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Biomedical subjects

H Wenk

Publications and source records attributed to H Wenk.

At least 19 recordsLinked to original sources
PubMed2006

Certification of vascular centers - a project of the German Society for Vascular Surgery.

OBJECTIVES: Due to the progress vascular medicine has made in conventional vascular surgery, endovascular procedures, and conservative therapy close, interdisciplinary cooperation is required. In order to assure the contextual and structural quality of vascular centers, the German Society for Vascular Surgery established a list of criteria for certification of each interdisciplinary vascular center. MATERIAL AND METHODS: Between July 2002 and December 2005, 77 centers have submitted a written application and have been audited by the commission for quality assurance of the German Society for Vascular Surgery, 59 vascular centers were certified for a period of 3 years with one center in each in Austria and in Switzerland, 13 centers were not certified (16.8%), and the applications of 5 centers are still pending. This analysis is based on 57 German certified vascular centers. RESULTS: Each center treats a median of 1149 inpatients (11% of these are emergency admissions) and 2,159 outpatients per year. Sixty percent of the patients treated have an arterial disease. All centers have vascular surgery and radiology departments. In 11 out of 57 centers, angiology services are offered in cooperation with affiliated physicians. Each vascular center has an average of 4.2 vascular surgeons, 3 radiologists and 1 angiologist. All centers offer radiological and ultrasound diagnostics (CT angiography in 100%, MRT in 95%, duplex sonography in 100%). Each clinic executes a median of 521 (233-1436) arterial operations and 263 (37-1055) arterial interventions. In addition, they execute varicose surgeries (n=217), shunt applications/revisions (n=58), minor amputations (n=57) and major amputations (n=42). They conduct 338 (92-3606) conservative therapies per year (POAD, diabetic foot, phlebothrombosis, chronic venous insufficiency). CONCLUSIONS: The certification of interdisciplinary vascular centers is a new approach to assure the contextual and structural quality of interdisciplinary vascular centers.

Ambulatory Surgical Procedures↗
PubMed2006

[Results of the certification of vascular centers by the German Society for Vascular Surgery].

INTRODUCTION: Advances in conventional vascular surgery, endovascular procedures and conservative treatment require close interdisciplinary cooperation. The term Vascular Centre indicates to patients and referring doctors optimal professional and organisational competence. METHODS: 73 applications by vascular centres for certification were made between June 2002 and December 2005, of which after audit 54 were successful for three years, including one centre each in Austria and Switzerland. 13 centres were not accepted and six are still under consideration. This analysis is based on the data of 52 certified centres in the Federal Republic of Germany. RESULTS: A mean of 1149 patients were hospitalized in these centres per year (12 % emergency admissions) and 2159 patients per year were treated as outpatients, 60 % with arterial vascular disease. All centres have vascular surgery and radiology department, 10 of the 52 centres cooperate with specialists in private practice to provide an angiology service. A mean of 460 arterial vascular operations and 239 arterial interventional procedures were performed at each centre annually. In addition there were operations for varicose veins (n = 217), shunt operations (n = 58) and major amputations (n = 42). Inpatient or outpatient conservative treatment (for peripheral vascular disease, diabetic foot syndrome, phlebothrombosis or chronic venous insufficiency) was given to a mean of 338 patients annually. CONCLUSIONS: Certification of interdisciplinary vascular centres provides structural and medical data and the beginnings of comparing such centres. A future task will be standardization of documentation and continuing assessment of the quality of results.

Certification↗
PubMed2004

[Malignant gastrointestinal stromal tumor (GIST) of the papilla vateri. A rare tumor entity].

We present the case report of a 68-year-old female patient who had a malignant gastrointestinal stromal tumor of the papilla of Vater. The abdominal CT showed a coin-shaped lesion in the liver (segment VIII). Intraoperative rapid histological examination detected an old parasitic hepatic cyst. To exclude metastasis, we performed duodenopancreatectomy with curative intention. The postoperative course was without complications and neither chemotherapy nor other adjunct treatment was necessary. Because of heterogeneity, the different localization, and in this case the rare localization, surgery of gastrointestinal stromal tumors is difficult. However, we adhered to oncological and therapeutic standards of surgery for papillary carcinoma. This case is discussed based on a review of the literature. However, until now there has been no case report of gastrointestinal stromal tumor of the papilla of Vater in the literature.

Aged↗
PubMed2002

[Late complications in the aorta and iliac artery following open aortic surgery].

Late complications following conventional repair of abdominal aortic surgery were measured in 304 patients. Further operations were necessary in 4.6 % of the patients after an average time of 8 years. Indications for further operation were: Suture line aneurysms (6), endoleak (2), kinking of the prosthesis (2), occlusion (2), infection (2). In one of these cases an aortoduodenal fistula was observed. There was no lethality in the redo operations. It can be shown that vascular follow up operations are necessary after conventional aortic surgery. In comparison to endovascular surgery, however, they are less frequent and can be performed with acceptable security for the patient.

Aged↗
PubMed1998

[Secondary ulcer perforation after endoscopic hemostasis with fibrin glue].

Emergency treatment of bleeding ulcer of the duodenum is endoscopy and endoscopic blood-staunching. In high-risk patients with Forrest Ia lesions or ulcers with visible vessel (Forrest IIa) endoscopic follow-up or early elective operation is required. Fibrin sealing can improve the results of endoscopic injection therapy for bleeding ulcer. Nevertheless, severe complications such as secondary perforation of the fibrin clot or recurrent bleeding can occur. Identification of high-risk patients and complications requires close monitoring and attention. A case of a secondary perforation of a bleeding ulcer of the duodenum after fibrin sealing is reported.

Aged↗
PubMed1997

[Choice of vascular prosthesis material in treatment of infrarenal abdominal aortic aneurysms--initial results of a prospective randomized study].

A prospective, randomized trial was performed to compare 40 patients with aortic aneurysms which were treated by implantation of dacron or PTFE prostheses. Follow up was done according to a defined protocol for 3 to 34 months postoperatively. There was observed neither graft failure, vascular occlusion, perigraft-reaction nor infection in any case. In one patient a periprosthetic haematoma occurred. During postoperative follow up in each group one patient died. There were no significant differences in dilation of the material in both groups. Dacron prostheses dilated to 28.2%, PTFE to 30.5%. In both groups the graft limb dilated more in comparison to the tube.

Aged↗
PubMed1997

[In vitro evaluation of blood vessel prosthesis dilatation--Dacron and PTFE--a new measuring technique].

Dilatation is the most significant complication of prosthetic vascular grafts. It is suspected to be a nidus of other graft complications. There have been a few studies on in-vitro-dilatation of the prosthetic vascular grafts. This is due to the lack of an effective and simple method to measure the transverse dilatation of the graft. We developed a new simple, reliable and cost-effective technique to evaluate the in-vitro-dilatation of prosthetic vascular grafts. The dilatation behavior of two different types of grafts (dacron and PTFE) was observed and compared under static pressure between 0 and 300 mmHg. The in-vitro- dilatations of dacron and PTFE grafts were 6.9% and 8.4% respectively. Interestingly, the dilatation rate for PTFE vascular grafts is higher than the indicated rate in the literature.

Blood Vessel Prosthesis↗
PubMed1996

[Ischemic colitis after vascular surgery reconstruction of an abdominal aortic aneurysm].

Between 1978 and 1994, a total of 678 patients were operated on for infrarenal (abdominal) aortic aneurysm at the Department of Surgery of Lübeck Medical University. Rupture had occurred in 165 patients, 351 were treated electively, and 162 presented with severe symptoms but no rupture. Only CT, angiography and intraoperative judgement were used for diagnosis. Reconstruction of the inferior mesenteric artery (IMA) was performed only in exceptional cases. Severe ischemic colitis occurred in 1.03% (in no case following elective surgery, in 0.66% of patients presenting with symptoms, and in 3.6% of patients in whom rupture had occurred prior to the operation). Three patients presented with mild ischemia, two with grade B ischemic colitis and three with transmural infarction. One patient had to be operated on for ischemic colitis despite open reconstruction of the IMA. We conclude from our data that there is no need to reconstruct the IMA as a routine procedure; this topic has been a controversial issue in the literature. We do reimplant a patent IMA when there is only oozing from the IMA and/or a borderline perfusion of the sigma following the operation, with at least one open internal iliac artery. When rupture had occurred, reconstruction should be performed if there is the slightest suspicion because of the increased risk, but only if the patient's cardiopulmonary condition allows this to be done. Analysis of our patients with ischemic colitis demonstrates the importance of maintaining stable circulatory conditions to prevent intestinal ischemia. Further diagnostic procedures (Doppler ultrasound, measuring of oxygen saturation or pH) may identify more patients at risk, but at the moment we do not consider these to be routine procedures.

Aged↗
PubMed1996

[Doppler and color Doppler ultrasound diagnosis in differentiation of focal liver lesions].

The frequent detection of benign liver lesions during ultrasound routine examination and a possible curative therapy of early detected malignant tumors require a reliable method of differentiation. Conventional gray-scale ultrasound, according to this problem, has been extended by the Duplex technique and color Doppler ultrasound. Measurement of blood flow velocity by Doppler in the center and at the periphery of liver lesions is not reliable enough to distinguish between benign and malignant lesions. Color Doppler ultrasound possesses some reliable criteria for differentiation. A central spot could be detected in 2 out of 12 hemangiomas, a giant spot in 1 out of 3 giant cavernous hemangiomas. The halo sign without detectable blood flow is considered to be specific for malignancy. We found this sign in 26 out of 81 malignant liver lesions and only in one benign lesion (sensitivity 32%, specificity 97%). The vascularization of focal liver lesions is excellently demonstrated with color Doppler ultrasound. This is very helpful for the diagnosis (e.g. "chaotic blood vessel architecture' in malignant tumors) and for the therapy of focal liver lesions (e.g. follow-up examinations after chemotherapy or chemoembolization). Therefore, application of Duplex and color Doppler ultrasound is highly recommended as a noninvasive diagnostic method of first choice for unknown liver lesions.

Blood Flow Velocity↗
PubMed1996

[Indications and results of surgically treated, with temporary vena cava filter managed patients].

Heavily injured patients, patients who underwent operations on pelvis, hips, abdomen or malignoma surgery, as well as gynaecology patients suffering from malignoma or previous deep femoral vein thrombosis in connection with pregnancy or obesity are at risk to suffer from pulmonary embolism with potentially lethal course. In a retrospective study we evaluated the advantage of the prophylactic use of temporary vena cava filters and their side effects. The indications were 18 cases of surgery, with known iliacal vein or cava thrombosis, 3 cases of pregnancy thromboses, and 1 high-dose heparinisation after acute pulmonary embolism without lysis. Additionally a postoperative lysis therapy was performed due to a life-threatening pulmonary embolism in 1 patient. 1 Cook filter (transfemoral), 3 Angiocor filters (transbrachial), and 19 Antheor filters (3 transjugular, 5 transfemoral, 11 transbrachial) were implanted. In these patients no clinically visible pulmonary embolism occurred under therapy, 3 thrombi were detected in the filter. Complications were caused either by the underlying therapy alone (1 lethal outcome of abdominal aortic aneurysm surgery), by the combination of therapy and cava filter implantation (1 case of arm haematoma, 1 ascending thrombosis) or by filter implantation alone (2 cases of v. subclavia thrombosis, 1 dislocation, 1 basket rupture). Since temporary cava filters have no secondary complications per se, their use seems justified as long as there is strict indication including presence of iliacal vein or cava thrombosis and risk of thrombi mobilisation.

Abdominal Neoplasms↗
PubMed1995

[The importance of sonography before laparoscopic cholecystectomy].

The increasing use of minimally invasive techniques for the treatment of symptomatic cholecystitis requires exact preoperative diagnosis. The significant sonographic findings are stones in the biliary system or indirect evidence of stones, consisting in dilatation of the bile duct to more than 10 mm, as well as free mobility of the abdominal wall to exclude peri-umbilical adhesions. Amongst 100 patients who had laparoscopic cholecystectomies there were 7 with bile ducts wider than 10 mm. In two of these cases calculi could also be demonstrated. ERCP was performed on the remaining five and in 3 of these stones were seen. Peri-umbilical adhesions were seen in 6 Patients, resulting in alternative placing of the incision. The sonographic findings which are of relevance to the surgeon were analysed in these 100 cases. A standardised examination protocol is an important feature for proper patient selection.

Adolescent↗
PubMed1995

Continuous measurement of cardiac output during aortic cross-clamping by the oesophageal Doppler monitor ODM 1.

We have compared the Doppler against the thermodilution technique for measurement of cardiac output in six patients during aortic surgery. The correlation coefficient between the two methods was between 0.76 and 0.84 during the different periods of the operation. Using the integral nomogram instead of direct calibration, the Doppler system underestimated cardiac output in atherosclerotic patients. However, the Doppler method did register accurately significant changes in cardiac output.

Aged↗
PubMed1995

[Incisional hernias after laparoscopic interventions].

The importance of the complication incisional hernia after laparoscopic surgery was determined by analyzing our own cases and extensive review of the literature. The data recorded give its incidence as 1 in 550 cases. The most frequent event was intestinal incarceration with a high portion of Richter's hernias. To avoid postlaparoscopic hernias the important step is suturing the fascia when the trocar diameter exceeds 5 mm. When external suturing of the fascia is impossible, the laparoscopic technique using the Reverdin needle is a sufficient procedure for fascial closure after minimally invasive surgery.

Cicatrix↗