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Biomedical subjects

P Haidl

Publications and source records attributed to P Haidl.

At least 19 recordsLinked to original sources
PubMed2005

[CT-Guided transthoracic aspiration of peripheral pulmonary nodules with a special bioptic needle].

Peripheral pulmonary nodules are difficult to reach bronchoscopically, so for a long time it has been tried, by the use of imaging techniques like X-ray, ultrasound and computed tomography, to aspirate these nodules for exact histological diagnosis. The computed tomography offers the best spatial orientation for methodical reasons, thus this technique is performed increasingly and with great accuracy in pulmonary lesions. Complications like bleeding into lung parenchyma or small pneumothorax after aspiration can be detected easier by computed tomography. In this study we evaluated the use of a special bioptic technique with the AUTOVAC(R) needle in 30 cases. Causing low parenchymal damage to the lung, this bioptic needle enables extraction of representative tissue samples for further pathological examination. In 21 of 30 (70 %) cases the histological specimen led to the diagnosis of malignancy, but 8 of those malignant specimen could have been verified as primary or secondary malignancy by using additional immunocytochemical techniques. In 2 of 30 cases (7 %) harmless hemorrhage into lung parenchyma occured after aspiration. In another 4 of 30 (13 %) cases pneumothorax occurred, requiring chest tube placement. The ct-guided lung biopsy with the AUTOVAC(R) needle represents a safe, low resilient diagnostic tool to obtain large tissue samples of specimen in good quality. Even in patients with compromised lung function because of severe chronic obstructive lung disease and/or emphysema, the described aspiration technique can be performed, if at the moment of aspiration procedure a pneumologist with corresponding equipment and trained medical staff is present, in order to place a chest tube in case of pneumothorax.

Biopsy, Needle↗
PubMed2004

[Powder inhalation systems].

Inhalation of bronchodilators and corticosteroids is the mainstay treatment for patients with obstructive lung diseases. Many dry powder inhaler devices and drug combinations are now available, and competing promotional claims can confuse both prescribers and patients. The appropriate dose of a given drug may be different for a pressurized metered dose inhaler (pMDI) and a dry powder inhaler (DPI). DPIs create aerosols by drawing air through an aliquot of dry powder. The powder contains either micronized (< 5 micro m in diameter) drug particles bound into loose aggregates, or micronized drug particles that are loosely bound to large (> 30 micro m in diameter) lactose or glucose particles. Usually, the drug particles are bound to carrier particles and are stripped form the carrier particles by the energy provided by the patientacute;s inhalation. The release of respirable particles of the drug requires inspiration at relatively high flow rates (30 - 120 L/min). Other important factors influencing aerosol generation and lung deposition are device design (resistance to airflow) and environmental conditions (humidity, temperature). Preferably, patients should employ only one type of aerosol-generating device for inhalation therapy. The technique of use varies among devices, and repeated instruction is highly advisable, to ensure that the patient uses the device appropriately. At present, DPIs are recommended for prophylactic and maintenance therapy in patients with asthma and chronic obstructive pulmonary disease, but not for patients with acute severe bronchoconstriction or children less than 5 years of age.

Administration, Inhalation↗
PubMed2004

[Respiratory therapist: introduction of a new profession].

Respiratory therapists are healthcare professionals taking care of patients with pulmonary disorders. They are an allied health specialty, practicing under medical direction. The professionalism of nurses and therapists must grow up to act successfully in new fields of medicine, where evidence-based independent action is necessary. Specialized therapists can help us coordinate separated processes (diagnoses, therapy and nursing). The profession "Respiratory Therapist" was created in the United States 50 years ago. We intend to introduce this profession also in Germany. We follow many other countries who have already taken this step. We hope that we can reach yet a higher quality of patient care.

Evidence-Based Medicine↗
PubMed2002

[Late pulmonary manifestation of ovarian and breast cancer--which contribution provide immunohistochemical techniques?].

The two case studies are describing 2 females with tumor-suspicious lung opacities including pleural effusions. Both patients have had a smoking history of more than 20 packyears and both underwent surgery for a breast respectively an ovarian cancer 10/15 years before. Conventional staining of the biopsies does not allow in most cases the differentiation between a primary lung carcinoma or the metastasis of an extrapulmonary tumor. Immunohistochemical techniques can give clues as to the origin of the primary tumor. The contribution of these methods in finding the correct diagnosis in the two presented cases is discussed. The cooperation between clinician and pathologist should be emphasized. The transfer of all important information is essential.

Aged↗
PubMed2002

[Influence of an oscillating physiotherapy device (RC-Cornet trade mark) on the regional distribution of the pulmonary aerosol deposition in patients with COPD].

BACKGROUND: The inhalation of ipratropium bromide via a jet nebulizer obtained a significantly higher bronchodilation, if the oscillating physiotherapy device RC-Cornet trade mark was integrated into the exaspiratory limb of the nebulizer. Therefore we investigated the influence of the RC-Cornet trade mark on the central pulmonary radioaerosol deposition as well as the relationship between central and peripheral lung deposition in patients with chronic obstructive lung disease in a controlled study. METHODS: Lung ventilation scintigraphy was performed routinely in 14 pat. with COPD (Nebulizer: PARI VECTOR trade mark, radioaerosol 500 MBq tin-colloid). At first all pat. inhaled a single breath from the nebulizer, afterwards the lungs were scanned with a planar gamma camera. Both groups (biometric and lung function data were identical) then inhaled another 5 breaths. In group A the RC-Cornet trade mark was inserted into the exaspiratory limb, in group B a normal exaspiratory valve. Once more lung scans were collected. Evaluation of the scans by means of a "region of interest" technique, dividing the lungs in a central and a peripheral area. Measuring of the radioactivity (impulse) per pixel and determination of the penetration index (PI). RESULTS: The following 5 breaths led to a significant increase of the central aerosol deposition (i. e. decrease of PI) in comparison with the measuring after the first breath in both groups (A 0,41 +/- 0,07 to 0,38 +/- 0,08, p = 0,04; B 0,38 +/- 0,08 to 0,34 +/- 0,11, p = 0,02). However, no difference could be recognized between the groups. No significant difference was seen with respect to the impulses per pixel. CONCLUSION: Neither the aerosol deposition in the central region of the lung nor the relation between central and peripheral deposition (PI) differs between the both groups. The effect of the RC-Cornet trade mark mentioned in the introduction seems to be caused by physiotherapeutic induced changes of the mucus transport and not by an enhanced central drug deposition.

Administration, Inhalation↗
PubMed2001

["Epidemiology" of the value of orally administered morphine as therapy of severe pulmonary emphysema of the pink-puffer type].

OBJECTIVES: Patients with severe emphysema from pink puffer type (PPT) are symptom-limited due to dyspnea even at low level of activity. In this study we investigated the clinical effect of oral morphine in this group of patients. MATERIALS AND METHODS: Based on the analysis of medical records (n = 456 patients) and a currently answered questionnaire (n = 205 patients) we analyzed data of all patients with emphysema being treated from 1995-1999. RESULTS: Dyspnea improved during the adaptation period on the ward in 59.4% of the whole population being treated with morphine and in 67.7% of the analyzed patients after discharge. Before discharge the treatment with morphine was finished by 38.9% of the population. In the group of long-term survivors approximately 50% of patients continued the treatment. In total, about 10% of the collective finished the treatment due to intolerable side effects. In the 5-year observation period morphine has been increasingly applied in an earlier stage of the disease. CONCLUSION: In patients with severe emphysema from pink puffer type a trial with morphine is justified. In particular the beneficial effect on dyspnea in the responder group and the acceptable rate of side effects underline this strategy.

Administration, Oral↗
PubMed2001

[Does the inhalation of a 1% L-menthol solution in the premedication of fiberoptic bronchoscopy affect coughing and the sensation of dyspnea?].

BACKGROUND: Inhalation of l-menthol inhibits cough and has been shown to reduce respiratory discomfort associated with loaded breathing. We investigated the effect of the inhalation of a 1% l-menthol solution in the premedication of fiberoptic bronchoscopy (FB) on the frequency of cough and the irritability of the tracheobronchial mucosa during FB in a blinded, randomized and placebo controlled study. METHODS: 64 pat. (30-78 yrs, 55 males) underwent routine FB. Premediction: atropine and hydrocodone s.c., inhalation of oxybuprocain by means of a jet nebulizer, sedation on demand. Verum-group: inhalation of 3 ml 1% l-menthol-solution. Placebo-group: 3 ml 0.05% l-menthol (to provide the typical smell). Before and after inhalation peak respiratory flow (PEF) was registered, during FB the frequency of cough was measured. The bronchoscopist scored the irritability of the tracheobronchial mucosa using a visual analog scale. The patients answered a questionnaire addressing their perception of dyspnea and cough on the day after FB compared to the day before. RESULTS: The cough counts didn't show a significant difference between the groups. The irritability of the mucosa was increased in the verum group (main bronchus verum 62.2 +/- 22, placebo 48.6 +/- 23 [mm vissual analog scale, p = 0.03]). Cough and dyspnea reported by the patients decreased on the day after FB significantly compared to the day before (no difference between the groups). The inhalation of 1% l-menthol induced a significant increase of the PEF (verum 307 +/- 103 pre, 329 +/- 84 post [l/min, p = 0.003]) compared to placebo. CONCLUSIONS: The inhalation of 1% l-menthol did not enhance the tolerability of the FB. However, l-menthol induced a significant increase of the PEF immediately after inhalation. Finally sensation of dyspnea was decreased in both groups at the day post FB.

Administration, Inhalation↗
PubMed2001

[Stabilization of two patients with brittle asthma by inhaled beclomethasone dipropionate with small particle size].

UNLABELLED: Two patients with brittle asthma whose bronchial obstruction was less variable during treatment with HFA-beclomethasone (HFA-BDP) solution aerosol than with other previous treatments are presented here. In order to evaluate whether this improvement was related to the smaller particle size of the new formulation (MMAD 1.1 mu vs 4 mu with the CFC-formulation) both patients participated in a prospective case study sequence. METHOD: During a 4 week run-in both patients inhaled 200 micrograms of HFA-BDP (Ventolair) BID from the Autohaler followed by 4 weeks of treatment with 500 micrograms CFC-BDP (Aerobec) BID from the Autohaler in study phase 1 and 4 weeks of treatment with 200 mcg HFA-BDP (Ventolair) BID from the Autohaler in study phase 2. During the entire study period other concomitant medications remained unchanged. The dose of CFC-BDP was chosen to be 2.5 times higher than the HFA-BDP dose to get approximately comparable amounts of intrabronchial deposition. During the study Peak-Flow and concomitant medications were recorded daily. RESULTS: Both patients showed significantly higher Peak-flow values during treatment with Ventolair (HFA-BDP) than during treatment with AeroBec (CFC-BDP). P-values were p < 0.0001 and p < 0.005 for patient 1 and 2 respectively. CONCLUSION: At a comparable intrabronchial dose these two cases of brittle asthma showed significant improvements in control of bronchial obstruction with a BDP-formulation of smaller particle size. This is an indicator that smaller airways in the periphery of the lung participate in the inflammatory process leading to bronchial obstruction and that deposition of inhaled steroids in this region could have therapeutic advantages.

Administration, Inhalation↗
PubMed2000

Inhaled isotonic alkaline versus saline solution and radioaerosol clearance in chronic cough.

The aim of the present study was to test the influence of inhaled isotonic Ems salt (brine from the spa of Bad Ems, Germany) compared to isotonic saline on radioaerosol clearance (RC) in patients with chronic cough. Ems salt is an alkaline solution (pH 8.0-9.0) containing largely bicarbonate ions rather than the chloride ions present in isotonic saline (pH 6.4). RC was assessed with a radioaerosol technique using technetium-99m albumin in supine patients. After a 30-min baseline measurement of RC according to a single blind and randomized design, patients inhaled Ems salt (n=22, 20-77 yrs) or isotonic saline (n=21, 34-72 yrs) via a jet nebulizer (Pari Boy) for 10 min and were scanned for an additional 30 min. There was no difference between the two groups before intervention in terms of deposition pattern, lung function and baseline RC rate. After inhalation of Ems salt, the RC rate (1/tau) improved significantly from 0.15+/-0.14 (mean+/-SD) to 0.53+/-0.70 L.h(-1) (p<0.005); no change was found after isotonic saline (0.13+/-0.13 to 0.08+/-0.09 L.h(-1), NS). Voluntary coughs performed after 60 min had no effect on the RC rate. However, in the Ems salt group, significantly more patients reported an inhalation induced cough. Compared to the Ems salt patients, who did not cough during and after inhalation, the RC rate in the cough group was enhanced significantly (0.10+/-0.12 versus 0.73+/-0.83, p=0.017), this effect being seen more frequently in females (p=0.003). It is concluded that Ems salt improves radioaerosol clearance significantly in patients with chronic cough. The underlying mechanism, regarding whether induced cough, increased water content in the mucus or enhanced ciliary beat frequency is the leading cause of Ems salt action, remains unclear.

Adult↗
PubMed1999

[Withdrawal from the respirator (weaning) in long-term ventilation. The results in patients in a weaning center].

BACKGROUND AND OBJECTIVE: Patients subjected to an increased load and with a decreased capacity of their respiratory muscles may be difficult to wean from mechanical ventilation. Using a weaning strategy with a focus on unloading respiratory muscles may be successful even after long-term mechanical ventilation. In a prospective uncontrolled study, we examined the outcome of our weaning protocol. PATIENTS AND METHODS: Under prolonged mechanical ventilation in outlying intensive care units (44.3 +/- 38.1 days) 232 patients (64.8 +/- 12.7 years, 149 males, 83 females) with the following underlying diagnoses were investigated: chronic obstructive pulmonary disease (54.3%), neuromuscular diseases (16%), thoracic restriction (10.8%), chronic left heart failure (7.3%), postsurgical ventilatory failure (6.9%) and miscellaneous conditions (4.7%). Our weaning strategy was focused on type of mechanical ventilation, endotracheal tubes, non-invasive interface, oxygen supply and transport capacity, body position and home mechanical ventilation, if an increased load or a decreased capacity of the respiratory muscles remained after weaning. RESULTS: Altogether 65% of the patients (n = 152) were weaned in a mean duration of 7.5 days. Intermittent home mechanical ventilation followed in 45 patients (19.4%). In our hospital died 64 patients (27.6%). After a stay of 19.7 +/- 12.2 days in our hospital 72.4% of the patients (n = 168) were discharged. The postdischarge 3-month mortality of the cohort was 36.5%. CONCLUSION: Applying our weaning strategy about 65% of the patients requiring long-term mechanical ventilation were successfully weaned. Weaning was achieved in approximately one fifth of the time previously spent on mechanical ventilation. However, the 3-month mortality of the investigated cohort was 36.3%.

Aged↗
PubMed1999

Scintigraphy for evaluating early aspiration after oral feeding in patients receiving prolonged ventilation via tracheostomy.

OBJECTIVE: In tracheotomised patients the incidence of aspiration is difficult to determine because investigators often apply different criteria. In this study a scintigraphic method was used to visualise feeding aspiration directly and the results were compared with clinical evidence of aspiration. DESIGN: Prospective study in difficult-to-wean patients with tracheostomy. SETTING: Respiratory ICU. PATIENTS AND METHODS: The study population consisted of 62 consecutive patients (16 females, age: 64.1+/-11.1 years). All patients were tracheotomised and had previously been long-term ventilated in other ICUs due to weaning failure. The scintigraphic test was performed during spontaneous breathing. The standard nutrition consisted of a liquid, semi-liquid and solid meal which was labelled with 100 MBq 99mTc-human serum albumin. MEASUREMENTS AND RESULTS: Scintigraphic aspiration (SA) was defined as positive if radioactivity was detected in the bronchial system using a scintillation camera. Furthermore, aspiration was proven clinically (CA). CA and SA yielded identical results in 54 of the 62 patients [10 positive (16%) and in 44 negative (71%)]. CA, but not SA, was seen in 4/62 (6.5%) and SA, but not CA, was found in 4/62 (6.5%) patients. CONCLUSIONS: Our data re-emphasise that aspiration in tracheotomised patients is common (in our study approximately 30%). The scintigraphic method failed to identify all tracheotomised patients with clinically significant aspiration; however, it did suggest that some patients had subclinical aspiration.

Aged↗
PubMed1999

[Daytime mechanical ventilation in chronic ventilatory insufficiency].

BACKGROUND: Nocturnal hypoventilation is associated with chronic ventilatory insufficiency (CVI). Noninvasive mechanical ventilation (NIV) performed overnight relieves symptoms of hypoventilation and improves daytime blood gases in CVI. In order to test whether the efficacy of NIV depends on its being applied during sleep we conducted a prospective case controlled study comparing daytime mechanical ventilation (DV) in awake patients with nocturnal mechanical ventilation (NV) given in equal quantities. PATIENTS AND METHODS: We enrolled 34 clinically stable patients (age: 56.1 +/- 12.1 years, 20 female) with CVI due to both restrictive lung and chest wall disorders and neuromuscular disease. Using a prospective case-control design, matched subjects were allocated alternately to DV and NV. RESULTS AND CONCLUSIONS: There were no significant differences between the groups in the improvement of the measured parameters; (e.g. PaCO2; DV: from 57.6 +/- 4.3 to 44.0 +/- 4.6 mm Hg, NV: from 55.5 +/- 3.5 to 45.0 +/- 4.1 mm Hg, p < 0.0001). We conclude that in many respects, when compared to NV, DV in awake patients is equally effective for the treatment of CVI.

Adult↗
PubMed1999

[Scintigraphic demonstration of aspiration in long-term ventilation patients with tracheotomy].

The main complication of enteral feeding in prolonged mechanical ventilation via tracheostomy is the subsequent aspiration pneumonia. We used a scintigraphic method for the detection of enteral feeding aspiration and compared the results with clinical evidence of aspiration. The study population consisted of 62 consecutive tracheotomised patients (16 females, age: 64.1 +/- 11.1 years). The swallowing test was done in an upright or semirecumbent body position with the patients spontaneously breathing. The standard feed consisted of a liquid, semiliquid and solid meal which was labelled by 100 MBQ 99 TC. Scintigraphic aspiration (SA) was defined as positive if radioactivity was detected in the bronchial system. Clinical aspiration (CA) was defined as positive if there was cough, choking and distress after swallowing; furthermore, when receiving enteral feeding during suctioning or bronchoscopy. Both clinically significant aspiration (CA) and scintigraphic aspiration (SA) were found to be identical in 10 of 62 (16%) patients. CA, but not SA: 4/62 (6.5%). SA, but not CA (Subclinical aspiration): 4/62 (6.5%). Nor CA neither SA: 44/62 (71%) patients. Radiolabelled feed can be used as a feasible marker to detect aspiration. The test is a useful screening test and strategy to minimize aspiration. The scintigraphic method failed to identify all tracheotomised patients with clinically significant aspiration. However, scintiscanning did suggest that some patients had subclinical aspiration.

Deglutition↗
PubMed1997

[Anemia increases work of breathing in patients with lung disease].

BACKGROUND: Pulmonary diseases with marked disorders in gas exchange or chronic overload of the respiratory pump needs increased ventilatory requirements. Additionally in these patients anemic may aggravate the ventilatory load. We thereby evaluated whether in these patients treatment of anemia (red blood cell transfusion: RBCT) leads to an improvement of the ventilatory load in comparison to the anemic patients without pulmonary disease. PATIENTS AND METHODS: We examined 21 patients with an anemia (Hb < 11 g%, 12 men). Fifteen patients had a pulmonary disease (group A), 6 patients suffered from anemia without pulmonary disease (group B). Subsequently within 8 hours the patients got 2 to 3 RBCT. We studied the patients on the day of admission and 24 to 36 hours after transfusion. The patients kept bed rest for spontaneous breathing 1 hour prior to the actual examination without supplemental oxygen. Hemoglobin, hematocrit, respiratory rate, respiratory minute volume and arterial blood gases were measured. On the following day we repeated the same procedures. RESULTS AND CONCLUSIONS: Anemia in patients with an increased ventilatory requirement causes an additional increase of work of breathing. In these patients-in contrast to patients without compromised lungs-2.2 red blood cell transfusions lead to an impressive reduction of VE (about 20%) and correspondingly also to a reduction of WOB.

Aged↗