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Frankfurt (Oder), Germany

Jenni F.,Clinic for Internal Medicine
The American journal of emergency medicine | Year: 2013

We report on a 35-year-old man who presented to the emergency department with acute abdominal pain, postural hypotension, and tachycardia after having been diagnosed with Epstein-Barr virus infection 1 week before. Abdominal ultrasound and computed tomography revealed splenic rupture, and the patient underwent successful proximal angiographic embolization of the splenic artery. The course was complicated by painful splenic necrosis and respiratory insufficiency due to bilateral pleural effusions. Six weeks later, he additionally developed severe sepsis with Propionibacterium granulosum due to an intrasplenic infected hematoma, which required drainage. All complications were treated without surgical splenectomy, and the patient finally made a full recovery. Source

Fritzsch J.,Clinic for Internal Medicine | Splettstoesser W.D.,University of Federal Defense Munich
Journal of Medical Microbiology | Year: 2010

This case of pneumonic tularaemia elucidates two aspects: it is believed to be the first documented case of bacteraemia caused by Francisella tularensis subsp. holarctica biovar II; furthermore, it illustrates the remission of septic pneumonic tularaemia without appropriate antiinfective therapy. A blood culture from a patient with community-acquired pneumonia was found to be positive for F. tularensis subsp. holarctica biovar II after 10 days of cultivation. Meanwhile, the patient had been treated with ceftriaxone, followed by sultamicillin and clindamycin. The patient continued suffering from fever of up to 40.7 °C and rising C-reactive protein (CRP) for 4 days before the fever and CRP declined. The isolated strain was later tested and found to be resistant to the antibiotics used. The present case underlines that F. tularensis subsp. holarctica infections may cause severe symptoms but mostly have a favourable outcome. © 2010 SGM. Source

Bernasconi M.,University of Basel | Tamm M.,University of Basel | Bingisser R.,University of Basel | Miedinger D.,University of Basel | And 4 more authors.
Chest | Year: 2011

Background: Recently, the use of systemic biomarkers to monitor and assess the clinical evolution of respiratory disease has gained interest. We investigated whether midregional proatrial natriuretic peptide (MR-proANP) predicts survival in patients with COPD when they are admitted to the hospital for exacerbation. Methods: One hundred sixty-seven patients (mean age 70 years old, 75 men) admitted to the hospital for exacerbation were followed up for 2 years. MR-proANP was measured on admission, after 14 days, and at 6 months. The predictive value of clinical, functional, and laboratory parameters on admission were assessed by Cox regression analyses. The time to death was analyzed by Kaplan-Meier survival curves. Results: MR-proANP level was significantly higher on admission for exacerbation, compared with recovery and stable state(P =.004 for the comparison among all time points). MR-proANP correlated with the Charlson condition and age-related score(P <.0001), left ventricular ejection fraction(P <.0001), C-reactive protein(P =.037), and FEV1 % predicted(P =.004). MR-proANP levels were similar in patients requiring ICU treatment and in those treated in the medical ward(P =.086). Thirty-seven patients (22%) died within 2 years. MR-proANP levels were higher in nonsurvivors compared with survivors (median [interquartile range] 185 pmol/L [110-286] vs 92 pmol/L [56-158], P <.001). Mortality was higher across MR-proANP quartiles (log rank P <.0001). Charlson condition and age-related score(P =.001), PaCO2(P <.0001), and MR-proANP (P =.001) predicted mortality in the univariate Cox-regression model. Both MR-proANP and PaCO2 were independent predictors of mortality in the multivariate Cox regression model. Conclusions: MR-proANP at exacerbation is associated with 2-year long-term survival in patients with exacerbation of COPD. © 2011 American College of Chest Physicians. Source

Krantz E.,Clinic for Internal Medicine | Trimpou P.,Sahlgrenska University Hospital | Landin-Wilhelmsen K.,Sahlgrenska University Hospital
Journal of Clinical Endocrinology and Metabolism | Year: 2015

Context: Growth hormone (GH) treatment increases bone mineral density (BMD) in women with postmenopausal osteoporosis. Objective: The objective was to report bone data, fractures, and quality of life (QoL) in a 10-year follow-up of women who had received GH for 3 years and compared with controls followed in parallel. Design and Setting: A follow-up of a double-blind, placebo-controlled study conducted at Sahlgrenska University Hospital was performed. Patients: Eighty women aged between 50 and 70 years with osteoporosis and estrogen hormone replacement were studied and compared with an age-matched random population sample of women (n = 120) from the World Health Organization Monitoring of Trends and Determinants in Cardiovascular Disease project (Gothenburg, Sweden). Interventions: Patients were randomized to GH 1.0 U or GH 2.5 U recombinant human GH or placebo sc daily during 3 years. All received calcium 750mgand vitaminD400Uand were followed up during 10 years. Main Outcome Measures: BMD and bone mineral content were measured with dual-energy X-ray absorptiometry. QoL was estimated with the 36-item Short Form. Results: GH increased BMD and bone mineral content dose dependently in all regions (P=.01, GH 1.0 U, and P = .0006, GH 2.5 U vs placebo). After 10 years the number of fractures decreased from 56% to 28% (P = .0003) in patients evenly distributed between groups. In controls, fractures increased from 8% to 32% (P = .0008). QoL did not change during GH treatment or during the 10-year follow-up and did not differ compared with controls. Conclusion: GH treatment was beneficial for bone and fracture outcome after 10 years but did not affect the QoL of the women with postmenopausal osteoporosis. Copyright © 2015 by the Endocrine Society. Source

Yagmur E.,RWTH Aachen | Yagmur E.,Medical Care Center | Frank R.D.,Clinic for Internal Medicine | Neulen J.,RWTH Aachen | And 2 more authors.
Clinical and Applied Thrombosis/Hemostasis | Year: 2015

Background: Platelet hyperaggregation is known to be associated with arterial and venous thromboembolic events. The prevalence of platelet hyperaggregation in patients with chronic kidney disease (CKD) has not been described to date. Methods: Platelet hyperaggregation in patients with renal disease was defined by comparison of platelet aggregation patterns to non-CKD patients without thromboembolic disorders and healthy controls. Results: Among the 30 hemodialysis patients and 34 renal transplant recipients, 20 (67%) and 28 (82%) showed significantly decreased median δ-epinephrine aggregation and increased 0.5 mol/L epinephrine response (65% and 54%) compared to healthy controls and non-CKD patients. In concordance to the laboratory finding of platelet hyperaggregability, renal transplant recipients showed a high rate of thromboembolic events (normal platelet aggregation: 0 events and platelet hyperaggregation: 30 events in 13 of 28 patients). Conclusions: Patients with CKD exhibit a hitherto unappreciated high prevalence of platelet hyperaggregability indicating sticky platelet syndrome. Laboratory testing of platelet hyperaggregability may supplement the assessment of thromboembolic complications in patients with CKD. © The Author(s) 2013 Source

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