Publications by authors named "Pleger E"

Unlabelled: In seven pneumological centres 266 patients with different pneumological diseases were investigated. After having clarified several questions regarding the severity of the dyspnoea, cough intensity and the volume of sputum, as well as basic clinical investigation and after an x-ray of the thorax, the diagnosis was arrived at. Subsequently the lung function investigation with the flow-volume curve (including IVC, FVC, PEF, FEV1, MEF50%) and the body plethysmographic Rt and IGV were carried out.

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Starting from the polyvalent sense of a limitation of the maximum available respiratory flow there is to be pointed to the necessity of the decentralized measurement of resistance. The instrument IfM E1 permits the use of the simple forced oscillation technique for estimations of ROS and the derived values delta ROS and STAV all over the country. The advanced forced oscillation method, based on the fixed frequency technique, contained the option for estimation of the residual volume and especially the phase-angle.

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With the aim of determining the significance of the principle of the multi-frequency forced oscillation technique employed by the custo vit to determine the airway resistance, measurements were performed on a number of test subjects, employing a unit available with three different software modifications. A comparison with the resistance values obtained with other equipment (whole-body plethysmograph, Siregnost FD5), revealed the diagnostic usefulness of the technique of frequency-dependent resistance. It was also confirmed that the phase angles, also obtainable with the custo vit, play a considerable role in the significant differentiation of the degree of obstruction.

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In three groups of healthy subjects and patients with pulmonary fibrosis or pulmonary emphysema, the secondary periodical oscillatory phenomena observed under conditions of normal breathing and a slow VC manoeuvre on the Siregnost FD 5 were broken down into a volume- and a flow-synchronous component, as also a third component with no correlation with either volume or flow, and which can be observed in the primary parameters Ros and psi, as also the secondary parameters Rre and phi. While both fibrotic patients and healthy subjects revealed a volume-inverse phase behaviour, patients with pulmonary emphysema revealed a volume-proportional phase behaviour. This difference in volume dependence is explained by the difference in elastic recoil in patients with fibrosis as compared with those suffering from emphysema, and the associated different influence on the filling of the lungs with air and blood.

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In patients with chronic obstructive airway disease, comparative examinations using body plethysmography were performed with a view to evaluating the effectiveness of two forced oscillation techniques, fixed-frequency and poly-frequency techniques in estimating disorders of respiration mechanics. At slight and moderate elevations in bronchial flow resistance, a better agreement was found between the custo vit resistance figure and body plethysmography. A differentiation of healthy subjects from patients with low-grade obstruction by means of the FD 5, requires the establishment of the phase angle (phi), too, while in the case of the custo vit unit, this is possible by demonstrating the frequency dependence of the impedance.

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The practical application of the forced oscillation technique for the analysis of the mechanics of respiration is hampered by the fact that the measured frequency-dependent impedance values R(f) and X(f) cannot be related directly to the parameters airway resistance Raw and pulmonary compliance CL. Furthermore, various derived oscillatory parameters are employed which are not directly comparable even with one another. In order to be able to estimate the diagnostic relevance and comparability of the impedance curves R(f) and X(f), their form-specific characteristics R = R(5)-R(20) and X(5), as also the equipment-specific parameters Ros (Siregnost FD5) and Rfo (custo vit), the relationships of these oscillatory parameters to Raw and CL were simulated in a structural model of the respiratory system, and tested in the real system.

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Against the background of the working hypothesis of the 1-parametric Siregnost FD 5 forced oscillation technique-phase angle psi may be invariant in a clinical reference population-the hypothetical straight Ros-P line is in good agreement with the crowd of extremely nonlinear Rre-P-lines only within narrow limits. Neglecting phase angle measurements it might be useful to insert a known linear resistor into the airway to determine the pertaining Rre-P relation. In spite of selective tuning to the oscillation frequency of 10 Hz there is full sensitivity to stationary flow; alinear stationary flow characteristics of resistors can be readily determined by forced oscillation.

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The importance of the phase angle in oscillatory measurements of resistance depends on the presence or absence of an endobronchial obstruction. In case there is an obstruction, a negative phase angle is first of all an expression of the low compliance of the larger airways and points to an underestimation of the real flow resistance. If there is no obstruction one can state facts about the peripheral compliance, in particular taking into consideration the dependence of the phase signal on actual lung volume.

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The oscillatory resistance (Ros) can be measured routinely by simple set frequency technique under physiological conditions relatively independent of age and cooperation of the examinee. It is as a complex number of the breathing mechanics only relatively comparable with the body plethysmographic resistance. Taking into consideration the dependence on actual lung volume and seriousness of obstruction one can give statements adequately reliable for practice with the help of ROS within a limit from 1 to 10 hPa/l/s.

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There is pointed to the necessity, to clear up pathophysiologically a limitation of the maximum available respiratory volume or flow. The required investigations of breathing mechanics for registering the impedance under quiet breathing and measuring the residual volume are possible with the oscillation method at the base. There are listed the insecurities of the taken parameter with a short description of the basic theory of the oscillation method (fixed frequency technique).

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The residual volume can oscillatorily be estimated in an easy way with the help of diving-gas. The oscillatory unit, furnished with a sensor of density, serves as a quick helium-analyser. An overestimation of the residual volume can appear as a result of the high volatility of the used gas, an underestimation can result because of the non-registration of lung parts with entrapped air.

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Tests were carried out on the usefulness of doubling the reference resistor during airways resistance measurement by forced oscillation method (set frequency technique). Measurements on 110 random subjects using the standard reference tube (Zo = 10 hPa/1/s) for comparison showed almost identical Ros values using the experimental tube, while the latter gave higher Ros values as obstruction increased. Comparisons with the bodyplethysmographic Rt on 65 patients with a chronic obstructive airways disease yielded a closer approximation to the identity curve from 7.

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Tests were conducted on 90 smokers and a control group of 20 non-smokers using not only simple spirometry but also pneumotachography and the forced oscillation technique, including flow- and resistance-volume graphs. FEV1 was proved to be a sensitive screening test for early recognition of disfunction in the region of the small airways. 39,5% of the younger light smokers already showed signs of impairment to the breathing mechanics indicating exobronchial obstruction.

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A sample of 57 geriatric surgical patients were investigated with the aim of establishing which additional information the forced oscillation method yields for the assessment of an increased operation risk as compared with spirometry. In addition to the proved diagnosis of a restrictive ventilatory disturbance as causing a limitation of the maximum available respiratory volume, the measuring of the oscillatory resistance makes it possible in particular to prove and quantify the obstruction. Over and above this, the measuring of resistance fluctuation while breathing at rest makes it possible to differentiate a geronto-typical exobronchial component of the obstruction.

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