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U Metzger

Publications and source records attributed to U Metzger.

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

[How risky is lung resection today?--perioperative morbidity and mortality in open thorax surgery].

We retrospectively analyzed hospital morbidity and mortality following primary open lung surgery from August 1990 to December 1994 in 187 consecutive patients. 180 pulmonary resections and 7 exploratory thoracotomies were performed in 141 men and 46 women, with mean age 60.4 +/- 11.9 years. 142 patients were aged < 70 years (median 58.5), and 45 (25%) > 70 years (median 73). Tumor stage as well as preoperative ASA classification and FEV1 were similar in these age groups. No difference could be found in hospital morbidity of elderly compared to younger patients (> or = 70 years: 40%; < 70 years: 40.8%), but 30-day mortality was higher in elderly (8.9% versus 2.8% in younger subjects). Elderly patients who died postoperatively presented a higher preoperative risk (ASA 2.75) compared to nonfatal cases in the same age group (ASA 2.18). Morbidity and mortality increased with the extent of surgery; the 30-day mortality was nil in the group of wedge and segmental resections (0/23), 1.9% in lobectomies (2/106) and 7.8% in pneumonectomies (4/51). Our results in general match those of comparable centers in Switzerland and the international literature. Since the overall complication rate was not increased compared to younger patients, we assume that polymorbidity of single cases was the cause of higher mortality after extended open lung surgery in septuagenarians and octogenarians. In consequence, the scope of surgery should be reduced as far as possible. In addition, the perioperative risk for the senescent patient can be improved by identification of high risk cases. With this attitude we take the view that lung resection can honestly be recommended to the elderly also.

Adolescent↗
PubMed1997

Long-term complete remission of melanoma liver metastases after intermittent intra-arterial cisplatin chemotherapy and surgery.

This paper presents the case of a female patient with liver metastases of a malignant melanoma showing complete remission after 10 courses of regional, intra-arterial chemotherapy with cisplatin. The drug was administered as continuous infusion for 5 days. The daily dosage amounted to 30 mg/m2. The interval between courses was 6 weeks. Nausea and vomiting were seen after each course, while pathological serum creatinine levels only appeared after the eighth course. The only lesion in the liver still visible on CT scan after chemotherapy was removed by left hemihepatectomy. Meticulous histological examination revealed a big focus of necrotic tissue without any tumour cells. At the time of publication the patient is alive and disease-free over 9 years later.

Antineoplastic Agents↗
PubMed1996

[The animal health card for dairy cows--an instrument for veterinary herd health care and quality assurance in milk production].

A chart (62 x 82 cm) for veterinary herd health management based on a hand written card system is presented. The chart serves basic needs especially in small Swiss dairyherds. It is easily understood and immediately installed for the end user, the farmer and veterinarian. Furthermore an EXCEL-based tool is programmed to assist in standard data analyses. This chart meets the needs for documentation in quality assurance programs within dairy production.

Animals↗
PubMed1996

[Technique and results of laparoscopic rectum resection].

The general principles of oncologic operations for colorectal cancer are the same for both open and laparoscopic surgery. Isolation of the tumor by occlusion of the intestinal lumen, early blockage of venous outflow, complete resection of the lymph node bearing mesenterium, high ligation of the artery and prevention of tumor cell dissemination during extirpation of the specimen are the most important factors. We present our technique for laparoscopic abdominoperineal resection, which fulfills the above mentioned criteria. From June 1993 to October 1994 we operated on 19 patients (median age 68 [47-91] years; male/female ratio 10/9). Laparoscopic abdominoperineal resection of the rectum was palliative in 3 patients and curative in 16. Tumors were located 3 (1-8) cm from the anal verge. In 3 patients the operation was converted to open surgery. Intraoperative complications were encountered in 3 patients. Median operation time was 300 (200-400) minutes and postoperative morbidity 8/19 (42%) leading to reoperation in one patient. 30-day mortality was nil. Three patients died 5, 8, and 14 months postoperatively due to metastatic disease (all 3 after initial palliation). One patient had local recurrence and liver metastasis and died 14 months after operation. Another patient died from liver metastases. In one patient a single liver metastasis was successfully removed. 14 patients were tumor-free after a median follow-up of 10 (3-14) months. There was no implantation metastasis on a trocar site. Laparoscopic abdominoperineal resection of the rectum is feasible and the results are comparable with those of open surgery. Local recurrence rate and incidence of liver metastases are comparable with open surgery after this short follow-up. However, 5-year survival is needed to judge the oncological radicality of laparoscopic abdominoperineal resection of the rectum.

Adenocarcinoma↗
PubMed1996

[Lung surgery in elderly patients--an increased risk?].

During 1990 to 1994, 180 pulmonary resections and 7 exploratory thoracotomies were performed and retrospectively analyzed for age-dependent hospital morbidity and mortality. Out of 141 men and 47 women (average age 60.4 +/- 11.9 years), 45 patients were 70 years or older (median 73 years). Mean ASA classification values were similar between patients under 70 years of age and the elderly (2.17 +/- 0.72), mean FEV1 was reduced in the group of old aged (2.45 +/- 0.61 vs. 2.71 +/- 0.82). No difference could be found in hospital morbidity of septuagenarians and octogenarians compared to younger patients (> or = 70 years: 40%; < 70 years: 40.8%), although hospital mortality increased in the elderly (11.1% vs. 3.5% in younger) with lethal cases presenting a higher preoperative risk rate (ASA 2.75 vs. 2.18). In conclusion, we did not experience an increased overall rate of complications after open lung surgery in the elderly, however, the risk of mortality increased in senescent patients with the appearance of a complication.

Aged↗
PubMed1995

Is there still a place for abdominoperineal resection of the rectum?

During the past two decades, low anterior resection (LAR) with colo-rectal or colo-anal anastomosis has replaced abdominoperineal resection (APR) as the primary surgical therapy for rectal cancer. Several studies, although not prospectively randomized, have shown that the outcome after LAR with deep anastomosis and APR is comparable concerning mortality, local recurrence rate and survival. Adequate clearance of the tumour, and not the surgical procedure performed, is the determinant factor influencing the outcome. Whereas most tumours in the upper third and mid-rectum are amenable to a sphincter-saving procedure (SSP), the lower third of the rectum is of debate in this respect. Small tumours (T1) in the lower third can be treated by peranal local excision. Low grade tumours with a T2 or T3 stage located above 3 cm from the dentate line are treated by SSP. There is still a place for for advanced tumours (T3 and T4) below 5 cm from the anal verge, in case of deficiency of the anal sphincter, and when the sphincter complex is infiltrated by the tumour. Preoperative staging measures are essential for patients selection in relation to height of the tumour above the anal canal, depth of tumour invasion into the rectal wall, and presence or absence of regional lymph node metastases. Biology of rectal cancer and its implication on surgery, preoperative staging of rectal cancer, technique and results of the main three surgical options, and the advent of laparoscopy are discussed in this article.

Abdomen↗
PubMed1994

[Anterior resection of the rectum by double stapling. Retrospective study of 100 consecutively operated patients].

The double stapling technique for anterior resection of the rectum since its first description in 1980 has greatly facilitated the anastomosis of the low rectum. Few people use it also for high anastomosis of the rectum, the majority preferring hand-suture. We used this technique for 100 consecutive anterior resections of the rectum performed between August 1990 and November 1992. 51 patients had diverticulitis, 46 had carcinoma of the rectosigmoid colon, 2 had complications after pelvic irradiation and one had Crohn's disease. Surgical complications occurred in 22 patients. They include 8 patients with anastomotic leak (4 severe and 4 minor), all operated for carcinoma. Mortality was 3%. Our experience shows that this technique can be safely performed in a teaching hospital with many surgeons. It was a safe technique for high anastomosis. Surgical complication rate was higher in patients with recurrence of carcinoma and in patients previously irradiated.

Adult↗
PubMed1994

[Isolated fracture of the lesser tuberosity of the humerus: case reports and review of the literature].

Only 17 cases of isolated avulsion fracture of the lesser tuberosity have been reported in the literature since Hartigan's report in 1895. Whereas in children, conservative treatment is almost successful, in adults operative restoration is the method of choice in order to obtain full painless range of motion with normal strength of muscle control. Surgical excision of the fragment of lesser tuberosity after failed conservative treatment may relieve the patient's symptoms. Three own cases and a review of the literature are discussed.

Adult↗
PubMed1994

[Long-term follow-up of surgically treated intra-articular calcaneus fractures].

Between 1980 and 1991 we treated 150 joint fractures of the os calcis with open reduction and internal fixation with a special AO-plate. In this report we show the results of 36 fractures in 33 patients after an average follow-up of 89 months (43-132). Patients got back their working ability between 4.6 and 5.6 months. At the time of the clinical control two third of the patients had a working ability of 100%. 4 patients changed their profession due to the poor result of the fracture. 12% of the cases ended in spontaneous or secondary arthrodesis of the lower ankle joint. One third of the patients need orthopedic supports or special shoes. 73% of the patients are satisfied with the result.

Adolescent↗
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

"Fatigue and malaise" as a quality-of-life indicator in small-cell lung cancer patients. The Swiss Group for Clinical Cancer Research (SAKK)

"Fatigue and malaise" (FM) is a frequent, non-specific symptom of cancer patients caused by the disease, its treatment and psychological distress. Since comprehensive quality of life assessment is often not feasible in multicentre clinical trials, short, but clinically relevant, quality of life indicators have to be defined. In a representative subsample of 127 patients in a phase-III randomized small-cell lung cancer trial comparing two different regimens of combination chemotherapy, quality of life was assessed at the beginning of each of the six treatment cycles with a self-rating questionnaire including an early version of the EORTC questionnaire, a mood adjective check list (Bf-S) and a single linear-analogue self-assessment scale (LASA) measuring general well-being. FM, measured with a five-item Likert subscale of the EORTC questionnaire, showed moderate to high intercorrelations with other EORTC subscales assessing disease symptoms, toxicity of treatment, role functioning, personal functioning, restriction of social activity, psychological distress, emotional (Bf-S) and general well-being (LASA). At baseline, FM was one of the most pronounced symptoms. Over the six cycles 43%-31% of the patients complained of moderate to severe fatigue. Over the first two cycles FM tended to decrease, slightly increasing during cycles 3 and 4 and decreasing again before cycle 6. In a multiple regression analysis over the six cycles, 53% of the variance of FM was explained by patient-rated symptoms of disease and toxicity (disease alone: 43%; toxicity alone: 35%). Initial performance status, previous weight loss, treatment arm, cycle number and age predicted the scores of FM over the six cycles.(ABSTRACT TRUNCATED AT 250 WORDS)

Affect↗
PubMed1993

Primary endocrine therapy for advanced breast cancer: to start with tamoxifen or with medroxyprogesterone acetate?

BACKGROUND: The availability of compounds effective against metastatic disease and at the same time excellently tolerated even in long-term administration has determined the choice of tamoxifen as primary treatment for palliation in metastatic breast cancer. Other drugs or other hormonal approaches were hardly tested against tamoxifen, especially as first-line treatment. PATIENTS AND METHODS: 119 patients with metastatic breast cancer and no prior endocrine therapy were randomized to receive either tamoxifen (TAM) 20 mg/day orally (64 patients), or medroxyprogesterone acetate (MAP) 1g/day i.m. 5 days/week for 4 weeks and then 500 mg twice a week (55 patients). The subsequent endocrine therapy was also prospectively defined at study entry. RESULTS: A total of 111 events, contributing to the endpoint 'time to progression' have so far been observed: a study of similar size would have a 90% power to detect a hazard ratio of 1.85. Initial MAP was associated with a significantly higher remission rate (50% versus 30% for tamoxifen; p = 0.023) and a marginally significantly longer median time to progression (8.8 versus 5.4 months; p = 0.051). Overall survival was also longer for the MAP group (28 versus 20 months; p = 0.384). The use of MAP was associated with a significantly higher toxicity, mainly hypertension, weight gain and tremor. CONCLUSIONS: The implications of these results are that initial endocrine therapy in postmenopausal patients with metastatic disease should be MAP if the patient is willing to accept the side effects of high-dose progestins. Progestins should be tested in the adjuvant setting for postmenopausal women, especially those with no tendency to hypertension or obesity.

Adult↗
PubMed1993

[The gamma nail--an ideal implant for treatment of unstable fractures in elderly patients].

Altogether we used the Gamma-Nail in 150 cases. We show here a series of 50 instable pertrochanteric femur fractures in very old patients which we treated with a Gamma-Nail. All cases started with full weight bearing at the 4th day after operation. A clinical and radiological control 12 weeks later shows good mobilisation of the hip in 70% of the cases. Shortening of the operated leg is rare in comparison of cases treated with a DHS. Two thirds of the patients returned after dismission of the hospital to the old social situation. The advantages in treating instable pertrochanteric femur fractures with the Gamma-Nail are immediate full weight bearing without risks of shortening of the operated leg and the closed reduction of the fracture.

Aged↗
PubMed1993

[Stable interlocking intramedullary nailing of humeral fractures with the Seidel nail].

22 fractures of the humerus (15 traumatological, 7 pathological) were treated with the Seidel-Nail. The results after a follow-up between 4 and 20 months showed good mobility of the shoulder. As major complications two paresis of the radial nerve occurred. One disappeared spontaneously. The Seidel-Nail is a good implant for all kind of shaft fractures with an intact distal fragment of 5 cm and also for fractures of an intact humerus head.

Aged↗