RESUMEN
Pulmonary rehabilitation of patients with advanced lung diseases especially with COPD patients has become more important over past years. For patients in which lung transplantation is indicated major studies concerning pre- and postoperative rehabilitation are still missing. Nevertheless, growing evidence suggests that training therapy and other components of comprehensive rehabilitation should be an essential part of the whole concept in order to augment the therapeutic success of LTx. The time prior to LTx may be used as "bridging to transplant" by improving strength, endurance and mobility. Intensive motivation and knowledge transfer can prepare patients as good candidates. The rehabilitation after LTx aims at regaining physical abilities and health related quality of life using the increased breathing capacities. The manuscript presents the importance, aims and specific features of rehabilitation prior to and following LTx. Finally the therapeutic concept will be discussed with regard to the economic burden and the limited resources in lung transplantation.
Asunto(s)
Enfermedades Pulmonares/rehabilitación , Enfermedades Pulmonares/cirugía , Trasplante de Pulmón/efectos adversos , Trasplante de Pulmón/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Terapia Combinada , Humanos , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/rehabilitación , Cuidados Preoperatorios/métodosRESUMEN
BACKGROUND: Oxy-Gen lite, a recently developed combined electrolysis and fuel cell technology, de-novo generates oxygen with high purity for medical use from distilled water and room air. However, its use in patients with chronic respiratory failure has never been evaluated. OBJECTIVES: To test the clinical applicability and safety of Oxy-Gen lite technology, we enrolled 32 COPD patients with chronic hypoxemia and long-term oxygen therapy (LTOT) in a controlled, randomized, multicenter clinical trial. MATERIALS AND METHODS: Standard continuous oxygen therapy with a maximal flow rate of 2 L/min was tested against pulsatile oxygen delivery by Oxy-Gen lite. Oxygen saturation at seated-rest was recorded over 30 min and used as a primary read-out parameter. Oxygen saturation was also recorded during mild physical strain (speaking out loud) or overnight's sleep. RESULTS: Both methods of oxygen supply established oxygen saturations within the normal range (i.e., upper plateau of the sigmoid oxyhaemoglobin dissociation curve) compared to breathing room air (p<0.0001). Mean oxygen saturation under standard continuous oxygen flow or Oxy-Gen lite technology during rest, physical strain or sleep proved statistically equivalent (95%CI<2.5% of reference saturation). CONCLUSION: The use of Oxy-Gen lite in COPD patients with hypoxemia and LTOT Asunto(s)
Terapia por Inhalación de Oxígeno/instrumentación
, Enfermedad Pulmonar Obstructiva Crónica/terapia
, Adulto
, Anciano
, Suministros de Energía Eléctrica
, Electrólisis/instrumentación
, Diseño de Equipo
, Femenino
, Humanos
, Hipoxia/sangre
, Hipoxia/terapia
, Masculino
, Persona de Mediana Edad
, Oxígeno/sangre
, Esfuerzo Físico
, Enfermedad Pulmonar Obstructiva Crónica/sangre
, Descanso
, Sueño
RESUMEN
BACKGROUND AND OBJECTIVE: Hantavirus ("epidemic") nephropathy (HN), or hemorrhagic fever with renal syndrome (WHO nomenclature), is an infection caused by strains (e.g. Puumala) of Hantavirus, which is often accompanied by acute renal failure. Although its typical symptomatology has been fully reported, it is rarely included in the differential diagnosis of renal nephropathy. This study investigated whether, in the presence of typical symptoms, specific search for a certain constellation of laboratory values in association with a typical history can more often provide the diagnosis of HN. PATIENTS AND METHODS: 18 patients (4 females, 14 males; average age 41 years) fulfilled the following inclusion criteria: abnormal values for creatinine, LDH and C-reactive protein, proteinuria and hematuria, as well as thrombocytopenia in conjunction with fever, back- and headache. After the diagnosis had been confirmed by demonstrating antibodies against the Puumala strain of hantavirus, follow-up included laboratory tests and clinical observation. RESULTS: All patients fully recovered without any sequelae. There was a clearly increased frequency of cases at the Reutlingen Clinic compared with the previous years (maximally 7 cases per year in 1995-1999). The incidence in the Reutlingen region was probably at least 6.5/100 000 inhabitants. CONCLUSION: At least in endemic regions HN is one of the most common causes of acute renal failure. The increase of cases can, among other reasons, be explained by the described prospective diagnostic schema. But climatic factors with changes in the density of the vector (bank vole) cannot be excluded.
Asunto(s)
Lesión Renal Aguda/etiología , Anticuerpos Antivirales/análisis , Fiebre Hemorrágica con Síndrome Renal/diagnóstico , Virus Puumala/inmunología , Adulto , Animales , Proteína C-Reactiva , Creatinina/sangre , Diagnóstico Diferencial , Femenino , Alemania/epidemiología , Fiebre Hemorrágica con Síndrome Renal/complicaciones , Fiebre Hemorrágica con Síndrome Renal/epidemiología , Humanos , Masculino , Proteinuria , Enfermedades de los Roedores/transmisión , Roedores , ZoonosisRESUMEN
HISTORY AND ADMISSION FINDINGS: A 34-year-old man with chronic inflammation of both tear glands for 10 years was admitted because of severe upper abdominal pain and jaundice. INVESTIGATIONS: Transaminase and cholestasis parameters were raised, as were gamma-globulins on electrophoresis. Ultrasound revealed an echo-poor diffusely enlarged pancreas with hypervascularity on colour-Doppler. Endoscopic retrograde cholangiopancreatography (ERCP) indicated chronically changed pancreatic ducts of varying diameter and stenosis, as well as a filiform distal stenosis of the common bile duct. A pancreatic biopsy showed chronic sclerosing pancreatitis with broad periductal lymphocytic infiltration. TREATMENT AND COURSE: ERCP and a guide-wire papillotomy were performed, followed by placement of a nasobiliary catheter. All findings markedly improved on oral prednisone. CONCLUSION: This case supports the supposition that in idiopathic chronic pancreatitis autoimmune processes may be responsible for the changes in the pancreatic ducts. Immunosuppressive treatment is thus recommended in these cases.
Asunto(s)
Enfermedades Autoinmunes/diagnóstico , Pancreatitis/diagnóstico , Administración Oral , Adulto , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Enfermedades Autoinmunes/diagnóstico por imagen , Enfermedades Autoinmunes/tratamiento farmacológico , Colangiopancreatografia Retrógrada Endoscópica , Enfermedad Crónica , Estudios de Seguimiento , Humanos , Masculino , Pancreatitis/diagnóstico por imagen , Pancreatitis/tratamiento farmacológico , Prednisona/administración & dosificación , Prednisona/uso terapéutico , Factores de Tiempo , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler en ColorRESUMEN
UNLABELLED: The conventional ultrasound examination of the pancreas from ventral is - especially concerning the leftsided parts of the organ - limited by interposition of stomach, flexura duodenojejunalis or colon. The transsplenic view to the cauda pancreatis is less known, but allows quite often a good possibility to examine this part of the retroperitoneal organ, even when examination from ventral is impossible. AIM: Comparison of ventral and transsplenic ultrasound examination - with and without tissue harmonic imaging (THI) - in regard to the diagnostic accessability to the cauda pancreatis. METHOD: Ultrasound examination of 135 patients from both positions with and without THI and comparison of the accessability by experienced examiners. RESULTS: As examination from the ventral position allows a proper view to the cauda only in 58 %, the transsplenic position allows an adequate view in 98 %. The examiners regarded THI as a useful improvement in examining the pancreas in 85 %. CONCLUSION: The transsplenic view to the pancreas is less known than the examination from the classical ventral transducer position. It enables the examinator quite often to examine the pancreatic cauda even when examination from ventral is impossible. Therefore it should be enclosed in the routine procedure of abdominal ultrasound examination. THI is a further possibility to improve the ultrasound access to the pancreas, especially when conditions for a good view and proper examination are limited.
Asunto(s)
Páncreas/diagnóstico por imagen , Bazo/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Páncreas/fisiología , Postura , Bazo/fisiología , Ultrasonografía/métodosRESUMEN
HISTORY AND CLINICAL FINDINGS: A previously healthy 32-year-old woman was admitted with shock symptoms 5 days after an uneventful home delivery. She developed a fever up to 39.5 degrees C during the days after delivery with sore throat, diarrhoea and muscle aches in all limbs. On physical examination there were swellings of the arms and lower legs as well as macular and vesicular erythrodermia, especially of the trunk. INVESTIGATIONS: Abnormal laboratory findings were thrombocytopenia (20,000/microliters), increased serum concentrations of fibrin breakdown products (102 mg/dl) and of C-reactive protein (> 200 mg/dl), increased creatine kinase (5700 U/l), transaminases (GOT 220 U/l, GPT 52 U/l), creatinine (2.0 mg/dl) and urea (114 mg/dl). Streptococcus pyogenes was grown on blood culture and from vaginal smear. Sonography, echocardiography and radiological examinations failed to demonstrate a septic focus. TREATMENT AND COURSE: Mechanical ventilation was required for 7 days because of respiratory failure and shock symptoms (toxic shock-like syndrome, TSLS). Penicillin G and tobramycin were given after the bacteriological diagnosis. Severe consumption coagulopathy was successfully treated with antithrombin III and platelet concentrates. After extubation she was found to have a flaccid tetraparesis, especially of the right and of the legs, due to soft-tissue necrosis and damage to peripheral nerves. An embolic occlusion of the right brachial artery 4 weeks after onset of the disease required upper-arm amputation. CONCLUSION: One of the decisive factors for the prognosis of TSLS is early antibiotic treatment. The prodromal symptoms in this case underline the necessity of early recognition and treatment to prevent a full-blown picture of the syndrome.