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Biomedical subjects

J Furrer

Publications and source records attributed to J Furrer.

At least 37 records · Page 2Linked to original sources
PubMed1999

Thiamin deficiency in HIV-positive patients: evaluation by erythrocyte transketolase activity and thiamin pyrophosphate effect.

BACKGROUND AND AIMS: The aim of the study was to determine the thiamin status in HIV-positive patients. METHODS: Measurement of erythrocyte transketolase activity (ETK) and thiaminpyrophosphate (TPP) effect in 55 consecutive HIV-positive patients of a specialized outpatient clinic were grouped into five groups according to their CD4 counts. Comparison of results of HIV-positive patients with age-matched control group of 22 healthy subjects. RESULTS: Of the patients, 27% had a pathologically-increased TPP effect, 18% of the patients had pathologically-low ETK. The percentage of pathological values of TPP effect in the patients was significantly higher compared with the control group. There was no statistically significant correlation between pathological thiamin status and stage of the disease, zidovudine therapy or nutritional status of the patients. CONCLUSIONS: Thiamin deficiency in HIV-positive patients was found in a higher percentage than previously reported. Thiamine deficiency is not only present in advanced stages of HIV-infection, but also in clinically asymptomatic patients.

Adult↗
PubMed1996

[Hypertension refractory to therapy].

A 41-year-old musician developed severe refractory hypertension 13 years after radiotherapy of the retroperitoneum because of a teratocarcinoma of the right testis. An angiography revealed severe stenoses of both renal arteries. After percutaneous transluminal angioplasty of both renal arteries, blood pressure valves returned to the normal range. Radiation-induced injury of arteries may provoke premature atherosclerosis, which cannot be differentiated morphologically from common atherosclerosis. Patients who develop severe hypertension some years after radiotherapy of the retroperitoneum should therefore be screened for the presence of renovascular hypertension.

Adult↗
PubMed1991

[Histiocytosis X. Clinical aspects and course in 5 patients].

Histiocytosis X developed in five patients (one woman and four men) when aged between 15 and 44 years. The initial sign in four of them was eosinophilic granuloma of the bone, in one it was pulmonary involvement. In three patients the disease remained confined to bone, while in two it involved the lungs and central nervous system, respectively. Osteolysis regressed spontaneously in one of the men, while in the woman there has been no recurrence 8 years after resection of the focus. In another man an osteolytic focus in a rib was noted after a 9-year recurrence-free interval. The man with pulmonary and bone involvement received chemotherapy with vinblastine and prednisone: dyspnoea and cough disappeared, vital capacity improved and the interstitial lung changes regressed. The osteolytic foci were repeatedly irradiated in the man with bone and CNS involvement. This brought about considerable reduction in pain but no significant radiological changes of the foci. Two courses of chemotherapy were given over 12 years, once with vincristine and prednisone, afterwards with cyclophosphamide. This arrested the progression of the osteolytic foci, but each time they recurred when the drugs were stopped.

Adolescent↗
PubMed1990

[Albumin or protein standardized fructosamine-plus, 2 new indices for evaluating diabetic metabolic status].

We have evaluated a new method for the determination of glycated serum proteins (fructosamines), which are elevated in diabetics. In accordance with earlier findings fructosamine depends not only on mean blood glucose but also on albumin- and total protein concentrations. Therefore fructosamine is not useful as an index of diabetic blood glucose control without consideration of an individuals albumin- or protein-concentration. We propose albumin- or protein-standardized fructosamines as new indices of diabetic control.

Blood Glucose↗
PubMed1988

[Diabetes insipidus in chronic myeloid leukemia. Remission of hypophyseal infiltration during busulfan treatment].

In a 53-year-old male who presented with diabetes insipidus as the first symptom of chronic myelocytic leukemia, computed tomography of the sella showed infiltration of the posterior pituitary gland. Busulfan treatment was given for one month and the infiltration had disappeared ten weeks after initiation of therapy. At the same time the severity of the diabetes insipidus diminished for a period of three months. Diabetes insipidus is a rare complication of chronic myelocytic leukemia: only 8 similar cases have been reported in the last 75 years.

Busulfan↗
PubMed1984

Decreased thiosulfate sulfur transferase (rhodanese) in Leber's hereditary optic atrophy.

In mammals the major portion of cyanide is converted to thiocyanate by the liver enzyme thiosulfate sulfur transferase (TST) (rhodanese). We have found a much reduced activity of this enzyme in liver biopsies from two affected males of a family with Leber's hereditary optic atrophy and in two isolated cases of the same disease, (compared to liver biopsies from controls or liver samples obtained at autopsy). In one of the patients we studied the effect of a 3-day thiosulfate infusion. The urinary excretion of thiocyanate which was low prior to the infusion was raised during the thiosulfate treatment; in a healthy control person the same thiosulfate infusion did not alter the thiocyanate excretion rate. This suggests that cyanide detoxification which is suboptimal in patients with Leber's disease may be increased by thiosulfate infusion.

Adolescent↗
PubMed1983

[Transcapillary diffusion of Na-fluorescein in skin areas of the dorsum of the foot in juvenile diabetics].

Fluorescence videomicroscopy after intravenous injection of Na-fluorescein serves to quantitate dye diffusion out of single capillaries or capillary groups in an almost atraumatic manner [2, 4, 6, 8, 9]. In 14 young patients with a mean disease duration of 10 years and in 16 healthy controls, fluorescent light intensity was measured continuously during one hour at the dorsum of the foot by a videodensitometer covering an average of 68 capillaries. 1 second and 5 minutes after first appearance of the dye in the foot skin, the amount of the tracer detected in the area of measurement was significantly increased in the diabetics (p less than 0.05-0.001). At 1 minute, for example, mean fluorescent light intensity reached 47.2 +/- 18.1% of the maximal individual intensity and in the normals only 29.3 +/- 10.8% (p less than 0.01). In the patients the capillaroscopic image was characterized by early blurring, whereas the pericapillary halo of the controls contained more dye than the more remote interstitial space and remained well delineated for a much longer time. The new technique offers the possibility of studying transcapillary diffusion as an expression of microangiopathy in different groups of diabetic patients, and of following the effect of therapeutic regimens.

Adult↗
PubMed1982

Patterns of diffusion through skin capillaries in patients with long-term diabetes.

We used intravital fluorescence videomicroscopy to study the pattern of transcapillary and interstitial diffusion in the nail folds of 13 patients with long-term diabetes and of 12 healthy controls. In both groups intravenously injected sodium fluorescein left the intravascular compartment. Its distribution in the pericapillary space and in the remote parts of the interstitial space was measured on single frames of the television tape by videodensitometers that are sensitive to intensities of fluorescent light. In the diabetics the dye passed both physiologic diffusion barriers--the capillary wall and the pericapillary space--in significantly increased amounts (P less than 0.01). The enhanced penetration of the tracer into the remote area caused an early homogeneous, milky blurring of the capillary image, whereas in the controls the pericapillary space remained clearly delineated for as long as 40 to 50 minutes after the appearance of the dye. The altered pattern of diffusion could be explained by increased permeability of the diffusion barriers, or, alternatively, by either changes of the mobility of the dye due to binding of the dye by intravascular or interstitial proteins or abnormal hemodynamics in the microvascular circulation. This technique provides a quantitative, noninvasive method of studying the natural history of diabetic microangiopathy.

Adult↗
PubMed1982

[Factitious hypoglycemia: clinical aspects, diagnosis and course in a non-diabetic male].

The case of a 37-year-old man without diabetes is reported who began to experience repetitive episodes of loss of consciousness. For 11/2 years the patient suffered from attacks of fatigue associated with sweating, tachycardia, blurred vision and finally unconsciousness. In the presence of low blood sugar and high plasma insulin values, an insulin producing pancreatic adenoma was initially suspected. In view of the negative results of radiological investigations, the different blood sugar reactions during fasting tests with and without supervision, together with low concentrations of C-peptide and high insulin values during various hypoglycemic episodes, factitious hypoglycemia was diagnosed. Finally, an ampoule of insulin was found in a locked suitcase of the patient. Therefore, in patients with fasting hypoglycemia as well as insulin producing adenoma, surreptitious insulin injections as part of a Müncchausen syndrome should be considered.

Adult↗
PubMed1981

Changes in tissue sensitivity to vasopressin in hereditary hypothalamic diabetes insipidus.

Specific binding of (125I) arg8-vasopressin to mononuclear phagocytes of the circulating blood was studied in 3 patients (one male, two females) with hereditary hypothalamic diabetes insipidus before, during and after therapy with 1-desamino-8-D-arginine vasopressin and compared with values of 15 normal donors (7 males, 8 females). Before therapy specific radioligand binding activity was considerably increased (0.3 +/- 0.08 fmoles/2.2 X 10(5) cells/ml) versus controls (0.23 +/- 0.04 fmoles/2.2 X 10(5) cells/ml). Increased binding was due to increase in receptor concentration per cell. In contrast, during treatment and after withdrawal of therapy the receptor binding activity was 0.1 +/- 0.05 fmoles/2.2 X 10(5) cells/ml. The dissociation constant (KD) for hormone binding before therapy (25 +/- 0.2 pM) was roughly identical with that of normal donors (24 +/- 0.8 pM), indicating insignificant changes in receptor affinity. During treatment and 48 h after withdrawal of therapy, however, the KD value was 11 +/- 0.45 pM, which amy be accounted for by an elevation in the binding affinity. We conclude that untreated patients with hereditary hypothalamic diabetes insipidus have increased tissue sensitivity to vasopressin, but have decreased binding capacity during and even two days after discontinuation of therapy, possibly as the result of 1-desamino-8-D arginine vasopressin-induced desensitization phenomena.

Adolescent↗
PubMed1980

[Furosemide and metolazone: a highly effective diuretic combination].

The natriuretic and diuretic effects of combined treatment with furosemide and metolazone have been studied quantitatively. 15 hospitalized patients with severe fluid retention who showed no reduction of body weight despite treatment with furosemide received metolazone in addition for 3 days. 11 patients had biventricular heart failure with edema, and 4 had cirrhosis of the liver with ascites. Following the addition of metolazone at a starting dose of 2.5 mg/d, a highly significant increase in diuresis and natriuresis, with a corresponding reduction in body weight, was seen in all patients pretreated with a daily dose of 40-370 mg furosemide (mean 122 mg/d). On the first day of this combined treatment the mean sodium excretion increased from 131 to 303 mval/d (2 p less than 0.01) and the mean urine volume increased from 1677 to 2940 ml/d (2 p less than 0.01). The mean reduction in body weight was 6.1 kg (2 p less than 0.001) within 7 days of continuous treatment. Even at low doses metolazone significantly potentiates the diuretic effects of furosemide and therefore simplifies the treatment of fluid retention. High doses of furosemide can be avoided in many cases, a factor of particular advantage in ambulatory long term therapy and in patients with decreased kidney function. It may also lower the cost of the therapy. In 3 patients the furosemide dose had to be lowered after metolazone was started, to avoid an excessive negative fluid balance. These cases clearly demonstrate the importance of daily checks on the patient's body weight after starting combined therapy with furosemide and metolazone.

Ascites↗
PubMed1980

Renovascular hypertension: treatment by percutaneous transluminal dilatation.

Eight patients with unilateral renovascular hypertension underwent percutaneous transluminal dilatation. In seven, renal-artery stenoses were caused by atherosclerotic lesions and in one, by fibromuscular hyperplasia. After a 6-month follow-up period, three patients were cured of hypertension anf four showed improvement. Only one patient failed to respond: Failure was caused by an occluded left renal artery 3 months after the procedure. Renal angiographic studies were repeated in six patients after 6 months of follow-up and showed patent vessels in five and reoccurrence of a slight renal-artery stenosis in one. In one patient angiographic control studies done after 3 months showed an occluded renal artery. In five patients mean pressure gradient across the renal-artery stenoses was 89 +/- 22.8 mm Hg before percutaneous transluminal dilatation and 16.4 +/- 18.5 mm Hg after being controlled for 6 months. Our results indicate that percutaneous transluminal dilatation may be valuable in the treatment of renovascular hypertension.

Aged↗
PubMed1979

[Minoxidil in treatment resistant hypertension].

22 patients (4 female, 18 male, mean age 47 +/- 10.7 years) with severe essential hypertension (n = 21) and renovascular hypertension (n = 1) were treated with a mean daily dosage of 16.3 +/- 5.1 mg minoxidil for up to 42 weeks. In addition, all patients received a diuretic (hydrochlorothiazide or furosemide) and a beta-blocker (pindolol or propranolol). 8 patients were treated simultaneously with alpha-methyl-dopa. Within one week minoxidil led to a significant reduction in both systolic and diastolic supine blood pressure (p less than or equal to 0.005) from 201.3 +/- 29.0/125.4 +/- 19.2 mm Hg to 172.8 +/- 28.3/106.0 +/- 19.9 mm Hg. The maximum initial blood pressure response was observed after 3 weeks with a mean daily dosage of 12.2 +/- 9.4 mg of minoxidil (160.5 +/- 20.7/99.4 +/- 13.8 MM Hg, p less than or equal to 0.001). Throughout the remaining period a constant and significant reduction in supine systolic and diastolic and upright diastolic blood pressure was achieved (p less than 0.005-less than 0.001) whereas at times systolic blood pressure values could not be lowered significantly. Body weight and pulse rate showed no significant changes throughout the study. In some cases furosemide had to be added by up to 500 mg/day to counteract minoxidil induced water and salt retention. Only moderate doses of beta-blockers were required to prevent a drug induced rise in pulse rate. In these patients a significant change in renal function was not observed. The results show that minoxidil is a potent drug in the treatment of severe essential hypertension.

Adult↗
PubMed1979

[Renovascular hypertension. Prognostic value of renal venous renin determinations (author's transl)].

In the present study the effect of surgery on blood pressure was investigated in 35 patients with renovascular hypertension: 17 patients with fibromuscular hyperplasia (FMD) and 18 with atherosclerosis (ASS) of the renal artery. Patients with FMD were younger (31,8 years), showed a shorter duration of hypertension (1.8 years) and were prevalently female (82%), whereas patients with ASS were markedly older (48.2 years), showed a longer duration of hypertension (2.6 years) and were most often male (78%). In both groups of patients the intravenous urogram was positive in a comparable high percentage (FMD=64%, ASS=61%). Following surgical intervention 47%(n=8) of the 17 patients with FMD were cured, 47% (n=8) were improved and only 6% (n=1) showed insufficient reduction of blood pressure values. In ASS the respective values were 28, 55 and 17%. Consequently a good effect of surgery (cured and improved) was observed in 88.5% of all patients. Patients with ASS who failed to respond to surgery (n=3) showed a remarkable long duration of hypertension (7.0 plus or minus 1.4 years). Plasma renin activity (PRA) was determined preoperatively in both renal veins in all 35 patients. From these values the PRA-ratio (PRA affected/unaffected side) was calculated. In 27 patients PRA determinations were repeated following (15 and 30 min) intravenous injection of 40 mg furosemide. PRA-ratios of larger than or equal to 1.5 were considered to be significant. In 31 patients with unilateral renovascular hypertension PRA-ratios were correlated to the postoperative blood pressure reduction. No significant differences in mean PRA-ratios were observed between cured and improved patients. Furthermore, for the total group of 31 patients no significant correlations were obtained between PRA-ratios and postoperative blood pressure reduction. Our results do not support the widespread opinion that PRA determinations in both renal veins are useful to predict the effect of surgery in patients with unilateral renovascular disease. Therefore, from our experience this method should not be recommended as obligatory in the diagnostic work-up of renovascular hypertension.

Adult↗