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Biomedical subjects

P Gertsch

Publications and source records attributed to P Gertsch.

At least 91 records · Page 5Linked to original sources
PubMed1989

[Long-term follow-up following liver resection].

There are various benign or malignant conditions which may necessitate a liver resection. The long-term follow-up after such an operation calls for precise knowledge of the causal affection and of the local conditions encountered at that time. Certain complications can arise during the immediate postoperative phase and others at a later stage. Also, the condition which necessitated the hepatectomy may continue to develop or recur. The diagnosis of the complications occurring after a liver resection is important, as it often reveals a need for treatment.

Hepatectomy↗
PubMed1989

[After-care in liver transplantation].

Liver transplantation is assuming an increasingly important role in present-day hepatology; it is the preferred treatment in many cases of acute or chronic liver disease. The results have shown constant improvement thanks to the introduction of standardized techniques for removal and implantation of the liver, improved immunosuppression and postoperative care. Good long-term results--a five-year survival rate in up to 70% of the cases--can only be achieved by strict self-discipline on the part of the patient and careful postoperative follow-up, with close collaboration between the general practitioner, the hepatologist and the transplant surgeon.

Combined Modality Therapy↗
PubMed1988

[Radiologic diagnosis of early complications following kidney transplantation].

Postoperative complications after renal transplantation, such as hematomas, abscesses, urinomas, lymphoceles and obstruction of the ureter, can be diagnosed by means of sonography. Early vascular complications, such as venous thrombosis and arterial occlusion or stenosis, can be recognized by duplex sonography and accurately depicted by angiography to allow planning of surgical intervention. Stenosis of the renal artery is amenable to treatment by percutaneous angioplasty. Parenchymatous complications (acute tubular necrosis, acute rejection, cyclosporin-A-toxicity) can cause changes in the intrarenal flow patterns at duplex sonography, but this examination does not allow accurate diagnosis and differentiation of these changes. Magnetic resonance imaging is a very promising method for the differential diagnosis of parenchymatous complications.

Humans↗
PubMed1987

[Carcinoma of Vater's ampulla and precursor states].

Treatment of periampullar carcinoma is known to be more rewarding than that of the cancer of pancreas. Operative mortality however remains high, and five-year survivors are a minority. Diagnosis of precancerous lesions should improve the prevention of these tumours. We review our ten-year experience, in which 16 periampullary carcinomas were operated on in patients aged between 45 and 90 years (average 69). 10 Whipple and 3 local resections, and 3 by-pass procedures were performed. Two patients died during the first two postoperative weeks, after a Whipple and a by-pass procedure respectively. Survival after the Whipple operations averaged 35 months (3 patients are still alive up to 60 months later) and 9.9 months after the other procedures. All the histologic specimens were reviewed for lesions such as adenomatous polyps or epithelial dysplasias coexisting with carcinoma. We found such associations in 3 biopsies or local excisions and in 4 pancreaticoduodenal resections. These findings confirm that periampullar carcinoma is preceded in a significant number of cases by pre-malignant conditions. It is hoped that awareness of this fact will make possible early diagnosis and treatment.

Adenoma↗
PubMed1987

Assessment of hospital workload in war surgery.

The aim of treatment of casualties in war time is to offer a chance of survival to the greatest number of patients. This goal can be approached by selecting for treatment patients who have a real chance of survival and by reducing the duration of operations as much as possible. Should the operative time be limited to an assessed predetermined duration as proposed in certain armies? Conditions for the observation of war wounded were particularly favourable in the ICRC (International Committee of the Red Cross) Hospital in Peshawar (Pakistan) because all treatments were started and completed in the same place. During the summer of 1985, a major battle took place near the Pakistan border. Analysis of 212 operated patients, of whom 68 per cent arrived at the hospital less than 48 h after the injury, showed that the operations lasted 90 min on average. Abdominal procedures were the longest. Patients stayed in the hospital for an average of 4 weeks; those with lesions of the extremities stayed longer (5.8 weeks) than those with abdominal or thoracic lesions (4.3 and 3 weeks). The results show that the long duration of an operation has not been correlated either with an unfavourable outcome or with an increased postoperative workload. As far as possible, accelerating the turnover of operations by increasing the number of operating teams should be the objective rather than the selection of patients who require short operations. Such selection would have resulted in the death of most seriously wounded patients in this series.

Adolescent↗
PubMed1986

[Endoscopic sclerosing for hemorrhage due to ruptured esophageal varices. Results of a prospective study of 50 cases].

A prospective evaluation of sclerotherapy for bleeding esophageal varices has been conducted in 50 unselected consecutive patients. According to Child's classification, 36% were class A, 34% class B and 30% class C. Sclerotherapy was performed on an emergency basis in 22 patients and was delayed a few hours for the others. The aim of the technique was to obliterate the varices by intra- and paravariceal injections of polidocanol 1%. Injections were performed weekly for the first 3 weeks of treatment, then 3- or 6-monthly. Four patients had a severe recurrent hemorrhage during the first month. The mortality during that period was 12%. Follow-up was possible in 81% of the surviving patients. Four stenoses were treated by dilatation. Four patients had a late-recurring hemorrhage which was easily controlled in 3. Four patients died later, 3 of liver insufficiency and one of hemorrhage.

Adult↗
PubMed1986

Changing patterns in the vascular form of Ehlers-Danlos syndrome.

We report and analyze two cases of Ehlers-Danlos syndrome (EDS) type 4. The first manifestation of the disease was a spontaneous perforation of the colon in a 47-year-old man; he was successfully reoperated on five years later for the rupture of an abdominal aortic aneurysm. Abdominal pain demonstrated the syndrome in a 33-year-old woman in whom multiple abdominal aneurysms were found. A ligation of the anterior tibial artery for spontaneous rupture was performed five years later. Light and electron microscopic studies of the skin disclosed similar alterations in both cases. The diameter of the collagen fiber bundles was reduced and the diameter of collagen fibrils was increased. It appears that EDS type 4 might be less characteristic than has been previously described. Classification of the different types of EDS according to electron microscopy is not possible.

Collagen↗
PubMed1986

[Treatment of esophageal varices in children by sclerotherapy].

The treatment of portal hypertension in children by portosystemic shunt or Vosschulte dissection-ligature is not definitive. Recurrent oesophageal varices or high gastrointestinal bleeding occur on a medium-term and long-term basis. We are investigating endoscopic sclerotherapy as a therapeutic alternative. The aim of this prospective study is to analyse the treatment and follow-up of 7 children with prehepatic portal hypertension who have undergone sclerotherapy, using a flexible endoscope. The first results at short-term and medium-term follow-up are encouraging. The authors discuss the technique, complications and emergency use of sclerotherapy.

Adolescent↗
PubMed1985

Endoscopic variceal pressure measurements: response to isosorbide dinitrate.

An endoscopic pressure sensor has been evaluated in the measurement of oesophageal variceal pressure and its response to drug ingestion. The variceal pressure showed a highly significant correlation with the splenic pulp pressure (r = 0.97) in six patients with liver disease of diverse aetiology and with hepatic venous wedge pressure (r = 0.92) in eight alcoholic cirrhotic men. Intraduodenal infusion of isosorbide dinitrate in the cirrhotics produced no change in wedge pressure or endoscopic variceal pressure despite profound falls in arterial systolic pressure. Thus isosorbide dinitrate appears to be of no value in treating portal hypertension. This study establishes the endoscopic pressure sensor as a valuable tool in screening drugs in this condition.

Adult↗