Biomedical subjects

M Furrer

Publications and source records attributed to M Furrer.

At least 19 recordsLinked to original sources

PubMed1995

Severe skiing injuries: a retrospective analysis of 361 patients including mechanism of trauma, severity of injury, and mortality.

All ski accident patients requiring an inhospital treatment at our institute from 1984 to 1992 (n = 2,053) were analyzed retrospectively. The incidence, pattern, and severity of the injuries, as well as the 30-day mortality comparing two time slots (1984 to 1988 and 1989 to 1992) were analyzed for the 361 cases classified as "serious" injuries according to the following definitions and groupings: group 1, multiple trauma (Injury Severity Score > or = 18) and patients with multiple fractures (n = 179; group 2, abdominal or thoracic single trauma (Abbreviated Injury Scale (AIS) score > or = 2, n = 58); and group 3, isolated head injuries (AIS score > or = 2, n = 124). Serious injuries were observed in 19% in the first period compared to 16% in the second period (not significant). Two hundred thirty-eight of 361 patients injured themselves by just falling, while 117 collided with some sort of obstacle like other skiers (45), trees or rocks (27), posts, pylons, barriers (20), and moving objects (25) such as piste machines, ski lifts, automobiles, and in one case a helicopter. Six skiers were caught on the ski run by an avalanche. Comparing the two time periods, trauma circumstances did not change significantly. The number of most severe head injuries (AIS score > or = 4) increased from 11.6 to 19.3% (p < 0.05). The overall mortality increased from 2 to 7% (p < 0.05). Group 2 had the best prognosis with no mortality, while group 3 was rated worst with 8%. Skiing remains a major source of serious trauma in winter resort areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

[Invasive diagnosis of mediastinal space-occupying lesions. On differential indications between cervical mediastinoscopy, parasternal mediastinotomy and video thoracoscopy].

The role of video-thoracoscopy (VT) as an invasive diagnostic procedure for mediastinal lesions not reachable by cervical mediastinoscopy (CM) has still to be defined, particularly with regard to parasternal mediastinotomy (PMT). Diagnostic efficiency and morbidity of the three methods were assessed and compared in a consecutive series over a 18 months-period after determination of a new diagnostic strategy. Among 77 interventions in 73 patients the following distribution of the methods referred was achieved: 42 CM (paratracheal and anterior subcarinal biopsies), 17 PMT (biopsies of anterior mediastinal lesions) and 18 VT (3 paratracheal, 3 posterior subcarinal, 3 anterior, 5 aortico-pulmonary window, 4 posterior biopsies or resections). All procedures were performed in general anesthesia for VT the double-lumen technique was used. Drains could be removed not later than the second postoperative day. In 7/17 cases of PMT the pleural space was opened and drained. Mean operation time (incl. waiting period for intraoperative frozen section and complete resection in a few cases) was 77 (45-100) min for VT, 49 (10-180) min for PMT and 41 (20-105) min for CM. Histological diagnosis of biopsy specimens were conclusive in all VT cases, in 15/17 PMT (88%) and in 37/42 CM (88%). Two major complications occurred: one recurrent nerve palsy following VT-resection of a neurinoma originating from the recurrent nerve itself; in a second patient submitted to mediastinoscopic biopsy, venous bleeding had to be managed by surgical sternotomy. CM as the most approved method for paratracheal and anterior subcarinal biopsies has not lost its importance. PMT as a simple and usually extrapleural intervention can further be advocated for anterior mediastinal lesions. VT turns out to be rather a complementary than a competitive invasive mediastinal diagnostic procedure and is regarded as method of choice for diagnostic approach to posterior, posterior subcarinal and aorticopulmonary lesions.

Adolescent↗

PubMed1994

[Is the "classical" release of the flexor retinaculum in carpal tunnel syndrome obsolete?].

Carpal tunnel release used to be the standard treatment for carpal tunnel syndrome. However, some authors now prefer reconstruction of the transverse carpal ligament, due to suspected palmar dislocation of the median nerve in wrist flexion after simple ligament release. In this retrospective study the topographic location of the median nerve after release is investigated and an attempt made to find a correlation with the postoperative clinical outcome. In computed tomography no palmar subluxation of the nerve was found, even in a patient with a poor clinical result.

Adult↗

PubMed1994

[Video-endoscopic surgical technique in established thoracoscopic interventions].

The video shows six different established thoracoscopic interventions besides the treatment of spontaneous pneumothorax. Adhesiolysis (1) is demonstrated in a patient with malignant pleural effusion, followed by palliative pleurodesis by talkage (2). Resections of benign extra- (3) and intrapulmonary (4) tumors are shown as well as endoscopic pericardial fenestration (5) and thoracic sympathectomy (6).

Humans↗

PubMed1994

[Acute Leriche syndrome in a previously healthy woman: differential diagnosis of embolic occlusion].

The case report describes an acute total ischemia of both legs in a young otherwise healthy woman. Based on the patient's history, the physical findings and further investigations, the differential diagnosis is discussed. The emergency procedure with a successful desobliteration of a strictly localized arteriosclerotic plaque by Fogarty catheter was followed by open thrombendarterectomy 10 days later because of a persistent stenosis. Finally the clinical manifestations of such rare occlusive disease of the aorta are discussed as well as the bilateral ischemic syndrome of the lower extremities originally described by Leriche in 1940.

Adult↗

PubMed1994

[Organization and significance of quality control in recent surgical methods exemplified by 85 consecutive thoracoscopic interventions].

The rapid evolution or rather revolution of minimally invasive surgical techniques is stimulating new technical and clinical innovations. Quality control is of great importance in new areas of technical development where standards do not yet exist. By recording detailed documentation of patient data, indications, operative procedures and initial follow-up we can compare this new technology with the gold standard therapy. This documentation system for thoracoscopic interventions was developed together with the Swiss Group of Laparoscopic and Thoracoscopic Surgeons. This pilot project of 85 consecutive thoracoscopic interventions will demonstrate the acceptability, clinical application and ease with which data can be analyzed. Operative techniques are described in detail: 20 diagnostic interventions with biopsy, 19 apical parietal pleurectomies (+/- resections of bullous lung tissue), 10 therapeutic lung tissue resections, 19 palliative pleurodesis, 5 treatments of pleural empyema, 1 mediastinal tumor resection, 1 esophagectomy, 4 thoracic sympathectomies plus 6 other procedures. Data entry is efficient with mean total time of 10 min for each record. All of the data are entered into a computer database. The possibilities for interpreting and combining this data are presented. The operative techniques can easily be related with history, indications, anesthesia, complications and results. First evaluation of thoracoscopic efficiency is possible. In addition, a detailed analysis of intra- and postoperative complications and of the hospital course can be performed.

Documentation↗

PubMed1994

[Blessings of technology? The severely injured skier--a result of technical equipment on the ski slope].

In a retrospective manner we studied the injury pattern of 2053 patients following a skiing accident that required hospital admission in the year 1984-1992. Of these 361 or 18% were categorised as severely injured according to the AIS/ISS scoring system. 31% of these 361 skiers were injured by colliding at considerable speed with either a moving object (other skier, snow cat, ski-lift, etc) or fixed obstacles (trees, rocks, pilons, etc) along the ski slopes. As the most extensive injuries seem to result from collisions with the latter, fixed obstacles, it should be requested that more protective measures are being taken to prevent such severe accidents.

Adolescent↗

PubMed1994

[Minimally invasive thoracic surgery].

Surgery of the intrathoracic organs may be performed without compromise of respiratory mechanics considering minimally invasive principles. An analysis of our experience of 373 thoracoscopic interventions reveals that the diverse procedures performed on the pleura (pleurectomy, pleurodesis), on the lung (wedge resection, fistula closure, ligature of parenchymatous leaks) and on other definec anatomical structures such as the sympathetic nerve or the thoracic duct, are effective in the therapy of intrathoracic disease. The most important pathological conditions which may be treated by thoracoscopy are listed. The range of complications (7%) and their causes are discussed. Current developments and innovations are summarized by a short review of the literature.

Cause of Death↗

PubMed1994

Three years' experience in video-assisted thoracic surgery (VATS) for spontaneous pneumothorax.

In a prospective study (June 1990 to June 1993), 79 patients were treated for spontaneous pneumothorax by video-assisted thoracoscopic methods with regular follow-up. The observation time was from 3 to 36 months (mean 19.6 months) and was more than 24 months in 27 patients. In 57 patients spontaneous pneumothorax was primary and in 22 secondary. The 53 male and 26 female patients were aged between 17 and 87 years (mean 37 years). Twenty-one patients were treated thoracoscopically for first episode, 22 for persistent pneumothorax (> 7 days), and 36 for a recurrence. Endoscopic examination failed to reveal any lung alteration in four patients (5.1%), and treatment then consisted of simple drainage. Leaks were sealed 26 times by means of a Roeder loop with local anesthesia and 14 times by wedge resection with endotracheal anesthesia and one-lung ventilation; 34 patients were treated by pleurectomy. No deaths occurred. Surgical morbidity was 3.8%, and the postoperative complication rate was 5.1%. One patient was excluded from the follow-up study after conversion to a thoracotomy for control of arterial bleeding. We noted six recurrences; four occurred in the first 21 days and three after ligation of the leak with a Roeder loop. We conclude that video-assisted thoracoscopic treatment of spontaneous pneumothorax by wedge resection and pleurectomy has a recurrence-free rate of 93.8% (45/48) and is therefore an effective treatment for all forms of spontaneous pneumothorax.

Adolescent↗

PubMed1993

Pericardial biopsy and fenestration.

Employing a video thoracoscopic pericardial fenestration constitutes a promising technique for the investigation and treatment of chronic pericardial effusions. It combines the benefit of low invasiveness with the advantages of open biopsy. The procedure simultaneously allows both an accurate diagnosis under visual control (inspection, aspiration, well-targeted biopsy of pathological processes) and the performance of effective therapeutic intervention. Without imposing unacceptable stress, it also facilitates rapid symptom relief in patients with advanced malignant disease whose general condition is severely impaired.

Aged↗

PubMed1993

[Does administration of fibrin glue prevent development of lymphoceles after radical lymphadenectomy?].

Surgical approaches to the groin and axilla, almost radical lymph node dissections (RLND) are followed frequently by lymphocysts. In a prospective randomized study of 30 inguinal or axillary RLND we used at half of the cases 1 ml of the two-component fibrin glue (Tissucol), applied as a spray to seal the wound at the end of the operation. At 27 patients not only a prophylactic RLND but a selective hyperthermic cytostatic perfusion of the extremity was performed because of a locally advanced malignant tumor. There was no difference between the two groups of patients in age, diagnosis, surgical technique, and follow-up. In two cases of the fibrin glue (FG)-group and in 4 cases of the control group a second intervention because of a local wound healing problem had to be performed. The mean amount of postoperative drainage fluid was 1065 +/- 822 ml at the FG-group and 1332 +/- 1093 ml at the control group. Also postoperative drainage time (9 vs. 12 days) and postoperative hospital stay (18 vs. 22 days) were shorter at the FG-group, however, without statistical significance. 11 of 14 patients of the FG-group and 10 of 14 patients of the control group had normal scars after lymphadenectomy without signs of lymphocysts at the clinical follow-up. At our high risk patients (very high amount of postoperative drainage fluid in comparison to other series) prophylactic fibrin glue sealing after RLND could not prevent lymphocysts and lymphatic fistulae.

Adult↗

PubMed1993

[Thoracoscopic treatment of recurrent or persistent spontaneous pneumothorax].

The video shows an endoscopic modification of the established conventional surgical therapy of recurrent or persistent spontaneous pneumothorax: The indications and endoscopic techniques of parietal pleurectomy, ligature of leaking bullae and wedge resection are demonstrated. Our first experience on 50 patients indicates, that minimal postoperative pain and a relatively short hospital stay (mean 3.6 days postop.) are the advantages of minimal invasive techniques also in thoracic surgery. Long-term results are however still lacking.

Humans↗

PubMed1993

[Thoracoscopic interventions].

The technique of minimal invasive surgery has successfully been introduced into the area of thoracic surgery. Surgery of the intrathoracic organs may now be performed without compromise of respiratory mechanics, thus allowing the operative treatment of an ever widening range of pathological conditions. An analysis of our experience (287 thoracoscopic interventions in the last three years) reveals that the diverse procedures performed on the pleura (pleurectomy and pleurodesis), on the lung (wedge resection, fistula closure and ligature of parenchymatous leaks) and on other defined anatomical structures such as the sympathetic nerves or the thoracic duct, are effective in the therapy of intrathoracic disease. The most important pathological conditions which may be treated by thoracoscopy are listed. The range of complications and their causes, which developed in 8% of all procedures, are discussed. The current limitations of this method are defined in the context of the situations where thoracoscopy was discontinued (9 times), a thoracotomy performed (17 times) or a further procedure became necessary (14 times). Current developments and innovations are summarized by a short review of the literature.

Humans↗

PubMed1993

Four-compartment fasciotomy and venous calf-pump function: long-term results.

Twenty-one patients who underwent a four-compartment fasciotomy between January 1, 1986, and December 31, 1987, were revisited with respect to venous calf-pump function 32 to 56 months (mean, 46.2 months) after fasciotomy. Enrollment criteria consisted of an intact motor innervation, palpable pedal pulses, the absence of venous hypertension, and deep venous thrombosis before and during the treatment requiring fasciotomy and unimpaired ankle and knee joint function. None of the patients showed signs of chronic venous hypertension at assessment. Ambulatory strain-gauge plethysmography revealed no significant difference in recovery time and refilling volume values between the two limbs of each patient (p > 0.1) and between limbs in which fasciotomy was performed and those of normal subjects (p > 0.1). Color flow duplex scanning revealed patent popliteal veins with normal respiration-induced phasic flow pattern and absent reflux in all patients. All visible calf veins were patent, compressible, and without morphologic alterations. The fasciotomy wound was closed by delayed skin suture (the fascia remaining divided) in 48% and by skin grafts of the lateral incision in 52% of the patients, without significant difference in recovery time and refilling volume values (p > 0.1) at assessment. Fasciotomy does not lead to venous calf-pump dysfunction, irrespective of whether the wound is closed by delayed suture or skin grafts.

Adolescent↗

PubMed1993

Thoracoscopic pleurectomy for treatment of complicated spontaneous pneumothorax.

This report describes a thoracoscopic approach for performing parietal pleurectomy. We have developed and used this technique successfully in 12 patients for treatment of recurrent spontaneous pneumothorax with extended bullous lung alterations (stage 4 according to the classification of Vanderschueren). For this purpose we need videoendoscopy and specially designed equipment, including pliable silicone trocars and angled instruments. The mean age of the patients was 38 years; no deaths and no complications occurred. The average period of postoperative hospitalization was 3.3 days. During the follow-up period ranging between 5 and 10 months (mean 7.5), no relapsing pneumothorax was observed.

Adult↗

PubMed1993

[Thoracoscopic lobectomy in the animal model].

To evaluate the possibility of a pure thoracoscopic lobectomy by preparation and selective division of hilar structures we performed left cranial lobectomies in 5 Göttingen mini-pigs. The vessels and the main bronchus were isolated and divided by an Endo-GIA stapler. As an alternative technique we used clips or endoscopic ligation. Inside the thoracic cavity the resected lobes were divided into 2 or 3 parts by the Endo-GIA. They could be extracted without destroying the tissue therefore making macroscopic examination possible. The intraoperative blood loss was minimal and all the pigs survived the operation. Two pigs were sacrificed initially, the remaining three one month later. These three showed no evidence of pleural fistula or atelectasis in remaining lung tissue either macroscopically or histologically. It appears that thoracoscopic selective lobectomy is technically possible at least in pig studies. Further studies will show whether thoracoscopic lobectomy in patient with malignancy is as effective as open radical thoracotomy techniques and if endoscopic mediastinal division is possible.

Animals↗

PubMed1992

[Pleurodesis technique in malignant pleural effusion].

Malignancy is the leading cause of exudative pleural effusion in patients over 60. Several techniques for palliative treatment of malignant pleural effusions (MPE) are recommended; in particular, sclerosing agents have been instilled into the pleural cavity. In up to 30%, recurrence of MPE cannot be prevented. In recent years excellent results (recurrence rate less than 10%) have been reported using the technique of thoracoscopic talkage. After a review of the most frequent techniques of pleurodesis, a treatment strategy, mentioning the indications for the thoracoscopic procedure, is presented stressing the following guidelines: after complete thoracocentesis the patient's respiratory symptoms should decrease significantly and the compressed lung must be expanded clinically and radiologically after drainage. For patients fulfilling these conditions thoracoscopic pleurodesis is an effective initial treatment. It seems to be a safe procedure with minor side effects even for patients in a reduced general condition.

Antineoplastic Agents↗

PubMed1992

The surgical treatment of spontaneous pneumothorax by video-thoracoscopy.

Since March 1991, 66 patients with spontaneous pneumothorax were treated thoracoscopically employing the principles of minimally invasive surgery. Of these cases, 14 involved a first occurrence, 18 had a pneumothorax longer than 7 days, and 34 were recurrences; causative lung disease was determined in 25 patients. The blebs and bullae were ligated with chromic catgut Roeder loop or resected with the Endo-GIA stapler. If pathological changes to the lung consistent with Vanderschueren's stage IV were found (n = 36), the treatment was extended to include a parietal pleurectomy. No complications requiring therapy were encountered, the average postoperative hospital stay was 3.2 days. During an average observation period of 10 months (1-27) the recurrence rate was 4.5%. Thoracoscopic therapy proved to be a simple and safe method for all forms of spontaneous pneumothorax.

Adolescent↗