PubMed HealthSearch

Biomedical subjects

U Neff

Publications and source records attributed to U Neff.

33 records · Page 2Linked to original sources

Esophagectomy without thoracotomy: is there a risk of intramediastinal bleeding? A study on blood supply of the esophagus.

In transhiatal blunt esophagectomy there is surprisingly little bleeding if no adjacent great vessels are torn. This prompted an investigation by new injection techniques and corrosion on the human esophageal vasculature three-dimensionally. The three main arterial sources were confirmed: the superior thyroid artery, bronchial arteries at the level of the carina, and the left gastric and splenic artery. Two facts became obvious that were not appreciated hitherto. All major vascular trees divide into minute branches at some distance from the esophagus. Those branches go on to form a dense submucosal interconnected network. It appears that such small extraesophageal branches, when torn, will have the benefit of contractile hemostasis. Previous claims made that essential nutritional vessels arise from intercostal phrenic arteries or the aorta directly could not be confirmed. These findings would confirm blunt esophagectomy for tumors within the wall of the organ as a relatively safe procedure in terms of bleeding hazards.

Adult

Intercondylar fractures of the humerus. An operative approach.

In this paper we review a series of thirty-four intercondylar fractures of the distal end of the humerus that were treated by open reduction over a ten-year period. The fracture patterns were classified according to the system of Müller et al. and a strict rating scale incorporating subjective data, objective motion, and the functional status of the involved elbow was used for the results. At a mean follow-up of 5.8 years, thirteen results were rated as excellent; fourteen, as good; four, as fair; and three, as poor. Complications included postoperative neuritis in five patients; three non-unions; and refracture, heterotopic bone, and deep sepsis in one patient each.

Adolescent

[The muscles and blood supply of the stomach].

Using human gastric specimens, figures are presented for gastric muscle thickness and the myoarchitecture is described. The study shows that the blood supply to the cardia, gastric fundus and body is excellent, due to the many anastomosing arteries, but is less good at the curvatures of the gastric antrum and poor at the anterior and posterior walls of this area, due to absent or minute anastomoses.

Cardia

[Management of intra-abdominal abscesses and space with pedicled omentoplasty].

The greater omentum is an organ of excellent absorption ability and or infect defence. Transposition at vascular pedicle is a simple and very useful procedure. According to our experience with 8 patients it is most suitable to fill hollow spaces for example in the liver (echinococcus cysts); it is also very useful for covering huge contaminated irradiation defects frequently occurring with pelvic exenteration.

Abdomen

[Antibiotic prophylaxis in colon surgery with Cefazolin].

In a prospective randomized and controlled double-blind trial the effect of prophylactic systemic administration of Cefazolin in elective colorectal surgery on postoperative wound infection was investigated. The incidence of wound infection was significantly reduced (P less than 0.01) from 32% in the control group to 10% in the treated group. Furthermore there was a significant reduction (P less than 0.05) in hospital stay of about 3 days.

Cefazolin

[Spontaneous rupture of the spleen during anticoagulant therapy].

Three cases of spontaneous rupture of the spleen in patients which were on long-term anticoagulant therapy are reported. In patients with the trias faulty coagulation, signs of hemorrhagic shock and of peritonitis in the upper abdominal part the possibility of a spontaneous rupture of the spleen must be considered. The diagnosis can then be confirmed by a positive peritoneal lavage. Once the diagnosis is made, the therapy is splenectomy.

Aged

Appendicitis diagnosis today: clinical and ultrasonic deductions.

A total of 111 patients referred with a diagnosis of suspected "appendicitis" were entered into a prospective study. The surgeon and radiologist in charge of ultrasonography made separate diagnoses, and their findings were then combined and discussed as indications for surgery. Clinically, a history of pain migration proved to be reliable (p < 0.0001) as a diagnostic indicator, in contrast to nausea and initial irregularity of bowels. The duration of symptoms was significantly shorter in patients with proved appendicitis than among patients with negative findings (median 24 hours compared with 41 hours, p < 0.04). Among patients with perforated appendicitis, the symptomatic history was prolonged (not significantly) by 3 hours. Peritoneal signs such as pain on percussion, rebound tenderness, guarding, and a leukocytosis of more than 13,000/mm3 were indicative of appendicitis (p = 0.0001 for each sign). Lively bowel sounds excluded the possibility of appendicitis (p = 0.001). Scanty bowel sounds, rectal tenderness, axillorectal temperature difference, and a left shift in leukocytes were of no diagnostic significance. The doctor's "clinical experience" is significant at the level of p < 0.03. On ultrasonography, the following signs were indicative of appendicitis: periappendicular infiltration (p = 0.0003), a visible "cockade," and an appendix larger than 12 mm in diameter (p = 0.04). For 75% of the patients the surgeon was sure of his own clinical diagnosis and did not allow himself to be influenced by the sonographic findings. In 12% of doubtful cases ultrasonographic results decisively favored operation, and in 4.5% (n = 5) it prevented an unnecessary laparotomy in the presence of positive clinical symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent