Helvetica chirurgica acta最新文献

The charts of all the patients operated upon for paraesophageal hernia (HPO) were reviewed. 24 patients could be found between 1976 and 1992. The mean age was 64 years, with 15 men and 9 women. 15 patients had a pure HPO, whereas 9 had a mixed hernia (HPO and laxial hiatal hernia). 3 patients presented with acute symptoms, and 2 of them were operated on emergently. The remaining patients had elective surgery, consisting of reduction of the stomach (all cases), excision of the hernia sac (12), closure of the diaphragm (17) and gastropexy (8). There was no mortality. Due to the fact that acute complications occur in as much as 30-40% of the cases, elective surgery should be proposed to any patient with a known paraesophageal hernia if the operative risks are not prohibitive. A careful preoperative assessment including endoscopy and pH-manometry of the esophagus will provide arguments to add a antireflux procedure to the standard operation, which should include reduction of the stomach, resection of the sac, closure of the hiatal defect and gastropexy.

Tension-free repair, a prerequisite for long-term stability, cannot always be achieved with conventional techniques established for groin reconstruction. Lichtenstein gathered substantial experience simply by closing the hernia in a tension-free fashion using prosthetic material. However, most surgeons fearing graft infection are reluctant to further evaluate this technique. In a feasibility study we entered 70 patients (29 patients with recurrent hernia) receiving a polypropylene mesh (Marlex) to bridge the defect from the inguinal ligament to the internal oblique muscle. Only 1 wound infection and 1 local hematoma requiring reoperation were observed. Nearly 2 years follow-up data revealed no case of recurrence. The Lichtenstein procedure deserves more attention from surgical community and might be a reliable technique esp. in large hernias and redos.

Traumatic avulsion of the right diaphragm from the lumbocostal arch is a very rare lesion. The authours report the case of a 27-year-old man who had suffered a severe polytrauma with blunt thoracic injury, fracture of the lumbar spine, Malgaigne-type fracture of the pelvis and fracture of the femoral shaft on the right side, 10 years before. At the time of injury the lesion of the diaphragm went unnoticed. The diagnosis was made 10 years later when the patient was referred for chronic right thoracic pain combined with postprandial abdominal distension and crampy pain in the abdomen. The chest radiogram and CT-scan showed displacement of the right kidney and most of the right colon into the thorax due to avulsion of the diaphragm from its dorsal insertion on the lumbocostal arch. Surgical repair was necessary to obtain relief from pain and to prevent intestinal obstruction. Reduction of the hernia, reinsertion of the diaphragm to the lumbocostal arch and reinforcement of the repair with a prolene mesh prosthesis was performed through a right thoracophrenolumbotomy incision.

"Is there any safe and optimal treatment of hyperlipidemia following heart transplantation?" The problem of hypercholesterolemia following heart transplantation if often underestimated. Up to now there is no concept of therapy allowing an optimal adjustment of lipid parameters. Therapeutical trials using ion exchange resins, derivatives of nicotinic acids and fibrates were not successful due to cyclosporine A interaction, hepatotoxicity and limited efficacy of the applied substances. In a prospective, randomized and controlled trial we investigated the effects of the HMG-CoA-reductase inhibitor simvastatin in heart transplant recipients. The study included 70 patients (simvastatin n = 37, control group n = 33). 8 patients died within the first three months following heart transplantation. Purpose of the study was the adjustment of the LDL-cholesterol values in the simvastatin treated group to < or = 110 mg/dl. Following 24 months of treatment a mean LDL-cholesterol plasma level of 110 mg/dl was obtained. The corresponding mean value of the control group was 150 mg/dl. The difference between both groups was significant (p < 0.001). In the same period the mean HDL-cholesterol values increased by approx. 15% in both groups (no significant difference [p > 0.05]). The ratio of LDL/HDL-cholesterol was significant lower in the simvastatin treated group (2.28) than in the control group (2.94) (p < 0.05). There was no significant difference in Lp(a) values. No adverse side effects were observed within the observation period of 24 months, particularly no increase in the frequency of rejection episodes. Summarizing the above, we recommend low-dose simvastatin therapy as a safe and optimal treatment of hypercholesterolemia following heart transplantation.

Financial responsibility is one of the important aspects of hospital management. At the hospital of Uster a trial with a profit center concept was started in October 1991. This concept included development of management tools such as reference figures to check costs, returns and performance. Thus it was possible to obtain an equilibrium between personnel costs and performance within 6 months. In the first half of 1993 the budgeted performance figures for 1993 have so far been reached. Although a complete implementation of a profit center concept in a public hospital does not seem possible, a profit center-like structure helps to obtain financial control and enables the hospital management to readily adapt to changing conditions.

We report two recent observations of an angiographic artefact called "standing waves". It results in the same characteristic beaded pictures than fibromuscular dysplasia. It is induced by the angiography catheter and is related to the speed of injection. The possible occurrence of this artefact should be borne in mind whenever the films show dysplastic lesions in more than one artery.

Vascular surgery in growing organisms is still problematic. Especially in surgical therapy of coarctation of the aorta, high restenose rates are documented if non-absorbable polypropylene and running suture technique ist used. Theoretically, absorbable suture material allows a running suture technique with less restenose rates. Our study compares absorbable (polyglyconat and polydioxanon) with non-absorbable (polypropylene) suture material for repair of aorta in growing dogs. Anastomoses performed with absorbable suture material show after one year very good functional results without any local complications. In conclusion we can say that absorbable suture material allows formation of safety vascular anastomoses and doesn't impair growth of anastomoses.

From 1967 to 1992 at the University Hospital of Zurich 16 patients (14 male, 2 female) with 22 popliteal artery entrapment syndromes underwent a surgical treatment. In this period several different operation procedures were used. The modern operative procedure depends on the degree of the arteries wall compression. The procedure of choice for minimal compression of arterial wall is a musculo-tendinous decompression with a medial replacement of the popliteal artery. In the cases of severe compression we used autologous venous bypass from femoropopliteal I to popliteal III.