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Biomedical subjects

D Sege

Publications and source records attributed to D Sege.

At least 19 recordsLinked to original sources
PubMed2001

Repetitive intraoperative use of recombinant hirudin (Lepirudin) in peripheral vascular surgery with HITT.

Heparin induced thrombocytopenia with thrombosis (HITT) is a rare but dangerous complication related to the application of unfractionated heparin or low molecular weight heparin. Due to an antibody dependent in vivo platelet activation, severe thromboembolic episodes may occur. We present the case of a patient with HITT following implantation of an aortobifemoral graft secondary to bilateral common iliac artery stenoses. An arterial clot developed and led to a partial occlusion of the graft to the right external iliac artery. Heparin was replaced by Lepirudin, a recombinant hirudin. A bolus of 0.4 mg/kg body weight was given, thereafter 0.15 mg/kg body weight per hour was administered continuously i.v. to maintain the aPTT 2- to 2.5-fold above the baseline value. The platelet count (minimum 47 G/l) normalised within two days. During thrombectomy of the right common femoral artery we used Lepirudin intraoperatively (bolus injection of 0.2 mg/kg body weight) to prevent any further platelet and coagulation activation during the clamping phase. Six months later the patient underwent two further bypass operations due to severe stenoses of both superficial femoral arteries. Due to the high risk of thromboembolism if HITT recurred, a bolus of 0.2 mg/kg body weight of Lepirudin was given during each intervention. No bleeding complications occurred. In addition Lepirudin appeared to decrease platelet consumption in the absence of active thrombosis. Direct thrombin inhibitors such as Lepirudin possess no heparin-like immunological properties and seem to have become the therapeutic "gold-standard" in patients with HITT. Our experience suggests that the repetitive intraoperative use of Lepirudin is safe and effective.

Anticoagulants↗
PubMed2001

[Postoperative heparin-induced thrombopenia with thromboembolism (HITT)--a rare complication of heparin therapy?].

Many surgical patients receive either unfractionated or low-molecular weight heparin in a prophylactic or therapeutic intention. Feared upon the administration of heparin is the heparin-induced thrombopenia (HIT). In HIT type 1, the heparin directly interacts with the platelets. The platelet count rarely falls below 100,000/microliter and normalizes again despite continuous administration of heparin. In HIT type 2 or HIT with thrombosis (HITT) the platelet count usually falls more than 50% and due to an antibody-dependent platelet activation, thromboembolic episodes may occur. Compared to non-surgical patients, the incidence of HITT in the postoperative phase is markedly increased. In suspicion of a HITT, heparins should immediately be stopped and replaced by an alternative coagulant because of a high risk of further thromboembolic complications. Direct thrombin-inhibitors such as the recombinant hirudins are considered to be safe and effective. They have no heparin-like immunological properties and therefore, they seem to become the therapeutic and prophylactic "gold-standard" in patients with HITT.

Heparin↗
PubMed1999

[Perforating veins and venous insufficiency].

As communicating link between the deep and the superficial venous system the perforating veins are of special importance. With the introduction of the subfascial videoendoscopic dissection of the perforating veins the interest in anatomic and topographic aspects of the surgical treatment of insufficient perforators has increased. Different pathophysiological conditions can cause insufficient perforating veins. We can distinguish between a primary form and a secondary form caused by an advanced varicosis of the main superficial veins. A third entity consists in an insufficiency created by a postthrombotic alterations of the deep venous system. Primary insufficient perforators should be treated surgically. In the case of a secondary insufficiency the indication is dependent on the extent of the pathological findings. If there is an obstruction of the deep venous system which causes the insufficiency of a perforator the vein should not be divided. The videoendoscopic subfascial dissection of the insufficient perforating veins has several advantages compared with direct percutaneous exposure. The technique is easy to learn, however it requires profound knowledge about the compartmental spaces and the topographic anatomy of the perforating veins in the lower leg.

Endoscopes↗
PubMed1997

[Carotid endarterectomy--5-year results in St. Gallen canton hospital].

The 5-year results following carotid endarterectomy at our institution were analysed retrospectively. The aim of this study was to compare our results with those published in the ECST and NASCET studies as a measure of quality control. We studied the outcome of 101 carotid endarterectomies which were performed between 1989 and 1993 in 90 patients. 74 operations were carried out in "symptomatic" and 27 in "asymptomatic" patients. The standard anaesthetic procedure was a cervical plexus block, which was completed in 87% of all operations. The 84 surviving patients on December the 31th 1993 were all followed up with a clinical and directional Doppler examination in our angiologic outpatient clinic during the first half of 1994. The perioperative stroke rate was 1.98% for the whole group and 2.7% for the "symptomatic" group. The cumulative stroke rate for a period of three years (measured by the Kapplan-Meier method) amounted to 3% (1% per year); the cumulative stroke rate for the "symptomatic" group was 4% in a two year period (2% per year). The results and outcome of carotid endarterectomy at our institution are comparable to the ECST and NASCET studies regarding perioperative mortality, perioperative stroke rate and rate of ipsilateral stroke during the first 2 years after operation.

Aged↗
PubMed1996

[Efficacy of organ exchange rules in a 7 million population nation].

The suitability of organ exchange rules were analysed retrospectively in a country with a population of 7 million not connected to international organ sharing organisations following the opening of a national coordination centre 2 years previously. The results demonstrate that the sharing rules work frictionless and efficiently, and that compulsory registration of every organ donor (cadaveric and living) guarantees entire transparency of organ source and exchange, therefore preventing any illegal activity. An unacceptably high mortality rate for patients awaiting a highly urgent organ (specifically heart or liver) shows that connection to an international organ exchange organisation is desirable in this respect.

Health Care Rationing↗
PubMed1994

[Results in surgery of bronchus carcinoma].

During a 6-year period from 1986 to 1991, 119 patients with lung cancer underwent thoracotomy. 112 underwent surgical resection with lymphadenectomy. The mean age of the 97 male patients was 62.7 years, and of the 15 female patients was 62.7 years, and of the 15 female patients 57.1 years. 54 patients were in stage I, 23 stage II, 21 stage IIIa, 8 stage IIIb and 6 stage IV. Pneumonectomy was performed in 20 cases, bilobectomy in 2, lobectomy in 81, segmentectomy in 3 and sleeve lobectomy in 6. Perioperative death occurred in 2.7% of all patients, 5% of patients who underwent pneumonectomy and 2.2% of patients who underwent lobectomy. Serious complications occurred in 19% of all thoracotomy patients. The re-thoracotomy rate was 6% and mortality 0.8%. The cumulative 5-year survival rate in all 112 patients with surgical resection was 54.6%, and for the 54 patients with radical resection 60.3%.

Aged↗
PubMed1992

[Incidence of recurrence in long-term follow-up of 100 patients after surgery for primary hyperparathyroidism].

The percentages for recurrence or persistence of hyperparathyroidism after operation for pHPT vary between 3 and 7% according to the pertinent literature. These groups of authors have a broad experience based on a large number of patients treated. At our institute we have operated for pHPT an average of 5 patients per year. Given our limited experience we reexamined 100 consecutive patients which were operated for pHPT between 1968 and 1988 in order to determine our own rate of recurrence. The rate for persistent or recurrent hyperparathyroidism was at 8% slightly higher than in the literature reviewed. When reexamining the patients we took the history concerning the preoperative symptomatology and its postoperative course. Furthermore we compared a radioimmunoassay measuring the midmolecule region of the parathyroid hormone with a immunochemiluminometric assay determining the intact and biologically active hormone regarding sensitivity and specificity. The results are presented and compared with the literature reviewed.

Aged↗
PubMed1991

[Therapy of urologic complications in 210 consecutive kidney transplantations].

The results of 210 consecutive renal transplant operations between 1969 and 1989 were assessed with respect to urological complications. 17 patients had urological problems. 4.7% of the patients had ureteric complications (obstruction or leakage). 2.8% of this series showed other general urological complications like bladder bleeding, extravasation at the ureterovesical anastomosis and bladder leakage. One patient had interstitial cystitis and an anastomosis of the transplant ureter with an ileal conduit was performed. Ureteric complications were managed in all cases by revisional surgery, excision of the affected segment followed by ureteroneocystostomy or uretero-/pyeloureterostomy. Bladder bleeding and extravasation at the ureterovesical anastomosis were treated by transurethral and percutaneous drainage procedures. Open surgery was necessary for great bladder leakage. In all cases the function of the transplant kidney could be maintained.

Follow-Up Studies↗
PubMed1991

[Results of in situ bypass].

The "in situ" bypass technique was adopted by our group in 1986. A total of 53 "in situ" bypasses were carried out until June 1989. The worst symptoms were incapacitating claudication, rest pain or ischemic necrosis, each in about one third of the patients. The site of the distal anastomosis was the popliteal artery below the knee in 40 instances, the peroneal artery in 7 and other infrapopliteal vessels in 6. Valve incisions were performed uneventfully with reusable instruments featuring a sharp-edged blade and an indicator for rotation control of the blade ("Insitutom RC"). Vein branches were located mostly by angiography, but residual arteriovenous fistula remained a vexing problem. In the beginning they were ligated under local anaesthesia. Later on they were dealt with successfully using transluminal embolization. Patients were last examined in July 1990 when the follow-up time ranged from 12 to 51 months. 4 patients had died and 5 were lost to follow-up. Patency rates were evaluated according to the life-table method. They were gratifying for femoro-popliteal bypasses with 87 percent after one year and 83 percent after two and three years. Femoro-tibial-peroneal bypasses performed below average, but their number was too small to draw conclusions.

Adult↗
PubMed1991

[Mid-term results of our first 53 "in situ" bypasses].

The "in situ" bypass technique was adopted by our group in 1986. A total of 53 "in situ" bypasses were carried out until June 1989. The worst symptoms were incapacitating claudication, rest pain or ischemic necrosis, each in about one third of the patients. The site of the distal anastomosis was the popliteal artery below the knee in 40 instances, the peroneal artery in 7 and other infrapopliteal vessels in 6. Valve incisions were performed uneventfully with re-usable instruments featuring a sharp-edged blade and an indicator for rotation control of the blade ("Insitutom RG"). Vein branches were located mostly by angiography, but residual arterio-venous fistula remained a vexing problem. In the beginning they were ligated under local anaesthesia. Later on they were dealt with successfully using transluminal embolization. Patients were last examined in July 1990 when the follow-up time ranged from 12 to 51 months. 5 patients had died and 5 were lost to follow-up. Patency rates were evaluated according to the life-table method. They were gratifying for femoro-popliteal bypasses with 87% after one year and 83% after two and three years. Femoro-tibial-peroneal bypasses performed below average, but their number was too small to draw conclusions.

Adult↗
PubMed1990

[Simultaneous intra- and extralobar lung sequestration and its intermediate stages].

We operated upon a patient with a simultaneous intra- and extrapulmonary sequestration in relationship to the same left lower lobe. The rarity of this form of pulmonary sequestration and its contribution to the comprehension of the pathogenesis of this malformation justifies the present publication. Most of the distinctive characteristics between the two different sequestration form found in the literature can be questioned. The unit of the lesion in our patient with the stalk connected intra- and extrapulmonary part, the identical histology, the arterial supply and venous drainage they have in common, points impressively to one single coherent structure - an organoid.

Adult↗
PubMed1989

[Intestinal angiodysplasia--a diagnostic and therapeutic challenge].

During an eight-year period we have treated 10 patients for intestinal angiodysplasia complicated by major hemorrhage. This condition represents a degenerative, acquired lesion mostly in elder people consisting of thin-walled vessels of venous origin. Angiodysplasias are usually multiple and predominantly localized in the right colon. Besides localizing the bleeding source the exclusion of concomitant lesions capable of bleeding but not responsible for hemorrhage represents the main diagnostic problem. Segmental colectomy for angiodysplasia is rarely followed by rebleeding when preoperatively the site of hemorrhage has reliably been identified, mainly by angiography. Today the colonoscopic electro- or lasercoagulation of vascular ectasia represents a valuable alternative therapeutic procedure. Subtotal colectomy should be used only as a last resort.

Adult↗