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Biomedical subjects

H M Becker

Publications and source records attributed to H M Becker.

At least 37 records · Page 2Linked to original sources
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

Traumatic aneurysms of the descending thoracic aorta.

From July 1979 to December 1985 we observed 51 patients with traumatic lesions of the descending thoracic aorta. Twenty-nine had acute ruptures, mostly accompanied by multiple injuries, and 27 had to be operated upon immediately. Twenty-two patients (19 males, 3 females) had chronic traumatic aneurysms of the descending thoracic aorta (more than six weeks after trauma). Mean age at the time of trauma was 24 years. Mean age at time of surgery was 36.5 years. Twelve patients were symptomatic. All were treated surgically. At surgery, complete aortic disruption was found in 15 patients and partial rupture in seven. We did not use aortic shunting of any kind, only aortic cross-clamping. Hypertension was controlled by intravenous drug infusion. The ruptured aortic segment was replaced in all cases by prosthetic Dacron graft. There were no operative deaths. One patient (age 77) died 11 weeks after surgery from multiple organ failure. One case of postoperative paraplegia was observed. This patient recovered almost completely from his neurological deficit.

Adult↗
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↗
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↗
PubMed1984

Biogenic grafts in arterial surgery--long-term results (I. The homologous vein--II. The modified heterologous bovine carotid artery--III. The human umbilical vein).

This report summarizes the authors' experience with homologous vein grafts, modified heterologous bovine carotid artery grafts and human umbilical vein grafts in reconstructive vascular surgery. The homologous saphenous vein, taken from living donors, was implanted in 21 patients. The high percentage of early and late complications (28% and 38%, respectively), the difficult availability and the development of modern materials appear to suggest that these grafts, at least the type used in this study, should no longer be employed. The experience with 102 femoro-popliteal and femoro-tibial bypasses in 140 revascularization operations carried out with modified heterologous bovine carotid artery grafts (Solcograft) is presented. The cumulative patency rate was 43% after 5 years for the above-knee and 33% for the below-knee femoro-popliteal bypasses. The high early and late complication rates (37% and 35%) lead us to believe that this graft should also no longer be employed. The human umbilical cord vein (Meadox-Dardik-Biograft) was used in performing 68 femoro-popliteal and 15 femoro-crural bypasses in 60 limbs of 57 patients. The patency rates calculated according to the standard life table method was 36% for the above-knee (after 5 years) and 32% for the below-knee femoro-popliteal bypass (after 4 years) and 31% (after 3 years) for the femoro-tibial bypass, respectively. On the understanding that other materials should be preferred in the individual case, this material still seems to be recommendable as a graft of second or third choice.

Adolescent↗
PubMed1983

[Aneurysm of the abdominal aorta. Results of surgical therapy].

According to experiences in treating more than 400 patients with abdominal aortic aneurysms (AAA) following statements can be made: 1. Diagnosis of an AAA is identical with indication for surgical treatment. Only in cases of extremely high operative risk (aggravating organ deficiencies especially of heart and lungs) an expectant attitude is justified. 2. Preoperative angiography is considered to be desirable. 3. Rupture of the aneurysm depends on size and form, but small sized aneurysms can rupture as well. 4. It is of advantage to have the patients prepared preoperatively for several days for minimizing the operative risk. 5. Long follow-up results are good, the operation is able to prolong life expectancy of these patients.

Adult↗
PubMed1983

[Peripheral arterial occlusive disease of the lower extremities].

Disturbance of the arterial perfusion of the lower limbs with occlusion in the aorto-iliac area presents a broad field of operative treatment in younger patients below 70 years of age. In older people caution is necessary depending on preexisting multiple morbidity. If necessary, extra-anatomic bypass operations have to be taken into consideration in order to save a jeopardized leg. Limb salvage should be accomplished whenever possible. In case of involvement of the femoro-popliteal region even in old age patients aggressive surgery for limb salvage is important because of high mortality due to primary amputation and last not least because of better life quality and for cardiovascular training. Conservative treatment of occlusions in the aorto-iliac area is not promising much success. Therefore in this area vascular surgery is the treatment of choice. In contrary arterial occlusion of the femoro-popliteocrural region--especially if both are combined--can be positively influenced by conservative angiological regimen. Hence conservative therapy should always be tried first, before difficult and long lasting vascular reconstructions are taken into consideration. One should not forget that surgery of occlusive vascular disease is only a symptomatic therapy, not a curative one. Life expectancy is not enhanced, but only ability of walking is saved. Generally spoken, the patient with occlusive vascular disease of the lower limbs nowadays can be offered a differentiated and individualized therapy including, also, non-surgical procedures. Well planned reconstructive vascular surgery has a good long time prognosis saving the physical integrity and efficiency of the older patient suffering from disabling vascular alterations.

Aged↗