Biomedical subjects
Publications and source records attributed to B Schär.
Presumed innocent: typical chest pain and a positive stress test, but normal coronary arteries at first sight; this is the typical pattern of myocardial bridging. We present a interesting case report and details about diagnosis and therapy that nowadays should be offered to such patients.
OBJECTIVE: To determine the prevalence of the factor V Leiden mutation in patients with postthrombotic and non-postthrombotic venous ulcers. DESIGN: Case-control study. SETTING: Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland. PARTICIPANTS: Seventy-three consecutive outpatients and inpatients with venous ulcers and 45 age- and sex-matched control subjects (matched to the 42 patients with postthrombotic syndrome). MAIN OUTCOME MEASURES: Frequency of postthrombotic and non-postthrombotic findings in patients with venous ulcers. Prevalence of the factor V Leiden mutation in these different subgroups. RESULTS: Postthrombotic syndrome was identified as the cause of 42 (58%; 95% confidence interval [CI], 45%-69%) of 73 venous ulcers, and the remainder were caused by primary valvular insufficiency. In postthrombotic ulcers, the prevalence of the factor V Leiden mutation was 38% (95% CI, 24%-54%) (16/42), which corresponds to an odds ratio of 13.2 (95% CI, 2.8-62.3; P<.001). In non-postthrombotic venous ulcers, the prevalence was 16% (95% CI, 5%-34%) (5/31), which corresponds to an odds ratio of 3.2 (95% CI, 1.0-10.0; P =.07). CONCLUSIONS: The factor V Leiden mutation is highly prevalent in patients with postthrombotic venous ulcers. Even patients with non-postthrombotic venous ulcers show a moderately elevated prevalence of the factor V Leiden mutation. Some of the latter might be misclassified because of near-to-perfect revascularization after asymptomatic deep venous thrombosis. However, as long as the therapeutic consequences of the factor V Leiden mutation are not established, systematic screening cannot be recommended in patients with venous ulcers.
Jejunoileal bypass was an effective method of treatment for weight reduction in severe cases of obesity. However, long-term follow-up revealed serious and even lethal side-effects, e.g. acute liver failure, as shown in a case report of a patient who died 28 years post-operatively of acute liver failure as a direct result of liver cirrhosis. We therefore conclude that jejunoileal bypass should no longer be performed, especially as better methods, such as gastric banding, exist. Patient care and monitoring is highly important and, if feasible, the bypass procedure should be reversed.
We describe two different manifestations of cardiac myxoma. Both have in common late diagnosis. The first patient suffered from a right sided myxoma. The histological diagnosis is unexpected. In the second case, the diagnosis of a myxoma in the left arterial cavity is made only two years after the first symptoms. We discuss epidemiology, symptoms, diagnosis, treatment and prognosis of atrial myxoma.
Burkitt-lymphoma is a rare disease, that belongs to the aggressive Non-Hodgkin-lymphomas. Next to histology, that shows a characteristic pattern, and immunophenotyping additional cytogenetic and molecular biology techniques are used to demonstrate in most cases a translocation of the oncogen c-myc on chromosome 8 to any of the immunoglobulin genes on chromosome 14, 2 or 22. With short term intensive chemotherapies a cure rate of 85-95% of patients with Burkitt-lymphoma can be obtained today.
Cocaine is a frequently used drug with many known effects on the cardiovascular system. It leads also to structural changes of the coronary arteries that can result in severe chest pain or even acute myocardial infarction. We discuss two patients with infarction, differentiate between chest pain and infarction and suggest some important therapeutic measures.
On the basis of the thesis that social inequality has increased during the nineties in all western societies, and that this development is a reason for considerable concern with respect to public health, the authors propose the establishment of a long term monitoring system within the Swiss school health services. A re-analysis of the data obtained in a Swiss epidemiological study of seven-year-olds in the eighties demonstrates that social class was an important determinant of health and development of these children also during a period of economic boom. For various health and developmental problems odds-ratios (lower class vs. upper class) between 1.7 and 6.4 were found. Social class of the parents is considered as a reliable indicator of the socio-economic situation of children also for future long term observations. The number of significant somatic health problems as well as disorders of motor and speech development of six- or seven-year-olds are proposed as indicators of health status which can be assessed repeatedly at reasonable cost and with standardised methodology. This project could be started rather easily within the newly established Swiss "Health Observatory".
We report the case of a 50-year-old female in whom the connection between hypocalcemia and heart failure was not made until a second hospital admission for left ventricular failure. Under appropriate calcium supplementation the symptoms were relieved within 2 days and the patient remained well thereafter. The hypocalcemia was found to be caused by autoimmune hypoparathyroidism. Heart failure due to hypocalcemia has been rarely reported, and even in textbooks the subject is poorly documented. The physiologic functions of calcium and the implications of deficiency for heart muscle are outlined, with a review of the literature. A treatment regimen for hypocalcemia is recommended.
A 69-year-old woman was admitted to the hospital for fever of unknown origin with nightsweats and weight loss. Diagnosis of endocarditis lenta with streptococcus viridans and a preexisting mitral-valve prolapse with small regurgitation jet was established. Signs and symptoms of endocarditis lenta are stressed in the discussion. Special attention is given to transesophageal echocardiography and to the connection of endocarditis with mitral-valve prolapse.
Agranulocytosis is a rare but sometimes extremely dangerous adverse drug reaction which can be induced by almost any drug. We report the case of a 89-year-old man with a well-documented granulocyte chart, who received allopurinol in addition to preexisting therapy with cardiovascular drugs. Three weeks later agranulocytosis was found which bone-marrow biopsy indicated was drug-induced. After cessation of all drugs, isolation and antibiotic therapy, the leukocyte count returned to normal but the patient died four weeks later from progressive renal failure. A relation between allopurinol therapy and agranulocytosis was presumed. The drugs which might have caused this adverse reaction are discussed. The incidence, signs, symptoms and treatment are summarized and proposals are made concerning the action to be taken in the event of drug-induced agranulocytosis.
Spontaneous perforation of the esophagus (Boerhaave syndrome) is a rare diagnosis in acute thoracic or epigastric pain. We present the case of a swiftly diagnosed and successfully treated rupture. Apart from pathophysiology, symptoms and diagnosis, the differential diagnosis and therapeutic options are discussed in more detail.
In a prospective randomized trial the effects of continuous peridural analgesia on gastrointestinal motility and the postoperative course was studied in 48 consecutive patients with elective colorectal resections. 24 patients had peridural analgesia (PDA) with bupivacaine while 24 patients received intravenous analgesia (IVA) with pentazocine. With PDA the first passage of flatus and faeces was significantly accelerated. PDA was not associated with an increased rate of anastomotic breakdown and there were no respiratory complications in the PDA group.
One of the most serious manifestations of hereditary angioneurotic edema is the occurrence of an acute airway obstruction due to laryngeal edema. The anesthetic technique of choice is a conduction rather than an intubation anesthesia. In the treatment of an acute attack steroids and antihistamines are commonly ineffective. Specific prophylactic and therapeutic measures involving the infusion of fresh-frozen plasma and treatment with Danazol are described.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.