PubMed Health⌕ Search

Biomedical subjects

R Inderbitzi

Publications and source records attributed to R Inderbitzi.

At least 19 recordsLinked to original sources
PubMed1999

[Systematic scientific quality improvement in surgical specialties. The AQS mode].

BACKGROUND: How can the new legal requirements (Law on Statistics 1992 with its corresponding regulations of 1993: minimum data record of the Federal Department of Statistics (BFS) with ICD codification and the law on medical insurance 1995 with its corresponding regulations of 1996: necessity of documenting quality and efficiency) be integrated into the daily hospital routine with reasonable expenditure of time and costs? METHOD: The BFS minimum data record was combined with additional information on quality improvement on one single questionnaire. The surgical departments of the Hospital Limmattal in Schlieren and the Regional Hospital Bienne founded the Association for Quality Improvement in Surgery (AQC) in 1995 and have tested the AQC system for two years. RESULTS: Until the end of 1997 data from 15,115 surgical procedures were collected in our database. In addition to the more time consuming collection of the "minimal data set of the Federal Department of Statistics (BFS)" which requires between 3 to 10 minutes, the collection of the additional AQC-data will take 1 to 3 minutes. DISCUSSION: There is an increasing expenditure of time and costs as a result of legal requirements. Expenditure may, however, be kept within manageable limits if a single questionnaire serves several purposes simultaneously. The AQC system does not only meet the legal requirements as to systematic quality improvement and BFS statistics, but can also be used for the annual statistics of the clinic, the statistics of individual surgeons, and for hospital comparisons provided other clinics adopt the system as well. There are no standards, reference areas or indicators as yet, but such tools may now be developed much more easily with comprehensive data available through the AQC system. CONCLUSIONS: The AQC system has proved to be a manageable tool in the hospital routine; it could thus be implemented as a wide-area system to provide systematic quality improvement and to meet other statistical requirements.

Humans↗
PubMed1998

[Septic pylephlebitis with detection of gas in the portal vein: a rare complication of sigmoid diverticulitis].

Pylephlebitis, septic thrombosis of the portal vein and its branches, is an infrequent complication of intra-abdominal inflammatory processes which may lead to thrombosis of the portal vein or to liver abscesses. Air in the protal venous system usually predicts a fatal outcome. The survival rate calculated in all reported cases is less than 25%. It is important to detect portal venous gas early. In detection of portal venous gas, ultrasound and computed tomography are more sensitive than plain radiographs. Pylephlebitis used to be a dreaded complication of appendicitis, but the incidence of this disease has greatly declined since the development of antibiotics and modern surgical techniques. We present two cases of pylephlebitis associated with gas in the portal vein as a result of left colonic diverticulitis treated by bowel resection. In spite of the occurrence of portal venous gas, the outcome may be favourable if this disease undergoes prompt surgical treatment.

Colectomy↗
PubMed1998

[Rupture of a Baker cyst with compartment syndrome. A rare complication of knee arthroscopy].

We report a case of leakage of irrigation fluid into the extra-articular soft tissue, due to rupture of a Baker's cyst during arthroscopy of the knee joint. A four-quadrant fasciotomy of the calf musculature was performed to prevent the devasting ischemic complications of an imminent compartment syndrome. A survey of the literature reveals no consensus regarding the treatment of such complications. On the contrary, some authors recommend avoiding fasciotomy and waiting for spontaneous reabsorption of the irrigation fluid.

Aged↗
PubMed1997

[Does a shower put postoperative wound healing at risk?].

A prospective randomized study was designed to determine the effect of postoperative water contact on tissue healing. A total of 121 patients undergoing open hernia repair was divided into two groups. The first group was permitted to shower postoperatively, allowing the wound to come into direct contact with the water, the second group was instructed to keep the incision dry. Water contact, wound healing and patient satisfaction were assessed. There was no difference in wound healing between the two groups and no manifest infection.

Adult↗
PubMed1996

[Chronic cholestatic liver disease and grand mal seizures].

HISTORY AND CLINICAL FINDINGS: A 48-year-old woman was hospitalised because of grand-mal seizures. 3 years previously a malignant melanoma had been resected from the skin of the back. She was also known to have chronic cholestasis of unknown cause. On physical examination there were postictal signs, but no neurological abnormalities and no jaundice. INVESTIGATIONS: Biochemical tests demonstrated greatly increased alkaline phosphatase (576U/I). gamma-GT (1556U/I) and leucine aminopeptidase (258U/I). The transaminases were only slightly raised (GOT 113U/I, GPT 82U/I). Magnetic resonance imaging of the brain revealed a single intracerebral space-occupying lesion, compatible with a melanoma metastasis. Endoscopic retrograde cholangiopancreatography discovered a filiform, short stenosis in the choledochal duct, histologically an adenocarcinoma. TREATMENT AND COURSE: The cerebral metastasis was removed stereotactically without complications. A Whipple-type gastroduodenopancreatectomy was performed 2 months later. Histology of an intraoperative liver biopsy revealed Caroli's syndrome (focal intrahepatic biliary dilatation) with congenital hepatic fibrosis. Cholestasis persisted after the operation and was treated with ursodeoxycholic acid. The patient has now been free of symptoms for 3 years. CONCLUSIONS: Caroli's syndrome should be included in the differential diagnosis of chronic cholestasis of unknown cause. The case also demonstrates the justification, under certain conditions, of aggressive treatment even when there are two different malignancies.

Adenocarcinoma↗
PubMed1996

Controlled multicenter trial of laparoscopic transabdominal preperitoneal hernioplasty vs Shouldice herniorrhaphy. Early results.

BACKGROUND: In February 1993 a prospective randomized multicenter trial was initiated to compare laparoscopic transabdominal preperitoneal hernioplasty to Shouldice herniorrhaphy as performed by surgeons of nonspecialized clinics. METHODS: Until January 1994, 87 patients with 108 hernias took part in the trial (43 Shouldice and 44 laparoscopic repairs). RESULTS: The laparoscopic procedure took significantly longer than did the open operation but caused less pain as measured by pain analogue score and consumption of paracetamol and narcotics. The postoperative complication rate was 26% in the open and 16% in the laparoscopic group. The patients in the laparoscopic group were discharged earlier and their convalescence was shorter than after open hernia repair. There has been one early recurrence in the laparoscopic and two in the open group to date with a mean follow-up of 201 days. CONCLUSIONS: Laparoscopic hernia repair causes less pain than the conventional operation and enables the patient to return to full work and usual activities earlier. The recurrence rate will not be known for 5 years.

Abdomen↗
PubMed1994

[Video-endoscopic surgical technique in established thoracoscopic interventions].

The video shows six different established thoracoscopic interventions besides the treatment of spontaneous pneumothorax. Adhesiolysis (1) is demonstrated in a patient with malignant pleural effusion, followed by palliative pleurodesis by talkage (2). Resections of benign extra- (3) and intrapulmonary (4) tumors are shown as well as endoscopic pericardial fenestration (5) and thoracic sympathectomy (6).

Humans↗
PubMed1994

[Organization and significance of quality control in recent surgical methods exemplified by 85 consecutive thoracoscopic interventions].

The rapid evolution or rather revolution of minimally invasive surgical techniques is stimulating new technical and clinical innovations. Quality control is of great importance in new areas of technical development where standards do not yet exist. By recording detailed documentation of patient data, indications, operative procedures and initial follow-up we can compare this new technology with the gold standard therapy. This documentation system for thoracoscopic interventions was developed together with the Swiss Group of Laparoscopic and Thoracoscopic Surgeons. This pilot project of 85 consecutive thoracoscopic interventions will demonstrate the acceptability, clinical application and ease with which data can be analyzed. Operative techniques are described in detail: 20 diagnostic interventions with biopsy, 19 apical parietal pleurectomies (+/- resections of bullous lung tissue), 10 therapeutic lung tissue resections, 19 palliative pleurodesis, 5 treatments of pleural empyema, 1 mediastinal tumor resection, 1 esophagectomy, 4 thoracic sympathectomies plus 6 other procedures. Data entry is efficient with mean total time of 10 min for each record. All of the data are entered into a computer database. The possibilities for interpreting and combining this data are presented. The operative techniques can easily be related with history, indications, anesthesia, complications and results. First evaluation of thoracoscopic efficiency is possible. In addition, a detailed analysis of intra- and postoperative complications and of the hospital course can be performed.

Documentation↗
PubMed1994

[Minimally invasive thoracic surgery].

Surgery of the intrathoracic organs may be performed without compromise of respiratory mechanics considering minimally invasive principles. An analysis of our experience of 373 thoracoscopic interventions reveals that the diverse procedures performed on the pleura (pleurectomy, pleurodesis), on the lung (wedge resection, fistula closure, ligature of parenchymatous leaks) and on other definec anatomical structures such as the sympathetic nerve or the thoracic duct, are effective in the therapy of intrathoracic disease. The most important pathological conditions which may be treated by thoracoscopy are listed. The range of complications (7%) and their causes are discussed. Current developments and innovations are summarized by a short review of the literature.

Cause of Death↗
PubMed1993

Pericardial biopsy and fenestration.

Employing a video thoracoscopic pericardial fenestration constitutes a promising technique for the investigation and treatment of chronic pericardial effusions. It combines the benefit of low invasiveness with the advantages of open biopsy. The procedure simultaneously allows both an accurate diagnosis under visual control (inspection, aspiration, well-targeted biopsy of pathological processes) and the performance of effective therapeutic intervention. Without imposing unacceptable stress, it also facilitates rapid symptom relief in patients with advanced malignant disease whose general condition is severely impaired.

Aged↗
PubMed1993

Osteosynthesis of the injured chest wall. Use of the AO (Arbeitsgemeinschaft für Osteosynthese) technique.

Open reduction and osteosynthesis with AO (Arbeitsgemeinschaft für Osteosynthese) technique, using 3.5 mm reconstruction plates and 3.5 mm cancellous screws, were performed in all cases of chest wall injury considered for surgical stabilization since 1990, viz. 11 with posttraumatic flail chest and one with painful nonunion of two ribs. In the ten survivors with flail chest, stability was achieved without secondary dislocation, giving good pain relief, improved respiratory mechanics and reduced duration of ventilatory support and intensive care requirements. Lasting pain relief was obtained also in the case of costal nonunion. No complications related to the osteosynthesis arose during follow-up for a mean of 11 months. Chest wall injuries in flail chest and painful nonunion of ribs can be easily and efficiently stabilized with the AO technique.

Adult↗
PubMed1993

[Does administration of fibrin glue prevent development of lymphoceles after radical lymphadenectomy?].

Surgical approaches to the groin and axilla, almost radical lymph node dissections (RLND) are followed frequently by lymphocysts. In a prospective randomized study of 30 inguinal or axillary RLND we used at half of the cases 1 ml of the two-component fibrin glue (Tissucol), applied as a spray to seal the wound at the end of the operation. At 27 patients not only a prophylactic RLND but a selective hyperthermic cytostatic perfusion of the extremity was performed because of a locally advanced malignant tumor. There was no difference between the two groups of patients in age, diagnosis, surgical technique, and follow-up. In two cases of the fibrin glue (FG)-group and in 4 cases of the control group a second intervention because of a local wound healing problem had to be performed. The mean amount of postoperative drainage fluid was 1065 +/- 822 ml at the FG-group and 1332 +/- 1093 ml at the control group. Also postoperative drainage time (9 vs. 12 days) and postoperative hospital stay (18 vs. 22 days) were shorter at the FG-group, however, without statistical significance. 11 of 14 patients of the FG-group and 10 of 14 patients of the control group had normal scars after lymphadenectomy without signs of lymphocysts at the clinical follow-up. At our high risk patients (very high amount of postoperative drainage fluid in comparison to other series) prophylactic fibrin glue sealing after RLND could not prevent lymphocysts and lymphatic fistulae.

Adult↗
PubMed1993

[Thoracoscopic treatment of recurrent or persistent spontaneous pneumothorax].

The video shows an endoscopic modification of the established conventional surgical therapy of recurrent or persistent spontaneous pneumothorax: The indications and endoscopic techniques of parietal pleurectomy, ligature of leaking bullae and wedge resection are demonstrated. Our first experience on 50 patients indicates, that minimal postoperative pain and a relatively short hospital stay (mean 3.6 days postop.) are the advantages of minimal invasive techniques also in thoracic surgery. Long-term results are however still lacking.

Humans↗
PubMed1993

[Thoracoscopic interventions].

The technique of minimal invasive surgery has successfully been introduced into the area of thoracic surgery. Surgery of the intrathoracic organs may now be performed without compromise of respiratory mechanics, thus allowing the operative treatment of an ever widening range of pathological conditions. An analysis of our experience (287 thoracoscopic interventions in the last three years) reveals that the diverse procedures performed on the pleura (pleurectomy and pleurodesis), on the lung (wedge resection, fistula closure and ligature of parenchymatous leaks) and on other defined anatomical structures such as the sympathetic nerves or the thoracic duct, are effective in the therapy of intrathoracic disease. The most important pathological conditions which may be treated by thoracoscopy are listed. The range of complications and their causes, which developed in 8% of all procedures, are discussed. The current limitations of this method are defined in the context of the situations where thoracoscopy was discontinued (9 times), a thoracotomy performed (17 times) or a further procedure became necessary (14 times). Current developments and innovations are summarized by a short review of the literature.

Humans↗
PubMed1993

[Thoracoscopic lobectomy in the animal model].

To evaluate the possibility of a pure thoracoscopic lobectomy by preparation and selective division of hilar structures we performed left cranial lobectomies in 5 Göttingen mini-pigs. The vessels and the main bronchus were isolated and divided by an Endo-GIA stapler. As an alternative technique we used clips or endoscopic ligation. Inside the thoracic cavity the resected lobes were divided into 2 or 3 parts by the Endo-GIA. They could be extracted without destroying the tissue therefore making macroscopic examination possible. The intraoperative blood loss was minimal and all the pigs survived the operation. Two pigs were sacrificed initially, the remaining three one month later. These three showed no evidence of pleural fistula or atelectasis in remaining lung tissue either macroscopically or histologically. It appears that thoracoscopic selective lobectomy is technically possible at least in pig studies. Further studies will show whether thoracoscopic lobectomy in patient with malignancy is as effective as open radical thoracotomy techniques and if endoscopic mediastinal division is possible.

Animals↗
PubMed1992

[A villous adenoma of the duodenum].

X-ray contrast examination of the upper gastrointestinal tract in a 73-year-old man with nocturnal heartburn demonstrated a constant filling defect in the duodenum. Gastroduodenoscopy revealed a 4 x 3 cm polypoid mucosal change of the duodenal wall adjacent to the pancreas. Histological examination of an endoscopically obtained biopsy showed a tubulovillous adenoma with severe mucosal dysplasia. The affected segment of duodenum was resected. Serial sections showed extensive focal carcinomatous degeneration of an adenoma. The postoperative course was unremarkable. At endoscopy 30 months later, when the patient was free of any symptoms, there was no macroscopic or microscopic evidence of recurrence. Experience so far indicates that villous adenoma of the duodenum should be treated by radical surgery.

Adenoma↗
PubMed1992

[Pleurodesis technique in malignant pleural effusion].

Malignancy is the leading cause of exudative pleural effusion in patients over 60. Several techniques for palliative treatment of malignant pleural effusions (MPE) are recommended; in particular, sclerosing agents have been instilled into the pleural cavity. In up to 30%, recurrence of MPE cannot be prevented. In recent years excellent results (recurrence rate less than 10%) have been reported using the technique of thoracoscopic talkage. After a review of the most frequent techniques of pleurodesis, a treatment strategy, mentioning the indications for the thoracoscopic procedure, is presented stressing the following guidelines: after complete thoracocentesis the patient's respiratory symptoms should decrease significantly and the compressed lung must be expanded clinically and radiologically after drainage. For patients fulfilling these conditions thoracoscopic pleurodesis is an effective initial treatment. It seems to be a safe procedure with minor side effects even for patients in a reduced general condition.

Antineoplastic Agents↗