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Biomedical subjects

M Reiner

Publications and source records attributed to M Reiner.

At least 55 records · Page 3Linked to original sources

[Fever of long standing in atrial myxoma].

A 39-year-old man is described who presented with the unspecific signs of systemic disease (elevated erythrocyte sedimentation rate, increased gamma-globulins, positive rheumatoid factor; clubbing, splenomegaly) and with fever whose origin remained undiagnosed for 8 years despite numerous investigations. Later in the course of the disease, the signs of mitral stenosis appeared, suggesting left atrial myxoma even in the absence of arterial embolization. This diagnosis was established by echocardiography and confirmed by angiocardiography as well as at operation, after which all the systemic signs and symptoms disappeared.

Fever↗

[Fat embolism syndrome without fractures].

Report on an 18-year-old patient who developed a respiratory distress syndrome after trauma without bone fractures and with only minimal soft tissue contusion. Twelve hours after the accident fever and dyspnea appeared, accompanied later by hemoptysis, microhematuria, a fall in hemoglobin and in platelet count, petechiae on the skin and in the conjunctiva, cotton-wool lesions in the retina and micronodular shadows in the lungs. Various pathogenetic mechanisms other than bone marrow fat embolism are discussed in the light of this case.

Accidents, Traffic↗

[Cushing's syndrome and adrenal suppression by means of intranasal use of dexamethasone preparations].

In two 15-year-old boys with bronchial asthma and allergic rhinitis, bronchospasm disappeared with prolonged use of intranasal dexamethasone ointment and drops respectively. Both showed cushingoid features and total or partial suppression of adrenocortical function. The first patient died during a sudden and unexpected asthma crisis one week after withdrawal of the 0.25% dexamethasone ointment he had been taking at the rate of 1.8 mg/day for one year. The second boy recovered near-normal adrenocortical function 3 months after gradual withdrawal of the 0.01% dexamethasone nose drops he had been on at an average daily dose of 0.5 mg, for the past 6 years. An acute trial in 10 normal volunteers showed marked short-term suppression of endogenous cortisol production after a single intranasal ointment application containing 0.9 mg dexamethasone. Long-term use of dexamethasone preparations on the nasal mucosa may be dangerous by inhibiting hypophyseal-adrenocortical function. Abrupt withdrawal may lead to sudden relapse of a potentially life-threatening accompanying disease such as bronchial asthma.

Adolescent↗

Abnormal calcium metabolism in normocalcaemic sarcoidosis.

In studies of calcium metabolism in 13 unselected patients with untreated sarcoidosis all were normocalcaemic but five had hypercalcuria. All had normal renal function. Calcium absorption was indexed by a double isotope test. 45Ca hyperabsorption occurred in six patients. Ten kinetic studies were carried out with 47Ca and in six bone turnover was increased. 45Ca absorption correlated well with the calculated bone uptake rate of calcium, and with urine calcium excretion. These results suggest that in sarcoidosis abnormalities in calcium metabolism are fairly common although they rarely result in sustained hypercalcaemia.

Adult↗

[Treatment of Paget's disease with phosphonates].

A group of 22 patients with Paget's disease of bone was treated with a diphosphonate (sodium etidronate; EHDP), a stable synthetic analogue of inorganic pyrophosphate. This substance was given during 3 months at the dose of 20 mg/kg body weight per day, and proved effective by reducing the raised urinary excretion of total hydroxyproline and by lowering the concentration of serum alcaline phosphatase. It also improved the disease-related osteo-articular pain in 60% of the patients. A rise in serum phosphate under EHDP therapy is due to the increase in renal tubular reabsorption of phosphate. Bone histology showed regression of disease activity and the appearance of lamellar structure in newly formed bone. Because of a transient increase of the amount of uncalcified osteoid, it is advisable to give the diphosphonate in courses not over 3 months or at a reduced daily dose.

Adult↗