1
|
Steinemann DC, Müller-Stich BP, Angehrn F, Nocera F. [New and Established Multimodal Therapeutic Strategies in Advanced Rectal Cancer]. Praxis (Bern 1994) 2023; 112:539-544. [PMID: 37823809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Locally advanced rectal cancer has a high risk of local recurrence which can be reduced by multimodal therapy. Neoadjuvant radiotherapy or radiochemotherapy has been established. Nevertheless, this has not proved to improve overall survival. The benefit of adjuvant chemotherapy after neoadjuvant radiotherapy or radiochemotherapy remains unclear. Current studies are investigating total neoadjuvant therapy with different sequences of radiotherapy and chemotherapy followed by rectal resection. This procedure shows high pathologic complete remissions up to 28 % as well as an improvement in disease-free and metastasis-free survival. Under study conditions, in case of clinical complete remission, watchful waiting with close follow-up and surgery can be considered only in case of local tumor recurrence.
Collapse
Affiliation(s)
- Daniel C Steinemann
- Clarunis - Universitäres Bauchzentrum, St. Claraspital und Universitätsspital Basel
| | - Beat P Müller-Stich
- Clarunis - Universitäres Bauchzentrum, St. Claraspital und Universitätsspital Basel
| | - Fiorenzo Angehrn
- Clarunis - Universitäres Bauchzentrum, St. Claraspital und Universitätsspital Basel
| | - Fabio Nocera
- Clarunis - Universitäres Bauchzentrum, St. Claraspital und Universitätsspital Basel
| |
Collapse
|
2
|
Nocera F, Haak F, Ly C, Posabella A, Angehrn F, von Flüe M, Steinemann DC. Comparison of surgical outcomes in elective sigmoid resection for diverticulitis in different indication-specific strategies: A propensity-score matched cohort study with 636 patients. Br J Surg 2022. [DOI: 10.1093/bjs/znac181.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Comparing different surgical guidelines for recurrent uncomplicated diverticulitis, a careful benefit-risk assessment is recommended although different approaches giving the indication for surgery exists. The purpose of this study was to evaluate the impact of indications-specific strategies on surgical outcomes allowing adequate benefit-risk consulting.
Methods
All patients undergoing elective colonic resection for diverticulitis between January 2011 and March 2020 in our institution were included. They were divided into two groups based on the strategy for surgical indication: relative surgery indication group (RSI; CDD (classification of diverticula disease) Type 2a, 3a and 3b, n = 585) and absolute surgery indication group (ASI; CDD Type 2b and 3c, n = 318). Propensity score-matching (PSM) was applied at a ratio of 1:1 to compare the RSI and the ASI group.
Results
In the univariate analysis, RSI patients were younger (62±10.4 vs. 67.7±11.4, p<0.05), had a higher physical status (ASA score 1 or 2 in 80.7% vs. 60.8%, p<0.05), were less immunosuppressed (3.4% vs. 6.9%, p<0.05) and suffered less from coronary heart disease (3.8% vs. 7.2%, p<0.05). After PSM, 318 vs. 318 patients were selected and baseline characteristics resulted comparable. The proportion of laparoscopic resection was 94.7% in RSI versus 84.6% in ASI (p<0.05) and the conversion rate to open surgery for laparoscopic resection was 5.0% in RSI and 13.8% in ASI (p<0.05). Intraoperative complications were rare in both groups (3.1% vs. 5.3%, p=0.24). Mean operation time was shorter in RSI (211±62 vs. 229±72, p<0.05). Major morbidity (Clavien/Dindo ≥3b) occurred less frequently in RSI (3.8% vs. 10.1%, p<0.05) and the overall comprehensive complications index (CCI) was lower in RSI (9.4±12.2 vs. 12.9±14.9, p<0.05). Anastomotic insufficiency occurred in 0.9% in RSI and in 2.5% in ASI (p=0.22). A defunctioning stoma was received by 0.9% in RSI and 11.0% in ASI (p<0.05).
Conclusion
Our study demonstrates that even after PSM analysis patients with RSI in contrast to patients with more advanced diverticular disease have a lower risk of suffering from postoperative overall morbidity and major morbidities as well as the risk of receiving a temporary stoma. These observations should be considered when counselling patients with an equivocal indication for surgery for diverticular disease.
Collapse
Affiliation(s)
- F Nocera
- Department of Visceral Surgery, Clarunis – University Abdominal Center , Basel, Switzerland
| | - F Haak
- Department of Visceral Surgery, Clarunis – University Abdominal Center , Basel, Switzerland
| | - C Ly
- Department of Visceral Surgery, Clarunis – University Abdominal Center , Basel, Switzerland
| | - A Posabella
- Department of Visceral Surgery, Clarunis – University Abdominal Center , Basel, Switzerland
| | - F Angehrn
- Department of Visceral Surgery, Clarunis – University Abdominal Center , Basel, Switzerland
| | - M von Flüe
- Department of Visceral Surgery, Clarunis – University Abdominal Center , Basel, Switzerland
| | - D C Steinemann
- Department of Visceral Surgery, Clarunis – University Abdominal Center , Basel, Switzerland
| |
Collapse
|
3
|
Gass JM, Daume D, Schneider R, Steinemann D, Mongelli F, Scheiwiller A, Fourie L, Kern B, von Flüe M, Metzger J, Angehrn F, Bolli M. Laparoscopic versus robotic-assisted, left-sided colectomies: intra- and postoperative outcomes of 683 patients. Surg Endosc 2022; 36:6235-6242. [PMID: 35024933 PMCID: PMC9283164 DOI: 10.1007/s00464-021-09003-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/31/2021] [Indexed: 11/29/2022]
Abstract
Background Robotic-assisted colorectal surgery has gained more and more popularity over the last years. It seems to be advantageous to laparoscopic surgery in selected situations, especially in confined regions like a narrow male pelvis in rectal surgery. Whether robotic-assisted, left-sided colectomies can serve as safe training operations for less frequent, low anterior resections for rectal cancer is still under debate. Therefore, the aim of this study was to evaluate intra- and postoperative results of robotic-assisted laparoscopy (RAL) compared to laparoscopic (LSC) surgery in left-sided colectomies. Methods Between June 2015 and December 2019, 683 patients undergoing minimally invasive left-sided colectomies in two Swiss, high-volume colorectal centers were included. Intra- and postoperative outcome parameters were collected and analyzed.
Results A total of 179 patients undergoing RAL and 504 patients undergoing LSC were analyzed. Baseline characteristics showed similar results. Intraoperative complications occurred in 0.6% of RAL and 2.0% of LSC patients (p = 0.193). Differences in postoperative complications graded Dindo ≥ 3 were not statistically significant (RAL 3.9% vs. LSC 6.3%, p = 0.227). Occurrence of anastomotic leakages showed no statistically significant difference [RAL n = 2 (1.1%), LSC n = 8 (1.6%), p = 0.653]. Length of hospital stay was similar in both groups. Conversions to open surgery were significantly higher in the LSC group (6.2% vs.1.7%, p = 0.018), while stoma formation was similar in both groups [RAL n = 1 (0.6%), LSC n = 5 (1.0%), p = 0.594]. Operative time was longer in the RAL group (300 vs. 210.0 min, p < 0.001). Conclusion Robotic-assisted, left-sided colectomies are safe and feasible compared to laparoscopic resections. Intra- and postoperative complications are similar in both groups. Most notably, the rate of anastomotic leakages is similar. Compared to laparoscopic resections, the analyzed robotic-assisted resections have longer operative times but less conversion rates. Further prospective studies are needed to confirm the safety of robotic-assisted, left-sided colectomies as training procedures for low anterior resections.
Collapse
Affiliation(s)
- Jörn-Markus Gass
- Department of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| | - Diana Daume
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Romano Schneider
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Daniel Steinemann
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Regional Hospital of Lugano, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Andreas Scheiwiller
- Department of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Lana Fourie
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Beatrice Kern
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Markus von Flüe
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Jürg Metzger
- Department of General Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Fiorenzo Angehrn
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Martin Bolli
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland.
| |
Collapse
|
4
|
Nocera F, Wilhelm A, Schneider R, Koechlin L, Daume D, Fourie L, Steinemann DC, von Flüe M, Peterli R, Angehrn F, Bolli M. Robot-assisted vs. laparoscopic repair of complete upside-down stomach hiatal hernia (the RATHER-study): A prospective comparative single center study. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Complete upside-down stomach (cUDS) hernias are a subgroup of large hiatal hernias characterized by high risk of life-threatening complications and technically challenging surgical repair including complex mediastinal dissection. In a prospective, comparative clinical study, we evaluated intra- and postoperative outcomes, quality of life and symptomatic recurrence rates in patients with cUDS undergoing robot-assisted, as compared to standard laparoscopic repair (the RATHER-study).
Methods
All patients with cUDS herniation requiring elective surgery in our institution between July 2015 and June 2019 were evaluated. Patients undergoing primary open surgery or additional associated procedures were not considered. Primary endpoints were intra- and postoperative complications, 30-day morbidity, and mortality. During the 8-53 months follow-up period, patients were contacted by telephone to assess symptoms associated to recurrence, whereas quality of life was evaluated utilizing the Gastroesophageal Reflux Disease–Health-Related Quality of Life (GERD-HRQL) questionnaire.
Results
A total of 55 patients were included. 36 operations were performed with robot-assisted (Rob-G), and 19 with standard laparoscopic (Lap-G) technique. Patients characteristics were similar in both groups. Median operation time was 232 min. (IQR: 145-420) in robot-assisted vs. 163 min. (IQR:112-280) in laparoscopic surgery (p < 0.001). Intraoperative complications occurred in 5/36 (12.5%) cases in the Rob-G group and in 5/19 (26%) cases in the Lap-G group (p = 0.28). No conversion was necessary in either group. Minor postoperative complications occurred in 13/36 (36%) Rob-G patients and 4/19 (21%) Lap-G patients (p = 0.36). Mortality or major complications did not occur in either group. Two asymptomatic recurrences were observed in the Rob-G group only. No patient required revision surgery. Finally, all patients expressed satisfaction for treatment outcome, as indicated by similar GERD-HRQL scores.
Conclusion
While robot-assisted surgery provides additional precision, enhanced visualization, and greater feasibility in cUDS hiatal hernia repair, its clinical outcome is at least equal to that obtained by standard laparoscopic surgery.
Collapse
Affiliation(s)
- F Nocera
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - A Wilhelm
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - R Schneider
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - L Koechlin
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - D Daume
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - L Fourie
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - D C Steinemann
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - M von Flüe
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - R Peterli
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - F Angehrn
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - M Bolli
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| |
Collapse
|
5
|
Abstract
Background By improved surgical technique such as total mesorectal excision (TME), multimodal treatment and advances in imaging survival and an increased rate of sphincter preservation have been achieved in rectal cancer surgery. Minimal-invasive approaches such as laparoscopic, robotic and transanal-TME (ta-TME) enhance recovery after surgery. Nevertheless, disorders of bowel, anorectal and urogenital function are still common and need attention. Purpose This review aims at exploring the causes of dysfunction after anterior resection (AR) and the accordingly preventive strategies. Furthermore, the indication for low AR in the light of functional outcome is discussed. The last therapeutic strategies to deal with bowel, anorectal, and urogenital disorders are depicted. Conclusion Functional disorders after rectal cancer surgery are frequent and underestimated. More evidence is needed to define an indication for non-operative management or local excision as alternatives to AR. The decision for restorative resection should be made in consideration of the relevant risk factors for dysfunction. In the case of restoration, a side-to-end anastomosis should be the preferred anastomotic technique. Further high-evidence clinical studies are required to clarify the benefit of intraoperative neuromonitoring. While the function of ta-TME seems not to be superior to laparoscopy, case-control studies suggest the benefits of robotic TME mainly in terms of preservation of the urogenital function. Low AR syndrome is treated by stool regulation, pelvic floor therapy, and transanal irrigation. There is good evidence for sacral nerve modulation for incontinence after low AR.
Collapse
Affiliation(s)
- Fabio Nocera
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Disease, St Clara Hospital and University Hospital, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Fiorenzo Angehrn
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Disease, St Clara Hospital and University Hospital, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Markus von Flüe
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Disease, St Clara Hospital and University Hospital, Kleinriehenstrasse 30, 4058, Basel, Switzerland
| | - Daniel C Steinemann
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Disease, St Clara Hospital and University Hospital, Kleinriehenstrasse 30, 4058, Basel, Switzerland.
- Department of Surgery, University Hospital Basel, Spitalstrasse 23, 4031, Basel, Switzerland.
| |
Collapse
|
6
|
Zeindler J, Angehrn F, Droeser R, Däster S, Piscuoglio S, Ng CKY, Kilic E, Mechera R, Meili S, Isaak A, Weber WP, Muenst S, Soysal SD. Infiltration by myeloperoxidase-positive neutrophils is an independent prognostic factor in breast cancer. Breast Cancer Res Treat 2019; 177:581-589. [PMID: 31267330 DOI: 10.1007/s10549-019-05336-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/22/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Myeloperoxidase (MPO) is an enzyme secreted by neutrophil granulocytes as a result of phagocytosis during inflammation. In colorectal cancer, tumour infiltration by MPO expressing cells has been shown to be independently associated with a favourable prognosis. In this study, we explored the role of MPO-positive cell infiltration and its prognostic significance in invasive breast cancer. METHODS We performed immunohistochemical staining for MPO on multiple tissue microarrays comprising a total of 928 human breast cancer samples with detailed clinical-pathological annotation and outcome data. RESULTS MPO-positive cell infiltration (≥ 5 cells/tissue punch) was found in 150 (16%) of the 928 evaluable breast cancer cases. In univariate survival analyses, infiltration by MPO-positive cells was associated with a significantly better overall survival (p < 0.001). In subset univariate analyses, the infiltration by MPO-positive cells was associated with significantly better overall survival in the Luminal B/HER2-negative subtype (p = 0.005), the HER2 enriched subtype (p = 0.011), and the Triple Negative subtype (p < 0.001). In multivariate analysis, MPO expression proved to be an independent prognostic factor for improved overall survival (p < 0.001). CONCLUSIONS This is the first study to show that infiltration of MPO-positive cells is an independent prognostic biomarker for improved overall survival in human breast cancer.
Collapse
Affiliation(s)
- Jasmin Zeindler
- Breast Cancer Center, University Hospital Basel and University of Basel, 4031, Basel, Switzerland
| | - Fiorenzo Angehrn
- Department of Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, Basel, Switzerland
| | - Raoul Droeser
- Department of Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, Basel, Switzerland
| | - Silvio Däster
- Department of Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, Basel, Switzerland
| | - Salvatore Piscuoglio
- Visceral Surgery Research Laboratory, Clarunis, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Charlotte K Y Ng
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Ergin Kilic
- Institute of Pathology, Hospital Leverkusen, Leverkusen, Germany
| | - Robert Mechera
- Department of Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, Basel, Switzerland
| | - Samuel Meili
- Department of Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, Basel, Switzerland
| | - Andrej Isaak
- Department of Vascular and Endovascular Surgery, University Hospital Basel, Basel, Switzerland
| | - Walter P Weber
- Breast Cancer Center, University Hospital Basel and University of Basel, 4031, Basel, Switzerland
| | - Simone Muenst
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Savas Deniz Soysal
- Department of Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, Basel, Switzerland. .,Visceral Surgery Research Laboratory, Clarunis, Department of Biomedicine, University of Basel, Basel, Switzerland.
| |
Collapse
|
7
|
Kuhn C, Angehrn F. Use of high-resolution ultrasound to monitor the healing of leg ulcers: a prospective single-center study. Skin Res Technol 2009; 15:161-7. [DOI: 10.1111/j.1600-0846.2008.00342.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Kuhn C, Angehrn F, Sonnabend O, Voss A. Impact of extracorporeal shock waves on the human skin with cellulite: a case study of an unique instance. Clin Interv Aging 2008; 3:201-10. [PMID: 18488890 PMCID: PMC2544366 DOI: 10.2147/cia.s2334] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this case study of an unique instance, effects of medium-energy, high-focused extracorporeal generated shock waves (ESW) onto the skin and the underlying fat tissue of a cellulite afflicted, 50-year-old woman were investigated. The treatment consisted of four ESW applications within 21 days. Diagnostic high-resolution ultrasound (Collagenoson) was performed before and after treatment. Directly after the last ESW application, skin samples were taken for histopathological analysis from the treated and from the contra-lateral untreated area of skin with cellulite. No damage to the treated skin tissue, in particular no mechanical destruction to the subcutaneous fat, could be demonstrated by histopathological analysis. However an astounding induction of neocollageno- and neoelastino-genesis within the scaffolding fabric of the dermis and subcutis was observed. The dermis increased in thickness as well as the scaffolding within the subcutaneous fat-tissue. Optimization of critical application parameters may turn ESW into a noninvasive cellulite therapy.
Collapse
|
9
|
Angehrn F, Kuhn C, Sonnabend O, Voss A. Extracorporeal shock waves as curative therapy for varicose veins? Clin Interv Aging 2008; 3:175-82. [PMID: 18488887 PMCID: PMC2544363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
In this prospective design study the effects of low-energy partially focused extracorporeal generated shock waves (ESW) onto a subcutaneous located varicose vein - left vena saphena magna (VSM)- are investigated. The treatment consisted of 4 ESW applications within 21 days. The varicose VSM of both sides were removed by surgery, and samples analyzed comparing the treated and untreated by means of histopathology. No damage to the treated varicose vein in particular and no mechanical destruction to the varicose vein's wall could be demonstrated. However, an induction of neo-collagenogenesis was observed. The thickness of the varicose vein's wall increased. Optimization of critical application parameters by investigating a larger number of patients may turn ESW into a non-invasive curative varicose treatment.
Collapse
Affiliation(s)
| | | | | | - Axel Voss
- SwiTech Medical AGKreuzlingen, Switzerland
| |
Collapse
|
10
|
Abstract
The present study investigates the effects of low-energy defocused extracorporeal generated shock waves on collagen structure of cellulite afflicted skin. Cellulite measurement using high-resolution ultrasound technology was performed before and after low-energy defocused extracorporeal shock wave therapy (ESWT) in 21 female subjects. ESWT was applied onto the skin at the lateral thigh twice a week for a period of six weeks. Results provide evidence that low-energy defocused ESWT caused remodeling of the collagen within the dermis of the tested region. Improving device-parameters and therapy regimes will be essential for future development of a scientific based approach to cellulite treatment.
Collapse
|
11
|
Angehrn F, Schultheiss HR, Blum B. [Traumatic pneumatocele--a case report]. Langenbecks Arch Chir 1986; 367:113-8. [PMID: 3754299 DOI: 10.1007/bf01259260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The posttraumatic pneumatocele is a rare intrapulmonary lesion following blunt thoracic injury. By means of a well documented case report this rare form of lung contusion is demonstrated and the clinically important differential diagnosis is discussed.
Collapse
|
12
|
Schultheiss HR, Angehrn F. [Perineal wound healing following abdominoperineal rectum excision]. Helv Chir Acta 1984; 51:79-82. [PMID: 6724987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|