Breathing abnormalities during sleep

The purpose of this communication is to review obstructive and central breathing abnormalities that may occur during sleep, such as obstructive sleep apnea, and Cheyne-Stokes respiration. Emphasis is placed on noninvasive monitoring of the breathing pattern and intrapleural pressure swings by respiratory and surface inductive plethysmography, respectively, which establish the diagnosis of these abnormal breathing patterns.

[Therapy of severe asthma crisis in children. Therapeutic course. A propos of 40 cases]

Forty children with severe asthma were admitted to an intensive care unit from 1970 to 1981. Criteria of severity were alteration of consciousness, circulatory failure, hypercarbia greater than 7 KPa and paradoxical pulse greater than 35 mmHg persisting in spite of correct treatment. Some therapeutic measures (oxygen, corticosteroids, antibiotics, hydratation) were not modified during this period. On the contrary, bronchodilators, used at a higher dose since June 1980, were very effective on bronchospasm without side effects, making controlled ventilation unnecessary. These results seem to be very encouraging but have to be confirmed.

[How dangerous is the dipyridamole test?]

In 203 patients with clinical symptoms of coronary artery disease, cardiac and extracardiac side effects of the dipyridamole test were investigated. Following dipyridamole (0.75 mg/kg body wt. i.v.), heart rate increased significantly, whereas arterial blood pressure remained almost constant. Dyspnea was noted in 80 cases (40.5%). In 48 patients (23.6%) rhythm disturbances were recorded; 58.1% suffered from extracardiac side effects such as congestion in the head, vertigo, heaviness of arms and legs, sensations of heat, upper abdominal pain, and nausea. A detailed report is given of 4 cases with extraordinary symptoms during or after the injection of dipyridamole. A life-threatening status anginosus with dyspnea, ST-segment elevation, and cardiac arrhythmia was observed in one of these cases. High-dose dipyridamole cannot be considered to be harmless. The test should not be performed without continuous ECG monitoring and other safety measures.

Pediatric cardiopulmonary resuscitation

Pediatric cardiopulmonary resuscitation refers to those measures used to restore ventilation and circulation in children. This article defines how cardiopulmonary resuscitation in infants, children, and adolescents differs from cardiopulmonary resuscitation in adults and delineates the drugs and dosages to be used in the resuscitation of pediatric patients.

Monitoring aminophylline therapy using Jusko's dosage guidelines

Treatment with aminophylline, according to the nomogram published by Jusko and coworkers, was monitored in 13 patients suffering from acute exacerbations of COPD. After 24 h of therapy, the clinical state, the pO2 and the pCO2 values were markedly improved. Theophylline plasma concentrations were maintained within the therapeutic range. A slight but noticeable increase of drug serum levels during therapy could be related to changes in the arterial pH; the implications of this finding are discussed.

Lack of suppressor T cells in renal transplant recipients and activation by aminophylline

Immunoregulatory T-cell subsets were determined in 16 patients after renal transplantation. Suppressor and helper T lymphocytes were isolated with the aid of theophylline according to the method described by Shore et al. [1]. The system model used for assessing the function of these subsets was the local xenogeneic graft-versus-host reaction (GVHR). Lack of suppressor T cells was found in 6 out of the 16 patients, all 6 in acute steroid nonresponsive rejection crisis. Four of these patients received aminophylline per os at a dose of 1000 mg/kg per day and the T-lymphocyte subsets were retested several days afterwards. Active suppressor T cells (TS) appeared in all 4 treated patients, paralleled by disappearance of rejection crisis and a dramatic decrease of serum creatinine levels. These findings suggest that the inactivation of the immunoregulatory suppressor subset, probably by the immunosuppressive treatment, may play an important role in acute rejection and that activation of this subset of T suppressors could be of beneficial effect and prevent renal rejection.

[Obstruction parameters and pulmonary artery pressure in asthmatics after administration of aminophylline]

In 30 asthmatics after the application of aminophylline the measurement of the pressure of the pulmonary arteries as well as of the parameters of the respiratory function FEV1.0 and Rt was performed. It is proved a significant decrease of pressure in the lesser circulatory system. The reduction of the bronchial obstruction cannot be proved by means of the respiratory impulse test (FEV1.0), but by the determination of the resistance to respiration (Rt).

[Early diagnosis of central respiratory disorders in infants to avoid postoperative complications]

Infants with a higher incidence of frequent and prolonged apneas during sleep (sleep apnea syndrome) as a consequence of a delayed maturation of respiratory control, have an increased risk for respiratory problems after anesthesia. In 12 babies (one to five months old) showing visible apneas with cyanosis up to 12 hours after herniotomies, the respiratory pattern was examined by impedance pneumography during spontaneous sleep. The mean apnea duration (M.A. value) amounted to 8,6 +/- 5,96 sec/min, whereas the M.A. value of a comparable control group was significantly lower (2,97 +/- 2,13 sec/min) Aminophylline prophylaxis of risk infants diminished significantly the frequency of postoperative respiratory complications.

Delayed cerebral vasospasm is not reversible by aminophylline, nifedipine, or papaverine in a "two-hemorrhage" canine model

Angiographic spasm of cerebral arteries was produced in dogs by successive injections of cisternal blood 48 hours apart. Angiograms were taken before and after each cisternal injection. There was progressively greater angiographic vasospasm of the basilar artery. Intravenous aminophylline, 10 mg/kg/hr, reversed vessel constriction on the 1st and 3rd day after one injection of cisternal blood. On the 5th day after two blood injections (on Day 1 and Day 3), intravenous aminophylline, nifedipine (1 mg/kg), and intra-arterial bolus injection of 2 mg/kg papaverine failed to reverse the constriction. The intractable constriction produced in this model resembles that found in patients. The calcium antagonist, nifedipine, is as ineffective as the more traditional vasodilators in reversing vasospasm in this model.

Main mechanisms of therapeutic action in atopic asthma in children

Immunological disorders are clearly demonstrated in children suffering from the atopic form of bronchial asthma, namely increase in the levels of total and specific IgE and a decrease in the number of T cells. Specific hyposensitization produces, in addition to a good clinical effect, an immunomodulating action which is not restricted to the formation of blocking antibodies but is displayed also by T cell stimulation. Our studies revealed a reduction in the level of prostaglandins E and increase in the content of prostaglandins F-2 as well as a decrease in the cAMP levels in blood serum and urine in the period free of attacks; the demonstrated effect of Euphylline, Intal and Zaditen on these values confirms the expediency of introducing these agents into the therapeutic complex.

Renal effects of aminophylline in hepatic cirrhosis

In 18 cirrhotics with impaired renal perfusion intravenous injection of aminophylline 3 mg/kg b.w. increased mean renal blood flow (133-Xenon washout) from 1.77 +/- 0.71 to 1.99 +/- 0.44 ml/g/min (p less than 0.01). No significant change in cardiac output was found. In a further 10 cirrhotic patients the administration of aminophylline 3 mg/kg decreased the mean tubular reabsorption of sodium in the proximal section of the nephron (distal delivery) from 10.5 +/- 6.2 to 16.3 +/- 16.5 (p less than 0.01). Free-water production increased as a consequence of the increased supply of sodium to the diluting segment. Thus, aminophylline acts favourably on the functional renal impairment that occurs in hepatic cirrhosis.

Study of oxtriphylline SA in 50 asthmatics

Fifty clinically stable patients with asthma on maintenance theophylline therapy, mean dose of 15 mg kg-1 per day, were switched to an equivalent dose (X 1.56) of oxtriphylline SA for seven doses. All subjects remained clinically stable after the change during the study period. Oxtriphylline SA appears to be useful for the maintenance treatment of asthma and can be safely substituted for other theophylline maintenance regimens.

[Serum theophylline levels in aminophyllin treatment in children]

Long-term treatment of childhood asthma with theophylline or theophylline ethylenediamine (Aminophyllin) preparations requires dosage according to the various age groups. In order to achieve therapeutically satisfactory concentrations, estimations of theophylline levels in serum showed that in cases of good correlation between Aminophyllin dosage and theophylline levels smaller children required higher Aminophyllin doses than big children or adults. The therapeutic range of theophylline is around 7 to 15 mg/l beyond the newborn age. In order to obtain these concentrations children from the 1st to the 4th year require Aminophyllin doses of 6 mg/kg t.i.d., children between 5 and 12 years 5.5 mg/kg t.i.d. and adults beyond the 50th year of life 3 to 3.5 mg/kg t.i.d. Generally the first dose should be higher and is 6-7 mg/kg or 6-6.5 mg/kg or 4 mg/kg, respectively. Regular estimations of serum theophylline levels greatly help to improve safety of long-term treatment.

Failure of peak expiratory flow rate to predict hospital admission in acute asthma

Our study evaluated the ability of early peak expiratory flow rates (PEFR) to be predictive of hospital admission while double blinding the measurements and using a standardized treatment protocol and specific admission criteria. The measurements were recorded prior to and after initial therapy. Eighty-six acute asthmatic episodes in 51 patients were analyzed. Nine (10.5%) of the episodes resulted in hospitalization; 77 (89.5%) resulted in discharge. No correlation with admission was found for the initial PEFR, a second PEFR following treatment, or the differences between these two values. Our study indicates that early PEFRs alone are not useful predictors of the need for hospital admission. Although a significant number of patients in our study population presented with severe airflow obstruction, they responded sufficiently to treatment to permit discharge.