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Biomedical subjects

R Schlumpf

Publications and source records attributed to R Schlumpf.

At least 37 records · Page 2Linked to original sources
PubMed1997

Haemodynamic effects of pneumoperitoneum in elderly patients with an increased cardiac risk.

We studied the haemodynamic changes induced by pneumoperitoneum (PP) in elderly patients with increased cardiac risk (ASA class III; n = 10; age 72.3 +/- 8.8 years, mean +/- SD, P < 0.05; group 2) and compared the results with patients at normal risk (ASA class I, II; n = 12; age 55.6 +/- 11.8 years; group 1). Thermodilution measurements were performed after induction of general anaesthesia (T1), after onset of PP (T2, intraabdominal pressure 14 mmHg) and after additional 15 degrees head-up tilt (T3). In both groups PP, as compared with T1, induced a significant increase in mean arterial pressure (MAP, mmHg, group 1: 77 +/- 14 to 96 +/- 18, P < 0.05/group 2: 75 +/- 10 to 102 +/- 18, P < 0.01), mean pulmonary artery pressure (MPAP, mmHg: 15 +/- 5 to 22 +/- 4, P < 0.01/18 +/- 3 to 25 +/- 5, P < 0.01), central venous pressure (CVP, mmHg: 7 +/- 2 to 15 +/- 3, P < 0.01/7 +/- 2 to 12 +/- 2, P < 0.01), pulmonary capillary wedge pressure (PCWP, mmHg: 9 +/- 4 to 16.3, P < 0.01/8 +/- 2 to 15 +/- 6, P < 0.01) and in systemic vascular resistance (SVR, dynes s cm-5: 1415 +/- 375 to 1873 +/- 412, P < 0.01/ 1502 +/- 360 to 2067 +/- 647, P < 0.01). Cardiac index (CI, L min-1 m-2: 2.3 +/- 0.3 to 1.9 +/- 0.3, P < 0.05/2.2 +/- 0.4 to 2.2 +/- 0.5 P = 0.76) and oxygen delivery index (DO2I, mL min-1 m-2: 388 +/- 54 to 324 +/- 61, P < 0.05/358 +/- 69 to 353 +/- 82, P = 0.77) decreased in group 1 but not in group 2. Heart rate, stroke Index, pulmonary vascular resistance, arteriovenous oxygen content difference and oxygen consumption index were unchanged. After head-up tilt MAP (mmHg, 92 +/- 15, P < 0.05/ 101 +/- 17, P < 0.01), MPAP (mmHg, 20 +/- 3, P < 0.01/22 +/- 4, P < 0.05), CVP (mmHg, 12 +/- 2, P < 0.01/10 +/- 2, P < 0.01) and PCWP (mmHg, 12 +/- 3, P < 0.05/12 +/- 5, P < 0.05) remained elevated compared with T1 in both groups, SVR (dynes s cm-5, 1575 +/- 372, P = 0.13/1793 +/- 528, P < 0.01) in group 2 only. No complications occurred. The results indicate that PP is associated with significant but relatively benign haemodynamic changes. Anaesthesia for laparoscopic cholecystectomy may be performed safely also in elderly ASA class III patients with increased cardiac risk. An adequate haemodynamic monitoring is recommended.

Aged↗
PubMed1997

Pyelonephritis and vesicoureteral reflux after renal transplantation in young children.

PURPOSE: We assessed morbidity and risk factors of pyelonephritis in children after renal transplantation. MATERIALS AND METHODS: Between 1986 and 1995, 41 children underwent transplantation and all who had documented pyelonephritis were evaluated. RESULTS: Six children who underwent transplantation before age 7 years had 1 to 3 episodes of pyelonephritis with significant renal dysfunction and vesicoureteral reflux into the grafted system. An antireflux reimplantation procedure in 5 children was complicated by temporary functional obstruction in 3. No further infection occurred after correction of vesicoureteral reflux. After a median of 4.5 years post-transplantation all patients have a functioning graft. CONCLUSIONS: After renal transplantation vesicoureteral reflux and young recipient age are major risk factors for pyelonephritis with subsequent graft dysfunction.

Adolescent↗
PubMed1997

Experimental technique for (laparoscopic) bowel anastomosis: transient endoluminally stented anastomosis (TESA).

A new technique for bowel anastomosis is presented. The principle of transient endoluminally stented anastomosis (TESA) is based on anastomosing the two bowel ends around a resorbable stent of polyglycolic acid (PGA) in seroserosal contact. To evaluate the feasibility of TESA for bowel anastomosis, laparoscopic colon anastomosis following sigma resection was performed in five juvenile pigs. Three animals were sacrificed 2 months postoperatively, and the anastomoses were examined radiologically and histologically. One animal was sacrificed at day 2, suffering from acute peritonitis due to small bowel leak but with regular colon anastomosis. One trial was terminated at the fourth postoperative day because of insufficiency of the colon anastomosis. Three animals did not have any complications during the 2-month follow-up. In these animals the colon anastomoses were not detectable radiologically at the time of death. The microscopic examination showed intact mucosal and muscular layers without foreign material. Our study demonstrates that laparoscopic application of TESA to colon anastomosis is a feasible method. These results will further stimulate our future research for an anastomosis technique avoiding remnant foreign material.

Anastomosis, Surgical↗
PubMed1997

Stones spilled during cholecystectomy: a long-term liability for the patient.

Within the last 2 years, an increasing number of case reports concerning stone spillage during laparoscopic cholecystectomy and its long-term consequences have been published. Recently three patients were treated for abscesses caused by spilled stones at our institution. One of them had the longest interval between cholecystectomy and abscess formation on record. Her abscess developed 20 years after open cholecystectomy. The second patient had been admitted with one of the few cases of cholelithopthysis reported after laparoscopic cholecystectomy. All three cases and their long history of recurrences clearly underline the necessity for open debridement and drainage with stone removal for definitive treatment of these patients.

Abscess↗
PubMed1996

[25 years of dialysis and kidney transplantation in children and adolescents].

Between 1970 and 1994 84 children and adolescents with end stage renal failure (ESRF) were started on renal replacement therapy (RRT). Renal transplantation was the main goal from the beginning. The long term results were evaluated with emphasis on survival, development and social integration. RRT was started in nearly half of the children (45%) between the age of 10 and 15 years and in 14% before 5 years. 52 patients were first treated by hemodialysis (HD) and 27 by peritoneal dialysis (PD, since 1979). 5 patients underwent preemptive transplantation. By December 1994, 75 patients had received 99 grafts, i.e. 75 1st, 21 2nd and 3 3rd grafts; 3 kidneys were from living related donors and 8 patients were transplanted elsewhere. 7 patients were still on dialysis and 2 had died before transplantation. Actuarial patient survival (Kaplan-Meier) after start of RRT is 88% at 10 years and 75% at 17-25 years. Actuarial patient survival after first transplantation increased from 91% (1970-1984) at 5 years to 97% (1985-1994). 7 of the first 10 patients transplanted from 1970-1974 are alive, all with functioning grafts (4 with their first graft). 9 patients died after transplantation: 4 of recurrent disease, 2 of viral (CMV, EBV) infections and 1 each of spinalioma, allergic shock and traffic accident. First graft survival was 37% at 10 years. It increased from 53% (1970-1984) to 72% (1985-1994) at 5 years. The main causes of first graft loss (n = 33) were irreversible rejection (21) and recurrent disease (7). All patients aged > 22 years were further evaluated: patients with start of RRT 1970-1979 (group A, n = 18) were compared with those starting RRT from 1980-1987 (B, n = 19). Mean adult height in A was less than in B (163.9 cm vs 168.5 cm in men; 146.3 cm vs 156.5 cm in women). 50% in A vs 32% in B had a disability. Fewer patients in A (39%) than in B (62%) were fully employed. Considerably more patients in A (61%) than in B (37%) lived with their parents or siblings although the mean age in A was 31 years vs 25 years in B. 3 women were married (all in B), 2 of them gave birth to 3 healthy children and the third was pregnant. Long term patient and graft survival, somatic development and social integration have improved over the years due to a variety of factors. A comprehensive approach is necessary in treating children with ESRF.

Adolescent↗
PubMed1996

Laparoscopic ultrasonography during cholecystectomy.

The routine use of intraoperative cholangiography during cholecystectomy has been debated extensively. Intraoperative ultrasonography was a quick, efficient alternative in open cholecystectomy. A prospective controlled trial to evaluate its usefulness in laparoscopic cholecystectomy is reported. Two groups of 100 patients each were examined during operation with laparoscopic ultrasonography and intraoperative cholangiography. In the first group an adapted urethral probe was used and in the second group a new specialized laparoscopic probe. Intraoperative cholangiography followed immediately after laparoscopic ultrasonography in each patient. In group 1 bile duct stones (n = 4) were detected with a sensitivity of 100 and 75 per cent, a specificity of 98 and 99 per cent, and an overall accuracy of 98 per cent for both ultrasonography and cholangiography. In group 2, 11 patients demonstrated common duct calculi. The sensitivity, specificity and overall accuracy for laparoscopic ultrasonography and intraoperative cholangiography were 91 and 64 per cent, 100 and 100 per cent, and 99 and 96 per cent respectively. The differences between groups 1 and 2 and between ultrasonography and cholangiography were not significant. Variations in the anatomy of the bile duct were observed in 21 patients in group 1 by laparoscopic ultrasonography and in 20 by intraoperative cholangiography. In group 2, 64 variations were demonstrated in 50 individuals by ultrasonography and 61 variations in 47 patients by cholangiography. Vascular variations were seen with ultrasonography in 22 and 24 patients in groups 1 and 2 respectively. In conclusion, laparoscopic ultrasonography (with either probe) proved as accurate as intraoperative cholangiography in detecting bile duct stones, and the specialized probe detected significantly more variations of the bile duct than the adapted probe.

Adolescent↗
PubMed1996

Preoperative risk assessment in elective general surgery.

Despite improved surgical techniques there is still a risk of mortality in elective general surgery. In a prospective study preoperative data from 3250 patients were collected and compared with postoperative systemic complications, using univariate chi 2 analysis. Highly significant (P < 0.00001) variables were subjected to stepwise logistic regression analysis. The severity of operative procedure, higher American Society of Anesthesiologists (ASA) grade, symptoms of respiratory disease and malignancy were found to be significant risk factors predicting postoperative morbidity (P < 0.05). Using these four variables, a simple preoperative risk scoring system has been defined. Class A (up to 5 points) was defined as a low-risk group (systemic complication rate 5.0 per cent), class B (5-7 points) was intermediate risk (systemic complication rate 17.9 per cent) and class C (8-10 points) was high risk (systemic complication rate 33.3 per cent). Patients at high risk for perioperative and postoperative complications are more likely to be identified by this analysis than by using the ASA classification alone.

Elective Surgical Procedures↗
PubMed1996

A novel dextran 40-based preservation solution.

Although the University of Wisconsin (UW) solution has become the standard solution for the preservation of kidneys for transplantation, the importance of the colloid hydroxyethylstarch (HES), one of the key compounds of the UW solution, has been questioned repeatedly. It is now established that HES is not necessary for routine kidney preservation. However, colloids may still be advantageous in UW like solutions for the purpose of multiorgan procurements and the preservation of organs from marginal donors. It has been shown in various experimental models that dextran 40 may successfully substitute for HES. Dextran 40 is not only cheaper but also has a variety of biological effects that may be beneficial during the graft reperfusion phase. The aim of this clinical study was to examine the efficacy of a dextran 40-based preservation solution (Dex-PS) for its use in human kidney graft preservation and to compare the transplantation results with kidneys preserved with UW solution. A total of 87 kidneys were preserved with Dex-PS and matched with 87 kidneys preserved with UW solution. Both groups were comparable in terms of donor and recipient characteristics and both had a high proportion of kidneys from nonheart-beating donors. Patient survival and graft survival after 1 year were 95% and 86% for the Dex-PS group and 94% and 90% for the UW group, respectively (P = NS). Primary nonfunction, delayed graft function, postoperative need for dialysis, and follow-up of serum creatinine were statistically comparable between these two groups. We conclude that dextran 40 can safely replace HES in UW solution for the purpose of clinical kidney preservation. There were no statistically detectable differences in graft performance between the kidneys preserved with UW and those preserved with Dex-PS.

Adenosine↗
PubMed1996

Sterno-laparotomy and extracorporeal circulation for liver transplantation after repeat-surgery for Budd-Chiari syndrome.

The surgical management of two patients undergoing living transplantation for Budd-Chiari syndrome is reported. Mesenteriocaval shunt had previously been performed in both cases, followed by transcaval liver resection and hepatoatrial anastomosis after 3 and 5 years, respectively. Liver transplantation was necessitated by deteriorating liver function with portal hypertension and recurrent bleeding. The successful operation was performed via sternolaparotomy. Atrioatrial anastomosis was constructed during cardiopulmonary bypass, considerably simplifying the technical procedure and dramatically reducing blood loss.

Adult↗
PubMed1996

Rapidly progressive portal hypertension 23 years after post-traumatic arterioportal fistula of the liver.

Intrahepatic arterioportal fistulas may occur after blunt abdominal trauma and lead to severe portal hypertension, which can be prevented by early diagnosis and treatment. The diagnostic workup of an asymptomatic young male with elevated transaminases revealed an arterioportal fistula secondary to a traumatic liver rupture during childhood, 23 yr earlier. Three years after initial diagnosis, the patient presented with gastrointestinal hemorrhage. Progression of portal hypertension had resulted in esophageal varices and ascites. After ligation of the right hepatic artery, the esophageal varices and ascites disappeared. Twelve months after surgery, the patient is asymptomatic without any signs of liver decompensation or recurrence of gastrointestinal hemorrhage. Our case demonstrates that rapid progression of portal hypertension with severe complication can occur in patients with arterioportal fistula after a long-lasting asymptomatic course of 23 yr. Simultaneous chronic hepatitis C may have a contributory role.

Accidents, Traffic↗
PubMed1996

[Intraoperative ultrasonography of the liver].

INTRODUCTION: In many centers specialized in hepatobiliary surgery intraoperative sonography (IOUS) has become a mandatory intraoperative diagnostic tool for intraoperative decision making. We have started applying this technique during liver recections and operations for cancer of the colon in 1988. This presentation is a retrospective report on the first author's personal experience with this technique. PATIENTS AND METHODS: Ninety-two patients were examined intraoperatively, either at Zürich University Hospital or Groote Schuur Hospital in Cape Town. There were 37 female and 55 male patients aged 21 to 84 years (average: 56 yrs). Thirteen patients had primary malignanctes of the liver (group 1) and37 patients underwent IOUS during liver resection for secondary liver tumors (group 2). 14 patients were scanned during operation for benign lesions of the bile ducts and liver (group 3). 28 patients were screened for metastases during resection of gastrointestinal cancers (group 4). The equipment consisted of an Aloka Echocamera SSD 630 and a T-shaped 5 MHz small part in Zürich and a Siemens SI 400 unit with a similar scanner in Cape Town. RESULTS: In group 1 IOUS demonstrated additional information in 9 patients and changed operational procedure in 7 cases. In group 2 IOUS improved on preoperative imaging in 17 cases and changed the approach in 14. Seven patients with benign lesions profitted from IOUS. Additional information changing surgical procedure was gained by IOUS in 6 patients of group 4. CONCLUSIONS: IOUS is a valuable intraoperative imaging technique which is easily performed by the surgeon himself. It should be part of every operation for cancer of the colon and every resection of the liver.

Adult↗
PubMed1996

Comparison of two antilymphocyte globulins replacing cyclosporin A after first kidney allotransplantation and prolonged graft ischemia.

ATG/Fresenius (5 mg/kgBW) and ATGAM (Upjohn, 12.5 mg/ kgBW) replacing cyclosporin A were given during 7 d after transplantation to 20 patients in 1992 and 30 patients in 1993, respectively. Numbers of mismatches, combined kidney-pancreas transplantation and severe infections were not different for the two groups. However, prednisone pulse therapies and additional antilymphocyte globulin treatments were more frequent after ATGAM than after ATG induction (p < 0.01, chi 2-test).

Antilymphocyte Serum↗
PubMed1996

[Biliary and gastrointestinal bypass: laparoscopic possibilities].

OBJECTIVE: Although surgical biliary bypass for non-resectable peri-ampullary tumors is superior to endoscopic stent placement, the latter has become popular because of its "minimally invasive" approach. Laparoscopic biliary bypass would appear to offer the advantages of both. However, this technique remains technically difficult using existing instrumentation. In this paper the efficacy of a new endoscopic device designed for rapidly completing a small diameter intestinal anastomosis under laparoscopic guidance is summarized. METHODS: In 57 female pigs different techniques for laparoscopic choledocho-jejunostomy have been evaluated. 36 animals underwent a new instrumental anastomosis (TESA = temporary endoluminally-stented Anastomosis) using different size absorbable stents. The results have been compared with 21 animals undergoing laparoscopically handsewn anastomosis. Follow-up and results were identical with minimal differences in final diameter of bile ducts and anastomoses but the operating time was significantly less in the animals operated by TESA-technique.(105 versus 165 min, p < 0.01). CONCLUSIONS: Applying TESA or handsewn anastomosis, laparoscopic choledochojejunostomy can be performed rapidly and safely revealing good bypass function over a period of three and six months respectively. With regard to treatment for non-resectable peri-ampullary tumors TESA may offer a new therapeutic approach combining the benefits of minimally invasive endoscopic stent placement with the functional results and lower readmission of conventional Roux-en-Y choledochojejunostomy.

Anastomosis, Surgical↗
PubMed1996

[The mesh prosthesis, indispensable component in safe hernia repair?].

The recent and actually ongoing development does not allow to design an undeniable state of the art strategy for the repair of primary and recurrent hernias at this moment. For primary hernias the posterior approach with placement of a prosthetic mesh, whether conventionally or endoscopically, is not yet a recommendable common standard. However, due to its potential advantages the endoscopic mesh hernioplasty is a choice to be offered to the patients with informed (including alternative methods) consent. Less invasive, simple techniques will remain or become the methods of first choice; Shouldice might keep its importance but Lichtenstein (a method using a mesh!) will spread out in the near future. For the repair of recurrent hernias the posterior, prosthetic hernioplasty- by the open or more and more by the endoscopic route-has become a new standard in a lot of institutions. In this situation the more invasive anaesthesia and implantation of a foreign body is easily justifiable. Surgeons strictly adhering to the anterior approach, might intraoperatively decide to perform an "anterior onlay" according to Lichtenstein or an "anterior sublay" according to Rives. Thus, the use of a prosthetic mesh for hernia repair is becoming more and more common, by the anterior approach for the primary hernia, mostly by the posterior (endoscopic) approach for the recurrent hernia.

Endoscopy↗
PubMed1996

[Technical aspects of minimally-invasive cancer surgery of the colon: the complete laparoscopic procedure].

A literature review of current laparoscopic colon resection techniques in cancer clearly demonstrate prevalent violation of cancer surgery rules as defined in conventional procedures. Non performed Turnbull-manouver, mobilization of the affected bowel segment prior to ligation of vessel supply and questionable non-touch-technique due to pull through of the tumor prior to resection mainly account for this mal-strategy. Owing to a new instrument (EPR 18/70) a concept for total laparoscopically achieved resection and re-anastomosis as well as the possibility to put Turnbull-bandings is presented. In an experimental (n = 168) and preliminary clinical application (n = 11) encouraging results have been achieved leading not only to a strategy for safe and effective application of circular staplers but also to a concept for laparoscopic bowel resection in cancer which is close to the common conventional strategies.

Colonic Neoplasms↗
PubMed1996

[Efficacy of organ exchange rules in a 7 million population nation].

The suitability of organ exchange rules were analysed retrospectively in a country with a population of 7 million not connected to international organ sharing organisations following the opening of a national coordination centre 2 years previously. The results demonstrate that the sharing rules work frictionless and efficiently, and that compulsory registration of every organ donor (cadaveric and living) guarantees entire transparency of organ source and exchange, therefore preventing any illegal activity. An unacceptably high mortality rate for patients awaiting a highly urgent organ (specifically heart or liver) shows that connection to an international organ exchange organisation is desirable in this respect.

Health Care Rationing↗