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Biomedical subjects

S Daum

Publications and source records attributed to S Daum.

16 recordsLinked to original sources

[Bronchial asthma. Pathogenesis and clinical aspects].

Asthma bronchiale (a.b.) is defined as paroxysmal or permanent, partly or completely reversible dyspnoea due to a bronchospasm resulting from pathological hyperreactivity of the bronchial system. In the pathogenesis participate allergic, immuno-infiltrative and genetic factors, irritating substances (environment) and infectious. The allergic constituent acts via sensitization and allergization of the mast cell, to its degranulation with release of mediators (histamine, serotonin, leukotrienes, thromboxane, PAF) with subsequent bronchoconstriction and production of viscous mucus. As to adrenergic factors, a block of beta-adrenergic receptors and reduced adrenal function is involved. As to non-adrenergic factors an increased sensitivity of the parasympathetic--vagus is involved which conditions bronchoconstriction and hyperkrinia. From the clinical aspect extrinsic (atopic) and intrinsic (cryptogenic) asthma bronchiale can be differentiated. The former is encountered more frequently in childhood and adolescence, in subjects with a positive family-history, high IgE and positive skin tests and a known allergen. The latter type of a.b. is found in adolescence, in subjects with a negative family-history, with eosinophilia; it is conditioned by infection (e.g. chronic bronchitis), strain, cold and takes a dangerous course (aspirin). As to the course, attacks of a.b. are involved with a symptom-free interval (extrinsic a.) easily controlled by treatment. Then there is the chronic form with a variable course and the necessity of permanent treatment. Status asthmaticus is in recent years with increasing frequency the cause of death and thus calls for maximal treatment. It is the third most serious form of a.b. Assessment of arterial blood gases is very important as a check of treatment as well as from the prognostic aspect (cross-over intubation). From the differential diagnostic aspect we must consider the asthmoid component in chronic bronchitis, pulmonary embolism, left-sided cardiac failure, tracheal or bronchial compression by an aortal aneurysm, tumour. The differential diagnosis is not always easy.

Asthma

Phenotypic and functional characterization of human TCR gamma delta+ intestinal intraepithelial lymphocytes.

Intestinal intraepithelial lymphocytes (IEL) appear to represent a peculiar set of immune cells compartmentalized at the interface between the organism and the external environment. In previous studies we observed that within human IEL TCR-tau/delta T cells represent a major fraction that predominantly express the CD8 molecule and preferentially uses the V-delta-1 gene segment. Thus these data suggested a preferential accumulation/homing of CD8+ V-delta-1+ IEL within the human intestinal epithelium. However, to date the functional role of these cells with regard to immune regulation at this most critical immunological site is poorly understood. In this study, the cytotoxic potential and proliferative capacity of human IEL in response to mitogenic stimuli has been characterized with respect to IEL T cell receptor type and TCR-tau/delta variable gene segment usage as determined by flowmetry. The frequency of TCR-1+ IEL expressing both CD56 and CD16 which are considered to be NK-cell markers was found to be much higher (38.9 +/- 12.4%) than within intestinal lamina propria lymphocytes (LPL) (9.1 +/- 4.8%) or peripheral blood lymphocytes (PBL) (6.4 +/- 3.3%). In contrast, the fractions of CD16-CD56+ cells within IEL, LPL and PBL were comparable. Surprisingly, IEL mediated NK-cell activity (K562 lysis) was virtually absent whereas within PBL it was within the normal range. Furthermore, in cytotoxicity assays employing 51Cr-labeled OKT3 hybridoma cells and P815 cells as targets, the cytotoxic potential of IEL was much lower than that of PBL.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Palliative endobronchial tumor reduction by laser therapy. Procedure--immediate results--long-term results.

Over a period of 3 years, 224 laser treatments were performed on 105 patients. 84% were carried out under local anesthesia and 16% under general anesthesia. A neodymium-YAG laser (MBB-AT) was used. In 74% of the cases complete or partial tumor removal was possible. 72% of the successfully recanalized stenoses were still open after 4-6 months. In 19% of the cases low-grade complications occurred. The mortality was below 1%. The chief indications for endobronchial laser treatment are exophytic endobronchial tumors in the area of the trachea and primary bronchi. Endobronchial laser coagulation is indicated when surgery is no longer possible. It serves primarily to improve ventilation and bronchial drainage and in particular to prevent retention pneumonia.

Bronchial Neoplasms

Asbestos disease in maintenance workers of the chemical industry.

In several large groups of workers employed in chemical plants, chest x-ray abnormalities (small irregular opacities and/or pleural changes) of the type known to be induced by asbestos were found in a proportion of those examined. A cross-sectional study of maintenance workers in a large chemical plant was undertaken to evaluate the prevalence of asbestosis; 185 workers were examined. Radiologic evidence of parenchymal interstitial fibrosis was found in 24% of those examined; in 10% of workers, parenchymal fibrosis was the only abnormality. Pleural fibrosis and/or calcification was found in the absence of parenchymal fibrosis in 14% of cases; in another 14% of workers, both parenchymal and pleural abnormalities were detected. The prevalence was significantly higher in those employed 20 or more years. Pleural abnormalities were more prevalent than were parenchymal changes. The increased risk of lung cancer and mesothelioma remains to be studied.

Adult

[Hemodynamic studies during temporary, unilateral occlusion of the pulmonary artery (author's transl)].

During pre-operative evaluation of 35 patients prior to pulmonary resection, pressure measurements in the right heart and pulmonary circulation were performed. In addition to pressure values, pulmonary ventilation and partial pressures of the blood gases were assessed before and during unilateral occlusion of the pulmonary artery at rest and during exercise. Statistically significant increased values from regression analysis were obtained for mean pulmonary artery pressure, right ventricular end-diastolic pressure, pulmonary vascular resistance and right ventricular work. The results show that plethysmorgraphic and ergometric studies as well as their combination with blood gas analysis, are not indicative of changes in right ventricular or pulmonary arterial hemodynamics. Prior to pulmonary resection, catheterization should be performed at rest and during exercise to assess these variables.

Adult

Health status of styrene-polystyrene polymerization workers.

Styrene monomer is a greatly used chemical, chiefly in the production of polystyrene. A cross-sectional health survey of 493 production workers was undertaken at the oldest and largest monomer production, polymerization, and extrusion facility in the United States. Relative exposure durations and levels were obtained from occupational histories and corroborated by spot air sampling, blood and fat styrene concentrations and levels of urinary mandelic and phenylglyoxylic acids. Statistically significant differences between the prevalence of abnormalities in high and low exposure groups were found for the following: history of acute prenarcotic symptoms, history of acute lower respiratory symptoms, peroneal nerve conduction velocities, relative lymphocytosis, and elevated gamma glutamyl transpetsidase. The following showed no distinct pattern in prevalence when analyzed by exposure group: chest radiographic changes; indices or restrictive, obstructive and small airway dysfunction; other hepatic and hematological parameters; carcinoembryonic antigen level; sputum cytopathology; radial nerve conduction velocities; and ophthalmological findings. Clinically significant abnormalities were rare.

Environmental Exposure

[Acute respiratory distress syndrome after near-drowning (author's transl)].

After successful rescue from drowning there may develop a situation which is called secondary drowning, resulting in acute respiratory distress characterized by interstitial pulmonary oedema, hypoxaemia, hypercapnia and acidosis during drowning, direct alteration of the alveolar membrane by aspirated water and particulate matters and a volume overloading by adsorption and--not seldom--inept therapy. This situation requires mechanical ventilation and forced diuresis, combined with high doses of steroids, antibiotics and digitalis. We present the case of an eleven year old patient whose clinical course demonstrate the necessity of exact clinical observation after rescue from drowning. After development of acute respiratory distress only the immediate utilization of the therapeutic modalities of an intensive care may result in a satisfactory outcome. Four months later our patient had normal pulmonary function except for a moderate reduction of compliance.

Anti-Bacterial Agents

Clinical studies of styrene workers: initial findings.

Styrene monomer is a high volume chemical used chiefly in production of polystyrene. A clinical survey of 493 production workers was undertaken at the oldest and largest monomer production, polymerization, and extrusion facility in the U.S. Relative exposure durations and levels were obtained from occupational histories. Significant differences between the high and low exposure groups were found with regard to history of acute prenarcotic symptoms, acute lower respiratory symptoms, prevalence of FEV 1/FV less than 75 per cent, and elevated GCTP. Other liver function tests, chest x-ray, FVC less than 80 per cent, and hematological parameters showed no distinct pattern. A concomitant mortality study has been mounted and is in progress.

Adult