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Biomedical subjects

P M Suter

Publications and source records attributed to P M Suter.

At least 19 recordsLinked to original sources
PubMed2004

[Forgotten metabolic side effects of diuretics: lipids, glucose and vitamin B1 (thiamin) metabolism].

Diuretics could lead to an impairment of lipid and glucose metabolism. These potentially adverse effects of the diuretics could be compensated by non-pharmacological strategies such as weight loss or physical activity. Diuretics lead to an increased urinary loss of vitamin B1 (thiamine), a diuretic side effect which is often forgotten. In the setting of a high vitamin B1 intake the increased urinary excretion is of no pathophysiologic relevance. However, in the setting of low or suboptimal dietary intakes of thiamine the insufficient thiamine nutriture may be of importance. Vitamin B1 plays an important role in energy metabolism, especially also at the level of the heart muscle. Wet beri-beri is the characteristic vitamin B1 deficiency disease, which is besides others also characterized by heart failure. Evidence suggests that heart failure can be improved by the additional administration of Vitamin B1. Older individuals under a chronic diuretic therapy should obtain an oral vitamin B1 supplementation.

Diabetes Mellitus, Type 2↗
PubMed2003

[Is the Swiss population gaining body weight? Body mass index in insurance applications between 1950 and 1990].

In this study 4435 insurance applications to the Swiss Life insurance company ("Rentenanstalt") by individuals aged 20-39 years from the time period 1950-1990 were evaluated. Each application contained the self-reported body weight, height, and other informations such as martial status or city of residence. For each individual the body mass index (BMI) was computed and the prevalence of overweight and obesity for each year was calculated using standard definitions. This is the first study which tries to determine the prevalence rates of overweight and obesity in Switzerland over time. The absolute body weight (kg) increased continuously from 1950 to the year 2000. The most pronounced increase was seen in individuals (aged 20-29 years) above the 90th percentile of body weight and BMI, i.e. already overweight and/or obese individuals showed the largest increase in body weight. In men (aged 20-29 years) the prevalence of overweight increased between 1980 and 1990 by more than 10% to a prevalence rate of 25%. In women (aged 20-29 years) the prevalence of overweight increased continuously from 1960 onward and reached a rate of 10.5% in 1990. In the age group of the 30-39 years old individuals no change in the prevalence rates was observed. These data suggest that there is a trend for an increased prevalence of overweight in Switzerland. Since the study sample was not representative for the Swiss population the results have to be interpreted with caution only. Nevertheless the results are in agreement with the trends in other countries and it can be assumed that similar developments do occur also in Switzerland.

Adult↗
PubMed2003

[Nutritional issues in hypertension: useful or useless?].

In view of the very efficient pharmacological therapy of hypertension the nonpharmacological strategies are nearly forgotten. Many nutritional strategies are known to reduce blood pressure. In the past single strategies have been implemented with variable success. Salt restriction leads to lowering of blood pressure in salt sensitive individuals. In daily practice the restriction of salt is still the top priority. However, salt restriction alone is often not successful. A change in the whole dietary pattern, i.e. a reasonable restriction of salt intake in combination with an increased potassium intake from food as well as control of body weight has a much higher potential for blood pressure reduction. Potassium rich food is usually low in sodium, in addition potassium has favorable effects on sodium handling (e.g. natriuretic effect of potassium). In addition it is easier to implement a moderate sodium restriction in combination with a higher potassium intake (i.e. a diet rich in fruits and vegetables). Future strategies should focus on a global moderate change in the diet and life style pattern.

Age Factors↗
PubMed2003

[The metabolic syndrome].

Alterations in the intermediary metabolism respectively a "metabolic maladaptation" to the modern lifestyle represents an important risk factor for most chronic diseases, especially also for cardiovascular risk. An increased concentration of free fatty acids plays a central role in the pathophysiological sequence of events. Overweight and obesity represent one important cause for the increase in free fatty acids and are thus potentially preventable causes. It seems that the metabolic syndrome represents the result of our genetic predisposition as a response to the modern lifestyle characterized by physical inactivity and a increase in the duration of the postprandial status.

Blood Glucose↗
PubMed2003

[Treatment refractory hypertension with atrophic kidney: attending to one and not neglecting the other].

The incidence of primary aldosteronism in patients with difficult to treat hypertension is higher than previously stated in texts. The clinical picture of hypokalemic hypertensive patients remains unreliable as a third of the patients are normokalemic. Considering the diagnosis is the most important step in diagnosing primary aldosteronism. The clinical suspicion has to be confirmed biochemically.

Adult↗
PubMed2002

[Painful lipoma?].

The adiposis dolorosa (Dercum's disease) was described already in 1892. Many questions about its physiopathological mechanism are still unresolved. Presentation of a patient with this disease is reported, followed by a brief review of the literature, where the pathogenesis, the differential diagnosis and the therapeutical approaches of this syndrome are especially pointed out.

Adiposis Dolorosa↗
PubMed2002

[Madelung's disease (benign symmetric lipomatosis): still a mystery?].

The benign symmetric lipomatosis (Madelung's disease) is frequently associated with alcoholism. After 150 years of history, many questions about its physiopathological mechanism are still unresolved. Presentation of a patient with this rare condition is reported, followed by a review of the literature, where the pathogenesis, the differential diagnosis and the surgical approach of this syndrome are especially pointed out.

Adrenergic beta-Agonists↗
PubMed2002

Propofol and midazolam versus propofol alone for sedation following coronary artery bypass grafting: a randomized, placebo-controlled trial.

The aim was to compare the efficacy and side-effects of propofol combined with a constant, low dose of midazolam versus propofol alone for sedation. In a prospective, randomized and double-blinded study, 60 male patients scheduled for elective coronary bypass grafting were enrolled. Postoperatively, patients were stratified to receive either a continuous intravenous infusion of midazolam 1 mg/h or placebo. Target Ramsay sedation score was 3 to 5 corresponding to conscious sedation. An intention-to-treat design for propofol was performed to reach target sedation. Efficacy of sedation was statistically significantly higher in the group midazolam + intention-to-treat with propofol compared with the group placebo + intention-to-treat with propofol (91% vs 79%; P=0.0005). Nine of 27 patients in the midazolam group (33.4%) and nine of 26 patients in the placebo group (34.6%) needed no supplementary propofol. Weaning time from mechanical ventilation was longer in the midazolam group whether or not they required supplemental propofol when compared with placebo group (all: 432 +/- 218 min vs 319 +/- 223 min; P=0.04; supplementary propofol: 424 +/- 234 min vs 265 +/- 175 min; P=0.03). The cumulative number of patients remaining intubated was significantly higher in the group midazolam + propofol compared with the group placebo + propofol (P=0.03). In conclusion, target sedation is reached slightly more often by the co-administration of propofol and a low dose of midazolam, but weaning time from mechanical ventilation is prolonged by the co-administration of propofol and a low dose of midazolam.

Aged↗
PubMed2002

Nutrition and aging: a consensus statement.

OBJECTIVE: To consider the relationship between nutrition and aging. To summarize existing knowledge and identify areas of ignorance. DESIGN: Experts from a range of relevant disciplines received and considered a series of questions related to aspects of the topic. SETTING: University of Hohenheim, Stuttgart, Germany. INTERVENTION: The experts met and discussed the questions and arrived at a consensus. CONCLUSION: Many specific conclusions were drawn that support the general view that as we age an inadequate nutrition contributes to the loss of function and the development and progression of disease. Nutritional status is influenced by a range of medical, physiological, psychological, social and situational variables. Adequate nutrition and physical activity are aspects of a health-promoting lifestyle. The encouraging of better nutrition and the taking of exercise is a cost-effective way of decreasing the incidence and progression of age-related disease. The earlier such interventions are introduced the better.

Aged↗
PubMed2001

[Overweight and obesity in the Zurich canton. A LuftiBus study].

In this study the data from 30,598 subjects participating in the LuftiBus project during 1993-1998 were analyzed for the prevalence rates of overweight and obesity. 36.6% of men and 23.6% of the women in the total population were overweight (BMI 25.0-29.9 kg/m2) and 6.6% of the men as well as 7.5% of the women were obese (BMI > 30.0 kg/m2). At a younger age the women were in general lighter, however, with advancing age women became heavier than men. The prevalence data from this study are in quite good agreement with data from other Swiss epidemiologic studies as well international studies. The rather high prevalence rates of obesity show clearly that the problem of obesity can only be solved by preventive means.

Adult↗
PubMed2001

Is it worth treating fever in intensive care unit patients? Preliminary results from a randomized trial of the effect of external cooling.

BACKGROUND: Antipyresis is a common clinical practice in intensive care, although it is unknown if fever is harmful, beneficial, or a negligible adverse effect of infection and inflammation. METHODS: In a randomized study, rectal temperature and discomfort were assessed in 38 surgical intensive care unit patients without neurotrauma or severe hypoxemia and with fever (temperature >/=38.5 degrees C) and systemic inflammatory response syndrome. Eighteen patients received external cooling while 20 received no antipyretic treatment. RESULTS: Temperature and discomfort decreased similarly in both groups after 24 hours. No significant differences in recurrence of fever, incidence of infection, antibiotic therapy, intensive care unit and hospital length of stay, or mortality were noted between the groups. CONCLUSIONS: These results suggest that the systematic suppression of fever may not be useful in patients without severe cranial trauma or significant hypoxemia. Letting fever take its natural course does not seem to harm patients with systemic inflammatory response syndrome or influence the discomfort level and may save costs.

Analysis of Variance↗
PubMed2001

Evaluation of two processed EEG analyzers for assessment of sedation after coronary artery bypass grafting.

OBJECTIVES: Processed EEG monitoring has been suggested for sedation depth evaluation in intensive care unit (ICU) patients. The present study investigated the efficacy of two processed EEG monitors using SEF90% or SEF95% and BIS to differentiate between conscious (Ramsay score 4) and unconscious sedation (Ramsay score 6). DESIGN AND SETTING: Prospective, randomized trial in a surgical ICU of a university teaching hospital. PATIENTS: Patients recovering from elective coronary bypass grafting. INTERVENTION: One of two EEG analyzers was installed (A: Aspect A-1000 measuring SEF95% and BIS; D: Drager pEEG measuring SEF90%). At ICU admission unconscious sedation (Ramsay score 6), and at three 30-min intervals conscious sedation (Ramsay score 4) were investigated. MEASUREMENTS AND RESULTS: Fourteen patients were monitored by A and 14 by D. The interindividual variability (coefficient of variation 32-69 %) was large for all three processed EEG methods. SEF90% of analyzer D and BIS of analyzer A showed a statistically significant difference between unconscious and conscious sedation (11 +/- 3 and 17 +/- 6 Hz, p = 0.005; 74 +/- 10 and 83 +/- 10, p = 0.02). Positive and negative predictive values for SEF90% of analyzer D (0.57, 95% CI 0.34-0.77; and 0.92, 95% CI 0.64-0.99) and BIS of analyzer A (0.55, 95 % CI 0.32-0.76; and 0.87, 95 % CI 0.60-0.98) were too low for discrimination between conscious and unconscious sedation. CONCLUSIONS: The use of processed EEG monitoring cannot be recommended for assessing sedation depth after cardiac surgery.

Aged↗
PubMed2001

A multi-centre, double-blind, placebo-controlled study of liposomal prostaglandin E1 (TLC C-53) in patients with acute respiratory distress syndrome.

OBJECTIVE: To evaluate the safety of liposomal PGE1 (TLC C-53) in patients with acute respiratory distress syndrome (ARDS), and determine its efficacy in improving oxygenation and reducing ventilator dependency. DESIGN: A multi-centre, randomized, double-blind, placebo-controlled clinical study. SETTING: Thirty-one hospitals in six European countries. PATIENTS: One hundred two patients with ARDS. INTERVENTIONS: Patients were randomized in a 2:1 ratio to receive infusions of either the study drug TLC C-53 or placebo. Infusions were given over 60 min every 6 h for 7 days. The dose of study drug started at 0.6 microg/kg per h, rising over 24 h to a maximum dose of 1.8 microg/kg per h. MEASUREMENTS AND MAIN RESULTS: Seventy patients received the study drug and 32 placebo. Sixty-nine patients (47 treatment, 22 placebo) completed the study protocol. Patients were monitored for changes in the PaO2/FIO2 ratio, changes in lung compliance, time to off-ventilator and 28-day mortality, in addition to basic haematological and haemodynamic parameters. There were no significant differences in demographics and baseline characteristics between the two groups. There were no differences in the time to off-ventilation (16 days with treatment, 16.6 days with placebo, p=0.94) or in 28-day mortality (30% with treatment, 28% with placebo, p=0.78). There was a difference in the time to achieve a PaO2/FIO2 ratio above 300 in favour of TLC C-53 (10.3 versus 26.5 days) but this was not statistically significant (p=0.23). CONCLUSIONS: TLC C-53 was generally well-tolerated but failed to reduce mortality or duration of mechanical ventilation.

Aged↗
PubMed2001

Effect of alcohol on postprandial lipemia with and without preprandial exercise.

OBJECTIVE: Different factors such as exercise habits and alcohol consumption may modulate postprandial lipid metabolism. What are the effects of alcohol on postprandial metabolism in untrained and trained individuals? METHODS: The postprandial lipid response to an oral fat load (1 g fat per kg body weight (bw)) with and without alcohol (0.5 g/kg bw) was evaluated in physically trained healthy young men (T, n = 12, mean +/- SD age 27 +/- 3 years. BMI 21.6 +/- 1.4 kg/m2) after a premeal running session and in untrained healthy young men (UT, n = 8, age 24 +/- 1 years, BMI 23.2 +/- 1.8 kg/m2) without a premeal exercise session. The T subjects ingested 35.5 +/- 2.7 g alcohol, the UT subjects 38 +/- 0.6 g. Fat was given as butter and the carbohydrates as marmalade and zwieback (rusk). The T subjects received 1.20 +/- 0.05 g fat and 1.02 +/- 0.04 g carbohydrates per kilogram lean body mass. The corresponding numbers for the UT subjects were 1.28 +/- 0.08 g and 1.20 +/- 0.06 g. The postprandial lipemia was observed for an eight-hour period. RESULTS: Alcohol led to an increase to the triacylglycerol area under the curve (AUC) in the T subjects from 7.4 +/- 0.4 mmol/L * h on the control day to 11.3 +/- 0.9 mmol/L * h (p = 0.001). The corresponding numbers in the UT subjects were 13.4 +/- 2.3 mmol/L * h to 19.4 +/- 3.5 mmol/L * h (p = 0.004). Alcohol intake and physical activity training were the major determinants of the triacylglycerol (TG) AUC in these subjects. CONCLUSION: The ingestion of a high fat meal in combination with alcohol leads to an increased in the postprandial lipemia independently from the level of training. It is suggested that this unfavorable effect of alcohol and a high fat diet could be modified by fat restriction or a combination of a premeal exercise session and a higher level of physical activity training.

Adult↗
PubMed2001

Review of medical prevention of vasospasm after aneurysmal subarachnoid hemorrhage: a problem of neurointensive care.

Cerebral vasospasm remains a devastating medical complication of aneurysmal subarachnoid hemorrhage (SAH). It is associated with high morbidity and mortality rates, even after the aneurysm has been secured surgically or radiologically. A great deal of experimental and clinical research has been conducted in an effort to find ways to prevent this complication. The literature includes extensive coverage of in vivo animal model studies of SAH and vasospasm. These experimental studies have contributed to tremendous advances in the understanding of the mechanisms leading to cerebral vasospasm. Most of the experimental settings, however, have demonstrated varying levels of ability to predict accurately what occurs in human SAH. Therefore, although animal models have been developed to test new therapies, most of the treatment effects have been shown to be less compelling when trials have been conducted in clinical settings. The interpretation of current literature is complicated further by the imprecise estimation of the incidence of cerebral vasospasm, which is due to various degrees of clinical expression, ranging from the absence of symptoms in the presence of increased blood flow velocities at transcranial Doppler or vessel diameter reduction at angiography to neurological manifestations of severe ischemic deficits. In addition, a change over time in the incidence pattern of human SAH and vasospasm, possibly related to improved surgical techniques and overall patient management, may have occurred. This topic review collects the relevant literature on clinical trials investigating prophylactic therapies for cerebral vasospasm in patients with aneurysmal SAH and emphasizes the need for large clinical trials to confirm the results derived from clinical experience. In addition, it points out some experimental therapies that may hold promise in future clinical trials to prevent the occurrence of vasospasm.

Critical Care↗