Biomedical subjects
T Hess
Publications and source records attributed to T Hess.
Occurrence of exanthems in relation to aminopenicillin preparations and allopurinol.
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[Thirst and fluid metabolism in old age].
Water balance depends on an intact regulating mechanism for volume and osmolality. While thirst has a very important function in osmoregulation, in repletion of volume deficits it is of little importance. A thirst deficit is common in old persons and often a cause of dehydration in geriatric patients. Diagnosis, treatment and prevention of dehydration are discussed.
[Incidence, significance and epidemiology of drug side effects].
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[Exanthema during frequent use of antibiotics and antibacterial drugs (penicillin, especially aminopenicillin, cephalosporin and cotrimoxazole) as well as allopurinol. Results of The Berne Comprehensive Hospital Drug Monitoring Program].
Of 19,653 patients hospitalized in the medical divisions of two teaching hospitals, 3980 were treated with an aminopenicillin, 808 with other penicillins, 427 with a cephalosporin, 2619 with cotrimoxazole and 846 with allopurinol. The first part of the study deals only with the incidence of exanthemas definitely or probably due to a specific drug on the basis of clinical considerations. The exanthema incidence is 8.0% for aminopenicillins, 4.7% for other penicillins, 1.9% for cephalosporins and 2.8% for cotrimoxazole. The second part of the study employs a cross-tabulation to determine the incidence of exanthemas definitely and probably drug-induced, and the temporal relationship of these reactions to aminopenicillin and allopurinol exposure. The observed risks of developing an exanthema are as follows: aminopenicillin without allopurinol 10.1%, aminopenicillin combined with allopurinol 7.2%, allopurinol without aminopenicillin 3.0%, neither of the two drugs 1.5%. The increased incidence of exanthemas observed by the Boston Collaborative Drug Surveillance Program (BCDSP) in patients concomitantly treated with aminopenicillin and allopurinol was not confirmed by our results. Our hypothesis is that the time of exposure to aminopenicillins might have been shorter for patients of the BCDSP who were not treated in connection with neoplastic disease and did not receive allopurinol. The incidence of aminopenicillin induced exanthemas increases severalfold with the duration of exposure time during the first 2-3 weeks. In the CHDMB, on the other hand, exposure time does not differ between the patients treated with aminopenicillin alone or in combination with allopurinol.
Fibrin formation and platelet aggregation in patients with acute myocardial infarction: effects of intravenous and subcutaneous low-dose heparin.
Fibrinopeptide A (FPA) and beta thromboglobulin (BTG) were measured in 42 patients with acute myocardial infarction (AMI) allocated on admission to one of three groups: 14 patients received a heparin bolus injection of 5000 IU intravenously followed by a 2-hour intravenous infusion (830 IU/hr) (group 1), 14 patients received a heparin bolus of 5000 IU subcutaneously (group 2), and the remaining 14 patients received no anticoagulant treatment (group 3). In group 1 the initially elevated FPA level of 5.8 +/- 1.8 ng/ml dropped to 2.0 +/- 1.5 ng/ml 30 minutes after the intravenous heparin bolus injection of 5000 IU (p less than 0.001) and returned to normal (1.9 +/- 0.8 ng/ml) in 8 of 14 patients. The initially elevated BTG level of 64 +/- 21 ng/ml did not change significantly during intravenous heparin treatment, whereas there was a rapid but only transitory increase in platelet factor 4, (PF4) from 25 +/- 9 to 74 +/- 16 ng/ml (p less than 0.01) after the intravenous heparin bolus. In group 2 the initial FPA of 5.0 +/- 2.3 ng/ml was similarly elevated as in group 1 and dropped to 2.7 +/- 1.7 and 3.3 +/- 1.5 ng/ml 2 and 4 hours after 5000 IU subcutaneously (p less than 0.05), whereas 6 and 8 hours after subcutaneous heparin bolus the mean FPA levels were 4.2 +/- 1.7 and 5.5 +/- 2.0 ng/ml and no more significantly different from the initial FPA values. BTG and PF4 did not change significantly after the subcutaneous heparin bolus. In group 3 the initially elevated mean FPA level of 4.9 +/- 2.4 ng/ml did not change significantly during the first 8 hours after admission, whereas the FPA level 24 hours after admission was 8.4 +/- 3.9 ng/ml and higher than the initial value (p less than 0.01). We conclude that heparin may reduce the elevated FPA level in plasma found in patients with AMI; however, neither subcutaneous nor intravenous heparin in a dosage frequently used is sufficient to consistently normalize the elevated rate of fibrin formation found in these patients.
Contribution of radon and radon daughters to respiratory cancer.
This article reviews studies on the contribution of radon and radon daughters to respiratory cancer and proposes recommendations for further research, particularly a national radon survey. The steady-state outdoor radon concentration averages 200 pCi/m3, and indoor levels are about 4 times higher. The primary source of radon in homes is the underlying soil; entry depends on multiple variables and reduced ventilation for energy conservation increases indoor radon levels. Occupational exposures are expressed in units of radon daughter potential energy concentration or working level (WL). Cumulative exposure is the product of the working level and the time exposed. The unit for cumulative exposure is the working level month (WLM). The occupational standard for radon exposure is 4 WLM/year, and 2 WLM/year has been suggested as a guideline for remedial action in homes. Epidemiologic studies show that miners with cumulative radon daughter exposures somewhat below 100 WLM have excess lung cancer mortality. Some 3% to 8% of miners studied have developed lung cancer attributable to radon daughters. All of the underground mining studies show an increased risk of lung cancer with radon daughter exposure. All cell types of lung cancer increased with radon exposure. If radon and smoking act in a multiplicative manner, then the risk for smokers could be 10 times that for nonsmokers. The potential risk of lung cancer appears to be between 1 and 2 per 10,000/WLM, which yields a significant number of lung cancers as some 220 million persons in the United States are exposed on average to 10 to 20 WLM/lifetime.
Fall in systolic blood pressure due to metamizol (dipyrone, noramidopyrine, novaminsulfone). Results from the Comprehensive Hospital Drug Monitoring Berne (CHDMB).
A fall in systolic blood pressure which was not accompanied by any other symptoms of anaphylactic shock was first observed in 1972 and 1973 by our team in four patients after they had received metamizol-containing drugs parenterally. Of the 17,407 patients monitored from 1974-1981, ten further cases exhibited a fall in systolic blood pressure within minutes up to six hours after intravenous administration of metamizol. In all of these cases, a causal relationship between drug administration (0.5-2.5 g) and the reaction described was considered 'likely' or even 'definite'. During the same period, 67 arterial hypotensive incidents were registered in connection with other drugs. Between 1976 and 1981, 7 out of 15,678 patients monitored in the Comprehensive Hospital Drug Monitoring Berne (CHDMB) showed this adverse reaction. In relative figures, this represents 0.34% of the 2,053 patients who received parenteral treatment with a metamizol preparation.
[Tachycardia with wide QRS complex].
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[Pericardial tamponade].
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[False-positive porphobilinogen determination test (Hoesch test) after administration of pirprofen].
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[Acute graft-versus-host disease following a single transfusion of erythrocytes].
A 50-year-old severely immunodeficient woman with malignant non-Hodgkin lymphoma died from graft-versus-host disease due to transfusion of a single unit of packed red cells. Three days after this transfusion a maculo-papular rash appeared, followed by generalized erythroderma refractory to therapy and eventually progressing into generalized ulcero-squamous dermatitis. This case, and a review of other similar cases published elsewhere, prompt the authors to recommend prophylactic irradiation of blood products prior to their administration to patients with cellular immunodeficiency, particularly in cases of acute leukaemia or malignant lymphoma where patients receive intensive radio- and/or chemotherapy regimens. To appreciate the degree of cellular immunodeficiency in such risk patients, simple criteria should be developed to assess the efficiency of the cellular immune system.
Rapidly progressive glomerulonephritis accompanying Legionnaires' disease.
A rapidly progressive, crescentic glomerulonephritis with acute oliguric renal failure occurred simultaneously with legionnaires' disease (LD) in a 52-year-old man. The diagnosis of LD was based on a sixfold rise in indirect fluorescent antibody titer against Legionella pneumophila serogroup 4. Treatment with erythromycin lactobionate resulted in a clinical resolution of pulmonary manifestations. The impairment of kidney function, however, was progressive and within two weeks led to end-stage renal failure requiring regular hemodialysis. This observation suggests that LD may trigger severe acute glomerulonephritis.
Efficiency of canine renal blood flow autoregulation in kidneys with or without glomerular filtration.
In order to evaluate vascular (myogenic) and tubular (tubuloglomerular feedback) mechanisms involved in renal blood flow (RBF) autoregulation, canine kidneys with filtration (normal) and without filtration (nonfiltering, NFK; ureteral-obstructed, UO) were studied. RBF was monitored in response to stepwise reductions in renal perfusion pressure of -20, -40, and -60 mm Hg from control pressure. None of the three groups demonstrated significant changes in RBF from their respective control values (normal, 380 ml/min/100 g; NFK, 179 ml/min/100 g; UO, 153 ml/min/100 g) until the lowest pressure (-60 mm Hg from control pressure). All three groups responded to the pressure reductions with significant decreases in renal vascular resistance. However, the calculated efficiency of the autoregulatory response for the NFK and UO groups was significantly less than for the normal group. Elimination of tubuloglomerular feedback (NFK and UO) did not necessarily eliminate renal vascular autoregulation, but did reduce the efficiency of autoregulation. It is suggested that both vascular (myogenic) and tubular (tubuloglomerular) mechanisms may coexist to efficiently autoregulate blood flow in normal filtering kidneys. However, a reduction in metabolic activity as a contributor to the reduced ability to autoregulate in these kidneys could be an additional possibility.
Incorporation of aluminium and effect of removal in experimental osteomalacia and fibro-osteoclasia.
Osteomalacia (OM) and fibro-osteoclasia (FO) was induced in growing rats by feeding a low calcium, low phosphorus, vitamin D poor diet or a low calcium diet respectively. After two weeks, Al Cl3 was supplemented up to a content of 0.1% of elemental Al and feeding continued for another two weeks, when half of the animals were sacrificed and the rest treated with desferrioxamine. In spite of similar blood aluminium concentrations, OM rats retained more Al in bone than FO rats. Desferrioxamine (DFO) treatment resulted in a significant decrease of Al in OM rats and tended to decrease Al in FO rats. Simultaneously the per cent mineral weight of the bone increased. We conclude that the preexisting bone pathology (OM or FO) is related to aluminium uptake and removal by DFO, which results in rapid mineral uptake.
[Significance of age, sex, kidney function, atopy and number of prescriptions for the occurrence of adverse drug reactions, studied by multivariate statistical methods. Results from the Comprehensive Hospital Drug Monitoring Berne (CHDMB)].
UNLABELLED: The influence of five factors (age, sex, renal function, atopy and number of drugs) on the incidence of adverse drug reactions (ADRs) is analysed by multivariate statistical methods (loglinear models for contingency tables). The study is based on a total of 19,653 inpatients in the "Comprehensive Hospital Drug Monitoring Berne (CHDMB)". RESULTS: 1. The risk of ADRs mainly increases with the number of drugs. 2. Increasing age and female sex are also confirmed as risk factors by these statistical methods. Reduced renal function (increased serum creatinine) is strongly correlated with advancing age. Renal function, however, yields more pertinent information on ADR risk than does age. 3. In atopic and non-atopic patients, the ADR risk is identical. In both groups of patients the same number of drugs was given. If the pathogenetic mechanisms of the ADRs (allergic or pharmacologic in the broad sense) are considered, it is found that atopic patients show a ratio of about 2:1 pharmacologic to allergic reactions, compared to about 3:1 in non-atopic subjects. A reduction in the incidence of ADRs is best attained by even more restricted use of drugs and better and earlier adaptation of drug dosage to diminished renal function.
[Reducing blood pressure with Dipyron (novaminsulfone sodium)].
A fall in systolic blood pressure without other symptoms of anaphylactic shock has been described following the administration of drugs containing dipyrone. This adverse reaction was first observed in 4 patients by the same team in 1972-1973. Ten further cases with a fall in systolic blood pressure by at least 20 mm Hg occurring within minutes to 6 hours after intravenous administration of dipyrone are presented in this paper. In each of them this adverse reaction was considered to be probable or even definite. During the years 1976-1981 drug exposure was registered for all 15 678 patients of the two medical divisions of Comprehensive Hospital Drug Monitoring Berne. This adverse reaction was found in 7, representing 0.34% of the 2053 patients who received intravenous treatment with a dipyrone preparation.