is characterised by persistent hypercapnia during the day and predominant hypoventilation during sleep. In this study we wanted to know whether work of breathing (WOB) in a sitting and supine position separates both groups. PATIENTS AND METHODS: OSA population: 20 men, 50.5 +/- 9.2 years, Body Mass Index (BMI: 54.1 +/- 6.9 kg/m2, pO2: 65.6 +/- 6.6 mmHg, pCO2: 40.6 +/- 3.1 mmHg, OHS-group: 14 patients, 13 men age: 53.1 +/- 9.3 years, BMI: 53.1 +/- 9.3 kg/m2, pO2: 51.8 +/- 10.5 mmHg, pCO2: 53.8 +/- 9.2 mmHg. The control group consisted of 10 normal weighted subjects. The intrathoracic pressures were assessed by an oesophageal catheter; at the same time, the minute ventilation (VE) and the breathing frequency (fb) were measured via a pneumotachygraph. The area under the pressure-volume loop was correlated to WOB. After reaching steady state VE, fb, and WOB were determined in sitting and supine position. RESULTS: In the OSA-group the apnoea index (AI) was 48.6 +/- 17.7/h and the respiratory disturbance index (RDI) was 66.3 +/- 19.4/h. The forced expiratory volume (FEV1) was 77.3 +/- 23% pred. and the vital capacity (VC) was 76.3 +/- 18.6% pred.; 7 out of 20 patients suffered from chronic bronchitis. In the OHS-group the AI was 21.5 +/- 19/h and the RDI 44.3 +/- 28.2/h. The majority of OHS patients had an airway obstruction (FEV1: 55.8 +/- 17.5% pred., VC: 58.8 +/- 12.8% pred.); 12 out of 14 patients suffered from chronic bronchitis. Compared to the OSA population WOB in the OHS group was significantly higher both in the sitting (0.67 +/- 0.28 J/I versus 1.04 +/- 0.32 J/I, p < 0.001) and supine positions (1.23 +/- 0.25 J/I versus 1.91 +/- 0.43 J/I, p < 0.001). Compared to the sitting position VE and fb did not change significantly in both groups lying supine. CONCLUSIONS: Compared to the OSA group at the same BMI the WOB of the OHS population was significantly increased in the sitting and supine position. The main reason for these findings may be the increased airway obstruction due to chronic bronchitis. Both populations did not change the breathing patterns during the different positions.

Adult↗
PubMed1997

[Nasal strips without effect on obstructive sleep apnea and snoring].

Recently a nose plaster (NP, Breathe-Right) has been increasingly used in the treatment of obstructive sleep apnoea (OSA) and snoring. Hence, we examined the use of the NP as a treatment of both OSA and snoring without OSA. The NP has a elastic spine that increases the diameter of the nostril and is thought to reduce the degree of OSA and snoring. According to the polysomnographic data two groups were differentiated: Group A (30 patients with OSA, apnoea index > 10/h, 26 men) and Group B (20 snorers, without OSA, 13 men). After the diagnostic polysomnography the efficacy of the NP was measured with a cardiorespiratory polygraph on the 2 following nights. In the group A the polygraphic data (apnoea index, time of apneas, desaturation index, time of desaturations, mean and nadir SaO2) were studied; in group B the snoring index (snoring events/hour) was measured. A questionnaire scored quality of sleeping, daytime condition and the quality of nose breathing. In neither group were the recorded polygraphic findings different with the NP although with the NP an improved nose breathing was scored in both groups. In group A 90% of the patients scored the daytime sleepiness unchanged and 10 of 30 patients described an improved quality of sleep. In group B there was no change in the frequency of snoring events with the NP. Neither the degree of OSA nor of snoring without OSA were changed by the NP, which can therefore not be considered a treatment of these conditions. However, the majority of the study population were impressed by the symptomatic improvement in nose breathing.

Dilatation↗
PubMed1997

[Changes in the time spent awake in obstructive sleep apnea and snoring--results of a pilot study].

Continuous positive airway pressure (CPAP) therapy reduces sleeping time per day and daytime sleepiness in obstructive sleep apnoea (OSA) and heavy snoring. Due to sleep fragmentation the OSA and heavy snoring are associated with a daytime sleepiness and increased necessity of sleep. In this pilot study the effect of CPAP-therapy on daytime sleepiness and sleep time during 24 hours were assessed in patients with OSA or heavy snoring (daytime sleepiness, none or slight apnoea with AHI < 10/h and benefit of CPAP). We studies 42 patients with OSA (AHI: 34.5 +/- 23.6) and 15 patients with heavy snoring: inclusion criteria: Patients with OSA (AHI > 10/h, ESS-Score > 8) and heavy snoring (AHI < 10/h, ESS-Score > 8) who were treated with nCPAP. Before and 2 months after initiation the CPAP-therapy all patients completed diary cards recording the sleeping time/day for 1 month; additionally they scored sleepiness using the Epworth sleepiness scale (ESS-score ranged from 0 to 24, the higher the score the worse the sleepiness) before and 2 months after initiation the CPAP-therapy. In the whole study population nCPAP-therapy reduced the sleeping time significantly by a mean period of 46 minutes per 24 hours (from 8.3 +/- 1.3 to 7.5 +/- 1.2 hours, p < 0.001) and improved the ESS score from 13.7 +/- 4.6 to 6.1 +/- 3.6 (p < 0.0001). In respect of the change of sleeping time/day and of the sleepiness score there was no significant difference between the OSA and heavy snoring group. With CPAP the AHI in OSA patients was reduced from 34.5 +/- 23.6/h to 3.2 +/- 3.2/h. Due to the improvement of sleep-related breathing disorders CPAP therapy reduced the mean sleeping time/day by approximately 10% and the daytime sleepiness score both in patients with OSA and heavy snoring compared to the pretreatment period.

Airway Obstruction↗
PubMed1996

[Satisfaction of cataract patients].

BACKGROUND: Most of the presentations concerning quality assurance following cataract surgery are based upon objective data, as it should be. But the success of an eye-clinic is not limited by such objective data, but on the contentment of the patients and the local colleagues, who direct the patients. Our aim in the following study is to find out, if there is a correlation between objective data and the contentment of cataract-patients. MATERIAL AND METHODS: 101 non-selected patients were asked about their contentment following cataract surgery and lens implantation. They were asked twice; first immediately after surgery and second two months after surgery. The subjective data of the patients were compared with objective data. RESULTS: 99% of the patients were content with the surgery, but only 88% were content with their visual acuity. There was no correlation between contentment of the patients and visual acuity. 13% of the patients reached a vision below 0.2. All but one said to have a good or moderate vision. 16% claimed to have poor or very poor vision, they all had a vision between 0.2 and 1.0. CONCLUSIONS: The ophthalmic surgeon must not be satisfied by his own good surgical results. In addition, he has to take care of the contentment of his patients. But it is even more dangerous, if the surgeon is proud because of his many content patients. Even if the patients are satisfied, he has to take care, if he really deserves the thanks of them.

Adult↗
PubMed1996

A school-based clinic for elementary schools in Phoenix, Arizona.

A community hospital, a school district, and a private pediatrician's office collaborated to ensure all children enrolled in five elementary schools had access to health care services. The school nurse at each school identified children needing health care services and obtained parental consent. The school nurse referred children to a nurse practitioner who visited one school each day. School nurses and space in the nurse's office were provided by the school district. The hospital provided a nurse practitioner as well as pharmacy, radiology, laboratory, and emergency department services. The pediatrician as medical director for the program provided vision, training, and community connections, and served as collaborating physician for the nurse practitioner.

Ambulatory Care Facilities↗
PubMed1995

Platelet aggregation inhibiting and anticoagulant effects of oligoamines, XXX: Absorption, organ distribution, and excretion of the oligoamine (+)-(S,S)-1,4-bis-[4-(3-iodo-4-methoxyphenyl)-butylamino]-butane-2,3-di ol and its metabolites.

The pharmacokinetic behaviour of the 131-iodine-labelled title compound 3* and its metabolites in mice was investigated. A two phase, 1st order elimination profile was observed. The second phase is very slow leaving about 35% of radioactivity in the mice even 100 h after i.v. injection, because of high affinity to liver and spleen, caused by strong binding of oligoamines to phospholipids of liver and blood cell membranes. The blood-brain-barrier is not passed. No deep compartments were observed. The doses necessary for antithrombotic effects in vivo were calculated from the blood levels to be 20.5-39.7 mumol/kg for a time interval of 1-6 h after administration.

Animals↗
PubMed1995

Distribution behaviour of 131-iodine labelled trans-N,N'-bis-(ethoxy-carbonyl)-N-[4-(3-iodo-4-methoxyphenyl)butyl]-N' -5- phenylpentyl)-1,4-cyclohexanedimethanamine.

The title compound 9, which is a prodrug, and its active metabolite 7 were labelled with 131I (7*/9*) to investigate their pharmacokinetic behaviour, including the distribution between stomach, gut, muscle, blood, lung, liver, kidney, adrenal gland, heart, and spleen. Four hours after oral administration of 7* to mice only 3% of the dose had been absorbed from the g.i. tract. After 24 h 54% of the radioactivity still is found the gut, predominantly in the small intestine. These results explain why 7, which is a potent antiplatelet drug in vitro, shows no antithrombotic effect in vivo. In contrast, the produg 9/9* is absorbed considerably, i.e. up to 50% in 4 h from the g.i. tract depending on the dose applied and the vehicle used. At doses in the micromolar range the absorption appears to be diffusion limited. The highest concentrations are found in the liver and the kidneys suggesting a first pass effect of 7 followed by renal excretion. From the blood levels achieved, the dose necessary for an antithrombotic effect has been calculated to be about 100 mg/kg. In summary, the N-ethoxycarbonyl derivatives of oligoamines appear to be suitable prodrugs for oral administration of oligoamines.

Animals↗
PubMed1995

[Increase in hypercapnia in exercise--an unloading strategy?].

BACKGROUND: Chronic hypercapnia seems to preserve the overloaded respiratory pump from manifest muscle failure. In order to get information about the regulation of the ventilation under exercise we investigated clinical stable hypercapnic patients. PATIENTS AND METHODS: Twenty-one patients (20 males, 53.7 +/- 13.2 years) with obesity-hypoventilation syndrome (8), chronic obstructive lung disease (4), scoliosis (3), myopathy (2) and post-Tbc (2) were examined. Ventilation parameters (fb, Vt, VO2), respiratory muscle strength (PImax, PEmax), arterial blood gases (pO2, pCO2), respiratory quotient (RQ) and lactate were measured at rest and at the end of 5 minutes of maximal bicycle exercise. The control group consisted of 10 healthy persons. RESULTS AND CONCLUSIONS: A significant augmentation of the pre-existing hypercapnia under exercise (reflecting hypoventilation in relation to the predicted value) was observed in all patients with chronically overloaded respiratory muscles. This mechanism seems to be wise because it protects the respiratory pump from failure.

Adult↗
PubMed1995

[Value of transtracheal oxygen insufflation in the weaning period after long-term ventilation].

BACKGROUND: In many cases, respiratory muscle failure is the reason for unsuccessful weaning attempts after long-term ventilation. Therapeutic measures must therefore be aimed at unloading the respiratory pump. In this present study we examined whether, in particular, the transtracheal O2-insufflation (TTO2) results in a change of breathing patterns and unloads the respiratory muscles. PATIENTS AND METHODS: We examined 6 patients (5 males, age 65.6 +/- 3.9 years, diagnosis: chronic obstructive lung disease), who received long-term mechanical ventilation in outward intensive care units. Baseline resting data (arterial blood gas analysis, the breathing frequency and the minute volume) were obtained with the patients breathing room air for 1 hour. After receiving TTO2 with a flow of 21/min for another 1-hour-period the measurements were repeated. RESULTS AND CONCLUSION: In our study we could show that the TTO2 leads to an impressive decrease in inspiratory work of breathing-relative to the minute ventilation by about 28%. Therefore TTO2 is of great importance in the weaning phase subsequent to prolonged mechanical ventilation due to the respiratory muscle failure.

Aged↗
PubMed1995

[Foreign body reaction after lens implantation. Correlation between visual acuity and density of giant cells].

In the early postoperative stage giant cells often appear on IOLs. Independent of this, a foreign-body reaction may start about 3 months after surgery from posterior synechia. Foreign-body reaction occur more frequently in diabetic patients or patients with glaucoma. In a prospective trial, we examined the surface of the IOLs from 115 patients with diabetes or glaucoma using specular microscopy. We compared the maximal density of the cells to visual acuity. One week and 1 month after surgery, the maximal density of giant cells was between 0 und 20/mm2; vision (median) was independent of the giant cell density in all groups between 20/25 and 20/30. Three months after surgery, the maximal density of giant cells was between 0 und 35/mm2; vision (median) was 20/25 in patients with no giant cells or cell densities up to 15/mm2. Seven patients had cell densities between 16 and 35/mm2; visual acuity (median) was 20/125. The difference was significance was (P < or = 0.05). Six months and 1 year later after surgery, the maximal density of giant cells was between 0 and 41/mm2; the vision (median) in patients with giant cell densities up to 15/mm2 was between 20/20 and 20/25. In five examinations the cell densities were found to be in the range of 16 to 40/mm2; visual acuity (median) was 20/80 in these cases. The difference is not significant (P < or = 0.05). A foreign-body reaction with more than 15 giant cells/mm2 is a rare complication of cataract surgery with lens implantation. Three months after surgery, this complication correlates with poor vision.

Aged↗
PubMed1995

[Epithelialization of porous biomaterials with isolated respiratory epithelial cells in vivo].

Extensive tracheal defects after prolonged assisted ventilation, trauma or large resections in tumor surgery are a challenge in plastic and reconstructive surgery. Defects which cannot be satisfactorily repaired reguine near of an alloplastic tracheal replacement. Previous experimental and clinical experiences in the development of an alloplastic tracheal prosthesis have demonstrated that the main cause for failure is the lack of an epithelial lining of luminal surfaces and inadequate biophysical properties of the prosthesis. With the use of a cell-seeding technique tested in vitro on biomaterials epithelialization of tracheal prostheses can be tested in vivo. In animal experiments isolated respiratory cells were seeded into implanted tubular prostheses of porous polyurethane or expanded polytetrafluorethylene. Light and scanning microscopic investigations then showed the tendency of epithelialization to occur on the luminal surfaces. Vigorous squamous epithelium cell layers that were single and (predominantly) multiple layers were found. Differentiated cilated or mucous cells were not detected in any case. The present results have shown that epithelialization of incorporated porous implants is possible. The realization of usable tracheal replacement for clinical practice must still be tested in further experiments.

Animals↗