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Biomedical subjects

M Merlini

Publications and source records attributed to M Merlini.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Value of antral mucosectomy, selective proximal vagotomy and a combination of the 2 procedures in serum gastrin production and inhibition of stomach acid. An experimental study].

This experimental study was aimed at determining the volume and acidity produced by the normal stomach, following antral mucosectomy (MA), proximal selective vagotomy (VSP) and combination of both procedures. In 10 mongrel dogs, a double-lumen tube was placed in the stomach under general anesthesia. One of the lumen was rinsed with a constant flow and the other retrieved the gastric secretion. Gastric secretion and acidity were calculated every 10 minutes for 120 minutes. At 60 minutes, pentagastrin was injected. After these controls, a MA was carried out in half the animals and a VSP in the other half. 6 and 12 weeks postoperatively, the same controls were repeated. The dogs were then submitted to the operation of the other group. Following MA and pentagastrin stimulation, the gastric secretion (volume) is not modified with regard to the preoperative levels. On the other hand, after VSP, pentagastrin stimulation induces only a small volume response. The vagus thus seems to be involved in liquid secretion of the stomach. Following MA, pentagastrin stimulation lowers gastric pH at 6 weeks but not at 12 weeks postoperatively. Gastrin is known to have a trophic effect on the oxyntic mucosa. This effect disappears in a few weeks and explains these different figures. Following VSP, gastric acidity decreases and plasmatic gastrin increases. In this situation, pentagastrin directly acts on a trophic mucosa and produces the important lowering of the gastric pH. Finally, after MA, pentagastrin induces an increase in plasmatic gastrin. This effect seems to be mediated by central stimulation of the nuclei of the vagus nerve.

Animals↗
PubMed1992

[Definitive surgery in complicated gastroduodenal ulcers].

Indications for surgical therapy in uncomplicated peptic ulcer disease have decreased considerably since the introduction of H2-receptor blocking drugs and more recently omeprazole. On the other side, the number of acute complications such as perforation or hemorrhage has remained nearly constant. The recent literature seems to indicate that the pattern of patients presenting with complications has changed and that the number of acute ulcers has increased. In a review of 283 patients, we found 150 perforated ulcers (PU) and 133 bleeding ulcers (BU). Almost all the patients with PU and 70% of the patients with BU have been treated operatively. The mortality is 14.3% and 12.5%, respectively. The vast majority of our patients have chronic ulcers, and only 7% have acute or subacute lesions confirmed by histologic examination. Based on our experience and the literature, we propose a therapeutic algorythm for these two conditions.

Aged↗
PubMed1992

[Treatment of vascular lesions associated with open fractures].

Vascular injuries associated with open fractures occur rarely, in about 1% of the cases. Brachial and popliteal arteries are the most exposed vessels in combination with humeral, femoral and tibial fractures. Vascular lesions are first diagnosed clinically: hard signs of arterial trauma (for instance, a pulseless extremity) certainly indicate the injury. Soft signs (for instance, a wound adjacent to a great vessel) only suggest the vascular trauma. Doppler signal allows to distinguish an ischemic extremity from a member still perfused by collaterals. Preoperative arteriography is indicated in patients presenting with soft signs of arterial injury. It is also indicated in patients with hard signs when further information can help the plan of reconstruction. Fracture stabilization is generally carried out before vascular repair. Arteries are prepared in healthy segments and, in most cases, a venous bypass is performed. Veins proximal to the tibial trifurcation are sutured. Specific differences between upper and lower limb in the evaluation and treatment of vascular injuries associated with open fractures are mentioned.

Arteries↗
PubMed1992

[Esophagogastroduodenoscpy by the surgeon].

In 1990, 123 gastroscopies were performed by surgeons in the Department of Surgery, General Hospital, La Chaux-de-Fonds, Switzerland. Seventy-five percent of these procedures were done on a diagnostic basis and twenty-five percent were controls. Endoscopy includes diagnostic, therapeutic and control procedures of numerous surgical diseases. It is thus important for the general surgeon to be committed in the endoscopic management of these pathologies. Furthermore, preoperative gastroscopy can influence or modify the operative technique. By his nearly inborn knowledge of anatomy, tissue consistency and texture, the surgeon has a priceless advantage to learn, practice and teach endoscopy. Therefore, teaching programs in surgical endoscopy should be widely created and developed in university and teaching hospitals to allow young surgeons a systematic and progressive training during their residency.

Duodenal Diseases↗
PubMed1992

[Development of a gastroplasty with variable diameter. Experimental study using artificial sphincters].

The vertical banded gastroplasty is currently the most popular technique in the surgical treatment of morbid obesity. This experimental study was aimed to create a gastroplasty with a variable stoma. The Marlex band was replaced by the cuff of an artificial sphincter to allow selective variation of the diameter of the stoma. The study was carried out on four mongrel dogs. The artificial sphincter was connected to a subcutaneous port. Injection of sterile fluid into the port inflates the cuff and decreases the surface of the stoma. The study was followed up for one year. Under gastroscopic control the system was regularly activated, the diameter and the surface of the stoma was measured and calculated. The sphincter allowed the surface of the stoma to decrease from 103 +/- 2.0 mm2 to 61 +/- 2.1 mm2. There was no significant variation of the surface for each volume unit injected into the system. After one year, the systems and stomachs were harvested and examined. It is possible to create a gastroplasty with a variable stoma. This system works without any technical problem. Microscopic examination of the stoma shows no peri-sphincteric fibrosis.

Animals↗
PubMed1991

[Role of the A2 hospital in general surgery training in Switzerland].

A full training in general surgery is difficult to achieve and involves an important professional commitment. In Switzerland, surgical theoretical and operative knowledge is mainly acquired in University Hospitals (A1 hospitals). A2 hospitals (smaller teaching hospitals) can be the best complement for this training. In these departments, general surgeons have a broad field of activity, including gastrointestinal, chest, vascular, outpatient surgery, conservative treatment and internal fixation of fractures and, sometimes, surgical endoscopy. Operative activity is intense. These departments thus allow privileged teaching positions for surgical residents and chief residents.

Curriculum↗
PubMed1989

Acetaldehyde activation of poly(ADP-ribose)polymerase in hepatocytes of mice treated in vivo.

The activities of poly(ADP-ribose) polymerase and of DNA polymerases alpha and beta and the level of cytochrome P450 were determined in mouse parenchymal liver cells 5 h after treatment with 0.1, 0.3, 1.0, and 3.0 mumole of acetaldehyde. Injection with 1.0 and 3.0 mumole of acetaldehyde induced an increase in poly(ADP-ribose) polymerase activity and in the P450 level, but had no effect on DNA polymerases. The stimulation of poly(ADP-ribose) polymerase activity can be used as an index of induced DNA damage. The possibility of using this experimental approach with other cells derived from mice treated in vivo with different xenobiotics is discussed.

Acetaldehyde↗
PubMed1989

[Iterative surgery in germ cell tumor].

Between 1979 and 1988, iterative surgery was performed on 13 patients for a germ-cell tumor. Apart from orchidectomy, surgery was not the first modality of treatment. On the other hand, 21 surgical procedures were performed for residual tumoral masses after chemotherapy or recurrences. In one third of the cases, only necrosis of fibrosis was resected. Out of 13 patients, 7 died of tumor; 6 are alive (3 with complete remission). Surgery is always indicated in stage IIA to IV nonseminomatous tumors in case of residual tumoral deposits after chemotherapy. For seminoma, surgery is carried out only for retroperitoneal residues larger than 3 cm in diameter. Surgery is also indicated for persistent pulmonary or mediastinal metastases following chemotherapy. Complete surgical excision of residual masses may be technically difficult but is of prime importance as combined chemotherapy and surgery doubles the complete remission rate in comparison to chemotherapy alone.

Combined Modality Therapy↗
PubMed1989

[Epidermoid carcinoma of the esophagus: preliminary results of combined treatment].

In 1986, a prospective study was started in CHUV on the squamous-cell carcinoma of the esophagus treated with a multimodality protocol associating preoperative chemotherapy and surgery. Nineteen patients are currently followed-up. Dysphagia is the main symptom and was found in 16 patients (84%). After chemotherapy, dysphagia disappeared completely in 7 cases (44%), regressed in 7 other cases and worsened in 1 case. Twelve patients were operated on, without operative mortality. Histologically, no tumor was found in one case (5%) after the preoperative treatment. Follow-up is currently too short to draw statistical conclusions. The rationale, advantages and perspectives of the multimodality treatment are presented and compared with different recent series.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[Pancoast's tumor: multi-disciplinary treatment and combined cervico-thoracic approach].

Five patients were treated from May 1987 to April 1988 in CHUV, Lausanne, for a superior sulcus tumor (3 epidermoid, 2 undifferentiated carcinomas). Treatment consisted of preoperative radiotherapy (3000 cGy)-surgery-postoperative radiotherapy (1500-2500 cGy). Two patients died from metastases. Only one patient presented with a local recurrence. Surgical resection was carried out by combined cervical and thoracic exposure. The cervical approach allows separation of the tumor from the subclavian artery, brachial plexus and vertebrae. Then, by thoracotomy, the superior lobe with tumor and thoracic wall is removed. Technical aspects of the procedure are described.

Carcinoma↗
PubMed1987

[Clinical study and gastroscopy of biliary gastritis following gastric resection and Roux-en-Y anastomosis].

Between 1981 and 1985, seven patients (mean age 44 years) underwent surgery for benign gastroduodenal ulcer in the Department of Surgery. Cantonal Hospital, Fribourg, Switzerland. Surgical indications were a double subcardial and prepyloric ulcer recurring after medical treatment, a duodenal and jejunal anastomotic ulcer after gastroenterostomy, two duodenal ulcers which recurred after vagotomy, and three perforated ulcers (subcardial, prepyloric, duodenal). All patients underwent two-thirds gastrectomy with a Roux-en-Y loop. Clinical investigations and gastroscopy were performed 1-5 years postoperatively. Clinical results were excellent in 5 cases (Visick 1), good in one (Visick 2), and moderate in one (Visick 3). Symptoms and signs associated with biliary gastritis were found as follows: vomiting 1 patient; epigastric pain 1 patient; weight loss 1 patient; anemia 1 patient. No bile staining was seen in any patient. Gastric biopsy demonstrated a normal mucosa in 2 patients and gastritis in 5 patients. Roux-en-Y gastrectomy gives satisfactory results in certain benign gastroduodenal ulcer situations. Perianastomotic and gastric stump gastritis may exist without biliary reflux.

Adult↗
PubMed1985

Malignant tumors of the anus. A study of 106 cases.

This study of 106 cases of malignant tumors of the anus has shown that the diagnosis was often made late. In 15 percent of the patients the tumor was at the anal margin; in 61 percent, in the anal canal, and in 24 percent, the tumor was so extensive that its origin could not be determined clinically. In nearly half of the cases, the cancers were advanced and showed perirectal metastases. Surgical treatment was the rule, with local excision for carcinomas of the anal margin and abdominoperineal resection for tumors of the canal. The general prognosis over a period of several decades remains poor. We found a 20 percent 5 year survival rate for epidermoid carcinoma of the anal canal, excluding deaths from causes other than cancer during the follow-up period.

Adenocarcinoma↗