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Biomedical subjects

U Metzger

Publications and source records attributed to U Metzger.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Heart contusions: pathological findings and clinical course].

After blunt chest trauma, myocardial contusion is frequently suspected, but diagnostic criteria are difficult to define and commonly accepted recommendations for duration and form of patient monitoring are lacking. We therefore conducted a retrospective review of the hospital records of 50 consecutively hospitalized patients with the diagnosis of myocardial contusion after blunt chest trauma, and analyzed the pathological laboratory, ECG and echocardiography findings as well as the associated injuries and cardiac-related complications. The average injury severity score was 25 +/- 8. Initially 98% of the patients were hemodynamically stable. In 90% there were abnormal enzyme levels consistent with myocardial injury. Typically, the maximum level of CPK-MB, LDH and CPK-MB/CPK (MB-fraction) was found initially and these values declined rapidly. The MB fraction normalized within 8 hours. In 32% of the patients there were the following ECG changes consistent with myocardial contusion transient: ventricular tachycardia (12%), ST/T changes (12%), complete right bundle branch block (10%), atrial fibrillation (4%), first degree AV block (2%). The episodes of ventricular tachycardia were registered within the first 24 hours; in 5 of these 6 patients the admission ECG was normal. An echocardiography was done in 64% of the patients and in 37% showed either a pericardial effusion, regional wall motion abnormalities, a pneumopericardium or an intramyocardial hematoma in the free wall of the right ventricle. One patient died of multiorgan failure during this hospitalization. There were no sudden cardiac deaths. The diagnosis of myocardial contusion is vital in unstable patients but also very important in hemodynamically stable patients, despite its low morbidity. The minimum program we recommend for diagnosis and monitoring should include enzyme levels (CPK, CPK-MB) and ECG controls. Echocardiography may be necessary as well. If during the initial compulsory 24 hour monitoring of ECG and hemodynamics no complications occur, further monitoring is not necessary.

Adolescent↗
PubMed1992

[Large myelolipoma with reversible hypertension].

Myelolipomas are rare, benign, usually asymptomatic tumors of the adrenals consisting of fatty and hemopoietic tissue. New imaging techniques lead increasingly to incidental findings. Diagnosis of a myelolipoma is confirmed by fine needle aspiration yielding mature adipose tissue together with hematopoietic cells, in particular megakaryocytes. Pathophysiology is unclear, correlations to hormonal disturbances are discussed and increased incidence of hypertension associated with myelolipoma has been reported. We describe a female patient who was found at evaluation of hypertension to have a myelolipoma of more than 1 kg of weight. Liposarcoma was suspected and the tumor excised. After excision blood pressure returned to normal.

Adrenal Gland Neoplasms↗
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

Phase II study of intra-arterial fluorouracil and mitomycin-C for liver metastases of colorectal cancer.

Effectiveness, toxicity and complications of 5-fluorouracil (FU) and mitomycin-C (MMC) treatment were analyzed in 30 patients with metastatic colorectal cancer confined to the liver. The treatment schedule was FU 2.0-2.5 g/day for 5 days followed by MMC 10 mg/m2 every 2 h on day 6 to a maximum total dose of 60 mg. Treatment courses were repeated every 6 weeks and were given on an outpatient basis via external pump and arterial port systems. In 30 fully evaluable patients, one complete response, 17 partial responses (overall response rate 60%), and stabilization of disease in 8 patients (26%) were obtained for a median duration of 13 months. Median overall survival was 18.2 months (25.5 months for responding patients, 15 months for nonresponders). Grade 1-2 toxicity (WHO classification) consisted of leukopenia (23%), mucositis (20%), nausea/vomiting (16%), and abdominal pain (10%). Two patients (7%) developed severe mucositis. No life-threatening side effects were observed; in particular, there was no sclerosing cholangitis or chemical hepatitis. Catheter-related problems (occlusion, displacement, rupture, infection) occurred in 10 patients (33%) at a median follow-up time of 12 months. We conclude that intra-arterial FU and MMC constitute an effective, safe, and nontoxic treatment in metastatic colorectal cancer confined to the liver. Catheter-related problems are the most important factors limiting treatment.

Adult↗
PubMed1991

Risk factors in abdominal surgery.

The term risk is understood to be the danger of the occurrence of an undesired, life-threatening event. The probability of this undesired event is greater in the presence of a risk factor than in its absence. In general surgery, these risk factors can be classified into five groups: The environment, the surgeon, the operation per se, the disease, and the patient himself. Abdominal surgery is especially suited to clarify and to illustrate this classification. Some typical risk factors are described, and for each group the measures for risk prevention or risk reduction are discussed.

Abdomen↗
PubMed1990

[Colon carcinoma--1990].

Colorectal cancer is a major public health problem in Western industrialized countries. It is estimated that more than a quarter of a million people are affected by this disease each year. The population-adjusted yearly incidence rate has remained constant at approximately 40 to 50 cases per 100,000. About 75% of the individuals with these cancers have a primary surgical resection with hope of complete tumor eradication. Despite the high resectability rate and a general improvement in surgical therapy, nearly half of all patients with colorectal cancer still die of metastatic tumor. Major progress has been made in various aspects of colorectal cancer over the last few years, including molecular biology, screening and adjuvant therapy.

Adenomatous Polyposis Coli↗
PubMed1990

[Adjuvant therapy in colorectal carcinoma].

In Western industrialized countries colorectal adenocarcinoma is the second most common solid malignant tumor. Despite radical surgery in 75-80% of all cases, about 50% of the patients with colorectal carcinoma die of this tumor. The essential advances of recent years are reduction of the surgical complication rate and of postoperative mortality. Recent studies show that radiotherapy for rectum carcinoma and chemotherapy (5-fluorouracil in combination with levamisole) for colon carcinoma can be significantly helpful as an additional measure in certain subgroups. However, such so-called multimodality treatment concepts need adequate equipment and experience and should only be implemented, whenever possible, in controlled clinical trials.

Adenocarcinoma↗
PubMed1990

Effectiveness and low toxicity of hepatic artery infusion with fluorouracil and mitomycin for metastatic colorectal cancer confined to the liver. The Swiss Group for Clinical and Epidemiological Cancer Research (SAKK).

The usefulness of hepatic artery infusion (HAI) with floxuridine is limited by the severe biliary and hepatic toxicity of floxuridine. This prompted the SAKK to evaluate the effectiveness, toxicity and feasibility of HAI with fluorouracil (FU) and mitomycin (MMC) administered by an external portable pump. Of 28 patients treated, partial responses were obtained in 14 (50%, 95% confidence interval: 30% to 70%) and stabilization in 11 (39%, 21% to 60%), for a median duration of 12.6+ months. Median survival was 19.5+ months. Grade I-II toxicity (WHO) consisted of nausea (46%), leucopenia (32%) thrombocytopenia (21%) and abdominal discomfort (25%). Two patients developed gastro-duodenal ulcers and two others grade III leucopenia. No life-threatening side effects, especially no sclerosing cholangitis or chemical hepatitis, were observed. In conclusion, HAI with FU and MMC is a valid alternative to floxuridine HAI in metastatic colorectal cancer confined to the liver.

Adult↗
PubMed1990

[Palliative therapy of rectal cancer by electrocoagulation].

Palliative therapy for rectal carcinoma is only indicated in selected patients who do not tolerate radical surgery or with very advanced disease. In a retrospective series the results of transanal electrocoagulation are analyzed. In addition patients or their relatives were questioned about the treatment related increase in quality of life and the wish of recurrent coagulation if needed. The main indication for transanal electrocoagulation was rectal stenosis, blood loss, discharge of mucosa and tumor as well as pain. Anal incontinence only gets better when it is due to discharge. However, transanal exposition bears the risk of worsening the incontinence. The electrocoagulation is favored by all continent patients before colostomy. The main indication for a colostomy was incontinence and fistula. Palliative irradiation was concentrated in patients with pain. In 59 operations upon 40 patients there was one rebleeding and one death due to sepsis resulting in a mortality of 1.7%. We conclude from our results that transanal electrocoagulation is a safe procedure in patients with rectal carcinoma who do not qualify for radical surgery.

Aged↗
PubMed1990

[Long-term results of surgical treatment of lung metastases].

A retrospective review covered 110 patients who had had 130 thoracotomies for 193 lung metastases between 1960 and 1988. The cumulative survival rate after 5 years was 39%, 24% after 10 years and 13% after 15 years. The median survival was 3.8 years; the average survival was 7 years. In a multivariate analysis, response to prior chemotherapy, local tumor extent (intrapulmonary versus extrapulmonary disease) and venous drainage (caval versus portal) were the most important prognostic factors. The number of metastases and the interval between primary tumor and lung metastases were of minor prognostic importance.

Adolescent↗
PubMed1990

[Omniflow: a new vascular prosthesis for hemodialysis access].

Between January and November 1988 20 a.-v. shunts for haemodialysis access were performed at the University Hospital of Zurich with the Omniflow, a prosthesis composed of sheep collagen and polyester mesh. The main reason to implant this vascular prosthesis was the failure of Cimino-shunts. In 9 cases a straight and in 11 cases a performed "u" shape graft was used. During the follow-up period of 3-11 months the following 6 complications were observed: 5 graft thrombosis (in 2 cases due to hypotonia, in other 2 cases due to wrong graft selection and in 1 case due to narrowed venous anastomosis), and one graft dysfunction due to a stenosis in the patients vein. In comparison to the vascular prostheses used earlier, the Omniflow graft is characterized by a high patency rate and an easy puncturing.

Arteriovenous Shunt, Surgical↗
PubMed1990

[5 and 10 years results of surgical treatment of lung metastases].

This is a report on 105 patients who had 125 thoracotomies for 188 lung metastases between 1960 and 1987. The cumulative survival rate at 5 years was 39% and 24% at 10 years and 13% at 15 years. The median survival is 3.7 years, the average survival is 7 years due to prolonged follow-up. With combined modality therapy, testicular and uterine cancers yielded the best survival results with a 5-year survival rate of 100% and 67%, respectively. In multi-variate analysis, response to prior chemotherapy, local tumor extent (intrapulmonary versus extrapulmonary disease) and venous drainage (caval type versus portal type) were the most important prognostic factors whereas the number of metastases and the interval between primary tumor and lung metastases were of minor prognostic importance. The present results are compared with long-term results of other centres and emphasize the importance of resection in combined modality therapy concepts of lung metastases.

Adolescent↗
PubMed1990

[Following curative resection of colorectal cancer, portal chemotherapy especially benefits non-transfused patients].

After curative resection of colorectal cancer, immediate short-term postoperative intraportal adjuvant chemotherapy reduces the relative risk of recurrence and death in the non-transfused patient significantly, when compared to transfused patients without chemotherapy. This is demonstrated in a multivariate analysis using the Cox model on a group of 469 patients who have been intraoperatively randomized to receive either intraportal chemotherapy for 7 days or no further treatment. The transfused patients with chemotherapy and those receiving neither transfusions nor chemotherapy had a relative risk of recurrence and death situated in between the two groups mentioned above, not statistically different from either of them. In the setting of this study, 7 days postoperative intraportal chemotherapy seems particularly effective in the non-transfused patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

[Intraoperative sonography].

Intraoperative sonography was introduced at our institution in November 1987. We have since examined 55 patients, of which 27 suffered from liver disease, 16 from pancreatic problems and 11 from hyperparathyroidism. A short description of the technique applied is given for each organ. The intraoperative sonography of the liver showed additional information in one third of the cases. The sensitivity of intraoperative sonography in hyperparathyroidism was 78%, the specificity 72%.

Adenoma↗
PubMed1989

[Initial results of adjuvant portal liver infusion following radical surgery of colorectal cancer (Swiss Study Group for Epidemiologic and Clinical Cancer Research Study 40/81)].

Between July 1981 and June 1987, 533 patients from 7 participating institutions have been entered in a prospective randomized trial to assess the value of adjuvant portal infusion (5-Fluorouracil 500 mg/m2/d x 7 continuous infusion + Mitomycin-C 10 mg/m2 on day 1 as a bolus injection through portal venous catheter) compared to radical surgery alone. The portal venous catheter was placed through any side-branch of the mesenteric venous system during laparotomy for the primary tumour. Using the transabdominal route, there have been no catheter-related complications. Overall hospital mortality in the study was 1.75% and was not influenced by adjuvant treatment. Analysis of 469 eligible patients at a median follow-up of 48 months revealed 39.1% recurrencies in the control group and 31.8% in the infusion group (p = 0.09, logrank). Median survival of control patients is 72 months, of chemotherapy treated patients not yet reached. Significant survival advantages have been detected for those 195 (85%) patients who received full-dose adjuvant chemotherapy (67% versus 53% 5-year survival). Due to the low number of deaths in this trial, prolonged follow-up is needed for definitive survival conclusions.

Antineoplastic Combined Chemotherapy Protocols↗