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D J Bac

Publications and source records attributed to D J Bac.

30 records · Page 2Linked to original sources
PubMed1994

Post-sclerotherapy bacterial peritonitis: a complication of sclerotherapy or of variceal bleeding?

To assess the risk of bacterial peritonitis following endoscopic variceal sclerotherapy (EVS), we recorded the incidence of this complication within 2 wk of the procedure in all patients (n = 216) undergoing 1092 sclerotherapy sessions in our hospital during a 5-yr period (1987-1992). The sclerotherapy sessions were separated in prophylactic EVS (without a previous bleeding, n = 172 sessions), elective EVS (following a previous variceal bleeding, n = 720), and emergency EVS (within 24 h of a variceal bleeding, n = 200). During the study period, 60 patients with spontaneous bacterial peritonitis were recorded. In 10 patients, peritonitis was diagnosed within 14 days after EVS. Six patients received emergency EVS and four elective EVS. In seven patients, Gram-negative aerobic and anaerobic microorganisms were cultured from the ascitic fluid, and in three patients cultures were negative; however, an elevated ascitic fluid polymorphonuclear cell count of > 0.5 x 10(9) cells/L was present. The mean period between EVS and the diagnosis of peritonitis was 3.5 days. On average, the patients had been febrile during 2.1 days before the diagnosis was established. None of the patients who had received prophylactic EVS developed peritonitis. The calculated risk to develop peritonitis following elective EVS was 0.5% (4/742 sessions) and following emergency EVS 3% (6/200 sessions) (p = 0.019, Fisher's exact test). Gram-negative gut-derived microorganisms were the most common pathogenic bacteria cultured from the ascites, which is different from the microbial flora causing bacteremia after EVS. This suggests that the risk for bacterial peritonitis is determined primarily by factors associated with bleeding, such as shock with increased bowel wall translocation of bacteria. These results indicate that standard antibiotic prophylaxis before EVS is not indicated, but could be considered in patients with liver cirrhosis and ascites receiving emergency EVS.

Adult↗
PubMed1993

Paracentesis. The importance of optimal ascitic fluid analysis.

An accumulation of peritoneal fluid can result from a variety of conditions, cirrhosis of the liver being responsible for about 75% of all patients with ascites. Malignancy accounts for 10-12% and cardiac failure for about 5%. The remaining 8-10% of ascites cases have a variety of causes, including tuberculosis, pancreatic disease and kidney disease. An early and accurate diagnosis often depends on an appropriate ascitic fluid analysis. Patients with known liver cirrhosis and clinical deterioration also need to have a paracentesis, with a determination of the ascitic fluid leukocyte and neutrophil count and adequate bacteriological cultures of their ascitic fluid. The diagnostic value of different ascitic fluid parameters and their ability to distinguish between several aetiologies and their complications, is discussed.

Ascites↗
PubMed1992

Blood culture bottles are superior to lysis-centrifugation tubes for bacteriological diagnosis of spontaneous bacterial peritonitis.

The conventional method of ascitic fluid culturing was compared with the bedside inoculation of ascites into blood culture bottles and into lysis-centrifugation tubes. The conventional culture method was compared with the blood culture bottle method in 31 episodes of spontaneous bacterial peritonitis (SBP). Cultures were positive with the conventional culture method in 11 (35%) episodes and with the blood culture bottle method in 26 (84%) episodes (P less than 0.001). The lysis-centrifugation tube method was compared with the blood culture bottle method in 24 episodes of SBP. Cultures were positive with the lysis-centrifugation tube method in 11 (46%) episodes and with the blood culture bottle method in 19 (79%) episodes (P less than 0.05). Moreover, the blood culture bottle method also shortened the time needed for the detection of bacterial growth. In conclusion, bedside inoculation of ascites into blood culture bottles should be used routinely for patients with suspected SBP. Culturing of ascites in lysis-centrifugation tubes is more laborious than and inferior to that in blood culture bottles.

Ascites↗
PubMed1992

Mastocytosis and Sjögren's syndrome.

A 61 year old man with dryness of the eyes and mouth, constitutional and musculoskeletal symptoms is described. A diagnosis of fibromyalgia with Sjögren's syndrome was made elsewhere. Further examination, however, disclosed diffuse mast cell infiltration in several organs, including the labial accessory salivary glands.

Bone Marrow↗
PubMed1991

Evaluation of CA19-9 serum levels for monitoring disease activity during chemotherapy of pancreatic adenocarcinoma.

Between 1987 and 1990 21 patients with proven adenocarcinoma of the pancreas were treated with chemotherapy in four different phase II studies. For 14 patients, serial measurements of CA19-9 serum levels and clinical evaluations of response by computed tomography scan and/or ultrasound were available. Clinical stable disease and progressive disease were accompanied by stable or exponentially rising serum levels of CA19-9. One patient with clinical partial remission showed a 90% decline of CA19-9. However, a 75% decline of CA19-9 was also observed in a patient with rapidly progressive disease. These data seem to indicate that the CA19-9 serum level may be used as an easy and sensitive tool to evaluate progressive disease during chemotherapy.

Adenocarcinoma↗
PubMed1989

An evaluation of the impact of care groups on knowledge about oral fluid therapy.

Care groups (CGs) consist of unpaid volunteers, mostly women from local villages, with a commitment to promote health and well-being, with a particular emphasis on child health. CGs have been shown to be effective in promoting changes in health practices, promoting better personal hygiene and helping in the control of infectious diseases. The CG system was introduced in Venda's Donald Fraser Health Ward and oral fluid therapy (OFT) for diarrhoeal diseases was promoted from the beginning. In 1985 a survey was conducted to identify to what extent diarrhoea was a problem in the community and to determine the degree of knowledge about OFT in the population. Six hundred households in 10 villages with CGs and 600 households in 10 villages without CGs were surveyed. Despite the fact that in the CG area 76% of the respondents were aware of OFT, only 38% of these knew how to prepare the solution correctly (chi 2; P less than 0.001). The findings are discussed in the context of the theory on communication of innovations, and some recommendations are made.

Child Care↗
PubMed1985

In vivo and in vitro chloroquine-resistant falciparum malaria in Venda. A case report.

A Venda child with Plasmodium falciparum malaria had a recurrence of illness 3 weeks after an adequate course of chloroquine. She was treated again with chloroquine and improved clinically but had persistent asexual parasitaemia during the 9 days after completion of the second course of treatment. At this stage chloroquine-resistant malaria was suspected but she was treated again with chloroquine in higher dosage, as alternative antimalarial drugs were not available locally. The patient recovered clinically, her parasitaemia cleared, and she showed no side-effects. Although not routinely recommended, a higher dose of chloroquine may be a useful option when alternative antimalarial drugs are not readily available. Chloroquine resistance was confirmed by Rieckmann's in vitro method, which showed complete inhibition of schizont development in the presence of 16 pmol chloroquine base per well instead of 6 pmol or less as seen with sensitive strains. This case is the first reported of proven chloroquine-resistant malaria acquired in the RSA. This single case does not indicate the existence of a drug-resistant malaria problem in the RSA but points to a need for clinical vigilance and for appropriate surveillance.

Child↗
PubMedDate not supplied

Hygiene, skin infections and types of water supply in Venda, South Africa.

The impact of the installation of a system to supply chlorinated drinking water in Venda, South Africa, on water quality, water use and health status was evaluated by means of questionnaires, examination for skin infections, and microbiological analysis of water samples. Although the water collection journey became shorter in comparison with use of traditional water supplies such as boreholes and unprotected springs, water use per caput showed no increase. The improved water supply showed no contamination with coliforms even after storage. Borehole water exhibited low coliform counts at the source, but after storage a 10- to 15-fold increase took place. Water samples from unprotected springs exhibited high coliform counts, which declined during storage. The prevalence of infectious skin diseases (27.5%) and diarrhoea (3.7%) among pre-schoolchildren showed no correlation with the quality of drinking water or the use of water per caput. Although the prevalence of infectious skin diseases did exhibit a negative correlation with the frequency of washing, no significant health benefit of the improved water supply could be demonstrated in this limited study.

Child, Preschool↗