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Biomedical subjects

P Aeberhard

Publications and source records attributed to P Aeberhard.

At least 37 records · Page 2Linked to original sources
PubMed1995

Infrainguinal arterial reconstruction with non-reversed autologous vein after angioscopy guided valvulotomy ex situ.

AIMS: The advantages of in situ autologous vein grafts for long infrainguinal arterial reconstructions are the tapered conduit, minimising size mismatch at proximal and distal anastomoses, and the possibility of using small sized veins with good results. Unfortunately, in about 30% of legs the ipsilateral saphenous vein is inadequate rendering in situ bypass grafting impossible. To profit from a valveless autologous vein graft in these cases we routinely performed ex situ valvulotomy after harvesting the contralateral saphenous vein or good quality segments of the ipsilateral saphenous vein. METHODS: The ex situ valvulotomy was performed under angioscopic guidance using a flushing-type Mill's valvulotome. RESULTS: Fifty non reversed grafts in 46 patients entered a prospective surveillance program. Primary and primary-assisted patency rates at 2 years were 68% and 82% respectively, early graft thrombosis 2%, late stenosis 8% and major amputation rate with a patent graft 6%. No technique related problems were noticed. CONCLUSION: Angioscopy guided valvulotomy was safe and simple and allowed good quality control of the veins. The presented results in this study are comparable to other recently reported series of in situ bypass. The clinical use of small flexible endoscopes allows a safe and atraumatic valvulotomy and simultaneous quality control of autologous vein grafts.

Adult↗
PubMed1995

Angioscopy guided in situ bypass versus angioscopy guided non reversed bypass for infrainguinal arterial reconstructions. A comparison of outcome.

In situ bypass grafting depends on an adequate ipsilateral greater saphenous vein. To profit from a tapered, valveless conduit in legs without an adequate greater saphenous vein, we routinely used the contralateral saphenous vein non reversed. In some reconstructions to the infrageniculate popliteal and the proximal anterior tibial artery we used the non reversed instead of the in situ technique because of the distance between the natural course of the saphenous vein and the recipient artery. This retrospective study compares the outcome of 48 in situ bypasses to the outcome of 66 non reversed bypasses. Endoluminal manipulations in all veins were visually controlled using an angioscope. The two groups of bypasses (in situ versus non reversed) did not differ concerning age, sex, risk factors, operative mortality, indication for surgery and distribution of the recipient arteries. There was a tendency for a lower wound complication rate in "in situ" compared to non reversed bypasses (10% versus 27%; p = 0.086). There were no differences in cumulative primary and primary assisted patency rates between the two groups after two years. We prefer the angioscopy guided in situ technique for reconstructions to infrageniculate arteries because of a low wound complication rate and excellent patency rates. In the absence of an adequate ipsilateral saphenous vein and in reconstructions to recipient arteries not presenting themselves for the in situ technique, similar results can be achieved with angioscopically prepared non reversed grafts.

Angioscopy↗
PubMed1995

[Is the cost of pedal reconstructions justified in potential amputation of the lower extremity].

From May 1990 to April 1994 we performed 24 arterial reconstructions to pedal arteries in 23 patients. There were 12 women (52%) and 11 men (48%) suffering from chronic critical ischemia of the lower extremities. The 30 day-mortality was 9%. 3 early graft thromboses had to be corrected. This was successful in two cases, but failed in one case, making below knee amputation in this patient necessary. Another leg with a patent graft had to have a below-knee amputation due to persistent foot infection. Secondary procedures to correct graft stenoses were performed in 8 legs (33%). All patients entered a prospective surveillance program to study primary (64% at 12 months) and primary assisted patency rates (81% at 24 months). Limb salvage rate was 90% at 24 months. We think that reconstructions to pedal arteries are worthwhile in properly selected patients. Limbs can be salvaged in a high percentage improving quality of live considerably.

Adult↗
PubMed1995

[Imaging of peri-anal and perirectal abscesses and fistulae using endoluminal ultrasound diagnosis].

Endoluminal sonography was performed in 31 patients with suspected perianal or perirectal abscesses or fistulas. Patients with unequivocal clinical findings underwent surgical treatment without preceding sonography. The aim of the sonographical examination was to identify the abscesses, their topographical location, and the internal opening of the fistulas. These results were compared with operative findings. An abscess was diagnosed in 22 patients and could be confirmed by surgery in 21. In one patient a hypoechogenic scar resulting from previous surgery was erroneously interpreted as an intersphincteric abscess. The remaining 9 patients suffered from a fistula without abscess. In all 21 abscesses the sonographic examination showed the correct topographical location. There were 5 perianal, 8 intersphincteric and 8 ischiorectal abscesses. The operation demonstrated the internal opening of the fistula in 17 of 35 cases. Only 9 of these 17 openings (53%) had been identified by preoperative ultrasonography. The endoluminal sonography is a good method to find a perianal or perirectal abscess and to show the topographical location. It should be performed in all cases with an obscure preoperative clinical situation.

Abscess↗
PubMed1994

[Symptomatic enterothorax in right-sided dorsal rupture of the diaphragm].

Traumatic avulsion of the right diaphragm from the lumbocostal arch is a very rare lesion. The authours report the case of a 27-year-old man who had suffered a severe polytrauma with blunt thoracic injury, fracture of the lumbar spine, Malgaigne-type fracture of the pelvis and fracture of the femoral shaft on the right side, 10 years before. At the time of injury the lesion of the diaphragm went unnoticed. The diagnosis was made 10 years later when the patient was referred for chronic right thoracic pain combined with postprandial abdominal distension and crampy pain in the abdomen. The chest radiogram and CT-scan showed displacement of the right kidney and most of the right colon into the thorax due to avulsion of the diaphragm from its dorsal insertion on the lumbocostal arch. Surgical repair was necessary to obtain relief from pain and to prevent intestinal obstruction. Reduction of the hernia, reinsertion of the diaphragm to the lumbocostal arch and reinforcement of the repair with a prolene mesh prosthesis was performed through a right thoracophrenolumbotomy incision.

Adult↗
PubMed1994

[Endo-anal and endorectal ultrasound of inflammatory diseases].

We performed endoluminal sonography in 23 patients with suspected inflammatory perianal or perirectal disease. In 11 patients with known fistulous disease we searched for an abscess cavity or attempted to demonstrate the track of the fistula. 8 patients were examined for perianal pain of unknown origin. In 1 patient we used the rectal sonography to define the size and precise location of an abscess. Another patient was examined for a submucous rectal tumor. Twice we used sonography for postoperative follow-up, once after incision of a dorsal horseshoe abscess and once after lateral sphincterotomy. In 19 of 23 patients (82%) with perianal inflammatory disease, endorectal sonography was either diagnostic or provided useful additional informations.

Abscess↗
PubMed1994

[Cost saving after-care in infra-inguinal vascular reconstruction].

To assess the indications for routine colour flow duplex surveillance, 43 infrainguinal autogenous vein grafts were prospectively entered into a surveillance protocol. Screening consisted of measurements of ankle brachial indices (ABI) and colour flow duplex imaging of the entire graft length. All grafts at risk had a serial fall in resting ABI of more than 0.1. This study suggests that resting ABI measurements are a very sensitive and non-expensive primary screening procedure, provided that all grafts with ABI changes of more than 0.1 are further evaluated. About 60% of ABI-screened grafts needed further evaluation because of ABI changes of greater than 0.1, incompressibility of arteries or extension of the graft to the ankle or pedal arteries. Colour flow duplex scanning was very useful in excluding of identifying and localising graft problems and deciding on further invasive diagnostic and therapeutic procedures.

Aftercare↗
PubMed1994

[Intramural duodenal hematoma after blunt abdominal injury in childhood. Case report].

Gastrointestinal injuries after blunt abdominal trauma in childhood are seldom. In 30% of the patients, the site of injury is the duodenum. In 60% associated injuries including other abdominal or extraabdominal lesions are found. Most frequently duodenal damage consists in parietal haematoma, seldom in duodenal laceration. Duodenal haematoma can be resolved non-operatively in 50%. Operation is recommended for children in whom there is no evidence of partial resolution of the obstruction after 10-14 days or in cases with development of a parietal laceration with peritonitis and/or retroperitonitis. For diagnostic computed tomography is the examination of choice.

Child, Preschool↗
PubMed1994

[Status of portal perfusion in colorectal cancer. Swiss Study Group for Clinical Cancer Research].

533 patients with diagnosis of operable colorectal carcinoma were randomized to receive either a single course of portal infusion with Mitomycin-C (MMC) and 5-Fluorouracil (5-FU) starting immediately after operation, or no adjuvant treatment. Of these, 505 (94%) were evaluable. Over the median follow-up of 8 years, the adjuvant therapy reduced the risk of recurrence by 22% (Hazard ratio = 0.78%, 95% CI 0.61-0.99; P = 0.045). The relative reduction of relapse on death was similar in all subgroups (i.e. nodal status, localization). However, adjuvant portal chemotherapy proved to be most efficient in the subgroups of patients with tumor involvement of the regional lymph nodes (Dukes C) and of patients with colon cancer. Analysis of the pattern of relapse showed that most of the difference in overall and disease-free survival is to be attributed to a consistent reduction of all kinds of tumor recurrences (i.e. local relapses, liver metastases and/or other distant metastases) in the treated group, rather than to liver relapses alone. We conclude therefore, that part of significant benefit obtained for patients with operable colorectal carcinoma treated with a single course of adjuvant chemotherapy via the portal vein might be due to the additional systemic effects of the portal chemotherapy and further study of perioperative treatment with and without prolonged chemotherapy appears worthwhile.

Adenocarcinoma↗
PubMed1993

[Villous adenoma of Vater's papilla. Problems in diagnosis and therapy].

Adenomas of the ampulla of Vater are rare tumors which cause the same diagnostic problems as adenomas of the colon and rectum. From 1984 to 1991 we treated 5 patients with adenomas of the ampulla of Vater verified by endoscopy and biopsy. All 5 patients underwent transduodenal papillectomy and reimplantation of the common bile duct and pancreatic duct with intraoperative frozen section examination of the specimen. In 2 out of the 5 cases, the definitive diagnosis was invasive carcinoma undetected by frozen section examination. Both patients subsequently underwent partial duodenopancreatectomy with preservation of the pylorus. In one of our patients villous adenoma was detected six years after the insertion of a biliary endoprosthesis for alveolar echinococcus infiltrating the bifurcation of the hepatic ducts, a finding which raises the question as to an etiologic role of long-time biliary duct stenting. We discuss the diagnostic problems of the adenoma-carcinoma sequence and the therapeutic options.

Adenocarcinoma↗
PubMed1993

Pattern of recurrence in rectal carcinoma: implications for the design of (future) studies on adjuvant therapy.

255 patients who underwent potentially curative surgical treatment for rectal carcinoma at the Cantonal Hospital Aarau from 1981 to 1989 have been followed up and the results analysed for overall survival and the timing and occurrence of local and distant recurrence in relation to the initial tumor stage. The patients had received standard surgical treatment for rectal carcinoma with the exception of 28 patients who had been randomized to the treatment arm of SAKK protocol 40/81 and were given perioperative adjuvant portal chemotherapy. 10 patients with large fixed tumors had preoperative radiation therapy. In UICC stage I most patients were cured by surgery alone, local recurrence as rare, and distant metastases appear in about 10% of pT2. cases. In stage II about one fifth of the patients developed a recurrence with one third of them having only local recurrence, and two thirds having either combined local and distant recurrence or distant recurrence alone. The small subgroup of pT4 pN0 had a very poor prognosis with early occurrence of distant metastases. In stage III the actuarial five-year survival was 25%, 60% of stage III cases had pN1 nodal disease. No patient with pN2-3 disease was alive after five years follow-up. The overall risk of distant metastases in stage III was 64%. Local recurrence rate was highly dependent on the pT-stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1993

[Giant cell tumor--an unusual cause of pathologic fracture of the femoral neck].

The uncommon giant cell tumors of bone are generally benign but locally aggressive with tendency for local recurrence. They are located in the epimetaphysis of the long bones, predominantly in the distal femur, proximal tibia and distal radius; the location in the proximal femur is very rare. Because of their location and the high local recurrence, therapy, mainly of the rare pathological fractures, is difficult and controversial. We are presenting a well documented case with joint salvage and good outcome.

Adult↗
PubMed1993

Behaviour of surgically corrected infrainguinal vein grafts.

During a period of 4 years (1988-1992) we detected in a series of 114 infrainguinal vein grafts 22 bypasses (19%) with 26 hemodynamically significant (> 50%) stenoses. The secondary cumulative patency rate of 114 bypasses was 92% at 12, 84% at 24 and 84% at 36 months. Twenty-three secondary surgical procedures consisting of vein patch angioplasty (n = 10), interposition grafting (n = 3) or jump- or sequential grafting (n = 10) were performed to correct stenoses. One graft correction was technically not feasible, resulting in graft occlusion. Two patients refused surgery. All corrected grafts were prospectively studied both by ankle brachial measurements and color flow Duplex scanning every 3 to 6 months. Cumulative graft patency after reintervention in 20 grafts was 95% at 12 months and 95% at 24 months. Mild stenosis (< 50%) of revision sites was observed in 2 grafts. No single stenosis remote of revision site developed during follow-up (mean 20.4 months), confirming the opinion that stenosed vein grafts after correction do not demonstrate a higher incidence to develop strictures than normal grafts. No tertiary procedures were necessary, as all categories of secondary procedures normalized graft and limb hemodynamics. This series demonstrates that excellent long term results after surgically corrected high grade graft lesions justify an aggressive approach to these stenoses.

Aged↗
PubMed1993

[Multi-organ procurement from the perspective of a hospital not involved in transplantation. Requirements, implementation, problems].

Our algorithm is an example in which way the multiple organ donation can be organised in a hospital, which doesn't perform transplantations. We are showing problems which occur during the evaluation of the donor and till the explantation can be performed. In the conclusion we are demanding for better coordination and better support from the transplantation centers.

Hospital Shared Services↗
PubMed1993

[Treatment of recurrent inguinal hernia by implantation of a pre-peritoneal prosthesis. Results of a prospective study].

44 patients with 47 recurrent inguinal hernias entered a prospective study. All patients were operatively managed by a standardized technique using a polypropylene (Prolene) mesh inserted through a pre-peritoneal approach. Operating in the pre-peritoneal space avoids dissection of the scared cord and the "inlay" prosthetic mesh safely creates a new "fascia transversalis" with a low rate of recurrences. All patients were personally controlled every 6 months with a follow-up time of 12 to 60 months (mean 20.2 months). The low postoperative morbidity included only one seroma, no infection and no testicular complications. We observed one recurrence occurring 6 months after surgery (2%). The described operative technique using an inlay patch is recommended as the therapy of choice in all recurrent groin hernias.

Adult↗
PubMed1992

[Did management of breast carcinoma progress in the 80s?].

During the last decade there have been important changes in diagnosis and therapy of breast cancer. Breast conserving surgery in patients with small tumors combined with radiation therapy has gained wide popularity due to better cosmetic results without significant changes in survival. Results in breast cancer treatment have been markedly ameliorated by early diagnosis and treatment. It is hoped that this will be accomplished by routine mammographic screening in asymptomatic women. In this retrospective study data of 398 breast cancers are analyzed. All patients underwent surgery between 1981 and 1988. To demonstrate changes in the stage at the time of diagnosis during the last decade, the material has been divided in two groups: group 1 represents the tumors diagnosed in 1981/82, and group 2 those diagnosed in 1987/88. Comparison of these two groups did not show any significant changes in cancer stage at operation during the last ten years. Screening programs are planned and have to be supported in order to ameliorate the results of breast cancer treatment. Intensive public information is necessary to motivate medical personnel and women for early breast cancer detection by mammography.

Breast Neoplasms↗
PubMed1992

The role of colour flow duplex screening in infra-inguinal vein grafts.

To assess the indications for routine colour flow duplex surveillance, 43 infra-inguinal autogenous vein grafts were prospectively entered into a surveillance protocol. Screening consisted of measurements of ankle brachial indices (ABIs) and colour flow duplex imaging of the entire graft length. Twelve significant stenoses have been detected in 10 grafts (23%) using duplex, all within 6 months of surgery. All grafts at risk had arteriography confirming the duplex findings, but detecting one additional stenosis. Two grafts at risk were not detected by duplex scanning (sensitivity 83%). All grafts at risk (12) had a serial fall in resting ABI of more than 0.1. Most of the detected graft stenoses could be corrected surgically, improving the 1 year primary cumulative patency rate of 54% to a secondary patency rate of 88%. This study suggests that resting ABI measurements are a very sensitive (sensitivity: 100%) and simple primary screening procedure, provided that all grafts with ABI changes of more than 0.1 are further evaluated. The interval specificities of ABI measurements were 77% at 3, 71% at 6, 67% at 12 and 78% at 18 months (mean 73%). About 60% of ABI-screened grafts needed further evaluation because of ABI changes of greater than 0.1, incompressibility of arteries (ABI greater than 1.3) or extension of the graft to the ankle or pedal arteries. Colour flow duplex scanning was very useful in excluding or identifying and localising graft problems and deciding on further invasive diagnostic and therapeutic procedures. Ankle brachial index measurements as the primary examination for selecting patients for colour flow duplex scanning seems to be a safe screening procedure.

Adult↗