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L von Segesser

Publications and source records attributed to L von Segesser.

133 records · Page 8Linked to original sources
PubMed1983

[Appendicular invagination and post-appendectomy invagination].

Intussusception of the appendix is an uncommon event (200 cases previously reported) and intussusception after appendicectomy is rare (20 cases previously published). Two recent cases are reported, the first with primary appendiceal intussusception and the second ileocolic intussusception after appendicectomy. In the second case the final pathology report revealed an intussuscepted caecal duplication responsible for the ileocolic intussusception. This event has not been previously reported. Symptomatology, investigation, classification, differential diagnosis and surgical tactics are discussed.

Adolescent↗
PubMed1978

[The problem of airway collapse in lung emphysema. Correlation between intravital lung function measurements and morphometric data].

Lowering of forced expired volume in one second as a percentage of vital capacity (FEV1%VC) and check-valve phenomenon of expiratory flow curve (CVPh) are clinical signs of bronchial collapse. In this study the correlations between these functional parameters and morphologic findings are studied. The study comprises autopsy cases in which lung function had been tested 1.5 years on average before death. In 138 cases emphysema was graded on papermounted macrosections and in 52 cases bronchi were studied by morphometry. 19 of the latter were analysed more thoroughly; 9 had shown CVPh. The results were as follows: 1. Collapse phenomena occur more frequently in cases with destructive emphysema than in cases without. However, it is not exclusive to the former. 2. FEV1 and CVPh correlate with hypertrophy of bronchial glands. 3. Cases with CVPh show hypertrophy, not atrophy, of the walls of central bronchi. It follows that bronchial collapse phenomena are mainly influenced by increased bronchial secretion of viscous mucus and not by emphysematous destruction of lung parenchyma. On forced expiration, mucus plugging probably leads to a decrease of intrabronchial pressure in the downstream bronchi. Thus, the downstream bronchi may collapse because the equal pressure point between intrabronchial and intrathoracic pressure shifts from the central to more peripheral bronchi.

Bronchi↗
PubMedDate not supplied

Extended follow-up after atrial repair for transposition of the great arteries: a younger age at surgery improves late survival.

BACKGROUND: Surgical treatment for transposition of the great arteries (TGA) usually involves anatomic repair, although atrial repair is used in cases with special coronary artery patterns. METHODS: Records of all 239 patients surviving at least 30 days after atrial correction of TGA between 1962 and 1987 at the University Hospital in Zurich were reviewed. The mean length of follow-up time was 13.7 years (median 14.9 years; range from 0.05 to 30.1 years). The average age at surgery was 45.7 months (range from 7 days to 24.4 years). One hundred twenty-one patients had a simple TGA, whereas the remaining 118 had a complex TGA. RESULTS: The surviving patients were in NYHA class I at time of follow-up. The most common reasons for death were systemic right ventricular dysfunction and sudden rhythm disturbances. There was a major risk for late cardiac event in patients over 3 years old at operation (p = 0.02) and also in patients with complex TGA (p = 0.03). However, date of surgery, previous surgery, or the postoperative requirement for a pacemaker did not greatly affect late cardiac mortality. CONCLUSIONS: Although the procedure of choice for TGA is the arterial switch operation, the promising findings of the current long-term study, which reports the longest follow-up to date, indicate that the atrial switch operation is a good alternative procedure for the rare cases where the use of arterial switch procedures is limited.

Adolescent↗
PubMedDate not supplied

Repair of anomalous origin of the left coronary artery from the pulmonary artery without early and late mortality in 9 patients.

An anomalous origin of the left coronary artery from the pulmonary artery is a very rare congenital malformation. We examined the early and late results of 9 patients (4 males and 5 females, mean age at operation: 6.5 years +/- 6 years). Eleven operations were performed in these 9 patients. The following types of operation were performed: ligation of the left coronary artery close to the pulmonary artery in one case, coronary artery bypass grafting in 3 patients, reimplantation of the LCA into the aorta in 3 patients and interpulmonary artery tunnel repair ("tunnel operation") in 4 instances. These operations were combined with plastic reconstruction of the mitral valve (1 patient) or aneurysmectomy of the left ventricle (3 patients). There was no intra- or early operative mortality. After a mean follow-up of 7.3 years, all patients are alive and in New York Heart Association functional class I, except one patient suffering from dyspnoea during moderate exercise. In two patients complications requiring reoperations occurred after 4 and 100 months respectively: stenosis of the distal anastomosis after coronary artery bypass grafting using saphenous vein and thrombosis of the intrapulmonary tunnel. We conclude that an anomalous origin of the left coronary artery from the pulmonary artery is best operated by reimplantation of the vessel into the aorta at any age of life. Concomitant pathology may be corrected simultaneously, without increasing operative mortality.

Adolescent↗
PubMedDate not supplied

A compliant small-diameter vascular prosthesis lined with functional venous endothelial cells.

The long-term patency of small-diameter vascular grafts is still unsatisfactory. In contrast to native arteries, they are inelastic and lack active antithrombogenicity. To improve long-term patency, a new 4 mm internal diameter prosthesis was developed which is compliant and lined with functional endothelial cells (ENC). The wall of this prosthesis consists of a microporous polyurethane-siloxane copolymer reinforced with a polyester network. It displays compliance (13.2 x 10(-4) mmHg-1) comparable to native arteries, is nonkinkable (minimum radius of curvature = 5 mm), burst resistant, and easily suturable. Using a lining procedure, coverage of prostheses by ENC was in excess of 95%. The ENC populations were found to be highly pure (by factor VIII-related antigen, DilAcLDL uptake) and to produce about 0.3 ng prostacyclin per cm2. In vitro tests of shear stress resistance demonstrated that ENC monolayers on the new elastic prosthesis remain intact for 3 hr in physiologically pulsating culture medium (Vmax = 50 cm/sec). Lined prostheses implanted for 24 hours in mongrel dogs as an arteriovenous shunt demonstrated the antithrombogenicity of the cultured ENC. The results suggest that small-diameter vascular prostheses which are compliant, porous, and actively antithrombogenic are feasible.

Animals↗
PubMedDate not supplied

Irreversibility of cyclosporine-induced renal function impairment in heart transplant recipients.

The use of cyclosporine therapy for heart transplant recipients has been associated with a significant improvement of graft survival. Renal function impairment is a frequent finding in patients chronically treated with cyclosporine. The purpose of this prospective randomized study was to establish renal function in a group of heart transplant recipients receiving chronic cyclosporine treatment and to test the hypothesis of reversibility of cyclosporine-induced nephropathy by late reduction of cyclosporine. A total of 28 patients who underwent operation at least 18 months before this study began were randomly assigned to either group A (n = 14), in which the whole-blood polyclonal cyclosporine target trough level was reduced from 400 to 600 micrograms/L to 200 to 400 micrograms/L, and group B (n = 14), in which the level was maintained at 400 to 600 micrograms/L. Renal and cardiac function were assessed by paraaminohippuric acid, inulin and lithium clearances and heart catheterization, respectively, at entry and 4 months later. Cellular rejection in the transplanted heart was monitored by at least four endomyocardial biopsies every 14 days with the histologic Texas scale (grading: 0 to 10). In heart recipients renal blood flow (592 +/- 202 ml/min/1.73 m2) and glomerular-filtration rate (74 +/- 33 ml/min/1.73 m2) were significantly lower (p < 0.01), and mean arterial blood pressure (109 +/- 13 mm Hg) and renal vascular resistance (22.4 +/- 9 mm Hg/dl/min/1.73 m2) were significantly higher than the corresponding values in normal controls (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗