M Turina

University of Zurich, Zürich, Zurich, Switzerland

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Publications (605)1885.83 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: Screening of Gardner syndrome (GS) patients is tailored towards prevention of colorectal cancer (CRC). However, many patients suffer from desmoid tumors, which are challenging to treat due to invasive growth and local recurrence. The aims of our study were to determine the effectiveness of screening in GS and analyze outcome of desmoid tumors by treatment modality. METHODS: This was a cohort study of a family of 105 descendants with GS. All family members who agreed were screened by endoscopy, and colorectal resection was performed upon pending malignancy. Resectable desmoids were excised, whereas large tumors were treated by a combination of brachytherapy (BT) and radiotherapy (RT). Main outcome measures were the incidence of CRC and overall and disease-specific mortality (ClinicalTrial.gov ID NCT01286662). RESULTS: Thirty-seven of 105 family members have GS. Preventive colorectal resections were performed in 16 patients (15 %), with one death due to gastric cancer. In four patients who denied screening endoscopy, invasive tumors of the colon (three patients) and stomach developed. Of 33 desmoid tumors, 10 (30 %) were located in the mesentery, 17 (52 %) in the abdominal wall, and 6 (18 %) in extra-abdominal sites. Excision of 12 desmoids was performed in eight patients. Four desmoids were treated by BT and RT and showed full or partial remission. CONCLUSIONS: Provided adequate screening, good long-term control of colorectal tumors is achievable. However, desmoid tumors determine survival and quality of life in many patients. Our data suggest good local control using a combination of brachytherapy/radiotherapy in large desmoids unsuitable for surgical resection.
    International Journal of Colorectal Disease 11/2012; · 2.24 Impact Factor
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    ABSTRACT: INTRODUCTION: Morbid obesity and its consequences are considered risk factors for adverse outcome in trauma, although the pathophysiologic mechanisms are incompletely understood. The aim of this study was to compare initial resuscitation, treatment, and short-term outcome of severely injured patients by body mass index (BMI). METHODS: A total of 1,084 severely injured patients with an injury severity score of 16 or greater were enrolled between 1996 and 2009 and grouped according to BMI. Their course of treatment and in-hospital outcome were analyzed by univariate and multivariate comparison. RESULTS: Of these patients, 603 (55.6%) were of normal weight with a BMI between 18.5 and 24.9, 361 (33.3%) had BMI values between 25 and 29.9, and 90 patients (8.3%) were obese (BMI ≥ 30). Thirty patients (2.8%) had BMI levels below 18.5. All groups were comparable with respect to injury severity, initial resuscitation, and time to ICU admission. There was a tendency towards higher mortality in obese patients (mortality 24.4%) and also overweight patients (mortality 18.8%) when compared with patients with a normal BMI (mortality 16.6%). Obese patients showed the highest mortality on day 0 (8.9% vs. 2.8% in the normal-weight group, P = 0.023), mostly due to persistent shock (6.7%). When corrected for BMI, obese patients are provided significantly lower volumes of intravenous fluids during the initial resuscitation period. CONCLUSION: In contrast to the mostly American literature, only a low percentage of trauma patients at a European trauma center are obese. These patients are at risk of higher mortality from persistent hemorrhagic shock in the initial phase after trauma, which may potentially be related to relative hypovolemia during the resuscitation period. In the later course of treatment, no significant differences exist with respect to specific complications, hospital stay, or in-hospital mortality.
    Critical care (London, England) 05/2012; 16(3):R77. · 4.72 Impact Factor
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    ABSTRACT: Western trauma centers are increasingly confronted with elderly trauma patients in parallel to an increase of the elderly population. The purpose of this study was to identify shortcomings and opportunities for improvement in the treatment of elderly trauma patients. Retrospective analysis of a prospectively collected single-center trauma database. Patients were grouped according to age and analyzed using univariate and multivariate analysis. 158 patients (7.6%) were older than 75years, and 604 patients (28.9%) were between 50 and 75years. Although comparable with respect to injury severity (injury severity score (ISS) 29-33) and age-adjusted Acute Physiologic and Chronic Health Evaluation (APACHE) score, there was a significant increase in mortality beyond the age of 50 (>75years: 63.9%), with age being an independent predictor of mortality. Despite a similar rate and severity of head injuries (affecting 71% of all patients), mortality of head injuries was highest in patients >75years (70.2%), accounting for the increased mortality in this group. Patients >75years old were less likely to undergo craniotomy, and withdrawal of medical support occurred five times more frequently. Surviving patients ≥50years required shorter ICU care than patients below 50years (7.8 vs. 12.4days). With increasing life expectancy and sustained independence, elderly trauma patients have become a regular occurrence in trauma services. Despite comparable injury severity and physiologic status upon admission, these patients suffer from disproportionately high mortality rates. Closed head injuries account for the majority of fatalities, regardless of the extent of therapeutic measures applied.
    Archives of gerontology and geriatrics 03/2012; 55(3):660-6. · 1.36 Impact Factor
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    ABSTRACT: Standardized surgical training is increasingly confronted with the public demand for high quality of surgical care in modern teaching hospitals. The aim of this study was to compare the results of laparoscopic cholecystectomy (LC) performed by resident surgeons (RS) and attending surgeons (AS). In this retrospective review of prospectively collected data 1,747 LC were performed in a community hospital between 1999 and 2009. Seven hundred seventy operations were performed by RS. Parameters analysed included the duration of operation and length of hospital stay, intraoperative complications, 30-day morbidity and mortality. Duration of operation was 88 (25-245) min for RS vs. 75 (30-190) min by AS (p = 0.001). Elective operations were shorter when performed by AS (70 (30-190) [AS] vs. 85 (25-240) [RS] min, p = 0.001). Length of hospital stay was shorter in patients treated by RS (4 (1-49) days [RS] vs. 5 (1-83) days [AS], p = 0.1). Intraoperative complications showed no differences between the groups (1.0% [RS] vs. 1.3% [AS], p = 0.6), whereas 30-day morbidity was lower in patients treated by RS (3.8% [RS] vs. 6.2% [AS], p = 0.02). Overall mortality was 0.6% and independent of surgical expertise (0.5% [RS] vs. 0.8% [AS], p = 0.5). Provided adequate training, supervision and patient selection, surgical residents are able to perform LC with results comparable to those of experienced surgeons.
    Langenbeck s Archives of Surgery 01/2012; 397(1):103-10. · 1.89 Impact Factor
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    ABSTRACT: Traumatic anterior dislocation of the hip joint is rare. Additional injuries to the hip due to dislocation are even more infrequent. Outcome is limited by osteoarthritic joint degeneration or the occurrence of avascular necrosis of the femoral head. Anterior hip dislocation occurred in ten of 100 patients with traumatic hip dislocations (8 men, mean age: 43, 22-62years) at two major trauma centres, between January 2001 and December 2008. Four patients had impaction fractures of the femoral head and three patients had fractures of the anterior acetabular wall. One patient presented with an open dislocation. In three of the ten patients surgical treatment was necessary. Nine patients were evaluated retrospectively at a follow-up of 4.8 ± 2.3 years (mean ± SD). The mean scores were 88 ± 19 (Harris Hip-Score), 15 ± 23 (WOMAC-Score), level 6 (UCLA-Score). Four cases presented with only fair clinical or radiological results according to Epstein. AVN with collapse of the femoral head was observed in one. Traumatic anterior hip dislocations presented in six of the ten cases with additional injuries to the hip. Surgical treatment in cases with deep impaction fractures of the femoral head or with large fragments of the acetabulum may improve the outcome.
    Archives of Orthopaedic and Trauma Surgery 03/2011; 131(9):1273-8. · 1.36 Impact Factor
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    ABSTRACT: This study reviews our 10-year institutional experience with damage control management and investigates risk factors for early mortality. The trauma registry of our level I trauma centre was utilized to identify all patients from 01/96 through 12/05 who underwent initial damage control procedures. Demographics, clinical and physiological parameters, and outcomes were abstracted. Patients were categorized as either early survivors (surviving the first 72 hours after admission) or early deaths. During the study period, 319 patients underwent damage control management. Overall, 52 patients (16.3%) died (early deaths) and 267 patients (83.7%) survived the first 72 hours (early survivors). Early deaths showed significantly deranged serum lactate (5.81±0.55 vs. 3.46±0.13 mmol/L; P<0.001), base deficit (10.10±0.95 vs. 4.90±0.28 mmol/L; P<0.001) and pH (7.16±0.03 vs. 7.29±0.01; P<0.001) levels compared to early survivors on hospital admission. An International Normalized Ratio >1.2, base deficit >3 mmol/L, head Abbreviated Injury Scale ≥3, body temperature <35°C, serum lactate >6 mmol/L, and hemoglobin <7 g/dL proved to be independent risk factors for early mortality on hospital admission. Several risk factors for early mortality such as severe head injury and the lethal triad (coagulopathy, acidosis and hypothermia) in patients undergoing damage control procedures were identified and should trigger the trauma surgeon to maintain aggressive resuscitation in the intensive care unit.
    Journal of Emergencies Trauma and Shock 01/2011; 4(4):450-4.
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    ABSTRACT: Local microbial tolerance was investigated in a murine model of peritonitis. Peritoneal bacterial burden and inflammatory cytokine concentrations were determined at different times, within 48h after infection. Peritoneal macrophages were harvested from naïve mice or from mice 48h after infection and underwent ex vivo stimulation with different concentrations of Klebsiella. Cytokine secretion was determined in the supernatants. Peritoneal bacteria concentrations, remained relatively steady between 24h (median: 5.04 log CFU) and 48h (median: 5.19 log CFU) after infection. Peritoneal cytokine concentrations peaked early but were already diminished at 48h after infection, despite persistent high bacteria levels. Macrophages, harvested from naïve mice responded vigorously to ex vivo stimulation with 10(5) CFU and 2 x 10(8) CFU Klebsiella. Cells harvested from animals 48h after infection, were unresponsive to an ex vivo stimulation with 10(5) CFU Klebsiella, but fully responded to 10(8) CFU. Persistent intraabdominal bacterial infection induced dose dependent microbial tolerance in peritoneal macrophages.
    Cellular Immunology 05/2009; 258(1):98-106. · 1.74 Impact Factor
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    ABSTRACT: The aim of this study is to compare the results of laparoscopic management of acute small bowel obstruction (SBO) from abdominal adhesions to both exploratory laparotomy and secondary conversion to open surgery. Ninety-three patients (mean age 61 years) with adhesion-induced SBO were divided into successful laparoscopy (66 patients [71%]), secondary conversion (24 [26%]), and primary laparotomy (three patients). Patients with successful laparoscopy had more simple adhesions (57%), fewer prior operations, and lower American Society of Anesthesiologists (ASA) class. Operative time was shortest in the laparoscopy group (74.3 +/- 4.4 min), as was the duration of both intensive care unit and hospital stay. Mortality was 6%, regardless of operative technique. A trial of laparoscopic adhesiolysis by a surgeon with advanced laparoscopic skills seems advisable in the majority of patients with acute adhesive SBO, whereas patients with more extensive adhesions, higher ASA class, and more than two prior abdominal operations often require laparotomy to achieve equally satisfactory outcome.
    Langenbeck s Archives of Surgery 04/2009; 395(1):57-63. · 1.89 Impact Factor
  • Gastroenterology 01/2009; 136(5). · 12.82 Impact Factor
  • Gastroenterology 01/2009; 136(5). · 12.82 Impact Factor
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    ABSTRACT: Elevated lactate and interleukin-6 (IL-6) levels were shown to correlate with mortality and multiple organ dysfunction in severely traumatized patients. The purpose of this study was to test whether an association exists between 24-hour lactate clearance, IL-6 and procalcitonin (PCT) levels, and the development of infectious complications in trauma patients. A total of 1757 consecutive trauma patients with an Injury Severity Score (ISS) > 16 admitted over a 10-year period were retrospectively analyzed over a 21-day period. Exclusion criteria included death within 72 h of admission (24.5%), late admission > 12 h after injury (16%), and age < 16 years (0.5%). Data are stated as the median (range). Altogether, 1032 trauma patients (76.2% male) with an average age of 38 years, a median ISS of 29 (16-75), and an Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II score of 14 (0-40) were evaluated. The in-hospital mortality (>3 days) was 10%. Patients with insufficient 24-hour lactate clearance had a high rate of overall mortality and infections. Elevated early serum procalcitonin on days 1 to 5 after trauma was strongly associated with the subsequent development of sepsis (p < 0.01) but not with nonseptic infections. The kinetics of IL-6 were similar to those of PCT but did differentiate between infected and noninfected patients after day 5. This study demonstrates that elevated early procalcitonin and IL-6 levels and inadequate 24-hour lactate clearance help identify trauma patients who develop septic and nonseptic infectious complications. Definition of specific cutoff values and early monitoring of these parameters may help direct early surgical and antibiotic therapy and reduce infectious mortality.
    World Journal of Surgery 01/2009; 33(3):558-66. · 2.23 Impact Factor
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    ABSTRACT: Intestinal perforation following blunt trauma to the abdomen is a rare but life-threatening complication in patients with pre-existing inguinal hernia. We examined retrospective case series of patients with intestinal perforation following blunt abdominal trauma. Within 2 years, three patients with pre-existing inguinal hernia were referred to our clinic following simple falls while cross-country skiing. Upon signs of abdominal tenderness and radiographic evidence of free air, explorative laparotomy with revision of the affected bowel segments was performed. The postoperative course was uneventful in two patients. One developed adhesive ileus and incisional hernia within 1 year. Intestinal perforation must be suspected in patients with inguinal hernia and signs of diffuse abdominal tenderness following blunt trauma. Urgent explorative laparotomy with revision of the affected bowel segments is mandatory in patients with free abdominal air. Secondary hernia repair may represent the safest and most reliable approach and should be delayed until full recovery from the initial surgery.
    Der Chirurg 11/2008; 80(3):231-7. · 0.52 Impact Factor
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    ABSTRACT: D-Mannitol is a substance widely used for both clinical applications as a strong diuretic and in basic research as a purportedly inert osmotic control substance. However, recent experiments have shown that mannitol is able to decrease neutrophil apoptosis in vitro by more than 25%. The aim of the current study was to assess mannitol's effects on two immune cell activation markers; CD11b on neutrophils and monocytes, and HLA-DR on monocytes. Exposure of diluted whole blood (1:10 in RPMI 1640) to increasing concentrations of mannitol for 24 h was associated with a significant increase in both monocyte and neutrophil CD11b expression in non-lipopolysaccharide (LPS)-stimulated samples. Monocyte HLA-DR, but not neutrophil HLA-DR, was significantly higher in the presence of 16.5 mM/l mannitol, whereas isoosmolar NaCl had no effect. Levels of IL-6 and TNF-alpha were not affected by mannitol in our model. All reagents were tested negative for endotoxin contamination. Together, these data indicate that mannitol may directly interact with neutrophils and monocytes. Further systematic evaluation is indicated to define the precise immunomodulating actions of mannitol, and to assess these effects in patients receiving such therapy.
    Inflammation 05/2008; 31(2):74-83. · 2.46 Impact Factor
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    ABSTRACT: To identify opportunities for improvement in quality performance profile while maintaining better clinical outcomes. A prospective study of 5285 surgical specialty procedures including hip and knee replacement, cholecystectomy, hysterectomy, nonaccess vascular and cardiac procedures, and colorectal resections in 16 Kentucky hospitals was undertaken. The following observations were made after univariate and stepwise logistic regression analysis, from the Surgical Care Improvement Project. (1) Impaired functional status, age > or =65, and ASA class 4 or 5 status were significant predictors for both morbidity and mortality. (2) beta blockade medication was maintained in only 70% of patients already receiving such medications; interestingly, vascular surgery and patients with known cardiac history did not have beta blockade initiated 52% of the time. (3) Appropriate blood glucose control was not achieved in 31% of patients with diabetes and in 20% of nondiabetics. (4) deep vein thrombosis (DVT) prophylaxis was independent of high-risk status, with wide variation in practice. Patients undergoing total hip or knee replacement or colorectal resections had highest rates (0.7%) of pulmonary emboli. (5) A poor choice of antibiotic prophylaxis agent occurred in 8% of patients and was associated with a 3-fold increase in mortality (P < 0.01). (6) Hypothermia on arrival in PACU was present in 7% of patients after major colorectal resections and was ominously associated with an over 4-fold increase in mortality (P < 0.01). (7) Preoperative WBC >11,000/mm in elective operations was associated with nearly 3-fold increase in mortality (P < 0.05). Now more than ever, surgeons must verify performance measures and outcomes. This study of clinical outcomes permits identification of underappreciated contemporary risk factors and some obvious measures by which surgical practices can more objectively be evaluated.
    Annals of Surgery 03/2008; 247(2):380-8. · 6.33 Impact Factor
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    ABSTRACT: Refractory complications from pelvic radiotherapy often require surgical treatment. Their management may be dictated by the primary tumor, radiation dose, and type and combination of radiation injuries, and may require transient diversion in most cases to guarantee good outcomes. Retrospective 10-year cohort analysis compared with statewide epidemiologic data. During a 10-year period, 14 791 patients in Kentucky were treated with pelvic radiotherapy. Forty-eight were referred to a university colorectal surgical unit for evaluation of refractory radiotherapy complications that had failed conservative medical management. Epidemiologic statewide data were compared with hospital data regarding the treatment and outcome of patients with refractory pelvic radiotherapy complications. Twenty-five patients had received radiotherapy for colorectal carcinoma, 10 for prostate cancer, 7 for carcinoma of the cervix, and 6 for other tumors. Patients presented with 1 or more complications, including radiation enteritis (60%), strictures (53%), fistulae (17%), nonhealing wounds (15%), and de novo cancers in radiated fields (10%). Low anastomotic strictures (10%) were initially treated by dilation under sedation. Six patients (12%) ultimately required permanent diversion. All radiation-induced fistulae required an operation. Determining the proper treatment requires careful judgment and assessment of the degree and type of injury, patient anatomy, and sphincter function. Patients presenting with colorectal anastomotic and primary bowel strictures as their main complication had the best results, while most patients with severe radiation enteritis and very distal strictures required permanent diversion.
    Archives of surgery (Chicago, Ill.: 1960) 02/2008; 143(1):46-52; discussion 52. · 4.32 Impact Factor
  • Gastroenterology 01/2008; 134(4). · 12.82 Impact Factor
  • Thoracic and Cardiovascular Surgeon - THORAC CARDIOVASC SURG. 01/2008; 56.
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    ABSTRACT: The lung produces a localized immunologic response to systemic trauma, characterized by an initial proinflammatory period with production of interleukin (IL)-8 and IL-18, followed by an anti-inflammatory phase with elevated levels of IL-10. Recent studies have shown a correlation between alveolar IL-10 and the rate of local neutrophil apoptosis. The aim of the present study was to further characterize the association of alveolar IL-8 and IL-10 after trauma with neutrophil activation, apoptosis, and phagocytic capacity. Bronchoalveolar lavage fluid (BALF) was obtained from 17 trauma patients with an Injury Severity Score >/=16 who required mechanical ventilation. Neutrophils from venous blood of healthy volunteers were incubated in either (1) cell culture media (control), (2) culture media + BALF, (3) culture media + BALF + anti-IL-8 neutralizing antibody, or (4) culture media + BALF + anti-IL-10. Surface CD11b expression, ability to phagocytose fluorescent bacteria, and neutrophil apoptosis were determined by flow cytometry. Phagocytosis and CD11b expression were both augmented on postinjury day 1 when compared with controls. Neutralization of IL-10 or IL-8 produced no significant differences in phagocytosis or CD11b expression. However, neutralization of IL-10 significantly decreased the rate of apoptosis in samples from postinjury day 1. Phagocytosis and CD11b expression on neutrophils are IL-8 and IL-10 independent. However, our data indicate that alveolar neutrophil apoptosis is dependent on IL-10 at early time points after injury. Elucidation of this pathway may allow novel interventions to prevent posttraumatic pulmonary dysfunction.
    The Journal of trauma 10/2007; 63(4):733-9. · 2.35 Impact Factor
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    ABSTRACT: Understanding of data-reporting methods is imperative for correct interpretation of the medical literature as well as for proper performance of future clinical research. Recent developments in biostatistics have greatly changed the types of statistical analyses used and the minimum quality standards that must be maintained. Different types of review are described, including systematic review with and without meta-analysis. Minimum reporting standards, sources of bias, both quantitative and qualitative, and references are discussed. Meta-analysis has become a clearly defined technique, with reporting standards for both randomized controlled trials and observational studies. It is assuming a wider role in the surgical literature. Although many sources of bias exist, there are clear reporting standards and readers should be aware of these when studying the literature.
    British Journal of Surgery 12/2006; 93(11):1315-24. · 4.84 Impact Factor
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    ABSTRACT: Recent studies have demonstrated decreased numbers of interstitial cells of Cajal in patients suffering from severe chronic constipation as measured by c-Kit (CD117) and CD34 immunohistology. In this study, we wished to determine whether there were abnormalities in the number of neurons of the Auerbach's plexus, their CD117 and CD34 immunoreactivity, or the thickness of colon wall sections in patients with refractory slow transit colonic constipation as compared with control subjects. Specimens from 13 patients who had undergone subtotal colectomy for severe chronic constipation refractory to medical treatment were compared with normal controls. Enteric neurons of Auerbach's plexus were counted, and thickness of the circular and longitudinal layer of the muscularis externa as well as total muscularis externa was measured. Quantitative assessment of anti-CD117 and anti-CD34 immunoreactivity was performed using an Automated Cellular Imaging System and expressed as fractional scores. Except for a decreased circular muscle layer thickness in the constipated patients, no statistically significant differences were observed between the two groups. In particular, there was no relationship between CD117/CD34 fractional staining score and the duration or severity of disease, despite the selection of highly symptomatic individuals requiring colonic resection. Using quantitative immunohistochemistry for CD117/CD34, we could not detect a relationship between fractional CD117/CD34 staining score and chronic constipation as compared to controls.
    International Journal of Colorectal Disease 10/2006; 21(6):527-32. · 2.24 Impact Factor

Publication Stats

5k Citations
1,885.83 Total Impact Points

Institutions

  • 1982–2012
    • University of Zurich
      • • Department of Biostatistics
      • • Institut für Anästhesiologie
      • • Internal Medicine Unit
      • • Klinik für Herz- und Gefässchirurgie
      Zürich, Zurich, Switzerland
  • 2005–2009
    • University of Louisville
      • Department of Surgery
      Louisville, KY, United States
    • U.S. Department of Veterans Affairs
      • Department of Surgery
      Washington, D. C., DC, United States
  • 1991–2004
    • Zürcher Höhenklinik Wald
      Zürich, Zurich, Switzerland
  • 2001
    • Triemli City Hospital
      Zürich, Zurich, Switzerland
    • University Hospital RWTH Aachen
      Aachen, North Rhine-Westphalia, Germany
  • 2000
    • Swiss Paraplegic Centre
      Nottwil, Lucerne, Switzerland
  • 1982–1999
    • Schulthess Klinik, Zürich
      Zürich, Zurich, Switzerland
  • 1998
    • Heinrich-Heine-Universität Düsseldorf
      Düsseldorf, North Rhine-Westphalia, Germany
  • 1996–1997
    • University Hospital of Lausanne
      Lausanne, Vaud, Switzerland
  • 1967–1997
    • Psychiatrische Universitätsklinik Zürich
      Zürich, Zurich, Switzerland
  • 1995
    • Inselspital, Universitätsspital Bern
      Berna, Bern, Switzerland
  • 1989–1995
    • Universitätsspital Basel
      Bâle, Basel-City, Switzerland
    • University of Chicago
      • Department of Medicine
      Chicago, IL, United States