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Biomedical subjects

M Genoni

Publications and source records attributed to M Genoni.

68 records · Page 4Linked to original sources
PubMed1993

Helicopter mountain rescue of patients with head injury and/or multiple injuries in southern Switzerland 1980-1990.

The aim of prehospital treatment of head injuries and severe multiple injuries is to prevent additional cerebral damage. When accidents occur in remote mountain areas, time is lost covering the distance to the nearest cabin or village where the rescue team can be called by telephone. Rapid transport of a trained physician to the patient can save precious time and allows prompt control of respiration and circulation at the scene of the accident. In a series of 57 rescue operations between 1980 and 1990, we used a helicopter staffed by an emergency physician and equipped with a winch. The hospital mortality rate was 12 percent (7 out of 57 patients). At 6 months after the accident, a normal neurological state was registered in 44 of the 55 survivors (88 per cent), whereas mild neurological deficiencies were noted in six patients (12 per cent). No persistent coma or vegetative state was seen. This experience suggests that fast rescue by a helicopter equipped with a winch and with an experienced emergency physician on board in an effective way of preventing secondary cerebral damage after accidents in remote mountain areas.

Adult↗
PubMed1993

[Development of surgical treatment of transposition of great vessels in the last 15 years. Methods and early results].

Between 1978 and June 1992, 213 patients were operated for transposition of the great arteries at our institution. 148 patients underwent atrial repair, 41 patients an anatomic repair and 24 patients only palliation. Since 1986 the anatomic repair has progressively replaced the arterial repair: 1978-1986 95-100% atrial repair, 1992 100% anatomic repair. At operation the average age of the patients treated by atrial repair was 22 months, resp. 10 months from 1986 to 1991, for anatomic repair 9 months, resp. 46 days in 1991/1992. The 30-day mortality for atrial repair was 11% (17/148), for anatomic repair 22% (9/41), resp. 12% (3/24) in 1991/1992. Potentially superior long-term results for anatomic repair are possible, but cannot be demonstrated at present.

Child↗
PubMed1993

[Stomach cancer: 10 years experiences with surgical treatment and possibilities for improving the prognosis].

We retrospectively evaluated data on 111 consecutive patients operated between 1976 and 1985 for gastric carcinoma. Patients were staged according to the TNM classification (stage I - 17%, II - 15%, III - 30%, IV - 37%). 66 patients (59.5%) underwent radical resection. Most of curative resections were subtotal distal gastrectomies. Extended lymphadenectomy was not performed. The operative mortality rate was 7.4% in case of curative resections, and 9.6% overall. 20 out of 66 radically operated patients (30%) were treated with adjuvant cytotoxic chemotherapy, while 9 out of 45 non radically operated patients were treated with palliative cytotoxic chemotherapy. The median follow-up time was 36 months (range: 1-166 months) for patients operated for cure and 25 months for the whole population. The estimated adjusted 5-year survival rate was 41.3% after operation in a curative intent, 82.9% for stage I, 62.8% for stage II, 17.8% for stage III, 3.3% for stage IV. The duration of symptoms before diagnosis was longer than 6 months in 18 patients (16.2%) and longer than 10 months in 9 patients (8.1%). Patients who were symptomatic since more than 10 months were on the average about 10 years younger than the rest of the population. The median duration of symptoms was 3.2 months overall, but reached 7.1 months in patients less than 40 years old. Patients with an early gastric cancer (11/111: 9.9%) or stage I disease (19/111: 17.1%) had always symptoms since less than 5 months. The proportion of early gastric cancer increased from 6.3% (3/48) to 12.7% (8/63) from 1976-1980 to 1981-1985, simultaneously to the diffusion of the upper gastrointestinal endoscopy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Gonococcal endocarditis: an infection as rare as it dangerous. Apropos of a case: the importance of suspicion in diagnosis and of immediate treatment].

Gonococcal endocarditis, although extremely rare, is increasing in frequency, particularly among young exposed patients. It has a distinct predilection for aortic and mitral valve involvement and tends to cause rapid valvular destruction and acute heart failure. Blood cultures are often negative during the first (3 to 31) days. Echocardiography with Doppler is helpful in detecting valvular vegetations, regurgitation and signs of hemodynamic deterioration. Early antibiotic treatment may stabilize the hemodynamic situation only in mitral but not in aortic valve involvement, which necessitates prompt valvular replacement in the event of perforation and/or annulus abscess. Gonococcal endocarditis should be the first item to be excluded in cases of fever with systemic symptoms in young people with a history of sex-transmitted disease. We present a typical case.

Adult↗
PubMed1990

[Omniflow: a new vascular prosthesis for hemodialysis access].

Between January and November 1988 20 a.-v. shunts for haemodialysis access were performed at the University Hospital of Zurich with the Omniflow, a prosthesis composed of sheep collagen and polyester mesh. The main reason to implant this vascular prosthesis was the failure of Cimino-shunts. In 9 cases a straight and in 11 cases a performed "u" shape graft was used. During the follow-up period of 3-11 months the following 6 complications were observed: 5 graft thrombosis (in 2 cases due to hypotonia, in other 2 cases due to wrong graft selection and in 1 case due to narrowed venous anastomosis), and one graft dysfunction due to a stenosis in the patients vein. In comparison to the vascular prostheses used earlier, the Omniflow graft is characterized by a high patency rate and an easy puncturing.

Arteriovenous Shunt, Surgical↗
PubMed1990

[Postoperative complications following biliodigestive anastomoses].

Between 1980 and 1988 a total of 91 bilidigestive anastomoses were performed in 91 patients at the University Hospital of Zurich. Fifty-seven percent of the patients with an average age of 55 years were male. The main reasons for surgery were cancer of the pancreas, gallbladder or bile-duct in 38%, and chronic pancreatitis in 33%. In 57% the bilidigestive anastomosis was performed as hepaticojejunostomy, in 38% as choledochojejunostomy. The hospital mortality was 7.6%, the morbidity 40%. Thirteen percent had a leakage of the anastomosis: 11% of the hepaticojejunostomy and 17% of the choledochojejunostomy. Ten percent of the patients with a one-layer single knotted suture presented a leakage of the anastomosis, 11% of those with a two-layer single knotted suture, and 25% of those with a continuous suture. Only a quarter of the leakages had to be reoperated. All the others could be managed conservatively. Renal failure appeared in 13%. Two of those patients needed dialysis. No cases of gastrointestinal bleeding were found in this series. Concluding from these results we perform the bilidigestive anastomosis as hepaticojejunostomy with a one- or two-layer single knotted suture.

Adult↗
PubMed1989

[Utilization of helicopters for the prevention of secondary cerebral lesions in severe craniocerebral injuries].

The prehospital emergency treatment of craniocerebral trauma tries to avoid secondary cerebral lesions by controlling respiration and circulation. The therapy consists of heavy sedation with Midazolam, analgesia with morphine, artificial hyperventilation, PaO2 over 12 kPa and average arterial pressure above 80 mmHg. Our series of 46 patients recovered between 1982-1988 had a hospital mortality of 23%. 46% of the patients were polytraumatized. A normal neurologic state 6 months from the accident was registered in 86.4%. For 13.6% it was slightly pathological and no vigilant coma state was reported. The most effective rehabilitation method at the site of the accident has to secure the cerebral oxygen supply and reduce potential increase in intracranial pressure for avoid secondary cerebral lesions.

Adult↗
PubMed1988

[Systemic thrombolysis using streptokinase. Experiences at the Civic Hospital of Lugano in the framework of the ISIS-2 study].

With a small group of Swiss hospitals we had an opportunity of participating in ISIS-2, the major study on thrombolysis in acute myocardial infarction. Experience with our microcosm (Ospedale Civico Lugano) was compared with the macrocosm of the results of ISIS-2 in 17,187 randomized patients (in brackets). Mortality was 5.1% (7.8%) in our streptokinase group and 15.8% (12.8%) in our placebo group. In the ISIS-2 study the combination of thrombolytic therapy with streptokinase, and of antiplatelet therapy with aspirin, showed a reduction of approximately one third in acute mortality of myocardial infarction, stroke and reinfarction. Our experience confirms the reduced incidence of allergic side effects (3.5%), major bleeding (0.3%) and minor bleeding (2.9%) during or after thrombolytic therapy.

Administration, Oral↗
PubMed1984

[Diagnostic problems in acute pulmonary embolism].

In a retrospective study over the years 1978-1982, 729 cases of acute pulmonary embolism were analyzed in relation to history, clinical signs and laboratory findings and the results compared with the findings of the urokinase pulmonary embolism trial. As far as history and clinical symptoms were concerned, breathlessness, chest pain, tachypnea, tachycardia and cyanosis were the dominating features. Among laboratory tests, the radiological and electrocardiographic findings of pulmonary hypertension were of little value. In contrast, arterial hypoxemia and isotope scanning provided the most reliable diagnostic information. The most frequent problem in differential diagnosis was acute myocardial infarction.

Acute Disease↗
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

The infected aorta.

BACKGROUND: Despite the improvements achieved in antibiotic therapy, severe aortic infection resulting in mycotic aneurysms is still a highly lethal disease and surgical management remains a challenging task. PATIENTS AND METHODS: A total of 43 patients with severe aortic infections were analyzed and separated in four groups: (1) Infections of the aortic root Ventriculo-aortic disconnection due to deep aortic infection (6 patients). Two patients were operated using homo-composit grafts. Of the 6 patients total, one died early and two died late during a mean follow-up of 6 years. The two patients with homografts are still alive. (2) Infections of the ascending aorta and the aortic arch. In situ repair for mycotic aneurysmal lesions of the ascending aorta was performed in 6 patients using synthetic graft material in 4/6, biological material in 1/6 and direct suture in 1/6. Two patients had to be reoperated; one of them died early. There was no recurrent infection during a mean follow-up of 6 years. (3) Infections of the descending thoracic and thoraco-abdominal aorta in-situ repair for mycotic aneurysmal lesions of the descending and thoraco-abdominal aorta was performed in 12 patients using homografts in five. Two patients died early and two other patients died late during a mean follow-up of 6 years. (4) Infections of the infrarenal abdominal aorta. In this series of 19 patients with mycotic infrarenal aortic aneurysms, in situ reconstruction was performed in 12 (5/12 with homografts) and extra-anatomic reconstruction (axillo-femoral bypass) was performed in 7. Hospital mortality was 5/19 patients and another 5/19 patients died during a mean follow-up of 6 years. One of the early deaths was due to aortic stump rupture. Two patients with axillo-femoral reconstructions were later converted to descending-thoracic-aortic-bifemoral bypasses. Five thromboses of axillo-femoral bypasses were observed in three of the seven patients with extra-anatomic repairs. RESULTS: Infections of the aortic root, the ascending aorta and the aortic arch are approached with total cardio-pulmonary bypass, using cardioplegic myocardial protection and deep hypothermia with circulatory arrest if necessary. Proximal unloading and distal support using partial cardiopulmonary bypass is preferred for repair of infected descending and thoracoabdominal aortic lesions, whereas no such adjuncts are required for repair of infected infrarenal aortic lesions. CONCLUSIONS: The anatomical location of the aortic infection and the availability of homologous graft material are the main factors determining the surgical strategy.

Aneurysm, Infected↗