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Biomedical subjects

G Omlor

Publications and source records attributed to G Omlor.

At least 19 recordsLinked to original sources
PubMed2004

[Restenosis of carotid artery after stenting associated bleeding in the vascular wall].

Stenting is an alternative procedure to the endarterectomy in patients with severe (> 70 %) symptomatic stenosis of the carotid artery. Its value is actually tested in large controlled randomised multicenter studies. Many vascular surgeons postulate no benefits for the patients but a higher complication rate for the stenting procedure. Especially the possibility of mechanical irritations of the endothel caused by the stent itself seems to be a major problem. Despite thousands of stenting procedures of the carotid artery, there exist no reports of patients with direct mechanical irritation of the carotid artery through the stent itself. It is only published a higher risk of embolisation. This case of a 71-years old patient, who had a irradiation of the head and neck region 5 years ago for cancer therapy, is presented here. After the irradiation (60 gr) the stent was not so fixed in the carotid wall as usually. Therefore the stent caused a mechanical irritation of the sclerotic plaque with a bleeding in the carotid wall and subsequent severe stenosis at the end of the stent with higher level of infarction volume. This case demonstrates the risk of the theoretical postulated irritation of the endothel through the stent itself in a high movement region.

Aged↗
PubMed2004

[Transumbilical laparoscopic-assisted "one-trocar" appendectomy -- TULAA -- as an alternative operation method in the treatment of appendicitis].

INTRODUCTION: Appendectomy is one of the most commonly performed surgical procedures in general surgery and laparoscopic appendectomy represents the beginning of minimal invasive era in visceral surgery. But until yet, laparoscopic appendectomy is not the standard method for removal of the appendix and the discussion about the value and the advantages of laparoscopic appendectomy is still going on between the opponents and advocates of this method. In this article we present the transumbilical laparoscopic assisted "one-trocar" appendectomy (TULAA) as an alternative procedure for appendectomy and our experiences with this technique, which is up to now not very well known in Germany. METHOD: From November 1, 2000 to December 31, 2002, we performed appendectomy in 350 patients. 163 patients (46.6 %) underwent TULAA in the technique of Begin. All of them were examined two weeks and three months after surgery. RESULTS: In 94.5 % the "one-trocar" appendectomy was successful and there were no intraoperative complications. The mortality was 0 %. Conversion to the open procedure was necessary in 3 patients (1.8 %), respectively introduction of accessory trocars was necessary in 6 patients (3.7 %). In 111 from 163 patients (68.1 %) appendectomy was performed because of acute appendicitis. In 14.1 % we detected additional secondary findings during the laparoscopy. The postoperative complication rate was 3.6 %. CONCLUSION: The transumbilical laparoscopic assisted "one-trocar" appendectomy complements the minimal invasive procedures in visceral surgery. The operating technique combines the simplicity and the safety of conventional appendectomy with the survey of laparoscopic appendectomy. It minimizes the trauma of surgery and shows a perfect cosmetic result.

Acute Disease↗
PubMed2002

[Primary and secondary aortoiliac reconstructions in patients with coexistent horseshoe and pelvic kidney].

The coexistence of dystopic kidney and abdominal aortic aneurysm or aortoiliac occlusive arterial disease is uncommon (0.12-0.15 %) and constitutes a technical challenge to vascular surgeons. Between 1997 and 1999 we performed 249 aortoiliac reconstructions and encountered four patients (1.6 %) with dystopic kidneys. The aortoiliac reconstructions were performed successfully in all patients while maintaining renal blood supply. Aortoiliac reconstructions in patients with horseshoe or pelvic kidney show similar results as regular reconstructions on the condition that optimal preoperative diagnosis and operative technique are used considering atypical renal vessels. Nevertheless, pelvic kidneys can lead to serious complications as we describe in this report. On the basis of our patients anatomy, embryology and surgical management of this entity.

Aged↗
PubMed2000

[Effect of preoperative preoperative visualization therapy on postoperative outcome after inguinal hernia surgery and thyroid resection].

UNLABELLED: This randomized controlled trial aims to evaluate the influence of preoperative relaxation techniques on postoperative outcomes. From January 1997 to June 1998 208 patients were operated on for primary inguinal hernia or goiter. The patients were randomized into two groups: Group A (n = 103) underwent the surgical treatment with a preoperative visualization therapy. Group B (n = 105) underwent the surgical treatment without a preoperative therapy. Patients with age under 18 years, ASA-status IV-V, recurrent inguinal hernia or recurrent goiter and malignant neoplasms were excluded from the study. There were no differences in age, sex, duration of the operation, training of the surgeon, and preoperative blood parameters between the two groups. RESULTS: During the postoperative follow-up we observed more hematomas (group A with visualization therapy: 30.3%, group B without visualization therapy: 44.4%) as well as more pain (group A: 4.2, group B: 5.2) and analgesic consumption (group A: 59.7 mg Tramadol HCL, group B: 72.5 mg Tramadol HCL) in group B (p < 0.05). There were no significant differences in infections, nausea, hypocalcemia, tetania, recurrent nerve palsy, fever. CONCLUSIONS: Preoperative visualization therapy reduces significantly the number of postoperative hematomas after inguinal hernia repair. Furthermore a decrease of analgesic requirements after surgical treatment was observed.

Adult↗
PubMed2000

[Open carotid endarterectomy: the classical operation method, experimental carotid stenting].

UNLABELLED: In a retrospective study we examined the possible of obtaining better results with a new operation technique of the carotid artery, the so-called "no-touch isolation" in comparison with conventional operation technique. PATIENTS AND METHODS: 49 patients, who had been operated in 1997 and 1998 by this new operation technique, were compared with a group of 39 patients, who had been previously operated with the conventional technique. The new "no-touch isolation" technique is aimed at avoiding possible intraoperative and postoperative embolies. First, the carotis internal artery was exposed and clamped distal to the stenotic plaque very atraumatically. The operation was further carried out without the use of an intraluminal shunt. At the end of the procedure the operation results were checked by means of an intraoperative angiography. In case of a possible embolization source, like pieces of intima, an intraoperative revision was carried out until all embolization material was removed. RESULTS: The two compared groups were not different regarding age, sex, symptomatology, degree of stenosis, and risk factors. No significant differences in context with the applied operation method for TEA (with or without patch, Eversions-TEA, etc.) could be detected. The group operated with the "no-touch isolation" technique had significantly longer operationtimes and also significantly longer clampingtimes than the group operated with the conventional technique. However, the postoperative results were better. Significantly fewer neurological deficits appeared and, in addition significantly fewer patients had to be revised because of secondary hemorrhages. CONCLUSION: The "no-touch isolation" technique is, at the moment, the best surgical procedure for the carotid artery. It is the method of choice for patients with symptomatic stenosis of the internal carotid artery with more than 70% stenotic degree.

Adult↗
PubMed1999

[Endoscopic harvesting of the vena saphena magna for peripheral vascular reconstruction].

OBJECTIVE: By using an endoscopic, video-assisted instrumentarium we harvested the great saphenous vein for peripheral bypass surgery through minimal skin incisions with the purpose to reduce the wound complications. METHOD: Endoscopic subcutaneous saphenous vein harvesting was performed in 15 patients who underwent peripheral bypass surgery for intermittent claudication. In 6 patients the vein was taken from the affected leg and in 9 patients the vein was harvested from the opposite leg. RESULTS: In every case where the vein was taken from the affected leg we observed severe hematomas, which was in one case complicated by an abscess. Once we converted to the open procedure and in one patient endoscopic preparation led to a small vein injury. When the vein was harvested from the opposite leg no complications occurred. CONCLUSION: The endoscopic subcutaneous saphenous vein harvesting in peripheral bypass surgery with a special video-assisted instrumentarium is feasible. The cosmetic advantages of this procedure are associated with high costs and a long operating time. Although we were not able to demonstrate a reduction of wound complications in our patients, the endoscopic vein harvesting in peripheral bypass surgery should be considered a very promising procedure. Nevertheless we cannot recommend the method for a wide clinical use at this time.

Aged↗
PubMed1998

Microembolic signals and intraoperative stroke in carotid endarterectomy.

OBJECTIVES: Microembolic signals (high-intensity transient signals, HITS) detected by means of transcranial Doppler sonography (TCD) may be relevant for intraoperative strokes in carotid endarterectomy (CEA). MATERIAL AND METHODS: An intraoperative HITS detection study was performed on 77 patients (63 men, 14 women, mean age+/-SD, 64+/-8 years) with a total of 81 CEAs. Using the Scandinavian Stroke Scale the patients were clinically examined by a neurologist preoperatively and postoperatively within 6 h. A deterioration of the Scandinavian Stroke Scale was considered an intraoperative stroke if persisting longer than 24 h. Cranial computed tomography (CT scan) was performed preoperatively and 3 to 5 days postoperatively. By means of TCD total HITS count and mean blood velocity changes, for shunting, were recorded sufficiently in the middle cerebral artery in 79 CEAs. RESULTS: HITS were significantly more frequent in symptomatic [n = 53; HITS: median, 15 (range 1-159)] than in asymptomatic stenoses [n = 26; HITS: 6.5 (0-41); P < 0.001]. An intraoperative stroke in the hemisphere ipsilateral to the operation occurred in eight of the 81 CEAs. On postoperative CT scans, five of the eight strokes showed new corresponding territorial infarctions. In the three strokes without new CT lesions, the mean blood velocity changes after clamping indicated normal cerebral perfusion. Total HITS count was significantly higher in procedures with intraoperative strokes [n = 8; HITS: 33 (11-159)] than in the uncomplicated [n = 71; HITS: 10 (0-62); P = 0.002]. No stroke occurred in 37 CEAs with 10 or less HITS, but eight in 42 CEAs with 11 or more HITS [P = 0.006; relative risk 1.23 (95% confidence interval: 1.06 to 1.43)]. CONCLUSION: Microembolism seems clinically relevant in carotid endarterectomy. Asymptomatic patients may run a lower risk of intraoperative embolization.

Aged↗
PubMed1996

[Elective lymph node dissection in malignant melanoma--status of color Doppler findings].

Since there is still a controversial discussion about the ELND in melanoma patients, the purpose of this prospective study was to optimize the indication concerning ELND by ultrasound examinations. 144 patients with primary melanomas were checked every 3 months after excision. Echomorphologic pattern and intranodal vascularisation in the color-flow Doppler modus provide essential information for differential diagnosis. We found 47 patients (32.6%) with suspicious ultrasound lesions. 50% of these patients had no pathological clinical findings, the histological findings of excised lymph nodes were positive in all cases. It must be emphasized, however, that the group with lymph node metastases included 12 patients with low-risk-melanomas (2 x Tis, 10 x T1 < 1 mm tumor thickness). In comparison with a historical control group (141 patients), where ELND was performed routinely in high-risk-patients ( > T2), the incidence of ELND in our hospital decreased more than 50%; at the same time the percentage of detected lymph node metastases increased (twice).

Adult↗
PubMed1995

[Ischemia of the extremity as a rare complication of alloplastic joint replacement].

Two cases of extremity ischemia after alloplastic knee and hip joint replacement are presented. In both cases early operative intervention led to complete recovery. The mechanisms of iatrogenic vascular injury following arthroplastic operations on the hip and knee joint are demonstrated. In particular, the importance of preexisting vascular occlusive disease is stressed. Diagnostic procedures and implications for treatment are discussed.

Aged↗
PubMed1993

Rapid measurement of blood leakage during regional chemotherapy.

In order to avoid complications after regional chemotherapy (isolated hyperthermic perfusion) of the extremities, rapid measurement of blood leakage from the extracorporeal to the systemic circulation is important. A method using technetium-99m in vivo red blood cell (RBC) labelling is reported that provides results within 3 min. Blood samples drawn from the systemic and the extracorporeal circulation were measured for 99mTc activity using a mobile well counter, and the leakage values calculated. The mean result was 7.6% +/- 6.5%/15 min (n = 209). The corresponding flow rate was 100.2 +/- 85.7 ml/15 min (mean +/- SD). The values for isolation perfusion of the upper and the lower extremities are compared. The leakage results using 99mTc RBC labelling were correlated with other blood pool markers. Iodine-125 human serum albumin and indium-113 m transferrin were administered in subgroups of 4 and 19 patients simultaneously. Using linear regression, the coefficient of correlation was 0.72 for 99mTc/113mIn and 0.58 for 99mTc/125I. Comparison with the alternatives suggests that the rapid method of leakage measurement after 99mTc RBC labelling can be considered one of the most practicable and reliable methods available.

Chemotherapy, Cancer, Regional Perfusion↗
PubMed1993

Effect of peak inspiratory pressure on the filtration coefficient in the isolated perfused rat lung.

Positive inspiratory pressure- (PIP) ventilated, isolated rat lungs become edematous when perfused at rates approximately the normal cardiac output. The study was conducted to test the hypothesis that high peak inspiratory pressures contribute to the edema development. Five isolated lungs were perfused at a rate of 24.4 +/- 2.2 ml.min-1.100 g body wt-1 with 40% whole blood (diluted with saline containing 4.0 g/100 ml bovine serum albumin) and ventilated with peak pressures ranging from 0 to 20 mmHg. The lungs exhibited edema at PIP values > 9.3 mmHg. The stable pulmonary vascular pressure and resistance suggested that the edema may have resulted from a PIP-induced increase in microvascular permeability. In a second study, the stability of the preparation was evaluated during a 3-h test period. Seven lungs were ventilated at a peak inspiratory pressure of 8.0 mmHg and perfused at 26.8 +- 1.7 ml.min-1 x 100 g body wt-1. Microvascular integrity was maintained for approximately 2 h as indicated by filtration coefficient measurements of 0.175 +/- 0.068, 0.197 +/- 0.066, and 0.169 +/- 0.067 g.min-1 x mmHg-1 x 100 g-1 at 25, 70, and 115 min, respectively, after initiation of the study. The results suggest that isolated rat lungs perfused at rates that parallel normal rat cardiac output and ventilated at low peak inspiratory pressures provide a viable mechanism for evaluation of the pathophysiology of microvascular injury.

Animals↗
PubMed1993

[Fournier's gangrene].

Today Fournier's gangrene ranks among necrotizing fasciitis. Most of the cases reveal the origin of the disease (proctogenic, urologic, gynecologic). Untreated, the polybacterial synergistic infection will overwhelmingly spread along anatomically defined fascias of the pelvic floor. Thus the lethality rate is high, especially in patients with risk factors i.e. diabetes, alcoholism, arterial occlusive disease, chronic consumptive disorders and obesity. Only by instant and radical surgical excision of the total gangrenous tissue the spreading of the disease and the developing of sepsis can be stopped together with calculated antibiotic therapy and intensive care. Mutilating operations (i.e. penectomy, orchiectomy) are seldom necessary; thus plastic reconstructions will show good results both in function and cosmetic. Based on the experience with 6 patients, a pathogenic concept, concerning both diagnosis and therapy, is presented: after radical emergency surgery in the first risky stage, an elective approach can safely be performed in a second stage for the repair of functional lesions.

Aged↗
PubMed1993

[Cardiocirculatory side effects of hyperthermic extremity perfusion].

The risk of cardiocirculatory disorders was investigated in 23 consecutive patients with high-risk melanomas, who had been treated with hyperthermal limb perfusion. Postoperatively, there was a rise in the pulmonary vascular resistance. In addition, 14 patients with vascular occlusive diseases (1-2b, Fontaine) showed intraoperatively an increasing amount of leakage of the extracorporeal circulation. Elevations of thromboxane and prostacyclin in excess of the norm caused by mechanical and thermic traumatization of blood in the heart lung machine were detected in 8 patients investigated during and after the perfusion procedure. Significant increase of cisplatin, one of the two cytostatic agents injected extracorporeally, could not be demonstrated in the blood of the systemic circulation by atomic absorption spectroscopy. Increased pulmonary and arterial pressure disorders were observed in the group with occlusive vascular diseases, caused by a rising rate of vascular collaterals to the body and the rising rate of thromboxane and prostacyclin in the body blood flow. We believe that it is necessary to monitor pulmonary arterial pressure during isolated limb perfusion, especially in patients with vascular occlusive disease.

Adult↗
PubMed1993

[Technique and results of hyperthermic perfusion of the extremity in melanoma patients].

The results of hyperthermic isolated limb perfusion therapy in 36 patients with stage II-IV malignant melanoma of the extremities are presented. With the technique employed, neither severe complications nor functional deficiencies attributable to the perfusion therapy were observed. The findings on follow-up for up to 36 months are comparable to those reported in the literature, with survival rates of about 90% for stage II and III patients and nearly 50% for stage IV patients. Thus, our technique appears to be beneficial, especially in respect of the very low rate of side effects.

Adult↗
PubMed1993

[Blind loop of the large intestine--bypass enteropathy or diversion colitis?].

Investigating three patients with longstanding diarrhoea, severe abdominal bloating and cramps revealed an exclusion of the right hemicolon in all patients and additionally of the terminal ileum in one of them. The anastomosis of the ileo-colic bypass, performed decades ago due to complicated appendicitis, was stenotic in two of them. Because a classical blind-loop-syndrome could not be proven, the functional disorder is described as a clinical entity characterized by signs of bypass-enteropathy and diversion-colitis. The importance of the radiological examination for diagnosis and therapy-planing is emphasized, because endoscopically and histologically Crohn's disease might be suspected. The surgical reintegration of the bowel into the orthograde continuity of the intestinal tract is recommended as the causative treatment. Symptoms disappear completely and patients win normal health even after some decades, because the morphological signs of inflammation are reversible and bowel function is not lost during the exclusion.

Adult↗
PubMed1992

[Risks and benefits of thrombendarterectomy in bilateral internal carotid artery stenosis].

Among the patients who were operated for cerebrovascular insufficiency, one third suffered from bilateral stenoses of the internal carotid artery. In a retrospective analysis of 47 patients who were operated in consecution and of 28 patients who refused operation and were treated conservatively, the outcome was compared to cases with a one-sided stenosis. 31 patients were operated on one side and 16 on both sides. 28 of the surgically treated cases were followed up for an average of 32 months. The morbidity of 3.2% of the bilateral cases was twice as high as that of the unilateral cases. A permanent neurological deficit was observed in 2 patients after reconstruction of the asymptomatic but higher grading stenosis, but in none of the 18 cases after reconstruction of the symptomatic side although the stenosis of the other side was not removed. Patients with bilateral stenoses of the internal carotid artery should therefore be operated first on the symptomatic side. The frequently concomitant coronary artery disease of these patients prevents an improvement of the survival period in the group of bilaterally operated patients. The success in these cases concerns only the quality of life. The risk of a subsequent stroke in the 28 not operated cases with bilateral stenoses was 14.6% and therefore much higher than in the group of operated patients. Increase of the stenoses during the observation period is a prognostically unfavorable sign. Low dose treatment with platelet aggregation inhibitors (less than 500 mg ASS) increased the risk of an apoplectic insult.

Carotid Artery, Internal↗
PubMed1992

[The celiac trunk compression syndrome: a rare disease picture].

We report the case of a 49-year-old woman who complained of strong epigastric pain, emesis, diarrhea, and a weight reduction of 10 kg. The diagnosis of a coeliac axis compression syndrome was made based on a typical angiographic picture. Half a year after the operative resection of the median arcuate ligament and the coeliac plexus, the patient is completely symptom-free and her weight has increased by 4 kg. In our opinion, the most important prerequisite for the indication to operate is the careful exclusion of all other possible diagnoses in combination with all the typical findings.

Angiography↗