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Biomedical subjects

W Brunner

Publications and source records attributed to W Brunner.

At least 19 recordsLinked to original sources
PubMed1995

[Pruritus--also a challenge in internal medicine].

Generalized or localized itch without primary skin manifestations may be the presenting symptom of serious internal diseases. Five characteristic cases of pruritus are discussed: Hodgkin's disease, primary sclerosing cholangitis, polycythemia vera, iron deficiency (with pica), and uremia. Other important causes must be considered; all forms of cholestasis, including primary biliary cirrhosis, drug-induced, pregnancy-related, and extrahepatic cholestasis; other hematologic and malignant disorders such as non-Hodgkin's lymphoma, leukemia, multiple myeloma, solid tumors, and myelodysplastic syndromes; metabolic and endocrine diseases, most notably diabetes mellitus, hyperthyroidism, hypothyroidism, and carcinoid syndrome; focal neurologic diseases such as brain tumors, cerebral infarctions and multiple sclerosis; adverse drug reactions without rash; infectious diseases, especially parasitic and HIV infections. A diagnostic laboratory screening for pruritus of undetermined origin is suggested.

Adult↗
PubMed1995

Karyomegalic interstitial nephritis: further support for a distinct entity and evidence for a genetic defect.

Karyomegalic interstitial nephritis was first described in 1979 by Mihatsch, who was reporting three such cases. We report here four additional cases as well as two family investigations. Our findings support the association of karyomegaly and interstitial nephritis as a distinct entity. Typical clinical features are asymptomatic progressive renal failure in the third decade of life and recurrent infections, mostly of the upper respiratory tract. Histologic alterations consist of markedly enlarged and hyperchromic nuclei in many tubular epithelial cells throughout the nephron accompanied by interstitial fibrosis in the surrounding atrophic tubules. Karyomegaly is not limited to the kidneys. In one case, autopsy revealed karyomegaly in epithelial and mesenchymal cells of many other organs. However, no association of karyomegaly with further histologic damage is evident except in the kidneys. Because of the familial clustering, karyomegalic interstitial nephritis seems to be an inherited disease. Examination of the nuclear proliferation-associated structures proliferating cell nuclear antigen/cyclin, Ki 67, and p53 suggests an inhibition of mitosis in karyomegalic cells. The finding of the same HLA haplotype, A9/B35, in four of six HLA-typed cases suggests the possibility of a genetic defect on chromosome 6, which is inherited and linked to the HLA locus.

Adult↗
PubMed1994

The respiratory health impact of a large urban fire.

OBJECTIVES: In July 1988, a fire destroyed a huge supermarket warehouse in Richmond, Calif, sending smoke into residential neighborhoods for nearly a week. There was no organized public health response. To evaluate the respiratory health impact on the general population, a survey of emergency room visits and hospital admissions to the two acute-care hospitals serving the population downwind was conducted. METHODS: Medical records of 489 patients meeting specified diagnostic criteria during the week of the fire and several reference periods were abstracted. Ratios of proportions for respiratory diagnoses (i.e., emergency room visits for a given diagnosis/total emergency room visits) were calculated, comparing the fire week with the reference periods, and 1988 mortality data for the area were reviewed. RESULTS: Ratios of proportions for emergency room visits for asthma and all lower respiratory conditions increased significantly during the fire. Respiratory-related hospitalizations also increased. However, there was no observable increase in respiratory mortality. CONCLUSIONS: This fire was found to have had a moderate impact on the respiratory health of local residents. Public health intervention is indicated to prevent respiratory morbidity when extended exposure to structural fire smoke is predictable.

Asthma↗
PubMed1993

[Brucellosis: case report and synopsis of 10 cases (1973-1992) in the Chur canton hospital].

A 33-year-old patient from former Yugoslavia presented with low back pain and fever. Plain X-rays and myelography were normal, but a technetium-99m scan was suspect for vertebral osteomyelitis. Serology and blood cultures were positive for Brucella (melitensis). Antibiotic therapy with tetracycline and rifampicine rapidly improved the signs and symptoms of the infection. A retrospective analysis of 11 cases of Brucellosis treated in the Kantonsspital, Chur, over the years 1973 to 1992 revealed that 9 patients were foreign workers from rural areas in the Mediterranean region (Spain, Portugal, Italy, Yugoslavia, Greece). The majority had a history of consuming milk and dairy products from their own farm animals up to a few months before the onset of symptoms. Blood cultures were positive in 5 cases (B. melitensis) while the remaining 6 had high titers of agglutinating antibodies. A diagnostic delay of several weeks to months was typical. Because Brucellosis usually presents with unspecific often flu-like symptoms, with unspecific laboratory findings, and with a varying array of organ manifestations a high index of suspicion is essential for a timely diagnosis.

Adolescent↗
PubMed1993

Are HIV-infected injection drug users taking HIV tests?

OBJECTIVES: Knowledge of infection is essential for human immunodeficiency virus-type 1 (HIV-1) treatment initiation and epidemic control. This study evaluates infection knowledge among infected injection drug users and acceptance of confidential testing among injection drug users, particularly those infected with HIV-1. METHODS: A total of 810 injection drug users entering treatment in Contra Costa County, Calif, were examined. Clients were tested with unlinked (blinded) tests and simultaneously counseled and offered voluntary confidential HIV-1 antibody testing. Data on confidential testing acceptance, previous testing, drug use, and demographic information were collected. RESULTS: Of the 810 tested, 105 (13.0%) were infected. The current confidential test was accepted by 507 (62.6%). HIV seroprevalence in the unlinked survey was four times greater than in the voluntary survey (13% and 3.5%, respectively). HIV-1 infection was associated with refusal of a confidential test largely because most infected injection drug users (n = 58; 55.2%) already knew of their infection. Of the 47 injection drug users who were not aware of their infection, 12 (25.5%) accepted the test. Although African-American injection drug users presented with a higher infection rate (37.3%), they were three times less likely to know of their infection. CONCLUSIONS: "In-clinic" HIV-1 testing is highly accepted, and most infected clients in treatment will learn their status. Nevertheless, voluntary testing data are likely to yield considerable underestimates of the true rate of infection among injection drug users.

AIDS Serodiagnosis↗
PubMed1987

[Acquired cystic renal changes--a clinically relevant problem in long-term dialysis].

While dialysis patients survive renal failure for years and even decades, multiple morphologic alterations take place in their kidneys. One of these (so to speak) "postmortem" changes is the formation of secondary renal cysts. A patient with end stage renal failure due to amyloidosis is described who was dialysed at home for 9 years. Intravenous pyelography and renal biopsy in the predialysis period likewise documented the presence of amyloidosis and the absence of cystic disease. Ultrasonography of both kidneys, a suspicious increase in hematocrit and the autopsy finding of numerous large cysts also showed the presence of acquired cystic disease. The frequency and complications of this newly recognized disease in longterm dialysed patients are discussed. Recommendations are given concerning follow-up of these patients, with a view to early detection of tumor development within the cysts.

Amyloidosis↗
PubMed1987

[Post-traumatic/postoperative immune deficiency syndrome].

Severe trauma, major surgery and burns (TSB) are often followed by infections, adult respiratory distress syndrome and multi-organ failure, complications which are thought to be the consequence of the post-TSB immunodeficiency syndrome. The most important data and hypotheses in this regard are summarized. After a TSB event large amounts of tissue debris, endotoxins and microorganisms have to be eliminated. Further important factors in TSB are stress reactions, malnutrition, loss and replacement of fluids and therapeutic measures. The elimination of unwanted elements is partly carried out by non-specific mechanisms such as opsonisation, chemotaxis and phagocytosis by granulocytes and cells of the macrophage/monocyte lineage, while specific reactions of humoral and cellular immunity also play a role. Severe TSB is thought to be associated with growing exhaustion of the unspecific defense system, leading to deficient specific immune reactions. Routinely measurable parameters only partly reflect the complex events after TSB: there is a decline in serum levels of fibronectin, immunoglobulins and some components of complement, in chemotaxis, phagocytosis and intracellular killing, and in circulating T3 and T4 lymphocytes as well as some lymphocyte functions. Some of these measurable parameters of defense mechanisms are statistically predictive for the occurrence of infections and other sequelae of TSB. Specific prophylactic and therapeutic measures can only be taken, if at least some of the complex events after TSB are better understood.

Antigen-Antibody Reactions↗
PubMed1987

[Diagnosis of lung embolism. Prospective study].

In a prospective study over the years 1983-1985, 300 cases of acute pulmonary embolism were analyzed in relation to predisposing factors, clinical signs, arterial blood gas analysis and isotope perfusion scanning. Comparison of this prospective study with an earlier retrospective one showed similar results, with the exception of isotope scanning, an investigation which has gained increasing diagnostic reliability (highly suggestive results in 94% of patients with massive pulmonary embolism and in 64% with submassive pulmonary embolism). In two thirds of the cases the diagnosis was established during the first day after hospitalisation. In 10% of the patients pulmonary embolism occurred despite anticoagulant therapy.

Aged↗
PubMed1986

[Acute rhabdomyolysis].

By damaging cell membrane integrity, acute rhabdomyolysis leads to electrolyte shifts according to the concentration gradients and the liberation of intracellular substances. Diagnosis is confirmed by the presence of a high serum creatinkinase activity (CK) and myoglobinuria. For clinical purposes myoglobinuria is demonstrated by a blood-positive dipstick in the absence of hematuria or hemoglobinuria. Rhabdomyolysis is usually acquired and is rarely due to hereditary enzyme defects. The authors report on 61 patients admitted in the last 15 years with rhabodomyolysis. In the past 4 1/2 years the diagnosis was suggested by CK greater than 5000U/1 in 49 patients, representing 1.6% of all admissions in the departments of medicine and surgery. Originally described in crush situations, rhabdomyolysis has been observed with increasing frequency as a consequence of muscular stress and self crush due to coma or hemi- and paraplegia during the last decades. 24% of the patients with this diagnosis had had an intoxication, and in 70% there were multiple simultaneous causes. Autoimmune diseases, infections of bacterial, viral and fungal origin, endocrinopathies, and thermic and ischemic injuries can also provoke rhabdomyolysis. As a consequence of fluid shift into the damaged muscle a compartment syndrome may lead to vascular or neural defects. In 80% of cases there is initial hypocalcemia, turning later into hypercalcemia. Other frequent electrolyte disorders accompanying rhabdomyolysis are hyperkalemia, hyperphosphatemia and a widened anion gap. 6 of 13 patients showed the typical blood changes found in patients with disseminated intravascular coagulation. Acute renal failure developed in 30 patients, 15 of whom underwent dialysis or hemofiltration.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1985

Ganglioside patterns in amyotrophic lateral sclerosis brain regions.

In a search for evidence of biochemical disorders in regions of postmortem brain other than the motor cortex in amyotrophic lateral sclerosis (ALS), ganglioside patterns were also examined in the frontal, temporal, and parahippocampal gyrus cortex. In 21 ALS brains studied (20 sporadic, 1 familial), abnormal patterns were found in the frontal cortex (81%), temporal cortex (75%), motor cortex (70%), and parahippocampal gyrus cortex (71%). Patterns were established by measuring the percentage distribution of 12 ganglioside species. Two abnormal patterns were detected. One was based on low proportions of GD1b, GT1b, and GQ1b associated with high proportions of GM2 and GD3 (GM1, GD1a, GD2, and GT1a values were normal). The second abnormality was the appearance of Gx. Neither abnormality was seen in the 13 non-ALS control brains. The first, and predominant, abnormality was found in the frontal cortex in 14 brains, and the second was observed in 13 brains; 10 brains showed both abnormalities. These findings thus constitute evidence that the disease process in ALS extends beyond the motor cortex and involves neurons in several brain areas.

Aged↗
PubMed1985

Influence of N-acetylcysteine on the hexachlorobenzene induced porphyria in rats.

The course of hexachlorobenzene (HCB) induced porphyria was not influenced by the concomitant administration of N-acetylcysteine (NAC) to the animals: urinary excretion of total porphyrins and porphyrin precursors as well as the hepatic aminolevulinate synthase activities were not influenced by NAC treatment. In addition, no differences could be shown between the HCB and the HCB/NAC combination group concerning the hepatic cytochrome P-450 contents or the P-450 dependent enzyme activities.

5-Aminolevulinate Synthetase↗
PubMed1984

[Changes in gastric mucosa, liver and mesenteric vessels following bipolar electrocoagulation].

The implications of bipolar electrocoagulation with a modified probe (BICAP) were tested in rat gastric mucosa, liver tissue and mesenteric vessels. This was done during the coagulation and at different intervals, up to 14 days later, by intravital microscopy of the exposed organs. A histological treatment of the respective tissues ensued at the closing of each experiment. Applying a current of 25 watt and contact times lasting for 5 secs and longer, perfect tissue necrosis develops which has clean and straight edges. The extensions on the surface and into the depth of gastric mucosa match precisely the contact area with the instrument. In the deeper mucosal layers there is a fungiform spread of necrosis while in the liver it remains uniform and shows the same diameter as on the surface. As a late result and notwithstanding the confinement of the coagulation to the mucous membrane, a local peritonitis may develop. Within contractile vessels the action of bipolar coagulation stops the blood flow which is only irreversible, when the current and contact times are extended to bring about necrosis in neighbouring tissue. Within the microcirculation of the liver the blood flow is preserved up to the very boundary of the necrosis.

Animals↗