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Biomedical subjects

M Rotter

Publications and source records attributed to M Rotter.

At least 37 records · Page 2Linked to original sources
PubMed1989

Plasma concentrations of free and sulfoconjugated dopamine, epinephrine, and norepinephrine in healthy infants and children.

Plasma concentrations of free and sulfoconjugated catecholamines were measured in healthy infants and children under resting conditions. Free norepinephrine and epinephrine levels were up to three times higher in healthy children under 2 years than in adults, even under true resting conditions. In contrast, free dopamine concentrations of all age groups fell within the normal range for adults. The levels of sulfoconjugation were in the adult range.

Adolescent↗
PubMed1989

Bacterial contamination of dialysate in dialysis-associated endotoxaemia.

Bacteriological investigations and endotoxin (ET) determinations were performed during a routine haemodialysis session for six patients. The glucose free dialysate was prepared with untreated tap water. All patients were dialysed for 5 h. Pseudomonas aeruginosa was regularly isolated in numbers up to 10(7) cfu ml-1 from samples of the dialysate inflow, the dialysate site and the dialysate outflow. ET levels in the plasma of the patients increased continuously during haemodialysis and were always higher in the blood outflow line of the dialyzer than in the blood inflow. Despite the high bacterial counts in the dialysate and the increasing ET levels in the patients plasma neither bacteraemia nor fever was observed. The former is due to the impermeability of the dialyzer membrane for bacteria, the latter is explained by low pyrogenicity of P. aeruginosa endotoxin. Inspection of the dialyzer machines revealed that air-traps and heater-unit for the incoming (untreated) tap water before mixing with the dialysate concentrate were the only sites where high bacterial release was feasible, as this part of the machine escaped disinfection due to the construction of these devices. We recommend the regular disinfection of all parts of a dialyzer machine, including heating units, air traps and valves.

Dialysis Solutions↗
PubMed1989

[CT-guided biopsy: methods, results and complications].

Percutaneous CT-guided biopsies were carried out in 350 patients; on 291 occasions, 14- or 18-gauge and, on 59 occasions, an 0.95 mm cutting biopsy cannula was employed. Using the 14- and 18-gauge needles, a histological diagnosis was possible in 191 cases, a sensitivity of 82.7%. The 0.95 mm cannulas proved successful in 39 of the 59 punctures, producing a markedly lower sensitivity of 66.2%. The most common cause of an incorrect biopsy with large needles was bad position of the needle, whereas the small needles provided inadequate material. Complications which, however, did not require treatment, occurred in 5 patients (1.4%).

Biopsy, Needle↗
PubMed1989

[Causation of stomatitis during cytostatic chemotherapy for head and neck tumors].

In a prospective trial involving 17 patients with head and neck tumors an attempt was made to relate the occurrence of stomatitis during cytostatic chemotherapy to changes in the resident microbial population, if any. Of the 17 patients who received the same cytostatic regimen, 10 developed stomatitis after a mean interval of 12 days. Smears were taken of the 2 patient subgroups (with and without stomatitis) at the onset of treatment and after comparable intervals during treatment and compared to those of a normal control group. Pretreatment smears did not show any quantitative or qualitative differences in the aerobic and anaerobic microbial spectrum between the 3 subgroups examined. During treatment patients developing mucositis were found to show a statistically significant multiplication of pathogens, while the other 2 groups still did not differ from one another. Together with the direct cytostatic effect of chemotherapy, proliferation of pathogens in the oral cavity appears to contribute to the development of stomatitis.

Adult↗
PubMed1989

[Monitoring infection at the intensive care unit--a multicenter pilot study].

During a period of 3 months an infection survey was carried out in 4 intensive care units (ICUs), 2 in Vienna, Austria, and one each in Ulm and Münster, Federal Republic of Germany, using a common protocol. A total of 329 patients was monitored prospectively. This pilot study was performed to evaluate the usefulness of parameters included in the monitoring form. It was attempted to characterize the patient populations of the four units. Mean duration of stay (1-12 days), mortality (8-26%), leading diagnosis upon admission, intubation rate (41-91%) and use of pulmonary artery catheter (12-35%) were distinctly different. The rate of patients admitted already with an infection was 9-43%, septicemia was diagnosed in up to 27% of the diseased. The rate of infection acquired in the unit was between 12 and 37%, the most frequent types were bronchopneumonia, septicemia and urinary tract infection. When septicemia patients were compared to non-septicemia patients who had been admitted for more than 3 days, it appeared that the latter stayed significantly shorter at the ICU and showed less frequently bronchopneumonia or urinary tract infection at the time of admission. Septicemia patients acquired more frequently additional infections like broncho-pneumonia or urinary tract infection while staying at the ICU. The median day of onset of septicemia was the fifth day and only in a quarter of cases diagnosis could be supported by a positive blood culture. The use of antibiotics in the 4 ICUs is compared and shows marked differences. Based upon experience with this type of infection survey a new modified protocol is introduced, which displays the time course of documented events.

Anti-Bacterial Agents↗
PubMed1989

[Application of an infection control protocol at an anesthesiology intensive care unit].

We studied the efficiency and practicability of a new protocol for surveillance of nosocomial infection in 99 patients admitted to our intensive care unit (ICU) between October 1985 and March 1986. The protocol contained the therapy given before admission to the ICU and daily records of: (1) therapy suspected to increase the risk of nosocomial infection (ventilatory support, operations, hemofiltration, central venous and arterial catheters, Swan-Ganz catheters, etc.); (2) parameters possibly associated with bacterial infections (white blood cell count, body temperature, platelet count, creatinine clearance, hemodynamic values, clinical suspicion of infection, suspected site of infection, pathological chest X-ray, etc); and (3) bacteriologic data (results of cultures from blood, tracheal aspirate, urine, wound secretions) and antibiotic treatment. Sepsis was diagnosed in 28 patients, and 28 had positive blood cultures; these two groups were not identical. Twenty-nine patients died, more than half of them having a serious nosocomial infection. Factors associated with nosocomial infection were: fever greater than 38.5 degrees C, recurrent fever, leucocytosis, leucopenia, thrombocytopenia; duration of stay at the ICU; ventilatory support, operations, mass transfusions, and therapy with catecholamines. Use of a Swan-Ganz catheter and hemofiltration were associated with nosocomial infection, but they were usually begun after the clinical onset of sepsis. Therapy administered before admission to the ICU was not associated with nosocomial infection. Bacterial colonization of tracheal aspirate was detected in 2/3 of the ventilated patients. The most common bacteria isolated were staphylococci in blood cultures. Pseudomonas sp. and Candida albicans in tracheal secretions, and Candida albicans in urine cultures.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesiology↗
PubMed1988

[The antibacterial effect of ciprofloxacin, ofloxacin and norfloxacin in vitro].

MICs of ciprofloxacin (CIP), ofloxacin (OFL) and norfloxacin (NOR) were assessed with a total of 523 strains of 7 species (spp) of enterobacteriaceae, various pseudomonads, methicillin-susceptible and -resistant S. aureus, L. monocytogenes, Legionella species and C. difficile. In addition, the MBCs were assessed with S. aureus and E. coli. With break-points of less than or equal to 0.5 and greater than or equal to 4 mg/l all strains of E. coli, K. oxytoca, P. mirabilis and indole-positive Proteus spp. were susceptible to all 3 antibiotics. Proportions of susceptible strains almost as high were found with E. cloacae, S. marcescens, K. pneumoniae and methicillin-susceptible staphylococci. With Legionella spp. the MICs of CIP and OFL always indicated susceptibility, whereas with NOR only 62% of the strains were inhibited. Pseudomonads, especially others than P. aeruginosa, were only moderately susceptible to CIP and OFL, but never to NOR. Listeria monocytogenes was susceptible to OFL in 96%, to CIP in 56%, but never to NOR. C. difficile was always resistant. The MBC-values either equalled the MICs or surpassed them up to 2 times at maximum indicating a bactericidal mode of action. Despite of slightly lower MICs of CIP in vitro, OFL seems to be comparably effective. NOR is regarded less effective.

Bacteria↗
PubMed1988

The psychiatrist's guide to right and wrong: judicial standards of wrongfulness since M'Naghten.

In insanity defense litigation, the precise legal definition of wrongfulness is often critically important. References in the M'Naghten Rules to the appropriate standard of wrongfulness were ambiguous, resulting in a divergence of judicial opinion as to whether wrongfulness means legal wrong, subjective moral wrong, or objective moral wrong. This article reviews and analyzes these three judicial standards of wrongfulness in the context of case law from jurisdictions that follow each of the respective standards. The evolution of knowledge of right and wrong tests of criminal responsibility is traced back to its philosophical roots. Most psychiatrists claim no expertise in matters of morality or law. The American Psychiatric Association would bar psychiatric expert testimony on the ultimate issue of insanity, on the grounds that there are "impermissible leaps in logic" when psychiatrists opine on the probable relationship between medical concepts and moral-legal constructs. Whether or not they testify on the ultimate issue, psychiatrists should ascertain the applicable standard of wrongfulness in order to properly relate their findings to the relevant legal criteria for insanity and thereby enhance the probative value of their testimony.

Expert Testimony↗
PubMed1987

[Campylobacter pylori, gastritis and peptic ulcer].

In the course of routine gastroduodenoscopic examination of 218 patients bioptic mucosal specimens were examined bacteriologically for the presence of Campylobacter (C.) pylori. The organism was isolated from 52 out of 53 patients (98%) with duodenal ulcer, 7 out of 9 with gastric ulcer (78%), 24 out of 31 with mucosal erosions (77%), 10 out of 10 with duodenitis (100%), 16 out of 16 with chronic active gastritis (100%) and from 40 out of 73 patients (55%) with inactive chronic gastritis. By contrast, all specimens from 26 patients with endoscopically and histologically normal mucosa were negative for this bacterium. The rate of elimination of C. pylori from mucosal specimens was investigated as a first step towards studying the influence of antibiotic therapy upon healing of gastric and duodenal ulcers. For this purpose 30 patients with duodenal ulcers were treated either with ranitidine alone (15) or together with bacampicillin (15), which was shown to be highly active in studies with ampicillin in vitro. After 4 weeks the organism was still found in specimens from all patients treated with ranitidine alone, but also in 12 out of 15 patients given combined therapy. This result demonstrates that systemic antimicrobial chemotherapy with bacampicillin is insufficient to eradicate C. pylori from the stomach and the duodenum.

Adult↗
PubMed1986

Does transurethral resection of prostatic carcinoma promote tumor spread?

122 patients with prostatic carcinoma treated by radiation therapy were reviewed. An actuarial analysis was done on survival comparing patients treated by transurethral resection (TURP) prior to radiation to those diagnosed by needle biopsy. Survival rates were not significantly different between groups. TURP was also without effect on interval free of distant or local recurrence. Survival and time to distant or local recurrence were analyzed by tumor stage and grade. A multivariate analysis with the Cox model was made by which the effects of TURP and tumor grade and stage were examined simultaneously. TURP was without effect on survival rates and interval to distant or local recurrence after adjustments had been made for the effects of stage and grade.

Actuarial Analysis↗
PubMed1986

[Does radiosterilization of the vagina occur through therapeutic radiation dosages?].

The endogenous genital flora is a major source of infections of the female genital tract, especially in patients with cervical or endometrial cancer. Until recently the "radiosterilisation of the vagina", respectively a prophylactic and/or therapeutic effect of irradiation (external high voltage as well as intracavitary-radium) concerning infections was postulated in the literature. This theory was disproved in a prospective clinical and bacteriological study covering 48 patients with advanced cervical cancer undergoing primary intracavitary radium-irradiation and 38 patients with inoperable endometrical cancer, undergoing primary Iridium-192-afterloading. Following intracavitary radium for cervical cancer some typical nosocomial pathogens like Streptococcus faecalis, Enterobacter, Klebsiella, Proteus and Pseudomonas were isolated significantly more frequently than before treatment. Likewise, the mean number of aerobic bacterial species increased significantly after irradiation. Also primary Ir-192 (afterloading) irradiation did not alter the frequency of isolation of the resident flora in endometrial cancer patients. Therefore, "radiosterilisation" of the vagina as result of radiotherapy does not exist.

Adenocarcinoma↗
PubMed1986

[Susceptibility of the Bacteroides fragilis group to 10 antibiotics. Results of 4 laboratories in Austria].

The susceptibility of 197 strains of the Bacteroides fragilis group (109 B. fragilis, 27 B. thetaiotamicron, 23 B. vulgatus, 1 B. distasonis, 11 B. ovatus and others) to penicillin G, cefoxitin, latamoxef, piperacillin, mezlocillin, clindamycin, metronidazole, tetracycline, doxycycline and chloramphenicol was tested by an agar dilution method. 4 microbiological laboratories in Austria participated in this investigation. In all laboratories the same method was used and a joint quality control carried out. The most active substances were metronidazole and clindamycin (MIC50 1.0 and 0.5 respectively; MIC90 4 mg/l for both). Tetracycline showed only little activity, whereas doxycycline inhibited a major portion of the strains at therapeutically relevant concentrations (MIC50 16 and 2 mg/l, MIC90 32 and 16 mg/l, respectively). The MIC90 of chloramphenicol was 8 mg/l. Piperacillin and mezlocillin were about equally active (MIC50 both 16, MIC90 32 and 64 mg/l, respectively). For penicillin G, the MIC values were also favourable, the MIC90 being 32 mg/l. The possible causes for the discrepancy between the good in vitro activity and the clinical ineffectiveness of penicillin G are discussed. The cumulative MIC values (50, 90%) for cefoxitin were 8 and 32 mg/l, respectively. The MIC's of latamoxef showed a wide distribution resulting in a low MIC50 (4 mg/l) and a high MIC90 (128 mg/l). This distribution was due to the differing susceptibility of the individual species within the Bacteroides fragilis group. For B. thetaiotaomicron the highest MIC values were determined. This species as a whole was less susceptible to the beta-lactam antibiotics tested. The non beta-lactam antibiotics showed no substantial species related differences. No relevant differences between the individual laboratories were observed.

Anti-Bacterial Agents↗
PubMed1985

[Resistance of blood culture isolates in vitro to 4 aminoglycoside antibiotics in Austria--1982/83].

Over the period September 1982 to February 1983 268 blood culture isolates were consecutively collected in 4 microbiological laboratories in Austria (Linz, Vienna, Graz, Feldkirch) and 251 of these strains (streptococci excluded) were tested for resistance to Gentamicin (G), Tobramycin (T), Netilmicin (N) and Amikacin (A) using a microtitre broth dilution method. This investigation was part of an international study. Of the bacterial strains examined 57% were staphylococci (34% Staphylococcus aureus) and 43% gram-negative rods (18% E. coli, 17% other enterobacteriaceae and 5% Pseudomonas aeruginosa etc.). 25% of all strains tested were resistant to Gentamicin (MIC greater than 4 mg/l), 27% to Tobramycin (MIC greater than 4 mg/l), 6% to Netilmicin (MIC greater than 4 mg/ml) and 5% to Amikacin (MIC greater than 8 mg/l). The resistance rate of staphylococci was markedly greater towards Gentamicin (35%) and Tobramycin (39%) than Netilmicin (4%) and Amikacin (6%). The respective percentages of resistant gram-negative rods were considerably smaller, except in the case of Netilmicin (G 13%, T 11%, N 8%, A 4%). Regional differences were observed between Linz and Vienna in the resistance of staphylococci to Gentamicin (24% versus 49%) and Tobramycin (33% versus 53%). On a weight basis Netilmicin was the most active substance in combating nearly all groups of bacteria. Also in strains sensitive to the other aminoglycosides the MIC values of Netilmicin were considerably lower than for the other substances. A noteworthy feature in comparison with the results of other countries participating in this international study was the distinctly higher incidence of staphylococci among the blood culture isolates and the considerably higher percentage of aminoglycoside-resistant strains in Austria. Analysis of the data suggests that the high resistance rates among staphylococci are a consequence of selection by frequently used antibiotics. Hence, it appears essential to observe the development of aminoglycoside resistance in Austria closely and to recommend that these substances, of extreme value in the treatment of severe infections, should be used solely for the most stringent indications.

Aminoglycosides↗
PubMed1984

Postoperative infections in colonic surgery after enteral bacitracin-neomycin-clindamycin or parenteral mezlocillin-oxacillin prophylaxis.

In a prospective randomized, blind trial, three groups of patients undergoing elective colonic surgery were compared for frequency of surgical wound infection, intra-operative wound contamination and other postoperative infections. All patients allotted to the three groups received whole gut irrigation (101 balanced salt solution) by gastric tube on the evening before surgery and were treated as follows. Group A: no antibiotics; Group B: neomycin (1 g/l) + bacitracin (50,000 IU/l) + clindamycin (900 mg/l), contained in the last 31 of irrigation fluid; Group C: mezlocillin (4 g) + oxacillin (2 g) intravenously (iv) at induction of anaesthesia, followed by two identical doses at 8 and 16 h. The rate of postoperative wound infection was highest in A (38 per cent) and much lower in B (3.3 per cent, P less than 0.002) and C (6.9 per cent, P less than 0.004). The difference between B and C was statistically not significant. In A a correlation was established between the degree of wound contamination and the occurrence of wound infection. Intra-operative wound contamination was lowest in B (30 per cent), equal in A (58.1 per cent) and B (55.2 per cent). Other infections were least frequent in group C (four of 29 patients), but were not significantly different to groups B (six of 30) and A (nine of 31). It is concluded that antibiotics together with an effective mechanical preparation considerably reduce the rate of wound infection in colonic surgery.

Adult↗