Biomedical subjects
G Schulthess
Publications and source records attributed to G Schulthess.
[Infectious mononucleosis (primary infection with Epstein-Barr virus].
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[Malaria. Primary symptoms: fever, headache, nausea, vomiting, diarrhea].
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[Early summer meningoencephalitis (ESME). Main symptoms: fever, headache, meningitic and encephalitic symptoms].
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[Painful shoulder in the elderly--not always of degenerative nature].
A 81-year-old man suffered, without any preceding trauma, from progressive pain of his left shoulder since 3 weeks. The left upper arm was warm and swollen with a palpable solid mass. Mild normocytic anemia and an increased erythrocyte sedimentation reaction were determined. X-ray showed an osteolytic lesion of left humerus with pathological fracture and involvement of soft tissue. Multiple myeloma was diagnosed from the biopsy of this lesion, detection of paraprotein IgA Kappa in the serum, and a 15-20% plasma cell infiltration of the bone marrow. The patient responded well to radio-therapy and intravenous application of biphosphonates--the fracture healed by conservative therapy. The treating physician--on the basis of clinical experience and by intuition--has to decide considering medical history and clinical findings whether musculoskeletal pain must be investigated further. Diagnosis of multiple myeloma requires monoclonal protein (paraprotein) in the serum or urine, plasma cell infiltration of the bone marrow, and evidence of end-organ damage (anemia, renal insufficiency, bone lesions or hypercalcemia).
[Multilocular large erythemas and fever].
A 44-year old man consulted our emergency room three months after returning from holidays in Sri Lanka: Following a short episode of fever, he observed rise of four large reddish skin lesions that central paling. We considered infection with Borrelia burgdorferi (erythema migrans), streptoccoci (erysipelas), or fungi (tinea corporis). Erysipelas was improbable because of slow progression with little systemic inflammatory response, fungi were not detected in direct microscopic examination. Aspect of the skin lesions was typical for erythema migrans, however, we were not familiar with multilocular appearance of this disease. Nevertheless--on the basis of clinical observations and detection of serum IgM against Borrelia burdorferi--we diagnosed multilocular erythema migrans and treated with doxycycline 200 mg daily for 10 days. The skin lesions completely disappeared within a few days. Erythema migrans may present unilocular or multilocular, depending on Borrelia species involved. In Europe (mainly B. afzelii and B. garinii), multilocular manifestation is rare and, therefore, often misinterpreted. It is important, however, to diagnose and treat multilocular erythema migrans because early hematogenic dissemination is underlying. In America B. burgdorferi sensu stricto infection more often presents with multilocular erythema migrans and systemic clinical manifestations.
[(Micro-)hematuria (in adults). Main symptoms: evidence of erythrocytes in urine sediment].
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[Chronic pancreatitis. Main symptoms: chronic abdominal pain, weight loss in steatorrhea, secondary diabetes mellitus].
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["Subacute thyreoiditis" without response on corticosteroid therapy].
A 49-year old employee of a drug store with neck pain, painful thyroid gland, and elevated erythrocyte sedimentation rate (38 mm/h) was diagnosed as subacute thyreoiditis (de Quervain). However, application of oral corticosteroids (prednisone 50 mg/d) during three days did not reduce pain as expected. Therefore, the patient was admitted for further evaluation. Clinical examination showed a female in a pain-relieving posture (forward neck flexion). Further examinations including ultrasound of the thyroid, computertomography of the neck, and ENT examination did not reveal etiology of the pain. Finally, electrocardiography showed subacute infero-posterior myocardial infarction, and coronary angiography revealed severe coronary two vessel disease. Tabacco smoking since the age of fourteen (35 pack years) was identified as the only major risk factor for premature atherosclerosis. Diagnosis of subacute thyreoiditis is made from clinical and laboratory findings. Treatment with nonsteroidal antiinflammatory drugs or corticosteroids usually relieves pain within two or three days. Otherwise, etiology of the disease must be re-evaluated considering any disease localized in neck or thorax region. Antiinflammatory treatment of subacute thyreoiditis has to be continued for weeks or months.
[Extrapulmonary tuberculosis (in adults). Often unspecific general symptoms, main symptoms are related to diseased organs].
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Effect of macrolides on peripheral arterial disease depends on patient selection and adequate treatment.
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[Egg intake and cardiovascular risk].
Egg yolk has the highest content of cholesterol observed in different types of food. Intake of one egg per day increases the serum concentration of LDL cholesterol by 0.10 mmol/l. In healthy people eating a Western diet, egg consumption does not correlate with cardiovascular risk. However, a significant increase of the risk was observed in diabetic subjects starting from an intake of 5-7 eggs per week. However, dietary pattern rather than a single component of nutrition influences cardiovascular risk. The egg - rich in proteins, unsaturated fatty acids, vitamins and minerals - should be part of our nutrition, and it is not justified to recommend a general limitation of egg intake. However, we do not advice unbalanced high egg consumption. A cardioprotective diet is characterized by high variability and contains plenty of fruits, vegetables, and complex carbohydrates.
[Subacute thoracic pain].
A 75-year old woman with essential hypertension presented two days after the onset of a sudden and strong thoracic pain. The pain did neither increase during breathing nor decrease after the ingestion of nitroglycerine, and could not be triggered by physical manipulation of the thoracic wall. Electrocardiogram showed a left bundle branch block, chest X-ray showed a widened upper mediastinum. Rupture/dissection of an aberrant right subclavian artery (a. lusoria) could be diagnosed by computed tomography. Successful implantation of an endovascular stent-graft was carried out. Evaluation of (sub)acute thoracic pain should include two-plane chest X-ray and, in case of a widened mediastinum, further investigation by computed tomography. In case of highly suspected rupture/dissection of an intrathoracic artery, a specific imaging procedure such as computed tomography is crucial.
[Emergency landing due to a passanger with chest pain, dyspnea, and vomiting].
A 20-year old student had suffered since 3 years from diabetes mellitus type I, which was well-controlled by insulin-pump therapy. During a flight from Moscow to Los Angeles, the student all of a sudden had chest pain, dyspnea, and he vomitted repetitively--emergency landing at Zurich airport was necessary. The student presented at the emergency unit in a poor general condition with tachypnea (32/min) and tachycardia (136/min). Arterial blood gas analysis showed severe metabolic acidosis (pH 7.04), while pulmonary or cardiac disease could be ruled out. Diabetic ketoacidosis was caused by the pump running short of insulin. Treatment included rehydration and administration of insulin. Administration of insulin by an insulin-pump allows to continuously and flexibly adjust the dosage according to the requirement of the body. Interruption of insulin administration can cause, however, relatively fast ketoacidosis because exclusively short-acting insulin is used.
[Unexpected complication in an elderly lady suffering from rheumatoid arthritis].
A 66-year old female suffering from rheumatoid arthritis was treated with methotrexate and intra-articular steroid injections. She had gone through pulmonary tuberculosis at the age of 2 years, also, surgery had been performed 2 years ago because of perforated sigmoid diverticulitis. The patient now presented with episodes of abdominal pain and diarrhea as well as occasional night sweats. Laboratory investigation (normal BSR, CRP and white blood cell counts) did not indicate the presence of an inflammatory process, such as reoccurrence of diverticulitis. However, leukocyturia was repetitively found in this patient with the conventional urine culture yielding no significant bacterial growth. Further urine investigation did not indicate infection with Chlamydia trachomatis or Neisseria gonorrhoeae. Ziehl Neelson stains of morning urinary samples did not show acid-fast rods, however, Mycobacterium tuberculosis was finally isolated by culture. Thus, urogenital tuberculosis was finally diagnosed in this patient. Infection, hematogenic dissemination, and spontaneous remission of pulmonary tuberculosis had occurred more than 60 years ago. After a long latent period, reactivation of tuberculosis happened during drug-induced immunosuppression. The patient was successfully treated with an anti-tuberculosis triple-drug therapy during 2 months followed by a double-drug therapy during 4 months.