[Mechanical colonic ileus as a complication in acute pancreatitis].
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Acute Disease↗
Biomedical subjects
L Kager
Publications and source records attributed to L Kager.
The effect of piperacillin prophylaxis on the colonic microflora In patients undergoing colorectal surgery.
Piperacillin was given parenterally in doses of 4 g every 8 h for two days to 20 patients undergoing colorectal surgery. A series of serum and fecal specimens were taken to analyse piperacillin concentrations. Tissue samples from the gut wall were taken during surgery. The maximum serum concentrations during surgery were reached 15 min after piperacillin administration. On Day 0 the mean half-life was 1.9 h and the mean area under the serum concentration curve was 536.8 mg/l. The piperacillin concentrations in the tissue samples ranged from 4.2 to 103.5 mg/kg. The tissue/serum ratio was 0.45. The piperacillin concentrations in the fecal samples ranged from not detectable to 101.2 mg/kg. Fecal samples were also collected during the investigation period for the cultivation of aerobic and anaerobic bacteria. Of the aerobic bacteria, enterococci, streptococci and enterobacteria decreased in on fourth of the patients during the prophylaxis period. Anaerobic bacteria, e. g. cocci, gram-positive rods, fusobacteria and bacteroides, decreased in two thirds of the patients during the same period. After the piperacillin administration period, the aerobic and anaerobic colon microflora returned to the pre-treatment pattern in most patients. Postoperative infections due to Escherichia coli, Morganella morganii, Bacteroides fragilis, peptococci and peptostreptococci occurred in two patients.
Aged↗
The effect of short-term cefoxitin prophylaxis on the colonic microflora in patients undergoing colorectal surgery.
Cefoxitin was administered intravenously to 11 patients undergoing colorectal surgery; the initial dose was 2 g given at the induction of anesthesia followed by two 2 g doses at intervals of six hours. Serum samples and faecal specimens were taken to determine the cefoxitin concentrations. Tissue samples from the gut wall were obtained at surgery. The serum concentrations 15 min after administration ranged from 106.6 to 664.0 mg/l [mean: 295.8 +/- 61.0 (SE) mg/l]. Cefoxitin concentrations in the faecal samples were between 0 and 57.7 mg/kg. Cefoxitin concentrations in the tissue samples varied from 9.0 to 68.3 mg/kg. Faecal samples were also obtained during the investigation period for the cultivation of aerobic and anaerobic bacteria. Enterobacteria decreased and enterococci increased during the first two days. Anaerobic cocci and gram-negative rods also decreased during the same period. The colonic microflora returned to normal after two weeks in all patients and no new colonizing cefoxitin-resistant bacteria were isolated. No postoperative infections occurred.
Adult↗
Effect of aztreonam on the colon microflora in patients undergoing colorectal surgery.
Aztreonam was given intravenously at a dose of 1 g at induction of anaesthesia, followed by subsequent doses of 1 g at eight hour intervals during 48 hours to 20 patients undergoing colorectal surgery. A series of serum and faecal specimens were taken for analysis of aztreonam concentrations. Tissue samples from the gut wall were taken at surgery. The maximum serum concentrations (mean value 114.7 mg/l) during surgery were reached 15 minutes after aztreonam administration. The aztreonam concentration in the tissue samples varied from 4.1-28.3 mg/kg and the concentration in the faecal samples from 0.4-34.4 mg/kg. Faecal samples were also collected during the investigation period for cultivation of aerobic and anaerobic bacteria. Enterobacteria were suppressed significantly during the prophylaxis period and there was a significant increase of staphylococci in ten of the patients. Three of these patients developed postoperative wound infections with staphylococci. Among the anaerobic bacteria, only minor changes were observed during the same period. After two weeks, the microflora was normalized in all patients. Five postoperative infections including an anastomose dehiscence in one patient occurred.
Aged↗
Tinidazole--microbiology, pharmacology and efficacy in anaerobic infections.
Tinidazole is a 5-nitroimidazole with selective activity against anaerobic bacteria and protozoa. It is bactericidal at low concentrations and its spectrum covers most anaerobic bacteria and some capnophilic microorganisms. Anaerobic bacteria known to be resistant to tinidazole include anaerobic streptococci, actinomyces and propionibacteria. Tinidazole is one of the most active antibacterial agents against Bacteroides fragilis which is one of the most resistant species of anaerobic bacteria. Only a few strains have been reported to be resistant. Tinidazole has been shown to be efficacious in protozoal infections such as trichomonal vaginitis, amoebiasis and giardiasis. Clinical studies have also shown that tinidazole is efficacious in the treatment of anaerobic infections including respiratory tract infections, intra-abdominal sepsis and obstetrical and gynecological infections. Since tinidazole has no activity against aerobic bacteria, it must be combined with other antibacterial agents in the treatment of mixed infections involving aerobic and anaerobic bacteria. Tinidazole has also been used successfully alone or in combination with other antimicrobial agents for prophylaxis in patients undergoing elective colonic and abdominal surgery, emergency appendectomy and gynecological surgery.
Anaerobiosis↗
[Unexpected regeneration of a congenital unilateral hypoplastic- dysplastic kidney after a contralateral nephrectomy for Wilms tumor].
The congenital hypoplastic-dysplastic kidney is characterized by a significant reduction of renal mass, an abnormal parenchymal differentiation and is associated with anomalies of the whole urinary tract. Not much is known about the ability for regeneration in such a kidney. We report on a 2 year 11 months old boy with an anaplastic Wilms tumor of the left kidney, in whom after tumor-nephrectomy an unexpected functional and sonographically documented morphological regeneration of the contralateral hypoplastic-dysplastic kidney occurred. The regeneration of this kidney is especially notable, because it occurred during nephrotoxic chemotherapy and radiotherapy.
Antineoplastic Combined Chemotherapy Protocols↗
Occurrence of acute nonlymphoblastic leukemia in two girls after treatment of recurrent, disseminated Langerhans cell histiocytosis.
The occurrence of Langerhans cell histiocytosis (LCH) and acute leukemia in one individual has rarely been observed. Despite few exceptions, two distinct patterns of association appear evident: acute lymphoblastic leukemia preceding LCH and LCH preceding acute nonlymphoblastic leukemia (ANLL). The latency of ANLL after the diagnosis of LCH is suggestive of a therapy-related process. This report describes two new cases in whom ANLL was diagnosed 7 years 8 months and 5 years 8 months after the start of initial treatment of disseminated recurrent LCH. Morphology showed blasts from FAB-type M4/M5 in the first patient, who died due to progression of leukemia. The second patient showed myelodysplastic syndrome (refractory anemia with excess of blasts in transformation; RAEB-t) and is now in remission from leukemia 3 years 11 months after allogeneic bone marrow transplantation. The review of a total of 26 patients with ANLL after LCH suggests that the disease has a poor prognosis and allogeneic BMT seems to be the treatment of choice.
Bone Marrow Transplantation↗
The impact of different antimicrobial agents on the normal gastrointestinal microflora of humans.
In the present study the impact on the gastrointestinal microflora of peroral administration of penicillin, bacampicillin, clindamycin, erythromycin, doxycycline, and tinidazole was investigated. The effects on the colonic flora of parenteral administration of ampicillin plus sulbactam, cefoxitin, clindamycin, and tinidazole also were studied. Pronounced changes were observed in the oropharyngeal and colonic microflora in patients receiving clindamycin, erythromycin, and tinidazole (intravenous), whereas moderate changes were seen in those patients receiving doxycycline, cefoxitin, and ampicillin plus sulbactam. Penicillin, bacampicillin, and tinidazole (peroral) produced only minor changes. In most patients with an altered microflora, colonization with new bacterial strains was found.
Adult↗
Effect of imipenem/cilastatin on the colonic microflora.
The effect of imipenem/cilastatin on the colonic microflora was investigated in 10 patients receiving the drug for six to 11 days. Fecal specimens were cultured quantitatively for aerobic and anaerobic microorganisms before, during, and after therapy. Imipenem/cilastatin treatment was associated with minor changes in the colonic flora. A small decrease in the numbers of enterobacteria, enterococci, anaerobic cocci, and organisms of the Bacteroides fragilis group was observed. After treatment was discontinued, the microflora returned to normal in all patients, and no new colonization with imipenem-resistant bacteria was seen. No patient had Clostridium difficile or its cytotoxin in feces. No adverse gastrointestinal reactions were registered.
Adult↗
Imipenem/cilastatin in the treatment of intraabdominal infections: a review of worldwide experience.
Imipenem is a new broad-spectrum beta-lactam antibiotic, which when administered with cilastatin may be a suitable alternative to the combination of an aminoglycoside and either clindamycin or a nitroimidazole as therapy for intraabdominal infections. The clinical and microbiologic results for 164 assessable patients given imipenem/cilastatin for intraabdominal infections are reported. Only three of 416 bacterial strains isolated prior to therapy from intraabdominal infection sites were resistant to imipenem (one of Staphylococcus epidermidis, one of Morganella morganii, and one of the Fusobacterium varium). Resistance acquired during treatment was reported in four cases: for three strains of Pseudomonas aeruginosa and for one strain of Proteus mirabilis. Of 412 strains susceptible to imipenem prior to therapy, 359 were eradicated during treatment. The frequency of clinical cure or improvement was 91%. Imipenem/cilastatin seems to be a useful alternative to the combination of an aminoglycoside with either clindamycin or a nitroimidazole.
Abdomen↗