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Biomedical subjects

J Steurer

Publications and source records attributed to J Steurer.

At least 73 records · Page 4Linked to original sources
PubMed1997

[Castleman's disease--a rare cause of a febrile state with lymphadenopathy].

HISTORY AND CLINICAL FINDINGS: A 26-year-old man had a prolonged fever, 10 kg weight loss and generalized lymphadenopathy, first diagnosed as a malignant lymphoma. On admission he was febrile and in a markedly reduced physical condition. Submandibular, angular, cubital and inguinal lymph nodes were slightly enlarged bilaterally. INVESTIGATIONS: Serology and blood cultures were negative. Sonography and computed tomography showed enlarged lymph nodes in the neck, mediastinum, axillae, retroperitoneum and mesentery. Biopsies of lymph nodes and bone marrow revealed changes characteristic of Castleman's disease. TREATMENT AND COURSE: Prednisone was administered, 20 mg daily for 20 days, the dose gradually reduced over 4 months. The fever ceased after 14 days and the patients's working capacity was fully restored after 7 weeks. CONCLUSION: In a case of prolonged fever of unknown cause Castleman's disease should be included in the differential diagnosis. It at first consists of polyclonal lymphatic proliferation. But transformation to malignant lymphoma and systemic Kaposi's sarcoma have been described in the disease's generalized form.

Adult↗
PubMed1997

[The effect of short-term hyperventilation on the concentration of ionized serum calcium].

BACKGROUND AND OBJECTIVE: Paraesthesias and carpopedal spasms on hyperventilation are explained by a reduction in ionised serum calcium (ISC). We tested whether 5-minute hyperventilation changes the concentration of ISC. SUBJECTS AND METHOD: Arterial blood samples were obtained via a small plastic catheter introduced into the femoral artery of ten healthy male volunteers (mean age 33 years) before, during and after 5 minutes of hyperventilation, which was achieved by deep and rapid breathing and considered adequate when the end-expiratory pCO2 had fallen to 2.5 kPA within the first minute and remained below this level during the remaining 4 minutes. These criteria were met in nine of the ten patients. The ISC concentration was measured with an ion-selective electrode, the pH, paCO2 and bicarbonate levels with an autoanalyser. RESULTS: Paraesthesias of the fingers and hand occurred in nine of the volunteers, carpopedal spasms in seven. Despite a definite rise in pH from 7.39 +/- 0.02 to 7.75 +/- 0.045, the concentration of ISC did not change significantly during the hyperventilation. CONCLUSION: Paraesthesias and carpopedal spasms which occur during hyperventilation are not caused by a fall in ionised serum calcium in arterial blood.

Adult↗
PubMed1997

Changes in arterial and transcutaneous oxygen and carbon dioxide tensions during and after voluntary hyperventilation.

The purposes of our study were (1) to investigate whether a 3-min short-term hyperventilation leads to posthyperventilatory hypoxemia and (2) to assess the role of transcutaneous blood gas measurements for monitoring oxygen and carbon dioxide changes during the after the test. In 10 male volunteers arterial and transcutaneous blood gases were measured simultaneously before, during and after a 3-min voluntary hyperventilation maneuver. Baseline arterial PO2 increased from 13.7 +/- 0.4 kPa (103 +/- 3 mm Hg) to 18.6 +/- 0.3 kPa (139 +/- 2.3 mm Hg; p < 0.005 compared to baseline) during hyperventilation. After the provocation test posthyperventilatory hypoxemia occurred with a minimal mean value of 7.8 +/- 1.3 kPa (58.5 +/- 9.8 mm Hg; p < 0.05 compared to baseline). Whereas close agreement between arterial and transcutaneous measurements was obtained for carbon dioxide values before hyperventilation, transcutaneous O2 consistently underestimated arterial O2. A short-term over-breathing of 3 min causes a significant posthyperventilatory hypoxemia. We hypothesize that posthyperventilatory hypoxemia is caused by hypopnea as a result of depleted CO2 body stores. Noninvasive transcutaneous blood gas measurements are not reliable for monitoring blood gas changes during and after hyperventilation, most probably because of the slow response time of the electrodes and the reflex vasoconstriction of the skin vessels.

Adult↗
PubMed1997

Skin hyperemia in a habitual blusher.

Blushing, a vascular skin response to emotion is difficult to investigate since subjects are not able to blush on demand in a laboratory setting. Laser Doppler fluxmetry measures blood flux changes noninvasively. In a 28 year old lady distressed by habitual blushing we were able to document changes in skin blood flux during blushing. Forehead skin blood flux increased suddenly from 20 to 45 arbitrary units and returned to baseline values after about 3 minutes. It is the first time that emotionally provoked hyperemia in head skin is documented.

Blushing↗
PubMed1996

Predictors of the presence and extent of peripheral arterial occlusive disease.

BACKGROUND: Data relating lipids to the angiographic presence and extent of atherosclerosis, as reported for the coronary circulation, are lacking for the peripheral site. METHODS AND RESULTS: This study comprised 102 patients with peripheral arterial occlusive disease (PAOD) referred for elective percutaneous transluminal angioplasty and 100 age-matched control subjects with normal coronary and peripheral angiograms. The presence of PAOD was defined as > or = 1 stenosis with > or = 50% narrowing, and the extent was defined as the total of > or = 50% lesions in the iliac, femoral, popliteal, and crural beds. The relation of lipids and nonlipid risk factors to the presence of PAOD was tested by stepwise logistic regression analysis; their relation to the extent of disease was analyzed by simple regression and stepwise discriminant analysis. The presence of PAOD was significantly and positively associated with LDL cholesterol (P = .0003), triglycerides (P = .0001), apolipoprotein B (P = .0073), and smoking (P = .005) and was significantly and negatively associated with HDL2 cholesterol (P = .0085) and apolipoprotein A-I (P = .021). In the logistic model, LDL cholesterol, triglycerides, smoking, and systolic blood pressure were selected as independent predictors of PAOD presence. The extent of PAOD was significantly and negatively correlated with HDL3 cholesterol (P = .005), HDL cholesterol (P = .013), and apolipoprotein A-I (P = .021) and was significantly and positively associated with smoking and fasting blood glucose. Age, smoking, and blood glucose were selected by the discriminant analysis as independent predictors of the extent of PAOD. CONCLUSIONS: From this large case-control study, it is concluded that the presence of PAOD is predicted by parameters of LDL, triglyceride, and HDL2 metabolism, whereas the extent of PAOD is related to HDL3 and nonlipid risk factors.

Adult↗
PubMed1996

[Costs of diagnosis in emergency room consultations].

The costs for diagnostic workup in the medical emergency room were analyzed for 1000 consecutive patients in the course of a cost analysis program. Next to demographic data, the complaints leading to admission, all diagnostic procedures and tests as well as the final diagnosis were recorded. According to cumulated tariffs of individual services, the total cost for the 1000 patients amounted to Sfr. 303000. Medical, laboratory and technical services each amounted to one third of this sum. The cost of Sfr. 303 per patient compared rather well with those of Sfr. 350 for the average initial consultation at the outpatient clinic. The three symptoms thoracic or abdominal pain and headache covered 50% of the reasons for admission. The five most common diagnoses were: common cold, chest wall tenderness, gastroenteritis, headache and acute upper respiratory tract infection. The most cost-intensive workup was performed for nausea and vomiting and abdominal or thoracic pain. Technical procedures such as chest films and upper panendoscopy were responsible for high costs. Assessment of costs according to symptoms and final diagnosis, respectively, yielded almost identical results. In both cases, minimal and maximal costs varied by a factor of 20 or more.

Adult↗
PubMed1996

[Febrile state and pleural effusion].

A 42 year old patient was admitted for evaluation of a febrile state and left thoracic pain. Chest-X-ray revealed a left-sided pleural effusion nonresponsive to a trial antibiotic treatment. The subsequent punction yielded sterile exudate without microorganisms or malignant cells. Tuberculostatic treatment for suspected tuberculosis lead to exacerbation and hospitalization. Antibodies against native DNA first became detectable during the further course. Together with anamnestic information about fatigue, hair loss and the family history revealing two sisters touched by the disease, the diagnosis of systemic lupus erythematodes was made. Corticosteroids led to rapid improvement with complete resolution of the pleural effusion.

Adult↗
PubMed1996

[Cough, fever and exanthema].

We report on a 29-year-old female patient who developed a dolent nodular exanthema on both lower legs after a prolonged respiratory infection of about 14 days. The chest X-ray showed a distinct enlargement of the left hilus and reduced transparency in the left upper pulmonary lobe. These findings were interpreted as pneumonia with para-infectious erythema nodosum. The serology showed IgM antibodies against chlamydia pneumoniae. Therapy with a macrolide antibiotic led to a rapidly improved general condition and also to the disappearance of the exanthema. There are some reports on single cases with erythema nodosum accompanying an infection with chlamydia pneumonia.

Adult↗
PubMed1996

[Febrile status and exanthema following a trip to the jungle].

A 30-year-old female entered the emergency room for medical advice because of progressive deterioration of general health with headache, arthralgias, myalgias and fever after a vacation of three weeks in Malaysia and Hong Kong. Because of persistent fever, lymphadenopathy, slight leuco- and thrombocytopenia and only insignificantly elevated humoral signs of an inflammatory process, the patient was treated symptomatically after exclusion of malaria. A viral disease was suspected. Two days later, an exanthema erupted suddenly on the trunk. Pinhead-sized livid, flat macules, increasing in size within hours and spreading to the extremities, were observed. Further investigations revealed a significantly elevated titer of IgG directed against rickettsia conorii, leading to the diagnosis of Mediterranean spotted fever. Under antibiotic treatment with tetracycline, the aforementioned findings regressed within few days, and the patient recovered completely.

Adult↗
PubMed1996

[Mydriasis, tachycardia].

We report a case of plant poisoning with atropa belladonna. A student took the berries because of the hallucinogen effects. In this case report we describe the symptoms and the therapy of poisoning with atropa belladonna. Another part informs about the historic and cultural importance of this nightshade. Since antiquity, the lethal as well as the hallucinogenic effects of poisoning with atropa belladonna are well known; therefore, they are an important part of orgies and rituals.

Adult↗
PubMed1995

[Electrolyte changes during and after voluntary hyperventilation].

Paresthesia and tetanic finger cramps during hyperventilation-induced respiratory alkalosis are believed to derive from a pH-dependent decrease of ionized serum calcium. In the study reported here, ionized serum calcium, total calcium and total protein were measured during a three-minute hyperventilation period in ten volunteers. During hyperventilation finger paresthesias appeared in all probands without proof of any significant change in ionized serum calcium (1.26 +/- 0.05 mmol/l at the end of the three-minute hyperventilation period). Total protein increased as a consequence of hyperventilation-induced transient hemo-concentration. Paresthesias and tetanic finger cramps during the three-minute hyperventilation could not be related to changes of ionized serum calcium; however the other electrolytes, i.e. sodium, magnesium, potassium, chloride, phosphate and bicarbonate, showed, with the exception of sodium, significant changes.

Adult↗