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Biomedical subjects

W Weder

Publications and source records attributed to W Weder.

At least 127 records · Page 7Linked to original sources
PubMed1993

[Gastroenterostomy "par principe" or "de nécessité" in palliative therapy of pancreatic cancer?].

There has been a controversy for years concerning the value of the prophylactic gastroenterostomy (GE) in patients suffering from irresectable pancreatic cancer. A retrospective analysis of the patients undergoing palliative bypass-operations for pancreatic cancer at Zurich University Hospital between 1982 and 1990 revealed 53 patients (28 male, 25 female) with an average age of 68 years. Twenty-one patients received a double bypass, 18 received a hepaticojejunostomy, 12 a primary and 2 a secondary GE. Mortality and morbidity for double bypass were 14% and 33%, for hepaticojejunostomy 5% and 28% and for primary GE 25% and 50%. Secondary GE was associated with a mortality and morbidity of 1 of 2 cases. Two patients received a secondary GE and two more showed signs of duodenal obstruction amounting to 20% incidence for secondary duodenal obstruction. Delayed gastric emptying was observed in only 2 patients with primary GE. These data suggest the use of a prophylactic double bypass.

Aged↗
PubMed1993

[Retroperitoneal sarcoma. Therapy and course].

The incidence of retroperitoneal soft tissue sarcomas is with 0.1 to 0.2 percent very low. The tumors most often present as asymptomatic masses until the lesions are quite large, compared with the anatomic part, resulting in compression of nerves, vessels, bowel etc. The recommended management is the aggressive radical tumor excision including the pseudocapsule followed by a consequent clinical, ultrasonography and CT-scan follow-up. Tumor recurrences should be attempted in the same manner as primary tumors.

Adolescent↗
PubMed1993

[Thoracoscopic resection of a schwannoma].

Schwannomas are most often benign tumors originating from the sheath of peripheral nerves. Most are asymptomatic and detected incidentally on a routine chest X-ray. Resection is generally recommended to confirm the diagnosis. In a 35-year-old patient we resected and removed an intrathoracic schwannoma of the 6th intercostal nerve thoracoscopically. The technique of resection and protected removal is described.

Adult↗
PubMed1993

Local and systemic toxicity of intra-hepato-arterial chemotherapy for treatment of unresectable liver metastases of colorectal cancer with 5-Fluorouracil and high dose Leucovorin.

We report our preliminary results of an ongoing phase-II-study with special regard to local and systemic toxicity, using a combined regimen of high dose Leucovorin and 5-Fluorouracil applicated intra-hepato-arterially. During 24 chemotherapy cycles we saw only mild to moderate systemic toxicity and there was no chemical hepatitis. First results concerning the response rate are encouraging. The modulation of 5-Fluorouracil (5-FU) with folinic acid represents a significant step in the treatment of colorectal cancer. Administration of chemotherapy through the hepatic artery for liver metastases of colorectal cancer allows high local drug concentration with relative low systemic toxicity. Until now there is little information about the local and systemic toxicity of high dose Leucovorin combined with 5-FU applicated intra-hepato-arterially. We describe our experience with this therapy in a running phase-II-study with special regard to local and systemic toxicity.

Aged↗
PubMed1993

Minimal invasive surgery for treatment of enlarged symptomatic liver cysts.

Congenital solitary liver cysts are a common finding, but they are usually asymptomatic; however, symptoms occur in about 16% and then require treatment. Ideally, complete or partial resection of the cyst is the treatment of choice but always implies invasive surgery. We report the case of a 50-year-old woman suffering from a massively enlarged cyst in the left liver lobe. We decided to resect the extraphepatic part of the cyst by laparoscopic surgery. The patient was discharged absolutely asymptomatic 3 days following surgery. We conclude that open resection of symptomatic congenital liver cysts should be replaced by laparoscopic removal when cysts are mostly extrahepatically located. The laparoscopic procedure combines the advantages of minimal invasive surgery with the demand for a radical effective treatment.

Cysts↗
PubMed1993

[Long-term results of open parietal pleurectomy in treatment of recurrent spontaneous pneumothorax].

The open parietal pleurectomy is an effective treatment of recurrent or persistent spontaneous pneumothorax with a low recurrency rate of 3.3% in our series. The long-term course reveals very good functional results. A relatively high number of patients complains about chest wall pain or a painful thoracotomy scar. Also remarkable is the rate of dissatisfaction with the cosmetic result of the thoracotomy. Regarding both complaints thoracoscopic pleurectomy should be able to improve the results and the acceptance of this operation.

Adult↗
PubMed1992

[Preventive or therapeutic parathyroidectomy in primary hyperparathyroidism].

The only causal treatment of primary hyperparathyroidism (PHPT) is parathyroidectomy. There are indications in the literature that despite operation expectation of life is shortened because of an increased frequency of cardiovascular and malignant diseases leading to the recommendation for early surgery even in uncomplicated PHPT. It is easier to convince an asymptomatic patient of an operation when he is informed about complications and consequences of an expectative attitude. Therefore, we reviewed our 71 patients operated upon during a 4-year-interval, 58 of whom were followed-up. During 82 operations 115 pathologically altered parathyroid glands were removed. Two persistent paralyses of the recurrent nerve occurred, however, without alteration of the voice. Follow-up of 82% of patients revealed 2 cases of recurrent nephrolithiasis (1 hypercalcaemia, 1 normocalcaemia). Three (5%) true recurrences were found, but neither a pancreatitis nor a peptic ulcer was noted during long-term follow-up. None of the 137 patients operated for a bleeding or perforated peptic ulcer during the last 10 years and 1 of 55 patients with acute pancreatitis during the past 8 years suffered from a PH-PT. However, morbidity and mortality of these two conditions was high. Although correlation to PHPT was low we recommend early operation of PHPT because of the low morbidity rate, zero lethality and reduced expectation of life.

Adenoma↗
PubMed1992

Thoracoscopic resection of benign schwannoma.

The recent improvement of endoscopic surgical instruments allows new therapeutical application of thoracoscopy. We report a thoracoscopic resection of a benign schwannoma of the 6th intercostal nerve in a 35-year-old patient. The operative technique and extraction of the tumor from the chest is described. Postoperative morbidity was minor. We consider the thoracoscopic resection as first choice of treatment.

Adult↗
PubMed1992

Comparison of the University of Wisconsin preservation solution and other crystalloid perfusates in a 30-hour rabbit lung preservation model.

The University of Wisconsin solution, which contains a high potassium concentration (120 mmol/L), was evaluated for rabbit lung preservation by comparing it with a modified University of Wisconsin solution with low potassium (4 mmol/L), a low-potassium dextran solution (4 mmol/L), and simple surface cooling. In the first three groups rabbit lungs were flushed in situ with the solution (n = 5 in each group); then the lung-heart block was harvested and stored at 10 degrees C for 30 hours. In the surface cooling group the lungs were harvested without flushing and then simply immersed in saline and stored. For assessment, the stored lung was ventilated with room air and perfused with fresh venous blood at a rate of 40 ml/min for 10 minutes. Assessment of lung function included gas analysis of effluent blood, mean pulmonary artery perfusion pressure, and peak airway pressure. Among these parameters, oxygen tension was most sensitive. Oxygen tension at 10 minutes' perfusion in the modified University of Wisconsin (95 +/- 6 mm Hg) and low-potassium dextran (99 +/- 4 mm Hg) groups was significantly higher than that in the surface cooling (61 +/- 7 mm Hg) and University of Wisconsin (51 +/- 7 mm Hg) groups. There was no difference between the modified University of Wisconsin and low-potassium dextran groups or between the surface cooling and University of Wisconsin groups. We conclude that the low-potassium University of Wisconsin solution is superior to the high-potassium University of Wisconsin solution and that the lactobionate and raffinose included in the University of Wisconsin solution as impermeants do not improve lung preservation in this model.

Adenosine↗
PubMed1992

[Is routine intra-operative cholangiography in laparoscopic cholecystectomy truly unnecessary?].

The introduction of laparoscopic cholecystectomy as method of choice for gall stone treatment reopened the question whether to continue with routine intraoperative cholangiography or to switch over to a selective indication. In order to set an accurate indication for selective intraoperative cholangiography it was our goal to develop a tool for preoperative identification of patients with a high risk of common bile duct stones. A preoperative score, indicating the risk of common bile duct stones, was designed. A history of jaundice, elevated levels of bilirubin, alkaline phosphatase, amylase (serum), ALAT (GPT) or ASAT (GOT), a common bile duct wider than 10 mm or containing concrements and multiple gallstones smaller than 10 mm were valued as risk indicators, whereas normal wide bile duct, large or solitary gallstones were valued as decreasing the risk of common bile duct stones. The retrospective screening of 289 consecutive conventional cholecystectomies (1986-1990) for these risk indicators demonstrated a good correlation of the risk score with the occurrence of common bile duct stones. A prospective application of the score, with improved ultrasound examination and routine preoperative intravenous cholangiography, mandatory for laparoscopic cholecystectomy at our institution, will define the high risk group definitely and allow an accurate selective use of intraoperative cholangiography.

Cholangiography↗
PubMed1992

[Revascularization of tracheal transplants with omentum].

UNLABELLED: In a series of 6 dogs we performed an autotransplantation of a four-ring segment of the thoracic trachea. In 3 cases the omentum was brought into the chest and wrapped around the transplant (omentum group) and compared with the others (control group). After 20 days or at occurrence of severe tracheal stenosis the study was determined. In the omentum group all tracheal transplants healed with structural integrity. Microfil injection into the gastro-epiploic artery demonstrated revascularization through omental vessels. In the control group all transplants developed a severe stenosis due to chondromalacia within 2 weeks. IN CONCLUSION: The omentum can successfully revascularize a transplant of a four-ring segment of the thoracic trachea.

Animals↗
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

[Does tissue pH measurement quantify circulation in the transplanted bronchus in lung transplantation].

Ischemia of the airway is the main cause of severe complications in lung transplantation. Tissue-pH is used as an indicator of ischemia in the myocardium and various other tissues. We developed a pH needle probe which can be applied through a bronchoscope to enable repeated measurements of the pH in the bronchus mucosa. In 8 conditioned mongrel dogs (20-25 kg) an autotransplant of a 4-ring segment of the thoracic trachea was performed and wrapped with an omental pedicle flap in 4 of them (omentum group vs control group). PH-measurements of the mucosa were performed at 3 points of the circumference of the normal trachea as well as the transplant. The measurements were done immediately postoperative and at day 3, 8, 14 and 20 using a modified MI 506 pH-needle electrode with an Ag-AgCl skin reference electrode and a Fisher accumet pH-meter (model 910). After 3 weeks or at occurrence of a severe tracheal stenosis macroscopic and histologic examination of the trachea was done. All animals in the omentum group finished the study. One developed severe stenosis due to tracheal malacia. Three of the four control-dogs had a severe tracheal stenosis at day 12, 13 and 16 which necessitated termination of the experiment. The pH-difference between trachea and transplant immediately postoperative was 0.16 +/- 0.02 in the 4 dogs with healed transplants and 0.15 + 0.03 in the 4 dogs with stenosis due to chondromalacia. Follow-up measurements at day 3 and 8 showed a pH-difference of 0.2 for the group with chondromalacia vs. 0.1 for the healed tracheas (not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed1991

[Modified postoperative prevention of recurrence in euthyroid struma nodosa].

In a prospective clinical study after uni- or bilateral subtotal thyreoidectomy, cause of euthyreote goitre, no substitution with L-thyroxin was ordered postoperatively. The follow-up after three months and one year shows a representative time for judgement of the hormonal situation after three months. Over one year 55% with bilateral resection need hormone substitution but only 4% with unilateral. Bilateral subtotal thyroid resection seems to be a too extensive resection to leave enough functional thyroid tissue for a physiological function.

Euthyroid Sick Syndromes↗
PubMed1991

Influence of intraalveolar oxygen concentration on lung preservation in a rabbit model.

We previously reported the use of an inexpensive screening model for lung preservation involving ventilation and perfusion of excised rabbit lungs after their preservation. We now have extended this model by perfusing the preserved lung in cross circulation with an anesthetized rabbit to permit stable reperfusion of the preserved lungs for 60 minutes. With this model we compared the results of lung preservation with the lungs inflated with nitrogen, room air, or 100% oxygen during 24 hours of hypothermic storage. Four groups of animals were studied: group 1, excision and immediate evaluation; group 2, inflation with room air and storage for 24 hours at 10 degrees C; group 3, same as group 2, with 100% oxygen for inflation during storage; group 4, same as group 2, with 100% nitrogen for inflation during storage. Assessment of the ex vivo perfused lung consisted of (1) blood gas analysis of inflow and outflow blood at 10-minute intervals; (2) continuous pulmonary artery and airway pressure monitoring; (3) measurement of pulmonary venous oxygen tension after 1 hour of reperfusion, with inflow oxygen tension adjusted to 15 mm Hg; (4) wet/dry weight ratio. We conclude that the paracorporeal circuit does not, in itself, cause lung injury over a 1-hour period; lungs preserved with nitrogen inflation rapidly became edematous and failed to function on reperfusion. Preservation with 100% oxygen inflation appears superior to inflation with room air.

Animals↗
PubMed1990

[Status of lung transplantation: developments, indications and results].

Lung transplantation has proven to be a successful treatment for selected patients with end stage pulmonary disease. The indications are restrictive, chronic obstructive or infective lung diseases and diseases associated with high pulmonary resistance. The choice of the appropriate operation as single lung transplantation, double lung transplantation or heart-lung transplantation is based on the various end stage lung diseases. From 1983 till april 1989 76 single lung and 49 double lung transplants were performed in different centers with an actual survival rate of 60% for single and 57% for double lung transplants.

Animals↗