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Biomedical subjects

R Thurnheer

Publications and source records attributed to R Thurnheer.

At least 19 recordsLinked to original sources
PubMed2003

Simultaneous bilateral spontaneous pneumothorax in a patient with recurrent, extraosseous multiple myeloma.

A patient with simultaneous bilateral spontaneous pneumothorax (SBSP) due to pulmonary and pleural manifestations of recurrent multiple myeloma is presented. The patient died in shock of unknown cause. The diagnosis was suspected from pleural fluid examination showing an exudate with numerous plasmocytes. Macroscopically and histologically, the visceral organs and the bone marrow were infiltrated with multiple monoclonal proliferations of plasma cells staining positively for IgG and lambda chains. SBSP is a rare condition and may be caused by trauma, parenchymal lung disease, infections, or neoplasms. This is the first report of SBSP caused by pleuropulmonary infiltration of multiple myeloma.

Aged↗
PubMed2002

Improved quality of life after lung volume reduction surgery.

Lung volume reduction surgery (LVRS) improves dyspnoea, pulmonary function, and physical performance in patients with severe pulmonary emphysema. This study investigated the impact of LVRS on health-related quality of life (HRQL) over a 2-yr period following surgery. Thirty-nine consecutive patients were prospectively assessed before LVRS, and followed over 24 months postoperatively. The assessments included pulmonary function, dyspnoea (Medical Research Council (MRC) dyspnoea score), 6-min walking distance (6MWD) and HRQL using the Short Form 36-item questionnaire (SF-36). Several domains of SF-36 improved considerably over 2 yrs after surgery: Physical Functioning: 39 +/- 4 (mean +/- SEM) versus 16 +/- 2 (p<0.01); Vitality: 51 +/- 3 versus 32 +/- 3 (p<0.01); Social Functioning: 72 +/- 4 versus 51 +/- 5 (p<0.01). Also, improvements in pulmonary function (forced expiratory volume in one second (FEV1): 27 +/- 1% predicted, residual volume (RV)/total lung capacity (TLC): 0.65 +/- 0.01), 6 MWD (274 +/- 16 m) and dyspnoea (MRC: 3.9 +/- 01) were sustained for up to 2 yrs after LVRS (FEV1 36 +/- 2% pred, RV/TLC: 0.58 +/- 0.02; 6 MWD: 342 +/- 19 m; MRC: 2.0 +/- 0.2; p<0.05). In patients with severe emphysema, lung volume reduction surgery had positive effects on health-related quality of life and pulmonary function over 2 yrs.

Dyspnea↗
PubMed2001

Accuracy of nasal cannula pressure recordings for assessment of ventilation during sleep.

Nasal prong pressure monitoring (PNOSE) is utilized to assess ventilation during sleep. However, it has not been rigorously validated against the gold standard of face-mask pneumotachography (VFM). Therefore, we compared PNOSE with VFM in 20 patients with suspected sleep apnea during nocturnal polysomnography, and analyzed factors affecting accuracy of PNOSE-derived variables. Patients rated their nasal obstruction on a visual analog scale. Mean +/- SE apnea/hypopnea index (AHI) by VFM was 24.0 +/- 5.1 h(-1). The bias (mean difference) and limits of agreement (+/- 2 SD) of AHI derived from PNOSE, and square root-transformed PNOSE, a measure proposed as a surrogate of airflow, were +3.9 (+/- 4.6), and -0.9 (+/- 9.0) h(-1). Subjective scores of nasal obstruction before polysomnographies did not herald inaccuracy of AHI from PNOSE. Square root-transformed PNOSE closely tracked pneumotachographic airflow over 10 breaths (r(2) among signals 0.88 to 0.96) but the relationship among these signals was highly variable if comparisons were extended over an entire night. Compared with face-mask pneumotachography, nasal pressure monitoring provides accurate AHI for clinical purposes even in patients perceiving nasal obstruction. Square-root transformation provides near linear nasal pressure/airflow relationships over a short time but is not essential for estimation of AHI.

Adult↗
PubMed2001

Influence of age and gender on upper airway resistance in NREM and REM sleep.

The prevalence of irregular breathing during sleep is age and gender dependent, but the reason for this is unknown. This study tested the hypothesis that older men have a greater sleep-related increase in respiratory resistance. In 48 healthy subjects, 12 in each of four groups of younger and older men and women, airway resistance was measured during wakefulness and sleep using a mask, pneumotachograph, and catheter-mounted pressure sensors. Total respiratory resistance and total "low-flow," and "high-flow" oropharyngeal resistance were analyzed from 170,000 breaths, high flow being at rates above 50% maximal inspiratory flow. High-flow oropharyngeal and total respiratory resistance increased during non-rapid eye movement (NREM) sleep in all groups but not low-flow resistance. Total respiratory resistance increased from 12 +/- 1.2 cmH(2)O. l(-1). s(-1) awake to 16.2 +/- 2.4 in NREM sleep in young men, from 22.8 +/- 3.6 to 33.6 +/- 5.4 in young women, from 18 +/- 3 to 34.8 +/- 4.8 in older men, and from 26.6. +/- 4.2 to 34.2 +/- 6 in older women. The percentage of change in total respiratory resistance from awake to NREM sleep was not different between age groups or genders. We conclude that there are no major age or gender differences in the changes in airway resistance with sleep in normal subjects.

Adolescent↗
PubMed2000

Redo lung volume reduction surgery in a patient with alpha1-antitrypsin deficiency.

Lung volume reduction surgery is a palliative procedure that improves dyspnea and pulmonary function in selected patients with advanced emphysema. Postoperative benefit is sustained for an individual period and depends on the emphysema morphology, the surgical technique, and other not yet well-defined factors. The question whether lung volume reduction surgery can be performed a second time on the same thoracic cavity is often raised but experience in this regard is lacking. We describe a patient who has undergone a successful redo operation 2 years after the initial lung volume reduction surgery.

Humans↗
PubMed2000

[Diagnosis of sleep apnea syndrome--role of family practitioner].

The obstructive sleep apnea syndrome is a highly prevalent and underdiagnosed disease. Repetitive arousals due to upper airway obstruction lead to hypersomnia. Due to the insidious onset, patients often underestimate the severity of their symptoms. Relatives can give helpful additional informations and should be involved in history taking and motivation for treatment. In general, GP's are confronted with the problem of fatigue and hypersomnia in the first line. They play the most important role in selecting patients for further investigations. The patient history helps to separate hypersomnia from fatigue. Hypersomnia indicates falling asleep at daytime in unappropriate situations, especially when the subject is passive. Often, a multidisciplinary approach including respiratory physicians, ENT specialists, orthopedic dentists and neurologists is warranted. Anatomic narrowing of the upper airway must be ruled out by clinical investigation. Overnight sleep studies detect apneas/hypopneas and repetitive arousals. Continuous positive airway pressure, applied by a nose mask and a flow generator remains the mainstay of therapy. Motivation, counseling and troubleshooting especially in the beginning of this therapy are of outmost importance. Ongoing research aims to improve comfort of nose masks and optimize function of flow generators.

Adult↗
PubMed1999

Efficacy and cost effectiveness of oral ganciclovir in the prevention of cytomegalovirus disease after lung transplantation.

BACKGROUND: Cytomegalovirus is the single most frequent pulmonary pathogen in lung transplant recipients who survive at least 2 weeks. Patients at increased risk are either seropositive or have received an allograft from a donor with latent infection. Morbidity and mortality caused by cytomegalovirus disease is still considerably high. METHODS: In an open, comparative study, we evaluated the efficacy, tolerance, and cost effectiveness of postoperative ganciclovir prophylaxis: intravenous dose of 2x5 mg/kg/day for 14 days, followed by either intravenous doses of 5 mg/kg]day (five patients), or oral doses of 3x 1000 mg (nine patients) up to 90 days. Oral ganciclovir was continued until prednisone was tapered below 15 mg/day. Prophylaxed groups were compared with a historical control (eight patients) in respect to cytomegalovirus disease, in-hospital stay, overall costs, and survival. Follow-up times and the net state of immunosuppressive therapy between groups were comparable. RESULTS: Six (75%) of the non-prophylaxed patients developed cytomegalovirus disease compared to none in the intravenous and one in the oral ganciclovir group (P=0.013). The non-prophylaxed patients had a longer cytomegalovirus-related in-hospital stay (P=0.018) and nonsignificantly higher cytomegalovirus-related costs. Bronchiolitis obliterans syndrome was less frequent with prophylaxis (P=0.039), and survival tended to be better (P=0.072). The only adverse effect was a subclavian vein thrombosis in the intravenous ganciclovir group. CONCLUSIONS: In lung transplant recipients, ganciclovir prophylaxis, either intravenous or oral, is safe, well tolerated, and effective in preventing cytomegalovirus disease. Moreover, ganciclovir prophylaxis seems likely to reduce the incidence of bronchiolitis obliterans syndrome. The oral formulation might be preferable because its convenience and possibly lower costs.

Administration, Oral↗
PubMed1999

Practicability and safety of dipyridamole cardiac imaging in patients with severe chronic obstructive pulmonary disease.

We tested the practicability of dipyridamole myocardial nitrogen-13 ammonia positron emission tomography (dipyridamole (13)NH(3 )PET) for the perioperative risk assessment of coronary artery disease (CAD) in a cohort of patients with severe chronic obstructive pulmonary disease (COPD) undergoing lung volume reduction surgery (LVRS). Twenty consecutive LVRS candidates, 13 men and 7 women (mean age 57+/-2 years), without symptoms of CAD were prospectively studied by dipyridamole (13)NH(3 )PET. Side-effects and overall tolerance were assessed by a questionnaire and visual analogue scale. Repeated pulmonary function tests were performed before and 4, 12, 16 and 30 minutes after dipyridamole injection. All dipyridamole (13)NH(3 )PET studies were negative for CAD. Seventeen patients underwent LVRS without cardiac complications; three patients did not undergo LVRS for other reasons. Nine patients suffered intolerable dyspnoea requiring i.v. aminophylline. Mean FEV(1) decreased significantly after dipyridamole infusion: in nine patients the reduction in FEV(1)exceeded 15% from baseline. We found that dipyridamole is not well tolerated and causes significant bronchoconstriction in patients with severe COPD. Although all dipyridamole-induced side effects can be promptly reversed by aminophylline, dipyridamole cannot be recommended as a pharmacological stress in this setting.

Ammonia↗
PubMed1999

Role of lung perfusion scintigraphy in relation to chest computed tomography and pulmonary function in the evaluation of candidates for lung volume reduction surgery.

Lung perfusion scintigraphy is employed to evaluate patients with severe emphysema who are candidates for lung volume reduction surgery (LVRS). Our purpose was to investigate the role of scintigraphy in relation to chest computed tomography (CT) and lung function in this setting. Six observers blinded to clinical data retrospectively scored preoperative scintigrams of 70 patients undergoing bilateral video-assisted LVRS according to the distribution of lung perfusion as homogeneous, intermediately heterogeneous, or markedly heterogeneous. Heterogeneity of emphysema distribution was also assessed by chest CT. Dyspnea and pulmonary function were measured preoperatively and 3 mo postoperatively. In 42 patients with markedly heterogeneous, in 18 with intermediately heterogeneous, and in 10 with homogeneous perfusion, mean (+/- SE) FEV1 increased by 57 +/- 8% (p < 0.0001), 38 +/- 9% (p < 0.001), and 23 +/- 9% (p = NS) (p = NS for intergroup comparisons). In a multiple regression analysis, functional improvement after LVRS was more closely correlated with preoperative hyperinflation and the degree of emphysema heterogeneity estimated by chest CT than with the degree of perfusion heterogeneity assessed by scintigraphy. In 16 of 22 patients with homogeneous emphysema distribution in the chest CT scintigraphy revealed intermediately or markedly heterogeneous perfusion. We conclude that lung perfusion scintigraphy has a limited role in prediction of outcome, but it may help to identify target areas for resection in LVRS candidates with homogeneous CT morphology.

Adult↗
PubMed1998

Effect of lung volume reduction surgery on pulmonary hemodynamics in severe pulmonary emphysema.

OBJECTIVE: The presence of pulmonary hypertension in severe pulmonary emphysema has been considered a relative contraindication to lung volume reduction surgery (LVRS). There was concern that resection of lung tissue might further increase pulmonary artery pressure. To address this point, the prevalence of pulmonary hypertension in candidates for LVRS was investigated. The changes in pulmonary artery pressures after bilateral videoassisted thoracoscopic resection was studied in patients with homo- and heterogeneously destroyed emphysematous lungs. DESIGN: The pulmonary arterial pressures by right heart catheterization were prospectively assessed, before and 6 months after LVRS in 21 consecutive patients (15 males, six females, mean (+/- S.E.) age: 62 +/- 1.9, range 42-74 years). All were former smokers and three had ZZ-AT1 deficiency. The inclusion criteria were: (a) severe bronchial obstruction (FEV1 < 35% predicted); (b) pulmonary hyperinflation (RV/TLC > 0.60); and (c) absence of hypercapnia (PaCO2 < 50 mmHg). RESULTS: The FEV1 had increased from 28 +/- 2% to 35 +/- 3% of the predicted value (P < 0.05) 6 months after surgery. The RV/TLC had declined from 0.65 +/- 0.02 to 0.55 +/- 0.02; PaO2 increased (66 +/- 1 versus 71 +/- 2 mmHg, P = 0.04), PaCO2 (38 +/- 2 versus 36 +/- 1 mmHg, P = 0.26) did not change. The pulmonary artery mean pressure (PAPmean) remained unchanged (18 +/- 1 versus 19 +/- 1 mmHg, P = 0.26). In six patients PAPmean was > or = 20 mmHg (up to 24 mmHg) preoperatively. After 6 months, six patients had a PAPmean > or = 20 mmHg (up to 31 mmHg). CONCLUSIONS: In patients with severe emphysema who are candidates for LVRS (but have only mild to moderate hypoxemia and a PaCO2 < 50 mmHg) we found no relevant pulmonary hypertension and pulmonary artery pressure did not change significantly after surgery. Therefore, routine right heart catheterization is not mandatory for preoperative evaluation.

Adult↗
PubMed1998

Bronchial manifestation of acute febrile neutrophilic dermatosis (Sweet's syndrome).

We describe a 62 yr old female with acute febrile neutrophilic dermatosis (AFND) or Sweet's syndrome, involving the bronchial mucosa. The patient presented with classical skin manifestations of AFND accompanied by bilateral pneumonia, pleural effusions and lesions of the oral mucosa. The diagnosis was confirmed by skin and mucosal biopsies. Bronchoscopy revealed raised pustules, similar to the lesions of the skin, suggesting bronchial involvement of AFND. The patient responded to systemic corticosteroids only for a short period and died as a result of multiorgan failure. Postmortem findings confirmed dense, focal neutrophilic infiltrates of the bronchi and bronchioles. No underlying disease was found.

Bronchial Diseases↗
PubMed1998

Exercise performance and gas exchange after bilateral video-assisted thoracoscopic lung volume reduction for severe emphysema.

Lung volume reduction surgery (LVRS) improves dyspnoea and pulmonary function in selected patients with severe emphysema. The purpose of this study was to assess the effects of LVRS on exercise performance and gas exchange in relation to changes in pulmonary function. In 40 patients (63.2+/-1.4 yrs, mean+/-SE) with severe emphysema (forced expiratory volume in one second (FEV1) 29+/-1% predicted, residual volume/total lung capacity (RV/TLC) ratio: 0.63+/-0.01) we assessed dyspnoea, pulmonary function and exercise performance before and 3 months after bilateral video-assisted thoracoscopic LVRS. The Medical Research Council dyspnoea score fell from 3.5+/-0.1 to 1.4+/-0.1 (p<0.0005); FEV1 increased by 55+/-9% to 44+/-2% pred (p<0.0005), RV/TLC decreased from 0.63+/-0.01 to 0.51+/-0.02 (p<0.0005). The diffusing capacity remained unchanged. Maximal work load during bicycle ergometry increased from 34.3+/-2.0 to 48.9+/-2.4 W (p< 0.0005), maximal oxygen uptake (V'O2max) from 10.0+/-0.4 to 12.8+/-0.3 mL x kg(-1) x min(-1) (p<0.0005). The increase in maximal ventilation during exercise (V'Emax) from 29.5+/-1.5 to 38.6+/-1.8 L x min(-1) (p<0.0005) was associated with increases in tidal volumes at isowatt and maximal exercise while corresponding breathing frequencies remained unaltered. The increases in V'O2max and V'Emax correlated with the increases in FEV1 and the decreases in RV/TLC. We conclude that the improvement in pulmonary hyperinflation and airflow obstruction after bilateral thoracoscopic lung volume reduction surgery may reduce ventilatory limitation, thereby increasing exercise capacity.

Adult↗
PubMed1997

Salvage therapy with mycophenolate mofetil for lung transplant bronchiolitis obliterans: importance of dosage.

BACKGROUND: Bronchiolitis obliterans (BO) is the most important long-term complication of lung transplantation. Treatment of this condition is often unsuccessful. METHODS: A patient presented with early BO. Despite OKT3 and the addition of methotrexate, the patient needed persistently high doses of prednisone to maintain lung function at a moderate level. Only the substitution of azathioprine by mycophenolate mofetil (MMF, 3 g/day) made it possible to reduce the dose of prednisone. RESULTS: Reduction of the dose of MMF to 2 g/day resulted in a deterioration of lung function, which improved impressively after MMF was increased again to 3 g/day. CONCLUSIONS: MMF may be a valuable therapy for lung transplant BO. However, the use of a high dose, i.e., 3 g/day, may be crucial.

Adult↗