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Biomedical subjects

C Armbruster

Publications and source records attributed to C Armbruster.

84 records · Page 5Linked to original sources
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↗
PubMed1987

[Comparison of the effectiveness of ceftazidime and cefazolin/tobramycin in patients with inflammatory diseases of the lower respiratory tract].

We compared the efficacy of ceftazidime and cefazolin in combination with tobramycin in the treatment of lower respiratory tract infections. Bacterial pathogens were isolated from sputum or bronchial secretions from 92 patients. The clinical results were identical in both groups: All patients showed an improvement of the clinical symptoms or were cured. 88% of the patients in the ceftazidime-group and 76% of the patients in the cefazolin/tobramycin-group showed an eradication of the pathogens without superinfection. This difference was not statistically significant (p = 0.095). Monotherapy with ceftazidime was clinically and bacteriologically as effective as a combination therapy with cefazolin and tobramycin.

Adult↗
PubMed1985

[Extensive multiple hamartomas of the lung of the diffuse juvenile type].

The case report of a 12 year-old female patient suffering from extensive multiple hamartomas of the left lung (diffuse juvenile type) is presented. The clinical features were atypical due to the large size of the tumour. The entire left lung and parts of the pleura and pericardium were involved. The diagnosis was reached only after histological examination of the operation specimen, as is usual with intrapulmonary hamartomas of the lung.

Biopsy↗
PubMedDate not supplied

Stapling devices in gastrointestinal surgery.

In a series of 189 patients, 197 operations (251 stapled anastomoses) were performed. U.S. Surgical Corporation instruments (GIA n = 156, EEA n = 36, TA n = 59) were used in surgery of the stomach, pancreas, small and large bowel, and the rates of complications were investigated. The EEA gave 14% complications because of the frequent failure (33%) of the anastomosis after low anterior resection. The reasons for failure were incomplete rings, colonic wall damage and too short rectal stumps. The use of the EEA in esophago-jejunostomy and esophago-gastrostomy was safe and the postoperative course uneventful. The GIA was used in intestinal and colonic surgery and was pleasant and quick to use (right hemicolectomy: 1 hour 40 minutes; sigmoid resection: 1 hour 45 minutes). Complications occurred in the intestine (6%) and colon (7%). Only with GIA stapled anastomoses was there a risk of hemorrhage (2.5%). The incidence of anastomotic leakage (all staplers) was 3.6%; the stapler was responsible for a 2.0% mortality. Weighing up the indications and contraindications of stapling devices, this method presents an advantageous but not indispensable method in gastrointestinal surgery.

Adult↗
PubMedDate not supplied

Diagnosis of Pneumocystis carinii pneumonia by bronchoalveolar lavage in AIDS patients. Comparison of Diff-Quik, fungifluor stain, direct immunofluorescence test and polymerase chain reaction.

OBJECTIVE: To assess the sensitivity, specificity and accuracy of Diff-Quik, fungifluor stain, the direct immunofluorescence test (DIFT) and the polymerase chain reaction (PCR) in the diagnosis of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-infected patients. STUDY DESIGN: From December 1992 through November 1993, 112 bronchoalveolar lavage fluid (BALF) samples were obtained from 80 HIV-infected patients. BALF samples were processed for cytologic and microbiologic analysis and for PCR. Cytologic examination was carried out on Diff-Quik-stained cytocentrifuge preparations and with May-Grünwald-Giemsa staining and fungifluor staining. For diagnosis of PC infection, DIFT and PCR were used. RESULTS: Thirty-two of 112 acute episodes were caused by P carinii. Diff-Quik had the highest sensitivity (84.8%) as compared to fungifluor stain (60.0%), DIFT (59.4%) and PCR (65.6%). The specificity was 98.7% with Diff-Quik, 100% with fungifluor stain, and 98.6% and 97.3% with DIFT and PCR, respectively. Accuracy was high with every method (94.4% with Diff-Quik, 88.3% with fungifluor stain, 86.7% with DIFT and 87.6% with PCR). CONCLUSION: Diff-Quik is a good diagnostic tool in the diagnosis of PCP. The combination of Diff-Quik and fungifluor stain is recommended because of its cost-effectiveness and because of its rapid diagnosis of severe PCP. PCR and DIFT should be used only on patients judged clinically to have PCP with discrepant results in Diff-Quik and fungifluor stain in BALF samples.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Pleural effusions in human immunodeficiency virus-infected patients. Correlation with concomitant pulmonary diseases.

The objective of our study was to evaluate the prevalence of pleural effusions in patients with the acquired immunodeficiency syndrome, to correlate these effusions with any concomitant pulmonary diseases and to evaluate the role of cytologic examination in the diagnosis of the effusions. Twenty-eight of 389 (7.2%) human immunodeficiency virus-infected patients had pleural effusions and 27 of the 28 were suffering from concomitant pulmonary diseases. Those diseases were bacterial pneumonia (9), mycobacterial infection (7), non-Hodgkin's lymphoma (4) and Kaposi's sarcoma (2). Pneumocystis carinii pneumonia was diagnosed in two patients, and cytomegalovirus pneumonitis and pulmonary aspergillosis and small cell carcinoma in one patient each. Cytologic examination of pleural effusions provided conclusive diagnoses of mycobacterial infection in 2 of the 7 patients, of non-Hodgkin's lymphoma in 4 and of P carinii infection in 2.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Improved results after aggressive treatment of colonic involvement in necrotizing pancreatitis.

BACKGROUND/AIMS: Colonic involvement is a rare but serious event in necrotizing pancreatitis. Early detection of this complication is difficult; a delay of diagnosis may lead to perforation and peritonitis. Two strategies of therapy have been developed in the last few years: an aggressive regimen of early resection and a conservative approach with ileostomy and observation. MATERIALS AND METHODS: Fourteen of 118 patients treated for necrotizing pancreatitis from 1988 to 1995 presented with colonic necrosis. The diagnosis of necrosis was made if the color of the bowel wall demonstrated ischemia or hemorrhagic infarction or pulsations of the mesocolic vessels could not be palpated. The first two patients were treated by a conservative approach the following 12 by immediate large bowel resection. Follow-up results of all surviving patients were obtained. RESULTS: Patients with colonic lesions demonstrated an advanced septic state compared to patients who did not present this complication. Differences in the average Apache 2 scores on admission and the incidence of multiple organ failure were significant (Apache 2 score; 16.6 versus 11.9, p = 0.028, Wilcoxon; multiple organ failure; 71% versus 35%, p = 0.028, Fisher's exact test). Results after establishment of early discontinuity-resection of colonic necrosis compared favorably to those of a conservative strategy (mortality 4/12; 33% versus 2/2; 100%). The overall mortality was 43% (6 of 14 patients). Restorative surgery was performed in 6 patients without substantial morbidity and no mortality. Follow-up results were satisfactory in the majority of the patients. CONCLUSIONS: Early resection of colonic lesions improves results in this dangerous complication of necrotizing pancreatitis.

Adult↗
PubMedDate not supplied

Improved results after aggressive treatment of colonic involvement in necrotizing pancreatitis.

BACKGROUND/AIMS: Colonic involvement is a rare but serious event in necrotizing pancreatitis. Early detection of this complication is difficult; a delay of diagnosis may lead to perforation and peritonitis. Two strategies of therapy have been developed in the past few years: an aggressive regimen of early resection and a conservative approach by ileostomy and observation. MATERIALS AND METHODS: Fourteen of 118 patients treated for necrotizing pancreatitis from 1988 to 1995 presented with colonic necrosis. The diagnosis of necrosis was made if the color of the bowel wall demonstrated ischemia or hemorrhagic infarction or pulsations of the mesocolic vessels could not be palpated. The first two patients were treated by a conservative approach, the following 12 patients by immediate large bowel resection. Follow-up results of all surviving patients were obtained. RESULTS: Patients with colonic lesions demonstrated an advanced septic state compared to patients who did not present this complication. Differences in the average Apache 2 scores on admission and the incidence of multiple organ failure were significant (Apache 2 score; 16.6 versus 11.9, p = 0.028, Wilcoxon; multiple organ failure; 71% versus 35%, p = 0.028, Fisher's exact test). Results after establishment of early discontinuity-resection of colonic necrosis compared favorably to those of a conservative strategy (mortality 4/12; 33% versus 2/2; 100%). The overall mortality was 43% (6 of 14 patients). Restorative surgery was performed in 6 patients without substantial morbidity and no mortality. Follow-up results were satisfactory in the majority of the patients. CONCLUSIONS: Early resection of colonic lesions improves results in this dangerous complication of necrotizing pancreatitis.

Adult↗