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Biomedical subjects

C Armbruster

Publications and source records attributed to C Armbruster.

At least 19 recordsLinked to original sources
PubMed1995

[Crohn disease in an AIDS patient].

We report on a 32-year-old homosexual AIDS patient with Crohn's disease of the ileocecal region. Radiographically the bowel of this region showed thickening of the wall and moderate narrowing of the lumen. Sonography showed an enlargement of the mesenterial lymph nodes. Due to mechanic ileus, ileocecal resection was performed. Histology of the resected bowel segment revealed extensive inflammatory changes throughout the wall and deep ulcerations, corresponding to changes in Crohn's disease. An underlying infection was histologically excluded. The immunologic aspects of Crohn's disease and of AIDS, and the differential diagnoses of Crohn's disease in AIDS patients, are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1995

[Therapeutic failures after gastric bypass operations for morbid obesity].

BACKGROUND: Although gastric bypass is an effective treatment for morbid obesity, the postoperative results are unsatisfactory in 10% of all patients. Therapeutic failures after an operation performed with the sole purpose of reducing the risk of obesity-associated diseases have to be taken seriously. The goal of this study was to investigate the causes of these failures. METHOD: From 1979 to 1993, 165 gastric bypass operations (technique: Mason-Griffen) were performed. Long-term results were obtained in 60 patients after an average of 6.6 years (range 3-13). On follow-up all patients were examined and asked about their level of satisfaction with the weight loss achieved and changes in eating habits. RESULTS: In 6 patients the weight reduction was regarded as insufficient (BMI > 35 and reduction of BMI < 10). The causes of these failures were technical in 3 cases (gastric pouch to 0 large in 1, dilatation of gastrojejunostomy in 2). Three patients had a high calorie intake through an intact gastric bypass by snacking. Three patients regarded the operation as a failure although they had achieved significant weight loss, because they could no longer eat the usual amounts of food. CONCLUSION: Correct surgical technique and preoperative information on the changes in eating habits after a gastric bypass operation are the most important steps in preventing therapeutic failures.

Adolescent↗
PubMed1995

[The day care unit--a patient and personnel oriented and cost effective patient management?].

Based on the increasing number of chronically ill patients with restricted life expectancy it was necessary to reorganize the health care system. Aim of the study was to evaluate the benefits for patients and health care workers and the costs of day hospital care. In March 1991 a day clinic with 20 beds for HIV-antibody negative and HIV-infected patients was established. The number of patients treated increased from 122 patients in April 1991 to 487 patients in March 1993. During a 6 1/2-month period in 1994 2745 patients--33% were HIV-infected - were treated and diagnosed on this ward. The mean duration of hospital stay was 1.8 days. From January 1994 till 19th July 1994 200 diagnostic invasive procedures were performed, 150/200 were bronchoscopies. During the same period 158 non invasive diagnostic procedures were done. 436 cycles of chemotherapy were applicated and 277 patients were treated with blood products. 55/2745 patients (2%) had to be admitted to the ward because of worsening of the clinical condition. Based on the increasing number of patients who preferred the day clinic to the ward, it was an optimal sort of taking care for patients. Based on the results of questionnaires answered by nurses, working at the day clinic is beneficial for health care workers. Since the mean duration of hospital stay is reduced to 1.8 days the day clinic is cost-effective.

Attitude of Health Personnel↗
PubMed1995

[Herpes simplex virus type II infection as an exophytic endobronchial tumor].

We report the case of a 52 year-old homosexual AIDS patients suffering from Herpes simplex virus type II infection of the esophagus and the bronchial system. The chest radiograph revealed a homogeneous, well-defined consolidation of the right upper lobe. Gastroscopy showed an ulcer of the esophagus and gastritis of the antrum. Bronchoscopically, marked necrotizing tracheobronchitis and an exophytic tumour causing complete blockage of the apical segment of the right upper lobe were demonstrated. Histological examination of the biopsy specimens of the esophagus and of the bronchus revealed Herpes simplex virus type II infection of both organs. The patient was treated by acyclovir for 2 weeks. 6 weeks after the diagnosis of acute Herpes simplex virus type II infection had been established, the patient died as a result of a highly malignant non-Hodgkin's lymphoma of the cerebellum. Autopsy showed no remaining endobronchial tumour. Histological examination of the bronchus showed no evidence of viral infection or non-Hodgkin's lymphoma. An endobronchial tumour caused by Herpes simplex virus type II infection has not been described up to now.

AIDS-Related Opportunistic Infections↗
PubMed1995

Highly selective vagotomy plus Jaboulay: a possible alternative in patients with benign stenosis secondary to duodenal ulceration.

BACKGROUND: The treatment of patients with duodenal ulcers has undergone radical changes in recent years. Symptomatic stenotic obstruction of the gastric outlet, however, has remained a specific indication for elective operation, with gastric resection (Billroth I or II) and vagotomy often used as options for intervention. STUDY DESIGN: The present report describes the results of highly selective vagotomy (HSV) in combination with lateral Jaboulay gastroduodenostomy in the treatment of patients with benign stenosis secondary to duodenal ulceration. Functionality of results and patient satisfaction have been focal aspects in our assessment. RESULTS: During a period of five years, HSV plus Jaboulay was performed upon 19 patients (14 men and five women, with an average age of 55 years). No operative mortality was seen. The postoperative follow-up period ranged from 12 to 60 months. There were no ulcer recurrences, the functional results (roentgenographic double-contrast technique) were excellent, and patient satisfaction was high (Visick grade I, 67 percent; Visick grade II, 33 percent). CONCLUSIONS: As evidenced by the results, HSV plus Jaboulay seems to represent a convincing alternative to gastric resection in the treatment of patients with benign stenosis secondary to duodenal ulceration.

Adult↗
PubMed1995

[Idiopathic CD4+ T-lymphocytopenia in 2 patients without indications for HIV infection].

We report on two patients with idiopathic CD4+ T cell depletion. A 26 year-old woman presented to us with acute respiratory failure requiring mechanical ventilation. Despite combined antibiotic therapy parenterally the opacities increased in the chest X-ray. An open lung biopsy was performed and led to the histological diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP). Respiratory function was improved impressively by high dose parenteral cortisone administration. This patient showed a general lymphocytopenia with severe CD4+ T cell depletion (60(37%)/mm3 blood). The CT4+ T cell concentration increased during a follow up period of 14 months, but did not reach normal values. The second patient was a 33 year-old homosexual. He was admitted with a mucocutaneous fungal infection which was successfully treated by antifungal drugs. This patient demonstrated a transient CD4+ T cell depletion (350(32%)/mm3 blood). In both patients HIV type 1 and 2 infections were excluded by antibody- and p 24-antigen testing, polymerase chain reaction and virus culture. CONCLUSION. Idiopathic CD4+ T lymphocytopenia differs from HIV infection in immunological profile, in the tendency to reversal of the CD4+ T cell depletion over time and in its better prognosis. It is unclear if this is a new syndrome and whether a transmissible agent, or possibly a genetically-determined reaction to noxious agents is responsible.

Adult↗
PubMed1994

Prognostic factors for survival in colonic perforation.

Colonic perforation is an abdominal emergency with high morbidity and mortality. This retrospective study was performed to evaluate the prognostic relevance of several factors and to characterize patients at high risk. One hundred and twelve patients (61 women, 51 men) were treated for colonic perforation from 1979 to 1992. Diverticulitis [65 patients (58%)] and carcinoma [24 patients (21%)] were the commonest pathology. In 62 cases (55%) perforation was found to be covered; 50 (45%) times it was free. 34 (30%) patients had diffuse peritonitis. Resection with primary anastomosis was performed 43 times (7 times with a protective colostomy). Resection without restoration of the intestinal continuity was carried out 53 times (including 49 Hartmann operations). Suture with drainage was performed 16 times mainly after iatrogenic perforation (8 times with a colostomy). The overall mortality was 19.6% (22 patients). The prognostic importance of various factors was investigated by univariate analysis (Wilcoxon and Chi-square test) and stepwise logistic regression including sex, age, underlying disease, localization and type of perforation, degree of peritonitis, pre- or postoperative organ failure, surgical procedure, reoperation, sepsis and the Mannheimer Peritonitis Index (MPI) score. Age over 65 years (relative risk 4.6, P = 0.0089), organ failure (relative risk 40, P = 0.001) and MPI (relative risk for an increase of 10 points 2.72, P = 0.001) proved to be the only risk factors of significance. The patient's course is determined by the septic state, while the underlying pathology and degree of peritonitis did not significantly influence survival.

Adolescent↗
PubMed1994

[Infections with Mycobacterium tuberculosis and MOTT (Mycobacteria other than tuberculosis) in HIV infected and AIDS patients].

AIDS is characterized by a variety of opportunistic infections and malignant tumours. Tuberculosis occurs 500 times more often in HIV-infected patients than in patients with normal immunological function. In contrast to tuberculosis, which is diagnosed before the 1st AIDS defining disease, MOTT-infections are complications of late stage HIV-disease. The occurrence of drug-resistant strains of mycobacterium tuberculosis is a problem to be solved by the public health services. In contrast in MOTT-infections therapeutic problems exist.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Home care of AIDS patients from the medical and nursing viewpoint--a project in Vienna].

Based on the longer survival time of HIV-infected patients the spectrum of HIV associated complications changed. The frequency of neurological diseases, as AIDS dementia complex, is increasing. Therefore there is more need for nursing of AIDS patients. Aim of the study was to evaluate the cost-effectiveness, the practicability and the influence of home care on the outcome of the patients. During a 1-year period 7 AIDS patients were treated by 4 nurses and 1 doctor in a home care setting. Three of these patients were immobile and needed nursing; the four other received their parenteral therapy at home. Nursing took 2 to 7 hours, the administration of parenteral therapy one and a half hour per day and patient. 226,520 Austrian Schillings were spent for the care of the 7 patients during 1 year. By minimizing the duration and the number of hospital stays the quality of life of the patient was improved. Home care did not influence the outcome of the patients negatively.

Acquired Immunodeficiency Syndrome↗
PubMed1993

[Dorso-ventral continuous irrigation using the Incise Pouch].

Dorso-ventral lavage procedures in the treatment of abdominal sepsis are often complicated by technical and nursing problems. With the help of the Incise Pouch, which consists of an adhesive foil with a plastic bag around it, we have succeeded in solving the main problems of the dorso-ventral lavage procedure. (1) All the lavage solution is collected in the bag and drawn into a vacuum pump. The suction drains are placed directly in the bag. This enables us to measure the lavage solution exactly. (2) There is no leakage of liquid into the bed, so that the patient remains dry. (3) The danger of intestinal fistulas or intraabdominal bleeding caused by suction drains is eliminated (by putting them into the bag of the Incise Pouch). If reexploration of the abdominal cavity ("on demand" or planned) is done, the Incise Pouch remains in position. This method makes early diagnosis and treatment of postoperative complications possible.

Bandages↗
PubMed1993

The effects of norepinephrine on hemodynamics and renal function in severe septic shock states.

OBJECTIVE: To investigate the effect of norepinephrine (NE) on hemodynamics, oxygen metabolism and renal function in patients with severe septic shock. DESIGN: Prospective study. SETTING: Post-operative ICU in a municipal general hospital. PATIENTS: The study included 56 patients with extreme low resistance states due to abdominal sepsis, who remained hypertensive (MAP < 60 mmHg) despite optimal fluid therapy and dopamine > 20 micrograms/kg/min and cumulative doses of dopamine and dobutamine > 30 micrograms/kg/min, respectively. INTERVENTIONS: After registration of baseline values dopamine was reduced to 2.5 micrograms/kg/min, and norepinephrine was administered starting at a dose of 0.05 micrograms/kg/min until a mean arterial pressure of more than 60 mmHg could be maintained. MEASUREMENTS AND RESULTS: During norepinephrine infusion (dosage ranging between 0.1-2 micrograms/kg/min, mean dose rate: 0.4 micrograms/kg/min) mean arterial pressure and systemic vascular resistance index increased significantly (p < 0.001). After 8 h a significant increase in stroke volume (p < 0.05) and decrease in heart rate (p < 0.05) could be observed. There was no significant change in cardiac index (CI), oxygen delivery (O2AVI) and oxygen consumption (VO2I). Creatinine clearance increased significantly (p < 0.005) from a control value of 75 +/- 37 ml/min to 102 +/- 43 ml/min after 48 h NE-treatment. CONCLUSION: Our results suggest that norepinephrine can be used safely in the treatment of severe septic shock states. Mean arterial pressure and glomerular filtration rate improved markedly without deleterious effects on CI, O2AVI and VO2I.

Acute Kidney Injury↗
PubMed1993

Laparoscopically assisted implantation of ventriculoperitoneal shunts.

Laparoscopically-assisted minimally invasive procedures have been applied to a broad spectrum of abdominal interventions. Neurosurgeons performing ventriculoperitoneal shunt operations for hydrocephalus used to place the peritoneal catheter by performing an upper abdominal midline or subcostal incision. In this report, to reduce the patient's inconvenience caused by the laparotomy wound, three consecutive ventriculoperitoneal shunts were implanted, assisted by laparoscopy. By means of three incisions (one 10 mm supraumbilical for the camera and two 5 mm in the right hypochondric region for instrumentation) the peritoneal catheter was placed next to the epiploic foramen. After subcutaneous pull-through of the catheter to the right supraclavicular region, the operation was continued by the neurosurgeon. The postoperative course was uneventful in all cases. The patients were dismissed 3-7 days after surgery. Short time follow-up (212, 202, and 169 days after surgery) showed no complications and perfect function of the ventriculoperitoneal shunts.

Abdomen↗
PubMed1993

[Contribution of nuclear medicine to management of pulmonary complications in patients with acquired immune deficiency].

Opportunistic lung infections and malignancies are life-threatening complications in HIV-positive patients. In 72 HIV-positive patients the role of different non-invasive tests such as lung function tests, blood gas analysis, 67 gallium scanning and epithelial lung clearance with 99m Tc-DTPA for the management of these patients was prospectively studied. For all non-invasive tests the mean values of patients with pulmonary complications (n = 25) differed significantly from those of asymptomatic HIV-positive patients (n = 47) (p < 0.001). In 10 patients presenting with acute Pneumocystis carinii pneumonia, 99m Tc-DTPA clearance rates and 67 gallium uptake differed significantly before and after therapy (4.80 +/- 1.23%/min vs 2.47 +/- 0.72%/min and 2.15 +/- 0.42 vs 1.39 +/- 0.18, respectively). Follow-up after therapy revealed different time courses of these tests for normalization. A significant inverse correlation was found between DLCO and 99m Tc-DTPA lung clearance (r = -0.90, p < 0.001, n = 35). A diffuse homogeneous 67 gallium uptake is not diagnostic for PCP, the same pattern was found in a patient with lymphoid interstitial pneumonitis and in patients with CMV pneumonitis; these patients also had accelerated epithelial lung clearance rates. 67 gallium (6/6) was superior to 99m Tc-labelled immunoglobulin G (3/6) for detection of PCP. The 3 patients with Kaposi sarcoma of the lung had negative 67 gallium scans, but positive 201 thallium scans and increased 99m Tc-DTPA clearance rates.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗