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Biomedical subjects

H Erasmi

Publications and source records attributed to H Erasmi.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1991

[Palliative surgical treatment of cancer of the esophagus].

Palliative surgery, including cleaning resection, colon or stomach bypass, intubation or fistula is all one can offer to the majority of patients suffering from oesophageal carcinoma due to an usually advanced tumor stage at the time of diagnosis. The primary goal is to prevent or resolve dysphagia. A prolongation of survival time can - with the exception of cleaning resection - not be expected by these procedures. The average survival time was 9.4 months after cleaning resection and 4.7 months after other palliative procedures in our series. If a cleaning resection is not possible, the endoscopic implantation of an endotube is the treatment of choice because of its low mortality and morbidity.

Adenocarcinoma↗
PubMed1991

Vascular anastomoses with absorbable suture material: an experimental study.

A synthetic, monofilament, absorbable suture material, polytrimethylene carbonate, was tested to determine its suitability for use in arterial anastomoses. The material studied is a copolymer made of trimethylene carbonate and polyglycolic acid, with a retention time in the tissue of up to six months. In an experimental group of 12 mongrel dogs, using simple end-to-end anastomoses, aortic and femoral patch grafts of bovine heterograft material and iliofemoral bypass implants of 5 mm of expanded polytetrafluoroethylene prostheses were performed and arteriographically and histologically documented. Direct intraindividual comparisons were made with the absorbable (polytrimethylene carbonate) and nonabsorbable (polypropylene, expanded polytetrafluoroethylene suture) materials, a total of 108 anastomoses. No suture material-related complications such as ruptures or suture line aneurysms occurred. Polytrimethylene carbonate sutures led to less inflammation and scar tissue formation than polypropylene sutures. Complete absorption of the suture material by hydrolytic decomposition was followed by an almost complete regeneration in all layers of the vessel wall. Regeneration of the connective tissue structures of the media was noted. Initial associated reactions in the intima eventually disappeared. Both suture materials were equivalent histologically in the early months of the study, but after 10 month follow-up differences were observed, especially in the structure of the media, apart from the fact that polytrimethylene carbonate is absorbed completely after four to seven months.

Anastomosis, Surgical↗
PubMed1991

Longterm study of a compliant biological vascular graft.

Clinically implanted prostheses of biological origin have recently been shown to develop aneurysms within several years. To study this process, recently developed bovine heterografts that were implanted in canine ilio-femoral arteries for 27 to 45 months, were studied in vivo and in vitro. Seven out of seven grafts were patent with only one showing evidence of focal aneurysm. Measurements of mechanical properties, including water permeability, compliance, and burst pressure, and of heat shrink temperature and dry weight were obtained before and after a period of controlled exposure to bacterial collagenase; all data suggested that much of the original graft had been replaced with host tissue. However, enzyme susceptibility was less than that of fresh bovine arteries, indicating that at least some of the grafts' crosslinked collagen was preserved. The compliance of these explants was similar to that reported for autogenous vein. Histological examination of the graft wall revealed cellular "intimal" and adventitial zones containing host-generated collagen surrounding a central zone devoid of cellular infiltration, which appears to be unmodified graft "media" highly resistant to degradation. We conclude that, when properly processed, biological prostheses can act as a bioresorbable scaffold for the orderly replacement of structural elements during healing, promoting continued mechanical integrity of the graft. These promising results encourage the further development of prostheses of biological origin.

Animals↗
PubMed1991

[Conventional and cine-MRT in patients with aneurysms of the abdominal aorta].

We studied 40 patients with aneurysms of the abdominal aorta by MRI. These results were compared with those obtained by real-time sonography (n = 40), angiography (n = 32) and CT (n = 16). In 30 patients the imaging results were compared--as far as possible--with the operative findings. MRI proved more reliable, especially if compared with sonography, in evaluating renal or iliac artery involvement. Mural thrombi were detected more often (93%) by MRI than by CT (85%) or sonography (83%). Cine-MRI showed strong turbulences in 33%. Turbulences did not correlate with the size of the aneurysm.

Adult↗
PubMed1991

[Surgical therapy of bronchial cancer. Healing or palliation?].

In spite of the revolutionary innovations concerning diagnostic and intensive care techniques as well as better understanding of tumour biology during the last decade, rates of resection and long-term survival in bronchogenic carcinoma could not be improved. Nevertheless there is no reason for therapeutic nihilism. On the contrary all efforts are to be done in investigation on practicable, suitable, and supportable screening programmes to improve the patients outcome.

Carcinoma, Bronchogenic↗
PubMed1991

[Primary and secondary aorto-intestinal fistula in infrarenal aortic replacement].

During the past 20 years 17 patients with abdominal-aortic-intestinal fistulas have been operated in our department. Hospital-letality accounted till 1986 with 75%. Since then we preferred direct reconstruction by implantation of a vascular graft, covered by omentum in primary fistulas. Hospital letality could be reduced by this management to 0% in primary fistulas by a total survival rate of 67%.

Aorta, Abdominal↗
PubMed1991

[A new biological vascular prosthesis].

In an experimental study on sheeps a new biologic vascular graft was implanted, 30 x in carotidal, 30 x in aortal position. Only one early occlusion of the graft, due to technical reasons, could be observed. Without aneurysmatic degeneration all graft were in function at the time of harvesting the samples. Morphologically a "revitalisation" of the grafts could be proved.

Animals↗
PubMed1991

[Stents in iliac vascular changes].

The results of 79 iliac stent placements in 64 patients are reported. The technical success rate was 96%. The systolic pressure gradient dropped from 44 mmHg before to 2.8 mmHg after stent placement. This differed significantly as compared to a group treated by conventional PTA (gradient 5.8 mmHg). The cumulative patency after 18-20 months was 90%. Angiographic controls up to 19 months after "stenting" demonstrated only one secondary stent occlusion. Iliac stents therefore are a very valuable supplement to classic PTA.

Angioplasty, Balloon↗
PubMed1990

Surgical therapy of oesophageal carcinoma.

During the past 10 years, postoperative mortality associated with surgical treatment of oesophageal carcinoma has been reduced by one-half. However, it appears that all efforts to improve long-term survival with extensive excisional procedures and adjuvant chemotherapy and radiotherapy have failed. Fifty-six of 100 patients presenting to the surgeon with an oesophageal carcinoma have resectable disease. Recent studies suggest that seven of them will die from postoperative complications and 49 patients will be discharged from the hospital after an average of 3 weeks. Of these patients, 27 will survive the first, 12 the second, and ten the fifth year. Although it may be possible to further reduce postoperative complications and mortality, the chances of improving the long-term prognosis of patients with oesophageal carcinoma seem small.

Combined Modality Therapy↗
PubMed1990

[Monitoring and management of the central nervous system in treatment of tumor cachexia].

After palliative surgery artificial nutrition is indicated primarily in patients receiving postoperative chemotherapy or radiotherapy. The techniques of ambulatory enteral or parenteral nutrition have been standardized during the past decade. They can be used with minimal risk even in patients with advanced cancer. An improvement of the nutritional status can be expected in most of the patients. Further clinical trials are needed to determine whether the patients' quality of life improves.

Cachexia↗
PubMed1990

[Percutaneous transluminal angioplasty of the subclavian artery: technic, results, risks].

The results of 27 percutaneous transluminal angioplasties (PTA) of the subclavian artery are reported in 25 patients. 13 patients complained of claudicatio brachii, 7 also demonstrated symptoms of vertebral-basilar insufficiency. In 5 cases this was the sole indication for PTA. 23 (85.2%) of 27 interventions were limited to the proximal section of the subclavian artery. In 22 (81%) the obstructions were localized on the left side. A technical success could be achieved in 24 (88.9%) of 27 interventions. The angiographic appearance of the homolateral vertebral arteries before and after PTA differed significantly. No PTA led to an occlusion of the previously patent vertebral artery. A retrograde flow was no longer seen after PTA. The haemodynamic significance was also demonstrated by the differences in brachial-occlusion pressures (mean 51 mmHg before, 7 mmHg after PTA). Complete or partial relief was achieved after technically successful PTA in 90% of patients with brachial symptoms and in 50% with vertebral-basilar insufficiency. Complications occurred in one (3.7%) of 27 procedures. Published data on PTA of the subclavian artery are discussed.

Adult↗
PubMed1990

[Percutaneous transluminal angioplasty of the infrarenal abdominal aorta].

The results of percutaneous transluminal angioplasty (PTA) (n = 13) of the lower abdominal aorta are reported in 12 patients. The mean patient age was relatively low (46 years). In 7 cases there were isolated aortic obstructions (6 stenoses, 1 occlusion). In the remaining 6 aortic stenoses, there were also major atherosclerotic lesions distally. The mean diameter of the aortic section in which PTA was performed, measured 8.2 mm. The total diameter of the PTA balloon(s) averaged 19.1 mm. The arterial gradient dropped significantly from 41.4 mm Hg (mean) to 2 mm Hg after PTA. The arm-ankle index increased significantly from 0.64 to 0.97. The follow-up included 9 patients; 1 showed restenosis 38 month after PTA. There were no clinically relevant complications. The data published on abdominal PTA in atherosclerotic lesions are summarized.

Adult↗
PubMed1990

[Results of surgical treatment of pulmonary metastases].

During the period from 1. 1. 1980-31. 12. 1989 71 patients underwent lung resection for pulmonary metastases. In 21 cases, the primary tumours were sarcoma, in 19 cases carcinoma of the kidney, and 14 cases of melanoma. There were 9 cases of testicular carcinoma, 5 of colorectal carcinoma, and in 1 case each larynx-, oesophagus-, and oral cavity-carcinoma. In 51 patients we could perform an atypical wedge resection, lobectomy was carried out in 19 patients. 1 patient underwent segmental resection. Hospital lethality counted with 0.7%. For all patients, the cumulative survivals revealed an one-year actuarial about 60%, a 3-year actuarial survival of 40%, and a 5-year actuarial survival rate of 38%.

Follow-Up Studies↗