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H Stiegler

Publications and source records attributed to H Stiegler.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Long-term results of unsuccessful thrombolysis and secondary thrombectomy of deep leg-pelvic vein thromboses: a critical analysis].

According to the literature, fibrinolytic therapy of acute thrombosis of the pelvic and deep lower leg fails in about 15%. As the primary patency rate correlates with the long term results, we intended to investigate whether the failures of 15% might be improved by a secondary thrombectomy. 87% of 31 thromboses treated by secondary thrombectomy were investigated by clinical, morphological and functional examinations. The data show that in case of the intervention taking place within 8 days (total age of the thrombus including the period of lysis treatment) the results were excellent, within 8-14 days they were still good. Patients below the age of 30 years benefited most by the therapy. However, the postulated "airtight effect" could not be demonstrated. Early diagnosis is of paramount importance. The period of lysis treatment should be limited and in case of failure a secondary thrombectomy should be offered to the patient.

Adolescent↗
PubMed1993

[Macroangiopathy in diabetes mellitus].

Although there is no evidence of effectiveness of interventional trials concerning macroangiopathy in diabetes mellitus, the focus of primary prophylaxis is based on the treatment of risk factors and optimal adjustment of metabolic parameters. This should contain the prophylaxis of the diabetic foot (foot care, teaching, pressure bearing) in the neuro-ischaemic risk patient. In the secondary prophylaxis acetylsalicylic acid has been proven as effective in the cerebral, cardial, and peripheral vascular regions in different dosages. The aim of the symptomatic therapy is the improvement of the peripheral vascular disease symptoms, which could mean an improvement of the pain-free walking distance or the avoidance of an extremity-threatening ischaemic syndrome. The therapeutic range includes a structured exercise programme, conservative medical treatment, catheter procedures, and bypass surgery as well as amputation. The different procedures are mainly dependent on the general condition of the in many cases multimorbid patients, the clinical stage, the psychological burden and the angiologic status. There should be always an interdisciplinary discussion, which helps to find the right therapeutic decision. All the therapeutic activities should be seen under the guideline of an improvement in the quality of life.

Arterial Occlusive Diseases↗
PubMed1992

[Subcapsular hematoma of the liver in HELLP syndrome. An interdisciplinary emergency].

The HELLP-syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), known as a complication during pregnancy, is associated with preeclampsia and may cause subcapsular liver hematomas. In case of hepatic rupture the lives of mother and unborn are threatened. Therefore, an interdisciplinary diagnostic and therapeutic approach is discussed and compared to two examples. The diagnosis of subcapsular liver hematoma must lead to urgent delivery through Cesarean section. Thereafter, the surgeon may decide between observation on an intensive care unit and urgent operation in case of hepatic rupture, without endangering the unborn.

Adult↗
PubMed1992

[Lung embolisms in a surgical patient sample. A retrospective study over 9 years].

In a retrospective study of surgical patients during a period of 9 years 296 cases of pulmonary embolism were recorded by analysing autopsy findings and perfusion pulmonary scans. The frequency of pulmonary embolism among patients who underwent a surgical procedure was 0.55%, the frequency of lethal pulmonary embolism was 0.15%. In autopsy disseminated micro-pulmonary embolism were often found (n = 129, 44%). With regard on the preceding operation a high frequency of pulmonary embolism after septic abdominal surgery (1.5%) and vascular surgery (0.9%) became obvious, especially after operations on the abdominal or thoracic aorta (2.1 resp. 4.8%). In 198 cases venous thrombosis were found. 104 (52%) of these were located in the cranial venous system and in 46 patients there was a connection to the site of central venous lines.

Adult↗
PubMed1992

[Thrombectomy after unsuccessful thrombolytic therapy of deep leg vein thromboses: an effective procedure?].

Lysis of acute thromboses of the pelvic and deep lower leg veins is not always successful. According to the literature, 11-20% of the cases remain occluded. In such cases the majority of authors continue therapy with anticoagulants (heparin, dicumarol). 31 thromboses which had been unsuccessfully treated by lysis were subsequently thrombectomized after a few hours. All external iliac veins could be opened. The amount of occluded common iliac veins could be reduced from 94% to 16%. In 19% a stenosis due to a venous spur remained. The complete patency rate of the extremity veins could be improved by 55%. This shows that a marked improvement of the primary patency rate could be reached despite the failed lysis. This is a prerequisite of a favourable longtime result. An evaluation of the late results is planned and will be published at a later date.

Adolescent↗
PubMed1991

[Incidence and symptomatology of lung embolism in relation to the site of deep venous thrombosis].

The uncertainty about the true incidence of pulmonary embolism (PE) in connection with deep venous thrombosis (DVT) becomes evident when comparing the results of autopsy--vs. clinical studies, with the former showing a three-fold elevated rate of embolisation. In order to evaluate the percentage of clinically inapparent PE, all patients (65 females, 54 males, mean age 61.3 years) hospitalized between April 1989 and March 1990 with suspected DVT and/or PE underwent duplex-sonography and pulmonary scintigraphy. In 108 cases, DVT could be ascertained, whereas 11 patients only suffered from PE. In 57.4% of all DVT, PE was diagnosed. Of the 73 cases with PE, only 53.4% of the patient stated typical symptoms primarily. In more than 1/4 of the patients with primary symptoms of PE, no DVT could be diagnosed. There was no significant difference between the occurrence of PE in relation to the localisation of DVT, with 1/3 to 1/2 being asymptomatic. 1/4 of the patients with leg-thrombosis and 1/7 with thrombosis of the iliac vein did not complain of typical symptoms of thrombosis. Furthermore, an increased PE-rate seems to occur with an elevated ultrasound echogenity of the thrombus. As a result of the study pulmonary szintigrams seem to be indicated in all cases of DVT in order to evaluate the total PE risk.

Adult↗
PubMed1990

[Results of local thrombolysis with special reference to diabetic metabolism].

The influence of diabetes on the primary and long-term success rate after 145 local thrombolyses in peripheral arterial disease stages III and IV was evaluated. 75 patients suffered from thrombotic, 62 patients from embolic occlusions, with eight patients suffering from thrombangitis obliterans. Regarding the localisation of vascular occlusion 0.6% suffered under an occlusion of the iliacal artery, 21% of the femoral artery, 16% of the popliteal artery, 7% of the vessel of the lower limb and 55.4% showed a combined occlusion of the femoral- and popliteal artery and the artery of the lower limb. In cases of embolic occlusions only marginal differences could be observed, while the primary success-rate of thrombotic occlusions showed greater differences between both groups (75% vs. 91%). During the follow-up, no differences between both groups could be established (patency-rate of 79% for both groups). The same applies to the prognostic factors: peripheral run off, length, duration of occlusion and the clinical stage (Fontaine IIb to IV). The remarkable differences between diabetic and non-diabetic patients in cases of occlusions of more than 16 cm (66% vs. 88% in primary and 55% vs. 77% in long-term success) can be explained by the high percentage of diabetic patients with poor run-off and microangiopathy. Regarding the above parameters, primary and long-term results seemed to be less in diabetic patients, even though a long-term patency could be observed in 2/3 of diabetic patients in stages IIb and IV with primary success.

Adult↗