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D Oertli

Publications and source records attributed to D Oertli.

At least 55 records · Page 3Linked to original sources
PubMed1996

Long-term results after open and semiclosed thrombendarterectomy for aortoiliac occlusive disease.

OBJECTIVES: This study reviews the long-term results of 514 aortoiliac thrombendarterectomies (TEA's). DESIGN: A prospective study in a major university hospital in Switzerland. SUBJECTS: 353 male and 62 female patients with aortoiliac occlusive disease. Operative indications: disabling claudication (n=334), rest pain (n=44), and gangrene (n=37). METHODS: Open and semiclosed TEA's were performed on 167 and 347 limbs, respectively. Follow-up was continuous and complete in 97.1 % of patients over a period of more than 15 years. RESULTS: The overall life-table patency rate at 5, 10, and 15 years postoperatively were 93.4 %, 90.4 %, and 84.2 %, respectively. Fifteen years postoperatively, the patency rate of 92.3 % after open TEA was significantly higher (p<0.04) than after semiclosed TEA (79.5 %). However, similar patency rates of 69.5 % and 69.8 % were observed 20 years postoperatively. Further significant prognostic factors on patency were: anatomic localization (p<0.004), preoperative stage of arterial occlusive disease (p<0.008), and gender (p<0.007). Patient's age did not influence the outcome in terms of patency. Hospital mortality rate was 1.2 %. Early obstruction occurred in 2.2 %, leading to subsequent early amputation of 1.4 % and reoperations in 1.2 %. The long-term actuarial survival rates of the patients were 55 %, 36 %, and 18 % after 10, 15, and 20 years postoperatively. CONCLUSION: Both open and semiclosed TEA give highly satisfactory long term results in aortoiliac occlusive disease with a low morbidity and low mortality.

Aortic Diseases↗
PubMed1996

Non-replicating recombinant vaccinia virus encoding murine B-7 molecules elicits effective costimulation of naive CD4+ splenocytes in vitro.

Using a series of new insertion/expression vectors, we constructed a set of recombinant vaccinia viruses (recVV) encoding the murine T cell costimulatory molecules mB7-1 or mB7-2, or both together in the same construct. On infection with replication incompetent and non-cytopathic recVV, several tumour cell lines expressed the respective molecules and bound to CTLA-4. The highest binding capacity was found when both mB7 molecules were co-expressed. Mouse B16.F10 melanoma cells expressing mB7-1 or mB7-2 provided effective costimulation for proliferation of resting CD4+ T cells in the presence of concanavalin A and plate-bound anti-T cell receptor antibodies, respectively. If mB7-1 and mB7-2 were delivered together on the same cell, the proliferative response of CD4+ T cells increased further. The costimulatory effect could be blocked with CTLA-4, the soluble ligand for B7 molecules. The possibility of engineering tumour cells using recVV holds implications for the future design of vaccination strategies.

Abatacept↗
PubMed1995

[Laparoscopic adrenalectomy in pheochromocytoma].

Standard adrenalectomy for pheochromocytoma was until recently performed via the transperitoneal open approach. The disadvantage of the open procedure is a more painful and longer recovery. With good surgical experience in laparoscopic techniques and in endocrine surgery, laparoscopic adrenalectomy can be performed safely without complications. The advantage of the laparoscopic technique is excellent vision of the operative field with magnification even of very small vessels. The first two cases of laparoscopic right adrenalectomy at our institution are described.

Adrenal Gland Neoplasms↗
PubMed1995

[Thrombendarterectomy in aorto-iliac occlusive disease].

An overview is given of the history and operative techniques of open and semiclosed thrombendarterectomy (TEA) for aortoiliac obstructive disease. The second part of the paper reviews the long-term results of 514 aortoiliac TEA's performed in 415 patients between 1959 and 1972. The data were prospectively acquired and the analysis was done on a retrospective basis. Median follow-up was over 15 years. Open and semiclosed TEA were performed on 167 and 347 limbs respectively. Hospital mortality was 1.2% and operative morbidity 11.1%. The overall life-table patency rate at 5, 10, 15, and 20 years was 93.4%, 90.4%, 84.2% and 69.5% respectively. Patency rate depended on significant factors: open versus semiclosed method (p < 0.04), anatomic localization: common iliac artery versus external iliac artery (p < 0.0004), preexisting stage of occlusive disease: stage II versus stage IV (p < 0.008), and gender: female versus male (p < 0.007). Patient's age was not a predictive factor on patency. The limb salvage rate was greater than 90% even in long-term follow-up. We conclude that in aortoiliac obstructive disease both open and semiclosed TEA give highly satisfactory long-term results with low mortality and morbidity rates.

Aged↗
PubMed1995

Parathyroidectomy in primary hyperparathyroidism: preoperative localization and routine biopsy of unaltered glands are not necessary.

BACKGROUND: An assessment was made of operative risk and outcome after parathyroidectomy for primary hyperparathyroidism. METHODS: A retrospective study was conducted in a single center university hospital in Switzerland. The 173 patients (130 women and 43 men) ranged from 17 to 89 years of age (mean, 62.0 years). No routine preoperative localization methods were used for primary neck exploration. Parathyroidectomy was performed under general anesthesia. No routine use was made of intraoperative biopsy of glands whose macroscopic appearance was normal. The 173 patients underwent 179 operations (170 primary and 9 secondary interventions). Resection of a single gland was performed in 127 cases (73.4%) and of two glands in 36 cases (20.8%). Subtotal parathyroidectomy (3 1/2 glands) was performed in 10 cases (5.8%). RESULTS: Of 170 patients with primary intervention, 164 (96.5%) were normocalcemic after operation. Six of 170 patients (3.5%) underwent early reexploration. Three additional patients underwent late secondary procedures. These nine secondary operations were successful in seven patients (78%). At follow-up (mean, 24.7 months after operation) normocalcemia was noted in 163 of 171 patients (95.3%). Persistent and recurrent hyperparathyroidism occurred in 1.2% and 3.5% of patients, respectively. Permanent postoperative hypoparathyroidism was noted in 4% (six of seven patients underwent a subtotal parathyroidectomy for multiglandular hyperplasia). Operative morbidity and mortality were 2.3% and 0.6%, respectively. CONCLUSIONS: Our surgical strategy for treatment of primary hyperparathyroidism has proved to be safe with a favorable outcome in more than 95% of patients. This was possible without the routine use of preoperative localization studies and intraoperative biopsy of macroscopically normal glands. Routine biopsy of normal-appearing glands seems to be unnecessary and may increase the risk of hypoparathyroidism.

Adolescent↗
PubMed1994

[Prognostic factors in resected stomach carcinoma].

Between January 1982 and December 1991, 232 consecutive patients (121 male, 111 female) with gastric adenocarcinoma were treated at our clinic. Resection of the tumors (resectability 73.7%) included lymphadenectomy of compartment I (D1 resection). The tumors were classified according to the Borrmann's and Laurén's criteria and according to the TNM system. 171 patients underwent resection of the tumor, 49 palliative surgery and 12 were treated nonsurgically. The operative morbidity in patients with resection and palliative operations was 20.5% and 10.2% respectively, and the mortality rate was 0.6% and 8.2% respectively. Follow-up data (median 6 years postoperatively) were available for 229 out of 232 patients (98.7%). After resection, the five year actuarial survival rate according to the method of Kaplan-Meier was 38.2%. The probability of survival increased to 47.5% after potentially curative resection. An univariate and a multivariate analysis by the proportional hazard model (Cox regression analysis) identified several significant prognostic parameters for survival (in order of their significance): tumor stage (TNM), N-stage, percentage of positive lymph node metastases among removed nodes, Borrmann criteria, T-stage, metastases in five and more lymph nodes, diameter of the tumor, serosal involvement, peritoneal and hepatic metastases, and patient's age. The following parameters did not have a prognostic value in our analysis: grading, Laurén classification, and localization of the tumor. We conclude that the identification of several prognostic factors allows us to estimate the probability of survival for each individual patient. In future these factors may influence decision-making on adjuvant treatment of gastric cancer.

Actuarial Analysis↗
PubMed1994

[Results following resection in early stomach carcinoma].

The results of surgical resection in early gastric cancer were analyzed retrospectively. These operations were performed between 1982 and 1991 on 52 consecutive patients (29 women, 23 men; average age 64 [35-85] years). The tumours were resected by total gastrectomy in 11, by subtotal gastrectomy in 31, and by Billroth I resection in 10, followed by limited lymphadenectomy of the perigastric group of lymph-nodes (D1 dissection). There was one operative death (1.9%). The tumor was confined to the mucosa in 36 patients (69%), while submucosal infiltration was present in 16 (31%) and metastases to the regional lymph-nodes in seven (13%). Follow-up examination took place in all patients, after an average period of observation of 6.1 years. For the total group the 5-year survival rate, including operative mortality, was 83.7%. It correlated with the depth of penetration of the tumour and nodal involvement. 5-year survival rate for mucosal tumour was 90%, with submucosal infiltration 66.7% (P < 0.03), without lymph-node metastasis 86.4%, with it 68.6% (P < 0.05). The extent of resection and the tumour classification (according to Laurén--intestinal or diffuse) did not influence survival.--Early gastric cancer, contrary to that in the advanced stages, has a very good prognosis. But it is significantly altered by the depth of penetration of the tumour and nodal metastasis.

Adult↗
PubMed1994

Perioperative and postoperative tranexamic acid reduces the local wound complication rate after surgery for breast cancer.

A randomized double-blind trial has shown that, in 160 women with breast cancer undergoing lumpectomy or mastectomy with axillary clearance, perioperative and postoperative administration of tranexamic acid 1 g three times daily resulted in a significant reduction in the mean postoperative drainage volume compared with patients given placebo (283 versus 432 ml, P < 0.001). The frequency of postoperative seroma formation was also decreased by tranexamic acid administration (27 versus 37 per cent, P = 0.2). Haematoma formation was infrequent in both groups and was not altered by administration of tranexamic acid. No infectious complications occurred. Age over 60 years was a significant risk factor for overall wound complications but tumour size and regional lymph node metastases were not. Tranexamic acid may be used to reduce the frequency of postoperative wound complications following surgery for breast cancer.

Age Factors↗
PubMed1994

[Intestinal obstruction with invagination caused by an inflammatory fibroid polyp of the small intestine].

We observed the rare case of a 50-year-old man with intestinal obstruction due to an inflammatory fibroid polyp (IFP) of the jejunum. Here, we report its clinical and pathological characteristics, and its histologic appearance. Limited small bowel resection led to complete recovery of the patient. In a short review of the literature, possible pathogenetic mechanisms as well as diagnostic and therapeutic means are discussed. Although rare, IFP should be considered in the differential diagnosis of small bowel obstruction.

Anastomosis, Surgical↗
PubMed1994

Complete traumatic transection of the thyroid gland.

A case of traumatic transection of the thyroid gland with secondary substantial hematoma and respiratory distress is presented. Hemorrhage into the altered thyroid gland is well known. However, there are only a few reports of severe hemorrhage associated with trauma. A short review of the literature is given and the mechanism of trauma is discussed.

Aged↗
PubMed1993

[Developments in the surgical therapy of colonic diverticulitis].

All patients admitted to our department with diverticulitis of the left sided colon between 1980 and 1990 were retrospectively evaluated. Staging was performed according to the Hinchey classification. Altogether, 263 patients were evaluated; 71% had complicated diverticulitis and 29% simple diverticulitis. Of those patients with complicated diverticulitis, 68% required surgery due to abscess formation and/or perforation, 19% because of obstruction, 10% because of fistula formation, and 3% due to intestinal hemorrhage. While primary resection (primary reanastomosis in 82% or Hartmann procedure in 13%) was carried out in 250 patients (95%), 13 patients (5%) did not obtain this result (colostomy) following the initial operation. None of the patients who presented with simple diverticulitis died in the postoperative period. The total operative mortality and mortality for complicated diverticulitis amounted to 6.5% and 9%, respectively. In comparison to a former analysis from our department, resection of the primary focus during the initial operation led to a significant decrease in morbidity and mortality. In patients with complicated diverticulitis and peritonitis, primary resection and anastomosis also achieved favourable results in 78%.

Abscess↗
PubMed1993

Extraperitoneal manifestation of perforated diverticulitis.

We observed five cases of unusual extraperitoneal presentation of diverticulitis during an 11 year period. During that time, a total of 263 patients were operated for diverticulitis. Patients 1-4 presented with an inflammatory spread of diverticulitis through the abdominal wall; in patient 5 multiple abscesses were present in the left thigh. Inadequate resection and previous radiotherapy in patient 4 might have contributed to the complicated course. In patient 5, poor condition initially allowed only local drainage of the thigh abscesses. Despite laparotomy and sigmoid resection a few days after drainage, the fatal outcome could not be prevented. A more extensive resection and a protecting colostomy might have prevented the fistulous complication in patient 4. A primary resection and abscess drainage might have averted the fatal outcome in patient 5.

Abdominal Muscles↗
PubMed1993

Primary carcinoma of the gallbladder: operative experience during a 16 year period.

OBJECTIVE: To evaluate the results of operations for primary carcinoma of the gallbladder during the 16 year period 1975-1990. DESIGN: Retrospective study. SETTING: University affiliated hospital in Switzerland. SUBJECTS: 55 consecutive patients with primary carcinoma of the gallbladder. INTERVENTIONS: Resection with curative and palliative intent was done in 34 (62%) and in 10 (18%), respectively. Thirty nine (62%) had simple cholecystectomy and two (4%) radical resections; the remaining 14 (25%) had palliative operations. RESULTS: 23 Patients (42%) had early tumours (confined to the gallbladder wall, TNM stages I and II), and 32 (58%) had late tumours (TMN stages III and IV). A tumour of the gallbladder was suspected from preoperative ultrasonography in 20 of 37 examined patients (54%); 17 (31%) had occult lesions. Five patients died during the 30 day postoperative period (9%), and the overall median survival was 8.6 months. One and five year survival rates were 40% and 7%, respectively. Only four patients had long term cures after cholecystectomy alone. CONCLUSION: There was a high incidence of locoregional recurrence among patients with stage II disease, and this group benefit from more radical resections. For advanced tumours, palliation alone is preferable.

Aged↗
PubMed1992

[Prevention of thromboembolism in hip traumatology: low molecular weight heparin versus dextran].

A prospective, randomized trial has been undertaken to evaluate the prophylactic effects of low molecular weight heparin (LMWH) and dextran-70 in 216 patients with hip fracture during a postoperative period of ten days. Deep vein thrombosis (DVT) was diagnosed using the 125Iodine fibrinogen uptake test, confirmed by ascending venography. 113 patients received LMWH and 103 dextran-70. The frequency of DTV of 14.2% in the LMWH group was significantly lower compared with the 30.1% in the dextran group (p less than 0.003). During the first 10 days postoperative there were no fatal pulmonary embolism (PE). After this period PE occurred in 2 patients (1.8%) in the LMWH group and 1 patient (1.0%) in the dextran group. In each group one patient died from PE. There was no major bleeding in either group. The frequency of local complications was slightly higher in the dextran group (10.7%) compared with the LMWH group (3.5%). The postoperative hemoglobin level was significantly lower in dextran treated patients than in patients receiving LMWH (p less than 0.0001).

Adult↗