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Biomedical subjects

H Fürst

Publications and source records attributed to H Fürst.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Locoregional recurrence of rectal carcinoma. Surgical therapy and prognosis].

In a retrospective analysis, 140 patients with locoregional recurrence of rectal carcinoma were investigated in respect of prognostic factors. Neither classification of the primary tumor nor adjuvant therapies showed any significant influence on long-term survival, calculated according to the Cutler-Ederer method. The 3-(5-) year probability of survival of 52 (18) % is significantly better in cases with local curative operations than the 3 (0) % in cases with local palliative operations. Therefore, early indication for a possible radical resection of the recurrent tumor is essential. In 37.1%, local curative operations could be performed. The probability of long-term survival is significantly influenced by the kind of recurrence. Patients with local recurrence (anastomosis) after primary resection have the best prognosis with a 84 (33) % 3-(5-) year probability of survival. Independent of the kind of primary operation, the survival data on the remainder of patients after local curative operation for recurrent tumors are comparable. They are, however, still better than for non-curative operations. The striking differences in perioperative mortality (3 months) with regards to therapeutic intention (25% for local palliative operations without resection, 7.1% in cases of palliative surgery with resection and 1.9% in cases with local curative operations) must result in criteria for resectability being determined preoperatively on the basis of intensive diagnostic measures. Thus, the rate of palliative operations without benefit for the patient may be minimized.

Adult↗
PubMed1995

Application of transcranial Doppler sonography to evaluate cerebral hemodynamics in carotid artery disease. Comparative analysis of different hemodynamic variables.

BACKGROUND AND PURPOSE: Transcranial Doppler sonography in combination with manipulation of cerebral resistance vessels is widely used to screen patients with suspected intracranial hemodynamic disturbances. Maximal flow velocity (Vmax), mean flow velocity (Vmean), cerebral pulsatility index (CPi), and cerebral resistance index (CRi) have all been used to describe cerebral hemodynamics. The present study examined CO2 reactivity of the above hemodynamic variables with respect to its variability between different age groups and its capability to discriminate between normal and abnormal findings. METHODS: Absolute and relative CO2 reactivity of Vmax, Vmean, CRi, and CPi were determined in both hemispheres in 30 young and 37 elderly control subjects and in 245 consecutive patients with strictly unilateral symptomatic (n = 101) or asymptomatic (n = 144) carotid artery disease (> 80% stenosis or occlusion). RESULTS: Hemispheric reactivities of Vmean, CRi, and CPi were significantly age dependent. Hemispheric Vmax reactivity and interhemispheric differences of individual reactivities (except absolute CPi reactivity) did not vary with age and could therefore be used to define normal values. Patient classification according to these values revealed different frequencies of subjects with pathological findings (3% for hemispheric Vmax reactivity, 5% to 7% for interhemispheric differences of Vmax or Vmean reactivity, 39% and 45% for interhemispheric differences of relative CRi and CPi reactivity, respectively). CONCLUSIONS: Hemispheric reactivities are less suitable to evaluate cerebral hemodynamics than interhemispheric differences, since most of the latter do not vary with age. However, interhemispheric differences vary with respect to their discriminatory power. Power is low for interhemispheric differences of Vmax and Vmean reactivity, since the corresponding frequencies of abnormal findings do not differ from the 5% frequency expected in the reference population (reference range defined as mean +/- 2 SD). With respect to the discriminatory power, interhemispheric differences of relative CRi and CPi reactivity may be superior to other parameters.

Adult↗
PubMed1994

Effect of carotid endarterectomy on patterns of cerebrovascular reactivity in patients with unilateral carotid artery stenosis.

BACKGROUND AND PURPOSE: Patients with unilateral significant carotid artery stenosis present with a variable intracranial hemodynamic status. In the majority of patients, hemodynamics are normal because of sufficient collateral flow. One subgroup shows poor ipsilateral hemodynamics because of a severely reduced blood supply, whereas in another subgroup of patients a steal phenomenon from the contralateral to the ipsilateral hemisphere can be observed during pharmacological provocation. The present study examined the effect of carotid endarterectomy (CEA) on these patterns of cerebrovascular hemodynamics in patients with carotid artery stenosis. METHODS: The CO2 reactivity of the cerebral resistance index (CRi) was determined with transcranial Doppler sonography in 63 patients with unilateral high-grade to threadlike carotid artery stenosis before and 3 months after CEA and in 37 control subjects. The interhemispheric asymmetry of CRi reactivity of the control group was used to differentiate between normal and abnormal findings. RESULTS: In patients with normal CRi asymmetry (comparable CRi reactivities at both hemispheres, n = 41), CEA did not change hemispheric CRi reactivity. In patients in whom CRi reactivity was absent at the contralateral hemisphere (intracerebral steal during hypercapnia, n = 12), CEA abolished the steal phenomenon by significantly increasing CRi reactivity at the contralateral hemisphere (preoperative, -1.0 +/- 2.1 %CRi/vol%CO2; postoperative, 5.2 +/- 0.7 %CRi/vol%CO2; P < .01). Patients who showed severely diminished ipsilateral CRi reactivity, compatible with a significantly reduced perfusion pressure at the poststenotic hemisphere (n = 10), demonstrated an improvement of ipsilateral CRi reactivity after surgery (preoperative, 0.6 +/- 0.8 %CRi/vol%CO2; postoperative, 3.7 +/- 1.1 %CRi/vol%CO2; P < .01). CONCLUSIONS: Most patients do not respond significantly to CEA. One small subgroup of patients who presented with severely disturbed ipsilateral hemodynamics demonstrated postoperative improvement at the poststenotic hemisphere, whereas in another small subgroup, who showed a steal phenomenon at the contralateral hemisphere, CEA improved contralateral hemodynamics. Determination of preoperative CRi reactivity allowed precise prediction of the effect of CEA on intracerebral hemodynamics.

Aged↗
PubMed1994

Patterns of cerebrovascular reactivity in patients with unilateral asymptomatic carotid artery stenosis.

BACKGROUND AND PURPOSE: Intracranial hemodynamic status varies in patients with unilateral significant carotid artery stenosis. It ranges from normal, because of sufficient collaterals, to poor, because of a severely reduced blood supply that puts the patient at an increased risk of stroke or cerebral ischemia. The present study examined patterns of abnormal cerebrovascular hemodynamics in patients with asymptomatic carotid artery stenosis. METHODS: The CO2 reactivity of the cerebral resistance index (CRi) and of mean blood flow velocity (vmean) was determined via transcranial Doppler sonography in 91 patients with unilateral high-grade to threadlike carotid artery stenosis and in 37 control subjects. The interhemispheric asymmetry of CRi reactivity of the control group was used to differentiate between normal and abnormal findings. RESULTS: We found that 64.8% of the patients demonstrated normal CRi asymmetry with comparable CRi reactivity (ipsilateral, 4.42 +/- 0.44 %CRi/vol%CO2; contralateral, 4.51 +/- 0.39 %CRi/vol%CO2) and vmean reactivity (ipsilateral, 0.080 +/- 0.004 m/s per vol%CO2; contralateral, 0.079 +/- 0.005 m/s per vol%CO2) at both hemispheres. In 16.5% of the patients, CRi reactivity was supranormal at the affected hemisphere. This phenomenon was due to an exaggerated dilatory response of the ipsilateral hemisphere and was combined with an absent CRi reactivity of the contralateral hemisphere (ipsilateral, 6.63 +/- 1.03 %CRi/vol%CO2; contralateral, -1.16 +/- 1.78 %CRi/vol%CO2). In contrast, hemispheric vmean reactivities were comparable (ipsilateral, 0.078 +/- 0.008 m/s per vol%CO2; contralateral, 0.077 +/- 0.008 m/s per vol%CO2). The remaining 18.7% showed severely diminished ipsilateral CRi reactivity (ipsilateral, 1.91 +/- 0.83 %CRi/vol%CO2; contralateral, 8.48 +/- 1.00 %CRi/vol%CO2) and vmean reactivity (ipsilateral, 0.073 +/- 0.007 m/s per vol%CO2; contralateral, 0.108 +/- 0.012 m/s per vol%CO2; P < .01), compatible with a significantly reduced perfusion pressure at the poststenotic hemisphere. CONCLUSIONS: Most asymptomatic patients do not suffer from severely abnormal hemodynamics at the poststenotic hemisphere. One small subgroup of patients presented with severely disturbed ipsilateral hemodynamics; another small subgroup demonstrated a steal phenomenon with secondary dilation of large cerebral vessels at the contralateral hemisphere. These subgroups require specific evaluation of proper treatment.

Aged↗
PubMed1994

[Leiomyosarcoma of the inferior vena cava--diagnosis and therapy].

We report four patients with primary vascular leiomyosarcoma of the inferior vena cava. Even after radical surgery the prognosis is serious because of local tumor recurrence and distant metastases. Although controlled studies are difficult because of the small number of patients, a multimodal therapeutic approach needs to be developed.

Adult↗
PubMed1993

[Transcranial Doppler sonography and cerebrovascular reserve capacity].

Measurements of blood flow velocity in the basal cerebral arteries during functional testing by means of transcranial Doppler sonography are reviewed. Special emphasis is placed on cerebrovascular reserve capacity, which we determined in two groups of patients with obstructive cerebrovascular disease and in normal persons. We discuss the value of functional testing during endovascular neuroradiological procedures.

Cerebrovascular Circulation↗
PubMed1992

Mediastinal pancreatic pseudocyst.

Pseudocysts of the pancreas are a rare cause of a mediastinal mass. They are clinically characterized by the combination of thoracic symptoms (shortness of breath, dysphagia, pleural effusions) with complaints in the upper abdominal quadrants and weight loss. The diagnosis is usually made by CT scan or MRI including upper abdominal views. Internal drainage via an abdominal route performed either as cystogastrostomy or cystojejunostomy is the treatment of choice.

Aged↗
PubMed1992

Pathophysiology of unilateral high-grade carotid artery stenosis: evaluation of intracranial haemodynamics by analysis of velocity waveforms from the middle cerebral artery.

1. Transcranial flow velocity waves were measured via Doppler sonography of the middle cerebral artery during hypo-, hyper- and normo-capnia. Applying the principle of vascular impedance, flow velocity waves were analysed in 30 young subjects, 37 elderly subjects and 18 patients with high-grade unilateral internal carotid artery disease. 2. There was evidence that the relative peak-to-peak velocity in the middle cerebral artery could serve as an index of peripheral wave reflection and cerebral resistance (CRi). The response of CRi to changes in arterial CO2 concentration (CRi reactivity) showed a clear age-dependency. However, the absolute side-to-side asymmetry of CRi reactivity (delta R) did not vary with age and could be used to define a normal range (0-4%CRi/vol.%CO2). 3. Selective angiography demonstrated no cerebral cross-flow through the anterior part of the circle of Willis in nine patients with carotid artery stenosis whose absolute delta R was above the normal range and whose CRi reactivity of the affected hemisphere was lower than that of the healthy opposite hemisphere. Conversely, another group of nine patients, whose ipsilateral CRi reactivity was higher than the contralateral CRi reactivity, demonstrated cross-flow through the anterior part of the circle of Willis. 4. delta R may be used to identify patients who have high-grade internal carotid artery stenosis and present with low cerebral vascular resistance owing to poor intracerebral collaterals.

Adult↗
PubMed1992

[Crohn disease in advanced age].

Crohn's disease of late onset (greater than 65 years) is rare condition. Typical features are the localisation in the distal gastrointestinal tract and the presence of associated diseases such as cardiovascular disorders and/or diverticulitis. In about 25% of the cases mild intestinal hemorrhage occurs. Delay in diagnosis is sometimes due to coexistent diverticulitis. Ischemia has been suggested to be responsible for the development of the histological changes which occur in Crohn's colitis. Therefore, we carried out a retrospective analysis of our patients treated between 1978-1988 to reevaluate the resected specimens. 10 patients (6.2% of all surgical patients with Crohn's disease) were at least 65 years old at the time of primary operation. In 5 cases hematochezia was one of the symptoms before operation, two patients presented with massive hemorrhage of the lower GI-tract. Granulomas were seen only in 5 patients, whereas in all specimens transmural inflammation was detected. In 8 out of 10 patients vascular lesions were seen, among those thickening of the intimal and medial layers, thrombosis or bleeding. Our findings support the thesis that ischemia might play a role in the pathogenesis of Crohn's disease of late onset.

Aged↗
PubMed1990

[Transcranial Doppler curve analysis. On the pathophysiology of unilateral carotid stenoses].

Vascular reactivity to changes in arterial CO2 content can be measured by analysis of Doppler curves in the middle cerebral artery (MCA). Vascular reactivity indicates the capability of the cerebrum of controlling peripheral resistance. In patients with threatening cerebrovascular disease (CVD) vascular autoregulation may be reduced. The circle of Willis plays a central role in the pathophysiology of unilateral high-grade ICA-stenosis. Previous classification of the degree of stenosis or of the clinical stage does not allow to describe the actual pathophysiology or prognosis of CVD sufficiently.

Adult↗
PubMed1989

The value of cw-Doppler ultrasonography and DSA in the diagnosis of extra- and intracranial stenosis--a comparison with intraoperative findings.

The use of cw-Doppler sonography and digital subtraction angiography (DSA) for diagnosis of cerebro-vascular insufficiency (CVI) was evaluated in a retrospective study. 113 findings obtained by DSA and 315 findings obtained by cw-Doppler sonography were compared to the corresponding intraoperative finding. Furthermore, we examined the incidence of accompanying intracranial stenoses of the carotid artery. The impact of these stenoses on the CVI stage was analyzed by means of 200 transcranial Doppler sonographic studies. Cw-Doppler sonography (sensitivity: 95%) was clearly superior to DSA (sensitivity: 70%) for diagnosis of high grade and subtotal stenoses of the internal carotid artery (ICA). Sensitivity of both methods was insufficient for diagnosis of low grade stenoses (cw-Doppler: 50%, DSA 25%). Analysis of 200 transcranial Doppler sonographic studies did not reveal pathologic changes of intracranial vessels in 67% of all cases. This finding did not depend on the condition of the extracranial vessels and did also not depend on the CVI stage. Additionally, there was no correlation between the incidence and degree of intracranial stenoses and the CVI stage or the degree of stenosis of the ICA. These results support the view that Doppler sonography is the method of choice for diagnosis of high grade stenoses of the carotid artery. The use of DSA is limited to cases in which kinking or occlusion is suspected. Additional intracranial changes did not correlate with the CVI stage.

Angiography↗
PubMed1984

[Syndrome of the narrow superior thoracic aperture. Thoracic outlet syndrome].

The neurovascular compression syndromes of the thoracic outlet are mainly characterised by pressure lesion of the brachial plexus and secondly in addition by vascular damages. An indication for surgery exists in cases of persistent or progressive complaints, loss of function of shoulder, arm or hand musculature as well as occurrence of vascular damage. The treatment of choice consists of transaxillary resection of the first rib. Irreversible vascular damage requires additional vascular surgery. Within 5 years 31 operations were performed in 27 patients with a thoracic outlet syndrome. Eleven patients became completely free of symptoms, nine showed clear-cut improvement. Four patients reported lack of improvement. Deterioration was seen in three patients. Preoperative atrophy of small hand muscles is associated with lack of complete functional restitution of nerves and muscles. Predominance of vascular symptoms permits complete restitution to be expected. Results in cases with predominantly neurological symptoms are unsatisfactory.

Adolescent↗
PubMed1984

[Stage-III cerebrovascular insufficiency in stenoses and occlusions of the extracranial A. carotis. An indication for surgery?].

Reconstructive surgery was performed on 93 patients with stage III cerebrovascular insufficiency, extracranial stenoses and (or) occlusions of the cerebral blood flow. Compared with the spontaneous course in acute stroke, results of surgery point towards recommending an aggressive procedure provided certain criteria are observed (time limit, absence of haemorrhagia), particularly in view of the potential mortality of the condition. Late prognosis, assessed on the basis of 40 patients subjected to neurological follow-up 4 1/2 years after the operation, can be considered favourable.

Carotid Artery Thrombosis↗