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H P Simmen

Publications and source records attributed to H P Simmen.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Severe necrotizing fasciitis].

The pathophysiology of necrotizing fasciitis remains unclear in patients with no apparent immunologic disorders. Between 1987 and 1990 we treated six patients with necrotizing fascitis and septic-toxic multiple organ failure, three patients survived. The mean age was 38 years (25-62). In all patients the primary bacteriological examination revealed streptococcus. Between the first symptoms and an adequate therapy were 4 days in surviving patients and 7 days in patients who died. Four patients showed spread of the gangrene into the adjacent tissue: muscles (n = 3), bowel (n = 2), mediastinum (n = 1). Adequate débridement was not possible or not performed in patients with spread into the abdominal cavity or the mediastinum. These patients did not survive. The duration of intensive care treatment in surviving patients were 14 to 78 days. We conclude that survival of patients with severe necrotizing fasciitis is influenced by the delay before adequate treatment, the localisation of the gangrene and intensive care facilities.

Adult↗
PubMed1992

[Prospective analysis of infections of the upper extremity].

In a prospective investigation infections of the upper extremity are examined with respect to incidence, bacterial pathogens, operative or conservative treatment, and duration of disability for work. A total of 255 patients (pts) (170 men, 85 women; mean age 37 years, range 16-85) were entered into the study. In a 12-month period 163 (64%) were treated as outpatients, the condition of 92 pts (36%) required hospitalisation. Conservative and operative treatment was performed in 82 (32%) and 173 (68%) pts, respectively. Conservative treatment included fixation by cast as well as antibiotics (penicillinase resistant penicillin), usually given by the oral route for a mean of 4 days. Surgical procedures consisted of excision and debridement. Intraoperatively intravenous antibiotics were instituted for a mean of 3 days, followed by oral application for another 4 days. In 135 of 173 pts who underwent surgery, sufficient material for bacterial culture was obtained. There was a polymicrobial infection in 50% of pts. Most common isolated pathogens were Staphylococcus aureus, beta-hemolytical streptococci group A, and indigenous skin flora in 34%, 21%, and 11%, respectively. Among the 255 pts there were 26 HIV-positive iv drug abusers, who suffered from abscesses at injection sites. The infections in these immunocompromised HIV-positive pts did not reveal differences with respect to number and species of isolated pathogens as compared to immunocompetent pts. Resistant bacteria were not found. Response to treatment was satisfactory usually within a few days in all but 12 pts (4.7%) in which the failure could be attributed to inadequate primary debridement.

Adolescent↗
PubMed1992

[Follow-up of abdominal surgery by analysis of pH, p02 and pCO2 in drainage fluid].

Milieu factors such as pH, pO2, and pCO2 have previously been shown to permit reliable intraoperative discrimination of infected and non-infected peritoneal or drainage fluid. The presence of infection was associated with pH less than 7.1, pO2 less than 6.5 kPa and pCO2 greater than 8 kPa. These variables were monitored in the immediate postoperative period to quantify clinical improvement and to evaluate their potential for the early detection of infective complications. 21 patients underwent laparotomy for intraabdominal infections such as perforated appendicitis or perforated sigmoid diverticulitis. 5 were operated on for reasons other than infection. Fluid was sampled from a drainage tube every second day for a mean period of 7 days for determination of pH, pO2, and pCO2. A score ranging from 0 (normal) to 6 (severely ill) was calculated from these measurements. Specimens were obtained intraoperatively from 14 patients with documented infections and their mean score averaged 5 (range 3-6). Specimens were obtained on days 4 and 6 from 18 patients whose progress was uneventful and their mean score was 0.3 (range 0-2). 4 of these 26 patients developed postoperative infections after anastomotic breakdown, and each of their scores increased 1-2 days before the infection became clinically obvious, reaching values ranging from 3-6. In contrast, only 1 of 18 patients who made uneventful progress scored greater than 2 after day 3 (p less than 0.01). We conclude that assessment of milieu factors in peritoneal or drainage fluid permits quick and easy monitoring of the postoperative course.

Abdomen, Acute↗
PubMed1991

[Permanent arterial approach to the lower extremity using a totally implantable reservoir system].

In 10 patients with peripheral arterial occlusive disease intraarterial infusions were performed using a totally implantable port system. The port is fixed to the gluteal fascia on the outside of the iliac wing. The inferior epigastric artery is dissected through an additional incision above the inguinal ligament. A 2 mm catheter is connected to the port and inserted through the epigastric artery into the external iliac artery. Using this new suprainguinal technique the groin remains intact permitting surgical and interventional procedures. In one case a dislocation of the catheter occurred. The reason for this complication was an unsafe surgical fixation. The totally implantable port system is an alternative to conventional intraarterial infusions. There are several advantages using the suprainguinal technique as described above.

Aged↗
PubMed1991

[False aneurysm in a vascular surgery patient population].

40 false aneurysms have been diagnosed at the University Hospital in Zürich during the last three years. These aneurysms are mainly (24) anastomotic aneurysms with synthetic arterial substitutes. 6 false aneurysms were found after arterial catheterization. The majority of these 40 aneurysms (60%) were localized in vicinity of joints. The time interval between the original procedure (anastomosis, arterial catheterization, trauma) and the diagnosis of false aneurysm varies from a few days to 21 years. In seven cases a endarterectomy preceded the development of a false aneurysm. Three therapeutic groups are presented.

Adult↗
PubMed1991

[Emergency hospitalization for acute, non-accidental abdominal pain. Prospective data of a surgical university clinic].

During a 19-month period 549 patients (278 women, 271 men) suffering from abdominal pain unrelated to trauma (mean age 48.2 years) entered the emergency room of the Department of Surgery of the University Hospital Zürich. 43% presented during business hours, whereas 57% were admitted during nighttime and/or weekends. Clinical examination, abdominal roentgenograms (upright and supine) as well as sonography were the most commonly used diagnostic tools. 40% suffered from abdominal pain of unknown cause. The most common diagnosis on admission was appendicitis. Only half of these cases really proved to be an appendicitis. In 36% the diagnosis on admission corresponds both to the initial diagnosis made by a member of staff during his first visit, as well as to the final diagnosis. The initial diagnosis agrees in 57% with the final diagnosis. In 10% of the patients the cause of pain was not elucidated despite extensive diagnostic procedures. High technology and sophisticated diagnostics are less important than the clinical evaluation. The decision between operative or nonoperative treatment was mainly based on clinical findings.

Abdomen, Acute↗
PubMed1991

Risk factors in abdominal surgery.

The term risk is understood to be the danger of the occurrence of an undesired, life-threatening event. The probability of this undesired event is greater in the presence of a risk factor than in its absence. In general surgery, these risk factors can be classified into five groups: The environment, the surgeon, the operation per se, the disease, and the patient himself. Abdominal surgery is especially suited to clarify and to illustrate this classification. Some typical risk factors are described, and for each group the measures for risk prevention or risk reduction are discussed.

Abdomen↗
PubMed1991

Emergency room patients with abdominal pain unrelated to trauma: prospective analysis in a surgical university hospital.

During an 8-month-period, 241 patients suffering from abdominal pain unrelated to trauma (mean age 48 years) attended the emergency room of the Department of Surgery of the University Hospital, Zürich. Forty-three percent presented during working hours, while 57% were admitted during the night or at the weekend. Clinical examination, abdominal roentgenograms (upright and supine) and sonography were the most commonly used diagnostic tools. Forty percent suffered from abdominal pain of unknown origin. The most common diagnosis on admission was appendicitis, but only half of these cases proved to be appendicitis. In 36% the diagnosis on admission corresponded both to the initial diagnosis made by a member of staff during his first visit, and to the final diagnosis. The initial diagnosis agreed with the final diagnosis in 57%. In 10% of the patients the cause of pain was not elucidated despite extensive diagnostic procedures. High technology and sophisticated diagnostic evaluation are less important than the clinical evaluation. The decision between operative and nonoperative treatment was based mainly on clinical findings.

Abdominal Pain↗
PubMed1990

Gluteal necrosis after acute ischemia of the internal iliac arteries.

Ligation of the internal iliac artery mostly remains without consequences because of the well established collateral network. In patients with compromised collateral circulation however, acute interruption of both hypogastric arteries during aorto-iliac surgery or transluminal embolisation can lead to necrosis of the gluteal muscles and other adjacent organs (rectum, bladder, lumbosacral plexus). Experience with 3 similar cases after aorto-iliac surgery demonstrates two main intraoperative mechanisms: 1. Embolisation, 2. Ligature of both internal iliac arteries in patients with compromised arteriosclerotic collaterals. Despite of adequate therapy, mortality is over 70%. The most important feature during aorto-iliac operations is to preserve at least one internal iliac artery by either reimplantation of the main stem or by an additional bypass to this artery.

Aged↗
PubMed1989

[Basic aspects of the preventive use of antibiotics in general surgery].

Antibiotics are administered prophylactically before operation (at induction of anesthesia) in order to achieve sufficient tissue concentrations when contamination happens. Antibiotic prophylaxis is usually given as a single dose. It is clearly indicated in abdominal surgery. It is also recognized in association with the use of prosthesis in cardiac, vascular, and bone surgery although there is no proven benefit. According to definition, administration of antibiotics in a perforated hollow viscus or an open fracture is not a prophylaxis. First and second generation cephalosporines are recommended for prophylactic use. In abdominal surgery, aminoglycosides too, combined with a drug directed against anaerobic bacteria are widely used.

Anti-Bacterial Agents↗
PubMed1987

Imipenem (N-F-thienamycin) versus netilmicin plus clindamycin. A controlled and randomized comparison in intra-abdominal infections.

In a randomized study the clinical and bacteriologic effectiveness of imipenem was compared with the classical combination of netilmicin with clindamycin in patients who had surgery for an intraperitoneal infection, localized or generalized, with positive bacteriologic findings of the specimen taken at surgery. Excluded were all patients who received other antibiotics before surgery, or who died within 3 days after antibiotic therapy was started. Imipenem was given at a dose of 500 mg t.i.d., clindamycin 600 mg t.i.d., and netilmicin according to serum levels. The diagnoses ranged from postoperative peritonitis, gallbladder empyema, perforated gastroduodenal ulcer, small bowel perforation with and without obstruction, and perforated appendicitis to perforation of the colon. The bacteriologic work-up included examination of the primary specimen (aerobic and anaerobic), the urine, feces, and serologic testing for Candida albicans once or twice a week and after the course of antibiotic therapy. In addition, pH measurements of abscesses and drainage fluids were performed. Ninety-three patients entered the study. Forty-seven patients were treated with imipenem (test group), and 46 patients were treated with the combination therapy (control group). The two groups did not show significant differences in age, sex, diagnostic groups, risk factors, primary bacteriology, and duration of therapy (mean: 6.7 days). Thirty-eight patients (80.9%) treated with imipenem were cured, six patients (12.8%) were improved, and there were three (6.4%) failures. The respective numbers for the control group were 31 (67.4%), 10 (21.7%), and 5 (10.9%). The mean duration of hospitalization was 19 days for the test group and 24.5 days for the control group. There were four wound infections in the test group and 11 wound infections in the control group. Imipenem is at least as effective in the adjuvant therapy of intra-abdominal infections as the combination of netilmicin with clindamycin.

Adolescent↗
PubMed1985

Aminoglycoside monitoring: timing of peak levels is critical.

Recommendations for optimal therapeutic peak concentrations of aminoglycosides are often not differentiated with respect to duration of infusion and timing of peak sample thereafter. To document the relevance of the timing, 139 dose intervals were analyzed in 58 patients during administration of gentamicin, amikacin, and netilmicin. Serum concentrations measured immediately after 30-min infusions were compared with concentrations obtained 90 min later (2 h values). The ratio of 30 min/2 h concentrations showed considerable variability. This ratio was less than 1.5 in 15% of the dose intervals analyzed and greater than 3 in 8% of the intervals. The poor correlation between concentrations measured at 30 min and at 2 h was documented by the coefficients of variation of 0.82, 0.30, and 0.67 for gentamicin, amikacin, and netilmicin, respectively. This variability was not explained by interindividual differences, renal function, or drug half-life. However, the initial decrease in concentrations was significantly lower in patients with impaired renal function (p less than 0.001). These data suggest that timing is critical for the sampling of serum to determine peak levels in patients and the definition of optimal therapeutic concentrations.

Aminoglycosides↗
PubMed1982

[Erythromycin].

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Chemical and Drug Induced Liver Injury↗
PubMed1982

Erythromycin (2 X 1 g) as a Regimen for community-acquired pneumonia.

Erythromycin is regarded more and more as the primary therapy for community-acquired pneumonia. In a prospective study, treatment with erythromycin was evaluated in cases of community-acquired pneumonia requiring hospitalisation. Therapy was started intravenously with 1 g erythromycin lactobionate b. i. d., followed by 1 g erythromycin ethylsuccinate b. i. d., administered orally, until the patient had definitely recovered. Twenty-four patients with documented pneumonia were admitted to the study; five were excluded since the infections were caused by bacteria which were not susceptible to erythromycin. Nineteen patients responded well to therapy. No severe side-effects could be observed. Erythromycin (1 g b. i. d.) appears to be an effective, well-tolerated regimen for severe community-acquired pneumonia.

Erythromycin↗
PubMed1981

[Assessment of aminoglycoside serum concentrations. Comparative study using gentamicin (author's transl)].

Four methods were used to assess gentamicin concentrations in 37 sera of patients treated with gentamicin. It was shown that the bioassay (agar diffusion) and the enzyme immunoassay correlated well, and the latex agglutination inhibition test badly, with the radioenzyme assay which was used as the reference method. Among presently available methods only the bioassay can be performed with relatively little equipment.

Gentamicins↗