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Biomedical subjects

A M Hirschl

Publications and source records attributed to A M Hirschl.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Effect of zinc oxide on Aspergillus species: a possible cause of local noninvasive aspergillosis of the maxillary sinus].

During the last years the appearance of radiopaque concrements in the maxillary sinus was reported. These could be identified as root-filling material for teeth of the upper jaw containing zinc oxide. This suggested that excess root-filling material containing zinc oxide in the maxillary sinus could favour the development of a local, non-invasive aspergillosis. Therefore, we tested Aspergillus fumigatus, A. flavus, A. terreus, A. nidulans and A. niveus for the influence of zinc oxide. Cza-pek-Dox agar was inoculated with the six different Aspergillus strains. Circular cavities stamped into the agar's center of each plate were filled with aliquots of the dilutions of a geometric series of zinc oxide dissolved in 0,1n H2SO4. All plates were then incubated for seven days at 37 degrees C. Readings were taken on the 3rd, the 5th and the 7th day. It became obvious that solved zinc oxide promotes the growth of all the tested Aspergillus species. This influence diminished with decreasing concentration. This effect could be observed on all days of measurement. Only A. niger showed an attenuated dependence, probably due to the a priori high growth rate of this species on Czapek-Dox agar. It is concluded that overfilling of maxillary teeth with a zinc oxide containing root filling material favours the development of local aspergillosis.

Aspergillosis↗
PubMed1996

Serological tests for monitoring Helicobacter pylori eradication treatment.

Serological tests for the detection of Helicobacter pylori-specific antibodies are useful in epidemiological studies, as a pre-endoscopic screening procedure, and as therapeutic follow-up. For the latter application, they represent an alternative to invasive and expensive diagnostic methods such as endoscopy and breath test, respectively. However, serological tests are suitable only for long-term treatment monitoring in adults. As the significant reduction of specific antibodies, and not seronegativity by itself, is regarded as a criterion of therapeutic success, it is always necessary to establish the antibody kinetics. Enzyme-linked immunosorbent assay (ELISA) based tests are best suited for this. The most relevant antibody class to be detected is H. pylori-specific IgG. The main indication for employing serology is the therapeutic follow-up of patients who, on the whole, are free of complaints.

Adult↗
PubMed1996

Amoxicillin for the treatment of Helicobacter pylori infection.

Amoxicillin is one of the most active antimicrobials against Helicobacter pylori in vitro, with a minimum inhibitory concentration (MIC) of < or = 0.01-0.1 mg/l. Thus far, neither primary nor secondary resistant strains have been found. Amoxicillin, which has a bactericidal effect on H. pylori, but is less inhibitory in the stationary growth phase and against cell-adherent or slowly growing H. pylori, probably has both topical and systemic activity. It is fairly acid stable and is less affected by gastric acidity than macrolides. Nevertheless, its activity in vivo is considerably enhanced when it is given concomitantly with proton pump inhibitors. Several amoxicillin-containing treatment regimes have yielded H. pylori eradication rates of > or = 90%. Of particular interest are 1-week treatment regimens containing amoxicillin + clarithromycin + omeprazole, or amoxicillin + metronidazole + omeprazole, as well as a 1-h topical therapy developed in Japan.

Amoxicillin↗
PubMed1995

Polymerase chain reaction for detection of Chlamydia pneumoniae in gargled-water specimens of children.

The objective of the present study was to establish the occurrence of Chlamydia pneumoniae by direct detection in gargled-water specimens obtained from 193 children suffering from acute or chronic respiratory infections. Specimens were analyzed by an indirect immunofluorescence test (IIF), a genus-specific antigen enzyme immunosorbent assay (EIA) and the polymerase chain reaction (PCR). The pathogen was detected in three children by PCR only. As underlying disease, chronic obstructive bronchitis resistant to therapy was reported. In two of the children, the presence of pneumonia could be verified by X-ray. With a detection threshold of target DNA obtained from two inclusion forming units (IFU), the PCR proved clearly more sensitive than EIA becoming positive at levels of 100 IFU and above. No interpretable results could be obtained for the IIF.

Adolescent↗
PubMed1995

Effects of macro- and microcirculatory functions on ceftriaxone concentrations in tissues of patients with stage IV peripheral arterial occlusive disease.

The objective of the study was to determine the ceftriaxone levels achievable within lesions (toe or forefoot area) in patients with septic gangrene and to investigate the relationship between macro- and microcirculatory parameters and antibiotic concentration. Fifteen patients with severe chronic peripheral occlusive disease received an intravenous injection of 2 g of ceftriaxone. Antibiotic levels in venous and capillary blood and in an exudative part of the lesion were measured. Macrocirculatory functions were assessed by Doppler sonography, plethysmography, and angiography; microcirculatory functions were assessed by quantitative capillaroscopy and fluorescence video microscopy. The mean antibiotic concentrations measured between 4 and 8 h after injection were 92 +/- 26 micrograms/ml in venous blood and 84 +/- 46 micrograms/ml in capillary blood. The concentration in tissue reached its maximum 4 h after injection; the average concentration at between 2 and 8 h was 95 +/- 55 micrograms/ml. Only dynamic capillary parameters showed significant (P < 0.01) correlations to antibiotic levels in tissue. Significantly (P < 0.01) higher levels in tissue were observed in patients with adequate microcirculatory functions (138 +/- 48 micrograms/ml) than in patients with poor microcirculatory function (51 +/- 26 micrograms/ml). Microcirculatory dysfunction appears to be the limiting factor for tissue antibiotic levels. However, even those patients with poor microcirculatory function showed tissue antibiotic levels that were above the MICs for the pathogens most frequently isolated from gangrenous lesions. Therefore, intravenous application was found to be adequate and additional measures such as intra-arterial therapy or Bier's occlusion are basically unnecessary. Our finding that microcirculatory function is the limiting factor for the tissue antibiotic concentration is corroborated by computations based on a three-compartment model.

Aged↗
PubMed1995

Helicobacter pylori reinfection with identical organisms: transmission by the patients' spouses.

Reinfection with Helicobacter pylori after eradication is responsible for the recurrence of duodenal ulcer disease. The mode of transmission has not yet been established. In this study, 18 patients with chronic duodenal ulcers in whom H pylori had been eradicated with amoxicillin and metronidazole were entered into a prospective follow up study. Control endoscopies were performed 4, 8, 14, 27, and 43 months after starting treatment and the results of direct tests were compared with the kinetics of H pylori specific IgG titres. After eradication there was a noticeable and consistent fall in anti-H pylori IgG, while reinfections were characterised by a significant increase in specific titres. Reinfection was detected in two patients after 14 and 43 months, respectively. The H pylori strains responsible for these reinfections, the corresponding pretreatment isolates, and the strains isolated from the spouses of these patients were examined by polymerase chain reaction based DNA fingerprinting. Analysis showed that reinfection had been caused by the same H pylori strain and identified the spouses of these patients as carriers of the identical strain. Considering the genomic diversity and the interpatient heterogeneity of H pylori these results suggest a person to person transmission of H pylori reinfection. By the end of the observation period reflux oesophagitis had developed in 10 of the 16 patients who had not been reinfected. This surprising finding may be explained by the changed eating habits of patients after healing of duodenal ulcer disease.

Adult↗
PubMed1995

[Infection with Chlamydia trachomatis in patients of an ambulatory sterility clinic].

In order to investigate a presumed association of certain anamnestic data with Chlamydia trachomatis infection of infertile women, appropriate specimens were examined from 100 patients of an infertility clinic. PCR and nucleic acid hybridization were positive in 5% of the patients, corresponding in both tests; IgG was found in 31% and IgA in 5% of patients. The prevalence was highest in the age-group of 26-35 years (21 of 55) and higher in patients who had been trying to conceive for > 2 years (12 of 37) as than those trying < or = 2 years (3 of 13). The proportion of IgG-positive women was significantly (p = 0.03) smaller in Turkish patients (3 of 22) than in those of other origin (11 of 33 from former Yugoslavia and 15 of 39 Austrian women). The prevalence was higher in patients with reported pelvic inflammatory disease (11 of 30) as compared to patients without (15 of 50). With a pathological state of the Fallopian tubes the prevalence was 12 of 25, with normal tubes 6 of 18 (p > 0.05). Thus, there seem to exist anamnestic hints as to chlamydial infections. Because of their high prevalence in patients with sterility we recommend screening for chlamydial infection prior to undertaking any invasive diagnostic procedure of the Fallopian tubes.

Adolescent↗
PubMed1994

Single and multiple strain colonization in patients with Helicobacter pylori-associated gastritis: detection by macrorestriction DNA analysis.

Helicobacter pylori isolates from 18 patients were examined by macrorestriction DNA analysis to determine whether > or = 2 strains can coexist in the human stomach. Four biopsy samples from different sites in each patient's stomach were cultured, and 12-14 clones of H. pylori per patient were analyzed. DNA of 15 of the 18 isolates was digestible: 12 by NotI and 3 by NruI. Within 14 of these digestible isolates, the patterns of all clones were identical. The isolate of 1 patient showed two digestion patterns, a finding that was confirmed by arbitrary primer polymerase chain reaction. The typeable isolates of all patients, except 2 who underwent gastroscopy on the same day, differed markedly from each other. These results indicate a noticeable discrepancy between the pronounced interpatient heterogeneity and the rare intrapatient variation of H. pylori.

Base Sequence↗
PubMed1994

[Pulsed-field gel electrophoresis for the epidemiological analysis of yeast isolates].

Up to now, pulsed field gel electrophoresis (PFGE) has been used successfully for the analysis of the chains of infection of multiresistant staphylococci, enterococci and other germs involved in hospitalism. The purpose of this study was to find out whether yeast isolates from mothers and those from their newborns differed in genotypes. In this investigation, 103 parturient mothers and their children were examined for colonization by yeasts in sampling the vaginal secret at delivery and by taking swabs from the oral mucosa and the anus of the children on the third day after parturition. The samples were cultured on Sabouraud glucose agar and incubated for 48 hrs at 37 degrees C. The differentiation of the isolates was done biochemically by means of the VITEK-AMS system and morphologically on rice-extract agar. Subsequently DNA-fingerprinting analysis was carried out. In 6 cases we could prove the presence of Candida spp. in the mothers as well as in their children. In all cases the strains from mother and child showed the same banding pattern. Likewise, the strains isolated out of the vaginal secretion and the vaginal epithelium of individual women were identical. The differences observed between strains isolated from various women were of low or medium degree. This shows the PFGE to be an efficient procedure to demonstrate the relation of strains derived from mothers and their newborns.

Anal Canal↗
PubMed1994

[Helicobacter pylori: pathogens, pathomechanisms and epidemiology].

H. pylori organisms are microaerophilic gram-negative curved or spiral bacteria that live in the mucus layer of the gastric epithelium. Since the discovery of H. pylori similar organisms have been found in humans (H. cinaedi, H. fennelliae, H. heilmanii) and animals. H. pylori causes chronic active gastritis and is an important factor in the development of peptic ulceration and gastric cancer. Narrow host range, tissue specificity and chronic inflammation are characteristic features. Putative virulence factors of H. pylori are structural components (flagella, adhesins...) extracellular bacterial products (urease, protease, phospholipase, cytotoxin...), induction of autoimmune reactions and the activation or stimulation of cellular products (PAF, interleukins, TNF alpha...). Colonization with H. pylori is common throughout the world; it is likely that one half of the world's population is infected. In developed countries few infections occur during childhood, whereas in developing countries most persons are infected by the age of 10 years. Socioeconomic factors seem to determine the age of acquisition. Person to person spread is the most likely form of transmission, but it is not clear whether this is fecal-oral or oral-oral. No non-human reservoir has been identified so far.

Cross-Sectional Studies↗
PubMed1993

Effect of ranitidine and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer.

BACKGROUND: Persistent infection with Helicobacter pylori is associated with the recurrence of duodenal ulcer. Whether the efficacy of bismuth therapy in reducing the rate of recurrence of duodenal ulcer is due to its antimicrobial effects on H. pylori or to a direct protective action on the mucosa is still a matter of debate. METHODS: To study the effect of the eradication of H. pylori on the recurrence of duodenal ulcer, we treated 104 patients with H. pylori infection and recurrent duodenal ulcer with either amoxicillin (750 mg three times daily) plus metronidazole (500 mg three times daily) or identical-appearing placebos, given orally for 12 days. All patients also received ranitidine (300 mg each night) for 6 or 10 weeks. Endoscopy was performed before treatment and periodically during follow-up for up to 12 months after healing. RESULTS: Among the 52 patients given antibiotics, H. pylori was eradicated in 46, as compared with 1 of the 52 given placebo (89 percent vs. 2 percent, P < 0.001). After six weeks, the ulcers were healed in 48 patients given antibiotics and 39 given placebo (92 percent vs. 75 percent, P = 0.011). Side effects, mainly diarrhea, occurred in 15 percent of the patients given antibiotics. Among the patients followed up for 12 months, duodenal ulcers recurred in 4 of 50 patients given antibiotics and 42 of 49 given placebo (8 percent vs. 86 percent, P < 0.001). Ulcers recurred in 1 of 46 patients in whom H. pylori had been eradicated, as compared with 45 of 53 in whom H. pylori persisted (2 percent vs. 85 percent, P < 0.001). CONCLUSIONS: In patients with recurrent duodenal ulcer, eradication of H. pylori by a regimen that does not have any direct action on the mucosa is followed by a marked reduction in the rate of recurrence, suggesting a causal role for H. pylori in recurrent duodenal ulcer.

Adult↗
PubMed1993

Kinetics of specific IgG antibodies for monitoring the effect of anti-Helicobacter pylori chemotherapy.

A total of 104 patients with recurrent duodenal ulcer were treated with either ranitidine plus amoxicillin plus metronidazole or ranitidine plus placebo. To study the effect of the eradication of Helicobacter pylori on the systemic immune response in an IgG ELISA, sera were drawn from all patients before the onset of therapy and at 6, 16 +/- 2, 32 +/- 2, and 60 +/- 2 weeks after therapy. In patients with eradication of the organism, a significant (P < .001) reduction of the specific IgG titer occurred. This was not observed in patients without bacterial eradication. If a titer reduction of > 50% was taken as an indicator for eradication of H. pylori, the sensitivity of the serologic test was 97.6%-99.7%. Its specificity increased with the interval to the onset of chemotherapy from 56.3% to 97.6%. Serologic tests are simple to perform and cause very little discomfort to the patient.

Amoxicillin↗
PubMed1993

Comparison of three methods for the determination of the sensitivity of Helicobacter pylori to metronidazole.

A comparison of various methods for the determination of the sensitivity of Helicobacter pylori to metronidazole was undertaken. The validity of the agar dilution, the disc diffusion and the Epsilometer (E) test was studied using a total of 86 strains, 16 of which were known to be resistant to metronidazole. All tests were carried out on Mueller-Hinton agar with 5% sheep blood. The results of the disc diffusion and the E-test were highly significantly (P < 0.001) associated with those of the agar dilution test, which was taken as a standard (r = -0.96 and r = 0.96, respectively). Investigation of the accuracy of the repetitive (n = 10) testing ten sensitive and one resistant strains, showed that the disc diffusion test led to a systematic and significant (2p < 0.001) underestimation of the MIC values calculated from the inhibition zone diameters via linear regression. In contrast, the results of the E-test did not differ significantly from those of the agar dilution test. The precision of the agar dilution test was significantly worse (2p < 0.005) than the E-test and the disc diffusion test. Because of its accuracy and significantly better precision, the E-test is recommended as the best and simplest method for routine antibiotic sensitivity testing of H. pylori.

Culture Media↗
PubMed1992

Bacterial flora in mal perforant and antimicrobial treatment with ceftriaxone.

The objectives of this pilot study were to identify the bacterial flora of neurotrophic ulcers, and to determine whether treatment with ceftriaxone improves the clinical picture. Twenty-five patients (15 male, 10 female, mean age 70 +/- 11 years) with mal perforant were treated with 2 g ceftriaxone once daily until the ulcer was healed, or for a period of 6 weeks. Biopsies were taken from the ulcer floor before and after therapy. Initially, the following bacteria were found, in order of frequency: Staphylococcus aureus, enterobacteria, coagulase-negative staphylococci, enterococci and streptococci as well as Pseudomonas aeruginosa. Under therapy with ceftriaxone, the lesions of 11 patients were healed; in 5 patients improvement > 50% was observed and in 4 patients improvement was < 50%. In 3 patients there was no change in the condition. Two patients had to stop treatment due to diarrhea. Asepsis was achieved in 5 patients despite persistence of the ulcer. The control group (25 patients without antibiotic therapy) showed the following results: healing in 6, improvement > 50% in 5, improvement < 50% in 10, and no change in 4. The results for the treatment group have to be compared with a historical control group since, for ethical reasons, the implementation of a double-blind study would not be feasible.

Aged↗
PubMed1991

Evaluation of a commercial latex test for serological diagnosis of Helicobacter pylori infection in treated and untreated patients.

The value of a commercially available latex test (Pyloriset) for the diagnosis of Helicobacter pylori infection by demonstration of specific antibodies was compared with that of direct diagnostic methods such as culture, biopsy-urease test and microscopy of fuchsin-stained smears. The sera were from 136 patients who prior to this study either had or had not been treated for Helicobacter pylori-infection simultaneously with amoxicillin (3 x 750 mg/day) and metronidazole (3 x 500 mg/day) for 12 days. On average, the sensitivity of the test was 90%. The specificity with sera from untreated patients was 75.9%; with sera from treated patients specificity was 22.2%, 28% and 20% 1, 3 and 6 months respectively after start of treatment. Only as late as one year after the onset of chemotherapy did the specificity return to 67%. Because of its low specificity this test does not offer any advantage over other tests in the detection of Helicobacter pylori-infection or in monitoring the chemotherapeutic success.

Amoxicillin↗
PubMed1991

[Differences in the pathogen spectrum of the conjunctival sac before and after irrigation of the lacrimal apparatus].

The microbial flora in the conjunctival sac of 30 patients was investigated. Qualitative and quantitative differences before and after irrigation of the lacrimal system were found. In some cases a quantitative increase was registered. In 12 cases conjunctival samples before and after irrigation changed. Negative results before and bacterial growth of coagulase-negative staphylococci after irrigation were found in 4 cases. In 3 cases unfavourable changes were seen. Pseudomonas, Klebsiella and beta-hemolytic streptococci were isolated after irrigation in these cases. In the other cases differences were insignificant. The sense of preoperative irrigation of the lacrimal system is discussed and questioned.

Aged↗
PubMed1990

[Helicobacter pylori and nonsteroidal antirheumatics].

The frequency of occurrence of Helicobacter pylori in the antral mucosa was investigated prospectively in a group of 66 patients (17 men, 49 women, mean age 58 +/- 8.4 years) who had been treated with nonsteroidal anti-rheumatic drugs and 33 controls (14 men, 19 women, mean age 60.7 +/- 6.6 years) who had not received these drugs. In the first group the indication for gastroscopy was ingestion of nonsteroidal antirheumatic drugs for at least 8 weeks, irrespective of dyspeptic symptoms (present in 25 patients), while in the second group the reason for endoscopy was either clinical symptoms (n = 18) or the presence of blood in the faeces. Helicobacter pylori was demonstrated by culture in 36 out of the 66 patients who had received nonsteroidal antirheumatics (54.5%); these comprised 24 out of 46 patients (52.2%) with chronic inactive gastritis and 12 out of 15 patients (80%) with chronic active gastritis. In the control group H. pylori was detected by culture in 22 out of 33 patients (66.7%); these included 11 out of 19 patients (57.9%) with chronic inactive gastritis and 11 out of 12 patients (91.7%) with chronic active gastritis. H. pylori was not demonstrated in any of the seven patients who had histologically normal gastric mucosa. In both groups there was significant correlation between demonstration of the microorganism and severity of inflammation. There is hence no evidence that nonsteroidal antirheumatic drugs have any influence on the colonisation of the antral mucosa by Helicobacter pylori.

Anti-Inflammatory Agents, Non-Steroidal↗