Biomedical subjects
Publications and source records attributed to J J Brugger.
A gastro-jejuno-colic fistula detected by upper gastric contrast-radiography was the cause of severe diarrhea, miserere and weight loss. It had developed after gastro-jejunal anastomosis. Surgical correlation was achieved by a single intervention, possible because of preoperative care and modern suture technology.
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Flexible fiberoptic sigmoidoscopy more and more replaces sigmoidoscopy with a rigid tube. In a retrospective series of 152 rigid sigmoidoscopies we analysed depth of endoscopy and findings. In 36% of patients without anaesthesia endoscopy had to be stopped at 15 cm and in further 31% at 20 cm leading to a highly significant difference to the anesthetized patients (p less than 0.0005). A good history of the present illness allows separating of bleeding carcinoma and polyps proximal to the sigmoid colon which have to be examined by colonoscopy. In routine screening for blood loss per anum it is desirable to achieve in all patients a maximal security not to overlook a finding, because of the medical costs. We have enlarged the list of indications for the rigid sigmoidoscopy by Marks et al. as a practical compromise: delineation of rectal lesions, side localization and critical rectal measurements, surveillance of disease states or anastomoses within its reach, for performing rectal biopsy and rectal polypectomy, in patients with possible contamination of the instrument, endoscopy in the anesthetized patient before a proctological operation if case history excludes a higher sited lesion. In all other cases there is an indication for colonoscopy or barium contrast enema. It is stressed that in patients with blood loss per anum the search for the source always is done by flexible fiberoptic sigmoidoscopy.
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Between 1976 and 1979, 76 patients underwent tricuspid annuloplasty (TA) for predominant tricuspid regurgitation (TR). The TR was functional (secondary to mitral valve disease) in 70, postrheumatic in 4, posttraumatic in one and secondary to myxomatous degeneration in one. The mean preoperative functional class was 3.05 and cardiac index 2.15 +/- 0.53 l/min/m2. All but 8 were in atrial fibrillation. Pulmonary vascular resistance over 250 dyn x sec x cm-5 was present in 28 patients. The original de Vega technique was applied in 55, a modified annuloplasty technique was used in the remaining 21 cases. There were 3 early and 6 late deaths, none being related to annuloplasty. One early and 2 late complications were attributable to tricuspid annuloplasty. At control after 6 months, 64 of 72 patients had improved at least one functional class. Three presented moderate TR on clinical examination. Mean observation time now averages 30 months (20 to 48 months). De Vega annuloplasty is a safe and effective method for the treatment of functional TR. It is of particular value during the early postoperative period in preventing right ventricular overload.