[Sleep apnea. Pathophysiology, diagnosis, therapy].
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Carbon Dioxide↗
Biomedical subjects
S Thalhofer
Publications and source records attributed to S Thalhofer.
[Pleural diseases in magnetic resonance tomography (MRT)].
MR images of 48 patients with histologically confirmed benign and malignant diseases of the pleura were retrospectively compared with CT and bioptically/surgically obtained findings. In 47/48 patients pathological changes of the pleura were visualized by increased signal intensities on T2-weighted and contrast enhanced T1-weighted MR images. This lead to a slightly improved sensitivity compared to CT, where pathological pleura findings were confirmed in 45/48 patients. MRI was able to identify 24/28 confirmed pleural effusions, whereas CT was successful in 26/28 patients. In two cases effusions not identified on CT were visible on T2-weighted MRI. 4 pleural effusions were missed with MRI.. On CT images differentiation of pleural changes vs effusions or adjacent lesions of lung parenchyma was successful in 20/28 and in 17/23 cases, respectively. Contrast enhanced T1-weighted images achieved the highest diagnostic accuracy with 22/28 and 20/23 cases, respectively. Signal intensities on MRI were unsuitable as sole criterion for the differentiation of benign and malignant diseases of the pleura. Contour and pattern of spreading of pleural changes were helpful in differential diagnosis. Nodular changes, thickening of more than 10 mm and mediastinal, circumferential and entire hemithoracic affection of the pleura were suggestive for malignant pleural disease. Infiltration of the diaphragm and the chest wall were most indicative for malignancy; here MRI (2/2 resp. 18/19 cases) was superior to CT (0/2 resp. 14/19 cases). CT was superior in the detection of pleural calcifications and osseous destruction.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Nuclear medicine diagnosis in bronchial cancer].
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Antibodies, Monoclonal↗
[Oxygen saturation and sleep structure in patients with dilated cardiomyopathy].
It is known that patients suffering from severe cardiomyopathy may develop cyclic changes in breathing (Cheyne-Stokes-breathing) (2, 3). Coughing and dyspnea may be linked to periodic breathing. Specific detailed polysomnographic studies of sleep architecture and oxygen saturation have not been published. Eight patients suffering from dilatative cardiomyopathy (NYHA III-IV) were studied by pulse oximetry and polysomnography. Six of eight patients had severe breathing irregularities. These disturbances became manifest partially as Cheyne-Stokes breathing, partially as central sleep apnea. During these periods, oxygen saturation dropped as far as to 65 per cent of the original level.
Adult↗
[Drug therapy of sleep-related respiration disorders].
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Carbonic Anhydrase Inhibitors↗
[Therapy of sleep apnea with theophylline (Uniphylline) administration every evening].
Sleep apnoea (SA) has a prevalence of 1-10% in men. The physiological sleep is disturbed. SA is associated with cardiopulmonary disease (systemic arterial hypertension, cardiac arrhythmics, cor pulmonale) and the quality of the patient's life is reduced. Thirty male patients participated in a study to investigate the influence of an oral dose of theophylline on sleep apnoea. Under theophylline a significant reduction of apnoea events and of the apnoea index was seen.
Adult↗
[Long-term follow-up of sleep apnea therapy with sustained-release theophylline administered every evening].
Sleep apnoea increases mortality and morbidity. The physiological sleep profile is disturbed and functional capacity is decreased. At present nasal CPAP breathing (continuous positive airway pressure) seems to be the best treatment method in obstructive sleep apnoea. However, this therapy is expensive, imposing a strain on the patient, and hence some patients will not tolerate it. Medical treatment of sleep apnoea with theophylline has proved effective. In 40 patients suffering from sleep apnoea, long-term treatment with sustained-release theophylline was investigated. Responders show a significant reduction of apnoeic phases and of apnoea index at the beginning and after long-term treatment. Using an individual theophylline dosage with morning theophylline concentration between 5 and 8 micrograms/ml, only few side-effects occurred. Positive effects on cardiopulmonary capacity could be detected. The Broca index does not change significantly. Sustained-release theophylline applied in the evening showed a positive effect on sleep apnoea in responders.
Adult↗
[Hemodynamic changes with and without CPAP-ventilation in patients with sleep apnea].
In 21 patients suffering from severe sleep-apnoea syndrome we measured continuously haemodynamic parameters, blood gases, ECG, EEG, respiratory rate and ultrasonic cardiogram before and under treatment with nasal CPAP-breathing. All patients (male, age 29 to 58 yrs) had normal blood gases, heart-minute-volumes pulmonary artery pressures and left ventricular end-diastolic wedge pressures, when they were awake. During sleep all developed a decrease of pO2 and severe pulmonary artery hypertension with mean pulmonary artery pressures of 64 mmHg. In 10 patients an enlargement of the right ventricular diameter up to 13 mm difference could be seen. Treatment with nasal CPAP-breathing could reduce or even prevent changes in blood gases and in the haemodynamic system. The pulmonary artery pressures normalised in all patients. No right ventricular enlargement could be seen during nasal CPAP-breathing. Treatment with CPAP-breathing could normalise haemodynamic disorders in patients with severe SAS and may perhaps prevent development of cor pulmonale.
Adult↗
[Follow-up study of patients with sleep-related respiration disorders without obstruction of the upper airways (central apnea)].
This is a report on 16 patients with central asphyxia. All patients had respiratory global insufficiency. The period of observation was 3.5 years. In all cases deterioration of the blood gases took place. All patients died due to right heart failure. Implantation of a diaphragm pacer caused an increase of pO2 during sleep.
Carbon Dioxide↗
Long-term treatment of angina pectoris with bisoprolol or atenolol in patients with chronic obstructive bronchitis: a randomized, double-blind crossover study.
Forty outpatients suffering from angina pectoris due to coronary artery disease and concomitant reversible. chronic obstructive bronchitis were treated with the beta1-selective beta-blockers atenolol (50 mg) and bisoprolol (5 mg) for 6 months in each case, following a randomized, double-blind crossover study design. Lung function tests were carried out by means of whole-body plethysmography before and then several times during treatment. 2 to 4 h after drug intake (once daily in the morning). The main target variables for the factorial analysis of variance for comparison of the two beta-blockers were the airway resistance (AWR), the forced expiratory volume in the first second (FEV1), and the peak expiratory flow rate (PEFR). Bicycle ergometry was performed before and after therapy in order to check the cardiovascular effects of the two beta-blockers. The patients were questioned as to their angina pectoris and bronchitis symptoms at the monthly check-ups. There was no difference between the two beta-blockers (p > 0.05), both causing a slight increase in AWR, which increased with therapy duration, and a small but significant decrease in FEV1 and PEFR (p < 0.01). The bronchitis symptoms were not affected; however, seasonal influences were detected. Atenolol and bisoprolol had comparably pronounced effects on the cardiovascular parameters during ergometry (blood pressure, heart rate, W x min product, and ST-segment depression) and the frequency of angina pectoris attacks. Even beta1-selective beta-blockers may cause an impairment of lung function in patients with chronic obstructive bronchitis. This may be due to the presence of beta1-adrenoceptors in the bronchial tissue. Fifty milligrams of atenolol and 5 mg of bisoprolol once per day are effective in the treatment of angina pectoris.
Adrenergic beta-1 Receptor Antagonists↗
Tranquilizers, analgetics and antidepressants in patients treated with hemodialysis.
Tranquilizers, analgetics and antidepressants are applied in different ranges in the treatment of patients on hemodialysis. Due to many different pharmacokinetic properties, no perfect rules for dosage in acute or chronic hemodialysis exist. Adequate applicable drugs without adaptation disregarding different states of renal failure are such with predominate hepatic metabolism and elimination or with inactive metabolites. In the management of acute renal failure, usually in connection with multiple organic disorders, a nonschematic, individually adapted therapy is indicated. In some substances, therapy can be determined by control of plasma concentration levels, in other drugs dosage is possible exclusively according to clinical effects. Substances with side effects on coagulation or acid-base equilibrium should be avoided. It is recommendable to get well acquainted with one substance out of each group in order to avoid polypragmasy.
Acetaminophen↗
[Therapy of bronchial cancer in the elderly].
Multimorbidity and prognosis of tumor determine diagnostic and therapeutic management of bronchial carcinoma in the elderly. The knowledge of histopathological diagnosis is important for further therapy. Physiological alterations and decreased cardiopulmonary capacity allow surgical resections in a reduced extent, only. In elderly, chemotherapy of small-cell-cancer often shows side-effects. Therapeutic management with a palliative character should mostly be used in elderly.
Aged↗
[Changes in cardiopulmonary capacity after pacemaker implantation in the elderly].
Elderly patients often suffer from several diseases. A combination of heart failure and low heart rate causes a decrease of cardiopulmonary capacity in the elderly. Analysis of gas exchange during exercise allows to determine cardiopulmonary capacity. Twenty-one patients older than 70 years were examined by spioergometry, before and 1 week after implantation of a pacemaker. Blood pressure, breath-frequency, oxygen-uptake, carbon dioxide emission, and respiratory quotient were measured. One week after implantation of a pacemaker system, there was an improvement of cardiopulmonary capacity and oxygen uptake at the moment of aerobic-anaerobic exchange. An additional positive effect was seen in elderly patients after implanting a system with rate-response stimulation (VVIR). Elderly patients with bradycardia profit from the implantation of a pacemaker system. Rate-response stimulation seems to be more effective in increasing cardiopulmonary capacity in the elderly.
Aged↗