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Biomedical subjects

K Rhyner

Publications and source records attributed to K Rhyner.

At least 19 recordsLinked to original sources
PubMed1992

[Suspicion of anemia-inducing gastrointestinal bleeding: how far should assessment go?].

In a retrospective evaluation of 362 patients with iron deficiency anemia or visible blood loss from the gastrointestinal tract (hematemesis or melena), the bleeding source could not be found in 18% of cases (66 patients) even by extensive gastrointestinal endoscopy. In these cases neither small bowel studies nor repetitive endoscopic examinations increased the diagnostic yield. On the other hand, gastrointestinal endoscopy resulted in the diagnosis of gastrointestinal malignancy in 25 cases, most of whom could be resected curatively. The fecal occult-blood test was positive in 85% of the cancer patients, indicating the usefulness of this test as a diagnostic tool. If the bleeding source remains obscure in spite of extensive gastrointestinal endoscopy and gastrointestinal malignancy has been excluded, further investigation by small bowel studies or angiography is unrewarding and only indicated in selected cases.

Adult↗
PubMed1992

[The "sarcoidosis-lymphoma syndrome"--a lymphocyte dysregulation?].

Sarcoidosis and malignant lymphoma can occur in the same patient; sarcoidosis appears first, the malignant lymphoma follows later. The case histories of three patients illustrate what Brinker first coined as the "sarcoidosis-lymphoma syndrome". In two patients a pulmonary sarcoidosis stage I was diagnosed over 30 years respectively 4 years prior to the histological diagnosis of highly malignant Non-Hodgkin lymphoma. The third patient suffered from generalized sarcoidosis with splenomegaly, , granulomatous hepatitis and interstitial lung disease, in addition to which a lymphoproliferative syndrome was diagnosed. Comparing the pathogenesis of malignant lymphoma and sarcoidosis, parallels such as T-cell dysfunction, which probably facilitates malignant transformation of B-cells, become apparent. In both diseases the transforming gene could be the Ebstein-Barr virus.

Adult↗
PubMed1991

[Histiocytosis X. Clinical aspects and course in 5 patients].

Histiocytosis X developed in five patients (one woman and four men) when aged between 15 and 44 years. The initial sign in four of them was eosinophilic granuloma of the bone, in one it was pulmonary involvement. In three patients the disease remained confined to bone, while in two it involved the lungs and central nervous system, respectively. Osteolysis regressed spontaneously in one of the men, while in the woman there has been no recurrence 8 years after resection of the focus. In another man an osteolytic focus in a rib was noted after a 9-year recurrence-free interval. The man with pulmonary and bone involvement received chemotherapy with vinblastine and prednisone: dyspnoea and cough disappeared, vital capacity improved and the interstitial lung changes regressed. The osteolytic foci were repeatedly irradiated in the man with bone and CNS involvement. This brought about considerable reduction in pain but no significant radiological changes of the foci. Two courses of chemotherapy were given over 12 years, once with vincristine and prednisone, afterwards with cyclophosphamide. This arrested the progression of the osteolytic foci, but each time they recurred when the drugs were stopped.

Adolescent↗
PubMed1990

[Malignant lymphoma: a study of an outpatient cohort].

Data from 168 patients with malignant lymphoma were collected. 57 had Hodgkin's disease, 76 suffered from non Hodgkin's lymphoma and 35 presented with chronic lymphocytic leukemia. All patients were treated between January 1980 and December 1986 at the medical policlinic of the university of Zurich either as in- or outpatients. Presentation at the time of diagnosis, therapeutic regimen and treatment success as well as prognostic features of disease were evaluated. Overall the therapeutic results in this patient cohort were good and comparable with the results of large prospective studies. Complete remission rate (CRR) was 91% and overall survival rate (OSR) after 5 years was 72% for Hodgkin's disease. In Non Hodgkin's lymphoma of low malignancy OSR was 60% after 5 years and 39% in NHL of intermediate or high malignancy. In NHL CRR varied according to histologic subtype. In Hodgkin's disease staging according to the Ann Arbor classification and extranodal involvement including the spleen proved meaningful for prognosis. In NHL the international working formulation (IWF) was a useful prognostic tool. Anemias, higher age and relapses carried a poorer prognosis whereas induction of remission was a favorable prognostic sign. For chronic lymphocytic leukemia staging according to Binet was found a useful prognostic criterion.

Adult↗
PubMed1990

[Nosebleed, vision disorders].

A 79-year-old man had repeated episodes of nose bleeding, disturbances of vision and anemia. Elevated WBC and lymphocytosis suggested chronic lymphatic leukemia. Serum electrophoresis revealed IgM paraproteinemia. The disease progressed rapidly under appropriate therapy. An autopsy revealed NHL of the lymphoplasmocytoid type (IWF: A--LP-immunocytoma), a NHL carrying a slightly poorer prognosis than classical chronic lymphatic leukemia.

Aged↗
PubMed1989

[Combined GM-CSF and erythropoietin therapy in myelodysplastic syndrome].

A 60-year-old patient with a myelodysplastic syndrome (MDS) corresponding to refractory anemia with an increase in blast cells (RAEB) was treated with granulocyte-macrophage colony stimulating factor (GM-CSF) and erythropoietin (EPO) for severe symptomatic pancytopenia. During the GM-CSF treatment a distinct increase in granulocytes was observed, but the reticulocytes and thrombocytes decreased to the point where treatment had to be discontinued after eight days. After subsequent treatment with EPO the reticulocyte count rose from 0% to 2%. However, this rise alone was insufficient to decrease the number of blood transfusions required. The thrombocyte count rose to the original values after the cessation of GM-CSF therapy while continuing treatment with EPO. Bone marrow investigations were performed before and after GM-CSF treatment and indicated a distinct increase in the myeloid precursor cells after therapy, without an increase in blasts. On the other hand, an obvious decrease in erythro- and megakaryopoiesis was observed.

Anemia, Refractory, with Excess of Blasts↗
PubMed1989

[A gene probe test for serum RNA proteolipid in neoplasia].

We describe for the first time the specific determination of a tumor associated nucleic acid found in 50 of 57 sera from cancer patients. The novel tumor marker "RNA-proteolipid" described by us contains an mRNA of about 10 kilobases. We have established a test to determine this RNA by hybridization. A cDNA was obtained by reversed transcription from RNA using serum from a patient with Hodgkin's lymphoma. The cDNA was then ligated into a M13 phage and cloned in Escherichia coli. The phage DNA was sulfonated chemically and hybridized to RNA from neoplastic sera which was immobilized on nylon. The bound DNA was detected by an immunoassay.

Adult↗
PubMed1989

[Serum erythropoietin levels: a new diagnostic tool?].

The development of highly specific antibodies against recombinant human erythropoietin (EPO) has recently made the accurate radioimmunological measurement of serum levels of this hormone possible. In this study we determined the serum-EPO levels in 100 healthy volunteers, in 54 patients suffering from polycythemia vera and in 51 patients with secondary polyglobulia. The mean levels for the healthy group were found to be 11.3 +/- 3.4 mU/ml in females and 8.0 +/- 3.2 mU/ml in males. Patients with polycythemia vera had serum-EPO levels of 4.3 mU/ml, while those with secondary polyglobulia had significantly higher levels averaging 30.3 mU/ml (p less than 0.0001). However, an overlapping of serum-EPO values in the range between 10 and 20 mU/ml occasionally occurs. Our results show that measurement of the serum-EPO level can be useful in the differential diagnosis of polyglobulias. Additionally, sequential EPO level measurements after phlebotomy and after hemorrhage show a pronounced increase in serum-EPO in secondary polyglobulia, while in polycythemia vera the level only increases slightly.

Diagnosis, Differential↗
PubMed1989

[Dyspnea, cough, febrile state].

A 71-year old man was admitted because of increasing dyspnea and fever. Myelomonocytic leukemia was diagnosed on blood films. Diffuse bilateral pulmonary infiltrates detected on chest radiographs were related to the febrile state. Because leukemic infiltrates as well as pneumonia were possible causes for the pulmonary lesions antibiotic therapy followed by prednisone on the same day was initiated. An unusually rapid improvement of the pulmonary infiltrates within 4 days was indicative of a leukemic infiltrate. The patient died a few days later and the diagnosis of diffuse leukemic pulmonary infiltrates was confirmed at autopsy.

Aged↗
PubMed1989

[Plasma cell leukemia].

The following article describes five patients with plasma cell leukemia treated during the last two years at a Medical University Polyclinic. Plasma cell leukemia is a disease which was seen extremely rarely in the past. The disease can develop in patients with multiple myeloma or, even more rarely, as a "de novo" disease. Generally patients with plasma cell leukemia are younger than the multiple myeloma patients and have a higher incidence of organomegaly. Despite the fact that patients with plasma cell leukemia received the same intensive chemotherapy as those with multiple myeloma, their prognosis was considerably worse, with a median survival time of only five month.

Adult↗
PubMed1989

[Serum erythropoietin levels in several diseases].

The accurate radioimmunological measurement of serum erythropoietin (EPO) levels has only been possible since the development of highly specific antibodies directed against recombinant human EPO. In the present study, we determined the serum EPO levels in 100 healthy volunteers and in over 300 patients with anemias and hyperglobulinemia of various causes. In the healthy group, the females had levels of 11.3 +/- 3.4 mU/ml, while the males had levels of 8 +/- 3.2 mU/ml. The serum EPO concentrations were inversely related to the degree of anemia in patients with nonrenal anemias, while predialysis patients with renal anemias showed only partially such a tendency. Hemodialysis patients exhibited EPO-levels that were inadequately low relative to the degree of anemia. Patients with hyperglobulinemia had significantly higher serum EPO-levels than healthy individuals and polycythemia vera patients, the latter having particularly low serum EPO levels. Our results show that the determination of serum EPO levels can be of value in the differential diagnosis of hyperglobulinemia. Finally, sequential measurements document fluctuating serum EPO-levels after gastrointestinal hemorrhages and in patients with iron deficiency anemias receiving iron substitution. The probable reason for this phenomenon seems to be the intermittent utilisation of the hormone by EPO-sensitive erythropoietic precursor cells.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Polycythemia vera: clinical aspects and course in 86 patients].

We analyze symptoms, clinical course, and survival time of 86 patients with polycythemia vera treated between 1966 and 1987 at the medical polyclinic of the University Hospital of Zürich. The mean age of disease onset in 40 men and 46 women studied was 59 years. Most commonly the first symptoms were vertigo and headache (49%) and pain in the extremities (42%). Clinically, plethora was found in half of the cases and 56% showed signs of abnormal arterial and venous circulation. Two thirds of the patients had thromboembolic complications and 40% had hemorrhages chiefly occurring in the gastrointestinal tract. 48% of the patients died after an average survival time of 10 years. The most common cause of death (46%) was acute myelogenous leukemia, followed in 32% by thrombosis and/or embolism and in 7% by death due to hemorrhage. 18 of the 19 leukemia patients were treated with myelosuppressive agents. Patients treated with 32P showed a substantially higher incidence of malignancy than the group of patients not receiving 32P (p less than 0.001). The development of malignancies also seems to be related to the dosage of 32P. Patients who developed malignancies generally received higher doses of 32P (30 vs 20 mCi). Therefore, consistent phlebotomy therapy and restrictive chemotherapy combined with low dosage salicylates appears to be superior to 32P-therapy.

Antineoplastic Agents↗
PubMed1988

[Malignant lymphomas in HIV-infected patients].

Eleven patients with non-Hodgkin's lymphoma and three patients with Hodgkin's disease were observed among 876 anti-HIV-positive subjects attending the AIDS clinic at the University Hospital, Zurich, Switzerland. Compared to the general population this represents a 50-fold (95% confidence limits: 25-90) increased risk of non-Hodgkin's lymphoma and an 11.4-fold (2.3-33) increased risk for Hodgkin's disease in anti-HIV-positive men. High malignancy, advanced stage of disease at the time of diagnosis, and extranodal localization are characteristic of non-Hodgkin's lymphoma in AIDS patients, which carries a poor prognosis. However, remissions and prolonged disease-free survival are possible in individual cases. Only one opportunistic infection was observed during 92 months of treatment and observation using a mild chemotherapeutic regimen (m-BACOD). Less myelosuppressive chemotherapeutic schedules appear to be more beneficial than aggressive regimens in anti-HIV-positive patients due to the lower incidence of opportunistic infections.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Mycobacterioses in patients with HIV infection].

Mycobacterial infections were confirmed in 629 HIV-infected persons (1.4%). Five patients had a generalized infection with Mycobacterium avium complex (MAC), four an extrapulmonary tuberculosis caused by Mycobacterium tuberculosis (M. tbc). In general, the tuberculosis was the first severe opportunistic infection, while infections with MAC were more frequent in patients with already manifest AIDS. Common to all patients were a septic temperature and definite shift to the left of neutrophil granulocytes. Four of five patients with MAC also had diarrhoea, and three of four with tuberculosis additionally had peripheral lymphomas. The chest x-ray films were normal in six of the nine patients. The diagnosis was made in six patients primarily by the microscopic demonstration of acid-fast bacteria in lymph node tissue or stool, in three patients by culture from blood or liver tissue. Microscopic stool examination was helpful: in three of five patients with MAC and one of two with M. tbc in the stool culture, acid-fast bacteria had already been demonstrated. In an individual case MAC infections could not be distinguished either clinically or morphologically from infections with M. tbc, but only by culture.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Erythropoietin--the first hematologic hormone in clinical use].

Recombinant human erythropoietin raises serum erythropoietin concentrations to adequate levels and restores the hematocrit to normal values in the vast majority of anemic, end stage renal disease patients undergoing regular hemodialysis. It can eliminate the need for transfusions and thus the risk of immunologic sensitization, infection and iron overload. Erythropoietin not only alters laboratory findings but improves the well being and performance of patients on hemodialysis as well. Side effects are minimal and neither antibodies nor resistance to the recombinant hormone have been observed so far. Along with the rise in hematocrit and blood viscosity some patients developed increased blood pressure and a few hypertensive encephalopathy, but after brief interruption of therapy erythropoietin treatment could be continued in combination with antihypertensive drugs. The pathophysiology of the increase in blood pressure, the risk of encephalopathy and the possibly somewhat higher risk of thrombosis remain to be elucidated. Nevertheless, the first recombinant hematopoietic hormone has passed its first clinical trials with success.

Anemia↗
PubMed1988

[Diabetes insipidus in chronic myeloid leukemia. Remission of hypophyseal infiltration during busulfan treatment].

In a 53-year-old male who presented with diabetes insipidus as the first symptom of chronic myelocytic leukemia, computed tomography of the sella showed infiltration of the posterior pituitary gland. Busulfan treatment was given for one month and the infiltration had disappeared ten weeks after initiation of therapy. At the same time the severity of the diabetes insipidus diminished for a period of three months. Diabetes insipidus is a rare complication of chronic myelocytic leukemia: only 8 similar cases have been reported in the last 75 years.

Busulfan↗
PubMed1988

[Idiopathic cold agglutinin disease. Clinical aspects, therapy and course in 6 patients].

Clinical features, diagnostic procedure, therapy, course of the disease and prognosis in 6 patients with severe idiopathic chronic cold agglutinin disease are described. In 5 patients the main complaint was cold mediated acrocyanosis. The cold agglutinin in all patients was of anti-I type and belonged to IgM immunoglobulin. Keeping warm provided symptomatic relief and the hemolysis decreased to a milder form. Treatment with glucocorticoids alone failed in two patients but succeeded in combination with chlorambucil or cyclophosphamid. One patient developed a lymphoproliferative disorder 11 years after diagnosis of idiopathic chronic cold agglutinin disease.

Aged↗