Biomedical subjects

M A Häcki

Publications and source records attributed to M A Häcki.

7 recordsLinked to original sources

PubMed1983

[Pyrazinamide versus ethambutol in short-term therapy of lung tuberculosis. A randomized study].

Recent experience suggests that the duration of chemotherapy of tuberculosis can be shortened to 6-9 months, without an increase in the relapse rate, if the treatment if started with 3 or 4 drugs including isoniazid (INH), rifampicin (RMP) and pyrazinamide (PZA). In a controlled study of culture-positive advanced pulmonary tuberculosis we have compared treatment regimens with PZA in a dosage of less than 2 g and with ethambutol (EMB). 113 patients were given, in random order for 2-3 months, either PZA (25 mg/kg body weight) or EMB (25 mg/kg) together with RMP (450 or 600 mg) and INH (5 mg/kg). The last two drugs were given for a total of 9 months. Patients treated with PZA showed a (not significantly) earlier conversion to negative cultures after an average of 7 weeks. After 18 months follow-up there have been no relapses on these regimens. 2 patients, both treated with EMB, did not respond to therapy. Drug-induced hepatitis was seen in 5 patients with PZA and in 2 patients with EMB. The hepatitis was always observed during the first month of therapy and was fully reversible. Three of the 4 patients with clinically apparent hepatitis were over 70 years of age. Three patients with elevated uric acid levels had arthralgia which led in one of them to termination of therapy. The preliminary results of our study show that the treatment regimen with PZA does not lead to a higher rate of side effects if used with particular moderation in older patients.

Adult↗

PubMed1983

[Acetazolamide in hypercapnic chronic obstructive lung disease--a renaissance?].

The use of acetazolamide, a carbonic anhydrase inhibitor, in chronic obstructive pulmonary disease (COPD) remains controversial. A substantial improvement in blood gas values has been documented, with correction of metabolic alkalosis in COPD, in hypoxemic sleep apnea at high altitudes and in acute mountain sickness. This randomized, double-blind study examined the short and long term effects of acetazolamide (2 X 250 mg) on 14 patients with hypoxemia, hypercapnia and metabolic alkalosis (paO2 49 +/- 5.2 mm Hg, paCO2 50 +/- 3.6 mm Hg, base excess + 5.7 +/- 2.3). A crossover between acetazolamide and placebo occurred on days 3, 6 and 9. On day 12 the patients were again randomized and one group further treated with acetazolamide for 4 1/2 (1-7) months. During the short term phase, a significant rise in paO2 to 58 +/- 6.6 mm Hg with acetazolamide was noted, followed by a drop to 53 +/- 5.7 mm Hg with placebo. The paO2 of the five patients on long-term acetazolamide therapy remained unchanged (59 +/- 2.5 mm Hg) while the untreated patients showed a significant drop in paO2 to 46 +/- 8.2 mm Hg. No side effects and no severe metabolic acidosis were noted during acute or long term treatment. Acetazolamide appears to improve hypoxemic and hypercapnic COPD patients with metabolic alkalosis on short and long term therapy.

Acetazolamide↗

PubMed1983

[Chemotherapy of tuberculosis--compliance, side effects and incidence of recurrence].

In the years 1977-1980 290 patients were treated for pulmonary tuberculosis with standardized therapy: for the first five months isoniazid (INH), ethambutol (EMB) and rifampicin; INH and EMB were then continued for a total of up to 9-18 months (average 15 months). The patients' own physicians accepted the recommended duration of therapy in 85% of cases. During hospitalization, 96% of tests for INH in the urine were positive. Side effects, primarily consisting of elevated transaminases, were observed in 48% of the patients. 21-63 months after the beginning of therapy, reexamination of 220 of the patients showed 2 failures and 5 relapses. The relapses can be attributed to poor patient compliance (3 patients), a slow healing process with negative cultures only after 2 or more months of therapy (3 patients) and/or too short duration of therapy: 3 of the 7 patients treated for less than 9 months suffered relapses. Before administering short term therapy of 9 months or less in Switzerland it is necessary to take into consideration the age distribution, history and stage of the disease in the patients and our system of health care by family physicians.

Adult↗

PubMed1982

[Long-term digitalis therapy of elderly patients. Is digitalization unnecessary in the majority of cases?].

More than 40% of patients hospitalized in the Wald Altitude Clinic of Zürich are already on long-term digitalis therapy upon admission. During a 6 month period long-term digoxin therapy was discontinued in 97 patients (age 74 +/- 9 years) with stable cardiac insufficiency (NYHA class I-III) and sinus rhythm. During the hospitalization (37 +/- 20 days), clinical signs and symptoms, body weight, radiological heart size, and systolic time intervals were monitored. After an observation period of one week, digoxin was discontinued in all patients. Body weight, cardio-thoracic ratio and left ventricular ejection time remained unchanged after cessation of digoxin therapy during hospitalization. The pre-ejection period showed a significant increase from 89 +/- 17 to 95 +/- 19 msec. Six patients were re-instituted on digoxin therapy, 3 due to progressive cardiac insufficiency, 2 due to atrial fibrillation, and 1 at his own request. After telephone follow-up six months later with the family physician an additional 20 patients were put back on digitalis. Among the total of 26 patients requiring further digitalization an absolute indication was found only in 12 (14%), 8 due to progressive cardiac insufficiency and 4 due to atrial fibrillation. In this study digitalis therapy could be discontinued without ill effects in 86% of elderly clinically stable patients in sinus rhythm. The authors therefore recommend a more cautious use of long-term digitalis therapy and, in already digitalized patients in sinus rhythm, a controlled trial period of discontinuation.

Age Factors↗

PubMed1976

[Diagnostic approaches in systemic lupus erythematosus (author's transl)].

333 sera from 295 patients were tested for antinuclear antibodies (ANA) by indirect immunofluorescence, and for their binding capacities towards "native", double stranded DNA (anti-nDNA) by a commercially available radioassay kit. 63 out of 66 SLE sera were ANA positive, and 42 were anti-nDNA positive. 267 "non-SLE" sera were also tested, originating from patients with chronic aggressive hepatitis (77), rheumatoid arthritis (86), scleroderma (40), pseudo-LE syndrome (35), and various other "collagenous" diseases (29). 120 of these 267 sera were ANA positive, while only 16 (6%) gave elevated anti-nDNA values. Thus it appears that this anti-nDNA test kit is a helpful tool for the serological diagnosis of SLE.

Antibodies, Antinuclear↗

PubMed1975

Drug-induced pseudolupus.

Of fifteen patients with pseudolupus (a syndrome characterised by recurrent fever, myalgia, arthralgia, pleuritis, pulmonary infiltrates, pericarditis, myocarditis, and by mitochondrial antibodies in the absence of nuclear antibodies), all had been treated with "Venocuran", one of a great number of drugs used for venous diseases. This drug, available in twenty countries under various names, contains phenopyrazone, horse-chestnut extract, and cardiac glycosides extracted from various plants. Further studies revealed that up to 90% of long-term users of venocuran acquired mitochondrial antibodies. This was not true for patients with venous diseases being treated with other drugs. About 30% of long-term users of venocuran might experience prodronal symptoms, such as myalgia and arthralgia, while more than 10% could develop the full disease.

Antibodies↗

PubMed1975

[Transfer factor. Properties and possible therapeutic applications (author's transl)].

Transfer factor (TF) is a dialysable and ultrafilterable extract from human leukocytes. It contains only substances with a molecular weight of less than 10 000. Several biological activities of TF are so far known. These refer to the transfer of specific cellular immunity from one individual to another and a stimulating effect, probably of an unspecific nature, on the cellular immune system. So far, favorable therapeutic results have been obtained in chronic candidiasis and a few other chronic infectious diseases, in the Wiskott-Aldrich syndrome and possibly also in some special malignant tumors. The small number of treatments does not permit any firm conclusions to be drawn.

Arthritis, Rheumatoid↗