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Der pupillographische Schlafrigkeitstest (PST, AMTech, Weinheim) konnte in einer fruheren Studie Erfolge nach zwei Nachten Anwendung einer Therapie mit nasalem kontinuierlichem positivem Atemwegsdruck (nCPAP) objektivieren. In der vorliegenden Studie sollte der Effekt einer dreimonatigen Therapie mit nCPAP mittels PST erfast werden. Der PST mit einer Mesdauer von 11 Minuten wurde in kompletter Dunkelheit (Infrarotbrille) und unter Reizabschirmung durchgefuhrt. Die Patienten sasen auf einem bequemen Stuhl, der Kopf ruhte auf einer Kinnstutze. Zur Bewertung dienten die beiden Parameter Pupillenunruhe-Index und das Amplitudenspektrum ≤0,8 Hz, ermittelt durch eine schnelle Fourier Transformation. Bei 35 mannlichen Patienten im Alter von 30 bis 70 Jahren (Mittelwert 52,7) mit obstruktivem Schlafapnoe-Syndrom (OSAS) wurde in der Klinik Lowenstein nach polysomnographischer Diagnostik (System Alice 1.20, Heinen und Lowenstein, Bad Ems) eine nCPAP-Therapie angepast. Vor der Einstellung und bei der Kontroll-Polysomnographie nach drei Monaten fanden jeweils um 10 Uhr, 14 Uhr und 18 Uhr PST-messungen statt. In die Auswertung gingen nur Daten von denjenigen Patienten ein, die konsequent und ausreichend (mindestens 5h/Nacht) ihr Gerat benutzt hatten. Der Apnoe-Hypopnoe-Index (AHI) der Patientengruppe vor Therapiebeginn betrug im Mittel 35,5/h (15–67,7), die prozentuale Schlafzeit bei weniger als 90% Sauerstoffsattigung (T90) betrug 19,4%, die unter 95% (T95) 59,9%. Der Vergleich der Vormittagsmessungen mit dem PST ergab einen signifikanten Ruckgang des Pupillenunruhe-Index, die mittlere Reduktion betrug 21%. Vor der Therapie lag der Vormittagswert bereits auf dem Nachmittagsniveau, nach drei Monaten zeigte dieser Wert die hochste zentralnervose Aktivierung im Tagesverlauf. Dagegen wurden die Nachmittags-und Abendwerte des PST durch drei Monate nCPAP-Therapie nur unwesentlich beeinflust. Mit dem PST konnte der Therapieeffekt von nCPAP nach drei Monaten objektiviert werden. Gunstigster Meszeitpunkt entsprechend den Ergebnissen dieser und der fruheren Therapiestudie ist der Vormittag.

Extrafine aerosols may improve asthma symptom control through increased lung deposition of medication to inflamed peripheral airways.The effect of switching patients with asthma maintained on up to 2000 microg/day chlorofluorocarbon-beclomethasone dipropionate (CFC-BDP), 1600 microg/day budesonide, 1000 microg/day fluticasone, or 2000 microg/day flunisolide, to a reduced dose of hydrofluoroalkane-134a BDP (HFA-BDP) extrafine aerosol (maximum 800 microg/day) was investigated during an open-label multicentre study. Following a 7-14-day run-in on previous medication, 716 patients were randomised to 24 weeks' treatment with an appropriate reduced dose of HFA-BDP.Morning peak expiratory flow (AM PEF) measurements showed that, after 24 weeks, the reduced dose of HFA-BDP maintained equivalent lung function compared with all previous medications. Furthermore, asthma symptom scores revealed improvements across all groups and the proportion of symptom free days and nights and beta-agonist free days increased significantly (p0.05) in all but one group. Quality of life improved with 80% of patients reporting goo/very good overall asthma control compared with 70% previously. Treatment-associated adverse events were generally infrequent, mild and transient.Patients on conventional inhaled corticosteroids may reduce their daily steroid dose to 800 microg or less whilst maintaining lung function and improving asthma symptom control by using the extrafine aerosol of HFA-BDP.

A 29-year-old woman with chronic bronchial asthma and inflammatory bowel disease, previously classified as idiopathic, was hospitalized because of bouts of fever and increasing dyspnoea and diarrhoea. Chest radiograph showed extensive bilateral pulmonary infiltrates. Thought to be suffering from bacterial pneumonia she was treated with broad-spectrum antibiotic, but without improvement even after a change of antibiotics. Numerous diagnostic tests failed to find any causative organism. Subsequently she was found to have peripheral eosinophilia and pericardial effusion associated with echocardiographic and electrocardiographic signs of myocarditis, which raised the suspicion of allergic granulomatous vasculitis (Churg-Strauss syndrome). The patient's acute illness contraindicated a lung biopsy, but the clinical picture left no doubt of the true diagnosis. Treatment with methylprednisolone (initially 250 mg, then 80 mg daily) rapidly improved the clinical, radiological and biochemical findings. But four months later, under maintenance treatment with 15 mg methylprednisolone daily, she experienced another bout of colitis and, a few days later, pulmonary recurrence of the Churg-Strauss syndrome, both clinically and radiologically. The dose of methylprednisolone was raised to 60 mg daily. The inflammatory bowel disease, endoscopically manifesting as ulcerative colitis, was most likely part of the systemic vasculitis.-This case demonstrates that colitis can be the primary manifestation of Churg-Strauss syndrome.

We re-examined the hypothesis of Cajal3, later refuted by Weiss and Taylor20, that cells in distal stumps of transected peripheral nerves exert an attractive (tropic) effect on regenerating axons. This question was re-assessed in vivo using surgical materials and assay procedures not available to those workers. Proximal stumps of transected rat sciatic or cat peroneal nerves were inserted into the single inlet end of a hollow, Y-shaped Silastic implant. Regenerating axons were provided with alternative targets consisting of a vacant arm vs one occupied by a sciatic nerve graft (rat), or a tibial (Tout) vs peroneal (Pout) distal nerve stump (cat). In some cases Pout was rendered metabolically compromised relative to Tout by exposing the former to dry ice and inhibitors of DNA and RNA synthesis. At 4.5 or 6 weeks postoperatively, the number of regenerating axons in each fork of the implant was assessed by morphometric analysis (total number of non-myelinated and myelinated axons greater than 1 micron in diameter at 4.5 weeks, and total number of myelinated axons at 6 weeks postoperatively), or by quantification of an axonally transported label. Rat sciatic nerve fibers exclusively regenerated toward the nerve graft, suggesting the existence of a neurotropic lure. In cats, morphometric analysis revealed a 10-(4.5 week) and 6-fold (6 week) greater number of axons growing towards untreated Tout vs treated Pout. When both distal stumps were untreated, more axons were seen in forks leading to Pout. Analysis of transported label confirmed the preferential growth of axons towards untreated Tout vs treated Pout for both motor and sensory axons. In separate experiments, Nuclepore filters (0.2 microns, pore size) were inserted between distal nerve stumps and outlet ends of Silastic implants. Preferential regeneration toward untreated stumps was observed if the distance between proximal and distal nerve stumps was equal to but not greater than 4-5 mm. These results suggest that peripheral nerve fiber regeneration in vivo can be directed by cells in distal stumps of transected nerves, and that this effect can be mediated over distances of several millimeters via diffusible factors.