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Biomedical subjects

T Hau

Publications and source records attributed to T Hau.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1991

[Drug therapy of surgical infections. Limits and dangers].

Antibiotics belong to the most commonly used drugs in surgical practice. Even though they are usually safe adverse reactions and side effects will occur. They can be divided into pharmacologic side effects (impairment of coagulation, ototoxicity, nephrotoxicity), immunologic side effects (immunosuppression, allergic reactions), microbiologic side effects (emergence of resistance, superinfection) and iatrogenic problems. The most commonly made mistakes are antibiotic therapy without clear indication, neglecting pharmacokinetics, unwarranted combination therapy and failure to perform necessary surgical procedures. In order to minimize side effects and errors a limited number of substances should be selected depending on local conditions. Usually, ten antibiotics are sufficient for general surgical practice.

Anti-Bacterial Agents↗
PubMed1990

Antibiotics in elective colon surgery. A randomized trial of oral, systemic, and oral/systemic antibiotics for prophylaxis.

A prospective, randomized double-blind study was undertaken to compare the efficacy of three prophylactic regimens (oral neomycin and erythromycin, intravenous cefoxitin, and a combination of both oral and intravenous antibiotics) in patients undergoing elective colorectal surgery. One hundred sixty-nine patients were randomized and 146 patients were evaluable. Septic complications occurred in 11.4 per cent of patients receiving oral antibiotics only, in 11.7 per cent of patients receiving intravenous cefoxitin alone, and in 7.8 per cent of patients receiving both oral and intravenous antibiotics. These differences were not statistically different. The greatest number of septic complications occurred in those patients with anastomotic disruptions. Two patients died (1.3%), both of whom had major anastomotic failures. There was no advantage between any of the groups in the incidence of wound infection (3.9-6.8%). Thus, no advantage could be identified in this study in the combination of oral and intravenous antibiotics in elective colorectal surgery.

Administration, Oral↗
PubMed1990

[Etiology, diagnosis and therapy of soft tissue infections].

Soft tissue infections are caused by a multitude of bacteria. Their pathogenicity depends on the ability to adhere to surfaces, certain characteristics of the cell wall, exoenzymes or exotoxins, and endotoxins. Because etiologic classification of soft tissue infections is not satisfactory, we propose a clinical classification. 1. Abscesses are caused by staphylococci (carbuncle or suppurative hydroadenitis) or by polymicrobial infections (most subcutaneous abscesses). They are treated by incision and drainage and primary closure of the skin after drainage and curettage is often successful. Only in special cases are antibiotics indicated. 2. Cellulitis mostly caused by streptococci responds well to antibiotic therapy without surgery. 3. Ulcerative lesions i.e. pseudomonal gangrene and Meleney's gangrene need specific antibiotic therapy and complete excision with delayed grafting.

Abscess↗
PubMed1989

Maxillary anterior esthetics. Preservation of the interdental papilla.

Periodontal therapy for the maxillary anterior area requires careful consideration as to the choice of therapy, as esthetic results are just as important as eradication of disease. The extensive shrinkage or loss of the interdental papilla, especially between the two central incisors as a result of periodontal therapy, should be minimized by the proper selection of therapy. Thorough subgingival scaling and root planing without surgical flaps is the treatment of choice as the maxillary anterior area is compatible for this type of therapy from the anatomic and access standpoints. In the posterior dentition, the surgical, conventional flap approach is encouraged after initial scaling, because of the anatomy of the roots (concavities, furcations) and difficulty with access makes thorough root therapy difficult. Fortunately, esthetics is not a major concern in the posterior areas. If surgical therapy is necessary for the maxillary anterior area, the papilla preservation flap technique better preserves the papilla for esthetic purposes but allows good access to the roots for root planing and, if necessary, the placement of graft material.

Dental Plaque↗
PubMed1988

Moxalactam vs tobramycin-clindamycin. A randomized trial in secondary peritonitis.

One hundred five patients with peritonitis were randomized to receive either tobramycin sulfate plus clindamycin phosphate or moxalactam alone before surgical intervention. Fifty-nine patients were evaluable. A mean of 3.1 (moxalactam) and 3.5 (tobramycin-clindamycin) pathogens per patient were identified. Overall success rate was 85% (tobramycin-clindamycin, 24/30; moxalactam, 26/29). When patients with appendicitis were excluded, there was an observed but not statistically significant advantage of moxalactam over tobramycin-clindamycin (85% vs 67%). There were five deaths (tobramycin-clindamycin, four; moxalactam, one). Other complications included hypoprothrombinemia (tobramycin-clindamycin, five; moxalactam, five), renal dysfunction (tobramycin-clindamycin, three; moxalactam, one), and superinfection (tobramycin-clindamycin, nine; moxalactam, six). More wound infections were noted in the group given tobramycin-clindamycin. These data suggest that moxalactam is as safe and efficacious as tobramycin plus clindamycin. The observed benefits of this agent warrant study in a larger sample to verify advantages of moxalactam over combination therapy.

Abscess↗
PubMed1988

Randomized trial of imipenem-cilastatin versus gentamicin plus clindamycin in the treatment of polymicrobial infections.

The comparative efficacy of imipenem-cilastatin versus clindamycin and gentamicin in the treatment of polymicrobial infections was evaluated. Eleven patients completed treatment with the former and nine with the latter. Conditions treated included infected extremity ulcers, peritonitis, perirectal abscess, soft-tissue abscess, abdominal abscess, and acute diverticulitis. Similar rates of bacteriologic and clinical cure or improvement were achieved with the two treatments. Superinfection occurred in two patients who received imipenem-cilastatin and one who received clindamycin and gentamicin. No significant difference in adverse effects was noted. Imipenem-cilastatin appears to be an effective antibiotic in treating polymicrobial infections; however, a much larger patient population would be required to detect a significant difference in the efficacy rates or frequency of adverse effects when comparing the two regimens.

Adult↗
PubMed1988

[Kidney autotransplantation in therapy of complex renovascular diseases. Indications, technic and results].

Fibromuscular dysplasia of the renal artery can be treated by vascular surgical reconstruction or percutaneous transluminal angioplasty. If, however, the secondary and tertiary branches of the renal artery are involved, this lesion cannot be corrected with conventional surgical techniques or invasive radiologic methods. Because the disease often affects young patients, in whom an etiologic treatment of the hypertension is desirable, we have performed ex vivo repair of lesions of the renal artery and its branches with autotransplantation of the kidney in five patients. Four patients had renovascular hypertension and one patient an aneurysm of a tertiary branch of the renal artery. Postoperatively, renal function, as evidenced by renal scan and renal function studies, was normal in all autotransplanted kidneys. All four patients with renovascular hypertension had normal blood pressure postoperatively. Only one patient had to be treated with single drug antihypertensive therapy.

Adult↗
PubMed1988

[Fine needle biopsy of the pancreas with computerized tomography control].

The results of 96 computed tomography guided percutaneous pancreatic aspiration biopsies were reviewed and compared with the findings at laparotomy or autopsy or with a follow-up of at least one year. In only four instances the follow-up was inadequate and in 29 cases the specimen did not allow a cytologic or histologic diagnosis. Of the remaining 67 biopsies 65 were diagnosed correctly and only 2 incorrectly. This corresponds to a sensitivity of 67.7% and a specificity of 97%. In patients with primary pancreatic cancer the figures for sensitivity or specificity are 76.8% and 97.3% respectively. We did not observe any serious complications. Only one patient had a transient rise of the serum amylase. We believe that the percutaneous aspiration biopsy of the pancreas guided by computed tomography is a safe and effective method in the histologic and cytologic diagnosis of pancreatic lesions.

Biopsy, Needle↗
PubMed1987

[Pathology, diagnosis and therapy of liver abscess].

Bacterial hepatic abscesses are a rare but serious disease. They develop either secondary to injuries or ischemia of the liver, infections in the drainage area of the portal vein, systemic sepsis or biliary infections. An abscess secondary to injuries or ischemia of the liver or infections in the drainage area of the portal vein, is usually caused by a mixed flora consisting of gramnegative aerobes and anaerobic bacteria. Hepatic abscesses secondary to systemic sepsis contain Staphylococci or Streptococci, while in abscesses on the basis of biliary infections gramnegative organisms are found. Clinically, one can find signs of systemic sepsis, pain in the right upper quadrant and a tender enlarged liver. Jaundice is absent unless a biliary obstruction is present simultaneously. The diagnosis is confirmed by ultrasonography or computerized tomography. An uncertain diagnosis can be confirmed by aspiration under ultrasonographic or computertomographic guidance. The therapy consists of administration of antibiotics and surgical or percutaneous drainage. Surgical drainage via laparotomy is always mandatory if one suspects a primary infectious focus within the abdomen. The mortality of multiple liver abscesses is 20 per cent, that of single abscesses 10 per cent. Amebic abscesses have been observed in nonendemic regions sporadically after travel or spontaneously. Clinical and radiological manifestations are the same as for bacterial abscesses. They are differentiated from bacterial abscesses by positive serology for amebiasis or aspiration which yields the typical anchovy paste. Most important complications are hepato-bronchial fistulae, empyema and amebic pericarditis. The therapy consists of a nitroimidazole and a luminal amebicide. Except for diagnostic reasons aspiration is only indicated for large abscesses of the left lobe of the liver. Mortality of an uncomplicated amebic liver abscess should be under one per cent.

Amebicides↗
PubMed1986

Antibiotics fail to prevent abscess formation secondary to bacteria trapped in fibrin clots.

We inoculated 120 rats with 2 X 10(9) Escherichia coli or 2 X 10(9) Bacteroides fragilis suspended in normal saline solution or incorporated into fibrin clots. In the control group, all animals died after inoculation with E coli, but none died after the inoculation with B fragilis; both were suspended in normal saline solution. Escherichia coli entrapped in fibrin did not cause mortality but did result in abscess formation in all animals. Bacteroides fragilis incorporated into fibrin clots resulted in abscess formation in the majority of animals. Treatment with gentamicin sulfate, ampicillin sulfate, and cefoxitin sodium completely abolished the mortality secondary to E coli suspended in normal saline solution but did not influence the rate of abscess formation secondary to E coli incorporated into fibrin clots. Similarly, cefoxitin and clindamycin phosphate did not significantly change abscess formation secondary to B fragilis incorporated into fibrin clots. We conclude that systemic antibiotics are ineffective in the prevention of abscesses secondary to bacteria trapped in fibrin, either because they do not reach bactericidal levels in the fibrin clot, as in the case of gentamicin, ampicillin, and clindamycin, or, as in the case of cefoxitin, because of the inoculum effect caused by the high number of bacteria. Fibrinogen or fibrin itself do not afford any protection of bacteria against the action of antibiotics.

Abscess↗
PubMed1986

Evaluation of computed tomography guided percutaneous biopsy of the pancreas.

The results of 96 computed tomography guided percutaneous pancreatic aspiration biopsies were reviewed to evaluate the diagnostic sensitivity, specificity and accuracy in pancreatic mass lesions. These were assessed by comparing pathology results to findings at subsequent laparotomy, autopsy or to immediate and long term clinical findings. Effects of varying the size of the biopsy needle and the number of aspirations performed were examined. Of the primary tumors of the pancreas in which adequate material was obtained, 97.3 per cent were correctly diagnosed with one false-negative and no false-positive results. The over-all sensitivity rate for primary tumor so the pancreas was 71.9 per cent using a No. 22 gauge "skinny" needle and 86.7 per cent using a No. 20 gauge needle. Over-all diagnostic accuracy for all types of lesions was 61.8 per cent using a No. 22 gauge needle and 73.3 per cent using a No. 20 gauge needle. A No. 19 gauge needle with a sheath was used on lesions with fluid or necrotic debris when a pseudocyst was a possibility. Over-all diagnostic accuracy using a No. 19 gauge sheathed needle was 81.8 per cent on all types of lesions. There was no benefit in using two passes versus a single aspiration. There were no complications, regardless of the needle size or number of passes. The serum amylase level increased in one instance after biopsy and this returned to normal a few days after biopsy. Computed tomography guided aspirations are safe and effective in evaluation of focal or diffuse enlargements of the pancreas when proper techniques and appropriate precautions are used.

Biopsy, Needle↗
PubMed1985

The spectrum of peritonitis in renal transplant recipients.

Peritonitis in immunosuppressed renal transplant recipients continues to be associated with a high mortality. Twenty-four patients with intraperitoneal infections were identified in 542 consecutive renal transplant recipients over a period of 15 years (4.4%). Sixteen of the 24 (66.6%) died as a result of these infections. Transplant wound sepsis and the complications and surgery of gastrointestinal diseases accounted for the majority of instances. During the period 1980-1983 only four cases occurred with no episodes being due to wound complications. Symptoms and signs were vague and nonspecific, and in three patients the diagnosis was made only at autopsy. Surgery aimed to eliminate the septic focus with the drainage of abscesses and the avoidance of large bowel anastomoses. In 22 patients, a polymicrobial flora was obtained from the contaminated peritoneal cavity, with an average of 2.25 organisms per patient. These data suggest that the prohibitive mortality of peritonitis in renal transplant recipients may be lowered by prophylactic gastrointestinal surgery prior to transplantation, as well as by measures designed to lower the incidence of transplant wound sepsis. Peritoneal lavage, computed tomography, and laparotomy in the face of an undiagnosed source for sepsis may be warranted in these high-risk patients.

Adolescent↗
PubMed1984

Disposition of total and unbound prednisolone in renal transplant patients receiving anticonvulsants.

Kidney transplant patients receiving phenytoin or phenobarbital may have decreased graft survival. These drugs have been shown to enhance the metabolism of glucocorticoids. We determined the disposition of total and unbound prednisolone in six stable kidney transplant patients receiving prednisone for immunosuppression and phenytoin or phenobarbital for a seizure disorder. Six similar patients not on anticonvulsants served as controls. A single intravenous dose of prednisolone was administered, and plasma samples were analyzed for prednisolone using a high-performance liquid chromatographic assay. Equilibrium dialysis was used to determine unbound prednisolone concentrations. Pharmacokinetic analysis showed that the half-life of prednisolone was shorter in the anticonvulsant group compared to the controls, based on both total (2.3 +/- 0.4 vs. 3.4 +/- 0.2 hr (SD), P less than 0.01) and unbound (1.7 +/- 0.3 vs. 2.4 +/- 0.2 hr, P less than 0.01) concentrations. Total drug clearance was 10.4 +/- 2.8 liters/hr (0.171 +/- 0.087 liters/hr X kg) in the anticonvulsant group versus 7.2 +/- 1.2 liters/hr (0.100 +/- 0.014 liters/hr X kg) in the controls (P less than 0.05). Unbound prednisolone clearance was 57.2 +/- 12.1 versus 46.4 +/- 8.7 liters/hr (P greater than 0.05) and for weight-corrected estimates 0.886 +/- 0.224 liters/hr X kg versus 0.644 +/- 0.115 liters/hr X kg (P less than 0.05) in the two groups, respectively. Thus, the disposition of prednisolone is altered by anticonvulsants in kidney transplant patients and may require dose alteration.

Adolescent↗
PubMed1983

Role of surgical and percutaneous drainage in the treatment of abdominal abscesses.

Reviewing our experience with 32 surgically and 13 percutaneously drained abdominal abscesses, we propose the following criteria for computed tomography (CT)-assisted percutaneous drainage: (1) the absence of more than two abscess cavities or loculations; (2) drainage route not traversing bowel, uncontaminated organs, or uncontaminated peritoneal or pleural spaces; (3) the absence of a source of continuous contamination; and (4) the absence of fungi as causative organisms. Of nine abscesses that met these criteria, seven were successfully drained percutaneously. In all abscesses that did not meet the criteria, percutaneous drainage resulted in complications. Of the 32 surgical patients, six would have been candidates for percutaneous drainage according to these criteria. Two of those patients experienced technical complications that might have been prevented by the use of percutaneous drainage. Surgical intervention is the preferred treatment in the majority of patients; however, in properly selected patients, CT-assisted percutaneous drainage is highly successful and can prevent unnecessary morbidity and mortality.

Abdomen↗