Biomedical subjects

M Jenny

Publications and source records attributed to M Jenny.

At least 19 recordsLinked to original sources

PubMed1994

Crystallization and preliminary X-ray analysis of wild-type and K272A mutant glutamate 1-semialdehyde aminotransferase from Synechococcus.

Crystals of the pyridoxal-5'-phosphate dependent enzyme glutamate-1-semialdehyde aminotransferase (EC 5.4.3.8) from Synechococcus have been grown from polyethylene glycol solutions. The wild-type enzyme crystallizes in space group P2(1)2(1)2(1), with cell dimensions a = 68.4 A, b = 108.0 A, c = 122.6 A. The inactive mutant in which the cofactor-binding lysine 272 residue is replaced by alanine (K272A) gives monoclinic crystals of space group P2(1) with cell dimensions a = 67.1 A, b = 108.6 A, c = 124.5 A and beta = 115.7 degrees. These crystal forms diffract to 2.4 A and 2.7 A resolution, respectively.

Crystallization↗

PubMed1992

[Fewer negative appendectomies thanks to improved clinical diagnosis].

108 consecutive patients presenting with suspected acute appendicitis were studied prospectively. To improve clinical performance, 19 clinical criteria were evaluated. For cases with unclear diagnostic situations laparoscopy was performed. With 10 of the above mentioned criteria the score published by de Dombal, which can reach a maximal value of 7 points, was calculated. For data processing the rate of negative appendectomies as well as the de Dombal score were used. 61 appendectomies with 7 (11.5%) perforations, 48 (78.7%) acute inflammations and 6 (9.8%) normal appendices have been performed. 39 (36.1%) patients with non-specific abdominal pain were observed for 3 +/- 2 days before discharge, while 7 (11.5%) had another surgical disease. In the appendectomized patients the score was 4.3 +/- 1.1 with perforation, 4.4 +/- 1.0 with acute inflammation and 3.8 +/- 1.3 with a normal appendix (p = ns). The score for non-specific abdominal pain in patients not undergoing surgery was significantly lower (2.2 +/- 1.2; p less than 0.01). Patients with other surgical diseases had a score of 3.1 +/- 1.1 with no significant difference from patients who had undergone appendectomy or from those with non-specific abdominal pain. Laparoscopy was performed in 16 (14.8%) patients. 9 patients had appendicitis, 4 non-specific abdominal pain and 3 another surgical disease. Improved clinical examination significantly (p less than 0.05) reduced negative appendectomies from 20.3% to 9.8% without a rise in the rate of perforation due to prolonged observation. The 6 patients with negative appendectomy could not be identified even by improved clinical examination.

Acute Disease↗

PubMed1992

[Negative appendectomies can be decreased by improved clinical assessment alone].

We had a 20% rate of negative appendectomies in our patients presenting with suspected appendicitis. We suggested that an improved clinical examination would reduce this rate. 84 consecutive patients presenting with suspected acute appendicitis were prospectively studied. 10 clinical features were used to calculate a score which should distinguish appendicitis and non-specific abdominal pain. 53 appendectomies with 6 (11.3%) perforations, 41 (77.4%) acute inflammations and 6 (11.3%) normal appendixes have been performed. 26 patients suffered from non-specific abdominal pain, 5 had an other surgical disease. In the appendectomized patients the score was 4.2 +/- 1.2 with perforation, 4.4 +/- 1.1 with acute inflammation and 3.8 +/- 1.3 with a normal appendix (p = ns). The score for non-specific abdominal pain in patients without operation was significantly lower (2.0 +/- 1.1; p less than 0.01). Patients with other surgical disease had a score of 2.8 +/- 1.5 with no significant difference to patients which had undergone appendectomy. Negative appendectomies were reduced by improved clinical examination from 20.3% to 11.3% without change in the rate of perforation. The remaining patients with negative appendectomies could not be identified by improved clinical examination even by means of the score. But the use of the score improved the performance of the clinicians.

Abdomen, Acute↗

PubMed1991

[Clinical examination remains the most important part of the diagnosis in suspected appendicitis].

This paper reports why the rate of unnecessary appendectomies can not be reduced exclusively by selected diagnostic laparoscopy. 75 women and 94 men greater than or equal to 16 years of age which had undergone appendectomy and/or diagnostic laparoscopy were analyzed for 19 clinical criteria in a retrospective study. We operated on 26 (17.0%) perforated, 100 (65.4%) acutely inflamed and 27 (17.6%) normal appendixes. 29 diagnostic laparoscopies showed 16 normal and 13 inflamed appendixes. 60 to 66% of the criteria had been evaluated. Important confirmatory signs and symptoms which would have allowed to establish a diagnosis had been overlooked very often. We did not find any sign or symptoms with discriminatory value. We conclude that a major cause of unnecessary appendectomies and imprecise indications for laparoscopy has been incomplete preoperative clinical examination.

Adolescent↗

PubMed1981

[Acute appendicitis: can diagnosis and surgical indications be more precisely ascertained?].

Of 408 patients hospitalized for suspected appendicitis, 347 underwent appendectomy. 20.5% of the appendices removed were gangrenous or perforated, while 19.8% showed no acute inflammation. Retrospective analysis of the data collected from all of the 347 patients who underwent surgery and a review of the literature suggest that the following measures could contribute to a lowering of both perforation rate and rate of negative laparotomies: (1) Reconsideration of present concepts on the clinical picture of acute appendicitis and a more precise definition of the terms used. (2) Improved methods of history-taking and examination of patients. (3) More complete recording of the data collected in every case of suspected appendicitis, (4) Intensive in-hospital observation for a short period of time. (5) Laparoscopy in cases which remain doubtful.

Acute Disease↗

PubMed1980

[Traumatic duodeno-pancreatic dehiscence with avulsion of Vater's ampulla].

2 to 5% of blunt abdominal trauma have a pancreatic lesion. Avulsion of the ampulla and intact pancreas from the duodenum is an extreme rarity. Successful treatment in a 34-year-old car driver was the placement of a Roux-en-Y limb to the ampulla and pancreas with closure of the duodenum.

Accidents, Traffic↗

PubMed1978

[Hyperthyroidism in older patients].

This study comprises 81 thyrotoxic patients with onset after the age of 60. In elderly persons, toxic multinodular goiter is the most common cause (68%) of hyperthyroidism, followed by solitary thyroid nodules (16%) and Graves' disease (16%). Cardiovascular disorders (cardiac failure, arrythmias etc.) constitute the first and often the only symptom in 62% of the cases. The other forms of appearance are both various and deceptive: depression, slight fever, asthenia or nausea. Separate analysis of the three forms of hyperthyroidism did not reveal clinical, biological or therapeutic differences between them, except an inferior rate of captation for the toxic nodules. Isolated measurement of T3 or T4 is often insufficient to confirm the diagnosis because either of these hormones may appear at a normal rate. In three cases only the free thyroxin index was pathological on first determination. The authors have established that the autonomous nodules are larger and more active after, rather than before, 60 years of age, and have attempted to define their morphological identity. The results of the treatment are analyzed and preference is expressed for radioactive iodine in every form of hyperthyroidism.

Aged↗

PubMed1978

[Stress fracture of the calcaneus].

The localization of a stress fracture of the os calcis seems to be unknown in Switzerland. A typical case is reported. A review of the literature shows a remarkable change of frequency in the localization of stress fractures from the matatarsals to the os calcis caused by modern methods of military training.

Adult↗

PubMed1977

[Surveillance of hypothyroidism treatment].

The efficacy of substitution treatment in primary or secondary hypothyroidism is based on the diappearance of the clinical signs of the disease and the return of blood levels of thyroxine and TSH within normal limits. The dosage should be adapted to the age of the patient the duration of the course of the hypothyroidism and the state of the heart. The cardio-vascular consequences of hypothroidism are so serious that one should know how to detect them straight away, and thus prevent complications with would prevent proper substitutive treatment.

Humans↗

PubMed1977

[Inappropriate secretion of ACTH in cases of bronchial carcinoma].

In the light of seven cases of adrenal hypercorticalism associated with tumoral secretion of ACTH, the syndrome of inappropriate ACTH secretion is reviewed. This entity, which is related primarily to anaplastic bronchial carcinoma is characterized by paucity of clinical signs of hypercorticalism, rapidity of evolution and typical biological modifications. Other important criteria are hypokalemic alkalosis, high plasma levels of ACTH and 17-OHCS and failure of dexamethasome to suppress endogenous steroid secretion. However, the diagnosis can be proven only by extraction of a significant quantity of tumoral ACTH.

17-Hydroxycorticosteroids↗

PubMed1976

Effect of amiodarone on serum triiodothyronine, reverse triiodothyronine, thyroxin, and thyrotropin. A drug influencing peripheral metabolism of thyroid hormones.

2-n-Butyl-3-(4'-diethylaminoethoxy-3',5'-diiodobenzoyl)-benzofurane (amiodarone), a drug used in arrythmias and angina pectoris, contains 75 mg of organic iodine/200 mg active substance. Four studies were performed to test its effect on thyroid hormone metabolism: (a) nine male subjects were treated with 400 mg of amiodarone for 28 days; (b) five male subjects received, for the same period of time, 150 mg of iodine in the form of Lugol's solution; (c) five subjects received 300 mug L-thyroxine (T4) for 16 days; from the 10th to the 16th day, 400 mg of amiodarone was added; and (d) five euthyroid subjects received 300 mug L-T4 for 16 days. The changes in serum thyroid-stimulating hormone (TSH), serum total T4, 3,5,3'-triiodothyronine (T3), free T3, and 3,5',3'-triiodothyronine (reverse T3, rT3) were measured, and the pituitary reserve in TSH was evaluated by a thyrotropin-releasing hormone (TRH) test. The results show that amiodarone induced a decrease in serum T3 (28+/-5.1 ng/100 ml, mean+/-SEM, P less than 0.0S and 82.7+/-9.3 ng rT3/100 ml, P less than 0.01). The control study with an equal amount of inorganic iodine did not induce these opposite changes but slightly lowered serum rT3, T3, and T4. In the third study, serum rT3 increased as under amiodarone treatment, thereby proving that these changes were peripheral. It is suggested that amiodarone changes thyroid hormone metabolism, possibly by reducing deiodination of T4 to T3 and inducing a preferential production of rT3. Amiodarone also increased the response of TSH to TRH. The maximal increment of serum TSH above base line was 32+/-4.5 muU/ml under treatment and 20+/-3 muU/ml before treatment (P less than 0.01). During this test, the serum T3 increase was more pronounced than during the control period (83+/-13 and 47+/-7.4 ng/100 ml, P less than 0.05).

Adult↗

PubMed1974