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Search Results: 1 - 10 of 32696 matches for " Daniel Oertli "
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Transperitoneal Laparoscopic Adrenalectomy: Assessment of the Surgical Learning Curve
Lukas Meier,Henryk Zulewski,Daniel Oertli
ISRN Minimally Invasive Surgery , 2013, DOI: 10.1155/2013/936209
Abstract: Background. We report a single surgeon’s experience of 52 transperitoneal laparoscopic adrenalectomies (LAs) performed between 2001 and 2010. In addition, we compared this series with our first published series of LAs performed between 1994 and 2001. Methods. Our series includes 24 left, 20 right, and 4 bilateral LAs performed in 48 patients. To estimate the learning curve, we chronologically divided the sample of unilateral LAs into two groups of 22 patients and compared the operating time, estimated blood loss, maximum diameter of the lesion, complications, and length of hospital stay. Results. Mean operating time was significantly lower (94 versus 78?min, ) and mean intraoperative blood loss was significantly lower (156 versus 60?mL, ) after more experience had been gained. Additionally, a trend towards removing larger lesions was observed. There was no significant difference in terms of hospital stay. Conclusions. Observing a single surgeon’s experience of nine years in laparoscopic adrenalectomy, this study indicates that it takes approximately 20–25 procedures to flatten the learning curve. Thus, for single centers with a volume of approximately five LAs performed per year, we suggest a selection of a few experienced surgeons to perform LAs in order to improve outcomes. 1. Background Since its first performance in 1992, laparoscopic adrenalectomy (LA) has quickly become the standard method for surgical treatment of benign and selected malignant adrenal pathologies [1, 2]. Although there are no randomized controlled studies comparing open adrenalectomy versus LA, the multitude of retrospective analyses and case reports clearly demonstrate the benefits of LA in terms of feasibility, safety, morbidity, hospital stay, and recovery time [2–7]. We have already affirmed the benefits of LA with our first series of 22 LAs performed between 1994 and 2001. Compared with open adrenalectomy, LA resulted in less blood loss, lower postoperative analgesic requirements, and shorter hospital stays [8]. The aim of this paper is to present our subsequent series of 52 consecutive transperitoneal LAs performed between 2001 and 2010 in order to evaluate the learning curve associated with this technique. We reevaluated the major parameters (indications, morbidity, hospital stay, blood loss, and lesion size) and especially focused on operative duration over time. 2. Methods For this survey, we retrospectively included all patients in whom unilateral or bilateral transperitoneal LA was performed between April 2001 and November 2010. The most common indication was a
Small Bowel Obstruction Caused by an Incarcerated Hernia after Iliac Crest Bone Harvest
Steven d'Hondt,Savas Soysal,Philipp Kirchhoff,Daniel Oertli
ISRN Surgery , 2011, DOI: 10.5402/2011/836568
Abstract:
Ischemic preconditioning-induced hyperperfusion correlates with hepatoprotection after liver resection
Oleg Heizmann, Georgios Meimarakis, Andreas Volk, Daniel Matz, Daniel Oertli, Rolf J Schauer
World Journal of Gastroenterology , 2010,
Abstract: AIM: To characterize the impact of the Pringle maneuver (PM) and ischemic preconditioning (IP) on total blood supply to the liver following hepatectomies.METHODS: Sixty one consecutive patients who underwent hepatic resection under inflow occlusion were randomized either to receive PM alone (n = 31) or IP (10 min of ischemia followed by 10 min of reperfusion) prior to PM (n = 30). Quantification of liver perfusion was measured by Doppler probes at the hepatic artery and portal vein at various time points after reperfusion of remnant livers.RESULTS: Occlusion times of 33 ± 12 min (mean ± SD) and 34 ± 14 min and the extent of resected liver tissue (2.7 segments) were similar in both groups. In controls (PM), on reperfusion of liver remnants for 15 min, portal perfusion markedly decreased by 29% while there was a slight increase of 8% in the arterial blood flow. In contrast, following IP + PM the portal vein flow remained unchanged during reperfusion and a significantly increased arterial blood flow (+56% vs baseline) was observed. In accordance with a better postischemic blood supply of the liver, hepatocellular injury, as measured by alanine aminotransferase (ALT) levels on day 1 was considerably lower in group B compared to group A (247 ± 210 U/I vs 550 ± 650 U/I, P < 0.05). Additionally, ALT levels were significantly correlated to the hepatic artery inflow.CONCLUSION: IP prevents postischemic flow reduction of the portal vein and simultaneously increases arterial perfusion, suggesting that improved hepatic macrocirculation is a protective mechanism following hepatectomy.
Cytokine & chemokine response in the lungs, pleural fluid and serum in thoracic surgery using one-lung ventilation
Andreas Breunig, Franco Gambazzi, Beatrice Beck-Schimmer, Michael Tamm, Didier Lardinois, Daniel Oertli, Urs Zingg
Journal of Inflammation , 2011, DOI: 10.1186/1476-9255-8-32
Abstract: Broncho-alveolar lavage (BAL) fluid of both the collapsed, operated and the ventilated, non-operated lung, respectively, pleural space drainage fluid and blood was collected and the concentrations of interleukin (IL)-6, IL-1RA and GROα were determined with enzyme-linked immunosorbent assays in 15 patients.Substantial inter-individual differences in the BAL fluid between patients in cytokine and chemokine levels occurred. In the pleural fluid and the blood these inter-individual differences were less pronounced. Both sides of the lung were affected and showed a significant increase in IL-6 and IL-1RA concentrations over time but not in GROα concentrations. Except for IL-6, which increased more in the collapsed, operated lung, no difference between the collapsed, operated and the ventilated, non-operated lung occurred. In the blood, IL-6 and IL-1RA increased early, already at the end of surgery. GROα was not detectable. In the pleural fluid, both cytokine and chemokine concentrations increased by day one. The increase was significantly higher in the pleural fluid compared to the blood.The inflammatory response of cytokines affects both the collapsed, operated and the ventilated, non-operated lungs. The difference in extent of response underlines the complexity of the inflammatory processes during OLV. In contrast to the cytokines, the chemokine GROα concentrations did not react in the BAL fluid or in the blood. This indicates that GROα might not be useful as marker for the inflammatory reaction in complex surgical procedures.Thoracic surgery such as esophagectomy or lobectomy triggers a more severe systemic inflammatory reaction than intra-abdominal surgery [1]. One possible explanation is the fact that most thoracic procedures mandate a one-lung ventilation (OLV) strategy. The OLV leads to a collapse of the lung that is operated with subsequent shunting of blood and possible hypoxemia. The contralateral lung is ventilated and may suffer from ventilator-induced injury
Annular pancreas associated with duodenal carcinoma
Enrico Br?nnimann, Silke Potthast, Tatjana Vlajnic, Daniel Oertli, Oleg Heizmann
World Journal of Gastroenterology , 2010,
Abstract: Annular pancreas (AP) is a rare congenital anomaly. Coexisting malignancy has been reported only in a few cases. We report what is, to the best of our knowledge, the first case in the English literature of duodenal adenocarcinoma in a patient with AP. In a 55-year old woman with duodenal outlet stenosis magnetic resonance cholangiopancreatography showed an aberrant pancreatic duct encircling the duodenum. Duodenojejunostomy was performed. Eight weeks later she presented with painless jaundice. Duodenopancreatectomy revealed a duodenal adenocarcinoma, surrounded by an incomplete AP. Thus, co-existent malignancy with AP can be present without obstructive jaundice and without being visible through preoperative diagnostics.
Differential pattern and prognostic significance of CD4+, FOXP3+ and IL-17+ tumor infiltrating lymphocytes in ductal and lobular breast cancers
Raoul Droeser, Inti Zlobec, Ergin Kilic, Uwe Güth, Michael Heberer, Giulio Spagnoli, Daniel Oertli, Coya Tapia
BMC Cancer , 2012, DOI: 10.1186/1471-2407-12-134
Abstract: A tissue microarray (TMA) including 894 ductal and 164 lobular breast cancers was stained with antibodies recognizing CD4, FOXP3, and IL-17 by standard immunohistochemical techniques. Lymphocyte counts were correlated with clinico-pathological parameters and survival.CD4+ lymphocytes were more prevalent than FOXP3+ TILs whereas IL-17+ TILs were rare. Increased numbers of total CD4+ and FOXP3+ TIL were observed in ductal, as compared with lobular carcinomas. High grade (G3) and estrogen receptor (ER) negative ductal carcinomas displayed significantly (p < 0.001) higher CD4+ and FOXP3+ lymphocyte infiltration while her2/neu over-expression in ductal carcinomas was significantly (p < 0.001) associated with higher FOXP3+ TIL counts. In contrast, lymphocyte infiltration was not linked to any clinico-pathological parameters in lobular cancers. In univariate but not in multivariate analysis CD4+ infiltration was associated with significantly shorter survival in patients bearing ductal, but not lobular cancers. However, a FOXP3+/CD4+ ratio > 1 was associated with improved overall survival even in multivariate analysis (p = 0.033).Ductal and lobular breast cancers appear to be infiltrated by different lymphocyte subpopulations. In ductal cancers increased CD4+ and FOXP3+ TIL numbers are associated with more aggressive tumor features. In survival analysis, absolute numbers of TILs do not represent major prognostic indicators in ductal and lobular breast cancer. Remarkably however, a ratio > 1 of total FOXP3+/CD4+ TILs in ductal carcinoma appears to represent an independent favorable prognostic factor.Tumor-infiltrating lymphocytes (TILs) are frequently considered to reflect host immune response against malignant tumors [1]. TILs have been shown to infiltrate a variety of tumors of diverse histological origin [2,3]. Their exquisite tumor specificity has been demonstrated in a number of cases and it has led to the characterization of tumor associated antigens. Although resident
Laparoscopic Treatment of a Rare Right Diaphragmatic Rupture with Small Bowel Herniation after Blunt Thoracic Trauma
H. Hoffmann,D. Oertli,O. Heizmann
Minimally Invasive Surgery , 2010, DOI: 10.1155/2010/109062
Abstract: Blunt traumatic diaphragmatic rupture (BTDR) is a life-threatening condition with an incidence from 0,8%–1,6% in blunt trauma, mostly located on the left side. The main prognostic factors are severe side injuries and the delay of diagnosis. We present a rare case of a 68-year-old female, with an isolated right diaphragm rupture. The diagnosis was done with a delay of 4 days by thoracic radiographs, which showed a herniation of small bowel into the right thoracic cavity. A reposition of the small bowel and a closure of the diaphragmatic defect by running suture were carried out laparoscopicly. Although large prospective studies concerning the outcome of laparoscopic approach to right BTDR are still missing, we could show, that laparoscopy can be performed safely in right traumatic diaphragm rupture. 1. Introduction Blunt traumatic diaphragmatic rupture (BTDR) is a life-threatening condition with an incidence of 0.8%–1.6% in blunt trauma [1–3]. The closure of the diaphragm rupture must be performed immediately. The diagnosis often happens to be late due to the absence of typical symptoms or other major injuries dominating the clinical aspect [4]. An isolated BTDR is rare and thus might be followed by a period of weeks or months not revealing any symptoms [2, 5]. Most BTDR are located on the left side in the musculotendinous intersection [1, 3, 4]. Right BTDR are rarely described and less frequent [6]. Herniation of colon, small bowel, or liver may occur and result in ileus, necrosis, and perforation [4, 7]. 2. Narrative We present a rare case of a 68-year-old female hospitalized in the neurological department due to Parkinson disease. She fell onto a chair hitting her right hemithorax. Initially, subjective symptoms have been missing. The examination showed a slightly reduced breath without any signs of pneumothorax or dyspnea, a decent pressure pain and a bruise. 4 days after trauma, she developed a progressive pulmonal decompensation with desaturation. Additionally, there have been signs of ileus. The chest radiograph displayed a herniation of bowel into the right hemithorax with consecutive ileus signs (Figure 1). Figure 1: Chest radiograph shows bowel herniation into right hemithorax. We performed a laparoscopic approach and found a ?cm rupture of the right diaphragm with herniation of 1 meter small bowel. The bowel appeared vital after reposition. The transdiaphragmatic thoracoscopy displayed a collapsed lung and a dislocated rib fracture (Figure 2). After irrigation of the thoracic cavity we made a direct laparoscopic strainless running suture with
High Myeloperoxidase Positive Cell Infiltration in Colorectal Cancer Is an Independent Favorable Prognostic Factor
Raoul A. Droeser, Christian Hirt, Serenella Eppenberger-Castori, Inti Zlobec, Carsten T. Viehl, Daniel M. Frey, Christian A. Nebiker, Raffaele Rosso, Markus Zuber, Francesca Amicarella, Giandomenica Iezzi, Giuseppe Sconocchia, Michael Heberer, Alessandro Lugli, Luigi Tornillo, Daniel Oertli, Luigi Terracciano, Giulio C. Spagnoli
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0064814
Abstract: Background Colorectal cancer (CRC) infiltration by adaptive immune system cells correlates with favorable prognosis. The role of the innate immune system is still debated. Here we addressed the prognostic impact of CRC infiltration by neutrophil granulocytes (NG). Methods A TMA including healthy mucosa and clinically annotated CRC specimens (n = 1491) was stained with MPO and CD15 specific antibodies. MPO+ and CD15+ positive immune cells were counted by three independent observers. Phenotypic profiles of CRC infiltrating MPO+ and CD15+ cells were validated by flow cytometry on cell suspensions derived from enzymatically digested surgical specimens. Survival analysis was performed by splitting randomized data in training and validation subsets. Results MPO+ and CD15+ cell infiltration were significantly correlated (p<0.0001; r = 0.76). However, only high density of MPO+ cell infiltration was associated with significantly improved survival in training (P = 0.038) and validation (P = 0.002) sets. In multivariate analysis including T and N stage, vascular invasion, tumor border configuration and microsatellite instability status, MPO+ cell infiltration proved an independent prognostic marker overall (P = 0.004; HR = 0.65; CI:±0.15) and in both training (P = 0.048) and validation (P = 0.036) sets. Flow-cytometry analysis of CRC cell suspensions derived from clinical specimens showed that while MPO+ cells were largely CD15+/CD66b+, sizeable percentages of CD15+ and CD66b+ cells were MPO?. Conclusions High density MPO+ cell infiltration is a novel independent favorable prognostic factor in CRC.
H. pylori exploits and manipulates innate and adaptive immune cell signaling pathways to establish persistent infection
Anne Müller, Mathias Oertli, Isabelle C Arnold
Cell Communication and Signaling , 2011, DOI: 10.1186/1478-811x-9-25
Abstract: Innate immune cells as well as epithelial cells forming a first barrier to infection detect invading pathogens via their conserved microbial structures, the so-called pathogen-associated molecular patterns (PAMPs). Examples of PAMPs include microbial nucleid acids, and cell wall and flagellar components such as peptidoglycan, lipopolysaccharide (LPS), lipoproteins and flagellins [1]. PAMPs are recognized by at least four distinct classes of innate immune or pattern recognition receptors (PRRs) that are present either on cytoplasmic and endosomal membranes (Toll-like receptors, TLRs, and C-type lectin receptors, CLRs) or in the cytosol (NOD-like receptors, NLRs, RIG-like receptors, RLRs). Generally speaking, the ligation of TLRs, CLRs or RLRs results in the activation of pro-inflammatory transcription factors in the nucleus; in contrast, most NLRs are involved in the assembly of multi-protein complexes termed "inflammasomes", which process pro-IL-1β and pro-IL-18 to generate the mature, bioactive cytokines [2] (summarized in Figure 1).PRRs are present not only on hematopoietic cells, but also on gastric epithelial cells which form a first line of defense against H. pylori infection [3,4]; therefore, many of the seminal studies in the field have focused on examining H. pylori recognition by epithelial cells. In particular, TLR4, 5 and 9 have been detected immunohistochemically on gastric epithelial cells in H. pylori-infected as well as uninfected patients, which in principle allows these cells to sense and respond to the infection [3,4]. Interestingly, H. pylori differs from other gastrointestinal pathogens in that it has evolved to largely avoid recognition by PAMPs. H. pylori flagellin is a poor ligand of TLR5 [5] due to mutations in the TLR5 recognition site of the N-terminal D1 domain of flagellin [6]. Indeed, mutating residues 89-96 of the strongly recognized Salmonella flagellin to the corresponding H. pylori flaA sequence abolishes TLR5 recognition [6]. The ba
Long-term patterns of chironomid assemblages in a high elevation stream/lake network (Switzerland) – Implications to global change
Brigitte Lods-Crozet,Beat Oertli,Christopher T Robinson
Fauna Norvegica , 2012, DOI: 10.5324/fn.v31i0.1361
Abstract: A long-term monitoring program was initiated in 2002 on running and standing waters in a high elevation cirque landscape (Macun) in the Swiss National Park. The region comprises contrasting basins with different water sources, a glacier-fed basin and two precipitation-fed basins. Sampling of 26 permanent and temporary ponds (or small lakes) and of interconnecting streams (10 sites) was conducted from 2002 to 2010. Pond macroinvertebrate assemblages were dominated by chironomids with 42 taxa. The Orthocladiinae were the dominant subfamily in richness and abundance with 22 taxa. The greatest diversity was found in ponds located in the south and outlet basins. The inter-year variability for the same pond is high, but no clear temporal trend was noticed in ponds frequently monitored ponds. The Orthocladiinae subfamily was also the richest in the stream sites where 33 taxa were collected. The north and south basins were separated on the basis of chironomid assemblages. The chironomid assemblages in the stream network shows a temporal trend from 2002 but it cannot be linked to any clear change at the community structure level. The higher richness and abundance in stream sites and ponds of the south basin could be related to a greater heterogeneity in water physico-chemistry and substrata, and by the presence of Bryophyta. The understanding of the environmental factors that influence faunal assemblages is crucial for the protection of this sensitive alpine pond network where a relatively high overall regional diversity (49 taxa) is detected. From the literature, temperature is recognized as the driving force on changes in chironomid assemblages in alpine systems. Our results support the use of chironomids as flagship indicators in the assessment of climatic change in alpine landscapes. doi: 10.5324/fn.v31i0.1361. Published online: 17 October 2012.
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