[Povidone-iodine eyedrops for the prevention of newborn conjunctivitis].
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Anti-Infective Agents, Local↗
Biomedical subjects
P Buchmann
Publications and source records attributed to P Buchmann.
[Does laparoscopic colonic carcinoma surgery satisfy the radicality criteria of open surgery?].
Minimal invasive surgery is applicable to almost all colorectal operations, with major benefit for the patient. Technically even cancer operations can be performed. However, in laparoscopic assisted colorectal surgery the question of radicality outweighs that of performability and patient comfort. From a prospective series of 88 laparoscopic colorectal operations, 36 were for carcinoma. 34 patients who underwent conventional surgery were matched with regard to age, sex, type of operation and tumor stage (TNM, grading) to compare the two techniques. The two interventions followed exactly the same guidelines. We compared the length of the fixed specimens, the number of resected lymph nodes and the need for blood transfusions. Postoperative complications were noted and follow-up was 3-12 months. The data obtained showed no difference between the two treatment groups, with a slight trend towards laparoscopic surgery with regard to number of resected lymph nodes. A portside metastasis was observed 9 months after an initial tumor stage T4N1M1. The close relation between the portside and infiltration of the adenocarcinoma into the abdominal wall together with a drain placed through this whole was suspected to be the cause of this complication. We conclude that laparoscopic assisted colorectal surgery for cancer is equal to open operation regarding radicality of resection. Long term results are mandatory to determine the value of minimal invasive surgery in the field of oncology.
Adult↗
[How safe is laparoscopic colon surgery?].
Like any new technique, laparoscopic colon surgery must display results of the same or even better quality than established methods. In this hospital every laparoscopic colon operation has been registered since 1993. Patients were informed orally or in writing that the laparoscopic procedure is a new surgical technique and that, in particular, long term results in colon carcinoma are lacking. Patients who did not undergo the laparoscopic method were those who did not agree to this type of surgery, had tumor infiltrations without extensive liver metastases, or tumor sizes where laparotomy to retrieve the specimen is not much smaller than the open surgery incision. All operations without exception were performed by two laparoscopically skilled abdominal surgeons. We used four 12 mm Troicarts placed in a diamond position, the criteria for mobilization and resection strictly following those of open surgery. In rectosigmoid resection the specimens were extracted suprapubically, with simultaneous implantation of the anvil, in the other cases at appropriate sites. The anastomoses were created either by the double stapling technique or with a single layer running suture. 88 patients underwent operation. The change to open surgery was 11%. The reasons for the change were chiefly inflamed, bleeding diverticulitis tumor, carcinoma infiltrations and, in one case, bleeding. The anastomosis failure rate of the descendorectostomy, and in all laparoscopic colon operations, was 4% and compares favourably with the literature. This was also true of stenosis incidence. The wound infection rate is on the whole the same as for open surgery. The complication in the descendorectostomy is reduced by half in the laparoscopic procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[The value of defecography for diagnosis of rectocele and rectal prolapse].
The role of defecography with respect to rectoceles and to any grade of rectal prolapses has not been defined so far. Therefore, we studied 42 out of 45 patients that were submitted to a defecography between 1988 and 1992 for defecation disorders of unknown origin. In particular, we compared the diagnosis obtained by anamnestic data and the physical examination with the defecographic results and the definitive diagnosis with regard to the chosen therapies and the results. Rectocele and rectal prolapse were very frequent pathologies with 69% and 33% respectively. Of 23 patients with a clinically palpable rectocele, defecography was false negative in 4 and moreover, it did not provide any information about the functional relevance of the rectocele. Yet, it disproved the clinically diagnosed prolapses in 6 of 15 subjects, but revealed one in 5 of 27 patients that were presumed normal. On the other hand, a previously not diagnosed rectocele was detected in 6 out of 19 patients by means of defecography, but none of them proved to be of any clinical relevance. Of all rectoceles, only 48% were regarded responsible for the patients' symptoms and were therefore operated. Hereby, the indication for a surgical approach based more on anamnestic data and the proctological examination than on radiographic findings. Contrarily, the indication for a rectopexy--even if given only in 4 of those 14 patients with any grade of invagination--mainly based on the dynamics during defecation as documented by defecography.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Treatment of elbow ankylosis by means of transplantation of the entire joint. Preliminary communication. 1908.
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Ankylosis↗
[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↗
[Sliding flap-plasty in treatment of anal fistula: a prospective study].
The common therapy for trans- and intersphincteric fistula usually is opening the fistula tract. Healing and rough continence thereafter is uneventful, but when follow-up is intensified and patient are asked for slight soiling and discharge many minor complaints become evident. Therefore we started a series of patients suffering from inter-, trans-, extrasphincteric or supralevatoric fistula with an advancement flap procedure after excision of the fistula, without dissection of any muscle fibre. Up to now 23 patients were operated including 5 with Crohn's disease. 17/23 were healed primarily and 6/23 failed to heal with 5 successful reoperations. 4/5 Crohn's patients operated during quiescent disease are healed. No discharge or soiling was reported after a follow-up time from 5 months to almost 2 years. In conclusion advancement flap gives best results in respect to continence. The flap should include not only mucosa but underlying internal sphincter muscle fibres too.
Adult↗
[Retroperitoneal rectum perforation during barium enema].
The examination of rectum and colon with barium sulfate is a method which is increasingly replaced by the endoscopy; therefore, the routine of doing this examination is increasingly vanishing. This means that the risk of this method increases. We report a case and discuss the symptomatology as well as the management of a perforation of the rectum during an examination with barium sulfate.
Aged↗
[The endoscopic treatment of malignant biliary tract stenoses with endoprostheses].
In 65 patients (36 men, 29 women; mean age 74 [43-90] years) obstructive jaundice caused by malignant biliary stenosis was treated by endoscopic retrograde insertion of a 10 or 12 F synthetic endoprosthesis. The rate of complications of the endoscopic intervention was 5% (n = 3), 30-day mortality rate was 11% (n = 7) and method-related mortality was 8% (n = 5). Good drainage was achieved in 39 of 41 patients (95%) with the 12 F endoprosthesis, and in 15 of 21 patients with a 10 F one (71%) (P less than 0.001). Renewed jaundice due to prosthesis occlusion occurred in 31 patients an average of 103 (11-350) days after placement. Interval until occlusion correlated with the site of the stenosis and the length of the endoprosthesis. Jaundice recurred earlier in patients with long prostheses and proximal biliary stenosis than in those with a short prosthesis and distal stenosis. In 20 patients with renewed jaundice the endoprosthesis was replaced endoscopically. At that time 13 of the patients had a cholangitis. Occlusion of the new endoprosthesis was more common in patients with cholangitis (9 of 13) than those without (2 of 7; P less than 0.05). These findings indicate that endoscopic biliary tract drainage should be performed with as short a 12 F endoprosthesis as possible. In view of the potential need for early change of endoprosthesis the biochemical parameters of cholestasis should be regularly monitored.
Adult↗
[Preventive or therapeutic parathyroidectomy in primary hyperparathyroidism].
The only causal treatment of primary hyperparathyroidism (PHPT) is parathyroidectomy. There are indications in the literature that despite operation expectation of life is shortened because of an increased frequency of cardiovascular and malignant diseases leading to the recommendation for early surgery even in uncomplicated PHPT. It is easier to convince an asymptomatic patient of an operation when he is informed about complications and consequences of an expectative attitude. Therefore, we reviewed our 71 patients operated upon during a 4-year-interval, 58 of whom were followed-up. During 82 operations 115 pathologically altered parathyroid glands were removed. Two persistent paralyses of the recurrent nerve occurred, however, without alteration of the voice. Follow-up of 82% of patients revealed 2 cases of recurrent nephrolithiasis (1 hypercalcaemia, 1 normocalcaemia). Three (5%) true recurrences were found, but neither a pancreatitis nor a peptic ulcer was noted during long-term follow-up. None of the 137 patients operated for a bleeding or perforated peptic ulcer during the last 10 years and 1 of 55 patients with acute pancreatitis during the past 8 years suffered from a PH-PT. However, morbidity and mortality of these two conditions was high. Although correlation to PHPT was low we recommend early operation of PHPT because of the low morbidity rate, zero lethality and reduced expectation of life.
Adenoma↗
[Anal condylomata acuminata in HIV positive patients].
Since July 1986 we started with following all patients with condylomata acuminata including HIV-testing and human papilloma virus (HPV) identification by DNA-DNA-hybridisation (southern blot). Seventy patients are included, 39 of them are seropositive. The ratio male to female is 59 to 11, in seropositives 35 to 4, in negatives 24 to 7. The average age is 28 and 31 years respectively. The number of homosexuals and junkies is significantly higher in seropositives. Seventeen patients are in HIV-stage II, 11 in stage III and 10 in stage IV according to CDC-classification. Characteristic for the seropositives was an extensive growth on the rectal mucosa and the very rapid growth of initially subtotally resected lesions in order to prevent stenosis. Sixty-five patients were treated by one stage radical operation with electrocauter. Surprisingly recurrency is more frequent in seronegatives, however, the lesion is much smaller in this group. A hypothesis to explain this observation is brought forward. Postoperative complications occurred only in HIV-stages III and IV. We therefore recommend single shot antibiotic prophylaxis in these patients. The HPV-identification showed no malignancy associated HPV-types in both groups but a higher incidence of HPV 11 in higher HIV-stages which we cannot explain. We conclude from our series that, if operation is indicated, one stage radical electrocoagulation of condylomata acuminata is a necessary procedure in seropositive patients and a save one in negative patients but antibiotic prophylaxis should be given in stage III and IV. Anal condylomata acuminata are a hint for possible HIV-positivity.
Adolescent↗
[Is routine intra-operative cholangiography in laparoscopic cholecystectomy truly unnecessary?].
The introduction of laparoscopic cholecystectomy as method of choice for gall stone treatment reopened the question whether to continue with routine intraoperative cholangiography or to switch over to a selective indication. In order to set an accurate indication for selective intraoperative cholangiography it was our goal to develop a tool for preoperative identification of patients with a high risk of common bile duct stones. A preoperative score, indicating the risk of common bile duct stones, was designed. A history of jaundice, elevated levels of bilirubin, alkaline phosphatase, amylase (serum), ALAT (GPT) or ASAT (GOT), a common bile duct wider than 10 mm or containing concrements and multiple gallstones smaller than 10 mm were valued as risk indicators, whereas normal wide bile duct, large or solitary gallstones were valued as decreasing the risk of common bile duct stones. The retrospective screening of 289 consecutive conventional cholecystectomies (1986-1990) for these risk indicators demonstrated a good correlation of the risk score with the occurrence of common bile duct stones. A prospective application of the score, with improved ultrasound examination and routine preoperative intravenous cholangiography, mandatory for laparoscopic cholecystectomy at our institution, will define the high risk group definitely and allow an accurate selective use of intraoperative cholangiography.
Cholangiography↗
[Technique of intraoperative laparoscopic cholangiography].
Since laparoscopic cholecystectomy has been established at our institution, the routine use of intraoperative cholangiography was abandoned but preoperative intravenous cholangiography and sonography are mandatory. However, these investigations are not always conclusive and in some cases not applicable. We have therefore started to use selective intraoperative laparoscopic cholangiography for laparoscopic cholecystectomy. Our technique and the materials required for this peroperative investigation are described in the present article.
Cholangiography↗
[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↗
[Initial experiences with the bio-fragmentable Valtrac anastomosis ring].
The biofragmentable ring (Valtrac) to perform a sutureless bowel anastomosis was used in a short period until complications rate became to big. There were six ileo-colostomies with the 28 mm ring and 7 colo-colostomies with the 31 mm ring. In 4 patients additional sutures were placed because the ring was shining through the tissue. Thirteen patients (4 women, 9 men) with a mean age of 63 years (36-78) were included. Complications occurred in 3 men (71, 36 and 63 years old). Two of them had an additional suturing. One demonstrated insufficiency at day four with many small gabs in the anastomotic line according to the ring design. Histology demonstrated perfect microcirculation. The second patient developed a fistula three weeks after operation. Both had an ileo-colostomy. The third operated because of a gastrocolic fistula with cachexia reentered hospital seven weeks postoperatively with a new gastrocolic fistula on X-ray. He died with a cardiac arrest. Postmortem was refused. We conclude from our results that the Valtrac ring should be used only by experienced surgeons, there is no reduction in operation time, and ileo-colostomy needs special care. We believe that surgeons using an extramucosal monofilament running suture for colonic anastomosis are more unlikely to switch to the Valtrac ring than those using other technics.
Adult↗
Improved perineal wound healing with the omental pedicle graft after rectal excision.
The aim of this study was to determine whether significant improvement in perineal wound healing could be achieved by placing parts of greater omentum into the sacral cavity after rectal excision. 74 patients were evaluated, in 38, parts of the greater omentum were mobilised into the presacral cavity. The omentum flap increased primary healing from 41% to 61%. Sinus formation was reduced. Since using routine omentoplasty all wounds have healed by five months. Complications occurred only twice. In one patient the omentum became partially necrotic, while in another small bowel obstruction occurred due to herniation beneath the root of the flap. We conclude from our results that omentoplasty after rectal excision is a useful method to improve perineal wound healing and should be performed as routine procedure.
Adenocarcinoma↗
[Uni- and ipsilateral pulmonary edema after surgery on the lung].
Unilateral pulmonary edema can develop after evacuation of pleural liquid and pneumothorax, after pneumonectomy at the contralateral side and as a special form in left ventricular failure. Unilateral ipsilateral pulmonary edema in the remaining parenchyma after operations of the lung has been described very rarely. Eight patients are here described, once after a decortication and seven times after a pulmonary resection. Radiologic signs occurred generally 12-24 h after the operation and persisted for three to seven days. The first postoperative X-ray was always more or less normal. We believe that the cause of the edema is a mechanical traumatisation of the remaining parenchyma of the lung at the time of the operation which results to a capillary leak. Left ventricular failure and excessive fluid application after the operation can be a risk factor. Generally no clinical signs are present during the edema, but respiratory insufficiency, as with patient 8 can occur. Therefore it is important to distinguish unilateral pulmonary edema from other diagnosis like pneumonitis, hemothorax and atelectasis.
Aged↗
Risk factors in abdominal surgery.
The term risk is understood to be the danger of the occurrence of an undesired, life-threatening event. The probability of this undesired event is greater in the presence of a risk factor than in its absence. In general surgery, these risk factors can be classified into five groups: The environment, the surgeon, the operation per se, the disease, and the patient himself. Abdominal surgery is especially suited to clarify and to illustrate this classification. Some typical risk factors are described, and for each group the measures for risk prevention or risk reduction are discussed.
Abdomen↗