Helvetica chirurgica acta最新文献

From January 1990 to December 1992, 25 balloon angioplasties were performed in the Department of Surgery, La Chaux-de-Fonds, Switzerland. The indications were claudication in 19, and limb salvage in 6 patients. In 4 patients, the stenosis was dilated in association with a femoropopliteal bypass (2 patients) or an intraluminal stent (2 patients). The follow-up period ranged from 3 to 36 months with a cumulated patency rate of 81%. Percutaneous transluminal angioplasty for atherosclerotic lesions of the lower extremity is associated with a good success rate. Important variables influencing patency include indications, site and extent of lesion and whether the responsible lesion is stenotic or occlusive. The advent of endovascular surgery has transformed the landscape of vascular disease management. In so doing it has confused the border between the various medical specialties. The decision to use transluminal angioplasty, should be a joint decision between surgeon and radiologist, but transluminal angioplasty should be part of the vascular surgeon's armamentarium.

We report on the 1-year follow-up after laparoscopic cholecystectomy in a consecutive series of 116 unselected patients. So far no such follow-up data have been published. The follow-up rate was 94%. All patients have been personally assessed on the base of a standardized follow-up form either at the hospital (58%) or by the general practitioner (42%). Using an adapted modified Visick classification we have found an excellent or good result in 96% of the patients. Although there were some minor dyspeptic complaints and a few abnormal laboratory findings no patient had a suspicion of residual or recurrent gall stones. There has been no reoperation. In conclusion laparoscopic cholecystectomy yields very satisfactory short-term results 1 year after operation even in an unselected population of patients.

Between 1988 and 1992 we treated in our hospital 79 patients with a complicated diverticular disease. We analysed and compared two groups (group A 42 cases January 1988 to February 1991/retrospectively, group B 37 cases March 1991 to December 1992/prospectively). We studied our operative procedure in respect to the postoperative morbidity and lethality, the number of performed and persistent stomata and the mean length of stay. The complications of diverticular disease in both groups were similar. Since March 1991 we performed primary resection with primary anastomosis in 89% of the patients, three-stage resection or primary resection with an anastomosis and a proximal colostomy was no more done. The Hartmann procedure was rarely chosen (only in 4 of 37 patients). In spite of forcing the primary resection with a primary anastomosis in group B, the complication rate (local and general) decreased from 35.7% to 29.7%, the lethality rate from 9.5% to 2.7%. The number of performed stomata showed a great difference with 22 in group A against 4 in group B. The mean length of stay was 31 versus 22 days. Therefore we consider primary resection with an anastomosis for the best therapy in complicated diverticular disease.

Functional treatment of injured joints is increasing since the introduction of semi-rigid plaster. Injuries to the ligaments of the ankle joint, ruptured Achilles tendon, but also other joints with injured ligaments are suitable for this therapy. We report about our experience of 120 treated ligamental injuries of the ankle joint, treated in a conservative way with semi-rigid plasters.

Intraoperative balloon angioplasty was performed on 17 patients and 19 arteries undergoing a concomitant vascular reconstructive procedure during the past 24 months. All angioplasties were performed with the aid of digital substraction angiography (DSA) in the operating room. The primary purpose of intraoperative angioplasty was mainly to increase outflow (18) or inflow (1) in conjunction with a planned vascular procedure. Dilatation obviated the need of more extensive vascular reconstruction in these elderly patients.

Spontaneous pneumothorax (PNO) is usually due to rupture of a small subpleural bleb into the pleural cavity and affects mainly young men. After simple drainage, recurrence occurs in about 50% of cases. The risk of recurrence increases after each new PNO. Secondary PNO complicates an underlying pulmonary disease, especially chronic obstructive pulmonary disease with emphysema. A new form of secondary PNO has emerged in the recent years in AIDS patients with pneumocystis carinii pneumonia. We have shifted to a thoracoscopic therapy of PNO since May 1991. 25 PNO in 24 patients (1 bilateral) have been treated since that time up to April 1993. 19 PNO were primary, whereas 6 were secondary, included 3 iatrogenic PNO. Resection of the leaking parenchymal area was performed in 20 patients, and parietal partial pleurectomy was done in 20 cases. In the remaining cases, fibrin glue was applied on the lesion and in 3 cases, chemical pleurodesis was attempted using silver nitrate or talc. 1 AIDS patient died of ARDS. 3 patients had recurrent PNO and had thoracotomy without complication. 21 patients did well. Partial PNO recurred in one of them 4 months later, and was treated by simple needle aspiration. Thoracoscopy is a useful method to treat recurrent or persistent spontaneous PNO. After only 25 cases, our success rate in primary PNO is 90%. There should be a learning curve. On the basis of our experience, we believe that recognition of the lesion and its resection as well as apical parietal pleurectomy are necessary to obtain good results and a low recurrence rate.

About 500 cases of localized pleural mesothelioma are known from the literature. These benign or malignant tumors arise most frequently from the visceral pleura, rarely from the pericardium. They are not associated with asbestos. Correct diagnosis is rarely made preoperatively. Resection is the treatment of choice and can be curatively even in the malignant type. Clinical, radiological and pathological findings, therapy and prognosis are described.

Complex unstable cervical spine injuries in polytraumatized patients are stabilized ventro-dorsally in a two-stage procedure. The ventral stabilization is a day-one surgery with the goal to get primary stability for intensive care, early spinal decompression and protection against secondary damage of the spinal cord. The additional dorsal stabilization allows early functional treatment or in case of spinal cord lesions early neurorehabilitation. The combination of severe brain injury and unstable cervical spine injury is especially demanding concerning diagnostic and therapeutic procedures.