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Biomedical subjects

P Gertsch

Publications and source records attributed to P Gertsch.

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

[Liver transplantation: results with living donors].

Liver transplantation with harvesting of the graft from living related donors is a new technique. It was introduced in 1989 as a response to the shortage of donor organs for small children in the west and to the complete absence of such organs in Japan. Results have been as good as for transplantation from cadaveric donors. Our experience confirms these results and shows that this technique, so far restricted to small children in most cases, can also be extended to adults in selected cases.

Adult↗
PubMed1994

Portal hypertension promotes bacterial translocation in rats mono- and non mono-associated with Escherichia coli C25.

The basis for the high incidence of infectious complications in portal hypertension (PHT) remains unclear. The hypothesis that PHT induces bacterial translocation (BT) was tested in a rat model with or without mono-association with streptomycin resistant Escherichia coli C25 and with or without hypovolemic shock. PHT was achieved by partial portal vein ligation and three weeks later hypovolemic shock (HS) was induced. Blood, liver, spleen and mesenteric lymph nodes cultures were performed twenty-four hours later. PHT promoted BT to mesenteric lymph nodes in indigenous flora (4/6 [67%]) and mono-associated animals (7/9 [78%]) compared to sham laparotomy and sham shock (SL + SS) animals (0/6 [0%] and 2/9 [22%] respectively) (p = 0.03). The combination of PHT and HS resulted in increased mortality in mono-associated (7/15 [47%]) and non mono-associated animals (8/15 [53%]). No significant translocation was noted in liver and spleen and bacteremia was found only in the PHT + HS mono-associated animals (4/8 [50%]). PHT induces BT to mesenteric lymph nodes and this may account for the high incidence of septic complications associated with PHT. In this model, the addition of HS to PHT leads to an increased mortality but without uniform translocation of the gut flora beyond mesenteric lymph nodes.

Animals↗
PubMed1994

Late graft dysfunction after liver transplantation for primary biliary cirrhosis: disease recurrence versus chronic graft rejection.

Possible recurrence of primary biliary cirrhosis (PBC) in the transplanted liver has been reported. We discuss a case of presumed PBC recurrence after liver transplantation. However, the patient's full documented 9-yr follow-up after liver transplantation confirmed the diagnosis of chronic liver graft rejection instead of recurrent disease. This case report underlines not only the difficult differential diagnosis between recurrent PBC and chronic rejection, but it also stresses that complete follow-up, including strict morphological follow-up, is necessary before definitive conclusions can be drawn.

Diagnosis, Differential↗
PubMed1993

Long-term results of transhiatal esophagectomy for esophageal carcinoma. A multivariate analysis of prognostic factors.

BACKGROUND: Perioperative mortality and survival after esophagectomy have improved over the past 10 years. Although stage is the most powerful predictor of long-term survival, it remains unclear whether other factors influence prognosis. METHODS: Between 1981-1991, 100 patients with esophageal carcinoma were uniformly treated by transhiatal esophagectomy without adjuvant therapy. Results and prognostic factors of long-term survival were analyzed by univariate and multivariate analyses (log-rank test and Cox regression model). RESULTS: Forty-eight patients had severe associated medical conditions, and 26 patients were older than 69 years of age. Mortality was 3%, and morbidity was 68%. With a median follow-up of 52 months, median survival was 18 months. The overall 5-year survival was 23%, but it was 63% for early stages (pT1 + pT2). In the multivariate analysis, the risk of dying was increased by 4.9 (risk ratio) for patients with carcinomas invading beyond the muscularis propria (pT3 + pT4), compared to lower stages (pT1 + pT2) (P < 0.0001). To a lesser extent, longterm survival was also adversely affected by transfusions (packed erythrocytes) after controlling for stage (risk ratio 1.7; P = 0.047). Age (> 69 years), preoperative weight loss, tumor location, histology (adenocarcinoma versus squamous cell carcinoma), fresh frozen plasma, and splenectomy did not influence survival. CONCLUSION: In this study, transhiatal esophagectomy provided palliation for esophageal cancer with a low-perioperative mortality. Prolonged survival or cure was obtained for the majority of patients operated on in the early stages. Blood transfusions had a slight adverse effect on long-term survival.

Adenocarcinoma↗
PubMed1993

Recurrent cholangitis with and without anastomotic stricture after biliary-enteric bypass.

We recently surgically treated 24 patients incapacitated by recurrent cholangitis after biliary-enteric anastomosis performed for benign disease. Contrary to commonly held dogma, as many as one third of the patients had no evidence of anastomotic stricture indicated by radiologic and operative findings. We identified several other primary and coexistent pathogenetic factors including intrahepatic stricture in 42% of the patients, intrahepatic calculi in 25%, improperly constructed enteric conduits in 13%, and conditions that predispose to bacterial overgrowth in the biliary tree in 17%. Seventy-one percent of the patients had multiple etiologic factors, and of those patients without demonstrable anastomotic stricture, intrahepatic stricture was particularly common. Seventy-one percent remained symptom-free in their first year after operation. The most difficult situation to manage, and the factor responsible for most recurrences after our reoperation, involved intrahepatic stricture. A combined surgical and interventional radiologic approach to complex cases may be useful in selected patients.

Adult↗
PubMed1993

Acute thrombosis of the splanchnic veins.

The consequence of an acute thrombosis in the splanchnic veins on the viability of the intestine has not been well defined in the literature. Spontaneous recovery or total necrosis of the bowel have both been described. We treated seven patients with thrombosis of the splanchnic veins and adopted a surgical approach in three patients with extended and complete thrombosis of the superior mesenteric vein, portal vein, and splenic vein, while four patients with partial thrombosis of the superior mesenteric vein or protal vein recovered with conservative treatment. A 22-year literature review has identified 64 cases of acute thrombosis in the splanchnic veins, with complete information regarding the location and extent of the thrombosis, the treatment, and the outcome. Different anatomical patterns of thrombosis with mortality rates varying between 0% and 76% seem to be related to the extent and completeness of venous obstruction.

Acute Disease↗
PubMed1993

Management of traumatic liver injuries.

Liver injuries in Europe are usually caused by blunt trauma and a high mortality rate is generally reported. The severity of liver injury in 175 patients was graded from I to V and the Injury Severity Score assessed. Seventy-five patients in a prospective study (1987-1990) were treated according to a defined protocol. Non-operative management was used for those who were haemodynamically stable on admission. In unstable patients who proceeded to surgery, liberal use of packing was made and a low threshold for relaparotomy employed. Increasing experience resulted in fewer indications for resection and a 40 per cent rate of non-operative treatment in the prospectively managed group. The overall mortality rate was 12 per cent (15 per cent in the retrospective and 8 per cent in the prospective group). Death in patients with multiple injuries should only rarely result from liver trauma.

Adolescent↗
PubMed1993

Manometry of esophageal varices: comparison of an endoscopic balloon technique with needle puncture.

BACKGROUND: A noninvasive technique of pressure measurement in esophageal varices using an endoscopic balloon has been shown to be reliable in vitro. In the present study, this method was tested in vivo. METHODS: Thirty-seven pressure measurements in esophageal varices were performed in 34 patients by two independent operators (A and B) using an endoscopic balloon and compared with measurements performed by needle puncture by a third operator (C). RESULTS: Three measurements performed with the endoscopic balloon were rejected because they were noninterpretable. Measurements performed by A and B correlated well (correlation coefficient, 0.90); interobserver variability (r) was 0.88. Of 37 punctures performed for pressure measurements, 4 resulted in bleeding and 8 measurements were rejected as uninterpretable. Regression analysis showed a good correlation between the needle puncture and balloon techniques for pressure measurements performed by both operators (y = 5.3 + 1.0x, r = 0.8; y = 6.2 + 0.9x, r = 0.8), and analysis of variability showed a measurement bias of -5.3 +/- 4.1 and -4.1 +/- 3.5 cm H2O. No significant difference in variceal size measured with the endoscopic balloon or endoscopic forceps was found. CONCLUSIONS: The endoscopic balloon allows measurement of pressure in esophageal varices without hazard to the patient; in addition, it may be used to assess the varix size.

Adult↗
PubMed1993

[Whipple's operation for tumors of the pancreatic head and periampullar area].

Between 1986 and 1991 35 partial duodenopancreatectomies have been performed in the Clinic for visceral surgery of the University of Berne. 17 for adenocarcinoma of the pancreas and 18 for miscellaneous malignant or semimalignant pathologies such as ampullary or duodenal carcinomas, cystadenomas and distal bile duct carcinomas. The mortality was 5%. Postoperative complication was observed in 50% of cases. Leak at the pancreaticojejunal anastomosis was the most common surgical complication but healed under conservative treatment with somatostatin within few days in 5 of 6 cases. The median survival for patients with adenocarcinoma of the pancreas is 550 days, for patients with other pathologies 1200 days with some long-term survival in ampullary carcinomas. These results show on one hand that this kind of surgery can be realized with acceptable morbidity and mortality rate, on the other hand that further clinical trials in systemic adjuvant treatment are indicated especially in pancreatic cancer to improve the disappointing long-term results.

Adenocarcinoma↗
PubMed1993

[Cholecysto-cholangiography as an alternative to cystic duct cholangiography in laparoscopic cholecystectomy].

Intraoperative cholangiography may be an important adjunct to laparoscopic cholecystectomy in order to prevent bile duct lesions. Laparoscopic cannulation of the cystic duct can be very difficult and time consuming. We therefore developed a simple technique of cholecystocholangiography. The gallbladder is punctured and filled with contrast medium after having localised the cystic duct and put a metal clip as a landmark. The study included 52 patients having either cholecystocholangiography or cystic duct cholangiography. In 13 out of 26 patients (50%) cholecystocholangiography failed because of obstruction of the cystic duct. The cholangiograms showed complete filling of the bile ducts in 5 (19%) and incomplete visualisation in 8 cases (31%). Cystic duct cholangiography showed significantly better results with good delineation of the biliary tree in 19 cases (73%). Five cholangiograms were suboptimal (19%) and only 2 studies failed (8%). The relation between cystic duct and common bile duct was clearly visible in 24 cases (92%) with cystic duct cholangiography compared with 13 cases (50%) with cholecystocholangiography. Cystic duct cholangiography has better success rates in delineating biliary anatomy in order to prevent bile duct injury. Cholecystocholangiography is a good alternative in cases where the cystic duct cannot be initially visualized.

Adult↗
PubMed1993

Indications and limitations of percutaneous cholecystostomy for acute cholecystitis.

Percutaneous cholecystostomy (PC) was used as an alternative to operative therapy in 21 elderly or critically ill patients with suspected acute cholecystitis. All had associated disabling diseases, ten (48 percent) were older than 65 years, nine (43 percent) were in the intensive care unit and eight (38 percent) were recovering from recent operations. Among the 21 patients, 18 had cholecystitis (eight calculous and ten acalculous); in three patients, the procedure was only diagnostic. In 16 of 18 patients with acute cholecystitis, immediate relief of symptoms and significant improvement of laboratory signs of cholecystitis occurred. Persistent signs of peritonitis and uncertainty of diagnosis led to cholecystectomy without complication in one patient. Colonic perforation, as a result of technical complications, necessitated laparotomy in another patient. No other complication of PC was noted. Mortality rate of a patient with cholecystitis, treated by PC, was 5.5 percent (one of 18). Among ten patients with acalculous cholecystitis, only one patient underwent cholecystectomy because of a direct complication of PC. The other nine patients are alive and symptom-free with an intact gallbladder after a mean follow-up period of 16 months. Among eight patients with calculous cholecystitis, four later underwent cholecystectomy, three died from underlying disease, and one patient had stones extracted percutaneously. These results indicate that PC is an effective temporary measure in elderly or critically ill patients with acute cholecystitis and, under close clinical supervision, a safe alternative to surgical intervention. In patients with acalculous cholecystitis, PC can be used as an immediate and definitive therapy, and cholecystectomy can be avoided.

Acute Disease↗
PubMed1993

Transhiatal esophagectomy using a ring dissector.

Subtotal esophagectomy may be performed without thoracotomy by transhiatal dissection. We describe an alternative to the classical technique of transhiatal manual blunt dissection of the esophagus using a ring dissector, which allows a less traumatic dissection of the esophagus above the carcinoma of the esophagus. This instrument, designed for this particular purpose, produces a rapid and clean blunt dissection.

Equipment Design↗
PubMed1992

[Liver transplantation: current aspects from the East].

The shortage of organs from cadaveric donors for liver transplantation has resulted in the development in Australia and the United States of the technique of partial hepatectomy on living related donors. As multi-organ harvesting from cadaveric donors is not accepted in Japan, procurement from living related donors is the only source of organs in this country, where active development in this field has been initiated.

Australia↗
PubMed1992

[Anemia-inducing colonic diverticular hemorrhages].

20 patients with massive lower gastrointestinal bleeding caused by segmental or total colonic diverticular disease are presented. The bleeding source was localized by colonoscopy, angiography and intraoperatively in 5, 5 and 2 patients respectively. The hemorrhage occurred in the right colon in 9 patients and in the left colon in 3 patients. Due to ongoing bleeding 9 patients needed immediate surgery (7 right hemicolectomies, 1 left hemicolectomy, 1 sigmoidectomy). The median transfusion requirement of operated individuals was 14 units of blood. 2 (22%) patients died from postoperative complications. The remaining 7 patients had no recurrent bleeding during a median follow-up of 3.5 years (0.5-9 years). 11 patients with arrested bleeding (median transfusion requirement 3 units of blood) were treated conservatively. During a mean follow-up of 4.5 years (1.5-10 years) only one (9%) of the conservatively treated patients complained of recurrent bleeding requiring sigmoidectomy. We conclude that massive and ongoing hemorrhage (greater than 6 units of blood) occurs predominantly in right-sided colonic diverticula and requires immediate surgery. Arrested bleeding (transfusion requirements less than 6 units of blood) from colonic diverticula can be treated conservatively since operative mortality is high and recurrent bleeding is rare.

Adult↗
PubMed1992

Malignant cells are collected on circular staplers.

Anastomotic recurrence after resection of colorectal carcinoma has been attributed to insufficient clearance, migration of tumor cells into lymphatics, or implantation of exfoliated malignant cells during anastomosis. We studied 10 patients submitting to low anterior resection for cancer 6 to 16 cm (mean, 12.6 cm) from the anal verge. The anastomosis was performed with a circular stapler introduced transanally into the rectum using the established technique. No lavage of the rectal stump with a cytotoxic agent was conducted before the anastomosis was performed. Having completed the anastomosis, the stapler and the doughnuts were washed with saline, which was collected for cytologic examination. The doughnuts were then examined histologically; all were tumor free. In 9 of the 10 cases, malignant cells were identified in the centrifuged saline. It may be that malignant cells collected by the stapler are implanted during anastomosis and cause subsequent anastomotic recurrence.

Aged↗