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Biomedical subjects

E C Reisinger

Publications and source records attributed to E C Reisinger.

At least 55 records · Page 3Linked to original sources

Hemoglobin variants recently detected in Austria.

Measurement of glycated hemoglobin (HbAtc) is used for routine management of diabetic patients. Glucose linkage to HbAtc reflects mean blood glucose levels during the last 3 months before examination. Various methods for HbA1c determination show abnormal values with hemoglobin variants. In some diabetic patients excessively high HbA1c values with high-performance liquid chromatography (HPLC) led to the detection of Hb Graz. In addition to Hb Graz, other silent hemoglobin variants have been found in Austria. Here we review Hb Graz, Hb Sherwood Forest, and Hb Okayama detected while using HPLC for the measurement of HbA1c in diabetic patients.

Austria↗

Hemoglobin Sherwood Forest detected by high performance liquid chromatography for hemoglobin A1c.

Hb Sherwood Forest has been so far identified in only one patient in 1977. This study describes the second detection of this hemoglobin variant by routine high performance liquid chromatography (HPLC) in a diabetic patient and her healthy grand niece. In both, glycosylated hemoglobin (HbA1c) values were excessively elevated (52%), as determined by HPLC with a cation exchange column. The latex agglutination test showed values of HbA1c in the expected normal range. Citrate agar electrophoresis revealed a hemoglobin variant with a mobility similar to HbF. Amino acid analysis and DNA sequence analysis revealed an Arg-->Thr exchange at codon 104 of the beta-chain. This sequence has been described as Hb Sherwood Forest in 1977. The hemoglobin variant is clinically silent and might be confused with excessively high HbA1c in routine measurement of glycosylated hemoglobin.

Aged↗

Use of interferon gamma and mebendazole to stop the progression of alveolar hydatid disease: case report.

We describe a 28-year-old female who presented with metastatic spread of a suspected occult tumor. The diagnosis of alveolar echinococcosis was established by needle biopsy of the liver and ELISA. The patient's clinical symptoms initially decreased after treatment with mebendazole, but the lesions progressed during the following 6 months. Albendazole was not available in Austria. Because the synthesis of interferon gamma (IFN-gamma) and IFN-alpha is markedly decreased in patients with echinococcosis, we treated our patient with IFN-gamma while continuing mebendazole therapy. This combination halted progression of the disease during the 12 months of follow-up.

Adult↗

Recurrent Salmonella enteritidis sepsis and hepatic tuberculosis.

A 33 year old woman with recurrent Salmonella enteritidis sepsis is described. Penicillins, ceftriaxone, ciprofloxacin, and chloramphenicol could not eradicate the salmonellas but a combination of high dose ciprofloxacin and ceftriaxone for the eighth episode successfully cured the infection. The combination of ciprofloxacin and ceftriaxone may be a valuable therapeutic regimen in patients with recurrent salmonella sepsis. Prolonged intrahepatic cholestasis resulting from granulomatous hepatitis in this patient improved considerably with empiric ursodeoxycholic acid treatment. A liver biopsy specimen showing non-caseating epitheloid granulomas was positive for mycobacterial DNA by polymerase chain reaction. Repeated bronchoscopy with multiple biopsies eventually revealed caseating granulomas with acid fast bacilli in the lung biopsy specimens. Therefore, tuberculosis was diagnosed as the underlying disease and the cause of granulomatous hepatitis in this patient and tuberculostatic treatment was started. Polymerase chain reaction for mycobacterial DNA may be helpful in the differential diagnosis of hepatic granulomas when routine histological examination and culture of biopsy specimens are not diagnostic. Tuberculosis should be considered as one of the diseases predisposing to recurrent salmonella sepsis.

Adult↗

[Increased prevalence of serum IgA Chlamydia antibodies in obesity].

Obesity is metabolically related to diabetes type II. We have previously shown that seroactive (IgG- and IgA-Chlamydia antibody positive) chlamydial infection of asymptomatic patients is more frequent in type II diabetic patients than in nondiabetics, independent from metabolic control. Thus we investigated 119 nondiabetic patients (66 +/- 9 years, HbA1c < 6%) of our department for seroactive chlamydia infection using an immunoperoxidase reaction and compared the results to the anthropometric data. The prevalence of seroactive chlamydial infection was significantly (p < 0.05) higher in the considerably overweight patients with a BMI > 30 kg/m2, both when compared to lean patients (BMI < 24 kg/m2) and when compared to all those with BMI < 30 kg/m2. For slight to moderate obesity the prevalences were slightly (but not significantly) increased. Due to the fact that similar data were obtained for type II diabetic patients, an unknown relation to insulin resistance might be the underlying cause and should be further investigated.

Aged↗

[Transmission of HIV infection].

The increasing number of human immuno-deficiency virus (HIV) infections and the shift from traditional risk groups to the general population give reason for reviewing the routes and risks of virus transmission. In Africa HIV is transmitted mainly by heterosexual contact; in Europe and the USA homosexuality is still the leading cause of infection, however, heterosexual transmission is increasing dramatically. The heterogeneity of HIV strains and host factors may contribute to the progression of HIF infection to AIDS. Vaginal fluid and sperm are infectious, ulcerations caused by venereal diseases and some sexual practices increase the risk of HIV transmission. The use of condoms reduces the risk of infection, but does not eliminate it completely. Saliva is not a likely source for HIV transmission, but oral sex is a risk factor. HIV transmission from mother to child can occur either in utero, during delivery or by infected breast milk. Intravenous drug abusers still get infected by needle sharing. The risk of infection due to therapy with blood products can be minimized by anti-HIV antibody testing, neopterin screening, and virus inactivation. Cell-free blood products can be effectively heated and/or treated with solvent/detergent mixtures. Virus inactivation in fresh frozen plasma is not yet possible.

Blood Component Transfusion↗

Serum levels of the soluble receptor for tumor necrosis factor in patients with renal disease.

Tumor necrosis factor-alpha (TNF-alpha) has been found to be elevated in patients during hemodialysis and is thought to mediate some of the immune and metabolic dysfunctions in these patients. It has been speculated that infusions of soluble TNF receptor (sTNF-R) may prevent some of the cytotoxic effects of TNF. However, little is still known about preexisting serum TNF-R levels in patients with chronic renal failure, with or without hemodialysis. Therefore we analyzed serum samples of sTNF-R in 26 patients with chronic renal failure (group I), 61 hemodialysis patients (group II), 9 renal transplant recipients with acute renal failure requiring posttransplant dialysis (group III), 13 renal transplant patients with rejection and moderate kidney dysfunction (group IV), and 21 renal transplant recipients with borderline kidney dysfunction and diverse infectious complications (group V). Control groups consisted of 34 blood donors and diseased controls (11 renal transplant recipients with normal kidney function without complications). All patient groups showed significantly higher sTNF-R levels compared to the control groups. In groups I, IV, and V comparable levels were observed. In group I there was a clear correlation between sTNF-R levels and serum creatinine. The highest sTNF-R serum levels were seen in groups II and III, but there was no correlation with creatinine. In the posttransplant cases (group III and diseased controls) there was a decrease in sTNF-R with improvement of kidney function. These data strongly suggest that sTNF-R serum levels are dependent on kidney function.

Adult↗

[Toxoplasmosis peri-myocarditis as initial manifestation of highly malignant non-Hodgkin's lymphoma].

A case report of a 28-year-old mother of two children with FUO is presented. Physical examination revealed an anemic and febrile woman, who lost 10 kg of weight during the past 3 months. Furthermore, two lymphatic nodes with diameters below 1 cm were detected at the neck and inguinal region. A search for origin of fever including evaluation of foci, malignancies and laboratory investigations was primarily unsuccessful. At day 7 after admission a pericardial murmur could be heard. Echocardiography revealed a pericardial effusion, which increased up to 4 cm during the following days, leading to hemodynamic impairment and asystole. Immediate CR was successful, pericardial effusion was aspirated. Looking for etiology of fever the presence of IgM-antibodies against toxoplasma gondii by an ELISA test was possible. Therefore, toxoplasmosis was diagnosed and a treatment-regimen comprising pyrimethamin and sulfadiazin was initiated. Because of the threat to life and very high titers of C-reactive protein, antibiotic therapy (imipenem) was given additionally. An immunologic impairment was excluded by normal ratio of CD4:CD8 of lymphocytes, normal HIV-test and a nonsuspicious Jamshidi-biopsy of the bone marrow. However, in week 9 after admission lymphatic node-tumors suddenly appeared at the neck and pulmonary hilus. After diagnostic exstirpation a malignant non-Hodgkin-lymphoma (T-cell-type) was diagnosed. It is concluded that in obscure pericardial effusion toxoplasmosis should be considered and that this manifestation may be a precursor of malignant non-Hodgkin-lymphoma.

Adult↗

Agenesis of the dorsal pancreas in a woman with diabetes mellitus and in both of her sons.

Complete agenesis of the dorsal pancreas has rarely been described. Complete agenesis of the dorsal pancreas in a female who developed insulin-dependent diabetes mellitus at the age of 39 years is reported. The diagnosis of agenesis of the dorsal pancreas was suspected by abdominal ultrasound and confirmed by abdominal computed tomography (CT), magnetic resonance imaging, and endoscopic retrograde pancreatography. Her exocrine pancreatic function was essentially normal. Both of the patient's sons also had agenesis of the body and tail of the pancreas verified by abdominal CT but had no evidence of diabetes mellitus. This familial occurrence of agenesis of the dorsal pancreas suggests that hereditary mechanisms may play a role in the pathogenesis of this anomaly.

Adult↗

Spontaneous bacterial peritonitis in a hemodialysis patient with systemic lupus erythematosus.

Spontaneous bacterial peritonitis (SBP) is defined as infection of preexisting ascites without evidence for any intraabdominal source for secondary infection. SBP is now recognized with rising frequency and has mainly been reported in patients with alcohol-induced cirrhosis of the liver. We report SBP in a female dialysis patient whose ascites was not due to liver disease, but was possibly due to lupus erythematosus or represented 'nephrogenic ascites'. The patient had severe abdominal pain and a positive rebound phenomenon, fever and an elevated peripheral white cell count of 21,000 cells/microliters. Ascitic fluid analysis revealed an exudate with a protein concentration of 5.2 g/dl, 13,000 white cells/microliters with 94% neutrophils and positive cultures for Streptococcus morbillorum. Because of the dramatic clinical features the patient underwent laparotomy which did not reveal a source for secondary infection and in retrospect was unnecessary. The patient responded well to antibiotic therapy. This case report draws attention to SBP as a cause of acute abdomen in patients on chronic hemodialysis.

Aged↗

[Self-medication of 193 travelers in the tropics. Recommendations for clinical counseling of tropical travelers and organization of a tropical travel pharmacy].

Medical advice for the traveller is of increasing importance since in the past decade in industrialized countries there is a steady increase in numbers of travellers and distance travelled. Self medication was evaluated in 193 travellers to malaria-endemic areas. Diarrhoea, fever and headache were the most frequent symptoms. Antidiarrhoeal agents, analgetics/antipyretics, antibiotics and oral contraceptives were the drugs most often used by travellers. One case of mefloquine-resistant and chloroquine-sensitive Plasmodium falciparum malaria acquired in West Africa was reported, another patient took pyrimethamine/sulfadoxine because of suspected malarial fever. The main reasons for drug consumption in travellers to tropical and subtropical areas are functionally divided into 4 groups: vaccination and prophylaxis, medication during the outward and return journey, illness occurring during stay abroad and long-term medication. This classification should be considered when medical advice is given for travellers and is the basis for choosing the contents of a pocket dispensary for travellers.

Adolescent↗

Dextran sulphate reduces diphenylhexatriene anisotropy in human peripheral blood lymphocytes: impact on plasma membrane fluidity and HIV-cytopathogenicity.

Cytopathogenicity of HIV and other enveloped viruses is reduced by membrane fluidizing agents and by dextran sulphate (DS). To investigate whether DS exerts its antiviral action via plasma membrane fluidization of host cells, we performed anisotropy measurements on human peripheral blood lymphocytes (PBL) using the fluorescent marker diphenylhexatriene. Anisotropy was decreased in DS-exposed PBL indicating increased fluidity in the hydrophobic membrane interior.

Adult↗