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Biomedical subjects

A Aulich

Publications and source records attributed to A Aulich.

At least 55 records · Page 3Linked to original sources
PubMed1987

Absorbable polydioxanone suture for venous anastomoses: experimental studies using venography and transluminal angioscopy.

Because of their increased tendency to stenosis and spasm and thrombosis, results after venous anastomoses are often unsatisfactory. Nonabsorbable sutures and a continuous suture technique have been suggested to have a negative effect on the compliance of vascular anastomoses. Eighty venous anastomoses were performed with either an interrupted or continuous suture technique, using polypropylene or polydioxanone (PDS) sutures, according to a randomised experimental model. The anastomoses were divided in four groups: (1) Nonabsorbable suture material, continuous suture technique; (2) Nonabsorbable suture material, interrupted suture technique; (3) Absorbable suture material, continuous suture technique; and (4) Absorbable suture material, interrupted suture technique. The morphology of the anastomoses was controlled by venography directly after closure of the wound and at weekly intervals for 2 months and monthly intervals thereafter until 2 years had passed. In 10 cases venography was followed by transluminal angioscopy in the early postoperative period and after 1, 2, 4, 8 and 12 weeks. In the first 2 months moderate and high degree stenoses were found in all 4 groups by venography. After 8 weeks there was a significant decrease in the incidence of stenosis in all groups with the exception of the group, in which continuous nonabsorbable suture had been used. Using angioscopy a marked swelling of the intima at the site of the anastomoses could be detected in the early postoperative period in all experimental groups. After 2 months no significant narrowing could be identified in groups 2, 3 and 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1987

The role of subclavian-carotid transposition in surgery for supra-aortic occlusive disease.

From 1977 through 1985, 1043 patients underwent operation for supra-aortic occlusive disease. One hundred thirty-four of these patients (13%) with 146 lesions of the aortic arch branches (innominate, 25; subclavian, 103; and multiple, 10) had one or more symptoms of subclavian steal (78%), transient ischemic attacks (37%), arm ischemia (37%), and others (7%). However, according to results of a critical prospective neurologic examination, the classic steal syndrome appeared in only 13 patients (10%), vertebrobasilar insufficiency in 32 patients (24%), and hemispheric symptoms in 48 patients (36%). Symptomatic and/or significant internal carotid occlusive disease was present, ipsilateral in 28% and contralateral in 31% of the patients. Other supra-aortic vessels were involved in 49% of the patients. During the same period 192 patients with supra-aortic occlusive disease were treated without surgical intervention for various reasons. Fifty-five patients (27%) were completely asymptomatic except for the presence of reversed flow within the vertebral artery. The surgical approach in 138 operations was extrathoracic (ET) in 71% of patients (innominate artery, 2; subclavian artery, 95; and arch syndrome, 1) and transthoracic (TT) in 29% of patients (innominate artery, 23; subclavian artery, 8; and arch syndrome, 9). Generally, bypass procedures were preferred, but for 72 (71%) of the subclavian lesions subclavian-carotid transposition (SCT) was performed. Three patients had been referred for complications of previous carotid-subclavian bypass. The grafts were removed and vertebral and arm circulation restored by SCT. Carotid end-arterectomy was performed simultaneously (20%) or staged (3%) in 8% of the innominate procedures and 25% of the subclavian reconstructive procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[CT follow-up of neurocysticercosis treated with praziquantel].

Praziquantel therapy has produced a much better prognosis in neurocysticercosis since 1980. The computed tomographic findings and follow-up study in 4 patients with neurocysticercosis before and after praziquantel therapy are described. The special difficulties of differential diagnosis and further diagnostic procedures are discussed in cases in which calcifications are absent and only solitary foci can be found.

Adult↗
PubMed1986

Percutaneous transluminal angioscopy. A new imaging technique for diagnosis of extracranial arterial disease.

Angiography and ultrasound techniques are well established methods for the detection of extracranial vascular disease, but they only allow indirect demonstration of changes in the vessel wall. The development of an ultra-thin fiberscope allows direct demonstration of the pathogenic process in the vessel lumina by angioscopy. The percutaneous transfemoral approach for carotid angiography enables the combination of both methods. After development of an appropriate catheter system we investigated the value of this method producing definite lesions by vascular surgery in adult dogs followed by repeated examinations using angioscopy. Vessel wall alterations such as stalagmite-shaped lesions, subintimal bleeding and thrombotic layers, plaques, ulcerations and postoperative intimal bridging or ablation, which could not be identified by angiography have been analysed with high resolution of details using angioscopy with a video monitoring technique.

Animals↗
PubMed1984

Detection of early atherosclerotic lesions by duplex scanning of the carotid artery.

A high-resolution ultrasound B-mode imaging system combined with a 16-sequential range-gated pulsed Doppler flow measuring device was used for the evaluation of nonstenotic extracranial carotid artery disease. Various types of atherosclerotic lesions were differentiated by Duplex system examinations in 54 carotid arteries examined in vitro in a postmortem study and in 51 carotid arteries examined in vivo from patients with angiographically proven cerebrovascular disease. In addition, the multigated Doppler system allowed the analysis of flow velocity profiles throughout the carotid arteries, the distinction between intraarterial flow and recent thrombus, and in particular the estimation of local flow alterations, which are diagnostic in the presence of sonolucent and shadowed plaques behind echo-dense lesions. A number of difficulties, which at present limit the application of Duplex system examination as a non-invasive "stand alone" method for detecting carotid disease, are discussed.

Angiography↗
PubMed1984

The superiority of combined continuous wave Doppler examination over periorbital Doppler for the detection of extracranial carotid disease.

Non-invasive examination of 431 vessels in 333 patients with cerebrovascular disease in all stages was performed in order to compare the reliability of the periorbital Doppler test alone and together with the more difficult insonation of the carotid arteries in the neck (combined Doppler). These findings were compared with those of subsequent arteriography. Extracranial obstructive (greater than 50%) carotid disease was detected with 100% sensitivity by the combined Doppler, but with only 48% sensitivity by the periorbital indirect test. The specific ability of both methods to identify non-stenotic carotid arteries (less than 50%) was similar at about 98%. Only the combined Doppler examination reliably differentiated various degrees of obstruction, comparable to that obtained with arteriography. Non-obstructive plaques could not be detected or excluded by either Doppler test. More refined methods will be necessary for their evaluation.

Adolescent↗
PubMed1984

Progress in carotid artery surgery at the base of the skull.

From 1977 to 1984, 752 reconstructions of the supra-aortic arteries were performed at our service. In a group of 31 patients presenting with transient ischemic attacks (13) or minor strokes (15), preoperative multiplane angiograms identified lesions from various causes in extremely high locations (fibromuscular dysplasia, 10; atherosclerosis, 6; traumatic changes, 10; spontaneous dissection, 3; and mycotic aneurysms and others, 4) in 34 internal carotid arteries (aneurysms, 10; and stenosis, 24). Surgery was performed on 30 patients. Flow restoration was achieved by resection and vein graft replacement (20), gradual dilatation (5), thromboendarterectomy (6), and tangential clip for exclusion of a lateral aneurysm (1). Only one patient was treated with an extracranial-intracranial anastomosis because the stenosis extended into the carotid siphon. One patient was treated with heparin. Exposure of the internal carotid artery (ICA) at the base of the skull required dissection of the digastric muscle, careful mobilization of the cranial nerves, and detachment of the styloid process in 29 patients. Partial resection of the mastoid process was helpful in two patients. The carotid bone canal was opened from the lateral side in four cases to allow the most distal anastomosis 1 cm within the carotid canal. Back-bleeding was controlled by a balloon catheter. A shunt was impossible to use and clamping time averaged 62 +/- 40 minutes. Except for one recurrent stroke and two transient ischemic attacks no other neurologic deficits occurred. Cranial nerve damage could not be avoided in 21 cases (nervus recurrens, 7; nervus glossopharyngeus, 16; and nervus facialis, 4) but disappeared clinically within a 1- to 6-month period in all but two. Each surgical patient underwent control angiography, which demonstrated 30 arteries to be patent, two became occluded, and one had an insignificant stenosis. We conclude that standard surgical techniques are unsuitable for repair of highly located lesions of the ICA. Although extracranial-intracranial anastomosis has been proposed in patients with planned ligation of the ICA, the anatomic reconstruction remains advantageous because flow is restored to normal and the source of emboli is eliminated. With the use of a special approach, graft replacement can be performed up to the base of the skull.

Adolescent↗
PubMed1982

[Aneurysm of the internal carotid artery at the base of the skull (author's transl)].

A 15-year-old diabetic boy suffering from recurrent peritonsillar infections developed a mycotic aneurysm of the internal carotid artery at the base of the skull. The aneurysm was approached through a cervical and retroauricular incision. The styloid process was burred down at its base. The sternocleidomastoid muscle and the digastric muscle were resected from the mastoid. The internal carotid artery was clamped proximally and blocked with a balloon-catheter distally. The carotid bone canal was opened 10 mm and the carotid artery resected until normal vessel wall was reached. A vein graft was placed end-to-end with single stitches, using 8 X 0 monofil sutures with a small needle. The postoperative course was uneventful except for a temporary paresis of the peripheral facial nerve. Postoperative angiography revealed restoration of the vessel to normal, the patient is now free of symptoms.

Adolescent↗
PubMed1981

[Stenoses and occlusions of the innominate trunk (author's transl)].

Direct comparison with neuroradiologic and surgical data show that stenoses and occlusions of the innominate trunk may be recognized safely by Doppler ultrasound despite localisation close to the aorta. Formation of sonographically demonstrable and haemodynamically complicated vascular by-passes is the reason for the mainly asymptomatic or very uncharacteristic complaints of these cases (78%) among the relatively rare stenosing occlusions of the lumen (0,65%) of the innominate trunk (18 out of 2768 patients). Only in four cases were there focal neurological losses or symptoms of hypoperfusion of the arm. Invasive diagnostic measures should thus be used sparingly. The indication for vascular surgery should be limited to a few cases as long as the natural course of these extracranial vascular changes and the risk of cerebral injury have not been established with certainty.

Adult↗
PubMed1980

[Subclavian-carotid transposition in the treatment of obstructive subclavian disease with steal syndrome].

Eleven patients with subclavian steal syndrome underwent end-to-side transposition of the subclavian into the common carotid artery. The post-operative evaluation was done in every case by neurological examination, brachial blood pressure measurement, transcutaneous Doppler examination and by angiography. The operative result of this reconstruction, which was performed mainly on high-risk patients, was excellent. The symptoms of subclavian steal disappeared. In all but one patient the brachial pressure raised to normal. After transposition a blood flow reduction of 20% was measured intraoperatively in the peripheral common carotid artery, while the vertebral blood flow reversed to its natural direction. The peripheral common carotid artery pressure measured simultaneously remained unchanged, and hemodynamic criteria of carotis steal were not detected. The blood flow quality at the anastomosis was measured by the turbulence index in patients with an ideal reconstruction. The amount of blood flow distortion caused by the anastomosis was negligible. Therefore a long patency is expected. In patients with occlusive disease of the proximal subclavian artery we like to recommend the transposition as the procedure of choice, because the method uses one single incision for the extrathoracic exposure and one anastomosis-only without any graft material.

Arterial Occlusive Diseases↗
PubMed1978

The diagnostic value of CT for radiotherapy of cerebral tumors.

The paper deals with CT followup studies on 73 patients with cerebral tumors who received radiotherapy. The value of CT for the indication of radiotherapy, for followup therapy and for the demonstration of therapeutic success are discussed. Since the cerebral tumors become visualized by means of CT in their entire extent and can be differentiated from perifocal edema, the question arises whether radiotherapy should consist of higher doses in the future. It is also suggested that the "clinical malignancy" may be used to compare the behavior of cerebral tumors when there is no exact histological classification. The possible histopathological effects of radiotherapy (edema, necrosis) and their demonstration by CT are discussed.

Adult↗
PubMed1978

[The use of computer tomography for radiation therapy of cerebral tumours (author's transl)].

The application of computer tomography should be extended for indicating the need and choice of radiotherapy for cerebral tumours, and for observing the effects of treatment. In 26 patients it has been shown that CT is superior to conventional neuro-radiological methods in showing indications and in planning of radiation therapy. Forms of treatment can be suitably adapted where the histological type of the tumour is known. In most cerebral tumours, the beneficial effect of irradiation has been evident in our patients. Our criteria were based on the concept of "clinical malignancy", no attempt was made at a histological classification of the tumours.

Adult↗
PubMed1978

Value and limits of computerized axial tomography in ORL.

The CT findings in some selected cases presenting lesions of the paranasal sinuses and the orbits are compared with the conventional tomograms. Referring to these examples, our experience of value and limits of CT in ORL is reported. Furthermore, a few remarks to CT in cerebellopontine angle tumors are given. Finally, there are pointed out some general considerations concerning radiodiagnostic questions in tumors of the ORL region.

Brain Neoplasms↗