Biomedical subjects

P Aeberhard

Publications and source records attributed to P Aeberhard.

At least 19 recordsLinked to original sources

PubMed2001

Infrainguinal arterial reconstruction with autologous vein grafts: are the results for the in situ technique better than those of non-reversed bypass? A long-term follow-up study.

BACKGROUND: The aim of this study was to answer the question if the in situ technique in infrainguinal arterial reconstruction is better than the non reversed one in long-term follow-up. METHODS: Patients were included in a prospective study at operation. 387 infrainguinal arterial reconstructions in 367 patients performed from 10-88 to 12-98 were retrospectively analysed. RESULTS: 280 non-reversed and 107 in situ bypass procedures were performed. Primary patency rates at 60 months were 63.3% for non-reversed and 57.9% for in situ grafts (p=n.s.). Primary assisted patency rates were 81.8% and 84.5% respectively (p=n.s.). Limb salvage rate was not different in either group. The 30-day mortality was 1.9% in the in situ group and 0.7% in the non-reversed group (p=n.s.). CONCLUSIONS: There is no difference in outcome between in situ and non-reversed vein grafting. Absence of statistical difference between the two procedures may be mainly due to the routine use of angioscopic quality control.

Aged↗

PubMed2001

[Rupture of a sinus of Valsalva aneurysm in the left atrium].

Ruptures of sinus of Valsalva aneurysms are a rare complication, and very few cases of rupture in the left atrium have been described. In this clinical case we report the case of a patient hospitalised with a scenario of cardiac insufficiency revealing a very large posterior sinus of Valsalva aneurysm, associated with a bicuspid aortic valve, and rupture in the left atrium. The diagnosis was by transthoracic and transoesophageal multiplan echocardiography, and the treatment surgical, with a good result.

Aged↗

PubMed2000

[Quality control in patient education. Results of a patient survey about the patient education protocol of the Swiss Society of Surgery in 6 Swiss hospitals].

In the past years the number of malpractice suits due to lack of patient information has increased. Because there have been no generally accepted guidelines for preoperative patient information, the Swiss Society of Surgery has decided to work out an informative brochure tailored to the needs of patients. It takes into account that the need to know beforehand is increasing rapidly. In collaboration with the judiciary service of the Swiss Medical Federation all the items and points of legal relevance have been compiled to establish an informative brochure. Based on this protocol, patients in surgical departments of 6 Swiss community hospitals were asked before discharge to qualify the preoperative information offered to them. 2660 questionnaires were evaluated. The majority of patients considered the information regarding their diagnosis, the complications, risks, treatment and postoperative care, the sketches describing the operation and the overall degree of information as good or very good. Almost 60% of all patients stated that no alternative treatment had been discussed with them other than the planned procedure. In most of these patients operative procedures were chosen and carried out for which there were few or no other acceptable options. 2/3 of the patients asked for immediate preoperative written information, especially if they had malignant disease. Barely 4% of the patients were not reassured by the information provided to them. The fact that 2/3 of all patients re-read the informative protocol before the operation underlines how important it is to hand out a copy of the protocol to satisfy the informative needs of the patients. To our surprise the vast majority of patients uttered little concern about giving their signature to forms that were presented to them. Only 2% of the patients felt that giving a signature would cause them grave reservations. The informative protocol devised by the Swiss Society of Surgery is well adapted to the informative needs of the patients and allows for a structured conversation. It facilitates documentation and offers valid legal proof for the physician that he/she has provided adequate information.

Adult↗

PubMed2000

Coverage of enterococci in community acquired secondary peritonitis: results of a randomized trial.

INTRODUCTION: The increasing number of enterococcal infections in hospitals and reports about the development of resistance of these bacteria make it necessary to review their importance as co-pathogens in secondary peritonitis. MATERIALS AND METHODS: A prospective randomized controlled trial on primary therapy of secondary peritonitis was carried out in six centers comparing cephalosporin-based antibiotic therapy to acylaminopenicillin-based therapy. RESULTS: Enterococci were only cultured in 6 of 110 cases from the abdomen and were found in only 5 cases of postoperative complications. No differences were found between penicillin-based vs. cephalosporin-based therapy. CONCLUSION: The study supports the view that these bacteria continue to play a minor role in secondary peritonitis. The point has to be emphasized, however, that the patients under study were in relatively good condition (APACHE II median 9 for cephalosporins and 10 for penicillins) and that postoperative cases of peritonitis were excluded.

Adult↗

PubMed1999

Prospective audit of laparoscopic totally extraperitoneal inguinal hernia repair: a multicenter study of the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTC).

BACKGROUND: This article reports the results of a multicenter prospective audit of totally extraperitoneal (TEP) inguinal hernia repair conducted by the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTC) from May 1995 to August 1996. METHODS: At 29 Swiss centers 1,605 inguinal hernia repairs were performed in 1,186 patients. Half of the repairs were performed by operators whose experience consisted of fewer than 51 procedures. Patients were followed up for 1 year. RESULTS: Bilateral repairs were performed in 35% of the patients, and 15% of all repairs were for recurrent hernia. Conversion rates to the transabdominal preperitoneal (TAPP) technique and open surgery were 1.8% and 1.6%, respectively. Main postoperative complications were hematoma and urinary retention. At 3 months, seroma was more frequent with slit prosthesis. The recurrence rate was 0.6% at 3 months and 1.6% at 1 year, not depending on the type of implant. The rate for recurrent hernias did not differ from that for primary repairs. CONCLUSIONS: Total extraperitoneal (TEP) repair can be performed with low morbidity and a high level of patient satisfaction. The effects of the learning curve are not to be neglected. The 1-year recurrence rate is 1.6%. Published data on TEP suggest that late recurrences may be less frequent than after open repair.

Female↗

PubMed1998

Prognostic value of beta1,6-branched oligosaccharides in human colorectal carcinoma.

Increase of beta1,6-branched oligosaccharides is possibly associated with tumor progression and lymph node metastasis. The aim of this study was to determine the prognostic value of beta1,6 branches in human colorectal carcinoma. Expression of beta1,6 branches was histochemically evaluated using the leukoagglutinating Phaseolus vulgaris lectin, PHA-L, in 92 clinically documented colorectal carcinomas, of which 31 had formed lymph node metastases. The follow-up time ranged between 4 and 14 years (median, 10.3 years). A PHA-L staining index (SI), taking into account staining intensity and its percentage of tumor cut surface area, was established. The carcinoma SI was highly associated with the disease-free survival (P = 0.004) and overall survival (P = 0.005). Patients with a carcinoma SI of >1, as compared to those with a SI of < or =1, were at significantly higher risk for tumor recurrence, with a shorter disease-free survival (hazard ratio = 2.59, P = 0.005) and significant higher risk of death with shorter overall survival (hazard ratio = 2.51, P = 0.007). The carcinoma SI was also associated with the presence of lymph node metastases. We conclude that PHA-L staining in human colorectal carcinoma sections provides an independent prognostic indicator for tumor recurrence and patient survival and is associated with the presence of lymph node metastases.

Adult↗

PubMed1998

Total mesorectal excision for cancer of the rectum.

The concept of total mesorectal excision (TME) was first described by R. J. Heald in 1982 as a radical cancer operation based on the anatomy of fascial planes and fibrous spaces of the pelvis. The ampulla recti is invested by a fascia propria which is a part of the visceral pelvic fascia. The fascia propria is separated from the parietal pelvic fascia by the pelvirectal fibrous space, which is a compartment of the subperitoneal space of the pelvis. The lateral ligaments of the rectum divides the pelvirectal space into a prerectal and a retrorectal part. TME is defined as the resection of the rectum with its surrounding fatty and lymphatic tissue contained within the visceral sheet of the pelvic fascia. The dissection proceeds in the nearly avascular cleavage plane between the visceral and the parietal fascial sheets, allowing maximal protection of the hypogastric nerves and the inferior hypogastric plexus. Continuity of the prerectal and retrorectal parts of the field of dissection is established by dividing the lateral ligaments of the rectum slightly inside the point where they swing away from the parietal fascia of the pelvic side wall. By following this plane of dissection it is possible to achieve en bloc excision of the total mass of perirectal lymphatic and fatty tissue down to the pelvic floor.

Humans↗

PubMed1998

[Toxic megacolon: surgical timing important!].

Toxic megacolon is defined as a fulminant attack of colitis with total or segmental dilatation of the colon. Toxic megacolon is mostly a complication of nonspecific ulcerative colitis or Crohn's colitis but it may also occur in pseudomembranous colitis and other forms of infectious colitis. Toxic dilatation of the colon is a sign of transmural acute inflammation in which perforation of the colon is impending or may already have occurred. Free perforation means a fourfold increase in the mortality of a fulminant attack of colitis. Dilatation of the colon is not by itself an indication for immediate operation. The dilatation may increase, fluctuate or even disappear, leaving the patient still severely ill with toxic colitis requiring immediate surgery. The indication and optimal timing of surgical intervention require optimal interdisciplinary collaboration between surgeons and gastroenterologists. The procedure of choice for surgical treatment of toxic megacolon is colectomy and ileostomy. The mortality and morbidity of urgent surgery have been decreased by avoiding rectal excision. The rectal stump is either closed as a pelvic Hartmann's pouch or the sigmoid remnant is exteriorized as a mucous fistula or closed subcutaneously. Progress in intensive therapy and perioperative patient management has relegated simple decompression by diverting loop ileostomy and skin-level colostomy as advocated by Turnbull et al nearly 30 years ago to the role of an obsolete procedure which seems hardly ever preferable to resection of the diseased bowel.

Colectomy↗

PubMed1997

[Large Brunner's adenoma of the duodenal bulb--a case report].

Benign proliferative changes of the Brunner's glands account for about 10% of neoplasias of the duodenal bulb. Since the first description by Cruveilhier in 1835 about 120 cases have been reported in the English literature. The authors present a case of adenoma of Brunner's gland of unusual dimensions (10 x 5.5 x 2.8 cm). Clinical presentation was by melena, anemia and vague epigastric discomfort. Treatment was by laparotomy with duodenotomy and surgical polypectomy. Proliferative changes of Brunner's glands may manifest as diffuse or localized nodular hyperplasia and Brunner's adenoma. They are localized in the submucosa and small superficial endoscopic biopsies may fail to confirm the diagnosis. Malignancy seems to occur only very rarely with only 14 cases reported in the literature. As the majority of Brunner's adenomas are quite small, endoscopic polypectomy will confirm the diagnosis and cure the condition in most instances. Large symptomatic adenomas may require surgical resection.

Adenoma↗

PubMed1997

[Intraoperative cholangiography in laparoscopic cholecystectomy: a simple, cost-effective techniques].

Description of an easy technique to perform an intraoperative cholangiography (IOC) during laparoscopic cholecystectomy at low cost. After puncture of the abdomen in the right hypochondrium with a commercial vein cannula used as a "mini-trocar", this cannula is mounted by an ureteral catheter (UC). By means of the inlying metal-mandrin the UC can be performed in a slightly curved fashion, which permits an easy cannulation of the Ductus cysticus. Furthermore the mandrin prevents an obstruction of the lumen by the metal clip used to fix the UC in the D.cysticus. After withdrawal of the mandrin the IOC can be performed by use of a commercial syringe fitting to the light-blue plastic adapter delivered with the UC. The method is safe, quick and easy and with a price of less than Swiss francs 10.- per IOC it is unrivalled regarding the costs.

Cholangiography↗

PubMed1997

[The value of diagnostic peritoneal lavage in emergency situations].

PURPOSE: The literature on diagnostic peritoneal lavage in the assessment of blunt abdominal trauma reflects an ongoing controversy. Therefore we conducted a prospective evaluation of the diagnostic management of blunt abdominal trauma used at our clinic, in which this procedure plays a substantial role. During the years 1993 and 1994 a total of 75 patients could be included in the study. The study population consisted of all patients with a diagnosis of blunt abdominal trauma. In addition, all trauma patients who were unresponsive on admission to the emergency receiving unit underwent the same program of diagnostic work-up. This group included polytraumatized patients, patients with craniocerebral injuries and all those who had been intubated prior to admission. Patients with stable vital signs were evaluated first by sonography of the abdomen, whereas those showing signs of hypovolemic shock received a diagnostic peritoneal lavage as the first evaluation of abdominal trauma. In order to assess the relative value of the two diagnostic methods, all patients who had had ultrasound as their first examination subsequently also underwent peritoneal lavage. RESULTS: 37 patients (49%) had lavage evidence of intraperitoneal bleeding. Of these 22 (29% of the total) subsequently underwent emergency laparotomy with lesions requiring surgical treatment found in 21 (95%). Only in one patient (1.3% of the study population) laparotomy failed to reveal a lesion requiring surgical correction. The accuracy of peritoneal lavage findings as an indication for laparotomy was 99%, compared to 82% for ultrasonography used as a initial diagnostic procedure. Diagnostic peritoneal lavage is quick, safe and almost independent of the experience of the investigating physician. It can be performed during other diagnostic procedures and can be repeated at will. If beyond macroscopical evaluation the lavage fluid is assessed chemically, even duodenal and pancreatic lesions as well as injuries to other hollow viscera can be suspected. With a sensitivity of 100% and a specificity of 98%, diagnostic peritoneal lavage is an extremely reliable diagnostic tool. It should be used as the initial diagnostic procedure in all hypovolemic and/or unresponsive patients suspected of having suffered blunt abdominal trauma. In conscious patients with stable vital signs, ultrasonography can be used for initial diagnosis. It should, however, be complemented by subsequent peritoneal lavage whenever the clinical course gives rise to suspicion.

Abdominal Injuries↗

PubMed1997

[Necrotizing fasciitis cause by beta-hemolytic streptococci with fatal outcome--a case report].

The authors report two cases of necrotizing fascilitis (NF) occurring after surgical interventions on the breast (reduction mammoplasty in one patient and mastectomy for breast cancer in the other). In both cases the etiologic agent were group A pyogenic streptococci and both patients died. NF caused by hemolytic streptococci is a highly lethal disease (over 70% in literature). It starts typically with a purple lesion of the skin, followed by necrotizing fascial infection with secondary necrosis of the overlying skin and rapid progression to septic shock and multiorgan failure. This development is characteristic for NF and allows, together with microbiological results, to distinguish NF from other necrotizing soft tissue infections. Early recognition and aggressive surgical debridement are the mainstays of successful management. Antibiotics and intensive care therapy are indispensable. Hyperbaric oxygen or other supportive therapies do not lower death rate.

Adult↗

PubMed1997

Anatomical basis and rationale of total mesorectal excision.

The concept of TME for cancer of the mid rectum has been introduced by Heald in 1982. Since then the evidence in favor of routinely applying TME in all operable cases of mid and low rectal cancer has kept growing. TME has been shown to reduce the number of R1 resections and increase the number of R0 resections, resulting in a significantly reduced recurrence rate compared to traditional surgical technique. The authors have produced a video which illustrates the anatomical basis and technical details of TME. TME is the resection of the rectum together with the fatty and lymphatic tissue contained within the visceral sheet of the pelvic fascia. This paper details the anatomical basis of TME, describing the fascial structures and fibrous spaces along which the dissection must proceed.

Adipose Tissue↗

PubMed1996

Surgical recurrence of perforating and nonperforating Crohn's disease. A study of 101 surgically treated Patients.

PURPOSE: This is a study of the long-term course of surgically treated Crohn's disease designed to identify prognostic factors predictive of the time course and probability of surgical recurrence. PATIENTS AND METHODS: The study is based on the records of 101 patients admitted to our institution for surgical treatment of Crohn's disease from January 1, 1970 to December 31, 1985. Follow-up was complete in 97 (96 percent) and incomplete in 4 patients. Median follow-up from the date of first operation was 13.25 years. The cumulative probability of requiring surgical treatment for recurrent disease was calculated using the life table method and further analyzed with the log-rank test and Cox regression. RESULTS: The time to reoperation in this series was not significantly influenced by sex, age at onset of symptoms, age at diagnosis, age at first operation, anatomic location, and number of sites involved at the time of first operation. The only variable that had a statistically significant effect on the time to reoperation was characterization of disease at the time of operation as being perforating (P) opposed to nonperforating (NP). Median interval between the first and second intestinal operation was 1.7 years for the P group and 13 years for the NP group (P value, 0.005), and the median time between any two operations undergone during the study period was 2 years for the P group and 9.9 years for the NP group (P = 0.0002). The risk of having to undergo reoperation for recurrence was greatest during the first two years after an operation, and this was mainly because of a short time to surgical recurrence in the P group of indications. Therefore, the yearly hazard of requiring further surgery was maintained at approximately 5 percent. CONCLUSION: The cumulative probability of requiring a reoperation for patients undergoing surgery for the P type of Crohn's disease is significantly different from that of patients with NP indications. The risk of having to undergo further surgery is particularly high during the first two years following an operation for perforating disease. The concept of a relatively aggressive perforating type of Crohn's disease and a more indolent nonperforating type is confirmed by the results of this study.

Adult↗

PubMed1996

[Sepsis score in surgical intensive care medicine].

In a prospective study (400 patients, intensive care stay > 18 h) the following data were documented daily: Clinical sepsis, a modified sepsis score, Apache II-score, number of organ failure, Elastase-concentrations and injury severity score (ISS > or = 20 = polytrauma). On admission day a prognostic assessment for early diagnosis of septic complications during intensive care could be demonstrated by a combination of the modified sepsis score and the number of organ failures and the presence of polytrauma. All other parameters did not have any predictive value.

APACHE↗

PubMed1996

A Historical Survey of Humanitarian Action.

Humanitarian medical associations emerged in France in the 1970s, working first in the developing world and then within their own country. Médecins Sans Frontières (Doctors Without Borders) and Médecins du Monde (Doctors of the World) have been active in the debate concerning the boundaries of international humanitarian law. Some of the many associations which now exist around the world have put the "right of interference" redefined by the United Nations as "the right of access to victims" (Resolution 43-141) into practice, while others strongly oppose it. This article, contributed by a witness to some of the most severe crises in recent history, from Biafra to Rwanda, provides a history of humanitarian action and examines the roles of states, churches, and nongovernmental organizations both with respect to their humanitarian missions, and in the interpretation of international humanitarian law. How can "interference" in the face of the unacceptable be reconciled with the concept of state sovereignty? How can genocide be prevented and ruthless dictators barred from disposing of their populations with impunity? This article suggests the current limits, and perhaps even a retreat in humanitarian thinking given the context of a new world order.

Journal Article↗

PubMed1996

[Full-thickness abdominal wall closure of laparoscopic trocar incision sites: a new, simplified technique].

Description of a safe, quick, easy and cheap technique of suture closure of laparoscopic trocar sites utilizing a reusable instrument ("hook-needle") developed for the purpose. The procedure is done under laparoscopic vision without the need for laparoscopic suture handling and results in a one stage closure of all relevant layers of the abdominal wall. Other techniques recently published for the same purpose are critically reviewed.

Abdominal Muscles↗

PubMed1995

[Fasciola hepatica--a unusual cause of acute cholecystitis with cholestatic jaundice].

A 29-year-old patient was admitted with acute abdomen in the 17th week of pregnancy. History revealed two episodes of colic in the right hypochondriac area during the previous six months, but no other abdominal complaints. Clinically the picture was that of acute cholecystitis. Laboratory findings included an elevated white cell count, a slight elevation of serum transaminases and a marked increase of serum alkaline phosphatase and bilirubin. Echographically there were dilated intra- and extrahepatic bile ducts containing two hyperechogenic elements without casting an acoustic shadow. A hydrops of the gallbladder with sludge and a thickening of the wall could also been seen. Because of pregnancy an ERCP could not be performed due to the need for X-ray, so we had to resort to open surgery. Under tocolytic and antibiotic shielding we carried out open cholecystectomy and choledochoscopic exploration of the common bile duct. Using a Fogarty balloon catheter we extracted two live, adult liver flukes and placed a T-tube in the duct. Because of positive fecal probes for fasciola eggs the T-tube had to be left in place until childbirth. Afterwards we performed a pre-cut-papillotomy by ERCP and took the T-tube out, having confirmed a clear duct on a T-tube-cholangiogram. With negative fecal probes and the eosinophilia on the white cell count returning to normal, we decided against the planned chemotherapy and assumed self-healing of the disease. The patient has been well since.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen, Acute↗