Search PubMed⌕ Search

Biomedical subjects

W Zimmerli

Publications and source records attributed to W Zimmerli.

At least 109 records · Page 6Linked to original sources
PubMed1993

[Personal experience with preventive use of antibiotics in elective colon surgery. A retrospective study].

We reviewed in a retrospective study all our 616 electively operated colons over 15 years from 1976 to 1990 for morbidity and mortality depending the antibiotic prophylaxis. Interventions were performed on 578 patients with a mean age of 65.5 + 13.7 years; in 38 cases there was an earlier elective colic operation. The sex ratio was 1.26 men to 1 woman. 71.8% of the indications were adenocarcinomas of the colon. All other diagnostics, as well as different types of interventions were included in the study. All interventions was preceded by large bowel preparation. The colic anastomosis were almost always handswen in two layers. Until 1982 systematically, we gave prophylaxis by combination of aminoglycoside with metronidazole or clindamycin, n = 329 (53.4% of 616). We then changed to ceftriaxone, n = 287 (46.6% of 616). Ceftriaxone was applied in single dose (n = 142), in multi doses (n = 71) and combined in almost all cases with metronidazole (n = 74). We found significantly better morbidity and mortality results with ceftriaxone than in the aminoglycoside combined group: The ceftriaxone group had a septicemia or colocutaneous fistulas requiring reoperation incidence of 1.4% (4/287) versus 4.6% (15/329) (p = 0.023). Mortality decreased from 4.9% (16/329) under aminoglycoside combined prophylaxis to 1.74% (5/287) in the ceftriaxone group (p = 0.033). The infection rate of the surgical accesses diminished from 13.1% (43/329) to 8% (23/287) under ceftriaxone (p = 0.043).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1993

[Retrospective study of emergent surgery on the left colon].

From 1976 to 1988, 123 emergency left colon procedures were carried out. 79 were single-step procedures, 34 were two-step and 10 were three-step. The presence or not of peritonitis was not systematically taken into consideration for procedure choice. Two of the 79 single-step patients presented an anastomosis leakage repair. Three of seven patients with postoperative peritonitis required reoperation for abscess formation. These figures are not significantly higher than those encountered in the two- or three-step procedure groups. As it was, one of these patients required a reintervention for fistula excision, as well as upper stomy trouble. In summary, we can say that emergency left colon resection with anastomosis without protective stomy is preferable with associated adequate antibiotherapy.

Adenocarcinoma↗
PubMed1993

Glycosylation of alpha 1-acid glycoprotein in systemic onset juvenile rheumatoid arthritis and acute bacterial infection: value in differential diagnosis.

Agarose based affinity immunoelectrophoresis with free concanavalin A (Con-A) as ligand was used to examine the microheterogeneity of alpha 1-acid glycoprotein in sera of patients with systemic onset juvenile rheumatoid arthritis (JRA) and acute bacterial infections. In JRA, a decreased proportion of Con-A reactive alpha 1-acid glycoprotein variants was found when compared to healthy control. In contrast, acute bacterial infection showed an increased reactivity. Investigation of glycosylation may be useful in the differential diagnosis of systemic onset JRA and acute bacterial infection.

Acute Disease↗
PubMed1992

[Role of antibiotics in surgically treated active endocarditis].

In a retrospective study of 30 patients in whom a valve was replaced during active endocarditis, the role of the concomitant antimicrobial therapy was analyzed. In 75% of the patients with less than 1 week of adequate treatment before surgery, but only in 13% (p less than 0.001) with at least 1 week of therapy, could the microorganism be cultivated from the excised valve. Patients with bacteria on the valve had a 4-fold increased risk for prosthetic valve endocarditis and 2.7-fold more frequent paravalvular leakage. Therefore, in the absence of severe cardiac failure, the valve replacement should not be performed before the second week of therapy. Patients in whom microorganisms can be cultivated from the valve need a complete postoperative course of antimicrobial therapy.

Adult↗
PubMed1992

Failure to control AIDS-related CMV-retinitis with intravenous ganciclovir.

Between January 1988 and May 1991 intravenous ganciclovir (GCV) treatment was administered to eight male AIDS-patients with unilateral cytomegalovirus (CMV)-retinitis. Despite of continuous therapy with at least the recommended dose of GCV, three patients developed slowly progressive CMV-retinitis in the fellow eye after 4 to 13 months. The progression could not be stopped by GCV and thus bilateral blindness resulted after 12 to 22 months. The number of CD4-lymphocytes in the blood was reduced in all patients, but particularly in patients with progressive disease. Treatment failure was partly related to the duration of CMV-retinitis and partly to the degree of immunodeficiency. Intravenous treatment with GCV alone can not stop the progression of CMV-retinitis in long-term survivors and in those with advanced immunodeficiency.

AIDS-Related Opportunistic Infections↗
PubMed1992

[Morphologic aspects of therapy-resistant cytomegalovirus retinitis].

Intravenous ganciclovir treatment was performed in eight male AIDS patients with primary unilateral CMV-retinitis. Three patients developed slowly progressive CMV-retinitis in the fellow eye despite adequate dose of ganciclovir. These different CMV-manifestations are shown in a sequence of fundus pictures. Three types of CMV-lesions were observed in connection with this study. Untreated central lesions showed the aspect of crumbled cheese and ketchup. Untreated lesions in the peripherie were yellowish-white, granular, "dry" and showed in most cases no haemorrhages. Lesions appearing during treatment showed initially "dry" white opaque subretinal areas, turning later on to the typical aspect of untreated lesions. The progression could not be stopped by highdose ganciclovir i.v. and thus bilateral blindness resulted after 12 to 22 months. The level of CD4-lymphocytes in the blood was diminished in all patients, but much more in patients with progressive disease.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Successful treatment of disseminated nocardiosis complicated by cerebral abscess with ceftriaxone and amikacin: case report.

We report the case of an 85-year-old female patient who suffered from disseminated Nocardia asteroides infection complicated by a cerebral abscess. Treatment with amikacin for 2 weeks and ceftriaxone for 6 weeks led to complete recovery, and there was no recurrence of disease over a follow-up period of 12 months after therapy. The use of ceftriaxone in combination with amikacin might significantly shorten the duration of treatment for patients with disseminated nocardiosis. This combination of antibiotics merits further investigation with use of a larger sample of patients.

Aged↗
PubMed1992

Antimicrobial treatment of orthopedic implant-related infections with rifampin combinations.

The purpose of this prospective clinical study is to evaluate the role of combination chemotherapy with rifampin in the treatment of orthopedic device-related infections in which the implant could not be removed. Eleven patients with orthopedic implant-related infections due to staphylococci or streptococci were treated with the implant in situ. Each antimicrobial regimen included rifampin in combination with a beta-lactam antibiotic or ciprofloxacin. The median duration of treatment with rifampin was 86 days (range, 15-336 days) with a median follow-up of greater than 24 months after cessation of therapy. Treatment was successful for 82% of patients. Failures were associated with documented inappropriate treatment. These preliminary clinical data are supported by data from in vitro studies and animal experiments. Combination therapy with rifampin, in particular rifampin and a quinolone, should be considered for patients with orthopedic implant-related infections if the implant cannot be removed.

Adult↗
PubMed1992

[Double incision for operation of carpal tunnel syndrome--14 years experience].

15 years ago I started to do the surgical release of carpal tunnel syndrome by the "double incision technique", avoiding the postoperative tenderness in the so called carpal barrier. The postoperative results of 293 operations prove the small morbidity, the short inability for work, the small loss of strength and the few postoperative complications. The danger of this very well tolerated method is that the extend of the ulnar artery, the motor branch and the palmar cutaneous branch of the median nerve may be abnormal and the mentioned structures may be harmed by the operation. A well trained surgeon will practice this technique with success, but it should not be applicated by beginners.

Adult↗
PubMed1992

[Localized bacterial skin infections and dermatologic manifestations of systemic infections].

Localized bacterial skin infections are frequent. In furunculosis, a local treatment is usually sufficient. In case of frequent recurrence a possible staphylococcus aureus colonization should be looked for and eliminated. Erysipela is treated by systemic antibiotics in order to avoid complications such as streptococcal gangrena or parainfectious glomerulonephritis. Anaerobic cellulitis and gas gangrena are postoperative or posttraumatic infections of the soft tissues which require a combined surgical and antibiotic treatment. Systemic infections may be recognized by characteristic skin lesions. These skin lesions are the consequence of bacterial emboli, vasculitis, intravascular coagulation or toxins, respectively. Examples for such manifestations are lesions in endocarditis, purpura fulminans, ekthyma gangrenosum, disseminated candidemia and toxic shock syndrome.

Anti-Bacterial Agents↗
PubMed1991

Glycosylation of alpha 1-acid glycoprotein in relation to duration of disease in acute and chronic infection and inflammation.

Microheterogeneity of acute phase proteins frequently differs in acute and chronic types of inflammation. However, it is unknown whether these changes depend on the duration of the inflammation in a given disease. We therefore investigated the microheterogeneity of alpha 1-acid glycoprotein (AGP) in sera from patients with acute and chronic bacterial infection in comparison to rheumatoid arthritis and ankylosing spondylitis. In acute bacterial infection Con A-reactivity of AGP was significantly elevated. By contrast, AGP in chronic bacterial infection showed the same glycosylation pattern as rheumatoid arthritis and ankylosing spondylitis being characterized by a decreased reactivity to Con A. Serial measurements in individual patients with bacterial infections showed a transition from the initially elevated to decreased reactivity to Con A as the disease became chronic.

Acute Disease↗
PubMed1991

[Nosocomial pneumonia in ventilated patientsø].

Nosocomial pneumonia is a complication in 20-65% of patients on mechanical ventilation. The tracheal tubes cannot avoid aspiration from the upper respiratory tract or the stomach. According to several (but not all) authors, gastric colonization with a high density of microorganisms is a major risk factor for the genesis of nosocomial pneumonia in ventilated patients. In most but not all intensive care units, gram negative microorganisms are the predominant etiologic agents of nosocomial pneumonia. In neurosurgical patients other microorganisms such as Staphylococcus aureus and Hemophilus influenzae play an important role. For rapid and correct diagnosis, new techniques such as bronchoalveolar lavage or the protected specimen brush have been developed. In prophylaxis, endotracheally administered antibiotics have not proved to be efficacious. In contrast, selective decontamination of the gut has a beneficial effect. However, long-term studies with this technique have still to prove that emergence of resistant microorganisms is not a major problem. Empirical treatment of pneumonia in ventilated patients should be guided by the results of surveillance cultures.

Bronchoalveolar Lavage Fluid↗
PubMed1991

Influence of the anti-inflammatory compound flosulide on granulocyte function.

Polymorphonuclear leukocytes (PMN) are involved in inflammatory reactions. It is thought that oxygen-derived free radicals released from activated PMN may participate in tissue damage during inflammation. We have shown that flosulide (6-(2,4-difluorophenoxy)-5-methylsulfonylamino-1-indanone ), a novel highly potent anti-inflammatory compound, inhibits superoxide production induced by N-formyl-Met-Leu-Phe (FMLP), C5a and PMA without impairing bacterial killing or chemotaxis. Flosulide (10(-5)-10(-7) M) was more potent in inhibiting the FMLP-induced respiratory burst of PMN than the structurally related compound nimesulide. FMLP-induced superoxide generation was also inhibited by two human flosulide metabolites. A good correlation between this in vitro effect and in vivo anti-inflammatory potency in rat adjuvant arthritis was found for flosulide and its metabolites. Indomethacin, piroxicam and ibuprofen did not inhibit the respiratory burst at 10(-5) M. FMLP receptor number was decreased by 36% in the presence of 10(-5) M flosulide. However, a 250-fold molar excess of flosulide could not displace labeled FMLP from the receptor. Inhibition of degranulation of primary and secondary granules was a common effect of all anti-inflammatory compounds tested. At a concentration of 10(-5) M, all drugs inhibited degranulation to about the same degree, independent of their in vivo anti-inflammatory activity.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1991

[Prosthesis infections: is ambulatory conservative therapy possible?].

Infections associated with prosthetic devices involve an increased risk of persistence or relapse if the foreign body is not removed. Clinical and experimental observations indicate a lack of correlation between the minimal bactericidal concentration of a drug and its efficacy in device-related infections. Alternative in-vitro tests indicate that the efficacy of a drug experimental implant-associated infections depends on its activity on non-growing and adhering microorganisms. These data have been evaluated in a clinical pilot study. 12 patients with orthopedic device-related infections were treated with rifampin-containing regimens because this drug has excellent activity on adherent microorganisms. The success rate was 83% during a follow-up period of 2 years or until the removal of the device. Nevertheless, before considering conservative treatment of device-related infections, controlled clinical studies are needed which confirm the experimental results.

Animals↗
PubMed1991

[Cyst of the seminal vesicle with ipsilateral kidney agenesis].

Unilateral cyst of the seminal vesicle, ipsilateral ectopic ureter and ipsilateral renal agenesis are the components of a rare congenital abnormality affecting the male urogenital tract. The clinical picture is characterized by a retrovesical cystic tumor which may be asymptomatic or cause nonspecific symptoms. Differential diagnosis includes cysts of the Müllerian duct, the urogenital sinus/ejaculatory duct, and the prostate. Pelvic ultrasonography is an appropriate method of investigating patients in whom this malformation is suspected, whereas more invasive radiologic procedures are indicated in selected cases only. Treatment for retrovesical cysts should be restricted to symptomatic patients. Conservative therapy may result in subjective improvement, but surgical exploration and excision of the abnormal organs is the only definitive treatment.

Abnormalities, Multiple↗
PubMed1991

Neutrophil function and pyogenic infections in bone marrow transplant recipients.

In a consecutive entry trial, the incidence and time course of decreased neutrophil function was assessed in 20 patients treated with allogeneic bone marrow transplantation (BMT). The aim of the study was to assess the prognostic value of low neutrophil function for late pyogenic infections. Chemotaxis, superoxide production, and phagocytic-bactericidal activity were studied before and 2, 6, 9, and 12 months after BMT. Skin window migration was quantitatively assessed 2 months after BMT. Infectious complications were recorded prospectively with preset criteria during 1 year. Six of the 20 leukemic patients had defective neutrophil function before BMT. Two months after BMT all 10 patients with greater than stage II graft-versus-host disease (GVHD), and 6 of 10 patients with less than or equal to stage II GVHD had at least one decreased function. At this time, patients with subsequent pyogenic infections had lower chemotaxis (P less than .05), phagocytic-bactericidal activity (P less than .005), and superoxide production (P less than .025) than those without. Defective skin window migration and combined defects were predictive for late pyogenic infections. At 9 months all tests were normal in seven patients surviving without GVHD. In contrast, at 9 months three of three patients, and at 1 year two of three with chronic GVHD had still decreased neutrophil function. In conclusion, neutrophil function is frequently impaired during the first months after BMT. Combined neutrophil defects predispose to pyogenic infections and indicate the patient at risk.

Blood Bactericidal Activity↗