Biomedical subjects

P Gertsch

Publications and source records attributed to P Gertsch.

131 records · Page 8Linked to original sources

PubMedDate not supplied

Chronic pancreatic pleural effusions and ascites.

The occurrence of pleural effusion or ascites, secondary to internal pancreatic fistula, is a rare clinical syndrome and diagnosis is, therefore, often missed. The fluid accumulation has been attributed to disruption of the pancreatic duct or to rupture of a pseudocyst. In a 20 year period, 106 patients were hospitalized in the department of surgery, CHUV, with a diagnosis of chronic or chronic relapsing pancreatitis, and 77 with that of pancreatic pseudocyst. During this time, five patients with chronic pancreatic and pleural or peritoneal effusions have been observed. These five cases present a good pattern of the possible causes and evolution of the disease. Wirsungography is of great value for the surgical management of these patients, allowing the right technique to be chosen for each particular case. Surgery caused disappearance of the effusions in our five patients.

Adult↗

PubMedDate not supplied

Aorto-intestinal fistula after reconstructive arterial surgery.

In a group of 184 patients with synthetic, arterial bifurcation grafts, we have performed 16 operations for distal anastomotic pseudo-aneurysms and 11 for proximal anastomotic pseudoaneurysms. Four of the latter were encountered in three patients and took the form of aorto-intestinal fistulae. Excision of the arterial prosthesis, suture of the intestinal orifice and insertion of a new extra-anatomic bypass seems to be the treatment of choice. However, excision of an aortobifemoral prosthesis and replacement in situ with a new prosthesis or even suture of the aortic fistula with a patch represent acceptable treatment in certain particular situations.

Aged↗

PubMedDate not supplied

[Clipping for prophylactic partial occlusion of the inferior vena cava].

The partial occlusion of the inferior vena cava in the prevention of fatal pulmonary embolism has been used for years in different ways. Over a period of one, and a half year, we put 11 clips of Miles, once for prophylaxis and 10 times after pulmonary embolism. Two patients died during the first 15 postoperative days. Seven patients had a phlebologic control by a Doppler ultrasound, venous plethysmography, isotopic cavography, and grey scale ultrasound. It has been proved that the inferior vena cava was permeable in 6 of the 7 controlled patients. The indications as well as the late results of these operations are discussed.

Adolescent↗

PubMedDate not supplied

Resection of metastases to the alimentary tract from malignant melanoma.

Metastases to the celio-mesenteric organs from malignant melanoma are studied retrospectively in 22 autopsied cases and in seven surgically treated patients. Metastatic disease to one or more celio-mesenteric organs was found in 86.3% of postmortem examinations: the liver was the most frequently involved organ, followed by the pancreas, peritoneum, small bowel, biliary tract spleen, colon and stomach, in that order. Surgery only resulted in long-term asymptomatic survival in those patients with a long relapse-free interval and a single metastasis. It is concluded that, apart from cases with intestinal obstruction or massive GI bleeding, resection should be reserved for patients with a relapse-free interval of at least 15 months and with a single "alimentary" metastasis. It is suggested that diagnosis of systemic spread at the asymptomatic stage would improve prognosis of stage IV malignant melanoma.

Adult↗

PubMedDate not supplied

Techniques and results of variceal pressure measurements.

Pressure in esophageal varices can be measured by puncture of a varix, or using an endoscopic gauge or by means of an endoscopic balloon. Puncture is usually regarded as an invasive technique in contrast with the other two. Puncture technique has been considered as the "gold standard" to which other methods of measurement should be compared but its results have not been analyzed critically until recently. The pressure gauge has given reliable pressure measurements in vitro, but results in vivo are still controversial. The new technique using an endoscopic balloon has been assessed in vitro and in vivo, and has given reliable pressure measurements. Studies have been performed by either using the needle puncture technique or the endoscopic gauge. It has been shown that pressure in esophageal varices varies during respiratory cycle, but that the pressure gradient between varices and esophageal lumen (transmural pressure) remains unchanged. Similarly, during Valsalva's maneuver, transmural pressure remains unchanged in most cases in spite of a rise in variceal pressure. Pressure in esophageal varices correlated with portal pressure in spite of possible difference in their respective values. The effects of pharmacological substances on variceal pressure has also been investigated using the above mentioned techniques. Non-invasive techniques should allow measurement and studies on a broader scale.

Blood Pressure↗