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H J Vonesch

Publications and source records attributed to H J Vonesch.

8 recordsLinked to original sources
PubMed1989

[Nocturnal hypoglycemia with reference to hormonal counterregulation in type I diabetics receiving insulin therapy].

Frequency, symptomatology and risk factors for nocturnal hypoglycemia were investigated in 77 type 1 diabetics. The patients were hospitalized overnight after a normal working day and were kept on their usual insulin regimen. Nocturnal blood sugar levels less than 2.8 mmol/l were found in 25% of 77 patients. In most cases the hypoglycemic event was not noticed by the patients. Additionally, nocturnal hormonal counterregulations were investigated in 22 patients. Plasma adrenalin, noradrenalin, somatotropin, cortisol and glucagon were measured every 2 hours. Although most of the patients were asymptomatic, a significant increase in plasma adrenalin was observed during hypoglycemia episodes. On the other hand, the increase in noradrenalin and somatotropin concentration was not significant. Blood sugar levels of 5 mmol/l and lower at 22 p.m. and at 7 a.m. (as well as diabetes duration) were identified as risk factors for nocturnal hypoglycemia. Nocturnal hypoglycemia occurs irrespective of the amount of insulin injected in the evening or at bedtime. Similarly, neither the time of late insulin injection nor the degree of metabolic control as assessed by HbA1c differed in patients undergoing hypoglycemic episodes and patients without hypoglycemia.

Adult↗
PubMed1984

[Nocturnal hypoglycemia in type-I diabetics, an underestimated risk?].

In 22 type I labile diabetics aged 20-64 years, various nighttime blood sugar (BS) values were obtained. Although 13 patients in 15 of 43 nights investigated measured below 2.8 mmol/l (50 mg%) for many hours, two thirds remained symptomless while the remainder suffered from minor hypoglycemic symptoms. The lowest BS values were obtained at about 3 a.m. Prospective as well as retrospective estimation of the hypoglycemic risk was performed with the aid of fasting and bed time BS. Causes and measures for prevention of the unexpectedly large number of episodes of nighttime hypoglycemia are discussed. Additionally, 18 healthy volunteers aged 24-61 years were investigated during 22 nights in regard to BS-values for comparative purposes: the lowest measured BS was 3.7 mmol/l (66 mg%) with an average nighttime BS of 4.9 +/- 1.1 mmol/l (86 +/- 5 mg%).

Adult↗
PubMed1984

[Bezoar with real and simulated complications].

A 64-year-old patient with lower abdominal complaints "come un sasso nel stòmaco" was admitted as an emergency with acute upper gastrointestinal haemorrhage. There was a discrepancy between the clinically unremarkable abdomen and the large amounts of free air subdiaphragmatically on the left side as seen in the radiograph. Endoscopy did not contribute greatly due to presence of a large "coagulum". Surprisingly, at operation a huge phyto-bezoar measuring 15 x 8 x 8 cm, and a benign pressure ulcer in the great curvature were found. The perforation had only been mimicked, the air sickle was within the stomach and was demarcated by the round upper pole of the bezoar.

Bezoars↗
PubMed1983

[Various forms of giant cell arteritis: diagnostic difficulties and significance of biopsies].

15 cases of giant cell arteritis newly diagnosed in the period 1979-1982 at the University Medical Outpatient Clinic, Basle, are presented. 10 cases can be classified as polymyalgia rheumatica, including one patient with aortic arch syndrome and involvement of the femoral arteries. 4 patients had cranial involvement. One patient diagnosed at an early stage exhibited non-characteristic general symptoms only. In 3 patients the diagnosis was suspected immediately, while the others underwent extensive investigations to rule out malignant and infectious diseases. Localized or generalized osteoarthrosis was often present. Most of the patients had severe general symptoms. Elevated sedimentation rate (88 +/- 34 mm 1st hr), anemia (11.6 +/- 1.8 g/dl) and elevation of alpha 2-globulin fraction were constant laboratory findings. Histologic examination of the temporal artery was positive in 2 of 7 cases with polymyalgia rheumatica. Out of 4 cases with cranial symptoms 3 had a positive histologic result. The biopsy result can be improved by removal of a more generous sample of artery segment. Therapy, relapses and complications are discussed.

Aged↗
PubMed1982

Uncommon extensive juxtacortical necrosis of the brain.

A previously healthy woman in middle age, vacationing in Spain, is treated with a massive dose of insulin for minimal hyperglycemia following an apparent gastrointestinal disease. This results in rapid coma and, 20 days later, in death. At autopsy, the main finding consists in a remarkable and uncommon ribbon-like juxtacortical necrosis of the white matter in both hemispheres of the telencephalon. There is also a microscopic focal necrosis in the pons cerebri. The grey matter of cortex and basal nuclei, and the subcortical arcuate fibers are spared. The detailed autopsy fails to reveal other essential changes. We have not been able to find reports on an identical case. Hypoglycemic coma usually causes cerebral lesions different from those seen in the present case. A brief analysis of the differential diagnosis is made. In the absence of unequivocal signs of infection, vascular disease or degenerative marks, the findings are tentatively related to complex interactions between fluid loss, hypoglycemic coma, hypoxia and other metabolic disturbances.

Brain↗