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Biomedical subjects

S Martinoli

Publications and source records attributed to S Martinoli.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Excessive medical care menace quality].

We show how medicine and in particularly surgery risks to produce excessive services rendered. The excess of medicine always implies a loss of quality. We stress the fact of how important a maximal elimination of therapeutic insecurity in the doctor would be. During medical and surgical training, the intense observation of the geographic variations in operative frequency as well as habituation to serve critics concerning indications are an indispensible element for quality growth.

Cost Control↗
PubMed1995

[Ischemic preconditioning improves postischemic function, but not energy metabolism of skeletal muscles].

Ischemic preconditioning (IP) refers to a phenomenon whereby short periods of ischemia reduce tissue damage after a subsequent sustained ischemia. The effect of IP before tourniquet ischemia of the extremities has not yet been evaluated. We developed a rat model of skeletal muscle ischemia and measured the effect of IP on postischemic function and high-energy phosphate levels. IP consisted in three cycles of 10 min ischemia and 10 min reperfusion each. IP improved significantly skeletal muscle function after 3 hours of ischemia and 2 hours of reperfusion. High-energy phosphate levels, however, remained unchanged. This study is the first that shows a protective effect of IP in skeletal muscles. These results furthermore suggest that the protection of energy metabolism is not a mechanism of IP in this model. IP could be easily performed before surgery of the extremities under tourniquet ischemia. The protective effect on postischemic skeletal muscle has therefore to be further investigated.

Animals↗
PubMed1994

[Localized fibrous tumor of the pleura. 2 case reports and differential diagnoses].

The localized fibrous tumors of the pleura are rare neoplasms, also known as "benign pleural fibromas" or "localized mesotheliomas", but those names are inaccurate. The tumors are composed of undifferentiated mesenchymal cells, intermediate and differentiated fibroblasts and collagenous interstitial tissue. Their origin is normally the submesothelial layer of the visceral pleura. Mesothelial differentiation is not present. The grading of malignancy doesn't correlate with final outcome, adequacy of surgical excision being the most important factor. This neoplasm may recur but retain its basical histologic features. The positive results for vimentin and negative results for cytokeratin antibodies help to distinguish the localized fibrous tumors from the mesothelioma. We present too cases and their diagnostic possibilities.

Adult↗
PubMed1994

[Sacral chordoma: a consideration in low back pain].

We present the case of a sacral chordoma (S3-S5). Its diagnostic problems as well as its pathological properties and the epidemiologic situation are discussed. The therapy and the surgical procedure are outlined.

Adult↗
PubMed1994

[Diarrhea and peritonitis in infection caused by type A beta hemolytic streptococcus].

During the last years the cases of severe group A streptococcus infection have increased. The clinical manifestation of this streptococcal toxic shock syndrome is similar to the better known toxic shock syndrome (TSS) provocated by staphylococcus. Shock, bacteremia and acute respiratory distress syndrome are common features, and death has been associated with this infection in 30% of patients. We present the case of a 46-year-old man who fell gravely ill with sepsis, diarrhoe, scarlatina rash, desquamation of hands and feet and acute abdomen caused by group A streptococcus infection. Finally we discussed the possible port of entry of this infection, the different clinical manifestation and the concepts of treatment.

Appendectomy↗
PubMed1994

[The importance of surgical assistants from the viewpoint of the heads of surgery].

60 heads of surgical units of non-university hospitals in Switzerland were questioned about their opinion about their assistants. The questionnaire was divided into: general data about hospital size and number of assistants, employment criteria, further education, operative activities and working hours of assistants. The answers are representative for the situation in non-university hospitals in Switzerland.

Clinical Competence↗
PubMed1994

[Central liver lesion by a high velocity bullet with massive hemorrhage: what is the solution?].

The management of severe hepatic trauma may represent a challenge in the presence of haemodynamic instability, coagulopathy, hypothermia or metabolic failure. Moreover, the choice of treatment should consider the prevention of complications. The omentum has many advantages including hemostasis, infection preventing, viability and adaptability to reconstruction as a space filler. We report the case of a 19 year-old patient who sustained a gunshot wound, involving the right elbow and forearm and the abdomen with burst of right kidney and a penetrating centro-hepatic injury (stage IV). Surgical treatment was successfully performed in two times, by gauze packing for temporary control of haemostasis and after 24 hours by omental packing to fill the dead space of hepatic lesion. The viable omentum was placed through the hepatic hole and fixed posteriorly to the skin. The postoperative period was uneventful, excluding the development of a biliary fistula which resolved after external drainage. We conclude that omental packing is a valid solution when dealing with penetrating liver injury.

Abdominal Injuries↗
PubMed1994

[Status of portal perfusion in colorectal cancer. Swiss Study Group for Clinical Cancer Research].

533 patients with diagnosis of operable colorectal carcinoma were randomized to receive either a single course of portal infusion with Mitomycin-C (MMC) and 5-Fluorouracil (5-FU) starting immediately after operation, or no adjuvant treatment. Of these, 505 (94%) were evaluable. Over the median follow-up of 8 years, the adjuvant therapy reduced the risk of recurrence by 22% (Hazard ratio = 0.78%, 95% CI 0.61-0.99; P = 0.045). The relative reduction of relapse on death was similar in all subgroups (i.e. nodal status, localization). However, adjuvant portal chemotherapy proved to be most efficient in the subgroups of patients with tumor involvement of the regional lymph nodes (Dukes C) and of patients with colon cancer. Analysis of the pattern of relapse showed that most of the difference in overall and disease-free survival is to be attributed to a consistent reduction of all kinds of tumor recurrences (i.e. local relapses, liver metastases and/or other distant metastases) in the treated group, rather than to liver relapses alone. We conclude therefore, that part of significant benefit obtained for patients with operable colorectal carcinoma treated with a single course of adjuvant chemotherapy via the portal vein might be due to the additional systemic effects of the portal chemotherapy and further study of perioperative treatment with and without prolonged chemotherapy appears worthwhile.

Adenocarcinoma↗
PubMed1993

[Traffic deaths and traffic injuries: also an economic problem for society].

Based on an epidemiological observation on traffic accidents in the Swiss canton of Ticino, 1985, the following statement is possible: In Switzerland, 900 people die every year as a result of traffic casualties. Many victims of these accidents will be disabled for life. Direct and indirect costs of traffic injuries reach 3 billion Swiss francs a year. Only a small amount (6%) is devoted to medical treatment. The biggest part is due as compensation for lost income, disability allocations and loss of productivity. Among the avoidable fatalities those caused by traffic accidents have a very undesirable effect, because they involve mainly the young. More efforts should be undertaken to lower the mortality on the road, because it changes the Swiss population pyramid in a significant manner.

Accidents, Traffic↗
PubMed1993

Revisiting the most informed consumer of surgical services. The physician-patient.

Little is known about the consumption of medical and surgical services by the most informed consumer in the health care market: the physician-patient. Such knowledge should be important for the understanding of the role of information on consumption, supplier-induced demand, the doctor-patient relationship, unnecessary medical services, and the adequacy of professional practices to the renal health needs of the "ordinary patient." We measured by questionnaire the standardized consumption of seven common surgical procedures. Except for appendectomy, the age- and sex-standardized consumption for each of the common surgical procedures was always significantly higher in the general population than for the "gold standard" of physician-patients. The data suggest that (a) contrary to prior research, doctors have much lower rates of surgery than does the general population; and (b) in a fee-for-services health care market without financial barriers to medical care, less-informed patients are greater consumers of common surgical procedures.

Adolescent↗
PubMed1993

[How useful is mediastinoscopy today?].

The present retrospective study evaluates 197 mediastinoscopies, performed between 1981 and 1990. The aim of the study was an actual evaluation of mediastinoscopy as an investigation for diagnosis and staging of intrathoracic diseases. Although the introduction of CT-scanning has caused a considerable decrease in the number of performed mediastinoscopies per year, we find that mediastinoscopy because of its high sensitivity (75%) and specificity (100%) still has an important place in the evaluation of intrathoracic diseases. It represents no alternative to CT, but a complementary diagnostic tool. As a conclusion four indications for mediastinoscopy today are proposed.

Adult↗
PubMed1992

[Gardner syndrome: possibility of early detection of carriers by examination of the ocular fundus?].

Through indirect ophthalmoscopic examination it was possible to analyse three families originated from the same Swiss alpine valley (Poschiavo) and carrying Gardner syndrome (SdG) to check if their members with SdG were presenting hypertrophic changes of the retinal epithelium which is supposed to be an early symptom of that syndrome. This lesion was found to be present only in two out of 11 patients (18%) with at least one symptom of SdG. Because of its lacking sensitivity, ophthalmoscopic examination is not able to substitute colonoscopy as a valid screening method to find out which members of a SdG-family are at risk to develop colonic poliposis and cancer.

Chromosome Aberrations↗
PubMed1992

[Open fractures. The problem of their classification and solution using the IMT-NV de l'AO (Osteosynthesis Study Group) system].

The IMT-NV system proposed by the AO-ASIF for classifying soft tissue injuries associated with long bone fractures allows to avoid the troubles of the historical discussion between two different opinions: which is the most important feature of an open fracture? The extent of the skin lesion or the deeper muscular and neurovascular damage? This classification as it is proposed in the new AO-manual will bring more precision and more possibilities in comparing different surgical approaches to this hard challenge called open fracture.

Fractures, Open↗
PubMed1992

[Final evaluation of the randomized multicenter study SAKK 40/81: adjuvant portal chemotherapy of curatively resected colorectal cancer].

Between 1981 and 1987, 533 patients from 9 institutions have been entered in a randomized trial to assess the value of adjuvant portal infusion (5-Fluorouracil, Mitomycin C) compared to radical surgery alone. Analysis of 469 evaluable patients at a median follow-up of 5.8 years revealed 110 recurrences in the control and 94 recurrences in the infusion group. Estimated 5-year disease-free survival was 52% and 61% respectively (hazard ratio 1:0.75; 95% confidence interval 0.57-0.99; p = 0.046). Overall survival was 59% in the control and 69 in the infusion group (p = 0.048). Adjuvant portal infusion did not influence the occurrence of liver metastases but reduced the overall recurrence rate.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

[Esophageal manometry prior to and following anti-reflux surgery].

We analysed the esophageal manometry of 36 patients before, and of 25 patients 1 to 14 years (5.8 years) after, fundoplication. The results were compared with the findings in 30 asymptomatic volunteers. Fundoplication raised the mean lower esophageal sphincter pressure from 6.2 mm Hg to 14.5 mm Hg, i.e. normal values (controls 20.2 mm Hg). The shortened lower esophageal sphincter length and its intraabdominal segment were overcorrected (increase from 3.2 to 5.2 cm [controls 4.1 cm] and 1.3 to 2.6 cm [controls 2.1 cm] respectively). The rate of non-specific motility disorders after fundoplication was reduced from 61% to 28% (controls 7%). A clear relationship between the success of fundoplication and either preoperative or postoperative manometric results could not be established.

Adult↗
PubMed1990

[Desmoid tumor and Gardner syndrome: a little known surgical dilemma. Presentation of 2 cases].

Two patients affected with Gardner's syndrome and desmoid tumour are presented: a 35-year-old man without polyposis coli who developed a clavicular posttraumatic desmoid tumour, and a 52-year-old woman with polyposis coli who died of an intra-abdominal desmoid tumour 3 years after prophylactic colectomy. A close follow-up of patients with Gardner's syndrome for early detection of desmoid tumours after surgery is recommended.

Abdominal Neoplasms↗
PubMed1990

[Hanggliding accidents: epidemiology and clinical aspects].

The authors reviewed their experience with hanggliding injuries, and additional cases in the literature. As most accidents are due to how people fly (inexperience), and where people fly, the authors conclude that an adequate training is mandatory.

Accidents, Aviation↗