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ABSTRACT: The antibody response to bacteria of the so-called HACEK group, i.e. Haemophilus spp., Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens and Kingella kingae, was measured in sera of six patients with endocarditis. The corresponding isolates from their blood cultures were identified by conventional methods, including reactions for nitrate reduction and catalase as well as acid production from sugars. Crude antigens were prepared by glycine extraction and sonification of the blood culture isolates, and used to determine titers by complement fixation. A patient with Haemophilus parainfluenzae bacteremia received a short course of antibiotic therapy, and relapsed with spondylitis and endocarditis 5 months later. Titers of sera against his own isolate rose from 1:40 to 1:320 and fell to 1:40 after therapy within one year. A patient with C. hominis endocarditis had a similarly prolonged course. The complement fixation titer against his own isolate was already 1:240 before antibiotics were administered. Another patient with C. hominis endocarditis presented a titer of 1:320 2 weeks after the diagnosis. These three patients revealed C-reactive protein values over 50 mg/l in the first serum sample. Decrease of both antibody titers and C-reactive protein values correlated with clinical improvement. Two patients with prosthetic valve replacement 5 months earlier developed C. hominis and K. kingae endocarditis, respectively. At admission, C-reactive protein values were 64 and 82, respectively, and therapy was instituted immediately. The first sera were received 3 and 6 weeks, respectively, after isolation of the corresponding blood culture isolates and revealed already low titers, i. e. 1:80 and 1:60, respectively. A woman with A. actinomycetemcomitans endocarditis received immediate therapy and did not develop titers against her own isolate. CRP was 100 at admission and remained over 50 5 weeks later. We conclude that the complement fixation assay with individual antigen preparations was easy to perform and allowed monitoring of the antibody response in 5 of 6 HACEK endocarditis cases under therapy, but the usefulness of this method to find culture-negative HACEK endocarditis needs to be established.
Apmis 06/1998; 106(5):547-52. · 1.99 Impact Factor
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ABSTRACT: A case of prosthetic valve endocarditis with Propionibacterium acnes is described. The diagnosis was documented by histology and isolation of P. acnes from both blood and anulus tissue. Grinding of the tissue, which was first omitted to avoid contamination, was indispensable for cultivating the agent. The literature for P. acnes endocarditis is reviewed.
Journal of Clinical Microbiology 01/1995; 32(12):3043-5. · 4.15 Impact Factor
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ABSTRACT: Escherichia fergusonii was isolated from a 69-year-old male with pancreatic carcinoma and cholangiosepsis from gallbladder fluid, three blood cultures, feces, and a superficial wound of the abdomen. Biochemical reactions, antimicrobial susceptibility patterns, susceptibility to polyvalent phage 0-1, and rRNA gene restriction analysis suggested that the four strains were of clonal origin. Our data indicate that E. fergusonii possesses a pathogenic potential in humans.
Journal of Clinical Microbiology 09/1993; 31(8):2201-3. · 4.15 Impact Factor
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ABSTRACT: We report a case of pancreatitis with fatal liver failure, in a 21-year-old, mentally retarded patient, taking valproic acid (VPA) therapy, together with a review of the literature of this rare side effect. Until March 1991, only 24 cases of isolated pancreatitis and six cases (including ours) of pancreatitis with hepatic failure under VPA treatment have been published. Most of the patients were less than 20 years old, and injury to the pancreas developed during the first year of therapy in 72% of the patients, approaching a mortality of 21%. Pancreatitis associated with liver failure has a poor prognosis mainly because of the VPA hepatotoxicity. It seems that the pancreatic side effects fluctuate between two extremes: asymptomatic hyperamylasemia and fatal pancreatitis.
Journal of Clinical Gastroenterology 01/1992; 13(6):690-3. · 3.16 Impact Factor
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ABSTRACT: Fatal hepatic failure associated with valproic acid therapy is a rare side effect occurring in 1:5000-10,000 of the patients exposed to this antiepileptic drug. Its relevance arises from its fatal outcome and the high number of patients who are treated with this drug (one million worldwide in 1988). 112 cases were published up to 1988. Most of the affected patients were young (less than 10 years old), male, and mentally retarded. Many were under antiepileptic polytherapy. The children of this age group constituted only 23% of the patients treated with valproic acid but 73% of all fatalities. 90% of the patients developed hepatic failure in the first 5 months of therapy. Low doses or therapeutic serum levels of valproic acid do not prevent this dramatic event. Specific therapy is not known. In addition to the case report we review the literature and make recommendations for monitoring therapy with valproic acid.
Schweizerische medizinische Wochenschrift 03/1991; 121(7):228-33. · 1.68 Impact Factor
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ABSTRACT: In a 63-year-old patient presenting with signs of classical diphtheria including membranous pharyngotracheobronchitis and myocarditis, Corynebacterium ulcerans was isolated in pure culture from the membranes. The strain produced a toxin specific for C. ulcerans but no diphtheria toxin. The patient was discharged after a complicated hospital course including respiratory and cardiac failure. Besides Corynebacterium diphtheriae, which has very rarely been isolated in Switzerland in recent years, Corynebacterium ulcerans should be considered as a cause of classical diphtheria.
Schweizerische medizinische Wochenschrift 01/1991; 120(48):1812-6. · 1.68 Impact Factor
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ABSTRACT: A review of 52 patients with celiac disease showed the development of malignant tumors in eight cases (15%). The following malignomas were diagnosed: one malignant lymphoma, one multiple myeloma, one rhabdomyosarcoma, one carcinoma of the uterus, one carcinoma of the sigmoid colon and three adenocarcinomas of the small bowel. Patients with tumors showed significantly lower hemoglobin, lower serum albumin, and higher sedimentation rates than patients without tumors. The possibility of underlying malignoma must always be considered in all patients with newly diagnosed coeliac disease and in patients where symptoms of a known celiac disease change without alteration of the prescribed diet.
Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis 05/1990; 79(17):533-6.
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ABSTRACT: Among 5 patients with bacteremia due to Fusobacterium necrophorum, 3 young adults had post-anginal sepsis (Lemierre syndrome), including one with the classical secondary metastatic complications of pulmonary abscesses, pleural empyema, arthritis and hepatobiliary disturbances. The primary focus was a cholangiogenic abscess in an 81-year-old woman, and fetid otitis following a radical operation for cholesteomatous chronic otitis media in a 29-year-old male. Septicemia due to Fusobacterium necrophorum, and in particular Lemierre syndrome, are presented in the light of the literature.
Schweizerische medizinische Wochenschrift 04/1990; 120(13):440-5. · 1.68 Impact Factor
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ABSTRACT: We describe three patients with celiac disease complicated by adenocarcinoma of the small intestine, and summarize the 36 cases of this association that have been reported. Retrospectively we found an increased risk (relative risk 25-250) of developing adenocarcinoma of the small intestine in patients with celiac disease in the region of Winterthur (north-east Switzerland). We therefore suggest that celiac disease be considered a premalignant condition not only for malignant lymphoma and gastrointestinal tumors, but also for adenocarcinoma of the small intestine. Synchronous or metachronous development of carcinoma in one of our patients and in two cases reported in the literature offer further evidence that celiac disease is a premalignant condition for adenocarcinoma of the small bowel. In several patients celiac disease was diagnosed only after diagnosis of the carcinoma. With regard to asymptomatic or subclinical celiac disease, it seems justifiable to search for possible underlying celiac disease in all patients with established diagnosis of adenocarcinoma of the small intestine.
Schweizerische medizinische Wochenschrift 03/1990; 120(5):135-41. · 1.68 Impact Factor
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ABSTRACT: Clostridial pleuropulmonary infection in a patient with suspected pulmonary embolism is described. Clostridium subterminale was recovered as the sole pathogen on several occasions despite antibiotic therapy. The patient died of cardiac failure after a complicated course in hospital. Clostridium subterminale is a rare pathogen and has not so far been reported as the sole cause of pleuropulmonary infection.
Journal of Infection 12/1989; 19(3):277-80. · 4.13 Impact Factor
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ABSTRACT: We report on three young females complaining of bloody diarrhea of acute onset due to hemorrhagic colitis associated with oral amoxicillin therapy. The bloody diarrhea with abdominal cramps began 4 to 6 days after starting the treatment. Right colon was involved in two patients, and the descending and sigmoid colon in the other. Stool cultures and search for Cl. difficile toxins were repeatedly negative. Biopsy revealed marked mucosal hemorrhage (2/3), erosions (2/3) and thrombosed vessels (2/6). Symptoms rapidly resolved after 2 to 6 days. Extensive allergic evaluation in one patient did not reveal a hypersensitivity reaction. A literature review reveals another 31 patients with this characteristic form of colitis associated with ampicillin or amoxicillin therapy.
Schweizerische medizinische Wochenschrift 06/1989; 119(21):733-5. · 1.68 Impact Factor
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ABSTRACT: Aluminium-containing phosphate binders were replaced by a calcium and magnesium carbonate-containing antacid in 20 patients on long-term haemodialysis, over a three-month period in all of them, for 12 months in ten. After two months the serum aluminium level fell (mean +/- SD) from 3.0 +/- 1.6 to 1.4 +/- 0.5 mumol/l (P less than 0.001). After three months the serum phosphate level had fallen from 1.8 +/- 0.4 to 1.5 +/- 0.4 mumol/l (P less than 0.05), while during the same period parathormone (PTH-NH2) fell from 1.4 +/- 1.4 to 0.8 +/- 0.7 ng/ml (P less than 0.05). Serum total calcium concentration rose after two months from 2.2 +/- 0.2 to 2.4 +/- 0.2 mmol/l (P less than 0.001). In a third of patients the uraemic acidosis was corrected, standard bicarbonate rising from 18 +/- 2 to 21 +/- 3 mmol/l (P less than 0.05). Serum pH, potassium, sodium, magnesium and alkaline phosphatase did not change significantly. Hypercalcaemia was an expected disadvantage: repeated symptom-free episodes of hypercalcaemia occurred in six of 20 patients during the first three months and in a further two up to 12 months. These episodes were successfully controlled by a reduction of CaCO3/MgCO3 dosage and readministration of Al(OH)3. Extraosseous calcifications were not observed.
DMW - Deutsche Medizinische Wochenschrift 05/1989; 114(17):659-64. · 0.53 Impact Factor
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ABSTRACT: Technetium scintigraphy established sacroiliitis in a 21-year-old man who had complained of hip pain for two weeks. Brucella melitensis was cultured from hip-joint fluid. He was treated with 160 mg trimethoprim and 800 mg sulphamethoxazole, three times daily for six weeks. He also had prophylactically 600 mg rifampicin daily by mouth for the last three weeks. He was symptom-free four weeks after onset of treatment. At follow-up one year later there was no sign of recurrence. Brucella titres and blood sedimentation rate were within normal limits.
DMW - Deutsche Medizinische Wochenschrift 03/1989; 114(7):258-61. · 0.53 Impact Factor
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ABSTRACT: A report is presented on two patients with severe visual loss and scotoma following an episode of alcohol-induced pancreatitis. A 35-year-old man with pancreatitis developed visual loss in both eyes. Ophthalmoscopic examination revealed extensive ischemic infarcts with bilateral hemorrhage and cotton-wool spots, a clinical picture similar to that of (post-traumatic) Purtscher's retinopathy. Goldmann visual fields demonstrated paracentral scotomas. Fundoscopic lesions had disappeared 3 months after the acute event and visual acuity improved gradually from 0.1 to 1.0. In a 36-year-old man, cerebral infarction was established by CT as a possible cause of visual loss. CSF examination revealed Sudan-III positive material suggesting cerebral fat embolism as the cause of cerebral infarcts. Visual fields showed central scotomas. During the 4-year follow-up period there was a gradual improvement in visual acuity.
Schweizerische medizinische Wochenschrift 06/1988; 118(19):722-5. · 1.68 Impact Factor
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ABSTRACT: To assess the risk of radiation-induced cancer of the colon we studied 196 patients with a history of radiation treatment for cancer of the female genital system. After a median follow-up of 12.4 years (range 10-15 years) corresponding to 1172 patient-years, 94 (48%) patients were still alive. 84 (89%) of these patients were evaluated for a second primary cancer to the colon. In 38 (45%) colonoscopic examination was performed. 3 patients were found to have a second primary cancer to the colon compared with 0.32 expected (relative risk 9.3) on the basis of rates from the Zürich Tumor Registry. Due to partial long-term survival, patient non-compliance and non-feasibility of colonoscopic examination, only one fourth of all patients initially treated by radiotherapy for cancers of the female genital system were suitable for colon screening. For these high risk women, colorectal tumor screening should be integrated into a gynecologic tumor follow-up.
Schweizerische medizinische Wochenschrift 06/1988; 118(19):716-21. · 1.68 Impact Factor
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ABSTRACT: In 1980 a large series of patients with Lyme carditis was first described. The most frequent symptom was atrioventricular block, more unusual were other arrhythmias, nonspecific ECG alterations, cardiomegaly and pericarditis. We report the case of a 51-year-old man with Lyme carditis which presented as atrial fibrillation and atrioventricular block 2 degrees. Gallium-67 scan was negative. The arrhythmias ceased during therapy with doxycycline. The clinical findings, diagnosis and therapy of Lyme carditis are discussed.
Schweizerische medizinische Wochenschrift 04/1988; 118(10):358-62. · 1.68 Impact Factor
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ABSTRACT: New infection with tuberculosis is a risk for hospital patients, and it would therefore be desirable to evaluate the proportion of converters by a simple epicutaneous test. It is also known that reactions to Mantoux tests of different manufacturers may vary widely. Simultaneous tuberculin skin tests with tuberculin Berna, tuberculin Kopenhagen and Monotest Mérieux have been compared in 81 geriatric patients and 54 young volunteers. Monotest Mérieux and Mantoux test with tuberculin Berna were administered in 222 additional patients, and it was therefore possible to compare a Monotest and a tuberculin test in a total of 357 patients. There was no statistically significant difference between the two Mantoux tests. An unexpectedly high false positive rate was found with Monotest. The reasons for this are discussed. The two products used in Switzerland today are equivalent. Positive reactions to Monotest need confirmations by Mantoux test.
Schweizerische medizinische Wochenschrift 11/1987; 117(42):1628-32. · 1.68 Impact Factor
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ABSTRACT: A 34 year old female long distance runner is reported with bloody diarrhoea. Colonoscopy revealed patchy haemorrhagic mucosal lesions throughout the colon. The most extensive lesions were found in the sigmoid colon. Histologic examination disclosed mucosal haemorrhage, dilated capillaries, patchy fibrosis and superficial erosions. Additional findings in this patient were haemorrhagic gastritis, microscopic haematuria and rhabdomyolysis. The only medication taken by the patient was oral contraceptives. We conclude that ischaemic colitis is one of the possible mechanisms leading to gastrointestinal blood loss in competitive runners.
Gut 08/1987; 28(7):896-9. · 10.11 Impact Factor
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ABSTRACT: We performed a prospective case control study and found among 306 patients, in whom a complete colonoscopy was done, 19 patients (6%) with angiodysplasia of the colon. These patients were significantly older than control subjects (p less than 0.05). Nine patients (47%) with angiodysplasia had no bleeding and were identified incidentally by colonoscopy performed for other indications. To clarify the possible role of underlying occlusive arterial diseases we compared the 19 patients with angiodysplasia with a control group, matched for sex and age, in whom a complete colonoscopy did not reveal a vascular anomaly. An increased incidence of cardiovascular diseases was found (p less than 0.001). Risk factors for cardiovascular diseases were significantly associated with angiodysplasia (p less than 0.05). These data support the contention that these acquired vascular lesions might result from chronic submucosal arteriovenous shunting secondary to mucosal ischemia due to underlying occlusive arterial diseases.
Hepato-gastroenterology 07/1987; 34(3):127-31. · 0.66 Impact Factor
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ABSTRACT: In patients with inflammatory bowel disease the presence of epitheloid cell granuloma is considered to be the most reliable single criterion for the presence of Crohn's disease. We report on 6 patients (5 female, 1 male, mean age 73.5 years) with acute onset of inflammatory bowel disease, in whom the presence of epitheloid cell granuloma led to the diagnosis of Crohn's disease. However, concomitant major bleeding (4/6), absence of small intestinal involvement, and absence of extraintestinal manifestations suggested the presence of ischemic colitis. Histologic findings including thrombosed vessels (6/6), mucosal (5/6) and submucosal (3/4) hemorrhage, and mucosal (3/6) and submucosal (3/4) fibrosis supported this diagnosis. A review of the literature suggests that many clinical features of assumed Crohn's disease in elderly patients are atypical and would be most consistent with an ischemic pathogenesis: rarity of fistula, low recurrence rate, low rate of small intestinal involvement and extra-intestinal manifestations, and increased incidence of major colonic bleeding would best fit with an ischemic pathogenesis in at least some of these patients. We suggest that in elderly patients with "Crohn's colitis", even in the presence of epitheloid cell granuloma, an ischemic etiology should be considered.
Schweizerische medizinische Wochenschrift 04/1987; 117(17):643-50. · 1.68 Impact Factor
