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Biomedical subjects

A Senning

Publications and source records attributed to A Senning.

At least 91 records · Page 5Linked to original sources

[Small cell bronchus carcinoma: surgery or not?].

According to literature the operability rate of small cell carcinoma of the bronchi varies from 6 to 26%. Out of this group of patients the 5-year survival rate is 0--5%. During the 8 years from 1965 to 1973 we observed 65 patients suffering from small cell bronchial carcinoma. All were men. The average age was 56.5 years. Out of this group of 65 patients 13 underwent operations. In 7 cases pneumonectomy, in 1 case lobectomy were performed. 3 patients became radical pneumonectomy. In 2 cases thoracotomy was performed. On the average the operated patients survived for 6.1 months. Out of the 13 patients 12 died during the first year and one patient survived 2 years after the operation. Out of the 52 patients who were found to be inoperable 42 had radiotherapy. In 2 patients additional chemotherapy was given. In the group of 52 patients, 58% died during the first 6 months and 85% died during the first year after diagnosis. 3 patients survived 13, 14 and 15 months respectively and one patient died 35 months after diagnosis. We come to the conclusion that surgery has not brought any advances in the treatment of this tumour. Our bad experience is shared by most authors. Indications for surgical treatment of this tumour therefore are extremely limited.

Adult↗

[Reducing hemodilution through ultrafiltration following cardiopulmonary bypass].

Reduction of post-bypass-hemodilution by ultrafiltration was assessed. Five dogs were subjected to 1 hour of cardiopulmonary bypass and were hemodiluted with 2 liters of Ringer lactate solution to a hematocrit below 20%. An arterial hemofilter was then incorporated into the system and 1 liter of fluid was ultrafiltrated for 16 minutes during partial bypass. The filtrate was free of protein and hemoglobin. There was a significant increase of the hematocrit from 19 to 29%, and protein from 2,7 to 5,4 g%. No hemodynamic alterations were seen during or after filtration. Osmolality remained within normal limits (from 284 to 296 mOsm/kg). In addition, no electrolyte imbalance was found. The method is therefore safe for quick volume removal without the side effect of diuretics.

Animals↗

[Results following radical pneumonectomy for bronchial carcinoma].

Between 1968 and 1978 82 radical pneumonectomies were performed in our clinic because of a bronchial epidermoid carcinoma. In 49 patients the operation was performed at least 5 years ago (December 31, 1973). 23 patients had a radical pneumonectomy with intrapericardial ligation of the vessels, atriumwall resection or pericardial resection (group A). In addition 13 patients had a dissection of the mediastinal lymphnodes (group B). In the remaining patients (n = 13) parts of the thoracic wall had to be removed (group C). The postoperative lethality (30 days) is 17.6% in group A, 38.5% in group B (2 patients died because of hematogenous metastases, 2 of pulmonary embolism and 1 of generalized pneumonia) and 10% in group C. The 5-year survival is 13% for group A, 8% for group B and 10% for group C.

Bronchial Neoplasms↗

Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty.

In percutaneous transluminal coronary angioplasty, a catheter system is introduced through a systemic artery under local anesthesia to dilate a stenotic artery by controlled inflation of a distensible balloon. Over the past 18 months, we have used this technic in 50 patients. The technic was successful in 32 patients, reducing the stenosis from a mean of 84 to 34 per cent (P less than 0.001) and the coronary-pressure gradient from a mean of 58 to 19 mm Hg (P less than 0.001). Twenty-nine patients showed improvement in cardiac function during follow-up examination. Because of acute deterioration in clinical status, emergency bypass was later necessary in five patients; three showed electrocardiographic evidence of infarcts. Patients with single-vessel disease appear to be most suitable for the procedure, and a short history of pain indicates the presence of a soft (distensible) atheroma likely to respond to dilatation. We estimate that only about 10 to 15 per cent of candidates for bypass surgery have lesions suitable for this procedure. A prospective randomized trial will be necessary to evaluate its usefulness in comparison with surgical and medical management.

Adult↗

The role of the surgeon in percutaneous transluminal dilation of coronary stenosis.

Percutaneous transluminal dilation (PTD) of coronary artery stenosis is performed by means of a balloon-tipped catheter introduced from a peripheral artery. It was attempted in 45 patients; stenosis was passed in 33 and was successfully dilated in 28 patients (62%). The method failed in 17 patients: in 6 of them an abrupt closure of a stenosed artery or a beginning infarction necessitated an emergency revascularization. There were no deaths or serious complications, but an infarction developed in 1 patient despite immediate bypass grafting. PTD was successful in 5 out of 7 patients who had recurrent angina after previous coronary bypass grafting: in 2 of them stenosis of a distal coronary artery and in 3 a stenosed bypass graft were dilated. PTD is a new method of treatment of coronary artery disease and is an addition rather than an alternative to coronary bypass grafting. The best results can be expected in patients with single-vessel disease, with a short history of angina (less than 1 year), and with narrow, noncalcified proximal stenosis. Some late complications of bypass grafting are also amenable to this method of treatment.

Adult↗

Percutaneous transluminal dilatation of coronary artery stenosis.

Percutaneous transluminal dilatation (PTD) of coronary stenosis is performed by means of a balloon-tipped catheter introduced from a peripheral artery. PTD was attempted in 56 patients; stenosis was successfully dilated in 38 patients (68%). The method failed in 18 patients: in 6 (11%) of them an abrupt closure of the stenosed artery or a beginning infarction necessitated an emergency revascularization. There were no serious complications or deaths; one patient developed a transmural infarction in spite of the immediate bypass grafting. PTD was also successful in 6 out of 9 patients with recurrent angina following previous coronary bypass grafting. Intraoperative dilatation by coronary arteriotomy was attempted in 6 patients, but the results were inconclusive. PTD is a new method of treatment of coronary artery disease; it represents an addition rather than an alternative to coronary bypass grafting. The decision for PTD should be made jointly by cardiologist and surgeon; the ideal patient has a short history of angina with narrow, proximal stenosis without any calcifications. Cardiosurgical standby is mandatory during PTD; the results are best and the risk lowest in patients with single vessel disease.

Adult↗

Isolated mitral valve replacement with the Björk-Shiley tilting disc prosthesis.

Between July 1970 and June 1977, 151 patients underwent isolated mitral valve replacement with the Björk-Shiley valve. The follow-up period extended over 8 years to June 1978. Hospital mortality was 5.2% (8/151), late mortality 8.4% (12/143). Actuarial survival analysis predicts 84 (+/- 4) % of patients to be alive at 5 years and 80 (+/- 6) % at 8 years. Thirteen patients sustained 15 episodes of thromboembolic complications; actuarially 88 (+/- 4) % of patients were free from this complication at 5 years and 81 (+/- 8) % at 8 years. Other valve-related complications included paravalvular leak (7), prosthetion showed an improvement of at least one class in 84% of patients.

Adolescent↗

Pre- and postoperative left ventricular contractile function in patients with aortic valve disease.

In 43 patients left ventricular micromanometry and cineangiography were performed preoperatively and and 20 months after aortic valve replacement. A score of left ventricular functional impairment, derived from 5 to 8 haemodynamic variables, was calculated as: number of pathological indices x 100/total number of determined indices. Preoperatively the score of left ventricular functional impairment amounted to 35 per cent in group 1 (aortic stenosis: n = 19), to 61 per cent in group 2 (combined lesion:n = 15) (P less than 0.05), and to 87 per cent in group 3 (aortic regurgitation: n = 9) (P less than 0.001). In contrast, the functional classification according to the NYHA showed similar impairment in the 3 groups. Postoperatively the score of left ventricular functional impairment decreased significantly in all 3 groups to 10, 16, and 27 per cent, respectively, but the score of group 3 remained raised (P less than 0.05) as compared with that of group 1. The patients with residual left ventricular dysfunction had a higher preoperative left ventricular muscle mass than the patients with normal or near normal postoperative left ventricular function. It is concluded that (1) at similar functional impairment according to the NYHA classification left ventricular contractile function is more severely impaired in aortic regurgitation and in aortic regurgitation + aortic stenosis than in aortic stenosis alone, (2) left ventricular function improves significantly after valve replacement in all three forms of aortic valve disease, (3) residual functional impairment is greater in aortic regurgitation than in aortic stenosis or aortic stenosis + aortic regurgitation, and (4) persistent postoperative left ventricular functional impairment is found in the patients with severe preoperative hypertrophy.

Adult↗

Constrictive endocarditis. Report of a case with successful surgery.

An 18-year old white youth presented with severe right heart failure and was found to have an obliterated and funnel-shaped right ventricle, massive tricuspid regurgitation, and mitral regurgitation. The haemodynamic findings were those of cardiomyopathy with obliteration on the right side. He underwent surgery consisting of decortication and peeling off of a thickened right ventricular endocardium, tricuspid valve replacement, and mitral valve repair. After surgery there was pronounced haemodynamic as well as clinical improvement. The pathological picture was that of constrictive endocarditis. We recommend this method of treatment for patients with obliterate cardiomyopathy on either side of the heart.

Adolescent↗

[Surface changes of the pulmonary valve following pulmonary valve xenotransplantation in the descending aorta. An experimental study in dogs].

Upon implantation in the descending aorta, glutaraldehyde-conditioned pulmonary valves (n = 46) are immediately covered by a protein layer, followed by a fibrinous layer. Two to thirty minutes later platelets, WBCs, macrophages, and microthrombi are incorporated into the valve's surface. After 3 weeks the first collagen fibers appear on the surface and slowly build a collagen layer that grows toward the free edge. These changes are very similar to the surface changes of bioprostheses implanted in humans.

Animals↗

[Early scanning electron microscopy changes in the surface of woven dacron vessel prosthesis. An experimental study in dogs].

To evaluate platelet-inhibiting drugs in vivo, we implanted artificial vessels into the arterial blood-stream of dogs. Following different periods of normal blood-flow through the prosthesis, pieces were cut out and prepared for scanning electron microscopy (SEM). Through the SEM we studied surface changes of the samples, in particular those of platelets. They very soon loose their disclike form becoming relatively spherical and make contact with each other by means of pseudopods that are formed at that stage. Red blood cells are caught up in this 3-dimensional network causing the inner surface of the dacron prosthesis to look like an underwatergarden.

Animals↗

[Bronchiolo-alveolar cell carcinoma].

15 cases of bronchiolo-alveolar cell carcinoma were observed at the Dept. of Surgery of the University Hospital of Zurich from 1961 to 1976. The mean age of these patients was 56 years. The sex distribution was 13 males and 2 females. Five cases were discovered accidentally; the symptoms of the remaining 10 were uncharacteristic. Cytology, bronchoscopy and mediastinoscopy were negative at early stages. Diagnosis was made by histologic examination of the specimens only. Needle biopsy, performed routinely over recent years, proved helpful in 4 cases. In 12 out of 14 patients, lobectomy was considered 'radical'; nevertheless, only 2 survived more than 5 years. The disseminated form of the bronchiolo-alveolar cell carcinoma is characterized by a particularly poor prognosis. According to our experience and to the literature, only the solitary, nodular type shows a more favourable outlook.

Adenocarcinoma, Bronchiolo-Alveolar↗

[Hemoptysis].

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Bronchial Diseases↗

[Therapy of pleural empyema after pneumonectomy with open-window drainage and continuous rinsing].

From 1961 to 1977 24 thoracic empyemas (=4,75%) after 507 pneumonectomies were observed at the Surgical Clinic A of the Zurich University Hospital. Two methods for the management of this condition are discussed: open-window drainage (CLAGETT) and continuous rinsing of the pleural cavity (LUIZY). The first mentioned method proved to be a palliative one in our patients: no thoracostomy could be re-closed operatively. Two thoracic windows healed up spontaneously without recurrence of an empyema; one patient died shortly after the operation from respiratory insufficiency. Of the five patients treated by continuous rinsing, four were cured as for their empyema, but one of the latter died from renal insufficiency. In one case an open-window drainage finally had to be accomplished.

Adult↗