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Biomedical subjects

M Furrer

Publications and source records attributed to M Furrer.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1992

[Case report: endoscopic resection of a 5 cm intrathoracic lipoma].

Technical possibilities of operative thoracoscopy are demonstrated on the occasion of the presentation of an endoscopic resection of a benign intrathoracic tumour. Thoracic video-endoscopy is definitely a useful constituent of the treatment of defined pleural or pulmonary processes, since it can be used in addition to biopsy (which serves to assure the correct diagnosis) without rendering the diagnostic procedure more complicated to any significant extent.

Female↗
PubMed1992

[Surgical thoracoscopy--indications and technique. Early results in spontaneous pneumothorax].

The use of minimally invasive techniques in the thoracic cavity allows for the application of operative techniques through endoscopic ways, avoiding the functional burdening of a thoracotomy. Indications of operative thoracoscopy are mentioned. Endoscopic surgical techniques are described. For example, the therapy of spontaneous pneumothorax can be carried out in its entirety by endoscopic leak ligature, wedge resection of the lung and parietal pleurectomy. Three of the 49 patients with spontaneous pneumothorax suffered from an early recurrence after thoracoscopic treatment (6.1%). Long-term results are still outstanding. The final merit of the method cannot yet be set.

Algorithms↗
PubMed1991

Management of displaced supracondylar fractures of the humerus in children.

A series of 33 children with displaced supracondylar fractures of the humerus (SFH) were all treated operatively by open reduction and internal fixation or by closed reduction and percutaneous pinning. A follow-up study was performed on average 29 months (range 3-63 months) after the injury. In 18 per cent of cases primary neurovascular injury was observed and confirmed at operation. Of these patients 32 had open reduction and internal fixation by K-wires; in only one case was closed reduction and percutaneous pinning attempted. If there was preoperative neurological deficit, the nerves were visualized; however nerve suture was not required in our series. In one case we had to reconstruct both the brachial and radial arteries because of intimal lesions totally occluding the vessels. The average hospital stay was 9 days, including pin removal, which was usually performed about 4-5 weeks later, at the time of plaster removal. By Innocenti's criteria, 27 of 30 patients reviewed had an excellent result; three had a good result and three patients were lost to follow-up. There were no complications due to the operation, such as wound healing problems, infections or nerve lesions. In the light of our experience and of the good results, we recommend that displaced SFH be managed by open reduction and internal K-wire fixation. Percutaneous pinning is a good alternative method when closed reduction is successful at the first attempt.

Bone Nails↗
PubMed1991

Five years' follow-up of severely injured ICU patients.

We conducted a 5-year follow-up study of a group of 461 consecutive trauma patients treated in our Intensive Care Unit from 1980 to 1983. The entry criteria (initial survival and severe injury: ISS greater than or equal to 18) were fulfilled by 233 patients with a mean ISS of 29.3 and mean age of 35.6 years. Data on prehospital care, type and timing of surgery, and hospital and ICU stay were recorded during hospital discharge. The protocol strictly asked for a personal interview and a physical examination. Mailed questionnaires or phone interviews were not allowed. The areas of medical sequelae, aftercare, missed injuries, occupation, insurance, social integration, economics, legal aspects, and traffic involvement were covered. We were able to gather final information from 223 (95.6%) of the 233 cases. Forty-three patients (18.4%) died in the hospital, 13 patients (5.6%) died later, and 167 (76.5%) were eventually seen. Only 10 patients (4.4%) were lost to follow-up. Outcome was judged using the Glasgow Outcome Scale (GOS), which was compared with a GOS value given prospectively at the time of hospital discharge. Eighty-nine percent of the survivors were healthy or slightly disabled (GOS 5 and 4), 9% were severely disabled, and only 2% were in a persistent vegetative state. Outcome after 5 years was better than tentatively prognosed at the time of hospital discharge. Ninety-one patients with severe head injuries (AIS 4-5) were additionally tested using the Mini Mental State instrument. This test revealed normal mental functions in 77% and dementia, mostly of a minor degree, in 23% of the head-injured patients. Almost all the early deaths and two thirds of the late deaths were related to severe head injury. Seventy-nine percent of the survivors were working after 5 years. During the post-trauma period, patients experienced reduced social well-being and also changed professional and recreational activities. There appears to be extensive room for improvement in the posthospital recovery phase. We conclude that survivors of critical trauma have a very good chance, after 5 years, of regaining a high quality of life. All efforts at improving trauma survival and quality of trauma care are therefore worthwhile and deserve high priority.

Adolescent↗
PubMed1991

[Interlocking intramedullary nailing of the femur: is the advantage of early mobilization gained by risking a malposition?].

We report a follow-up of 57 consecutive femoral fractures treated by internal fixation with the AO Universal Interlocking Nall. All fractures (91% follow-up) had healed within a mean of 22 months (range 9-50) after operation. Full weight-bearing was possible after an average of 9 weeks (range 2-20). The only infection occurred after a secondary open lengthening osteotomy. In 5 cases a rotational malposition or length discrepancy had to be corrected shortly after initial surgery. Rotational malposition in excess of 10 degrees occurred in 26% of cases (mostly external rotation) and length discrepancy exceeding 1 cm in 13% (mostly shortening). The frequency of malposition is explained by the absence of rotational or length control during operation. We recommend that malposition be correlated without delay by reoperation.

Adolescent↗
PubMed1989

[The treatment of dislocated supracondylar humerus fractures in childhood].

33 children with displaced SFH were all treated operatively by open reduction and internal fixation or closed reduction and percutaneous pinning. A follow-up study was performed on average 29 (range 3-63) months after the injury. In 18% of the cases an initial injury of the neurovascular structures was observed and documented during the operation. 32 times open reduction and internal fixation by K-wires was performed, only once, closed reduction and percutaneous pinning was attempted. In the presence of a preoperative neurologic deficit, the nerves were always visualised, never, however, a nerve suture was necessary. In one case we had to reconstruct both the arteria brachialis and radialis because of intima lesions with total obstruction of the vessels. The average time of hospitalization was 9 days, which includes the time for removal of the pins, which was usually performed about 4,5 weeks later simultaneously with the removal of plaster. Using Innocenti's criteria, 27 of 30 reviewed patients had an excellent result, 3 had a good result. Early complications due to the operation such as wound healing problems, infection or nerve lesions did not occur. 3 patients could not be reached any more. We recommend for the management of the displaced SFH open reduction and internal fixation by K-wires as the method of choice. Percutaneous pinning is a valid alternative when closed reduction succeeds easily at the first attempt.

Child↗
PubMed1989

[Endomyocardial biopsy following heart transplantation: results and complications].

Heart transplantation (HTPL) has worldwide become a well established therapy of terminal heart failure. Besides non-invasive parameters the endomyocardial biopsy (EMB) is proved to be the goldstandard method for early detection of graft rejection. At the University Hospital of Zurich 31 HTPL have been performed between September 1985 and December 1987. 100 out of 460 EMB's showed moderate or severe rejection and needed additional immunosuppressive treatment. 1.5% of all EMB's caused further treatment due to local or systemic complications.

Biopsy↗
PubMed1988

[Indications and contra-indications for heart transplantation].

Indication and contraindications for selection of patients for cardiac transplantation are given on the basis of 2 years' experience in evaluating a total of 65 patients, 30 of whom received heart transplant. Heart transplant must be considered in patients with: 1. Severe heart failure without response to maximal medical treatment. 2. End stage coronary artery disease where clinical heart surgery is no longer feasible. 3. Intractable malignant arrhythmia associated with pump failure. Heart transplant is contraindicated in: 1. Patients with extracardiac polymorbidity. 2. Cardiac low output with renal and hepatic impairment. 3. Compliance failure. 4. Increased pulmonary artery resistance. 5. Age over 60 years.

Adult↗
PubMed1988

[Treatment and follow-up care after heart transplantation].

Today survival rates after heart transplantation of around 80% at 1 year and around 65% at 5 years are realistic. Most patients attain NYHA functional class I. Due to progress in donor and recipient selection, in immunotherapy, and in a systematic follow-up program post transplant, heart transplantation today has become an accepted treatment in special forms of terminal heart disease. Between September 23, 1985, and May 15, 1987, 19 patients were transplanted in Zurich. After an average of 7 months (1-20), 18 patients are alive with NYHA functional class I. The follow-up program checks systematically for the three main problems post transplant (rejection, infection, and drug-induced side-effects). Regular endomyocardial biopsy is the gold standard for diagnosis of rejection. Non-invasive methods, such as cyto-immunological monitoring, neopterin, or beta 2-microglobulin, are not a substitute but valuable adjunctive diagnostic methods.

Adult↗
PubMed1978

[Urethro-cystometry: a comparison between open-end catheters with flow and microtransducer catheters (author's transl)].

In 40 women a comparative urethrocystometric study between microtransducer catheters and open-end catheters was performed. Analysis of resting and cough urethrapressure profile concerned clinical and practical value as well as reproducibility. All of these aspects can better be achieved by microtransducer catheters compared to the open-end catheter system. Best results were obtained when measuring with microtransducers in standing position.

Female↗
PubMed1978

[The diagnosis of urinary incontinence in gynaecology. Indications for urodynamic diagnosis and description of urodynamic diagnostic apparatus (author's transl)].

Our experience with comparative measurements using various methods of diagnosis of urinary incontinence resulted in the development of a urodynamic measurement station within the department. This station is equiped for urethrocystotonometry with microtransducers for urethrocystograms and for lateral urethrocystograms. The technological details of the apparatus are described. The greatest diagnostic value give measurements in the standing patient. The methods of measurement, the interpretation of the results and the pre-operative records of urethral pressure profiles are described. The urethrocystotonometry is especially valuable for functional diagnosis. For the morphologic evaluation and especially in view of the choice of the operative procedure a modified method of the lateral urethrocystogram is used.

Female↗