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Biomedical subjects

P Aeberhard

Publications and source records attributed to P Aeberhard.

At least 19 recordsLinked to original sources
PubMed1992

[Did management of breast carcinoma progress in the 80s?].

During the last decade there have been important changes in diagnosis and therapy of breast cancer. Breast conserving surgery in patients with small tumors combined with radiation therapy has gained wide popularity due to better cosmetic results without significant changes in survival. Results in breast cancer treatment have been markedly ameliorated by early diagnosis and treatment. It is hoped that this will be accomplished by routine mammographic screening in asymptomatic women. In this retrospective study data of 398 breast cancers are analyzed. All patients underwent surgery between 1981 and 1988. To demonstrate changes in the stage at the time of diagnosis during the last decade, the material has been divided in two groups: group 1 represents the tumors diagnosed in 1981/82, and group 2 those diagnosed in 1987/88. Comparison of these two groups did not show any significant changes in cancer stage at operation during the last ten years. Screening programs are planned and have to be supported in order to ameliorate the results of breast cancer treatment. Intensive public information is necessary to motivate medical personnel and women for early breast cancer detection by mammography.

Breast Neoplasms↗
PubMed1992

The role of colour flow duplex screening in infra-inguinal vein grafts.

To assess the indications for routine colour flow duplex surveillance, 43 infra-inguinal autogenous vein grafts were prospectively entered into a surveillance protocol. Screening consisted of measurements of ankle brachial indices (ABIs) and colour flow duplex imaging of the entire graft length. Twelve significant stenoses have been detected in 10 grafts (23%) using duplex, all within 6 months of surgery. All grafts at risk had arteriography confirming the duplex findings, but detecting one additional stenosis. Two grafts at risk were not detected by duplex scanning (sensitivity 83%). All grafts at risk (12) had a serial fall in resting ABI of more than 0.1. Most of the detected graft stenoses could be corrected surgically, improving the 1 year primary cumulative patency rate of 54% to a secondary patency rate of 88%. This study suggests that resting ABI measurements are a very sensitive (sensitivity: 100%) and simple primary screening procedure, provided that all grafts with ABI changes of more than 0.1 are further evaluated. The interval specificities of ABI measurements were 77% at 3, 71% at 6, 67% at 12 and 78% at 18 months (mean 73%). About 60% of ABI-screened grafts needed further evaluation because of ABI changes of greater than 0.1, incompressibility of arteries (ABI greater than 1.3) or extension of the graft to the ankle or pedal arteries. Colour flow duplex scanning was very useful in excluding or identifying and localising graft problems and deciding on further invasive diagnostic and therapeutic procedures. Ankle brachial index measurements as the primary examination for selecting patients for colour flow duplex scanning seems to be a safe screening procedure.

Adult↗
PubMed1992

[Spontaneous lung torsion after acute pleuropneumonia].

We report on a case of spontaneous torsion of the right lung in a 59 years old woman which occurred after an acute pneumonia followed by chronic empyema and progressive dyspnea with marked respiratory disability. Despite extensive diagnostic procedures including bronchoscopy and bronchography the true diagnosis could be established only by thoracotomy performed in order to cure the chronic empyema. The abnormal hilar rigidity by preexisting calcified sarcoidosis of the lymph-nodes is suggested to be a major risk factor for developing lung torsion as it has been emphasized in a few similar reports from the literature. Surgical reposition of the displaced lung is the most effective treatment and can save and restitute lung structure and function even in patients with prolonged course and delayed diagnosis.

Diagnosis, Differential↗
PubMed1992

[Does the surgical technique modify the incidence of local recurrence after mastectomy?].

This article discusses operative technique in relation to the prevention of local recurrence following modified radical mastectomy (MM) for carcinoma of the breast. As with any other surgical procedure, a satisfactory outcome requires both a correct indication and attention to the details of operative technique. The indications for MM may be defined from the currently accepted contraindications to breast preservation, while most of the contraindications to MM relate to the presence of a stage IIIb or IV carcinoma. The ideal treatment needs to be defined for the individual case, avoiding both unnecessary overtreatment with its associated morbidity and dangerous undertreatment with consequent reduction of the chance for cure. In our view, confirmation of the diagnosis by an excisional biopsy with frozen section examination should be obtained irrespective of a positive finding in an aspirated specimen. The incision for biopsy must be chosen in such a way that it will be encompassed by a subsequent mastectomy incision. When mastectomy is performed the cavity of the excisional biopsy must not be entered. This includes preservation of the barrier of the pectoralis fascia. When breast preservation is an option, the excisional biopsy must fulfill the criteria of a lumpectomy or tumorectomy, which include a 0.5 to 1 cm macroscopically tumor-free margin, orientation of the specimen by sutures, and immersion of the specimen in india ink. As the extent of intraductal component cannot be reliably determined by frozen section examination, waiting for the definitive pathology report may be better than an immediate decision to perform a mastectomy or breast preservation. The skin incision for mastectomy is transverse or slightly oblique, ending laterally about five cm below the axillary pit. The skin flaps must not include the full thickness of the subcutaneous fatty tissue. The preserved layer of fatty tissue must not be irregular. Axillary dissection of levels I and II is sufficient for staging. Skip metastases to level III occur in less than five percent of cases. Therefore routine dissection of level III with its associated increased risk of lymphedema is not justified.

Biopsy↗
PubMed1992

[Breast saving therapy of breast cancer: sensitivity of mammography in relation to primary tumor size].

A number of patients with early breast cancer are candidates for conservative surgery and irradiation. The possibility for limited surgery has to be discussed with the patient preoperatively and depends mostly on tumor-size in relation to breast-size. We correlated mammographic and pathologic measured tumor-size in a retrospective study in 57 breast cancer patients. The sensitivity of mammography depended on the accepted range of error between mammographic and pathologic measured tumor-size. With an accepted range of +/- 20% the sensitivity was only 45%, with an accepted range of +/- 30% it was 63%. These rather bad results advise to have a very careful preoperative discussion with the patient about breast conserving or ablative surgery. Possibly there is higher sensitivity in preoperative tumor-size measurement with real-time-sonography.

Breast↗
PubMed1992

Angioscopy-guided semiclosed technique for in situ bypass with a novel flushing valvulotome: early results.

To allow and facilitate endoluminal vein preparation under angioscopic guidance for in situ bypass grafting, a Mill's valvulotome was equipped with a flushing channel. The advantages of the novel valvulotome are obvious: it allows perfect angioscopic view within a saphenous vein that still contained blood by adjusting the jet of lactated Ringer's solution directly to the lens of the angioscope; it permits the use of very small angioscopes without integrated flushing channels, preventing endothelial damage. The described technique was tested in 27 peripheral reconstructions in 26 patients. The secondary cumulative patency rate within a follow-up time of 4 to 30 months (mean, 14 months) was 89%. The described technique substantially facilitates in situ bypass grafting and minimizes early and late complications and further improves surgical outcome.

Aged↗
PubMed1992

[The Frey operation: a valuable enrichment of therapeutic possibilities of chronic calcifying pancreatitis].

Frey's duodenum-preserving resection is one of three techniques of conservative surgery for the relief of pain in chronic calcifying pancreatitis of the pancreatic head described since 1985 [2, 3, 7]. In our view Frey's procedure is the most satisfactory of the three techniques. It does not require transsection of the pancreas and is suitable to deal with ductal stenoses and stones not only in the pancreatic head but also in the body and tail of the pancreas. We have been impressed by the quality of pain relief obtained and by the smoothness of the postoperative course following this operation. Duodenum-preserving resection of the pancreatic head is greatly facilitated by the use of the ultrasonic dissector which permits dissection in a nearly bloodless field and is particularly suitable for achieving decompression of the intrapancreatic part of the common bile duct by dissecting anyway fibrosed and calcified tissue. The techniques of duodenum-preserving resection of the head of the pancreas are based on principles which have stood the test of time. They have, however, been introduced only a few years ago, and their role in the treatment of severe pain associated with chronic pancreatitis yet awaits more precise definition.

Calcinosis↗
PubMed1992

[The pattern of recurrence of T3 rectum cancer].

Rectal carcinoma is one of the most common tumors of the GI-tract. At the time of initial treatment the majority of our patients had a stage T3 tumor. In order to contribute to the development of new guidelines for adjuvant therapies we analysed the patterns of recurrence in the patients operated with curative intention in our institution between 1981 and 1989. The pattern of recurrence shows that every fifth patient could benefit of a local measure to reduce local recurrence and that every second patient with positive nodal histopathology could benefit of a systemic adjuvant chemotherapy.

Adenocarcinoma↗
PubMed1992

[Final evaluation of the randomized multicenter study SAKK 40/81: adjuvant portal chemotherapy of curatively resected colorectal cancer].

Between 1981 and 1987, 533 patients from 9 institutions have been entered in a randomized trial to assess the value of adjuvant portal infusion (5-Fluorouracil, Mitomycin C) compared to radical surgery alone. Analysis of 469 evaluable patients at a median follow-up of 5.8 years revealed 110 recurrences in the control and 94 recurrences in the infusion group. Estimated 5-year disease-free survival was 52% and 61% respectively (hazard ratio 1:0.75; 95% confidence interval 0.57-0.99; p = 0.046). Overall survival was 59% in the control and 69 in the infusion group (p = 0.048). Adjuvant portal infusion did not influence the occurrence of liver metastases but reduced the overall recurrence rate.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

In situ femorodistal bypass: novel technique for angioscope-assisted intraluminal side-branch occlusion and valvulotomy. A preliminary report.

To allow and facilitate complete endoluminal vein preparation under angioscopic guidance for in situ femorodistal bypass grafting, a novel instrument was constructed. In experiments in cadavers we developed the occluder valvulotome, consisting of a modified Mills' valvulotome containing a laterally-ending working channel, a retrograde cutting blade and an advanceable Teflon tube within the working channel. Using this instrument in combination with commercially available wire coils, we successfully performed five femorocrural in situ reconstructions with endoluminal valvulotomy and embolization of a total of ten thigh tributaries. The technique allows angioscope-assisted valvulotomy and simultaneous endoluminal tributary occlusion, making long skin incisions and extensive vein dissection obsolete.

Aged↗
PubMed1990

[Current status of therapy for gastroduodenal ulcer].

Over the last 25 years there has been a considerable decrease in the prevalence of peptic ulcer worldwide. Since the introduction of potent anti-ulcer drugs the number of elective operations for peptic ulcer (PU) has decreased considerably, whereas the number of emergency operations has remained largely unchanged. The current incidence of PU perforation is 4-10 per 100,000 population. Perforation accounts for 40-50% of emergency operations for PU. Currently one third to over one half of patients presenting with PU perforation are aged over 65, with an increasing percentage of female patients and gastric ulcer perforations. There appears to be a correlation between PU perforation and ingestion of non-steroidal antiinflammatory drugs (NSAIDS), especially in women over the age of 65. About 50% of patients presenting with perforation of PU do not report a previous history of ulcer dyspepsia or treatment with anti-ulcer drugs. Many authors think the lack of a PU history reported by many patients is unreliable and may lead to erroneous conclusions in about half of patients. Mortality of PU perforation is currently 10-20% in most series, with a higher mortality of 10-40% for perforated gastric ulcer (GU) compared to duodenal ulcer (DU), for which mortality rates of 0-10% are currently reported. A number of centers report an increase in PU perforation mortality: this is due to an increased number of elderly patients in whom ulcer perforation mortality is enhanced by preexistent or concomitant diseases of other organs and systems. In the treatment of PU perforation the discussion centers around the choice between simple closure of the perforation and definitive ulcer surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Emergency resection and primary anastomosis for sigmoid volvulus in an African population.

We report 30 patients who underwent operation for sigmoid volvulus during a two year period at the St. Francis Hospital, Tanzania. Five patients were managed initially by non-operative reduction. They all underwent elective resection of the sigmoid during the same hospitalisation with one operative death. Twenty-five patients underwent emergency laparotomy, 12 of them having gangrenous bowel. Resection was carried out in 21 patients, 18 of whom had a primary anastomosis without protective colostomy. In spite of the high incidence of gangrenous bowel (57%), there was only one operative death (5%) in the 18 patients. Initial management of sigmoid volvulus should consist of non-operative attempts at reduction provided that the bowel is viable. Elective resection should be performed during the same hospitalisation. Where non-operative therapy fails or bowel gangrene is present, emergency laparotomy has to be carried out. In the authors' experience resection of the sigmoid and primary anastomosis can be performed safely in this situation.

Adolescent↗
PubMed1990

Effectiveness and low toxicity of hepatic artery infusion with fluorouracil and mitomycin for metastatic colorectal cancer confined to the liver. The Swiss Group for Clinical and Epidemiological Cancer Research (SAKK).

The usefulness of hepatic artery infusion (HAI) with floxuridine is limited by the severe biliary and hepatic toxicity of floxuridine. This prompted the SAKK to evaluate the effectiveness, toxicity and feasibility of HAI with fluorouracil (FU) and mitomycin (MMC) administered by an external portable pump. Of 28 patients treated, partial responses were obtained in 14 (50%, 95% confidence interval: 30% to 70%) and stabilization in 11 (39%, 21% to 60%), for a median duration of 12.6+ months. Median survival was 19.5+ months. Grade I-II toxicity (WHO) consisted of nausea (46%), leucopenia (32%) thrombocytopenia (21%) and abdominal discomfort (25%). Two patients developed gastro-duodenal ulcers and two others grade III leucopenia. No life-threatening side effects, especially no sclerosing cholangitis or chemical hepatitis, were observed. In conclusion, HAI with FU and MMC is a valid alternative to floxuridine HAI in metastatic colorectal cancer confined to the liver.

Adult↗
PubMed1990

[Sonographic criteria of acute acalculous cholecystitis.Critical observation of the clinical records of sedated, ventilated and parenterally nourished patients].

After comparing the classical ultrasonographic findings of acute acalculous cholecystitis with our findings on 24 clinical and sonographic followed acute care unit patients, we have to pay attention to the possible reversibility of such phenomena as increased gallbladder wall thickness, low-level echo surrounding the gallbladder and sludge. In our experience, there is no correlation between a negative cholecystokinin stimulation test and an acute acalculous cholecystitis.

Acute Disease↗
PubMed1990

[Text, archiving, coding--integration with electronic data processing].

For a successful computer-installation in the medical area you need a staff, which is used to work with computers in the daily routine. We tried with this project to establish the computer in a medical office by doing the whole patient-related writings on a specially tailored software. Most of the daily routine can now be done with the help of the computer. A certain time-saving effect could be achieved, although this was not our first aim. On this base we are now able to solve other problems such as coding, statistics or archiving routines by using our established computer environment.

Archives↗
PubMed1989

Non-homogeneous intrahepatic drug distribution in intraportal infusional chemotherapy demonstrated by Tc-99m-MAA perfusion SPECT.

Perioperative adjuvant cytotoxic chemotherapy given through a portal vein catheter may reduce the incidence of metachronous liver metastases following curative resection of colorectal carcinoma. It has generally been assumed that positioning the tip of the catheter in the stem of the portal vein will ensure homogeneous drug distribution to the whole liver. This hypothesis has been put to the test in 10 patients receiving intraportal chemotherapy according to protocol 40/81 of the Swiss Group of Clinical Cancer Research. Catheter position in the stem of the portal vein was checked angiographically the first and last day of a 7-day chemotherapy course. Perfusion scans using 99m-Tc-MAA made during therapy were compared to static liver scans obtained with 99m-Tc sulfur colloid one day after conclusion of chemotherapy. The results were evaluated on planar scans and by SPECT. Slow infusion of the tracer substance under conditions duplicating those of cytotoxic drug infusion used in the protocol resulted in decreased or missing perfusion of the left liver lobe and gross non-homogeneous perfusion in nearly all of the patients.

Aged↗
PubMed1989

[Initial results of adjuvant portal liver infusion following radical surgery of colorectal cancer (Swiss Study Group for Epidemiologic and Clinical Cancer Research Study 40/81)].

Between July 1981 and June 1987, 533 patients from 7 participating institutions have been entered in a prospective randomized trial to assess the value of adjuvant portal infusion (5-Fluorouracil 500 mg/m2/d x 7 continuous infusion + Mitomycin-C 10 mg/m2 on day 1 as a bolus injection through portal venous catheter) compared to radical surgery alone. The portal venous catheter was placed through any side-branch of the mesenteric venous system during laparotomy for the primary tumour. Using the transabdominal route, there have been no catheter-related complications. Overall hospital mortality in the study was 1.75% and was not influenced by adjuvant treatment. Analysis of 469 eligible patients at a median follow-up of 48 months revealed 39.1% recurrencies in the control group and 31.8% in the infusion group (p = 0.09, logrank). Median survival of control patients is 72 months, of chemotherapy treated patients not yet reached. Significant survival advantages have been detected for those 195 (85%) patients who received full-dose adjuvant chemotherapy (67% versus 53% 5-year survival). Due to the low number of deaths in this trial, prolonged follow-up is needed for definitive survival conclusions.

Antineoplastic Combined Chemotherapy Protocols↗