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Biomedical subjects

D Conen

Publications and source records attributed to D Conen.

At least 19 recordsLinked to original sources
PubMed1999

[Methotrexate pneumonitis].

A 72 year old female with rheumatoid arthritis was treated with methotrexate for nine months. Four days before admission she complained of dyspnea NYHA III. Chest-X-ray revealed diffuse interstitial pneumopathy. Pulmonary infection was excluded by several microbiological samples. A pulmonary manifestation of rheumatoid arthritis is usually more chronic. Methotrexate-induced pneumonitis remained the most probable diagnosis. We halted methotrexate and initiated therapy with glucocorticoids. This treatment led to rapid clinical improvement and complete resolution of radiological changes.

Aged↗
PubMed1999

Glucagon-like peptide-1: a potent regulator of food intake in humans.

BACKGROUND/AIMS: Studies in animals suggest a physiological role for glucagon-like peptide-1-(7-36)-amide (GLP-1) in regulating satiety. The role of GLP-1 in regulating food intake in man has, however, not been investigated. Subjects-Sixteen healthy male subjects were examined in a double blind placebo controlled fashion. METHODS: The effect of graded intravenous doses (0, 0.375, 0.75, and 1.5 pmol/kg/min) of synthetic human GLP-1 on food intake and feelings of hunger and satiety was tested in healthy volunteers. RESULTS: Graded GLP-1 infusions resulted in a dose dependent reduction in food intake (maximal inhibition 35%, p<0.001 v control) and a similar reduction in calorie intake (32%; p<0.001). Fluid ingestion was also reduced by GLP-1 (18% reduction, p<0.01). No overt side effects were produced by GLP-1, but subjects experienced less hunger and early fullness in the period before a meal during GLP-1 infusion at the highest dose (p<0.05). CONCLUSIONS: Intravenous infusions of GLP-1 decrease spontaneous food intake even at physiological plasma concentrations, implying an important role for GLP-1 in the regulation of the early satiety response in humans.

Adult↗
PubMed1998

Is routine replacement of peripheral intravenous catheters necessary?

BACKGROUND: Guidelines developed by the Centers for Disease Control and Prevention, Atlanta, Ga, recommend that peripheral intravenous catheters be changed every 3 days. However, routine replacement of central venous catheters is no longer supported in their latest update. OBJECTIVE: To evaluate the risk to patients of having peripheral intravenous catheters left in place for as long as they are clinically indicated. METHODS: This observational study in a university-affiliated, 700-bed hospital was designed to evaluate the day-specific risk (incidence density) for phlebitis, catheter infection, and obstruction with catheters remaining in place as long as clinically indicated. All consecutive patients who required peripheral intravenous catheterization for 24 hours or more were enrolled during a 10-week period. Outcome variables are phlebitis, catheter-related infections, and obstruction. Evaluated risk factors include age, sex, underlying disease, anatomical insertion site, catheter diameter, first or subsequent catheter, duration of catheterization, type of admission, hospital location, type of infusate, and antibiotic therapy. RESULTS: A total of 609 catheters that were in place for 1 to 28 days were evaluated. Phlebitis, catheter-related infection, and obstruction occurred in 19.7%, 6.9%, and 6.0% of catheters, respectively. We were unable to demonstrate an increased risk after 3 days of catheterization. The day-specific risk indicated a linear function of all outcome variables. CONCLUSIONS: The hazard for catheter-related complications--phlebitis, catheter-related infections, and mechanical complications--did not increase during prolonged catheterization. The recommendation for routine replacement of peripheral intravenous catheters should be reevaluated considering the additional cost and discomfort to the patient.

Adolescent↗
PubMed1998

Antibody response in six HACEK endocarditis cases under therapy.

The antibody response to bacteria of the so-called HACEK group, i.e. Haemophilus spp., Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens and Kingella kingae, was measured in sera of six patients with endocarditis. The corresponding isolates from their blood cultures were identified by conventional methods, including reactions for nitrate reduction and catalase as well as acid production from sugars. Crude antigens were prepared by glycine extraction and sonification of the blood culture isolates, and used to determine titers by complement fixation. A patient with Haemophilus parainfluenzae bacteremia received a short course of antibiotic therapy, and relapsed with spondylitis and endocarditis 5 months later. Titers of sera against his own isolate rose from 1:40 to 1:320 and fell to 1:40 after therapy within one year. A patient with C. hominis endocarditis had a similarly prolonged course. The complement fixation titer against his own isolate was already 1:240 before antibiotics were administered. Another patient with C. hominis endocarditis presented a titer of 1:320 2 weeks after the diagnosis. These three patients revealed C-reactive protein values over 50 mg/l in the first serum sample. Decrease of both antibody titers and C-reactive protein values correlated with clinical improvement. Two patients with prosthetic valve replacement 5 months earlier developed C. hominis and K. kingae endocarditis, respectively. At admission, C-reactive protein values were 64 and 82, respectively, and therapy was instituted immediately. The first sera were received 3 and 6 weeks, respectively, after isolation of the corresponding blood culture isolates and revealed already low titers, i. e. 1:80 and 1:60, respectively. A woman with A. actinomycetemcomitans endocarditis received immediate therapy and did not develop titers against her own isolate. CRP was 100 at admission and remained over 50 5 weeks later. We conclude that the complement fixation assay with individual antigen preparations was easy to perform and allowed monitoring of the antibody response in 5 of 6 HACEK endocarditis cases under therapy, but the usefulness of this method to find culture-negative HACEK endocarditis needs to be established.

Aged↗
PubMed1996

[Successful therapy of salicylate poisoning using glycine and activated charcoal].

Acute intoxications with salicylates are common. In a dosage of 150-300 mg/kg they are severe, and above 500 mg/kg potentially fatal. To commit suicide 4 patients ingested 375-460 mg/kg acetylsalicylic acid; 3-8 hours after ingestion salicylate blood levels of up to 760 mg/l were observed. The patients were treated for a period of 16 hours with oral charcoal and glycine (1 g/kg initially, followed every 4 hours by 0.5 g/kg, and 8 g initially, followed by 4 g, respectively). To increase urinary pH (7-9) they received i.v. NaHCO3. Blood levels of salicylic acid including its metabolites dropped initially with a virtual half-life of 2-4 hours. 18 hours after hospital admission every patient was in good general condition; none of them required hemodialysis. The urinary excretion of total salicylate reached only 6-14% of the dose within the first 12 hours of therapy, clearly indicating the importance of combined therapy with glycine and charcoal in achieving a good clinical outcome.

Adult↗
PubMed1996

[Modifiability of antibiotic use in a medical clinic].

The most costly drug interventions in hospitals are in the treatment of infectious diseases. To improve the cost-effective use of antibiotic drugs it is necessary to consider rational indications, appropriate administration (sequential therapy) and control of antimicrobial resistance. To obtain more information about prescribing habits, antibiotic prescription forms were collected prospectively over a six-month period in the Clinic of Internal Medicine at the Cantonal Hospital of Aarau. The influence of this new prescription form on antibiotic use, including the indication for therapy, was analyzed and compared with the results of a similar study done in 1994. The results showed use of a wide variety of different antibiotics for the same indication, prevalence of intravenous administration, and widespread use of new and expensive antibiotics. The total cost of antibiotics was not reduced compared with the previous period. The characteristics of antibiotic use were easily analyzed with minimal additional effort. With such data, specific actions for quality improvement in antibiotic use can be taken through a multidisciplinary educational approach with regular instruction on therapy guidelines, definition of first-line agents, information on the advantages of sequential therapy, and periodic reevaluation.

Anti-Bacterial Agents↗
PubMed1996

[Should postoperative thromboembolism prevention be extended to the post-hospitalization phase?].

A large number of patients medically treated for deep vein thrombosis and pulmonary embolism have a history of surgery in the immediate past. We therefore inquired whether it is possible to identify specific risk factors which would allow general recommendations for anticoagulation therapy in the postdischarge period. During the 30-month study period 325 patients were treated at the Cantonal Hospital, Aarau, for DVT and/or pulmonary embolism. 35 (10.8%) had undergone surgery 8 weeks previous to admission. Perioperative management (anticoagulation, chronology, mobility etc.) was analyzed retrospectively. 20% of the 35 patients with postdischarge deep vein thrombosis and/or pulmonary embolism had previously undergone an ambulatory surgical procedure. A large number of thromboembolic complications occurred between the 4th and 12th day after discharge. In 40% of the patients, however, they occurred after the 14th posthospital day. High- and low-risk patients were impossible to define on the basis of the type of surgery, length of hospital stay and time course of thromboembolic complications. We conclude that prophylaxis of thromboembolism in ambulatory surgery should be re-thought: patients undergoing arthroscopy should receive prophylaxis for thromboembolism for at least 4-6 weeks post discharge.

Adult↗
PubMed1995

[Intramuscular injections--an outdated form of administration? 6 cases of Staphylococcus aureus sepsis following intramuscular injections].

Intramuscular injections can lead to local and systemic complications, such as abscess and sepsis. These are often caused by Staphylococcus aureus, occur in immunocompromised as well as in immunocompetent persons, and often need extensive medical and surgical treatment. We describe 6 cases with sepsis and multiple abscesses caused by Staphylococcus aureus after intramuscular injections. In view of possible serious complications, the indication for intramuscular injection as a method of drug administration is critically analyzed.

Abscess↗
PubMed1994

[Centralized preparations of cytostatic agents: a method for quality control].

Cytotoxic drugs are frequently used in a hospital setting. They are mainly administered intravenously and require reconstitution and preparation of the solutions. This is commonly done by nurses in the nursing station. However, cytotoxic drugs are potentially hazardous to personnel and patients, and appropriate waste disposal is necessary. Centralized preparation of cytotoxic medication reduces these risks and problems. We review our experience with centralized preparation and controlled application of chemotherapy in a major medical center. It improves overall safety in reducing exposure to the drugs, while errors of dosage and handling can be decreased and costs and volume of hazardous waste are lower to a substantial extent. Central preparation of cytotoxic drugs is feasible and allows improved quality control.

Antineoplastic Agents↗
PubMed1994

[Reversible neurological complications in chronic alcohol abuse with hypophosphatemia].

Severe hypophosphatemia is rare, usually affecting chronic alcoholics and patients under total parenteral nutrition. The most important clinical features are rhabdomyolysis and neurological deficits. The latter may take various forms and can affect the peripheral as well as the central nervous system. Symptoms of polyradiculitis with progressive paresis or cerebellar symptoms such as dysarthria, dysphagia and ataxia are frequent manifestations. Rarely, hypophosphatemia can cause confusional states, epileptic seizure or coma. The differential diagnosis includes Guillain-Barré polyradiculitis, diffuse encephalopathy, Wernicke encephalopathy and central pontine myelinolysis. We describe the neurological signs in a female chronic alcoholic who developed severe ataxia and tetraparesis after a week's course of parenteral, phosphate-free nutrition. Complete recovery occurred after adequate substitution of phosphate.

Acidosis↗
PubMed1994

[Sense and usefulness of preventive diagnosis].

The value of preventive screening tests is controversial. The predictive value of such testing depends on the incidence of the disease as well as of the sensitivity and specificity of the available tests. Cardiovascular and neoplastic diseases have been a model for preventive testing. We review the pertinent literature on preventive screening tests with special emphasis on the value of a thorough history and physical exam.

Adult↗
PubMed1991

[Therapy and prognosis of bacterial arthritis: a retrospective analysis].

Antibiotic therapy and immediate drainage of the infected joint are established practice in the treatment of septic arthritis. The best method of drainage (repeated puncture, arthroscopy or surgical discharge) remains controversial. We analyze 34 patients with septic arthritis admitted to our hospital from 1984 to 1988. The pathogen was Staphylococcus aureus in 19 cases (56%), streptococcus in 6 (18%), pneumococcus in 2 (6%), other bacteria in (9%) and unknown in 4 (12%). In 62% the infection was blood-borne. The knee was affected in 12 cases (35%) and the shoulder in 10 (30%). A preceding joint puncture was the main source of infection. In 24 patients (70%) the initial joint drainage was by repeated puncture, while in 10 cases (30%) surgical drainage was the initial treatment. In 11 of the 24 patients initially treated by repeated puncture, surgical drainage was needed in the course of treatment because of persistent local infection of the joint. In only 13 (39%) was "medical" treatment alone effective. 5 patients died (14.7), 3 (8.8%) due to the infection. All deaths occurred in the "medical" group. 21 patients were asked about symptoms in the affected joint. In 71% there were no problems or only minimal ones, while in 29% there were distinct problems. 5 of the 6 patients with severe symptoms had been treated by repeated puncture. We conclude that surgical drainage of an infected joint is prescribed too rarely in departments of rheumatology and internal medicine. Arthroscopic or surgical drainage is indicated in cases of coxarthritis, omarthritis, in cases where symptoms last longer than 7 days and in patients with severe sepsis.

Adult↗
PubMed1991

[Infectious endocarditis: reasons for a delayed diagnosis].

The diagnosis of infectious endocarditis (IE) remains difficult. The delay until diagnosis is remarkably long. Despite progress in microbiological culture technology and the use of echocardiography, no improvement has been seen in recent years. We analyze the causes of delay in all patients with IE admitted to the Cantonal Hospital Aarau between 1976 and 1987. 60 patients with 62 episodes were included in the study. The delay from first medical consultation with IE-related symptoms to hospital admission was 46 days. In cases of antibiotic pretreatment (45%) it extended to 66 days. IE was included in the differential diagnosis by the referring physicians in 29% only, whereas it was considered in the hospital on admission in 64%. Despite long lasting fever of unknown origin, only in one case was a blood culture performed before hospitalization. The symptoms of IE were different at the beginning of the disease compared to the time of admission (general malaise in 35% and 87% respectively, fever 80% and 85%, night sweat 2% and 66%, weight loss 0% and 56%, chills 21% and 47%, joint pain 16% and 27%, dyspnea 13% and 24%). We conclude that the main reasons of the diagnostic delay in IE are antibiotic therapy prior to microbiological workup, different symptoms at the onset of IE and at the time of hospitalization, insufficient awareness of the disease among general practitioners and omission of blood cultures in patients with fever of unknown origin, especially where there is a history of valvular heart disease.

Adult↗
PubMed1991

[Acute transverse myelitis in systemic lupus erythematosus: successful therapy with cyclophosphamide and prednisone].

We describe a patient with acute transverse myelitis as the first symptom of systemic lupus erythematosus who was successfully treated with cyclophosphamide and prednisone. The literature on transverse myelitis is reviewed and its clinical presentation, diagnosis, therapy and prognosis are discussed. A new therapeutic approach involving cyclophosphamide and prednisone is proposed.

Adult↗
PubMed1990

[The evaluation of prescribing practice in a general internal medicine outpatient clinic with special reference to gastrointestinal medicines].

Prescribing patterns of 13 residents in a medical outpatient clinic were evaluated between March and June 1986. Prescribed drugs influencing the gastrointestinal tract were also analyzed in order to define quality of the therapeutic process. Advertising for these special drugs in 3 Swiss medical journals was analyzed and compared with the prescribing behavior of participating physicians. 6300 patients with 3346 prescriptions (0.5 prescription/patient) were enrolled in the study. 16.5% of all prescriptions involved cardiovascular, 13.5% gastrointestinal, 9.5% non steroidal antirheumatic, 9.1% analgesic, 7.7% psychotropic and 7.4% antibiotic drugs. The share of 14 other classes of drugs was less than 4%. 471 prescriptions of gastrointestinal acting drugs were distributed over 288 patients (0.6 prescription/patient). 160 patients had irritable bowel syndrome, 40 ulcer disease, 23 inflammatory/infectious bowel disease, 18 gastroesophageal reflux, 18 anal diseases, 11 other gastrointestinal disorders and 15 were treated without diagnosis. Distribution of drugs was as follows: 27.5% bulk laxatives, 26% antacids, 15.7% H2-receptor antagonists, 13.5% anticholinergic agents, 4.9% laxatives, 3.4% loperamide, 9% other drugs. There was an increase in prescriptions per visit from 0.8 in 1980 to 1.5 in 1986. No important influence of drug advertising in 3 different medical journals published between January and June 1986 could be found. Considering the documented diagnoses, the therapeutic decisions were correct in 95.5% of cases treated. In conclusion, drug prescribing habits are permissive, the therapeutic approach is acceptable and the influence of drug advertising is negligible.

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