PubMed Health⌕ Search

Biomedical subjects

W Weder

Publications and source records attributed to W Weder.

At least 19 recordsLinked to original sources
PubMed1995

[Isolated lung transplantation].

Over the last 10 years, single and bilateral lung transplantation has developed from an experimental technique to a valid therapy for patients with end-stage pulmonary or pulmonary-vascular disease. The main reasons for this progress are better defined selection criteria, improved operative technique and organ preservation, optimized peri- and postoperative management and more precise immunosuppressive and antiinfective therapy. Since 1983 more than 3000 lung transplantations have been performed worldwide with a 1- and 3-year survival rate of 70-90% and 60-70% respectively. In Switzerland 41 lung transplantations have been performed since 1992 with a 1-year survival rate of more than 80%. Indications, technique, treatment and results are discussed.

Adult↗
PubMed1995

Detection of liver metastases: comparison of superparamagnetic iron oxide-enhanced and unenhanced MR imaging at 1.5 T with dynamic CT, intraoperative US, and percutaneous US.

PURPOSE: To compare the sensitivities of superparamagnetic iron oxide-enhanced and unenhanced magnetic resonance (MR) imaging at 1.5 T with those of percutaneous ultrasound (US), intraoperative US (IOUS), and dynamic computed tomography (CT) in the preoperative assessment of metastatic liver disease. MATERIALS AND METHODS: Eighteen patients with liver metastases who were candidates for curative surgery underwent presurgical imaging. Thirteen patients underwent surgery and IOUS after undergoing preoperative US, CT, and MR imaging. RESULTS: In the preoperative imaging group, the standard of reference was the total number of lesions detected with any of the modalities. Superparamagnetic iron oxide-enhanced MR imaging was the most sensitive modality (99%). In the surgical group, the standard of reference was the total number of metastases identified at IOUS and pathologic examination. IOUS had the highest sensitivity (80%), followed by superparamagnetic iron oxide-enhanced MR imaging (56%). CONCLUSION: Superparamagnetic iron oxide-enhanced high-field-strength MR imaging facilitates the preoperative evaluation of potentially curable metastatic liver disease; however, it is inferior to IOUS.

Colorectal Neoplasms↗
PubMed1995

[Thoracoscopic surgery--experiences with a practical training course using an animal models].

Various thoracoscopic procedures have recently become an established method in thoracic surgery. However, a systematic teaching program is lacking. We present our experience with a 1-day training course, using anaesthetized pigs. Thoracoscopic operations, such as pericardial fenestration, wedge resection of the lung, subaortic and mediastinal lymph node dissection and pleurectomy have been exercised in groups of two. 7-12 months following the teaching course 40% of the participants had performed more than ten diagnostic or therapeutic thoracoscopic interventions in clinical situations. We conclude that our course helps participants to successfully apply this technique in clinical practice.

Animals↗
PubMed1994

[Thoracoscopic surgery--is thoracotomy still necessary?].

Thoracoscopic surgery has made substantial progress in recent years due to advances in video-optic systems and the development of new instruments for endoscopic surgery. Currently many interventions which routinely required thoracotomy can be performed thoracoscopically. This includes pleurectomy, decortication, wedge-resection, pericardial window, sympathectomy, biopsy or, in certain situations, resection of a mediastinal tumor. Thymectomy for myasthenia gravis or lobectomy can be performed thoracoscopically as well. The article gives on overview of the current standing of thoracoscopic surgery. The benefit of thoracoscopic surgery is reduced postoperative pain, including diminished impairment of pulmonary function, and hence a shorter hospital stay and a more rapid recovery.

Empyema, Pleural↗
PubMed1994

[Long-term course following kidney transplantation].

The first 100 recipients of cadaveric renal allotransplants operated at our institution between 1964 and 1971 were retrospectively analyzed in terms of a long-term follow-up, complications and survival parameters. Patient and graft survival (indicated in parenthesis) after transplantation were 68% (58%) at 1 year, 50% (38%) at 5 years, 40% (27%) at 10 years, 32% (20%) at 15 years and 20% (13%) at 20 years. Half-life of graft survival was computed using two different mathematical models and was compared with the results of a control group operated in 1986. Half-life was 9.5 years for the study group and 13 years for the control group respectively.

Adolescent↗
PubMed1994

Local and systemic toxicity of intra-hepatic-arterial 5-FU and high-dose or low-dose leucovorin for liver metastases of colorectal cancer.

In an ongoing prospective study 11 patients with unresectable liver metastases from colorectal carcinoma have been treated with hepatic-arterial infusion of 5-FU (1 g m-2) for 24 h on days 1 to 5 combined with a rapid infusion of high-dose leucovorin (100 mg m-2) (HD-regimen) or low-dose leucovorin (20 mg m-2) (LD-regimen) on days 1, 3 and 5. There was only mild local toxicity grade 1 and grade 2 in both regimen. Twenty-four cycles with high-dose leucovorin and 42 cycles with low-dose leucovorin showed a mild to moderate systemic toxicity, including haematological changes, stomatitis and diarrhoea. We did not see any grade 4 toxicity and no treatment-related fatalities occurred in this series. Eighty per cent reduction of leucovorin dosage leads to a significant decrease in grade 2 and grade 3 haematological and gastrointestinal toxicity.

Aged↗
PubMed1994

Cavernous destruction of an upper lung lobe in a healthy young man. An unusual roentgenographic presentation of allergic bronchopulmonary aspergillosis.

We describe a 32-year-old man with no history of pulmonary disease who presented with extensive cavernous destruction of the right upper lobe as an incidental finding on a chest x-ray film. All major criteria of allergic bronchopulmonary aspergillosis (ABPA) were present. Histologic examination of the resected lobe showed the typical features of ABPA. The differential diagnosis of multiple cavitating lesions should include ABPA.

Adult↗
PubMed1994

[Preventive digitalis therapy in open thoracotomy].

Prophylactic digitalization is still recommended after open lung surgery in order to prevent cardiac arrhythmias in the postoperative period. Since a beneficial effect of this potentially harmful medication is only poorly documented, we conducted a prospective randomized trial. Patients undergoing elective open lung surgery were divided into two groups one of which received digoxin postoperatively, the other not. Randomization was performed independently in three groups with regard to the extent of surgery, i.e. pneumonectomies in patients of any age, (bi-)lobectomies in patients > 50 and other (less extended) operations in patients > 60. Patients who were either too young for either group or who had already taken digoxin before surgery were followed separately. Monitoring was performed continuously in the ICU and conventional ECG was registered after 24, 48 and 72 hours and weekly until dismission.--Cardiac arrhythmias are very frequent in the early postoperative period with a maximum between the third and the fifth postoperative day. Any kind of arrhythmias were present in 19 of 30 patients (63%) compared to 14 of 35 patients (40%) in the control group. Symptomatic arrhythmias that needed treatment occurred in 11.4% of the control group, but in 33.3% of the patients with prophylactic digitalization. We therefore conclude that a general prophylactic digitalization after open lung surgery is not indicated, but that arrhythmias should be treated individually.

Adolescent↗
PubMed1994

[Thoracoscopic partial pneumonectomy: morbidity and length of hospitalization].

Advances in endoscopic surgical instruments and video-technology enable the safe and fast resection of lung tissue through a thoracoscope. We report our technique and the early outcome of our first 36 patients. In a series of 46 thoracoscopic lung tissue resections, performed with a 3-cm Endo-GIA or with a 6-cm Linear-Cutter, we did not observe any complications. The chest tube was removed 3.7 days following tumor resection and after 2.8 days in case of simple biopsy. Patients could be discharged home 5.3 days following tumor resection and 4.2 days following biopsy. Complaints after a follow-up period of 3 months were almost neglectable.

Adult↗
PubMed1993

[Spontaneous rupture of the left hepatic duct].

A previously well 24-year-old man complained of persistent epigastric pain after a session of intensive muscle building exercise especially of the abdominal muscles. The abdomen was diffusely tender without guarding. There was an increased concentration of bilirubin (64.7 mumol/l), GOT (117 U/l), GPT (529 U/l) and alkaline phosphatase (150 U/l). Ultrasound examination showed a widening of the choledochal duct to 11 mm without signs of gallstones. Endoscopic retrograde cholangiography additionally revealed contrast-medium extravasation from the left hepatic duct. Computed tomography, performed immediately afterwards, confirmed the extravasation, while liver and pancreas were unremarkable. Laparoscopy revealed a 5 mm tear in the left hepatic duct, close to the hepatic duct bifurcation with bile effusion into the peritoneal cavity. The latter was rinsed endoscopically with Ringer's solution and drains were placed in the omental bursa and subhepatically in the region of the bile leak. To relax the sphincter Oddi glycerol trinitrate was administered postoperatively, for the first five days 72 mg/24 h intravenously, then for nine days twice daily 20 mg by month. No more bile drained as early as the second postoperative day and the patient was free of symptoms 2 weeks later.

Adult↗
PubMed1993

[Gastroenterostomy "par principe" or "de nécessité" in palliative therapy of pancreatic cancer?].

There has been a controversy for years concerning the value of the prophylactic gastroenterostomy (GE) in patients suffering from irresectable pancreatic cancer. A retrospective analysis of the patients undergoing palliative bypass-operations for pancreatic cancer at Zurich University Hospital between 1982 and 1990 revealed 53 patients (28 male, 25 female) with an average age of 68 years. Twenty-one patients received a double bypass, 18 received a hepaticojejunostomy, 12 a primary and 2 a secondary GE. Mortality and morbidity for double bypass were 14% and 33%, for hepaticojejunostomy 5% and 28% and for primary GE 25% and 50%. Secondary GE was associated with a mortality and morbidity of 1 of 2 cases. Two patients received a secondary GE and two more showed signs of duodenal obstruction amounting to 20% incidence for secondary duodenal obstruction. Delayed gastric emptying was observed in only 2 patients with primary GE. These data suggest the use of a prophylactic double bypass.

Aged↗
PubMed1993

[Retroperitoneal sarcoma. Therapy and course].

The incidence of retroperitoneal soft tissue sarcomas is with 0.1 to 0.2 percent very low. The tumors most often present as asymptomatic masses until the lesions are quite large, compared with the anatomic part, resulting in compression of nerves, vessels, bowel etc. The recommended management is the aggressive radical tumor excision including the pseudocapsule followed by a consequent clinical, ultrasonography and CT-scan follow-up. Tumor recurrences should be attempted in the same manner as primary tumors.

Adolescent↗
PubMed1993

[Thoracoscopic resection of a schwannoma].

Schwannomas are most often benign tumors originating from the sheath of peripheral nerves. Most are asymptomatic and detected incidentally on a routine chest X-ray. Resection is generally recommended to confirm the diagnosis. In a 35-year-old patient we resected and removed an intrathoracic schwannoma of the 6th intercostal nerve thoracoscopically. The technique of resection and protected removal is described.

Adult↗
PubMed1993

Local and systemic toxicity of intra-hepato-arterial chemotherapy for treatment of unresectable liver metastases of colorectal cancer with 5-Fluorouracil and high dose Leucovorin.

We report our preliminary results of an ongoing phase-II-study with special regard to local and systemic toxicity, using a combined regimen of high dose Leucovorin and 5-Fluorouracil applicated intra-hepato-arterially. During 24 chemotherapy cycles we saw only mild to moderate systemic toxicity and there was no chemical hepatitis. First results concerning the response rate are encouraging. The modulation of 5-Fluorouracil (5-FU) with folinic acid represents a significant step in the treatment of colorectal cancer. Administration of chemotherapy through the hepatic artery for liver metastases of colorectal cancer allows high local drug concentration with relative low systemic toxicity. Until now there is little information about the local and systemic toxicity of high dose Leucovorin combined with 5-FU applicated intra-hepato-arterially. We describe our experience with this therapy in a running phase-II-study with special regard to local and systemic toxicity.

Aged↗
PubMed1993

Minimal invasive surgery for treatment of enlarged symptomatic liver cysts.

Congenital solitary liver cysts are a common finding, but they are usually asymptomatic; however, symptoms occur in about 16% and then require treatment. Ideally, complete or partial resection of the cyst is the treatment of choice but always implies invasive surgery. We report the case of a 50-year-old woman suffering from a massively enlarged cyst in the left liver lobe. We decided to resect the extraphepatic part of the cyst by laparoscopic surgery. The patient was discharged absolutely asymptomatic 3 days following surgery. We conclude that open resection of symptomatic congenital liver cysts should be replaced by laparoscopic removal when cysts are mostly extrahepatically located. The laparoscopic procedure combines the advantages of minimal invasive surgery with the demand for a radical effective treatment.

Cysts↗