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Biomedical subjects

D Will

Publications and source records attributed to D Will.

13 recordsLinked to original sources
PubMed2001

[Interventional ERCP in patients with cholestasis. Degree of biliary bacterial colonization and antibiotic resistance].

Interventional ERCP in patients with cholestasis. Degree of biliary bacterial colonization and antibiotic resistance. Biliary obstruction together with bacterial colonization of the bile duct may lead to development of acute cholangitis. The aim of our prospective study was to investigate the presence and degree of biliary bacterial colonization by means of bile aspiration during ERCP in patients with biliary obstruction. Furthermore, we evaluated antibiotic therapy regimens, which would cover the bacterial species obtained by ERCP and subsequent culture in each patient. In addition, analysis of risk factors was performed that would predispose to the development of cholangitis.80 patients with clinical and laboratory evidence of biliary obstruction underwent ERCP with initial aspiration of bile via the cannulation catheter. This material was used to culture aerobic and anaerobic bacteria and determine the colony count/ml bile, followed by identification of each species and antibiotic resistance testing. The minimal inhibitory concentration for Levofloxacin, Ciprofloxacin, Piperacillin, Ampicillin, Ceftriaxone, Imipenem, Gentamycin und Metronidazole was determined. Immediately after the ERCP or if the body temperature (after ERCP) rose to > 38 degrees C blood cultures were obtained. In 45 (56 %) patients biliary colonization with bacteria could be identified (56 %). In 20 patients a single isolate was cultured, in 25 cases mixed infection was present. A total of 83 species were isolated. The most common bacteria were E. coli, Enterococcus and Klebsiella. 9.6 % of all isolates were obligatory anaerobes. In 9 of 80 patients bloodcultures tested positive for bacterial growth (rate of bacteremia: 11.3 %). 10 patients had acute cholangitis clinically before ERCP, 13 patients developed signs of infection after ERCP. Statistically significant factors contributing to the risk of infection were age of the patient, the clinical condition of the patient before ERCP and the biliary colony count. Patients with development of infection after ERCP showed a significantly higher incidence of bacterial colonization of the biliary tree and a higher colony count. In all bacterial species Imipenem (4.5 %) or Levofloxacin (2.2 %) exhibited the lowest rate of in-vitro resistance. Based on these data, the implementation of Levofloxacin in combination with anaerobic coverage is advantageous as a calculated therapy for patients with acute cholangitis.

Adult↗
PubMed1999

B notifications and the detection of tuberculosis among foreign-born recent arrivals in California.

OBJECTIVE: To evaluate the effectiveness and limitations of the B notification program for detecting tuberculosis among recent foreign-born arrivals in California. DESIGN: Retrospective cohort study. All foreign-born visa holders with a B notification who arrived in California from January 1992 through September 1995 (n = 27 412) were matched with a listing of foreign-born persons who arrived in the US during the same time period and who were reported to have active tuberculosis in California within one year of their arrival from January 1992 through September 1996 (n = 2547). RESULTS: Overall, 3.5% (95% confidence interval 3.3%, 3.8%) of all persons with a B notification were reported to have active tuberculosis within a year of arrival. Recent arrivals with a B notification and tuberculosis accounted for 38% of all foreign-born cases of tuberculosis reported within one year of arrival. Compared to recent arrivals without a B notification, those with a B notification were more likely to have pulmonary tuberculosis, less likely to have smear-positive pulmonary disease and reported with tuberculosis sooner after their arrival in the US. The B notification program was not able to identify 87% of the smear-positive pulmonary tuberculosis cases in adults, and did not identify 99% of these highly infectious cases among Latin Americans. CONCLUSIONS: Although the evaluation of persons who enter the US with B notifications has a high yield for identifying active tuberculosis cases, it was not able to identify the majority of recent arrivals with the most infectious form of tuberculosis.

Adolescent↗
PubMed1998

Tuberculosis in children and adolescents: California, 1985 to 1995.

OBJECTIVES: To describe the epidemiology and clinical characteristics of tuberculosis (TB) among children and adolescents and to define children at risk for TB. SETTING: 4607 children 0 to 14 years of age and 1615 adolescents 15 to 19 years of age reported with TB in California. METHODS: We analyzed surveillance data reported to the California Department of Health Services TB Control Branch from 1985 through 1995. RESULTS: TB cases increased 22% among children 0 to 4 years of age and 66% among children 5 to 14 from 1985 through 1995. Case rates were highest among children 0 to 4 years of age (13/ 100000 children), but declined from 1993 to 1995, except for black children 0 to 4 years of age. Minority children 0 to 14 years of age had case rates 6- to 34-fold higher than did white children. Pulmonary TB was the most common site of disease in all age groups (71 to 82%). TB meningitis was most common in children 0 to 4 years of age (5%). Most children (64%) did not have cultures done; however, among culture-proved cases isoniazid-resistant Mycobacterium tuberculosis was isolated in 7%. Adolescents were more likely to have cavitary pulmonary disease (24%), to be foreign-born (78%) or homeless (4%) and to have an isoniazid-resistant strain isolated (13%) than were children 0 to 14 years of age (P < 0.05). CONCLUSIONS: TB in children and adolescents increased substantially in the mid-1980s and early 1990s. Pediatric TB remains a serious health problem, especially among minority children and adolescents. Our findings indicate that TB control programs need improved strategies to prevent infection and detect disease in this population.

Adolescent↗
PubMed1998

Implementing enterprisewide databases: a challenge that can be overcome.

The evolving health care industry is placing new demands on its participants. Traditional institutional boundaries are being replaced by the need to cooperate, collaborate, and share increasingly scarce resources to provide high-quality care to patients. Information, which historically was coveted and protected, must now be shared by the multiple providers and organizations that together provide services. This need to share information has brought on the need for organizations to build common databases from which reports can be run, trends can be noted, and patient information can be drawn. Data warehouses and clinical data repositories are being recognized as solutions to issues of segregation of information. Both solutions are relatively new to health care, and there is acknowledgment that neither is simple to implement and that both represent new challenges to health care organizations. The article provides working definitions of the two solutions, describes at a high level some of the challenges associated with their implementation, and provides some of the key steps required to develop, implement, and realize the benefits of the clinical data repository or data warehouse.

Computer User Training↗
PubMed1995

[Psychophysical stress reactions during a psychoanalytic interview].

In 37 young volunteers analytically oriented interviews were taken and their effects being compared to those of conventional stressors using mental arithmetic. Because of their similarity to day-to-day stressors we expected higher cardiovascular reactions (blood pressure, heart rate and catecholamines) under interview situations than in mental arithmetic. Conforming this hypothesis, we found higher reactions in blood pressure regulation, while heart rates were not higher under interview situations compared to laboratory stressors. Epinephrine showed a qualitative difference: Only in interview situations we found a significant rise of 27%. Plasma cortisol also showed a rise in interview situations, however, smaller. We therefore suggest, that analytically oriented interviews are an adequate method to investigate cardiovascular reagibility in young hypertensive-prone persons.

Adult↗
PubMed1991

[Indirect azygos-vein-continuation syndrome with aneurysm of the inferior vena cava].

Nausea and emesis after exercise were leading symptoms in a 28 year old patient with indirect vena azygos continuation syndrome. This anomaly was verified by sonography, abdominal CT and by venography. The CT examination revealed initially structures of malignant appearance low to the renal position by angiography. This appeared to be distended collaterals. Therapeutic intervention aims primarily to the prevention of complications such as thrombosis of the distal venous flow or venous insufficiency of the lower extremities. Prophylactically we suggest low dose heparin and compression stockings.

Adult↗
PubMed1983

Approaching the incestuous and sexually abusive family.

This paper reviews family transactional theories of incest and sexual abuse. Two main types of family are described: the chaotic family and the "endogamous" incestuous family. Some general features of incestuous and sexually abusive families are then discussed, after which some basic principles of clinical work with such families are considered.

Adolescent↗
PubMed1983

Some techniques for working with resistant families of adolescents.

This paper reviews some of the causes of resistance in families of adolescents being seen in conjoint family therapy. Two main types of resistance are described: resistance due to excessively high anxiety and resistance due to excessively low anxiety. Techniques for dealing with such resistance are then discussed: first, directive techniques designed to lower or heighten anxiety and secondly, strategic techniques designed to exploit resistance to a therapeutic end.

Adolescent↗
PubMed1983

Teaching some principles of individual psychodynamics through an introductory guide to formulations.

One objective of psychiatric education can be to help trainees describe and understand major concerns patients experience in their key relationships, inner conflict and sense of self. A precis of major concepts and principles in this area (usually known as psychodynamics) is presented without the metapsychological framework which makes some of the literature difficult to grasp. This is intended to make learning more efficient and to facilitate the formulation of hypotheses about the presence or absence of specific conflicts, and problems in key relationships. We do not propose that these hypotheses necessarily explain psychopathology but that they (a) supplement formal diagnosis; (b) enrich the clinical data base by providing hypotheses which are testable in part by clinical observation and which can be tested scientifically; (c) provide understanding crucial to psychotherapy.

Conflict, Psychological↗
PubMed1977

["Prophylactic" calcium administration in excretory urography in infants (author's transl)].

The technical approach to excretory urography in the first year of life - especially in small babies - is described. Rare incidents and the clinical toleration are discussed. More than 50% of babies had dyspeptic disturbances following excretory urography. In a previous investigation considerable metabolic changes were found immediately after injection of the contrast medium. Reduction of the calcium blood level seems to be most important. Occasionally convulsions may be induced. 3 ccm/kg body weight of a methylglucaminate is used generally with good toleration (Urovist-Schering). In this investigation 10 babies received 3 ccm Calcium-Sandoz just before the injection of the contrast medium. This prevented hypocalcemia but other electrolytes, for instance potassium had a similar blood level trop as in the control group. Potassium-magnesium-aspartat remained ineffective. Prevention of incidents in babies were reviewed. One possibility could be premedication of calciu. Addition of electrolyte solution (an industrial product) to the contrast medium in children under the age of one year seems to give further improvement. More investigations are necessary.

Calcium↗