[Prevention of thromboembolism from the viewpoint of forensic medicine].
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Biomedical subjects
Publications and source records attributed to G Carstensen.
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For the relaxation of the physician-patient relationship from 1975 on Settlement Institutions and Expert Commissions were established at all General Medical Councils of the Federal Republic of Germany. The first Settlement Institution was founded on April 24th, 1975 in Bavaria, the first Expert Commission on December 12th, 1975 in North-Rhine. These institutions without example met all requirements and have stand the test. Quality standards are ensured by cooperation of lawyers. The 7288 reproaches of malpractice during the 12,5 years at the Expert Commission North Rhine are analyzed. Out of these 7288 reproaches 1126 cases of malpractice were assessed.
In two randomized prospective trials grafts impregnated with gelatine were compared to those not impregnated. In the first trial a double-velours graft (n = 50) was compared with a graft without velours trimming (n = 50) implanted in the aorto-iliac bifurcation. One half of the grafts in both groups were gelatine-impregnated. In the second trial 24 grafts without velours trimming (Cooley II, Meadox), 24 grafts manufactured by a new warp-knitting procedure without velours trimming (Protegraft 2000, B. Braun AG) and 24 identical grafts of B. Braun AG but with gelatine impregnation were evaluated. Gelatine-impregnated or not the grafts without velours showed no satisfying results. An elevated intraoperative bleeding incidence and a low two-years-patency rate of 64% were noted. On the other hand all double-velours grafts, gelatine-impregnated or not, showed a 100% patency rate two years after implantation. In the second trial a slight reduction in intraoperative blood loss was noted when using the gelatine-impregnated grafts.
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A report on 130 operations of carotid elongation is presented. Indications for reconstruction are based on angiography, neurologic symptoms, and recently, on ultrasonography (Doppler's). Several surgical methods have been performed: 25 resections of the internal carotid artery, 5 resections of the common carotid artery, 3 resections of loop aneurysms. The main operative techniques were resection and neoimplantation, the latter with patch-plastic surgery. Usually, a shunt was used. Mortality was 0%, lethality, 2%. During a follow-up period of 6 weeks to 2 years, 86% of the patients were found to be free of complaints, and 14% were without change of the neurologic symptoms. The good neurologic results are convincing.
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The results of impedance plethysmographic examination were evaluated by a mathematical curve analysis. The magnitude of the exponential coefficient of the saturation and discharge function provides a highly accurate measure of the loss of functionality. The percentage change in the flow rate may be obtained by substitution of the exponential coefficients in a model formula.
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The different physical screening tests (ultrasound Doppler technique, plethysmography, phlebodynamometry) are easy documented and make possible a less dangerous, less expensive, and extensive statement about the venous hemodynamics of the lower extremity. The quota of diagnostic error can be minimized and the indication for operation is secure.
Results of reconstructive vascular surgery in 86 patients with vertebral artery and subclavian artery insufficiency are reported. 1. The neurologic symptomatology can be improved effectly and persistend by an astonishing small risk of operation. 2. The basic disease remains untreated and reduces life-expectancy. 3. The The valuation of reconstructive vascular surgery for the human rehabilitation is missing biometric facts. The advantage can't be described according to the statistics, it helps patients to a worth living life.
Results of reconstructive vascular surgery in 352 patients (aged 3 to 75 years) with extracranial arterial occlusions (295 of internal carotid artery) with intermittent symptoms or minor neurological defects are reported. Advantages of reconstructive surgery in the prevention of recurrence are: (1) further cerebrovascular episodes more frequently affect the non-operated side or brain-stem; (2) neurological recovery is quicker and more complete in operated than conservatively treated patients. However, reconstructive surgery, while preventing further cerebrovascular episodes, does not influence definite neurological defects.
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