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Biomedical subjects

U Kuhlmann

Publications and source records attributed to U Kuhlmann.

At least 109 records · Page 6Linked to original sources
PubMed1982

[Eosinophilic esophagitis, a rare manifestation of eosinophilic gastroenteritis].

Eosinophilic gastroenteritis is a rare disease characterized by gastrointestinal symptoms, peripheral eosinophilia and massive infiltration of segments of the gastrointestinal tract by eosinophils. A case of this disease in a 25-year-old patient with symptoms of slight dysphagia and isolated esophageal involvement is described. Improvement of the symptoms, but not of the histological abnormalities, was obtained by steroids combined with withdrawal of the food components probably responsible for the symptoms.

Adult↗
PubMed1981

[Incidence and clinical significance of thromboses and thrombo-embolic complications in nephrotic syndrome patients].

Chest X-ray, pulmonary isotopic photoscanning. Doppler sonography of iliac and femoral veins, inferior venacavagram and phlebography of the renal veins have been performed in 26 patients with nephrotic syndrome in order to determine the frequency and localization of thromboses and thromboembolic complications in these patients. 7 of 26 patients (26.9%) exhibited thromboses or thromboembolic complications (2 left sided renal vein thromboses, 1 right sided ileofemoral thrombosis and 1 bilateral ileofemoral thrombosis with occlusion of the vena cava inferior). In one patient renal vein thrombosis caused pulmonary embolism. In 3 other cases with life-threatening severe episodes of pulmonary embolism, the origin of the emboli could not be detected. Serum albumin level was found to be an appropriate parameter to assess the risk of thrombosis development in these patients. In 7 patients with thromboses or thromboembolic complications the serum albumin level was below 2 g/dl, whereas in 19 patients without these complications the serum albumin level was, with one exception, higher than 2 g/dl (1.5 +/- 0.3 g/dl vs. 2.6 +/- 0.5 g/dl; p less than 0.001). The possible pathophysiologic mechanisms for this observation are discussed. Our results help to identify the population of nephrotic patients who are most likely to experience thromboembolic disease. It therefore would be justifiable to carry out a prospective controlled study examining the question, whether this group of patients with benefit from prophylactic anticoagulation.

Adult↗
PubMed1981

Platelet aggregation and beta-thromboglobulin levels in nephrotic patients with and without thrombosis.

Platelet aggregation and beta-thromboglobulin levels were studied in 17 patients with the nephrotic syndrome. Thrombosis or thromboembolic complications occurred in 4 of these patients with serum albumin levels below 2 g/100 ml. Pathologic platelet aggregation assessed by estimating alpha 2-angle values derived from platelet aggregation curves was seen in the 4 patients with thromboembolic complications (alpha 2-angle 69.5 degrees +/- 10.1 degrees), whereas patients without thrombosis showed normal alpha 2-angle values (less than 30 degrees) with only one exception. In addition, patients with thromboembolic complications demonstrated significantly elevated beta-thromboglobulin levels, when compared with those not having thrombosis or thromboembolic complications (76.8 +/- 14.3 ng/ml vs 44.8 +/- 8.6 ng/ml, P less than 0.001). The decrease in serum albumin concentration showed an inverse relationship with both, alpha 2-angle values (r = -0.82, P less than 0.001) and beta-thromboglobulin levels (r = -0.83, P less than 0.001) indicating a regulatory role of serum albumin in platelet aggregation. We conclude, that altered platelet aggregation as well as hypercoagulability may be involved in the pathogenesis of thrombosis and thromboembolic complications in the course of the nephrotic syndrome.

Adult↗
PubMed1981

Renal venous renin activity in various forms of curable renal hypertension.

The diagnostic and predictive value of renal venous renin determinations was investigated in 73 patients who had various forms of hypertension associated with unilateral renal disease and who were operated upon. Patients with fibromuscular hyperplasia showed a markedly higher cure rate than cases with arteriosclerotic renal artery stenosis (64% vs. 25%) and were less frequently not improved (4% vs. 12%). Patients with unilateral (non-vascular) small kidney and patients with unilateral hydronephrosis showed comparable high cure rates (53% and 50%, respectively), whereas in no patient with a unilateral renal cyst did postoperative blood pressure return to normal. In the present study no statistically significant correlation was found between postoperative pressure reduction and PRA-ratios in either the whole group of patients or in the various subgroups. A negative PRA-ratio (less than or equal to 1.4) was found in 36% of all cured patients. In particular, cured patients with fibromuscular hyperplasia showed a high percentage (38%) of falsely negative tests. As expected, characteristic differences were observed in simple clinical data between cured and improved patients. Patients with normal postoperative blood pressure were significantly young (34.7 +/- 13.6 years) than improved cases (47.3 +/- 10.8 years; P less than 0.001) and cured patients showed lower preoperative blood pressure values (192 +/- 29/119 +/- 15) than improved ones (214 +/- 31/126 +/-117 mm Hg). Thus our results document a limited prognostic value of renal venous renin determination in patients with hypertension due to unilateral renal disease.

Adolescent↗
PubMed1980

[Furosemide and metolazone: a highly effective diuretic combination].

The natriuretic and diuretic effects of combined treatment with furosemide and metolazone have been studied quantitatively. 15 hospitalized patients with severe fluid retention who showed no reduction of body weight despite treatment with furosemide received metolazone in addition for 3 days. 11 patients had biventricular heart failure with edema, and 4 had cirrhosis of the liver with ascites. Following the addition of metolazone at a starting dose of 2.5 mg/d, a highly significant increase in diuresis and natriuresis, with a corresponding reduction in body weight, was seen in all patients pretreated with a daily dose of 40-370 mg furosemide (mean 122 mg/d). On the first day of this combined treatment the mean sodium excretion increased from 131 to 303 mval/d (2 p less than 0.01) and the mean urine volume increased from 1677 to 2940 ml/d (2 p less than 0.01). The mean reduction in body weight was 6.1 kg (2 p less than 0.001) within 7 days of continuous treatment. Even at low doses metolazone significantly potentiates the diuretic effects of furosemide and therefore simplifies the treatment of fluid retention. High doses of furosemide can be avoided in many cases, a factor of particular advantage in ambulatory long term therapy and in patients with decreased kidney function. It may also lower the cost of the therapy. In 3 patients the furosemide dose had to be lowered after metolazone was started, to avoid an excessive negative fluid balance. These cases clearly demonstrate the importance of daily checks on the patient's body weight after starting combined therapy with furosemide and metolazone.

Ascites↗
PubMed1980

Renovascular hypertension: treatment by percutaneous transluminal dilatation.

Eight patients with unilateral renovascular hypertension underwent percutaneous transluminal dilatation. In seven, renal-artery stenoses were caused by atherosclerotic lesions and in one, by fibromuscular hyperplasia. After a 6-month follow-up period, three patients were cured of hypertension anf four showed improvement. Only one patient failed to respond: Failure was caused by an occluded left renal artery 3 months after the procedure. Renal angiographic studies were repeated in six patients after 6 months of follow-up and showed patent vessels in five and reoccurrence of a slight renal-artery stenosis in one. In one patient angiographic control studies done after 3 months showed an occluded renal artery. In five patients mean pressure gradient across the renal-artery stenoses was 89 +/- 22.8 mm Hg before percutaneous transluminal dilatation and 16.4 +/- 18.5 mm Hg after being controlled for 6 months. Our results indicate that percutaneous transluminal dilatation may be valuable in the treatment of renovascular hypertension.

Aged↗
PubMed1980

Control of plasma aldosterone during chronic hemodialysis.

To investigate the effect of chronic hemodialysis (CH) on adrenal aldosterone release plasma aldosterone (PA), plasma renin activity (PRA), plasma cortisol (PC) and the serum concentrations of potassium (K) and sodium (Na) were measured before and at monthly intervals up to 26 months after initiation of CH in 42 patients with terminal renal failure. Body weight (BW), systolic (BPs) and diastolic (BPd) blood pressure were determined simultaneously. With 2 exceptions PA, PRA and PC as well as BW, BPs and BPd showed no significant changes. Following month 2 K was always significantly higher than the starting value while significantly higher Na values were observed in 12 of 26 different test periods (P less than 0.05--less than 0.001). Correlation analysis between the various parameters determined in this study revealed in 16 of 26 different months a significant relationship between PA and PRA (P less than 0.05--less than 0.001) and as expected in 20 of 26 between BPs and BPd (P less than 0.05--less than 0.001). Only at times were punctual correlations seen between any of the remaining parameters. Our results demonstrate that the prime influence of the renin angiotensin system on PA remains unaltered during CH. We conclude that the observed punctual correlations between the various parameters determined in this study are random and do not reflect a true relationship.

Adult↗
PubMed1980

[Incidence of proteinuria and nephrotic syndrome in renal vein occlusion caused by a tumor].

A retrospective study was conducted in 13 patients with phlebographically diagnosed tumor-induced renal vein occlusion to evaluate the incidence and extent of proteinuria and/or nephrotic syndrome. In 5 patients minimal proteinuria was found, but in none of the patients were the criteria of nephrotic syndrome fulfilled. These data can be used as additional evidence that renal vein occlusion is not the cause of nephrotic syndrome. They underline the hypothesis that, in cases of nephrotic syndrome associated with renal vein occlusion, the thrombic occlusion of the renal vein is a complication of the excessive renal protein loss and developing hypercoagulability.

Aged↗
PubMed1979

[Hypertension in unilateral (non-vascular) nephrosclerosis: renin activity in the venous kidney blood and effect of nephrectomy].

13 patients (9 females, 4 males) with hypertension and unilateral (non-vascular) small kidney underwent nephrectomy. Before surgery, renin activity (PRA) was measured in renal vein blood before and/or 15 and 30 minutes after intravenous stimulation with 40 mg furosemide. From these PRA values renin rations (PRA affected side/PRA unaffected side) were calculated. A ratio of greater than or equal to 1.5 was considered to be significant. After a mean postoperative observation period of 3.9 +/- 1.3 years 6 patients (46%) were cured and 6 were improved. In only 1 patient (8%) did hypertension remain unchanged. No differences could be observed between the renin ratios of cured and improved cases. Furthermore, in no patient was a correlation found between preoperative renin ratios and the degree of postoperative blood pressure reduction. Finally, both patients with renin ratios less than or equal to 1.4 were cured by surgery. Marked differences between cured and improved patients were seen in preoperative blood pressure values, age, duration of hypertension and renal function. Cured patients were younger and had much lower mean systolic and diastolic blood pressure values, shorter duration of hypertension and better renal function than improved patients. These results show that the diagnostic and prognostic validity of renal venous renin ratios is very limited in patients with a unilateral (non-vascular) small kidney. In these patients the effect of nephrectomy can already be predicted by analyzing simple anamnestic, clinical and chemical data.

Adolescent↗
PubMed1979

[Renovascular hypertension. Prognostic value of renal venous renin determinations (author's transl)].

In the present study the effect of surgery on blood pressure was investigated in 35 patients with renovascular hypertension: 17 patients with fibromuscular hyperplasia (FMD) and 18 with atherosclerosis (ASS) of the renal artery. Patients with FMD were younger (31,8 years), showed a shorter duration of hypertension (1.8 years) and were prevalently female (82%), whereas patients with ASS were markedly older (48.2 years), showed a longer duration of hypertension (2.6 years) and were most often male (78%). In both groups of patients the intravenous urogram was positive in a comparable high percentage (FMD=64%, ASS=61%). Following surgical intervention 47%(n=8) of the 17 patients with FMD were cured, 47% (n=8) were improved and only 6% (n=1) showed insufficient reduction of blood pressure values. In ASS the respective values were 28, 55 and 17%. Consequently a good effect of surgery (cured and improved) was observed in 88.5% of all patients. Patients with ASS who failed to respond to surgery (n=3) showed a remarkable long duration of hypertension (7.0 plus or minus 1.4 years). Plasma renin activity (PRA) was determined preoperatively in both renal veins in all 35 patients. From these values the PRA-ratio (PRA affected/unaffected side) was calculated. In 27 patients PRA determinations were repeated following (15 and 30 min) intravenous injection of 40 mg furosemide. PRA-ratios of larger than or equal to 1.5 were considered to be significant. In 31 patients with unilateral renovascular hypertension PRA-ratios were correlated to the postoperative blood pressure reduction. No significant differences in mean PRA-ratios were observed between cured and improved patients. Furthermore, for the total group of 31 patients no significant correlations were obtained between PRA-ratios and postoperative blood pressure reduction. Our results do not support the widespread opinion that PRA determinations in both renal veins are useful to predict the effect of surgery in patients with unilateral renovascular disease. Therefore, from our experience this method should not be recommended as obligatory in the diagnostic work-up of renovascular hypertension.

Adult↗