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Biomedical subjects

A Leimgruber

Publications and source records attributed to A Leimgruber.

At least 19 recordsLinked to original sources
PubMed2006

[Lake Geneva Region guidelines on management of adult asthma].

Asthma is a major cause of chronic morbidity throughout the world. In Switzerland, 6.9% of the adult population is suffering from asthma. The standards of treatment are unfortunately not met in most western countries, as well as in Switzerland. We put forward a complete guideline on management of adult asthma, inspired from GINA and BTS guidelines, and adapted to the specific needs of general practitioners working in french part of Switzerland. This guideline reflects a consensus between allergy, lung and emergency specialists, working in the 2 university hospitals of the Lake Geneva Region (HUG and CHUV).

Adult↗
PubMed2006

[Pathogenic mechanisms in systemic sclerosis and their therapeutical consequences. Part 1: pathogenesis].

Systemic sclerosis I(cleroderma) is a connective tissue disease caracterized by an aberrant immune activation, a vasculopathy and a fibrosis of skin and multiple internal organs (lung, kidneys, gut, among others). At present no unifying pathogenetic hypothesis exists to explain all aspects of this disease. The current hypothesis is that in patients with a favourable genetic background, certain environmental factors could produce alterations of cellular and humoral immunity and alterations of the microcirculation resulting in excessive fibrosis. A crucial component in systemic sclerosis pathogenesis is the persistent and unregulated activation of genes encoding the various extracellular matrix proteins. This is in correlation with different cytokines and growth factors produced mainly by T lymphocytes.

Fibrosis↗
PubMed2006

[Pathogenic mechanisms in systemic sclerosis and their therapeutical consequences. Part 2: treatment].

Systemic sclerosis (scleroderma) is considered as the most severe connective tissue disease. It is characterized by an abnormal immune activation, a vasculopathy and a fibrosis of the skin and of multiple internal organs. Numerous progress in the understanding of the pathogenesis with identification of key molecules have permit to introduce novel treatments that improve the management of some aspects of the disease. ACE inhibitors are effective in resolving renal crisis. Cyclophosphamide is useful for treatment of fibrosing alveolitis. Prostaglandins, endothelin receptor antagonists and phosphodiesterase type 5 inhibitors permit to improve the treatment of the vascular complications (digital ulcerations, pulmonary arterial hypertension) of scleroderma.

Fingers↗
PubMed2006

[Allergo-immunology].

Allergic rhinitis is a frequent illness. New therapeutic options are being developed to counteract its impact on quality of life and health costs. This article presents two of these options, laser rhinophototherapy and Butterbur Ze 339, a drug derived from petasites. The immunodepressing effect of phototherapy has been tested in nasal mucosa. This application has shown satisfactory anti-inflammatory results in nasal cleaning fluid and, consequently, has enabled to reduce allergic rhinitis. The effect of butterbur on the symptoms of allergic rhinitis has to be understood in relation with the inhibition of cysleucotrienes synthesis, as well as its action on eosinophils and mastocytes. However, long-term studies involving large cohorts of patients are needed if we want to prescribe these treatments without restrictions.

Humans↗
PubMed2005

[Skin tests in allergology: really so simple?].

In allergology, skin tests (ST) are one of the main tools. Their simplicity, rapidity of the result, low cost, near absence of risk make them complements of choice to the patient history which remains the crucial step of the diagnosis. ST demonstrate in vivo the capacity of the cutaneous mast cells to potentially react to allergens. Their sensitivity is good, some precautions have to be taken into account (no antihistaminic drugs, quality of the extracts). Specificity is also good, but a positive test (which is suggestive of the presence of IgE) not always predicts clinical allergic manifestations. Knowledge of limits and pitfalls of ST is of major importance, especially when it comes to selecting extracts for specific immunotherapy and to investigate severe anaphylactic reactions to food or drugs.

Diagnosis, Differential↗
PubMed2005

[Oral allergy syndrome and food allergy].

To obtain a precise diagnosis of food allergy, it is essential to take a careful and detailed clinical history. This allows for directing further investigations and the patient should receive adequate information. In a research setting, recombinant allergens obtained by biotechnologies permit to reach a precise identification of allergenic proteins, with the hope of treating patients exclusively with the proteins to which they are allergic. In case of light reactions, a strict allergen avoidance is not required, but it is preferable to avoid the consumption of potentially dangerous food in isolated sites and before or during physical effort. In case of severe anaphylactic reactions with potent allergens like hazelnuts, peanuts and sea food, strict information about allergen avoidance and prescription of an emergency kit will be given.

Allergens↗
PubMed2005

[Sarcoidosis: new therapeutic and pathogenic aspects for an "old" disease].

Sarcoidosis is a multisystemic disorder of unknown etiology characterized by non-caseating epithelioid granuloma. Clinical features are protean and the lack of a specific diagnostic test can make diagnosis difficult. The cause of this disease is still unknown but the diverse manifestations of this disorder help fuel the prevailing hypothesis that sarcoidosis has more than one cause each of which may promote a different pattern of illness. Recent progress, especially in immunology and molecular biology, has advanced our understanding of the pathogenesis of the disease and improved our ability to diagnose and treat this complex condition. This article gives an overview about current concepts in sarcoidosis and focus on immunopathogenic and therapeutic aspects.

Diagnosis, Differential↗
PubMed2005

[Widal triad (Asthma-Nasal polyposis-aspirin intolerance): an inflammatory metabolism abnormality].

Widal disease is characterized by symptomatic triad of aspirin intolerance, nasal polyposis and asthma. This disease is closely linked to abnormalities of the arachidonic acid metabolism. Partly of genetic origin, these anomalies are also related to the immune system function and probably to age. These factors induce an increase of cysleukotriene synthetase enzyme, and consequently an overproduction of cysleukotrienes that have both proinflammatory and bronchoconstrictive effects. In recent years, encouraging results were obtained with anti-leukotrienes, especially when they are associated with topic corticosteroids. Finally, numerous research that attempt to reach a better understanding of arachidonic acid metabolism are underway, which enables us to hope for future therapeutic advances.

Aspirin↗
PubMed2005

Intravenous immunoglobulin replacement prevents severe and lower respiratory tract infections, but not upper respiratory tract and non-respiratory infections in common variable immune deficiency.

BACKGROUND: Although the dose of 400 mg/kg body weight intravenous immunoglobulins (IVIG) every 3-4 weeks is now standard for treating patients with common variable immune deficiency, studies demonstrating its long-term benefits over low 200 mg/kg dose and its effects on infectious subsets (upper vs lower respiratory vs non-respiratory infections) are rare. METHODS: All patients from a single center with the diagnosis of common variable immune deficiency and whose clinical chart was available during three successive therapeutic periods [a pre-IVIG replacement period, a low-dose (200 mg/kg every 3 weeks) and a standard-dose replacement period (400 mg/kg every 3 weeks)] were screened retrospectively. RESULTS: Seven patients followed up for a total of 116 patient-years over the three defined periods of observation were recruited. When compared with low-dose therapy, standard-dose intravenous immunoglobulin therapy raised trough IgG levels from 4.3 to 6.5 g/l and significantly decreased the overall frequency of infections, with marked effects on lower respiratory tract and severe infection number. In contrast, non-respiratory and upper respiratory infections were, in comparison, resistant to therapy. CONCLUSIONS: Overall, these data support the use of standard-dose 400 mg/kg intravenous immunoglobulin therapy, despite the high cost, to raise trough IgG levels to 5-7 g/l, but underlines that some categories of infectious events (non-respiratory, upper respiratory) may need parallel surgical or pharmacological approaches to be optimally prevented or treated.

Adult↗
PubMed1999

Evaluation of acoustic rhinometry in a nasal provocation test with allergen.

BACKGROUND: The objective was to validate acoustic rhinometry (AR) in a nasal challenge with allergen. METHODS: Nasal response to allergen provocation was based on clinical and symptom scores, cross-sectional changes of the nasal mucosa as measured by AR with the Rhinoklack system, and peak nasal inspiratory flow (PNIF), in atopic and nonatopic volunteers. RESULTS: After allergen challenge, mean variation in minimal cross-sectional area (deltaMCA), as measured by AR, or in peak nasal inspiratory flow (deltaPNIF) in nonatopic volunteers, was -0.4+/-14.3% and 5.2+/-15.7%, respectively, compared to baseline. This allowed the determination of a reaction threshold of -29% for deltaMCA and of -26% for deltaPNIF. All but one of the 30 atopic patients reached the AR reaction threshold, whereas all patients reached the PNIF reaction threshold. AR and PNIF closely correlated with clinical and symptom scores for nasal congestion, since there was no significant difference at reaction threshold between both methods. CONCLUSIONS: In an allergen provocation test, AR appears to be as specific and sensitive as peak nasal inspiratory flow, with the advantage of being independent of the patient's active cooperation. Discrepancies between both methods emphasize the role of nasal cavity anatomy in measuring nasal congestion by AR.

Acoustics↗
PubMed1999

Idiotypic vaccination with a murine anti-dsDNA antibody: phase I study in patients with nonactive systemic lupus erythematosus with nephritis.

OBJECTIVE: To determine the safety and immunogenicity of an idiotypic anti-dsDNA vaccine in patients with nonactive systemic lupus erythematosus (SLE) and stable lupus nephritis. METHODS: Patients with SLE with a history of nephritis were randomized for vaccination with the murine anti-dsDNA monoclonal antibody (Mab) 3E10 in a dose ranging, double blind, placebo controlled study (phase I). RESULTS: Of the 9 patients injected with Mab 3E10, 5 showed a human anti-mouse antibody (HAMA) response, in large part antiidiotypic, which developed within the first 3 months in 3 strong HAMA responders, and more than one year after immunization in an initially weak HAMA responder. All but one nonresponder were receiving low dose prednisone. No adverse events, in particular no evidence of lupus flares, and no untoward laboratory findings were reported over a followup of 2 years. CONCLUSION: In patients with stable lupus nephritis, immunization with Mab 3E10 appears safe and can generate a significant antiidiotypic response. Idiotypic vaccination may be an approach to specific immunotherapy of autoimmune lupus nephritis.

Adult↗
PubMed1995

Referral pattern to the allergist for hay fever in a health-care system with open access to specialists.

Little is known about referral patterns to the allergist for hay fever. In a system with open access to the specialist, we investigated the reasons for consulting an allergist in 126 patients who completed a questionnaire on their first visit. Both sexes were equally represented, the median age was 29 years, the duration of the disease and the duration of seasonal symptoms were 9 years and 10 weeks (median), respectively, and 54% of patients reported a history suggestive of asthma. The symptoms were highly variable; on average, 5.6 on a 10-cm visual analog scale. Most of the patients (94%) had been treated for hay fever before. Only 30% were referred by another physician, the rest being self-referred. The reasons for referral were investigated. The overall motivation to consult was related to symptom severity in 63% of the patients; 37% consulted for other reasons, including an expectation of greater "know-how" on the part of the allergist concerning specific diagnosis, treatment, and advice or counseling. The stimulus triggering the consultation was clearly not related to symptoms or disease in 25% of the cases. We conclude from these data that many patients are clearly interested in benefiting from the professional skill of a fully trained allergist.

Adult↗
PubMed1993

Comparison of two in vitro assays, RAST and CAP, when applied to the diagnosis of anaphylactic reactions to honeybee or yellow jacket venoms. Correlation with history and skin tests.

We compared the results obtained with a new specific IgE assay (Pharmacia CAP system) to those of RAST and intradermal skin tests (ST) performed in 87 patients with a history of generalized reaction to honeybee or yellow jacket venom. When CAP and RAST were compared with positive ST performed with honeybee venom, CAP sensitivity was not significantly higher (98%) than that of RAST (95%). When yellow jacket venom was tested, CAP sensitivity (93%) was clearly superior to that of RAST (40%). When we compared the specificities of RAST and CAP to bee venom, RAST was positive in 21% of the 24 subjects with negative ST, and CAP in 42%. Among the 29 patients with negative ST to yellow jacket venom, RAST was positive in 17% and CAP in 28%. These results do not reflect a lower specificity of CAP, because CAP positivities could be inhibited in vitro, and because, in three patients with a history of anaphylactic reaction (one to honeybee, two to yellow jacket), CAP was the only positive test confirming the clinical observation. Among the 53 patients who were able to identify the offending insect (honeybee, 31; yellow jacket, 22), the cause of the anaphylactic reaction was usually confirmed by ST and CAP: honeybee venom 97% for both ST and CAP; yellow jacket venom 82% for ST, 86% for CAP. This was not the case for RAST, which confirmed honeybee venom hypersensitivity in 87% and yellow jacket venom hypersensitivity in only 41%. Thus, CAP is both more sensitive and more rapid than RAST, without losing specificity.

Adolescent↗
PubMed1993

Hereditary angioedema: uncomplicated maxillofacial surgery using short-term C1 inhibitor replacement therapy.

We report on the successful use of a pasteurized C1 inhibitor (C1-INH) concentrate during dental surgery of a patient affected by hereditary angioedema. The patient recovered fully without complications or side effects. Within 30 min, the first 1,000 U of C1-INH concentrate raised C1-INH concentration from 19 to 55% and function from 40 to 90% of the normal mean. When measured 4 h after the second injection, a further increase of the C1-INH concentration to 86% and a function of 106% relative to the normal mean was observed. Within 2 weeks C1-INH concentration returned to pretreatment level, while the function remained above this value. Serum liver enzyme values did not change and no anti-C1-INH alloantibodies were detected 10 months post-replacement therapy. We conclude that in patients affected by C1-INH deficiency, dental surgery and likely other traumatic procedures can be safely performed in conjunction with C1-INH replacement therapy even without preliminary treatment.

Adolescent↗
PubMed1991

Clinical evaluation of a new in-vitro assay for specific IgE, the immuno CAP system.

The Pharmacia CAP system is a new assay for specific IgE characterized by a new solid phase (hydrophilic polymer encased in a capsule). The CAP results were compared to those of the Phadebas IgE RAST and skin-prick tests (SPT) performed in 145 subjects suffering from rhinitis and/or asthma with eight common inhalant allergens (total number of tests = 1160). Concording CAP/RAST results were found in 91% of the tests. The CAP was positive in 78% and the RAST in 65% of the positive SPT. Conversely, the CAP was negative in 90.6% and the RAST in 96.4% of the negative SPT. A pattern negative SPT, negative RAST and positive CAP' was found in 56 tests (40 subjects): in four such subjects, the CAP positivity was confirmed by a positive IgE crossed radioimmunoelectrophoresis. Three borderline positive results were found among 240 negative controls (serum from cord blood or non-atopics). These data indicate that compared with SPT the CAP system is (a) more sensitive than the Pharmacia RAST and (b) does not seem less specific.

Adolescent↗
PubMed1982

[Multifocal pulmonary bilharzioma due to Schistosoma mansoni].

A case of mixed schistosomiasis in an African female immigrant from Cameroon is reported. Schistosoma mansoni was found in a symptomatic double abscess of the lower lobe of the left lung (1981). S. haematobium was present in the stool and the rectal mucosa but the patient had no symptoms. In Africa the patient had been treated for urinary and intestinal bilharziosis with niridazole in 1979, at which time she did not present pulmonary symptoms. After her arrival to Switzerland (1980) she complained of thoracic pain and bloody purulent sputum. A solitary pulmonary infiltration in the left lower lobe and eosinophilia were noted. Tuberculosis was suspected and, despite negative bacillary findings, trial treatment with tuberculostatics was started. As a smaller infiltration appeared beside the first, left lower lobectomy was performed followed by niridazole treatment. The exceptional diagnosis of pulmonary bilharzioma should be considered in patients with a solitary pulmonary infiltration who come from an area endemic for bilharziosis or who show clinical or laboratory signs of a present or past bilharzial infection.

Adult↗