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Biomedical subjects

W Zimmerli

Publications and source records attributed to W Zimmerli.

At least 145 records · Page 8Linked to original sources
PubMed1988

[Acute bacterial sacroiliitis caused by Salmonella cholerae-suis].

A 17-year-old schoolboy was admitted to hospital because of one-sided pelvic pain of uncertain aetiology and fever gradually rising over several days. Bacteriological analysis of blood cultures, skeletal scintigraphy and computed tomography revealed sacroiliitis caused by Salmonella cholerae-suis. Specific antibiotic treatment quickly stopped all symptoms and cured the infection. Radiologically there remained sclerosis of the sacro-iliac joint.

Acute Disease↗
PubMed1988

[AIDS and the lungs].

About half of patients with acquired immune deficiency syndrome (AIDS) have an associated pulmonary disease which is more often due to infections than to tumors. Rapid diagnosis is important, especially in Pneumocystis carinii pneumonia, since the prognosis depends on early treatment. A patient in good condition may be managed on an ambulatory basis. The manifestations of tuberculosis are often atypical, i.e. noncavitating with a diffuse infiltrate, hilar adenopathy and extrapulmonary foci. Treatment of atypical mycobacteria is not clearly effective and empirical treatment has little point since the resistance pattern is unpredictable.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Fatal peripheral catheter phlebitis].

A 75-year-old man suffered from suppurative thrombophlebitis as a complication of a peripheral venous catheter (1.2 x 45 mm Teflon). In spite of rapid removal of the catheter at the time of clinical diagnosis of phlebitis and adequate antibiotic treatment, the Staphylococcus aureus sepsis developed into lethal endocarditis. The risk of thrombophlebitis can be minimized by limiting (less than 72 hours) the duration of cannulation. If pus is detected within the lumen of the vein, surgical excision of the involved vein remains the treatment of choice.

Aged↗
PubMed1988

[Pyogenic sacroiliitis. Review of 8 personal cases and 200 cases from the literature].

Eight patients with a pyogenic infection of the sacroiliac joint are compared to 200 published cases. In all our patients the disease began with fever and immobilizing low back and buttock pain. All had bacterial growth in the blood cultures. Five out of 6 patients did not show inflammatory signs in the initial plain roentgenogram. Tc-99m scan was initially positive in 4 out of 6 patients. In 2 patients only the second scan, at 13 and 15 days respectively, was positive. All but one patient had a 4-6 week course of intravenous antibiotics. Three patients underwent surgery for abscesses or intraarticular sequestra. One patient with a small psoas abscess had only medical treatment under CT monitoring. All the patients recovered. From our observations and the literature we conclude that pyogenic sacroiliitis is often not recognized initially. Wrong diagnoses such as sepsis of unknown origin, appendicitis, discal hernia etc. can be avoided if pyogenic sacroiliitis is sought in a systematic fashion. The clinical diagnosis can be confirmed by bone scan, to be repeated at a later stage of disease (i.e. two weeks after onset) if the first examination is inconclusive.

Adolescent↗
PubMed1988

[Hepatic manifestations of the acquired immunodeficiency syndrome (AIDS)].

Hepatic manifestations of acquired immunodeficiency syndrome (AIDS) were analyzed in 76 consecutive patients. Serological markers of hepatitis B were found in 84%. All instances of biopsy-proven chronic hepatitis were associated with delta infection. One patient with intestinal cryptosporidiosis had a severe cholestasis. In the majority of patients histological examination of the liver revealed non-specific alterations, but in several cases was diagnostic of mycobacterial disease. The study of liver disease in HIV-infected patients could lead to a better understanding of diseases such as chronic hepatitis B and sclerosing cholangitis.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Reactivation of Staphylococcus aureus osteomyelitis after 49 years].

The treatment of chronic osteomyelitis is laborious and ill defined. We report the case of a 57-year-old woman admitted to hospital with Staphylococcus aureus septicemia due to relapse of osteomyelitis after an interval of 49 years. By surgical debridement, suction drainage and 8 months of high-dose antibiotic treatment we were able to control the infection in terms of clinical symptoms and laboratory parameters.

Anti-Bacterial Agents↗
PubMed1988

Pus potassium.

Membrane depolarization is an early event in cell stimulation. Since the resting membrane potential is dependent on the potassium composition of the extracellular medium, we investigated whether there are clinical situations in which potassium levels are high enough to depolarize polymorphonuclear leukocytes. We determined the ionic composition of sterile and infected interstitial fluid in humans and guinea pigs. All sterile extravascular fluids had physiological potassium levels in the same range as serum values. In contrast, human abscess fluids contained increased K+-levels (17 +/- 6.4 mmol/liter, N = 8) and 15 of 20 experimental abscesses in guinea pigs contained greater than 10 mmol/liter K+. In humans three of eight abscess fluid K+ levels and in guinea pigs three of five abscess fluid K+ levels were even greater than 15 mmol/liter. Thus, high K+ levels, previously shown to activate polymorphonuclear leukocytes, are observed in certain clinical situations associated with local inflammation.

Abscess↗
PubMed1987

[Prognostic factors in bacterial meningitis in adults. Retrospective analysis of 46 patients].

Clinical and laboratory data on 46 patients with acute bacterial meningitis were analyzed in a retrospective survey. The incidence of bacterial meningitis in hospital admissions was 1.3% and the mortality 33%. Streptococcus pneumoniae was the most frequent etiologic agent. Mortality was highest for pneumococcal meningitis and was higher in patients over 50 years of age (83% vs 25%, p less than 0.05). The initial stage of consciousness was prognostically important. All awake patients survived, while the more impaired the consciousness (from lethargy to coma), the higher the mortality (19%, 25%, and 78% respectively). Seizures and paresis of the third cranial nerve were significantly higher in lethal cases. Brain edema was the leading cause of death (60%). The interval between hospital admission and start of antibiotic treatment was crucial for prognosis. Patients who received the first dose of antibiotics within 3 hours after admission had a mortality of 13%, while a delay of 6-24 hours increased the mortality to 3/3.

Acute Disease↗
PubMed1987

Monocytes accumulate on Rebuck skin window coverslips but not in skin chamber fluid. A comparative evaluation of two in vivo migration models.

Migration of leukocytes into an inflammatory site is an important step of host defense. The Rebuck skin window and the skin blister chamber technique allow study of the dynamics of the inflammation in vivo. The type of inflammation is basically different in each of these methods. Whereas the former technique provokes a late monocytic response, the latter technique provokes virtually no monocyte accumulation. the difference between these two types of inflammation has never been systematically studied. We describe a skin blister chamber technique with a novel multiwell device which allows the observation of cell accumulation under different conditions, i.e., in presence and in absence of a foreign body (coverslip). This method proved simple and reproducible with variability among volunteers exceeding variability of replicate chambers within a given subject. Furthermore, it confirms that no monocytes accumulate in blister chambers during the first 20 h of inflammation, whereas monocytes accumulate on skin window coverslips within the first 6 h of inflammation. Control experiments show that the continuous presence of the coverslip in the skin window is the critical element provoking accumulation of monocytes. A different degree of neutrophil degranulation in presence and absence, respectively, of a foreign body may be responsible for the different types of inflammatory response.

Adolescent↗
PubMed1987

Neutrophils are hyperpolarized after exudation and show an increased depolarization response to formyl-peptide but not to phorbol myristate acetate.

The migration of polymorphonuclear leucocytes (PMN) to extravascular sites and the interaction with chemotactic substances at such locations is called exudation. Since stimulation of PMN in vitro modifies the characteristics of PMN, we asked the question whether similar modifications take place during in-vivo exudation. We found that resting guinea-pig peritoneal exudate PMN were hyperpolarized in comparison to blood PMN of the same species. Guinea-pig and human exudate PMN responded to lower N-formyl-methionylleucylphenylalanine (fmet-leu-phe) concentrations than blood PMN and exhibited a larger membrane depolarization. Furthermore, experiments with the fluorescence-activated cell sorter revealed increased forward light scatter from resting exudate PMN compared to blood PMN. Experiments with the fluorescence-activated cell sorter using the fluoresceinated ligand fmet-leu-phe-lysin-fluorescein (fmet-leu-phe-lys-F) indicated that the priming of exudate PMN was associated with increased fmet-leu-phe-lys-F binding on the individual cells. In contrast, phorbol myristate acetate (PMA) did not induce an increased membrane depolarization response in human and guinea-pig exudate PMN. With this stimulus, the only sign of priming was the shorter activation time in exudate PMN compared to blood PMN. Thus, in-vivo exudation modifies the characteristics of resting and stimulated PMN. The priming is different for different stimuli. Increased responsiveness to fmet-leu-phe may be due to fmet-leu-phe receptor upregulation. The distinct characteristics of exudate PMN that we describe may allow definition of clinical situations in which PMN are primed in vivo.

Animals↗
PubMed1986

Exudation primes human and guinea pig neutrophils for subsequent responsiveness to the chemotactic peptide N-formylmethionylleucylphenylalanine and increases complement component C3bi receptor expression.

After circulating in the vascular system a short time, polymorphonuclear leukocytes (PMN) migrate to extravascular sites in response to chemotactic stimuli. Prestimulation of PMN in vitro by secretagogues has been shown to increase their number of N-formylmethionylleucylphenylalanine (fmet-leu-phe) and complement component C3bi (CR3) receptors. We investigated whether the same phenomenon occurred in vivo, comparing characteristics of human skin chamber and guinea pig peritoneal exudate and blood PMN. Exudate PMN of both species contained approximately 28% less of the specific granule marker vitamin B12-binding protein (P less than 0.01) but a similar amount of the azurophil granule marker beta-glucuronidase. The total number of fmet-leu-phe receptors was 5.9 times higher in guinea pig exudate than in blood PMN (P less than 0.01) and 2.9 times higher in human exudate than in blood PMN (P less than 0.02). All exudate PMN and most blood PMN preparations showed a high affinity receptor (Kd approximately 2.3 X 10(-8) M) and a low affinity receptor (approximately 1.5 X 10(-7) M). The upregulation of fmet-leu-phe receptors in exudate PMN correlated with an improved responsiveness to fmet-leu-phe induced membrane depolarization, oxidative metabolism, and chemotaxis. In addition, the concentration of fmet-leu-phe that produced a half-maximal response of chemotaxis, superoxide production, and membrane potential depolarization was 10-fold lower in exudate PMN than in blood PMN. Human exudate PMN had a twofold increased C3bi receptor expression compared with blood PMN. Thus, a preferential loss of specific granules is associated with increased number of high and low affinity fmet-leu-phe receptors and increased C3bi receptor expression not only in vitro, but also in vivo. The data indicate that exudation primes PMN for their subsequent responsiveness to fmet-leu-phe, a modification that may be crucial for efficient antimicrobial host defense.

Animals↗
PubMed1985

Effect of coenzyme-A, NAD, alpha lipoic-acid and cocarboxylase on survival of rats with galactosamine-induced severe hepatitis.

Galactosamine, a selective hepatotoxin, produces in rats histologic alterations, which show the characteristics of severe human viral hepatitis. In the present study the efficacy of two different cofactor regimens (coenzyme A, NAD, alpha lipoic-acid, cocarboxylase) in rats with fulminant galactosamine hepatitis were tested. The results showed an improvement of the short-term survival with a short-term treatment and definitely better survival with a long-term regimen with cofactors.

Animals↗