Biomedical subjects

H P Simmen

Publications and source records attributed to H P Simmen.

59 records · Page 4Linked to original sources

PubMed1981

[Use of antibiotics in ambulatory care. Results and reflections on a survey of practicing physicians in the canton of Zurich].

To survey antibiotic use in general practice, questionnaires were sent to 1160 practitioners in the Canton of Zurich. 510 (44%) were returned. Antibiotics had been administered for respiratory tract infections in 60% and urinary tract infections in 20% of cases. Sulfamethoxazole/trimethoprim, followed by oral penicillin, tetracycline and aminopenicillin were prescribed most frequently. Adverse side effects do not appear to be significant in general practice. Guidelines for the diagnosis and treatment of the most frequent infectious diseases occurring in an outpatient population are presented.

Ambulatory Care↗

PubMed1979

[Gardner's syndrome (author's transl)].

An exact history was taken and clinical, endoscopic and histologic studies were performed in 14 family members of a case of Gardner's syndrome with triple symptomatology documented with biopsy and autopsy findings. Among the symptom-free probands five cases of colonic polyposis and three cases with gastric polyps were found. All polyps were histologically adenomatous. Dysplasias grade I and II were found repeatedly, in one 16-year-old adolescent there was already severe dysplasia within the gastric mucosal polyps. A warning is given against sub-classification of familial colonic polyposis and other syndromes within the definition of Gardner's syndrome. In future during diagnostic investigations for cases of Gardner's syndrome isolated gastric polyposis should be sought for as well as monosymptomatic colonic polyposis. Diagnostic procedures and treatment should depend on endoscopic and histological findings. Regular follow-up with endoscopic biopsies are to be encouraged not only in the diseased cases but also in all family members available.

Colonic Neoplasms↗

PubMedDate not supplied

Effect of peritoneal fluid pH on outcome of aminoglycoside treatment of intraabdominal infections.

Netilmicin and clindamycin were administered to 47 patients with an intraabdominal infection who underwent emergency laparotomy. Thirty-one patients were cured, seven were improved, and therapy failed in nine patients despite the fact that all aerobic bacteria isolated from these patients were sensitive to netilmicin as determined by standard in vitro susceptibility tests. The pH of peritoneal and drainage fluid collected intraoperatively and during follow-up correlated with clinical outcome. Acidic pH was found in 21 of 33 (64%) specimens sampled from patients with therapeutic failure compared to 17 of 80 (21%) obtained from the categories "cured" and "improved" (p < 0.001). Netilmicin concentrations in serum or peritoneal/drainage fluid did not correlate with clinical outcome. Netilmicin levels were above the minimal inhibitory concentration of the pathogens in 59 of 64 (92%) drainage fluid specimens in which aerobic bacteria were isolated. Aerobic bacteria were isolated in 91% of drainage fluid specimens if the pH was less than 7.0, compared to 37% if pH was more than 7.0 (p < 0.001). Reduction of pH antagonized aminoglycoside activity in vitro against clinical isolates of Escherichia coli. Surgical reexploration should be considered in cases of deterioration following a laparotomy associated with detection of acidic drainage fluid.

Abdomen↗

PubMedDate not supplied

Analysis of pH, pO2 and pCO2 in drainage fluid allows for rapid detection of infectious complications during the follow-up period after abdominal surgery.

Low pH (< 7.1) and pO2 (< 6.5 kPa) and high pCO2 (> 8 kPa) of peritoneal fluid have been previously associated with the presence of intra-abdominal infection. These parameters were monitored in drainage fluid following emergency laparotomy in 40 patients operated on for intra-abdominal infections and also in 15 patients who underwent laparotomy for another reason than infection. Significant differences were observed beginning on the fourth postoperative day between the 48 patients who improved or were cured and the seven patients in whom therapy failed due to anastomotic breakdown or abscess formation. Anastomotic leaks or abscesses were radiologically confirmed. In five of the seven failures, complications were first detected by analysis of pH, pO2 and pCO2 before clinical symptoms became evident. Specificity for each of these parameters in drainage fluid samples obtained after the second postoperative day was > 94%. Assessment of the three parameters allowed for simple, cost-effective, rapid and early detection of infectious complications following abdominal surgery.

Ascitic Fluid↗

PubMedDate not supplied

Infection in the upper body: hand and burn-wound microbiology and considerations for antimicrobial therapy.

Gram-positive bacteria are the predominant organisms in hand infection and in burn wounds of the upper extremities. In a recent study of isolates from patients who were treated at our institution, Staphylococcus aureus and beta-hemolytic Streptococcus group A organisms were the most common organisms in infection of the hand; they were found in 36.3% and 14.4% of cases, respectively. The most common organisms in burn wounds were Enterococcus species, S. aureus, and Escherichia coli, which were found in 21.2%, 20.5%, and 16.7% of patients, respectively. Between 1969 and 1989, the prevalence of Pseudomonas species in burns decreased markedly, whereas that of S. aureus remained relatively stable and that of Enterococcus increased substantially. Over this period, both enterococci and coagulase-negative staphylococci emerged as troublesome pathogens in patients with burns. Methicillin-resistant S. aureus, which was first seen in our institution in 1981, continues to be found in a small proportion of patients. We have achieved successful results in certain surgical settings with the use of gentamicin-dispersing polymethyl-methacrylate beads to provide sufficient antimicrobial concentrations in poorly vascularized or avascular tissue. Additional topical antimicrobials that are potent against gram-positive bacteria are needed.

Anti-Bacterial Agents↗