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Winterthur, Switzerland

Drymousis P.,Imperial College London | Raptis D.A.,University of Zurich | Spalding D.,Imperial College London | Fernandez-Cruz L.,University of Barcelona | And 4 more authors.
HPB | Year: 2014

Background Over the last decade laparoscopic pancreatic surgery (LPS) has emerged as an alternative to open pancreatic surgery (OPS) in selected patients with neuroendocrine tumours (NET) of the pancreas (PNET). Evidence on the safety and efficacy of LPS is available from non-comparative studies. Objectives This study was designed as a meta-analysis of studies which allow a comparison of LPS and OPS for resection of PNET. Methods Studies conducted from 1994 to 2012 and reporting on LPS and OPS were reviewed. Studies considered were required to report on outcomes in more than 10 patients on at least one of the following: operative time; hospital length of stay (LoS); intraoperative blood loss; postoperative morbidity; pancreatic fistula rates, and mortality. Outcomes were compared using weighted mean differences and odds ratios. Results Eleven studies were included. These referred to 906 patients with PNET, of whom 22% underwent LPS and 78% underwent OPS. Laparoscopic pancreatic surgery was associated with a lower overall complication rate (38% in LPS versus 46% in OPS; P < 0.001). Blood loss and LoS were lower in LPS by 67 ml (P < 0.001) and 5 days (P < 0.001), respectively. There were no differences in rates of pancreatic fistula, operative time or mortality. Conclusions The nature of this meta-analysis is limited; nevertheless LPS for PNET appears to be safe and is associated with a reduced complication rate and shorter LoS than OPS. © 2013 International Hepato-Pancreato-Biliary Association.

Horstmann M.,Kantonsspital Winterthur
Nephro-Urology Monthly | Year: 2012

Bladder cancer represents a major health care burden in many societies. Currently, cystoscopy and urinary cytology are the gold standard in bladder cancer detection. To further improve detection and/or to reduce expensive and invasive cystoscopies, highly sensitive and specific urine-based tumour markers are requested. Until now, several urine-based tumour markers for the detection and surveillance of bladder cancer have been developed and are commercially available. others are under research. This paper gives an overview of the currently commercially available urine-based tumour makers for bladder cancer. Information is based on a non-systematic PubMed literature search. All markers were at least in some studies superior to urinary cytology; however, none of them can be considered sensitive and specific enough alone to substantially reduce the necessity of cystoscopies. The recommended use of urine-based tumour markers therefore remains in adjunction to cystoscopy and for some of them in individual screening situations of patients at high risk. © 2012, Kowsar M.P.Co.

To prospectively compare the AirSeal® System valve-less Trocar with a standard Versaport™ Plus V2 Trocar as assistant insufflating port in transperitoneal and extraperitoneal robotic-assisted radical prostatectomy (t-RARP/e-RARP). Two consecutive cohorts of patients undergoing RARP using either a 12 mm AirSeal valve-less Trocar (n=19 [14 t-RARP/5 e-RARP]) or a 12 mm Versaport Plus V2 Trocar (n=17 [11 t-RARP/6 e-RARP]) were prospectively evaluated. Age, body mass index, tumor characteristics, and surgical approach were similar in both cohorts. Besides relevant clinical data, episodes of pressure loss (<8 mm Hg), the number of necessary trocar manipulations, the frequency of camera cleaning, and overall carbon dioxide (CO2) consumption were recorded and compared. Mean surgical time was 175 minutes in the AirSeal and 166 minutes in the Versaport group (p=0.55). Whereas in the AirSeal group, only one episode of pressure loss <8 mm Hg was observed; this occurred in mean 38 times in the Versaport group (p<0.0001). No trocar manipulations for specimen or needle retrieval were necessary in the AirSeal group in contrast to in mean 15 in the Versaport group (p<0.0001). Otherwise, no appreciable differences regarding overall operating time, blood loss, camera cleaning, or overall CO2 consumption were observed for the present study. Patient CO2 absorption was not evaluated. In the present study, the AirSeal Trocar offered a more stable pneumocavity and facilitated specimen retrieval and needle extraction.

Thienpont E.,University hospital Saint Luc | Schwab P.-E.,University hospital Saint Luc | Paternostre F.,University hospital Saint Luc | Koch P.,Kantonsspital Winterthur
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2014

Results: The mean (SD) PCA was 4° (1.4°) of external rotation. A significant correlation was found between more external rotation of the SEA and more proximal varus of the tibia or more distal valgus of the femur. For 59 % of the study population, 4° external rotation from the PCL would be the right amount of axial rotation to align the femoral component in line with the SEA. Nine per cent needs less, and 32 % needs more than 4° of axial rotation. On 105 (4 %) CT-based 3D models, external rotation between 7° and 11° was measured and 77 (73 %) of those cases were in varus or neutral alignment. In 132 patients, bilateral measurements were available and 94 (71 %) had rotation within 1° of the opposite side. This last finding underlines that there is even an intra-individual difference in distal femoral anatomy that can range from 1° to 5°.Purpose: Finding the anatomical landmarks used for correct femoral axial alignment can be difficult. The posterior condylar line (PCL) is probably the easiest to find during surgery. The aim of this study was to analyse whether a predetermined fixed angle referencing of the PCL could help find the surgical epicondylar axis (SEA) and this based on a large CT database with enough Caucasian diversity to be representable.Methods: A total of 2,637 CT scans and 3D reconstructions from patients on four continents, executed for preoperative planning and creation of patient-specific instrumentation, were used to perform anthropometric measurements and to measure the posterior condylar angle (PCA) between the surgical epicondylar angle and the PCL.Conclusions: This study was performed on a very large anthropometric CT and 3D models database and showed that there is a 41 % risk of malalignment if a fixed PCA referenced of the PCL is used in total knee arthroplasty. The clinical importance of this study is the observation that femoral axial anatomy is individual and also that it is determined by the tibial anatomy. A group of patients needs more than the average external rotation because they have more distal femoral valgus with dysplastic condyles or more proximal tibial varus with a bigger medial condyle.Level of evidence: III. © 2014, Springer-Verlag Berlin Heidelberg.

Frei H.-C.,Kantonsspital Winterthur | Hotz T.,Kantonsspital Winterthur | Cadosch D.,Kantonsspital Winterthur | Cadosch D.,University of Zurich | And 2 more authors.
Journal of Orthopaedic Trauma | Year: 2012

Objective: This study was designed to investigate the specific type and incidence of implant failure in patients with a proximal femur fracture treated with a proximal femoral nail antirotation. This device has a helical-shaped blade as a neck-head holding device, instead of the lag screw used in other intramedullary nails. The advantage of the blade is believed to originate from bone impaction and a larger bone-implant interface in comparison with the lag screw design, with consequential greater mechanical resistance to torsion in the cancellous bone. Patients and Methods: This is a retrospective cohort study conducted at the state hospital of Winterthur, Switzerland. From December 2006 until November 2008, 210 consecutive patients were treated with a pertrochanteric femur fracture (OTA type 31-A1, 31-A2, and 31-A3) using a proximal femoral nail antirotation. One hundred and twelve patients were followed up clinically for a minimum of 12 months after discharge. Clinical and radiologic assessment of fracture healing and/or implant failure was investigated. Results: We report 7 cases of implant failure with a "Cut Through," defined as a postoperative central perforation of the spiral blade into the hip joint, without any displacement of the neck-head fragment. Conclusions: Cut through needs to be distinguished from the well-known anterocranial perforation combined with a varus displacement of the neck-head fragment, known as "Cut Out," seen with intramedullary nails utilizing lag screws. Copyright © 2012 by Lippincott Williams & Wilkins.

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