[Clinical applications of ACE inhibitors].
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Angiotensin-Converting Enzyme Inhibitors↗
Biomedical subjects
P Greminger
Publications and source records attributed to P Greminger.
[Fever, somnolence, vomiting, diarrhea].
A 69-year-old female was admitted because of a febrile state, somnolence, nausea and diarrhea. Addison's disease known to have developed several years earlier after adrenal tuberculosis suggested Addisonian crisis triggered by an acute infection. Therapy with steroids and substitution of electrolytes and fluid led to rapid improvement. Streptococcus bovis was identified as causative agent. The known association of this germ with cancer of the colon led to further investigation which revealed cancer of the sigmoid and incidental cancer of a salpinx. After surgical removal of both cancers, the patient has remained free of complaints under substitution of steroids.
Adenocarcinoma↗
[Acute segmental hemorrhagic penicillin-associated colitis].
Four days after beginning a perioperative antibiotic prophylaxis with amoxicillin and clavulanic acid a 33-year-old patient developed an acute haemorrhagic diarrhoea with cramp-like lower abdominal pain. Coloscopy revealed diffuse mucosal oedema with map-like ulcerations, increased susceptibility to trauma and submucous haemorrhages extending from the middle of the ascending to the middle of the descending colon. Granulocytic inflammation with cryptal atrophy was seen histologically. Stool cultures, including tests for Clostridium difficile toxin, were normal. All symptoms disappeared within three days of discontinuing the medication. Coloscopy after one week revealed marked improvement, after three months nothing abnormal. Acute segmental haemorrhagic penicillin-associated colitis is rare and must be distinguished from antibiotic-associated pseudomembranous colitis.
Abdominal Pain↗
[Diminished vision, loss of libido, headache].
A 34-year old patient was diagnosed to suffer from a carcinoma of the pituitary gland. A developing panhypopituitarism was seen first and the complete extirpation of a chromophobe, non-secreting adenoma of the pituitary gland was preliminary not successful. During half a year the patient relapsed clinically and morphologically by scanning methods and the progression of the malignancy of the tumor from WHO grad (adenoma) to WHO grad III (carcinoma) was histologically confirmed.
Adenoma↗
[Nutrition and hypertension: what are the goals?].
The dependence of blood pressure on nutritional factors is reviewed in the light of possible therapeutic consequences. Salt restriction, increased administration of potassium, restriction of alcohol intake, weight loss and prescription of fish-oil are discussed by review of own and published data. All these measures may contribute to a reduction of hypertension although to a variable extent. They should be envisaged as therapeutic alternatives to drugs in mild hypertension.
Alcohol Drinking↗
[Disseminated histoplasmosis as the first manifestation of HIV infection].
A 29-year-old man who had been abroad for several years (mainly Mexico) fell ill with fever (up to 39.8 degrees C), night sweats, weight loss of 10 kg in 6 months (height 181 cm, weight 50.5 kg) and abdominal pain. Computed tomography of the abdomen revealed many enlarged abdominal lymph nodes. Serological tests were positive for HIV antibodies. Fine-needle biopsy of one of the enlarged lymph nodes revealed numerous macrophages with round inclusions, typical for Histoplasma capsulatum. Disseminated histoplasmosis was confirmed by direct antigen demonstration in serum and urine. The patient's serious clinical condition clearly improved and lymph node enlargement regressed after starting specific i.v. treatment with amphotericin B (initially 20 mg/dl, then 50 mg/dl). Although complete cure of the histoplasmosis in connection with the HIV infection is not to be expected, the patient has remained without symptoms for four months on 50 mg weekly of amphotericin B i.v., later changed to imidazole derivatives (400 mg ketoconazole or 200 mg itraconazole, respectively.
Adult↗
[Visceral leishmaniasis as an opportunistic infection. Case report and literature review].
With increasing numbers of immunocompromised patients a rise in the incidence of visceral leishmaniasis has to be expected. Presenting a case of visceral leishmaniasis in an HIV-infected patient and reviewing the literature, we discuss general aspects of this parasitic disease and special features of it as an opportunistic infection.
Adult↗
[Effect of a follow-up action in diet instruction].
Efficacy of diet-counseling was analyzed in 349 adipose patients, (140 men and 209 women.) The patients were guided in a specialized consultation service by diet-assistants. A daily caloric intake of 1200 calories was usually recommended. Mean observation time was 14.6 months in women, 15.4 months in men. After completion all patients were invited for a single check-up. 72.9% of the men and 81.4% of the women participated. Mean weight reduction during counseling amounted to 6.7 kg for men (n = 127) and 4.8 kg for women (n = 191). Blood pressure fell from 145/95 to 130/90 in men and from 140/92 to 135/88 in women. At the time of the follow-up visit a further reduction in body weight and blood pressure was noted in both sexes. Analysis of further factors disclosed a better performance of non-smokers vs. smokers and a higher frequency of consultations demanded by women. Treatment by diet-consulting is thus effective and its success persists after termination of the guidance by the diet assistant. A drop-out rate of 25% has to be accepted.
Adult↗
[Nosebleed, vision disorders].
A 79-year-old man had repeated episodes of nose bleeding, disturbances of vision and anemia. Elevated WBC and lymphocytosis suggested chronic lymphatic leukemia. Serum electrophoresis revealed IgM paraproteinemia. The disease progressed rapidly under appropriate therapy. An autopsy revealed NHL of the lymphoplasmocytoid type (IWF: A--LP-immunocytoma), a NHL carrying a slightly poorer prognosis than classical chronic lymphatic leukemia.
Aged↗
[Comparison of enalapril and captopril in the treatment of chronic heart failure].
The long-term effect of enalapril (group 1) and captopril (group 2) on clinical symptomatology and left ventricular function was evaluated in 29 patients with severe congestive heart failure (13 ischemic and 12 dilated cardiomyopathy, four valvular heart disease). During the 6-month observation period, five patients died (two on enalapril and three on captopril therapy = 6-month mortality rate 18%). Nine patients showed no beneficial effect of enalapril or captopril on clinical and hemodynamic findings (= nonresponders). The initial findings on these nine patients were, however, not significantly different from the clinical and hemodynamic findings on the patients who improved. Enalapril had to be discontinued in two patients because of side effects (progressive renal failure and gastrointestinal symptoms, respectively). A total of 22 patients completed the study, 11 treated with enalapril (mean dosage 25 +/- 10 mg/day) and 11 treated with captopril (mean dosage 77 +/- 26 mg/day). After 6 months there was a significant improvement according to the New York Heart Association (NYHA) classification, from 2.4 to 1.9 in group 1 (p less than 0.01) and from 2.7 to 1.9 in group 2 (p less than 0.001). The cardio-thoracic ratio (chest x-ray) decreased significantly from 0.59 to 0.56 (p less than 0.001) in group 1 and from 0.56 to 0.53 (p less than 0.001) in group 2. Physical working capacity (bicycle ergometry) showed a significant increase in both groups from 61% to 81% in group 1 (p less than 0.01) and from 66% to 83% in group 2 (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Blood Pressure↗
[Combined GM-CSF and erythropoietin therapy in myelodysplastic syndrome].
A 60-year-old patient with a myelodysplastic syndrome (MDS) corresponding to refractory anemia with an increase in blast cells (RAEB) was treated with granulocyte-macrophage colony stimulating factor (GM-CSF) and erythropoietin (EPO) for severe symptomatic pancytopenia. During the GM-CSF treatment a distinct increase in granulocytes was observed, but the reticulocytes and thrombocytes decreased to the point where treatment had to be discontinued after eight days. After subsequent treatment with EPO the reticulocyte count rose from 0% to 2%. However, this rise alone was insufficient to decrease the number of blood transfusions required. The thrombocyte count rose to the original values after the cessation of GM-CSF therapy while continuing treatment with EPO. Bone marrow investigations were performed before and after GM-CSF treatment and indicated a distinct increase in the myeloid precursor cells after therapy, without an increase in blasts. On the other hand, an obvious decrease in erythro- and megakaryopoiesis was observed.
Anemia, Refractory, with Excess of Blasts↗
[Blood pressure and nutrition].
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Blood Pressure↗
[Pneumothorax as a complication of Pneumocystis carinii pneumonia].
A pneumothorax occurred in a 29-year-old HIV-positive woman with rapidly progressive dyspnoea at rest and left-thoracic pain, dry cough and fever. Sputum test revealed Pneumocystis carinii pneumonia. Treatment was started with 20 mg/kg trimethoprim and 100 mg/kg sulfamethoxazole, but was poorly tolerated and changed for pentamidine, 4 mg/kg i.v. from the fifth day onwards. A chest drain was inserted, but pleurodesis became necessary after two further lung collapses. After three weeks secondary prophylaxis of the Pn. carinii pneumonia was started with pentamidine inhalations (60 mg every two weeks). The patient gradually improved under this regimen. Pneumothorax is a rare complication of Pn. carinii pneumonia, but should be considered in patients with rapid respiratory deterioration. In addition, Pn. carinii pneumonia should be considered in HIV-positive patients with pneumothorax.
Adult↗
[Fish oil: clinical application possibilities].
Current interest in fish-oil stems in part from epidemiologic evidence gathered in eskimos. Due to a high proportion of fish in their diet eskimos have a low incidence in cardiovascular mortality. The active principle in fish-diet are n-3-fatty acids. These modulate prostaglandin and leukotriene metabolism. Numerous studies have been undertaken to demonstrate clinical usefulness. Current interests focus on lipid lowering, inhibition of hemostasis and antihypertensive actions. Furthermore antiinflammatory and immunologic effects as well as uses in oncology are discussed.
Blood Pressure↗
[Rhodococcus equi infection in HIV disease].
A case of Rhodococcus equi pneumonia associated with septicemia and metastatic brain abscess in an HIV-infected male is presented. Clinical findings and the diagnostic and therapeutic approach are discussed. Cavitating pulmonary disease was rapidly improved by six-week combined oral and parenteral antibiotic treatment. However, pulmonary relapse and brain abscess were documented after one month. Therapy with ceftriaxone, ciprofloxacin and cotrimoxazole on an outpatient basis again led to clinical and radiological improvement after four weeks. Surgical resection of localized processes should be considered early, and prolonged antibiotic therapy over months is recommended.
Acquired Immunodeficiency Syndrome↗
Cure and improvement of renovascular hypertension after percutaneous transluminal angioplasty of renal artery stenosis.
In the present study we report our long-term experience in 82 patients with renovascular hypertension (48 with atherosclerotic stenosis, 34 with fibromuscular dysplasia) who were followed up for a mean observation period of 23.6 months after percutaneous transluminal angioplasty (PTA) of renal artery stenosis. Our results show a highly significant decrease in mean systolic and diastolic blood pressure. Cure rates were slightly higher in patients with fibromuscular dysplasia (41% cured, 47% improved) than in those with atherosclerosis (23% cured, 54% improved). Kidney function significantly improved in patients with cure, remained stable in those with improvement and worsened in cases classified as unimproved. These results document the good long-term effect of PTA on blood pressure and kidney function in patients with renal artery stenosis.
Adult↗
[Serum erythropoietin levels in several diseases].
The accurate radioimmunological measurement of serum erythropoietin (EPO) levels has only been possible since the development of highly specific antibodies directed against recombinant human EPO. In the present study, we determined the serum EPO levels in 100 healthy volunteers and in over 300 patients with anemias and hyperglobulinemia of various causes. In the healthy group, the females had levels of 11.3 +/- 3.4 mU/ml, while the males had levels of 8 +/- 3.2 mU/ml. The serum EPO concentrations were inversely related to the degree of anemia in patients with nonrenal anemias, while predialysis patients with renal anemias showed only partially such a tendency. Hemodialysis patients exhibited EPO-levels that were inadequately low relative to the degree of anemia. Patients with hyperglobulinemia had significantly higher serum EPO-levels than healthy individuals and polycythemia vera patients, the latter having particularly low serum EPO levels. Our results show that the determination of serum EPO levels can be of value in the differential diagnosis of hyperglobulinemia. Finally, sequential measurements document fluctuating serum EPO-levels after gastrointestinal hemorrhages and in patients with iron deficiency anemias receiving iron substitution. The probable reason for this phenomenon seems to be the intermittent utilisation of the hormone by EPO-sensitive erythropoietic precursor cells.
Acquired Immunodeficiency Syndrome↗
[Nephrogenic hypertension--interventional or surgical therapy].
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Angioplasty, Balloon↗