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Biomedical subjects

B Steckmeier

Publications and source records attributed to B Steckmeier.

At least 37 records · Page 2Linked to original sources
PubMed1994

Platelet response to vascular surgery--a preliminary study on the effect of aspirin and heparin.

Patients with peripheral arterial disease (PAD) demonstrate high cardiovascular mortality, which is further increased after arterial reconstruction. Enhanced platelet reactivity has been postulated for these patients. The effect of surgery and of periprocedural aspirin and heparin therapy on platelet reactivity was assessed with the Stagnation Point Flow Adhesio-Aggregometer (SPAA). The platelet adhesivity and aggregability of 44 PAD patients was quantitated perioperatively. Aspirin was administered during the entire course, low molecular weight heparin (LMWH) preoperatively and as of the fourth postoperative (pOP) day and unfractionated heparin (UH) upon surgery and three days thereafter. A group of 15 aspirin-free general surgical patients receiving LMWH and with no evidence of PAD served as controls. Plasma fibrinogen levels and platelet count were determined. The heparin-induced platelet activation (HIPA) assay for detection of heparin-associated thrombocytopenia (HAT) antibodies was also performed. Baseline values of SPAA-measured platelet reactivity (p < 0.001) and plasma fibrinogen (p < 0.01) were higher for patients as compared to controls and increased markedly after surgery. In the PAD group maximum platelet activation and fibrinogen levels coincided with a marked drop in platelet count and were concomitant to administration of unfractionated heparin. Thereby, a drop in platelet count of > 30% was observed in 25 patients (57%). The HIPA test verified HAT antibodies in 3 (12%) of these patients, two of which suffered postoperative thrombosis. In the control group significant pOP increases were noted only for plasma fibrinogen. Changes in platelet count and reactivity were minimal and nonsignificant. No thrombosis occurred and no HAT antibodies were detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Increased pre- and postoperative thrombocyte activity in vascular surgery patients].

To determine the effect of vascular surgery on platelet function, a perioperative investigation of 37 patients with peripheral arterial disease (PAD) was performed using the Stagnation Point Adhesio-Aggregometer (SPAA). The SPAA provides well defined flow conditions. By means of dark field microscopy platelet microthrombus formation can be directly observed and measured continuously. Mathematical evaluation of resulting growth curves renders the constants for adhesion and aggregation, Kpw and Kpp, respectively. The PAD patients were divided into 2 groups: diabetics (n = 9) and nondiabetics (n = 28), and were examined perioperatively at regular intervals (average: n = 8). Preoperatively all patients received aspirin and low molecular weight heparin (LMWH). As of surgery and up to the third postoperative day all patients received unfractionated heparin (UH), at which time LMWH was resumed. Plasma fibrinogen concentration was also determined. Data obtained preoperatively were compared to those of 40 healthy volunteers (without medications). In the present study a significant increase (p < 0.001) in platelet reactivity was verified in PAD patients in spite of aspirin and LMWH administration. As of the first and up to the 8th day after surgery, a marked increase in platelet adhesivity and aggregability as well as plasma fibrinogen concentration and a concomitant decrease in platelet count was observed. Maximum values were obtained during intravenous administration of UH. Thrombocytopenia (< 150,000/ml) was observed in 12 patients. The hypercoagulability response to vascular surgery observed in the present study occurred in spite of therapy with aspirin and heparin. Our findings indicate the need for further improvement in conventional therapy and the SPAA as a useful tool in monitoring the effectiveness of current as well as of future inhibitors of platelet function.

Adult↗
PubMed1993

[Prevention of thrombosis in surgery of the extremities. Physical methods in thrombosis prevention].

Physical therapy procedures for the prophylaxis of thrombosis are part of basic medical therapy. Their effect has been documented by numerous individual observations, even though no prospective studies are available. Since the inconvenience to the patient is minor, they should be implemented in all surgical patients. In the case of patients at risk of thrombosis such as in orthopedic surgery, the effect of such procedures is not sufficient. In this case physical therapy procedures can only supplement the medical prophylaxis of thrombosis. The effectiveness of technically more complex physical procedures has been documented in small studies, but due to the high technical and personnel costs, the application is restricted.

Bandages↗
PubMed1993

[Venous thrombosis--clinical aspects and diagnosis].

Physical examination is in most cases not specific or sensitive enough to diagnose venous thrombosis. Only in rare cases is it possible to diagnose thrombosis by history and examination alone. However, when the case history indicates that risk factors are present, one must suspect thrombosis even if the clinical findings are uncharacteristic. In this situation the diagnosis must be verified by additional technical examinations.

Edema↗
PubMed1993

[Treatment of venous thrombosis].

In the treatment of deep vein thrombosis (DVT), a rapid clinical diagnosis supported by the appropriate equipment, the age of the patient, and the extent of the thrombosis are the major determinants of successful therapy. Active and conservative treatment should be aimed at the prevention of pulmonary embolisms, rethrombosis and elimination of the thrombus, while preserving venous valvular function, which in turn is essential to avoid the development of post-thrombotic syndrome. The treatment of acute DVT remains controversial. For this reason the indication, treatment, and recently published results of thrombectomy, thrombolysis, and the possibilities for preventing DVT are discussed.

Anticoagulants↗
PubMed1991

[Simpson's atherectomy in embolizing leg artery stenoses].

We report on the treatment and follow-up of six patients with an unilateral "blue toe" syndrome. This is caused by atheromatous micro-embolisation to the digital arteries and requires urgent attention due to the painful cutaneous necroses and impending digital gangrene. In all patients, Simpson's atherectomy of proximally situated femoropopliteal stenoses caused the pre-gangrenous digital changes to heal completely. In a mean observation period of ten months no relapse occurred. The embolising material was presumably parietal fibrino-platelet thrombi which could be observed with angioscopy and were regularly detectable histologically in the excised tissue.

Aged↗
PubMed1991

[Surgery of the adrenal glands. Advantages and disadvantages of an anterior versus a posterior approach].

From Jan. 1984 until Oct. 1990 87 adrenalectomies in 75 patients were performed. In 29 patients the transabdominal anterior approach via a transverse upper abdominal laparotomy was carried out for unilateral left (18 pat.) or right adrenalectomy (11 pat.). 46 patients underwent 58 adrenalectomies using the posterior approach as described by Mayor. Using this approach with the patient in prone position, the 11th rib is resected, the pleural reflection identified, the Gerota's fascia incised and the suprarenal space exposed. When the anterior approach was used, blood transfusions were required in 34%. On the other hand, with the dorsal approach, a transfusion was necessary in only 4% of the patients. In 3 of 18 anterior left adrenalectomies a splenectomy was required (17%). The previous was not necessary in any patient having undergone a posterior adrenalectomy. Using the anterior approach postoperative hemorrhage occurred in 7%. No cases of bleeding were observed after posterior adrenalectomy. The average hospital stay was 14.6 days in the transabdominal and 8.5 days in the posterior group. The dorsal approach can only be used in cases in which the tumour is less than 5 cm. For larger of malignant tumours the transabdominal approach is mandatory. In conclusion the posterior adrenalectomy is superior to the anterior and should therefore be employed in appropriate cases.

Adrenal Gland Neoplasms↗
PubMed1989

[Experiences with rotation atherotomy and atherectomy].

In addition to currently available, low risk procedures for reestablishment of patency in arteriosclerotic vascular segments with bougier techniques as described by Dotter and the balloon dilatation modification according to Grüntzig, as necessary together with local thrombolysis, important new developments based on mechanical principles are the atherectomy according to Simpson as well as the rotation atherotomy with a flexible catheter and slowly rotating milling head or rapidly rotating head as used by Kensey. To provide a larger lumen of recanalization, we developed an atherotomy lathing catheter with a rapidly rotating head and various diameters which is now available for intraoperative use. The thrombendarterectomy as described by Vollmar with the "ring stripper" is used only intraoperatively and can only be performed retrograde. The effect of laser systems encompasses disintegration and ablation of occlusive material. The rotation atherotomy is based on the capability of discrimination between hard occlusive material and elastic vascular wall through suitable construction of the lathe head (Figures 1 a to 1 e). Since, in passive catheters, the capability of lathing at the tip is associated with a high risk of perforation and a lateral possibility for lathing is not achievable, the lathing performance should be small, at the center of rotation and orthogonal to the axis of rotation at the outer radius. Through combination with a spherical disc face perpendicular to the axis of rotation, which protrudes only slightly from the hemispherical catheter tip, with a maximum at the center and minimum at the lateral borders, the lathing head has only a slight risk of perforation and no undesired sheering forces (Figures 2a to 2d).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Dynamic angioplasty--a milling catheter for transcutaneous and intraoperative treatment of vascular occlusive disease.

Balloon angioplasty and bypass graft surgery are common procedures for treating vascular occlusive disease. The purpose of this preliminary investigation was to evaluate the effectiveness and the safety of a new catheter system, first introduced by KR Kensey. The system involves a flexible catheter with a high speed rotating tip, driven by an electrical motor. The tip is cooled by a continuous flow of sterile saline containing dextran 40, heparin and urokinase. Radiopaque contrast medium may be infused through the catheter to allow the device to be guided and to detect lesions and to evaluate the efficacy of treatment. The system was applied in three patients with occlusive vascular disease (Stage IIb) and segmental or total occlusion of the superficial femoral artery (SFA). The milling catheter was introduced percutaneously into the common femoral artery and guided to the area of occlusion under DSA control. In two patients total recanalisation was achieved after passage of the milling catheter. In one patient the totally occluded SFA could not be cannulated and a femoro-popliteal bypass was performed one week later. Complications such as perforation of the vessel or peripheral embolisation were not observed. Pedal pulses were improved significantly in one patient. Further investigations will be necessary to demonstrate whether the milling catheter can be safely used to revascularise patients with limb threatening peripheral vascular disease.

Angioplasty, Balloon↗
PubMed1987

[Thoracic outlet compression syndrome].

In patients suffering from chronic, therapy-resistant shoulder and arm pains, the thoracic outlet compression syndrome (TOS) should be included in the differential diagnosis. It is very important to look out for neurogenic disorders as well as early signs of vascular compression in order to prevent ischaemic injuries. Although the initial complaints appear slight and can in some cases be treated successfully by conservative methods, neurogenic disorders due to TOS as well as arterial and venous manifestations of the syndrome should be treated by resection of the first rib. Only in this way can irreversible neurogenic lesions and arterial or venous complications be prevented.

Arm↗
PubMed1987

[Compression syndromes in the popliteal area].

In young, active patients with intermittent or sudden-onset ischemic pain in the lower leg, the presence of an entrapment syndrome of the popliteal artery must be considered. This compression syndrome can be clinically and angiographically verified by an interruption in the continuity of the middle segment of the artery. As irritation of the arterial wall can lead to complete occlusion of the artery, all cases of entrapment syndrome within the popliteal fossa--even those causing few symptoms or none at all--require surgical revision. A dorsal approach should be used, and the anatomical variations of the artery listed elsewhere must be considered. The surrounding musculature on the fibrous structures causing compression must be incised or resected; in some cases vascular reconstruction is necessary. In the relatively rare soleus syndrome, there is entrapment of nerves and veins as well as of the artery. In such cases, the tendon of the soleus muscle must be split to obtain adequate decompression of the vascular nerve bundle.

Constriction, Pathologic↗
PubMed1986

[Local thrombolysis in acute occlusion of a femoropopliteal Gore-Tex bypass].

Occlusion of a femoro-popliteal Gore-Tex-bypass in two patients could be reopened using local low-dose thrombolytic therapy. Apart from the peripheral outflow effective anticoagulation treatment appears to have a deciding influence on long-term results. Application of the thrombolytic selectively to single vessels of the lower leg as well as a post-lysis effect offer the chance for an improvement in outflow. Combination of local lysis with vessel surgery may be an additional alternative for conservation of the extremities.

Acute Disease↗
PubMed1986

[Indications and results of caval filter operation using the Kimray-Greenfield filter].

Recurrent pulmonary embolism is a permanent risk. The caval filter is able to prevent embolism. The implantation can be done even in seriously ill patients under local anesthesia. In our patients no complication or recurrent embolism were observed. Only one case developed a thrombotic occlusion of the Kimray Greenfield filter as a result of retroperitoneal carcinosis. The relapse of embolism was prevented by the filter. All other implants were seen patent in the digital subtraction angiography.

Filtration↗