Biomedical subjects

R Inderbitzi

Publications and source records attributed to R Inderbitzi.

46 records · Page 3Linked to original sources

PubMed1990

[Experiences in the diagnostic and surgical video-endoscopy of the thoracic cavity].

Thoracoscopy is a well-established method for diagnostic evaluation of various manifestations of intrathoracic disease, with a high degree of sensitivity and specificity. While a rigid telescope is generally used, we have modified this technique by connecting a CCD-chip-camera to the thoracoscope to achieve direct visualization for observers. 52 patients were examined in this manner, 18 for diagnostic reasons and 35 for therapeutic purposes. The mean age of the patients was 55 years, ranging from 26 to 84 years. Potential risk factors associated with this modified endoscopic procedure were analyzed. Mortality was zero, but complications occurred in 5.6%. Surgical re-intervention was necessary in two cases for control of postoperative intrathoracic hemorrhage; in another case the introductory trocar caused superficial injury to the lung without further consequences. In these complications extensive scarring of the pleura was noted. It is only natural that the rate of complications is closely associated with a learning period during which the operative technique is improved. Following adequate mastery of the technique our goal is presently to treat spontaneous pneumothorax and malignant effusions by thoracoscopy. We strongly recommend treatment of malignant effusions and pneumothorax by thoracoscopy as a primary procedure and not secondarily when blind attempts at pleurodesis have failed and given rise to partially obstructive adhesions.

Adult↗

PubMed1990

[Colonic perforation following blunt abdominal trauma].

We describe the case of a fisherman who developed a delayed colonic perforation after falling into the bed of a stream. Colonic perforations after blunt abdominal trauma are not common; they mainly occur after a trauma of sudden deceleration, i.e. usually a traffic accident. Delayed perforations occur relatively frequently and are difficult to diagnose. In the initial stages the common diagnostic procedures are of little help and - except for early peritonitis - the clinical signs may be masked behind more impressive injuries. The history of sudden deceleration and the finding of persistent abdominal tenderness may point to the imminent or manifest perforation. Usually the correct diagnosis is made at laparotomy performed for suspected abdominal injury.

Abdominal Injuries↗

PubMed1990

[Acute appendicitis: avoiding unnecessary laparotomy in young women].

Eighty-eight consecutive patients undergoing surgery for clinical diagnosis of appendicitis are reviewed. The diagnosis was correct in 71 (85%), incorrect in 17 (15%). Of these 17 patients 5 suffered from other diseases demanding surgical treatment (diverticulitis, cholecystitis, torsion of ovarian cyst, pyosalpinx). Pain migration, local tenderness and WBC greater than 10,000/mm3 were significantly associated with appendicitis, whereas duration of pain, défense musculaire and body temperature did not allow any discrimination. In men, the diagnosis was correct in 42 out of 43, whereas in women only in 34 out of 45. All 11 women with incorrect diagnosis were less than 35 years old. We conclude that the diagnosis of appendicitis is particularly difficult in women younger than 35 years.

Acute Disease↗

PubMed1990

[Cystadenoma of the pancreas].

We report on a patient with a microcystic adenoma of the head of the pancreas. Cystic neoplasms of the pancreas comprise only about 2% of all exocrine tumours. They can be divided into two distinct groups with different prognoses: the microcystic glycogen containing tumours, which are always benign and the mucinous cystic tumours, the majority of which shows malignant dysplasia. Clinically they manifest as a palpable abdominal mass with unspecific upper abdominal pain. Preoperative diagnosis is difficult to achieve. Computer-tomography and ultrasound are the main radiological facilities that allow some degree of differentiation. During operation a frozen section is mandatory to differentiate between a pseudocyst and a real cyst with epithelial wall. Resection of the tumour is the therapy of choice. The prognosis of the microcystic adenoma is good, the prognosis of the mucinous cystadenoma-cystadenocarcinoma is much better than the prognosis of the adenocarcinoma of the pancreas.

Cystadenoma↗

PubMed1990

[The value of suprageniculate femoro-popliteal polytetrafluoroethylene prosthesis in surgical treatment of chronic arterial occlusive disease].

From January 1982 to December 1989, 74 patients with chronic critical ischemia were treated with an above knee-femoropopliteal PTFE-Bypass. The 5-year cumulative patency rate was 48%, the cumulative limb salvage rate 66%. In the same observation period 40 patients with a reversed saphenous vein above knee-Bypass were also followed-up. In this group the cumulative 5-year patency rate amounted to 77% and the limb salvage rate to 100%. The autogenous saphena magna is the conduit of choice for lower extremity artery bypass grafting. It showed in above knee reconstructions statistically significant superior results in comparison to PTFE grafts.

Adult↗

PubMed1990

[Acute mesenteric ischemia].

83 patients with acute intestinal ischemia are presented. The aim of the study is to characterize anamnestic and clinical signs of this severe disease. Mainly old people with various cardiac illnesses suffer from acute intestinal ischemia. Precise anamnesis sometimes leads to the etiology of the obstruction. Clinical examination may show the extent of the disease. Angiography is mandatory for correct diagnosis. Early recognition and aggressive therapy significantly improve prognosis.

Acute Disease↗

PubMed1989

[Inflammatory aneurysm of the abdominal aorta and ureteral obstruction].

The incidence of inflammatory abdominal aortic aneurysm (IAAA) is reported in between 5 and 15% of all cases of abdominal aortic aneurysms (AAA). As a diagnostic hint the CT- or MRI-scan shows the ureters typically displaced medially, caused by a simultaneously visible retroperitoneal perianeurysmal fibrosis. In IAAA, one has to expect about 25% ureteral congestion, uni- or bilateral. Since the probability of rupture of IAAA--in the natural course between 15 and 25% of the cases--does not apparently differ much from the arteriosclerotic AAA, the operative aorto-iliac reconstruction with bypass grafting is the only solution and procedure of choice. Postoperatively, renal insufficiency caused by congestion normalizes: long-term follow-up by CT-scanning demonstrates the regression of both retroperitoneal fibrotic process and ureteral entrapment. Therefore, the dangerous ureterolysis results to be unnecessary. Hydronephrosis due to ureteral obstruction following aorto-iliac bypass grafting, if progressive or symptomatic, should be treated first non-operatively by ureteral splint.

Aorta, Abdominal↗

PubMed1986

[Significance of thymectomy in the treatment of myasthenia gravis pseudoparalytica in a patient sample in Bern].

A retrospective assessment has been made of the medium to long-term outcome in 40 consecutive patients with myasthenia gravis in whom thymectomy was performed. Treatment of myasthenia gravis, when combined with thymectomy, was associated with a 40.6% complete remission rate and with partial remission in 43.8% of our cases, provided no thymoma was present. In the latter cases (n = 8) the results of surgical treatment were significantly poorer. This is in accordance with other reports in the literature. Based on our experience we are convinced that radical extended thymectomy, including resection of neighbouring mediastinal fat tissue, using longitudinal sternotomy for access, is the method of choice. This mode of treatment has been advocated by a number of authors in recent years, and we have reason to believe that this therapeutic concept will give rise to improved results in the patient group with thymoma also. In our series, such factors as sex, age and time interval between onset of disease and operation date were of minor importance and had no significant prognostic value. Due regard must of course be paid to the unspecific risks associated with age. Operative thymectomy is indicated whenever myasthenia gravis is diagnosed, with the exception of those cases presenting with ocular symptoms alone (group 1 of Osserman's classification).

Adolescent↗

PubMed1984

[Disability and type of assistance for the aged in a mountainous region].

Based on identical interviews, the frequency of functional disability and the type of help for the handicapped is compared between the aged populations of a Swiss mountain valley and of an urban area. Functional disabilities are more frequent in the mountain population. When help is needed, the aged in the mountain area receive it from their spouse or another family member, whereas help in urban circumstances is provided by spouses or by institutions.

Activities of Daily Living↗

PubMedDate not supplied

Thoracoscopic wedge resection.

Thoracoscopic surgery is decidedly expanded by the ability to perform pulmonary wedge resections of the lung by using the Endo-GIA-stapler. In addition to thoracoscopic biopsies, since July 1991 we have carried out wedge resections in 12 patients suffering from spontaneous pneumothorax (nine) or peripheral bronchial carcinoma (three). Postoperatively one air fistula persisted over 9 days. The chest tube was removed within 48 h in all other patients. There was no other major complication. The postoperative hospitalization period lasted 4.6 days (1-9 days). Operating time was 44 min (30-70 min). The benefit for the patient consists in the little-impaired breathing mechanics, the short hospital stay, and the favorable cosmetic result.

Adenocarcinoma↗