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Biomedical subjects

W Weder

Publications and source records attributed to W Weder.

At least 109 records · Page 6Linked to original sources
PubMed1996

Bronchiolitis obliterans in a patient with localized scleroderma treated with D-penicillamine.

D-penicillamine-associated bronchiolitis obliterans (BO) is a rare but well-known pulmonary complication in patients with rheumatoid arthritis or progressive systemic sclerosis. It has been assumed that in most, if not all cases, BO is a complication of the underlying disease rather than a side-effect of treatment. We report the case of a 46 year old man with scleroderma localized to his lower legs (morphea), who received a daily dose of 750 mg D-penicillamine. During the treatment of 1 yr duration, he developed progressive shortness of breath due to a worsening obstructive ventilatory defect suggesting BO, which was confirmed by surgical lung biopsy (constrictive BO). Bronchial obstruction progressed over the next 5 yrs and did not respond to corticosteroids. The patient finally underwent a successful single left lung transplantation. The histological features of constrictive BO were confirmed in the explanted lung. This observation suggests that D-penicillamine may induce bronchiolitis obliterans in the absence of a systemic connective tissue disease.

Antirheumatic Agents↗
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↗
PubMed1995

[Volume reduction surgery--a new treatment concept in advanced diffuse pulmonary emphysema].

Excision of large space occupying bullae in patients with emphysema is an accepted procedure if the underlying parenchyma is compressed and relatively normal. This operation may relieve symptoms of dyspnea and improve exercise tolerance. The volume reduction operation is based on different concept and designed for the diffuse type of emphysema. Resection of the most diseased lung in patients with marked hyperinflation may relieve thoracic distension and improve respiratory mechanics. We are currently evaluating prospectively the use of bilateral thoracoscopic volume reduction for patients with advanced, diffuse emphysema. During the last 1 1/2 years over 20 patients have been operated on. The average FEV1 was 765 ml/sec preoperatively and improved 40% within 3 months with a range of 0-100%. The 12 minute walking distance improved more than 100%. There was no perioperative mortality. Bilateral thoracoscopic volume reduction surgery is a palliative procedure but offers significant improvement in pulmonary function and exercise capacity for many patients.

Exercise↗
PubMed1995

[Isolated lung transplantation].

Over the last 10 years, single and bilateral lung transplantation has developed from an experimental technique to a valid therapy for patients with end-stage pulmonary or pulmonary-vascular disease. The main reasons for this progress are better defined selection criteria, improved operative technique and organ preservation, optimized peri- and postoperative management and more precise immunosuppressive and antiinfective therapy. Since 1983 more than 3000 lung transplantations have been performed worldwide with a 1- and 3-year survival rate of 70-90% and 60-70% respectively. In Switzerland 41 lung transplantations have been performed since 1992 with a 1-year survival rate of more than 80%. Indications, technique, treatment and results are discussed.

Adult↗
PubMed1995

Thoracoscopic mediastinal lymph node dissection: an experimental study in pigs.

Thoracoscopic lobectomy is feasible and can be performed correctly in terms of anatomy. Its application in bronchial carcinoma is often criticized, partly because of incomplete mediastinal lymph node dissection (MLD). We therefore developed the technique and studied the completeness of MLD in an animal experiment. Ten pigs were anesthetized and intubated with a double-lumen tube and the left lung was excluded from ventilation. Four trocars were inserted. Using a modified endo-Babcock clamp for traction we resected all ipsilateral tracheobronchial, pretracheal and paratracheal and paraesophageal lymph nodes (LNs) as well as nodes in the aortopulmonary window. An average of 19 +/- 5 mediastinal LNs were removed. Macroscopic control through a thoracotomy did not show any residual LNs at the site of operation. Complete resection of all ipsilateral LNs in the paratracheal and paraesophageal region as well as the aortopulmonary window can be performed thoracoscopically in pigs. This may offer further perspectives in the thoracoscopic treatment of bronchial carcinoma.

Animals↗
PubMed1995

Detection of liver metastases: comparison of superparamagnetic iron oxide-enhanced and unenhanced MR imaging at 1.5 T with dynamic CT, intraoperative US, and percutaneous US.

PURPOSE: To compare the sensitivities of superparamagnetic iron oxide-enhanced and unenhanced magnetic resonance (MR) imaging at 1.5 T with those of percutaneous ultrasound (US), intraoperative US (IOUS), and dynamic computed tomography (CT) in the preoperative assessment of metastatic liver disease. MATERIALS AND METHODS: Eighteen patients with liver metastases who were candidates for curative surgery underwent presurgical imaging. Thirteen patients underwent surgery and IOUS after undergoing preoperative US, CT, and MR imaging. RESULTS: In the preoperative imaging group, the standard of reference was the total number of lesions detected with any of the modalities. Superparamagnetic iron oxide-enhanced MR imaging was the most sensitive modality (99%). In the surgical group, the standard of reference was the total number of metastases identified at IOUS and pathologic examination. IOUS had the highest sensitivity (80%), followed by superparamagnetic iron oxide-enhanced MR imaging (56%). CONCLUSION: Superparamagnetic iron oxide-enhanced high-field-strength MR imaging facilitates the preoperative evaluation of potentially curable metastatic liver disease; however, it is inferior to IOUS.

Colorectal Neoplasms↗
PubMed1995

[Thoracoscopic surgery--experiences with a practical training course using an animal models].

Various thoracoscopic procedures have recently become an established method in thoracic surgery. However, a systematic teaching program is lacking. We present our experience with a 1-day training course, using anaesthetized pigs. Thoracoscopic operations, such as pericardial fenestration, wedge resection of the lung, subaortic and mediastinal lymph node dissection and pleurectomy have been exercised in groups of two. 7-12 months following the teaching course 40% of the participants had performed more than ten diagnostic or therapeutic thoracoscopic interventions in clinical situations. We conclude that our course helps participants to successfully apply this technique in clinical practice.

Animals↗
PubMed1994

[Thoracoscopic surgery--is thoracotomy still necessary?].

Thoracoscopic surgery has made substantial progress in recent years due to advances in video-optic systems and the development of new instruments for endoscopic surgery. Currently many interventions which routinely required thoracotomy can be performed thoracoscopically. This includes pleurectomy, decortication, wedge-resection, pericardial window, sympathectomy, biopsy or, in certain situations, resection of a mediastinal tumor. Thymectomy for myasthenia gravis or lobectomy can be performed thoracoscopically as well. The article gives on overview of the current standing of thoracoscopic surgery. The benefit of thoracoscopic surgery is reduced postoperative pain, including diminished impairment of pulmonary function, and hence a shorter hospital stay and a more rapid recovery.

Empyema, Pleural↗
PubMed1994

[Long-term course following kidney transplantation].

The first 100 recipients of cadaveric renal allotransplants operated at our institution between 1964 and 1971 were retrospectively analyzed in terms of a long-term follow-up, complications and survival parameters. Patient and graft survival (indicated in parenthesis) after transplantation were 68% (58%) at 1 year, 50% (38%) at 5 years, 40% (27%) at 10 years, 32% (20%) at 15 years and 20% (13%) at 20 years. Half-life of graft survival was computed using two different mathematical models and was compared with the results of a control group operated in 1986. Half-life was 9.5 years for the study group and 13 years for the control group respectively.

Adolescent↗
PubMed1994

Local and systemic toxicity of intra-hepatic-arterial 5-FU and high-dose or low-dose leucovorin for liver metastases of colorectal cancer.

In an ongoing prospective study 11 patients with unresectable liver metastases from colorectal carcinoma have been treated with hepatic-arterial infusion of 5-FU (1 g m-2) for 24 h on days 1 to 5 combined with a rapid infusion of high-dose leucovorin (100 mg m-2) (HD-regimen) or low-dose leucovorin (20 mg m-2) (LD-regimen) on days 1, 3 and 5. There was only mild local toxicity grade 1 and grade 2 in both regimen. Twenty-four cycles with high-dose leucovorin and 42 cycles with low-dose leucovorin showed a mild to moderate systemic toxicity, including haematological changes, stomatitis and diarrhoea. We did not see any grade 4 toxicity and no treatment-related fatalities occurred in this series. Eighty per cent reduction of leucovorin dosage leads to a significant decrease in grade 2 and grade 3 haematological and gastrointestinal toxicity.

Aged↗
PubMed1994

Cavernous destruction of an upper lung lobe in a healthy young man. An unusual roentgenographic presentation of allergic bronchopulmonary aspergillosis.

We describe a 32-year-old man with no history of pulmonary disease who presented with extensive cavernous destruction of the right upper lobe as an incidental finding on a chest x-ray film. All major criteria of allergic bronchopulmonary aspergillosis (ABPA) were present. Histologic examination of the resected lobe showed the typical features of ABPA. The differential diagnosis of multiple cavitating lesions should include ABPA.

Adult↗
PubMed1994

[Preventive digitalis therapy in open thoracotomy].

Prophylactic digitalization is still recommended after open lung surgery in order to prevent cardiac arrhythmias in the postoperative period. Since a beneficial effect of this potentially harmful medication is only poorly documented, we conducted a prospective randomized trial. Patients undergoing elective open lung surgery were divided into two groups one of which received digoxin postoperatively, the other not. Randomization was performed independently in three groups with regard to the extent of surgery, i.e. pneumonectomies in patients of any age, (bi-)lobectomies in patients > 50 and other (less extended) operations in patients > 60. Patients who were either too young for either group or who had already taken digoxin before surgery were followed separately. Monitoring was performed continuously in the ICU and conventional ECG was registered after 24, 48 and 72 hours and weekly until dismission.--Cardiac arrhythmias are very frequent in the early postoperative period with a maximum between the third and the fifth postoperative day. Any kind of arrhythmias were present in 19 of 30 patients (63%) compared to 14 of 35 patients (40%) in the control group. Symptomatic arrhythmias that needed treatment occurred in 11.4% of the control group, but in 33.3% of the patients with prophylactic digitalization. We therefore conclude that a general prophylactic digitalization after open lung surgery is not indicated, but that arrhythmias should be treated individually.

Adolescent↗
PubMed1994

[Thoracoscopic partial pneumonectomy: morbidity and length of hospitalization].

Advances in endoscopic surgical instruments and video-technology enable the safe and fast resection of lung tissue through a thoracoscope. We report our technique and the early outcome of our first 36 patients. In a series of 46 thoracoscopic lung tissue resections, performed with a 3-cm Endo-GIA or with a 6-cm Linear-Cutter, we did not observe any complications. The chest tube was removed 3.7 days following tumor resection and after 2.8 days in case of simple biopsy. Patients could be discharged home 5.3 days following tumor resection and 4.2 days following biopsy. Complaints after a follow-up period of 3 months were almost neglectable.

Adult↗
PubMed1993

[Thoracoscopic surgery: current indications].

Recent advances in the technologies for minimal invasive surgery have expanded the indications for thoracoscopic surgery. The thoracoscopic approach is for various operations, including pleurectomy, decortication, pulmonary wedge resection, pericardial window, the approach of first choice. Other operations such as resection of tumors in the mediastinum or thoracic wall, lobectomies or others, can often be performed by thoracoscopy. Indications and technical details are described.

Humans↗
PubMed1993

[Spontaneous rupture of the left hepatic duct].

A previously well 24-year-old man complained of persistent epigastric pain after a session of intensive muscle building exercise especially of the abdominal muscles. The abdomen was diffusely tender without guarding. There was an increased concentration of bilirubin (64.7 mumol/l), GOT (117 U/l), GPT (529 U/l) and alkaline phosphatase (150 U/l). Ultrasound examination showed a widening of the choledochal duct to 11 mm without signs of gallstones. Endoscopic retrograde cholangiography additionally revealed contrast-medium extravasation from the left hepatic duct. Computed tomography, performed immediately afterwards, confirmed the extravasation, while liver and pancreas were unremarkable. Laparoscopy revealed a 5 mm tear in the left hepatic duct, close to the hepatic duct bifurcation with bile effusion into the peritoneal cavity. The latter was rinsed endoscopically with Ringer's solution and drains were placed in the omental bursa and subhepatically in the region of the bile leak. To relax the sphincter Oddi glycerol trinitrate was administered postoperatively, for the first five days 72 mg/24 h intravenously, then for nine days twice daily 20 mg by month. No more bile drained as early as the second postoperative day and the patient was free of symptoms 2 weeks later.

Adult↗