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Biomedical subjects

M Röthlin

Publications and source records attributed to M Röthlin.

At least 37 records · Page 2Linked to original sources
PubMed1996

[The mesh prosthesis, indispensable component in safe hernia repair?].

The recent and actually ongoing development does not allow to design an undeniable state of the art strategy for the repair of primary and recurrent hernias at this moment. For primary hernias the posterior approach with placement of a prosthetic mesh, whether conventionally or endoscopically, is not yet a recommendable common standard. However, due to its potential advantages the endoscopic mesh hernioplasty is a choice to be offered to the patients with informed (including alternative methods) consent. Less invasive, simple techniques will remain or become the methods of first choice; Shouldice might keep its importance but Lichtenstein (a method using a mesh!) will spread out in the near future. For the repair of recurrent hernias the posterior, prosthetic hernioplasty- by the open or more and more by the endoscopic route-has become a new standard in a lot of institutions. In this situation the more invasive anaesthesia and implantation of a foreign body is easily justifiable. Surgeons strictly adhering to the anterior approach, might intraoperatively decide to perform an "anterior onlay" according to Lichtenstein or an "anterior sublay" according to Rives. Thus, the use of a prosthetic mesh for hernia repair is becoming more and more common, by the anterior approach for the primary hernia, mostly by the posterior (endoscopic) approach for the recurrent hernia.

Endoscopy↗
PubMed1996

[Technical aspects of minimally-invasive cancer surgery of the colon: the complete laparoscopic procedure].

A literature review of current laparoscopic colon resection techniques in cancer clearly demonstrate prevalent violation of cancer surgery rules as defined in conventional procedures. Non performed Turnbull-manouver, mobilization of the affected bowel segment prior to ligation of vessel supply and questionable non-touch-technique due to pull through of the tumor prior to resection mainly account for this mal-strategy. Owing to a new instrument (EPR 18/70) a concept for total laparoscopically achieved resection and re-anastomosis as well as the possibility to put Turnbull-bandings is presented. In an experimental (n = 168) and preliminary clinical application (n = 11) encouraging results have been achieved leading not only to a strategy for safe and effective application of circular staplers but also to a concept for laparoscopic bowel resection in cancer which is close to the common conventional strategies.

Colonic Neoplasms↗
PubMed1995

[Splenic neoformation following trauma-induced splenectomy--diagnosis and function].

GOAL: Regeneration of the spleen after posttraumatic splenectomy has been described in the literature. The goal of this study was to determine the rate of splenosis, its effect on hematology and postoperative infections and the value of sonography in the diagnosis of splenosis. PATIENTS AND METHODS: Fifty patients were examined sonographically one to 14 years after splenectomy. They were questioned concerning infections and a blood count was done. Data concerning the grading of the splenic rupture, additional injuries and postoperative complications were collected from their charts. RESULTS: Splenosis was detected sonographically in 17 patients. It was seen more often, the more severe the injury of the spleen had been. Patients under 30 years in the splenosis group had a shorter ICU and hospital stay and significantly less postoperative infections. Fourteen of 17 patients with splenosis had no hematological changes, while 32 of 33 patients without splenosis demonstrated Howell-Jolly bodies and acanthocytes. CONCLUSIONS: Sonography is a reliable method for visualisation of splenosis. The latter seems to prevent the hematological changes usually found after splenectomy. It also seems to reduce the number of postoperative infections in young patients.

Adolescent↗
PubMed1995

[Secondary traumatic diaphragmatic hernia with incarceration--a diagnostic problem].

In this paper we discuss the case of a 64-year-old patient suffering from a traumatic rupture of the diaphragm with delayed manifestation three years after the trauma. The subsequent diagnostic errors gave rise to a discussion of the value of the physical examination, imaging methods and invasive diagnostic methods, particularly laparoscopy and thoracoscopy in the acute and delayed diagnosis of diaphragmatic injuries.

Arrhythmias, Cardiac↗
PubMed1995

[Preservation of kidney transplants with a modified UW solution--initial clinical results].

Although the University of Wisconsin (UW) has become the standard solution for the preservation of kidneys for transplantation, the importance of the colloid hydroxyethylstarch (HES), one of the key compounds of the UW solution, has been judged controversial. It has been shown in various experimental models that dextran-40 may successfully substitute for HES. Dextran-40 is not only cheaper but also has a variety of biological effects which may be beneficial during the graft reperfusion phase. The aim of this clinical study was to examine the efficiacy of dextran-40 based preservation solution (Dex-PS) for its use for human kidney graft preservation and to compare the transplantation results with kidneys preserved with UW solution. A total of 87 kidneys were preserved with Dex-PS and matched with 87 kidneys preserved with UW solution. Both groups were comparable in terms of donor and recipients characteristics. Patient survival and graft survival after 1 year was 95% and 86% for the Dex-PS group and 94% and 90% for the UW group, respectively (p = n.s.). Primary non-function, delayed graft function, postoperative need for dialysis, and follow-up of serum creatinine were statistically comparable between these two groups. We conclude that dextran-40 can safely replace HES in the UW solution for the purpose of human kidney preservation for transplantation. There were no statistically detectable differences in graft performance between the kidneys preserved with UW and those preserved with Dex-PS.

Adenosine↗
PubMed1994

[Long-term course following kidney transplantation].

The first 100 recipients of cadaveric renal allotransplants operated at our institution between 1964 and 1971 were retrospectively analyzed in terms of a long-term follow-up, complications and survival parameters. Patient and graft survival (indicated in parenthesis) after transplantation were 68% (58%) at 1 year, 50% (38%) at 5 years, 40% (27%) at 10 years, 32% (20%) at 15 years and 20% (13%) at 20 years. Half-life of graft survival was computed using two different mathematical models and was compared with the results of a control group operated in 1986. Half-life was 9.5 years for the study group and 13 years for the control group respectively.

Adolescent↗
PubMed1994

[Ultrasound diagnosis of appendicitis by surgeons--a matter of experience? A prospective study].

A number of studies have shown that ultrasound has an advantage over physical examination in the diagnosis of acute appendicitis. Most of these studies were conducted by experts in the field of ultrasonography. In this study the influence of experience on the results of the sonography of acute appendicitis were evaluated. All 203 patients admitted to our unit between December 1990 and December 1992 were examined physically and sonographically by a team of surgeons consisting of one experienced sonographer and six inexperienced surgical trainees. Laparotomy was performed in 136 patients (46%). Appendicitis was demonstrated histologically in 119 cases (39.4%). Initial clinical findings were positive in 87 (28.8%). Sonography was positive in 119 patients (39.4%). The 163 patients not operated on demonstrated other pathology on ultrasound in 60 cases (19.9%). The rate of negative laparotomies amounted to 7.2% in our study. Sensitivity and specificity for the sonographic diagnosis were 92% and 95%, respectively. They were only 81% and 80% for physical examination. Overall accuracy was 92% for sonography. Sensitivity and specificity for the inexperienced surgeons were 87% and 93%, respectively, while the experienced surgeon reached values of 97% and 98%, respectively. The results of both groups are comparable with values in the literature, suggesting that ultrasound evaluation of appendicitis is not a diagnostic tool limited to a few experienced sonographers.

Abdomen, Acute↗
PubMed1994

The anatomy of the hepatoduodenal ligament in laparoscopic sonography.

Laparoscopic sonography was introduced at our institution in April 1991. It is presently being tested as an alternative to peroperative cholangiography as far as the visualization of the structures of the hepatoduodenal ligament--particularly the extrahepatic bile ducts--during laparoscopic cholecystectomy are concerned. So far, 75 patients have been examined with both modalities. The structures of the hepatoduodenal ligament could be seen sonographically in all patients, while in five patients, the cholangiography had to be aborted for technical reasons. Eleven patients (15%) had anatomical variations of the bile ducts. Nine of these were diagnosed sonographically. A duodenal diverticulum and a long common channel of common bile duct and pancreatic duct were seen only on cholangiography. Variations of the hepatic arteries were found in 15 patients (20%). We conclude that intraoperative laparoscopic sonography is a reliable tool for the visualization of the structures of the hepatoduodenal ligament. This new technique might replace peroperative cholangiography in the future.

Adolescent↗
PubMed1994

New, mobile-tip ultrasound probe for laparoscopic sonography.

A new ultrasound probe (type 8555) especially constructed for laparoscopic sonography has been developed in collaboration with B&K Medical A/S, Naerum, Denmark. The probe is 9.5 mm in diameter and the usable length of the rod is 39 cm. At the tip a convex scanner of 5-7.5-MHz frequency can be angled 90 degrees up and 45 degrees down. The scanner is capable of both real-time sonography and color-flow doppler. Our first trials showed that the scanner not only facilitates sonographic examination of the biliary tree but also permits visualization of the entire liver, the pancreas, the spleen, and other intraabdominal organs.

Humans↗
PubMed1994

[Results of surgery in gunshot and stab injuries of the trunk].

Between 1981 and 1990, 105 patients suffering from gunshot and stab wounds were admitted to the Department of Surgery of Zürich University Hospital. There were 17 female and 88 male patients aged 16-74 years (average 31 years) whose charts were studied retrospectively. 44 patients demonstrated gunshot injuries, while 60 suffered from stabwounds and 1 patient had both. The injuries were the result of a crime in 59, a suicide in 33 and an accident in 11 cases. In 2 patients the cause was not conclusive proven. Injuries to the lung (n = 54), the liver (n = 27) and to the stomach (n = 23) were seen most frequently. 45 patients underwent laparotomy, while 16 had a thoracotomy performed. Both thoracotomy and laparotomy were necessary in 10 cases. Complications were observed in 29.5% of the cases. They were significantly more frequent in patients with gunshot injuries (p < 0.0004). Overall mortality amounted to 14.3% (n = 15). Patients with gunshot wounds had a significantly higher mortality rate (p < 0.0005). Debridement and selective closure of the wounds (n = 25) did not result in a higher rate of abscess formation than open treatment (n = 17).

Abdominal Injuries↗
PubMed1994

[Results of surgery in hepatic echinococcosis].

Echinococcosis of the liver is a disease rarely seen in Switzerland. E. alveolaris is the parasite causing the indigenous cases, while most of the patients infected by E. cysticus have migrated from the Mediterranean region. 26 patients suffering from echinococcosis of the liver were treated at the Department of Surgery of Zürich University Hospital between 1983 and 1992. There were 12 female and 14 male patients aged between 21 and 72 years (mean: 41 yrs). In 6 cases the cause was an infection with E. alveolaris (group 1), all the other patients suffered from E. cysticus infection (group 2). In group 1, there were 3 segmentectomies, 2 hemihepatectomies and 1 exploratory laparotomy. In group 2, 16 patients underwent pericystectomy. Furthermore, 1 hemihepatectomy, 3 atypical resections and 2 segmentectomies were performed. Complications were seen in 100% in group 1 and in in 35% in group 2, respectively. 2 patients died postoperatively for a mortality of 8%. We concluded that infections with E. alveolaris are rarely resectable without increasing drastically the risk of the operation. Therefore, postoperative long-term chemotherapy is necessary. Operations for both types of echinococcosis are fraught with a high rate of complications.

Adult↗
PubMed1993

[Gastroenterostomy "par principe" or "de nécessité" in palliative therapy of pancreatic cancer?].

There has been a controversy for years concerning the value of the prophylactic gastroenterostomy (GE) in patients suffering from irresectable pancreatic cancer. A retrospective analysis of the patients undergoing palliative bypass-operations for pancreatic cancer at Zurich University Hospital between 1982 and 1990 revealed 53 patients (28 male, 25 female) with an average age of 68 years. Twenty-one patients received a double bypass, 18 received a hepaticojejunostomy, 12 a primary and 2 a secondary GE. Mortality and morbidity for double bypass were 14% and 33%, for hepaticojejunostomy 5% and 28% and for primary GE 25% and 50%. Secondary GE was associated with a mortality and morbidity of 1 of 2 cases. Two patients received a secondary GE and two more showed signs of duodenal obstruction amounting to 20% incidence for secondary duodenal obstruction. Delayed gastric emptying was observed in only 2 patients with primary GE. These data suggest the use of a prophylactic double bypass.

Aged↗
PubMed1993

[Intraoperative cholangiography and ultrasound in laparoscopic cholecystectomy].

For years there has been a controversy as to whether or not a routine peroperative cholangiography is indicated during conventional cholecystectomy. With the introduction of the laparoscopic technique, the reasoning has changed, but the controversy persists. The surgeon of today has the choice between two diagnostic modalities, which are to be presented here. Peroperative cholangiography was the technique usually employed during conventional operation. Many surgeons are in favor of routine intraoperative cholangiography during laparoscopic cholecystectomy. The goal of the examination is no longer the detection of unsuspected common bile duct stones, but the visualization of anatomical variations of the bile ducts and hepatic arteries for prevention of bile duct injuries. A difference in number of bile duct injuries in patients examined routinely or selectively has not yet been proven, so selective use of intraoperative cholangiography is still a safe strategy. A multitude of different catheters and introducer-sets for the laparoscopic operation are commercially available. We feel that a catheter should facilitate insertion without requiring the introduction of an additional cannula. An exception are the patients with known bile duct calculi, where a laparoscopic bile duct exploration is planned and the additional cannula is needed for this procedure anyway. Intraoperative cholangiography detects bile duct stones with a sensitivity of 95 to 100%. The sensitivity for the demonstration of anatomical variations of the bile ducts is smaller and anomalies of the arteries can not be demonstrated at all.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholangiography↗
PubMed1993

[Intraoperative ultrasound--an alternative to cholangiography in laparoscopic cholecystectomy? A prospective study].

The aim of this prospective study was the comparison of laparoscopic sonography with intraoperative cholangiography (IOC) during laparoscopic cholecystectomy. A 360 degree-sector scanner with a frequency of 5.5 MHz was used. The examination was successful in all 69 patients entered into the study. In the beginning 19 patients were examined sonographically without subsequent IOC. None of these patients had bile duct stones and their postoperative history was uneventful. In the 50 patients operated on subsequently both laparoscopic sonography and IOC were tried. IOC was not performed due to technical failure in 4 patients and due to allergic reactions to contrast media in one patient. Thirty-one patients demonstrated normal bile ducts without stones in both examinations. Ten patients had dilated ducts without stones. In three cases a stone was seen on IOC and intraoperative sonography. In one case a duodenal diverticulum containing debris, demonstrated by IOC, was the reason for a false positive sonographic finding. Sensitivity and specificity of laparoscopic sonography concerning the visualisation of bile duct stones were 100 and 98%, respectively. The time necessary for the examination was significantly shorter in laparoscopic sonography than in intraoperative cholangiography (p = 0.0001). If these results can be reproduced in a larger population of patients, laparoscopic sonography can be considered a safe, fast and non-invasive alternative to intraoperative cholangiography.

Adolescent↗
PubMed1992

[How much experience is required for ultrasound diagnosis of blunt abdominal trauma?].

Between July, 1st 1989 and June, 30th 1991, 312 patients were entered into a prospective study concerning the reliability of sonographic evidence in blunt abdominal trauma. There were 231 male and 81 female patients aged between 15 and 88 years (mean: 39.9 years). The sonographic team consisted of one experienced sonographer/surgeon (greater than 4000 examinations) and 3 sonographic beginners (less than 200 examinations at the start of the study). The experienced sonographer and the beginners examined 168 and 144 patients, respectively. Patient distribution to the two groups was done according to the sonographic duty roster without consideration of injury severity. The examination was performed with a mobile ultrasound unit at the surgical intake as part of the primary diagnostic work-up. It consisted of four sonographic views (right and left lateral longitudinal, suprapubic and epigastric transverse view) and took about 2 min. Clinical evidence supporting blunt abdominal trauma could only be found in 64 cases, while in 153 patients physical examination was equivocal due to assisted ventilation or paraplegia. Sensitivity and specificity for the clinical examination amounted to 80.6% and 44.5%, respectively. Sensitivity and specificity for the sonographic finding of intraabdominal liquid were 100% each for the experienced sonographer and 96% and 100%, respectively for the beginners. Organ lesions were demonstrated with a sensitivity and specificity of 45% and 99% by the experienced and 36% and 100% by the beginners. The experienced sonographer misdiagnosed one case of free intraabdominal gas, which could not be corroborated both by clinical and radiological evidence.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1992

[Abscesses and pseudocysts as a sequela of acute pancreatitis].

During studying the literature a big confusion around the item abscess can be recognized. Especially in the English publications it is used for sterile tissue necrosis, infected necrosis, infected pseudocyst or suppuration. Pancreas phlegmon means there a sterile mass of pancreas and peripancreatic oedema. With us an abscess still is a located plus collection surrounded by a more or less tight capsule and a phlegmon is a diffuse purulent infection in the tissue. This definition is important because the frequency and prognosis of a true abscess is far below an infected necrosis (with us 4 abscess in 48 necrotising pancreatitis but 54% infected necrosis). Abscess formation needs two to four weeks whereas pseudocyst develops rather fast in one to two weeks. Although spontaneous resorption of pseudocyst is possible, we recognized ten and operated on all of them either by internal drainage or by resection of the tail of the pancreas. Mortality of one series of 124 patients with acute pancreatitis was at 30 days 4% and 27%, respectively, when necrosis was present and overall mortality having treated all patients to final discharge was 5% and 44%, respectively. Mortality rate was constant in the last years but Ranson score was continuously increasing.

Abscess↗
PubMed1991

Phase II study of intra-arterial fluorouracil and mitomycin-C for liver metastases of colorectal cancer.

Effectiveness, toxicity and complications of 5-fluorouracil (FU) and mitomycin-C (MMC) treatment were analyzed in 30 patients with metastatic colorectal cancer confined to the liver. The treatment schedule was FU 2.0-2.5 g/day for 5 days followed by MMC 10 mg/m2 every 2 h on day 6 to a maximum total dose of 60 mg. Treatment courses were repeated every 6 weeks and were given on an outpatient basis via external pump and arterial port systems. In 30 fully evaluable patients, one complete response, 17 partial responses (overall response rate 60%), and stabilization of disease in 8 patients (26%) were obtained for a median duration of 13 months. Median overall survival was 18.2 months (25.5 months for responding patients, 15 months for nonresponders). Grade 1-2 toxicity (WHO classification) consisted of leukopenia (23%), mucositis (20%), nausea/vomiting (16%), and abdominal pain (10%). Two patients (7%) developed severe mucositis. No life-threatening side effects were observed; in particular, there was no sclerosing cholangitis or chemical hepatitis. Catheter-related problems (occlusion, displacement, rupture, infection) occurred in 10 patients (33%) at a median follow-up time of 12 months. We conclude that intra-arterial FU and MMC constitute an effective, safe, and nontoxic treatment in metastatic colorectal cancer confined to the liver. Catheter-related problems are the most important factors limiting treatment.

Adult↗