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Biomedical subjects

D E Low

Publications and source records attributed to D E Low.

At least 199 records · Page 11Linked to original sources
PubMed1989

Colorectal neodymium-YAG photoablative therapy. Comparing applications and complications on both sides of the peritoneal reflection.

Laser photoablative therapy has seen wide application in the esophagus, stomach, and rectum. Its use in the supraperitoneal colon has been less extensive because of fear of complications. One hundred fifteen patients who presented during a four-year period and underwent neodymium-YAG laser treatment on both sides of the peritoneal reflection (rectum, 47 patients; colon, 68 patients) were reviewed. The various lesions treated with laser therapy included 32 malignant tumors that presented with bleeding or obstruction, 44 large broad-based villous adenomas, six carcinoid tumors, and 33 patients with arteriovenous malformations or radiation proctitis who presented with acute hemorrhage or chronic blood loss. Overall treatment efficiency was 83% in the rectal group vs 87% in the colonic group. There was no significant difference in complication frequency or severity between the two groups, even though 45% of the colonic lesions were located in the thin-walled cecum. There was no laser-related mortality in this series. Laser photoablative therapy is safe and effective treatment for a wide variety of colorectal lesions. In experienced hands, it can be used on either side of the peritoneal reflection with equal efficiency and no increased risk of complications.

Adenoma↗
PubMed1989

Evaluation of five commercial systems for identification of coagulase-negative staphylococci to species level.

Five commercially available systems for identification of coagulase-negative staphylococci to the species level were evaluated using 163 clinical staphylococcal isolates. The conventional method of Kloos and Schleifer served as reference method. The API20GP system showed the highest rate of agreement with the reference method, correctly identifying 98.8% of the isolates. The Microscan system had an overall rate of agreement of 96.3%, and Staph-Trac, Sceptor and Staph-Ident rates of 88.8%, 87.6% and 84.% respectively.

Bacterial Typing Techniques↗
PubMed1989

Endoscopic variceal sclerotherapy as primary treatment for bleeding esophageal varices.

In this study of 75 patients with bleeding esophageal varices we confirm not only the ability of endoscopic variceal sclerotherapy (EVS) to control acute bleeding episodes but to effect variceal obliteration that confers a significant survival advantage, regardless of initial Child's classification. Survival correlates directly with the degree of hepatic dysfunction, although all patients regardless of Child's status have a statistically significant survival advantage when treated until esophageal variceal obliteration is achieved. All patients treated with EVS should be followed for life, but virtually all follow-up can be done on an outpatient basis. Shunt surgery should be reserved for: (a) patients whose acute bleeding cannot be controlled with EVS at the time of index bleed; and (b) patients who rebleed repeatedly or uncontrollably from gastric or duodenal varices. EVS is more cost-effective than other available treatments. It also effectively stabilizes potential candidates for orthotopic liver transplantation. Despite a progressive increase in the admissions for bleeding varices at our institution, the introduction of EVS has been associated with a significant decline in portosystemic shunt therapy. We believe that EVS is now the first-line treatment for all patients with bleeding esophageal varices.

Endoscopy↗
PubMed1989

Comparative in vitro activities of six new fluoroquinolones and other oral antimicrobial agents against Campylobacter pylori.

The in vitro susceptibilities of 56 clinical isolates of Campylobacter pylori to six new fluoroquinolones and other oral antimicrobial agents were determined by an agar dilution technique. Ciprofloxacin was the most active of the fluoroquinolones (MIC for 90% of strains tested [MIC90], 0.05 microgram/ml). Other fluoroquinolones had variable activities, although most isolates were moderately susceptible to fleroxacin (MIC90, 4 micrograms/ml) and lomefloxacin (MIC90, 4 micrograms/ml).

Ampicillin↗
PubMed1989

Activities of daptomycin and teicoplanin against Staphylococcus haemolyticus and Staphylococcus epidermidis, including evaluation of susceptibility testing recommendations.

The in vitro activities of daptomycin, teicoplanin, and three other antimicrobial agents were determined against 105 strains of Staphylococcus haemolyticus and 92 strains of Staphylococcus epidermidis. The MICs for 90% of strains tested (MIC90s) of fusidic acid and rifampin were less than or equal to 0.25 microgram/ml. The MIC90s of daptomycin and vancomycin were less than or equal to 4 micrograms/ml. Teicoplanin had a comparable MIC90 of less than or equal to 4 micrograms/ml for isolates of S. epidermidis. However, MIC90s were 8 and 16 micrograms/ml for oxacillin-susceptible and oxacillin-resistant S. haemolyticus, respectively. Disk diffusion tests were evaluated for daptomycin and teicoplanin. Disks with 30 micrograms of teicoplanin performed satisfactorily when S. epidermidis was tested, but when S. haemolyticus was tested, there was a very major error rate of 10% and a minor error rate of 38%.

Anti-Bacterial Agents↗
PubMed1989

Embolic mesenteric infarction: a unique initial manifestation of renal cell carcinoma.

Renal cell carcinoma is an unpredictable tumor that often has already metastasized when first seen. It can affect many organs before the primary tumor is found. We describe a unique example of renal cell carcinoma first seen as repeated episodes of small-bowel infarction caused by tumor emboli from a metastasis in the left ventricle. Although intestinal ischemia caused by emboli is not uncommon, intestinal ischemia resulting from metastatic tumor emboli occurs in only a small percentage of cases. We suggest that surgeons include the possibility of tumor emboli in the differential diagnosis for mesenteric or peripheral ischemia that cannot be attributed to more common causes.

Acute Disease↗
PubMed1989

Fifteen- to twenty-year results after the Hill antireflux operation.

Antireflux surgery, specifically the Hill procedure, has been shown to be effective management of refractory reflux when assessed in the relatively short term. This study follows 441 patients from the time of their initial operation and reports on assessments conducted after 5 to 10 years and 15 to 20 years. The late study group comprises 167 patients (mean age 71 years) with an average follow-up of 17.8 years; 15.6% of patients had undergone a previous antireflux operation. Overall subjective good and excellent results, as determined by the patients themselves, were seen to improve significantly (p less than 0.02) between the two follow-up periods, 82% and 88%, respectively. No serious late complications such as fistula, bleeding, or obstruction were observed in this series. The Hill antireflux operation, properly performed, provides durable long-term results.

Adolescent↗
PubMed1988

Cervical esophageal web associated with Zenker's diverticulum.

We reviewed 12 patients who underwent diverticulectomy and myotomy for Zenker's diverticulum. Fifty percent of these patients were found to have cervical esophageal webs that were resected at operation. The association of Zenker's diverticulum and esophageal webs is new. The present study demonstrates that it is not a rare relationship and that these webs can cause postoperative problems. We utilized the technique of open diverticulectomy and found that it facilitates cricopharyngeal myotomy and allowed intraoperative inspection of the esophageal lumen, thereby patients with coexisting intraesophageal pathologic abnormalities could be identified. This procedure can be performed within very acceptable limits of morbidity, as demonstrated in our study, although it is not recommended for surgeons who do not regularly operate on the esophagus. Surgeons should consider this technical approach to Zenker's diverticulum when the presence of cervical webs is known or suspected preoperatively. Cervical esophageal webs are a potential source of postoperative dysphagia. They should therefore be excised when encountered intraoperatively. The actual incidence of cervical esophageal webs and their potential role in the pathogenesis of cricopharyngeal muscle hypertrophy and Zenker's diverticulum will require additional study.

Aged↗
PubMed1988

Nd-YAG laser photoablation of sessile villous and tubular adenomas of the colorectum.

Neodymium (Nd)-YAG laser photoablation treatment was used to treat 46 patients with broad-based villous and tubular adenomas of the colon or rectum. These adenomas were distributed throughout the large bowel, with the majority (72%) located above the peritoneal reflection. Patients received an average of 2.1 treatments per adenoma, with 22 patients (48%) requiring only one treatment. Overall treatment success was achieved in 89% of cases (mean follow-up of 12 months), with four patients undergoing continued therapy. Of the patients who received a full course of treatment, only two (4%) were not taken to complete photoablation. Complications were minimal, and 92% of all laser treatments were done on an outpatient basis. Four patients had documented polyp recurrence that was controlled with additional laser treatment. Two patients with malignant polyps who were not surgical candidates were also treated with the laser, with no tumor recurrence seen at 11 and 14 months. Nd-YAG laser photoablation of large colonic polyps offers a safe, efficient, and cost-effective alternative to standard surgical resection.

Adenoma↗
PubMed1988

Problems with rapid agglutination methods for identification of Staphylococcus aureus when Staphylococcus saprophyticus is being tested.

Six rapid agglutination tests for identification of Staphylococcus aureus were evaluated by using 62 strains of S. aureus, 63 strains of S. saprophyticus, and 67 strains of other coagulase-negative staphylococci. S. saprophyticus was responsible for 19 of 26 false-positive results and 20 uninterpretable reactions. Thus, urinary staphylococcal isolates that are positive by rapid agglutination tests may require other confirmatory tests for the identification of possible S. saprophyticus.

Hemagglutination Tests↗
PubMed1988

Evaluation of a new latex test and a new enzyme immunoassay for determination of rubella immunity.

A new enzyme immunoassay (Rubenostika; Organon Teknika, Turnhout, Belgium), a new latex agglutination test (Rubalex; Orion Diagnostica, Espoo, Finland), and three other accepted methods for the determination of rubella immunity were compared with a standard hemagglutination inhibition assay. Of 224 serum samples tested, 54 (24%) were nonreactive and 24 (11%) were low titered. All procedures were very specific (94 to 100%). Rubenostika was the least sensitive method (88%), and Rubalex was the most sensitive (98%).

Antibodies, Viral↗
PubMed1988

Complete esophageal obstruction secondary to dissecting intramural hematoma after endoscopic variceal sclerotherapy.

Endoscopic variceal sclerotherapy (EVS) is an accepted alternative to surgery in many patients with bleeding esophageal varices. Esophageal ulceration is a common sequelae of EVS with chest pain, stricture, and perforation occurring less frequently. We present a patient with Laennec's cirrhosis and coagulopathy who developed an obstructing esophageal hematoma caused by submucosal dissection after two EVS treatments.

Adult↗
PubMed1988

Post Nissen syndrome.

The Nissen fundoplication is the most common anti-reflux operation performed. Gas bloat and inability to vomit after repair may be severe, but infrequently require reoperation; in contrast, other complications can be very debilitating or life-threatening. One hundred and sixteen patients who required reoperation for serious complications after Nissen repair are presented and classified according to the cause of the failed repair. Nissen complications resulted in recurrent reflux (86 per cent), severe dysphagia (60 per cent), esophageal dysmotility (48 per cent) and gastric perforation and fistualization (5 per cent). The "classic" Nissen fundoplication involves a blind 360 degree wrap, which includes the acid-producing parietal cell mass. The resulting pouch drains poorly and is, therefore, subject to gastric ulceration. Reoperation at our institution, using principally the Hill antireflux procedure, gave excellent or good results in 86 per cent, fair in 9 per cent and poor in 5 per cent. Three operative deaths (2.6 per cent) and one late death (0.9 per cent) occurred.

Adolescent↗
PubMed1987

Prospective assessment of risk of bacteremia with colonoscopy and polypectomy.

A prospective assessment was made of the frequency of positive blood cultures in patients undergoing colonoscopy with or without polypectomy. A total of 270 patients underwent 280 colonoscopies, of these, there were 105 patients that had 111 polypectomies. Blood cultures were taken prior to and within 15 min following each procedure. Six of 280 (2.1%) preprocedural blood cultures were positive. Seven of 169 (4%) blood cultures were positive within 15 min of insertion of the colonoscope in the colonoscopy only group. Eight of 223 (3.6%) blood cultures were positive within 10 min of the polypectomy. There was no clinical evidence of sepsis during the 24 hr following these procedures. In order to determine appropriate postprocedural sampling intervals, we induced a Staphylococcus epidermidis bacteremia with a mean of 1.16 X 10(6) colony forming units/ml on 10 occasions in seven dogs. Within 30 min of inoculation, we were able to detect only one colony forming unit/ml. The rate of positive blood cultures during colonoscopy alone and following polypectomy during colonoscopy is comparable to other gastrointestinal endoscopy procedures. The most optimal time to collect blood cultures in order to detect transient bacteremia is as soon after the procedure as is feasibly possible.

Animals↗
PubMed1987

Clinical significance of a test for slime production in ventriculoperitoneal shunt infections caused by coagulase-negative staphylococci.

Coagulase-negative staphylococci (CNST) are the most-common cause of ventriculoperitoneal shunt infections. Some of these strains produce a slime-like substance. We reviewed 19 episodes of ventriculoperitoneal shunt infections due to CNST in 17 patients. Eleven episodes of infection were caused by slime-producing CNST and eight by non-slime-producing CNST. Shunt obstruction and abdominal pain occurred more frequently when infectious episodes were due to slime-producing CNST than to non-slime-producing CNST (P less than .05). Despite appropriate antimicrobial therapy, the mean duration of fever was longer and the failure to eradicate the infecting organisms was more frequent when the infectious episodes were due to slime-producing CNST than to non-slime-producing CNST (P less than .025). Discriminate function analysis found, however, that only failure to eradicate the infecting organism (by antimicrobial therapy) occurred more frequently in infectious episodes due to slime-producing CNST than to non-slime-producing CNST (P = .01).

Adolescent↗
PubMed1987

Coagulase-negative staphylococci as true pathogens in newborn infants: a cohort study.

We examined the pathogenicity of coagulase-negative staphylococci (CONS) in newborn infants by comparing presenting nonspecific signs of infection in infants with and without CONS bacteremia. During a 6-month period 799 blood cultures were obtained in a tertiary care nursery; 81 (10.1%) grew CONS and 25 (3.0%) grew other bacteria. A comparison group of 121 infants was selected randomly from ill patients whose blood cultures were negative. In addition 70 well infants were matched to CONS-positive cases. Abnormal clinical signs, complete blood cell counts, C-reactive protein, alpha-1-acid glycoprotein and prealbumin were determined at the time of culture. Signs that discriminated best between infants with and without CONS bacteremia were identified by logistic regression analysis. Infants with CONS bacteremia did not differ from infants with sepsis caused by recognized pathogens, except for lethargy, which was significantly more common in unequivocal infection. Infants with presumed infection but negative blood cultures, and noninfected control patients had abnormal signs significantly less often than CONS-positive infants. C-reactive protein, hyperthermia, increased oxygen requirements and lethargy were the most useful signs in identifying neonatal bloodstream infection. This cohort study provides objective evidence for the pathogenicity of CONS in newborn infants.

Acute-Phase Proteins↗