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Biomedical subjects

H Kortmann

Publications and source records attributed to H Kortmann.

At least 19 recordsLinked to original sources
PubMed2003

[Quantifying stenosis of the internal carotid artery: which ultrasound criteria are relevant?].

UNLABELLED: Therapeutic decisions in cases of arteriosclerotic stenosis of the internal carotid artery usually depend mainly on the degree of stenosis. However, the recommendations with regard to suitable ultrasonographic criteria are so controversial that even authors of repute describe "confusion" and "chaos in methodology". AIM: The aim of this study is to assess which of the most frequently recommended sonographic criteria for stenosis best fulfill the requirements of an exact quantification of stenoses of the internal carotid artery. METHOD: In 42 consecutive cases the preoperative ultrasound findings were compared with the degree of stenosis in surgically removed specimens. The sonographic technique employed consisted of the analysis of 2 direct and 3 indirect hemodynamic criteria of stenosis. In 34 of these cases planimetry was performed, too. The specimens were obtained by eversion thrombendarteriectomy or arteriotomy; for determination of the degree of stenosis a Paladur molded cylinder was prepared and measured. RESULTS: Quantification of the haemodynamic criteria carries provided well with the endarterectomy specimens. Only in two cases there was a deviation of more than 10 %; however, in these two cases a change with time in the degree of stenosis was probably responsible for the discrepancy. In contrast, planimetry usually underestimated the degree of stenosis: In 61 % of the findings the ultrasonographic results differed by more than 10 % from the reference standard. CONCLUSION: Quantification of stenosis of the internal carotid artery should be made using a combination of direct and indirect haemodynamic ultrasonographic criteria.

Aged↗
PubMed2001

Dacron vs. polytetrafluoroethylene grafts for femoropopliteal bypass: a prospective randomised multicentre trial.

OBJECTIVES: To compare the patency of PTFE (Polytetrafluoroethylene) and unsealed knitted Dacron femoro-popliteal bypasses. DESIGN: Multi-centre prospective randomised trial. MATERIALS AND METHODS: Of 203 patients randomised, 194 were included in the final analysis (103 Dacron grafts and 91 PTFE grafts). The median follow-up was 36 months (range: 6-72 months); the distal anastomosis was above-knee in 141 and below-knee in 53 cases. Univariate comparisons of patency were made by the Kaplan-Meier method, multivariate calculations on the effects of covariables by a Cox regression analysis. RESULTS: There was no difference regarding primary and secondary patency or limb salvage between Dacron and PTFE. The primary 3-year patency for Dacron grafts was 64% (95% confidence interval [C.I.] 55-74%) and for PTFE grafts 61% (C.I. 49-72%). The corresponding 3-year secondary patency was 81% (C.I. 73-89%) and 75% (C.I. 65-86%) respectively, the limb salvage rate 90% (C.I. 84-96%) and 91% (C.I. 84-97%). Upon multivariate analysis below-knee anastomosis was the principal independent predictor of primary graft failure (risk ratio 1.7 [C.I. 1.05-2.8]), impaired secondary patency was associated with infragenicular bypass (risk ratio 3.3 [C.I. 1.8-6.3]) and distal gangrene (risk ratio [C.I. 1.01-3.8]p=0.048), major amputation was independently predicted by below-knee bypass, tissue necrosis, and poor run-off index. CONCLUSIONS: PTFE and Dacron are equally suitable for femoro-popliteal bypass.

Adult↗
PubMed1999

Inflammatory abdominal aortic aneurysm: A postoperative course of retroperitoneal fibrosis.

PURPOSE: The long-term outcome and the development of retroperitoneal fibrosis after surgery on an inflammatory aortic aneurysm was studied. METHODS: Between 1989 and 1997, 1035 patients underwent surgery for an abdominal aneurysm, 42 of whom (4.1%) had typical signs of inflammation. All patients underwent computed tomography (CT) scans before operation, and 26 patients were followed up with a CT scan after a median of 36 months (range, 10 to 91 months). RESULTS: The inflammatory layer resolved completely in only 23% of the patients. One patient had marked progression, 35% of patients showed improvement, and the remaining patients had no change, compared with the preoperative findings. Although clinical symptoms subsided in 90% of patients, in five cases an involvement of the ureter or intestine that did not exist at the time of operation developed. Although ureteral involvement to the inflammation tends to subside after surgery, persisting fibrosis was associated with ureteral entrapment in 30% of these cases and resulted in renal compromise in 49%. Hydronephrosis that was not present at the time of operation was found in 19% of patients, despite improving or stable inflammatory lesions. CONCLUSION: This case-control study supports the findings that retroperitoneal fibrosis persists longer than previously thought, and progression might even occur. Formerly uninvolved organs might become included in the process despite regression of the layer, leading to considerable problems if the condition is not treated in institutions familiar with this complex disease. We advocate a moderated follow-up scheme, as in the case of ordinary abdominal aortic aneurysm, and the need for long-term surveillance of inflammatory aneurysms.

Aged↗
PubMed1989

[Insufficiency of intra-abdominal immunity to infection in purulent peritonitis--sequela of disordered foreign body opsonization].

Despite a high concentration of serum proteins and intact phagocytes peritonitis exudates contain a large number of viable, pathogenic bacteria. The reason for this biological paradox is unknown. Our investigations reveal a pronounced defect in humoral opsonization of foreign particles in peritonitis exudate. We evaluated a modified chemiluminescence system allowing the determination of opsonic activity in serum and exudate. In serum we found a close correlation between opsonic activity and immunologically measurable levels of C3-complement and IgG. In purulent peritonitis exudates, however, the actual opsonizing activity was much less than expected according to the opsonin concentrations. We found a pronounced difference between immunologically determined opsonin levels and impaired opsonic function. Employing crossed immunoelectrophoresis massive C3-splitting into smaller fragments could be demonstrated in peritonitis exudates. In these exudates we found very high concentrations of granulocyte proteolytic (elastase) and oxidative (myeloperoxidase) enzymes which may lead to a functional destruction of opsonins followed by impaired opsonization in peritonitis exudate. The great number of bacteria and foreign particles in addition can cause a pronounced physiological consumption of complement components. The almost complete breakdown of intact C3-complement in intraabdominal exudate explains the deficient host defence in patients with severe peritonitis.

Bacterial Infections↗
PubMed1986

[Infrarenal aneurysm of the abdominal aorta in the elderly--surgical risk vs. danger of rupture].

426 consecutive patients who underwent operation for the resection of abdominal aortic aneurysm (AAA) between 1982 and 1985 were reviewed. The rate of the over 75-years old patients was 16.2%. In patients over 75 years, operated on electively, mortality was 4.2% but 47.6% in emergency cases. Compared with the younger patients the incidence of risk factors affecting mortality was only higher for myocardial insufficiency. AAA-rupture is more frequent in women. For asymptomatic AAA in the elderly an unstable angina pectoris, myocard insufficiency or incurable cancer limit operative approach because life-time will not benefit.

Aged↗
PubMed1986

Granulocyte proteinases as mediators of unspecific proteolysis in inflammation: a review.

In severe inflammatory response, various blood and tissue cells, including polymorphonuclear granulocytes, release lysosomal proteinases, extracellularly and into the circulation. Such enzymes, as well as normally intracellular oxidizing agents produced during phagocytosis, enhance the inflammatory response by degrading connective tissue structures, membrane constituents and soluble proteins by proteolysis or oxidation. We first used polymorphonuclear elastase (E) as a marker of such release reactions. The liberated proteinase competes with susceptible substrates, including alpha 1-proteinase inhibitor (alpha 1PI) and alpha 2-macroglobulin, and is eliminated finally as inactive enzyme-inhibitor complexes by the reticulo-endothelial system. Using an enzyme-linked immunosorbent assay, we determined the plasma levels of E-alpha 1PI following major abdominal surgery, multiple trauma and pancreatogenic shock. Whereas the operative trauma was followed by up to 3-fold increase of the E-alpha 1-PI, postoperative septicemia was associated with a 10 to 20 fold increase. The increase of E-alpha 1-PI and a concomitant decrease of plasma factors, such as antithrombin III, clotting factor XIII and alpha 2-macroglobulin, were correlated. Multiple trauma causes a substantial increase of E-alpha 1-PI up to 14 hours after accident. The released elastase seems to correlate with severity of injury, but assessing the relationship to consumption of plasma factors is complicated by concomitant transfusions. In acute pancreatitis, peaks, of E-alpha 1-PI coincide with a massive consumption of antithrombin III and alpha 2-macroglobulin during shock.

Blood Proteins↗
PubMed1985

Crural arterial reconstruction with an adjunct arteriovenous fistula for limb salvage.

Twenty-one femoro-crural bypass procedures with a distal arteriovenous fistula (dAVF) were constructed in 20 patients with severe leg ischemia (Fontaine stage III, IV). They were followed-up for 3 to 22 months, with a mean of 8 months. The 15 patients with patent grafts and fistulas no longer had pain at rest; ischemic necroses healed. Telethermography showed a considerable augmentation of the distal limb perfusion. The mean increase of the transcutaneous oxygen pressure was 30 mmHg. One early postoperative amputation was necessary due to graft infection. Another patient lost her leg because of bypass occlusion 9 months after arterial reconstruction. Four patients with late graft occlusion kept their regained mobility and alleviation. Our data confirm experimental results suggesting that femoro-crural bypass with a dAVF improves distal leg perfusion by reversal venous blood flow and stimulation of a collateral network. Femoro-crural bypass with a dAVF may be of benefit in selected cases when only one crural artery is patent and pedal arch vessels are absent.

Adult↗