R Mosimann

University Hospital of Lausanne, Lausanne, Vaud, Switzerland

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Publications (105)117.19 Total impact

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    ABSTRACT: This study includes 60 patients having schistosomal hepatic fibrosis and esophageal varices. Splenectomy alone was done for 14 patients having no history of haematemesis and gastroesophageal decongestion with splenectomy was done for the remaining 46 patients with history of haematemesis. Endoscopic variceal pressure measurements were done to all of them peroperatively and 21 days postoperatively. 17 patients, 7 after splenectomy and 10 after gastro-esophageal decongestion, were followed for 18 months post operatively. 21 days postsplenectomy, the variceal pressure dropped insignificantly from 38.09 to 33.27 cm H2O. During the following 18 months, three patients out of seven showed significant increase in variceal pressure. After decongestion with splenectomy, the mean variceal pressure dropped significantly from 42.03 to 29.17 cm H2O. For the 10 patients followed for 18 months, eight of them retained their variceal pressure as low as early postoperative figures. Thus gastro-esophageal decongestion with splenectomy is effective in reducing variceal pressure and in so doing it is better than splenectomy alone.
    International surgery 01/1994; 79(1):68-71. · 0.25 Impact Factor
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    ABSTRACT: This paper presents the results of the first 7 orthotopic liver transplants performed in Lausanne between December 1988 and September 1990. 6 patients are surviving; their rehabilitation is excellent.
    Schweizerische medizinische Wochenschrift 06/1991; 121(21):801-3. · 1.68 Impact Factor
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    ABSTRACT: Endoscopic sclerotherapy is now the treatment of first choice for oesophageal varices. However, in spite of its efficiency and safety, recurrent bleeding remains possible and oesophageal sclerosis does not cure other potentially incapacitating symptoms related to portal hypertension. This report describes four adolescents with prehepatic hypertension for whom sclerotherapy was inadequate. They were treated successfully by an autologous internal jugular vein interposition mesocaval shunt. This operation is safe, decompresses the whole splanchnic territory and obviates the need for long term endoscopic surveillance.
    Zeitschrift für Kinderchirurgie: organ der Deutschen, der Schweizerischen und der Osterreichischen Gesellschaft für Kinderchirurgie = Surgery in infancy and childhood 07/1990; 45(3):189-91. DOI:10.1055/s-2008-1042579 · 0.98 Impact Factor
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    ABSTRACT: This prospective study involving 24 patients operated for postoperative reflux gastritis spanned over the period between 1974 and 1987. Diagnosis by exclusion was based on clinical, endoscopic and histological findings collected a few months to 16 years following surgery, the outcome of which was either alteration or destruction of the antropyloric sphincteral mechanism. All patients had Y-loop gastrojejunostomy performed according to Roux's procedure (at 50 cm). The clinical results as assessed on the basis of Visick's score and by gastroscopy were good. Anatomopathological examination of pre- and postoperative bioptic specimens blind-collected by a single operator indicated that foveolar hyperplasia is a good indicator of enterogastric reflux.
    Journal de Chirurgie 04/1990; 127(3):123-8. · 0.50 Impact Factor
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    ABSTRACT: Because of the risk of overwhelming post-splenectomy infection, the current trend favors conservative treatment for splenic trauma. Out of a total of 70 cases of splenic trauma in adults seen over the last 5 1/2 years, 19 spleens were preserved, 13 with, 6 without operations. Ten operated spleens were examined by Duplex-sonography, on average 38 months after surgery. The results show that in all cases, the spleen was morphologically and hemodynamically restored to normal.
    Helvetica chirurgica acta 07/1989; 56(1-2):195-8.
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    ABSTRACT: Deep abdominal vessels blood flow can be measured noninvasively with the relation Q = V x A, where Q = flow, V = blood velocity and A = area of the considered vessel. In most Duplex devices, V is only calculated as a mean by the Doppler effect and A estimated by an echograph. Our newly developed multi-gated pulsed Doppler provides the velocity profile across the vessel, so minimizing errors in flow determination. On fifty healthy volunteers, we found flow of 717 +/- 238 ml/min for the portal vein, 1594 +/- 293 ml/min for the upper abdominal aorta and 794 +/- 168 ml/min for the lower aorta. These results are obtained through many technical and practical problems, but are feasible, even if still subject to errors. Further investigation will determine if the technique is also suitable for patients. Better assessment of deep abdominal vessels hemodynamics may be expected.
    Helvetica chirurgica acta 07/1989; 56(1-2):267-72.
  • B Yersin, A Genton, R Mosimann, P Magnenat
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    ABSTRACT: Three cases of severe alcoholic hepatitis associated with refractory ascites are reported. A LeVeen shunt was inserted which was effective and well tolerated. However, the shunt was removed in all 3 patients 8 months, 12 months and 9 years after insertion because of spontaneous migration (n = 2) or superior vena cava thrombosis (n = 1). At time of shunt removal all 3 patients had micronodular cirrhosis, but none had recurrent ascites during the 1-3 years of observation and despite the absence of diuretics. The eventual transient aspect of refractory ascites associated with alcoholic hepatitis is discussed, together with the potential beneficial and temporary role of LeVeen shunts in this condition.
    Schweizerische medizinische Wochenschrift 06/1989; 119(21):768-9. · 1.68 Impact Factor
  • Revue medicale de la Suisse romande 10/1988; 108(9):745-52.
  • Revue medicale de la Suisse romande 10/1988; 108(9):741-4.
  • G Buchheim, R Mosimann
    Revue medicale de la Suisse romande 10/1988; 108(9):725-30.
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    ABSTRACT: This postmortem study examined the hypothesis that degenerative lesions of the hepatic and cystic arteries contribute to acute and chronic gallbladder disease. In 201 unselected adult autopsies, atherosclerosis of the hepatic artery was found in 7.8&percnt;, and intimal fibrosis of the cystic artery in 12.4&percnt;. These incidences correlated with that of systemic atherosclerosis (p < 0.01). Our findings suggest that some cases of acute cholecystitis may be caused by arterial thrombosis or atheroembolism. These vascular lesions may also precipitate ischemic acute cholecystitis in low blood flow states. On the other hand, there was no correlation between degenerative changes in the arterial hepatico-cystic network and chronic acalculous cholecystitis (p > 0.05): it seems unlikely that hepatico-cystic vascular degeneration contributes to chronic gallbladder disease.Copyright © 1987 S. Karger AG, Basel
    Digestive surgery 01/1987; 4(1):14-18. DOI:10.1159/000171760 · 1.74 Impact Factor
  • P Gertsch, F Mosimann, P W Loup, R Mosimann
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    ABSTRACT: A prospective evaluation of sclerotherapy for bleeding esophageal varices has been conducted in 50 unselected consecutive patients. According to Child's classification, 36% were class A, 34% class B and 30% class C. Sclerotherapy was performed on an emergency basis in 22 patients and was delayed a few hours for the others. The aim of the technique was to obliterate the varices by intra- and paravariceal injections of polidocanol 1%. Injections were performed weekly for the first 3 weeks of treatment, then 3- or 6-monthly. Four patients had a severe recurrent hemorrhage during the first month. The mortality during that period was 12%. Follow-up was possible in 81% of the surviving patients. Four stenoses were treated by dilatation. Four patients had a late-recurring hemorrhage which was easily controlled in 3. Four patients died later, 3 of liver insufficiency and one of hemorrhage.
    Schweizerische medizinische Wochenschrift 05/1986; 116(17):569-71. · 1.68 Impact Factor
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    ABSTRACT: Quantitative blood flow measurements were performed on 37 normal lower limbs with a 128-channel digital pulsed Doppler (MDPD) system. The evolution of mean flow (QM), peak systolic flow (QS), diastolic flow (QD), and prograde stroke volume (PSV) was observed at rest, during postocclusive reactive hyperemia (PORH), and at 1-, 2-, and 3-min intervals. The QM at rest was 2.9 +/- 1.1 ml/s; PORH induced a four- to fivefold increase in QM and PSV secondary to a slight increase in QS and the disappearance of the reverse protodiastolic component of resting flow. Reverse flow was restored after 1 min. Both QS and QD returned to resting values after 2 min, whereas QM remained significantly higher after 3 min. To provide a better description of the hyperemic response, we also studied the evolution of the pulsatility index as as applied the flow curve (PIQ). Similarly, the systolic amplitude index (SAI) is presented. Our study demonstrates that pulsed Doppler techniques can be used for noninvasive quantitative assessment of blood flow at rest and during PORH. The values obtained on normal subjects provide base-line data for further investigation of pathological conditions.
    Journal of Clinical Ultrasound 03/1986; 14(3):165-70. DOI:10.1002/jcu.1870140302 · 0.80 Impact Factor
  • R. Mosimann, J. Walder, G. Van Melle
    Vascular and Endovascular Surgery 07/1985; 19(4):258-263. DOI:10.1177/153857448501900411 · 0.77 Impact Factor
  • Helvetica chirurgica acta 07/1985; 52(2):293-4.
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    ABSTRACT: The recent development of a new multigate pulsed Doppler system used in conjunction with an A-mode scan allows real time display of the velocity profiles across the vessel and quantitative flow measurement. Experimental in-vitro and in-vivo studies showed an excellent correlation between flow measurements obtained by this noninvasive method and by direct timed collection. Preliminary results of the post-occlusive hyperaemic response in normals and in patients with iliac stenosis are presented. Although no statistical comparison is allowed, it appears that the hyperaemic response is diminished when an iliac stenosis is present. A non-invasive method of quantifying the haemodynamic significance of profunda femoris artery stenosis is described. Finally, the velocity profiles and the flow curves in PTFE grafts were studied and compared to the flow patterns of the normal superficial femoral artery. The differences observed between the two conditions might explain the low patency rate of the synthetic grafts. Other fields of application of the method are suggested. The future development of a Duplex scanner combining B-mode imaging and the multigate Doppler system will allow the exploration of vessels within the abdomen and thorax: portal vein, in situ or transplanted renal arteries, ascending and abdominal aorta.
    Ultraschall in der Medizin 05/1985; 6(2):83-9. · 4.65 Impact Factor
  • Helvetica chirurgica acta 02/1985; 51(6):683-7.
  • Helvetica chirurgica acta 02/1985; 51(6):793-5.
  • Ultraschall in der Medizin 01/1985; 6(02):83-89. DOI:10.1055/s-2007-1006031 · 4.65 Impact Factor
  • P Gertsch, H Diserens, R Mosimann
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    ABSTRACT: Isolated actinomycotic liver abscess is rare. We report a case with fulminant evolution, which was treated successfully with surgery and penicillin. In human actinomycosis, Actinomyces israeli is the main infective agent. An abdominal localisation is uncommon, occurring in less than 25% of cases. Isolated liver lesions are extremely rare; their presence might be interpreted as the result of the hematogenous spread of a no longer present intestinal lesion. The evolution of actinomycosis is usually torpid. In the present case, mixed infection with Fusobacterium nucleatum might explain the acute evolution.
    International surgery 01/1985; 70(1):39-40. · 0.25 Impact Factor