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Biomedical subjects

H R Burger

Publications and source records attributed to H R Burger.

At least 37 records · Page 2Linked to original sources
PubMed1987

[Essential cryoglobulinemia with glomerulonephritis as a variant of the purpura-arthralgia-nephritis syndrome].

The syndrome of mixed cryoglobulinemia is clinically characterized by the findings of purpura, arthralgia and glomerulonephritis, the latter developing in up to 50% of the cases. The cryoglobulins have rheumatoid factor activity and serum levels of complement factor C4 are significantly reduced. A report is presented on seven patients with a typical purpura-arthralgia-nephritis syndrome and two patients with essential cryoglobulinemia, rheumatoid factor activity and glomerulonephritis without extrarenal manifestations of vasculitis. Based on these observations, measurement of rheumatoid factor activity is recommended in serum of patients with unclassified glomerulonephritis.

Complement C3↗
PubMed1987

[Diagnosis of glomerular and non-glomerular erythrocyturia using phase contrast microscopy of the urine sediment].

Recently the appearance of deformed polymorphous erythrocytes in the urinary sediment has been described as characteristic of glomerular bleeding. We studied 30 patients with histologically confirmed glomerular disorders and 25 patients with urological diseases and with hematuria. In the sediment of 10 ml urine 200 erythrocytes were counted under phase-contrast microscopy and evaluated relative to their morphology. The number of glomerular erythrocytes was expressed as a percentage. In all groups of glomerular disorders (mesangial-proliferative, membranous and membrano-proliferative glomerulonephritis, focal segmental glomerulosclerosis, glomerulonephritis of systemic disease, thinning of the glomerular basement membrane) the percentage of glomerular erythrocytes varied widely between 2 and 100%. In 7 cases less than 10% of glomerular erythrocytes were found. There was no correlation between the percentage of glomerular erythrocytes and the degree of renal insufficiency, hematuria or proteinuria. On the other hand, in patients with hematuria from the lower urinary tract, erythrocytes were uniformly non-glomerular in shape (95-100%). We conclude that 10-20% or more of glomerular erythrocytes in the urinary sediment are a good indicator of glomerular disease, whereas lower figures do not definitely rule out a glomerular origin for hematuria.

Erythrocytes↗
PubMed1986

Treatment of Budd-Chiari syndrome by dorsocranial liver resection and direct hepatoatrial anastomosis.

Since 1980 an operation which reestablishes the blood outflow from occluded hepatic veins was performed in 7 patients with Budd-Chiari syndrome by one of us (A. Senning). Using extracorporeal circulation a dorsocranial cylindrical resection of the liver including the confluence of the occluded hepatic veins was performed by transcaval approach. The incised right atrium was sutured around the resected liver area. There was one intraoperative death. In 6 patients with a mean postoperative follow-up of 19.2 months (4-42 months), the patency of hepatoatrial anastomosis was documented by angiography or Doppler-2d-echocardiography. Four patients are free of symptoms and signs of Budd-Chiari syndrome. In one of two patients with associated cirrhosis compression of inferior vena cava reoccurred and in another patient esophageal varices persist. We conclude, that the hepatoatrial anastomosis is an effective treatment of Budd-Chiari syndrome.

Adult↗
PubMed1986

[Ultrasound-guided incisional biopsy in generalized and focal diseases of the liver].

Sonographically guided liver biopsies under permanent visual control using fine needles are far less traumatic than previous biopsy techniques and carry a very low risk. They may be performed on an outpatient basis, especially when using the newly developed cutting-edge needle which allows to perform core biopsies of various parenchymal organs. Risks are discussed.

Biopsy, Needle↗
PubMed1985

[Mefenamic acid (Ponstan)-induced acute interstitial nephritis with reversible, severe, non-oliguric renal failure].

Acute interstitial nephritis is a rare complication of treatment with non-steroidal antiinflammatory drugs. A case is reported with severe, reversible, non-oliguric renal failure caused by biopsy-proven acute interstitial nephritis after therapy with mefenamic acid (Ponstan). Prednisone treatment resulted in normalization of renal function within 4 weeks.

Acute Kidney Injury↗
PubMed1985

[Effect of an enema on the macroscopic and microscopic appearance of the rectal mucosa].

In flexible fiberoptic sigmoidoscopy the application of an enema is mandatory. By contrast, rigid sigmoidoscopy can be performed without preparation. In 16 patients we tested the influence of a hypertonic enema on the macroscopic and microscopic appearance of the rectal mucosa. As a first step in the unprepared patient the mucosa was assessed and a rectal biopsy obtained. After enema this procedure was repeated. Development of mucosal edema was observed, although the histopathologist was not always able to decide whether or not the biopsy was taken before or after the enema. Histological assessment of edema requires histometric measurements which cannot be obtained from biopsy specimens. A knowledge of these changes is particularly important in assessment of inflammatory bowel disease, where edema of the unprepared mucosa means slight proctitis, and we recommend that the histopathologist be informed if enemas are used for bowel preparation.

Adult↗
PubMed1985

Bullous esophageal lesions due to cotrimoxazole: an immune-mediated process?

A 78-yr-old man experienced a generalized bullous eruption of the skin (a Stevens-Johnson variant of erythema multiforme) with simultaneous involvement of the esophagus due to co-trimoxazole. Immunologic tests revealed specific antibodies of the immunoglobulin G class but not of the immunoglobulin E class against sulfamethoxazole, and in particular against trimethoprim. Lymphocyte transformation tests demonstrated sensitized lymphocytes against trimethoprim but not sulfamethoxazole. The esophageal mucosa showed intraepithelial vesicle formation with diffuse cytoplasmic deposits of immunoglobulin G. This adverse drug reaction involving both the skin and the esophagus appears to be immune-mediated.

Aged↗
PubMed1985

Unilateral parenchymatous kidney disease and hypertension: results of nephrectomy and medical treatment.

In the present study 43 patients with unilateral parenchymatous kidney disease and hypertension were investigated. 20 patients were nephrectomized, 23 treated with antihypertensive drugs. Both therapeutic approaches showed an excellent and sustained blood pressure-(BP)-lowering effect. BP fell from 185 +/- 27/116 +/- 13 to 138 +/- 20/86 +/- 10 mm Hg in the operated and from 194 +/- 32/116 +/- 13 to 149 +/- 22/95 +/- 12 mm Hg in the medically treated patients after 2 and 6 weeks, respectively (p less than 0.001). BP was 142 +/- 16/89 +/- 11 and 136 +/- 16/90 +/- 10 mm Hg at the long-term follow-up in the 2 subgroups. In the operated group 70% (n = 14) were cured, 20% (n = 4) were improved and 10% (n = 2) unimproved. In the medically treated group 65% (n = 15) were normotensive, 26% (n = 6) improved and 9% (n = 2) treatment resistant. No significant correlation between postoperative BP reduction and lateralization of renin secretion (PRA-ratio greater than or equal to 1.5) was found. Although cured patients showed a higher mean PRA-ratio, 4 patients with a PRA-ratio less than 1.5 were cured (n = 2) or improved (n = 2) postoperatively. Our results document an excellent and sustained antihypertensive effect of both nephrectomy and medical treatment in patients with unilateral parenchymatous kidney disease and hypertension. They further limit the predictive value of renal venous renin determination in the preoperative workup.

Adolescent↗
PubMed1984

[Circulating immune complexes before and after kidney allotransplantation].

In a prospective study circulating immune complexes (CIC) were analyzed before and serially after renal transplantation in 141 consecutive patients. CIC were measured using the Raji cell assay as originally described by Theofilopoulos and Dixon. The amount of CIC was expressed as microgram heat aggregated human immunoglobulin G (IgG) equivalent/ml serum. The upper limit of normal sera was 25 micrograms/ml. The values are expressed as geometric means (- 1 SD/ + 1 SD). In 86 of 133 rejection episodes a renal biopsy was performed and the histopathologic changes were semiquantitatively assessed and classified in a cellular or vascular type of rejection. Before transplantation CIC were detected in 104 of 141 patients (73.8%) and the mean value was 65.6 (27.8-154.9) micrograms/ml. The level of CIC was positively correlated with the number of grafts (r: 0.43; P less than 0.01) and the occurrence of chronic active hepatitis (r: 0.31; P less than 0.01). No correlation was found between CIC and the underlying kidney disease, the number of blood transfusions prior to transplantation, and the pre-existing lymphocytotoxic antibodies. Graft survival and number of rejection episodes were not influenced by the level of CIC prior to transplantation. After transplantation CIC were elevated in 60 patients (41%), appeared transiently in 49 patients (35%) and were never detectable in 32 patients (23%). In patients with a graft survival less than or equal to 11 months the average and peak post-transplant CIC levels were significantly higher than patients with a graft survival of 12 months: 64.4 (21.8-191.0); 87.7 (26.0-295.8) versus 39.6 (18.4-85.3); 56.8 (21.0-150.1) micrograms/ml; P less than 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Kaposi's sarcoma and malignant lymphoma in AIDS.

A 48-year-old homosexual with contacts in different countries, including Haiti, presented with multiple pigmented or bluish nodules on both lower legs and upper arms. He had a history of secondary syphilis, hepatitis B and herpes zoster ophthalmicus. Biopsies of the skin tumors revealed a typical Kaposi's sarcoma of low grade malignancy. The endothelial origin of the tumor was indicated by the presence of specific endothelial organelles (Weibel-Palade bodies) in the cytoplasma of the tumor cells. Erythrocyte phagocytosis was found in tumor cells within and without the vascular channels. Laboratory tests were compatible with the clinical diagnosis of an acquired immune deficiency syndrome (AIDS) with a helper: suppressor T-lymphocyte ratio of 0.28 and a cutaneous anergy. In the course of the illness tumors of the stomach and duodenum were detected. Histology showed a malignant non-Hodgkin lymphoma of high grade malignancy. Within weeks the patient died in a cachectic state. Autopsy revealed a Kaposi's sarcoma of the skin with metastases in the stomach and a wide-spread malignant lymphoma in the gastrointestinal tract, in several visceral organs and in many lymph nodes.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Transluminal dilatation of experimental hydronephrosis in dogs: acute and chronic effects, haemodynamic changes, and histological findings.

In the present study the feasibility and effectiveness of transureteral dilatation with a double-lumen balloon-tipped dilatation catheter was investigated. In 6 dogs with experimentally induced unilateral fibrotic stenosis and hydronephrosis a total of 13 dilatations were performed through a cutaneous ureteroneostomy. The stenosis diameter could markedly be distended from 1.7 +/- 0.9 to 4.8 +/- 1.6 mm (p less than 0.001). The pyelon size changed not significantly during the intervention. Follow-up urographies 1 week after dilatation revealed partial or total restenosis in all but 2 dogs. The stenosis diameter had decreased by 2.6 +/- 1.5 mm (p less than 0.01). The mean pyelon size changed only slightly (28.2 +/- 14.7 vs. 26.1 +/- 6.2 cm2). In the 2 dogs with persistent distension of the stenosis a reduction in pyelon size was achieved. Blood pressure during acute ureteral ligation showed no change. Follow-up studies after 1 week revealed a significant fall of the mean arterial pressure from 100 +/- 22 to 83 +/- 19 mm Hg (p less than 0.005), which was also seen at the long-term follow-up in 5 dogs 13 +/- 8 weeks after ureteral ligation. Histological analysis showed mild to severe inflammation and distension of the collecting system and mild to moderate inflammation, atrophy, and glomerular cysts in the renal parenchyma. Interestingly, the 2 dogs with a successful result of dilatation showed no relevant inflammation in the dilated stenotic segment. In conclusion, transureteral dilatation of experimental ureteral stenosis with a balloon catheter proved to have an impressive acute effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗