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Biomedical subjects

J D Gruss

Publications and source records attributed to J D Gruss.

At least 19 recordsLinked to original sources
PubMed1992

[17 years experience with saphenous vein in situ bypass].

Long-term results of femorodistal in situ vein bypasses depend on the quality of the outflow tract. The cumulative patency of in situ bypasses to the third popliteal segment with a three-vessel runoff is 82.2% at 5 years, compared to 56% for bypasses to a single tibial artery. Immediate occlusions during the first 3 postoperative days are fatal for long-term permeability. After successful revision, the cumulative patency is only 39.5% at 5 years, compared to 64.9% for the whole group. A prospective randomized trial could show that an adjunct intra-arterial treatment with PGE 1 over 10 days can statistically significantly reduce the rate of fatal immediate occlusions.

Arterial Occlusive Diseases↗
PubMed1991

[Experiences with adjuvant prostaglandin therapy in vascular surgery interventions].

Two prospective randomized trials were referred. In the first study 50 patients with femorotibial greater saphenous vein in situ bypasses were treated intraarterially with 0.2 ng PGE 1/kg body weight/min and 15,000 i.U. of heparine continuously. The control group of 50 patients also got 15,000 i.U. of heparine and 3 x 0.5 g of Aspirin. We observed 2 (4%) immediate occlusions in the PGE 1 group and 7 (14%) immediate occlusions in the control group. This difference proved to be statistically significant. In the second study 83 patients with three level occlusions (ilio-femoro-tibial) in stage III and IV were treated with a profundaplasty. 42 patients received 60 micrograms PGE 1 in 250 ml saline twice daily. The control group of 41 patients only got twice 250 ml saline over a period of three weeks. In the PGE 1 group 26 patients (61%) showed disappearance of rest pain and healing of necrotic lesions, whereas in the control group this could only be achieved in 15 patients (35%). The difference proved to be statistically significant.

Alprostadil↗
PubMed1989

Experience with PGE1 in patients with postoperative trashfoot.

Within a 16 years observation period a trash phenomenon was seen in 15 patients. In 13 of these patients it occurred as a postoperative complication of a surgical intervention for infrarenal abdominal aortic aneurysm. In 2 cases an aortobifemoral bypass had become necessary because of an underlying AOD. In addition to the standard therapy with heparin 8 patients were intravenously given 2 ampoules of Prostavasin (60 mcg of PGE1) twice daily. All patients survived, and only in 1 case a thigh amputation was unavoidable. Apart from the heparinization, the 7 patients of the control group had received i.v. administrations of vaso-active drugs (naftidrofuryl, pentoxifylline) and hemodilution. 3 patients died within the first three postoperative days, one of them after a thigh amputation. A further patient suffered the loss of both lower legs, but survived and recovered completely as did 3 patients who did not require amputation. Though these results cannot claim the significance of a randomized controlled study they indicate that PGE1 may act favourably in the treatment of the trash syndrome.

Alprostadil↗
PubMed1989

Intravenous prostaglandin E1 versus pentoxifylline therapy in chronic arterial occlusive disease--a controlled randomised multicenter study.

In a controlled multicenter study 70 patients with chronic arterial occlusive disease stage IV according to Fontaine's classification were randomised to treatment with prostaglandin E1 (PGE1) or pentoxifylline (PX), administered over 4 weeks. Parameters of effectiveness were the reduction of analgesics, the relief of rest pain according to an analogue scale, the improvement of the ulceration according to an ulcer score and the healing of necrotic area. The results show that both forms of treatment produced a significant reduction in analgesic consumption and rest pain. Moreover in both groups a significant reduction of the ulcer score and healing of the necrotic area were observed. Side effects occurred in six patients of the PGE1-group and in ten patients of the PX-group, which required premature discontinuation of treatment in four patients of the PX-group. The study also demonstrated that PGE1 is more effective in the treatment of severe arterial occlusive disease than PX. With respect to the analgesic consumption, the reduction of ulcer score and the healing of necrotic area a significant difference was found in favour of PGE1. In accordance the six months follow-up examinations showed a marked deterioration in the PX-group opposed to the PGE1-group. The intravenous application of PGE1 over a period of 4 weeks in patients with severe arterial occlusive disease seems to be an effective therapeutical principle.

Aged↗
PubMed1988

[Reconstruction of unilateral iliac vein occlusion].

From 1 July 1971 through 6 June 1987, 46 of 10,644 reconstructive vascular interventions were Palma-operations. The morphological operability was ascertained by ascending phlebography and the functional indication by phlebodynamometry. The autologous contralateral saphenous vein was used in 19 patients as a transplant, whereas 27 patients received a spiral-wrap polytetrafluoraethylene (PTFE) prosthesis. All patients were given a temporary av-fistula. Followup was possible in 15 of the 19 autologous operations and in 25 of the 27 PTFE operations. Ten vein transplants and 21 PTFE transplants were still patent.

Adult↗
PubMed1987

[Prostaglandin E1 in stage III and IV arterial occlusive diseases. results of a multicenter study].

In a controlled randomized trial at four centers, using a common protocol, 57 patients with advanced chronic arterial occlusive disease (21 in stage III, 36 in stage IV) were treated with prostaglandin E1 (PGE1) or adenosine triphosphate (ATP) for three weeks. Both substances were administered intraarterially over 60 min. Daily dose of PGE1 was 20 micrograms, of ATP 30 mg. Both produced a significant reduction in resting pain at the end of the treatment phase, in stage III significantly better with PGE1. There was also a clear reduction in the use of analgesics, significantly more so with PGE1. Healing or improvement of ulcers was significantly better with PGE1, while there was no significant differences between the two drugs as regards stage improvement. Three amputations had to be performed in the PGE1 group, nine in the ATP group, a significant difference. Side effects in the form of reddening, pain and swellings occurred in 15 patients of the PGE1 group and six of the ATP group. Final verdict by the treating doctor about the success of treatment was significantly more favorable for PGE1.

Adenosine Triphosphate↗
PubMed1985

[10 years' experience with the in situ bypass].

From October 1, 1974 to March 31, 1984 467 femoropopliteal and femorotibial in situ vein bypasses were performed. Valvular incompetence is produced by the use of modified Hall strippers. The intraoperative angiography is mandatory to localize the tributaries and to detect pathological findings of the vein and technical errors. Overall cumulative patency rates were 84, 76, 71, and 67%, at 2, 5, 8 and 10 years. Cumulative patency rates for 117 tibial bypasses separately were 72, 68, and 68% at 2, 5 and 8 years.

Angiography↗
PubMed1977

[Treatment of the post-thrombotic syndrome: modification of May's femoral by-pass (author's transl)].

During May's femoral by-pass, one should avoid by sapheno-popliteal anastomosis, obstruction of the femoral vein damaged by the post-thrombotic syndrome. After the early work of Kunlin, arterio-venous fistulas are often found in reconstructive venous surgery. By making a transverse end-to-side anastomosis between the main peripheral saphenous vein and the posterior tibial artery behind the internal malleolus, one may obtain a protective effect on the sapheno-popliteal anastomosis, increasing the blood flow towards the main saphenous vein across the perforating veins down to the deep leg veins. The protective effect of the arterio-venous fistula seems to be of interest during inactivity of the muscular pump of the calf (postoperative phase and during rest at night).

Femoral Vein↗
PubMed1976

[Bypass operations in reconstructive vascular surgery, using prosthetic material (author's transl)].

Age and accumulation of risk factors in patients with arterial occlusive diseases in Fontaine's Stages III and IV do not always permit direct vascular reconstruction. A further indication for prosthetic bypass procedures is given by local infections following vascular surgical interventions, severe damage to soft parts after traumata and radiotherapy, and anus praeter in the pelvic region. In the supra-aortic region carotido-subclavian, subclavio-carotid and the carotido-carotid bypasses are already routine operations. The indications for axillo-femoral, carotido-femoral, femoro-femoral, iliaco-femoral and obturator bypasses are described and discussed with reference to our own experiences.

Aortic Diseases↗