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Biomedical subjects

R Amgwerd

Publications and source records attributed to R Amgwerd.

At least 37 records · Page 2Linked to original sources
PubMed1983

[Complications following cholecystectomy and their therapy].

426 patients who had undergone cholecystectomy took part in a retrospective study covering four years (1977-1980). 53 patients had gallbladder empyema. The complications in the 373 cholecystectomies without empyema were 4 wound infections (1.1%), 2 other infections, 10 postoperative hemorrhages (2.7%), 3 cases of retained stones (0.8%) and 7 other complications. Only 3 of the total of 6 infections required antibiotic therapy. Since the infection rate in the 373 patients without empyema was very low, and since it is known that bile is sterile in the early stages of acute cholecystitis, there is no indication even for prophylactic antibiotics. Treatment of acute cholecystitis is cholecystectomy within 24-48 h of onset of acute symptoms. The rate of infectious complications in patients with gallbladder empyema was 15.1%. Primary treatment for this disease is surgical removal of the infectious focus (cholecystectomy) and reduction of bacterial spread or treatment of peritonitis if already present.

Aged↗
PubMed1982

Adjuvant chemoimmunotherapy with LMF plus BCG in node-negative and node-positive breast cancer - intermediate report at 4 years.

A randomized surgical adjuvant trial in 242 evaluable patients with T1-3a, N0-1, and M0 breast cancer was initiated 4 years ago. The well-tolerated, oral combination chemotherapy with six cycles of Leukeran plus methotrexate plus fluorouracil (LMF) plus repeated BCG skin scarifications was used. After 4 years, the following results were seen: (1) significant increase of relapse-free (RFS) and also overall survival (S) in both pre- and postmenopausal node-negative patients versus surgical controls (RFS 91.1 vs. 701%, P = 0.003; S 96 vs. 88%, P = 0.03); (2) no significant increase of RFS or S in pre- and postmenopausal node-positive patients versus surgical controls (RFS 50.1 versus 44%, P = 0.49; S 70 versus 68 %, P = 0.9, respectively); (3) Patients receiving greater than 90% of the planned LMF dose showed significantly better survival after 4 years; and (4) Nonrandomized comparison with concurrent Swiss adjuvant studies with LMF alone indicate no beneficial or harmful effect of BCG skin scarifications in addition to the six-cycle LMF.

Breast Neoplasms↗
PubMed1982

[Mezlocillin in the antibiotic therapy of severe bacterial infections in visceral surgery].

Fifty-six patients suffering from severe and very severe bacterial infections received additional antibacterial treatment with mezlocillin following abdominal or chest surgery. There were 18 intestinal-peritoneal infections, 15 pleuropulmonary infections, seven patients with sepsis, six localized abscesses and ten patients receiving perioperative application. In 36 patients treatment had to be initiated before the pathogens had been identified. Twenty patients received mezlocillin alone and 37 in combination with an aminoglycoside. The clinical course and laboratory data were recorded while the patients were receiving antibiotic therapy. In 43 of the 56 patients, most of whom were suffering from mixed infections caused by anaerobes and aerobes or from fecal infections, a cure without complications could be achieved. In six patients a generalized infection was reduced to a local one which could be cured. Eight patients died, six of their surgical primary disease and two of septic complications. Apart from four instances of phlebitis at the site of the infusion, no side-effects resulted from our antibiotic therapy.

Abdomen↗
PubMed1981

[Prospective study on the prevention of wound infections after appendectomy for acute appendicitis].

In the search for an appropriate antibiotic to reduce the rate of postoperative wound infection in patients with acute appendicitis, we have randomized 150 patients preoperatively in a prospective 3-arm study. The operation technique was standardized for all patients and involved the use of plastic wound protectors. Bacterial contamination was documented by 3 swabs taken during operation. In 2 arms, patients received short-term adjuvant prophylaxis with either cefazolin or clindamycin/tobramycin. The third arm served as a control. Wound contamination ws proven in 33% of all cases but only 4% developed a real wound infection. The rate of infection was almost identical in all groups, without a statistically significant difference in the chi2 test. It is concluded that wound infection after appendectomy cannot be prevented by prophylactic use of antibiotics. Careful operation technique with local protective steps is quite sufficient. Antibiotics should therefore be reserved for special indications.

Acute Disease↗
PubMed1980

[Selective proximal vagotomy (SPV) - complete intraoperative control or not?].

The rate of recurrent duodenal ulcer following selective proximal vagotomy (SPV) has been assessed in two different groups of patients. Completion of vagotomy was left to the surgeons judgement in the first 50 consecutive cases, while in the following 50 cases a vagomotor electrostimulation device ("Vagorec") was used intraoperatively for control. The failure rate of 14% in the first group could be reduced to 2% in the second one. We believe that technique and success of SPV can be checked easily using this device. It is an educational remedy for the learning surgeon in order to avoid an incomplete SPV as well as it is a necessary tool for the experienced one.

Duodenal Ulcer↗
PubMed1977

[Clostridium infections with and without manifest gas gangrene. Report on 77 infections in 76 patients].

Systematic microbiological research and correlation of the histopathological findings obtained from random autopsies revealed 23 hitherto undetected clostridial infections including 11 cases of gas gangrene, 4 of septicemia, 3 of bacteremia, and 5 other clostridial infections. The knowledge gained from this study led to clinical diagnosis of several cases of gas gangrene which were confirmed bacteriologically and histologically. Of 8 hospital patients who were thus diagnosed in this surgical clinic, 7 recovered, including a case of gas gangrene of the abdominal wall. The problem in gas gangrene is timely clinical diagnosis. Little is known about gas edema illnesses which are not traumatically conditioned. Recognition of the local and general symptoms (local, violent, yet inappropriate pain in the wound, "unexplained" postoperative secondary bleeding, appearance of tachycardia wholly unrelated to the patient's temperature, sudden shock, rapid deterioration of patient's general condition, jaundice and rise in CPK) makes it possible to diagnose postoperative gas edema in time. 77 infections with isolation of clostridia, seen in 76 patients, are reported. On the basis of clinical and histopathological criteria they have been classified as follows: 22 cases with gas gangrene (clostridial myonecrosis), 16 cases with anaerobic cellulitis, 20 wound infections, 8 cases of septicemia, 5 of bacteriemia, 1 of tetanus, and 5 other clostridial infections.

Adolescent↗
PubMed1977

[Prognosis of local primary breast carcinoma under current therapy].

A retrospective study is presented on 225 selected patients with local primary carcinoma of the breast treated from 1963 to 1973 at the Surgical Clinic of the Cantonal Hospital, St. Gallen, Switzerland. All patients were under 70 years old. The results are compared of our two therapies, namely radical mastectomy of Halsted and a modified radical mastectomy consisting of mastectomy with dissection of the axilla but without removing the pectoral muscle. Both operations were followed by postoperative irradiation. In view of the short postoperative interval after modified radical mastectomy (from 1969), a five-year diseasefree survival is indicated. There was no statistically significant difference between the two therapies. Depending on age, patients with histologically negative lymph nodes of the axilla had a probability of 45-60% for 5-year diseasefree survival, against only 15-40% for those with positive axillary lymph nodes. The quality of survival is deemed important, and the authors therefore recommend the modified radical mastectomy, which disfigures a woman less than the Halsted operation.

Adult↗
PubMed1977

[Gas gangrene after abdominal surgery].

This is a report on nine cases of gas-gangrene which developped after abdominal surgery. In five patients the diagnosis was made at the bedside, three of these patients survived. Cardinal symptoms were rapid deterioration of the general condition, severe pain around the incision, tachycardia, and the appearance of jaundice along with a fall of the hemoglobin.

Abdomen↗