Spironolactone-associated hyponatremic coma.
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Aged↗
Biomedical subjects
M M Hirschl
Publications and source records attributed to M M Hirschl.
A new preparation of nifedipine for sublingual application in hypertensive urgencies.
A new preparation of nifedipine for sublingual application in hypertensive urgencies was investigated in a prospective study. Patients admitted to the Emergency Department with a persistent elevation of systolic blood pressure (SBP) greater than 190 mmHg and/or a diastolic blood pressure (DBP) greater than 100 mmHg received nifedipine 10 mg sublingual with a sprayer. A second dose was administrated fifteen minutes later if an adequate response defined as a stable reduction of SBP below 180 mmHg and DBP below 100 mmHg had not occurred. Of 30 patients, 21 (70%) responded to the first nifedipine application, 7 responded to the second dose, and 2 nonresponders had to be treated with urapidil. Overall mean SBP was 206 +/- 19 mmHg and mean DBP was 113 +/- 15 mmHg before treatment, and a significant antihypertensive effect was noted within fifteen minutes after nifedipine spray (p < 0.05). The maximum antihypertensive effect was for SBP in sixty minutes (146 +/- 19 mmHg) and for DBP after one hundred twenty minutes (78 +/- 18 mmHg). The average reduction in SBP was 29% and in DBP 31%. In first-dose responders (n = 21) a significant antihypertensive effect was noted within fifteen minutes. SBP declined from 205 +/- 21 to a minimum of 142 +/- 15 mmHg (22.3%) after sixty minutes and DBP from 113 +/- 13 to a minimum of 77 +/- 11 mmHg (22.2%) after one hundred twenty minutes. In second-dose responders (n = 7) a significant antihypertensive effect was noted within thirty minutes.(ABSTRACT TRUNCATED AT 250 WORDS)
Administration, Sublingual↗
Intravenous urapidil versus sublingual nifedipine in the treatment of hypertensive urgencies.
In a 6-month prospective study, the efficacy and safety of urapidil and nifedipine in an outpatient population with hypertensive urgencies (systolic blood pressure > 200 mm Hg; diastolic blood pressure > 110 mm Hg) was investigated. Response to treatment was defined as a stable reduction of systolic blood pressure below 180 mm Hg and diastolic blood pressure below 100 mm Hg 15 minutes after application of a single dose of either 25 mg urapidil intravenously (N = 26) or 10 mg nifedipine sublingually (N = 27). If the blood pressure was still elevated, a second dose of 10 mg nifedipine or 12.5 mg urapidil was given, and blood pressure response was evaluated 15 minutes after application of the second dose according to the aforementioned criterias. After the first application of nifedipine, 19 (70%) responders have been observed. Eight patients needed an additional 10 mg of nifedipine. In four of these patients, no reduction of blood pressure was observed after a second dose of nifedipine. In contrast, 24 (92%) patients responded well to the first application of 25 mg of urapidil. Two patients required a second dose of 12.5 mg of urapidil, but no nonresponder to urapidil was observed. No severe side-effects were noted in both groups. Intravenous urapidil is a highly effective drug in the treatment of hypertensive urgencies and is more effective than sublingual nifedipine, because the number of patients treated successfully was significantly higher.
Acute Disease↗
Comparison of three methods for the determination of the sensitivity of Helicobacter pylori to metronidazole.
A comparison of various methods for the determination of the sensitivity of Helicobacter pylori to metronidazole was undertaken. The validity of the agar dilution, the disc diffusion and the Epsilometer (E) test was studied using a total of 86 strains, 16 of which were known to be resistant to metronidazole. All tests were carried out on Mueller-Hinton agar with 5% sheep blood. The results of the disc diffusion and the E-test were highly significantly (P < 0.001) associated with those of the agar dilution test, which was taken as a standard (r = -0.96 and r = 0.96, respectively). Investigation of the accuracy of the repetitive (n = 10) testing ten sensitive and one resistant strains, showed that the disc diffusion test led to a systematic and significant (2p < 0.001) underestimation of the MIC values calculated from the inhibition zone diameters via linear regression. In contrast, the results of the E-test did not differ significantly from those of the agar dilution test. The precision of the agar dilution test was significantly worse (2p < 0.005) than the E-test and the disc diffusion test. Because of its accuracy and significantly better precision, the E-test is recommended as the best and simplest method for routine antibiotic sensitivity testing of H. pylori.
Culture Media↗
Microcirculation of nailfold capillaries in chronic hemodialysis patients with and without diabetes mellitus.
The present study was intended to determine whether hemodialysis patients with arteriovenous fistula showed changes of microcirculation in the upper extremity. In addition, the study was to show whether such changes were correlated to the shunt parameters, such as the shunt flow volume, and whether the presence of diabetes mellitus had any additional influence. The study included 43 patients undergoing chronic hemodialysis; ten of the 43 patients were diabetics. Morphological and hemodynamic parameters of microcirculation were determined using quantitative capillaroscopy, flow volume in the brachial artery and shunt flow were measured by means of pulsed Doppler ultrasonography. While the morphological microcirculatory parameters did not show any differences between shunt arm and contralateral side, statistically significant differences were seen for resting blood cell velocity and for the time to peak capillary blood cell velocity after reactive hyperemia. For the latter a correlation to the shunt flow volume could also be demonstrated for nondiabetic patients. As expected, the time to peak blood cell velocity after reactive hyperemia was prolonged in both arms of patients with diabetes mellitus. Apparently, diabetes mellitus had a more pronounced effect on hemodynamic parameters than the Cimino shunt. This and the shunt flow will result in a Raynaud symptomatology. Other symptoms associated with chronic hemodialysis are mainly related to the duration of hemodialysis.
Arm↗
Long-term follow-up of renal transplantation in type 1 and type 2 diabetic patients.
This study evaluated the long-term outcome of renal transplantation in type 1 (n = 25) and type 2 (n = 18) diabetic patients. Overall postoperative survival at 1 year was 69% in type 1 diabetes and 75% in type 2; at 5 years it was 62% in type 1 diabetes and 58% in type 2. Death was due mainly to cardiovascular disease (60%) and septic gangrene (20%). Outcome was examined in terms of graft function, which was poor in the majority (86%) of patients who died. Patients with fatal outcome suffered major vascular complications prior to renal transplantation and frequently had impaired graft function. Metabolic control was better in patients with good graft function (HbA1c < 6.2%) than in those with poor or no function of kidney transplant (HbA1c > 9.8%). In the absence of severe vascular complications renal transplantation may be the treatment of choice for both type 1 and type 2 diabetic patients with end-stage renal disease. Otherwise, renal transplantation is not able to improve the prognosis of patients with a history of severe vascular complications prior to renal replacement therapy.
Adult↗
Renal replacement therapy in type 2 diabetic patients: 10 years' experience.
The objective of this study was to determine the impact of renal transplantation and hemodialysis treatment on outcome of elderly diabetic patients with end-stage renal disease (ESRD) among other factors related to survival. Results of treatment of ESRD in 78 patients with non-insulin-dependent diabetes mellitus (type 2) showed a survival rate of 58% at 1 year and 14% at 5 years, independent of treatment modality. Patients who received a renal allograft had a higher survival rate as compared with patients on hemodialysis treatment (5-year survival, 59% v 2%; P < 0.005). Diabetic patients with a history of myocardial infarction, stroke, or peripheral gangrene before onset of renal replacement therapy had a worse prognosis in comparison to patients without vascular complications (5-year survival, 2% v 21%; P < 0.05). Analysis of patients who survived less than 6 months and more than 24 months was performed. Long-term survivors were slightly younger, had diabetes for a shorter period, and showed a better metabolic control of diabetes mellitus. Sixteen long-term survivors received a renal allograft. In contrast, only three short-term survivors were transplanted. Furthermore, short-term survivors also had a greater than 70% incidence of severe vascular complications before renal replacement therapy. A history of myocardial infarction, stroke, or peripheral gangrene is an independent predictor of decreased survival, irrespective of whether the patients were transplanted or maintained on chronic hemodialysis treatment. In contrast, renal transplantation improved survival of elderly diabetic patients without vascular complications and should be the treatment of choice in this specific group of patients.
Aged↗
[Incidence of acute mountain sickness at intermediate altitude in the Austrian alps].
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Adolescent↗
Accumulation of pneumocystis carinii pneumonia in patients after kidney transplantation.
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Austria↗
Comparison of plasma separation and immunospecific LDL-elimination in severe hypercholesterolemia.
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Adolescent↗
Arterial baroreflex sensitivity and blood pressure variabilities before and after carotid surgery.
Carotid surgery is frequently associated with postoperative blood pressure alterations. The role of baroreceptors with regard to these alterations was assessed in 50 patients by determining the pre- and postoperative mechanoreceptor sensitivity after Valsalva maneuver and intravenous injections of angiotensin and nitroglycerine as described by Smyth, Sleight and Pickering. In addition, blood pressure was monitored perioperatively and renin and aldosterone levels were measured. In patients with arterial hypertension a postoperative increase of receptor reactivity can be seen necessitating a reduction of antihypertensive therapy in more than 50% of cases. In normotensive patients no uniform response can be observed. A possible explanation for this effect might be the local increase of pressure in the operated vascular segment. The postoperative reintegration of receptor areas which had been adjusted to a reduced pressure level might induce a more sensitive response than can be seen for the remaining receptors, which usually are less responsive in hypertensive patients.
Aged↗
Evaluation of a commercial latex test for serological diagnosis of Helicobacter pylori infection in treated and untreated patients.
The value of a commercially available latex test (Pyloriset) for the diagnosis of Helicobacter pylori infection by demonstration of specific antibodies was compared with that of direct diagnostic methods such as culture, biopsy-urease test and microscopy of fuchsin-stained smears. The sera were from 136 patients who prior to this study either had or had not been treated for Helicobacter pylori-infection simultaneously with amoxicillin (3 x 750 mg/day) and metronidazole (3 x 500 mg/day) for 12 days. On average, the sensitivity of the test was 90%. The specificity with sera from untreated patients was 75.9%; with sera from treated patients specificity was 22.2%, 28% and 20% 1, 3 and 6 months respectively after start of treatment. Only as late as one year after the onset of chemotherapy did the specificity return to 67%. Because of its low specificity this test does not offer any advantage over other tests in the detection of Helicobacter pylori-infection or in monitoring the chemotherapeutic success.
Amoxicillin↗
Decreased postheparin lipolytic activity in renal transplant recipients with cyclosporin A.
The patterns of hyperlipidemia in renal transplant recipients (RTRs) are more variable than in the uremic state, showing increases in both very low-density lipoprotein (VLDL) and low density lipoprotein (LDL). This has been attributed, at least in part, to immunosuppressive therapy, especially to treatment with corticosteroids. Postheparin lipolytic activity (PHLA) was determined in 28 RTRs. Sixteen patients presenting with hyperlipidemia comprised group A, who were aged 49.8 +/- 13.5 years, and had a cholesterol of 8.24 +/- 1.86 mmol/liter, triglycerides of 6.02 +/- 3.33 mmol/liter. Twelve patients presenting cholesterol and triglyceride values within the normal range were in group B, and were aged 48.6 +/- 13.3 years. All RTRs received cyclosporin A (CsA) twice daily orally, which were divided in two equal doses and adjusted to provide CsA blood trough levels (RIA) in a range of 250 to 350 ng/ml. Twenty-one RTRs were additionally treated by alternate-day corticosteroids, whereas seven patients had CsA on their sole immunosuppressive agent. PHLA (mumol free fatty acids/ml/hr, given 10 and 20 min after 100 U/heparin kg body wt intravenously) was commonly reduced in RTRs (group A at 10/20 min: 5.6 +/- 1.1/5.26 +/- 1.2; group B: 8.26 +/- 2.91/8.38 +/- 3.44) as compared to the values obtained in healthy controls (15.3 +/- 2.9/17.2 +/- 5.0). This was mainly due to a reduction of the activity of the hepatic triglyceride lipase, and to a minor extent to a reduced activity of peripheral lipoprotein lipase. There was no statistically significant difference of PHLA in RTRs with or without corticosteroid treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Adrenal Cortex Hormones↗
Anti-interleukin-1 alpha autoantibodies in hemodialysis patients.
IL-1 activity is increased in hemodialysis patients and interest has recently been focused on IL-1 antagonism in various clinical settings. We studied the presence of anti-IL-1 alpha autoantibodies in sera from 49 hemodialysis patients, 159 kidney graft recipients and 89 chronic renal failure patients without renal replacement therapy. Within the three month study period 32.6% of the hemodialysis patients were found to present with anti-IL-1 alpha autoantibodies, in contrast to 5.6% of kidney graft recipients, 8.9% of chronic renal failure patients, and only 1.4% of healthy subjects. The presence of these autoantibodies was neither associated with primary kidney disease nor with the type of dialysis membrane we used. In addition, in antibody positive patients a pronounced increase of IL-1 alpha serum levels within a dialysis session from 14.8 +/- 4.7 pg/ml to 26.4 +/- 11.2 pg/ml (P less than 0.0005) was observed, contrasting to the more even increase from 14.1 +/- 3.1 pg/ml to 19.3 +/- 12.7 pg/ml (P less than 0.05) in the antibody negative group. Neither clinical symptoms due to adverse effects of IL-1 alpha nor some influence on erythropoiesis mediated by IL-1 alpha could be envisaged. Thus, we believe, that anti-IL-1 alpha autoantibodies, present in high frequency in hemodialysis patients, have a neutralizing effect on IL-1 alpha in these patients.
Aged↗
[Moenckeberg media sclerosis: clinical aspects in diabetic patients].
We assessed in 1662 consecutive diabetic patients systolic arm-ankle indexes by a Doppler ultrasonic method. In those patients with indexes greater than or equal to 1.3 directional Doppler sonometry and mercury strain gauge plethysmography were performed. In some instancies electronic oscillography, duplex sonography and vital microscopy were additionally done. In 4.45% of the patients functional findings of a mediasclerosis could be encountered. Location of arterial mediacalcinosis was documented by x-ray examinations. Sensitivity of none invasive methods was merely 100%, specificity ranged from 96% (Dopplersonometry) to 80% (Duplexsonometry). In 18.9% an occlusive arterial disease could additionally be found. Mediasclerosis preferentially was encountered in Type II diabetics of older age. In this group painful distal neuropathy in many instances existed mimicking claudication, retinopathy and nephropathy was as frequent as in other diabetics. Normal or elevated Doppler indexes did not exclude occlusive arterial disease whereas diabetics with mediasclerosis and ulcero-gangreneous lesions or amputations in most of the cases did not have occlusive arterial disease.
Adult↗
[Extra- and intracranial Doppler ultrasound. Evaluation of patients with surgical anastomosis of the arteria temporalis superficialis superficialis and arteria cerebri media].
During a mean postoperative period of 16 months, 51 patients who had received an extracranial-intracranial (EC-IC) arterial bypass were examined by means of transcranial and extracranial Doppler ultrasound, with the following results: the flow velocities of the middle cerebral artery (MCA) are postoperatively significantly lower than in normal control subjects. No differences were seen if the MCA was supplied via the EC-IC bypass or via any "natural" collateral vessels. In 32 cases, blood supply of the MCA artery was provided via the EC-IC bypass. In another 13 cases the MCA was supplied via the contralateral carotid artery and in six further cases via other collateral vessels. In the extracranial area, an internalisation of the flow pattern of the superficial temporal artery was found if the bloodstream from the anastomosis passed through the MCA. Similar changes at the external carotid artery were mainly due to the changed haemodynamics resulting from the extracranial occlusion of the internal carotid artery. No correlation was found between the clinical neurological course and haemodynamic data. The only indication for the EC-IC bypass, as we see it at the moment, is prophylactic surgery, such as, for example, treatment of giant aneurysms and definitely insufficient crossflow. All other indications that have been suggested after the publication of the results of the EC-IC Bypass Study Group will have to be confirmed by further study.
Aged↗
Carotid endarterectomy (CE) of the internal carotid artery (ICA) with and without patch angioplasty: comparison of hemodynamical and morphological parameters.
The aim of this study was to show, if patch angioplasty or direct closure of the blood vessel following carotid endarterectomy of the ICA resulted in any hemodynamical or morphological differences. Studies were carried out in eighteen and twenty patients, respectively within an average postoperative period of twenty-six month. All patients were examined with continuous-wave Doppler ultrasound, multi-channel pulse Doppler ultrasound and Duplex ultrasonography scanning. Comparing the two groups, differences are predominantly found at or near the site of the endarterectomized segment. Patients who received PTFE (Gore-Tex) patch angioplasty to close the arteriotomy, show in about 50% of all cases a dilatation--pantaloon effect (10)--at the carotid bifurcation (lumina greater than 1.1 cm) when investigating the vessel lumen with duplex sonography. This results in a statistical significant increase in turbulent flow disturbances at the bulb and the origin of the ICA. Furthermore, ICA flow velocity patterns after the endarterectomy point are still within the normal range when compared with patients not receiving a patch plasty, but still significantly elevated. Changes of the vessel wall, as such as intima elevation and intraluminal deposits are more frequently found distal to the endarterectomized segment and do obviously reduce the lumen. However, changes of flow volumina were not quantifiable. Atherosclerotic patients who underwent surgical treatment show as a characteristic finding due to atherosclerosis, a less laminar flow-pattern within the whole extracranial area, when compared with a normal healthy population.
Aged↗