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Biomedical subjects

Josef Finsterer

Publications and source records attributed to Josef Finsterer.

At least 91 records · Page 5Linked to original sources
PubMed2005

Mild leptospirosis with three-year persistence of IgG- and IgM-antibodies, initially manifesting as carpal tunnel syndrome.

Long-term persistence of IgG- and IgM-antibodies against leptospira after mild leptospirosis has not been reported. In a 45-year-old female pet-shop worker with carpal tunnel syndrome, accompanied by arthralgias, coughing, repeatedly elevated temperature, followed by easy fatigability, personality change, memory and speech disturbance, blurred vision, myalgia and swollen lymph nodes, leptospirosis was diagnosed, based upon history, clinical findings, and serological investigations. After the described symptoms had disappeared following doxycyclin for 2 weeks, IgG- and IgM-antibodies against leptospira remained positive during the next three years. This case illustrates that leptospirosis may start as carpal tunnel syndrome and that the severity of leptospirosis does not seem to be related to the intensity of the humoral immune response against the causative agent.

Anti-Bacterial Agents↗
PubMed2005

Closure of a patent foramen ovale: effective therapy of migraine and occipital stroke.

Whether stroke in a patient with migraine and patent foramen ovale (PFO) is due to PFO or migraine is difficult to decide. In a 33-year-old woman with migraine with aura, a visual field defect developed acutely. Neurological investigation revealed double vision when looking to the left and exaggerated patella tendon reflexes. Since then the patient complained about permanent visual impairment. CT- and MRI-scans of the brain showed a right occipital ischemic stroke. Intensive search for risk factors revealed cigarette smoking and chronic hypovolemia On transesophageal echocardiography an inter-atrial hypermobile septum and a PFO were detected. The patient underwent closure of the PFO by means of an Amplatzer PFO occluder nine weeks after the stroke. Since then she did not experience a further cerebrovascular event or migraine attack. This case shows that in a patient with PFO and migraine with aura, stroke may be attributable to migraine rather than to PFO. Occlusion of the PFO may reduce the frequency and intensity of migraine attacks.

Adult↗
PubMed2005

Lactate stress testing in sporadic amyotrophic lateral sclerosis.

Mitochondrial dysfunction is frequently observed in ALS. Mitochondrial dysfunction may result in increased serum lactate at rest or low levels of exercise, being used for diagnostic purposes. The study investigated if resting-lactate-determination is superior to lactate-stress-testing (LST) in demonstrating mitochondrial dysfunction in ALS. Included were 15 ALS patients, 4 women, 11 men, aged 37-72. Severity of the disease was assessed by the Norris-score. The control group comprised 66 healthy subjects, 40 women, 26 men, aged 36-76. Serum lactate was determined before, three times during, and once after a constant workload with 30 W on a bicycle ergometer. According to the EIEscorial criteria 8 patients had definite, 4 probable, 3 possible ALS. Resting lactate was increased in 2 patients, 1 with definite and 1 with possible ALS. The LST was abnormal in 5 patients with definite, 1 with probable and 1 with possible ALS. The mean Norris-score was 67.8 in patients with abnormal LST and 74.6 in patients with normal LST. In conclusion, the LST is more suitable than resting-lactate-determination in demonstrating mitochondrial dysfunction in ALS. The LST suggests mitochondrial dysfunction in half of the ALS patients. Mitochondrial dysfunction in ALS is related to the clinical severity of the disease.

Acidosis, Lactic↗
PubMed2005

Stroke in diabetic and non-diabetic patients: course and prognostic value of admission serum glucose.

BACKGROUND, AIMS: Whether diabetes mellitus affects the prognosis of stroke patients, and whether admission hyperglycemia influences prognosis similarly in diabetic as in non-diabetic patients is assessed controversially. The aims of the study were: 1) to compare the course of diabetic and non-diabetic acute stroke patients, and 2) to assess the influence of admission serum glucose levels on case fatality. METHODS: In 57 Austrian medical departments the hospital course of consecutive stroke patients was documented prospectively between June 1999 and October 2000. RESULTS: Two hundred and ninety-six (30%) of 992 patients had a history of diabetes mellitus. Intracerebral hemorrhage was more frequent in non-diabetic patients than diabetic (13% versus 5%, P=0.0001). Coronary heart disease was more frequent in diabetic than in non-diabetic patients (35% versus 24%, P=0.0003). The case fatality was 18% among non-diabetic and 16% among diabetic patients (P=0.3559). Among patients who were discharged alive, the Barthel Index increased from 50 to 90 in non-diabetic and from 45 to 75 in diabetic patients (P=0.0403). In non-diabetic patients, admission serum glucose>9.2 mmol/L was associated with a more than 4-fold increase in case fatality, compared with patients with serum glucose<5.7 mmol/L (P<0.0001). CONCLUSIONS: Diabetic stroke patients need special care since they tend to have a poorer recovery than non-diabetic patients. Admission hyperglycemia in non-diabetic acute stroke patients predicts a poor prognosis.

Aged↗
PubMed2005

Worsening of heart failure in Becker muscular dystrophy after nonsteroidal anti-inflammatory drugs.

A 40-year-old male with Becker muscular dystrophy and cardiac involvement was stable in New York Heart Association class II for 7 years. He then had arthralgia caused by bilateral gonarthrosis. He received diclofenac 100 mg/d and 500 mg/d mephenamine acid. Six weeks later, he was hospitalized because of heart failure (New York Heart Association class IV). Echocardiography revealed biatrial and biventricular dilation, a left ventricular end-diastolic diameter of 82 mm, an ejection fraction of 26%, a severe tricuspid regurgitation, and an elevated pulmonary artery pressure of 60 mm Hg. Nonsteroidal anti-inflammatory drugs were discontinued, and physiotherapy and equipment with a corset were initiated. He improved after treatment with parenteral diuretics, returning to class II. Nonsteroidal anti-inflammatory drugs should be given with caution in Becker muscular dystrophy with cardiac involvement.

Adult↗
PubMed2005

Rhabdomyolysis from Simvastatin triggered by infection and muscle exertion.

A 42-year-old woman received a 6-month course of simvastatin (20 mg/d) for hypercholesterolemia. Despite an infection with fever, fatigue, myalgias, and lumbar pain, she continued to perform her regular sports activities. Neurologic examination revealed bilateral ptosis and slight upper limb weakness. Serum creatine kinase was 41,000 U/L. Needle electromyography was nonspecifically abnormal. Discontinuation of simvastatin and reduction of the sports activities was followed by a prompt continual lowering of the elevated muscle enzymes to normal values over a 2-week period. The patient's infection, regular sports activity despite the infection, and a suspected mitochondrial defect were regarded as triggers of rhabdomyolysis.

Adult↗
PubMed2005

Antipsychotic drugs and QT prolongation.

Antipsychotic drugs (AD) are effective and frequently prescribed to more females than males. AD may cause serious cardiovascular side-effects, including prolonged QT interval, eventually leading to torsades de pointes (TdP) and sudden death. Epidemiologic data and case-control studies indicate an increased rate of sudden death in psychiatric patients taking AD. This review summarizes current knowledge about the QT prolonging effects of AD and gives practical suggestions. Amisulpride, clozapine, flupenthixol, fluphenazine, haloperidol, melperone, olanzapine, perphenazine, pimozide, quetiapine, risperidone, sulpiride, thioridazine and ziprasidone cause a QT prolongation ranging from 4 ms for risperidone to 30 ms for thioridazine. Our knowledge about the QT-prolonging effects of many AD is still limited. Females are under-represented in most studies. Many studies were conducted or supported by pharmaceutical companies. To avoid prodysrhythmia caused by QT prolongation, other factors influencing QT interval have to be considered, such as other drugs affecting the same pathway, hypokalemia, hypomagnesemia, bradycardia, increased age, female sex, congestive heart failure and polymorphisms of genes coding ion channels or enzymes involved in drug metabolism. Because the response of a patient to AD is individual, an electrocardiogram recording the QT interval has to be performed at baseline, after AD introduction and after occurrence of any factor that might influence the QT interval.

Adult↗
PubMed2005

Left ventricular hypertrabeculation/noncompaction as a cardiac manifestation of Duchenne muscular dystrophy under non-invasive positive-pressure ventilation.

Though cardiac involvement is a frequent finding in patients with Duchenne muscular dystrophy (DMD) at the wheel-chair-bound stage, left ventricular hypertrabeculation (LVHT) has not been reported. The patient is a 28-year-old male with the typical clinical features of end stage DMD. Since the age of 16 years he required ventilatory support by means of non-invasive positive-pressure ventilation (NIPPV), initially intermittently and since age 27 permanently. Since the age of 21 years he developed chronic heart failure, and since age 24 atrial flutter, successfully treated with amiodarone. After discontinuation of amiodarone because of hyperthyroidism, he developed atrial fibrillation. Echocardiography at age 28 revealed mitral insufficiency, enlarged left atrial diameter, and, surprisingly, LVHT. Since LVHT was absent at the initial echocardiographic examination, it was regarded acquired. The case shows that cardiac involvement in DMD may not only comprise rhythm abnormalities, valve abnormalities, and dilative cardiomyopathy, but also LVHT in single cases.

Adult↗
PubMed2004

Factors influencing mortality in atrial fibrillation. Post hoc analysis of an observational study in outpatients.

BACKGROUND: Whether patients with atrial fibrillation (AF) have an increased mortality compared with the general population is controversially assessed. METHODS: The mortality of 409 outpatients with AF (36% female, mean age 62 years, 39% paroxysmal AF, 27% lone AF), who were included in a prospective observational study, was compared with the mortality of the general population. RESULTS: The mortality was 4%/year and constant during the 10 years of follow-up. Age (p<0.0001), heart failure (p=0.0013) and echocardiographically detected reduced left ventricular systolic function (p=0.0353) were independent predictors. The mortality of AF patients was 1.4-fold higher than in the general population, of female 1.5 and of male 1.3. Patients with permanent AF had a 1.5-fold higher and patients with heart failure a 1.7-fold higher mortality than the general population. Patients with lone AF did not differ in the mortality from the general population. The mortality of AF patients was not influenced by the duration of atrial fibrillation. CONCLUSION: The prognosis of AF patients is dependent on the cardiovascular co-morbidity, especially the presence or absence of heart failure.

Adult↗