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Biomedical subjects

H Müller-Wiefel

Publications and source records attributed to H Müller-Wiefel.

At least 19 recordsLinked to original sources
PubMed1992

[Alternative mechanical autotransfusion. Hemofiltration vs. hemoseparation].

The effect of haemoconcentration of shed blood from operative field during vascular surgery by either centrifugation (cell separation, n = 10) or haemofiltration (n = 10) was investigated. Interest in this in-vitro-study was focused on the quality of the blood concentrated. Various parameters were measured in the patient (before onset of anaesthesia), and in the blood after suction from operative field: 1. shed blood, 2./3. after haemoseparation/-filtration. Both procedures were easy to perform but haemofiltration produced whole blood quicker than the cell-separation technique (1.2:3.0 minutes). All patients had normal parameters. Suction led to an activation of plasma coagulation and an increase of free haemoglobin and elastase. Haemoseparation in contrast to filtration led to an elimination of thrombocytes, elastase, free hemoglobin and all proteins including antithrombin III and fibrinogen; concentration of red cells was more pronounced after separation (hct 55 vs. 35%). Heparin reduction was better after separation but plasma-heparin-levels were in a tolerable range after both procedures (0.21 vs. 0.75 U/ml). None of the procedures was followed by the appearance of activated clotting factors (F XII a). The data presented demonstrate that haemofiltration may be an alternative in intra- and postoperative autotransfusion. The particular advantage of this method is the preservation of plasma proteins after concentration procedure thus avoiding the need for additional application of fresh frozen plasma in patients with significant blood loss.

Blood Loss, Surgical↗
PubMed1991

Occlusion of the brachial artery by thrombus dislodged from a traumatic aneurysm of the anterior humeral circumflex artery.

The successful treatment of a brachial artery occlusion caused by a chronic embolizing aneurysm of the anterior humeral circumflex artery is described. In the case of embolizing axillary artery aneurysms, the best therapy is resection of the aneurysm followed by distal thromboembolectomy and vascular reconstruction by a saphenous vein segment. Prosthetic material should be reserved as a second choice. In this particular case successful therapy consisted of ligation of the anterior humeral circumflex artery proximal and distal to the aneurysm, resection of the aneurysm, and transcubital thromboembolectomy.

Adult↗
PubMed1991

[Effective autotransfusion thanks to cooperation].

A 61-year-old female patient scheduled for major vascular surgery had several diseases, including cardiovascular, pulmonary, renal and hepatic insufficiency. Prior operations--major vascular surgery, strumectomy--had led in most cases to severe bleeding complications owing to a known inherited thrombopathia. Therefore, it was questionable whether an operation would be possible at all. Coordination of three medical departments (vascular surgery, anesthesiology and hematology) created an individual transfusion program. Over a period of 6 weeks, autologous blood was collected in the Anesthesiology Department by means of the so-called leap-frog technique, resulting in the availability of 4 units of autologous packed cells plus 9 units of autologous fresh frozen plasma by the day of surgery. During the operation we used a Shiley autotransfusion device (Autotrans). Two days before the preoperation substitution with homologous thrombocytes was started (one highly concentrated unit per day). This was continued until the 4th postoperative day. Operative procedure performed included reconstruction of iliac artery, bilateral profunda plastic and iliac-femoral cross-over bypass grafting. Only autologous blood products were utilized; apart from thrombocytes no further homologous derivatives were required. The patient had a normal recovery period with no episodes of bleeding or hematoma. There was no need for a long hospital stay. The case presented stresses the importance of good cooperation between physicians for successful treatment of our patients in general and effective use of autotransfusion in particular.

Blood Transfusion, Autologous↗
PubMed1989

[Bypass spanning the knee joint with synthetic prosthesis].

Synthetic tubes are the second choice for below-knee bypass materials. The ring-reinforced thin-walled Goretex-PTFE graft is an approved material which was tested in a multicenter study. The primary 3 years patency for below-knee femoral-popliteal bypass was 64%, for crural bypass 39%. A total of 195 grafts have been implanted. Long-term patency depends very much on the run-off conditions (81% in good and 43% in bad cases). The over-all limb salvage rate was 80% after 3 years.

Blood Vessel Prosthesis↗
PubMed1989

[Quality of life after surgical interventions--vascular surgery].

Vascular surgery is primarily a reconstructive discipline that contributes appreciably to the patient's quality of life (QL) by improving many organ and system functions. The definition of QL includes a variety of specific and very individual aspects. The postoperative evaluation of QL must be based on the one hand on hard data and common clinical parameters, and, on the other, on the individual feeling of the patient, who compares preoperative sequelae and postoperative functional improvement.

Activities of Daily Living↗
PubMed1987

[Results of the surgical treatment of acute circulatory disorders of the leg caused by arterial embolism and arterial thrombosis].

232 patients with arterial embolism (E) and 103 with arterial thrombosis (T) were treated. Operative mortalities were 18.9% (E) and 11.9% (T) respectively. The amputation rates were 5.6% (E) and 10.1% (T). Limb-salvage-rates were calculated as 78.4% (E) and 69.7% (T). The prospective study showed a 50%-mortality after 3 years in patients with (E) and after 7 1/4 years for the (T)-group. The amputation rate at the end of the follow-up was in (T)-patients three times higher than in the (E)-group.

Amputation, Surgical↗
PubMed1986

[Indications for the implantation of a vena cava filter].

Intracaval filter implantation is an alternative to surgical removement of the sources of pulmonary emboli. The indication for implantation of a Greenfield vena cava filter, which is the far advanced type, has to be a very narrow one, however. The two main indications are: recurrent emboli despite adequate anticoagulant therapy and contraindications to anticoagulation and no possibility for venous thrombectomy or thrombolytic therapy. Venous disobliteration by surgical (thrombectomy) or medical (streptokinase) means remains the therapy of choice.

Filtration↗
PubMed1979

[Doppler ultrasonic measurement for diagnosing carotid occlusions and stenoses (author's transl)].

Doppler ultrasonic measurements were performed in 74 patients suffering from cerebrovascular disorders. Flow direction was determined in the supratrochlear artery by using a directional Doppler sonographic instrument according to the method of Keller et al. 15 patients presented, unilateral or bilateral, with a flow reversal (i.e. direction of flow into the orbita via supratrochlear artery). In 8 of these patients carotis or aoitic arch angiographies were performed and in 4 cases necropsy reports were available. In all instances where flow reversal occurred severe carotid stenoses or occlusions were demonstrable. Thus 9 internal carotid occlusions, 1 common carotid occlusion, and 3 severe internal carotid stenoses were proved. One internal carotid occlusion and 3 internal carotid stenoses were operated on. Check-up sonograms after endarterectomy of carotid occlusions or stenoses showed a normal antegrade flow thus demonstrating patency of the carotid vessels. Obviously, supratrochlear flow reversal as measured by ultrasonic technique signals ipsilateral carotid vessel occlusion or stenoses. Furthermore, the method seems to be a reliable means for controlling carotid endarterectomy.

Aged↗
PubMed1976

[Congenital incomplete aortic-arch-syndrome as a rare cause of cerebral ischemia in consequence of a steal-syndrome (author's transl)].

A subclavian-steal-syndrome of a congenital origin is a rare observation. The authors report on a 27 years old female patient with characteristic symptoms. The vascular deformity consisted of a right-sided aortic arch, a right descending aorta, separate origins of the anonymous and the right carotid arteries, and an aplasia of the proximal parts of the left carotid and the left subclavian arteries. A combined dacron-venous-bypass was placed from the ascending aorta to the left arm-neck arteries and thus cerebral circulation was improved and the patient got free from symptoms. Special problems of morphology and hemodynamics are discussed on the hand of arteriograms.

Adult↗
PubMed1976

[Complications of arterial reconstructions below the knee for chronic vascular occlusion (author's transl)].

From 1967 to 1976 49 reconstructions were undertaken in the area distal of the art. poplitea: 30 femoral-crural bypasses, 12 TEA und 7 orthogradic desobliterations. Complications until clinical demission were reviewed. There were in 8 cases postop. thrombosis which led to 4 amputations. 6 patients suffered from wound infection with one consecutive amputation. 4 hemmorages had to be stopped surgically. THE OVER ALL RATE OF COMPLICATIONS WAS 36,7% WITH A PRIMARY MORTALity of 4%.

Aged↗
PubMed1976

[Clinical experiences with induced preoperative haemodilution in vascular surgery (author's transl)].

A procedure of haemodilution modified for the particular requirements of vascular surgery has been used on 90 hospital patients. 61% of the operations have been performed without using homologous blood. The method applied being clinically well tolerable, it the object of this study to find to what extent a measurable reduction of the loss of blood during the operation with consequently a reduction of the amount of homologous blood administered can be attained. If the tolerable loss of blood is estimated to be 600 ml, in 22% of the cases operated on the administration of homologous blood has been avoided. The improvement in rheology by the infusion of low molecular weight dextran is considered an additional advantage in the special field of vascular surgery.

Aorta↗