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Biomedical subjects

J Wagner

Publications and source records attributed to J Wagner.

At least 307 records · Page 17Linked to original sources
PubMed1990

Prospective randomized clinical trials of new quinolones versus beta-lactam antibiotics in lower respiratory tract infections.

In four prospective randomized clinical trials between November 1983 and March 1988, we studied 270 patients with severe bacterial infections, mainly lower respiratory tract ones. We compared ciprofloxacin and imipenem/cilastatin in the first study, ciprofloxacin and ofloxacin in the second study, ciprofloxacin and ticarcillin/clavulanic acid in the third study, and ofloxacin and cefpirome in the fourth study. A total of 90 pneumonias, 139 LRTIs, 22 septicaemias and 19 other bacterial infections were treated; the dominant pathogens were Pseudomonas aeruginosa and enterobacteria. Clinical success rates were high; cure or improvement was registered in 89% of the patients on ciprofloxacin, 89% on ofloxacin and 85% on beta-lactams. Treatment failures occurred mainly in ICU patients with terminal underlying diseases. Bacteriologically, eradication rates were high for enterobacteria and Staphylococcus aureus, but a relatively high persistence rate was seen for P. aeruginosa due to increased resistance and/or specific type and location of the infections. The incidence of side-effects was relatively high (23%-29%) which was related to careful monitoring. Adverse effects were group-specific (CNS reactions with quinolones, diarrhoea with beta-lactam antibiotics).

Cilastatin↗
PubMed1990

[Value of diagnostic procedures in fiberoptic bronchoscopy of pulmonary infections].

Fibreoptic bronchoscopy has become an important means of diagnosing infections of the lower respiratory tract, since it a method with few complications, whereas, on the other hand, the conventional non-invasive methods are hardly reliable in respect of diagnostic relevance. Frequent oropharyngeal contamination severely limits the significant assessment of the pathogenicity of cultured microorganisms. The protected specimen brush (PSB) or quantitative cultures of bronchoalveolar lavage (BAL) might be useful in solving this problem. These methods were studied in two prospective trials comprising 123 patients with suspected bronchopulmonary infection and 54 control patients. Both methods were found to be disappointing in respect of sensitivity; moreover, quantitative cultivation did not yield any differences with regard to specificity.

Bacterial Infections↗
PubMed1989

Combination effects of ciprofloxacin, clindamycin, and metronidazole intravenously in volunteers.

Despite the broad antibacterial spectrum of ciprofloxacin, most anaerobic organisms are resistant to the drug, whereas several gram-positive organisms are only moderately susceptible. Thus, in some clinical situations, combined treatment with ciprofloxacin and metronidazole or clindamycin could be useful. Therefore, the pharmacokinetics and serum bactericidal activities of ciprofloxacin in combination with clindamycin or metronidazole were investigated using a randomized crossover study design in 10 healthy volunteers. Ciprofloxacin (200 mg) was administered alone and in combination with clindamycin (600 mg) or metronidazole (500 mg); all drugs were given intravenously over 30 minutes. Serum and urine concentrations of the substances were measured using standard methods (high-performance liquid chromatography or gas chromatography). Blood samples for determination of serum bactericidal activity against five different aerobic and two anaerobic bacterial species (a total of 58 strains) were obtained one hour and six hours after drug infusion. All values were statistically analyzed by use of the Student t test.

Adult↗
PubMed1989

[Community-acquired pneumonia].

In a prospective study 212 patients were analysed who, between 1. 10. 1982-31.12. 1983 and 1. 10. 1985-31. 12. 1986, had been admitted to hospital because of pneumonia. The causative organism was identified in 127 of the 212 patients (60%). Pneumococcus was the most common organism (n = 64), as demonstrated by culture and immunological techniques of determining antigen or antibody. Next most common was Legionella (n = 15) of various species. Mixed infections were found in 11 patients, in all instances associated with pneumococci. There were 24 deaths (11.3%). It is concluded from these results that (1) determination of pneumococcal antigen in sputum, but not in urine or serum, can improve the identification of the causative organism; (2) Legionella is one of the most common causes of pneumonia acquired outside of hospital; and (3) adequate serological diagnosis of Legionnaire's disease is possible only if a large number of different species are tested for.

Adolescent↗
PubMed1989

[Infection caused by gram-positive and gram-negative bacteria. A comparative study].

The clinical symptomatology of bacterial septicemias was analysed in 417 patients of a University Hospital in West Berlin. Sepsis was caused by Gram-negative organisms in 229 cases, and by Gram-positive bacteria in 177 cases; 11 cases presented with a mixed type sepsis involving both Gram-positive and Gram-negative pathogens. With the exception of a drop in blood pressure, observed appreciably more often in Gram-negative infections (42.4% of the cases as compared with only 25.4% in the case of septicemia due to Gram-positive organisms, (p less than 0.01), no significant clinical differences were seen between Gram-negative and Gram-positive sepsis. Pathophysiological changes (thrombopenia, leukopenia, coagulopathies) that are considered classical reactions to endotoxin, were also observed in Gram-positive infections. The overall prognosis of septicemia was determined largely by the severity of the underlying pathological condition.

Bacterial Infections↗
PubMed1989

[Infection 1979 to 1986. Epidemiology, etiology, clinical aspects and prognosis in 691 patients].

691 patients with clinically and bacteriologically established sepsis were included in three prospective studies conducted at a university hospital with 1,300 beds in 1979, 1982 and 1986. Only 22.4% of the patients did not suffer from severe underlying diseases. There was a fairly even distribution of gram-positive and gram-negative organisms among the isolated pathogens. A marked increase was seen in the incidence of polymicrobic and mycotic infections. The most frequently isolated bacterial species were E. coli (24.9%), Staph. aureus (19.5%), Staph. epidermidis (8%), Enterococci (4.8%) and Klebsiellae (4.6%). 26.8% of the patients died. The mortality rate showed a marked decrease from 33.6% in 1979 to 22.4% in 1986.

Adult↗
PubMed1989

How physical settings affect chronic mental patients.

A study was conducted at New York State's Harlem Valley Psychiatric Center of the effects of physical changes in the ward environment on severely regressed psychotic inpatients and on the hospital staff who treat them. Two standard wards were remodeled according to principles in the scientific literature, preferences of those involved, and attempts to facilitate treatment goals. Within 8 months of the inauguration of the redesigned setting, there were selective behavior and attitude changes in both staff (N = 27) and patients (N = 37) as compared to four matched control wards (staff N = 44; patient N = 44): (1) staff mood level was raised significantly on a standard scale; (2) staff unscheduled absence rate was cut in half; (3) staff did not report significant improvement on scales of ward atmosphere and patient functioning; (4) patients themselves reported improvement in their self-images, but not in irritability, isolation, or depression; (5) patients reported significantly more satisfaction with the ward dayroom; (6) rate of patient violence decreased almost 50%.

Adaptation, Psychological↗