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Biomedical subjects

R Frei

Publications and source records attributed to R Frei.

At least 73 records · Page 4Linked to original sources
PubMed1994

Comparison of polymerase chain reaction with standard methods in the diagnosis of Mycobacterium tuberculosis infection.

The polymerase chain reaction (PCR) method was evaluated in the detection of Mycobacterium tuberculosis in comparison with direct microscopy and culture procedures including the standard radiometric system (Bactec). Amplified DNA fragments from clinical samples were analyzed by dot-blot and non-radioactive oligonucleotide hybridization techniques or by agarose gel electrophoresis. The results revealed nested PCR to be the method of choice. The combination of three culture methods could detect Mycobacterium tuberculosis in only 79% of PCR-positive cases. The mean time required to achieve a positive culture result was 17 days in contrast to the PCR method requiring only two to three days. The nested PCR assay provided rapid and reliable results allowing a definitive diagnosis particularly in a number of samples which were negative on culture.

Bacteriological Techniques↗
PubMed1994

Antimicrobial activity of FK-037, a new broad-spectrum cephalosporin. International in vitro comparison with cefepime and ceftazidime.

The in vitro activity of FK-037, a new parenteral 7-aminothiazolyl-methoxyimino cephalosporin, was compared with cefepime and ceftazidime against 6094 aerobic isolates collected in six medical centers worldwide. FK-037 demonstrated potent activity against the Enterobacteriaceae family except for some Enterobacter spp., Providencia spp., and Serratia liquefaciens (MIC90s, > or = 16 micrograms/ml). Against nonenteric Gram-negative bacilli, all compounds tested showed similar, but more limited activity. The FK-037 MIC50s for Pseudomonas spp. and P. aeruginosa were 2 and 4 micrograms/ml, respectively. The least susceptible organisms were Xanthomonas maltophilia, enterococci, and Bacillus spp. (MIC50s, > 16 micrograms/ml), followed by Flavobacterium spp., other nonenterics, and oxacillin-resistant Staphylococcus aureus (MIC50s, 16 micrograms/ml). Good FK-037 activity was observed against oxacillin-susceptible staphylococci as well as against beta-hemolytic and viridans-group streptococci (MIC90 range, < or = 0.12 to 2 micrograms/ml). While FK-037 was slightly more active than cefepime against Gram-positive organisms, enteric bacilli were most susceptible to cefepime. Overall, the antibacterial spectrum of both FK-037 and cefepime was superior to ceftazidime.

Cefepime↗
PubMed1994

Levofloxacin in vitro activity: results from an international comparative study with ofloxacin and ciprofloxacin.

Levofloxacin, the S-(-)-isomer of ofloxacin, was compared to ofloxacin and ciprofloxacin against > 6000 recent clinical isolates of Gram-positive and Gram-negative bacteria from six different countries. This international multicenter study demonstrated a high level of antibacterial activity of levofloxacin against all the members of Enterobacteriaceae [minimum inhibitory concentration (MIC)50s, < or = 0.03 to 0.12 mg/L] except Providencia rettgeri (MIC50, 2 mg/L), and Providencia stuartii (MIC50, 1 mg/L). Oxacillin-susceptible staphylococci (MIC50s, 0.12 to 0.25 mg/L), enterococci (MIC50s, 0.5 to 2 mg/L), and streptococci (MIC50s, 0.5 mg/L) were also susceptible to levofloxacin, but most isolates of oxacillin-resistant staphylococci had MICs of > or = 4 mg/L. Levofloxacin was also active against non-enteric Gram-negative bacilli, including Acinetobacter species (MIC50s, < or = 0.03 to 1 mg/L), Pseudomonas species (MIC50s, 0.5 to 1 mg/L) and Xanthomonas maltophilia (MIC50, 0.5 mg/L). Overall, levofloxacin inhibited 50% and 90% of all the tested strains at the concentrations of 0.12 and 4 mg/L, respectively. The activity of levofloxacin was generally two-fold greater than ofloxacin and equal to or slightly less potent than ciprofloxacin.

Asia↗
PubMed1994

Microbiological tests to predict treatment outcome in experimental device-related infections due to Staphylococcus aureus.

Treatment outcome of experimental device-related infections cannot be predicted by the results of standard susceptibility tests such as MIC. Microorganisms involved in such infections have a slow growth rate and adhere to surfaces. Therefore, laboratory tests were developed taking into account these properties and compared with the treatment outcome in an animal model. Vancomycin, teicoplanin, ciprofloxacin and fleroxacin were tested alone, or in combination with rifampicin for their ability to cure experimental device-related infections in guinea pigs due to Staphylococcus aureus ATCC 29213. Rifampicin alone or in combination was significantly more effective than the other four drugs (P < 0.001). Combined treatment with rifampicin had a higher cure rate than rifampicin alone. Treatment success was not predicted by an antibiotic trough level exceeding the MIC at site of infection. In contrast, drug efficacy was predicted if the stationary-phase MBC was in the sensitive range, and if glass-adherent S. aureus was killed by low drug concentrations.

Animals↗
PubMed1994

Duodenal bacterial overgrowth during treatment in outpatients with omeprazole.

The extent of duodenal bacterial overgrowth during the pronounced inhibition of acid secretion that occurs with omeprazole treatment is unknown. The bacterial content of duodenal juice of patients treated with omeprazole was therefore examined in a controlled prospective study. Duodenal juice was obtained under sterile conditions during diagnostic upper endoscopy. Aspirates were plated quantitatively for anaerobic and aerobic organisms. Twenty five outpatients with peptic ulcer disease were investigated after a 5.7 (0.5) weeks (mean (SEM)) treatment course with 20 mg (nine patients) or 40 mg (16 patients). The control group consisted of 15 outpatients referred for diagnostic endoscopy without prior antisecretory treatment. No patient in the control group had duodenal bacterial overgrowth. In the omeprazole group bacterial overgrowth (> or = 10(5) cfu/ml) was found in 14 (56%) patients (p = 0.0003). The number of bacteria (log10) in duodenal juice in patients treated with omeprazole was distinctly higher (median 5.7; range < 2-8.7) when compared with the control group (median < 2; range < 2-5.0; p = 0.0004). As well as orally derived bacteria, faecal type bacteria were found in seven of 14 and anaerobic bacteria in three of 14 patients. Bacterial overgrowth was similar with the two doses of omeprazole. These results indicate that duodenal bacterial overgrowth of both oral and faecal type bacteria occurs often in ambulatory patients treated with omeprazole. Further studies are needed to determine the clinical significance of these findings, particularly in high risk groups during long term treatment with omeprazole.

Adult↗
PubMed1994

Recurrent pyogenic granuloma with satellitosis--a localized variant of bacillary angiomatosis?

A 27-year-old male patient had recurrent pyogenic granuloma with satellitosis. Histologically, Warthin-Starry staining of the lesions revealed clumps of dark bacilli as found in patients with bacillary angiomatosis. IgG antibodies against Bartonella (Rochalimaea) henselae were elevated as shown by an indirect immunofluorescence assay. The patient did not present an obvious risk for HIV infection or immunosuppression, and no antibodies against HIV-1 and HIV-2 were found. Recurrent pyogenic granuloma with satellitosis may be a localized variant of bacillary angiomatosis.

Adult↗
PubMed1994

[The co-evolutional focus in individual, couple and family therapy].

A concrete formulation of focus is proposed that in structure and use is suitable for individual as well as couples and family therapy. The concept of coevolution (Willi 1985, 1991) forms a basis for the supposition that important personal developments are realised in human relationships. The development of one person is challenged, taxed, or hindered by the development of other persons. The formulation of a coevolutional focus consists of four steps: 1) The context of the relationship in which the current conflict emerges; 2) The identification of delayed stages of development; 3) The personal and interactional conditions which block this development; 4) Concrete changes which make the progress in the intended development recognizable. The focus in couples and family therapy integrates the impending development of the participants in their collusive interactions.

Adolescent↗
PubMed1994

[People in divorce and their ambivalence: initial use of a newly developed couples inventory].

It has been reported that intact internal, external and social accommodation is related to a stable partnership between men and women. Every partnership, however, is also characterized by a certain potential towards separation that may develop despite of the named stabilizing factors. This led to the question of how the accommodation is constituted in men and women during separation. A written questionnaire was, therefore, sent to a total of 35 men and women in separation. The Bradburn inventory was used to define the well-being of the volunteers in relation to a representative sample. Using a newly developed inventory, a number of items had to be rated twice: once to reflect the condition at the beginning of the partnership and once to reflect the situation during the last year. In addition, the relative contribution of a particular item in favor or against separation was asked. The Bradburn inventory shows that the general well-being of the test sample is more impaired than that of the representative sample. The evaluation of the 80% returned questionnaires revealed worsening of all items. Most important reasons to finish the partnership were i) the lack of verbal communication, ii) extramarital affairs, and iii) the impression that the partnership limits the personal development. Reasons to continue the partnership were different between those who initiated the separation and those who were left: The initiators predominantly mentioned structural factors such as financial situation, living conditions and care for children, whereas the non-initiators predominantly mentioned internal qualities of the partnership.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Mycoplasma hominis empyema following pleuropneumonia in late pregnancy].

Mycoplasma hominis (M. hominis) frequently colonizes the genital tract, but is rarely isolated from the respiratory tract. Dissemination of M. hominis has been documented in women with a febrile illness after delivery. Spontaneous recovery is the rule. A 32-year-old woman in the 29th week of pregnancy was hospitalized for pneumonia. She had to be ventilated for respiratory insufficiency and thoracic empyema. The child was delivered by section due to signs of stress in cardiotocography. In the ensuing days the mother's condition worsened, with fever, weight loss and persistent pleural effusion. Even after decortication and treatment with ceftriaxone fever and pleural effusion persisted. M. hominis was found in pleural fluid cultures. Treatment with doxycycline led to rapid defervescence and an improvement of the patient's condition.

Adult↗
PubMed1993

[Cervical lymphadenitis due to Mycobacterium malmoense in a child: case report and differential diagnosis of cervical lymphadenitis and lymphadenopathies].

Cervical lymphadenitis and lymphadenopathy are common in children and may be caused by local or systemic infection. There are a large number of possible etiologies. We report the case of a five-year-old boy with unilateral cervical lymphadenitis who was in good health and showed neither clinical nor laboratory signs of systemic infection. Despite repetitive empirical antimicrobial treatment, the lymph nodes increased in size. After surgical excision Mycobacterium malmoense grew from the lymph node culture. Based on a literature search (Embase and Medline 1980-1992), the most frequent infectious etiologies of pediatric cervical lymphadenitis and lymphadenopathies are summarized. Nontuberculous mycobacterial lymphadenitis is most frequent in children between one and five years of age, and is more common in girls than boys. The treatment of choice is surgical excision. In immunocompetent children treatment with antimycobacterial drugs is not needed even if relapse occurs.

Child, Preschool↗
PubMed1993

[Disinfection and sterilization: an overview for clinical practice].

The importance of disinfection and sterilization has increased in the past decade with the spread of HIV and Hepatitis B and C virus. Clear written instructions for sterilization and disinfection must be provided for all relevant items. The principles of sterilization and disinfection are reviewed with emphasis on clinical practice. Important examples and frequent clinical problems are discussed in detail by using the disinfection guidelines of the University Hospital of Basel.

Disinfectants↗
PubMed1993

[Unusual intestinal manifestations of tuberculosis].

In an 87-year-old Swiss female referred with complaints of bloody diarrhea and weight loss, colonoscopy revealed three ulcers in the rectum and colon. Cultures from the colonic ulcers were positive for Mycobacterium tuberculosis. There was no evidence of pulmonary infection. One week after adequate therapy was begun, a perforation occurred at the rectosigmoid junction. The sigmoid was resected and left-sided colostomy was performed. Seven days after surgery the patient died. Clinical features, diagnosis and morphological changes of intestinal tuberculosis are discussed.

Aged↗
PubMed1993

[Current methods in rapid diagnosis of tuberculosis].

The field of mycobacteriology has significantly advanced during the past 10 years. Optimized specimen processing, fluorescence microscopy, radiometric mycobacterial detection system, and use of nucleic acid probes for identification provide more rapid and more sensitive detection of tuberculous mycobacteria. Nevertheless, the diagnosis of tuberculosis is often a long and tedious process which can take up to several weeks. Recently, several new and rapid diagnostic tests have been developed. Despite major advances, the serodiagnosis of tuberculosis remains an investigational method requiring further development and prospective evaluation. Detection of tuberculostearic acid in cerebrospinal fluid by use of gas chromatography-mass spectrometry has proven to be a very rapid, sensitive, and specific test for tuberculous meningitis. The most recent development is the use of polymerase chain reaction (PCR) for the detection of Mycobacterium tuberculosis directly in clinical specimens. PCR is an extremely sensitive and rapid method based on in vitro amplification of specific DNA sequences. However, before using this method for clinical practice, further efforts to develop simple routine procedures that are safe from cross-contamination are warranted. Furthermore, large-scale trials are needed to determine the clinical value of diagnostic PCR assay for diagnosis of tuberculosis in different patient populations.

Bacteriological Techniques↗
PubMed1993

Risk of bacteraemia during extracorporeal shock wave lithotripsy.

Extracorporeal shock wave lithotripsy (ESWL) is widely used to treat urinary calculi. With increasing numbers of ESWL, more patients prone to infectious complications will be treated. However, little is known about the infectious risks of ESWL. To provide a basis for the rational use of antimicrobial prophylaxis, we studied the incidence of bacteraemia during ESWL. A total of 23 patients with urinary calculi were treated. Blood cultures (4-7 per patient) were taken before, during and immediately after ESWL, adding up to a total of 154 cultures. In 22 of these patients no bacteraemia was detected. In 1 patient small numbers of 2 different micro-organisms were found in 2 blood samples only. This finding, and the circumstances of blood collection, suggested contamination rather than bacteraemia. It was concluded that the risk of bacteraemia during ESWL is very low.

Adult↗
PubMed1993

Couples therapy using the technique of construct differentiation.

A central problem in couples therapy is the clients' tendency to persist in endless and fruitless alternation between attacking the partner and justifying themselves. The technique of construct differentiation described in this article has proved helpful in coping with this situation. In three clearly structured steps, the therapist explores the personal constructs of each partner in the presence of the other. Instead of concentrating in the usual way on circularity of thoughts, feelings, and behavior, the partners are hindered from interacting and are confronted by the therapist's questions concerning their own inner process, independently of that of the partner. By becoming aware of their own ambivalent constructs and those of the partner, the eagerness to convert the partner to their own point of view can be reduced, and the construct system of each partner can be enriched by the other's constructs. Construct differentiation proves especially useful in the treatment of power struggles and narcissistic collusions.

Adult↗