Search PubMed⌕ Search

Biomedical subjects

R L Galeazzi

Publications and source records attributed to R L Galeazzi.

At least 19 recordsLinked to original sources
PubMed1996

[Osteopenia in beta-thalassemia major].

Regular blood transfusions in patients with beta-thalassaemia major lead to secondary hemochromatosis in the majority of cases. As a consequence of chronic iron overload, many endocrinopathies may occur. The most frequent endocrine dysfunction is hypogonadotropic hypogonadism, which is mainly responsible for osteopenia in as much as 80% of thalassemic patients. The frequencies of other endocrine disorders (hypothyroidism, diabetes mellitus and hypoparathyroidism) are lower. We investigated 5 female patients aged 22-25 years for endocrine dysfunction and bone density. All presented with hypogonadotropic hypogonadism and amenorrhea (four primary and one secondary). 4 patients showed absent or delayed pubertal development and short stature (below 10th percentile). In all five, hypogonadism is the most relevant cause of osteopenia as demonstrated by osteodensitometry. Endocrine disorders, especially absent pubertal development, should be detected in good time and treated with hormonal replacement. Established osteopenia is treated hormonally and with vitamin D3 and calcium.

Adult↗
PubMed1996

Recurrent brain abscesses in an HIV-positive patient with hereditary hemorrhagic telangiectasia and arteriovenous malformations of the lung.

Patients with hereditary hemorrhagic telangiectasia are at risk for the development of brain abscesses. The history of a 47-year-old man infected with the human immunodeficiency virus and with hereditary hemorrhagic telangiectasia is reported. Within eight months, the patient presented twice with life-threatening cerebral abscesses at different sites. On both occasions, Streptococcus anginosus was cultured from the abscess material. Treatment consisted of parenteral antibiotics and neurosurgical drainage. After treatment of the second occurrence, the patient was placed on a prophylactic regimen of clindamycin. He remains relapse-free and is clinically stable 24 months after the second episode.

Anti-Bacterial Agents↗
PubMed1995

[Heparin-induced thrombocytopenia. Results from the Comprehensive Hospital Drug Monitoring (CHDM) Bern/St. Gallen].

Of 23,520 consecutive hospitalizations from 1980-1988 (corresponding to 16,628 individual patients) in three departments of general internal medicine, 8261 were treated with heparin. All observations of patients displaying a probable, possible or questionable relationship of thrombocytopenia to heparin (administered i.v. or subcutaneously) were electronically collected by the CHDM program, revised on the basis of the primary case records and selected by standardized criteria. 13 of the 8261 patients exposed to heparin were considered to have a probable or possible HIT, corresponding to a frequency of 0.157%. In two of them severe thrombocytopenia was observed (corresponding to 0.024%) accompanied in one case by a white clot syndrome. Thrombocytopenia was defined as a platelet value below 100 x 10(9)/l and severe thrombocytopenia as one below 30 x 10(9)/l. In the literature we found slight, asymptomatic thrombocytopenia in < or = 1-8% of heparin treated patients. Our result of 11 out of 8261 (corresponding to 0.133%) is low, partly because the thrombocyte count was not controlled systematically, the heparin used was mainly produced from swine intestinal mucosa, and no antibody tests had been carried out. To prevent severe thrombocytopenia from heparin we propose monitoring the platelet count if the treatment is to be continued for more than 5 days. The newer low molecular weight heparins, all of swine origin, are much safer compared to the traditional preparations in regard to risk of HIT and white clot syndrome.

Aged↗
PubMed1995

[Hyperprolactinemia].

In clinical endocrinology an elevated prolactin concentration in serum is often encountered. This may be either physiological during pregnancy and lactation or pathological in all other cases. The most frequent causes are drugs (dopamine antagonists, estrogens) and primary hypothyroidism. These hyperprolactinemic states have to be distinguished from prolactinomas and other tumors of the pituitary gland, which can increase the level of prolactin in the serum through different mechanisms. Drug therapy with dopamine agonists will almost always decrease prolactin levels, but will rarely cure the disease. Long-term success rates after surgery are 50% for microadenomas and 10 to 15% for macroadenomas. Therefore, the decision to operate should be made after careful discussion between the surgeon and the endocrinologist. Pregnancy will rarely cause expansion of the tumors, more often with macro- than with microadenomas. Pregnant women with prolactinomas have to be followed clinically, and drug therapy has to be instituted immediately when clinical signs of tumor progression exist.

Adenoma↗
PubMed1995

[Frequency of antibiotics-associated colitis in hospitalized patients in 1974-1991 in "Comprehensive Hospital Drug Monitoring", Bern/St. Gallen].

In 3 divisions of internal medicine of teaching hospitals of the Comprehensive Hospital Drug Monitoring (CHDM) Foundation Bern/St Gallen, 42,920 patients consecutively admitted between 1974-1991 were investigated for adverse drug reactions. Of these 16,150 patients (38%) had received at least one systemically administered antibacterial drug during the hospital stay. Antibiotic-associated colitis included the following diagnoses: pseudomembranous colitis, hemorrhagic colitis and milder forms of colitis. We collected the data of these patients by searching for all diagnoses which might represent antibiotic-associated colitis (from the list of WHO adverse drug reaction terminology). 9 individual patients with one episode of probable antibiotic-associated colitis were found. In 5 of these cases, only one drug given during the hospital stay seemed to be implicated. An additional 32 patients were admitted with antibiotic-associated colitis in relation to treatment with the same groups of drugs before hospital admission. Based on the exposure pattern of the 9 patients with antibiotic-associated colitis compared to all patients exposed during hospital stay, we estimated the following frequencies related to the drug groups with at least 1,000 patients exposed: for all antibacterial chemotherapeutics 0.6/1000 (0.25-1.06); all penicillins 0.6/1000 (0.22-1.32), for benzyl-, phenoxy-, ureido-, isoxazolyl penicillins and methicillin 2.0/1000 (0.42-5.92) and aminopenicillin or analogues, with or without clavulanic acid 0.6/1000 (0.18-1.35). For cephalosporins the frequency is 1.4/1000 (0.17-5.12). Under sulfonamides combined with trimethoprim or related substances (5077 exposed patients) and fluoroquinolones (1043 exposed patients) no case was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Cerebral toxoplasmosis with central diabetes insipidus and panhypopituitarism in a patient with AIDS].

Endocrine disorders in the course of HIV infection are often a result of opportunistic infections of endocrine organs. We describe the case of a 30-year-old HIV positive man in whom diabetes insipidus developed initially with no abnormal findings in cranial magnetic resonance imaging. 2 months later the patient presented with symptoms of panhypopituitarism. At this time, neuroradiologic examination was consistent with cerebral toxoplasmosis. Symptoms and neuroradiologic findings improved after treatment for cerebral toxoplasmosis. Toxoplasmosis is the most frequent opportunistic infection of the brain in patients with AIDS. In HIV positive patients with malfunction of the hypothalamic-hypophyseal system cerebral toxoplasmosis must be considered in differential diagnosis. Treatment of this disorder may alleviate symptoms and signs of endocrine malfunction.

AIDS-Related Opportunistic Infections↗
PubMed1993

[HIV prevention in HIV-positive drug addicts. A methadone-supported model].

In Switzerland, an estimated 15-25% of intravenous drug users (IVDUs) are infected with human immunodeficiency virus (HIV). It has been suggested that reduction of HIV-transmission-prone behavior could be achieved in so-called "early intervention programs". Few public prevention programs have so far been targeted to HIV-infected IVDUs. Socially marginalized, jobless, street-based, HIV-infected IVDUs are those hardest to reach for education programs: it was the hypothesis that they can be motivated for HIV-prevention efforts by methadone-based comprehensive social and medical care. The program was established by integrating one additional social worker in an outpatient clinic for infectious diseases in St. Gallen, a city with a population of 70,000 inhabitants in eastern Switzerland. Access to the 29 clients of this study (10 women, 19 men) was facilitated by offering methadone treatment (follow-up 5 to 29 months). Abstinence from additional illegal drugs was not required. Methadone, plus social care and medical treatment was provided by a small team consisting of a social worker, a physician and a nurse. A gradual approach was chosen to establish a working relationship with clients. The first attempt was to satisfy basic medical needs, housing, and financial support as well as to strengthen relevant personal relationships. Once trusting cooperation was established, reduction of transmission-prone behavior was targeted. The results show that social performance can be greatly improved by integrated social, psychological and medical assistance: for the 16 initially homeless housing was found, 14 found a job and for all but 2 basic financial support was eventually guaranteed. Self-reported drug abuse was markedly reduced, as was transmission-prone behavior by prostitution, unsafe sex practices, needle sharing and improper disposal of used syringes. Breaking the isolation of socially marginalized IVDUs seems to be the important move to enhance their social responsibility as carriers of HIV.

Adult↗
PubMed1993

[Lead poisoning following administration of "home specialties"].

Three cases of lead intoxication after the administration of "house specialties" are illustrated. The lead source could be traced to a lead-containing ointment in all three patients. Two of them suffered lead intoxication as a result of topical application to the lips, while the third had ingested the ointment orally. Clinical signs, diagnosis and therapy of lead poisoning are described in the light of the case reports. The patients were treated with various drugs (N-acetylcysteine and the complex chelators D-penicillamine and 2.3-dimercaptosuccinic acid (2.3-DMSA). The therapeutic effects were determined on specific laboratory features in blood and urine. N-acetylcysteine was not absolutely confirming in our case. D-penicillamine was effective, but only after removal of the source of exposure. Because of its known adverse drug reactions, we preferred the oral lead chelator 2.3-DMSA. Treatment with DMSA resulted in a considerable decrease in the blood lead concentration and in increase in urinary lead output. The urinary excretion of aminolevulinic acid and coproporphyrin normalized under DMSA. The treatment was well tolerated and no appreciable side effects were noticed. The literature on metabolism and the characteristic effects of lead intoxication is reviewed and the production, qualities and administration of emplastrum plumbi are described. All three lead-containing ointments are summarized by the characterizing term "house specialties". One wonders whether it is justified that there is still control and registration of such "house specialties" in Switzerland.

Adult↗
PubMed1993

[Pseudopancreatitis in entero-invasive salmonellosis].

The incidence of pancreatitis in bacterial enterocolitis is disputed. Two cases of young patients with S. enteritidis-induced enterocolitis and markedly elevated amylase and lipase blood levels are described. In both patients there were neither clinical nor ultrasonographic signs of pancreatitis. Furthermore, both had increased intestinal permeability for oral 51Cr-EDTA, a condition discussed as "leaky gut" in other publications. In one patient enzyme levels and 51Cr-EDTA resorption became rapidly normal, while in the other the values remained elevated after a 7-month interval with stool culture negative. Enhanced intestinal absorption of 51Cr-EDTA (mw 391) suggests--but does not definitely prove--an inflammatory response of the mucosa leading to increased intestinal permeability, which in turn may allow resorption of amylase (mw 62,000), lipase (43,000) or other macromolecules. Performance of a 51Cr-EDTA resorption test may be helpful in cases of clinical uncertainty.

Adult↗
PubMed1993

[Incidence of drug side effects by symptoms and syndromes. From the experiences of the Comprehensive Hospital Drug Monitoring and the Swiss Drug Side Effect Center. As an example: allergic and pseudo-allergic reactions with mild analgesics and NSAID].

From 1974 to 1989, 37,392 patients were admitted to the divisions of general internal medicine of the CHDM hospitals. 19,082 of them were treated with a minor analgesic or an NSAID. In 95 of the exposed patients, an allergic or a pseudoallergic reaction to one or two of these drugs was observed. From 1981 to 1990, general practitioners, hospitals and the pharmaceutical industry reported to SANZ 158 individual cases with comparable reactions to 175 exposures of the same kind. Of the 15 different syndromes and symptoms registered in both institutions, most were reactions of the skin, mainly the usual maculopapular exanthemas (rash), urticaria and angioedema. In the CHDM, allergic or pseudoallergic reactions were observed in 0.23% of patients exposed to minor analgesics (including ASA preparations on a daily dose up to 1.0 g and pyrazolones, mainly metamizole, propyphenazone) and in 0.81% of patients exposed to NSAIDs (including the pyrazolone oxyphenbutazone). In the experience of the Comprehensive Hospital Drug Monitoring in Berne and St. Gallen (CHDM) and the Spontaneous Adverse Drug Reactions Center of Switzerland (SANZ).

Adverse Drug Reaction Reporting Systems↗
PubMed1992

[Adverse reactions to natural remedies].

There are only a few systematic epidemiological studies concerning the frequency of adverse reactions (AR) to natural remedies. However, there are numerous case reports which sometimes also include some detailed pathophysiological investigations. In general, four different categories of side effects to natural remedies can be distinguished: 1--at normal use; 2--at excessive use; in this regard many publications exist, since natural products are generally assumed to be safe and, therefore, are frequently taken in overdose; 3--induced by falsified products, e.g. through addition of steroids to for example "natural" antiasthmatics; 4--induced through omission of an efficient and proven therapy because of unshakable believe in "nature". Since conclusive studies in this matter are methodologically cumbersome and very difficult to perform, two newer studies that address these problems in special situations (oncologic patients) are the more interesting.

Drug Contamination↗
PubMed1991

[Rhodococcus erythropolis infection in HIV-associated immunodeficiency].

We report the first case in the literature of human infection with Rhodococcus erythropolis in an HIV-positive patient. A 24-year-old bisexual flight attendant had severe HIV-associated immunodeficiency with a CD4 cell count of 0.02 G/l. He complained of multiple subcutaneous nodules at different sites on the extremities. Biopsy of one node at his left knee revealed granulomatous inflammation filled with acid-fast rods. These bacteria were identified as Rhodococcus erythropolis. The disseminated infection was restricted to the skin and showed a slow response to long-term therapy with amoxicillin/clavulanic acid. No relapse has been observed more than 6 months after discontinuation of antibiotic therapy. The etiology of a concomitant polyarthritis remains unknown; a relationship with the rhodococcus infection is possible as the arthritis responded well to the antibiotic therapy and did not reactivate after discontinuation of antibiotics. Due to the difficult isolation technic, this pathogen may be overlooked in routine diagnostic procedures. The implications in clinical practice are discussed.

Actinomycetales Infections↗
PubMed1989

[Amborum Special F and ASFO--2 glucocorticoid-containing herbal remedies].

Amborum Special F and ASFO are two names of a herbal remedy which is adulterated with the glucocorticoid betamethasone. Patients with asthma, rheumatic and chronic diseases import the drug direct from Burbank, California, USA. Its impressive antiasthmatic effect is reported in two patients. While under therapy the first patient developed Cushing's syndrome and the second showed suppression of adrenal cortisol production. The manufacturer, who claims that the drug contains no "western medicine" and in particular no cortisone, is unscrupulous enough to recommend it for children under two years of age. We have observed that a marked glucocorticoid effect and marked glucocorticoid side effects are achieved with small doses of betamethasone. A review of the literature and the two cases reported here suggest that the equivalence doses given in textbooks and tables of glucocorticoid equipotency are incorrect for betamethasone. Betamethasone is a more potent glucocorticoid than hitherto reported.

Adult↗
PubMed1987

The development of a German language (Berne) pain questionnaire and its application in a situation causing acute pain.

The adjectives used in the McGill Pain Questionnaire were translated into German. Nine of the 76 adjectives could not be translated satisfactorily. Accordingly, 10 new German adjectives were added by 22 physicians and psychologists, who were also asked to judge the grouping of the words and how adequately they express pain. Concordance of grouping was reached by more than 82% of the raters. The adjectives were assigned to 20 groups. In a next step 80 subjects assessed the words in each group on a visual analogue scale (VAS) with respect to intensity: for 3 of the 20 groups we found no difference in intensity between the adjectives within a group. They were not retained in the final version tested. Additionally each group was reduced to 3 adjectives by dropping the least discriminating words of each group; 17 groups of 3 words each were retained. In a third step a comparably composed group of 82 subjects rated the words in each group on VAS with respect to intensity: for each of the 17 triads there was a significant overall difference between the 3 adjectives on the VAS. In all but 4 of the 17 triads all 3 possible pairwise differences were significant as well. In spite of the significant differences of mean values there was considerable disagreement in individual intensity rankings of the 3 adjectives within the 17 groups. The validity of the German language (Berne) pain questionnaire (BPQ) was tested together with a verbal rating scale (VRS) and a VAS in a double-blind, complete cross-over study. A low osmolar (LO), a high osmolar (conventional) (HO) compound and 0.9% NaCl (placebo) (PL) were injected intra-arterially in patients with arteriovascular disease. We expected the LO compound to cause much less pain than the HO compound. The 3 conditions HO, LO and PL had significantly different effects on all 4 scales: VAS, VRS, RaW (scale of rank of words), and NoW (scale of number of words). The pairwise comparisons of PL with HO and LO resulted in significant differences also. The square of the correlation r for VAS/VRS was 0.64, for RaW/NoW 0.61, all other possible correlations were not significant. Our conclusions are: the translation of the MPQ into German was successful, and its validity could be shown. In our experiment, it differentiated acute, short lasting pain as well as the visual analogue and the verbal rating scales. The BPQ is a tool worth being examined in the laboratory and in studies of clinical pain syndromes.

Evaluation Studies as Topic↗
PubMed1986

[Polyneuropathy, organomegaly, endocrinopathy and skin changes in a case of solitary myeloma].

The case is reported of a 32-year-old woman with polyneuropathy, organomegaly, edema, endocrinopathy, dark skin and solitary myeloma with monoclonal gammopathy of IgG/lambda type. More than 100 cases of this rare disorder have been observed up to now, mainly in Japan. In recent reviews the terms POEMS-syndrome or Crow-Fukase-syndrome have been used. Local radiotherapy of the myeloma led to lasting regression of symptoms. Studies with immunocytochemistry and immunoelectroblotting revealed specific antibody activity against hypophysis, suggesting that the pathologic monoclonal myeloma antibodies may damage the neuroendocrinic centers in hypothalamus and hypophysis as the primary target. Most of the multisystemic symptoms would thus be explained as secondary alterations.

Adult↗
PubMed1986

The antiemetic activity of high-dose alizapride and high-dose metoclopramide in patients receiving cancer chemotherapy: a prospective, randomized, double-blind trial.

Alizapride is a new substituted benzamide with suggested superior antiemetic efficacy to and fewer side effects than metoclopramide. High-dose alizapride (4 mg/kg X five doses) was compared with high-dose metoclopramide (2 mg/kg X five doses) in a prospective, randomized, double-blind trial in 62 evaluable patients undergoing strongly emetic cancer chemotherapy. Patients receiving metoclopramide experienced significantly fewer vomiting episodes than patients receiving alizapride (median of three episodes vs. eight episodes; P less than 0.001). Metoclopramide was more effective in decreasing the volume of emesis than was alizapride (median of 100 ml vs. 360 ml; P less than 0.02). Seventy-two percent of the patients receiving alizapride and 57% of those receiving metoclopramide experienced side effects. High-dose metoclopramide is an effective antiemetic in patients receiving cancer chemotherapy. Alizapride is less effective and has more side effects than metoclopramide. We do not recommend the further use of alizapride.

Adult↗
PubMed1985

[Hemodynamic effects of a new long-acting isosorbide dinitrate].

The following hemodynamic parameters were measured at rest and 1, 2, 4, 6, 8, 12 and 24 hours after 100 mg of ISDNSR p.o. in 10 patients with dilated cardiomyopathy (NYHA class III-IV): mean pulmonary artery, pulmonary capillary wedge (PCW) and arterial pressures (AP), and cardiac output (thermodilution). Plasma levels of ISDN were determined by capillary gas chromatography at the same intervals and correlated with the hemodynamic changes. PCW fell from 24 +/- 1.5 (SE) to 18 +/- 1.8 mm Hg after 1 hour (p less than 0.05) and after 2 hours to 16.9 +/- 1.6 mm Hg. This change was sustained for 8 hours. At 12 hours PCW had increased again to 21 +/- 1.5 mm Hg and at 24 hours to 22 mm Hg. AP dropped from 89 +/- 5 to 81 +/- 4 mm Hg at 1 hour (p less than 0.2) and remained 80-84 mm Hg for 8 hours. It returned to baseline levels at 12 hours. Heart rate, cardiac index, systemic vascular resistance, stroke index and left ventricular work index did not change significantly during the observation period. Plasma levels of ISDN remained between 3 and 12 ng/ml for 16 hours. Thus, ISDNSR is an effective long-acting nitrate preparation which reduces preload for 8-12 hours. After this interval, nitrate tolerance starts to develop.

Blood Pressure↗