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Biomedical subjects

W Schweizer

Publications and source records attributed to W Schweizer.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Colorectal cancers: therapy of recurrences and metastases].

Recurrent disease from colorectal carcinomas is common. 25 percent of patients have apparent metastases at the time of first detection of the tumor, and at least 50% of patients die from their tumor. The aim of the postoperative follow-up of patients with carcinoma of the colon and rectum is thus to detect recurrent tumor when cure is still possible. Clinical examination and CEA-measurement is widely recommended as a reliable indicator for recurrence and metastases of colonic cancer. This may be combined with regular coloscopic surveillance for detection of anastomotic recurrences or a second colonic cancer. In case of suspicion of a recurrence or metastasis a full range of examinations should be performed to detect the site of recurrent tumor and to exclude wide spread disease. In case of a circumscribed lesion the patients may benefit from local radical resection. Patients with four or less unilateral liver metastases show a five year disease free survival reported of more than 30% and a disease free survival reported of more than 25%. Unfortunately because of wide spread misunderstanding of the potential of hepatic Rx only about 1/3 of potentially curatively resectable patients with liver metastases finally undergo liver surgery. A more active policy towards patients with colorectal disease concerning surveillance may lead to a better survival in selected cases.

Colorectal Neoplasms↗
PubMed1991

[Technical aspects of spleen saving therapy in splenic trauma].

The haematological and immunological consequences of splenectomy have been the subject of increasingly intensive studies over the last few years. As a result there has been a significant change in the management of splenic trauma with the emphasis on organ preservation which has been associated with a possible reduction in postoperative infectious complications. The safety of splenic preservation (splenorrhaphy) has been demonstrated. There has also been a change in the increased use of non-surgical (conservative) management of injuries in adults, a policy which previously was reserved for children. There is no difference in the postoperative bleeding rate between patients with splenectomies or patients with splenorrhaphies. Non-surgical treatment is in adults not yet established. In our department splenic preservation gets an increasing weight in our treatment policy, even in patients with multiple injuries. Our treatment policy initially classifies the splenic injury into one of five groups and this determines the subsequent operative procedures. The crucial part of the surgical technique in splenic preservation involves the immediate dissection and delivery of the spleen from its subdiaphragmatic position, thus avoiding iatrogenic injuries which can readily occur in the emergency situation. The hilus is then clamped with a non-crushing vascular or intestinal clamp, which avoids blood loss during the repair. The methods used for the repair depend on the grade of the injury. Means to prevent sutures cutting through the tissue (resorbable collagen platelets, resorbable gauze, teflon stripes) and a variety of methods to achieve haemostasis (infra red photocoagulation, haemostatic material and supportive mesh) are used.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemostasis, Surgical↗
PubMed1991

[Myocutaneous latissimus dorsi sliding flap in reconstruction of the lower thoracic wall in chronic fistula caused by cystic echinococcosis of the liver].

We report the successful treatment of a 47-year-old man who had a 22-year history of chronic discharge from a hepatic echinococcal cyst. Before treatment in our unit there had been 8 previous attempts to control the fistula. By means of a right thoracoabdominal incision (with resection of the 7th and 8th ribs) it was possible to perform a cystectomy with subsequent marsupialisation of the residual cyst wall to the skin. However, after 2 weeks subsequent treatment with maximal Albendazol therapy there was still a big persistent cavity which required further débridement. This resulted in resolution of the infection and allowed a definitive closure of the big cavity and the thoracoabdominal wall using a myocutaneous latissimus dorsi flap. The patient's subsequent course has been uneventful with no recurrence of the fistula.

Debridement↗
PubMed1991

[Comparison of partial Billroth I, classical Billroth II gastrectomy and resection with Roux-en-Y reconstruction with reference to postoperative quality of life].

53 patients submitted to gastric resection and reconstruction either by means of Roux-en-Y gastrojejunostomy, Billroth I or Billroth II operation were followed for a mean of three years and compared for clinical status using the Visick grading system, dumping grading after the method of Sigstad, and careful clinical questioning regarding post-gastrectomy symptoms. Personal follow up by the same examiner corresponding to a standardized questionnaire and the objective grading revealed that our results for individual operations compared well with the reports of other studies investigating mostly only one type of operation for one criterion. However, the Roux-en-Y reconstruction showed significantly better results when compared to Billroth I and especially Billroth II reconstruction. It is concluded that partial gastrectomy with Roux-en-Y reconstruction is the preferred approach provided that, in the light of the pathology encountered at operation, the procedure is technically feasible and adequate.

Adult↗
PubMed1990

[Postoperative course following stomach resection: a comparison of Billroth I, Billroth II and Roux-en-Y resection-reconstruction].

53 patients who underwent gastric resection and reconstruction either by Roux-en-Y gastro-jejunostomy, Billroth I or Billroth II operation, were followed for an average of three years and compared for clinical status using the Visick grading system, dumping grading by the method of Sigstad, and careful clinical questioning regarding post-gastrectomy symptoms. Response to a standardized questionnaire and objective grading showed that our results for individual operations compared well with others reports. However, the Roux-en-Y reconstruction showed significantly better results when compared to Billroth I, and especially Billroth II, reconstruction. It is concluded that partial gastrectomy with Roux-en-Y reconstruction is the preferred approach, provided that, in the light of the pathology encountered at operation, the procedure is technically feasible and adequate.

Anastomosis, Roux-en-Y↗
PubMed1990

Prognostic factors for malignant mixed müllerian tumors of the uterus.

This study examined factors affecting the survival of 28 consecutive patients with malignant mixed Mullerian tumors diagnosed at New York University Medical Center from 1971 through 1985. The cumulative 5-year survival for all patients was 38%. Patients with pedunculated tumors (18/25) had a significantly improved 5-year survival of 53% compared with patients having a tumor with a broad-based attachment (7/25), all of whom died within 1 year (p less than 0.01). Eleven patients whose tumors demonstrated vascular invasion had a worse prognosis compared with 14 patients without demonstrable vascular invasion (18% versus 53% 5-year survival; p less than 0.05). Interestingly, patients with pedunculated tumors persisted in having an improved survival even after correcting for vascular invasion, compared with patients having broad-based tumor attachment. Small tumor size (less than or equal to 7 cm) also proved to be a significant and independent prognostic indicator for improved survival. Advanced stage, heterologous sarcomatous elements, and deep myometrial invasion (greater than one-third invasion) tended to be associated with decreased survival, but not with statistical significance. Patient age and grade of the carcinoma element did not appear to affect survival.

Aged↗
PubMed1990

[IODIDA scanning for functional and morphologic assessment of the liver and bile ducts before and following surgical interventions in bile duct obstruction].

PROBLEM: Full pre- and postoperative assessment is mandatory in the management of complex cases of incomplete biliary obstruction. Investigations should not only define the level of extrahepatic bile duct obstruction but also detect intrahepatic obstruction, give some index of liver function and of the dynamics of biliary flow. Computed tomography, ultrasonography and direct cholangiography are very valuable. IODIDA-scanning provides a non-invasive method which not only complements other studies but also gives information otherwise unobtainable. CLINICAL MATERIAL: In an initial retrospective study 36 patients, 12 of whom had previously undergone operation for biliary obstruction, were fully investigated with particular reference to the use of IODIDA-scanning. PROCEDURE: 2-5 mCi of 99mTc labelled IODIDA were injected intravenously and the liver and upper abdomen scanned at 1 minute intervals and displayed at 5 minute intervals during the first hour. RESULTS: All patients were studied on admission and then postoperatively at intervals. In 31 of 36 patients IODIDA-scanning gave reliable evidence of the level of obstruction of biliary flow and of the patency of biliodigestive anastomosis. Assessment of liver function before and after biliary reconstruction was also possible. CONCLUSION: IODIDA-scanning has proved a valuable non-invasive method for the assessment of liver parenchymal function, intrahepatic abnormalities and of bile flow in cases of complex biliary obstruction. This is particularly valuable with the Roux-Y biliary reconstruction since ERCP is impossible and PTC an invasive method which, although supplying an accurate picture of major biliary obstruction, fails to characterize hepatic function and bile flow.

Adult↗
PubMed1990

[Diagnosis and treatment of traumatic injuries of the duodenum and pancreas: 21 cases].

Twenty one consecutive patients who sustained injuries to the duodenum or/and pancreas were admitted to our hospital over a ten year period. Sixteen blunt injuries and 5 penetrating injuries were encountered. Penetrating injuries were always suspected and treated by time; following blunt injury diagnostic delay was encountered in 7 patients and insufficient surgical procedure because of intraoperative misinterpretation in 2 patients. Most of the patients had associated intra-abdominal organ injuries. Adjuncts to diagnosis such as abdominal roentgenograms, serum amylase levels and gastroduodenography were not helpful. CT-Scan and ultrasound allowed to confirm the suspected diagnosis in 3 cases only. Intraoperative diagnosis was also challenging. Complete mobilization of the structures surrounding the duodenum and the pancreas to provide entire exposure was necessary. In 6 patients treated first in a peripheral hospital, diagnosis of the injury have been missed at first laparotomy and reoperation was necessary in all of them. Suture closure of the duodenum and drainage of the pancreatic region were the most common reparative technique used. More complicated procedures with pancreatic and/or duodenal resection were performed in 6 patients. Overall mortality in patients surviving more than 24 hours was 14% (suture line dehiscence after delayed operation and one death due to brain injury).

Adolescent↗
PubMed1990

[Diagnosis, etiology and treatment of cholangitis following bilio-digestive surgery].

Cholangitis occurring after biliary-enteric anastomosis is a well-recognized but insufficiently analyzed surgical complication. Guidelines for assessment have not been established and management remains controversial. We examined a two-year experience with recurrent cholangitis following bilio-enteric anastomosis; cholangitis in the absence of anastomotic obstruction was surprisingly frequently encountered. Although selected cases without anastomotic stenosis may be amenable to nonoperative treatment, a low threshold for surgical reintervention should be maintained because radiologic assessment of anastomotic patency is often equivocal and the clinical problem is often best managed surgically.

Cholangitis↗
PubMed1989

Resectability of large focal liver lesions.

Despite modern imaging techniques evaluation of the resectability of large focal liver lesions is often difficult or impossible until the time of operation. Based on experience with 54 primary or secondary focal liver tumours, a simple morphological classification has been found to be reasonably predictive of resectability. All tumours were classified before operation using computed tomography, ultrasound and angiography; 38 patients underwent laparotomy. Dependent, 'hanging' tumours (n = 7) were resected in six cases, expansively growing 'pushing' tumours (n = 19) were resected in 18 cases, and infiltrating, 'invasive' tumours (n = 17) were not resected because of involvement with major vascular structures. Eleven small tumours (less than 5 cm) were not classifiable by this system. This simple classification may be a useful clinical concept in preoperative assessment of resectability of focal liver lesions. Hanging tumours should always be resected, and large expansile tumours are generally resectable despite their size. Invasive tumours can only be resected in exceptional cases.

Humans↗
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↗
PubMed1989

[The resectability of large focal liver lesions].

This paper presents a simple clinical concept of tumor morphology considered to be of value in the preoperative assessment of focal liver tumours. Based on preoperative clinical and radiological investigation and laparotomy in a large number of liver lesions, we propose a classification of liver tumours of special value in the preoperative assessment of resectability of large primary and secondary liver tumours.

Adenoma↗
PubMed1989

[Blood transfusions and prognosis following curative resection of colorectal cancer: is there an association?].

More recently a number of retrospective analyses in rather ill defined patient populations demonstrated an association between perioperative blood transfusion and recurrence after curative resection of colorectal cancer. In the randomized trial (SAKK 40/81) (adjuvant cytotoxic intraportal infusion versus no further treatment) we evaluated the transfusion status in a well defined, prospectively documented and controlled patient population. Of 457 patients, 353 (77.2%) received either pre-, intra- or postoperatively blood transfusions. After a median follow-up of 4 years, the transfused patients developed significantly more recurrences (38.2%) than patients without blood transfusions (23.1%), the death-rate being 33.7% versus 23.0%, respectively. Patients without transfusion but treated with adjuvant intraportal chemotherapy are strikingly doing better (10.5% recurrences) than patients with perioperative blood transfusion not having an adjuvant treatment (44.5% recurrences).

Blood Transfusion↗
PubMed1989

[Angiography and intervention in tumors of the pancreas, liver and bile ducts].

The importance of angiography and of interventional radiology in tumours of the pancreas, liver and bile ducts is discussed. Angiography is performed prior to surgical intervention to assess tumour resectability, for a preoperative visualisation of vascular anatomy, as well as in non-diagnostic findings in ultrasound and computerised tomography. Diagnostic and therapeutic interventional techniques in the liver (fine needle puncture, perfusion, embolisation) and the bile ducts (PTC, ERCP, PTCD, endoprosthesis, stents) are performed selectively in tumour patients in close co-operation with surgeons, radiologists and gastroenterologists.

Angiography↗
PubMed1989

[A combined surgical and interventional-radiologic procedure in bile duct obstructions].

Surgery for biliary obstruction may be complicated by the presence of intrahepatic stones and, in difficult anastomoses, by the possibility of recurrent stricture formation. In order to decrease the need for further operation, the first surgical repair in selected cases should allow access for later radiological intervention. Primary operation consists of biliary digestive anastomosis using established techniques with a Roux-en-Y-loop. A limb of the Roux-loop may be brought to the abdominal wall and secured to the anterior parietal peritoneum to allow access for later radiological intervention either by utilizing an established tubal tract into the Roux-loop or by later puncture of the loop under ultrasound guidance. Since October 1986 we have treated 11 patients utilizing this technique. Six patients had complex strictures following cholecystectomy and two patients had obstructions secondary to alveolar or cystic Echinococcosis. One stricture was due to a previous liver resection, one followed previous operation for congenital atresia of the biliary tract and one consisted of multiple strictures and stones associated with oriental recurrent pyogenic cholangitis. In all 11 patients, postoperative radiological imaging was possible. In 6 patients, 14 radiological manoeuvers were carried out for dilatation or for removal of stones and debris. There were no complications. During a median follow-up of 11 months no patient needed further surgical intervention. The indications and techniques are outlined.

Adult↗
PubMed1989

[Diagnosis and therapy of liver injuries in the polytraumatized patient].

We examined 120 patients with liver trauma, 100 retrospectively (1973-1986 group I) and 20 prospectively (1986-1987 group II). The severity of the liver injury was categorized in 5 grades (modified after Moore) and the degree of multiple trauma was assessed by the injury severity score (ISS). Patients in the liver injury groups were equally distributed among grades I to IV; there was one patient with a grade V injury in both the retrospective and prospective group. The overall mortality was 14%, 15% for the retrospective and 10% for the prospective group. Mortality was mainly due to concomitant injuries (head injuries, ARDS, multiple organ failure, pneumonia) and only 3 patients in the whole group died as a result of continuous bleeding or because of prolonged hemorrhagic shock due to the liver injury. The defined protocol for the prospective group included early efficient resuscitation and blood/fresh frozen plasma transfusion, systematic and rapid assessment of injuries and determination of priorities of treatment. Immediate ultrasonography or peritoneal lavage was used for assessment and diagnosis of a liver injury and early selection of treatment according to the grade of the liver injury: Conservative management for stable cases consisted of close supervision and repeated investigations (CT, angiography). Immediate operation was undertaken for continuing hemorrhage. Postoperative care in an intensive care unit with a low threshold for reoperation in cases of suspected sepsis, ongoing hemorrhage or necrosis of liver tissue was an important part of the treatment. Our results suggest that death in multiple trauma patients should almost never be due to liver injury alone. Conservative treatment may be justified in some patients, but early resuscitation and operation directed at definitive or provisional control of hemorrhage with removal of all devitalized tissue and liberal use of early reoperation are essential in the management of severe liver injury.

Adolescent↗
PubMed1987

Chloroquine administration for malaria suppression after abdominal surgery.

Administration of chloroquine after major surgery is indicated in malaria endemic areas. In emergencies it is commonly administered parenterally after the operation. The present study, undertaken at St. Francis Hospital, Ifakara (Kilombero District), Tanzania, compared plasma chloroquine levels after oral and subcutaneous administration of 300 mg of chloroquine base in 14 patients after abdominal, non-bowel-resective surgery and in 12 controls. There were no significant differences in the plasma chloroquine levels of all groups, and the chloroquine concentrations reached suppressive levels for at least 3 days (greater than 0.1 nmol/ml). Oral administration was well tolerated in both patients and controls. In all areas where the Plasmodium strains are still sensitive to chloroquine and where parenteral chloroquine may not be easily available, oral chloroquine represents a cheap, easy and safe alternative for postoperative prophylactic malaria suppression. It can be applied after abdominal non-bowel-resective emergency surgery.

Abdomen↗