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H Erasmi

Publications and source records attributed to H Erasmi.

At least 19 recordsLinked to original sources
PubMed1996

[Functional relevance of the type I arteria proatlantica in carotid disobliteration].

Primitive embryonic anastomotic vessels between the carotid and vertebrobasilar arterial systems occasionally persist into adult live. Coincidence with cerebrovascular disease may be of functional relevance. We report a case of segmental internal carotid occlusion and aplasia of both vertebral arteries in combination with persistence of proatlantal artery type I. Recurrent cerebral ischemia required revascularization of the segmental occluded internal carotid artery. Disobliteration was successfully performed with an uneventful postoperative course. The patient recovered well from his neurological deficits. Clinically, the combination of persistent proatlantal artery with occlusive disease of the carotid arteries may lead to atypical neurological deficits. In cerebrovascular surgery, a persisting proatlantal artery, as a main supply vessel of the vertebrobasilar system, is of great importance if the carotid artery is clamped.

Adult↗
PubMed1996

Validity of SEP monitoring in carotid surgery. Review and own results.

OBJECTIVE: The sensitivity of intraoperative monitoring by means of somatosensory evoked potentials (SEP) in carotid surgery is to be examined. EXPERIMENTAL DESIGN: Prospective clinical investigation. In addition, the influence of circulatory parameters on SEP curves will also be tested. SETTING: Department of Surgery of a university clinic. MATERIALS AND METHODS: A total of 200 patients underwent intraoperative monitoring by means of somatosensory evoked potentials (SEP) during carotid endarterectomy between March 1, 1991 and August 1, 1994. MEASURES: In order to exclude blood pressure variations as a cause for amplitude changes the blood pressure and pulse were documented during the entire phase of preparation and clamping. RESULTS: A significant correlation could not be established between parameters of circulation and amplitude changes (r = 0.0026; p = 0.62). In seven cases of intraoperative amplitude reduction of more than 50% a stroke has been avoided by inserting a shunt. Despite the lack of an amplitude reduction, a watershed stroke of A.cerebri media and A.cerebri posterior occurred in two instances. Taking this into consideration the sensitivity of monitoring is 99.0% at a specificity of 100%. CONCLUSIONS: SEP-monitoring in carotid endarterectomy is simple to execute and is superior in sensitivity to EEG analysis. To avoid artefaction by anesthesia, a standard injection anesthesia is recommended. Farfield potentials should also be derived to avoid watershed infarctions.

Blood Pressure↗
PubMed1995

The thrombosed popliteal aneurysm with distal arterial occlusion--successful therapy by interdisciplinary management.

Aneurysms of the popliteal artery are rare. Their rate of incidence is reported from 0.1% up to 2.8%. Whereas surgical treatment in an asymptomatic stage bears no problems, the symptomatic stage in a high percentage of patients leads to extremity loss due to thrombosis or embolism. In these cases, amputation rates are reported from 16 to 69%. In the period 1981 - 1994 we saw 39 patients suffering from 58 popliteal aneurysms: 53.4% of these aneurysms were symptomatic. 24.1% of the popliteal aneurysms angiographically showed an occlusion of the popliteal and peripheral outflow tract with concomitant critical limb ischemia. By applying a preoperative local catheter fibrinolysis the outflow tract could be reopened in 13 ischemic extremities and a receiving segment could be recanalized for reconstruction. Following this procedure, in spite of the high number symptomatic cases we gained very good postoperative results in 70.7% of the treated extremities after a maximum follow-up time of 62 months. An aneurysm is commonly seen as a contraindication for the application of lytic therapy. But in the presence of critical extremity ischemia due to a thrombosed or embolizing popliteal aneurysm, preoperative catheter fibrinolysis can often help to save the extremity.

Adult↗
PubMed1995

Diagnosis, treatment and prognosis of the leiomyosarcoma of the inferior vena cava. Three cases and summary of published reports.

OBJECTIVE: To describe our experience with three cases of leiomyosarcoma of the inferior vena cava, and summarise current methods of diagnosis and treatment. DESIGN: Descriptive study. SETTING: University hospital, Germany. SUBJECTS: 3 Patients with histologically confirmed leiomyosarcoma of the inferior vena cava. INTERVENTIONS: Resection, with or without vascular reconstruction. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: Case 1 was diagnosed on magnetic resonance imaging, the tumour was resected, and the vena cava replaced with a polytetrafluoroethylene (PTFE) graft. She made an uncomplicated recovery and was well and free of symptoms 10 months later. Case 2 was diagnosed at operation (the differential diagnosis on computed tomography was a retroperitoneal tumour), the tumour was resected, and the defect oversewn. She made an uneventful recovery and was well and free of symptoms 14 months later. Case 3 was diagnosed at operation (a diagnosis of pancreatic cancer had been made preoperatively), the tumour was resected, and the defect oversewn. She was well and free of symptoms 10 months after operation. CONCLUSIONS: Magnetic resonance imaging is superior to computed tomography in the diagnosis of leiomyosarcoma of the inferior vena cava. The treatment of choice is resection; small defects can be closed by suture or PTFE patch, and large defects by PTFE prostheses. Reported resectability is 40% to 60%, but the prognosis is poor; the local recurrence rate is about 36%, most patients are dead within 2.5 years, and the 5-year survival is 30%. Chemotherapy and radiotherapy will give some degree of palliation, but do not affect the outcome.

Aged↗
PubMed1994

Hemodialysis via the Scribner shunt in childhood: a surgical evaluation.

From 1973 to 1988, 105 children with renal failure (average age, 6.5 years; range, 5 days to 16.2 years) were treated with hemodialysis via surgically implanted Scribner shunts (n = 120). The average duration of dialysis was 16 days (range, 1 to 194 days). Twenty-three patients died during treatment or during the hospital stay because of the underlying disease; no patient died because of shunt complications. The treatment was initially successful for 82 children, but 14 of them died within several months of discharge. Among the initially surviving 82 patients, the shunt was the only means of access for dialysis in 52. In the other 30, the primary Scribner shunt was unsuccessful; it required replacement, or the type of dialysis had to be changed. The shunts were implanted in the forearm in 23%, the groin in 40%, and the ankle in 37%. Early complications were local bleeding (17%) after an average of 37.3 days, shunt occlusion (34%) after an average of 47.3 days, infections (9.3%) after an average of 43.9 days, and decreased blood flow (8.5%) after an average of 47.7 days. Vessels were reconstructed after discontinuation of dialysis in 28 cases, in which the Scribner shunt had been implanted in the groin. No patient experienced immediate ischemic problems. Long-term follow up results were obtained for 60% (n = 40) of the surviving 68 children after an average of 7 years (range, 2.1 to 15.2 years). We found no evidence of arterial or venous complications at the former shunt site.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1994

Anastomotic aneurysms following aortofemoral vascular replacement.

Despite the advances in reconstructive vascular surgery, anastomotic aneurysms,--particularly in inguinal position--have remained an unsolved problem. Between 1985 and 1992 in 46 patients who underwent aortoiliac or aortofemoral bypass grafting 58 anastomotic aneurysms were operated in our institution. The mean interval between primary reconstruction and onset was 65.0 months. In 54% we observed real suture aneurysms. Technical faults are supposed to be the most causative factor in development of anastomotic aneurysm. The rate of recurrence after repair was 10%. There was no postoperative mortality. It is concluded that comprehensive follow-up is required after aortofemoral grafting. Because of the risk of peripheral embolization and local disruption surgical repair has to be done soon after the diagnosis of anastomotic aneurysm.

Adult↗
PubMed1994

Aorto-caval fistula--an uncommon complication of infrarenal aortic aneurysms.

Aorto-caval fistulas are an uncommon complication of infrarenal aortic aneurysms, being found in 0.22% to 6.04% of all cases. Operating on 1231 patients with abdominal aortic aneurysm in the last 30 years we saw 17 patients with an aortocaval fistula. While 5 patients showed an isolated fistula, 12 had an additional rupture of the aneurysm into the retroperitoneal space or the abdominal cavity. Only in four patients was the aorto-caval fistula diagnosed preoperatively. In 16 patients the fistula was closed from within the aorta. One patient needed ligation of the vena cava and the iliac veins. Mortality rate was 40% in the group with isolated fistula and 66.7% in the group with concomitant rupture. Aorto-caval fistula is a severe complication of abdominal aortic aneurysms, which may be fatal and demands early diagnosis and prompt treatment.

Aged↗
PubMed1994

[Bovine heterologous graft in replacement of a small calibre artery].

An experimental study of a new biologic vascular graft for reconstruction of small diameter arteries was carried out in 50 sheep. Results up to 2 years allow us to conclude that the new vascular prostheses may be "reutilized" by the host. Infections and aneurysmal degeneration were be observed. Early occlusion of the graft due to technical reasons occurred in only one case.

Animals↗
PubMed1994

[Juvenile arteriosclerosis: rare cause of generalized dilatative and stenosing vascular disease].

In addition to generalized arteriosclerosis connective tissue disease, systemic vasculitis as well as genetic metabolic disease are described to be the cause of stenotic and aneurysmatic vessel wall alteration. Although these causes are rather unusual, they must be considered for the diagnosis of a generalized vascular disease with arterial occlusion as well as aneurysm formation to determine the appropriate procedure for the individual. Whereas operative treatment should be avoided as far as possible for patients with Behçet's disease or Marfan syndrome, it is rather indicated for any kind of juvenile arteriosclerosis with arterial stenosis as well as dilatation. In this way the patient described in the following could be treated successfully by operation even though the cause of the juvenile arteriosclerosis was inexplicable, and in addition to local complications also the threatening rupture of the aneurysm could be controlled.

Aneurysm↗
PubMed1994

[Traumatic pseudoaneurysm of the axillary artery after shoulder dislocation].

By means of a case report the diagnostic and therapeutic procedures and prognosis of a pseudo-aneurysm of the axillary artery after shoulder dislocation are demonstrated. The diagnosis of aneurysms of the axillary artery is difficult in some cases. It is important to mention a possible vascular injury in case of close reduction of the shoulder. Therefore in all patients with a penetrating or blunt trauma of the shoulder or the upper arm a thorough neurovascular examination is required. In patients with neurologic deficits or alteration of the pulse a duplex ultrasound examination should be performed and in dubious cases an additional arteriography is indicated.

Aged↗
PubMed1994

[Place of surgical treatment of lung metastases].

From 1.1.1980 to 31.12.1992, ninety-four of our patients underwent surgical removal of pulmonary metastases. The classification of the primary tumours found cas as follows: sarcoma 24.5% (n = 23), renal carcinoma 22.3% (n = 21), malignant melanoma 19.1% (n = 19), colon carcinoma 15.9% (n = 15) and ovarian and testicular tumours with 10.6% (n = 10). Three cases presented metastases from a carcinoma of the floor of the outh. The remaining cases were secondaries from bronchial, oesophageal and larynx carcinoma and from a malignant thymoma. In 71 cases, the tumour was removed using an atypical resection technique, and in 22 cases by carrying out a lobectomy. In one case an "extended lobectomy" was performed. Hospital mortality was 1.1%. Survival rate was 60% at 1 year and 40% at 3 years. 38.3% of the patients lived for five years or more.

Carcinoma↗
PubMed1994

[Combined aneurysm of the popliteal artery and the tibiofibular trunk].

Arterial aneurysms of the infrapopliteal vessels are rare. The majority are false aneurysms caused by trauma. Presenting symptoms are calf mass and distal ischemia. Asymptomatic lesions may be found incidentally during arteriography. On the basis of a case report the procedure of surgical treatment concerning these aneurysms is described.

Adult↗
PubMed1993

[Metabolic changes after transperitoneal vascular interventions].

Thirty patients who had undergone transperitoneal vascular surgery were examined for hormonal disturbances and alterations of energy and protein metabolism. Of all hormonal alterations only the increased level of insulin activity in the early postoperative period is clinically important. The higher oxygen consumption and carbon dioxide production together with the increased protein turnover indicate an elevated energy expenditure. In order to prevent decompensation of the hypermetabolic metabolism, a reduced nutritional support after major vascular surgery is justified.

Aged↗
PubMed1992

A new vascular prosthesis of bovine origin.

An experimental study on a new biologic vascular graft for reconstruction of small diameter arteries was carried out in 50 sheep. A follow-up period of two years let us conclude that the new vascular prosthesis may be "re-utilized" by the host. Infection and aneurysmatic degeneration could not be observed. An early occlusion of the graft occurred in only one case, due to technical reasons.

Anastomosis, Surgical↗
PubMed1992

[Ergotism and ischemia of the limbs].

Clinical ergotism as seen today results almost exclusively from the intake of ergotamine tartrate in the treatment of migraine headache. Vasospasm of peripheral arteries is the leading clinical picture. Besides the formation of collaterals and a secondary thrombosis, the vasospasm is one of the specific findings in arteriography. Early diagnosis and withdrawal of the medication makes complete restitution possible. In all other cases intraarterial or intravenous infusion of sodium nitroprusside has turned out to be the most effective therapy. Balloon dilatation or operative intervention are an alternative therapy in those cases, where amputation of the limbs seems to be necessary.

Adult↗
PubMed1992

[The compartment syndrome with special reference to vascular surgery aspects. A patient sample of the Cologne University Clinic 1981 to 1991].

The compartment syndrome, a well known complication in traumatized patients, is not taken enough notice of in the literature of vascular surgery despite it's obviously important pathophysiological context. Considering arterial occlusive disease the ischemia as well as the reperfusion can increase the compartmental volume respectively the tissue pressure. The subfascial pressure measurement should not lead to a false certainty, since no critical pressure values exist that can serve as a general criterion for diagnosis and treatment. The "thought about it" may be the first step to a clinical diagnosis and subsequent therapy. Decompression of all four compartments at the lower leg by the technique of Matsen represents the therapy of choice for the compartment syndrome of the lower leg.

Adolescent↗