Biomedical subjects

T Jeck

Publications and source records attributed to T Jeck.

At least 19 recordsLinked to original sources

PubMed1998

[Reversible dementia].

A 65 year old woman, referred for differential diagnosis of dementia, presented with cognitive and mnestic deficits. Typical signs and symptoms of hypothyroidism led to the diagnosis of severe autoimmune thyroiditis. After six months of treatment with thyroid hormone, dementia, myopathy and ataxia had disappeared. The neurologic and neuropsychologic manifestations of hypothyroidism are discussed. In dementia the diagnosis of secondary and reversible forms is of great importance with regard to prognosis and treatment. Hypothyroidism is known to be a common and treatable cause of pseudodementia. Early diagnosis and adequate treatment are important to prevent further permanent deterioration of cerebral function.

Aged↗

PubMed1997

Comparison of bezafibrate and simvastatin in the treatment of dyslipidaemia in patients with NIDDM.

Fibrates and HMG CoA reductase inhibitors are commonly used in the treatment of diabetic dyslipidaemia. However, these two groups of drugs have not been compared in diabetic patients in a randomized controlled trial. Therefore, a multicentre study was performed in 73 subjects with non-insulin-dependent (Type 2) diabetes mellitus (NIDDM) and combined hyperlipidaemia (serum cholesterol 6.2-10.0 mmol l(-1), serum triglycerides 2.3-10.0 mmol l(-1)), comparing the efficacy of 400 mg bezafibrate with 10 mg simvastatin in a double-blind fashion. Treatment with bezafibrate during 12 weeks reduced serum triglycerides significantly more than simvastatin (-41% vs -22%, p < 0.001) and increased HDL cholesterol more (bezafibrate: + 17% vs simvastatin: + 9%, p < 0.05). LDL cholesterol levels decreased by 14% (p < 0.001) during simvastatin and increased by 21% (p < 0.01) during bezafibrate. This increase in LDL cholesterol was positively correlated with fasting serum triglycerides (p < 0.001) and was associated with a reduction of the serum apolipoprotein B concentration, suggesting an increase in LDL particle size. Metabolic control of diabetes (fasting glycaemia; HbA1c) and insulin secretion (C-peptide levels) were unaffected by both treatments. The incidence of side-effects during treatment was similar for both drugs. Thus, 400 mg bezafibrate mainly increases HDL cholesterol and lowers serum triglycerides but at the expense of an increase in LDL cholesterol; 10 mg simvastatin lowers LDL cholesterin more effectively but has a smaller effect on HDL cholesterol and triglycerides.

Aged↗

PubMed1996

Local ischemia causes carcinoma-like changes of the rectum.

PURPOSE: Bioptic specimens of typical cancerous changes in the rectum usually reveal signs of malignancy. Our goal was to describe the clinical feature, histologic findings, and long-term outcome of patients in whom typical findings of carcinoma of the rectum were discovered by endoscopy, but whose histologic data did not confirm the diagnosis of a malignant disease. METHODS: We conducted a retrospective review of eight patients seen in our hospital with a clinical diagnosis of colorectal cancer. RESULTS: All patients had typical macroscopic findings of colorectal cancer. Endoscopic examination was performed because of chronic gastrointestinal symptoms (tenesmus, diarrhea, hematochezia, recurrent rectal prolapses; n = 5), incidental masses detected by rectal palpation (n = 2), or acute rectal bleeding (n = 1). Instead of confirming malignancy, all histologic specimens showed typical signs of intestinal ischemia. In three patients, tumors were removed by endoscopy; the other patients received symptomatic therapy. All patients were followed for an average period of 46 months. In five patients, symptoms disappeared completely. Three patients continued to suffer from intestinal discomfort. In one case, progression of ischemic damage led to subtotal stenosis, which necessitated proctectomy. CONCLUSIONS: Our results indicate that, despite its rarity, "ischemic pseudocarcinoma" is an important differential diagnosis to cancer of the rectum. Prognosis is generally good. Only patients suffering from chronic symptoms may require surgical treatment.

Adult↗

PubMed1996

Incidental adrenal mass hampers the diagnosis of an extra-adrenal phaeochromocytoma.

This report describes a 65-year-old woman with a history of phaeochromocytoma and a right-sided adrenal mass. Biochemical findings and localisation procedures suggested an extra-adrenal phaeochromocytoma which was confirmed by surgery. We conclude that an extra-adrenal tumour should be considered in the evaluation of a phaeochromocytoma even if an adrenal tumour is present--the latter may represent an 'incidental' adrenal mass.

3-Iodobenzylguanidine↗

PubMed1994

Primary aldosteronism: difference in clinical presentation and long-term follow-up between adenoma and bilateral hyperplasia of the adrenal glands.

Since 1974 primary aldosteronism has been diagnosed in 71 patients in our outpatient clinic. Thirty-four patients had a unilateral aldosterone-producing adenoma, whereas bilateral adrenal hyperplasia was diagnosed in 37 patients. Although at the time of diagnosis the mean potassium values were lower and mean aldosterone levels were higher in patients with an adenoma, as compared to those with bilateral hyperplasia, these laboratory data did not allow us to differentiate between the two leading causes of primary aldosteronism in the individual patient due to pronounced overlap of laboratory values between the two groups. During the first few years, a successful differential diagnosis was made by adrenal phlebography and separate sampling of plasma aldosterone in both adrenal veins; later non-invasive imaging techniques such as computed tomography and radionuclide scanning were used. The best results were obtained in patients with adenoma who underwent adrenalectomy. Fifty-six percent of these patients were clinically and biochemically cured; 28% were improved and had normal blood pressure values during drug treatment. In contrast, patients with bilateral hyperplasia were treated pharmacologically, but only in half of the patients could normal blood pressure values be achieved. Two thirds of the male patients developed gynecomastia during spironolactone treatment. As expected, unilateral adrenalectomy was unsuccessful in the 7 patients with bilateral hyperplasia who underwent surgery. Our results confirm that surgical treatment of adrenal adenomas and drug treatment of bilateral hyperplasias are the appropriate therapy in primary aldosteronism. A differential diagnosis cannot be made on the basis of clinical and non-invasive laboratory data alone; imaging techniques have to be included in the diagnostic process.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗

PubMed1993

[Ischemic ulcer of stomach and duodenum: an unusual cause of a common disease].

Ischemia is a rare cause of gastric and duodenal ulcers. For the present study clinical and anatomo-pathologic data from cases published so far and from twelve own patients with ischemic ulcers have been investigated. Histopathology leads to the diagnosis of an ischemic cause with great accuracy. Our results show that ischemic ulcers occur often at gastric sites unusual for a peptic ulcer, and in some cases they look macroscopically different from peptic ulcers. The most common symptom was severe gastrointestinal bleeding. Pain, typical for peptic ulcers, has only rarely been noted by patients. Lethal courses were usually due to gastrointestinal bleeding resistant to therapy. Resection of the involved gastric or duodenal segment or surgical or angiologic reconstruction of the vessels respectively are promising therapeutic means. Without therapeutic intervention very different courses have been observed, ranging from spontaneous healing to fatal gastrointestinal bleeding. The benefit of inhibitors of acid secretion is so far unclear.

Aged↗

PubMed1992

[Acceptance of 24-hour blood pressure determination].

In interviews with 247 patients acceptance and behaviour during 24-hour-ambulatory blood-pressure recording were studied. In contrast to previous assumptions it was shown that the blood-pressure profile was not recorded during normal activities for a great part of patients. Very often the patients reduced their activity over the day. Our results show that for wider distribution and applications of this procedure the measuring devices have to be improved. A substantial part of patients experienced the ambulatory blood-pressure recording as an comfortable, such that one of eight patients declined a further recording and 20% of the patients complained about disturbed sleep.

Activities of Daily Living↗

PubMed1992

Comparison of casual, ambulatory and self-measured blood pressure in a study of nitrendipine vs bisoprolol.

In a double-blind, placebo-controlled study the antihypertensive efficacy and tolerability of a single morning dose of either 10 mg bisoprolol (n = 26) or 20 mg nitrendipine (n = 27) were investigated. Blood pressure was measured by three techniques: (1) Casual blood pressure 24 h after the dose; (2) ambulatory 24-h whole-day monitoring; and (3) self-recorded blood pressure in the morning 24 h after the dose (6-8 a.m.) and in the evening (6-8 p.m.). After 4 weeks of therapy bisoprolol had produced a highly significant reduction in blood pressure as assessed by causal, ambulatory day- and night-time monitoring, and self-measured morning and evening readings. Bisoprolol was significantly more effective than nitrendipine, which did not induce a significant reduction in the ambulatory night-time recordings. Whole-day ambulatory blood pressure profiles showed an antihypertensive effect of bisoprolol throughout the entire 24-h period. 24-h blood pressure curves after nitrendipine demonstrated a markedly shorter duration of action, with no reduction in early morning blood pressure. Adverse effects and tolerability of the two drugs were comparable. The average changes in systolic and diastolic blood pressure after bisoprolol and nitrendipine in 2-h periods of ambulatory monitoring (6-8 a.m. and 6-8 p.m.) and self-measured blood pressure (6-8 a.m. and 6-8 p.m.) showed a good agreement between ambulatory and self-measured blood pressure determinations with no significant difference between the methods. The results show that 24 h antihypertensive efficacy was more pronounced for bisoprolol than for nitrendipine at the doses studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗

PubMed1992

Betablocking drugs in essential hypertension: transdermal bupranolol compared with oral metoprolol.

In the present study the antihypertensive efficacy and tolerability of transdermal bupranolol (30 mg once-daily) was compared with oral metoprolol (100 mg once-daily). Blood pressure measurements were performed in the office, at home, and with ambulatory 24-h blood pressure devices. Systemic and local side-effects, as well as compliance and acceptance, were evaluated every two weeks. The treatment period lasted eight weeks. The results showed a significant decrease in blood pressure under the bupranolol transdermal therapeutic system in the office, at home, and with 24-h blood pressure measurements day- (08h00-20h00) and night-time (20h00-08h00). Under oral metoprolol there was a significant blood pressure decrease in the office, at home, and in the mean daytime values of the 24-h blood pressure measurements. The night-time values, however, demonstrated only a slight decrease in blood pressure, being significant only for diastolic values. Systemic side-effects were comparable in both groups. 69% of the patients had local side-effects at the patch side (erythema, papulous exanthema, pruritus). Six patients dropped out because of localized urticarial exanthema (five patients treated with transdermal bupranolol, one patient treated with oral metoprolol). In comparison to the oral form, twice as many patients had admitted to have been non-compliant with the patches (13 versus 7 patients). At the end of the study, 24 out of 32 patients preferred to be treated with capsules.

Administration, Cutaneous↗

PubMed1991

[Performing self-measurement of blood pressure: a patient survey].

In the present study the knowledge of 200 patients of our hypertension clinic about the technique of blood-pressure self-measurement was investigated using a questionnaire of 22 questions. 44-66% of the patients in different age groups measured their own blood-pressure, showing that self-measurement is commonly used, regardless of the age. 73% of the patients had bought a device on their own, but only 17% on the physician's advice. Possible causes for erroneous measurements were rarely known and underestimated by the patients. Due to lacking or insufficient instruction a relatively high percentage of the patients did not perform correct measurements. 45% did not measure the blood-pressure at the same time of day, 45% did not read systolic and diastolic pressures to the nearest 2 mmHg mark of the manometer scale, 59% did not count the pulse rate and 52% did not document the blood-pressure values. About half of the patients adjusted their medication on the ground of self-measured blood-pressure determinations. 45% of the elderly patients felt that their compliance had improved by self-measurement in contrast to 17% in the younger group. Given the increasing use of blood-pressure self-measurement we conclude that education of patients and physicians on possibilities and limitations of self-measurement as well as optimal training in the correct technique seem advisable.

Adult↗

PubMed1990

Casual versus ambulatory twenty-four-hour blood pressure measurement in a comparative study with bisoprolol or nitrendipine.

In a double-blind, placebo-controlled, randomly allocated study, the 24-h efficacy of a single morning dose of 10 mg of the beta-blocker bisoprolol (n = 17) versus 20 mg of the calcium channel antagonist nitrendipine (n = 19) was assessed using two different methods of blood pressure determination: (1) casual blood pressure determinations in the morning before the dose; and (2) ambulatory day-time (6 a.m. to 6 p.m.) and night-time (6 p.m. to 6 a.m.) blood pressure monitoring using a non-invasive automatic device (Spacelabs 90202). After 4 weeks both agents induced significant blood pressure reductions compared to the placebo period as assessed by both casual and ambulatory day-time readings, without significant differences in the blood pressure reductions induced by the two drugs (P less than 0.05). Ambulatory night-time values, however, showed a significant blood pressure reduction only for bisoprolol (from 138 +/- 16/84 +/- 12 to 129 +/- 15/77 +/- 11 mmHg); nitrendipine did not induce any significant systolic or diastolic blood pressure changes during this period (140 +/- 11/87 +/- 10 to 136 +/- 13/86 +/- 10 mmHg). Individual response rates were 47% for nitrendipine and 71% for bisoprolol. The incidence of side effects was comparable under both drugs. Our results indicate that bisoprolol was more effective over 24 h than nitrendipine. We also conclude that the value of casual blood pressure readings for the evaluation of therapeutic agents given once a day seems to be limited in comparison to 24-h ambulatory monitoring.

Adrenergic beta-Antagonists↗

PubMed1990

Self-measured blood pressures at home and during consulting hours: are there any differences?

Home blood pressures are lower than casual blood pressures and this difference is probably due to physician-patient interaction in a clinical stress situation. In order to prove this assumption we compared the casual blood pressures of 127 subjects, measured by a physician and by the subjects themselves in the presence of the physician, with self-measured values obtained at home over a 7-day observation period. The casual pressures were higher than the home pressures (delta = 7.6/3.9 mmHg) regardless of whether they were taken by the physician or by the subjects themselves in the presence of the physician. The subjects' casual readings (132.9 +/- 17.5/87.6 +/- 12 mmHg) were slightly, but significantly, higher than those measured by the physician (131.9 +/- 18.4/86.3 +/- 12.6 mmHg) and both systolic and diastolic self-measured casual values were highly significantly correlated with the physician's readings (r = 0.92 and 0.91, respectively; P less than 0.01).

Adult↗

PubMed1990

Individualizing antihypertensive therapy with enalapril versus atenolol: the Zurich experience.

With the present increasing concern for compliance and quality or life during antihypertensive treatment, drug therapy tailored optimally for the individual patient is becoming increasingly important. The aim of the present double-blind crossover study was to analyse the individual as well as the group blood pressure response under enalapril and atenolol. Our results show that the group effects of these drugs did not differ significantly. However, individually, two-thirds of the responding patients showed a preference for either enalapril or atenolol. A response to one drug did not predict a comparable response to the other drug. We conclude that double-blind crossover studies are a possible way of individualizing antihypertensive treatment. However, no appropriate methodology or definitions of terms for these studies have yet been established.

Adult↗

PubMed1989

[ Self measurement of blood pressure. Equipment and comparison of equipment].

Precision is the primordial criterion for the evaluation of a blood pressure measuring device. While traditionally devices based on the auscultation technique have dominated semiautomatic devices have recently gained acceptance. The latter permit to reduce procedure-related errors. They are simpler to use and require less demanding instruction but are more expensive than stethoscopic devices.

Auscultation↗

PubMed1989

[Self measurement of blood pressure: patient education].

Many patients measure their blood pressure without any instruction due to the availability of modern measuring devices. Although the technique can be mastered by most of the patients, some sources of error have to be eliminated. The aim of such an instruction is to explain these sources of error to the patients and to give them opportunity to practise the self measurement under medical supervision. An instruction sheet is handed out as a pamphlet. The patients are also directed to keep a record of all measurements which is periodically controlled by the physician. It is also advisable to reexamine the measuring technique of the patient from time to time and to check the accuracy of the patients measuring device.

Blood Pressure Determination↗

PubMed1989

[Why are blood pressure values higher in the doctor's office than at home?].

Blood pressure values measured by the patients at home are lower than those measured during medical consultation. To test whether the person measuring the blood pressure is responsible for this difference, the blood pressure of 127 patients was measured first by the doctor and then by the patients themselves during the consultation. There was a good agreement and no significant difference between the two measurements. Values taken at home were however significantly lower. Our results indicate, that difference between clinic and home blood pressure values does not depend on the person performing the measurement.

Blood Pressure↗

PubMed1989

[Diagnostic and prognostic aspects of home blood pressure measurement].

Up to now the diagnosis of hypertension has been based on a few casual blood pressure measurements in the physician's office according to WHO guidelines. Blood pressure measurements at home in the recent years have gained increasing popularity as a supplementary diagnostic tool. The establishment of an everyday blood pressure profile and exclusion of "white coat" hypertension are the main diagnostic indications. In borderline hypertension those patients with elevated home blood pressures can be identified. However world-wide epidemiologic studies are urgently needed to develop definitions of normal and pathological values for self-recorded blood pressure readings. From our experience diastolic home-recorded values higher than 90 mm Hg should be regarded as pathological.

Blood Pressure Determination↗

PubMed1989

[The therapeutic significance of home blood pressure measurement].

Optimization of antihypertensive therapy during the initial dose titration as well as the long term follow-up of chronic therapy constitute the main therapeutic indications of blood pressure measurement at home. Furthermore home blood pressure measurements may be of value in patients with unsatisfactory blood pressure response in whom poor compliance is suspected. Finally patients may adjust their antihypertensive therapy according to the level of self-recorded blood pressure measurements.

Antihypertensive Agents↗