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Biomedical subjects

A Schramek

Publications and source records attributed to A Schramek.

At least 19 recordsLinked to original sources
PubMed1993

Lower limb ischaemia in primary antiphospholipid syndrome.

Primary antiphospholipid syndrome (PAPS) is an autoimmune disorder manifested by recurrent thrombosis in the venous and arterial system. We report a group of seven patients with lower limb ischaemia associated with PAPS. Four were male patients and three were females, with a mean age of 37 years. All had a previous deep vein thrombosis and the majority, five out of seven, had a prior cerebrovascular accident (CVA). Prolonged activated thromboplastin time was demonstrated in all our patients and PAPS was established by positive thromboplastin titration index, circulating anticoagulant index and increased anticardiolipin levels. Symptoms included claudication in three, rest pain in four and gangrene in five patients. Angiography demonstrated thrombosis of various segments of the arterial tree including: aorta, iliac, femoral and popliteal arteries. Two patients were treated conservatively and one by percutaneous transluminal angioplasty (PTA) of the distal aorta. A total of eleven vascular surgical procedures were performed in four patients resulting in early postoperative thrombosis (2h-30 days) in 10 cases. Only one graft remained patent, when full heparinisation (1000 units/h) was used perioperatively. We conclude that PAPS patients are at high risk for graft thrombosis and should only be operated upon on full anticoagulation, starting at operation and proceeding indefinitely.

Adolescent↗
PubMed1992

[Trash foot following abdominal aortic surgery].

Peripheral embolism from dislodgement of intraarterial debris can convert successful surgery of the abdominal aorta into tragedy. An embolic shower from such surgery, often containing cholesterol, can result in forefoot or toe ischemia referred to as "trash foot." The incidence of this early complication is reported as 7-29%, but is believed to be even higher. Prevention and treatment includes heparin, embolectomy, lumbar sympathectomy, aspirin, rheomacrodex and prostaglandins. 3 such patients, 2 men aged 62 and 69, respectively, and a woman of 72, are reported. In 2 of the cases below-knee amputation was required, while the third patient died.

Aged↗
PubMed1992

Seatbelt injury to the common iliac artery: report of two cases and review of the literature.

Blunt trauma to the common iliac artery is rather rare. Moreover, seatbelt injuries to the common iliac artery have not yet been reported. This article presents two cases of seatbelt injury involving the common iliac artery. A deceleration-type mechanism is suggested as the primary cause of injury, resulting in the production of an intimal flap. The diagnosis of such an injury is based on clinical suspicion, a change of pulse, or lower limb ischemia. On arteriotomy the damage is greater than seen on external examination. Once diagnosed prompt treatment should follow to prevent loss of life or limb. The signs, symptoms, and modalities of treatment are reported, as well as a review of the literature.

Adult↗
PubMed1988

External longitudinal splitting of the biceps brachii muscle for coverage of repaired brachial vessels: an anatomical study and clinical application.

The external longitudinal splitting of the biceps brachii muscle offers a convenient and safe method for covering exposed vessels in the medial aspect of the arm in cases with loss of soft tissue. This anatomical study reveals rather variable and inconsistent patterns of blood supply to the biceps brachii muscle. The common denominator among the patterns is the fact that the nutrient vessels to the muscle originate in its posterior deep surface and course thereafter in a fan shape upward to the surface of the anterior aspect of the muscle. This microcirculatory pattern permits the external longitudinal splitting of the biceps brachii muscle along the whole anteromedial aspect of the short-headed belly without compromising its blood supply and function. An illustrative case is described.

Adult↗
PubMed1984

The etiology of "white bile" in the biliary tree.

"White bile" is the colorless fluid occasionally found in occluded biliary systems. The absence of pigments in this "bile" was not satisfactorily explained. The objectives of this study were to assess its etiology. In dogs, "white bile" developed whenever both the common bile duct and the cystic duct were ligated. In comparison, dark green ("black") bile occurred when only the common bile duct was ligated leaving the gallbladder in communication with the obstructed ducts. The pressure in extrahepatic ducts containing "white bile" was significantly higher than in those filled with "black bile." Flow in the extrahepatic ducts was assessed by the aid of radioiodinated human serum albumin (RIHSA). When "black bile" was present, the direction of flow was from the extrahepatic ducts into the gallbladder. Whenever "white bile" developed, a reverse flow from the extrahepatic ducts into the liver was observed. Thus, the role of the gallbladder appears to be decompression of the biliary system allowing bile flow from the liver even in obstruction. In the absence of the gallbladder water absorption activity, the colorless secretion of the bile ducts seems to "back wash" into the liver and replace the bile present in the ducts at the time of occlusion.

Animals↗
PubMed1984

Night blindness and liver cirrhosis as late complications of jejunoileal bypass surgery for morbid obesity.

A patient underwent end-to-side jejunoileostomy for morbid obesity, and 3 years later an end-to-end jejunoileostomy with ileotransversostomy was performed. Nine years later she presented with night blindness, severe diarrhea and mild jaundice and was found to have malabsorption with vitamin A and K deficiencies as well as asymptomatic liver cirrhosis. Her shunt was removed, and a gastric partition was performed. The night blindness and abnormal prothrombin time were corrected by the administration of vitamins A and K. This case demonstrates that complications may appear many years after jejunoileal bypass surgery, and therefore, the patients should remain under strict medical supervision indefinitely.

Female↗
PubMed1984

Treatment of liver trauma in the Lebanon War, 1982.

During the Lebanon War, 1982, 37 laparotomies were performed in our ward, mostly for penetrating abdominal trauma. The liver was injured in 11 of these patients and was bleeding at the time of laparotomy in all cases. Liver sutures were restricted to superficial wounds only. In deep lacerations, all devitalized liver tissue was removed by anatomic segmentectomy or lobectomy. Patients who had segmentectomies had a rapid and uneventful recovery, with the exception of one who developed jaundice but later recovered. In one case, the intrahepatic left main branch of the portal vein was repaired. Two soldiers died during surgery. We report our experience in liver surgery during the Lebanon War.

Abdominal Injuries↗
PubMed1983

Night vision in a case of vitamin A deficiency due to malabsorption.

Night vision was tested electroretinographically and psychophysically in a vitamin A deficient patient before and after therapy. Vitamin A deficiency resulted from malabsorption due to a jeujunoileal bypass operation. Before therapy the patient had severely reduced cone and rod function. After the reversal operation, accompanied by 5 injections of a total of 500,000 units of vitamin A, complete recovery of cone and rod functions was observed within 7 months. Shortly after therapy rod sensitivity reached the normal level, while the time course of rod adaptation remained slower than normal and the dark-adapted electroretinographic (ERG) responses were subnormal. At later stages the ERG responses reached normal amplitudes but rod adaptation stayed slow. Only after 7 months did night vision reach the normal level with regard to the time course of rod adaptation, rod sensitivity, and ERG responses.

Dark Adaptation↗
PubMed1983

Fibrinogen "Haifa" - a new fibrinogen variant. A case report.

A 30-year-old female presenting with arterial occlusions of the lower limbs was discovered to have a markedly abnormal thrombin time and reptilase time. Further investigations revealed the presence of a qualitatively abnormal fibrinogen. Two other family members who were completely asymptomatic had similar defects. The abnormal fibrinogen has been characterized and found to be a new variant and as such designated fibrinogen 'Haifa'.

Adult↗
PubMed1983

Primary repair of colon injuries.

Colonic injuries are usually treated by exteriorization, resection and colostomy, or primary repair with proximal colostomy. However, many cases of successful treatment of colonic wounds by primary suture without colostomy have been reported. Yet, these repairs are usually restricted to civilian injuries, stab wounds, perforations of the right colon, cases with few or no other organ injuries, a short time interval between injury and operation, absence of shock, and minimal fecal soiling. We considered lack of fecal spillage to be the only important factor for 12 consecutive patients, the majority war casualties, and performed primary colon repairs on them. All the other commonly accepted limiting factors were disregarded. There were no complications related to the bowel repair. Using these more liberal guidelines, the number of primary repairs of colonic injuries may be increased, thus reducing hospitalization time and cost, and more important, reducing morbidity and mortality associated with the creation and subsequent closure of colostomies.

Abdominal Injuries↗
PubMed1981

Progressing alterations in transient ischemia of skeletal muscles: an ultrastructural study.

Ultrastructural muscle changes resulting from temporary anoxia and their evolution were studied in dogs. Ischaemia of the hind limb was produced by subcutaneous ligation of all muscles of the thigh and clamping of the femoral artery. Revascularization was obtained by declamping and removal of the muscle ligature. The period of ischaemia ranged from 4 1/2 to 7 h, the latter being the upper limit allowing functional recovery after revascularization. 6-7 h of ischaemia revealed focal degenerative changes of varied intensity. These consisted of enlarged mitochondria with ruptured cristae, small pads of glycogen granules and accumulation of lipid vacuoles. The tubules of sarcoplasmic reticulum contained dense, fine-granular material. Focal myofibrillar destruction and disruption of the Z line were encountered in half of the cases. The myofibrillar damage was more severe 9 days after revascularization of the muscles. The functional recovery of the ischaemic limbs in the present study may be due to the focal nature of these changes.

Animals↗
PubMed1980

Long survival following combined treatment of inoperable cholangiocarcinoma: surgery, radiotherapy, and chemotherapy.

A jaundiced patient due to inoperable bile duct carcinoma was treated by a combination of surgery, radiotherapy, and chemotherapy. At the operation an intra-abdominal, extra-choledochal bypass of the tumor was performed with a T-tube obstruction 10 months after diagnosis, and no evidence of malignancy was seen. The T-tube was replaced by an Argyle tube. One year later jaundice reappeared, due to displacement of the tube, and islets of metastatic tumor ce and additional cytotoxic treatment was given. Three months later, after the patient's demise due to an unrelated cause, no evidence of the disease was found. This case demonstrates the importance of palliative by-passing of the tumor in order to relieve obstruction, thus enabling further oncological treatment, which may be, as in the present case, highly effective.

Adenoma, Bile Duct↗
PubMed1980

Congenital hepatic fibrosis with congenital heart disease. A family study with ultrastructural features of the liver.

A family with congenital hepatic fibrosis (CHF) and congenital heart disease (CHD) is presented. The consanguineous healthy parents gave birth to 12 children of whom 10 survived. One son had CHF and CHD, one daughter had CHF and a second daughter had CHD. Three other siblings probably had small a ventricular septal defect and another one probably had mild pulmonary valve stenosis. Development of portal hypertension and hypersplenism necessitated performing shunt operation on both siblings suffering from congenital hepatic fibrosis. Ultrastructural findings were giant mitochondria with large laminar inclusions in hepatocytes, and excess of villi and whorls of membranes and collagen fibrils between hepatocytes.

Adolescent↗
PubMed1980

Complete remission of Cushing's disease by total bilateral adrenalectomy and adrenal autotransplantation.

A 15-yr-old girl was diagnosed as suffering from Cushing's disease. She was treated by bilateral adrenalectomy and autotransplantation of one third of each adrenal to the corresponding thigh. The adrenal that was embedded in the right satorius muscle started functioning after about 1 yr, as proven by significant differences in cortisol levels in both femoral veins (82.5 and 17.5 micrograms/100 ml). 19-[131I]Cholesterol scanning showed adrenal tissue in the right thigh, while no adrenal remnant was demonstrated. Eleven years after surgery, the patient is symptom free and does not require replacement therapy. We find that adrenal autotransplantation, which is a simple and nonrisky procedure, should be considered whenever bilateral adrenalectomy is chosen as a treatment for Cushing's disease.

17-Ketosteroids↗