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Biomedical subjects

J Largiadèr

Publications and source records attributed to J Largiadèr.

At least 19 recordsLinked to original sources
PubMed2003

[Peripheral arterial occlusive diseases: opinion of lay audience].

An audience of about 500 elderly people were interviewed about their knowledge and therapeutic opinion on peripheral vascular disease. After a brief introduction by vascular surgeons 12 questions were presented for vote and answered with the use of a poll system. The audience proved well informed about the risk factors but confounded the symptoms. The participants declined to accept any limitation of their walking ability, overestimated the mid-term results of an eventual revascularisation and underestimated their risks and costs. 80% asked for a stop of smoking as a prerequisite for an intervention and again 80% were willing to pay by them-selves if the insurances would not reimburse them for an operation that would just improve their quality of life status. The honorarium for the surgeon was put up high. The poll shows that an audience can be enabled within a short period of time to deliberate therapeutic decisions and socio-economic problems. The answers reflect an overestimation of the medical possibilities but also a willingness to ask for and make personal contributions to a treatment which is not compelling in many cases.

Aged↗
PubMed2002

Therapeutic concept for acute leg and pelvic venous thrombosis.

Combination treatment in acute deep venous thrombosis essentially consists of a highly dosed locoregional thrombolysis of the valve-carrying crurofemoral axis and a mechanical thrombectomy of the valveless pelvic axis by Fogarty catheter. The success of this method is due to the fact that it largely eliminates the disadvantages of systemic thrombolysis, as well as those at conventional surgical thrombectomy, whilst retaining the advantages. Using combination treatment in acute leg and pelvic venous thrombosis within the first 7 days can result in restitutio ad integrum, i.e. complete desobliteration with maintained valve function in more than 80% of the cases.

Fibrinolytic Agents↗
PubMed2001

[Combination therapy of venous thrombosis with local thrombolysis and surgical thrombectomy].

Combination therapy in acute deep venous thrombosis essentially consists of a highly dosed locoregional thrombolysis of the valve carrying crurofemoral axis and a mechanical thrombectomy of the valveless pelvic axis by Fogarty catheter. The success of this method is due to the fact that it largely eliminates the disadvantages of systemic thrombolysis as well as conventional surgical thrombectomy whilst retaining the advantages. Using combination therapy within the first 7 days in acute leg and pelvic venous thrombosis can result in restutio ad integrum, i.e. complete desobliteration with maintained valve function (more than 80% of cases).

Combined Modality Therapy↗
PubMed1998

[Long-term outcome of distal bypass].

Although 30 years age reconstructive surgery on crural arteries was technically not feasible, primary successful revascularization is now possible in 95% of arterial occlusive diseases in the lower leg. If untreated, reocclusion of the graft occurs in 40 to 60% during the first postoperative year. With a close, morphologically oriented follow-up routine, an assisted primary patency of up to 80% and an even higher secondary patency can be achieved. Myointimal proliferation is mostly responsible for bypass failure in the early postoperative period especially at the site of the distal anastomosis.

Angiography↗
PubMed1997

[Acute abdominal pain. Surgeon's viewpoint].

From the surgical point of view acute abdominal pain is the cardinal symptom of acute abdomen. Additional leading symptoms of acute abdomen are tension of the abdominal wall, peristaltic disorders and, in rare cases, shock symptoms. Acute abdomen is an operational diagnosis for painful, in part life threatening diseases of various etiologies. The most frequent cause is acute appendicitis, followed by cholecystitis and by diverse forms of ileus. These three diseases together are the cause of acute abdomen in more than 80% of cases. Over 90% of cases with acute abdomen are treated surgically. The decision in favour of a surgical intervention must be determined within minutes to hours depending on the etiology. A delay may lead to further, partly most serious sequelae.

Abdomen, Acute↗
PubMed1996

[Small-caliber polyurethane arterial prosthesis: clinical and angiomorphological follow-up of 20 patients in a prospective study].

The five year patency rate for femoropopliteal vein bypass grafts is around 70% according to the literature. Patency rates for synthetic grafts (eg PTFE, Dacron) range between 43 and 57%. If a vein is not available there is a new polyurethane 6 mm artery substitute on the market, that has shown in vitro promising physical characteristics and good long term results after implantation in dogs. In a prospective, randomized trial the results of the new polyurethane graft (PUR) were compared with those of a Dacron graft of the same diameter. Included in the study were 20 patients with lower limb ischemia stage Fontaine II B, III and IV, 10 in each group. Patency rates, handling of the graft and complications were analysed. During the one year follow up 7 PUR grafts had to be changed due to recurrent bypass occlusion within the first 3 months. At the end of the year there were only one PUR-bypass but 8 Dacron grafts open. 5 PUR grafts were examined histologically and no morphological reason for the occlusion, especially no myointimal hyperplasia, was found. A special regard was brought to the arterial run-off in both groups. It was confirmed to be comparable with only slightly better data for the PUR group. The exact reasons for the astonishing bad results of the PUR graft for femoropopliteal above knee bypass cannot be explained in our study. Due to the unexpected high occlusion rate the study was stopped earlier then planned.

Aged↗
PubMed1996

[Treatment concept in deep pelvic-leg venous thrombosis].

The treatment of choice in acute deep vein thrombosis continues to be controversial. Conservative treatment with heparin and anticoagulation, systemic thrombolysis, thrombectomy and the combination of local thrombolysis and surgical unblocking are possible therapies. Regarding long term results; both after non operative treatment or after venous thrombectomy, many authors describe a majority of patients who suffer from chronic venous insufficiency in varying clinical severity. Requirements for normal venous function are complete phlebographic patency and valvular competence without venous reflux. Our proposed treatment for thromboses not older than 7 days combines local thrombolysis with venous thrombectomy to achieve these requirements and contains the following operative proceeding: An incision is made in the groin or - for more distal thromboses - on the proximal end of the clot. For the removal of the clot in the iliac vein a Fogarty-catheter is used. Urokinase is administered through a vein puncture in the instep while the blood flow is blocked by a pneumatic cuff around the thigh. After at least 20-30 minutes the clots can be removed through the proximal incision after removal of the cuff and manual massage of the leg. During this procedure the vein proximal of the venotomy is occluded by a soft clamp. An analysis of the results of 34 patients on average 3 1/2 years after combined therapy confirms normal valvular function of the popliteal vein in 27 (79%) cases. This improved long term outcome is going to be checked in an prospective study evaluating anticoagulation versus our treatment concept.

Blood Vessel Prosthesis↗
PubMed1995

[Gallstone surgery today].

The gold standard in treatment of cholelithiasis is and remains cholecystectomy. The gallbladder must be removed not because it contains stones but because it produces them. Only cholecystectomy prevents late complications. Laparoscopic cholecystectomy offers more comfort to the patient. By improved technique and refined instruments its indication can be continuously enlarged. Complicated forms of cholelithiasis such as the Mirizzi syndrome, chronic fibrosing cholecystitis, necrotizing infections and tumors as well as high operative risks are treated better by open cholecystectomy. Open and laparoscopic operations have both advantages and disadvantages. They are not competing procedures. On one hand, they have to be used individually according to their corresponding pathomorphology; on the other hand, their respective use has to be met by appropriate surgical skill. By no means the indication may orient itself on questions of prestige.

Cholecystectomy↗
PubMed1995

[Amebic appendicitis with subsequent perforated pancolitis].

Amoebic appendicitis is very rare, occurring in about 0.5 to 1% of acute appendicitis in tropical countries. The most severe complication is transmural amoebic colitis with perforation, described in 1.6 to 3.2% of cases. The mortality of such cases can be very high (up to 80%). We present a Swiss patient with amoebic appendicitis followed by severe perforated colitis; a total colectomy was necessary and the patient survived. Because of the good results of amoebicidal therapy and because of the severity of the complication after colitis we suggest that patients with signs of acute appendicitis after travel in tropical areas should be screened.

Aged↗
PubMed1995

[Endovascular and open reconstructive treatment of arterial occlusive disease of the lower extremity in the critical ischemia stage].

Arterial revascularization is mandatory in the vast majority of patients with critical ischemia in the leg. Open surgical and percutaneous catheter procedures (angioplasty, local thrombolysis, clot extraction) can each be applied alone or in combination to avoid major amputation. Given the low invasiveness and morbidity of percutaneous techniques, they should be the method of first choice, provided suitable occlusion morphology is available. If catheter therapy is not successful, surgery can be performed. Five-year patency after surgery for femoropopliteal obstructions is approximately 60% and 40% after catheter therapy. Iliac revascularization shows higher patency rates for both procedures. Percutaneous catheter techniques can be an alterative to vascular surgery, but more importantly both can be used as complementary procedures in the same patient, provided there ist good cooperation between the vascular surgeon and the person during the interventional angiology.

Angiography↗
PubMed1994

[Damage to the vessel wall by the Fogarty balloon catheter].

Thromboembolectomy with the Fogarty balloon-catheter is a well-established surgical therapy for the treatment of acute ischemia with generally good results. However, arterial injuries caused by balloon embolectomy occur in up to 6%. The different types of injury are mentioned, the role of myointimal hyperplasia as a result of endothelial denudation is discussed. We conclude that after balloon-catheter thromboembolectomy an early angiographic control should be performed and repeated 3 months postoperatively.

Aged↗
PubMed1994

[Treatment of venous stenoses and occlusions of benign etiology with vascular endoprostheses: a new, non-operative therapeutic concept].

8 patients (7 women and 1 man, age between 35 and 66 years, mean 46.3) suffering from a stenosis or occlusion of the pelvic or superficial femoral vein after surgical or percutaneous intervention were successfully treated with endovascular stents of the wallstent type. Clinical and Doppler sonographic as well as phlebographic controls showed patency of all stented lesions at followup times between 3 and 82 months (average 27 months). The use of percutaneous transluminal angioplasty (PTA) in the venous system in combination with implantation of self-expanding vascular endoprostheses offer a new therapeutic modality to treat veins with stenosis or occlusion of benign etiology without surgical intervention.

Adult↗
PubMed1993

[Chronic anterior tibial syndrome].

In two young athletic men we made the diagnosis of chronic tibialis anterior syndrome. Pain during strenuous exercise was localized in the anterolateral aspect of both calves. After stopping exercise the complaints disappeared within 15-20 minutes and not in 2-3 minutes as it would be typical for patients with atherosclerotic peripheral arterial occlusive disease. Diagnosis is based on patient history, normal clinical examination (systolic ankle pressure determined by Doppler-Sonography, electronic segmental oscillography) and increased intramuscular pressure at rest (> 10 mmHg) and after exercise (42 and 35 mmHg). Bilateral fasciotomy was performed in both patients. They are free of pain after 3 respectively 6 months postoperatively.

Adult↗
PubMed1992

Placement of venous stents: clinical experience with a self-expanding prosthesis.

A self-expanding vascular prosthesis was used to treat 20 venous stenoses or occlusions in 13 patients. The lesions were caused by tumor (n = 5), postoperative fibrous scars (n = 2), and chronic hemodialysis fistulas (n = 13). Follow-up ranged between 6 weeks and 53 months (mean follow-up, 14.9 months). Acute occlusion occurred in two stents, one within a tumor stenosis and one in a dialysis shunt after 3 days and 2 days, respectively. Balloon angioplasty, thrombolysis, and aspiration in the first case and balloon angioplasty and thrombolysis in the second case successfully restored patency. Definite occlusion occurred in these two patients after 8 weeks and 5 months, respectively. Ten secondary interventions were performed in three patients with 10 restenoses who had stenotic arm veins in chronic hemodialysis at presentation. Five of seven patients who received treatment for stenoses associated with hemodialysis underwent successful kidney transplantation 5-27 months after placement of vascular stents. Both patients who received treatment for benign strictures had patent stents at follow-up examinations performed at 45 and 53 months, respectively. Four of five stents placed for malignant stenoses were patent at venography (n = 3) or autopsy (n = 1).

Adult↗
PubMed1991

[Therapy of acute peripheral arterial occlusion].

Acute arterial occlusion in an extremity must be treated as a medical-surgical emergency since not only the affected limb is endangered, but the life of the patient as well. The cause of the acute occlusion is an embolism or in situ thrombosis. The most common source of embolism is the heart from which about 30% of the cardiac emboli obliterate the bifurcation of the femoral artery and about 4/5 of all emboli involve the extremities. Arterio-arterial emboli arise from aneurysms or from nonocclusive, ulcerated atheromatous plaques. Acute in situ thrombosis occurs mostly at the site of stenotic arteriosclerotic lesions. Aneurysms and dilated forms of atherosclerosis can be both the cause of in situ thrombosis as well as the source of an embolism. Differentiation between thrombosis and embolism can be extremely difficult but for acute treatment, however, it is of little relevance. There is a peak of both events in the seventh and eighth decades. On complete occlusion without adequate collaterals, the presentation is characterized by "the six Ps": pain, pallor, pulselessness, paresthesia, paralysis and prostration. With acute occlusion of central points such as the aortic bifurcation or the femoral artery bifurcation, there is complete ischemia with onset of rhabdomyolysis after four to six hours which can lead to severe local and generalized symptoms due to the dangerous metabolites released. In contrast, occlusion of isolated lower leg arteries usually only lead to transient symptoms. If arterial occlusion is suspected, prior to transportation to the hospital, 5000 I.E. heparin should be given intravenously. Acute thrombotic occlusion of large arteries is the surgical domain.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗