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Biomedical subjects

O Herman

Publications and source records attributed to O Herman.

At least 19 recordsLinked to original sources
PubMed1998

Etiology and risk factors of 180 cases of native valve endocarditis. Report from a 5-year national prospective survey in Slovak Republic.

Risk factors, etiology, and outcome of 180 cases of infective endocarditis (IE) in the Slovak Republic for 5 years were prospectively studied in a national survey. According to the Duke Endocarditis Service Criteria (1994), 169 cases were considered definitive and 21 possible/probable. The aortic valve was infected in 46.7%, mitral in 47.2%, and tricuspidal/pulmonary in 6.1% of cases. The majority of endocarditis cases was caused by Staphylococcus aureus and coagulase-negative staphylococci (CNS) (33.3%); only 12.2% were due to viridans streptococci; 11.7% were due to Enterococcus faecalis; 6.1% due to Haemophilus spp.; 10.1% due to other organisms; and 26.7% were culture negative. Single positive cultures of CNS were not considered clinically significant. More than 25% of 180 patients were older than 60 years. Rheumatic fever was a risk factor in 35.5%, dental surgery in 20.5%, prior cardiosurgery in 7.8%, and neoplasia in 6.7%. All patients were treated with antimicrobials (average length of therapy was 29.5 days) and 33.3% of patients also had surgery (valvular prosthesis replacement). Forty (22.2%) died, and 140 (77.8%) survived at day 60 after the diagnosis of endocarditis was made. All 40 deaths were attributable to infection. Univariate analysis comparing deaths and survivors did not show significant differences in most of the recorded risk factors between both groups, except age > 60 (40.0% versus 21.4%, p < 0.05), staphylococcal etiology (55.0% versus 27.1%, p < 0.04), and antibiotic therapy < 21 days (without surgery) (65.0% versus 3.6%, p < 0.01). These risk factors were significantly more frequently associated with deaths. Viridans streptococcal IE and surgical therapy in addition to antibiotics were associated with lower mortality in comparison to staphylococcal endocarditis (p < 0.045) or to cases treated with antibiotics only (p < 0.05). In comparison to other nationally based surveys in Europe (Greece, Croatia, France), the percentage of culture-negative endocarditis and spectrum of pathogens differed significantly.

Adult↗
PubMed1998

Clinical-radiological evaluation of poststernotomy wound infection.

The presumption that computed tomography is the "gold standard" imaging method for diagnosing poststernotomy sternal wound infection was never validated. This study was designed to evaluate the accuracy and role of computed tomography in diagnosing the extent of infectious complications following sternotomy. A high postoperative infection recurrence rate in our earliest cases (30 percent, 1984 to 1988) motivated us to assess whether this modality enables the surgeon to choose the optimal surgical approach, which will make it possible to reduce morbidity and mortality rates. Two-hundred three patients with poststernotomy sternal wound infections were operated upon between 1984 and 1993. All pertinent clinical and radiological data of these patients were collected retrospectively and reinterpreted by an unbiased radiologist; the radiological data were correlated both to the intraoperative clinical findings and to histological interpretation of the surgical specimens. The study group available for statistical analysis included 160 patients. Predictive statistical analysis confirmed that computed tomography is a highly reliable imaging method for identifying the different pathologies as soft tissue, sternum mediastinal infections, in sternal wound infection with overall sensitivity of 93.5 percent and specificity of 81.7 percent. New radiographic findings were identified for the distinction of costochondral infection. This complication was, and still is, a major deceptive clinical problem in these patients and the major contributor to recurrences. We propose a sternal wound infection classification system that outlines the recommended approach for each clinical-radiological condition. Since computerized tomography was found to be a highly accurate modality, we strongly believe that the surgeon should take its pathological-radiographic findings into serious consideration, even if there are no "clear-cut" clinical signs for an existing or recurring infection.

Adolescent↗
PubMed1997

Myxoid liposarcoma of the scalp: case report and literature review.

Myxoid liposarcoma of the head and neck is an extremely rare entity. The scalp region represents a risk factor to the patient because the diagnosis is usually made late, and the surgeon must have a high index of suspicion for this entity because suctioning the tumor without taking a biopsy further delays an accurate diagnosis.

Biopsy↗
PubMed1994

Sternal wound infection: our experience with 200 cases.

More than 200 patients with sternal wound infections have been treated in the Plastic Surgery Department of our Medical Center over the years 1984-1993. Most of these were referrals from other hospitals. In recent years, the cases have become more severe, partially due to the fact that cardiac surgeons tend to operate older and sicker patients more readily than they previously did. 80% of these were post coronary bypass surgery, and the others heart and heart-lung transplants, repair of congenital heart anomalies, valve replacements etc. Several of the cases were cardiac surgery re-do's. Risk factors for developing this complication, such as diabetes, obesity, technical errors of sternal incision, prolonged intubation, the use of aortic balloon, etc. will be discussed. Many of our earlier patients had chronic fistulae following conservative therapy with old treatment modalities. In recent years, patients are usually referred at the acute stage. Most patients undergo removal of sternum and ribs. Previously, reconstruction included mainly transfer of the rectus ahdominis muscle, whereas lately the pectoralis muscles is utilized. Omentum was used in only one case. The importance of pre-operative imaging procedures has been thoroughly studied in our series. Especially important is the definition of the extent of the infection, and localization of foreign bodies causing chronic infections, such as suture material, epicardial electrodes etc. A change in infectants has also been noticed. In the first half of the study period, Pseudomonas aeruginosa comprised at least 40%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Our experience with diagnosis, evaluation and treatment of poststernotomy sternal wound infections].

During 1984-1992 162 patients with post-sternotomy sternal wound infections were treated. Between 0.4-5% of these undergoing sternotomy suffer from this complication which carries a mortality of about 50% when treated by conventional, nonsurgical methods. 80% of our patients had undergone aortocoronary bypass surgery and 11% valve replacement. Major risk factors identified for postoperative infection were prolonged mechanical ventilation, prolonged extracorporeal bypass, smoking, diabetes, obesity and chronic lung disease. Of 152 patients who underwent surgery, 35 had recurrent infections, especially during the first years of the study. 10 were managed by conservative methods. Reconstruction of the chest wall was performed in 125, using pectoralis major flaps (74 cases), rectus abdominis muscle flaps (53), myocutaneous flaps (5) and omental flap (1). Our series demonstrates the importance of a comprehensive, multi-disciplinary approach in evaluating and stabilizing these often critically ill patients. Computed tomography together with sinography have proven to be of major importance in diagnosing the location and extent of sternal wound infections. Strict adherence to antibiotic protocols, radical debridement of infected bone and soft tissues and subsequent reconstruction with muscle flaps has enabled us to reduce recurrent infection and improve morbidity and mortality rates.

Anti-Bacterial Agents↗
PubMed1990

Serious infectious complications of midsternotomy: a review of bacteriology and antimicrobial therapy.

49 patients with severe infectious complications of midsternotomy incision were treated at our referral center over a 3-year period. 43 species of microorganisms were identified in 38 patients, the most common being Pseudomonas aeruginosa (37%) and Staphylococcus aureus (30%). Most of the patients underwent aggressive debridement and chest wall reconstruction by muscle transposition in combination with antimicrobial therapy. Antimicrobial therapy was given perioperatively according to the in vitro susceptibility of the organisms. Treatment was continued beyond this period for 2-3 weeks in patients with extensive deep seated infection or in those with positive cultures from intraoperative specimens. Some patients needed a longer course of up to 6-8 weeks antimicrobial therapy because of insufficient response to the shorter course. In all, 45/49 patients had complete wound healing. 28 recovered within 2-5 weeks and 16 required a more protracted course with additional surgery in 8; 1 wound did not heal after 20 months and 4 patients died from non-infectious complications. Due to the lack of specific guidelines in the literature as to the proper choice and length of administration of antimicrobial therapy for midsternotomy wound infection, and in view of these favorable results, we recommend our protocol in the treatment of midsternotomy wound infection (in combination with appropriate surgery).

Anti-Bacterial Agents↗
PubMed1989

The danger in skin grafting the bare mediastinum after sternectomy for postcoronary bypass dehiscence.

We describe a patient who underwent coronary bypass grafting, after which severe mediastinitis and sternal osteomyelitis occurred. Repair after sternectomy was undertaken with a rectus-abdominis myocutaneous flap. The distal fifth of the flap underwent necrosis and was replaced by a meshed split-thickness skin graft. A year later, a clip marking one of the bypass grafts nearly eroded through the skin graft, endangering the bypass graft. The skin graft was removed by abrasion, and the bypass graft was covered with a pectoralis muscle flap. We recommend that skin grafting of a granulating wound over coronary artery bypass grafts be avoided if possible.

Coronary Artery Bypass↗
PubMed1989

The S nipple-areola reconstruction.

Nipple reconstruction is performed as a last stage in breast reconstruction following mastectomy. Various methods of nipple reconstruction have been described, most of them utilizing either free composite grafts or local flaps. The main problem encountered using either method is the gradual absorption and flattening of the nipple. The technique we used in reconstructing 22 nipples, in preference over the various methods accepted in breast reconstruction, achieves a long-standing, protruding nipple constructed from two large local flaps raised from an S-shape design. The technique is simple and permits freedom in choosing the height of the nipple, even in the presence of a mastectomy scar. The size of the nipple thereby constructed is in excess of what was expected. Shrinkage occurs during the first 2 months, and the resulting size is more than adequate. The areola is reconstructed by a full-thickness skin graft harvested from a nonhairy area of the upper inner thigh. The local flaps lack the necessary color, which is achieved by tattooing.

Breast↗
PubMed1989

Congenital aplasia cutis: nonsurgical treatment with a synthetic skin substitute.

A case is presented of a newborn with a large abdominal wall defect of aplasia cutis conservatively treated with a new skin substitute (Omiderm). Omiderm is a thin, transparent membrane that is relatively inelastic when dry and capable of absorbing water. This provides an optimal environment for wound healing by preventing microbial invasion. It is simple to apply and easily removed, and it adheres without glue or staples. It is transparent, permitting direct vision of the defect. By enhancing the epithelialization process, shorter hospitalization is required. The large area of aplasia cutis healed completely under the Omiderm within 6 weeks.

Abdominal Muscles↗
PubMed1988

Faulty sternotomy and complications after median sternotomy.

In 11 of 55 patients with complications of median sternotomy, a paramedian sternotomy has been detected by computed tomography or at reparative operation. The thin side of the sternum is easily broken by the closing wires, this being the cause of instability and probably dehiscence and consequent infection and osteomyelitis. Most of the 11 patients in this group had some other predisposing risk factors, such as obesity, prolonged aortic cross-clamp time, and prolonged respiratory assistance. We suggest that, if a paramedian sternotomy is diagnosed at the primary operation, special closure techniques should be undertaken. Each patient with early dehiscence of a median sternotomy should undergo a computed tomographic examination. If a paramedian sternotomy is proved, simple reclosure is inadvisable. Sternectomy and closure with muscle flaps are then indicated.

Humans↗
PubMed1986

Four cases of dysphagia caused by anterior cervical spondylosis.

The management of four patients with dysphagia due to esophageal compression by anterior cervical osteophytes is described, and the literature is reviewed. Treatment of this condition is simple and without complication. Surgical removal of the bony ridges using the anterior cervical approach leads to complete recovery.

Cervical Vertebrae↗