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Biomedical subjects

C A Seiler

Publications and source records attributed to C A Seiler.

At least 37 records · Page 2Linked to original sources
PubMed1999

The bile duct anastomosis in liver transplantation.

In spite of the dramatic improvement of survival after orthotopic liver transplantation over the last decades, biliary tract complications are still the 'achilles heal' of liver transplantation with a potential risk of significant morbidity and mortality. Biliary leaks or strictures, the major types of biliary complications, may occur after direct choledocho-choledochostomy (CC) or Roux-Y choledocho-jejunostomy (CRY). The majority of these biliary complications, however, are often a consequence of surgical technique and therefore potentially amenable to improved surgical technique.

Anastomosis, Surgical↗
PubMed1999

[New approaches to the surgical treatment of diffuse peritonitis].

OBJECTIVE: We intend to analyze if additional treatment concepts are necessary in any case as a part of the standard therapy next to the well established principle of source control in the treatment of secondary peritonitis. DESIGN: A treatment concept with early intervention, source control and extensive intraoperative lavage (20-301) should be evaluated as a standard procedure in a prospective survey. Additional treatment concepts will be applied only for special reason (on demand). RESULTS: From 11/1993 to 9/1997 241 patients with diffuse peritonitis were treated with the concept mentioned above. Additional treatment concepts as continuous postoperative lavage (n = 20) and staged lavage (n = 4) were applied as primary treatment in 24 patients only (10%), mainly for impossibility of source control and evisceration. Source control at the initial operation was possible in 216 patients (90%). Due to secondary evisceration 3 patients had to undergo laparostomy for staged lavage later. Severity of peritonitis was determined according to the Mannheim Peritonitis Index (median 26, range 15-43). The primary causes of peritonitis were perforation, leakage and abscess after operation (n = 56), followed by diverticular (n = 42) and gastric or duodenal perforation (n = 39). The hospital mortality rate was 14% in the whole group, and the postoperative morbidity rate was 39%. CONCLUSIONS: Due to progress in intensive care and antibiotic treatment only a few patients (ca. 10%) need additional therapies such as postoperative or staged lavage. Surgical source control in combination with intraoperative lavage is sufficient in most of the patients with diffuse peritonitis.

Adolescent↗
PubMed1998

[Interdisciplinary evaluation for liver transplantation: the Bern concept].

Orthotopic liver transplantation (OLT) is the therapy of choice for a variety of end-stage liver diseases. The 5 year survival rate for electively operated patients with non malignant liver disease is exceeding 70%. Crucial for patient management is the early referral of the patient to a liver transplant center where an interdisciplinary evaluation of the patient is undertaken during a short hospital stay. The diagnosis will be confirmed, the operability assessed, contraindications excluded and the conservative treatment improved. A timely operation is of extreme importance and is based on an estimation of the severity and the dynamics of the liver disease. The liver transplantation should be performed early in a patient with a preserved liver function in order to achieve the best results.

Contraindications↗
PubMed1998

Evaluation of laser Doppler flowmetry to assess cyclosporine A-induced impairment of renal blood flow.

Cyclosporine A (CyA)-induced nephrotoxicity is a well-known complication of this potent immunosuppressive drug. It is caused by an elevation in renovascular resistance and impairment of renal blood flow. Currently, one of the principal experimental settings to assess renal hemodynamics has been using the in vivo fluorescent videomicroscopy (IVFV) method on hydronephrotic rat kidneys, which is expensive, time-consuming, not physiological, and not applicable to humans. In the present paper we have been able to confirm our working hypothesis that laser Doppler flowmetry (LDF) is a valuable tool for assessing microcirculatory changes in the rat kidney during CyA administration. Total subcapsular blood flow decreased to approximately 70% of baseline values (P < 0.05) and mean arterial pressure (MAP) increased initially to 113% of baseline values (P < 0.05) compared to only minor changes for cremophor (carrier substance) or no changes for sodium chloride solution 0.9%. LDF provides an easy and rapid technique and its major advantage is the potential use in assessing microcirculatory changes after kidney transplants in humans.

Animals↗
PubMed1998

Laparoscopic treatment of large paraesophageal hernia with totally intrathoracic stomach.

BACKGROUND: Once paraesophageal hernia has been diagnosed, it should be repaired immediately because of life-threatening complications such as bleeding, ischemia, and perforation when intrathoracic strangulation or volvulus occurs. We describe our surgical strategy for treating this rare type of hiatal hernia with regard to early and late postoperative complications. STUDY DESIGN: This was a retrospective case series from a university hospital. Twelve patients (seven women and five men) with a mean age of 64 years (range, 50-76 years) and a completely intrathoracic stomach underwent laparoscopic paraesophageal hernia repair. Seven patients had a type 2 hernia, and five patients had a type 3 hernia. Additional organoaxial volvulus was present in three patients. All patients underwent reduction of the stomach and the greater omentum, excision of the hernia sac, closure of the hiatal defect, and a floppy Nissen fundoplication. RESULTS: Because of severe adhesions, one patient needed an open stomach reduction (conversion rate, 8%). The mean operating time was 161 minutes (range, 110-200 minutes), blood loss was minimal, and the mean postoperative hospital stay was 6 days (range, 4-7 days). There were no intraoperative complications, but early postoperative complications occurred in three patients (25%; one with dysphagia, 1 reoperation due to organoaxial gastric rotation with gastroduodenal obstruction, and one with deep venous thrombosis). No deaths occurred. Followup in all patients is complete, with a mean followup time of 21 months (range, 3-40 months). The complication rate after long-term followup was 8%, and reflux esophagitis symptoms in one patient were completely relieved by medical therapy. CONCLUSIONS: Laparoscopic paraesophageal hernia repair was feasible and safe with low morbidity and mortality rates in this elderly patient group. To achieve good long-term results, standard surgical treatment should include reduction of the stomach, complete excision of the hernia sac, closure of the hiatal defect, floppy Nissen fundoplication, and anterior gastropexy.

Aged↗
PubMed1998

Missed diaphragmatic injuries and their long-term sequelae.

BACKGROUND: Blunt or penetrating truncal traumas can result in diaphragmatic rupture or injury. Because diaphragmatic defects are difficult to diagnose, those that are missed may present with latent symptoms of obstruction of herniated viscera. METHODS: A chart review of all patients admitted with late presentations of posttraumatic diaphragmatic hernias from 1980 to 1996 was undertaken. RESULTS: Ten patients with posttraumatic diaphragmatic hernias were treated in this specified period. There were six males and four females with a mean age of 65 years. Eight patients sustained blunt truncal traumas and two patients sustained penetrating truncal traumas. The hernias occurred in two patients on the right and in eight patients on the left side and contained the liver (n = 2), bowel (n = 10), stomach (n = 4), omentum (n = 5), or spleen (n = 1). The time until the hernias became clinically symptomatic ranged from 20 days to 28 years. In all but one patient, either routine chest roentgenograms or upper gastrointestinal contrast studies were diagnostic. All 10 patients underwent laparotomy (n = 9) or thoracotomy (n = 2) with direct repair of the diaphragmatic defect. One patient died 3 days after the operation, representing a mortality of 10%; the morbidity was 30%. CONCLUSION: Initial recognition and treatment of diaphragmatic rupture or injury is important in avoiding long-term sequelae.

Adult↗
PubMed1998

[Surgical therapy of ileus of the large intestine].

Acute colonic obstruction is a life threatening emergency. In this prospective study 69 patients suffering from large bowel obstruction, admitted between November 1993 and March 1998 to the University hospital of Bern, were analyzed with regard of the performed surgical procedure. The causes of obstruction were colorectal carcinomas (38%), other malignancies (19%), volvulus (13%), hernias (10%), diverticulitis (7%) and others (13%), 8 benign and 19 malignant lesions were surgically treated without colonic resection, the latter by colostomy (13), ileostomy (5) or bypass (1). All the other 42 patients had their obstruction resected within 24 hours after admission, 24 of them with primary anastomosis and 18 as a two-staged procedure. However, 9/18 (50%) patients never have had restoration of bowel continuity. No three-stage procedure was planned or performed. In-hospital mortality was 4/69 (5.8%), all of them after staged resections due to non-surgical complications. No anastomotic leakage was clinically apparent, neither in one-stage procedures, nor in completed two-stage procedures. Median length of total hospital stay in one-stage and two-stage procedures was 14 and 30 days, respectively. The advantages of one-stage procedures, especially in terms of subtotal colectomy, are discussed on the basis of an overview of the literature.

Acute Disease↗
PubMed1998

[Peritonitis in diverticulitis: the Bern concept].

INTRODUCTION: The colon is the most frequent origine for a diffuse peritonitis and diverticular perforation is again the most common source of a spontaneous secondary peritonitis. This paper first focuses on the treatment of peritonitis and secondly on the strategies of source control in peritonitis with special emphasis on the tactics (primary anastomosis vs. Hartmann procedure with colostomy) for surgical source control. PATIENT AND METHODS: Prospective analysis of 404 patients suffering from peritonitis (11/93-2/98), treated with an uniform treatment concept including early operation, source control and extensive intraoperative lavage (20 to 30 liters) as a standard procedure. Other treatment measures were added in special indications "on demand" only. Peritonitis was graded with the Mannheim Peritonitis Index (MPI). Tactics of source control in peritonitis due to diverticulitis were performed according to "general condition" respectively the MPI of the patient. RESULTS: The 404 patients averaged a MPI of 19 (0-35) in "local" peritonitis and a MPI of 26 (11-43) in "diffuse" peritonitis. The colon as a source of peritonitis resulted in MPI of 16 (0-33) in the case of "local" respectively 27 (11-43) in "diffuse" peritonitis. From 181 patients suffering from diverticulitis 144 needed an operation and in 78 (54%) peritonitis was present. Fourty-six percent (36) of the patients suffered from "local", 54% (42) from "diffuse" peritonitis. Resection with primary anastomosis was performed in 26% (20/78) whereas in 74% (58/78) of the patients a Hartmann procedure with colostomy was performed. The correlating MPI was 16 (0-28) vs. 23 (16-27) respectively. The analysis of complications and mortality based on the MPI showed a decent discrimination potential for primary anastomosis vs Hartmann procedure: morbidity 35% vs. 41%; reoperation 5% vs. 5%; mortality 0% vs. 14%. CONCLUSION: In case of peritonitis due to diverticulitis the treatment of peritonitis comes first. Thanks to advances in intensive care and improved anti-inflammatory care, a more conservative surgical concept nowadays is accepted. In the case of diverticulitis the MPI is helpful to choose between primary anastomosis vs. Hartmann procedure with colostomy as source control. The MPI includes the "general condition" of the patient into the tactical decision how to attain source control.

Adolescent↗
PubMed1997

[Liver transplantation at the Bern Island Hospital: results from the last 5 years].

Today, orthotopic liver transplantation (OLT) is the treatment of choice for the endstage of various liver diseases, a 1-year survival rate of 80% and a 5-year survival rate of 70% in elective patients without tumor is reported in international surveys. The liver transplant program of the Inselspital Bern is very small compared with international centers, and this may raise questions about the (long-term) results and the justification for such a program. During the last 63 months, 59 liver transplantations (including two retransplants) have been performed in 57 patients at the Inselspital. The 30-day mortality was 3.5% and the 2.5-year overall survival rate was 82% and 93% for elective cases without tumor. After a median follow-up of 29 months, 67% of all patients were reintegrated fully or part-time in their profession and 81% were independent of others' help. We conclude that even a small liver transplant program based on routine resources only can achieve results which are comparable to international standards.

Adult↗
PubMed1996

Thyroid gland surgery in an endemic region.

To assess the incidence, indications, and complications of (reoperative) thyroid gland surgery in an endemic region, we have retrospectively analyzed 1318 patients operated on between 1983 and 1994. There were 166 reoperations (13.5%). In comparison to the primary operation the indication for reoperation showed an increased rate of premalignant and malignant tumors (+16%) and a decreased rate of hyperthyroid disorders (-30%). The largest group operated on had benign multinodular goiters, with the same rate of indication for primary (57.4%) and secondary (57.8%) surgery. Permanent recurrent laryngeal nerve palsy rate following primary operation occurred at rates of 1.7% (1983-1990) and 0.7% (1991-1994) and for secondary operation 3.5% (1983-1990) and 5.6% (1991-1994), respectively. The change in recurrent nerve palsy rate in the later years was due to a more extensive resection policy at the primary operation and a more liberal approach to reoperative surgery. The high rate of reoperation for benign goiters (13%) and the new data of goitrogenesis have therefore directed our policy to more extensive resection of the thyroid tissue at the initial operation, increasing the rate of lobectomy from 27% (1982-1990) to > 90% (1991-1994) and at the same time lowering morbidity. Extensive resection of nodular tissue during the initial operation safely reduces the incidence of recurrent goiter and subsequently reduces the rate of reoperation and eliminates the high risk of morbidity associated with reoperative thyroid surgery. The indications for reoperation should be strict, and when unavoidable a modified lateral approach may be helpful.

Goiter, Endemic↗
PubMed1995

[Does acute graft rejection modify subsequent function of a transplanted liver?].

While in kidney, heart and pancreas transplantation the impairment of graft function associated with acute rejection is only partially reversible upon successful antirejection therapy, little is known about the effect of acute rejection on late graft function after liver transplantation. Our data however gives similar findings in regards to conventional and quantitative liver function tests in patients with or without acute rejection more than 12 months after liver transplantation. This may most likely be attributable to the unique regeneration potential of the adult human liver.

Acute Disease↗
PubMed1994

[Can the quality of a modest liver transplantation program compare to international standards? Results in Inselspital Berne].

Today, orthotopic liver transplantation is the treatment of choice for the endstage of various liver diseases, and a 1-year survival rate of over 80% is reported in international surveys. The liver transplant program of the Inselspital is very small compared to international centers and this may raise questions about the results and the justification for such a program. In a 24-month period, 20 liver transplants (including 2 retransplants) have been performed in 18 patients at the Inselspital. 2 patients (11%) died 20 and 268 days respectively after transplantation. 2 patients (11%) had significant morbidity 502 and 529 days respectively after transplantation. After a median follow-up of 11.5 months postoperatively, 14 (80% of all patients) lived an independent life. 9 (50%) were fully reintegrated in the household or in their profession and 5 others (30%) were working part time. We conclude that even a small liver transplant program based only on routine resources can achieve results comparable to international standards.

Adult↗
PubMed1994

[Indications for and results of recurrent surgery of the thyroid gland].

UNLABELLED: To assess the incidence, indications and complications of reoperative thyroid gland surgery we have retrospectively analyzed 1102 patients from the period 1983-1992. There were 148 reoperations (13%). The indications for reoperation showed an increase of premalignant and malignant tumors and a decrease of hyperthyroid disorders and of thyroiditis in +17%, -15% and -2% respectively. Indications for nodular goiters were identical for primary and secondary surgery. Newly discovered cancer accounted for 12 cases (9.2%) out of 35 reoperations for carcinoma. The rate of recurrent laryngeal nerve palsies for primary and secondary operations was 2% and 4% respectively. 19% of the patients undergoing reoperations had a preexisting unilateral nerve palsy. The rate of permanent hypoparathyroidism was 0.5% and was not influenced by the type of resection. Postoperative hypothyroidism depended on the extent of resection. The high rate of reoperations for benign goiters and the new data on goitrogenesis has directed our policy toward more extensive resection of nodular thyroid tissue. Since January 1991 this approach has increased the rate of lobectomies from the previous 27% to over 50% without increased morbidity. For reoperations we prefer the lateral cervical approach, to avoid ventral scarring from the former Kocher incision. CONCLUSION: Extensive resection of nodular tissue during the initial operation reduces the rate of recurrent goiters and subsequently the rate of reoperations, eliminating the high morbidity of reoperative thyroid surgery. Extensive resection with at least unilateral lobectomy can be performed safely. Indications for reoperation should be strict and, when unavoidable, a lateral approach should be chosen.

Goiter, Nodular↗
PubMed1994

Human anti-mouse antibody suppression with cyclosporin A.

BACKGROUND: Cyclosporin was used in an attempt to suppress the formation of human antimouse antibody (HAMA) after administration of murine monoclonal antibodies. METHODS: Thirteen patients were given oral cyclosporin (8.6-15 mg/kg/day) starting 2 days before administration of technetium-99m (99mTc) labeled F(ab')2 (3 patients) or Fab (10 patients) murine antibody fragment. Six to nine days later, patients received either rhenium-186 (186Re)-labeled F(ab')2 or an intact antibody. Cyclosporin was continued for 14 days after the second antibody administration. RESULTS: Five patients (38%) did not develop elevated HAMA titers for up to 8 weeks after antibody administration. These five patients had a median cyclosporin concentration of 726 ng/ml, while the eight patients who developed HAMA had a median cyclosporin level of 364 ng/ml. In contrast, when not given cyclosporin, 86% (24/28) of patients developed HAMA after receiving two doses of F(ab')2, and 100% (15/15) developed HAMA after receiving Fab followed by intact antibody. Toxicity from cyclosporin included elevation concentrations of bilirubin and creatinine, and increased blood pressure, which rapidly resolved after the cyclosporin was discontinued. CONCLUSIONS: This study demonstrates that cyclosporin given from 2 days before until 2 weeks after administration of either a F(ab')2 or intact murine antibody can suppress HAMA formation. This strategy may permit administration of repeated doses of murine-antibody-based radioimmunotherapy.

Animals↗
PubMed1993

Rhenium-186-labeled chimeric antibody NR-LU-13: pharmacokinetics, biodistribution and immunogenicity relative to murine analog NR-LU-10.

A mouse-human chimeric monoclonal antibody (NR-LU-13), with the same pancarcinoma antigen recognition site as a previously studied murine monoclonal antibody (NR-LU-10), was radiolabeled with 186Re using a bifunctional chelate. Nine patients (ages 31-81 yr) with metastatic adenocarcinoma received 186Re NR-LU-13. A single intravenous dose of 42 mg NR-LU-13 labeled with 25 mCi/m2 (two patients) or 60 mCi/m2 (seven patients) was administered. Mean serum disappearance half-time values for the chimeric 186Re NR-LU-10). Fifty percent of the radiolabel was excreted in the urine by 6 days. Tumor localization was demonstrated by gamma camera imaging in seven of nine patients. The percent injected dose per gram in a single tumor biopsy specimen was 0.003% at 72 hr postinjection. Absorbed dose to bone marrow was 1.5 +/- 0.7 rads/mCi and resulted in reversible myelosuppression in five of six evaluable patients who received 60 mCi/m2: median WBC nadir = 2500/microliters; median platelet nadir = 85,500/microliters. Low grade fever, nausea, slight elevations of liver function tests and mild allergic reactions were seen in some patients. The chimeric antibody elicited low levels of anti-NR-LU-13 antibody in six of eight evaluable patients (75%), in contrast to NR-LU-10 which elicited higher levels of human anti-mouse antibody in all patients. This pilot study demonstrates the ability of the chimeric antibody to target tumors with reduced (but not absent) immunogenicity and delayed clearance relative to the murine antibody.

Adenocarcinoma↗