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Biomedical subjects

M Merlini

Publications and source records attributed to M Merlini.

At least 37 records · Page 2Linked to original sources
PubMed1993

High-sensitivity electrophoretic method for the detection of Bence Jones protein and for the study of proteinuria in unconcentrated urines.

The study of proteinuria, and especially the search for Bence Jones proteins (BJP), has almost always required urine concentration. We evaluated a high-sensitivity electrophoretic method using unconcentrated urine based on colloidal gold staining. The sensitivity for the detection of BJP is further enhanced by immunofixation. Sensitivity to BJP is better than 1 mg/L and, apart from the alpha-1 microglobulin, all the proteins relevant to the classification of proteinuria can be visualized with a sensitivity of approximatively 3 mg/L.

Bence Jones Protein↗
PubMed1993

[Pain syndrome in the right iliac fossa and laparoscopy: routine appendectomy or not?].

Diagnostic laparoscopy is useful in the evaluation of patients with lower right quadrant pain when the diagnosis is uncertain. The object of this study was to determine whether a normal appendix should be routinely removed at laparoscopy. We have decided to do this in children, men under the age of 30 and women of childbearing age. However we do not perform appendectomy in men over the age of 30, women over 50 and in immunodeficient patients. This is a working hypothesis and is the basis of an on-going prospective study in our unit.

Abdominal Pain↗
PubMed1993

[Flexible choledochoscopy: two years experience].

This study is a retrospective review of 258 procedures on the gallbladder and bile ducts (115 without and 143 with flexible choledochoscope). There were 14 bile duct explorations for stone removal without choledochoscopy and 16 with a flexible choledochoscope. Residual stones were found in 2/14 (14.2%) cases without and 1/16 (6.3%) case with choledochoscope. A review of the literature confirms that there are fewer residual bile duct stones following flexible choledochoscopy. There were no complications attributable to the procedure.

Cholelithiasis↗
PubMed1993

[Storage of reports in endoscopic surgery].

A computer system, based on multimedia technology allowing informatic storing of endoscopic pictures, written summary of the case and personal oral commentary by the operating surgeon is presented. This system is time-sparing and does not require special training owing to a highly developed interface between the computer and the operator. The system is currently in clinical practice.

Compact Disks↗
PubMed1993

[Simultaneous proximal and distal revascularization for arterial obstruction of the leg at two sites. Indications, techniques and results].

In chronic aortoiliac occlusive disease, 50 to 75% of the patients have further femoropopliteal lesions. The surgical treatment of these multilevel obstructions is sometimes controversial: the distal reconstruction can be performed at the time of the proximal one or deferred to a later date. It can be difficult to determine the hemodynamic importance of an iliac stenosis. Angiography is not a perfect predictor of the iliac segment hemodynamics because as it underestimates the severity of aorto-iliac stenoses when single plane views are taken. Direct measurement of the femoral pressure at angiography disclosing a gradient between brachial and femoral arteries indicates significant iliac stenosis. Intraarterial papaverine administration can also be of importance to determine critical stenoses. Despite proximal reconstruction, distal ischemia can persist if peripheral resistance is high. Distal revascularization can relieve ischemic symptoms, providing an adequate outflow bed. However some patients do not benefit from this two-level procedure because of a steal phenomenon in the intermediate vascular bed.

Aged↗
PubMed1993

[In situ venous grafts. Indications, technique and results. Prospective study of 26 consecutive cases].

The in situ saphenous vein bypass has been introduced in our department since 1989. A total of 26 bypasses in 22 patients have been followed prospectively. Indications for revascularisation have been severe arterial insufficiency in 73% of the cases (stage III or IV). With the exception of one postoperative death (myocardial infarction), all the patients have recovered uneventfully, with a regression to stage I. No amputation has been necessary. Morbidity has been 30%, with mainly minor local complications. The primary patency rate is 83% at one year and 78% after 2 and 3 years, whereas the secondary patency rate is 91% at one year, and remains constant thereafter up to 3 years. Considering our results and those from the literature, we believe that the in situ technique is very valuable, especially for below-knee vascular reconstruction. Technical difficulties of the method are analysed.

Adult↗
PubMed1993

[The 60 hour week in surgery: possible or impossible?].

The number of hours of work per week by doctors is the subject of great controversy in many countries. This has led to restrictive legislation in several states or countries (New York and Great Britain, for example) which is both cumbersome and restrictive. We have polled the Swiss surgeons (both trained and in training) in teaching hospitals on this subject with a questionnaire which also covered some other aspects of training. A majority wishes that the working week be limited (to 60 h/week). However a real limit of 60 h per 7 day week (including call duty) is not reasonable. Furthermore the other problems are considered to be more important by 84% of respondents. Thus the overall opinion is that there are too many surgeons training in a poorly structured system, both on a personal and institutional basis.

Attitude of Health Personnel↗
PubMed1993

[Value of antral mucosectomy, selective proximal vagotomy and a combination of the 2 procedures in serum gastrin production and inhibition of stomach acid. An experimental study].

This experimental study was aimed at determining the volume and acidity produced by the normal stomach, following antral mucosectomy (MA), proximal selective vagotomy (VSP) and combination of both procedures. In 10 mongrel dogs, a double-lumen tube was placed in the stomach under general anesthesia. One of the lumen was rinsed with a constant flow and the other retrieved the gastric secretion. Gastric secretion and acidity were calculated every 10 minutes for 120 minutes. At 60 minutes, pentagastrin was injected. After these controls, a MA was carried out in half the animals and a VSP in the other half. 6 and 12 weeks postoperatively, the same controls were repeated. The dogs were then submitted to the operation of the other group. Following MA and pentagastrin stimulation, the gastric secretion (volume) is not modified with regard to the preoperative levels. On the other hand, after VSP, pentagastrin stimulation induces only a small volume response. The vagus thus seems to be involved in liquid secretion of the stomach. Following MA, pentagastrin stimulation lowers gastric pH at 6 weeks but not at 12 weeks postoperatively. Gastrin is known to have a trophic effect on the oxyntic mucosa. This effect disappears in a few weeks and explains these different figures. Following VSP, gastric acidity decreases and plasmatic gastrin increases. In this situation, pentagastrin directly acts on a trophic mucosa and produces the important lowering of the gastric pH. Finally, after MA, pentagastrin induces an increase in plasmatic gastrin. This effect seems to be mediated by central stimulation of the nuclei of the vagus nerve.

Animals↗
PubMed1992

[Definitive surgery in complicated gastroduodenal ulcers].

Indications for surgical therapy in uncomplicated peptic ulcer disease have decreased considerably since the introduction of H2-receptor blocking drugs and more recently omeprazole. On the other side, the number of acute complications such as perforation or hemorrhage has remained nearly constant. The recent literature seems to indicate that the pattern of patients presenting with complications has changed and that the number of acute ulcers has increased. In a review of 283 patients, we found 150 perforated ulcers (PU) and 133 bleeding ulcers (BU). Almost all the patients with PU and 70% of the patients with BU have been treated operatively. The mortality is 14.3% and 12.5%, respectively. The vast majority of our patients have chronic ulcers, and only 7% have acute or subacute lesions confirmed by histologic examination. Based on our experience and the literature, we propose a therapeutic algorythm for these two conditions.

Aged↗
PubMed1992

[Treatment of vascular lesions associated with open fractures].

Vascular injuries associated with open fractures occur rarely, in about 1% of the cases. Brachial and popliteal arteries are the most exposed vessels in combination with humeral, femoral and tibial fractures. Vascular lesions are first diagnosed clinically: hard signs of arterial trauma (for instance, a pulseless extremity) certainly indicate the injury. Soft signs (for instance, a wound adjacent to a great vessel) only suggest the vascular trauma. Doppler signal allows to distinguish an ischemic extremity from a member still perfused by collaterals. Preoperative arteriography is indicated in patients presenting with soft signs of arterial injury. It is also indicated in patients with hard signs when further information can help the plan of reconstruction. Fracture stabilization is generally carried out before vascular repair. Arteries are prepared in healthy segments and, in most cases, a venous bypass is performed. Veins proximal to the tibial trifurcation are sutured. Specific differences between upper and lower limb in the evaluation and treatment of vascular injuries associated with open fractures are mentioned.

Arteries↗
PubMed1992

[Esophagogastroduodenoscpy by the surgeon].

In 1990, 123 gastroscopies were performed by surgeons in the Department of Surgery, General Hospital, La Chaux-de-Fonds, Switzerland. Seventy-five percent of these procedures were done on a diagnostic basis and twenty-five percent were controls. Endoscopy includes diagnostic, therapeutic and control procedures of numerous surgical diseases. It is thus important for the general surgeon to be committed in the endoscopic management of these pathologies. Furthermore, preoperative gastroscopy can influence or modify the operative technique. By his nearly inborn knowledge of anatomy, tissue consistency and texture, the surgeon has a priceless advantage to learn, practice and teach endoscopy. Therefore, teaching programs in surgical endoscopy should be widely created and developed in university and teaching hospitals to allow young surgeons a systematic and progressive training during their residency.

Duodenal Diseases↗
PubMed1992

[Development of a gastroplasty with variable diameter. Experimental study using artificial sphincters].

The vertical banded gastroplasty is currently the most popular technique in the surgical treatment of morbid obesity. This experimental study was aimed to create a gastroplasty with a variable stoma. The Marlex band was replaced by the cuff of an artificial sphincter to allow selective variation of the diameter of the stoma. The study was carried out on four mongrel dogs. The artificial sphincter was connected to a subcutaneous port. Injection of sterile fluid into the port inflates the cuff and decreases the surface of the stoma. The study was followed up for one year. Under gastroscopic control the system was regularly activated, the diameter and the surface of the stoma was measured and calculated. The sphincter allowed the surface of the stoma to decrease from 103 +/- 2.0 mm2 to 61 +/- 2.1 mm2. There was no significant variation of the surface for each volume unit injected into the system. After one year, the systems and stomachs were harvested and examined. It is possible to create a gastroplasty with a variable stoma. This system works without any technical problem. Microscopic examination of the stoma shows no peri-sphincteric fibrosis.

Animals↗
PubMed1991

[Role of the A2 hospital in general surgery training in Switzerland].

A full training in general surgery is difficult to achieve and involves an important professional commitment. In Switzerland, surgical theoretical and operative knowledge is mainly acquired in University Hospitals (A1 hospitals). A2 hospitals (smaller teaching hospitals) can be the best complement for this training. In these departments, general surgeons have a broad field of activity, including gastrointestinal, chest, vascular, outpatient surgery, conservative treatment and internal fixation of fractures and, sometimes, surgical endoscopy. Operative activity is intense. These departments thus allow privileged teaching positions for surgical residents and chief residents.

Curriculum↗
PubMed1989

Acetaldehyde activation of poly(ADP-ribose)polymerase in hepatocytes of mice treated in vivo.

The activities of poly(ADP-ribose) polymerase and of DNA polymerases alpha and beta and the level of cytochrome P450 were determined in mouse parenchymal liver cells 5 h after treatment with 0.1, 0.3, 1.0, and 3.0 mumole of acetaldehyde. Injection with 1.0 and 3.0 mumole of acetaldehyde induced an increase in poly(ADP-ribose) polymerase activity and in the P450 level, but had no effect on DNA polymerases. The stimulation of poly(ADP-ribose) polymerase activity can be used as an index of induced DNA damage. The possibility of using this experimental approach with other cells derived from mice treated in vivo with different xenobiotics is discussed.

Acetaldehyde↗
PubMed1989

[Iterative surgery in germ cell tumor].

Between 1979 and 1988, iterative surgery was performed on 13 patients for a germ-cell tumor. Apart from orchidectomy, surgery was not the first modality of treatment. On the other hand, 21 surgical procedures were performed for residual tumoral masses after chemotherapy or recurrences. In one third of the cases, only necrosis of fibrosis was resected. Out of 13 patients, 7 died of tumor; 6 are alive (3 with complete remission). Surgery is always indicated in stage IIA to IV nonseminomatous tumors in case of residual tumoral deposits after chemotherapy. For seminoma, surgery is carried out only for retroperitoneal residues larger than 3 cm in diameter. Surgery is also indicated for persistent pulmonary or mediastinal metastases following chemotherapy. Complete surgical excision of residual masses may be technically difficult but is of prime importance as combined chemotherapy and surgery doubles the complete remission rate in comparison to chemotherapy alone.

Combined Modality Therapy↗
PubMed1989

[Epidermoid carcinoma of the esophagus: preliminary results of combined treatment].

In 1986, a prospective study was started in CHUV on the squamous-cell carcinoma of the esophagus treated with a multimodality protocol associating preoperative chemotherapy and surgery. Nineteen patients are currently followed-up. Dysphagia is the main symptom and was found in 16 patients (84%). After chemotherapy, dysphagia disappeared completely in 7 cases (44%), regressed in 7 other cases and worsened in 1 case. Twelve patients were operated on, without operative mortality. Histologically, no tumor was found in one case (5%) after the preoperative treatment. Follow-up is currently too short to draw statistical conclusions. The rationale, advantages and perspectives of the multimodality treatment are presented and compared with different recent series.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[Pancoast's tumor: multi-disciplinary treatment and combined cervico-thoracic approach].

Five patients were treated from May 1987 to April 1988 in CHUV, Lausanne, for a superior sulcus tumor (3 epidermoid, 2 undifferentiated carcinomas). Treatment consisted of preoperative radiotherapy (3000 cGy)-surgery-postoperative radiotherapy (1500-2500 cGy). Two patients died from metastases. Only one patient presented with a local recurrence. Surgical resection was carried out by combined cervical and thoracic exposure. The cervical approach allows separation of the tumor from the subclavian artery, brachial plexus and vertebrae. Then, by thoracotomy, the superior lobe with tumor and thoracic wall is removed. Technical aspects of the procedure are described.

Carcinoma↗