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Biomedical subjects

G A Cremer

Publications and source records attributed to G A Cremer.

At least 37 records · Page 2Linked to original sources
PubMed1985

[Septicemia in cirrhotic patients].

The clinical features of 22 patients with cirrhosis of the liver complicated by septicaemia were studied retrospectively and compared with a control group of 52 patients with septicaemia without cirrhosis. The incidence of septicaemia was higher in the cirrhotic group (4.25 p. 100) than in the control group (0.64 p. 100). The overall incidence of cirrhosis in patients with septicaemia was 19 p. 100. Nine of the 22 cirrhotic patients and 16 patients in the control group died. Prognostic factor common to both groups of patients were: shock, coma, delayed apyrexia and the isolation of more than one infecting organism on blood culture. Poor prognostic factors specific to the cirrhotic patients were the presence of ascites, especially if infected, and signs of hepatocellular failure.

Aged↗
PubMed1985

[Osteoarthritis caused by dematiaceous fungi. Apropos of 3 cases].

Three cases of osteoarthritis due to dematiaceous fungi are reported. The first case, a Drechslera longirostrata spondylitis complicating prosthetic valve fungal endocarditis responded only to the association of Amphotericin B and Ketoconazole. The second patient had chronic osteoarthritis of the knee due to Phialophora parasitica resistant to medical and surgical treatment after renal transplantation. These two cases are the first and the second known reports of clinical infection with these fungi. The third patient had osteoarthritis of the patella complicating a skin infection by a thorn prick. This was cured by surgical excision and 3 months' medical treatment. These cases of infections osteoarthritis of the knee followed subcutaneous abscesses. Deep tissue infections with dematiaceous fungi with osteoarthritic involvement are very rare (6 cases of Drechslera and 8 cases of Phialophora have been reported). These fungi are opportunist saprophytes of plants in subtropical regions. They are characterised on culture by their brown and black pigmentation and microscopy shows septated filaments. Cutaneous effraction is the usual portal of entry in man; patients commonly have depression of their immune systems. Osteoarthritis is generally due to local extension of a subcutaneous abscess. The functional sequellae can be very serious. Treatment comprises surgical excision of the infected tissues with antifungal drugs which may have to be given in association.

Adult↗
PubMed1985

[Attacks of gout and thromboembolic disease: role of heparin therapy].

The authors report 4 cases of acute gout in the lower limb occurring soon after starting heparin therapy for venous thromboembolic disease. As none of the usual factors which induce gout were present, the possible roles of the venous thrombosis and the heparin therapy were examined. Intra-articular thermic and acid-base changes secondary to the thrombosis could have explained the site of the attacks of gout in 3 of our 4 patients; the fourth patient had normal phlebography; the relationship between the attack and the start of heparin therapy suggested that the heparin may have induced the gout, possibly by an interaction with the synovial proteoglycans leading to the precipitation of urate crystals in the joint. In the absence of references in the literature, these hypotheses need further confirmation.

Acute Disease↗
PubMed1984

[Tuberculous meningitis in adults. Diagnostic elements: analysis of 32 cases].

The aim of this study was to determine the value of paraclinical investigations in the diagnosis of 32 adults with TB meningitis. Mycobacterium tuberculosis was found in spinal fluid cultures of 21 patients (66 p. 100). But only two had positive smears. In five with positive cultures the sampling was performed between one and 13 days after the beginning of chemotherapy. In 7 patients with negative spinal fluid cultures, mycobacterium tuberculosis was found in gastric contents aspiration (3); urine (2); bone marrow (1) and abscess (1). Cytochemical analysis of first spinal fluid samples showed an elevation of protein from 0.5 to 7 g/l in all patients (mean 2.1 +/- 1.6 g/l); sugar was low in 26 (mean 0.30 +/- 0.26 g/l); cell count was less than 500/mm3 in 26, with a mononuclear response in 24. 20 patients had lymphocytic and hypoglycorrachic meningitis. Cytochemical findings were independent of the delay between the first clinical symptoms and lumbar puncture. A. C. T. scan of the brain was performed in 8 patients with neurologic complications. Hydrocephalus was found in 3, and after the injection of contrast material, focal high-density areas in the basal cistern and the sulci of the cerebrum were observed in 2. Chest X ray showed miliary TB in 13 patients; but positive skin test for tuberculosis and hyponatremia were rarely helpful. To confirm adult tuberculous meningitis, we suggest that two spinal fluid samplings are necessary, but mycobacterium tuberculosis must be looked for simultaneously in the sputum, gastric contents, urine and bone marrow. Specific treatment can be started immediately after the first spinal fluid sampling. Chest X ray may be helpful, but C.T. scan of the brain and tuberculin test are of no value.

Adult↗
PubMed1983

[Tuberculous meningitis in adults. Prognostic factors].

Clinical and biochemical data likely to constitute prognostic factors were investigated in a retrospective study of 32 cases of tuberculous meningitis. Age appeared to be a much more important factor than the initial clinical severity of the disease and the delay of treatment. Over the age of 50 years, the mortality rate was doubled. There was no correlation between age and initial severity of the clinical picture. The number of cells and level of glucose in the CSF on admission were of no prognostic significance. CSF protein levels were higher in patients who died or developed complications than in those who made an uneventful recovery (p less than 0.05). The time required for temperature and CSF protein and glucose levels to return to normal had no prognostic value. An unfavourable or complicated course should be feared when CSF protein levels are higher than 7 g/l and in the presence of persistently low CSF glucose levels.

Adult↗
PubMed1982

[Hypercalcemia in large cell lymphoma. Possible role of prostaglandins E2 (author's transl)].

Hypercalcemias in lymphomas without bone involvement are exceptional. The mechanism of hypercalcemia, very rarely determined, results from release of parathyroid hormone like (PTH) or osteoclast activating factor like substances. Prostaglandins were not reported high in lymphomas with hypercalcemia. We report a case of hypercalcemia in large cell lymphoma with non-cleaved cell and without bone involvement. Plasma PGE2 were 775 pg/ml (normal 7,8 +/- 1,5 pg/ml), plasma PTH was 12 ng/prot./ml (normal 10-30 ng/prot./ml), calcemia was 3,7 mmol/l (normal 2,2-2,6 mmol/l). Ten days after the first chemotherapy, calcemia was normal, plasma PTH was undetectable and plasma PGE2 were 349 pg/ml. Nine months after the beginning of treatment, PGE2 were 16,8 pg/ml and calcemia 2,37 mmol/l. The possible roles of PGE2 in hypercalcemia and as tumor marker are discussed.

Aged↗
PubMed1982

[Familial hypocalciuric hypercalcemia: two case reports (author's transl)].

Two cases of familial hypocalciuric hypercalcemia (FHH) are reported with a review of the literature. Both cases had hypercalcemia, hypophosphatemia, variable parathormone (PTH) levels and hypocalciuria. The parathyroid glands were only slightly hyperplastic and subtotal parathyroidectomy did not reduce the hypercalcemia. FHH is an autosomal dominant congenital disease with high penetrance. It is characterised by hypocalcemia. This contradictory biological finding should alert the physician to the diagnosis and initiate a familial enquiry. The serum PTH and urinary cyclical-AMP levels do not distinguish FHH from primary hyperparathyroidism. Surgery is usually contraindicated because it is ineffective and because the disease is usually benign. Semi-quantitative bone histology in a patient with a high PTH level was normal. The value of bone biopsy in these cases is discussed.

Adolescent↗
PubMed1981

[Pancreatic cancer revealed by hyperosmolar coma: report on two cases (author's transl)].

Hyperosmolar diabetic coma revealed the presence of a pancreatic cancer in two patients. The first case was a 59-year-old man, without a history of diabetes, treated with prednisone for jaundice and marked weight loss over the last month, and admitted in hyperosmolar coma (346 m0sm/l). After recovery from the acute episode, a diagnosis of adenocarcinoma of the head of the pancreas was established following operation. The patient died six months later. The second case, a 71-year-old man also without a history of diabetes, was admitted in hyperosmolar coma (315 m0sm/l) during the course of a pulmonary infection. Rapidly fatal cholostatic jaundice appeared one year later. An adenocarcinoma of the head of the pancreas was demonstrated at autopsy. The diagnostic criteria in both cases were those of hyperosmolar diabetic coma. Though cases of combined diabetes and pancreatic cancer are well documented, only one case of hyperosmolar coma and cancer of the pancreas has been reported in the published literature. The pathogenesis of hyperosmolar diabetic coma is discussed. The fact that it developed during the course of a pancreatic affection could be explained by a functional reduction in insulin secretion, associated with a triggering factor such as dehydration, infection, hypoglycemic agent administration, etc... The onset of hyperosmolar diabetic coma in an elderly patient without a history of diabetes, especially with associated marked weight loss, should lead to investigation for a possible pancreatic cancer.

Adenocarcinoma↗
PubMed1979

[Papillary thyroid cancer lying within a toxic adenoma (author's transl)].

The association of hyperthyroidism and thyroid cancer is rare. The commonest finding is multilobular goitres. When a toxic adenoma is associated with a thyroid cancer they are usually clearly separate lesions. A thyroid cancer lying within a toxic adenoma, as in this case, is a much rarer occurrence, and a review of the published literature suggests that the relatively frequent association of the two lesions is fortuitous. The possibility of a cancer occurring near, or within a toxic adenoma, is an argument in of surgical treatment of these formations.

Adenoma↗
PubMed1975

[Association of Behçet's disease and pelvispondylitis in a subject without HLA W 27 antigen].

The authors report a new case of Behcet's disease in association with ankylosing spondylitis. A study of the HLA system in this patient, showed the presence of an HLA 5 (Behcet's disease) and the absence of HLA W 27 (ankylosing spondylitis). The authors recall the frequency of HLA W 27 during ankylosing spondylitis, whether primary or associated with psoriasis, or enteric disease. Desensitisation to autologous saliva proved a failure. A trial of D-Penicillamine produced no beneficial effect on the course of the mucosal ulcers and the inflammatory joints.

Adult↗
PubMed1975

[Gastric and pleural localization of Waldenström's disease].

The authors report a case of Waldenstrom's disease, the first sign of which, remaining for a long time the only sign, was a pseudo-carcinomatous infiltration of the stomach. Later, the patient developed a pleural localisation. These two lesions, gastric and pleural, are known but rare. The authors recall the main signs. They emphasize the long duration of the disease when treated by chlorambucil. A pathological IgM was found, not only in the serum of this patient, but also in the jejunal fluid aspirated during small intestinal biopsy.

Chlorambucil↗
PubMed1975

[Isolated rupture of the chordae tendineae of the mitral valve].

The authors report a personal case of mitral incompetence, due to rupture of the chordae tendineae and note the signs of this disease. The patient first developed pulmonary oedema with thoracic pain, a mitral systolic murmur and a presystolic gallop rhythm, which suggested the diagnosis in a patient in sinus rhythm with a normal size heart, the left atrium was expansive and there were obvious signs of pulmonary congestion. The rapidly fatal course may be explained by the large number of ruptured chordae tendineae. Autopsy showed that the mitral valve was normal in texture. Histological study of the ruptured cord, showed lesions of dense hyaline fibrosis and mucoid infiltration of the basic substance.

Aged↗