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Biomedical subjects

M Kuhn

Publications and source records attributed to M Kuhn.

At least 19 recordsLinked to original sources
PubMed1992

[Spontaneous reporting system for the assessment of new, unknown and rare undesirable effects of drugs].

The Swiss Drug Monitoring Center SANZ operates the spontaneous reporting system in Switzerland. Spontaneous reporting schemes represent the systematic approach to the collection of individual case reports on suspected adverse drug reactions (ADR). ADR spontaneous reporting systems are an important component of the postmarketing surveillance of drugs. Spontaneous reporting systems are primarily designed to detect new and unexpected ADR; they generate signals about possible ADR and create hypotheses to be tested in pharmaco-epidemiological studies. Besides collecting, analyzing and evaluating single case reports it is important to extract those cases from the data pool which can be used to produce signals. A computer-assisted early warning system enables SANZ to detect cases with signal function and thus to track down new, rare and unexpected ADR. Carefully selected parameters can help to identify important new hazards. However, the detection of new and unexpected ADR depends to a large extent on the minds of alert physicians and the practicing clinician's awareness of and cooperation with ADR reporting.

Adverse Drug Reaction Reporting Systems↗
PubMed1992

[Acute alveolitis due to mesalazine].

A 66-year-old male developed lymphocytic alveolitis with bronchiolitis after 3 month's treatment with mesalazin for ulcerative colitis. The patient's symptoms disappeared after halting mesalazin and increasing the steroid dose, the reduced diffusing capacity ameliorated and the thoracic X-ray normalized. The question whether this was a case of pulmonary involvement in inflammatory bowel disease or a drug side effect.

Aged↗
PubMed1992

Urodilatin: a new peptide with beneficial effects in the postoperative therapy of cardiac transplant recipients.

Renal failure after heart transplantation (HTx) still remains a serious problem, especially when cyclosporin A is used for immunosuppression in the early postoperative therapy. To preserve good renal function without reducing immunosuppressive cyclosporin A treatment, we administered urodilatin (CDD/ANP-95-126) in a long-term, low-dose infusion in addition to the usual medication after heart transplantation. From November 1990 to June 1991, 51 patients (46 male and 5 female; mean age 48 years) were treated with a 6-20 ng/kg bw.min infusion for 96 h after HTx. The renal function and hemodynamic parameters of these urodilatin-treated patients were compared in this sequential study with 40 patients (33 male and 7 female; mean age 49 years) who had undergone HTx previously from May to November, 1990, as controls. In this phase IIa study, both groups did not differ significantly with respect to age, sex, indication for HTx, and preoperative renal function. In comparison with controls patients treated with urodilatin had a significantly better renal function: a reduction in the peak plasma creatinine (PC values day 4: 1.5 +/- 0.11 vs. 2.19 +/- 0.19 mg/dl; P = 0.002), a lower peak serum urea (SU values day 4: 109 +/- 8 vs. 154.7 +/- 8.94 mg/dl; P = 0.0036), and a lower incidence of hemodialysis (6% vs. 10%) were observed. Adequate diuresis was maintained in spite of the reduction of furosemide by more than 60% (P = 0.005) on each day of urodilatin infusion in comparison with controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1992

Quality assurance in the emergency department: evaluation of the ECG review process.

STUDY OBJECTIVE: To determine whether the review of emergency department ECGs by cardiologists contributes to the quality of patient care. STUDY DESIGN: We retrospectively analyzed ED ECGs and compared interpretations of the treating emergency physicians with those of the reviewing cardiologists. We then evaluated the ED care of patients with potentially significant ECG abnormalities that were not detected by the treating emergency physicians, as well as the care of patients whose ECGs were "flagged" by the reviewing cardiologists as needing follow-up. SETTING: University hospital. PARTICIPANTS: Four hundred consecutive ECGs obtained on ED patients. MEASUREMENTS AND MAIN RESULTS: Thirty-three of the 400 tracings had undetected potentially significant or critical ECG abnormalities; this adversely affected patient care in two cases. These two tracings were not flagged by the reviewing cardiologists. Thirteen ECGs were flagged by the cardiologists; patient care was not altered in any of these cases. CONCLUSION: Review of ED ECGs by cardiologists did not affect patient care at our institution.

Aged↗
PubMed1992

Endothelin release and shift in prostaglandin balance are involved in the modulation of vascular tone by recombinant erythropoietin.

Hypertension is the main side effect developing in patients suffering from renal anemia who are treated with recombinant human erythropoietin (rhEPO). We investigated the effect of rhEPO on the vascular tone of rabbit aorta. rhEPO had no direct vasoconstrictor effect, but it enhanced norepinephrine (NE)-induced contractions of rabbit aortic rings. Relaxations to acetylcholine (ACh, 1 microM) were unaltered in the presence or absence of rhEPO, indicating that the endothelium-dependent NO pathway was not affected by rhEPO. In rings of human renal artery and rabbit aorta, rhEPO (200 U/ml) increased the synthesis of constrictor prostanoids. The cyclooxygenase inhibitors indomethacin and aspirin abolished the increase in prostanoid production. However, they did not completely suppress the rhEPO-induced enhancement of NE contractions in rabbit aorta. We further investigated the effect of rhEPO on prostanoid and endothelin-1 synthesis in cultured human endothelial cells. Endothelial cells from human umbilical veins (HUVEC) were isolated and cultured. After incubation with rhEPO, the formation of prostaglandin (PG) I2 (analyzed as its stable metabolite 6-keto-PGF1 alpha), PGF2 alpha, PGE2, thromboxane (Tx) B2, and of endothelin-1 (ET-1) was measured by radioimmunoassay (RIA). rhEPO (200 U/ml) increased the formation of PGF2 alpha and TxB2 and decreased the formation of PGI2 in HUVEC. The release of ET-1 was increased by nearly 90% in the presence of rhEPO (200 U/ml). We conclude that a shift in the balance of constrictor and relaxing prostanoids as well as an increased synthesis of ET-1 may contribute to the hypertensive side effect of rhEPO therapy. ET-1 may at least in part be responsible for the unexpectedly low inhibitory effect of indomethacin on rhEPO-enhanced contractions of rabbit aorta.

Animals↗
PubMed1992

Structural and functional properties of the p60 proteins from different Listeria species.

The major extracellular protein p60 of Listeria monocytogenes seems to be required for this microorganism's adherence to and invasion of 3T6 mouse fibroblasts but not for adherence to human epithelial Caco-2 cells. Western blot analysis with polyclonal antibodies against p60 of L. monocytogenes indicated the presence of cross-reacting proteins in the culture supernatants of all Listeria species. Protein p60 of L. monocytogenes could restore adhesion of the L. monocytogenes mutant RIII (impaired in the synthesis of p60) to mouse fibroblasts more efficiently than that of Listeria grayi. The amino acid sequences of the p60-related proteins of L. innocua, L. ivanovii, L. seeligeri, L. welshimeri, and L. grayi indicated highly conserved regions of about 120 amino acids at both the N-terminal and the C-terminal ends. The middle portions of these proteins, consisting of about 240 amino acids, varied considerably. These parts include the repeat domain consisting of repetitions of Thr (T) and Asn (N) which was present only, albeit in different arrangements, in the p60 proteins of L. monocytogenes and L. innocua. The p60-related proteins of L. grayi, L. ivanovii, L. seeligeri, and L. welshimeri each contained an insertion of 54 amino acids which was absent in the p60 proteins of L. monocytogenes and L. innocua.

Amino Acid Sequence↗
PubMed1992

Nitrates.

Nitrates have been used for the last 130 years to treat and control the symptoms of angina pectoris. Within the last 15 years, nitrates also have been shown to limit infarct size and to be beneficial in the treatment of patients with severe intractable heart failure, cardiogenic shock, severe mitral and aortic regurgitation, hypertensive episodes, and portal hypertension. The adequate use of nitrates to treat these disorders requires the ability to document a hemodynamic response and to closely monitor the adverse consequences of this therapy. Nitrates work by directly relaxing smooth muscle in resistance and capacitance vessels, thereby causing generalized dilation. Nitrates reduce preload and, at higher doses, reduce systemic vascular resistance and afterload. This chapter reviews the physiologic mechanisms that underlie nitrate therapy, the appropriate indications for nitrate use, the usefulness of specific agents, and their appropriate nursing implications.

Cardiovascular Diseases↗
PubMed1992

Angiotensin-converting enzyme inhibitors.

The angiotensin-converting enzyme (ACE) inhibitors available today include captopril (Capoten), enalapril (Vasotec), enaloprilat (Vasotec IV), lisinopril (Prinivil, Zestril), benazepril (Lotensin), fosinopril (Monopril), and ramipril (Atace). These drugs are used in the treatment of hypertension and congestive heart failure. They also are used in treating renovascular hypertension not amenable to surgery and are being studied to decrease left ventricular size after infarction and to determine whether they slow the rate of internal hyperplasia. Angiotensin-converting enzyme inhibitors have negative inotropic and chronotropic effects. This chapter discusses the ACE inhibitors and their actions, uses, adverse effects, contraindications, and nursing implications.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1992

Lipid-lowering drugs.

Controlling hyperlipidemia is an important aspect in the treatment and prevention of coronary artery disease. This article provides the clinician with a general reference for currently used lipid-lowering agents. Lipoproteins present in the plasma are defined and a brief overview of their functions is presented. Normal lipid uptake from the intestine and normal lipid metabolism are discussed to provide a basis for an understanding of the pharmaceutical treatment of hyperlipidemia. Guidelines are reviewed for interpreting lipid profiles according to the National Cholesterol Education Program. An evaluation of the agents currently used to treat hyperlipidemia is included. Lipid-lowering agents cause alterations in liver function; therefore, patients taking these medications are monitored closely. Patient teaching, including adverse effects of the medications, diet therapy and other alterable risk factors, is also reviewed.

Cholesterol↗
PubMed1992

[Liver angiography--technique, indications and significance in focal liver processes].

Retrospective analysis of 155 liver angiographies and the literature data was carried out to appraise the current relevance of liver angiography in digital subtraction technique (i.a. DSA) for diagnosis of focal liver changes. A focal liver lesion was detected by angiography in 58 out of the 80 patients (72.5%) we investigated with a confirmed hepatic space occupation; an angiography correlate of the tumour type diagnosed was shown in 41 out of 69 (59.4%) of malignancies confirmed by surgery or biopsy histology; in the benign lesions, the angiographic diagnosis was consistent with the histological result in five out of six cases. DSA is thus usually clearly inferior to the tomographic sonography, CT and MRI in detection and qualification of the tumour type. However, it is still indispensable for planning operations or chemoembolization and for exact imaging of the portal perfusion conditions because of the frequent vascular anomalies in the anatomy of the liver.

Adenoma, Bile Duct↗
PubMed1991

[The importance of the clinical differential diagnosis in the evaluation of a suspected drug reaction].

An adverse drug reaction has always to be considered if an obscure clinical picture is encountered. On the other hand every agency involved in drug monitoring has to take note of clinical differential diagnosis. Two examples illustrate how it was possible to explain by simple clinical evaluations suspected adverse drug reactions as manifestations of organic diseases.

Appetite Depressants↗
PubMed1991

[Spontaneous remission in histiocytosis X with lung and bone involvement].

Histiocytosis X is very rare in the adult. Since the illness is frequently asymptomatic it often causes diagnostic and therapeutic problems. Up to the present, assessment of the long-term course in the adult has required individual case records. A uniform therapeutic concept does not exist. According to prevailing opinion, asymptomatic patients do not require therapy. Our case record describes the spontaneous course in a young asymptomatic patient in whom histiocytosis X, which had affected lungs and bones, healed within 16 months.

Adult↗
PubMed1991

Glyceryl trinitrate increases platelet cyclic GMP after metabolism in fibroblasts.

Glyceryl trinitrate had no direct effect on cyclic GMP levels in platelets. However, in the presence of fibroblasts (RFL-6 cells), glyceryl trinitrate increased platelet cyclic GMP up to 7.8 fold (11.5 fold in the presence of superoxide dismutase). Fibroblasts alone had no effect. Endothelial cells alone increased platelet cyclic GMP up to 4.1 fold (9.6 fold in the presence of superoxide dismutase), but glyceryl trinitrate had no additional effect. Thus fibroblasts, but not endothelial cells, metabolize glyceryl trinitrate to a nitric oxide-like material that stimulates platelet soluble guanylyl cyclase.

Animals↗