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Biomedical subjects

J M Rothenbühler

Publications and source records attributed to J M Rothenbühler.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Emergency surgery of a case of perforated gastroduodenal ulcer].

Surgical treatment of acute perforated gastric and duodenal ulcer is connected to high postoperative lethality. By emergency procedure it has to be decided between performing a simple closure or performing initially a definitive operation to control the peptic disease. The therapeutic options at our institution are based on a severity score which includes patient's age, associated pathology, grade of the peritonitis, delay between the onset of symptom and surgery, history of ulcer disease. Charts of 90 patients consecutively operated during 6 years for acute perforated ulcer were analysed. The average age was 65.5 years, the operation was performed within 6 h in 47.3% of the patients. To perform or not a definitive operation is an important therapeutic option as by simple closure 45% recurrence is observed with a lethality of 36%. Based on our scoring system, 87.9% of all the patients underwent definitive operation. The lethality rate of this series of nonselected patients (52% were older than 70 years) was low: 6.3%. The use of the severity score help to choose patients to be treated by simple closure and patients which may be submitted to definitive emergency operation with low operative risk.

Adult↗
PubMed1992

[Sacro-coccygeal cyst: surgical techniques and results].

69 patients with a chronic inflamed pilonidal sinus were reviewed. They were operated either with a deep excision to sacrum (37 patients) or with the Lord Millar technique (32 patients). 66 patients (87%) were controlled at a mean follow-up of 3.7 years after the operation. The socio-economical advantage of the Lord Millar operation is demonstrated by the shorter hospital stay (4.9 vs 7.6 days) and the shorter period of disability (14 vs 26 days). 5 recurrent episodes were observed among the 31 patients followed-up after an excision (16%) and 7 among the 29 followed-up after a Lord Millar operation (24%). In the later group one recurrence was seen in the sub-group of the 16 patients regularly epilated after the operation (6%) and 6 in the sub-group of the 13 who were not controlled (46%). We conclude that the Lord Millar operation is an alternative to the deep excision operation provided the patients is motivated enough to come regularly to the control for an epilation.

Follow-Up Studies↗
PubMed1991

[Results of the surgical treatment of gastroduodenal hemorrhage].

383 operations for peptic ulcer were performed between 1984 and 1989. There were 114 operations for hemorrhage. The average age of patients was 65 years (21 to 90). 93% of our patients underwent preoperative endoscopy. 52.6% underwent emergency surgery whereas 47.4% had early elective operation. 91.1% of all patients underwent surgery with curative intention for peptic disease in the form of a highly selective vagotomy or partial gastrectomy. The overall mortality rate of 13.2% was influenced by age (less than 70 years: 6.5% / greater than 70 years: 20.4%), by localization of ulcer (stomach: 7%/duodenum: 16%), by time of operation (emergency: 22%/early elective: 6.3%) and by number of blood transfusions (less than 5 units: 7.7% / greater than 5 units: 21%). We conclude that bleeding gastroduodenal ulcers remain a significant complication of peptic ulcer disease. Only a multidisciplinary approach to gastroduodenal hemorrhage, including stabilization of vital functions, endoscopic hemostasis and early elective operation, will contribute to a reduction of mortality.

Adult↗
PubMed1991

[Esophageal manometry prior to and following anti-reflux surgery].

We analysed the esophageal manometry of 36 patients before, and of 25 patients 1 to 14 years (5.8 years) after, fundoplication. The results were compared with the findings in 30 asymptomatic volunteers. Fundoplication raised the mean lower esophageal sphincter pressure from 6.2 mm Hg to 14.5 mm Hg, i.e. normal values (controls 20.2 mm Hg). The shortened lower esophageal sphincter length and its intraabdominal segment were overcorrected (increase from 3.2 to 5.2 cm [controls 4.1 cm] and 1.3 to 2.6 cm [controls 2.1 cm] respectively). The rate of non-specific motility disorders after fundoplication was reduced from 61% to 28% (controls 7%). A clear relationship between the success of fundoplication and either preoperative or postoperative manometric results could not be established.

Adult↗
PubMed1991

[Diagnosis of susceptibility for malignant hyperthermia using in-vitro muscle contraction testing in Switzerland].

Malignant hyperthermia is a potentially fatal pharmacogenetic disorder triggered by volatile anesthetics (halothane, enflurane, isoflurane) and/or succinylcholine. The inheritance of malignant hyperthermia susceptibility is thought to be autosomal dominant and the incidence could be as high as 1:10,000. The only generally accepted diagnostic method at present involves a muscle biopsy followed by in-vitro halothane and caffeine contracture tests. 100 individuals from 45 families who were considered to be potentially malignant hyperthermia-susceptible were investigated from 1986 to 1990 by in-vitro muscle contracture tests using the protocol of the European Malignant Hyperthermia Group. Of 45 families analyzed, 28 had at least one person who was susceptible to malignant hyperthermia with a total of 64 malignant hyperthermia-susceptible individuals. 36 subjects in the 45 families were normal. In addition, our study shows that a femoral nerve block can be used in outpatients as a reliable anesthetic technique to perform biopsies from the vastus medialis muscle for malignant hyperthermia screening.

Adolescent↗
PubMed1991

[Cephalic prosthesis for fractures of the femoral neck (702 cases). Comparative results of simple and intermediate cephalic prostheses].

The authors are presenting a retrospective study of the long time results of 702 femoral cephalic endoprostheses, 451 unipolar and 251 bipolar. The mean age of the patients at the moment of intervention was 80 years, the operation was done in the majority of the cases for a fracture of the femoral neck. The average follow-up was 33 months for the unipolar, and 24 months for the bipolar prostheses. The rate of reoperations was similar in both series, but the rate of luxations was slightly lower for the unipolar prostheses. 82 patients (out of 120 surviving) have been controlled with an average follow-up of 6.5 and 4.5 years. The unipolar prostheses had a lower average New Mayo Hip Score (58.5 vs. 68.2). Radiologically, there were 7 acetabular protrusions in the group of unipolar prostheses and none in the other group. If both types of prostheses have their place in surgery of the hip, the authors recommend to implant bipolar prostheses in younger and more active patients, where a survival of many years is expected.

Actuarial Analysis↗
PubMed1991

[Surgical treatment of Achilles tendon rupture].

Ruptures of the Achilles tendon are rare, but their incidence seems to become higher due to changes of life style and to increasing sports activities. Concerning the optimal therapy--conservative or surgical--there still exist diverging opinions. In our clinic, we have always preferred surgical therapy. We present a survey of the results of surgical treatment in 139 patients. Based on our own experience and on a literature review we recommend surgical therapy for rupture of the Achilles tendon, mainly in view of the high incidence of reruptures after conservative treatment and the existing functional results.

Achilles Tendon↗
PubMed1991

[Is cecostomy still current for emergency relief of the colon?].

The policy of treatment in patients with acute obstruction of the left colon remains controversial. One-stage emergency colectomy and primary anastomosis is usually recommended. Is a multiple-stage approach with primary blowhole cecostomy still a valuable solution? This retrospective analysis of 117 patients with emergency cecostomies shows an overall perioperative mortality and morbidity which are favourable compared with those reported in series of similar cases treated by one-stage procedures. In all patients the colon obstruction was treated effectively by the cecostomy. Only two of the stoma-related complications required operative intervention. The second operation was performed after a mean interval of 12 days. The low perioperative mortality of 2.1% shows, that the time was successfully used to optimize the perioperative conditions. It is concluded that patients with a very poor risk may profit by preliminary decompression by blowhole cecostomy.

Aged↗
PubMed1990

[A year experience with extracorporeal shockwave lithotripsy of gallstones].

43 patients with symptomatic gallbladder stones were treated by extracorporeal shockwave lithotripsy and oral bile acids. In all patients the stones were successfully fragmented during the first lithotripsy session. 33 patients underwent 2-4 treatment sessions. In 16 out of 43 patients the stones disappeared within 7.9 months. The rate of stone dissolution was dependent on the number and size of stones. 3 patients required surgery because of frequent colic in one case, cholecystitis in one case and lack of cooperation in one case. No important side effects were noted except mild pancreatitis 3 weeks after lithotripsy in one patient. Results at this center of extracorporeal shockwave lithotripsy combined with oral bile acids indicate that this treatment may become an alternative to cholecystectomy in patients with a small number (less than 3) of stones not exceeding 30 mm in diameter.

Adult↗
PubMed1990

[Single-layer suture to re-establish the digestive continuity following partial gastrectomy].

We have introduced progressively since 1985 the single-layer continuous suture technique for gastroenteric anastomoses, since this technique has been proved to be safe in colonic anastomosis. From 117 gastrectomies performed between 1985 and 1988, 68 gastroenteric anastomoses were performed with the single-layer continuous suture technique (58%). In 1988 this technique has been applied to 92.5% of the gastroenteric anastomoses. The complication rate is low: 3% clinical leakage were found. We concluded that the single-layer continuous suture technique for gastroenteric anastomoses is safe, very simple and easy to perform. It is the logical extension to large and small bowel anastomoses that we have been doing, using this technique for over 4 years now with excellent results.

Aged↗
PubMed1990

[Technique of bile duct revision].

In view of the progress of endoscopic treatment of common bile duct pathologies the management of retained common duct stones following simple cholecystectomy has become a minor problem. Nevertheless duct stones should be recognized and removed during the cholecystectomy procedure. High risk patients or extreme forms of acute inflammation are an exception. For this purpose a standardized technique of revision of the common bile duct is recommended. We describe such a technique of the exploration of the common bile duct by means of manual extraction, Fogarty catheter, irrigation, distension--irrigation and flexible choledochoscopy.

Cholecystectomy↗
PubMed1990

[Surgical treatment of cholelithiasis and its complications. Comparison of 2 treatment periods].

We have realized a retrospective analysis of all cholecystectomies performed during two five-year periods (period I: 1970 to 1974, period II: 1984 to 1988) for stone disease. We were especially interested in the development concerning the type of intervention, the diagnostic procedures, the morbidity and mortality. Our analysis showed in the second period the substitution of the preoperative diagnostic procedure away from the cholangiography up to the ultrasound, a significant decrease of interventions, a marked decrease of surgically performed papillotomies and a reduction of mortality.

Ampulla of Vater↗
PubMed1990

[Value of extracorporeal piezoelectric lithotripsy in treatment of gallstone disease].

Alternative techniques were introduced in the last 20 years for the treatment of gallstones. Among these the extracorporeal shock wave lithotripsy followed by a systemic litholytic therapy represents undoubtedly the most attractive one. A group of two surgeons and two gastroenterologists has started to evaluate this treatment in April 1988, using a piezoceramic lithotryptic system (Piezolith 2300). From April 1988 to May 1989 we have treated 32 patients who fulfilled the selection criteria-symptomatic gallstone disease, 1-3 radiolucent concrements of less than 30 mm of diameter, functioning gallbladder. We noted only one pancreatitis as a complication of this treatment. The overall stonefree rate is 16% after two months, 32% after four months and 56% after six months, depending on the size and number of stones. A definitive evaluation and final conclusion will only be possible when the rate of late recurrences after this treatment will be known.

Adult↗
PubMed1989

[Pain-free piezoelectric extracorporeal shock wave lithotripsy in gallbladder stones. Initial experiences].

Efficacy and side effects of lithotripsy of gallbladder stones with a piezoelectric lithotriptor are assessed. 16 treatments were performed in 8 patients (1-3 per patient). Patients required no premedication, analgesia, infusion or monitoring. Gallstone fragmentation was achieved with all treatments. Laboratory findings remained unchanged after treatment, with the exception of one patient with mild pancreatitis. With adjuvant oral bile acid treatment, 6 of the 8 patients were stone-free within 3 days to 3 months. Extracorporeal shockwave lithotripsy with piezoelectric shock waves provides painless and efficient gallstone fragmentation. Repeated treatments may speed complete fragment dissolution.

Adult↗
PubMed1989

[Long-term results following fundus plication and vagotomy in reflux disease. Complaints after 10-20 years].

In 109 patients with primary reflux disease in whom combined fundoplication and vagotomy had been performed, the clinical results were evaluated by questionnaire 10-20 years (median 15.7 years) after operation. Indication for additional vagotomy was severe reflux disease and/or increased gastric acid output in 56 (A) and coexistent ulcer disease in 53 (B) patients. Vagotomy was truncular (with pyloroplasty) in 49, selective gastric (with pyloroplasty) in 50, and proximal gastric in 10 patients. Follow-up was available from 64 patients (59.6%). The results were as follows: 17.2% (A 19.4%, B 7.1%) had reflux symptoms, while 9.5% (A 11.4%, B 7.1%) needed medical antireflux therapy. Dysphagia was present in 28.2% (A 13.9%, B 35.7%), and gas-bloat in 54.7% (A 55.5%, B 53.6%). Typical postvagotomy symptoms were diarrhea in 23.5% (A 30.6%, B 14.3%) and dumping in 25.0% (A 22.2%, B 28.6%). Using the Visick classification criteria we found grade I and II in 73.4%, grade III in 17.2% and IV in 9.4%. Symptoms are frequent after fundoplication and vagotomy. The clinical result is more favourable in group B and for the combination of fundoplication with proximal gastric vagotomy.

Deglutition Disorders↗
PubMed1989

[Surgery in para-esophageal hiatal hernia: technic and results].

40 patients with paraesophageal hiatus hernia have undergone surgery over a period 25 years' period. Surgery consisted of gastropexy in 38 patients (ventral corpopexy in 32, fundophrenicopexy in 19), narrowing of the hiatus in 24 and fundoplication in 14. There was one operative death (2.5%). On follow-up 3 to 24 years later (mean 12.5 years) 17 of 20 patients (85%) have good or excellent results. 2 patients without additional antireflux surgery had to be reoperated later because of severe reflux disease (secondary fundoplication). 1 patient with gastropexy and fundoplication has recurrent reflux disease. X-ray studies in 18 patients showed recurrent paraesophageal hiatus hernia in 9 (50%). After operation for paraesophageal hiatus hernia a good clinical long-term result can be expected. To reduce the frequency of recurrent hernia, technical modifications should be considered.

Adult↗
PubMed1989

[Initial results with transversalis-plasty in the treatment of inguinal hernia].

Because of our recurrence rate of 7.2% after primary operation for inguinal hernia and 10% after operation for recurrent hernia using a modified Bassini procedure, we adopted a transversalis fascia repair under local anesthesia in November 1985. From November 1985 to December 1987 we performed 455 operations on 424 adults. During the introduction phase of this new technique there were especially initially 65 other procedures (modified Bassini or Cooper's ligament operation). 301 patients could be followed by letter 6 months after the operation. Only patients with pain or suspected recurrence were interviewed. We analyzed the group of patients who underwent a transversalis fascia repair (n = 390). 99% were satisfied with the local anesthesia. The average length of stay in the hospital after repair of a primary inguinal hernia could be shortened (2.8 days). The patients returned to work after an average rehabilitation of 3.1 weeks. We have had few early complications (0.7%). It is still impossible to say if this technique is sure in our hands because of the short and incomplete follow-up. Only the long-term results will show the real value of this operative procedure.

Abdominal Muscles↗