Biomedical subjects

P Greminger

Publications and source records attributed to P Greminger.

At least 37 records · Page 2Linked to original sources

PubMed1996

[The appearance of Sweet's syndrome during the transition from a myelodysplastic syndrome to erythroleukemia].

HISTORY AND CLINICAL FINDINGS: Two months after being diagnosed as having refractory anaemia with an excess of blasts in transformation (RAEB-T), a 62-year-old man presented in the emergency room with fever (40 degrees C) for two weeks and scattered deep-red macular indolent efflorescences over the chest, back, face and thighs. Other than splenomegaly there were no significant findings on physical examination. INVESTIGATIONS: Erythrocyte sedimentation rate was increased to 38 mm in the first hour. Haemoglobin concentration and platelet count were at the lower limits of normal, white cell count within the normal range. Differential count: 60 erythroblasts per 100 leukocytes and 33.5 blast cells. Two skin biopsies revealed massive oedema in the upper corium and focal erythrocyte extravasations. There were perivascular and perifollicular inflammatory infiltrates in the deeper layers and elastosis of the corium. There was no leukocytoclastic vasculitis. These findings established the diagnosis of Sweet syndrome and erythroleukaemia. TREATMENT AND COURSE: The erythroleukaemia was treated symptomatically and the skin changes gradually receded under prednisone, 1 mg/kg, but new spots occurred when the prednisone dose was halved. Candida oesophagitis occurred as a complication of the erythroleukaemia. Chest radiogram showed diffuse infiltrates in both upper lobes of the lung. Despite intensive antimycotic and antibiotic treatment the patient died 10 days later from pulmonary aspergillosis. CONCLUSION: This case report describes the rare occurrence of Sweet syndrome during the transformation from a myelodysplastic Syndrome to erythroleukaemia.

Anemia, Refractory, with Excess of Blasts↗

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↗

PubMed1996

[Abdominal pain].

A 37-year-old female patient was admitted to our outpatient clinic because of abdominal pain and absence of stool for five days. A diagnosis of acute intermittent porphyria was made by determination of porphyrins in the urine and the stool, the absence of skin symptoms and the measurement of urosynthase activity. As triggering event we suspect a viral infection. Neurological and neuropsychiatric symptoms were absent.

Abdominal Pain↗

PubMed1995

[Hypertension in the elderly: definition, indications for treatment and clarification].

Hypertension is the single most potent common and remediable risk factor for cardiovascular morbidity and mortality in the population over age 65. Data from newer intervention studies show that it is clearly beneficial to treat elderly patients with either both systolic and diastolic hypertension or with isolated systolic hypertension. The indication to start treatment in a given patient depends on blood pressure values, age and eventual concomitant disease. In the evaluation of the elderly hypertensive patient, multiple blood pressure measurements in the standing and lying patient should be taken. In the case of suspected carotid artery stenosis, a Doppler ultrasound is indicated before starting antihypertensive therapy. Finally, if refractory hypertension or kidney failure develop in an elderly patient, renal artery stenosis should be considered.

Aged↗

PubMed1995

[Treatment of hypertension in elderly patients].

Today indications for treatment of hypertension in older age are no longer contested, even if only systolic pressure is raised. The choice of the antihypertensive drug for elderly patients, however, depends on concomitant diseases. The diversity of the latter demands a judicious, individualized use of the available substances (diuretics, beta-blockers, calcium antagonists and ACE-inhibitors). In elderly patients as well, a marked reduction of the cardiovascular risk is achievable by pharmacotherapy. So far, however, such results have only been reported for the use of diuretics and beta-blockers, in purely systolic hypertension by diuretics exclusively; however smaller studies, suggest that comparably favorable results may be obtained with calcium antagonists.

Adrenergic Antagonists↗

PubMed1995

Combined treatment with captopril, hydrochlorothiazide and pravastatin in dyslipidemic hypertensive patients.

OBJECTIVES: Hypertension and hypercholesterolemia frequently coexist, necessitating concurrent treatments for both disorders. The present study aimed at evaluating the efficacy, the safety, and the toleration of captopril, an ACE inhibitor, hydrochlorothiazide, a diuretic, and pravastatin, a HMG-CoA reductase inhibitor co-administered in hypertensive patients in general practice. DESIGN: The patients were followed for 16 weeks and asked to comply with a lipid lowering diet for the whole period. Captopril, 50 mg/once daily, was administered alone for the first 4 weeks. Hydrochlorothiazide, 25 mg/day, was added after 4 weeks if required. Pravastatin treatment (20 mg/day) was started at the 8th week of the study and its dose was doubled 4 weeks later if needed. PATIENTS: A total of 603 patients with hypertension (diastolic blood pressure > or = 95 mmHg) and dyslipidemia (total cholesterol > 6.5 mmol/l) were included. SETTING: The study was performed in general practice by 230 physicians. MAIN OUTCOME MEASURE: Determination of blood pressure, circulating levels of total cholesterol, HDL-cholesterol and triglycerides, and blood chemistry for safety monitoring. RESULTS: At the end of the trial 75.1% of patients had their diastolic blood pressure < or = 90 mmHg and 43.5% a total cholesterol level < 6.5 mmol/l. The overall incidence of adverse events was 21.7%, leading to withdrawal in 10.9% of the total number of patients. The combined treatments had no deleterious effect on safety variables. CONCLUSIONS: Captopril, hydrochlorothiazide and pravastatin are effective and well tolerated medications to treat dyslipidemic hypertensive patients.

Adult↗

PubMed1995

Pulmonary oedema in healthy persons during scuba-diving and swimming.

The prevalence of pulmonary oedema during scuba-diving is unknown. In our referral centre for diving accidents we have observed several episodes of pulmonary oedema in four previously healthy persons while scuba-diving or swimming. Four events were documented by physical findings, typical chest radiographic changes, and arterial hypoxaemia. Four additional episodes were identified in one of the individuals by a suggestive history. No technical problems with the diving equipment were detectable and none of the individuals reported aspiration of water. In order to gather information about the incidence of pulmonary oedema, we carried out a survey among 1,250 divers. To elucidate possible underlying mechanisms of this complication we investigated forearm vascular resistance, levels of vasoreactive hormones, and left ventricular function by Doppler echocardiography, at room temperature and during cold exposure, in four patients and in healthy control subjects. We found only one additional person with a history suggestive of pulmonary oedema among 460 responders to the survey. We found no differences in forearm vascular resistance, left ventricular systolic and diastolic function, and plasma levels of epinephrine, norepinephrine, cortisol, aldosterone, renin and atrial natriuretic peptide between the patients with a history of pulmonary oedema and the control subjects. We conclude that the occurrence of pulmonary oedema during scuba-diving or swimming is an extremely rare event in healthy individuals. The mechanisms responsible remain unclear.

Adult↗

PubMed1994

[Bromocriptine-induced pleuropneumopathy].

A 64-year-old man was diagnosed to have Parkinson's disease when aged 42 years and since then has been treated with levodopa and benserazide (up to 875 mg daily). Bromocriptine (up to 35 mg daily) was added to the medication 9 years ago. 3 1/2 years ago he developed exertional dyspnoea (NYHA class II-III) and lost 5 kg in weight. Chest radiography demonstrated pleural effusion and interstitial pulmonary changes in both lung bases. Erythrocyte sedimentation rate was 37 mm in the first hour and the white cell count 10,400/microliters. Extensive tests failed to find malignant tumour or any infectious-inflammatory condition. As it was suspected that the pleuropulmonary changes were associated with the bromocriptine intake, it was discontinued and biperiden and selegiline substituted for it. The pleural effusion regressed almost completely within 8 weeks, and the laboratory tests pointing to inflammation disappeared completely. Clinical, biochemical and radiological tests have remained normal for the last 3 years. The clinical course makes a causal relationship between bromocriptine intake and the pleuropulmonary changes highly probable.

Benserazide↗

PubMed1994

[Diffuse thymus hyperplasia following chemotherapy for nodular sclerosing Hodgkin lymphoma].

A persistent or new mass in the anterior mediastinum after chemotherapy for mediastinal lymphoma poses a major differential diagnostic problem. Misinterpretation as a persistent or recurrent tumor may lead to additional unnecessary and potentially harmful therapy. Benign mediastinal tumors, albeit very rare, need confirmation by biopsy since they cannot be distinguished by radiological methods from persistence or relapse of lymphoma. We present a case report of a patient with diffuse thymic hyperplasia following successful chemotherapy for nodular sclerosing Hodgkin's disease, with a review of the literature.

Adult↗

PubMed1994

[Overweight in Switzerland. Cross-comparison of various studies with the Heureka Study].

In this study the most important Swiss studies on the incidence of overweight and obesity are summarized and compared to the corresponding prevalence rates from the Heureka study. Interestingly, data on body weight indexes (mostly mass indexes) and the various prevalence rates showed good accordance for younger age groups. In the upper age classes however, phenotypic differences concerning determinants and risk factors for overweight became obvious in the different Swiss populations (i.e. from geographically different regions of Switzerland). Nevertheless, regional risk factors could not been detected because specific data were lacking. The importance of uniform weight definitions for studies as well as for daily practise is stressed.

Adult↗

PubMed1994

[Acute abdomen].

A 28-year-old turkish patient was admitted to hospital several times within the last years because of acute abdominal and thoracic pain. On each admission laboratory parameters indicative of an acute inflammatory process were initially found to be slightly increased; however, the cause for the complaints remained undetected. During a recent episode of acute abdominal pain a short increase of these laboratory parameters (particularly of CRP) could be documented, and since no other diagnostic sign indicative of an other disease was found, familial mediterranean fever was diagnosed. A basic therapy with colchicine was initiated, and since five months the patient remained mostly free of symptoms.

Abdomen, Acute↗

PubMed1994

[Differential diagnosis of acute consciousness disorders].

The most important causes of syncope and coma are discussed. Syncope may be due to cardiac, vascular or cerebral disease. A cause of syncope is not established in up to 50% of cases. Where a diagnosis is possible the patient's history, physical examination, ECG and prolonged ECG monitoring serve to establish the underlying disease in most cases. Additional diagnostic tests should only be performed in patients with possible cardiac syncope, since these cases show a higher mortality rate than patients with non-cardiac syncope. Coma may be caused by metabolic disorders, intoxication or cerebral diseases, which are easily identified by history, physical examination and simple laboratory tests in most cases. Further evaluation of patients with unknown cause of coma depends on whether focal neurologic signs, meningeal irritation and fever are present.

Acute Disease↗

PubMed1994

[Cardiac syncope: 4 case reports].

We describe 4 patients with syncopes due to tachycardias of different etiologies. The causes and prognostic importance of syncopes are discussed together with the therapeutic options, e.g., antiarrhythmic therapy guided by programmed ventricular stimulation, surgery for ventricular tachycardia, implantation of a cardioverter/defibrillator, and radiofrequency ablation of arrhythmias. In particular, the clinical presentation of arrhythmogenic right ventricular dysplasia and Wolff-Parkinson-White syndrome are outlined.

Adult↗

PubMed1994

[HIV infection, fever and cholestasis].

A 35-year-old Swiss woman with AIDS experienced fever, jaundice and cough. Laboratory evaluation revealed signs of an infection and cholestasis. The examination by ultrasound showed thickening of the intra- and extrahepatic bile ducts and gallbladder wall, without dilatation or stones. Endoscopic retrograde cholangiography demonstrated diffuse sclerosing cholangitis like lesions in the biliary tract and confirmed the diagnosis of a HIV related cholangiopathy. The cause was a cytomegalovirus infection as shown by liver biopsy with detection of cytomegalovirus early antigen. The treatment with ganciclovir was of some efficacy with improvement of jaundice.

AIDS-Related Opportunistic Infections↗

PubMed1994

Chlorpromazine-induced vanishing bile duct syndrome leading to biliary cirrhosis.

We describe a 33-yr-old pregnant woman in whom a primary biliary cirrhosis-like syndrome developed after 2 wk of chlorpromazine therapy. The clinical course was characterized by severe jaundice lasting 22 mo, intense pruritus, fever, steatorrhea, high alkaline phosphatase levels and hypercholesterolemia. Jaundice resolved with initiation of ursodeoxycholic acid therapy, but subclinical cholestasis and low-level inflammatory activity persisted and ultimately evolved into biliary cirrhosis. The pathological substrate of this severe and prolonged cholestatic reaction was found to be the vanishing bile duct syndrome with a marked transient pseudoxanthomatosis.

Adult↗

PubMed1994

Morning versus evening administration of nifedipine gastrointestinal therapeutic system in the management of essential hypertension.

The nifedipine gastrointestinal therapeutic system (GITS) is a recently developed controlled-release formulation for once-a-day dosing. We evaluated the influence of morning versus evening administration of the drug in a randomized double-blind cross-over study including 15 essential hypertensives. Five patients had to be excluded from blood pressure analysis because of noncompliance (three cases) or intolerable side effects (two cases). To assess the exact duration of the antihypertensive efficacy noninvasive automatic ambulatory blood pressure monitoring was performed. After a placebo period patients were given 30 mg nifedipine GITS either at 1000 or 2200 hours. Twenty-four-hours systolic and diastolic blood pressure profiles documented a sustained antihypertensive effect of both nifedipine regimens throughout the whole period without affecting the circadian rhythm. Statistical analysis revealed no significant difference between morning and evening administration. Two patients stopped their medication because of intolerable side effects (fatigue and muscle cramps, respectively). Two more cases suffered from mild reversible headache which provoked no discontinuation of the drug. In conclusion our results document a sustained antihypertensive efficacy of 30 mg nifedipine GITS in patients with moderate essential hypertension. Time of administration has no impact on day- and nighttime blood pressure control.

Aged↗

PubMed1993

[Arthropathy in hemochromatosis].

Early diagnosis of hemochromatosis may prevent the numerous risks of iron overload. One of the most common early manifestations of this disease is arthropathy. The clinical and radiologic findings of hemochromatosis arthropathy are discussed. Diagnosis is suggested by simple laboratory tests and confirmed by liver biopsy with measurement of hepatic iron content. Treatment includes the removal of the excess body iron by phlebotomy. Unfortunately, symptoms of arthropathy tend to be resistant to phlebotomy.

Aged↗

PubMed1993

[Development of dementia].

A 67-year old male patient was admitted to our clinic because of slowly developing dementia. Severe dysfunction of memory, confusional states and urinary incontinence were observed. A diagnosis of general paresis was made by positive serology for syphilis and CSF examination. The patient's condition improved markedly after high-dose penicillin G treatment.

Aged↗