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Biomedical subjects

A Rohner

Publications and source records attributed to A Rohner.

At least 91 records · Page 5Linked to original sources
PubMed1990

[Liver transplantation in Switzerland. Initial results].

In Switzerland four university hospitals have engaged in a liver transplant program. Of the 40 transplanted patients, 21 were alive on May 31, 1989. This survival rate is encouraging as it relates to teams which have only recently started up; it should, however, be improved if it is to equal the results achieved by the best centres in the world. Several issues must be urgently addressed: the shortage of donors, requiring a better harvesting organization at the national level; a possible association with existing European bodies; and critical discussion regarding the number of centers which should perform liver transplants in the country.

Humans↗
PubMed1990

[Results of biliary surgery in a teaching center].

The last few years have seen the introduction of new medical approaches to treatment of gallstone disease. To investigate whether this was the consequence of disappointing results following surgical treatment, we undertook a one-year prospective study at the Clinic of Digestive Surgery in Geneva, a training center with an unselected patient population. From October 1986 to September 1987, 306 biliary operations were performed for calculous disease by 20 surgeons, most of whom were under training. Juniors were supervised by senior surgeons. Operative indications and management were based on the strict criteria established at our center. Over half the patients had suffered one or more complications of gallstone disease. Overall mortality and morbidity were 0.3% and 11.7% respectively. In conclusion, gallstone surgery, which is a definitive treatment, has provided us with very acceptable results and therefore should not be a reason for encouraging other conservative approaches in the treatment of gallstone disease.

Adult↗
PubMed1990

Gallstone ileus.

Thirty-seven patients (33 women and four men, median age 78 years) were operated on for gallstone ileus over a 12-year period with a median follow-up of 6.2 years. Twenty-three patients (62 per cent) had serious concomitant diseases. Plain abdominal radiographs performed at admission were diagnostic in only 17 patients (46 per cent) and other procedures such as ultrasonography, gastrointestinal contrast studies and computed tomographic scan were required in ten patients (27 per cent). The diagnosis was made before operation in 27 patients (73 per cent) but in only 17 (46 per cent) at admission. Obstructing stones were located in the terminal ileum in 27 patients (73 per cent), in the proximal ileum or jejunum in five (14 per cent), in the duodenum in two (5 per cent), and in the colon in three (8 per cent). In six instances (16 per cent), more than one stone was involved. Cholecystduodenal fistula was the most frequent fistula type (n = 25, 68 per cent), followed by cholecystcolonic (n = 2, 5 per cent) and cholecystduodenocolonic (n = 2, 5 per cent) types. The site of the fistula was not established in the other eight instances. A one-stage procedure consisting of the removal of the impacted stone, fistula repair and cholecystectomy was performed in eight patients, two of whom died. A second group of six patients underwent a two-stage procedure consisting of enterolithotomy followed by elective biliary surgery, with no mortality. Removal of impacted stones was the only surgical treatment in the remaining 23 patients, with five deaths. Operative mortality and morbidity rates associated with the initial procedure did not differ significantly among the three therapeutic groups, which were comparable in terms of patient age, associated concomitant diseases and APACHE II score. However, later biliary complications were prominent in patients treated only by enterolithotomy. These results support the view that a one-stage procedure is, when feasible, a valid option and may be the procedure of choice. When local or surgical conditions argue against a one-stage procedure, biliary surgery at a second stage should be considered, if residual stones are present. In poor risk patients, non-operative methods should be considered.

Aged↗
PubMed1990

Radical splenopancreatectomy with duodenal loop conservation in rats.

In an attempt to find a reproducible method of total splenopancreatectomy (TSP) with duodenal loop conservation in rats, we used the technique recently described by S. Houry and M. Huguier (Eur. Surg. Res. 15: 328, 1983) but were not able to induce a true diabetes. We therefore developed a more radical splenopancreatectomy (RSP) in rats and compared this technique with the TSP. RSP involves a more extensive dissection of the common bile duct, a short choledocoduodenal anastomosis, and total excision of the retroportal pancreatic lobules with the aid of a dissecting microscope. In rats who had undergone the TSP technique, blood glucose levels were maximal 8 hr after operation (270 +/- 16 mg/dl), and thereafter recovered baseline values. In contrast, after the RSP technique all the rats became diabetic as documented by persistent hyperglycemia (347 +/- 20 mg/dl at 8 hr, P = 0.01 compared to TSP; 500 +/- 20 mg/dl at 8 hr, P less than 0.0001). Eight hours after the operation, blood lipase levels increased more significantly after TSP than after RSP (847 +/- 247 IU/liter and 130 +/- 37 IU/liter, respectively, P = 0.01), and then decreased to 92 +/- 19 IU/liter at 24 hr in the TSP group and less than or equal to 30 IU/liter in the RSP group (P = 0.003), suggesting a more radical dissection of pancreatic tissue with the RSP technique. At sacrifice at 48 hr, no complications were found with either technique on macroscopic and microscopic examination, except for marked gastric distension with RSP. A third group of rats underwent RSP and were followed until natural death.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis↗
PubMed1990

Relation between flow-pressure-diameter studies in experimental stenosis of rabbit and human small bowel.

Patients with inflammatory and ischaemic bowel diseases seem to tolerate narrowing of the gut lumen to a critical degree of stenosis without obstructive symptoms. To determine the physical factors involved in bowel occlusion, we created an experimental model using New Zealand rabbits in acute experiments under general anaesthesia. At operation a loop of small bowel was isolated and canulated, proximally for perfusion and pressure recording and distally to monitor flow. Having established the physiological pressure and flow conditions in a normal loop of gut, a stenosis was created using circular adjustable rings of determined widths. Pressure and flow were measured constantly and the variables studied were luminal diameter, stenosis length, and perfusate viscosity. This experimental model was reproduced using resected segments of human small bowel. We found a critical point- at 60% of the original diameter-down to which the small bowel is able to maintain normal flow. At a diameter smaller than this, the physiological parameters are rapidly altered up to the point of complete obstruction. In the rabbit model bowel rupture occurs at 30% of the initial size. Increased viscosity of the fluid and length of the stenosis alter this critical point inducing a larger critical diameter. We did not observe any cumulative effect of multiple identical stenoses.

Animals↗
PubMed1990

Experimental porcine orthotopic liver transplantation: a training protocol for transplantation in humans.

The authors suggest that, prior to human liver transplantations, exhaustive training be undertaken on an animal model in order to acquire the expertise required for this delicate procedure. The pig has considerable anatomic similarities to man, as well as a comparable physiological and hemodynamic sensitivity, and has been used as a model by our experimental team to perfect our clinical liver transplantation technique. In particular, a surgical model representing the adult donor/child recipient situation has been developed. Anesthesia, extracorporeal bypass procedure and the full surgical protocol are described. This operative protocol was elaborated to mimic as closely as possible the clinical situation. Our model also allowed us to undertake several relevant physiological and pharmacological studies during the transplantation procedure.

Animals↗
PubMed1990

[Perforated tubular duplication of the sigmoid colon in adults].

Intestinal duplications are rare malformations and a diagnostic challenge. The case presented herein relates to a perforated tubular duplication of the sigmoid colon in a 23-year-old man with intermittent abdominal pain during 3 months and a bout of peritonitis which resolved spontaneously. This case is unusual since duplications generally spare adults, are seldom found in the colon, and do not perforate. The only cases of duplication which can be suspected preoperatively belong to the communicating type or those containing ectopic gastric mucosa. The intraoperative finding in this case of a malformative mesenteric cyst reminds us that duplications can be found in association with other intestinal, vertebral, or genitourinary tract malformations. In conclusion, intestinal duplications should be resected even when they are asymptomatic, as occasional cancerous transformation associated with a poor prognosis have been reported.

Abscess↗
PubMed1990

Dermoid cyst of the pancreas. Case report and review of the literature.

During an annual check-up in a 46 year-old man, a round mass was discovered in the left hypochondrium upon abdominal ultrasonography. Computed tomographic scan located the mass at the upper border of the body of the pancreas, suggesting an expansive process. Left pancreatectomy was performed, leading to the discovery of a dermoid cyst. This cyst was apparently part of the pancreatic parenchyma. Only 11 cases of dermoid cysts of the pancreas have been reported between 1918 and 1977. Elective enucleation of the cyst is thought to be adequate surgical treatment.

Dermoid Cyst↗
PubMed1990

Ruptured aneurysm of the omentum. Case report.

A 61-year-old man was operated on for a ruptured aneurysm located on the free margin of the omentum. Such patients should have preoperative arteriography as the source of the haemorrhage can be difficult to find at operation.

Aneurysm↗
PubMed1989

Increase of creatine kinase and lactate dehydrogenase in the serum of rats submitted to experimental intestinal infarction.

Acute intestinal ischemia is a severe condition for which no early biochemical index exists at present. We have investigated the effect of experimental intestinal infarction in the rat on the serum concentration of total creatine kinase, creatine kinase BB and total lactate dehydrogenase. Suppression of blood supply from the superior mesenteric artery resulted in marked increases of total creatine kinase, of its BB isoenzyme, and of total lactate dehydrogenase. Whereas total creatine kinase and total lactate dehydrogenase cannot be regarded as specific markers of the intestine, creatine kinase BB could prove to be more specific in view of its limited tissue distribution.

Animals↗
PubMed1989

[Hepatic hypertrophy after right hepatectomy of traumatic rupture].

The clinical, biochemical and morphological features of a massive hepatic hypertrophy is reported. It occurred in a young female patient with multiple injuries who had undergone right liver resection for traumatic liver rupture and right nephrectomy for rupture of the right renal artery. Subsequently, the patient developed deficiency of several organs, together with a septic state which led to her death 3 months after the trauma. The factors responsible for this massive hepatic hypertrophy (3,950 g) are discussed.

Adult↗
PubMed1989

Results of operative treatment of gastrointestinal tract tumors in patients over 80 years of age.

Between 1981 and 1986, 140 patients over 80 years of age were operated on for a gastrointestinal tract tumor in our service. There were 24 gastric, one small-bowel, 91 colonic, and 24 rectal cancers. Only 40% of the patients were preoperatively free of any systemic disorder other than tumor. We performed surgical procedures with a curative intent for 90 (64%) of them. Our mean overall postoperative mortality was 17%, but this rate could be decreased by performing elective operations on well-prepared patients. Over 80% of the deaths were related to systemic organ failures. Eighty-three percent of the survivors (96 patients) returned to their homes; 82% (94 patients) had normal activities for their age. The actuarial survival curve showed a 50% survival rate at three years, all tumoral stages included. These results support the view that surgery is a safe, valid option in the face of gastrointestinal tract tumors in the elderly.

Actuarial Analysis↗
PubMed1989

Acute pancreatitis and normoamylasemia. Not an uncommon combination.

A consecutive series of 352 attacks of acute pancreatitis (AP) was studied prospectively in 318 patients. AP was ascertained by contrast-enhanced CT scan in all but four cases in which diagnosis was made at operation or autopsy. Sixty-seven of these cases (19%) had normal serum amylase levels on admission (i.e., less than 160 IU/L, a limit that includes 99% of control values), a figure considerably higher than generally admitted. When compared to AP with elevated serum amylase, normoamylasemic pancreatitis was characterized by the following: (1) the prevalence of alcoholic etiology (58% vs. 33%, respectively, p less than 0.01), (2) a greater number of previous attacks in alcoholic pancreatitis (0.7 vs. 0.4, p less than 0.01); and (3) a longer duration of symptoms before admission (2.4 vs. 1.5 days, p less than 0.005). In contrast AP did not appear to differ significantly in terms of CT findings, Ranson's score, and clinical course, when comparing normo- and hyperamylasemic patients, although there was a tendency for normoamylasemic patients to follow milder courses. Serum lipase was measured in 65 of these normoamylasemic cases and was found to be elevated in 44 (68%), thus increasing diagnostic sensitivity from 81% when amylase alone is used to 94% for both enzymes. A peritoneal tab was obtained in 44 cases: amylase concentration in the first liter of dialysate was greater than 160 IU/L in 24 cases (55%), and lipase was greater than 250 U/L in 31 cases (70%). Twelve of these 44 cases had low peritoneal fluid and plasma concentrations for both enzymes. Thus little gain in diagnostic sensitivity was obtained when adding peritoneal values (96%) to serum determinations. AP is not invariably associated with elevated serum amylase. Multiple factors may contribute to the absence of hyperamylasemia on admission, including a return to normal enzyme levels before hospitalization or the inability of inflamed pancreases to produce amylase. Approximately two thirds of cases with normal amylasemia were properly identified by serum lipase determinations. AP does not appear to behave differently when serum amylase is normal or elevated, and should therefore be submitted to similar therapeutic regimens in both conditions.

Acute Disease↗
PubMed1989

[1 year of multiple organ procurement using the Starzl technic of rapid cooling: personal results].

We did perform 20 multiorgan procurements in 1987, using the last technique described by STARZL. We were very favorably impressed by the security (all organs harvested achieved good long-term function), the rapidity (mean operative time 125 min) and the flexibility of the technique. Waiting lists for hearts and livers in Switzerland are now becoming long, and it seems thus essential that all usable organs can be retrieved for transplantation.

Cadaver↗