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Biomedical subjects

P Gertsch

Publications and source records attributed to P Gertsch.

At least 127 records · Page 7Linked to original sources
PubMed1982

Endoscopic noninvasive manometry of esophageal varices: prognostic significance.

Our study attempts to establish a relation between the pressure in the esophageal varices and the clinical outcome in 18 patients in whom sclerotherapy for bleeding esophageal varices was performed. The measured pressure was compared to the endoscopic findings. Before sclerotherapy, a noninvasive manometric measurement was performed on the varices using a spheric membrane manometer fixed at the tip of an endoscope. Twelve of our 18 patients suffered repeated hemorrhage which led to death in five. We discovered a relation between the measured pressure and the outcome. Beside this, we measured the highest pressures in the largest varices. The relation that seems to exist between the pressure in the esophageal varices, the endoscopic findings, and the severity of the portal hypertension may provide new opportunities for research in this field.

Adolescent↗
PubMed1982

Strain gauge plethysmographic studies after clipping of the inferior vena cava.

Assessment of the hemodynamic effects of the IVC clipping by strain gauge plethysmography provides accurate quantitative data. These correlate very well with the other means of investigation used in the study. Eight patients were controlled in the Vascular Laboratory 9 to 43 months after clipping of the inferior vena cava. They submitted to clinical evaluation, Doppler ultrasound, isotopic venography, abdominal sonography, and strain gauge plethysmography of the lower extremities. This last method provided quantitative data; maximal venous outflow was found to be equivalent in the 8 patients included in the study and in a control group of 20 healthy young volunteers. Strain gauge plethysmography results correlate well with the other means of investigation and demonstrate the efficacy of the dilated venous collateral channels in restoring a normal venous return.

Abdomen↗
PubMed1980

[Verneuil's disease in the differential diagnosis of suppuration of the ano-perineo-buttock region].

Verneuil's disease or hidradenitis suppurativa is not frequent. Nevertheless since VERNEUIL's classic description in 1854, many cases have been reported. It is a disease of the apocrine sweat glands, that may arise on each of their localizations: axilla, breast areolae, umbilicus, perineum, groin, buttocks. The chronic suppurative disease of these glands give rise to multiple fistulous constantly infected tracts. The typical appearance usually allows a clinical diagnosis. Other disease may nevertheless look like hidradenitis suppurativa. We present two cases and discuss the differential diagnosis between the hidradenitis suppurativa and the chronic infection of a pilonidal cyst.

Buttocks↗
PubMed1979

[Infection after vascular surgery].

Infection after vascular surgery is a feared complication whose mortality rate remains high, inspite of an aggressive surgical approach, actually admitted by most of the authors. From 1970 to 1977 we have observed 6 infections after 1049 arterial operations: 5 out of 228 synthetic by-passes and 1 out of 296 venous by-passes. The global infection rate is 0.5%. This complication occurred in 2.1% of the cases after synthetic by-passes. Two out of these 6 infected patients had to be amputated and they died. We think that the general accepted treatment remains valuable in most of the cases, but that a more simple and less aggressive surgical approach can be of great interest in particular situations.

Aged↗
PubMed1977

[4 cases of potassium enteropathy].

The oral use of enteric-coated potassium chloride (and apparently of its slow-release form too) to compensate potassium loss during thiazide diuretic treatment may engender ischemic enteropathy. This iatrogenic condition is linked to the vaso-active properties of KCl, which act on blood vessels often damaged by hypertension or chronic heart failure. Four observations are presented involving stenosing ulceration or perforation of the small bowel following oral KCl treatment. The main clinical, pathological and therapeutic aspects are discussed.

Aged↗
PubMedDate not supplied

Initial experience with the harmonic scalpel in liver surgery.

BACKGROUND/AIMS: Hepatectomies are generally performed using a crushing clamp or by finger fracture. New instruments such as ultrasonic aspirators or water jet dissectors are increasingly used for precise dissection of intrahepatic structures. An ultrasonically activated scalpel has been introduced, mainly for laparoscopic procedures. The potential of this instrument in liver surgery remains to be defined. METHODOLOGY: In a prospective study, we have tested the harmonic scalpel (Ultracision, Ethicon Endo-surgery) in 16 consecutive patients undergoing liver surgery. The ease of parenchymal dissection and the hemostatic effect of the ultrasonically vibrating blade was assessed in each operation. Blood loss and transfusions were recorded. RESULTS: One patient underwent excision of a liver cyst and 15 patients 16 hepatectomies for colorectal metastases (7 cases), hepatocarcinoma (5 cases) and other benign or malignant conditions (4 cases). The liver was cirrhotic in 4 cases. The performance of the harmonic scalpel for dissection, cutting and hemostasis was good or excellent in 16 operations, and poor in 1 hepatectomy in a cirrhotic liver. Median blood loss was 400 mL (range: 0-1200 mL) and 4 patients received blood transfusions. CONCLUSIONS: The harmonic scalpel allows efficient section of liver parenchyma, precise dissection of intrahepatic structures, good hemostasis and section of small intrahepatic vessels.

Adult↗
PubMedDate not supplied

Surgical treatment of synchronous hepatocellular and esophageal carcinoma: case report and review of literature.

Simultaneous presentation of hepatocellular carcinoma and esophageal carcinoma is rare. Few cases have been reported as surgically curable. We treated a caucasian man of 68 years who presented a voluminous hepatocellular carcinoma in the right lobe of the liver and a superficial squamous cell carcinoma of the middle third of the esophagus. Both tumors seemed curable with surgery. We adopted a treatment consisting of two steps: 1) curative hepatic right trisegmentectomy; 2) three months later transhiatal esophagectomy. Two units of blood were transfused for both operations. Simultaneous hepatectomy and esophagectomy have been published in seven cases. We opted for resecting the tumors in two distinct procedures to lower the operative risk. Because of the large size of the hepatocellular carcinoma and the small size of the esophageal carcinoma, hepatectomy was performed first. The delay between the two interventions did not compromise the prognosis that is actually dependent of the hepatocellular carcinoma.

Aged↗
PubMedDate not supplied

Portal pressure measurements before and after Hassab's decongestion operation. A preliminary report.

This preliminary study included five patients with a history of haematemesis resulting from rupture of oesophageal varices complicating schistosomal hepatic fibrosis. Simultaneous measurements were taken of the endoscopic variceal pressure (EVP) and the free portal pressure (FPP) obtained by the cannulation of a mesenteric vein radical. These measurements were taken after laparotomy, after removing the spleen and after devascularization of the lower oesophagus and upper two thirds of the stomach. At the beginning the EVP was found to be identical with the FPP. Following splenectomy, the EVP dropped from a mean of 41.9 cm H2O to a mean of 25.8 cm H2O, whereas the FPP dropped from 40.7 cm H2O to 27.8 cm H2O. After decongestion, the EVP had a mean of 21.3 cm H2O and the FPP had a mean of 32 cm H2O. Two weeks after the operation the EVP remained unchanged at the end of the operation in two cases and increased by 5 cm H2O in one case. Accordingly it was concluded that Hassab's operation results in an immediate diminution of the EVP and FPP. However, the long-term results of this operation required further studies.

Adult↗
PubMedDate not supplied

Superinfected actinomycotic abscess of the liver.

Isolated actinomycotic liver abscess is rare. We report a case with fulminant evolution, which was treated successfully with surgery and penicillin. In human actinomycosis, Actinomyces israeli is the main infective agent. An abdominal localisation is uncommon, occurring in less than 25% of cases. Isolated liver lesions are extremely rare; their presence might be interpreted as the result of the hematogenous spread of a no longer present intestinal lesion. The evolution of actinomycosis is usually torpid. In the present case, mixed infection with Fusobacterium nucleatum might explain the acute evolution.

Actinomycosis↗