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Biomedical subjects

W Schweizer

Publications and source records attributed to W Schweizer.

At least 19 recordsLinked to original sources
PubMed1992

[Percutaneous transhepatic inserted self-expanding metal endoprosthesis in the palliative treatment of malignant obstructive jaundice].

Prospective studies comparing biliary-enteric bypass with implantation of endoprostheses in palliation of malignant obstructive jaundice showed no significant difference. A new self-expandable metal endoprosthesis was introduced to ameliorate the results in terms of early complication and occlusion rate. Between December 1988 and April 1991 we treated 35 patients (32 with malignant obstructive jaundice) by 50 self-expandable endoprostheses. The implantation was successful in 96% of patients. The early complication rate was 37% and the 30-day mortality 14%. In 89% of the patients relief of jaundice after 3 months was found. Recurrent jaundice and cholangitis occurred in 39%, whereas reoperation was necessary in 25%. 16 of 26 patients (61%) with malignant obstructive jaundice where alive after an average of 7.5 months. We found no advantage of the self-expandable endoprostheses compared with conventional plastic stents. Implantation of a self-expandable metal endoprosthesis may be an alternative to surgical bypass in selected cases. It would be interesting to evaluate the endoscopic route of insertion and to compare the results with palliative surgery in randomized studies.

Aged↗
PubMed1992

Prospective study in adults of splenic preservation after traumatic rupture.

Seventy-five adults with splenic injury were evaluated prospectively over 45 months to examine the possibility of splenic preservation. Haemodynamically unstable patients underwent surgery with the intent of splenic preservation. Stable patients received non-operative treatment regardless of the grade of splenic injury determined by ultrasonography and computed tomography. Thirty-seven patients required splenectomy and in 38 the organ was preserved (20 operative preservation, 18 non-operative treatment). Of 22 patients initially receiving non-operative treatment, there were four secondary haemorrhages after 7, 7, 10 and 13 days making surgery necessary. Three of these patients underwent splenectomy and in one the spleen was preserved by partial resection. After splenectomy four patients required reoperation because of rebleeding or for evacuation of a haematoma. Patients who had undergone splenectomy had a significantly increased infection rate (P < 0.005) compared with those in whom the spleen was preserved, even when patients were matched with respect to multiple trauma using the Injury Severity Score (P < 0.01).

Adolescent↗
PubMed1992

[Experimental atrophy/hypertrophy complex of the liver after portal and/or biliary ligation in the rat].

Patients with lobar or segmental, benign or malignant strictures of the biliary tree (with or without impairment of the portal blood flow) show a considerable atrophy of the involved area of the liver with a compensatory hypertrophy/hyperplasia of the remaining non affected liver. To investigate the importance of the biliary and portal obstruction for the development of this process, we used a rat model, with selective biliary and/or portal ligation of the anterior liver lobes (two thirds of the liver mass). Weight measurements, morphometry, functional scintigraphy (Hepatoiodida-scan) and blood enzyme analyses were done immediately postoperatively, at 30 hours and 4, 8 and 28 days after the operation. The major findings were: 1. 28 days after biliary and/or portal ligation there was no difference between the body weight of the four groups, all ligated animals having compensated for an initial greater percentage body-weight loss. 2. Total liver weight remained constant, while atrophy and hypertrophy/hyperplasia occurred although a progressive derangement of liver morphology was observed during that time. 3. A severe atrophy-hypertrophy-complex (AHC) developed after selective portal ligation, which in our experiment did not appear after selective biliary ligation. 4. Morphometrical changes after selective biliary ligation were reversible, whereas in liver lobes with selective portal ligation a progressive parenchymal destruction and involution with subsequent impairment of hepatic function of the concerned lobe was observed.

Animals↗
PubMed1992

[Acute abdomen in abdominal wall hemorrhage in anticoagulation].

10 patients with a history of systemic anticoagulation presented with an acute abdomen which proved to be due to a rectus sheath hematoma. Four patients gave a history of antecedent trauma. The prothrombin time was prolonged beyond the therapeutic range in 8 patients and therapeutic in two. The diagnosis of rectus sheath hematoma was made by non-invasive imaging (sonography [n = 8], CT-scan) in 9 patients and by operative exploration in one. 8 patients were treated non-operatively and one patient required a delayed evacuation of the infected hematoma. One patient died from myocardial infarction. We conclude that a careful history, physical examination and prothrombin time, in combination with radiologic evaluation (sonography, CT-scan) can confirm the suspected diagnosis of rectus sheath hematoma. It is important to think of this specific hemorrhagic complication induced by anticoagulation to prevent unnecessary surgery.

Abdomen, Acute↗
PubMed1992

[Prospective study of the early postoperative course of splenic rupture: spleen preservation versus splenectomy].

The haematological and immunological changes after splenectomy have been the subject of intensive research in recent years. As a consequence there has been a clear trend towards splenic salvage. Due to the availability of improved diagnostic investigations (sonography, CT) nonoperative treatment with close observation has become increasingly important in adults. 75 patients with documented splenic injury were prospectively evaluated over a 45-month period with an emphasis upon splenic preservation. Unstable patients had operative exploration with attempt at splenorrhaphy or partial splenic resection. Stable patients were managed nonoperatively, regardless of the degree of splenic injury as determined by sonography and/or computed tomography. In 38 patients the spleen was preserved by operative preservation in 20 and nonoperative treatment in 18 patients. 37 patients required splenectomy. Four patients were managed initially by nonoperative treatment, but required exploration for secondary rupture at 7, 7, 10 and 13 days. Delayed splenectomy was performed in three patients and one patient was treated by splenorrhaphy 7 days after admission. Bleeding complications occurred in one patient after splenorrhaphy (bleeding from the pancreatic tail) and the bleeding vessel could be transfixed during the same anaesthetic. Four patients required reexploration after splenectomy for hemorrhage (2) and evacuation of infected haematomas. The Injury Severity Score (ISS) of the splenectomy and splenic preservation group was determined. Splenectomised patients showed in the postoperative follow-up a significantly increased infection rate (40%, p less than 0.02) when compared to patients with splenic preservation (10%) or nonoperative treatment (11%), even when they were matched in respect of multiple trauma using the Injury Severity Score (ISS).

Adolescent↗
PubMed1992

[Final evaluation of the randomized multicenter study SAKK 40/81: adjuvant portal chemotherapy of curatively resected colorectal cancer].

Between 1981 and 1987, 533 patients from 9 institutions have been entered in a randomized trial to assess the value of adjuvant portal infusion (5-Fluorouracil, Mitomycin C) compared to radical surgery alone. Analysis of 469 evaluable patients at a median follow-up of 5.8 years revealed 110 recurrences in the control and 94 recurrences in the infusion group. Estimated 5-year disease-free survival was 52% and 61% respectively (hazard ratio 1:0.75; 95% confidence interval 0.57-0.99; p = 0.046). Overall survival was 59% in the control and 69 in the infusion group (p = 0.048). Adjuvant portal infusion did not influence the occurrence of liver metastases but reduced the overall recurrence rate.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

[Epidemiology of liver injuries in 14 district, urban, regional and canton hospitals in Switzerland].

224 patients with liver injuries treated in 14 District and Regional Hospitals over a 10-year period were retrospectively evaluated. The results were compared to those obtained in 175 patients referred to the Central University Clinic "Inselspital", Berne/Switzerland. In all cases the degree of multiple trauma was assessed by the Injury Severity Score (ISS) and the severity of the liver injury by a Liver Injury Score (modified after MOORE). Blunt injury to the abdomen as a result of road traffic accidents, accidents at work or sporting misadventures were responsible for about 80% of all liver injuries. Peritoneal lavage was the main special investigation and was reliable in the diagnosis of haemoperitoneum. Abdominal ultrasonography proved of additional value. It allowed in experienced hands not only the diagnosis of liver injury but also some assessment of the severity of injury. Additional injuries to other abdominal organs can be assessed. By utilizing abdominal ultrasonography (or computed-tomography) liver trauma were managed conservatively in selected stable patients with minor injuries. The overall mortality was 17% in the 224 patients and compares well with the international figures. The results of treatment revealed a low mortality for liver injuries Grades I to III, whether managed in a District or Regional Hospital or in the Central University Clinic. For more severe injuries (Grades IV or V) the prognosis was worse in the District or Regional Hospitals than in the Central University Clinic. 20% of patients with liver injury Grades I to III in stable circulatory condition could be treated conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Colorectal cancers: therapy of recurrences and metastases].

Recurrent disease from colorectal carcinomas is common. 25 percent of patients have apparent metastases at the time of first detection of the tumor, and at least 50% of patients die from their tumor. The aim of the postoperative follow-up of patients with carcinoma of the colon and rectum is thus to detect recurrent tumor when cure is still possible. Clinical examination and CEA-measurement is widely recommended as a reliable indicator for recurrence and metastases of colonic cancer. This may be combined with regular coloscopic surveillance for detection of anastomotic recurrences or a second colonic cancer. In case of suspicion of a recurrence or metastasis a full range of examinations should be performed to detect the site of recurrent tumor and to exclude wide spread disease. In case of a circumscribed lesion the patients may benefit from local radical resection. Patients with four or less unilateral liver metastases show a five year disease free survival reported of more than 30% and a disease free survival reported of more than 25%. Unfortunately because of wide spread misunderstanding of the potential of hepatic Rx only about 1/3 of potentially curatively resectable patients with liver metastases finally undergo liver surgery. A more active policy towards patients with colorectal disease concerning surveillance may lead to a better survival in selected cases.

Colorectal Neoplasms↗
PubMed1991

[Technical aspects of spleen saving therapy in splenic trauma].

The haematological and immunological consequences of splenectomy have been the subject of increasingly intensive studies over the last few years. As a result there has been a significant change in the management of splenic trauma with the emphasis on organ preservation which has been associated with a possible reduction in postoperative infectious complications. The safety of splenic preservation (splenorrhaphy) has been demonstrated. There has also been a change in the increased use of non-surgical (conservative) management of injuries in adults, a policy which previously was reserved for children. There is no difference in the postoperative bleeding rate between patients with splenectomies or patients with splenorrhaphies. Non-surgical treatment is in adults not yet established. In our department splenic preservation gets an increasing weight in our treatment policy, even in patients with multiple injuries. Our treatment policy initially classifies the splenic injury into one of five groups and this determines the subsequent operative procedures. The crucial part of the surgical technique in splenic preservation involves the immediate dissection and delivery of the spleen from its subdiaphragmatic position, thus avoiding iatrogenic injuries which can readily occur in the emergency situation. The hilus is then clamped with a non-crushing vascular or intestinal clamp, which avoids blood loss during the repair. The methods used for the repair depend on the grade of the injury. Means to prevent sutures cutting through the tissue (resorbable collagen platelets, resorbable gauze, teflon stripes) and a variety of methods to achieve haemostasis (infra red photocoagulation, haemostatic material and supportive mesh) are used.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemostasis, Surgical↗
PubMed1991

[Myocutaneous latissimus dorsi sliding flap in reconstruction of the lower thoracic wall in chronic fistula caused by cystic echinococcosis of the liver].

We report the successful treatment of a 47-year-old man who had a 22-year history of chronic discharge from a hepatic echinococcal cyst. Before treatment in our unit there had been 8 previous attempts to control the fistula. By means of a right thoracoabdominal incision (with resection of the 7th and 8th ribs) it was possible to perform a cystectomy with subsequent marsupialisation of the residual cyst wall to the skin. However, after 2 weeks subsequent treatment with maximal Albendazol therapy there was still a big persistent cavity which required further débridement. This resulted in resolution of the infection and allowed a definitive closure of the big cavity and the thoracoabdominal wall using a myocutaneous latissimus dorsi flap. The patient's subsequent course has been uneventful with no recurrence of the fistula.

Debridement↗
PubMed1991

[Comparison of partial Billroth I, classical Billroth II gastrectomy and resection with Roux-en-Y reconstruction with reference to postoperative quality of life].

53 patients submitted to gastric resection and reconstruction either by means of Roux-en-Y gastrojejunostomy, Billroth I or Billroth II operation were followed for a mean of three years and compared for clinical status using the Visick grading system, dumping grading after the method of Sigstad, and careful clinical questioning regarding post-gastrectomy symptoms. Personal follow up by the same examiner corresponding to a standardized questionnaire and the objective grading revealed that our results for individual operations compared well with the reports of other studies investigating mostly only one type of operation for one criterion. However, the Roux-en-Y reconstruction showed significantly better results when compared to Billroth I and especially Billroth II reconstruction. It is concluded that partial gastrectomy with Roux-en-Y reconstruction is the preferred approach provided that, in the light of the pathology encountered at operation, the procedure is technically feasible and adequate.

Adult↗
PubMed1990

[Postoperative course following stomach resection: a comparison of Billroth I, Billroth II and Roux-en-Y resection-reconstruction].

53 patients who underwent gastric resection and reconstruction either by Roux-en-Y gastro-jejunostomy, Billroth I or Billroth II operation, were followed for an average of three years and compared for clinical status using the Visick grading system, dumping grading by the method of Sigstad, and careful clinical questioning regarding post-gastrectomy symptoms. Response to a standardized questionnaire and objective grading showed that our results for individual operations compared well with others reports. However, the Roux-en-Y reconstruction showed significantly better results when compared to Billroth I, and especially Billroth II, reconstruction. It is concluded that partial gastrectomy with Roux-en-Y reconstruction is the preferred approach, provided that, in the light of the pathology encountered at operation, the procedure is technically feasible and adequate.

Anastomosis, Roux-en-Y↗
PubMed1990

Prognostic factors for malignant mixed müllerian tumors of the uterus.

This study examined factors affecting the survival of 28 consecutive patients with malignant mixed Mullerian tumors diagnosed at New York University Medical Center from 1971 through 1985. The cumulative 5-year survival for all patients was 38%. Patients with pedunculated tumors (18/25) had a significantly improved 5-year survival of 53% compared with patients having a tumor with a broad-based attachment (7/25), all of whom died within 1 year (p less than 0.01). Eleven patients whose tumors demonstrated vascular invasion had a worse prognosis compared with 14 patients without demonstrable vascular invasion (18% versus 53% 5-year survival; p less than 0.05). Interestingly, patients with pedunculated tumors persisted in having an improved survival even after correcting for vascular invasion, compared with patients having broad-based tumor attachment. Small tumor size (less than or equal to 7 cm) also proved to be a significant and independent prognostic indicator for improved survival. Advanced stage, heterologous sarcomatous elements, and deep myometrial invasion (greater than one-third invasion) tended to be associated with decreased survival, but not with statistical significance. Patient age and grade of the carcinoma element did not appear to affect survival.

Aged↗
PubMed1990

[IODIDA scanning for functional and morphologic assessment of the liver and bile ducts before and following surgical interventions in bile duct obstruction].

PROBLEM: Full pre- and postoperative assessment is mandatory in the management of complex cases of incomplete biliary obstruction. Investigations should not only define the level of extrahepatic bile duct obstruction but also detect intrahepatic obstruction, give some index of liver function and of the dynamics of biliary flow. Computed tomography, ultrasonography and direct cholangiography are very valuable. IODIDA-scanning provides a non-invasive method which not only complements other studies but also gives information otherwise unobtainable. CLINICAL MATERIAL: In an initial retrospective study 36 patients, 12 of whom had previously undergone operation for biliary obstruction, were fully investigated with particular reference to the use of IODIDA-scanning. PROCEDURE: 2-5 mCi of 99mTc labelled IODIDA were injected intravenously and the liver and upper abdomen scanned at 1 minute intervals and displayed at 5 minute intervals during the first hour. RESULTS: All patients were studied on admission and then postoperatively at intervals. In 31 of 36 patients IODIDA-scanning gave reliable evidence of the level of obstruction of biliary flow and of the patency of biliodigestive anastomosis. Assessment of liver function before and after biliary reconstruction was also possible. CONCLUSION: IODIDA-scanning has proved a valuable non-invasive method for the assessment of liver parenchymal function, intrahepatic abnormalities and of bile flow in cases of complex biliary obstruction. This is particularly valuable with the Roux-Y biliary reconstruction since ERCP is impossible and PTC an invasive method which, although supplying an accurate picture of major biliary obstruction, fails to characterize hepatic function and bile flow.

Adult↗
PubMed1990

[Diagnosis and treatment of traumatic injuries of the duodenum and pancreas: 21 cases].

Twenty one consecutive patients who sustained injuries to the duodenum or/and pancreas were admitted to our hospital over a ten year period. Sixteen blunt injuries and 5 penetrating injuries were encountered. Penetrating injuries were always suspected and treated by time; following blunt injury diagnostic delay was encountered in 7 patients and insufficient surgical procedure because of intraoperative misinterpretation in 2 patients. Most of the patients had associated intra-abdominal organ injuries. Adjuncts to diagnosis such as abdominal roentgenograms, serum amylase levels and gastroduodenography were not helpful. CT-Scan and ultrasound allowed to confirm the suspected diagnosis in 3 cases only. Intraoperative diagnosis was also challenging. Complete mobilization of the structures surrounding the duodenum and the pancreas to provide entire exposure was necessary. In 6 patients treated first in a peripheral hospital, diagnosis of the injury have been missed at first laparotomy and reoperation was necessary in all of them. Suture closure of the duodenum and drainage of the pancreatic region were the most common reparative technique used. More complicated procedures with pancreatic and/or duodenal resection were performed in 6 patients. Overall mortality in patients surviving more than 24 hours was 14% (suture line dehiscence after delayed operation and one death due to brain injury).

Adolescent↗
PubMed1990

[Diagnosis, etiology and treatment of cholangitis following bilio-digestive surgery].

Cholangitis occurring after biliary-enteric anastomosis is a well-recognized but insufficiently analyzed surgical complication. Guidelines for assessment have not been established and management remains controversial. We examined a two-year experience with recurrent cholangitis following bilio-enteric anastomosis; cholangitis in the absence of anastomotic obstruction was surprisingly frequently encountered. Although selected cases without anastomotic stenosis may be amenable to nonoperative treatment, a low threshold for surgical reintervention should be maintained because radiologic assessment of anastomotic patency is often equivocal and the clinical problem is often best managed surgically.

Cholangitis↗