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Biomedical subjects

B H Nachbur

Publications and source records attributed to B H Nachbur.

5 recordsLinked to original sources
PubMed1991

Isolated iliac aneurysms.

Isolated iliac aneurysms are relatively infrequent, often difficult to detect and therefore rarely considered in the differential diagnosis. Because of their close anatomical relationship to the ureters, bladder, colon, pelvic veins, femoral and sciatic nerve roots one is often misled. The consequences can be grave; chronic ureteric obstruction for instance can cause damage to one or both kidneys. With the growing frequency of tube grafting for aortic aneurysms it becomes increasingly important to consider the prevalence and incidence of isolated iliac aneurysms. The aim of this study is to report the incidence, clinical course and outcome of these lesions. In a consecutive series of 678 aorto-iliac aneurysms in the years 1972-1988 there were 53 isolated iliac aneurysms (7%) ranging in size from 3.5-14 cm whereas the reported incidence in the literature lies between 1-2%; the prevalence in consecutive autopsy series is even less than 1%. CT scanning proved to be the gold standard for the evaluation of pelvic aneurysmal disease whilst angiograms were of little help. A palpable mass was present in nine cases; GI-tract signs in 12 (five patients being operated on for suspicion of appendicitis or sigmoiditis), the genito-urinary tract was involved in eight cases, sciatic or femoral root nerve compression occurred in seven, recurrent pulmonary embolism in two, lower extremity ischaemia in seven and a-v fistula in one. The male:female ratio was 51:2 and that of ruptured to non-ruptured aneurysms 15:38. The site of isolated iliac aneurysms was the common and/or the internal iliac artery uni- or bilaterally. The external iliac artery was never involved.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Surgical thrombectomy versus conservative treatment for deep venous thrombosis; functional comparison of long-term results.

It is known that deep venous thrombosis (DVT) of the ilio-femoro-popliteal axis is frequently associated with irreversible damage to valvular competence of the veins and consequently with varying degrees of chronic venous insufficiency. Because preservation of the valvular function of deep veins can play an important role in preventing the postphlebitic syndrome we analysed and compared the long-term functional outcome of two equally large cohorts of patients treated either surgically for restoration of venous patency and valvular function (24 patients) or medically with heparin, oral anticoagulants and compression stockings (25 patients). The study was also intended to examine the impact of duration and extent of DVT as predictive factors of late outcome. Follow-up time was 7.6 and 7.9 years respectively, operative mortality nil. Assessment of venous function was based on clinical observations as well as on measurement of haemodynamic parameters. Non-fatal pulmonary embolism after onset of treatment occurred in both cohorts with an equal frequency of 13%. Patients operated on for ilio-femoral DVT were with few exceptions totally independent of any form of adjunctive hosiery which was in sharp contrast to the conservatively managed group. If onset of DVT had occurred more than 3 days earlier and extended from the ilio-femoral axis to the popliteo-crural level, surgery usually failed and patients were no better off than in the comparable medical group. The same pattern of late outcome was found for all other clinical and haemodynamic parameters; i.e. clinical signs of venous hypertension, valvular competence as judged by sonography, patient's self-assessment and the expelled volume and refilling time measured by dynamic plethysmography after standardised leg work. The mean expelled volume was 1.1 +/- 0.5 ml/100 g/min. for the surgical group treated early for ilio-femoral DVT and 0.7 +/- 0.5 ml/100 g/min for the corresponding medical group (P = 0.05). Recovery or refilling time was 50 +/- 21 s for the surgical group and 28 +/- 26 s for the medical group (P = 0.03). Thus, the clinical and haemodynamic effect of surgical thrombectomy was significantly superior to conservative management in ilio-femoral thrombosis treated within 3 days. For extensive thrombosis treated early the advantage of surgical thrombectomy was also evident, but the difference between the two treatment groups was not significant. The advantage of surgery was however totally lost in patients operated on for extensive DVT of long duration (i.e. greater than 3 days).(ABSTRACT TRUNCATED AT 400 WORDS)

Bandages↗
PubMed1989

[Duplex and transcranial sonography in cerebrovascular diseases].

Duplex and transcranial sonography make non-invasive assessment of cerebrovascular hemodynamics possible. Lesions of the carotid bifurcation are divided into the categories I-VI by which the different forms of carotid lesions are defined. Pathological alterations of the major basal cerebral arteries as well as the quality of collateral circulation via the ophthalmic artery and the circle of Willis are readily picked up and evaluated by transcranial doppler sonography. If cerebrovascular disease is suspected it is therefore recommended to proceed first with duplex and transcranial sonography. If the results are negative, then echocardiography is indicated. With these non-invasive methods a correct diagnosis can usually be made. Patients who are at great risk of suffering a stroke are integrated into a programme aimed at prevention of cerebrovascular insults and re-insults. This programme includes the elimination of the usual risk factors and specifically the medication of anti-platelet drugs or oral anticoagulants respectively in cases of cardiac embolism. In special well-defined cases endarterectomy of the carotid bifurcation might be indicated. Regular clinical examinations will enable a long-term follow-up and permit assessment of the efficacy of a preventive programme while simultaneously increasing patient compliance.

Carotid Artery Diseases↗
PubMed1982

Management of profound accidental hypothermia with cardiorespiratory arrest.

Complete recovery following rapid rewarming is described in three tourists who were admitted in a state of profound hypothermia with total cardiorespiratory arrest (rectal temperature ranging from 19 to 24 C). In all three patients, respiration and circulation had ceased during the rescue operation. Rapid core rewarming was achieved by thoracotomy and continuous irrigation of the pericardial cavity with warm fluids in one patient, whereas in the other two patients rewarming was accomplished with extracorporeal circulation using femoro-femoral bypass. In the first patient, the heart could not be defibrillated earlier than 90 minutes following thoracotomy; in the other patients rewarming was attained very rapidly, and within half an hour after institution of bypass, resuscitation of the heart was successful. The patients fully recovered their intellectual and physical abilities, despite the prolonged periods of circulatory arrest lasting from 2 1/2 to 4 hours. We conclude that rapid core rewarming is the adequate therapy for profound accidental hypothermia with circulatory arrest or low cardiac output. If feasible extracorporeal circulation represents the method of choice because it combines the advantage of immediate central rewarming with the benefit of efficient circulatory support, the heart is rewarmed before the shell, thus preventing the "rewarming shock" due to peripheral vasodilatation. Resuscitative efforts should be promptly initiated and vigorously pursued, even in the state of clinical death; in profound hypothermia neurologic examination is inconclusive regarding prognosis.

Accidents↗