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Biomedical subjects

C Armbruster

Publications and source records attributed to C Armbruster.

At least 73 records · Page 4Linked to original sources
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↗
PubMed1992

Nd:YAG laser treatment of colorectal malignancies: an experience of 4 1/2 years.

Between 1985 and 1990, 517 patients were treated for colorectal malignancies at our department of surgery. Nd:YAG laser therapy was used in 37 cases (7.1%). The mean age of these 22 men and 15 women was 71.4 years (range: 22-96 years). One hundred-twenty-nine Nd:YAG laser treatments were performed. Indications for laser treatment were (1) palliative tumor reduction (n = 21), (2) preresectional laser recanalization for obstructing carcinoma (n = 6), and (3) curative treatment (n = 10). Laser related complications included one perforation of the rectum and one rectovaginal fistula. One fatal pulmonary embolism occurred. After palliative treatment, five patients died because of tumor progression (mean survival time: 16 months), two because of other reasons. All patients with obstructing tumors could be recanalized successfully. After curative treatment, eight patients are still alive without tumor recurrence (mean survival time: 25.5 months), and two died of other causes. Palliative Nd:YAG laser treatment of colorectal malignancies is a competitive alternative to conventional surgery. Recanalization of obstructing tumors is an excellent treatment for large bowel obstruction, making one-stage resections possible. Curative treatment should be reserved for special cases only.

Adenocarcinoma↗
PubMed1992

[The value of barium double-contrast study in the aftercare of gastrectomy patients (Roux-Y)].

We evaluated 32 patients who had undergone jejuno-oesophagostomy for gastric carcinoma. Double contrast radiography was performed 3 to 36 months after gastrectomy, 3 to 14 days prior to routine endoscopy. Endoscopy is superior to double contrast radiography in detecting tumour recurrence, particularly in small tumours, due to the possibility of biopsy. Double contrast radiography is excellent in demonstrating the afferent loop. We found a high number of jejuno-oesophageal reflux and very different small intestine transit times without correlation to clinical signs and symptoms.

Adult↗
PubMed1992

[Differential diagnosis of ascites and abscess forming hepatitis in AIDS patients with reference to the first patient with microsporidia infection in Austria].

We report on a 30 years-old female AIDS patient suffering from generalized pneumocystosis and intestinal microsporidiosis. The chest X-ray showed a right-sided pleural effusion; the lungs showed no areas of consolidation and the heart and the vessels were normal in size. Sonography revealed multiple cystic lesions of the liver measuring 1-3 cm in diameter, as well as ascites. Pneumocystis carinii was detected on cytological examination of the bronchoalveolar lavage fluid, the pleural effusion and the ascitic fluid. Intestinal microsporidiosis was diagnosed by cytological examination of the stool. Both pneumocystis carinii infection and microsporidiosis may cause hepatitis and ascites. In our patient the organ manifestations of the two infections did not overlap. Since simultaneous organ manifestations are possible the differential diagnosis is discussed. This is the first case of microsporidiosis reported in Austria.

AIDS-Related Opportunistic Infections↗
PubMed1991

[Differential diagnosis of necrotizing sarcoid angiitis: necrotizing sarcoid angiitis and collagen disease--a case report].

The chest x-ray showed a bilateral micronodular pattern and hilar lymph nodes. Lung function test revealed a diminished VC, TLC and a reduced compliance and CO diffusion capacity. The histological examination of the lung biopsy showed sarcoid-like necrotising granulomatous formations of the vessel walls and destruction of these. Unusual was the coincidence of a sarcoidal necrotizing angiitis and a connective tissue disease which presented as Raynaud's disease. Antinuclear antibodies and antibodies against SSA-RO and Scleroderma 70 were identified. The histological examination of the skin biopsy showed changes pertaining to scleroderma. In accordance with the definition by Laevitt (4, 5), this disease is a polyarteritis overlap syndrome.

Adult↗
PubMed1991

[Wegener's granulomatosis with splenic involvement and Hashimoto's lymphomatous thyroiditis].

A case of a 37-year old female patient suffering from Wegener's granulomatosis is reported. The chest x-ray showed a tumorous consolidation of the right upper lobe and of the apical segment of the right lower lobe. The histological examination of the lung, the kidney and the spleen revealed necrotising granulomas typical of Wegener's granulomatosis. Additionally, a thyroiditis lymphomatosa Hashimoto was diagnosed. So far, coincidence of thyroiditis Hashimoto and Wegener's granulomatosis has not been reported in the literature. The involvement of the spleen was a rare manifestation of Wegener's granulomatosis.

Adult↗
PubMed1990

[Appendix cancer].

Explore the source record for details and available documents.

Adenocarcinoma, Mucinous↗
PubMed1990

[Noradrenaline in the "high output-low resistance" state of patients with abdominal sepsis].

We investigated the impact of norepinephrine administration on hemodynamics, oxygen metabolism and renal function in patients in severe septic shock. PATIENTS AND METHODS. Twenty-six patients with extremely low resistance who were between 24 and 87 years of age were included in the study. In 7 patients, acute necrotizing pancreatitis and superinfection was diagnosed; 19 patients suffered from diffuse peritonitis. The entrance criteria for the study were: a mean arterial pressure (MAP) of below 60 torr or, in chronic hypertensive patients, a decrease in systolic pressure of more than 50 torr compared to previous values, despite volume optimization, and dopamine greater than 20 micrograms/kg per min and cumulative doses of dopamine/dobutamine greater than 30 micrograms/kg per min, respectively. Cases with tachycardia greater than 140/min were also included in the study even when the inotropic medication dose was lower. After registration of baseline values, dopamine was reduced to 2.5 micrograms/kg per min, and norepinephrine was administered starting at a dose rate of 0.05 micrograms/kg per min, until a MAP of greater than 60 torr could be maintained. RESULTS. Of the 26 patients investigated, 16 survived; 10 patients with persisting sepsis died due to multiple organ failure (mortality: 38.5%). During the study period, a norepinephrine dosage ranging between 0.1 and 2 micrograms/kg per min was necessary to stabilize the arterial pressure. The mean dose rate was 0.3 micrograms/kg per min. The mean arterial pressure and systemic vascular resistance index showed a statistically significant increase of 30 and 20%, respectively, just after 1 h and distinctly remained above the initial values in the further course. The cardiac index remained constant or increased slightly. After 24 h a statistically significant increase in stroke volume and a decrease in heart rate could be observed. Creatinine clearance increased significantly from the control value of 73 +/- 48 ml/min to 114 +/- 37 ml/min after 48 h under norepinephrine treatment. O2-delivery and O2-consumption did not change significantly, although they showed a slight tendency to increase. CONCLUSION. When patients are in a septic high output-low resistance condition, particular attention must be paid to maintaining sufficient mean arterial pressures. Our results suggest that this essential goal can be achieved by norepinephrine. The mean arterial pressure and glomerular filtration rate improved markedly, and there was no evidence of bad effects such as an increased afterload on critical parameters like cardiac index, O2-delivery and O2-consumption.

Acute Disease↗
PubMed1989

[The place of selective proximal vagotomy in complicated duodenal ulcers].

From 1980 to 1988 417 patients underwent surgery for peptic duodenal ulcer. Complications were present in 217 patients: perforation (40%), bleeding (32%), stenosis (20%) or penetration (8%). Highly selective vagotomy was performed in 67% of all patients. The number of operations for duodenal ulcer decreased (1984 n = 61, 1988 n = 28) due to fewer operations for uncomplicated ulcers, whereas the number of operations for complicated cases remained equal. Mortality after highly selective vagotomy for complicated duodenal ulcer was 5.2%. All fatalities occurred after bleeding. Whereas highly selective vagotomy was performed frequently for stenosing (72%) and bleeding (68%) ulcers it was the exception in perforate duodenal ulcers (13%). A tendency to increased performance of highly selective vagotomy in complicated cases is evident (1981 40%, 1988 70%). A further increase seems possible by using more liberal indications for selective vagotomy in perforated ulcers and by more frequently carrying out preoperative endoscopic hemostasis in bleeding duodenal ulcers.

Duodenal Obstruction↗
PubMed1989

[Circular staplers in esophagojejunal and esophagogastric anastomoses].

A report on 100 consecutive esophagoenteric anastomoses (EEA stapler) following total (esophagojejunostomy) or proximal gastrectomy (esophagogastrostomy) is presented. The following intraoperative problems occurred: insufficiency of the purse string suture [4], lumen of the esophagus too small [1], rupture of the esophageal wall [4], incomplete rings [4]. Fatal postoperative complications included two cases of insufficiency of the esophagojejunostomy, whilst the remaining six postoperative deaths were not linked to the use of the stapler (operative mortality 8%). Follow-up showed no recurrence at the stapler line, but two anastomotic strictures occurred. The EEA stapler is a helpful instrument to reduce leakage at the esophagoenteric anastomosis and, hence operative mortality after total and proximal gastrectomy.

Adult↗
PubMed1989

Percutaneous endoscopic cholecystolithotripsy. Work in progress.

In spite of long-term adjunctive oral dissolution therapy, residual gallstones have been reported in up to 50% of gallstone patients 3 months after extracorporeal shock-wave lithotripsy. Six women and five men, aged 31-75 years, underwent percutaneous endoscopic cholecystolithotripsy between April 1988 and October 1988. The gallbladder was punctured by means of an anterior transperitoneal approach. The tract was dilated, and gallstones were removed with a modified 21-F cholecystoscope under direct visual inspection. Calculi too large for extraction were disintegrated with ultrasound or electrohydraulic lithotripsy. Eight patients were stone-free and two had small residual stones 3 months later; nine were stone-free 6 months after the procedure. Although more invasive than shock-wave lithotripsy, percutaneous endoscopic cholecystolithotripsy has the advantage of immediate removal of more calculi, causes less pain, necessitates less postoperative immobilization, and allows patients to leave the hospital sooner.

Adult↗
PubMed1989

Stonebearing gallbladders: CT anatomy as the key to safe percutaneous lithotripsy. Work in progress.

Percutaneous cholecystolithotripsy can be performed with a transhepatic or transperitoneal approach. Because the anatomy of the gallbladder varies from person to person, the authors began a study to evaluate the position of the gallbladder with computed tomographic scans of 100 patients known to have stones in their gallbladders. Four variations in the relationship of the gallbladder to the liver and anterior abdominal wall were noted: completely intrahepatic gallbladders (39%) (type I), gallbladders bulging anterior to the anterior rim at least in part (35%) (type II), gallbladders completely anterior to the liver (17%) (type III), and gallbladders in a lateral position (9%) (type IV). In 51%, the colon was in direct contact with the gallbladder, and in 13% it was positioned between the abdominal wall and gallbladder. A safe percutaneous puncture was not possible in 34% of the patients (nine type IV gallbladders, 23 type I organs, and two type III gallbladders with anterior interposition of the colon).

Adult↗
PubMed1989

[Effect of stress ulcer prevention on the incidence of ventilation pneumonia at a pulmologic intensive care unit].

In a retrospective analysis, the influence of stress ulcer prophylaxis on the incidence of ventilation pneumonia (VP) was investigated. In VP, we were able to isolate enterobacteria from the tracheal aspirate or bronchial secretion significantly (p = 0.015) more frequently than in the case of environmentally acquired and nosocomial pneumonia which were treated in the intensive care unit but did not comply with the criteria for VP. The detection of intestinal bacteria in the respiratory tract in VP patients supports the hypothesis that the "gastro-pulmonary" colonisation pathway represents a decisive factor in the development of VP. Patients undergoing long-term ventilation who had received ranitidine for prophylaxis of stress ulcer, developed VP statistically significantly more frequently (p = 0.044) than did patients with sucralfat cover. The non-physiologically high acid juice pH associated with the use of H2-antagonists leads to an increase in intestinal organisms within the stomach. By ascending the upper GI tract, the bacteria finally colonise the respiratory tract. Through the application of sucralfat, whose ulcerprotective action is not achieved by the inhibition of acid in the stomach, the incidence of VP in a pulmological intensive care unit was reduced.

Adolescent↗
PubMed1989

[Indications for primary anastomosis following resection of acute diverticulitis of the large intestine].

A retrospective review of 102 patients (1979-1987) was performed to evaluate the surgical management of complicated diverticulitis. The following operative strategy was found to be effective: 1. the Hartmann procedure in free perforation and diffuse peritonitis; 2. resection with primary anastomosis in free perforation and localized peritonitis, covered perforation, inflammatory tumor and fistulas, if healthy bowel ends could be used for anastomosis.

Acute Disease↗