Biomedical subjects
Publications and source records attributed to P Kalischewski.
We report a patient with systemic lupus erythematosus complicated by an acute demyelinating neuropathy. Conventional therapy with intravenous immunoglobulins and immunoadsorption complemented by pulse methylprednisolone and cyclophosphamide failed. Institution of filtration of the cerebrospinal fluid was followed by a rapid improvement of the paresis.
BACKGROUND: Hypothetically the right ventricular function measured by Equilibrium Radionuclide Ventriculography (RNV) is determined by the right ventricular ejection fraction and depends on the afterload. We investigated the possibility to evaluate the increased pulmonary artery pressure (PAP) by using this method. PATIENTS AND METHOD: We examined 109 patients (54.6 +/- 11 years) with chronic obstructive pulmonary disease (COPD). Lung function test, analysis of blood gases, pulmonary artery catheterisation and RNV were done within one week. RESULTS: There are 52 patients with non. 37 with labile and 20 with fixed pulmonary hypertension. Patients with normal PAP and nearly normal RVEF (49.2 +/- 8) were used as control group. Patients with pulmonary hypertension have had a lower mean RVEF, but there was no significant difference to the control group. Furthermore there was no significant correlation between mean PAP and RVEF detectable. By using RNV we diagnosed fixed pulmonary hypertension with a sensitivity of 95% and a specificity of 33% reduced RVEF and partial respiratory failure as a second noninvasive parameter achieved a more precise but not sufficient prediction of pulmonary hypertension, tested in Chi Square-Test. Obviously the RVEF depends not only on the afterload but also on the preload and contractility. However, influences on contractility are multidimensional and difficult to assess and to determine. CONCLUSION: Eventually it is not possible to use the RNV for measuring RVEF to diagnose pulmonary hypertension in COPD.
OBJECTIVES: To investigate the frequency, causes, and characteristic features of the course of isolated myasthenic crisis (defined as acute respiratory failure with the need for mechanical ventilation). To compare the effectiveness of three different therapeutic regimens (i.e., continuous intravenous infusion of pyridostigmine, pyridostigmine plus prednisolone, and plasma exchange) in terms of duration of ventilation and outcome of patients with myasthenic crisis. DESIGN: Population-based retrospective study covering the period 1970 to 1995. SETTING: University hospital, center for myasthenia gravis in Saxony, Germany. PATIENTS: Of 235 patients with myasthenia gravis treated at our institution, 44 patients developed a total of 63 myasthenic crises (average annual incidence 2.5%). INTERVENTIONS: Myasthenic crises were treated with pyridostigmine (n = 24), pyridostigmine plus prednisolone (n = 18), and plasma exchange (n = 21). MEASUREMENTS AND MAIN RESULTS: There were no significant differences between the three treatment groups with respect to clinical characteristics, duration of mechanical ventilation, complications, and outcome on release from intensive care and after 3 months. Eleven (17%) patients had severe cardiac arrhythmia, which ended fatally for six patients. CONCLUSIONS: None of the therapeutic regimens applied demonstrated any advantage over the others. All three regimens used were found to be effective and should be applied depending on the circumstances prevailing. Patients with myasthenic crisis must undergo careful cardiac monitoring, and temporary pace-making should be provided where clinically indicated.