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T Hau

Publications and source records attributed to T Hau.

At least 19 recordsLinked to original sources
PubMed1999

Risk factors associated with intraabdominal infections: a prospective multicenter study. Peritonitis Study Group.

INTRODUCTION AND METHODS: A prospective observational multicenter study with 18 hospitals was performed to assess preoperative risk, therapeutic management and outcome of patients with peritonitis. Data collection was carried out according to standardized and recommended definitions. Included in the study were 355 patients with macroscopically confirmed peritonitis. RESULTS: In the univariate analysis, the following factors influenced both the mortality and the incidence of postoperative complications: age, presence of certain concomitant disease, site of origin of peritonitis, type of admission and the ability of the surgeon to eliminate the source of infection. In addition, postoperative infective complications were related to the etiology of peritonitis and the exudate. In the multivariate analysis, APACHE II (P<0.001), successful operation (P<0.001), age (P<0.001), liver disease (P<0.03), malignant disease (P<0.04) and renal disease (P<0.05) turned out to be significant with respect to death. Escherichia coli was the predominant organism (51%), following by enterococci (30%) and bacteroides (25%). There was a significantly higher postoperative infection rate in patients with no adequate treatment of enterococci than patients with adequate treatment or no enterococci (P<0.05). CONCLUSION: The study demonstrated the important role of the physiological reserve of the patient and of the surgeon, which is not adequately reflected in existing scoring systems. Further investigations are needed to study the impact of enterococci on the outcome.

APACHE↗
PubMed1999

[Hierarchy in surgery in the United States].

There are few if any hierarchical structures in American surgery. The surgical department consists of general surgery and a variable number of subspecialties. It usually has a small number of main teaching hospitals, frequently in addition to the University Hospital, a County Hospital and a Veterans Administration Hospital. The faculty consists of all physicians who have finished their specialty training and hold a teaching appointment at the university. The members of the faculty are free and independent in their clinical teaching and research activities. Each teaching hospital has chief of surgery and each academic division (i.e. general surgery, cardiovascular surgery, oncologic surgery) is also headed by a chief of this section. The chairman of the department represents the department externally and internally, is responsible for the organization and the finances of the department, the education and training of students and residents as well as quality control relating to clinical activities, research and teaching.

Cross-Cultural Comparison↗
PubMed1999

[Thoracoscopic treatment of pleural empyema].

From August 1991 to May 1997 46 patients with pleural empyema in the fibrinopurulent phase underwent thoracoscopic surgery. There were 36 men and 10 women with an average age of 47 years ranging from 18 to 84. The average operating time was 77 minutes. When only one thoracostomy drain was inserted, the drainage time was 8.5 days, if two or three drainage tubes were used it was 10.5 days. The average hospital stay was 18.1 day (range from 7 to 45). We observed ten complications. Four operations had to be converted to an open procedure because of massive thickening and fibrosis of the pleura. Three patients did not tolerate one lung ventilation, once the lung did not collapse due to technical reasons and in one patient each we observed a laceration of the parenchyma and bleeding from the parenchyma. In both cases the problem was dealt with thoracoscopically. We observed a recurrent pleural empyema in four patients which occurred between the 28th and 77th postoperative day. In summary, thoracoscopic surgery in patients with pleural empyema in the fibrinopurulent phase is an effective and well tolerated alternative to open thoracotomy.

Adolescent↗
PubMed1997

Prognostic modelling in peritonitis. Peritonitis Study Group of the Surgical Infection Society Europe.

OBJECTIVE: To develop and to evaluate a new score to aid management in peritonitis. DESIGN: Prospective, multicentre study. SETTING: 18 departments of surgery in Germany. Austria, and Switzerland. SUBJECTS: 355 patients with peritonitis confirmed at laparotomy. INTERVENTIONS: Computation of four different prognostic systems: APACHE II; APACHE II and successful operation; APACHE II, successful operation and Goris score on the first postoperative day: and multivariate analysis. Predictions were evaluated according to the following criteria: specificity with a fixed sensitivity at 80%, receiver operating characteristic (ROC-) curve, and predictive value. MAIN OUTCOME MEASURE: The ability to predict hospital death and infective complications. RESULTS: Multivariate analysis was superior to APACHE II: APACHE II and successful operation: and APACHE II, successful operation, and Goris score. From the analysis a new prognostic model was derived from which it was possible to identify patients early in the postoperative period who are at high risk of developing further complications (prognostic peritonitis model: PPM). CONCLUSIONS: None of the existing scores was of particular use for therapeutic decision making in peritonitis. The new prognostic model should be the focus of further trials in the management of peritonitis.

APACHE↗
PubMed1997

Anatomic, physiologic, bacteriologic and immunologic aspects of peritonitis.

The anatomic aspect of peritonitis describes the division of the abdominal cavity into the supracolic, infracolic and paracolic spaces, moreover the lesser sac and the cul-de-sac of the pelvis. Physiologically the peritoneum plays an important role in the passive exchange of fluid and absorption of particles. Endotoxin, which is elaborated by bacteria activates the classical as well as the alternative complement pathway. It activates also the arachidonic acid metabolism, leading to the release of prostaglandins (PG) and leukotriens (LTC). The local host defense against a bacterial invasion includes the activation of cellular and humeral immunologic defense mechanism, in which the final product of the complement pathway (C5b-9), as well as chemoattractants C3a, C5a and C567 play a key role.

Abdomen↗
PubMed1996

Thoracoscopic pulmonary surgery: indications and results.

OBJECTIVE: To report our experience of thoracoscopic pulmonary operations from May 1991 to May 1994. DESIGN: Prospective open study. SETTING: District hospital, Germany. SUBJECTS: 93 patients who underwent 120 thoracoscopic procedures. INTERVENTIONS: Wedge resection (n = 56), pleural biopsy (n = 21), early decortication (n = 16), partial pleurectomy (n = 9), pleurodesis (n = 5), pulmonary biopsy (n = 4), segmentectomy (n = 3), evacuation of haemothorax (n = 3), biopsy of mediastinal tumor (n = 2), and costal biopsy (n = 1). MAIN OUTCOME MEASURES: Morbidity, mortality, and avoidance of open thoracotomy. RESULTS: Indications for thoracoscopic intervention were: solitary pulmonary nodule (n = 37), recurrent pneumothorax (n = 17), pleural empyema (n = 14), diffuse pulmonary disease/multiple nodules (n = 10), recurrent pleural effusion (n = 11), haemothorax (n = 3), and mediastinal tumour (n = 1). In 29 of 37 patients in whom we attempted resection of a solitary pulmonary nodule we obtained enough tissue for diagnosis, and avoided thoracotomy in 18 patients. Complications included pulmonary embolus (n = 1), recurrent empyema (n = 1), haemorrhage (n = 2), infection of the drain site (n = 3), and two persistent air leaks. One was closed at a second thoracoscopy and the other required open thoracotomy after which he developed pulmonary failure and died. One patient with a haemothorax developed multiple system organ failure and died, and attempted resection of a mediastinal tumour was unsuccessful. Three thoracoscopic procedures had to be abandoned because of dense adhesions. CONCLUSIONS: Thoracoscopic surgery is a safe, well tolerated, and cost effective alternative to open thoracotomy in selected patients.

Adolescent↗
PubMed1996

Predictors of outcome in patients with postoperative intra-abdominal infection.

OBJECTIVE: To assess those factors which predict prognosis in patients with postoperative intra-abdominal infections. DESIGN: Open study. SETTING: Teaching hospital, Germany. SUBJECTS: 48 patients who developed postoperative intra-abdominal infections between January 1989 and July 1993. INTERVENTIONS: Calculation of APACHE II score and Mannheim Peritonitis Index (MPI). Evaluation of single components of APACHE II score. MAIN OUTCOME MEASURE: Correlation between outcome and these variables together with time between first operation and reexploration, whether the source of infection was eliminated, whether the abdomen was managed by a closed or open technique, and the extent and origin of the infection. RESULTS: Both APACHE II and MPI predicted outcome. Of the single components of the APACHE II score studied, those that correlated significantly with outcome were the Glasgow coma scale and chronic health evaluation (p < 0.001 in each case), and age (p < 0.01). The extent of peritonitis (local or diffuse) correlated with the APACHE II score and with outcome (p < 0.001 in each case). The time that elapsed before reoperation was significantly shorter in patients who died (8 days) than in those who survived (16 days, p = 0.03). In 37 of the patients the source of infection was eliminated resulting in 7 deaths (19%); all 11 of those in whom it was not eliminated died. Of the 35 patients who underwent closed treatment of the abdominal cavity 8 died (23%) compared with 10 of the 13 who underwent etappenlavage (77%, p < 0.01). Patients who underwent closed treatment, however, had fewer risk factors. No other variable correlated with outcome. CONCLUSIONS: Outcome of patients with postoperative intra-abdominal infections correlates significantly with APACHE II and MPI, and in particular with age, Glasgow coma scale, and chronic health evaluation. It also correlates with time between the first and subsequent operations. Elimination of the source of infection and closed treatment of the abdominal cavity are associated with less risk factors and increased survival.

APACHE↗
PubMed1996

Upper gastrointestinal surgery and the appendix.

In healthy humans the stomach, duodenum and proximal small bowel are almost sterile. Under pathological conditions, however, bacterial overgrowth occurs. The need for and duration of postoperative antibiotic treatment is based on the time from perforation to operation, and the degree of contamination or infection. Our recommendation ranges from no antibiotic in early cases with minimal contamination to 5 days of treatment when established peritonitis is encountered. The duration of treatment following appendectomy for acute appendicitis depends on the intraoperative findings: simple appendicitis: no postoperative antibiotics; phlegmonous or gangrenous appendicitis: 3 day course; perforated appendicitis with peritonitis or abscess formation: 3- to 5-day therapy.

Anti-Bacterial Agents↗
PubMed1995

Planned relaparotomy vs relaparotomy on demand in the treatment of intra-abdominal infections. The Peritonitis Study Group of the Surgical Infection Society-Europe.

OBJECTIVE: To define the role of planned relaparotomy (PR) in the treatment of intraperitoneal infection, compared with that of relaparotomy on demand (RD). DESIGN: Case-control study on the basis of a prospective multicenter cohort analytic study. Statistical evaluation was done by the McNemar test for qualitative data and the Wilcoxon matched-pairs signed rank test for qualitative data. SETTING: Eighteen hospitals of different care levels in Austria, Germany, and Switzerland. PATIENTS: Thirty-eight of 42 patients with intra-abdominal infections who underwent PR were matched for APACHE II (Acute Physiology and Chronic Health Evaluation II) score, age, cause of infection, site of origin of peritonitis, and the ability of the surgeon to securely eliminate the source of infection with 38 patients taken from a cohort of 278 undergoing RD. INTERVENTIONS: Planned relaparotomy was defined as at least one relaparotomy decided on at the time of the first surgical intervention; RD, relaparotomy indicated by clinical findings. MAIN OUTCOME MEASURES: Mortality and incidence of postoperative multiple organ failure and infectious complications. RESULTS: There was no significant difference in mortality between patients treated with PR (21%) or RD (13%). Postoperative multiple organ failure as defined by a Goris score of more than 5 was more frequent in the group of patients undergoing PR (50%), compared with the group undergoing RD (24%) (P = .01), as were infectious complications (68% vs 39% [P = .01]). Infectious complications were due to more frequent suture leaks (16% vs 0% [P = .05]), recurrent intra-abdominal sepsis (16% vs 0% [P = .05]), and septecemia (45% vs 18% [P = .05]) in the PR vs the RD groups. The incidence of other complications was not different in the two groups. CONCLUSIONS: Until larger prospective studies are available, the indication for PR should be evaluated with caution.

Abdomen↗
PubMed1995

[Simultaneous occurrence of tracheobronchopathia osteochondropastica and mucoepidermoid carcinoma].

In a 51 year old male patient with tracheobronchopathia osteochondroplastica a mucodermoid carcinoma of the middle lobe of the lung was diagnosed. Tracheobronchopathia osteochondroplastica is a rare condition which is occasionally diagnosed by fiberoptic bronchoscopy. More frequently, however, it is only found at autopsy. Mucoepidermoid carcinomas derive from the glands of the bronchial tree and are divided in low-grade and high-grade tumors. The tumor should be locally resected, adjuvant radio- or chemotherapy is ineffective.

Bronchi↗
PubMed1995

Early thoracoscopic debridement and drainage as definite treatment for pleural empyema.

OBJECTIVE: To report our experience with early thoracoscopic debridement and drainage in the treatment of pleural empyema in the fibrinopurulent or early organising phase. DESIGN: Prospective open study. SETTING: District hospital, Germany. SUBJECTS: 10 Patients operated on between August 1991 and April 1993. INTERVENTIONS: Double lumen intubation, followed by thoracoscopic opening of the empyema, evacuation of all pus under vision, debridement of the lung, irrigation of the thoracic cavity and insertion of a chest drain. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: Cultures taken during the operation grew no pathogens in five cases; Streptococcus pneumoniae, and haemolytic streptococci (once in combination with Staphylococcus aureus), were cultured in two cases each; and Mycobacterium tuberculosis in one. Chest drains were removed a mean of 8.5 days after operation. All patients were well without signs of infection 1-21 months later, and in no case was conversion to open operation necessary. CONCLUSION: Early thoracoscopic debridement and drainage is a safe and effective alternative to open treatment of patients with pleural empyema in the fibrinopurulent or early organising phase.

Adult↗
PubMed1994

[Undetected esophageal foreign body aspiration in a patient with seizures].

We report an oesophageal foreign body in a patient with a seizure disorder secondary to encephalitis disseminata who was transferred to our department of neurosurgery because of rising intracranial pressure. He presented with confusion, motor aphasia, and dysphagia. However, the diagnosis of increased intracranial pressure could not be confirmed clinically or by computed tomography. A routine chest X-ray film showed a dental prosthesis projecting on the area of the hypopharynx. Bronchoscopy and oesophagoscopy showed the denture to be lodged in the hypopharynx, but it was impossible to remove it endoscopically. Therefore, an oesophagopharyngotomy was performed and the foreign body extracted. The postoperative course was complicated by pneumonia, which responded well to antibiotic treatment. The patient made an otherwise uneventful recovery and was able to eat without difficulty.

Adult↗
PubMed1992

[Tracheobronchopathia osteochondroplastica and coexistent mucoepidermoid carcinoma of the lung: Case report].

Pneumonia of the middle lobe that had been diagnosed by x-ray in a male patient of 51 years of age did not recede completely despite antibiotic treatment. CT showed a space-occupying growth in the middle lobe of about 1.5 cm size, with consecutive atelectasis. Bronchoscopy revealed a pronounced pattern of tracheobronchopathia osteochondroplastica, but it was not possible to confirm the middle lobe syndrome (Brock's syndrome) by histological examination. A mucoepidermoid carcinoma of the middle lobe was histologically established by thoracotomy besides the tracheobronchopathia osteochondroplastica. 9 months post-operatively there is no pointer to any recurrence or metastasising.

Carcinoma↗