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Biomedical subjects

S Ewig

Publications and source records attributed to S Ewig.

At least 127 records · Page 7Linked to original sources
PubMed1996

Autopsy findings in patients with human immunodeficiency virus infection with emphasis on the risk factor of hemophilia.

The autopsy findings of 80 human immunodeficiency virus (HIV)-infected adults, who died between 1982-1995, are presented with special emphasis on the risk factor of hemophilia. The study included 23 blood product recipients (hemophiliacs n = 21; non-hemophiliacs n = 2), 34 homosexuals, four intravenous drug abusers, and 19 patients with no known risk factor. Nearly all individuals (93%) showed the late stage of acquired immunodeficiency syndrome (AIDS). Blood product recipients had a significantly lower overall frequency of opportunistic infections (p < 0.05). Homosexuality was associated with the highest overall frequency of opportunistic infections and HIV-associated malignancies, such as Kaposi's sarcoma and malignant non-Hodgkin's lymphoma. Exclusive visceral involvement of Kaposi's sarcoma was frequent, and no decrease of Kaposi's sarcoma was observed during the study period. Pneumocystis infections, atypical mycobacteriosis, and non-Hodgkin's lymphoma showed a significant increase during the last five years (1991-1995) of the observation interval. Opportunistic infections and malignancies were the cause of death in approximately one-half of the patients. In blood product recipients, hepatic failure due to posthepatitic cirrhosis and hemorrhage due to hepatic failure with subsequent coagulopathy and in non-blood product recipients, bacterial bronchopneumonia, and diffuse alveolar damage were additional major causes of death. The data suggest a lower risk for HIV-infected blood product recipients, particularly hemophiliacs, to acquire opportunistic infections and malignant neoplasms.

Adult↗
PubMed1996

[Improved prognosis of first episode HIV associated Pneumocystis carinii pneumonia without preventive treatment: etiology and sequelae].

OBJECTIVE: The prognosis of first episodes of HIV-associated PCP has markedly improved. The knowledge about the reasons for this progress could bear important implications for the management of HIV-infected patients. PATIENTS AND METHODS: Clinical and laboratory parameters, as well as therapy and clinical course were documented. Prognostic analysis was performed using a logistic regression model. Early (1985-1988) and late (1989-1994) episodes were compared with regard to the results of the prognostic analysis. RESULTS: 67 patients (61 male, six female, mean age 35 +/- 12 years) without any prophylaxis presenting with a first episode of PCP were treated from 1985 until 1994. 95% of patients had a known HIV-serostatus prior to the diagnosis of PCP. Hemoglobin, percentage of neutrophils in BALF as well as AaDO2 were variables significantly associated with lethal outcome. The prognosis of late episodes was significantly improved (7 versus 32% lethal outcomes, log rank p < 0.01). AaDO2 as the only parameter found to be significantly associated with outcome was significantly lower in the late episodes, accordingly. The mean time until diagnosis of PCP was five days shorter in this group. Moreover, CD8 cell-count and serum albumin were found to be significantly higher, and mean loss of weight prior to diagnosis of PCP significantly lower. CONCLUSIONS: The prognosis of first episodes of PCP without any prophylaxis is most closely associated to the severity of pneumonia as reflected by AaDO2. Causes for a minor severity of PCP include an earlier diagnosis as well as better immunity and a better clinical performance at the time of PCP. The improved prognosis therefore results from the experience of the treatment center. A known HIV-serostatus and regular medical care by an experienced treatment center contributes significantly to improved outcome of PCP also in the group non-compliant to distinctive recommendations with regard to prophylaxis for PCP.

AIDS-Related Opportunistic Infections↗
PubMed1996

Immunosuppression may lead to progression of hepatitis C virus-associated liver disease in hemophiliacs coinfected with HIV.

OBJECTIVE: The aim of this study was to examine the interaction between HIV and hepatitis C virus (HCV) in hemophiliacs coinfected with the viruses and to investigate the possible relationship between immunosuppression and liver failure. METHODS: To identify risk factors for impending liver failure in hemophiliacs coinfected with HIV and HCV, we analyzed clinical and laboratory parameters, including CD4 count, aminotransferases (ALT, AST), cholinesterase, alkaline phosphatase, bilirubin, and gamma-glutamyltransferase, during 3 yr of follow-up (1990-1993) in four groups of patients: hemophiliacs with progressive immunodeficiency who were coinfected with HCV and HIV (group A, n = 49); hemophiliacs with stable immune function who were seropositive for HIV and HCV (group B, n = 95); hemophiliacs who were infected with HCV but not HIV (group C, n = 72); and homosexuals with progressive immunodeficiency who were infected with HIV but not HCV (group D, n = 24). RESULTS: Univariate analysis of data for group A showed a significant rise in gamma-glutamyltransferase and alkaline phosphatase (p < 0.01) that was not seen in groups B, C, and D. In a multivariate Cox regression analysis, age (odds ratio, 1.054 per yr; 95% confidence interval, 1.014-1.096 per yr), decline in CD4 count (odds ratio, 1.063 per cell/microl; 95% confidence interval, 1.037-1.091 per cell/microl), and alkaline phosphatase level (odds ratio, 1.012 per U/L; 95% confidence interval, 1.002-1.021 per U/L) emerged as independent determinants of death. CONCLUSIONS: Our data suggest that progressive immune dysfunction in hemophiliacs coinfected with HIV and HCV may influence progression of liver failure. In these patients cholestasis is an additional prognostic marker for survival that may reflect both exhausted immunity and impaired liver function.

Acquired Immunodeficiency Syndrome↗
PubMed1996

[Community-acquired pneumonia requiring inpatient treatment: outcome and prognostic rule].

OBJECTIVE: Mortality in community-acquired pneumonia (CAP) may be reduced by early identification of patients requiring intensive care treatment. The purpose of the study was to determine prognostic factors of outcome in patients with CAP in order to establish a clinically applicable discriminant rule. METHODS: 93 episodes of 92 patients with CAP were reviewed with regard to epidemiological, clinical, laboratory and microbiologic data. The prognostic analysis included a univariate as well as a multivariate approach in order to identify parameters correlated with death using the Cox regression hazard function in a backward stepwise selection model. The three parameters found to contribute most to the significance of the model were used in a discriminant rule for classification of outcome. RESULTS: The parameters found to be significantly different between survivors and non-survivors were heart rate, systolic, diastolic as well as mean blood pressures, leucocyte count, percentage of laymphocytes, and LDH values. The multivariate analysis revealed that heart rate, systolic arterial pressure, and LDH serum levels were associated best with lethal outcome (overall significance of the model p < 0.005). A prognostic rule composed of the variables heart rate > or = 90 beats/min, systolic arterial blood pressure < or = 80 mmHg and LDH > or = 260 U/l achieved a sensitivity of 77%, a specificity of 75% and positive and negative predictive values of 42% and 93%, respectively. It was associated with a 6-fold increased risk of lethal outcome. CONCLUSIONS: Heart rate, systolic blood pressure, and LDH values were associated best with death in a multivariate analysis. A discriminant rule consisting of these three variables achieved favourable classification results. The rule qualifies for further prospective validation and may prove useful in the management of hospital treated CAP.

Aged↗
PubMed1996

[Sleep apnea as a risk marker in coronary heart disease].

UNLABELLED: Obstructive sleep apnea (OSA) and coronary heart disease (CHD) are both frequent in the middle ages. Both disease share a similar spectrum or risk factors and attendant diseases. The aim of the study was to determine the prevalence of obstructive sleep apnea in patients with coronary heart disease diagnosed by coronary angiography. Furthermore, influence of sleep apnea and attendant diseases and risk factors for coronary heart disease, especially the risk for myocardial infarction and reduced left ventricular ejection fraction, was investigated. We included in this study 143 patients (121 men, 22 women mean age 60 +/- 8 years (35-81) who underwent coronary angiography because of angina pectoris or were suspicious for CHD due to noninvasive investigations. These patients has symptoms of OSA based on a standardized questionnaire. They underwent a four-channel screening with a non-laboratory-monitoring-system (NLMS) for detection of sleep-related breathing disorders. In addition, spectrum of risk factors and concomitant diseases were considered. Sleep apnea was more frequent in patients with CHD (30.6%) in comparison to patients without CHD (21.8%), but did not reach statistical significance. Patients with CHD and OSA had a significantly higher frequency of a history of myocardial infarction and had a significantly lower left ventricular ejection fraction than patients without OSA. IN CONCLUSION: Patients with the combination of OSA and CHD are at higher risk for myocardial infarction and reduced left ventricular ejection fraction. Patients with CHD should be screened for OSA in case of secondary prevention.

Adult↗
PubMed1995

[Nodular pulmonary opacities caused by a severe suppurative bronchitis and bronchiectases].

HISTORY AND CLINICAL FINDINGS: A 67-year-old man with chronic obstructive pulmonary disease (COPD) for many years and a heavy smoker was hospitalized because of increasing dyspnoea and moderately productive cough. His general condition was clearly impaired. He was markedly cyanotic, he had a barrel-shaped chest, and there were wheezing rhonchi throughout the lung. Body temperature was 37.8 degrees C. He had mild ankle oedema. The preliminary diagnosis was exacerbation of the COPD with global respiratory failure. TESTS: There was severe hypoxaemia (pO2 48 mm Hg) with hypercapnia (pCO2 46 mm Hg). Vital capacity was reduced to 1.81, one-second forced expiratory volume 0.91. Chest radiograph revealed multiple nodular opacities, such as seen in bronchial carcinoma with metastases. But computed tomography showed fluid-filled bronchi. Bronchoscopy demonstrated large amounts of dirty-white, sticky secretions as high up as the trachea, confirming the preliminary diagnosis. Klebsiella oxytoca and haemophilus influenzae were cultured from the secretions. TREATMENT AND COURSE: Immediate administration of amoxycillin and clavulanic acid (2.2 g daily) quickly led to clinical improvement. Chest x-ray was normalized after 10 days. But long-term oxygen treatment was instituted because of persisting resting hypoxaemia (pO2 46 mm Hg), after which he was discharged free of dyspnoea. CONCLUSION: To clarify nodular pulmonary opacities in a chest radiograph computed tomography should be performed before bronchoscopy.

Aged↗
PubMed1995

Prognostic analysis and predictive rule for outcome of hospital-treated community-acquired pneumonia.

In community-acquired pneumonia (CAP) mortality may be reduced by early identification of patients requiring intensive care treatment. The purpose of this study was to determine prognostic factors of outcome in patients with CAP in order to establish a clinically applicable discriminant rule. Ninety three episodes of CAP in 92 patients were retrospectively reviewed with regard to epidemiological, clinical, laboratory and microbiological data. The prognostic analysis included a univariate as well as a multivariate approach, in order to identify parameters associated with death using the Cox regression hazard function in a backward stepwise selection model. The three parameters found to contribute most to the significance of the model were used in a discriminant rule for classification of outcome. The parameters found to be significantly different between survivors and non-survivors were heart rate, systolic and diastolic as well as mean blood pressures, leucocyte count, percentage of lymphocytes, and lactate dehydrogenase (LDH) values. The multivariate analysis revealed that heart rate, systolic arterial pressure, and LDH serum levels were most closely associated with fatal outcome. A prognostic rule composed of the variables heart rate > or = 90 beats.min-1, systolic arterial blood pressure < or = 80 mmHg, and LDH > or = 260 U.l-1 achieved a sensitivity of 77%, a specificity of 75%, and positive and negative predictive values of 42 and 93%, respectively. It was associated with a six fold increased risk of fatal outcome. In conclusion, heart rate, systolic blood pressure, and LDH values were most closely associated with death in a multivariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1995

[Sleep apnea and cardiovascular risk].

Obstructive sleep apnea syndrome (OSAS) is the most important form of sleep-related breathing disorders due to its high prevalence and its potential for developing cardiovascular diseases. The increased morbidity of these patients is explained by the coincidence with cardiovascular diseases, and the increased mortality of untreated patients is due to cardiovascular complications, which depend on the degree of the breathing disorder. Heavy snoring, as a partial obstruction of the upper airways, and OSAS are independent risk factors for the development of cardiovascular diseases and stroke. Causal associations exist between acute hemodynamic changes, pressure and volume load, changes in the humoral and the central nervous system, and blood gas alterations during the obstructive apnea and the long-term condition due to OSAS. Obstructive apnea can be divided into an early phase, a late phase, and a phase of the postapneic hyperventilation with respect to hemodynamic changes, blood gas alterations, and the autonomic nervous system. The most striking changes in these parameters are seen at the end of apnea and in the first resumption of breathing, with an increase in systemic and pulmonary blood pressure, decrease in stroke volume, and a distinct change in heart rate. Manifestation of systemic hypertension even in the awake state is promoted by changes in the volume system, with activation of neurohumoral changes and by a resetting of baro- and chemoreceptors. Similar mechanisms are discussed in the development of pulmonary hypertension. In this circumstance the role of hypoxemia as a causal factor for pulmonary hypertension or as a consequence due to structural changes of the pulmonary vessels is controversial. OSAS is frequent in patients with coronary heart disease and these patients must be classified as a particular risk group because of apnea-associated silent myocardial ischemia and electric instability of the myocardium. The occurrence of arrhythmia in patients with OSAS is closely related to the apnea and hyperventilation events and depends on the sympathovagal balance. Early diagnosis and suitable therapy of patients at risk not only abolishes the sleep-related breathing disorder but also improves long-term outcome.

Autonomic Nervous System↗
PubMed1995

Clinical characteristics and outcome of Pneumocystis carinii pneumonia in HIV-infected and otherwise immunosuppressed patients.

The factors contributing to unequal mortality rates following Pneumocystis carinii pneumonia (PCP) in different groups at risk are poorly understood. We therefore compared the first episodes of PCP without prophylaxis in human immunodeficiency virus infected (HIV) and otherwise immunosuppressed patients in this retrospective study. A total of 58 HIV-infected and 16 otherwise immunosuppressed patients were analysed. The comparison included epidemiological, clinical, laboratory, radiological and microbiological data, as well as therapy and clinical course. A prognostic analysis was performed using a logistic regression model. The mortality was significantly different in the two groups (HIV group 17 versus non-HIV group 50%). Renal transplant patients had a higher survival rate as compared to malignancy or collagen vascular disease as underlying diseases at risk. Acute respiratory failure was more common in the non-HIV group. Variables found to be significantly associated with lethal outcome in univariate analysis were alveolar to arterial pressures difference for oxygen (P(A-a),O2), haemoglobin, platelet count, total protein, serum albumin, and gamma-globulins in the HIV-group, and serum albumin in the non-HIV group. In the multivariate analysis of the HIV group, platelet count and gamma-globulins remained independent prognostic factors. In conclusion, in the HIV-group, mortality is closely related to the severeness of PCP as well as to the severeness of the acquired immune deficiency syndrome (AIDS) disease. In the non-HIV group, malignancy and collagen vascular disease as underlying conditions at risk account for the high mortality rate. Its severeness was mainly reflected by serum albumin, which represented the only variable found to be significantly associated with death in both groups.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Diagnostic value of protected bronchoalveolar lavage in HIV-associated pneumonia].

OBJECTIVE: The concept of the protected bronchoalveolar lavage (PBAL) is to improve the diagnostic yield in bacterial pneumonia by unifying the high sensitivity of bronchoalveolar lavage (BAL) and specificity of the protected specimen brush (PSB). HIV-infected patients have been shown to have a high incidence of bacterial pneumonia as well as bacterial colonisation of the tracheobronchial tree. We therefore studied the value of PBAL in this population. METHODS: During a period of twelve months 40 episodes in 36 patients with symptoms suggestive of pneumonia were investigated retrospectively. In all cases without infiltrates on chest radiograph a CT-scan of the chest was performed. Patients without infiltrates also in CT-scan served as controls. Bronchoscopic investigation included a PSB and a PBAL in the same lung segment most prominently affected. Microbiological workup was performed for bacterial agents, mycobacteria, fungi, viruses and parasites. Quantitative cultures for bacteria were considered significant in case of > or equal to 10(3) cfu/ml in PSB and > or equal to 10(4) cfu/ml in PBAL. RESULTS: 32 episodes in 28 patients were identified as pneumonia. A definite diagnosis could be established in 19/32 (59%) of cases. Bacteria accounted for 10/19 (53%). Pneumocystis carinii for 9/19 (47%) of cases including one case that revealed mixed infection with Streptococcus pneumoniae and Pneumocystis carinii. Another pneumonia was due to Aspergillus fumigatus. The sensitivity for bacterial pneumonia was 44% for PSB and 56% for PBAL, the specificity 100%. The overall diagnostic accuracy was 60% and 68%, respectively. The yield for Pneumocystis carinii was 8/9 (89%). CONCLUSIONS: PBAL as compared to PSB had a superior diagnostic yield for bacterial pneumonia. As PBAL additionally conserved the yield of BAL reported for Pneumocystis carinii, it may represent a rational diagnostic technique for pneumonia in HIV-infected patients.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Sleep-related respiratory disorders in patients with implantable cardioverter/defibrillator devices--relationship between left ventricular function and respiratory disorder].

In order to detect sleep related breathing disorders (SRBD), 15 patients (6 with dilated cardiomyopathy [DCM], 9 with coronary heart disease [CHD], mean age 58 +/- 13 years) with implantable cardioverter/defibrillator [ICD] underwent polysomnography. A SRBD could be diagnosed in 27% of cases (n = 4; 3 DCM, 1 CHD). The reduction of the ejection fraction (EF) (normal, mild-to-moderate and severe, respectively) and the quality of sleep-related disturbances (normal, obstructive, and central/periodic) were significantly associated. In addition, in patients with DCM, the reduction of the EF correlated significantly with the amount of nocturnal oxygen-desaturation.

Adult↗
PubMed1994

[Cardiac manifestations in advanced HIV infection].

Incidence, type and clinical significance of cardiac involvement in advanced HIV infection was determined in 32 patients (30 men, two women; mean age 34.2 [21-52] years; mean CD4-cell number 52.2 [0-192]/microliters) over a period of 31 months. Any cardiac involvement was assessed diagnostically by one- and two-dimensional and Doppler echocardiography, complemented by other examinations and results of treatment. 14 patients (43.8%) had abnormal cardiac findings, presumably AIDS-associated. This included left ventricular pump dysfunction of various degrees of severity (n = 11), left ventricular dilatation (n = 2), pericardial effusion (n = 11), as well as cor pulmonale in primary pulmonary arterial hypertension (n = 2). In one patient the first manifestation of AIDS was tubercular pericarditis; in two patients there was a likely connection to disseminated pneumocystis infection and toxoplasmosis, respectively. In 11 patients no specific cause was found for the cardiac involvement. Nine of the 14 patients (64%) had symptoms due to the cardiac involvement. These findings indicate that the incidence and clinical significance of cardiac involvement must be taken into account in any treatment concept for AIDS.

AIDS-Related Complex↗
PubMed1994

[Polycystic and cavernous course of pneumocystis carinii pneumonia in AIDS].

We observed a polycystic and cavitating presentation of Pneumocystis carinii pneumonia as primary manifestation of AIDS in a patient with previously unknown HIV-infection. Pneumocystis carinii was histologically proved by transbronchial biopsy but not by bronchoalveolar lavage. A nearly complete resolution of all pulmonary lesions could be achieved with cotrimoxazole. Pneumocystis carinii must be considered in differential diagnosis of cystic and cavitating pulmonary disease in patients with unknown or positive serology for HIV-infection.

AIDS-Related Opportunistic Infections↗
PubMed1993

Pneumocystis carinii infections in HIV-infected hemophiliacs during aerosolized pentamidine prophylaxis.

The frequency, presentation, diagnosis and clinical course of Pneumocystis carinii infections (PCI) were studied during aerosolized pentamidine prophylaxis (AP) and its impact on the spectrum of AIDS-related and other pulmonary infections in HIV-infected hemophiliacs. We conducted an open study on primary (PP) and secondary (SP) AP. Breakthrough P. carinii infections (BPCI) and other infectious complications were analyzed retrospectively. Hemophiliacs without prior P. carinii pneumonia (PCP) who had been reluctant to any prophylaxis and who developed PCP served as control group. Statistical analysis of the efficacy of prophylaxis was performed by calculating confidence intervals of binomial p. Of 73 hemophiliacs (56 on PP and 17 on SP) 10 developed BPCI (7 in PP and 3 in SP) during a mean observation time of 14.9 months (range 0.5-30); total 13.6% (6.7%; 23.7%), PP 12.5% (5.1%; 24%), SP 17.6% (3.7%; 43.4%), confidence intervals at a level of 95%. Three BPCI presented atypically with cavitation (1), pneumothorax (2), Pneumocystis pleuritis (1), dissemination (2) as compared to none in the control group. Sensitivity of bronchoalveolar lavage (BAL) was 88.9%, specificity 100% (both 100% in the control group). PCP was the leading AIDS manifestation (21.3%), CNS manifestations taken together were more frequent (36.2%). Bacterial pneumonia was the most frequent respiratory infection. One patient of the study group with recurrent pneumothorax possibly died of BPCI as compared to no BPCI-related deaths in the control group. Efficacy of prophylaxis in hemophiliacs was comparable to other risk groups. AP alone may be insufficient for the control of PCI in patients with long-term profound immunodeficiency, especially in SP. 30% of BPCI presented atypically.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗