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Biomedical subjects

A Rohner

Publications and source records attributed to A Rohner.

At least 109 records · Page 6Linked to original sources
PubMed1989

[Single-stage excision anastomosis of left colonic obstruction excision treated as an emergency].

The results of four different types of operation were compared retrospectively in terms of mortality, morbidity, duration of hospital stay. Eighty-eight consecutive patients suffering from left colonic obstruction underwent emergency surgery from December 1976 to January 1988. There were 36 male and 52 female patients, aged from 41 to 93 years (mean 71), 25% of them being 78 or older. Carcinoma was the most frequent lesion (75/88, 85%). 1) One-stage resection and anastomosis was carried out in 23 patients with only one temporary ileostomy; there were two fatalities (8.7%) and one clinical anastomotic leak (4%) treated conservatively with success; mean hospital stay was 21.5 days. 2) Thirty-six patients underwent a Hartmann procedure, with four fatalities (11%) and a mean hospital stay of 23.0 days; 17 of the surviving 32 (53%) later had the second stage procedure, with no fatality, one clinical leak (6%), and mean stay of 20.7 days. 3) Twenty-six patients had simple decompressing colostomies with nine fatalities (35%); eight of the surviving 17 (47%) had colectomy and colostomy closure during the same hospitalization, with one fatality (6%); mean hospital stay was 41.4 days. 4) Finally, subtotal colectomy imposed by caecal ischemia (twice) or a previous right colectomy (in one instance) was performed three times with no death. Since january 1986, resections and primary anastomoses have been performed 20 times for 26 consecutive obstructions (77%). Our overall results in terms of mortality, morbidity and duration of hospital stay appear to favor resection and primary anastomosis in the treatment of selected cases of left colonic obstruction.

Adult↗
PubMed1988

Hepatic trauma: risk factors influencing outcome.

This retrospective study analyses the fate and associated risk factors of 99 patients who underwent laparotomy for hepatic trauma from 1977 to 1986. Blunt trauma (88 patients) and stab wounds (7 patients) had mortality rates of 36 and 14 per cent respectively. The overall death rate was 35 per cent. Multiple trauma patients had a significantly higher mortality for each additional system that was seriously injured. Pre-operative shock raised the mortality from 20 to 58 per cent (P less than 0.001). For patients over 50 years of age, the mortality rate increased from 30 (younger patients) to 63 per cent (P = 0.028). Minor hepatic wounds required relatively simple surgical measures in 60 patients, yet 13 died (22 per cent) of other causes. More sophisticated surgical management was applied to 27 major hepatic lesions, with 10 deaths (37 per cent). Twelve patients (seven with minor and five with major hepatic wounds) died before surgical treatment of the liver injury could be undertaken. The overall mortality rate of major hepatic wounds was 47 per cent and for minor wounds 30 per cent. However, the difference was not significant (P = 0.152). Resection was resorted to in 15 patients, 5 of whom subsequently died (33 per cent). Classical hepatic lobectomy led to 4 deaths (50 per cent). Among the 35 deaths, 6 were due to the hepatic trauma itself (5 exsanguinations and 1 intra-abdominal sepsis). Isolated hepatic injury was fatal in three patients. We believe that conservative surgical measures should be used whenever possible in patients with hepatic trauma, especially when risk factors are encountered.

Adolescent↗
PubMed1988

Value of contrast-enhanced computerized tomography in the early diagnosis and prognosis of acute pancreatitis. A prospective study of 202 patients.

Two hundred two patients admitted with the clinical suspicion of acute pancreatitis underwent computerized tomography scanning within 36 hours of admission. The diagnostic value of the computerized tomography findings was excellent, with a sensitivity of 92 percent and a specificity of 100 percent. One hundred seventy-six patients with acute pancreatitis defined according to the overall clinical course were included in the prognostic study. The pancreatitis was fatal in 21 patients, severe in 47 patients, and mild in 108 patients. The computerized tomography findings were classified into the following three groups on the basis of the extent of phlegmonous extrapancreatic spread: Group I, no phlegmonous extrapancreatic spread (100 patients, none died); Group II, phlegmonous extrapancreatic spread in one or two areas (28 patients, mortality rate 4 percent); and Group III, phlegmonous extrapancreatic spread in three or more areas (48 patients, mortality rate 42 percent) (p less than 0.0001). The following three scores from prognostic clinical and laboratory data were also obtained: Score 1, zero or one positive sign (82 patients, none died); Score 2, two to four positive signs (54 patients, mortality rate 13 percent); Score 3, five or more positive signs (40 patients, mortality rate 35 percent) (p less than 0.001). The combination of computerized tomography findings and prognostic signs had the best predictive value. Patients in Group III, Score 3 (24 patients) or Group III, Score 2 (19 patients) had mortality rates of 58 percent and 32 percent, respectively, and complications developed in all of the survivors. In addition, all except two acute pancreatitis patients in whom pancreatic abscess developed were found in Group III (p less than 0.0001). Furthermore, for Group III patients, the prediction of death associated with abscesses was enhanced by the number of prognostic signs. The mortality rate increased from 17 percent for Score 2 patients to 81 percent for Score 3 patients (p = 0.0078). As a result of this study, we recommend early computerized tomography for all Score 2 and Score 3 patients, since it allows prompt recognition of patients at high risk for systemic and local complications. Adequate therapy can then be directed to the group of patients to whom it is best suited. Serial computerized tomographies should be reserved for those patients presenting with phlegmonous extrapancreatic spread.

Acute Disease↗
PubMed1988

Comparative study of ceftriaxone and cefoperazone in the treatment of acute cholecystitis.

Forty patients with acute cholecystitis were divided into two randomized groups on the basis of the emergency antimicrobial therapy received, and were treated for a period of 5 days. The first group was given ceftriaxone (Rocephin), the second cefoperazone (Cefobis). This concomitant antimicrobial treatment of acute cholecystitis proved to be effective in 85% of the patients; 15% underwent 'à chaud' surgery on the 6th day because of a lack of response to the treatment. Ceftriaxone and cefoperazone proved to be equally effective. Use of ceftriaxone, however, was simpler (one injection a day) and the cost of treatment substantially lower.

Adult↗
PubMed1988

Surgical treatment of hydatid disease of the liver: a survey of 69 patients.

Sixty-nine patients were operated on because of hydatid disease of the liver from 1960 to 1986. There were 32 male and 37 female patients, with a mean age of 38 years at operation (range, 13 to 76 years). Forty-two cysts were solitary, 20 multiple, and 7 bilateral; 45 were located in the left lobe. Radical surgical procedures were carried out in 45 patients and consisted of cystectomy in six, pericystectomy in 25, and hepatectomy in 14; a conservative approach was used in 11 (resection of prominent part, internal or external drainage). The remaining 13 patients underwent a combination of both techniques. There were no deaths. Postoperative morbidity was low and equally distributed whether surgery was radical or conservative. Local complications occurred in six patients (9%), and seven other patients (10%) had systemic disorders. Four patients required reoperation: two for hemostasis and two for persistent fistulae (one biliary and one bronchobiliary). Of the 42 patients available for follow-up (61%), four (9%) had recurrent disease. One had undergone a pericystectomy and three, conservative procedures, at the time of primary surgery. Our results support the view that excisional surgery is a safe and valid option for patients with hydatid liver disease.

Adolescent↗
PubMed1987

A new abdominal drain for overflowing lavage in instances of severe pancreatitis with persistent peritoneal contamination.

Eight patients with severe acute necrotizing pancreatitis had a new removable drainage device applied which allowed for massive lavage drainage with water tightness and easy repeated abdominal and retroperitoneal revisions. The lavage clears the enzymes and the toxic products that continuously soil the abdomen and affect all other systems. Simultaneously, it acts as a peritoneal dialysis. There were no complications and the 50 per cent survival rate at three months compares favorably with that of corresponding instances in another study (p less than 0.02).

Abdomen↗