Search PubMed⌕ Search

Biomedical subjects

P Buchmann

Publications and source records attributed to P Buchmann.

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

[Technique of intraoperative laparoscopic cholangiography].

Since laparoscopic cholecystectomy has been established at our institution, the routine use of intraoperative cholangiography was abandoned but preoperative intravenous cholangiography and sonography are mandatory. However, these investigations are not always conclusive and in some cases not applicable. We have therefore started to use selective intraoperative laparoscopic cholangiography for laparoscopic cholecystectomy. Our technique and the materials required for this peroperative investigation are described in the present article.

Cholangiography↗
PubMed1992

[Abscesses and pseudocysts as a sequela of acute pancreatitis].

During studying the literature a big confusion around the item abscess can be recognized. Especially in the English publications it is used for sterile tissue necrosis, infected necrosis, infected pseudocyst or suppuration. Pancreas phlegmon means there a sterile mass of pancreas and peripancreatic oedema. With us an abscess still is a located plus collection surrounded by a more or less tight capsule and a phlegmon is a diffuse purulent infection in the tissue. This definition is important because the frequency and prognosis of a true abscess is far below an infected necrosis (with us 4 abscess in 48 necrotising pancreatitis but 54% infected necrosis). Abscess formation needs two to four weeks whereas pseudocyst develops rather fast in one to two weeks. Although spontaneous resorption of pseudocyst is possible, we recognized ten and operated on all of them either by internal drainage or by resection of the tail of the pancreas. Mortality of one series of 124 patients with acute pancreatitis was at 30 days 4% and 27%, respectively, when necrosis was present and overall mortality having treated all patients to final discharge was 5% and 44%, respectively. Mortality rate was constant in the last years but Ranson score was continuously increasing.

Abscess↗
PubMed1992

[Initial experiences with the bio-fragmentable Valtrac anastomosis ring].

The biofragmentable ring (Valtrac) to perform a sutureless bowel anastomosis was used in a short period until complications rate became to big. There were six ileo-colostomies with the 28 mm ring and 7 colo-colostomies with the 31 mm ring. In 4 patients additional sutures were placed because the ring was shining through the tissue. Thirteen patients (4 women, 9 men) with a mean age of 63 years (36-78) were included. Complications occurred in 3 men (71, 36 and 63 years old). Two of them had an additional suturing. One demonstrated insufficiency at day four with many small gabs in the anastomotic line according to the ring design. Histology demonstrated perfect microcirculation. The second patient developed a fistula three weeks after operation. Both had an ileo-colostomy. The third operated because of a gastrocolic fistula with cachexia reentered hospital seven weeks postoperatively with a new gastrocolic fistula on X-ray. He died with a cardiac arrest. Postmortem was refused. We conclude from our results that the Valtrac ring should be used only by experienced surgeons, there is no reduction in operation time, and ileo-colostomy needs special care. We believe that surgeons using an extramucosal monofilament running suture for colonic anastomosis are more unlikely to switch to the Valtrac ring than those using other technics.

Adult↗
PubMed1991

Improved perineal wound healing with the omental pedicle graft after rectal excision.

The aim of this study was to determine whether significant improvement in perineal wound healing could be achieved by placing parts of greater omentum into the sacral cavity after rectal excision. 74 patients were evaluated, in 38, parts of the greater omentum were mobilised into the presacral cavity. The omentum flap increased primary healing from 41% to 61%. Sinus formation was reduced. Since using routine omentoplasty all wounds have healed by five months. Complications occurred only twice. In one patient the omentum became partially necrotic, while in another small bowel obstruction occurred due to herniation beneath the root of the flap. We conclude from our results that omentoplasty after rectal excision is a useful method to improve perineal wound healing and should be performed as routine procedure.

Adenocarcinoma↗
PubMed1991

[Uni- and ipsilateral pulmonary edema after surgery on the lung].

Unilateral pulmonary edema can develop after evacuation of pleural liquid and pneumothorax, after pneumonectomy at the contralateral side and as a special form in left ventricular failure. Unilateral ipsilateral pulmonary edema in the remaining parenchyma after operations of the lung has been described very rarely. Eight patients are here described, once after a decortication and seven times after a pulmonary resection. Radiologic signs occurred generally 12-24 h after the operation and persisted for three to seven days. The first postoperative X-ray was always more or less normal. We believe that the cause of the edema is a mechanical traumatisation of the remaining parenchyma of the lung at the time of the operation which results to a capillary leak. Left ventricular failure and excessive fluid application after the operation can be a risk factor. Generally no clinical signs are present during the edema, but respiratory insufficiency, as with patient 8 can occur. Therefore it is important to distinguish unilateral pulmonary edema from other diagnosis like pneumonitis, hemothorax and atelectasis.

Aged↗
PubMed1991

Risk factors in abdominal surgery.

The term risk is understood to be the danger of the occurrence of an undesired, life-threatening event. The probability of this undesired event is greater in the presence of a risk factor than in its absence. In general surgery, these risk factors can be classified into five groups: The environment, the surgeon, the operation per se, the disease, and the patient himself. Abdominal surgery is especially suited to clarify and to illustrate this classification. Some typical risk factors are described, and for each group the measures for risk prevention or risk reduction are discussed.

Abdomen↗
PubMed1991

Peritoneal adhesions after laparotomy: prophylactic measures.

Abdominal adhesions are due to a locally decreased peritoneal fibrinolytic capacity occurring mainly in ischemic areas of the peritoneum. They help to guarantee the supply of blood to these areas, acting as a protective mechanism ("vascular graft"). With respect to abdominal surgery a general suppression of the ability to form adhesions would therefore seem to be questionable. We consider the currently employed or discussed methods with their advantages and disadvantages. No optimal solution to the problem of adhesions has been found so far. Nevertheless, appropriate surgical technique can permit us to control adhesion formation to a certain degree. If adhesions are unavoidable, placement of the greater omentum should be done carefully in the areas of risk.

Humans↗
PubMed1991

[Anal condylomata acuminata. A prospective comparison of HIV positive and negative patients].

Between July 1986 and May 1987 23 patients suffering from anal condylomata acuminata were treated at the University Hospital of Zurich. The influence of HIV-infection on the disease is described. An almost equal frequency of recurrencies between positives and negatives was observed in a three year follow-up time. However, in positive patients recurrence was earlier and much more extensive. A two-stage procedure which sometimes is advocated in very extensive lesions gave very bad results in HIV positives. We use a radical excision by electrocoagulation on the mucosa and perianally and avoid circular necrosis in the lower anal canal only. Infectious complications are not to be feared except in patients with symptomatic HIV-infection resulting in the recommendation for a antibiotic prophylaxis in such cases.

Anal Canal↗
PubMed1990

[Short- and long-term treatment results in perianal dermatitis using proctalgen: a controlled prospective study].

In a controlled study the short and long-term therapeutic efficiency and compatibility of Proctalgen was tested in the therapy of perianal dermatitis. The study includes 30 patients of whom 23 had previously been treated with other remedies. After a treatment period of 21 days, 18 patients (60%) were cured. 11 of the 18 cured patients were interviewed three years later and seven of them (64%) were still without any symptoms. None of the patients showed irritations of the rectal mucosa. Proctalgen has proved its short and long-term therapeutic efficiency especially in the treatment of patients with a short history and with no previous therapy and shows a good compatibility. Therefore Proctalgen is an excellent attribute to the therapeutics of perianal dermatitis especially because it is free of corticosteroids and anaesthetics.

Adult↗
PubMed1990

[Comparison of current proctological diagnostic studies].

The proctological investigation is explained, and the importance of the digital examination is stressed. Modern techniques do not alter the traditional examination but give more information on specific questions. Endosonography, computed tomography and magnetic resonance imaging help a great deal in tumor investigation. Endosonography is especially helpful in the definition of tumor extension, judgement of the anastomosis and rectal wall and lymph node involvement. Computer tomography permits to detect infiltration in the bone, and magnetic resonance imaging a precise tumor extension because of the multiplanar image. The distinction between recurrent tumor and postoperative fibrosis is possible by the latter and endosonography.

Anus Diseases↗
PubMed1990

[Bleeding and pain following anal surgery].

Bleeding and pain are frequent complications, following proctological procedures. Their intensity however, can be influenced by the therapist. Through careful hemostasis and wound closure the risk of bleeding is greatly reduced so that most procedures can be done on an outpatient basis. The intensity of pain experienced by the patient is very much personality dependent and is in general unpredictable. Pain can be reduced by using an improved technique (high position of rubber-band ligation, manual anal dilation). This paper deals mainly with bleeding and pain following treatment of external hemorrhoids, inner piles, fissure-in-ano, abscesses and fistulae.

Abscess↗
PubMed1990

[Malignant pleural mesothelioma: diagnosis, therapy and prognosis].

Clinical and radiological signs in 44 patients with a malignant mesothelioma of the pleura are described. 18 patients underwent radical pleuropneumonectomy with total resection of the ipsilateral diaphragma. In addition to mediastinal nodes were resected in eight cases, in three patients parts of the thoracic wall had to be removed, and in six patients partial resection of the pericardium was performed. In 15 patients (34%) palliative tumor resection was performed and in ten other persons an exploratory thoracotomy and palliative tumor resection. One patient is alive 13 years after radical pleuropneumonectomy. The mean survival time of the patients who died is after radical pleuropneumonectomy 20 months (0.2 to 54 months), after radical pleuropneumonectomy with pericardial resection 8.5 months (3 to 16 months), after palliative resection 9.7 months (0.5 to 29 months) and after exploratory thoracotomy 6.5 months (0.5 to 19 months). Three patients died within a month (6.9%), one after a radical pleuropneumonectomy, one after a palliative resection and one after an exploratory thoracotomy. The first patient died in the late sixties due to a postoperative aspiration, the other two due to tumor progression. We conclude that the radical pleuropneumonectomy can contribute to a better prognosis of the malignant pleural mesothelioma.

Adult↗
PubMed1990

[Decortication: indication and morbidity--a retrospective analysis].

Decortication, that is excision of both the visceral and parietal pleura, has become a rarely performed operation. It is used for control of empyema of the pleura or recurrent malignant pleural effusion. During the last ten years at the University Hospital in Zurich 50 decortications were performed upon 49 patients. Mortality was 4%, however, death was due to the primary disease and not related to the operation. 38 of 50 decortications were straight forwards. The main complication was bleeding, needing re-thoracotomy in three patients and leading in five patients to a pneumothorax due to occlusion of the suction drains. We conclude, that if conservative treatment fails to result in a rapid progress, decortication should be performed immediately.

Adolescent↗
PubMed1990

[Palliative therapy of rectal cancer by electrocoagulation].

Palliative therapy for rectal carcinoma is only indicated in selected patients who do not tolerate radical surgery or with very advanced disease. In a retrospective series the results of transanal electrocoagulation are analyzed. In addition patients or their relatives were questioned about the treatment related increase in quality of life and the wish of recurrent coagulation if needed. The main indication for transanal electrocoagulation was rectal stenosis, blood loss, discharge of mucosa and tumor as well as pain. Anal incontinence only gets better when it is due to discharge. However, transanal exposition bears the risk of worsening the incontinence. The electrocoagulation is favored by all continent patients before colostomy. The main indication for a colostomy was incontinence and fistula. Palliative irradiation was concentrated in patients with pain. In 59 operations upon 40 patients there was one rebleeding and one death due to sepsis resulting in a mortality of 1.7%. We conclude from our results that transanal electrocoagulation is a safe procedure in patients with rectal carcinoma who do not qualify for radical surgery.

Aged↗
PubMed1990

[Nosocomial lung infections. Epidemiology and problems of stress ulcer prevention].

The incidence of pulmonary complications in patients with tracheal intubation is 17-25%. The mortality rate is considered to be between 50 and 81%. Aspiration of contaminated gastric fluid has been suggested to be a source of many of these complications. Gastric fluid contamination depends on the pH of the gastric fluid among other things. This results in a much higher incidence of nosocomial pneumonias in patients receiving H2-blockers (36%) or antacids and H2-blockers (38%) than placebo (8%) or sucralfate (10%). In contrast H2-blockers, antacids, omeprazole, pirenzepine and sucralfate show similar bleeding rates due to stress ulcers, but all are significantly lower than that of placebo. The routine application of prophylaxis for stress ulcer bleeding should nowadays be reserved for risk patients only. If necessary antimuscarinic drugs or sucralfate should be applied.

Anti-Ulcer Agents↗
PubMed1990

[Experience with thoracoscopic pleurodesis in the treatment of idiopathic spontaneous pneumothorax].

Between January 1987 and December 1988 thoracoscopic pleurodesis has been used as a standard treatment for idiopathic spontaneous pneumothorax. Bullae were electrocoagulated, and visceral and parietal pleurae were cauterized. Chemical pleurodesis with 50% glucose-solution was added. 34 procedures were performed on 32 patients. The average hospital stay was 8 +/- 2 days. One patient suffered from postoperative Horner-syndrome. No other complications occurred. Patients were re-evaluated 11 +/- 8 months after the operation. Recurrence was found in four patients within 30 days. These patients underwent pleurectomy. Another patient had recurrence after two months. He was again and successfully treated by thoracoscopic pleurodesis. Our data show improvement of the results as compared with simple chemical pleurodesis.

Adolescent↗
PubMed1990

Antimicrobial management of postoperative infections in abdominal surgery: single or combination regimen?

In a prospective, controlled, randomized study, the clinical and bacteriologic efficacy of imipenem/cilastatin was compared with that of a standard combination of an aminoglycoside, amoxicillin, and clindamycin in patients with serious postoperative infections. Doses used were imipenem/cilastatin 1 gm q 8 hr, amoxicillin 2 gm q 8 hr, and clindamycin 0.6 gm q 6 hr. Aminoglycoside doses were individualized and monitored six times weekly with serum concentration assays. Sixty-three patients were entered into the study: 31 in the imipenem/cilastatin group and 32 in the combination group. Diagnoses included pneumonia (ten in the imipenem/cilastatin group and seven in the combination group), peritonitis (eight in the imipenem/cilastatin group and 15 in the combination group), and septicemia (eight in the imipenem/cilastatin group and three in the combination group). The two groups were comparable with respect to sex, age, underlying diseases, and duration of antibiotic therapy. In the imipenem/cilastatin group, 26 patients were cured and one improved (87%). In the combination group, 21 were cured and five improved (81%). Four patients receiving imipenem/cilastatin and six receiving the combination therapy failed to respond to treatment. Eighty percent of the bacterial isolates were eradicated, and 15% were suppressed in the imipenem/cilastatin group. Corresponding frequencies in the combination group were 84% and 11%, respectively. Isolated pathogens persisted in 5% of the patients in each group. It is concluded that imipenem/cilastatin appears to be an effective and well-tolerated alternative to a triple antibiotic combination in the treatment of serious postoperative infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗