Biomedical subjects
Publications and source records attributed to P Hahnloser.
Clonogenic cultures from 27 lung cancers were realised. For 68% of cases a clonogenic growth was observed, but no direct correlation could be done with the differentiation of the tumor or with the presence of ganglion metastases. EGF in medium increased the number of colonies obtained in 60% of cases.
From 1987 to 1989 a Günther vena caval filter was implanted in the inferior caval vein in 37 patients to prevent pulmonary embolism. 20 patients had already suffered from lung emboli and full anticoagulation did not prevent reembolization (11) or was contra-indicated because of hemorrhagic complications (5) or recent operation (4). 17 patients had developed severe deep venous thrombosis with a free ending thrombus (15) as shown by phlebography and in 2 other patients of old age prophylaxis seemed indicated to prevent migration of the thrombi. This device can be inserted percutaneously via a 10-French introduction system. No local complications were observed. 3 patients showed an oedema of a leg 2 to 7 days after insertion with spontaneous regression. One patient had the filter 12 days after implantation completely obstructed by a new embolus that needed to be removed surgically. One patient had an acute caval obstruction 1 1/2 years after implantation. it could not be determined if this was due to new embolisation or to thrombosis of the filter. No pulmonary reembolization was observed. Even if long-term results with the Günther vena caval filter can not be reported yet, it seems to be a satisfactory device for preventing pulmonary embolism.
Resection and primary anastomosis (RPA) in emergency left-side colon surgery is not universally performed because of anastomotic healing difficulties of unprepared, dilated, or inflamed colons. Ninety-three patients underwent emergency surgery for left-side colon disease. Sixty-three primary anastomoses were performed with a 16% mortality rate and a 6% incidence of anastomotic leakage. These results are similar to those reported in the literature, depending upon the pathology involved, and appear to justify resection and primary anastomosis in case of hemorrhage, trauma, and left-colonic obstruction. As for diverticular perforation with localized peritonitis, RPA can be attempted in some instances, if a protective stoma is added. Finally, in case of diffuse peritonitis, the Hartmann procedure still remains the safest method.
42 cases of chronic pancreatitis treated between 1976 and 1986, presenting 0.2% of all patients seen at the surgical clinic in the same period, have been reviewed. 37 patients (88%) were alcoholics and the prevalence of males was 83%. -Study of dietary habits showed a very high alcohol intake of 135.3 g alcohol per day, contrasting with the control group's alcohol consumption of 44.9 g per day. Alcohol intake calculated per life of patient with chronic pancreatitis represented 850.4 kg, whereas the control group consumed 344.1 kg (beer and wine). -Patients with chronic pancreatitis had started excessive alcohol consumption at an average age of 18 +/- 2 years and continued for an average of 18.0 +/- 1 years. These data correspond to zone A, i.e. Southern Europe. The evolution was analyzed with regard to persistence or cessation of alcoholism. Repeated attacks of chronic pancreatitis were seen in both groups. Patients abstaining from alcohol had only one attack during an average period of 10 years. Painful recurrences after surgery seem to be more frequent with persistent alcoholism (4 out of 5 patients), whereas in 15 patients without alcoholism they were observed only 3 times. -This shows that alcoholism remains the main factor in the natural history and evolution of chronic pancreatitis.
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Between 1981 and 1985, seven patients (mean age 44 years) underwent surgery for benign gastroduodenal ulcer in the Department of Surgery. Cantonal Hospital, Fribourg, Switzerland. Surgical indications were a double subcardial and prepyloric ulcer recurring after medical treatment, a duodenal and jejunal anastomotic ulcer after gastroenterostomy, two duodenal ulcers which recurred after vagotomy, and three perforated ulcers (subcardial, prepyloric, duodenal). All patients underwent two-thirds gastrectomy with a Roux-en-Y loop. Clinical investigations and gastroscopy were performed 1-5 years postoperatively. Clinical results were excellent in 5 cases (Visick 1), good in one (Visick 2), and moderate in one (Visick 3). Symptoms and signs associated with biliary gastritis were found as follows: vomiting 1 patient; epigastric pain 1 patient; weight loss 1 patient; anemia 1 patient. No bile staining was seen in any patient. Gastric biopsy demonstrated a normal mucosa in 2 patients and gastritis in 5 patients. Roux-en-Y gastrectomy gives satisfactory results in certain benign gastroduodenal ulcer situations. Perianastomotic and gastric stump gastritis may exist without biliary reflux.
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The present communication deals with scanning electronmicroscopical changes of autologous vein and autologous fascia lata, which were used as arterial implants. We examined material, which could be removed during reoperation for vascular occlusion. After one year, the surface exposed to the blood stream shows a homogenous layer of fibrin. Whilst the elastic fibers of fascia lata-transplants have nearly completely disappeared, we can still find them in the vein. This might be the essential reason for the longer survival of venous implants into the arterial blood stream.
In a preliminary communication a new method for endoluminal extraction of ureteral stones is described by using a catheter with two inflatable balloons. The length of the catheter is about 100 cm and its diameter corresponds to the usual ureteral catheters. It has four openings: the central opening is located at the end of the catheters. Two other lumina open into the two balloons located at a distance of 3-5 cm. An other opening is located between the two balloons. By insufflating and emptying of the distal balloon, the concrement in the ureter is mobilized and caught. By insufflating the two balloons and injection of contrast media through the opening situated between the two balloons, the ureter is ovistended, the stone is mobilized can be extrac "swimming" ie contrast media between the two balloons. Tillenow, o concrements have been extracted from the distal ureter by this method.
Within 1 1/2 years we have seen 4 pulmonary emboli, one of which was fatal. The origin was an isolated thrombophlebitis of the great saphenous vein. An autopsy, with dissection of the veins of the legs and of the pelvis, and phlebographies where there is any doubt of deep venous thrombosis, allow us to speak of isolated thrombosis of the great saphenous vein. The clinical level is always lower than the real level and the thrombus can grow through the saphenofemoral junction. The conservative treatment (anticoagulation and mobilisation) do not prevent a cranial ascension of the thrombus nor a pulmonary embolism. So, when the thrombosis is higher than the knee, we do a crossectomy of the great saphenous vein. We did this operation 8 times without complications.
A method of a telescope anastomosis for prevention of reflux was developed experimentally in dogs. After the resection of 40 cm of ileum and colon ascendens the ileal part was intussuscepted into the colon and fixed by seromuscular stiches. The vessels were left untouched. The intussuscepted part measured 3-4 cm. No ileus was observed in the 24 weeks. Glass balls of 1.2 cm diameter could pass through. Barium enema as well as air insufflation of different pressures showed no reflux. The serosa was covered pretty soon by a granular tissue and later on by normal mucosa.
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Pleuropneunomectomy with resection of the diaphragm only offers acceptable therapeutic results in patients with multifocal malignant mesothelioma of the pleura. Diaphragmatic replacement on the right side can be satisfactorily achieved by fixation of the liver to the thoracic wall. On the left side many homologous and heterologous tissues and prosthetic adjungts have been suggested with varying success. This report describes technique and results in two patients where the broad pedicled left hemipericard was successfully used to replace the resected left diaphragm.
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This study reports the treatment of 192 consecutive cases of spontaneous pneumothorax observed in 99 patients. Relapses are frequent, but it could be shown that their number can be reduced by more aggressive therapy. Conservative treatment led to 99 % of relapses, whereas they were reduced to 32 % by continuous pleural suction, as shown in 76 cases. Pleurodesis with glucose 40 % or 50 % solution followed by continuous suction for 7 days, is advertised by the authors for every first episode of spontaneous pneumothorax. Under this treatment relapses were observed in only 19 % of the cases. If however after this treatment a recurrent pneumothorax occurs, thoracotomy has to be considered for parietal pleurectomy and occasional resection of emphysematous bullae. This procedure was successfull in all 13 cases where it had been applied.
Out of 1629 patients who were hospitalised 1963 to 1973 for diagnosis and treatment of bronchogenic tumors, 731 underwent resection. 20 patients could be operated upon by lobectomy or bilobectomy and bronchial resection (Sleeve-resection). In two other patients the tumor could be resected through a bronchotomy. Postoperative complications were frequent (n = 6) on patients with malignant tumors (n= 15). We saw 3 times a bronchopleural fistula (2 patients had to be reoperated, 1 death), once a fatal empyema, once a fatal pneumonia of the contralateral side and once a bronchial stenosis of 50% of the lumen. On the patients with a benign tumor (n = 7) we saw in one patient a bronchopleural fistula and in another endobronchialgranulomas due to non resorbable suture material. Methods to prevent or cure these complications are presented consisting in the use of absorbable suture material and long lasting intrathoracic suction.