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Biomedical subjects

C Armbruster

Publications and source records attributed to C Armbruster.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Totally implantable, permanent central venous catheter systems in AIDS patients--a method for home care or an unacceptable infection risk?].

Aim of the prospective study was to evaluate the infection risk of port-a-Cath-systems in AIDS patients and the prognosis of these catheter related complications. Over a 5-year period (December 1989 through November 1994) 50 port-a-Cath-systems were implanted in 44 AIDS patients. 77.2% of the patients were homosexuals, 20.5% were iv drug abusers. In 68% the indication for implantation of the catheter was prophylactic parenteral treatment in CMV retinitis. The mean duration of catheter use was 131.5 +/- 100.4 days (range = 7-421 days). 20 (40%) catheter-related infections occurred, thus implying an infection rate of 0.3 infections per 100 catheter days without difference between the risk groups of patients. Homecare was associated with an infection rate of 0.26 infections/100 catheter days compared with 1.0 infections/100 catheter days in in-patients. The most frequent causative organisms (75% of the infections) were staphylococci (40% Staphylococcus epidermidis). 19/20 infected catheters had to be removed after treating the patients by antimicrobial agents for a mean of 9.63 +/- 1.92 days. In 5/19 cases the germ was eradicated for a short period of time, but in every case bacteremia relapsed and the catheter had to be explanted. In one patient antimicrobial chemotherapy alone was successful. 30 patients died, 4 (13.3%) due to generalized bacterial infection. Based on these results, port-a-Cath-systems are helpful and safe devices for patient-centered and cost-effective care of AIDS patients at home.

AIDS-Related Opportunistic Infections↗
PubMed1996

Perforated colorectal cancer.

PURPOSE: Perforations are rare but serious complications of colorectal cancer, with mortality rates of 30 to 40 percent. The aim of this retrospective study was to investigate possible indicators of prognosis and causes of death and to evaluate the risk of this complication by comparing results in perforated tumors with uncomplicated cancers or large-bowel perforations attributable to benign causes. METHODS: Data of postoperative and long-term results of 35 patients with perforated colorectal cancers were compared in 868 patients with uncomplicated cancers and 130 patients with large-bowel perforations attributable to benign diseases. Postoperative survival in perforated cancers (mortality, 40 percent) was determined by degree of peritonitis, septic state, and tumor stages. RESULTS: Comparison of the three groups demonstrated advanced tumor stages, a higher rate of septic organ failures, and higher mortality rates for perforated cancers. Long-term survival depended on tumor stages but did not differ in perforated and uncomplicated cancers. CONCLUSIONS: A cumulative effect of malignancy and sepsis may be responsible for the high postoperative mortality in malignant perforation. Patients with perforated cancers represent the highest risk group in colonic perforation.

Aged↗
PubMed1996

[Acute pulmonary histoplasmosis with liver and lung involvement outside the endemic area--differential diagnosis].

A case of acute pulmonary histoplasmosis in a non-endemic setting is described. A 36 year-old male patient was admitted because of fever attacks, weakness and dyspnea on exertion. The chest X-ray revealed bilateral patchy and nodular consolidations and bilateral enlargement of the hilar lymph nodes. On computed tomography of the abdomen the spleen was enlarged with a longitudinal diameter of 12.7 cm. Respiratory insufficiency was demonstrated by an arterial oxygen tension (PaO2) of 7.71 kPa at rest. Pathological values of liver function tests were indicative of liver involvement. A transbronchial lung biopsy was performed. Histologic examination of the biopsy specimen revealed scattered small nonnecrotizing granulomas with epithelioid cells and multinucleated giant cells. Precipitating antibodies to Histoplasma capsulatum were detected by immunodiffusion in bronchoalveolar lavage fluid and blood, IgG antibodies to Histoplasma capsulatum yeast antigens were revealed by enzyme immunoassay. The histoplasmin skin test was negative. The pneumonitis, lymph node and spleen enlargement and the pathological liver function tests resolved within one month without treatment. The PaO2 returned to normal within one week.

Adult↗
PubMed1996

[Long-term outcome of surgical therapy of acute necrotizing pancreatitis].

This paper discusses the long-term results after surgical treatment of necrotizing pancreatitis. Thirty-one patients were examined 3 years after the operation. The development of diabetes was the main problem in 29% of the patients and depended on the amount of pancreatic tissue resected (never after necrosectomy, in 47% after pancreatic resection; P = 0.005, Fischer's exact test). Of the patients, 77% were in good general condition and 68% were able to work. In 50% of the patients abdominal wall function was impaired but most of them could cope with this insufficiency. Of the patients with alcohol-induced pancreatitis, 75% were abstinent. Considering the severity of the disease, long-term results after surgical treatment of necrotizing pancreatitis are satisfactory.

Abdominal Muscles↗
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

Diagnostic value of stereotactic biopsy of cerebral lesions in patients with AIDS.

A neurological complication occurs in 40-60% of HIV infected patients during the course of the disease. In 10-20% the neurological complication is the first manifestation of the HIV infection. A reliable neuropathological diagnosis is a prerequisite for a specifically selected treatment. While modern computer-assisted imaging techniques, such as computed tomography or magnetic resonance imaging, do possess a high sensitivity, they do not as a rule permit an unambiguous diagnosis. Between October 1989 and July 1994 we biopsied 38 HIV infected patients stereotactically. The indication for the biopsy was determined by having radiologically detectable lesions with no regression tendency in patients under antitoxoplasmosis therapy. In 89% an unambiguous diagnosis was made based on the biopsy; 11% of the biopsies were not diagnostic. For the most part, toxoplasmosis (31%) and progressive multifocal leucoencephalopathy (29%) were involved. 18% of the patients suffered from a non-Hodgkin lymphoma. The foci were primarily frontal (47%), parietal (21%) or localised in the basal ganglia area (11%). The result of the biopsy led to a change in treatment for 52% of the patients. Morbidity and mortality of the operation were 0%. The results or our research series are similar to other groups. It was shown that stereotactic brain biopsy is a safe and effective method for establishing a sound basis for treating the frequently life-threatening cerebral complications of AIDS.

Acquired Immunodeficiency Syndrome↗
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↗