PubMed Health⌕ Search

Biomedical subjects

T Frick

Publications and source records attributed to T Frick.

At least 19 recordsLinked to original sources
PubMed1998

Donor factor V Leiden mutation and vascular thrombosis following liver transplantation.

The most commonly detected hypercoagulable state involves an abnormal factor V protein synthesized by the liver in which arginine at position 506 is replaced by glutamine as a result of a single-point mutation in the factor V gene (factor V Leiden). Liver transplantation is complicated by hepatic vascular thrombosis in up to 15% of cases, resulting in graft loss in most instances. This retrospective study examined the effect of the factor V Leiden mutation on the risk of hepatic vessel thrombosis after liver transplantation. The mutation was sought by polymerase chain reaction and Mnl I digestion of DNA where available from 214 recipients and 276 donors receiving 319 liver transplants. No donors or patients were homozygous for the factor V Leiden mutation. The prevalence of the heterozygous mutation was 19 of 276 (6.9%) in donors and 19 of 214 (8.9%) in recipients. Forty-one thrombotic episodes occurred after transplantation in the 276 transplants in which donor DNA was available for analysis; 22 involved the hepatic artery, 9 involved the portal vein, and 10 were deep venous thromboses. A donor factor V Leiden mutation was detected in the donor in 6 of 41 (14.6%) with any thrombotic event compared with 13 of 235 (5.5%) without (P = 0.03). The relative risk of any thrombosis with this mutation was therefore 2.32 (95% confidence interval [CI], 1.12-4.81). The factor V Leiden mutation was present in the donor in 4 of 31 (12.9%) cases complicated by hepatic vessel thrombosis (which always led to graft loss or death) and 15 of 245 (6.1%) cases without (P = 0.16). The relative risk of hepatic vessel thrombosis in the presence of this allele was therefore 2.00 (95% CI, 0.78-5.14). As anticipated, the presence of this allele in the recipient was not associated with deep venous or hepatic vessel thrombosis. The factor V Leiden mutation in the donor liver is not a major risk factor for hepatic vessel thrombosis and subsequent graft loss after liver transplantation.

Adolescent↗
PubMed1997

[Passive smoking in the workplace: a survey in the Zurich University Hospital].

The consequences of involuntary smoking are well documented. We conducted a survey among all employees of the University Hospital, Zurich, to assess their smoking habits and feelings about restrictions or a ban on smoking. In March 1995, a questionnaire was mailed to all 5230 hospital employees, 2620 (50.1%) completed forms were sent back. 76% of all staff are confronted with cigarette smoke during their worktime. 83% of these employees are distressed by tobacco smoke, and 43% feel that involuntary smoking affects their health. 19% of all employees are smokers. 19% of these are distressed by smokers at work themselves, whereas 13% feel that they are discriminated against by non-smokers. Restriction to designated smoking rooms (68%) or a ban on smoking (27%) would be supported by 95% of all employees. Even 89% of the smokers support smoking restrictions. These results show that there is a considerable demand for a smoke-free working environment among university hospital staff.

Adult↗
PubMed1995

[Cyst of the major omentum--laparoscopic diagnosis].

This report describes the case of a 22-year-old female patient with noncharacteristic complaints in the lower abdomen. Sonography revealed a large cyst close to the right adnexa, suggestive of adnexitis; however, laparoscopy, performed because of suspected adnexitis, revealed a cystic tumor connected to the omentum instead.

Abdomen, Acute↗
PubMed1993

Ultrasound in blunt abdominal and thoracic trauma.

Between July 1989 and June 1991, 312 patients with blunt thoracic or abdominal injuries were examined prospectively. Sonographic examination was performed by surgeons in the emergency room using a mobile ultrasound unit. In 113 (36.2%) cases pathologic findings were demonstrated sonographically. These included 47 cases of hemothorax, 11 pericardial effusions, 52 cases of intra-abdominal fluid, 24 lesions of intra-abdominal organs, and 10 cases of retroperitoneal hematoma. Physical examination findings were positive in 96 (30.8%), negative in 63 (20.2%), and equivocal in 153 (49.0%). Two hundred thirty-nine patients had between one and eight injuries in addition to the blunt abdominal or thoracic trauma. These patients had an average Injury Severity Score (ISS) of 19.9 (range, 1 to 75). The 73 patients with isolated blunt trauma of the thorax or abdomen had an ISS of 4.9 (range, 0-25). None of the 66 patients (21.2%) with positive clinical findings and negative sonographic examination results had to be operated on later in the course of treatment, while 5 (36%) of 14 patients (4.5%) with negative physical examination findings and positive sonographic findings had to undergo surgery. The sensitivity for the demonstration of intra-abdominal fluid and organ lesions was 98.1% and 41.4%, respectively. The overall sensitivity and specificity of the ultrasonic examination were 90.0% and 99.5%, respectively.

Abdominal Injuries↗
PubMed1993

[Etiology and therapy of pneumothorax in AIDS patients].

Pneumothoraces in patients with AIDS are a rare, acute and severe complication. Between January 1989 and December 1991 3 patients with spontaneous pneumothorax were operated after a 2-week treatment with chest tube drainage only had failed. The average follow-up time after the operation was 7 months. There was no recurrence. Within the same 3 years 3 patients were treated in the Clinic for Internal Medicine by means of tube drainage only. Thus, only one case was successful. The average survival after receiving the tube was 3 weeks. Their death was not related on their pneumothorax. The mean age of the 6 patients was 34 years (23-49). In 5 patients the pneumothorax was associated with Pneumocystis carinii-pneumonia and in 3 of them also with prophylactic pentamidine aerosol therapy. A minimal invasive operation of operable AIDS-patients with pneumothorax shows good results, shortens the time of therapy and is possible despite the bad prognosis of the disease.

AIDS-Related Opportunistic Infections↗
PubMed1993

Benefits of an automated narcotic retrieval system.

A comparison was made in effectiveness of lock and key and automated narcotics retrieval systems. Time required per narcotic averaged 137 seconds for the traditional mode and 48 seconds for the automated system. This resulted in a monthly savings of $594, along with general nurse satisfaction and a perception of increased security.

Automation↗
PubMed1993

[Acute pancreatitis after local infusion of divalent cations].

The association of hypercalcemia and acute pancreatitis had been experimentally reproduced in cats by local infusions of the divalent cation calcium whereas the monovalent cation potassium did not induce any pancreatic pathology. The purpose of the present study was therefore to investigate the role of further divalent cations in order to determine the relevance of ion valency for pancreatitis induction. Anesthetized male SIV-rats received divalent cations, of which a role in the pancreas had already been reported in the literature, through retrograde infusions into the splenic artery at a dose of 0.6 mmol/kgh for 3 hours and at a flow of 0.5-1.0 ml/h. The pancreas was then removed for morphologic studies. In the animals treated with calcium and manganese, pancreas showed a hemorrhagic necrosis of the acinar lobuli with leucocytic infiltrates. The barium treated animals spontaneously died after 49 +/- 15 minutes and revealed acute pancreatitis in the perfused, but not in the residual pancreas. Zinc at the initial dose induced an immediate heparin-refractory blood-clotting with subsequent ischemic necrosis whereas a lower dosis (0.002 mmol/kgh) led to an acute pancreatitis as seen after calcium. The magnesium treated animals and the controls did not reveal any pathology. We conclude that some divalent cations may induce an acute pancreatitis, but that the induction is not dependent on the cation valency.

Acute Disease↗
PubMed1992

[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↗
PubMed1992

[Severe necrotizing fasciitis].

The pathophysiology of necrotizing fasciitis remains unclear in patients with no apparent immunologic disorders. Between 1987 and 1990 we treated six patients with necrotizing fascitis and septic-toxic multiple organ failure, three patients survived. The mean age was 38 years (25-62). In all patients the primary bacteriological examination revealed streptococcus. Between the first symptoms and an adequate therapy were 4 days in surviving patients and 7 days in patients who died. Four patients showed spread of the gangrene into the adjacent tissue: muscles (n = 3), bowel (n = 2), mediastinum (n = 1). Adequate débridement was not possible or not performed in patients with spread into the abdominal cavity or the mediastinum. These patients did not survive. The duration of intensive care treatment in surviving patients were 14 to 78 days. We conclude that survival of patients with severe necrotizing fasciitis is influenced by the delay before adequate treatment, the localisation of the gangrene and intensive care facilities.

Adult↗
PubMed1992

[The open femoral fracture in war--173 external fixators applied to the femur (Afghanistan war)].

During the three years 1988 through 1990, more than 700 external skeletal fixations (AO/ASIF Tubular System) were utilized at the ICRC Hospital for Afghan War Wounded in Peshawar, Pakistan, 173 of which were for femoral fractures. 13% of the fractures were open grade II, and 71% open grade III, mostly due to high velocity gunshot or shrapnel injuries. Usually, the external fixator was left in place until consolidation of the fracture. The average time of external fixation was 128 days. Three major groups of complications have been observed: fracture complications, implant complications, and residual loss of function of the knee joint, probably the most significant permanent complication to the patient. In order to improve the functional results in treating open fractures of the femur, three measures are recommended: unilateral frame with posterolateral insertion of Schanz screws, postoperative positioning of the patient with 90 degrees of flexion of hip and knee joints and mobilization of the patient as soon as possible (on the first or second postoperative day).

Afghanistan↗
PubMed1991

[30-months extracorporeal electrohydraulic shock-wave lithotripsy of gallstones using the MPL-9000 at the Zurich University Hospital].

The effect of extracoporeal shockwave lithotripsy (ESWL) in combination with oral chemolitholysis on gallstone clearance was tested in a prospective study. We used a non-waterbath lithotripter, and the patients were treated without general anesthesia or intravenous analgesia. They solely received oral or subcutaneous premedication. Within the 30 months study-period 78 patients were selected according to the "Munich-criteriae". At the end of the study period 33 patients were free of stones, 20 patients had residual fragments, and 25 patients stopped the therapy prior to complete stone clearance because of compliance (n = 11), or methodological (n = 14) problems. This includes 3 patients in whom the ESWL had to be discontinued because of pain. No severe complications were seen with the exception of one attack of acute pancreatitis, from which the patient recovered. The rate of stone clearance was analyzed using the life-table calculation according to KAPLAN-MEIER to weigh the follow-up time of each patient. At 12 months it revealed a stonefree rate of 70% in patients who did not discontinue the treatment because of methodological problems. The advantage of ESWL is the possibility to treat gallstones without general anesthesia or intravenous analgesia. However, the patient-population must be highly selected, and there is the risk of recurrence.

Adult↗
PubMed1991

[Perioperative complications in thyroid gland surgery].

The perioperative complication rate of 548 thyroidectomies in 536 patients was evaluated in a retrospective study. Local problems were present in 14% of the patients. Most frequent were paralysis of the recurrent nerve (5.0%) and hematoma or hemorrhage (4.3%). Systemic complications were seen in 2% of the patients, usually cardiopulmonary decompensation requiring intensive care treatment. The operative and hospitalisation mortality was 0%. Statistical evaluation revealed that patients older than 50 years and patients undergoing rethyroidectomy were at higher risk for local complications. Our results show, however, that thyroidectomy is a low risk operation at a teaching institution.

Adolescent↗
PubMed1991

[Electron microscopy of the exocrine pancreas in experimental acute hypercalcemia].

Hypercalcemia has been associated with acute pancreatitis clinically and in the experimental animal. We studied the pancreatic ultrastructure in acute experimental hypercalcemia. Anesthetized cats (Pentobarbital, 0.55 mg/kg) received Ca++ (Calcium-Gluconate: 0.6 mmol/kgh; n = 4), K+ (KCl: 1.1 mmol/kgh; n = 4) or NaCl (0.9%; n = 4) locally through retrograde infusion into the splenic artery. Biopsies for electron microscopy (EM) were taken at three hours. Eight cats received intravenous Ca++ (0.6 mmol/kgh, 0.3 mmol/kgh after three hours) or NaCl (0.9%) for 12 hours. Biopsies were collected in two animals in three-hour intervals, and in all animals at twelve hours. After local calcium infusion necrotizing pancreatitis was seen macroscopically in the body of the pancreas. Biopsies for EM showed acinar cell necrosis, hydrops of nuclei and mitochondria and needle-like precipitates in the cytoplasma in the center of calcium perfusion. Biopsies taken from the peripheral region of the macroscopically altered tissue revealed desorganisation of the acinar polarisation and the endoplasmic reticulum, with zymogen granules appearing in the basolateral cell-portion. After intravenous calcium administration no macroscopical changes were seen. In EM acinar cells showed dilatation and proliferation of the golgi apparatus and increased number of condensing vacuoles indicating stimulation. Again, disorganisation of acinar cell polarisation was present. Control animals treated with K+ or NaCl showed normal pancreatic ultrastructure. The morphological changes after calcium infusion indicate direct damage to the acinar cell. Our results suggest that hypercalcemia induced pancreatitis could originate in the acinar cell.

Acute Disease↗
PubMed1991

[Gallbladder morphology after extracorporeal shockwave lithotripsy of gallstones with the MPL-9000].

The effects of extracorporeal spark-gap shockwave lithotripsy (ESWL) on human gallbladder-morphology are barely known. We studied the gallbladders of nine patients cholecystectomized 5 to 166 days after ESWL. Patients were treated one to three times receiving a mean of 1928 +/- 693 shockwaves per treatment, with a total of 3375 +/- 1307 per patient. Control gallbladders were of randomly selected patients after plain cholecystectomy (age and sex-matched). There was no difference in pathomorphology of the two groups. No signs of trauma related damage (hemorrhage, necrosis, ulceration, scar, or hemosiderin deposits) other than from surgical manipulation were found. Predominant pathomorphological changes were signs of chronic cholecystitis due to gallstone disease. In conclusion, spark-gap ESWL did not induce deleterious morphological damage to the gallbladder, although large numbers of shock waves were applied.

Adult↗