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Biomedical subjects

P Tschantz

Publications and source records attributed to P Tschantz.

At least 19 recordsLinked to original sources
PubMed2002

Pyosalpinx: not always a sexual transmitted disease? Pyosalpinx caused by Plesiomonas shigelloides in an immunocompetent host.

Plesiomonas shigelloides are ubiquitous Gram-negative bacteria that are found in fresh or marine water, particularly in tropical or warm climates; they were recently implicated in diarrhoeal disease. Patients usually present with a history of recent travel to tropical regions or consumption of uncooked seafood. Extraintestinal disease has rarely been reported, occurring generally in neonates or immunocompromised patients, and is often fatal. We report a case of right pyosalpinx due to P. shigelloides acquired by swimming in contaminated water. Laparoscopic salpingectomy led to a good outcome.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed2001

[Surgical wounds with or without dressings. Prospective comparative study].

STUDY AIM: The aim of this study was to compare the infectious local risk when the wound dressing was removed or not after 48 hours, and to look for the other advantages or disadvantages of these two methods. PATIENTS AND METHOD: Two groups of 50 patients who underwent a thoracic or abdominal procedure, class I or II according to Altemeier, have been randomly selected: one received a wound dressing after 48 hours, and the second did not. RESULTS: The clinical features were comparable between the two groups. There was no significant difference in the outcome of the two groups of patients in terms of wound infection (only one infected wound in each group). CONCLUSION: Wound dressing usually seems unnecessary.

Adult↗
PubMed2001

[Surgical indications and techniques in Basedow's disease, multinodular goiter and thyroid cancers].

This is a retrospective study of 47 near total and 30 total thyroidectomies for multinodular goiter, Graves' disease and thyroid cancer. Complications are rare: one permanent recurrent nerve palsy out of 154 nerves at risk, one definitive hypoparathyroidism. For a benign pathology, the former bilateral sub-total thyroidectomy should be replaced by a near-total thyroidectomy which leaves one unilateral thyroid remnant the size of a cherry. Using this technique, we did not observe any recurrence. Among 42 patients controlled after more than one year 1/3 have a normal thyroid function. Systematic substitution is not indicated. Thyroxine should be used only if hypothyroidism develops after the operation or if an increase of the thyroid remnant is demonstrated. Thyroid cancer should be treated by total thyroidectomy, except for noninvasive papillary cancer without node metastasis for which a total lobectomy is sufficient.

Goiter, Nodular↗
PubMed2001

[Thyroid nodules. Surgical aspects].

This is a restrospective study of 176 thyroid nodules operated between 1977 and 1990, excluding bilateral goiters. 145 were benign with 111 cold and 34 hot nodules; 31 were cancers. Fine needle biopsy (FNB) is useless in hot nodules. For the cold ones, even in recent series, FNB can give false positive or negative results. This means that the answer of FNB should be closely related to the clinical and US findings. The surgical treatment of thyroid nodules must be a total lobectomy including the isthmus. The recurrent laryngeal nerve must be followed entirely. There was no permanent nerve palsy among the 122 total lobectomies. The risk of developing another controlateral nodule later is low (2/110 cases). It is very difficult to distinguish a follicular cancer from an adenoma on frozen section. For this reason, the patient should be warned that a second operation might be necessary some days later if the definitive diagnosis is a follicular cancer. For a non-invasive and non-metastatic papillary cancer, total lobectomy is sufficient. More advanced papillary and all other thyroid cancers should be treated by a total thyroidectomy.

Adult↗
PubMed2001

[Pelvic and acetabular fractures, long term results, retrospective study from Cadolles from 1977 to 1997].

From 1977 to 1997, 51 unstable pelvic and/or acetabular fractures were operated in our institution. We could control 35 after a mean postoperative period of nearly six years. The outcome was analysed considering several factors: pain, neurological and genito-urinary problems, gait, social life, Xrays and clinical findings. Our results match well with those of other series. Different evaluation scores used in the literature are compared and discussed.

Acetabulum↗
PubMed2001

[When and how to investigate a mutation predisposing to the Lynch syndrome].

Lynch Syndrom (or Hereditary Non-polyposic Colorectal Cancer (HNPCC)) can be described as the presence of an autosomic dominant mutation predisposing to early colorectal cancer. Suggestive familial history and young patient with colorectal cancer should undergo thorough investigation. In Switzerland, investigation will first attempt to show microsatellites instability in fumoral cells, then mutation in blood. If positive, direct progeny and family should be tested. Those who are mutation free may be followed as normal population. The others should have more frequent colorectal and gynecologic follow-up. Surgical treatment will attempt to prevent synchrone or metachrone colorectal cancer by total colectomy. Preventive colectomy is attractive but controversial.

Adult↗
PubMed2001

[Pancreatic injuries: diagnosis and management].

Traumatic lesions of the pancreas are rare (3-12% of abdominal trauma). In Central Europe most of them are due to blunt trauma. We reviewed the series from four university and one central hospitals in Switzerland over a period of ten to twenty years. Among these 75 cases, 84% were consecutive to blunt trauma. All the cases with an open injury were operated on rapidly. 15 patients with blunt trauma were treated conservatively. Out of the 58 operated patients, 20 had a caudal resection, 3 a pancreatico-jejunal anastomosis and 1 a duodeno-pancreatectomy. The others were drained. Nine patients died, 5 of them as a direct consequence of the pancreatic lesions. The morbidity was high (48%). After an open abdominal trauma, or when the patient remains unstable after blunt trauma an emergency laparotomy should be undertaken. It can lead to damage control surgery as a first step when the general and local conditions are bad. When the patient is hemodynamicaly stable, a conservative approach should be considered. The best diagnostic tools are repeated CT-scan and amylasemia. A differed operation is indicated only if the general and local condition deteriorate.

Amylases↗
PubMed2000

Choledochocele demonstrated by computed tomographic cholangiography: report of a case.

Choledochocele is a rare cystic congenital malformation of the distal common bile duct, the precise pathogenesis of which remains unclear. It is usually diagnosed in adulthood after many examinations for unclear digestive symptoms, as in the patient whose case is described herein. Of all the diagnostic techniques available, endoscopic retrograde cholangiography (ERCP) seems to be the best; however, it is an invasive procedure associated with some morbidity. Spiral computed tomographic cholangiography with three-dimensional reconstruction is also an interesting screening technique. Malignant transformation of a choledochocele occurs very rarely, compared with other cystic malformations of the biliary tract. If a choledochocele is small and symptomatic, the lesion can be treated by endoscopic sphincterotomy, but larger cysts are more effectively removed by a surgical cystoduodenostomy. We present herein the case of a 25-year-old woman admitted to our hospital in March 1998 with upper right quadrant abdominal pain caused by a choledochocele, who was successfully treated by a cystoduodenostomy.

Abdominal Pain↗
PubMed2000

[Crohn's disease of the appendix].

A giant appendix is an extremely rare and improbable finding during surgery in suspected cases of acute appendicitis. Although this condition is primarily suggestive of neoplasia, it is usually due to an inflammatory or infectious disease. We report a case of Crohn's disease limited to the appendix, which was diagnosed after a short right ileocolectomy. Only 156 similar diagnoses have been reported in the literature to date. This disease appears to have a benign course and therefore differs from classical Crohn's ileocolitis. For this reason, these patients do not require any specific investigation or follow-up.

Adult↗
PubMed1999

[Cardiac perforation by a gastric ulcer: an unusual cause of death, after an esophageal and gastric resection of an epidermoid esophageal carcinoma].

We report here the case of a 55 year old female that underwent surgery for a well differentiated squamous cell carcinoma of the esophagus (middle third). Four months after surgery, she complains of neck pain, for which she is prescribed non steroidal antiinflammatory drugs (NSAID). A CT-scan and a Barium swallow are then normal. After three weeks of treatment, the patient is admitted on emergency to the Intensive Care Unit for a resuscitation hematemesis and atrial fibrillation with a fast ventricular response. The symptoms are stabilized after the transfusion of a few packed red blood cells. A few hours later, however, a massive hematemesis recurs and the patient dies despite intense resuscitation measures. Autopsy reveals three gastric ulcers, one of which had perforated through the cardiac left ventricular wall.

Carcinoma, Squamous Cell↗
PubMed1999

Utility and complications of permanent venous access devices (PVAD) in oncological treatments. Follow-up of 100 cases.

BACKGROUND: Permanent venous access devices (PVAD) are nowadays routinely implanted and used with some morbidity for the oncological treatments. The adequate timing of implantation based on the number of treatments, the survival rate and the complications has not yet been well estimated. METHODS: A hundred permanent venous access devices placed in oncological patients were followed-up prospectively. RESULTS: No mortality was seen due to the surgical act. A 11% morbidity rate was noted, largely due to infections, with 6 patients needing a second surgery. On average, 6 chemotherapy cycles were done after placing of the permanent venous access device. CONCLUSIONS: Due to these results and an average survival rate of 10.7 months, we suggest the placing of a permanent venous access device early in the management of oncological patients requiring chemotherapy cycles, so as to increase the comfort of the patient and to safeguard his peripheral venous system.

Adolescent↗
PubMed1998

[Post-mortem evaluation following oncologic treatment of the functional and bacteriologic status of 25 permanent venous access devices].

Permanent venous access devices allow long-term parenteral treatment under relatively safe and comfortable conditions. Nevertheless, this use is associated with some degree of (particularly infectious) morbidity. 25 permanent access devices were removed surgically in immediate autopsies and cultured. Some half were infected, with a clear prevalence (40%) for Staphylococcus coagulase negative. The results were related to clinical history and compared with the figures and conclusions of other studies. It is proposed that in certain situations cultures of native blood should be carried out more frequently through the permanent venous access, with a view to possible specific targeted antibiotic therapy associated with the heparinized lock.

Adult↗
PubMed1998

[A rare complication of permanent venous access: constriction, fracture and embolization of the catheter].

The pinch off syndrome due to squeezing of the implanted catheter is a rare complication of permanent venous access devices (0.1 to 1% of the cases). The cause is a mechanical catheter's compression in the costo-clavicular space, when implanted too medially in the subclavian vein. In case of lack of venous reflux or injection difficulties, sometimes complicated by local pain, a radiological control must be obtained to demonstrate signs of compression or beginning of fracture. Significant damage to the system is shown be extravasation of radioopaque contrast medium. The suspicion of catheter damage justifies early replacement of the system to avoid right heart or pulmonary artery embolism. The electron microscopic scanning tends to prove that the catheter's rupture is caused by a fatigue process.

Aged↗
PubMed1998

[Outcome of nonspecific right iliac fossa pain syndromes].

One-third of all cases of abdominal pain and a quarter of cases of right iliac fossa pain urgently admitted to hospital leave hospital with no precise diagnosis. Based on a series of 400 patients hospitalised for right iliac fossa pain, comprising 107 cases with no identified aetiology, this prospective study was designed to assess the medium-term outcome of these patients, with or without surgical exploration. 67 cases were reviewed at five years. No major diagnosis was missed. Over this 5-year period, 30 patients (45%) experienced another episode of abdominal pain. Among the third of patients (21 cases, 31%) reviewed for another episode of right iliac fossa pain, 7 were readmitted to hospital, with 5 operations, for histologically confirmed acute appendicitis in 3 cases (5% of the series). The patient and his attending physician must be informed of the nonspecific diagnosis established during the first hospitalisation. There is no significant evidence to suggest a psychological component in the recurrent nature of the pain. Cancer must be formally excluded in patients over the age of 50. When surgical exploration is performed, nowadays by laparoscopy, appendicectomy is recommended. This procedure does not decrease the risk of recurrent pain, but confirms the real absence of histopathological abnormality and decreases the number of subsequent hospitalisations.

Abdominal Neoplasms↗