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M Knoblauch

Publications and source records attributed to M Knoblauch.

At least 19 recordsLinked to original sources
PubMed1991

[Pulmonary venous occlusive disease. Case report and literature review].

We present the case of a 64-year-old female patient who died of pulmonary veno-occlusive disease. The patient had suffered for several months from increasing dyspnea and right heart failure. Chest x-ray showed signs of pulmonary hypertension as well as Kerley A- and B-lines and pre-edema and a moderately enlarged heart. The diagnosis of pulmonary veno-occlusive disease was confirmed by open lung biopsy. We compare our case with the other cases of pulmonary veno-occlusive disease (PVOD) published in the literature.

Aged↗
PubMed1990

[Persistent leg pain].

A 72 year old patient suddenly experienced severe lumbar pain irradiating into the right leg. Later on, weakness of the muscles thigh appeared. A thorough radiological investigation which showed degenerative alterations of the vertebral column did not supply an explanation. After a pathological titer against Borrelia burgdorferi was found in serum and radiculitis was detected on EMG, the diagnosis of Lyme-Borreliosis of the nervous system could be confirmed by analysis of the cerebrospinal fluid. Under intravenous antibiotic treatment with Ceftriaxone (2 to 4 g daily for three weeks) the symptoms regressed completely, and the pathological findings in the CSF regressed. The significance of some findings in CSF in relation to Borreliosis of the CNS.

Aged↗
PubMed1990

[Semiquantitative lipase determination--a useful screening test for pancreatitis?].

In 233 sera, taken from 112 patients and 20 healthy blood-donors, we have compared RapiTex-Lipase, a semi quantitative immunochemical latex test for the determination of the lipase, with the conventional quantitative method of determination in order to establish its diagnostical value as a screening test for acute pancreatitis. It appeared that, with a positive result of the test increased values of lipase were found in 98% of the cases, but that a negative result of the test did not exclude an increased lipase. The sensitivity of the test as to the quantitative determination of the lipase depended directly on the activity of the lipase and turned out to be acceptable at 88% only with values 4 X higher than the upper limit of the normal range. With values 5 X higher and more, it reached 100%. Even if the test, due to its very high level of discrimination, did not show a reaction in every case of unspecific extrapancreatic hyperlipasemia, its organ-specificity for the pancreas was reduced and came to 80 to 96% in patients with renal insufficiency, diseases of the liver, abuse of alcohol and in various non-pancreatic intra- or extra-abdominal affections. In 16/18 patients with acute pancreatitis the test used for screening turned out positive (sensitivity 89%), two patients with values between 2 and 4 X the upper limit of the norm had a negative test.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

[Antibiotic therapy of Lyme borreliosis].

There are still no definite patterns for antibiotic therapy of Lyme borreliosis. Recent studies have shown that ceftriaxone or tetracyclines are superior to the conventional penicillin. Against erythema chronica migrans (stage I) oral therapy, preferably with tetracycline, is sufficient. In cases with stage II symptoms, such as arthritis or neurological affections, high dose parenteral treatment, preferably with ceftriaxone, is recommended, although its effect on the neurologic symptoms is not yet proven. Carditis also calls for high dose parenteral administration of antibiotics, even though there are no published studies on this treatment as yet. Opinion is divided on the cutaneous symptoms such as acrodermatitis chronica atrophicans, morphea, lichen sclerosus et atrophicus (acute inflammatory stage) and lymphadenitis cutis benigna. Even if oral penicillin or tetracycline can cure existing symptoms, in the absence of longterm observations, it remains an open question whether oral treatment can prevent further complications or evolution to chronicity (stage III). For these clinical pictures there is also a tendency to give high dose parenteral antibiotics, and ceftriaxone is likely to win favour. In stage II Lyme borreliosis, autoimmune processes occur which scarcely respond to antibiotics any longer. Nevertheless, parenteral administration of high dose antibiotics remains sensible as a means of eradicating pathogens from the tissues, CSF or synovial fluids, and to avoid further complications. Evaluation of the therapeutic effects of corticosteroids or other immunosuppressive agents would require prospective studies.

Anti-Bacterial Agents↗
PubMed1990

[Diagnostic value of various laboratory parameters in acute pancreatitis].

In 427 samples of serum and urine, collected during their stay at hospital from 40 patients affected with acute pancreatitis, the sensitivity and the specifity of total amylase and lipase in serum, total amylase and pancreas isoamylase in urine, as well as the amylase-/creatinine clearance were determined. The pancreas isoamylase in serum was used as reference value. It appeared that the sensitivity of the lipase was next to that of the pancreas isoamylase in serum, even in limit ranges. Usually the lipase stayed pathological the longest and could therefore be used to identify in the best way even an easing-off pancreatitis. The diagnostic accuracy of the total amylase in serum and urine, of the pancreatic isoamylase in urine and of the amylase-/creatinine clearance was found to be obviously less reliable. The specifity of all examined tests was reduced in patients with renal insufficiency, liver disease, alcohol abuse and in patients with abdominal pains of non pancreatic origin. Concluding form our results and with regard to the expenditure of laboratory technique and to the time required by the methods of determination, we found that of all the examined parameters, the lipase was the most convenient for both emergency and routine diagnose of an acute pancreatitis.

Acute Disease↗
PubMed1989

[Diagnostic possibilities and limitations in Lyme borreliosis].

In Switzerland 5-35% of Ixodes ricinus ticks are infested with Borrelia burgdorferi (B.b.). There is a high risk of transmission of this infectious agent from any tick bite and 4-5% of affected subjects subsequently contract evident Lyme borreliosis. However, both tick bite and erythema chronicum migrans are unreliable diagnostic pointers as they are not usually found in the history of Lyme borreliosis patients. Similarly, an increased titer of antibodies against B.b. is not evidence of Lyme borreliosis, since this increased titer is found in some 10% of the healthy population. Finally, even a negative antibody titer does not rule out the diagnosis. The special problems of diagnosis are investigated in 7 patients with articular Lyme borreliosis and 9 patients with CNS symptoms. Articular Lyme borreliosis must be diagnosed by elimination even where there is an increased titer of antibodies against B.b., since neither the clinical picture, nor laboratory analysis of the synovial fluid, nor histologic and radiologic investigations show specific findings. There is a wide spectrum of neurologic symptoms. Diagnosis is easiest in cases with typical clinical findings (meningopolyneuritis), but in all other cases it is still by elimination. Among laboratory tests, calculation of an antibody index has proven helpful. Nevertheless, it is not always possible to differentiate Lyme borreliosis from encephalomyelitis disseminata. Antibiotic treatment has been tried in doubtful cases.

Adolescent↗
PubMed1989

[Tumor markers and immunomodulator substances in ascites--their value as screening and diagnosis parameters].

The object of this study was to determine the known laboratory parameters, tumor markers and immunomodulatory substances in 69 ascites of various etiology, and to test their diagnostic significance. The usual parameters such as protein content, LDH ratio, albumin quotient and albumin gradient, fibronectin, cholesterol and cell count did not reliably differentiate the etiology in each particular case, although the mean values of the various groups differed significantly. Even cytological investigation was negative in 6 out of 29 malignant ascites. Neither were the immunomodulatory substances such as neopterin, beta 2-microglobulin and interleukin-2 receptors suitable for differentiation. In patients with carcinoma of the prostate the values of prostate-specific antigen were significantly increased in ascites. The best separation between benign hepatic or cardiac ascites and malignant ascites was provided by ferritin (sensitivity 97%, specificity 100%). The values in benign hepatic or cardiac ascites were lower than 150 ng/ml and those in malignant ascites higher than 170 ng/ml.

Adjuvants, Immunologic↗
PubMed1989

[Diagnostic value of a diagnostic strip for determining urinary amylase].

The semiquantitative determination of amylase in urine with a stick-method has produced controversial results as to its diagnostical significance. In our study we compared the result of the Rapignost-test with the simultaneously measures activity of enzymes (total amylase, pancreatic isoamylase in serum and urine and lipase) in 323 samples of serum and urine taken from 32 patients affected with acute pancreatitis. On the 1st day of hospitalization Rapignost was positive in only 17 out of 32 cases. Both sensitivity and specificity of the test depended of the values referred to. Near range limits and in cases with slight or average increase of the enzymes, the correspondence of Rapignost results were unsatisfactory. We found a good correspondence in cases with normal low and excessively high values of the enzymes. On the whole, Rapignost showed the best correspondence with the pancreas isoamylase in urine. The result of Rapignost was also positive in 5 out of 15 cases with extrapancreatic increased urinary amylase, which confirms its lack of organ specificity. From case to case, the -, and + + test results of Rapignost did not lead to any conclusions as to the absolute values of the enzymes in serum and urine. Our results show that Rapignost does not offer enough safety either to confirm or to exclude an acute pancreatitis, and especially it should not be used as a screening test in emergency diagnostics. The determination of the enzyme, in particular in serum, can not be eluded.

Adult↗
PubMed1989

[Upper abdominal pain].

We report a female patient in whom the false diagnosis of acute pancreatitis was made, based on intensive epigastric pain and a four fold increase of amylase. The normal values for lipase and decreased values for the urinary amylase were suggestive of a constellation of macroamylasemia. Further investigations revealed a fresh ulcer in the bulbus duodeni as cause of the epigastric pain. With a therapy of cimetidine and antacids painlessness could be achieved within few days.

Abdomen, Acute↗
PubMed1989

[Extrapancreatic hyperamylasemia. Diagnostic value of isoamylase and lipase determination].

The P- and S-isoamylase and lipase of 72 patients with extrapancreatic hyperamylasemia were determined and their diagnostic value checked to rule out a pancreatic origin. The hyperenzymemia was generally slight although extremely high values were observed in isolated cases. The increased serum amylase results were more often caused by P-, rather than S-isoamylase, while in 28% of cases lipase was also increased. In lung diseases, anorexia and disorders of the head organs only S-isoamylase was pathologically increased while P-isoamylase and lipase remained normal. In other entities such as liver, stomach and intestinal diseases, functional disorders, acidosis, infections, etc., the isoenzymes and lipase showed a variable tendency to increase. Thus, extrapancreatic hyperamylasemia could not always be identified by detection of isoamylases or with the aid of lipase determinations. Overall, however, lipase more often remained in the normal range and was therefore more useful than determination of the isoamylases in differentiating hyperenzymemia.

Acidosis↗
PubMed1988

[Streptococcus bovis bacteremia and colonic diseases].

Four febrile patients were found to have a bacteraemia or endocarditis caused by Streptococcus bovis. Although there were no gastrointestinal symptoms, polyps in the colon, of a high degree of malignancy, were discovered in three. In the fourth, carcinoma of the colon, requiring resection, was found seven years after Streptococcus bovis endocarditis. The polyps were removed by endoscopy and the Streptococcus bovis infection in all cases cured by penicillin. All four patients had accompanying resistance-lowering illnesses, which favoured microbial invasion.

Adenocarcinoma↗
PubMed1988

[The epidemiology of Borrelia burgdorferi infections. A pilot study from the Männedorf area].

Only a few investigations have been conducted into the incidence of Lyme borreliosis and the prevalence and clinical value of increased antibody titers against Borrelia burgdorferi. We prospectively examined 241 persons and found increased titers in 23 (9.5%); only two of them had a history of Lyme borreliosis. The concentrations of increased IgG-antibody titers in healthy persons were comparable to those in patients with actual Lyme borreliosis. In the latter, IgM-antibodies were frequently absent. Our results suggest an infection rate of about 10% in this region of Switzerland. They further emphasize that the diagnosis of Lyme borreliosis must primarily be established clinically and by exclusion of other etiology.

Adult↗
PubMed1986

[Erythema migrans. The clinical spectrum of Borrelia burgdorferi infection].

17 patients with acute and chronic symptoms of Borrelia burgdorferi infection are described. These cases, which were diagnosed within a short period of time at the Männedorf-Zürich hospital, suggest that Erythema migrans disease is likely to be frequent in Switzerland as well as elsewhere.

Acrodermatitis↗
PubMed1985

The microvasculature of the small-intestinal mucosa of the rat: quantification of hemodynamic effects of topically applied cimetidine, ranitidine, somatostatin, and vasopressin.

The influence of topically administered cimetidine, ranitidine, somatostatin, and vasopressin on microvessels of the jejunal villus of the rat was investigated by means of an in vivo videomicroscopy technique. For all substances a dose-response curve concerning the change of vessel diameters was obtained. All four drugs induced a significant vasoconstriction at the capillary level. Maximum vasoconstriction was achieved with vasopressin. These results strongly suggest the presence and possibly importance of H2 receptors in the intestinal vascular bed of the rat.

Animals↗
PubMed1979

[Pseudocysts and retention cysts in acute and chronic pancreatitis (author's transl)].

42 cases of pancreatic cyst in acute (22 cases) pr chronic (20 cases) pancreatitis were seen between 1962 and 1976. Analysis of the case data revealed the following: (1) exact assignment of the cyst to acute or chronic pancreatitis is often possible only by long-term observation; (2) the cysts of chronic pancreatitis are not a uniform group: some (8 cases) apparently occurred in acute pancreatitis through necrotic episodes (pseudocysts), others (12 cases) by a retention mechanism; these "retention cysts" develop later in the course of chronic pancreatitis than the pseudocysts and produce a different clinical picture with better prognosis; (3) barium meal and retrograde cholangiopancreatography proved of diagnostic value' (4) if the cysts persist for more than six weeks operation is indicated because of the high incidence of complications.

Acute Disease↗