Biomedical subjects
Publications and source records attributed to P Waibel.
Imaging plays an important role in the diagnosis and therapy of children with suspected pulmonary infections. The role consists in confirmation or exclusion of pneumonia, differentiation between the entities, exclusion of other causes and evaluation of related complications.
This case report demonstrates the course of herpes simplex virus cerebritis in a patient aged 7 years 2 months who presented with non-specific symptoms followed by an epileptic attack. Subcortical, bilateral opercular and bilateral thalamic lesions were detected, but the temporal and inferior frontal lobes were spared. The patient developed anarthria, impairment of mastication and swallowing consistent with operculum syndrome. Diagnosis was made by magnetic resonance imaging and elevation of oligoclonal antibodies specific to herpes simplex virus in cerebrospinal fluid after an unexpectedly negative polymerase chain reaction test.
The case of an 11-year-old girl with mediastinal stage III B-E Hodgkin's disease is described. She achieved complete remission with combined chemoradiotherapy according to the Swiss Pediatric Oncology Group-HD Protocol 1985. Six months after all therapy was stopped, a slowly growing retrosternal mass was detected. Computed tomography (CT) and gallium-67 single-photon emission CT (SPECT) could not elucidate the true origin of the tumor, nor did ultrasound-guided transthoracic fine-needle puncture. Open biopsy with histologic examination of the lesion has successfully identified the mass as thymic hyperplasia, a rebound immunologic reaction after chemoradiotherapy that mimicked tumor regrowth.
OBJECTIVES: This study reviews the long-term results of 514 aortoiliac thrombendarterectomies (TEA's). DESIGN: A prospective study in a major university hospital in Switzerland. SUBJECTS: 353 male and 62 female patients with aortoiliac occlusive disease. Operative indications: disabling claudication (n=334), rest pain (n=44), and gangrene (n=37). METHODS: Open and semiclosed TEA's were performed on 167 and 347 limbs, respectively. Follow-up was continuous and complete in 97.1 % of patients over a period of more than 15 years. RESULTS: The overall life-table patency rate at 5, 10, and 15 years postoperatively were 93.4 %, 90.4 %, and 84.2 %, respectively. Fifteen years postoperatively, the patency rate of 92.3 % after open TEA was significantly higher (p<0.04) than after semiclosed TEA (79.5 %). However, similar patency rates of 69.5 % and 69.8 % were observed 20 years postoperatively. Further significant prognostic factors on patency were: anatomic localization (p<0.004), preoperative stage of arterial occlusive disease (p<0.008), and gender (p<0.007). Patient's age did not influence the outcome in terms of patency. Hospital mortality rate was 1.2 %. Early obstruction occurred in 2.2 %, leading to subsequent early amputation of 1.4 % and reoperations in 1.2 %. The long-term actuarial survival rates of the patients were 55 %, 36 %, and 18 % after 10, 15, and 20 years postoperatively. CONCLUSION: Both open and semiclosed TEA give highly satisfactory long term results in aortoiliac occlusive disease with a low morbidity and low mortality.
An overview is given of the history and operative techniques of open and semiclosed thrombendarterectomy (TEA) for aortoiliac obstructive disease. The second part of the paper reviews the long-term results of 514 aortoiliac TEA's performed in 415 patients between 1959 and 1972. The data were prospectively acquired and the analysis was done on a retrospective basis. Median follow-up was over 15 years. Open and semiclosed TEA were performed on 167 and 347 limbs respectively. Hospital mortality was 1.2% and operative morbidity 11.1%. The overall life-table patency rate at 5, 10, 15, and 20 years was 93.4%, 90.4%, 84.2% and 69.5% respectively. Patency rate depended on significant factors: open versus semiclosed method (p < 0.04), anatomic localization: common iliac artery versus external iliac artery (p < 0.0004), preexisting stage of occlusive disease: stage II versus stage IV (p < 0.008), and gender: female versus male (p < 0.007). Patient's age was not a predictive factor on patency. The limb salvage rate was greater than 90% even in long-term follow-up. We conclude that in aortoiliac obstructive disease both open and semiclosed TEA give highly satisfactory long-term results with low mortality and morbidity rates.
Appendix carcinoid in children is a rare condition which is found by accident at the histological examination of the appendix. We report on a rare case in which a covered perforation of a diverticulum had occurred. First of all the patient was treated conservatively with antibiotics and 2 months later the appendectomy à froid was performed. The annual follow-up of these patients is certainly indicated.
In an earlier study patients operated for arterial occlusive disease have been observed for at least 15 to 25 years. They have now been analysed for incidence, localization, time of appearance and results of reoperation of anastomotic aneurysms. These are not only seen after prosthetic bypass--2/3 of 27 cases--with an incidence of 7.8%, but also after vein bypass (5.23%), semiclosed endarterectomy with dacron patch (2.59%) or vein patch (5.23%) and open endarterectomy with vein patch (7.14%). The incidence depends mainly upon the time of observation. They appear in the inguinal area in 38.5%, near the adductor canal in 27%, above the inguina in 19% and below the knee in 15%. They have to be expected earlier with prosthetic bypass. Mortality after reoperation is higher with aortoduodenal fistula (18.75%) than without (7.14%). The postoperative patency rate was about 65%, amputation occurred only after prosthetic bypass as primary procedure. The patency rate was 80% after 1 year, remained at this level so after endarterectomy for 10 years and dropped after prosthetic bypass after 4 years considerably, leading to a high amputation rate within 15 years. Up to 10 years most of the patients who died in the later period had an open reconstruction at death and had up to that time no walking problems. Death was due to coronary heart disease in 55.5% and cancer of the lung in 22.2%.
1051 extremities with arterial reconstruction and anticoagulant prophylaxis were followed for at least 15 to 25 years. The results as to patency rate were best in patients with anticoagulation permanently in the therapeutic range. Interruption of the prophylaxis led to occlusions in half of the patients, most within the first year. 42 bleeding complications occurred in 37 patients, 0.005 per treatment year, 0.002 gastrointestinal, 0.0004 cerebral, 0.0001 with fatal outcome. Most bleedings occurred within the first ten years, 0.6 per treatment year in the first, 0.38 between the third and the seventh year, reaching a steady level of 0.46 at twelve years. Prophylaxis after arterial reconstruction for peripheral arterial disease should be restricted to patients without contraindications, in whom an optimal anticoagulation can be achieved within the first year.
The results of 729 extremities, operated for peripheral vascular disease and followed for at least 15 up to 29 years are presented. 457 aortoiliac reconstructions are compared with 272 in the femoropopliteal area. All patients suffered only from intermittent claudication. The two groups were compared as to patency rate, reocclusion, amputation rate and mortality. It is of great interest, that the great majority of patients dying in the follow up have open reconstructions and have taken therefore advantage of surgery in being free of walking difficulties up to their death. The results of aortoiliac reconstructions are better, the patency rate is higher, the amputation rate lower, but even femoropopliteal reconstructions do better and have lower amputation rates than in natural course of the disease. Patients with intermittent claudication below 50 years of age should not be admitted to femoropopliteal surgery, because the risk of amputation before death is higher.
Between 1958 and 1972 1051 extremities have been operated. In this study localisation and degree of the disease have not been considered separately. 90% of the extremities have been followed for at least 15 years and up to 29 years. The results of patency rate, mortality, occlusion- and amputation rate are presented. For better judgment of these results a new form of presentation was chosen, in which in periods of 5 years, up to 25 years the percentage of living open, occluded and amputated extremities as well as that of died open, occluded and amputated extremities can be recognized. Contrary to the well established opinion a very restricted indication for surgery in the younger age group up to 50 years with only intermittent claudication is proposed. The younger these patients are at the time of surgery the more probable is the risk of amputation before death. On the other hand compared with spontaneous course of the disease postoperative and later amputation and death rate are not adversely affected by surgery. Whether in patients with intermittent claudication surgery reduces later amputation rates is at least very doubtful.
The results of 1051 extremities, operated for peripheral vascular disease are presented. The follow-up was at least 15 years, the longest 29 years. 778 extremities underwent surgery for intermittent claudication, 273 for rest pain or necrosis. The overall results are acceptable and encourage the indication for reconstruction even in intermittent claudication in patients over 50-years-old. The two groups of extremities were compared as to patency rate, reocclusion, amputation rate and mortality. It is of great interest that the great majority of patients dying in the follow-up have open reconstructions and have therefore taken advantage of surgery in being free of walking difficulties up to their death. Patients below 50 years with intermittent claudication should not be admitted to surgery, because the risk of amputation before death is great.
By means of two of our own cases we report on congenital esophagostenosis which occurs in a proportion of 1:50,000. The typical clinical symptoms consist of frequent vomiting, regurgitation of undigested food particles which have no acid smell, and regurgitation of viscous mucus and saliva. In the last decade direct operative treatment has taken the place of primary bougienage therapy.
This case report illustrates that the risk of thromboembolism in the treatment of tall girls with high dose oestrogens is not negligible.
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