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Biomedical subjects

R Streuli

Publications and source records attributed to R Streuli.

At least 19 recordsLinked to original sources
PubMed2000

[Anemia, subcutaneous bleeding and weight loss. Disseminated metastasizing, mucinous adenocarcinoma of the stomach].

A 69 years old female patient was admitted to the hospital with anemia, loss of appetite and weight since three months. The physical examination showed extended cutaneous bleedings. Laboratory tests revealed a hemolytic anemia with fragmented erythrocytes. The bone marrow examination was characterized by erythroid hyperplasia and an invasion by mucin-producing adenocarcinoma cells. Upper endoscopy detected a small hiatal hernia with mucosal erosions between esophagus and stomach. The histology of the mucosal biopsy identified a poorly differentiated mucin-producing adenocarcinoma with portions of signet-ring cells. X-ray examination revealed osteoplastic bone metastases of the vertebrae and of the pelvis. We diagnosed a disseminated, mucin-producing adenocarcinoma of the stomach, associated with microangiopathic hemolytic anemia. In spite of rapidly begun chemotherapy with adriamycin and daily blood transfusions the woman died after four weeks.

Adenocarcinoma, Mucinous↗
PubMed1999

[Extrajudicial expert assessment--what is the basis for complaints against internists?].

In 1981, the Swiss Medical Association (FMH) set up an expert medical evidence office, from which patients or their dependents could request an extra-judicial expert report in cases of suspected error in diagnosis or treatment. Up to the year 1995, this office issued a total of 1675 expert reports, of which 109 were for the specialty of Internal Medicine. Since the office was founded, the number of expert witnesses called upon has continued to increase. The most common accusation was "failure to investigate or delay in investigation" (41 times, 48.2%) followed by the accusation of a "diagnostic error" (35 times, 41.2%). In 13 cases (20%) the expert report confirmed there had been a medical error, 46 (70.8%) negated such a finding, and no firm conclusion was reached in 6 expert reports (9.2%). Expert reports are very often requested by patients with malignant neoplasms, particularly if the disease is first diagnosed at an advanced stage, and these are associated with the most frequent accusation of delayed investigation. Communication problems between doctor and patient are a recurrent theme throughout the expert reports and this shows the importance of taking the patient's concerns seriously, of a well-founded explanation, and of being ready to discuss matters.

Expert Testimony↗
PubMed1998

[Severe hepatocellular damage after administration of paracetamol and chlorzoxazone in therapeutic dosage].

A 64 year old patient developed severe hepatocellular damage with jaundice and coagulopathy during ingestion of a combination of paracetamol and chlorzoxazone in therapeutic dosage. The risk factors for the development of liver cell necrosis following ingestion of paracetamol in therapeutic dosage are discussed. In particular in patients with risk factors (e.g. alcoholics and patients with heart failure) paracetamol-induced liver failure has to be considered in the presence of high transaminases, even when paracetamol was ingested in therapeutic dosage. Chlorzoxazone itself rarely can induce an idiosyncratic hepatocellular damage.

Acetaminophen↗
PubMed1997

[Convulsive seizure].

A formerly healthy 14-year old boy with difficulties at school was admitted after two generalized seizures. Blood samples taken in the emergency room revealed normal serum-values for glucose and magnesium, but low calcium and elevated phosphorus. First evaluations showed normal age-related psychophysical development, serum-PTH was elevated and serum-1,25(OH)2D was normal. A CT-scan disclosed symmetric intracerebral calcifications. Further investigations confirmed the diagnosis of pseudohypoparathyroidism type 1B. Adequate treatment with calcium and calcitriol normalized serum-calcium, phosphorus and serum-PTH. Interestingly, school performance improved, as did personal activity.

Adolescent↗
PubMed1996

[Jaundice, anemia and mitral valve insufficiency following mitral valve reconstruction].

A 33-year-old man was admitted because of jaundice. Five months ago a reconstruction of the mitral valve was performed because of mitral valve insufficiency. There was a history of heroin dependence until three years ago. Laboratory tests showed normochromic normocytic anemia, increased nonconjugated serum bilirubin, decreased plasma haptoglobin, hemoglobinuria and hemosiderinuria. The peripheral blood smear contained numerous fragmented red cells, and the bone marrow showed a markedly increased erythropoiesis and absent iron stores. The clinical examination as well as echocardiography revealed severe mitral valve insufficiency; therefore, a mitral valve replacement was performed. Introperatively the mitral valve showed ruptured chordae tendineae of the posterior leaflet and a leaking stitch of the anterior leaflet. We diagnosed a macrovascular hemolytic anemia with subsequent mechanical injury and fragmentation of red cells on a dysfunctioning mitral valve.

Adult↗
PubMed1995

[Systemic fibrosis (generalized form of Ormond's disease). Report of a case which achieved complete remission with cyclophosphamide and corticosteroids].

A 51-year-old engineer was admitted with progressive lower back pain which had started 4 months before. We found an elevated ESR and anemia. Chest X-ray showed bilateral polycyclic thickening of the pleura, and abdominal CT examination revealed a paraaortic tumorous lesion and a solid kidney tumor with a diameter of 5 cm on the left side. During the course of the disease we also observed an infiltration in the apex of the upper lobe of the left lung. Histological examination showed fibrotic tissue typical of Ormond's disease in the kidney tumor as well as in the pulmonary infiltrate. We diagnosed a systemic form of retroperitoneal fibrosis. Treatment with cyclophosphamide (combined with prednisone during the first 4 months) resulted in complete remission of the disease.

Antineoplastic Agents, Alkylating↗
PubMed1995

[Obscure impairment of consciousness].

A 60-year-old woman was admitted because of impairment of consciousness, vomiting and urinary incontinence. The CT-scan of the brain (without contrast agent) showed slight hypodensities in the areas of the basal ganglia. The great cerebral vein produced a very high intensity signal. We diagnosed an aseptic venous thrombosis of the great cerebral vein. The neurologic deficits increased, and an apallic syndrome was diagnosed in spite of heparin treatment. Causes of aseptic cerebral venous thrombosis are discussed.

Cerebral Veins↗
PubMed1992

[Fibrinolysis in a regional hospital].

From January 1, 1989 to September 30, 1990, 116 patients with acute myocardial infarction were hospitalized at the regional hospital of Langenthal. Of those 116 patients, 27 (23%) were treated with intravenous streptokinase; in 12 of them (44%) CPK reached its peak within 6 hours after starting lysis; all were admitted within 4 hours after the beginning of chest pain. Of the fibrinolyzed patients, 18 (67%) had arrhythmias which needed to be treated. In 10 of these 18 patients CPK reached its peak within 6 hours. Of the 89 patients not treated with streptokinase, 27 (30%) did not fulfill the entry criteria of the protocol, 16 (18%) had exclusion criteria, and 46 (52%) had exclusion criteria as well as absent inclusion criteria. In only 4 patients (4.5%) was lysis not possible because they entered hospital later than 6 hours after the beginning of pain, and 8 patients (9%) exceeded the upper age limit of 70 years. Of the 116 patients, 13 (11.2%) died; 12 were not treated with streptokinase. Our study shows that fibrinolytic treatment with streptokinase is a safe and effective therapy for patients with acute myocardial infarction and can easily be performed in a regional hospital.

Adult↗
PubMed1991

[Autologous blood transfusion in elective orthopedic surgery].

Despite extensive testing, blood transfusions still involve a minor risk of transmitting infections. Autologous blood transfusions (ABT) are safe in this respect. Within 31 months 145 of 149 patients were enrolled in this hospital's ABT program, the majority with planned total hip replacement. The mean age of the patients was 68.5 years. 72 patients donated 3 and 52 patients 2 units of blood, while 21 patients donated 1 unit. In 70 of the 145 patients (48%) the blood losses were covered by autologous blood. Of the 72 patients who donated 3 units, 50 (69%) did not depend on homologous blood. We observed only minor side effects in patients enrolled in the program. The establishment of an ABT program does not require complicated logistics, and almost every patient awaiting elective surgery is eligible for ABT.

Adolescent↗
PubMed1991

Perhexiline maleate-induced hepatitis.

We report on a case of perhexiline maleate-induced hepatitis secondary to a long-term administration of recommended daily dosages of 300 mg. The patient had a spectacular weight loss of 29 kg. He developed hepatitis, which subsided after drug withdrawal. Our electron-microscopic findings with the typical inclusion bodies and impaired hydroxylation capacity point to an underlying metabolic disorder as the pathogenetic mechanism.

Angina Pectoris↗
PubMed1990

[Paroxysmal non-hereditary angioedema].

Recurrent hypovolaemic shock had been occurring over the last five and four years, respectively, in a 53-year-old woman and a 46-year-old man who had previously been healthy. The attacks were characterized by a tension feeling and sometimes oedema in the limbs, as well as increased thirst. Within a few hours sweating, tachycardia, orthostatic complaints and shock would occur. The woman's systolic blood pressure would fall to 70 mm Hg and the pulse rate rise to 150/min. The man's blood pressure was not measurable by sphygmomanometer during his first attack. Haematocrit rose to 61 and 71.5%, haemoglobin concentration to 20.7 and 21.3 g/dl, respectively. On administration of plasma expanders all abnormal clinical and biochemical changes quickly disappeared, only to recur within weeks or months. The cause of the condition is an increased permeability of the tissue capillaries, while renal, pulmonary and cerebral vessels apparently are unaffected. During ketotifen and tebonin (gingko biloba extract) administration to the man, he required no further hospitalization for nine months, after which he had three severe attacks. The woman had a severe attack of hypovolaemic shock one month on this treatment. The prognosis of capillary leak syndrome is bad.

Angioedema↗
PubMed1988

[Salmonella enteritis with a serious course in patients without a suppressed immune system].

Infections with salmonellae causing gastroenteritis rarely lead to bacteremia (1-4%), and serious courses are almost exclusively observed in patients with a compromised immune system. In 1986-1987 we observed 4 patients with no evidence of disturbed cell-mediated immunity, who presented with severe bacteremic salmonellosis (1 patient with S. Heidelberg and 3 with S. enteritidis). 1 patient had septic shock with rhabdomyolysis, 1 patient acute renal failure and 1 patient acute endocarditis.

Acute Kidney Injury↗
PubMed1987

[Erythroleukemia in multiple myeloma. A case report].

Since the beginning of the seventies there have been an increasing number of reports of second malignancies in patients treated with cytotoxic agents. The commonest of these malignancies are acute nonlymphocytic leukemias. Such occurrences are also known in patients with multiple myeloma treated with melphalan. In a 74-year-old female with multiple myeloma treated with melphalan for 19 months, erythroleukemia developed 23 months after the start of treatment. The second malignancy has almost entirely displaced the myeloma cells in the marrow. In consequence, the paraprotein gradient in electrophoresis diminished in size.

Aged↗
PubMed1987

Comparative diagnostic value of the calcium-pentagastrin test versus the tolbutamide test in a patient with a somatostatinoma.

We describe a patient with a small somatostatinoma of the papilla of Vater without clinical evidence for diabetes mellitus, diarrhea, steatorrhea, or cholelithiasis, showing normal plasma basal levels for somatostatinlike immunoreactivity. The diagnosis was based on histologic and immunohistochemical analysis of tumor tissue and hypersomatostatinemia induced by the calcium-pentagastrin test. Before removal of the tumor both diagnostic tests recommended for the detection of a somatostatinoma, a tolbutamide test and a calcium-pentagastrin test, were performed. Whereas the calcium-pentagastrin test provoked a markedly elevated plasma somatostatin level in association with a depressed plasma neurotensin level, the tolbutamide test surprisingly did not. After removal of the tumor the calcium-pentagastrin test no longer induced hypersomatostatinemia. Further studies are needed to determine whether the calcium-pentagastrin test is a more reliable diagnostic test than the tolbutamide test in somatostatinomas with normal plasma basal levels.

Adenoma, Islet Cell↗