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Biomedical subjects

H Dedichen

Publications and source records attributed to H Dedichen.

At least 19 recordsLinked to original sources
PubMed1992

[Vascular injuries of the extremities].

The diagnosis of vascular injuries may be delayed because the symptoms are masked by other injuries or may develop gradually after the first examination took place. If serious ischemic damage is to be avoided, a high degree of diagnostic alertness is necessary, and angiography should be performed whenever vascular injuries are suspected. Most vascular injuries can be repaired by simple techniques: In our experience the most frequently used reconstruction techniques were direct suture of the artery or a longitudinal arteriotomy with thrombendarterectomy and patch plasty. In complicated injuries with much destruction of tissue, the best solution may be an extra-anatomic bypass with a prosthetic graft. Simultaneous venous injuries should be repaired and fasciotomies performed on liberal indications. Pseudoaneurysms and arteriovenous fistulae should be diagnosed and treated early.

Angiography↗
PubMed1989

[Aneurysm of the leg].

During the years 1967-87, 19 patients, all men, have been operated on for 26 aneurysms in the femoropopliteal area. Bi-lateral aneurysms were seen in 10 patients and 14 patients had aneurysms at several levels. 14 aneurysms were operated on as vascular emergencies. There was no perioperative mortality. Six grafts implanted for repair of popliteal aneurysms occluded. Two patients had a major amputation because of complications following acute surgical intervention. As a general rule periferal aneurysms should be treated operatively because they represent a threat to the limb by embolism, thrombosis and rupture.

Aged↗
PubMed1989

[Arterial injuries].

During the years 1963-87, 57 patients were treated for arterial injuries. Iatrogenic injuries are excluded. 60% were due to accidents and only 12% to interpersonal violence. Three patients died from the injuries, eight extremities required a primary amputation, eight patients got sequela related to orthopedic problems or ischemia, and 35 patients achieved complete restitution of function. 53% of the injuries were due to fractures, dislocations or contusions while 21% were caused by penetrating lesions. The most common lesion was an intimal rupture with dissection and thrombosis in an otherwise intact vessel (40%). The most frequently applied technique of reconstruction was longitudinal arteriotomy with thrombendarterectomy and patch plasty. Other arteries were repaired by direct suture, interposition of a suitable graft or by a bypass. Fasciotomies were based on liberal indications. A high degree of diagnostic alertness is necessary if irreparable ischemic damage is to be avoided.

Accidents↗
PubMed1989

[Late sequelae after arterial injuries].

Of 57 patients with arterial injuries, three died, eight had an amputation and 14 experienced various kinds of late sequelae. Four of the sequelae were due to inadequate primary surgical treatment: 1) A 16 year-old girl developed incapacitating claudicatio intermittens after a traffic accident causing serious contusions to the right leg. Angiography four years later showed occlusion of the popliteal artery, which was successfully reconstructed. 2) A 16 year-old boy had a femoral fracture with injuries to the femoral artery and vein. The vessels were reconstructed and circulation was restored, but fasciotomies were not performed. He developed a flexion contracture of the 1st toe which required resection of the proximal phalanx. This was interpreted as a Volkmanns contracture due to a compartment syndrome in the deep, posterior compartment of the leg. 3) A 18 year-old man had a fracture of the leg. Angiography demonstrated a minimal leak from the posterior tibial artery, but this was not surgically explored. Six weeks later a pseudoaneurysm ruptured and produced a large hematoma. Circulation was restored by arteriotomy and a patch plasty. 4) A 24 year-old man was hit in the groin by a 22 caliber rifleshot. An arteriovenous fistula was diagnosed but not surgically treated. Six years later he experienced cardiac failure and venous insufficiency. The fistula was closed, whereafter the symptoms disappeared. Blood flow in the fistula was 7,500 ml/min and the pressure in the distal femoral vein 37 mm Hg. These complications can be avoided by proper investigation and surgery at the time of initial treatment.

Adolescent↗
PubMed1989

Hemodynamics and blood flow distribution in experimental shock. The effect of noradrenaline and isoproterenol.

Cardiac output, regional blood flow and other hemodynamic variables were observed on dogs in hemorrhagic and in endotoxin shock. In hemorrhagic shock, a redistribution of cardiac output from other vascular beds to the coronary circulation was seen. This was induced by vasoconstriction in all vascular regions except the coronary arteries. In endotoxin shock, vascular resistance increased in some regions and decreased in others. A redistribution in favor of the mesenteric and femoral regions was seen. The coronary circulation was relatively well maintained in either shock models. Increased oxygen extraction was seen in all vascular beds. Blood pH was decreased corresponding to the degree and duration of the shock. Only small regional variations were observed in these variables. Noradrenaline increases vascular resistance in all regions except the coronary arteries. Isoproterenol reduces vascular resistance in all areas. Both drugs have cardiotropic effects. The same response was seen in normal as well as in shocked dogs. In addition to principal shock treatment, there may still be a place for the judicious use of these drugs in shock therapy.

Animals↗
PubMed1984

Penetrating peptic ulcer and aortic aneurysm with aortogastric fistula.

The case of a 71-year-old woman with an aortogastric fistula caused by the combination of a penetrating peptic ulcer and an aortic aneurysm is reported. Treatment consisted of excision of the ulcer and primary prosthetic grafting of the aorta. Recovery was uneventful. The possible relationship between aortic aneurysm and peptic ulceration is discussed, as are therapeutic alternatives.

Aged↗
PubMed1976

The papaverine test for blood flow potential of ileo-femoral arteries.

To establish drug and an optimal dose for a pharmacological test of the blood flow potential of an artery, the effect of intra-arterial injection of papaverine in varying doses was observed. The response to papaverine was then compared with that of other vasodilating drugs and with the physiological vasodilation of sympathectomy, exercise and postischemic hyperemia. In reconstructed atheromatous arteries, the injection of 40 mg papaverine HCl was found to induce a maximal local flow response, increasing blood flow in artery by approximately 250%. In normal arteries the response was higher. Tolazoline and isoxuprine induced a lower blood flow response and a higher fall in systemic blood pressure. The flow induced by papaverine was higher than flow after sympathectomy and light exercise and amounted to 88% of the maximum seen after 5 minutes ischemia. It is concluded that the blood flow induced by intra-arterial injection of 40 mg papaverine HCl represents a useful reference for flow potential of this artery.

Adult↗
PubMed1976

Hemodynamics in arterial reconstructions of the lower limb. I. blood flow.

In order to establish normal and critical rates for peroperative, arterial blood flow, measurements were performed on 230 ileo-femoro-popliteal arteries subjected to reconstruction for atherosclerosis. Mean, basal blood flow after reconstruction was 134, 254 and 372 ml/min in the s. femoral, c. femoral and c. iliac arteries in vessels remaing open. These flow rates increased to a maximum of 375, 822 and 975 ml/min after intra-arterial injection of 40 mg papaverine. Flow rates were significantly lower in operations followed by early failure. In successfully reconstructed arteries, the mean, basal flow was restored to normal, but flow amplitude was still reduced, diastolic backflow was rarely seen and the flow-response to intra-arterial papaverine was significantly less than in normal arteries. Critical flow rates could not be defined but the frequency of primary failure increased significantly when basal blood flow after reconstruction was less than 100 ml/min or the papaverine induced flow was less than 200 ml/min. Preoperative blood flow was found to correlate well with the primary results of the operation while correlation with late results was less evident.

Adult↗
PubMed1976

Hemodynamics in arterial reconstructions of the lower limb. II. Blood pressure.

In order to demonstrate common pressure gradients and peripheral arterial pressure in ileo-femoro-popliteal arteries before and after reconstruction for atherosclerosis, intra-operative pressure measurements were performed on 204 patients. Before reconstruction, the pressure differential was 44.3 mmHg in femoro-popliteal arteries and 29.0 mmHg in the iliac arteries. This was reduced to 8.4 and 4.1 mmHg by the reconstructions. In patients with femoro-popliteal disease, the pressure gradient was higher when gangrena or rest pain were present than when claudication was the principal symptom. When the iliac arteries were mainly involved, no such difference was seen. Postoperative gradients were slightly higher in arteries subjected to primary failure than in vessels remaining patent. The blood flow increase from intra-arterial papaverine injections accentuated existing pressure gradients and frequently disclosed gradients not manifest at basal flow rates.

Adult↗