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Biomedical subjects

G Zünd

Publications and source records attributed to G Zünd.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Dynamic obstruction of the left ventricular outflow tract: surgical problems].

Dynamic subaortic obstruction caused by septal hypertrophy may worsen the hemodynamics in some patients after heart surgery. Resection of the hypertrophied septum allows normal left ventricular function. We describe two patients with subaortic stenosis and a complicated postoperative course following heart surgery and additional resection of the subaortic muscular stenosis. One patient was reoperated because of residual obstruction of the left ventricular outflow tract; the postoperative course was uneventful thereafter. The second patient died after the primary surgery because of low output syndrome and sepsis. The postoperative management of this group of patients is difficult, demanding frequent assessment of the patient's hemodynamic condition and echocardiographic surveillance.

Aged↗
PubMed1994

Treatment of internal mammary artery malperfusion syndrome by additional venous graft: early postoperative angiographic results.

BACKGROUND: Internal mammary artery malperfusion syndrome is caused by an acute imbalance between myocardial demand and nutritional support through the mammary artery. METHODS: We performed early angiography in 11 consecutive patients in whom the perioperative course suggested mammary artery malperfusion. All patients received an additional saphenous vein graft distally to the mammary artery anastomosis. RESULTS: Postoperative angiography revealed patent mammary artery and vein graft in 10 patients (three with a markedly reduced caliber of the arterial graft). CONCLUSION: Additional vein graft is the treatment of choice in mammary artery malperfusion syndrome; it does not lead to occlusion of the internal mammary artery.

Coronary Angiography↗
PubMed1994

[Differential surgical therapy of popliteal entrapment syndrome 1967 to 1992].

From 1967 to 1992 at the University Hospital of Zurich 16 patients (14 male, 2 female) with 22 popliteal artery entrapment syndromes underwent a surgical treatment. In this period several different operation procedures were used. The modern operative procedure depends on the degree of the arteries wall compression. The procedure of choice for minimal compression of arterial wall is a musculo-tendinous decompression with a medial replacement of the popliteal artery. In the cases of severe compression we used autologous venous bypass from femoropopliteal I to popliteal III.

Adult↗
PubMed1994

[Preventive digitalis therapy in open thoracotomy].

Prophylactic digitalization is still recommended after open lung surgery in order to prevent cardiac arrhythmias in the postoperative period. Since a beneficial effect of this potentially harmful medication is only poorly documented, we conducted a prospective randomized trial. Patients undergoing elective open lung surgery were divided into two groups one of which received digoxin postoperatively, the other not. Randomization was performed independently in three groups with regard to the extent of surgery, i.e. pneumonectomies in patients of any age, (bi-)lobectomies in patients > 50 and other (less extended) operations in patients > 60. Patients who were either too young for either group or who had already taken digoxin before surgery were followed separately. Monitoring was performed continuously in the ICU and conventional ECG was registered after 24, 48 and 72 hours and weekly until dismission.--Cardiac arrhythmias are very frequent in the early postoperative period with a maximum between the third and the fifth postoperative day. Any kind of arrhythmias were present in 19 of 30 patients (63%) compared to 14 of 35 patients (40%) in the control group. Symptomatic arrhythmias that needed treatment occurred in 11.4% of the control group, but in 33.3% of the patients with prophylactic digitalization. We therefore conclude that a general prophylactic digitalization after open lung surgery is not indicated, but that arrhythmias should be treated individually.

Adolescent↗
PubMed1994

[Standardized follow-up after peripheral bypass operation].

We present a standard protocol of postoperative controls designed for early recognition of possible stenosis or graft failures after peripheral bypass operations. This protocol includes: a) angiography during the first week after surgery, b) clinical and Doppler-pressure measurement 1, 3, 6 and 12 months after surgery. 53 patients with 62 peripheral bypasses were followed. The cumulative patency rate was 87.5% after 12 months.

Aftercare↗
PubMed1994

[Use of a semi-elastic synthetic cast in functional treatment of fresh injuries].

Functional treatment of injured joints is increasing since the introduction of semi-rigid plaster. Injuries to the ligaments of the ankle joint, ruptured Achilles tendon, but also other joints with injured ligaments are suitable for this therapy. We report about our experience of 120 treated ligamental injuries of the ankle joint, treated in a conservative way with semi-rigid plasters.

Bandages↗
PubMed1994

A new approach to in vivo testing of vascular grafts?

We present an novel approach to in vivo testing of vascular grafts. Seven grafts of two different materials, each with an inner diameter of 5 mm, were joined together to form a bundle, the ends of which were joined to connecting segments with an inner diameter of about 15 mm. The device was then implanted into the abdominal aorta of an experimental animal. After surgery, the animal was followed by CT scan at regular intervals to assess patency of each individual graft. The model features an increased number of grafts per animal with standardized anastomoses and hemodynamic conditions, but it needs modification to lower its thrombogenic potential.

Anastomosis, Surgical↗
PubMed1993

[Functional therapy of Achilles tendon rupture].

We are going to present two cases with functional treatment of Achilles tendon ruptures. We define a treatment as functional if the involved limb is either not immobilized at all or whenever the immobilization is incomplete and for a limited time only and when no operation is necessary. The functional treatment is presented as an alternative, and we are going to present the advantage and disadvantage.

Achilles Tendon↗
PubMed1993

[Arterial popliteal entrapment syndrome as the cause of acute peripheral ischemia].

The popliteal artery entrapment syndrome results from an abnormal relation of artery and tendomuscular structures in the popliteal fossa, which can compromise the artery. We report our experience in 18 cases of popliteal artery entrapment syndrome in 14 patients (12 men, 2 women) operated on at the University Hospital in Zurich during the period 1967-1988. A follow-up examination was possible in 12 of the 14 patients in whom popliteal artery entrapment syndrome (both legs in 2) was treated surgically. These patients had first presented with ischaemic symptoms at an average age of 30 years. The correct diagnosis of an entrapment syndrome was made at an average age of 36 years. In all, 5 of the 14 patients were affected bilaterally. In 5 cases the first sign was an acute ischaemic syndrome. All these patients were young and had formerly taken active part in sport. The follow-up examination after an average age of 11.25 years showed a very good result in 13 cases, a good result in 2 cases and an unsatisfactory postoperative result in 1.

Adolescent↗
PubMed1993

[Indications, technique and interpretation of arterial Doppler ultrasound].

Doppler sonography is one of the most important diagnostic tools for angiologists and vascular surgeons, and also for general practitioners with an interest in vascular disease. It can be carried out easily and at low cost and at the same time provides reproducible, quantitative data on with further diagnostic and therapeutic decisions can be based. First, systolic arterial pressure in the anterior and posterior tibial and in the peroneal arteries are measured, with the Doppler probe placed at ankle level. A cuff is wrapped around the lower leg and inflated until the Doppler signal disappears and then deflated. The highest value measured in each leg is termed "ankle pressure". Division of the latter by systolic brachial pressure results in the so-called "ankle-brachial-index" or "ABI". Ankle pressure and ABI correlate well with clinical findings. In normal individuals, the ABI is greater than 1. In claudicators, it ranges between 0.3 and 0.9, in patients with resting pain between 0.1 and 0.5 and with ischemic tissue loss between 0.0 and 0.2. After angioplastic or surgical revascularisation procedures, a fall of the ABI by 0.15 or more is an indication of relevant hemodynamic deterioration and therefore calls for further investigation by arteriography or colour duplex sonography.

Arterial Occlusive Diseases↗
PubMed1993

[Differential diagnosis of ischemia of the lower extremities in young adults].

Lower-extremity arterial occlusive disease in individuals younger than 50 years is rare. We report on 4 young adults with lower limb ischemia, each of them with a different cause. According to literature premature atherosclerosis is the most common cause and is followed by thromboangiitis obliterans, coagulation abnormalities and popliteal artery entrapment syndrome. We suggest a diagnostic concept which could help to avoid undue delay.

Adult↗
PubMed1993

[Recurrent acute occlusions of the popliteal artery before age 50: popliteal entrapment syndrome?].

Compression of the popliteal artery by the medial head of the gastrocnemius muscle is termed "Popliteal Artery Entrapment". The anatomical course of the artery can be normal or abnormal. The entrapment can cause occlusion of the artery or peripheral embolism. This syndrome is an important differential diagnosis in younger patients with recurrent peripheral arterial ischemia. Diagnosis is made by history, clinical findings, arteriography and CT-scan of the knees. All cases of popliteal artery entrapment, whether the artery is occluded or not, should be operated on.

Adult↗
PubMed1992

[Indications for, technique and interpretation of arterial Doppler sonography from the vascular surgeon's viewpoint].

Doppler sonography is one of the most important diagnostic tools for angiologists and vascular surgeons and also for general practitioners with an interest in vascular disease. It can be carried out easily and at low cost and, at the same time, provides reproducible, quantitative data on which further diagnostic and therapeutic decisions can be based. First, systolic arterial pressures in the anterior and posterior tibial and in the peroneal arteries are measured, with the Doppler probe placed at ankle level. A cuff is wrapped around the lower leg and inflated until the Doppler signal disappears. The highest value measured in each leg is termed ankle pressure. Division of the latter by systolic brachial pressure results in the so-called ankle-brachial index or "ABI". Ankle pressure and ABI correlate well with clinical findings. In normal individuals it is greater than 1. In claudication it ranges between 0.3 and 0.9, in patients with resting pain between 0.1 and 0.5 and with ischemic tissue loss between 0.0 and 0.2. After angioplastic or surgical revascularization procedures, a fall of the ABI by 0.15 or more is an indication of relevant hemodynamic deterioration and, therefore, calls for further investigation by arteriography or color duplex sonography.

Arm↗
PubMed1992

Retroperitoneal malignant fibrous histiocytoma. Report of two cases.

We present 2 cases of malignant fibrous histiocytoma (MFH) of the retroperitoneum. Only 12-14% of all MFH occur in the retroperitoneum. Both patients were operated with the diagnosis of a kidney tumor. The surgical exposure showed a tumor arising from the retroperitoneum, infiltrating or surrounding the kidney. We would like to emphasize that large tumors of the retroperitoneum which resemble kidney tumors can also arise from mesenchymal tissue.

Diagnosis, Differential↗
PubMed1992

[Popliteal anastomotic aneurysm as the origin of recurrent embolism].

We report on a young patient who underwent numerous arterial interventions after injury to the right groin. After several years, a popliteal anastomotic aneurysm, unidentified at that time, began to cause recurrent peripheral emboli. The importance of an intensive search for the source of the emboli is demonstrated. Bland arteriography does not rule out the presence of an aneurysm and should prompt further investigation with duplex-sonography and/or MR-imaging. Aneurysms causing recurrent peripheral emboli are an absolute indication for surgery.

Adult↗
PubMed1992

[Acute ischemia of the lower extremity in an adolescent with Crohn disease].

The authors report a case with a rare form of peripheral ischaemia. A 25-year-old man with Crohn's disease suffers from sudden ischaemia of his right leg. There is no evidence of entrapment of the popliteal artery, of arterial embolism or Buerger's disease. Thrombocytosis in combination with hypercoagulability as described previously in patients with Crohn's disease seems to be the most probable cause. - In this case percutaneous transluminal thrombectomy and thrombolysis were more successful than surgical thrombectomy using balloon catheters.

Adolescent↗
PubMed1991

[Bodybuilding: hypokalemia and hypophosphatemia].

In preparing for competitive body building, body builders--in addition to continuous and hard muscle training--engage in stringent dietetic manipulations: the first few months of hypercaloric nutrition, rich in proteins, are devoted to the build-up of muscle mass. A second phase of reduced caloric intake is designed reduce subcutaneous fat, while, during the last week of preparations, extreme carbohydrate intake aims at loading muscles with glycogen. Simultaneously, sodium and water restriction results in extracellular and therefore subcutaneous volume deficit and better "definition" of muscle contours and structure. In the course of these dietetic manipulations a young body builder develops hypokalemia, hypophosphatemia, rhabdomyolysis and flaccid tetraparesis. The disturbances are pathophysiologically predictable.

Adult↗