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Biomedical subjects

D Conen

Publications and source records attributed to D Conen.

72 records · Page 4Linked to original sources
PubMed1983

Nifedipine in hypertensive emergencies.

The effects and safety of using oral nifedipine 10-20 mg as acute antihypertensive treatment were studied in a single-blind placebo-controlled study of 25 consecutive patients with very high blood pressure requiring emergency reduction. In addition the effect of this treatment on cerebral blood flow was investigated using xenon-133 in 10 patients randomly allocated to receive oral nifedipine or intravenous clonidine. Whereas placebo did not alter the blood pressure, oral nifedipine significantly reduced the systolic and diastolic blood pressures in all 25 patients (from 221 +/- 22/126 +/- 14 mm Hg to 152 +/- 20/89 +/- 12 mm Hg after 30 minutes, p less than 0.001). Heart rate increased from 74 +/- 11 to 84 +/- 11 beats/minute (p less than 0.01); this effect was inversely related to age (r = -0.65, p less than 0.01). The falls in systolic and diastolic blood pressures were closely related to the blood pressures before treatment ) r = 0.67, p less than 0.001 for systolic, and r = -0.58, p less than 0.01 for diastolic values). No serious unwanted effects were observed. Measurement of cerebral blood flow after nifedipine showed an increase in flow in four out of five patients. Clonidine, by contrast, reduced cerebral blood flow in all patients by up to 28%. Nifedipine is a simple, effective, and safe alternative drug for managing hypertensive emergencies, especially when continuous monitoring of the patient cannot be guaranteed.

Adult↗
PubMed1982

[Irritable colon--yes or no? Does the anamnesis help in the decision?].

To assess the value of history in evaluating abdominal pain, 45 outpatients (25 women and 20 men) aged 16-76 completed a questionnaire. The affirmative replies of the patients with organic disease were compared with those of patients with irritable bowel syndrome (IBS) by the chi 2 test. 17 patients had organic diseases while 28 had IBS. The features indicating an organic lesion (p less than 0.0005) were age over 50, history of short duration, bloody stools, bowel incontinence and urgency, pain at night, pain lasting minutes, colicly pain, and onset of pain 1-2 h after meals. Typical features of IBS (p less than 0.0005) were age below 50, frequent bowel movements of normal consistency, increased pain with emotional stress, a rigid personality and an exceptionally well-groomed appearance. From these findings the following conclusions are drawn: 1. Patients with organic disease always present with two symptoms indicative of an organic origin and with one highly significant symptom of IBS at most. 2. IBS is characterized by a broad range of various highly significant symptoms simultaneously. There is a larger number of significant symptoms against IBS (n = 10) than for it (n = 4). History serves rather to rule out IBS than to prove it.

Adolescent↗
PubMed1982

[Uveitis: a rational diagnostic program for practice in internal medicine].

Uveitis, as an inflammation of the uvea, the vitreous body or the choroid, should not be regarded as a disease but only as a sign of an underlying multisystem disorder. The cause of iritis cannot be established by examining the eye only. Differential diagnosis should take into consideration geographic, possible environmental and genetic background factors. Furthermore, it should be recognized that some causes are infectious, some allergic and some autoimmune in nature. Many, even sophisticated tests are available to detect and underlying disorder. To establish an expedient program for investigation of uveitis, 39 patients with uveitis were examined prospectively from May 1979 to December 1980. In taking the history, the geographical and genetic background and simultaneous therapy were noted. The full systemic examination paid special attention to accompanying oral or genital ulcerations or joint disorders. A tuberculin skin test, the blood sedimentation rate (BSR), leukocyte count, serological tests for herpes, cytomegaly, mycoplasma, venereal and brucella infections, toxoplasmosis, rheumatoid factor and antinuclear bodies must also be carried in every patient. In each patient a chest radiograph was taken. In 5 patients uveitis was due to toxoplasmosis, in 3 to Behçet's disease in 3 to sarcoidosis, in 2 to ankylosing spondylitis, and in 1 to ulcerative colitis. In 36% uveitis was associated with an underlying disease, while in 64% the investigations failed to disclose an accompanying disorder. A detailed history, a full systemic examination, BSR and a whole blood count, a tuberculin skin test, a TPHA test, a toxoplasma dye test, and a chest radiograph are recommended as an appropriate minimal program.

Adolescent↗
PubMed1982

An oral calcium antagonist for treatment of hypertensive emergencies.

The efficacy and safety of 20 mg of nifedipine as a single oral dose have been studied with respect to the use of the drug as an alternative treatment of hypertensive emergencies. The study population consisted of nine male and nine female patients, 47 to 80 years old. The mean systolic blood pressure decreased from 220 +/- 22 to 150 +/- 21 mm Hg and the mean diastolic blood pressure from 122 +/- 11 to 86 +/- 10 mm Hg (p less than 0.001) within 20-30 min. The decrease of blood pressure was paralleled by a small but significant increase (p less than 0.01) in heart rate from 74 +/- 9 to 85 +/- 10 beats/min. The fall of blood pressure was directly related to pretreatment values. Oral nifedipine can be recommended as a first-line drug to lower blood pressure in hypertensive emergencies.

Aged↗
PubMed1981

[An analysis of pharmacotherapy in an internal medicine ambulatory care clinic, using the example of cardiovascular-effective drugs].

The use of cardiovascular active drugs at a general internal medical outpatient clinic and its quality are assessed. In the spring of 1980, 209 prescriptions for cardiovascular drugs taken from a total of 1800 prescriptions were prospectively analyzed based on a previous retrospective review of medical records. The requirements for cardiovascular drug therapy, which had been fixed in advance, were met in 80%: thus, in 90% of all prescriptions the indication for therapy could be reconstructed from the medical record; the choice of the drugs used was considered adequate in 80% and the dose in 90%. However, the requested clinical investigations were recorded in only 65%, whereas laboratory tests were done in 90%. Of all drugs, therapy with digoxin was most often used without indication and without clinical follow-up of the patient. In the diuretics group potassium-saving preparations were used as drugs of first choice without adequate indication. In addition, therapy with beta-blocking agents in a group of elderly patients was not justifiable by the records. Side effects were registered in 4% of all cardiovascular drug prescriptions. Overall the quality of drug therapy was considered adequate. Cross-comparison was not possible due to lack of comparable studies in the literature.

Ambulatory Care↗
PubMed1981

[Haemoccult and Colorectal: a comparative prospective study on the detection of occult blood in the feces].

Comparison of Colorektal and Haemoccult in 600 stool samples from 200 ambulatory, non-selected patients over the age of 40 revealed an equal number of positively reacting specimens (Colorektal 5.8%, Haemoccult 5.7%). Comparison of the results in relation to patients showed 28 positive cases with Colorektal and 18 with Haemoccult. Diagnostic workup disclosed a lesion potentially responsible for the bleeding in 67% of the cases with Haemoccult-positive and 54% with Colorektal-positive stool samples.

Adult↗
PubMed1981

[Nine cases of imported Malta fever in Basle].

Report on 9 cases of Malta fever seen in Basle, Switzerland, in the first three months of 1980. In contrast to previous reports in the literature, positive blood cultures were found in 8 of the 9 patients. All were infected by direct contact with sheep and the clinical picture was classified in all cases. Therapy with Doxycyclin led to rapid improvement. No severe complications were observed. In the light of these cases the epidemiology, clinical picture, possible complications and therapy of this disease are discussed.

Adolescent↗
PubMed1981

[Evaluation of pharmacotherapy in general-internal ambulatory care as a possibility of quality control].

The therapeutic process at a medical outpatient clinic is evaluated. 1800 drug prescriptions for 839 patients issued by 9 medical residents from February to March 1980 were collected prospectively and analyzed by retrospective chart review. Although a rather high frequency of drug prescription (0.83 per consultation) was found, the average of 2 drugs per patient treated was considered to be low. Gastrointestinal drugs were prescribed most frequently (17% of all prescriptions), whereas antimicrobial agents (7%), psychotropic drugs (10%) and cerebrovascular vasodilators (0.8%) were used rarely in comparison with the results of other investigations. Evaluation of choice of drugs and frequency of their use was based on criteria from the literature. Analysis of prescribing patterns of the individual residents provided information about their pharmacotherapeutic peculiarities. Drug use of the group was judged to be satisfactory. The accuracy of the diagnostic workup preceding drug therapy was examined, and for 17% of all prescriptions no diagnosis could be found in the medical record. Furthermore, the chart review revealed unsatisfactory documentation of the drug therapy prescribed, i.e. 20% of prescriptions were not recorded. Educational feedback to the group was given to the residents. It was accepted as valuable information about medical behaviour and performance of the individual.

Ambulatory Care↗
PubMed1979

[The echocardiogram in mitral anulus calcification].

In agreement with the known high incidence of mitral anulus calcification in elderly patients, the authors have found corresponding calcifications in echocardiographic examinations in 61 patients as the single or additional cause of an abnormal systolic or diastolic murmur. The intracardiac calcifications were known of from the chest X-ray only in 6 patients. The echocardiograms served to locate and estimate the amount of the calcification. Calcifications of the aortic cusps, found in 75% of patients, may be of degenerative origin. The echocardiographic presentation of the degenerative calcifications can be misinterpreted either as postrheumatic valvular disease, posterior pericardial effusion or hypertrophic cardiomyopathy. Registration by continuous sector scan was necessary to differentiate these entities.

Aged↗
PubMed1979

[Hemolytic crisis and acute kidney failure from rifampicin].

Two cases are reported of hemolytic crisis and acute anuria after intermittent rifampicin medication. Immunologic tests demonstrate that the hemolysis was of the drug-induced heteroimmune type whereas the pathogenesis of the anuria was uncertain. For both complications the prognosis is good.

Acute Kidney Injury↗
PubMedDate not supplied

A skin test for autonomic neuropathy.

Intradermal injection of 0.5 microgram histamine produced equal skin reactions in normal individuals (n = 15) and in diabetic patients with (n = 10) or without (n = 9) evidence of autonomic neuropathy as well as in patients after lumbar sympathectomy (n = 5). Addition of noradrenaline (0.1 microgram) resulted in a significantly smaller skin reaction (mean +/- SEM) in normal (101.9 +/- 10.1 vs. 136.3 +/- 6.5 mm2, p less than 0.005) and in diabetic patients without autonomic neuropathy (101.8 +/- 8.4 vs. 123.9 +/- 8.7 mm2, P less than 0.05), but remained unchanged in diabetic patients with autonomic neuropathy (131.0 +/- 9.0 vs, 130.7 +/- 8.2 mm2, n.s.) and after lumbar sympathectomy (135.2 +/- 17.5 vs 130.2 +/- 19.6 mm2, n.s.) when compared with the reaction to histamine alone. Addition of terbutaline produced similar results as observed with noradrenaline. These findings suggest a defect at the adrenoceptor level in diabetic patients with autonomic neuropathy and in patients with lumbar sympathectomy. Thus, the combined intradermal injection of histamine and the adrenoceptor agonists noradrenaline or terbutaline represents a simple and useful test for identifying patients with impaired adrenergic function.

Adult↗