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Biomedical subjects

M Röthlin

Publications and source records attributed to M Röthlin.

At least 19 recordsLinked to original sources
PubMed2005

Anti-infectious prophylaxis after splenectomy: current practice in an eastern region of Switzerland.

Overwhelming post-splenectomy infection (OPSI) is a long-term risk in asplenic patients, which may be minimised by appropriate preventive measures. In this survey anti-infectious strategies after splenectomy were evaluated in an eastern part of Switzerland. We found 91 individuals in the canton of Thurgau, who underwent splenectomy between 1998 and 2003. We assessed adherence to vaccination guidelines, the use of antibiotics and the awareness of the infectious risks by review of hospital charts and by structured interviews with patients and their general practitioners. The total vaccination rate was 64/91 (70%). 6 patients were vaccinated pre-operatively, 50 during the hospital stay and 8 after discharge by the general practitioner. 64 received vaccination against pneumococci, 6 against haemophilus influenzae and 3 against meningococci. Although 39 died during the study period, none died of overwhelming sepsis. None of the patients received a booster vaccination. Prophylactic long-term antibiotics were given to 2 children but to none of the 89 adults. Three adults had a supply of stand-by antibiotics at home. Less than half of the patients who were interviewed knew that asplenia puts them at greater risk for life-threatening infections and few practitioners were aware that travel and animal bites pose a special threat. We conclude that after splenectomy vaccination discipline and patient education should be substantially improved and suggest the publication of comprehensive guidelines.

Adolescent↗
PubMed2004

Chronic necrotizing pulmonary aspergillosis complicated by pneumothorax.

A 61-year-old man presented with left-sided pneumothorax. On the chest computed tomograghy (CT), severe bilateral emphysema and left-sided pleural thickening were seen. His pneumothorax was drained with a chest tube. Because of a persistent air leakage, video-thoracoscopic wedge-resection of the suspected fistula and muscle-sparing minithoracotomy with extensive wedge resections of the left upper lobe were performed. Biopsy specimens showed micronodular mycetomas with septate hyphae highly suggestive of Aspergillus. The fungus destructed the lung tissue without vessel invasion. The patient had not been taking immunosuppressant drugs and had no prior opportunistic infections. Itraconazole was begun, the lung was expanded and the patient recovered. We propose that extensive resection of affected lung tissue in combination with long-term antifungal therapy with itraconazole is a valuable therapeutic option in patients with a complicated course of chronic necrotizing pulmonary aspergillosis (CNPA).

Antifungal Agents↗
PubMed2003

[Pancreatic pseudocysts--possibilities in surgical therapy].

Based on the classification of pseudocysts according to D'Egidio and Schein the different surgical techniques for the treatment of pancreatic pseudocysts, i.e. drainage procedures and resections are discussed. The role of laparoscopic techniques is demonstrated. The "competing" endoscopic and interventional techniques are mentioned. The prognosis of the patients after operations for pancreatic pseudocysts is to a smaller degree depending on the operating technique, but largely on the natural history of the disease and the discontinuation or continuation of the underlying pathogen.

Drainage↗
PubMed2001

Laparoscopic wedge resection for benign gastric tumors.

BACKGROUND: Both laparoscopic wedge resection and formal laparoscopic resection are used in the treatment of benign and malignant gastric diseases. METHODS: We performed totally laparoscopic wedge resection using stapling devices and three or four trocars. PATIENTS: Four patients were treated with this technique. All four suffered from gastrointestinal stromal tumors (GIST), and one presented with an additional gastric adenoma. Two were morbidly obese, and two had additional operations performed at the same time. Two patients were admitted for acute upper GI bleeding. RESULTS: All of the tumors were removed successfully. Operating time ranged from 135 to 215 min. Oral feeding commenced on days 2-4. Postoperative hospital stay ranged from 5 to 11 days. CONCLUSION: Laparoscopic wedge resection of benign gastric tumors is a safe, reliable method that should be further investigated and used on a broader scale.

Adenoma↗
PubMed2001

[Stomach surgery--are the requirements for specialist in general surgery still realistic?].

This paper discusses the possibility for a surgical trainee to acquire the necessary experience in gastric operations for his fellowship in general surgery. All operations of the stomach performed at the surgical unit of Lucerne Hospital between January 1994 and September 1997 were analysed retrospectively. Of 184 operations performed only nine were done by a trainee, four of which were gastrostomies and five operations of a perforated ulcer. These results prove the difficulties for a trainee to achieve the required number of operations. Possible solutions would be the acknowledgement of assisted operations for the fellowship in general surgery and/or the limitation of gastric operations performed by the trainee himself to the curriculum for the fellowship in visceral surgery.

Clinical Competence↗
PubMed2000

[Anal fissure--a new therapy concept].

The anal fissure is one of the most frequent causes for anal pain. Conservative treatment usually consists of laxatives, local anesthetics and nitroglycerin cream. These therapies have a high recurrency rate. Surgical interventions, i.e. manual dilatation and sphincterotomy are fraught with the danger of fecal incontinence. The completely reversible effect of botulinum toxin injection opens new possibilities in the treatment of anal fissures. Its use is discussed as part of a 3-stage therapeutic regimen.

Administration, Topical↗
PubMed2000

[Does every patient with pancreatic disease need ultrasound examination?].

The following paper discusses the indications for ultrasound examinations in pancreatic diseases. Transcutaneous, intraoperative, endoscopic, laparoscopic and interventional ultrasound techniques are reviewed in the context of acute and chronic pancreatitis, as well as pancreatic cancer and endocrine tumors of the pancreas. In acute pancreatitis the results of sonography are inferior to CT-scanning, which is still the examination of choice in cases with a necrotising course. In chronic pancreatitis ultrasound can be helpful in localising and draining pseudocysts. Intraoperatively the bile duct and pancreatic duct can be localised easily. In pancreatic cancer laparoscopic sonography as part of diagnostic laparoscopy reduces the number of negative laparotomies for irresectable cancer. Intraoperative ultrasound is mandatory during operations for endocrine tumors of the pancreas.

Acute Disease↗
PubMed1999

[Laparoscopic palliation of pancreatic carcinoma: initial experiences].

The greater part of patients presenting with pancreatic cancer is irresectable at the time of diagnosis. They are in need of palliative treatment. We report our first experience with a new concept of laparoscopic palliation based on the findings of preoperative imaging and diagnostic laparoscopy. Between 1995 and 1998, 10 patients underwent laparoscopic palliation. In 3 cases laparoscopic double bypass and 7 patients gastroenterostomy was performed, in some instances combined with endoscopic stenting. Postoperative morbidity was 10% for laparoscopic palliation. There was no mortality in laparoscopic bypass surgery. Postoperative hospital stay averaged 11 days. Our preliminary experience strongly suggests that laparoscopic palliation may greatly reduce the three major drawbacks of open bypass surgery, i.e. high morbidity and mortality, and long postoperative hospital stay. Prospective trials in larger study populations will be needed to define the place of this technique in the palliation of pancreatic cancer.

Aged↗
PubMed1999

Ultrasound scans done by surgeons for patients with acute abdominal pain: a prospective study.

OBJECTIVE: To evaluate the routine use of abdominal ultrasonography (US) in patients admitted to the surgical emergency unit with acute abdominal pain. DESIGN: Prospective study with a three-step evaluation of patients over a 12-month period. SETTING: University hospital, Switzerland. SUBJECTS: 496 patients (male/female = 234/262; mean age 45 years) who presented with acute abdominal pain. INTERVENTIONS: Every patient underwent routine investigations and had an abdominal US by the attending surgeon. MAIN OUTCOME MEASURES: Clinical diagnosis, post-ultrasonography diagnosis and final diagnosis. RESULTS: US improved the correct diagnostic rate from 348 (70%) to 414 (83%). The diagnostic accuracy for acute appendicitis and biliary tract disease improved after US from 455 (92%) to 488 (98%) and from 463 (93%) to 490 (99%), respectively; the corresponding sensitivities and specificities were 91% and 99% and 94% and 99%. CONCLUSIONS: Ultrasonography should be part of routine surgical investigation and should be mastered and used by surgeons.

Abdomen, Acute↗
PubMed1997

[Surgery in malignant obstructive jaundice: laparoscopic surgery--the future?].

The systematic staging of pancreatic cancer has facilitated exact evaluation of a patient's prognosis in recent years. Minimally invasive surgery, on the other hand, has produced new procedures which necessitate a distinct dichotomy between open, curative surgery and minimally invasive, palliative procedures. Diagnostic modalities facilitating an accurate assessment of resectability have to be found. Preoperative imaging and endoscopic techniques are only successful in about 50% of cases. Diagnostic laparoscopy is the only method for visualization of peritoneal metastases. The use of diagnostic laparoscopy and laparoscopic sonography raise the accuracy concerning resectability from 20% to between 75% and 100%. 33% up to 67% of patients deemed resectable by preoperative imaging show signs of unresectable cancer at laparoscopy and can be spared an unnecessary laparotomy. For these patients a choice of laparoscopic or endoscopic bypass techniques is available. The laparoscopic hepaticojejunostomy without sutures developed in Zurich has proven to be efficient in animal trials and will soon be implemented in clinical trials. A differentiated indication for laparoscopic bypass techniques and endoscopic stenting is necessary. The laparoscopic procedures should be employed in patients with a risk of duodenal obstruction or a projected mean survival of more than 6 months (stage III), while endoscopic stenting has already been established in the treatment of patients with a survival of less than 6 months (stage IV).

Algorithms↗
PubMed1997

Long-term complete remission of melanoma liver metastases after intermittent intra-arterial cisplatin chemotherapy and surgery.

This paper presents the case of a female patient with liver metastases of a malignant melanoma showing complete remission after 10 courses of regional, intra-arterial chemotherapy with cisplatin. The drug was administered as continuous infusion for 5 days. The daily dosage amounted to 30 mg/m2. The interval between courses was 6 weeks. Nausea and vomiting were seen after each course, while pathological serum creatinine levels only appeared after the eighth course. The only lesion in the liver still visible on CT scan after chemotherapy was removed by left hemihepatectomy. Meticulous histological examination revealed a big focus of necrotic tissue without any tumour cells. At the time of publication the patient is alive and disease-free over 9 years later.

Antineoplastic Agents↗
PubMed1997

Intravenous cholangiography is superfluous prior to laparoscopic cholecystectomy.

OBJECTIVE: Intravenous cholangiography (IVC) re-introduced into the preoperative diagnostic work-up of cholecystectomy after the change to the laparoscopic technique, was suggested to detect anatomical anomalies and bile duct stones. The value of IVC in this context was to be evaluated by this study. DESIGN: Prospectively controlled study. IVC findings were controlled by intraoperative imaging techniques such as laparoscopic sonography and intraoperative cholangiography. SETTING: Surgical unit of a university hospital. SUBJECTS: One hundred patients underwent laparoscopic cholecystectomy between January 1992 and January 1993. Eighty-five of these patients had both IVC and intraoperative cholangiography (IOC). There were nine technical failures for IVC and five for IOC. MAIN OUTCOME MEASURES: Anatomical variations and previously unsuspected common duct stones. RESULTS: Anatomical variations of the biliary tree and the hepatic vessels were detected by IVC in only three cases while IOC demonstrated 31 biliary and vascular anomalies in 28 patients. IVC demonstrated bile duct stones in one and IOC in two cases. CONCLUSIONS: We conclude that IVC is of little help in the diagnosis of anatomical variations of the biliary tree and should be omitted from the preoperative diagnostic work-up of laparoscopic cholecystectomy.

Adult↗
PubMed1997

[Value of Hartmann's operation as an emergency intervention in sigmoid diverticulitis].

INTRODUCTION: Improvements in antibiotic and intensive care treatment have facilitated the conservative therapy of patients suffering from complicated diverticulitis of the sigmoid for the time necessary for preparation in view of early elective resection of the sigmoid colon. Consequently, early elective resection of the sigmoid colon with primary anastomosis has become very popular as the treatment of choice in complicated diverticulitis. This has led us to a retrospective evaluation of our own results with both Hartmann's operation and resection with primary anastomosis. PATIENTS AND METHODS: 55 patients with complicated diverticulitis of the sigmoid colon were operated on at our institution between 1981 and 1990. Group I consisted of 33 patients (17 females and 16 males) aged 39 to 89 years who underwent Hartmann's operation. Group II included 11 patients (6 females and 5 males) aged 39 to 85 years treated by resection and primary anastomosis. The remainder of the patients was treated by a three-step procedure and should not be considered here. RESULTS: In group I 25 patients (76%) suffered complications either at the Hartmann's operation or at descendorectostomy or both. Mortality was 6%. Only 76% of patients had their stoma closed after an average of 3.8 months. The average hospital stay of both operations combined amounted to 61 days. In group II 3 patients had complications, one of which was lethal (lung emboly). The total hospital stay in this group averaged 22 days. CONCLUSIONS: For Hinchey stages I and II conservative treatment, bowel preparation and early elective resection with primary anastomosis should be attempted. In cases of general peritonitis (Stages III and IV) Hartmann's operation is still the treatment of our choice.

Adult↗
PubMed1996

[Intraoperative ultrasonography of the liver].

INTRODUCTION: In many centers specialized in hepatobiliary surgery intraoperative sonography (IOUS) has become a mandatory intraoperative diagnostic tool for intraoperative decision making. We have started applying this technique during liver recections and operations for cancer of the colon in 1988. This presentation is a retrospective report on the first author's personal experience with this technique. PATIENTS AND METHODS: Ninety-two patients were examined intraoperatively, either at Zürich University Hospital or Groote Schuur Hospital in Cape Town. There were 37 female and 55 male patients aged 21 to 84 years (average: 56 yrs). Thirteen patients had primary malignanctes of the liver (group 1) and37 patients underwent IOUS during liver resection for secondary liver tumors (group 2). 14 patients were scanned during operation for benign lesions of the bile ducts and liver (group 3). 28 patients were screened for metastases during resection of gastrointestinal cancers (group 4). The equipment consisted of an Aloka Echocamera SSD 630 and a T-shaped 5 MHz small part in Zürich and a Siemens SI 400 unit with a similar scanner in Cape Town. RESULTS: In group 1 IOUS demonstrated additional information in 9 patients and changed operational procedure in 7 cases. In group 2 IOUS improved on preoperative imaging in 17 cases and changed the approach in 14. Seven patients with benign lesions profitted from IOUS. Additional information changing surgical procedure was gained by IOUS in 6 patients of group 4. CONCLUSIONS: IOUS is a valuable intraoperative imaging technique which is easily performed by the surgeon himself. It should be part of every operation for cancer of the colon and every resection of the liver.

Adult↗
PubMed1996

[Efficacy of basic surgical diagnosis in acute abdominal pain].

This report describes a retrospective study concerning 314 patients suffering from acute abdominal pain admitted to the surgical emergency unit of Zürich University Hospital in 1992. Basic diagnostic work-up (history, physical examination, blood tests, sonography and abdominal X-ray) revealed the final diagnosis in 188 patients. Sonography was essential in 77 cases. Only 33 patients required additional examinations, such as CT-scan, gastroscopy or contrast X-rays. Ninety-three patients were discharged with a final diagnosis of "non-specific abdominal pain" (NSAP) after their symptoms had improved. A follow-up examination of these patients 6-18 months later resulted in a final diagnosis of somatic diseases in 8% of cases. This study demonstrated that the basic surgical diagnostics are efficient and reveal the final diagnosis with minimal delay. Abdominal sonography is the most important diagnostic tool in this context and should, therefore, be mastered and employed by the surgeon himself.

Abdomen, Acute↗
PubMed1996

[Diagnostic laparoscopy and laparoscopic ultrasonography: value of staging and assessment of resectability of pancreatic carcinoma].

The dismal prognosis of pancreatic cancer and the development of new, minimally invasive bypass techniques require a differentiated indication for open pancreatic resection. Diagnostic modalities, which facilitate an accurate assessment of resectability, have to be found. Modern imaging and endoscopic techniques fullfill these requirements in only about 50% of cases. Diagnostic laparoscopy is the only method for visualization of peritoneal metastases. The use of diagnostic laparoscopy and laparoscopic sonography raises the resectability rate to between 75% and 100%. 33% up to 67% of patients deemed resectable by preoperative imaging show signs of irresectable cancer at laparoscopy and can be spared a negative laparotomy. These patients can be treated by laparoscopic or endoscopic bypass techniques.

Endosonography↗