Biomedical subjects

P Walger

Publications and source records attributed to P Walger.

At least 37 records · Page 2Linked to original sources

PubMed1990

[Fever, dyspnea].

A 52-year-old female complained about non-distinct symptoms such as fatigue, night sweats and bone pain. Because of a febrile bronchitis, chest X-ray was performed, which disclosed enlarged hilar nodes and intestinal and acinar pulmonary infiltrates. Endobronchial biopsy and cultures from bronchial aspirate permitted to diagnose infection by legionella concomitant with sarcoidosis. After antibiotic treatment for legionellosis over four weeks, immunosuppressive therapy for sarcoidosis was initiated with glucocorticoids.

Diagnosis, Differential↗

PubMed1990

[Bronchoscopic diagnosis of therapy refractory pneumonia].

In 73 patients with pneumonia treated empirically with antibiotics or antimycotics, a bronchoscopy with bronchoalveolar lavage was performed in an attempt to identify the pathogens involved. Patients in whom it proved possible to detect a specific pathogen showed a lower mortality rate than did those in whom it was not possible to clarify the aetiology of the pneumonia (24 per cent and 34 per cent, respectively). In patients receiving empirical treatment over a long term, pneumonia persisted longer, and the mortality rate was higher, than in patients who were submitted to invasive examination early on.

Adolescent↗

PubMed1989

Diurnal variations of blood pressure in shift workers during day and night shifts.

The dependence of blood pressure upon internal rhythms and the short-term effects of shift rota on the blood pressure were investigated in shift workers. Blood pressure was measured every 30 min using automatic records for 24h in 17 physically working men in a chemical factory during their morning and night shifts. There were no differences of the mean blood pressure between the respective sleeping phases or between the working periods. The amplitudes of circadian blood pressure variations were equal. There was a phase difference of 8h corresponding to the lag between the working periods. At this 8-h lag the hourly means of the 24-h blood pressure were closely correlated (r=0.69). Comparisons of 24-h blood pressure profiles during the first and last days of night shift week showed that the effects of night work on the blood pressure were already fully developed within the first 24h (r=0.86). Thus the diurnal variations of the blood pressure are determined by the working and sleeping periods and largely independent of endogenous rhythm. There is no short-term alteration of the mean 24-h blood pressure after shift rota.

Adult↗

PubMed1989

Nocturnal hypertension in renal failure, haemodialysis and after renal transplantation.

Diurnal blood pressure variations in 20 patients with advanced renal failure, 20 patients on chronic haemodialysis, and 21 renal transplant recipients were compared with those of matched control groups without renal disease, using 24-h ambulatory blood pressure monitoring. Whereas the blood pressure during the day (from 8 a.m. to 8 p.m.) was roughly the same in the patients compared with their respective control groups, during the night (from 8 p.m. to 8 a.m.) it was substantially higher in all patient groups. The differences between the mean daytime and night-time values were significantly lower in the patients (P less than 0.05 to P less than 0.001). The nocturnal blood pressure decrease may be attenuated or even reversed in renal failure, in haemodialysis and after renal transplantation. In a proportion of these patients, 24-h ambulatory blood pressure monitoring showed an elevated nocturnal blood pressure, which may require some modification of treatment.

Blood Pressure↗

PubMed1989

[Medical and psychosocial effects of methadone substitution in HIV infected substance-dependent patients].

After an average observation time of 12 months we can confirm that methadone substitution on an outpatient basis has proved significantly useful for a majority of chronically intravenously opiate-dependent HIV-infected patients of the stages CDC IV or WR 3-6 if methadone is given under controlled conditions, the improvement consisting in an amelioration of certain medical and psychosocial parameters. In 25 out of 30 patients methadone substitution resulted in termination of the previously existing intravenous heroin addiction. In the further course of treatment one of these 25 patients could then be induced to undergo a methadone withdrawal course followed by long-term withdrawal therapy. Since the patients were no longer dependent on heroin, they were no longer compelled to procure it under all circumstances, so that crime and prostitution connected with the pressure to obtain heroin by all means were now superfluous. This provided the most important prerequisites for medical and social care for the patients. The decisive factors determining the effectivity of substitution and hence a successful stabilisation are the integration of the patient in a network of care including the family doctor, outpatient HIV care by a relevant clinic, drug advice centre of AIDS help, and a Public Health Office. This also guarantees that the patients act responsibly in respect of their AIDS infection. In very few patients the permanent success of the treatment was at high risk due to unsatisfactory social care, lack of social security measures, progression of the underlying disease, a too low methadone dosage level, and partnership conflicts.

Adult↗

PubMed1989

Twenty-four-hour blood pressure is not dependent on endogenous circadian rhythm.

The effects of shifted working and sleeping phases on the diurnal blood pressure rhythm were investigated in 15 physically working industrial shift workers at a slowly rotated three-shift system. Ambulatory 24-h blood pressure monitoring was performed during the morning and night shifts. In the two shifts the mean 24-h blood pressure was identical. There were no differences in the blood pressure levels in the sleeping phases or in the working periods between the two 24-h cycles. Diurnal blood pressure fluctuations had equal amplitudes. Corresponding to the lag between the working period there was a phase difference of 8 h between the 24-h blood pressure curves. At this lag, there was a high correlation between the mean hourly blood pressure values (r = 0.683). Twenty-four-hour blood pressure curves during the first and last day of a night shift were nearly equal. Thus the effects of shift rotation on the 24-h blood pressure profile were fully expressed within the first 24 hours. The immediate and complete adaptation of the 24-h blood pressure curve to shifted activity and sleeping phases indicates that activity determines the diurnal blood pressure profile. The blood pressure is largely independent of internal circadian rhythm.

Adaptation, Physiological↗

PubMed1989

Can secondary hypertension be identified by twenty-four-hour ambulatory pressure monitoring?

Circadian blood pressure rhythms were examined in subjects exhibiting various forms of secondary and essential hypertension and in normotensive subjects with and without renal disease. Indirect ambulatory blood pressure recordings were performed in 284 subjects for 24 h. In contrast to patients with essential hypertension and to normotensive healthy subjects, the circadian fluctuations of blood pressure were reduced in secondary hypertensives and in normotensive renal patients. In renal hypertensives, these alterations in the diurnal blood pressure variations were dependent on the degree of renal failure. Calculations based on comparisons of the mean sleeping and mean daytime blood pressures identified 89.8% of the essential hypertensives and 72.5% of the patients with secondary hypertension. A large proportion of the patients with secondary hypertension had very high blood pressure levels during sleep, in many cases even exceeding the daytime levels. Thus, 24-h ambulatory blood pressure curves from patients with secondary and essential hypertension can be distinguished from each other. In secondary hypertension, blood pressure monitoring during both day and night is particularly useful for evaluating frequently severe nocturnal hypertension, which may require particular treatment.

Blood Pressure Determination↗

PubMed1988