Biomedical subjects

F Harder

Publications and source records attributed to F Harder.

At least 181 records · Page 10Linked to original sources

PubMed1990

[Helicopter emergency medical system in the Basel region].

Between 1986 and 1988, 999 patients were treated on the emergency scene, then transported with the rescue-helicopter in the Basle area. 687 were victims of a trauma (70.5%) and 287 patients were suffering from an acute internal medicine disease. We performed in-field therapy on the accident scene itself in 53.9% of all the cases. According to our scoring system the presence of a physician was absolutely necessary in 56% of all the cases. Air rescue by helicopter allows fast transportation of patients and immediate high quality intensive care. The low mortality rate during treatment before transport (2.6%) and during the transport itself (0.3%) shows that early beginning of medical treatment on the accident scene is connected to better survival chances.

Accidents, Traffic↗

PubMed1990

[Value of extracorporeal piezoelectric lithotripsy in treatment of gallstone disease].

Alternative techniques were introduced in the last 20 years for the treatment of gallstones. Among these the extracorporeal shock wave lithotripsy followed by a systemic litholytic therapy represents undoubtedly the most attractive one. A group of two surgeons and two gastroenterologists has started to evaluate this treatment in April 1988, using a piezoceramic lithotryptic system (Piezolith 2300). From April 1988 to May 1989 we have treated 32 patients who fulfilled the selection criteria-symptomatic gallstone disease, 1-3 radiolucent concrements of less than 30 mm of diameter, functioning gallbladder. We noted only one pancreatitis as a complication of this treatment. The overall stonefree rate is 16% after two months, 32% after four months and 56% after six months, depending on the size and number of stones. A definitive evaluation and final conclusion will only be possible when the rate of late recurrences after this treatment will be known.

Adult↗

PubMed1989

[Pain-free piezoelectric extracorporeal shock wave lithotripsy in gallbladder stones. Initial experiences].

Efficacy and side effects of lithotripsy of gallbladder stones with a piezoelectric lithotriptor are assessed. 16 treatments were performed in 8 patients (1-3 per patient). Patients required no premedication, analgesia, infusion or monitoring. Gallstone fragmentation was achieved with all treatments. Laboratory findings remained unchanged after treatment, with the exception of one patient with mild pancreatitis. With adjuvant oral bile acid treatment, 6 of the 8 patients were stone-free within 3 days to 3 months. Extracorporeal shockwave lithotripsy with piezoelectric shock waves provides painless and efficient gallstone fragmentation. Repeated treatments may speed complete fragment dissolution.

Adult↗

PubMed1989

[Long-term results following fundus plication and vagotomy in reflux disease. Complaints after 10-20 years].

In 109 patients with primary reflux disease in whom combined fundoplication and vagotomy had been performed, the clinical results were evaluated by questionnaire 10-20 years (median 15.7 years) after operation. Indication for additional vagotomy was severe reflux disease and/or increased gastric acid output in 56 (A) and coexistent ulcer disease in 53 (B) patients. Vagotomy was truncular (with pyloroplasty) in 49, selective gastric (with pyloroplasty) in 50, and proximal gastric in 10 patients. Follow-up was available from 64 patients (59.6%). The results were as follows: 17.2% (A 19.4%, B 7.1%) had reflux symptoms, while 9.5% (A 11.4%, B 7.1%) needed medical antireflux therapy. Dysphagia was present in 28.2% (A 13.9%, B 35.7%), and gas-bloat in 54.7% (A 55.5%, B 53.6%). Typical postvagotomy symptoms were diarrhea in 23.5% (A 30.6%, B 14.3%) and dumping in 25.0% (A 22.2%, B 28.6%). Using the Visick classification criteria we found grade I and II in 73.4%, grade III in 17.2% and IV in 9.4%. Symptoms are frequent after fundoplication and vagotomy. The clinical result is more favourable in group B and for the combination of fundoplication with proximal gastric vagotomy.

Deglutition Disorders↗

PubMed1989

[Surgery in para-esophageal hiatal hernia: technic and results].

40 patients with paraesophageal hiatus hernia have undergone surgery over a period 25 years' period. Surgery consisted of gastropexy in 38 patients (ventral corpopexy in 32, fundophrenicopexy in 19), narrowing of the hiatus in 24 and fundoplication in 14. There was one operative death (2.5%). On follow-up 3 to 24 years later (mean 12.5 years) 17 of 20 patients (85%) have good or excellent results. 2 patients without additional antireflux surgery had to be reoperated later because of severe reflux disease (secondary fundoplication). 1 patient with gastropexy and fundoplication has recurrent reflux disease. X-ray studies in 18 patients showed recurrent paraesophageal hiatus hernia in 9 (50%). After operation for paraesophageal hiatus hernia a good clinical long-term result can be expected. To reduce the frequency of recurrent hernia, technical modifications should be considered.

Adult↗

PubMed1989

Conservation therapy for breast cancers other than infiltrating ductal carcinoma.

Pathologic review of 861 Stage I and II breast cancers yielded 152 patients (18%) with histologic types other than invasive ductal carcinoma. All patients had been treated by breast-conserving surgery and radiotherapy, including supplemental radiation to the tumor bed. For 67 patients with predominantly lobular carcinomas, the actuarial overall 5-year survival was 100% and 77% for node-negative and node-positive patients, respectively. The actuarial probability of recurrence in the treated breast (13.5% at 5 years) appeared to be somewhat greater than that observed after treatment of invasive ductal cancers (8.8% at 5 years, P = 0.11). Of 12 mammary recurrences in patients with lobular carcinoma, four occurred at a considerable distance from the original primary and seven were multifocal, involving more than one quadrant in five patients. Of 47 patients with strictly in situ carcinomas, one patient whose axillary nodal status had not been determined subsequently developed distant metastases. Three additional patients developed mammary recurrence, two at the primary tumor site and one in another quadrant. The actuarial 5-year mammary recurrence and overall survival rates were 4% and 98%, respectively. For 27 patients with true medullary cancers, overall survival at 5 years was 90%. One localized mammary recurrence was observed at the site of the original primary. Actuarial mammary recurrence rate was 4% at 5 years. No relapse was observed in ten patients with colloid and one patient with adenoid cystic carcinoma. The authors conclude that, in addition to its well-established efficacy in the treatment of infiltrating ductal carcinomas, the combination of tumor excision and radiotherapy appears to provide adequate local control for other histologic types as well. However, patients with lobular cancer appear to be at somewhat greater risk of mammary failure, and recurrences in such patients tend to be multifocal and multicentric.

Adenocarcinoma, Mucinous↗

PubMed1989

[Palliative biliodigestive anastomosis in non-resectable cancer of the head of the pancreas--with or without preventive gastroenterostomy?].

In 226 patients with malignant obstructive jaundice over a 10-year period (1975-1984) 92 presented with an unresectable carcinoma of the head of the pancreas and were treated with a palliative bilioenteric diversion: in 52 cases alone, in 20 cases with a therapeutic gastroenterostomy because of early duodenal obstruction, and in 20 cases with a simultaneous prophylactic gastroenterostomy. The latter did not increase perioperative morbidity (25% vs. 50% in bilioenteric diversion alone), mortality (5% vs. 19%) nor length of hospital stay (19.9 vs. 20.6 days). Later on patients with a prophylactic gastroenterostomy showed a decreased incidence of chronic vomiting (15% vs. 42%). No secondary gastroenterostomy was performed in this group, vs. 14% (6 patients) in cases with bilioenteric diversion alone (mortality 33%). We recommend the simultaneous prophylactic gastroenterostomy which does not increase morbidity, mortality and length of hospital stay and helps avoiding a risky secondary gastroenterostomy.

Aged↗

PubMed1989

[Initial results with transversalis-plasty in the treatment of inguinal hernia].

Because of our recurrence rate of 7.2% after primary operation for inguinal hernia and 10% after operation for recurrent hernia using a modified Bassini procedure, we adopted a transversalis fascia repair under local anesthesia in November 1985. From November 1985 to December 1987 we performed 455 operations on 424 adults. During the introduction phase of this new technique there were especially initially 65 other procedures (modified Bassini or Cooper's ligament operation). 301 patients could be followed by letter 6 months after the operation. Only patients with pain or suspected recurrence were interviewed. We analyzed the group of patients who underwent a transversalis fascia repair (n = 390). 99% were satisfied with the local anesthesia. The average length of stay in the hospital after repair of a primary inguinal hernia could be shortened (2.8 days). The patients returned to work after an average rehabilitation of 3.1 weeks. We have had few early complications (0.7%). It is still impossible to say if this technique is sure in our hands because of the short and incomplete follow-up. Only the long-term results will show the real value of this operative procedure.

Abdominal Muscles↗

PubMed1989

[Colostomy patients--well cared for, if counseled. Experiences of a colostomy counselling center].

The postoperative care of stoma patients concerns the surgeon, the nurse, the relatives as well as the family doctor. In past years, specialized stomatherapy services became more important, and they represent a real necessity for the patients, according to our own experience. We plead for a broad stoma patient care including stomatherapy services in all cases, either during hospitalization or as an out-patient service after having left hospital.

Adult↗

PubMed1989

[The reactions of patients to mandibular osseointegrated dental prosthesis/implants].

A removable denture as rehabilitation for complete edentulousness is not always sufficient treatment. Some patients cannot achieve acceptable function with this treatment and psychosocial problems sometimes arise. In recent years an alternative treatment has been available for these patients, viz. treatment with overdentures supported by oral implants. An interview has been made with the first 10 patients. The treatment was 3 to 5 ITI-implants in the mandible between the mental foramina. A barconstruction stabilized the implants and barclips were placed in the denture. There was a very positively reaction to the treatment. The patients have an improvement in oral function and retention of the denture. Also the psychosocial sequelae from which some of them previously suffered were reduced or removed.

Attitude to Health↗

PubMed1989

[Blood transfusions and prognosis following curative resection of colorectal cancer: is there an association?].

More recently a number of retrospective analyses in rather ill defined patient populations demonstrated an association between perioperative blood transfusion and recurrence after curative resection of colorectal cancer. In the randomized trial (SAKK 40/81) (adjuvant cytotoxic intraportal infusion versus no further treatment) we evaluated the transfusion status in a well defined, prospectively documented and controlled patient population. Of 457 patients, 353 (77.2%) received either pre-, intra- or postoperatively blood transfusions. After a median follow-up of 4 years, the transfused patients developed significantly more recurrences (38.2%) than patients without blood transfusions (23.1%), the death-rate being 33.7% versus 23.0%, respectively. Patients without transfusion but treated with adjuvant intraportal chemotherapy are strikingly doing better (10.5% recurrences) than patients with perioperative blood transfusion not having an adjuvant treatment (44.5% recurrences).

Blood Transfusion↗

PubMed1989

[Transplantation of kidneys of relatives].

In the last few decades kidney transplants have shown an increasing survival rate of about 85% after one year. The growing demand for transplants is limited by the insufficient availability of kidneys and the living donor represents a possible means of reducing the discrepancy between supply and demand. We report here results of 41 transplantations from related, living donors. The overall transplant survival rate at one year was 91% and at 5 years 71%. In the group treated with cyclosporine the survival rate was 92% at 5 years. The mean serum creatinine levels at the latest follow-up was 115 mumol/l, while the mean blood pressure was 139/82 mmHg. Donor nephrectomy resulted neither in morbidity nor mortality. An extensive follow-up study of 8 donors revealed normal values for both blood pressure and serum creatinine. Careful donor selection is crucial in order to guarantee the voluntary nature of donation and, thus, to avoid the risk of commercialism.

Follow-Up Studies↗

PubMed1989

[Prospective assessment study of 586 consecutive continuous, single layer, extra-mucosal colon anastomoses].

22 Swiss hospitals participated in a multicenter trial testing the acceptance and safety of a continuous single layer end-to-end colonic anastomosis for all mobile segments of the colon, i.e. above the peritoneal reflexion. No cases in elective or emergency surgery have been excluded. During one year other techniques have been totally dropped from the participating centers. Among 545 patients with 586 anastomoses in all centers participating during one full year there were only two clinical leaks. All participating hospitals have after this one year continued to use this technique. Many have expanded it to small bowel and gastric surgery.

Aged↗

PubMed1989

[Preoperative assessment of at-risk patients in traumatology].

In a randomized, prospective double blind trial evaluating antibiotic prophylaxis for internal fixation of proximal femur fractures, the prognostic value of preoperative risk parameters, namely triceps skinfold, upper arm circumference, dynamometry, serum albumin, transferrin, prealbumin, lymphocyte count and serum zinc was analyzed. A population at risk of postoperative infection could be defined with serum albumin value and lymphocyte count: a serum albumin of less than 40 g/l correlated with increased local complications and a lymphocyte count under 1400 microliters coincided with increase in systemic infections. No correlation between perioperative transfusion and postoperative infections was found.

Aged↗

PubMed1989

[Blood transfusion, short perioperative intraportal chemotherapy and recurrence of colorectal cancer].

Carcinomatous tumors usually have a rather slow proliferation rate. However, this process is sensibly accelerated as soon as immunodepressive phenomena occur. Blood transfusions may result in the appearance of a considerable mass of alloantigens and in simultaneous immunomodulation. On the basis of a series of 469 patients, we are able to realize that the intra-and postoperative administration of blood during the curative resection of colorectal cancers produced a poor prognosis. We also followed up subjects who had had chemotherapy via the portal system for one week but no blood transfusion. The prognosis was definitely better in these patients, and proved to be 2 to 3 times as favorable as for patients receiving blood transfusions without chemotherapy. The various results are thoroughly analyzed, the primary aim being the study of the effects of intraoperative portal chemotherapy. This leads to advocating the restriction of blood transfusions, and the use of autotransfusion or hemodilution if required.

Animals↗

PubMed1989

[Therapy and prognosis in 102 liver injuries].

Case histories of 102 patients with liver trauma were analyzed. 88% sustained blunt and 12% penetrating liver injury. 71% of all patients had a polytrauma. The liver injuries were classified in 4 types. With 25 patients primary resuscitation was unsuccessful, in 12 of these cases even though immediate laparotomy and aortic clamping was performed in the emergency room. In 62 of the remaining 77 patients haemostasis was accomplished with minor surgical procedures (lethality 16%), in 13 cases major surgery had to be performed (lethality 62%). Packing was used in one patient only. Prognosis of liver trauma depends mainly on associated injuries and on severity of liver trauma.

Adolescent↗

PubMed1989

[Indications-related and technical errors and their consequences in breast saving treatment].

Conservative treatment becomes an established procedure for small breast cancer worldwide. Randomized and non-randomized studies have shown equal prognostic results compared with the more radical operative treatment. This large-scale therapy only can be worthwhile, if the cosmetic results are better than breast reconstruction after mastectomy. Therefore a rigorous indication, a standardized technical procedure and a well-functioning team of interdisciplinary cooperation is required. Out of 500 conservatively treated patients we controlled a random sample of 134 relative to the cosmetic result. The results were related to our standard technique.

Breast↗

PubMed1989

[Breast saving therapy: diagnostic problems in after care].

From 1.1.1977 through 31.12.1985 two hundred seventy-five patients with stages pTis, pT1-2, pN0-1, cM0 breast cancer were treated by breast-conserving therapy. Six patients (2%) were lost to follow-up. Fifty-four patients developed significant subcutaneous or parenchymal induration in the treated breast. The induration was considered clinically suspicious for recurrence in 30/54 and non-suspicious in 24/54. Of the 30 suspicious indurations mammography was diagnostic or suggestive of recurrence in 12 (40%), and the diagnosis of recurrence could be confirmed microscopically in 16 (53%). Mammography showed no pathologic findings in 14/30 (42%) patients with suspicious indurations, and in 12/30 (40%) the impression of benignity was also confirmed microscopically. In patients whose mammograms were diagnostic or suggestive of tumor, malignancy was demonstrated by pathologic examination in all cases. In 21/24 (87.5%) clinically benign indurations no tumor could be found on microscopic examination. Twenty of these patients had a normal mammogram, and in only 1 of these was a recurrence discovered incidentally during a cosmetic operation. Four of the 24 patients with clinically benign indurations had pathologic mammograms, and in 2 of these the diagnosis of recurrence was established histologically. - The rate of agreement between suspicious clinical and mammographic or microscopic findings was about 50%, whereas the correlation for clinically benign indurations was greater than 80%.

Biopsy, Needle↗