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Biomedical subjects

M Genoni

Publications and source records attributed to M Genoni.

At least 55 records · Page 3Linked to original sources
PubMed1997

Temporary loss of cardiac autonomic innervation after the maze procedure.

OBJECTIVE: Blunted sinus node response to exercise has been reported after the maze operation. We suggested the autonomic vegetative function of the heart to be disturbed after the maze procedure. METHODS: 17 patients, mean age 63 +/- 15 years, with chronic atrial fibrillation for 49 +/- 46 months (range 5-65) underwent the maze procedure during mitral valve surgery. Bicycle stress test, 24-h electrocardiography and heart rate variability were analysed in 11 patients after three and in six after 14 +/- 3 months. Spectral analysis within two frequency bands, vector analysis of the main circular resultant and influence of orthostasis and Valsalva manoeuvre on different R-R intervals were calculated. RESULTS: One patient died from a perioperative ischaemic stroke. At follow-up, all patients were in sinus rhythm. Heart rate reached 84 +/- 14%, the mean circular resultant was 60 +/- 48%, the ratio of the longest to the shortest R-R interval during the Valsalva manoeuvre was 92 +/- 8% and the ratio of maximal to minimal R-R interval after orthostasis was 98 +/- 4% of the age-adjusted normal value. Maximal workload was 116 +/- 31 watts. All patients had abnormal heart rate variability. Heart rate variability was significantly more blunted after three months, than after 14 months (P < 0.05). The minimal heart rate and the difference between the maximal and the minimal heart rate during the 24-h electrocardiography were significantly correlated to the number of normal physiological tests (r = -0.52; P < 0.05; r = 0.71; P < 0.005); for the maximal heart rate, there was a positive trend only (r = 0.44; P = 0.07). CONCLUSIONS: Early after the maze procedure, a nearly total denervation of the sinus node is present, similar as seen after heart transplantation, with partial restoration of the autonomic function after one year. The exercise capacity of the patients was satisfactory.

Adult↗
PubMed1997

Aortobronchial and aortoesophageal fistulae as risk factors in surgery of descending thoracic aortic aneurysms.

OBJECTIVE: Assess outcome of patients with descending thoracic aortic aneurysms complicated by aortobronchial and aortoesophageal fistulae in comparison to patients undergoing repair of aortic aneurysms without fistulae. METHODS: In a consecutive series of 145 patients (age 60 +/- 12 years) with repair of descending thoracic and thoracoabdominal aortic aneurysms, 11 patients (8%; age 63 +/- 9; NS) primarily presented for hematemesis and/or hemoptysis. In 8/11 patients (73%) an aortobronchial fistula was identified, and 3/11 patients (27%) suffered from an aortoesophageal fistula. Five of 11 patients (45%) had undergone previous aortic surgery in the same region. RESULTS: Extent of aortic segments (range 1-8) replaced was 3.1 +/- 1.4 for all versus 2.6 +/- 0.9 for fistulae (NS). Aortic cross clamp time was 38 +/- 22 min for all versus 45 +/- 15 min for fistulae (NS). Mortality at 30 days was 18/145 (12%) for all versus 16/134 (12%) without fistulae versus 2/11 (18%) with fistulae (NS). Paraparesis and or paraplegia was observed in 11/145 (8%) for all versus 10/134 (7%) without fistulae versus 1/11 (9%) for cases with fistulae (NS). Nine additional patients died after hospital discharge, seven without fistulae and two with fistulae (days 80, and 120) bringing the 1-year mortality up to 23/134 (17%) without fistulae versus 4/11 (36%) with fistulae (NS). Further analysis shows that the 1-year mortality accounts for 1/8 patients (13%) with aorto-bronchial fistulae versus to 3/3 patients (100%) with aorto-esophageal fistulae (esophageal versus bronchial fistula: P = 0.018; esophageal versus no fistula: P = 0.006). CONCLUSIONS: Outcome of patients suffering from descending thoracic aortic aneurysms complicated by aorto-bronchial fistulae can be similar to that without fistulae, whereas for cases complicated by aorto-esophageal fistulae the prognosis seems to remain poor even after successful hospital discharge.

Aged↗
PubMed1997

Traumatic ventricular septal defect.

A 26 year old man was admitted to hospital following a traffic accident. He had been sitting in the back of a car without wearing a seat belt. He suffered crush injuries on the anterior chest wall, trunk, and legs. On admission he was awake and cooperative, but restless, and obviously in severe pain. Radiography of the skull, facial bones, chest, spine, pelvis, and legs revealed a shaft fracture of the left femur and tibia and fracture of the 7th and 8th right ribs. The patient was transferred to the University Hospital of Zurich for further assessment and surgical repair of the lower limb fractures three days later. Because of worsening clinical condition with onset of partial respiratory insufficiency and new loud systolic murmur at the left sternal edge, a transthoracic echocardiography was performed, which showed an apical ventricular septal defect. Surgery was performed immediately. The ventricular septal defect was successfully repaired using a Teflon felt patch and interrupted sutures with pledgets, and sealed with glue. At six months' follow up the patient was doing well. Ventricular septal defects after blunt chest trauma occur either because of heart compression between sternum and the spine or because of myocardial infarction. In the present case the ventricular septal defect appeared three days after the accident, probably secondary to a post-traumatic myocardial infarction. Patients with blunt chest trauma and suspicion of cardiac contusion should be monitored carefully.

Accidents, Traffic↗
PubMed1997

Ivemark syndrome. A case with successful surgical intervention.

A 19-day-old boy with Ivemark syndrome (splenic agenesis associated with complex cardiac malformations and visceral abnormality) underwent palliative surgery including Glenn and hemi-Fontan procedures. Five months later the child is alive and well. We believe that early palliative surgery is worthwhile in Ivemark syndrome with a single ventricle.

Abnormalities, Multiple↗
PubMed1996

[Time loss in the therapy of acute heart infarct].

As part of the ISIS study, the prehospitalization phase in 570 patients with acute myocardial infarction was evaluated and protocolled in 34 Swiss hospitals. The aim was to assess whether the time lapse between onset of pain symptoms and start of treatment could be shortened. It was felt that, particularly in the case of lethal cardiac arrhythmias, rapid intervention could secure reversal or controlled relief of symptoms and/or conduction disorders. The study protocol recorded the specific time lapses between onset of symptoms and notification of the physician, notification of the physician and hospital admission, and between hospital admission and therapeutic action. The longest time lapse observed was the patient's delay (57%). Delay by the patient was shortened when pain symptoms (a) occurred during daytime, (b) were preceded by symptoms in the week before the infarction, (c) occurred at work, and (d) occurred during exercise, particularly in the company of unknown persons. The longest time lapse observed in hospital was associated with the night shift. The time lost through delay in contacting a doctor, the main factor in delaying therapeutic action in acute myocardial infarction, is very difficult to influence since the target group for a public information campaign is hard to identify. On the other hand, the "door to needle" time lapse observed in hospital can be reduced by the introduction of clear-cut guidelines.

Aged↗
PubMed1996

[ACE-inhibitors in acute heart infarct].

The use of ACE-inhibitors in heart failure has been established over the past years. Their use is of uncertain value in the early phases of myocardial infarction, where they are supposed to prevent left ventricular dilatation. More recent studies (ISIS-4, GISSI-3) have tested early treatment by ACE-inhibitors in the acute phase of myocardial infarction. On one hand, it was possible to disprove reservations about risks (hypotension)n in a large cohort; on the other hand, a further reduction of mortality in hospitalized patients by 7% has been shown, corresponding to five patient lives saved for 1000 treated patients. Thus, after institution of the customary therapy of myocardial infarction (inhibitor of platelet aggregation, thrombolysis, beta-blocker) and after exclusion of specific contraindications (hypotension < 100 mmHg, renal failure) ACE-inhibitors could be administered in the acute phase of myocardial infarction. An analysis of the results from these large trials will show whether ACE-inhibitors may benefit groups of patients at particular risks (Killip > 1, age > 70 years, preceding renal failure) noticeably. ACE-inhibitors remain the treatment of choice in patients with developing left ventricular failure.

Acute Disease↗
PubMed1996

[Heart surgery in acute heart infarct. Indications and results].

The therapy of acute myocardial infarction has made major advances in the last 10 years. Cardiac surgeons have to adapt their strategies to the more aggressive management of acute myocardial infarction. Only in mechanical complications of acute myocardial infarction is cardiac surgery nowadays the therapy of choice. In cardiac rupture and ventricular septal defect, surgery is the only therapeutic option. In ischemic mitral regurgitation, cardiac surgery is required in the event of concomitant cardiogenic shock and pulmonary edema after intra-aortic balloon pump placement. Coronary artery bypass surgery my be indicated at low risk in patients with unstable angina pectoris when PTCA is not feasible or has failed, or in catheter emergencies.

Acute Disease↗
PubMed1996

Eradication of aortic infections with the use of cryopreserved arterial homografts.

BACKGROUND: The surgical treatment of vascular infection is associated with a substantial early and late mortality. Cryopreserved homografts were evaluated for in situ reconstruction in aortic infections. METHODS: Between January 1991 and July 1995, homografts were used in 19 patients (mean age, 61 +/- 13 years; range, 40-85 years) with mycotic aneurysms (9/19; 47%) or infected grafts (10/19; 53%) in the thoracic (7/19; 37%) or abdominal (12/19; 63%) aorta. Sepsis was present preoperatively in 14 of 19 (74%) patients, and 18 of 19 (95%) had received antibiotic treatment for 6.4 +/- 6 months (range, 1-36 months). Up to ten previous vascular procedures had been done in 11 of 19 patients (58%). RESULTS: There was one (5.2%) early and two (11%) late deaths, with one (5.5%) of the late deaths being homograft related. The mean hospital stay was 27 +/- 26 days (range, 7-84 days). Antibiotics were given postoperatively for 30 +/- 12 days (range, 4-84 days). During the follow-up period of 18.6 +/- 13 months (range, 7-60 months), there were no instances of reinfection, suture line rupture, homograft stenosis, or anastomotic aneurysms. CONCLUSIONS: Cryopreserved arterial homografts allow safe in situ reconstruction, decrease early and midterm mortality, and reduce antibiotic requirements. Early and midterm reoperations are unnecessary.

Adult↗
PubMed1996

Surgery for ruptured thoracic and thoraco-abdominal aortic aneurysms.

OBJECTIVE: To assess the outcome of patients with ruptured descending thoracic and thoracoabdominal aortic aneurysms undergoing emergency repair, in comparison to elective surgery for chronic lesions. METHODS: A prospective study of 100 consecutive patients operated upon the descending aorta (1-8 segments) using proximal unloading and distal protection with partial cardiopulmonary bypass, heparin surface-coated perfusion equipment and low systemic heparinization (loading dose 100 IU/kg, activated coagulation time > 180 s), staged cross-clamping, sealed grafts and graft inclusion. RESULTS: Arteriosclerotic lesions were present in 53/100 patients (53%) for all, 30/53 (56%) for chronic, and 21/33 (63%) for ruptured, aneurysms (NS). Dissecting lesions were found in 38/100 patients (38%) for all, 20/53 (38%) for chronic, and 8/33 (24%) for ruptured aneurysms (NS). Preoperative hematocrit was 38 +/- 6% for all, 40 +/- 5% for chronic, and 33 +/- 5% for ruptured aneurysmal patients (P < 0.001 ruptured versus chronic). The extent of aortic repair (1-8 segments) was 3.3 +/- 1.6 for all, 3.5 +/- 1.5 for chronic, and 3.2 +/- 1.4 for ruptured, aneurysms (NS). Transdiaphragmatic repair was performed in 51/100 (51%) of all, 28/53 (53%) of chronic, and 17/33 (51%) of ruptured aneurysms (NS). Aortic cross-clamp time was 38 +/- 21 min for all, 39 +/- 24 min for chronic, and 38 +/- 17 min for ruptured, aneurysmal patients (NS). The amount of red cells washed and autotransfused was 2792 +/- 2239 ml in all, 3143 +/- 2531 ml in chronic, and 2074 +/- 1350 ml in ruptured, aneurysmal patients (P < 0.025). The amount of packed red cells required was 2181 +/- 1830 ml for all, 1736 +/- 1333 ml for chronic, and 2947 +/- 2395 ml for ruptured aneurysmal patients (P < 0.010). Thirty-day mortality was 9/100 (9%) for all, 3/53 (6%) for chronic, and 5/33 (15%) for ruptured aneurysmal patients (NS). Parapareses/plegias occurred in 9/100 (9%) of all, 6/53 (11%) of chronic, and 3/33 (9%) of ruptured, aneurysmal patients (NS). Stepwise regression analysis identified aortic cross-clamp time as a predictor of early mortality (P = 0.002) and parapareses and paraplegias (P = 0.001). Age (P = 0.001), extent of repair (P = 0.008) and preoperative hematocrit (P = 0.001) were predictors for homologous transfusion requirements. CONCLUSION: Emergency repair of ruptured descending thoracic and thoracoabdominal aortic aneurysms can be achieved with acceptable results.

Aortic Dissection↗
PubMed1996

[32 years of Senning's correction for transposition of the great vessels].

Between 1962 and 1994 342 patients with transposition of the great arteries (TGA) were treated by atrial correction. Since 1992 the atrial switch operation is the treatment of choice for TGA. We reviewed our 32 year experience. Average age of the patients at operation was 69 months (7 days--8.5 years). 177/342 (52%) patients had a complex TGA: 74 patients with ventricular septal defect (VSD), 49 patients with pulmonary stenosis (PS) and 54 with both (VSD and PS). The 30 day mortality was for the whole series 15.7%. In the last 4 years 7.5%. The actuarial survival rate for all patients was 88% after 10 years and 82% after 20 years. For simple TGA 91% after 10 years and 83% after 20 years, for complex TGA 84% and 81%. The most important cause of death during our longterm observation were heart failure (19 patients) and sudden death (7 patients). Average follow-up for the whole group was 13.4 years. Most of the survivors are functionally symptom free (66% NYHA I) or they have slight symptoms (29% NYHA II). Only 5% were NYHA III or IV. Arterial switch operation has replaced the atrial correction for TGA. Nevertheless the longterm results after atrial correction remains encouraging. The main threat to the patients is the failure of the systemic ventricle.

Cardiac Surgical Procedures↗
PubMed1996

[Contraindications of thrombolytic therapy in acute myocardial infarct].

In 43 Swiss hospitals, 824 patients have been included in the ISIS-3 trial with suspected or proven myocardial infarction. Another 504 patients with proven myocardial infarction have been excluded for various reasons and have been registered in the study log-book (total 1328 patients). The usual clinical contraindications for thrombolysis are listed and discussed in this paper. 1/3 of those patients excluded from the trial had not received thrombolysis without clear contraindications (age, diabetes, anticoagulation, candidates for a pace-maker) and another 27% have had only relative contraindications (resuscitation, puncture, ulcer pain, hypertension). The new guidelines for thrombolytic therapy allowed more patients to benefit from this therapy.

Adult↗
PubMed1995

Prevention of residual ventricular septal defects with fibrin sealant.

BACKGROUND: Modern echocardiography now allows for the detection of a substantial number of residual ventricular septal defects (VSDs) after surgical patch repair that remained hidden in the past. Mostly without hemodynamic significance, residual VSDs may have clinical consequences (progressive dehiscence, hemolysis, prophylactic antibiotic treatment, endocarditis). To reduce the number and size of residual VSDs we performed an experimental and a clinical study. METHODS: (1) In an experimental setup, burst pressure of 60 fibrin glue-sealed defects (calibrated between 1.0 and 5.0 mm in diameter) was determined using a computerized recording system and pressure loads up to 500 mm Hg. (2) In a prospective clinical trial with blinded postoperative echocardiographic controls VSD closure was performed in 36 consecutive patients (age, 37 +/- 40 months; range, 4 to 134 months) using a polytetrafluoroethylene patch and running sutures reinforced with pledgets (22 of 36 patients) or sealed with fibrin glue (14 of 36 patients) in accordance to the surgeon's preference. RESULTS: (1) Experimentally, mean pressure load achieved was more than 500 +/- 0 mm Hg for 1.0-mm defects, 413 +/- 52 mm Hg for 2.5-mm defects, 363 +/- 58 mm Hg for 4.0-mm defects, and 313 +/- 48 mm Hg for 5.0-mm defects (r 0.873, p < 0.001). (2) Clinically, all patients survived. Residual VSDs at echocardiography were observed in 16 of 22 patients (72%) for reinforced versus 5 of 14 patients (36%) for sealed with fibrin glue (p < 0.05). Diameter of residual VSDs accounted for 1.3 +/- 1.2 mm for reinforced versus 0.3 +/- 0.4 mm for sealed with fibrin glue (p < 0.01). Hemodynamically significant residual VSDs were fond in 2 of 22 patients (9%) for reinforced versus 0 of 14 patients (0%) for sealed with fibrin glue (p = not significant). CONCLUSIONS: Small defects sealed with fibrin glue resist physiologic pressure load. Fibrin glue sealing of prosthetic patches during intracardiac VSD repair allows for significant reduction of number and size of residual VSDs. Improved long-term outcome can be expected.

Anti-Bacterial Agents↗
PubMed1994

Industrially manufactured all-in-one solution in visceral surgery.

OBJECTIVE: The goal of this study was to examine the handling and the effect of a commercially manufactured nutritional solution (VacuKit zero 1) on the postoperative metabolism and the liquid requirement after gastro-intestinal surgery. DESIGN: Open, prospective, nonrandomized study. SETTING: Ward of the visceral surgical department of a town hospital in Switzerland. PATIENTS: 36 consecutive patients after gastro-intestinal surgery. INTERVENTIONS: During the first 5 postoperative days 2,000 ml of the commercially manufactured nutritional solution were administered daily; it was composed of amino acids (100 g), glucose (1,120 kcal), fat (820 kcal) and electrolytes. RESULTS: The nitrogen balance in the postoperative phase was always positive. Laboratory analysis shows that this nutrition solution is well accepted, with stable carbohydrate and fat metabolism and with normal liver and electrolyte parameters. The patients received an average of 500 ml/24 h of additional liquids. CONCLUSIONS: Administration and handling of the solution VacuKit zero 1 requires no special equipment. The nutritional solution proved to be a safe and simple method of parenteral nutrition for metabolically stable patients in the visceral surgery department.

Adult↗
PubMed1994

[Type B aortic dissections: surgical technique and results].

Between 1978 and 1992, 70 patients were operated for type B aortic dissection (tear in the descending aorta without involvement of the ascending aorta). 15/70 (21%) patients had an acute dissection (onset of symptoms < 24 h), 19/70 (27%) a subacute dissection (onset of symptoms < 14 days), and 36/70 (51) a chronic dissection (onset of symptoms > 14 days). The indications for surgery in cases of acute dissection were: hematothorax, oliguria, leg ischemia and persistent pain. Persistent hypertension was an additional indication in cases of subacute dissection. In large majority (93%) of chronic dissections the indication for surgery was enlarged aortic diameter. In 86% (60/70) graft replacement of the aorta was performed, in 6% (4/70) extra-anatomic bypass, in 3% (2/70) fenestration, in 3% (2/70) thrombendarterectomy, in 3% (2/70). The overall mortality was 17% (12/70); 27% of acute dissection, 26% for subacute dissection, and 8% for chronic dissection. The morbidity for acute dissection was 73%, of subacute dissection 43%, and of chronic dissection 12%. The most frequent complications were: leg ischemia (8 patients), renal failure (4 patients), paraparesis (4 patients) and sepsis (2 patients). No paraparesis was encountered in surgery of the chronic dissection. Conservative treatment was tried in all acute B-dissections, with surgical therapy being reserved for complications of the dissection, such as rupture, such as rupture, risk of rupture (hematothorax, large aortic diameter resp. expansion, persistent hypertension, persistent pain) or ischemia of distal vascular beds. Long-term survival for chronic type B dissections is good. Strong control of risk factors (hypertension) is essential.

Adult↗
PubMed1994

[Occlusion of the distal aorta].

Between 1984 and 1992, 79 patients were operated for occlusion of the infrarenal abdominal aorta. 12/79 (15%) of the patients underwent emergency procedure for an acute Leriche syndrome. 67/79 (85%) of the patients with a chronic occlusion were treated electively. The surgical management includes in our series in 57/79 (72%) cases aortoiliac or aortofemoral prosthetic bypass, in 11/79 (14%) cases aortoiliac endarterectomy, in 6/79 (8%) cases embolectomy and in 5/79 (6%) extraanatomical axillofemoral bypass. For chronic total occlusion of the aorta the most common procedure was prosthetic bypass in anatomical position. For emergency cases embolectomy was performed in 42%. Early morbidity rate was 26% (21/79). The most frequent complications were thromboembolic events in 7 patients, myocardial infarction in 4 patients and renal insufficiency in 4 cases. The 30-day mortality 2.5% (2/79); the cause in both cases myocardial infarction. For atherosclerotic occlusive disease of the infrarenal abdominal aorta the prosthetic bypass is the first-choice surgical procedure. For embolic occlusions and for risk patients other less burdening procedures are available.

Adult↗
PubMed1993

[Castleman's disease].

A 17-year-old girl developed acute colicky periumbilical pain with haematuria. On examination a tightly elastic space-occupying lesion about 10 cm in diameter was palpable around the umbilicus. Erythrocyte sedimentation rate (ESR) was raised to 113 mm in the first hour. There was a microcytic anaemia (8.7 g/dl) and a positive Coombs test. Ultrasonography revealed a periumbilical space-occupying lesion of decreased echogenicity and left hydronephrosis. Computed tomography demonstrated a homogeneous noninfiltrative tumour, about 7 cm in diameter, with increased contrast medium concentration. The tumour, which was covered by peritoneum and well circumscribed, was excised from the base of the mesentery. Histologically it proved to have hyaline-sclerotic changes in the blood vessels and lymphoid and plasma cellular infiltrations, corresponding to a mixed form of Castleman's disease. In a second operation a left nephroureterectomy was performed. The kidney, the regional lymph nodes and the tissue which had caused the stenosis of the ureter all showed the same changes as the tumour. Postoperatively the ESR and the blood count became normal, but the Coombs test remained positive. During a subsequent pregnancy the ESR again rose. The patient has remained symptom-free for 38 months after the second operation.

Adolescent↗