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Biomedical subjects

G Salzmann

Publications and source records attributed to G Salzmann.

18 recordsLinked to original sources
PubMed1997

Heparin-related thrombosis despite normal platelet counts in vascular surgery.

BACKGROUND: Acute graft thrombosis is a severe complication in vascular surgery that may require limb amputation or even cause death. Because nearly all patients undergoing vascular surgery have had previous exposure to heparin, the presence of heparin-related anti-platelet antibodies typical for heparin-associated thrombocytopenia (HAT) is one underlying possible mechanism of acute graft thrombosis. Although thrombocytopenia is a typical finding of HAT, it is not clear whether the occurrence of clinically important HAT is necessarily associated with thrombocytopenia. PATIENTS AND METHODS: Ten out of 246 patients undergoing vascular surgery were diagnosed with HAT because of otherwise unexplained acute graft thrombosis that required recurrent surgical interventions. RESULTS: In all of the 10 patients, heparin-related anti-platelet antibodies were detected although the platelet counts were within the normal range. When HAT was diagnosed, heparin administration was stopped and, after autoantibody cross-reactivity with the heparinoid Danaparoid had been excluded, anticoagulation was continued using this anticoagulant. After heparin therapy was discontinued none of the 10 patients developed further thrombotic complications. CONCLUSION: The data presented demonstrate clearly that a normal platelet count does not exclude the possibility of HAT. As a consequence of this, HAT should be suspected in patients who develop thrombotic complications during heparin treatment, regardless of the actual platelet counts.

Adult↗
PubMed1996

[Chronic venous insufficiency].

In severe chronic venous insufficiency (CVI) the fascia cruris is increasingly involved in the pathological process. The resulting loss of compliance as a consequence of altered fascia texture leads to increased pressure in the compartments of the lower extremity, followed by reduced circulation. Arteries and nerves, which penetrate the fascia along with insufficient perforating veins, are damaged through the increased pressure and are therefore functionally impaired. Accordingly many pathological changes in the crural ulcer have their anatomical substrate here. The microcirculation is distributed by either primary varicosis with secondary insufficiency of the deep veins or by primary insufficiency of the deep venous system as seen in a post-thrombotic syndrome. Subsequent therapy should be based on this knowledge and therefore consists of medication and basic physical therapy along with dissection of the perforating veins-fasciotomy and fasciectomy combined with plastic surgery. All of the therapeutic measures have to take the stage of the CVI into consideration. In order to eliminate the insufficient perforating veins and to perform fasciotomy the endoscopic approach is considered the state of the art. In extreme cases, only fasciectomy combined with plastic surgery can lead to durable healing.

Combined Modality Therapy↗
PubMed1984

[Diagnostic value of CK-MB isoenzyme determinations in children with craniocerebral injuries and polytrauma].

Total creatine kinase (CK) and its myocardial isoenzyme (CK-MB) were determined in 71 children with isolated acute head injury (N = 30), with head injury and polytrauma but without chesttrauma (N = 11) and with head injury and polytrauma including chest trauma (N = 30) on the second and third day after injury. Electrocardiograms were recorded in 56/71 children on each of the first three days in hospital. Elevations of CK-MB isoenzyme over 6% respectively over 10% of total CK are found as frequently in children with head injury without chest trauma as in children with head trauma and chest trauma. In addition there is no significant correlation between the level of the CK-MB and the incidence of ECG features characteristically associated with heart contusion. This study shows that the determination of CK-MB cannot be used as a criterion for diagnosing heart contusion in children with head injury. The finding of CK-MB in the serum of 53% children with isolated head injury exceeding 6% of total CK, and in the serum of 33% children exceeding 10% of total CK strongly suggests myocardial damage to be a frequent complication of cerebral damage with consecutive extreme sympathetic stimulation.

Adolescent↗
PubMed1983

Perioperative infection prophylaxis in vascular surgery--a randomized prospective study.

In 300 reconstructive arterial operations of the abdominal aorta and the lower limbs, a randomized prospective study of the effect of perioperative infection prophylaxis with antibiotics was performed. The evaluation was carried out with regard to the frequency of severe postoperative wound infections. As prophylactic antibiotic Cefuroxime was initially used, Cefotaxim was later administered. Cefotaxim has been proven to be the appropriate antibiotic against the special microbial spectrum of our clinic. Side effects or complications due to the antibiotics were not found. Wound infections of all grades of seriousness occurred in the group without infection prophylaxis in 15.1%, in the antibiotic group in 3% (p less than 0.001). Serious wound infection endangering or involving the transplant were found in the group without prophylaxis in 7.2%, whereas in the antibiotic group in 1.5%. Infections of the vascular prosthesis were observed in 2.4% and 0.8% respectively. Most wound infections occurred in the groin. The most common infecting organisms were Staphylococcus aureus or epidermidis. A higher risk of wound infections due to old age or gangrene could not be observed. Although wound infections in peripheral vascular surgery are relatively rare, they have severe consequences. It is therefore advisable to administer perioperative infection prophylaxis which significantly reduces this complication, especially in patients with synthetic implants.

Animals↗
PubMed1977

[The hemophiliac as a surgical patient (author's transl)].

In the Surgical Clinic of the University of Munich, 23 surgical interventions were performed on 20 hemophiliac patients between 1967 and 1976. There were 13 emergency and 10 elective operations. The spectrum ranged from removal of atheroma to subtotal gastric resection. For adequate substitution of factors a comprehensive preoperative "hemostasis profile", selection of a suitable preparation and postoperative supervision with coagulation analysis are necessary. Despite a normalization of the hemostasis, atraumatic surgical technique is particularly important. Risks of substitution therapy are primarily hepatitis, allergic reactions and the appearance of inhibitors. Whereas, especially using low-fibrogenic substrates, the operative risk is not essentially increased, in our experience the patients seem to be endangered particularly by infection and septic complications.

Adolescent↗
PubMed1977

[Cardiac survival time under the influence of carbochromen: Studies and results].

In rabbits carbocromen was tested to influence heart tolerance to hypoxic conditions. The time between onset of asphyxia (induced by succinylcholin) and ECG silence was recorded. Carbocromen increased this time period by about 60 p c(p less than 0.001). It is discussed whether this effect is due to newly discovered metabolic changes or to the well known coronary vasodilation, both experimentally demonstrated for carbocromen.

Action Potentials↗
PubMed1976

[The diagnosis and therapy of mediastinal tumors (author's transl)].

From 1965 to 1973, 82 patients were operated on for mediastinal tumor. 42.7% of them were incidental radiological findings. Preoperatively, 66% of the mediastinal tumors were not morphologically confirmed. The lethality of the operation was 1.22%. Thymomas (29.3%) were the most frequent findings. 34.2% were malignant. While most patients with benign mediastinal tumors are cured by the operation, the 5 year survival rate for those with malignant tumors was 22%. Further special investigative procedures should only follow a guiding survey radiography in two planes if they can be expected to provide essential information on operability, operational tactics and approach.

Adolescent↗
PubMed1975

[Valvular replacement in florid endocarditis. Report on 5 cases].

This is an account of experience with valve replacement in patients with active endocarditis. In four patients the aortic valve was replaced, and in one, the mitral valve. Indication for surgery in all five cases was heart insufficiency. Two patients died, one of acute left heart failure five weeks postoperatively, and one of brain embolus in the presence of persisting acute endocarditis, four months postoperatively. Covered in the discussion are other indications for valve replacement in the presence of acute endocarditis, namely, serial emboli, fungus endocarditis, resistance to and toxic reactions of antibiotics, and mycotic sinus of valsava aneurysm. In conclusion, results obtained by other authors are reported.

Acute Disease↗
PubMedDate not supplied

[Late outcome after implantation of the PFC modular knee system].

AIM: The objective of the current, prospective study was the evaluation of long-term results after total knee arthroplasty with the PFC-Modular-knee system. METHOD: A total of 514 total knee arthroplasties were implanted between 1991 and 1994 in 248 female and 55 male patients. Their average age amounted to 62.4 years and 449 of them (87.4%) were re-investigated within the first half-year of 2000. Clinical and radiological data were evaluated according the recommendations of the American Knee Society. RESULTS: Late complications were observed in 6.5% of the cases. They consisted of prosthetic loosening (13 knees), patella problems (11 knees), instability (2 knees), periprosthetic fractures (2 knees), and one prosthesis fracture, 18 patients complained about a therapy-resistant, chronic pain syndrome. These findings lead to revision arthroplasty in 15 cases (3.3%). Preoperative American Knee Society Score values were on average 33, 35 an 17 points and improved to mean values of about 85, 79 and 5 points. Radiological signs of prosthetic loosening were observed in 12 cases (2.7%). CONCLUSION: Long-term results after total knee arthroplasty with the PFC-Modular-knee system showed a significant improvement in the patients' complaints and clinical findings at an average of 7.8 years postoperatively. Complication and revision rates of 6.5% and 3.3%, respectively, were low when compared with the international literature and--apart from this--decreased in the course of the observation time.

Aged↗
PubMedDate not supplied

[Treatment of splayfoot with prolapse of the metatarsal heads by Helal's Oblique Metatarsal Osteotomy (author's transl)].

The authors describe the technique of oblique osteotomy of the distal metatarsals after Helal, for treating splayfoot with prolapse of the metatarsals heads. It was performed on 189 metatarsals in 76 patients. The operation is technically straightforward, inexpensive and, with the appropriate indication, an efficacious intervention with a high success rate.

Adult↗
PubMedDate not supplied

[Plasma and tissue concentrations of biphenylacetic acid following 1 week oral fenbufen medication and topical administration of Felbinac gel on the knee joint].

In an randomised study 30 patients were treated during one week before undergoing an elective surgery of the knee joint with 1 or 2 g respectively of 3% Felbinac gel (biphenylacetic acid gel) or oral 300 mg Fenbufen thrice daily. Biphenylacetic acid (BPAA) is the therapeutically active metabolite of the non-steroid anti-inflammatory drug Fenbufen. Plasma concentrations were measured before, during therapy and at the time of the operation. During the surgery of the knee joint specimens of synovial fluid and -membrane, of cartilage, muscle and tendons as well as of the skin and the subcutaneous fatty tissue were obtained and the BPAA concentrations measured. There was a large variance of the obtained values in all groups. It seems that mainly methodical problems are responsible for this. At the time of surgery, the plasma concentrations following oral administration were with 10,080 ng/ml 20 to 50 times higher than those after topical administration. The tissue concentrations reached 1/8 to 1/2 of the plasma concentrations. The relation of tissue concentrations to plasma concentrations of BPAA was smaller in patients treated with oral administration than in patients treated with topical administration. Therefore a partial direct penetration of Felbinac into the deeper tissue compartments can be assumed. There was no significant difference in plasma-, synovial- or tissue concentrations between the two groups treated with the topical administration. The tissue concentrations were 1 to 2 orders of magnitude lower than those after oral administration. Only in the skin the concentrations were with 9160 respectively 3830 ng/g higher than those obtained after oral application (2110 ng/g).

Administration, Oral↗