4-Phase-Rhinomanometry (4PR)--basics and practice 2010.

The last comprehensive publications about the theory and practice of rhinomanometry appeared more than 20 years ago. Since the 1980's, the general progress of sensor techniques, fluid physics and data processing was accompanied by the permanent work of the authors to analyze the errors of rhinomanometry and to create a fundament for a contemporary and practical method that can be used in functional diagnostics of the nasal air stream. In this special document, the objectives and measurement principles, as well as the history of rhinomanometry are described in the first three chapters. It is pointed out, that the key parameters are not only intranasal pressure and flow, but also the factor time. The technical requirements as following from the dynamics of breathing are described. The process of averaging of rhinomanometric data lead to a separate and time-dependent analysis of the changes of pressure and flow and implicated the introduction of the 4 breathing phases (ascending and descending curve part in inspiration and expiration) into rhinomanometry and is therefore called 4-Phase-Rhinomanometry (4PR). Chapter 4 is containing a comprehensive analysis of the practical errors, which may follow neglecting the 4 breathing phases. The in chapter 5 described mathematical-physical concept of 4PR is based on the introduction of the terms "steady" and "unsteady" flow, in addition to the up to now used terms of laminarity and turbulence. After the derivation of the HOFFRICHTER-equation as explaining the loops around the intersection point of the x-axis and y-axis, a clinical classification of the rhinomanometric findings is given and confirmed by physical experiments with "artificial noses". Finally, testing the rhinomanometric method by CFD (Computational Fluid Dynamics), lead to the same conclusions as to the importance of 4 phases of the breathing cycle. The precondition for the worldwide introduction of new parameters into the 4PR is a comprehensive statistical analysis. The disadvantages of the present recommended standard values are described in chapter 6. Following previous studies in 5800 cases, the parameters Vertex Resistance (VR), Effective Resistance (Reff) and their logarithmic transformations have been investigated in 1580 rhinograms of different degrees of obstructions, also including the correlations to a VAS. It could be confirmed, that the parameters VR and Reff after logarithmic transformation, have a significant and high correlation to the sensation of obstruction. The new clinical classification of obstruction and conductance of the nose is proposed in Table 1 for Caucasian noses. Table 1. Clinical classification of obstruction and conductance for Causcasian noses. [see text for table]. Chapter 7 is dedicated to the advantages of 4PR in the functional diagnosis of nasal valve problems. Graphical as well as numerical solutions are available by the fact, that the motions of the nasal entrance as caused by the breathing process are now visible from the shape of the 4PR-curve. Discussing practical aspects in chapter 8, the start point of proposals and discussions are the standard recommendations of the ISOANA and the results of its consensus conference in 2003. In particular the calibration processes, hygiene, the correct attachment of the pressure tube at the nostril ("tape method") and the different measurement procedures (AAR, APR), decongestion and provocation tests are extensively described. Both the final chapters are clinical contributions from mainland China, which are of high importance because of the racial differences in nasal respiratory function. In chapter 9, tests of the assessment of normal nasal airway in adult Chinese by 4PR, rhinomanometry and acoustic rhinometry are presented. This investigation lead to the conclusion that 4PR is an important supplement to classic rhinomanometry and acoustic rhinometry, if the classification of obstruction is adapted to the higher basic resistance of the Chinese population. Chapter 10 is dealing with 4PR and acoustic rhinometry in the functional evaluation of septal deviations and concludes, that both methods are valuable objective instruments for the evaluation of nasal obstruction.

Snoring and sleep apnea. A population study in Australian men.

Snoring and sleeping apnea are reportedly associated with morbidity. We used home monitoring (MESAM IV) to measure snoring and sleep apnea in 294 men aged 40 to 65 yr from the volunteer register of the Busselton (Australia) Health Survey. In this group, 81% snored for more than 10% of the night and 22% for more than half the night; 26% had a respiratory disturbance index (RDI) > or = 5, and 10% had an RDI > or = 10. There was a relatively low correlation between percentage of night spent snoring and RDI (rho = 0.47, p < 0.005). Subjective daytime sleepiness plus RDI > or = 5 occurred in a minimum of 3%. Obesity was related to snoring, RDI, and minimum SaO2 (all p < 0.0001). There was no relationship between age and either RDI or snoring, but increased age was related to minimum SaO2 < 85% (p < 0.05). Alcohol consumption was not related to sleep-disordered breathing. Smokers snored for a greater percentage of the night than nonsmokers (41 versus 31%, p = 0.01). We conclude that, in middle-aged men, both snoring and sleep apnea are extremely common, and in this age range both are associated with obesity but not with age. However, a high percentage of snoring is not essential for the occurrence of sleep apnea, nor does it necessarily indicate that apnea is present.

[Nocturnal hypertension and sleep apnea: effect of the ACE inhibitor cilazapril on apnea-induced blood pressure increases during sleep]. / Nächtliche Hypertonie und Schlafapnoe: Effekt des ACE-Hemmers Cilazapril auf apnoe-induzierte Blutdruckanstiege im Schlaf.

The nocturnal increases in blood pressure in cases of obstructive sleep apnea are discussed as causes in connection with increased cardiovascular mortality in sleep apnea. Previous antihypertension therapy studies revealed the antihypertensive action of the ACE inhibitor cilazapril averaged over NREM (NR) and REM sleep (R). In the present study, the effect of this drug on the blood pressure increase within the stress segment of obstructive apnea in NR and R was investigated in a double-blind randomized study versus placebo. Data were collected in digital form with the help of cardiorespiratory polysomnography and intra-arterial blood pressure measurements; a total of 640 apnea in 16 patients were evaluated. Relevant increases in blood pressure occurred during the apnea which were, as expected, more pronounced in R (150/74 mmHg) than in NR (135/69 mmHg). The antihypertensive action of cilazapril was also stronger in R (systole--11.9/diastole--6.4 mmHg) than in NR (systolic--9.0 mmHg/diastolic--5.7 mmHg). Placebo caused significantly lower decreases in blood pressure (systolic--3.7 mmHg/diastolic--2.4 mmHg in R, systolic--2.8 mmHg/diastolic--1.8 mmHg in NR). Thus, evidence is provided for a clinically relevant blood pressure lowering effect of the drug cilazapril on the stress-induced blood pressure increases accompanying obstructive apnea both in NREM and in REM sleep.

[Comparative use of MESAM IV and polysomnography in sleep-related respiratory disorders]. / Vergleichender Einsatz von MESAM IV und Polysomnographie bei schlafbezogenen Atmungsstörungen (SBAS).

The high prevalence of sleep-related respiratory disturbances among the male population requires development of reliable outpatient measurement systems enabling the selection of patients to be admitted to the sleep laboratory. MESAM IV is such a system. It can record for up to 18 hours via four sensors a patient's snoring sounds, heart rate, oxygen saturation and posture. To test the reliability of the instrument we compared parallel night measurements by MESAM IV and polysomnography (PSG) via the respective Respiratory Disturbance Indices (RDI = number of apnoeas plus hypopnoeas per hour). The group of subjects studied numbered 68 patients of the sleep laboratory suspected of having sleep-related respiratory disturbances (age 18-78 years, average 50.8 yrs.; height 164-192 cm, av. 175.2 cm; weight 40-160 kg, av. 99.3 kg; body mass index 13.8-49.5, av. 32.3). Assessment of the MESAM measurements was effected on the one hand by means of a computer programme (version 1.2) that is part of the system, and on the other hand by 3 independent evaluators, two of whom were already experienced in MESAM evaluation. Each evaluator was unaware of all personal and clinical data of the patients and of the results obtained by the other evaluators. Visual assessment was performed according to fixed criteria with the inclusion of all four measurement signals of the system, whereas two mutually independent respiratory disturbance indices (RDI) were calculated by computer evaluation. The results of the various MESAM IV evaluations were compared with those of polysomnography.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacokinetics and disposition of the KS1/4 monoclonal antibody-desacetylvinblastine hydrazide conjugate LY203725 in rats and monkeys.

The plasma pharmacokinetics of the monoclonal antibody-vinca conjugate KS 1/4-desacetylvinblastine hydrazide (DAVLB-hyd; [3H]LY203725) have been evaluated in rats (17 mg/kg) and monkeys (15 mg/kg) after i.v. dosing. Plasma concentrations of radioactivity 1 hr after dosing were higher in monkeys than in rats. The biphasic elimination of radioactivity in rats was characterized by half-lives (T1/2) of 10 and 143 hr, whereas the elimination of radioactivity in monkeys was characterized by T1/2 values of 11 and 66 hr. Plasma total antibody and radioactivity concentrations were similar within 6 (rat) and 24 (monkey) hr after dosing; however, total antibody concentrations were greater than radioactivity concentrations thereafter, indicating the presence of free antibody in the plasma. Plasma elimination T1/2 values and areas under the curve of total antibody in rats and monkeys were greater than those of radioactivity. The presence of free antibody implies the presence of free DAVLB-hyd; however, plasma concentrations of free DAVLB-hyd were at least 3 orders of magnitude less than those of radioactivity in both species. The T1/2 of free DAVLB-hyd in plasma of LY203725 dosed monkeys was 16 hr. Hydrolysis of the conjugate to yield free DAVLB-hyd was observed upon incubation of conjugate with rat plasma in vitro. Administration of DAVLB-hyd to rats resulted in a rapid initial decrease in plasma DAVLB-hyd followed by a slower (T1/2 = 1.4 hr) elimination rate. Fecal excretion was the predominant mode of elimination of radioactivity in both rats and monkeys dosed with [3H]LY203725.

Analytical profile of metaclazepam.

Physical and physicochemical properties of 7-bromo-5-(2'-chlorophenyl)-2, 3-dihydro-2-(methoxy-methyl)-1-methyl-1H-1,3-benzodiazepine (metaclazepam, Talis), a new anxiolytic 2-methoxymethyl-1,4-benzodiazepine derivative, are reported. Furthermore the analytical methods for quantitative determinations of metaclazepam are described.

[X-Ray diagnosis of hepatic rupture in a newborn (author's transl)]. / Röntgenologisch dargestellte geburtstraumatische Leberruptur eines Neugeborenen

Presumably due to trauma during birth newborn infant had a hepatic rupture and intraabdominal haematoma, which was diagnosed by injection of contrast solution into the umbilical vein catheter. Radiographically the haematoma was seen in the left upper abdomen (perhaps in the omental bursa). Besides additional birth injuries the infant suffered from fetopathia diabetica, asphyxia, meconium aspiration syndrome, mediastinal emphysema and pneumoperitoneum.