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Biomedical subjects

D Conen

Publications and source records attributed to D Conen.

At least 73 records · Page 4Linked to original sources
PubMed1986

[Do doctors understand their patients?].

The extent to which doctors understand the complaints of their patients has been investigated by comparing patient complaints with the observation and assessment of these by the doctor. This involved questioning 259 patients and 30 doctor. From the 259 patients, three groups (a total of 57 patients) were formed, having common main symptomatologies. The extent to which the complaints of each of these patients corresponded with the clinical assessment was evaluated. The results revealed a close agreement between patient complaints and clinical assessment, not only for those patients with organo-medically diffuse symptoms (feeling of illness, tiredness, nervousness) but also for those with organ-medically clearly defined, localised (cardiac and thoracic pain) and mixed diffuse-localised complaints.

Adolescent↗
PubMed1985

[Does closely monitored control and therapy adjustment improve the prognosis in patients with severe heart insufficiency?].

The one year mortality of patients with severe congestive heart failure ranges between 30 and 70%. The effect was investigated of a stepped care program, including weekly monitoring and frequent adjustment of medical treatment, on the prognosis of 18 consecutive outpatients with severe congestive heart failure (NYHA class III and IV, 60 +/- 3.5 years). The diagnosis of congestive heart failure was proven by an invasively measured cardiac index below 2.5 l/min/m2 or by a left ventricular ejection fraction below 30%. Plasma adrenaline and noradrenaline values and plasma renin activity were substantially increased in all patients compared with 20 normals. 11 of the heart failure patients had coronary heart disease, 10 with a large left ventricular aneurysm, 6 patients had congestive cardiomyopathy and one patient had valvular heart disease with aortic insufficiency. In 9 patients ventricular tachycardias were registered, four had recurrent syncopes, and in 7 other patients atrial fibrillation, atrial flutter and paroxysmal supraventricular tachycardias were found. Medical treatment in all patients included pre- and afterload reduction by vasodilators. 11 patients received digoxin and 8 antiarrhythmic drugs. After a mean follow-up of 25 +/- 3.3 months, the one-year mortality was 7% and the two year mortality 15%. The favorable prognosis in patients in this special care program shows the favorable effects of individualized therapy, of frequent patient monitoring and the influence of strict compliance on survival and symptoms in patients with chronic congestive heart failure.

Adult↗
PubMed1985

[Intestinal parasitosis in irritable colon].

Parasitic infestation of the intestinal tract was investigated in a prospective study of 177 patients from southern Europe and Turkey. In a group of patients (n = 127) who attended the Medical Outpatients Department because of abdominal pain, pathogenic parasites were isolated from a single stool sample in 69 (54%). 19 patients had 2 or more parasites. 22 out of 25 patients reviewed after treatment were free of parasites, and 17 were symptom-free. Abdominal pain persisted unchanged in 8 patients. In a second group of patients (n = 50) with extraabdominal symptoms, 11 (22%) had pathogenic parasites in stool. Multiple infestation did not occur in this group. The results show that in this population group stool examination for parasites should be carried out routinely in the investigation of abdominal pain. The high prevalence rate possibly justifies a search for parasites even where there are no intestinal symptoms.

Adult↗
PubMed1985

[Sick sinus syndrome--clinical presentation, diagnostic and therapeutic measures in an ambulatory patient sample].

Incidence, clinical picture, ECG features, as well as chosen diagnostic and therapeutic measures were investigated in patients attending the Basel University Medical Outpatients Department with the diagnosis of sick sinus syndrome. A retrospective study was conducted by selecting patients' charts with this diagnosis during the period 1979-1983. Forty-four patients (17 women, 27 men, mean age 64.5 +/- 14.5 years) were "discovered" and divided into three groups: Group 1: asymptomatic patients with pathological ECG (n = 7), Group 2: symptomatic patients with pathological ECG (n = 22), Group 3: main symptom syncope (n = 15). All patients had had an ECG and 15 a 24-hour-ECG. Carotid sinus massage was performed in three patients and sinus node recovery time was measured in another three. Seventeen patients remained without treatment, 13 received a permanent pacemaker, 9 of whom had additional medication, while 12 were anticoagulated. Three patients who were not anticoagulated suffered a stroke. More invasive electrophysiological investigations should be undertaken only with caution. In group 1, further diagnostic or therapeutic consequences need to be drawn. In the symptomatic patients from group 2, 24-hour-ECG is indicated when there is a history of palpitations, dizziness or severe heart failure. The immediate implantation of a pacemaker is justifiable in group 3 patients. Drugs with antiarrhythmic activity should be avoided in these patients before pacemaker implantation.

Aged↗
PubMed1985

Antihypertensive treatment using calcium antagonists in combination with captopril rather than diuretics.

The antihypertensive efficacy of combination therapy with the angiotensin-converting enzyme inhibitor captopril and a diuretic or a calcium antagonist was compared in 16 patients with essential hypertension with a blood pressure of over 160/95 mm Hg having triple drug therapy. While monotherapy with a calcium antagonist--usually verapamil 500 mg/day or nitrendipine 70 mg/day--did not reduce diastolic blood pressure to greater than 95 mm Hg, this goal was achieved in 15 out of 16 patients with the combination of captopril (53 mg/day) and the calcium antagonists in the above dose (151 +/- 4/88 +/- 2 SEM mm Hg) and in 13 out of 16 patients with captopril (84 mg/day) and a diuretic (158 +/- 4/91 +/- 1 mm Hg). There was a direct relationship between intraindividual pressure responses to the two drug combinations (r = 0.88, p less than 0.001). Heart rate was similar and weight lower on the captopril-diuretic combination. Captopril's antihypertensive efficacy can be equally enhanced by calcium antagonists (without affecting renin long term) as by diuretics, which are thought to work by stimulating the renin-angiotensin system. The calcium antagonist-captopril combination may be of particular advantage in hypertensive patients who are otherwise difficult to treat.

Adult↗
PubMed1984

[Preventive chemotherapy of intrapulmonary residual tuberculosis with isoniazid--example of failed compliance by the physician].

Compliance with the recommendations of the Swiss Society for Tuberculosis and Lung Diseases regarding the treatment of patients with fibrotic pulmonary lesions with isoniazid was evaluated over the period March 1981-October 1982. 42 patients (mean age 53 +/- 16 years) were selected for preventive treatment. Diagnostic procedures were correctly performed in 22 patients (52.4%). 32 patients (76.2%) received the recommended drug initially. In 18 patients (42.9%) isoniazid was correctly prescribed for six months. In only 15 patients (35.7%) was the diagnostic and therapeutic approach correct. The reasons for these quality inadequacies on the diagnostic and therapeutic levels are discussed.

Aged↗
PubMed1984

[Treatment of hypertension emergencies].

Hypertensive emergencies are defined as situations where a seriously elevated blood pressure threatens the patients life or vital organ functions. Since treatment of hypertensive emergencies by a rapid reduction of blood pressure can be complicated by serious unwanted effects, the treatment indications should be defined cautiously. In addition the principles of autoregulation of blood flow and vascular resistance in hypertensive patients should be considered as well as the widely differing effects of the drugs used in hypertensive emergencies like alpha- and beta-adrenergic blocking substances, central sympatholytics and vasodilating agents. A reduction of cardiac output as a consequence of betablockade or central sympatholytics may be beneficial in patients with aneurysms, but may result in severe central hypoperfusion in others which can also be induced by vasodilators by local and systemic steal effects. Therefore we propose a treatment scheme for hypertensive emergencies based on pathophysiological considerations with special regard to cerebral perfusion. In many instances calcium-antagonists can be considered as drugs of first choice since they lower blood pressure in relation to pretreatment blood pressure and have only a weak negative inotropic effect. In addition they exert their vasodilating action predominantly in vessels with a high vasoconstrictor tone and do not reduce cerebral perfusion despite a marked reduction of blood pressure within a short time. In every case the initial emergency treatment should be followed by a careful long term management of hypertension.

Administration, Oral↗
PubMed1984

Value of serum PABA as a pancreatic function test.

In a total of 71 subjects (19 controls, 24 patients with non-pancreatic gastrointestinal disease, and 27 patients with pancreatic disease) an oral pancreatic function test using N-benzoyl-L-tyrosyl-PABA (BT-PABA) was performed with simultaneous determination of the serum para-aminobenzoic acid (PABA). Urinary excretion of PABA was significantly less (p less than 0.001) in patients with chronic pancreatitis (n = 12) and pancreatic carcinoma (n = 10) than in controls and in patients with non-pancreatic disease. The serum concentration curve in patients with chronic pancreatitis was significantly flattened (p less than 0.001) compared with that of the control group and the patients with non-pancreatic gastrointestinal disease. The discrimination between the controls and the patients with chronic pancreatitis was best at 120 minutes after administration of BT-PABA (lower limit of normal: 2.8 micrograms/ml). The results of our study show that determination of PABA serum concentration two hours after administration of BT-PABA is as valuable an index of pancreatic function as the urinary excretion of PABA.

4-Aminobenzoic Acid↗
PubMed1983

Nifedipine in hypertensive emergencies.

The effects and safety of using oral nifedipine 10-20 mg as acute antihypertensive treatment were studied in a single-blind placebo-controlled study of 25 consecutive patients with very high blood pressure requiring emergency reduction. In addition the effect of this treatment on cerebral blood flow was investigated using xenon-133 in 10 patients randomly allocated to receive oral nifedipine or intravenous clonidine. Whereas placebo did not alter the blood pressure, oral nifedipine significantly reduced the systolic and diastolic blood pressures in all 25 patients (from 221 +/- 22/126 +/- 14 mm Hg to 152 +/- 20/89 +/- 12 mm Hg after 30 minutes, p less than 0.001). Heart rate increased from 74 +/- 11 to 84 +/- 11 beats/minute (p less than 0.01); this effect was inversely related to age (r = -0.65, p less than 0.01). The falls in systolic and diastolic blood pressures were closely related to the blood pressures before treatment ) r = 0.67, p less than 0.001 for systolic, and r = -0.58, p less than 0.01 for diastolic values). No serious unwanted effects were observed. Measurement of cerebral blood flow after nifedipine showed an increase in flow in four out of five patients. Clonidine, by contrast, reduced cerebral blood flow in all patients by up to 28%. Nifedipine is a simple, effective, and safe alternative drug for managing hypertensive emergencies, especially when continuous monitoring of the patient cannot be guaranteed.

Adult↗
PubMed1982

[Irritable colon--yes or no? Does the anamnesis help in the decision?].

To assess the value of history in evaluating abdominal pain, 45 outpatients (25 women and 20 men) aged 16-76 completed a questionnaire. The affirmative replies of the patients with organic disease were compared with those of patients with irritable bowel syndrome (IBS) by the chi 2 test. 17 patients had organic diseases while 28 had IBS. The features indicating an organic lesion (p less than 0.0005) were age over 50, history of short duration, bloody stools, bowel incontinence and urgency, pain at night, pain lasting minutes, colicly pain, and onset of pain 1-2 h after meals. Typical features of IBS (p less than 0.0005) were age below 50, frequent bowel movements of normal consistency, increased pain with emotional stress, a rigid personality and an exceptionally well-groomed appearance. From these findings the following conclusions are drawn: 1. Patients with organic disease always present with two symptoms indicative of an organic origin and with one highly significant symptom of IBS at most. 2. IBS is characterized by a broad range of various highly significant symptoms simultaneously. There is a larger number of significant symptoms against IBS (n = 10) than for it (n = 4). History serves rather to rule out IBS than to prove it.

Adolescent↗
PubMed1982

[Uveitis: a rational diagnostic program for practice in internal medicine].

Uveitis, as an inflammation of the uvea, the vitreous body or the choroid, should not be regarded as a disease but only as a sign of an underlying multisystem disorder. The cause of iritis cannot be established by examining the eye only. Differential diagnosis should take into consideration geographic, possible environmental and genetic background factors. Furthermore, it should be recognized that some causes are infectious, some allergic and some autoimmune in nature. Many, even sophisticated tests are available to detect and underlying disorder. To establish an expedient program for investigation of uveitis, 39 patients with uveitis were examined prospectively from May 1979 to December 1980. In taking the history, the geographical and genetic background and simultaneous therapy were noted. The full systemic examination paid special attention to accompanying oral or genital ulcerations or joint disorders. A tuberculin skin test, the blood sedimentation rate (BSR), leukocyte count, serological tests for herpes, cytomegaly, mycoplasma, venereal and brucella infections, toxoplasmosis, rheumatoid factor and antinuclear bodies must also be carried in every patient. In each patient a chest radiograph was taken. In 5 patients uveitis was due to toxoplasmosis, in 3 to Behçet's disease in 3 to sarcoidosis, in 2 to ankylosing spondylitis, and in 1 to ulcerative colitis. In 36% uveitis was associated with an underlying disease, while in 64% the investigations failed to disclose an accompanying disorder. A detailed history, a full systemic examination, BSR and a whole blood count, a tuberculin skin test, a TPHA test, a toxoplasma dye test, and a chest radiograph are recommended as an appropriate minimal program.

Adolescent↗
PubMed1982

An oral calcium antagonist for treatment of hypertensive emergencies.

The efficacy and safety of 20 mg of nifedipine as a single oral dose have been studied with respect to the use of the drug as an alternative treatment of hypertensive emergencies. The study population consisted of nine male and nine female patients, 47 to 80 years old. The mean systolic blood pressure decreased from 220 +/- 22 to 150 +/- 21 mm Hg and the mean diastolic blood pressure from 122 +/- 11 to 86 +/- 10 mm Hg (p less than 0.001) within 20-30 min. The decrease of blood pressure was paralleled by a small but significant increase (p less than 0.01) in heart rate from 74 +/- 9 to 85 +/- 10 beats/min. The fall of blood pressure was directly related to pretreatment values. Oral nifedipine can be recommended as a first-line drug to lower blood pressure in hypertensive emergencies.

Aged↗
PubMed1981

[An analysis of pharmacotherapy in an internal medicine ambulatory care clinic, using the example of cardiovascular-effective drugs].

The use of cardiovascular active drugs at a general internal medical outpatient clinic and its quality are assessed. In the spring of 1980, 209 prescriptions for cardiovascular drugs taken from a total of 1800 prescriptions were prospectively analyzed based on a previous retrospective review of medical records. The requirements for cardiovascular drug therapy, which had been fixed in advance, were met in 80%: thus, in 90% of all prescriptions the indication for therapy could be reconstructed from the medical record; the choice of the drugs used was considered adequate in 80% and the dose in 90%. However, the requested clinical investigations were recorded in only 65%, whereas laboratory tests were done in 90%. Of all drugs, therapy with digoxin was most often used without indication and without clinical follow-up of the patient. In the diuretics group potassium-saving preparations were used as drugs of first choice without adequate indication. In addition, therapy with beta-blocking agents in a group of elderly patients was not justifiable by the records. Side effects were registered in 4% of all cardiovascular drug prescriptions. Overall the quality of drug therapy was considered adequate. Cross-comparison was not possible due to lack of comparable studies in the literature.

Ambulatory Care↗