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K Balzer

Publications and source records attributed to K Balzer.

At least 19 recordsLinked to original sources
PubMed2005

[Imaging techniques for showing the morphology and surface structure of extracranial internal carotid artery plaques].

Methods of determining plaques in the extracranial internal carotid artery are ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). The goal of this overview is to introduce these methods and discuss their diagnostic and clinical significance. Ultrasound has the capability of showing the echogenity of the plaques. This method seems to demonstrate a relationship with the incidence of hemispheric symptoms. A histological association could only rarely be seen. The surface structure can only be clearly and correctly evaluated in individual cases under optimal circumstances. Computed tomography is capable of showing the calcium content and specific site of the plaques. However, lipid content and fibrous tissue cannot be deduced reliably. The currently available image resolutions limit a detailed imaging of surface characteristics. Magnetic resonance imaging provides, in vitro, a correct rendering of plaque composition and endoluminal surface structure. In vivo it is possible to recognize both the fibrous cap and necrotic core as well as intraplaque hemorrhage. Because of certain artefacts more detailed images are difficult to interpret. In conclusion, further clinical trials should reveal, whether these methods can be set in clinical routine to detect plaque surface and morphology for stratifying patients at risk of hemispheric symptoms during the spontaneous course as well as during carotid interventions.

Angiography↗
PubMed2005

[Intraoperative monitoring in vascular surgery].

Despite the variety of possibilities to evaluate hemodynamics, ultrasound-in particular duplex sonography-is the method of choice. With an increasing number of endovascular procedures, intraoperative angiograms will remain indispensable. The method of angioscopy is reserved for individual cases. Indirect monitoring in carotid surgery will keep its significance. This includes measuring somatic evoked potentials as well as transcranial duplex sonography, with regard to the increasing importance of plaque morphology and possible neurological consequences. The general recommendation of applying at least one intraoperative control method is necessary in carotid surgery, even if intraluminal shunts are routinely implanted. In addition, quality control of the peripheral vascular system should be sufficiently documented by using one or more methods of examination. So far, in prospective randomized trials, results have not improved by applying intraoperative monitoring methods. Nevertheless, they are indispensable for the careful vascular surgeon and can help to avoid complications and revision with worse prognosis in some cases.

Aneurysm, Ruptured↗
PubMed2004

[Mycotic visceral artery aneurysm: clinical picture, diagnosis, differential therapy, and discussion of the literature].

Bacterially infected arterial aneurysms were named mycotic aneurysms by William Osler in 1885 due to their morphology. This rare vascular disease is mainly localized in the femoral artery but also occurs in the aorta and visceral arteries. After the first surgically treated mycotic visceral aneurysm in 1949, we found 36 casuistics in the literature. We report on two patients treated in our department with mycotic visceral aneurysms and discuss the literature concerning topography, differential diagnosis, and surgical management.

Adult↗
PubMed2004

Carotid artery calcium: accuracy of a calcium score by computed tomography-an in vitro study with comparison to sonography and histology.

OBJECTIVES: The aim of this study was to compare methods of quantifying calcification of the internal carotid artery. MATERIALS AND METHODS: We examined 92 internal carotid artery endarterectomy specimens. Grey scale median (GSM) values were calculated from optimized B-mode scans. The degree of calcification was assessed using radiographic calcification grading. Plaques were processed histologically, and classified into: (1) calcium-rich hard plaques, (2) lipid-rich soft plaques, and (3) combined plaques. The specimens were scanned in CT-scanner. The calcium score was determined as described by Agatston. RESULTS: Histopathology and GSM results concurred in 39 out of 92 cases (kappa=0.088). There was no significant correlation between the calcium score and the median GSM value (R=0.005; P=0.959). Histology and CT morphology showed a significant concordance (P<0.001). Also CT and radiomorphological classification showed close agreement (R=0.628, P<0.001). CONCLUSIONS: Calcium scores calculated using CT morphology enable precise in vitro evaluation of the calcium content of plaques in the internal carotid. In contrast, grey scale median values do not adequately reflect calcification of plaques.

Aged↗
PubMed2003

[Care dependency in nursing homes--a psychometric study].

The Dutch Care Dependency Scale, an instrument for the assessment of a patient's care dependency, has been translated into German. The purpose of this study was to examine the reliability and validity of the German version of the scale. The 15-item scale has been developed for the use in nursing homes. Data were collected from 81 people living in nursing homes in Berlin, Germany. The sample was measured three times. Cronbach's alpha was 0.94. Interrater and intrarater reliability revealed moderate to substantial Kappa statistics. As the results of this study were satisfying, positive recommendations regarding the suitability of the German version of the Care Dependency Scale for use in nursing homes could be made. However, further psychometric testing of the scale is recommended.

Aged↗
PubMed2003

[Why to operate on the carotid artery?].

UNLABELLED: AIM, METHODS, PATIENTS: In a prospective interdisciplinary study of 468 carotid artery stenoses we compared the ultrasound plaque morphology with the histological diagnosis. RESULTS: For detection of soft plaques and hard plaques by preoperative ultrasound examination we found a sensitivity of 80%. The accuracy for the estimation of the degree of the stenosis was 98%. In case of stroke in progression and completed stroke we found ulcerations by histological examination in 72%. By ultra-sound these ulcerations were detected only in 53%. We found a significant higher figure for TIA and stroke in soft plaque patients than in asymptomatic stage, in which hard plaque formation was seen more often. CONSEQUENCES: Patients with a soft plaque seem to have a higher risk of a postoperative permanent neurological deficit. However, the dangerous plaque formation with thrombosis or ulceration was not be detected with appropriate accuracy. Therefore the risk of embolisation cannot be predicted sufficiently by means of duplex scanning. This would be extremely important for the indication for stenting in this area. The number of HITS (high intensity transient signals) is 8 to 20 times higher in carotid stenting.

Carotid Arteries↗
PubMed2002

[Plaque morphology of the carotid bifurcation and incidence of embolisms in relation clinical stage of cerebrovascular insufficiency].

Vascular morphology and determination of plaque surface structure are getting more and more matter of interest before revascularisation procedures are performed. One reason may be the increase of interventional treatment (PTA). For that we investigated the value of ultrasound duplex scanning to predict preoperatively the vascular surface and plaque structure. 368 patients operated on obstructing stenosis of the carotid artery could be enrolled in this investigation. In all patients duplex ultrasound scanning was performed preoperatively. In 127 patient an analysis of TC-Doppler curve was possible. During some operations (eversion endarteriectomie) we performed experimental stent implantation. The evaluation was performed with statistical methods.

Aged↗
PubMed2001

[The care dependency scale, an assessment instrument].

The Care Dependency Scale, an instrument for the assessment of patients'care dependency, has been translated into German. The scale was tested on (inter-) rater reliability and criterion and construct validity in a hospital population on geriatric, surgical and paediatric wards. As the results of this study were very satisfying, positive recommendations regarding the suitability of the scale for use in the German nursing care situation could be made. However further psychometric testing of the scale is important, for instance in other populations. A final conclusion is that the scale may be used in care settings in German-speaking countries.

Dependency, Psychological↗
PubMed2001

[Results of endovascular exclusion of abdominal aortic aneurysms].

According to the principles of minimal invasive surgery a reduced operative trauma and complication rate are the main goals of endovascular aneurysm exclusion. From July 1996 to August 1999 we found 75 patients eligible for endovascular aneurysm therapy. The procedure was primarily successful in 95% of the patients. In the first time we had to switch to open surgery in 4 patients. There was 1 procedure related death. Most frequent later complications were graft occlusion (9.7%) and type I, II and III leakages (14.1%), which were partially repaired using endovascular techniques and partially by use of open surgery. In a selected group of patients the middle term results of infrarenal aneurysm therapy by endovascular stent graft implantation are promising.

Adult↗
PubMed2001

[Complications in varicose vein operations].

Although operations on varicous veins are regarded as easy and low-risk, severe complications with the involvement of arteries, veins and nerves can occur during the course of such operations and, in reconstruction, demand the whole spectrum of vascular surgery. Therefore, surgeons operating on varicous veins and on out-patients should possess sufficient experience in vascular surgery and be able to admit their patients to a centre of vascular surgery in the case of severe complications without unnecessary loss of time. Beside a perfectly done operation sufficient preoperative diagnostic examinations and postoperative care of the patient have to be claimed. The treatment of varicous veins in a hospital must be possible also in the future. The extent of the procedure is usually greater during stationary treatment and bilateral operations are feasible. Therefore, from the economic point of view, a stationary assignment for a few days does not seem more expensive than several single operations with subsequent outpatient treatment and repeated diagnostic examinations in ambulatory settings.

Ambulatory Surgical Procedures↗
PubMed2001

[What is the difference between ambulatory care and inpatient varicose vein patients?].

The operation of varicose veins seems to be safe and simple. Nevertheless, serious complications are possible requiring skill and experience in vascular surgery. A clinical treatment in these cases ist mandatory. Also extensive varicose veins and cases with comorbidity have to be operated in the hospital. Outpatient treatment is often less extensive and not sufficient ("quicker and sicker") and for that not cheaper than a clinical stay. Therefore operative treatment during a hospital stay must be possible even in times with shortness for money as regulated in the guidelines of the German Society for Vascular Surgery.

Ambulatory Surgical Procedures↗