PubMed Health⌕ Search

Biomedical subjects

D Conen

Publications and source records attributed to D Conen.

At least 19 recordsLinked to original sources
PubMed1991

[Therapy and prognosis of bacterial arthritis: a retrospective analysis].

Antibiotic therapy and immediate drainage of the infected joint are established practice in the treatment of septic arthritis. The best method of drainage (repeated puncture, arthroscopy or surgical discharge) remains controversial. We analyze 34 patients with septic arthritis admitted to our hospital from 1984 to 1988. The pathogen was Staphylococcus aureus in 19 cases (56%), streptococcus in 6 (18%), pneumococcus in 2 (6%), other bacteria in (9%) and unknown in 4 (12%). In 62% the infection was blood-borne. The knee was affected in 12 cases (35%) and the shoulder in 10 (30%). A preceding joint puncture was the main source of infection. In 24 patients (70%) the initial joint drainage was by repeated puncture, while in 10 cases (30%) surgical drainage was the initial treatment. In 11 of the 24 patients initially treated by repeated puncture, surgical drainage was needed in the course of treatment because of persistent local infection of the joint. In only 13 (39%) was "medical" treatment alone effective. 5 patients died (14.7), 3 (8.8%) due to the infection. All deaths occurred in the "medical" group. 21 patients were asked about symptoms in the affected joint. In 71% there were no problems or only minimal ones, while in 29% there were distinct problems. 5 of the 6 patients with severe symptoms had been treated by repeated puncture. We conclude that surgical drainage of an infected joint is prescribed too rarely in departments of rheumatology and internal medicine. Arthroscopic or surgical drainage is indicated in cases of coxarthritis, omarthritis, in cases where symptoms last longer than 7 days and in patients with severe sepsis.

Adult↗
PubMed1991

[Infectious endocarditis: reasons for a delayed diagnosis].

The diagnosis of infectious endocarditis (IE) remains difficult. The delay until diagnosis is remarkably long. Despite progress in microbiological culture technology and the use of echocardiography, no improvement has been seen in recent years. We analyze the causes of delay in all patients with IE admitted to the Cantonal Hospital Aarau between 1976 and 1987. 60 patients with 62 episodes were included in the study. The delay from first medical consultation with IE-related symptoms to hospital admission was 46 days. In cases of antibiotic pretreatment (45%) it extended to 66 days. IE was included in the differential diagnosis by the referring physicians in 29% only, whereas it was considered in the hospital on admission in 64%. Despite long lasting fever of unknown origin, only in one case was a blood culture performed before hospitalization. The symptoms of IE were different at the beginning of the disease compared to the time of admission (general malaise in 35% and 87% respectively, fever 80% and 85%, night sweat 2% and 66%, weight loss 0% and 56%, chills 21% and 47%, joint pain 16% and 27%, dyspnea 13% and 24%). We conclude that the main reasons of the diagnostic delay in IE are antibiotic therapy prior to microbiological workup, different symptoms at the onset of IE and at the time of hospitalization, insufficient awareness of the disease among general practitioners and omission of blood cultures in patients with fever of unknown origin, especially where there is a history of valvular heart disease.

Adult↗
PubMed1991

[Acute transverse myelitis in systemic lupus erythematosus: successful therapy with cyclophosphamide and prednisone].

We describe a patient with acute transverse myelitis as the first symptom of systemic lupus erythematosus who was successfully treated with cyclophosphamide and prednisone. The literature on transverse myelitis is reviewed and its clinical presentation, diagnosis, therapy and prognosis are discussed. A new therapeutic approach involving cyclophosphamide and prednisone is proposed.

Adult↗
PubMed1990

[The evaluation of prescribing practice in a general internal medicine outpatient clinic with special reference to gastrointestinal medicines].

Prescribing patterns of 13 residents in a medical outpatient clinic were evaluated between March and June 1986. Prescribed drugs influencing the gastrointestinal tract were also analyzed in order to define quality of the therapeutic process. Advertising for these special drugs in 3 Swiss medical journals was analyzed and compared with the prescribing behavior of participating physicians. 6300 patients with 3346 prescriptions (0.5 prescription/patient) were enrolled in the study. 16.5% of all prescriptions involved cardiovascular, 13.5% gastrointestinal, 9.5% non steroidal antirheumatic, 9.1% analgesic, 7.7% psychotropic and 7.4% antibiotic drugs. The share of 14 other classes of drugs was less than 4%. 471 prescriptions of gastrointestinal acting drugs were distributed over 288 patients (0.6 prescription/patient). 160 patients had irritable bowel syndrome, 40 ulcer disease, 23 inflammatory/infectious bowel disease, 18 gastroesophageal reflux, 18 anal diseases, 11 other gastrointestinal disorders and 15 were treated without diagnosis. Distribution of drugs was as follows: 27.5% bulk laxatives, 26% antacids, 15.7% H2-receptor antagonists, 13.5% anticholinergic agents, 4.9% laxatives, 3.4% loperamide, 9% other drugs. There was an increase in prescriptions per visit from 0.8 in 1980 to 1.5 in 1986. No important influence of drug advertising in 3 different medical journals published between January and June 1986 could be found. Considering the documented diagnoses, the therapeutic decisions were correct in 95.5% of cases treated. In conclusion, drug prescribing habits are permissive, the therapeutic approach is acceptable and the influence of drug advertising is negligible.

Advertising↗
PubMed1988

[Phase contrast microscopy demonstration of glomerular erythrocytes in urine: practicable in ambulatory practice?].

The use of phase-contrast microscopy in microhematuria, as proposed in 1979 by Birch and Fairley, renders morphological changes in red cells easily detectable and makes it possible to distinguish glomerular from non-glomerular bleeding. The aim of this study was to evaluate the practicability of this method as a routine laboratory test in ambulatory care. 60 patients with asymptomatic microhematuria (greater than or equal to 2 erythrocytes per high power field) were followed up over a one-year period. All patients were investigated by intravenous pyelography, ultrasound of urinary tract and three cytological examinations of the urine. The description of urine samples was done with phase-contrast microscopy by a first investigator at the beginning of the study and by a second after 12.8 months, blinded to clinical results and previous examinations. In 21 patients a definitive diagnosis was possible. In 18 patients the morphologic descriptions of the two investigators correlated with the clinical results. Only in two patients with established diagnosis there were differences between the urine description of the two investigators, and in one patient the interpretations of both investigators were wrong. These incorrect descriptions concerned patients with low-grade microhematuria. Thus, phase-contrast microscopy is a practicable method for the practitioner's use as a routine laboratory investigation. In low-grade microhematuria the method seems to be of minor value.

Ambulatory Care↗
PubMed1988

[Sex- or symptom-specific behavior of male residents? An analysis of diagnosis and therapy of ambulatory female and male patients with abdominal pain].

We investigated the influence of the patient's gender for diagnostic and therapeutic approach of physicians at the outpatient clinic of the university hospital of Basle. In a prospective study 13 male residents in their second and third year of medical training were observed in their management of 25 female and 25 male patients presenting with the leading complaint of abdominal pain with regard to taking of the medical history, the physical examination and the performed diagnostic and therapeutic procedures, without informing the participating physicians. The time spent for the first consultation and the number of follow ups performed were registered. Following differences in the management of female and male patients were observed: The time spent at the first consultation was 59 +/- 5 minutes in female and 45 +/- 3.5 in male patients (p less than 0.03). Fundoscopic examination was three times more often performed in female patients. Endoscopic examinations were more often observed in male patients (p less than 0.01). Antacids and H2-antagonists were more frequently prescribed in male (p less than 0.01). Spasmolytics and laxatives more frequently in female (p less than 0.01). In summary in male patients the diagnosis of functional disease was predominantly made after exclusion of an organic disease what does explain the use of more diagnostic procedures and the induction of a more specific therapy.

Abdomen↗
PubMed1988

Short- and long-term cerebrovascular effects of nitrendipine in hypertensive patients.

The aim of our studies was to evaluate the effect of acute treatment in hypertensive emergencies and of chronic and acute treatment in uncomplicated hypertensives with calcium antagonists on blood pressure (BP) and cerebral blood flow (CBF). Ten patients with high blood pressure requiring emergency reduction were randomized to treatment with oral nifedipine or intravenous clonidine. The effect on CBF was investigated using xenon-133. Twenty-one patients with mild to moderate hypertension were randomly assigned to nitrendipine (n = 10) and to verapamil treatment for 4 weeks. After 14 days of washout, all patients received chlorthalidone for 4 weeks. CBF was measured before calcium antagonists, after 4 weeks, after washout, and after 4 weeks of chlorthalidone. Until now, five patients with mild to moderate hypertension entered in an ongoing study. After 14 days of placebo, CBF and BP reduction were measured 2 h and 6 weeks after nitrendipine. In hypertensive emergencies, nifedipine and clonidine lowered BP significantly, whereas CBF increased after nifedipine and decreased after clonidine. After chronic treatment with nitrendipine and verapamil and after chlorthalidone, the BP-lowering effect was significant whereas CBF remained unchanged. Two hours after nitrendipine, BP decreased and CBF remained unchanged. The reason for increasing CBF in hypertensive emergencies after nifedipine is due to its spasmolytic effect on cerebral vessels. The unchanged CBF after short- and long-term treatment with nitrendipine is due to the fact that in these patients the autoregulatory mechanism is intact.

Adult↗
PubMed1987

Effects of antihypertensive treatment on cerebral perfusion.

Antihypertensive treatment reduces the risk of ischemic strokes and cerebral hemorrhage as complications of excessive or long-standing hypertension. However, neurologic dysfunction and brain damage may also accompany short-term, and under certain conditions, even long-term antihypertensive treatment. Therefore, treatment should be instituted restrictively and cautiously. Special regard should be given to the action of antihypertensive drugs on cerebral perfusion in patients with an increased risk for the development of treatment-induced cerebral ischemic complications, such as patients with hypertensive encephalopathy or autonomic dysfunction, and elderly patients with suspected sclerotic stenosis of cerebral or neck arteries. The structural and functional lesions of cerebral vessels observed in acute and chronic hypertension are reviewed, as are the effects of antihypertensive drugs on cerebral blood flow. Calcium channel blockers and angiotensin-converting enzyme inhibitors may have advantages as first-line drugs in the treatment of patients with an elevated risk of cerebral hypoperfusion, because of the selective action of these agents on vasoconstricted vessels and their differential effects in varying regional vascular beds. The excellent efficacy of these drugs in the short- and long-term treatment of hypertension may lead to changes in the traditional management of hypertensive emergencies as well as in management strategies for other patients at risk for treatment-induced complications.

Adrenergic beta-Antagonists↗