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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  63. Kongress der Nordrhein-Westfälischen Gesellschaft für Urologie; 20170608-20170609; Essen; DOCP 1.7 /20170419/
    Publication Date: 2017-04-19
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 2
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-0584
    Keywords: Hepatosplenic candidiasis ; Clinical picture ; Therapy ; Radiology ; Histology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Systemic candidiasis with Candida-induced abscesses, predominantly in the liver and the spleen, was diagnosed in 27 patients with haematologic malignancies after intensive cytostatic therapy. Specific features included septic fever unresponsive to antimicrobial therapy, hepatosplenomegaly with multiple lesions in the liver and spleen (diameter up to 2 cm) as detected by computed tomography (CT) or ultrasound, and an elevation in liver enzymes. During treatment, induced neutropenia, hepatic and splenic foci were poorly defined histologically and were not identified by imaging procedures. After granulocyte recovery these foci showed characteristic histological patterns. Ultrasound and/or CT investigations of the abdomen now revealed characteristic lesions in the liver and the spleen. Gamma-GT and alkaline phosphatase were early indicators of hepatic involvement in Candida septicaemia and were often already elevated in aplasia.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-0584
    Keywords: Key words Candida pneumonia ; Aspergillosis ; Bronchoscopy ; High resolution CT scan
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In a retrospective study of 56 patients with hematological malignancies and fungal pneumonia we have analyzed the value of different diagnostic procedures. In all patients (Candida n = 29, Aspergillus n = 23, mixed fungal infection n = 4) bronchoscopy and/or high-resolution computed tomography of the lungs was performed. Cultural detection of fungi in bronchoalveolar lavage was successful in 23/32 Candida and 11/23 Aspergillus pneumonias. Other relevant pathogens were identified by bronchoscopy in 21 cases. Thorax CT scans showed diagnostic evidence of fungal pneumonia in 10/13 Candida and in 16/18 Aspergillus infections. Blood cultures were positive in 9/33 Candida pneumonias and in none of aspergillosis cases. Serological testing and surveillance cultures had only limited value for the early diagnosis of pulmonary mycosis. Our data suggest that bronchoscopy and high resolution CT scans are mutually complementary diagnostic tools with high sensitivity in patients with hematological malignancies and new pulmonary infiltrates. These procedures facilitate the early and reliable recognition of invasive fungal disease which may have a bearing on the initiation, length, and differential therapy of antimycotic drugs.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-0584
    Keywords: Candida pneumonia ; Aspergillosis ; Bronchoscopy ; High resolution CT scan
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a retrospective study of 56 patients with hematological malignancies and fungal pneumonia we have analyzed the value of different diagnostic procedures. In all patients (Candida n=29,Aspergillus n=23, mixed fungal infectionn=4) bronchoscopy and/or high-resolution computed tomography of the lungs was performed. Cultural detection of fungi in bronchoalveolar lavage was successful in 23/32Candida and 11/23Aspergillus pneumonias. Other relevant pathogens were identified by bronchoscopy in 21 cases. Thorax CT scans showed diagnostic evidence of fungal pneumonia in 10/13Candida and in 16/18Aspergillus infections. Blood cultures were positive in 9/33Candida pneumonias and in none of aspergillosis cases. Serological testing and surveillance cultures had only limited value for the early diagnosis of pulmonary mycosis. Our data suggest that bronchoscopy and high resolution CT scans are mutually complementary diagnostic tools with high sensitivity in patients with hematological malignancies and new pulmonary infiltrates. These procedures facilitate the early and reliable recognition of invasive fungal disease which may have a bearing on the initiation, length, and differential therapy of antimycotic drugs.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-1440
    Keywords: Bronchoscopy ; Bronchoalveolar lavage ; Opportunistic infections ; Diagnosis ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Bronchoscopy was performed on 101 immunocompromised patients with fever and pulmonary infiltrates. Underlying diseases were mainly hematological malignancies. In 71% of cases, etiology of pneumonia was clarified by nonbioptic bronchoscopic methods (bronchoalveolar lavage, bronchial secretions, protected specimen brush). In 51% of cases, empirical antibiotic treatment was modified following bronchoscopy. In patients with early bronchoscopy a better prognosis regarding healing and survival was observed than in those cases, where bronchoscopy was performed later during pneumonia. Bronchoalveolar lavage was particularly suited for diagnosis of Pneumocystis carinii and pneumonia due to viruses or Legionella. Sensitivity and specificity of bronchoscopy were lower for diagnosis of mycotic pneumonia and of Gram-negative or Gram-positive bacteria.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-1246
    Keywords: Shift work ; Night shift ; Blood pressure ; 24-h blood pressure monitoring ; Circadian rhythm
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The dependence of blood pressure upon internal rhythms and the short-term effects of shift rota on the blood pressure were investigated in shift workers. Blood pressure was measured every 30 min using automatic recorders for 24 h in 17 physically working men in a chemical factory during their morning and night shifts. Mean 24-h blood pressures were identical in the morning and night shifts. There were no differences of the mean blood pressure between the respective sleeping phases or between the working periods. The amplitudes of circadian blood pressure variations were equal. There was a phase difference of 8 h corresponding to the lag between the working periods. At this 8-h lag the hourly means of the 24-h blood pressure were closely correlated (r = 0.69). Comparisons of 24-h blood pressure profiles during the first and last days of a night shift week showed that the effects of night work on the blood pressure were already fully developed within the first 24h (r = 0.86). Thus the diurnal variations of the blood pressure are determined by the working and sleeping periods and largely independent of endogenous rhythm. There is no short-term alteration of the mean 24-h blood pressure after shift rota.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-1750
    Keywords: Bronchoalveolar lavage (BAL) ; Pneumonia ; Neutropenia ; Differential cell count ; Lymphocyte subsets
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract One hundred immunocompromised HIV negative patients with microbiologically positive pneumonia underwent bronchoalveolar lavage (BAL) studies. Thirty cases showed peripheral neutropenia (〈1000 neutrophils/μL), Neutrophils per microliter. 70 did not. The total cell number in BAL, the differential cell counts, and the lymphocyte subsets (CD4, CD8, CD19, CD57) were measured. Patients with pneumonia and normal or elevated peripheral neutrophils had a significantly increased total number of cells in BAL compared to patients with peripheral neutropenia (3,2 ± 2 vs 1,3 ± 0,6 × 105 cells/ml Cells per milliliter. lavage fluid, p 〈 0.01). Ninety percent of the BAL differential cell counts obtained in patients exceeding 1000 neutrophils/μL showed a lymphocytic and/or neutrophilic alveolitis, whereas only 54% of patients with peripheral neutropenia displayed abnormal counts (p 〈 0.01). Yet the typical pattern of neutrophilic alveolitis was found more often for peripheral neutrophil counts over 1000/μL with high significance (p 〈 0.0001). Abnormal BAL cell patterns for neutropenic patients uniformly showed a lymphocytic alveolitis, only 10% additionally conformed with the pattern of neutrophilic alveolitis. Patients with pneumonia with and without peripheral neutropenia had similar findings in BAL lymphocyte subsets and exhibited a reduced CD4/CD8 ratio compared to controls (p 〈 0.05). The high susceptibility of severe neutropenic patients to pulmonary, especially fungal infections may be explained by the local lack of neutrophils.
    Type of Medium: Electronic Resource
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