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Biomedical subjects

O C Burghuber

Publications and source records attributed to O C Burghuber.

At least 19 recordsLinked to original sources
PubMed2003

[Diffuse interstitial lung diseases in association with connective tissue diseases].

This article gives a comprehensive overview of diffuse interstitial lung diseases especially those associated with connective tissue diseases. Interstitial lung diseases (ILD) represent a heterogeneous group of diseases of very different and partially unknown etiologies. Therefore, an exact classification of the ILD is difficult. ILDs are rarely seen in clinical practice and often lead to diagnostic problems. Diagnostic procedures require the patient's history, physical examination, serological-immunological and routine laboratory tests, pulmonary function testing, chest X-ray and high-resolution CT scan, bronchioloalveolar lavage (BAL) and bioptic procedures. The diagnostic approach to ILD requires an intensive multidisciplinary cooperation to offer early and effective therapeutic regimens.

Connective Tissue Diseases↗
PubMed2000

Accuracy of echocardiographic right ventricular parameters in patients with different end-stage lung diseases prior to lung transplantation.

BACKGROUND: Because there are few data available on the accuracy of 2D-echocardiography to assess right ventricular (RV) size and function in patients with far-advanced lung disease, in this prospective study, we compared various echocardiographic RV parameters with RV volumes derived from magnetic resonance imaging (MRI). METHODS: In 32 patients (18 male, 17 female) presenting for lung transplantation, we measured RV end-diastolic and end-systolic area as well as derived RV fractional area change, long-axis diameter, short-axis diameter, tricuspid valve anulus diameter (using 2D apical or sub-costal 4-chamber view), and RV end-diastolic diameter (using M-mode in the parasternal short-axis view). These values were compared with RV end-diastolic and end-systolic volumes derived by MRI, serving as the gold standard. RESULTS: Right ventricular end-diastolic area was the most accurate echocardiographic parameter of RV size (correlation to MRI: r = 0.88, p < 0.001), followed by RV end-diastolic short-axis diameter (r = 0.75, p < 0.001), long axis diameter (r = 0.66, p < 0.001), and tricuspid valve anulus diameter (r = 0.63, p < 0.001). In contrast, M-mode measurement of RV end-diastolic diameter was possible in only 24/35 (68%) patients and showed a weak correlation to MRI-derived RV end-diastolic volume (r = 0.56, p = 0.004). Right ventricular fractional area change correlated well with MRI-derived RV ejection fraction (r = 0.84, p < 0.0001). In a sub-group analysis, patients with vascular lung disease showed best agreement between both methods for RV end-diastolic area and RV fractional area change compared with patients with restrictive or obstructive lung disease. CONCLUSION: This study shows that in patients with far-advanced lung diseases, RV end-diastolic area demonstrated the best correlation with MRI-derived measurement of RV end-diastolic volume, and RV fractional area change compared favorably with MRI-derived ejection fraction. Despite reduced image quality, especially in patients with obstructive lung disease, these parameters can yield clinically valuable information.

Adult↗
PubMed1999

[Diagnosis of pulmonary embolism].

Although clinical assessment (good medical history, identifying patients at risk, recognition of common symptoms and signs, physical findings) and bed-side methods (standard laboratory tests, ECG, chest X-ray, arterial blood gas analysis, echocardiography and compression ultrasound of the lower extremities) for the diagnosis and/or exclusion of pulmonary embolism is highly insensitive and unspecific, the definition of clinical probability (pretest probability) still seems to be of outmost importance. Clinical probability guides initial medical therapy, induces further invasive and non invasive examinations (e.g. perfusion lung scan, spiral CT, gadolinium-enhanced magnetic resonance pulmonary angiography, contrast pulmonary angiography) and is still the final determinant in case of conflicting results of imaging modalities.

Diagnosis, Differential↗
PubMed1998

Aerobic endurance training program improves exercise performance in lung transplant recipients.

STUDY OBJECTIVE: To determine whether an aerobic endurance training program (AET) in comparison to normal daily activities improves exercise capacity in lung transplant recipients. PATIENTS AND STUDY DESIGN: Nine lung transplant recipients (12+/-6 months after transplant) were examined. All patients underwent incremental bicycle ergometry with the work rate increased in increments of 20 W every 3 min. Identical exercise tests were performed after 11+/-5 weeks of normal daily activities and then after a 6-week AET. The weekly aerobic training time increased from 60 min at the beginning to 120 min during the last week. Training intensity ranged from 30 to 60% of the maximum heart rate reserve. RESULTS: Normal daily activities had no effect on exercise performance. The AET induced a significant decrease in resting minute ventilation from 14+/-5 to 11+/-3 L/min. At an identical, submaximal level of exercise, a significant decrease in minute ventilation from 47+/-14 L/min to 39+/-13 L/min and heart rate from 144+/-12 to 133+/-17 beats/min, before and after the AET, was noted. The increase in peak oxygen uptake after AET was statistically significant (1.13+/-0.32 to 1.26+/-0.27 L/min). CONCLUSIONS: These data demonstrate that normal daily activities do not affect exercise performance in lung transplant recipients > or = 6 months after lung transplantation. An AET improves submaximal and peak exercise performance significantly.

Activities of Daily Living↗
PubMed1997

Severe pulmonary hypertension reversed by antibiotics in a patient with Whipple's disease.

The case is described of a 58 year old man with systemic Whipple's disease with pericardial and pleural effusions and severe pulmonary hypertension. After three months of antibiotic treatment there was a complete resolution, not only of the symptoms known to be associated with Whipple's disease (diarrhoea, arthralgia, pericardial and pleural effusions), but also of pulmonary hypertension.

Anti-Bacterial Agents↗
PubMed1997

The effect of lung transplantation on the neural drive to the diaphragm in patients with severe COPD.

Little is known about the effects of lung transplantation (LT) on the neural drive to the diaphragm and on the endurance of respiratory muscles in patients with severe chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate these effects of single-lung (SLT) and double-lung transplantation (DLT). The neural drive to the diaphragm was assessed during fatiguing inspiratory threshold loading manoeuvres in six SLT recipients, six DLT recipients and seven patients with severe COPD, by using diaphragmatic surface electromyograms. During threshold loading, the patients had to generate 80% of their maximal transdiaphragmatic pressure with each breath. The endurance of inspiratory muscles was defined as the time from the beginning of a resistive breathing trial until exhaustion (t lim). In DLT recipients and even in SLT recipients (on both sides), neural activation of the diaphragm was significantly lower than in COPD patients (p < 0.05). However, no statistically significant difference in t lim was seen between LT recipients and COPD patients. The data suggest that single-lung and double-lung transplantations cause a significant decrease of the neural drive to the diaphragm, while the endurance of inspiratory muscles is well-preserved in patients with advanced chronic obstructive pulmonary disease. This may contribute to reduced sensation of inspiratory effort during ventilatory stress, thus improving the quality of life.

Diaphragm↗
PubMed1996

Doppler assessment of pulmonary haemodynamics in chronic hypoxic lung disease.

Various methods of Doppler echocardiography are useful in the analysis of flow dynamics within the heart and the pulmonary circulation in patients with COPD. In addition, to distinguish patients with increased pulmonary artery pressures from those with normal pressures, Doppler techniques provide quantitative methods for estimating pulmonary artery pressures non-invasively. Doppler echocardiography can be performed repeatedly and can thus be used to assess serial changes in the clinical state of a patient or in the response to certain pharmaceutical interventions in the pulmonary vascular bed. The most useful and accurate method of estimating pulmonary artery pressures in patients with chronic hypoxic lung disease is the systolic trans-tricuspid gradient, calculated from tricuspid regurgitation detected by continuous wave Doppler echocardiography with estimation of the right ventricular pressure, followed by the acceleration time from pulmonary flow analysis using pulsed Doppler techniques. New contrast materials to enhance the continuous wave Doppler signal and transoesophageal echocardiography may provide even more satisfactory results in the future.

Blood Flow Velocity↗
PubMed1995

[Chronic thromboembolic pulmonary hypertension and its treatment with pulmonary thrombendarterectomy].

Chronic recurrent pulmonary embolism can lead to extensive pulmonary hypertension by obstruction of the pulmonary vessels. Pulmonary thrombendarteriectomy is a new approach to normalizing the elevated pulmonary vascular resistance by removal of the adsorbed thrombi. Between 1992 and 1994 we have operated on 8 patients aged between 34 and 62 years. The first patient died due to extensive reperfusion edema, all others showed significant improvement in hemodynamic parameters (mean pulmonary artery pressure preop. 63 +/- 5 mmHg; postop. 30 +/- 9 mmHg; Cardiac Index preop. 2.0 +/- 0.2 l/min; postop. 3.5 +/- 0.5 l/min; pulmonary vascular resistance preop. 1169 +/- 75 dyn; postop. 228 +/- 55 dyn) and exercise performance (NYHA classification preop. III-IV, postop. I-II). Pulmonary thrombendarteriectomy represents an efficient method to normalize elevated pulmonary pressure and exercise performance of patients with far-advanced chronic thromboembolic pulmonary hypertension.

Adult↗
PubMed1994

Effect of lung transplantation on diaphragmatic function in patients with chronic obstructive pulmonary disease.

BACKGROUND: To date there are no data on the effects of lung transplantation on diaphragmatic function in patients with end stage chronic obstructive pulmonary disease (COPD). It is not known whether the relation between the transdiaphragmatic pressure (PDI) and lung volume is altered in recipients after transplantation as a result of changes in diaphragmatic structure caused by chronic hyperinflation. The effect of lung transplantation on diaphragmatic strength was determined in patients with COPD and the relation between postoperative PDI and lung volume analysed. METHODS: Diaphragmatic strength was assessed in eight double lung transplant recipients, six single lung transplant recipients, and in 14 patients with COPD whose lung function was similar to those of the transplant recipients preoperatively. PDI obtained during unilateral and bilateral phrenic nerve stimulation at 1 Hz (twitch PDI) at functional residual capacity (FRC) and during maximal sniff manoeuvres (sniff PDI) at various levels of inspiratory vital capacity (VCin) served as parameters for diaphragmatic strength. Sniff PDI assessed at the various VCin levels were used to analyse the PDI/lung volume relation. RESULTS: Lung transplantation caused a reduction in lung volume, especially in the double lung transplant recipients. As a consequence sniff PDI was higher in the double lung transplant recipients than in the patients with COPD at all levels of VCin analysed. However, sniff PDI values analysed at comparable intrathoracic gas volumes were not reduced in the patients with COPD when compared with those who underwent lung transplantation. Bilateral twitch PDI values were similar in the patients with COPD and in the lung transplant recipients. In the single lung transplant recipients unilateral twitch PDI values were similar on the transplanted and the non-transplanted side. The relation between PDI and lung volume was similar in the patients with COPD and in the lung transplant recipients. CONCLUSIONS: In patients with COPD lung transplantation leads to an increase the maximal sniff induced PDI values by placing the diaphragm in a more favourable position for pressure generation. Since patients with COPD and postoperative lung transplant recipients showed similar PDI/lung volume relations, this suggests that chronic pulmonary hyperinflation does not cause major functional alterations of the diaphragm.

Adult↗
PubMed1994

Effect of lung transplantation on right and left ventricular volumes and function measured by magnetic resonance imaging.

To evaluate the effect of lung transplantation on right ventricular (RV) and left ventricular (LV) volumes and function, magnetic resonance imaging (MRI) was performed in 11 patients before and 6 to 24 months after single (n = 7) or double (n = 4) lung transplantation as well as in 15 healthy control subjects. Prior to transplantation, RV end-diastolic (RVEDVI, ml/m2) and end-systolic (RVESVI, ml/m2) volume indices were significantly increased in patients compared with those in control subjects. RV ejection fraction (RVEF, %), although within the lower normal range, was significantly reduced. In contrast, LV volume indices (ml/m2) were significantly smaller in patients than in control subjects, whereas LV ejection fraction (LVEF, %) was not different from that in normal subjects. After lung transplantation, MRI revealed a significant reduction in RVEDVI from 73 +/- 29 to 54 +/- 14 (p = 0.03) and RVESVI from 38 +/- 23 to 20 +/- 6 (p = 0.01) with a concomitant significant increase in RVEF from 48 +/- 14 to 63 +/- 6 (p = 0.01). Consecutively, the LV expanded to normal (LVEDVI from 49 +/- 12 to 65 +/- 14, p = 0.01; LVESVI from 23 +/- 9 to 28 +/- 7, p = 0.05), whereas LVEF remained unchanged (55 +/- 9 versus 56 +/- 8).

Adult↗
PubMed1993

Left ventricular diastolic impairment in type 1 diabetic patients with microalbuminuria.

The high incidence of cardiac mortality in type 1 diabetic patients is further increased when diabetic nephropathy is present. Since microalbuminuria (albumin excretion rate > 30 mg/day) represents an incipient stage of diabetic nephropathy, we decided to investigate whether incipient renal changes correlate with early diastolic cardiac dysfunction, known to preceed systolic dysfunction. To test this hypothesis, 13 normotensive type 1 diabetics with incipient nephropathy (mean age 37.8 +/- 3.5, diabetes duration 18.8 +/- 2.6 years), 13 type 1 diabetics without nephropathy (matched for age, diabetes duration and metabolic control) or other microangiopathic changes and 13 normal controls were studied. Diseases known to affect left ventricular performance were ruled out before investigation. Right and left ventricular parameters were assessed by M-mode and Doppler echocardiography. While parameters for left ventricular systolic function stayed within the normal range and did not differ between the two diabetic groups (ejection fraction 69.3 +/- 2.4 vs. 69.6 +/- 1.4%; fractional shortening 40.3 +/- 2.2 vs. 38.5 +/- 1.1%), diastolic function was significantly impaired in diabetic patients with microalbuminuria. This is expressed by an inversed early and late peak flow velocity ratio in patients with microalbuminuria (0.988 +/- 0.04 vs. 1.362 +/- 0.1; p < 0.05) and a significant percentual increase in late (atrial) filling (39.1 +/- 1.7 vs. 29.9 +/- 1.4% when compared to whole filling; p < 0.05) despite a similar rate-corrected isovolumetric relaxation period in both diabetic groups (98.4 +/- 5.8 vs. 95.5 +/- 6.2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Early experience with sequential bilateral lung transplantation.

We performed 20 sequential bilateral lung transplantation in 19 consecutive patients from April 1990 to May 1992. Perioperative mortality was low (2 patients). One-year actuarial survival was 70%. All survivors had normal blood oxygen tension (82 mm Hg, mean) while breathing room air and continuing improvement of pulmonary function. Bronchial dehiscence did not occur. Stents were implanted in 7 patients to control bronchial stenosis. Aggressive treatment of graft rejection has been effective in preventing obliterative bronchiolitis.

Bronchial Diseases↗
PubMed1993

[High-resolution computed tomography (HR-CT) of the lung following lung transplantation].

We report our high-resolution computed tomography (HRCT) and conventional CT findings after lung transplantation in 20 patients. Sixty-four examinations were performed 7-511 days after transplantation. The radiological observations were then correlated with the clinical results. The pathological findings in the early postoperative phase were pleural effusion, edema, and pulmonary consolidation. The HRCT findings associated with acute rejection were nonspecific. Dilation and thickening of the walls of the peripheral bronchi is a common, but non-specific feature in bronchiolitis obliterans. The manifestations of posttransplant lymphoproliferative disorder are discussed in two patients.

Adult↗
PubMed1993

Pulsed Doppler echocardiography to assess pulmonary artery hypertension in chronic obstructive pulmonary disease.

Noninvasive assessment of pulmonary artery hypertension would be of great value in patients with chronic obstructive pulmonary disease (COPD). Although continuous wave Doppler echocardiographic measurement of right atrial to right ventricular pressure gradient is the most useful method of noninvasive assessment of pulmonary artery hypertension, this technique is often limited in patients with COPD. In order to evaluate the usefulness of pulsed Doppler echocardiography, for the estimation of pulmonary artery pressure in COPD patients in whom continuous wave Doppler ultrasound has failed, we compared right ventricular systolic time intervals: pre-ejection period (PEP, ms), acceleration time (AT, ms), right ventricular ejection time (RVET, ms), and AT/RVET and PEP/RVET ratios, as measured by pulmonary artery pulsed Doppler traces, in 30 COPD patients, with the time intervals of 15 age- and sex-matched healthy volunteers, using the subcostal approach. In addition, right ventricular systolic time intervals of the COPD patients were correlated with invasive catheterization data (systolic and mean pulmonary artery pressure (PAPs and PAPm). AT and AT/RVET were significantly shorter in COPD patients (AT 92 +/- 4.3 ms; AT/RVET 0.38 +/- 0.03) as compared with healthy volunteers (AT 132 +/- 4.5 ms; p < 0.001; AT/RVET 0.46 +/- 0.02; p < 0.005), whereas RVET, PEP and PEP/RVET were not significantly different in both groups. A significant correlation was demonstrated between AT and PAPs (r = -0.76; p < 0.001) and PAPm (r = -0.82; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Intravenous therapy of chronic obstructive pulmonary disease with sodium glycinate theophylline monitored by a new bed side theophylline assay.

Although the therapy of airway obstruction with theophylline is well established, unwanted side effects can occur: overdosage and reactions to ethylendiamine, an additive to increase the solubility of theophylline. Frequent measurements of the theophylline blood levels and the use of ethylendiamine free preparations can avoid such problems. Therefore, we studied the validity of a new immunochromatographic bed side assay (Acculevel) prior and after infusion of sodiumglycinate-theophylline (Theospirex) in 13 patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Although theophylline levels increased above the therapeutic range (20 mg/L) in half of the patients after the infusion of 400 mg Theospirex in 1 hour, no toxic effects could be denoted. In addition, no influence on blood pressure and heart rate were found. We observed good correlations between this new immunochromatographic assay and theophylline levels measured with 2 well established reference methods (HPLC and turbidimetry, r = 0.87 and 0.91, respectively), although Acculevel revealed slightly higher values. Thus, the use of sodium-glycinate-theophylline and the new, fast bed side test system seems of practical importance in the therapy of COPD by potentially avoiding undesirable side effects.

Aged↗
PubMed1991

Raised circulating plasma levels of atrial natriuretic peptide in adolescent and adult patients with cystic fibrosis and pulmonary artery hypertension.

Since pulmonary artery hypertension (PH) complicates advanced stages of cystic fibrosis (CF), we wondered whether plasma concentrations of h-ANP would be increased in adult patients with CF. Furthermore, if only the right ventricle is faced with an increased afterload in these patients, the increased h-ANP plasma levels should stem primarily from the right atrium. To test this hypothesis we studied 12 adult patients with CF in a clinically stable condition using right heart catheterization. Mean pressures were measured in the right atrium (Pra) and pulmonary artery (Ppa), pulmonary capillary wedge (PCWP) position, and blood were drawn from the pulmonary artery and from a peripheral vein to determine h-ANP. Plasma levels in the pulmonary artery were significantly higher than in a peripheral vein (54.3 +/- 6.0 pg/ml vs. 32.2 +/- 4.4 pg/ml; p less than 0.001). Four of the 12 patients had PH (Ppa, 25.8 +/- 2.9 mmHg) whereas 8 patients exhibited normal pulmonary artery pressures (Ppa, 15.9 +/- 0.7 mmHg). Patients with PH had higher Pra (4.2 +/- 0.4 mmHg) than patients with CF without PH (1.9 +/- 0.7 mmHg; p less than 0.05). Plasma h-ANP concentrations were significantly higher in patients with CF with PH (70 +/- 10.4 pg/ml in the pulmonary artery; 42.6 +/- 4 pg/ml in a peripheral vein) than in patients with normal pulmonary artery pressure (43 +/- 3.3 pg/ml in the pulmonary artery; p less than 0.01; 24.7 +/- 5.6 pg/ml in a peripheral vein; p less than 0.05). Although our results are derived from a small group of patients with CF, we conclude from our results that in patients with CF PH may cause increased h-ANP secretion. The right atrium seems to be a major source.

Adolescent↗
PubMed1991

[Uni- and bilateral lung transplantation: patient evaluation and selection. Vienna Lung Transplant Group].

Lung transplantation has been available as a therapeutic option for patients with end-stage lung disease for only a short period of time. Since this procedure is now being successfully performed with increasing frequency in various transplantation centers, we must now begin to consider transplantation as a therapeutic options in patients with lung diseases unresponsive to medical therapy. Physicians are required to know principles involved for determination of suitable candidates and operative procedures of choice. We report here our experiences of preoperative assessment of patients undergoing lung transplantation. Patient selection, indications, contraindications, choice of operation, appropriate timing for transplantation and preoperative rehabilitation methods are discussed. It is concluded that appropriate recipient selection remains an important determinant for the success of this treatment modality.

Austria↗