Biomedical subjects
Publications and source records attributed to P Greminger.
A 28-year-old male patient was admitted to our outpatient clinic because of severe chest pain. Past history, ECG and laboratory findings revealed an anterior myocardial infarction and rhabdomyolysis after cocaine consumption. Coronary arteriography performed six days after the infarction showed no significant stenoses. In view of these findings a coronary vasospasm due to cocaine was postulated. Cocaine effects are discussed.
Self-assessment of blood pressure and ambulatory blood pressure monitoring (ABPM) are being more widely used in the diagnosis and therapy of hypertension, in addition to office blood pressure measurement. The present multicenter double-blind study compared cilazapril 2.5 to 5 mg (n = 26) to atenolol 50 to 100 mg (n = 27) over a period course of eight weeks. Office blood pressures in the morning before medication, ABPM over 24 h and self assessment of the blood pressure in the morning and evening were taken. The aim of the study was to find out if the results of ABPM and self assessment of blood pressure are similar when compared to office blood pressure measurement. After four weeks of therapy both cilazapril and atenolol achieved a significant and comparable reduction of blood pressure, which did not change significantly afterwards. Both medications showed a comparable blood pressure control over 24 h. with a once-a-day regimen. The comparison of the three techniques of blood pressure measurement demonstrates that ABPM results in significantly lower average daily values than office blood pressure measurement and that the self-assessed blood pressure values in most cases lie in-between. Although the diastolic ambulatory daily values were on the average 9 mmHg lower than the corresponding office values, it was not possible for an individual patient to accurately predict the ambulatory value obtained by to his office blood pressure value. Similar results were found for the values according to self assessment of blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
Explore the source record for details and available documents.
A 69 year old male patient was seen at our outpatient clinic because of a paravertebral mass in the routine x-ray-film of the chest. The patient was in good health, showed no loss of weight and complained only of slight cough probably due to his smoking habits. In view of these findings a benign lung tumor was suspected. However, the computed tomography of the chest revealed an aneurysm of the descending aorta which was successfully operated.
According to the computerized ICD registration, 20 new cases of non-tropical sprue were detected in our outpatient clinic between 1979 and 1990. 8 of these patients had an oligo- or asymptomatic form of this disease (40%). The clinical presentation and spectrum of abnormal laboratory findings in these 8 cases are described in detail. It is concluded that laboratory parameters indicating malabsorption, especially hematologic changes, are helpful for the detection of the oligo- and asymptomatic form of non-tropical sprue, and that, in cases with undetermined anemia, this form of sprue must be considered in etiologic differential diagnosis. Finally, it seems advisable to perform a biopsy as a routine procedure during endoscopy in cases with unclear anemia.
In the present study the effect of halving the dose of atenolol in 41 essential hypertensives was analyzed. Prereduction dosage of atenolol was 100 mg in 26 and 50 mg in 15 patients. In 16 cases the beta-blocker was administered as monotherapy and in the remaining patients atenolol was combined with a calcium antagonist and/or a diuretic. Dosage of these drugs was constant throughout the whole study. During an observation period of 12 weeks after halving atenolol from a mean dose of 82 mg to 41 mg, no significant changes in systolic and diastolic blood pressure or in response rate (defined as a diastolic blood pressure of 95 mm Hg or less) were observed. In view of our results and those of other authors, it is recommended that in patients with mild hypertension whose blood pressure has been kept below 140/85 mm Hg by treatment for at least one year, betablockers may be reduced in a step-wise fashion.
Explore the source record for details and available documents.
In the present study the effect of a combination of protein-restricted modified hypocaloric diet and a behavioural therapy in 125 obese patients was analyzed. Patients were divided in two groups: 96 patients were instructed and controlled by practitioners (group 1) and 29 patients were followed in our out-patient clinic (group 2). After 14 weeks on diet a mean weight reduction of 10.6 kg in group 1 and of 9.8 kg in group 2 was observed. Furthermore, a significant decrease in systolic and diastolic blood pressure and in mean cholesterol and triglyceride values was seen. Our results show the good effect of a modified protein-sparing fast in obese patients. However, it has to be emphasized that the most promising results have been those utilizing not only a nutritional but also a behavioral approach.
We evaluated the usefulness of the basal urinary 24-h excretion rates of free cortisol versus 17-hydroxycorticosteroids in the diagnosis of Cushing's syndrome. On an outpatient basis, both urinary free cortisol and 17-hydroxycorticosteroids levels were determined in 48 patients with Cushing's syndrome, as well as in 95 obese and 94 healthy control persons of normal weight. Determination of the urinary free cortisol content allowed a clear-cut distinction between the patients with hypercortisolism and the controls, resulting in a sensitivity of 100% and specificity of 98% for the diagnosis of Cushing's syndrome. The diagnostic accuracy of urinary free cortisol was distinctly superior to that of 17-hydroxycorticosteroids, which showed a wide overlap of values between the groups, with a sensitivity of 73% and a specificity of 94%. In conclusion, the measurement of basal urinary free cortisol provided an excellent diagnostic sensitivity and specificity in the assessment of adrenocortical function. This simple and accurate test thus seems to be particularly useful in the outpatient evaluation of patients with suspected Cushing's syndrome.
A 48 year old male patient presented with maculopapular rash, pruritus, peptic ulcer disease and attacks of headache and vertigo. Rubbing of the cutaneous lesions led to urticarial whealing which is indicative of abnormal mast cell proliferation in the cutis. Histologic evidence of abnormal mast cell proliferation in biopsy specimens of skin and bone marrow led to the diagnosis of systemic mastocytosis. Treatment with H1 and H2 receptor antagonists was started.
Eight months after sustaining a reversible left motor hemisyndrome, predominantly of the arm, a 47-year-old man known to have hereditary haemorrhagic telangiectasia (Osler's disease) again developed neurological symptoms (headache, vertigo, unsteady gait) with fever (up to 38.5 degrees C). Clinical features and findings on computed tomography indicated a cerebellar abscess. This was resected because it continued to enlarge despite antibiotic treatment with daily 2 g ceftriaxone and twice daily 0.5 g ornidazole. As another manifestation of Osler's disease further tests revealed an arteriovenous malformation (2.5 x 2.0 cm) in the right upper lobe of the lung, presumably the cause of the cerebral abscess. After wedge resection of the anterior upper lobe segment the further course was without complications.
We report on two patients with actinomycosis. The first case was a 45-year-old cachectic man with extensive bilateral pulmonary infiltrates. The lesions remained unclear for 18 months and only open lung biopsy with microscopic and cultural evaluation led to the diagnosis of actinomycosis. In the second case, classic cervico-facial actinomycosis in a 69-year-old farmer is described. Diagnosis was established on the basis of microscopic findings of "sulphur granules" eroding the mandible. Furthermore, the clinical presentation, with an indurated swelling of the jaw and intraoral fistula formation, was typical. The patient had a severe combined aortic valve lesion and died after ventricular fibrillation during hospitalization. Diagnosis could not be confirmed by culture, probably due to antibiotic prophylaxis against endocarditis during tooth extraction on the first day of admission. Diagnostic difficulties and microbiologic aspects are discussed, with special focus on the rare species of Actinomyces meyeri which was cultured from biopsy specimens from the lung of the first patient. So far this species has been described in only 13 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
A 59 year old patient with leg pain and dyspnea was hospitalized for suspected deep venous thrombosis and pulmonary embolism. The clinical, scintigraphic and radiological findings confirmed the diagnosis. Immediate therapy with heparin and oral warfarin resulted in an improvement of pain and dyspnea within a few days. The strategy for diagnostic evaluation of patients with suspected pulmonary thromboembolism is discussed.
A 38-year-old man was admitted to the hospital with complaints of persistent fever up to 40 degrees C, arthralgias, headache and a nonproductive cough. The white-cell count was within the normal range but was markedly shifted to the left and demonstrated toxic granulations. Sonographic examination of the abdomen revealed a slight enlargement of the spleen. A nonspecific reactive hepatitis which was clinically asymptomatic was detected by laboratory evaluation. Diagnosis of an acute Q fever was made by demonstration of antibodies against C. burnetii. Following therapy with doxycycline, the patient became afebrile within 48 hours.
Possible errors in the diagnosis and treatment of hypertension are discussed. The problems of blood pressure determinations are reviewed by comparing the results of sphygmomanometry in the doctor's office, of automated ambulatory blood pressure recording and of blood pressure self-measurement. In screening for renovascular hypertension one should be aware that no test is yet available which shows adequate sensitivity and specificity. Therefore, the only investigation that should be used to demonstrate a true stenosis is arteriography. When treating hypertensives it must be kept in mind that the benefits of antihypertensive medication, i.e. reducing morbidity and mortality from cardiovascular disease, should exceed the costs and side effects of the treatment. Finally, the effects of reduction in dose and discontinuation of antihypertensive medication are discussed.
A 54-year old patient was admitted to the hospital with chest pain, dyspnea and left-sided pleural effusion, which was confirmed by a radiograph of the chest. In view of an exposure to asbestosis a CT scan of the chest was performed, which showed pleural thickening. The suspected diagnosis of a malignant mesothelioma was confirmed by needle biopsy of a paraaortic lymph node. Because of the existence of metastases a palliative pleurectomy was performed. Histologically a malignant mesothelioma of the biphasic type was found. The patient died less than half a year later from local progression of the tumor.
A female patient suffering from a bronchial neuroendocrine tumor with unilateral left-sided carcinoid heart disease is reported. Repeated x-ray films of the chest showed a slowly growing lung tumor in the left lower lobe. The patient refused any diagnostic or therapeutic procedure to define the type of the tumor. During the follow-up of 24 years she developed severe mitral and moderate to severe aortic insufficiency, both invasively quantified by thermodilution techniques. During surgery for double valve replacement the patient died from left ventricular heart failure. Necropsy revealed the typical pattern of a bronchial neuroendocrine tumor without metastases. Examination of the heart disclosed the characteristic deposits of fibrous tissue on the cusps of both the mitral and the aortic valves whereas the right heart showed no abnormalities. Review of the literature suggests the unilateral left-sided carcinoid heart disease to be a very rare finding, its pathogenesis remains to be elucidated.
Recent case reports emphasize that HIV infection may influence the clinical picture, course and therapy of concurrent syphilis. The case of a 32-year-old patient with coinfection by T. pallidum and HIV is presented. Clinical presentation, diagnostic procedures and therapy are discussed in the light of the current literature. False negative serologic tests for syphilis in HIV-patients raise the question of the sensitivity of these tests in HIV infection. Efficacy of therapy for neurosyphilis and the value of CSF (cerebrospinal fluid) examination in early syphilis are of increased importance in HIV infection. Current guidelines for diagnosis and therapy of syphilis in HIV patients are outlined.