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Biomedical subjects

K Balzer

Publications and source records attributed to K Balzer.

At least 37 records · Page 2Linked to original sources
PubMed2000

Atherosclerotic carotid arteries--calcification and radio-morphological findings.

OBJECTIVES: Are there any predictable factors influencing the process of calcification in carotid arteries? BACKGROUND: The carotid arteries and especially the carotid bifurcation are one of the predisposed regions of atherosclerotic disease. Whether topography of the carotid sinus, flow patterns or different patient characteristics (e.g., diabetes mellitus, age, sex) are a factor determining calcification of atherosclerotic lesions is still hardly understood. METHODS: Morphological and morphometrical analysis including radiographic classification of different degrees of calcification on postmortal carotid arteries (90 men and 19 women) and 306 surgical samples after intramural desobliterations of carotid arteries (202 patients with diabetes, 104 patients without diabetes). RESULTS: Most common localization of radiographically identified calcified deposits are the carotid bulb (76%) especially on the lateral wall opposite the flow divider and the internal carotid artery (55%) especially the proximal 1 cm section. No difference in degree of calcification was found when comparing patients with and without diabetes (intermediate calcification in 59% of patients with diabetes and 50% without diabetes). More female patients with diabetes show calcification when compared to the group of patients without diabetes. Females produce calcification in atherosclerotic carotid lesions at an older age compared to male patients. CONCLUSIONS: Calcification is a frequent finding in advanced atherosclerotic carotid lesions. There is no difference in regard to degree, pattern of calcification or age distribution when comparing patients with and without diabetes mellitus. Atherosclerotic lesions more frequently found in female patients with diabetes may be due to less vasoprotection by estrogens.

Adult↗
PubMed2000

[Conventional thrombendarterectomy with carotid patch plasty vs. eversion endarterectomy: technique, indications and results].

We report our experience with carotid surgery during the past 11 years and a prospective randomized study on 600 patients with conventional thromb-endarterectomy (TEA) versus eversion-endarterectomy (EEA). First results gave EEA a slight advantage, which could not be proved in the following years. Both methods are equivalent in terms of postoperative and long-term results. Follow-up showed one difference between the two methods: Restenosis occurred more often in the TEA-group (14.7% TEA versus 6.5% EEA). The frequency of symptomatic restenosis was the same in both groups (3.8% TEA versus 3.9% EEA). EEA did not show late restenosis. We attribute this to the avoidance of patch-suture and the introduction of patch material, as was observed by other authors. No ruptures of venous patches occurred in our study after primary implantation, while two venous grafts ruptured after substitution of an infected Dacron patch. Infection rate for the Dacron patch was below 0.2% and is therefore negligible. Duplex-ultrasound is indispensable in evaluating plaque-morphology, although sensitivity is low in the detection of dangerous atherosclerotic lesions (73.4% for the soft plaque, 31.9% for ulcerations). In view of these results and a critical analysis of the current literature, we see slight advantages for EEA over TEA inspite of equivalent operative results. However, EEA is a suitable procedure only in connection with subtile intraoperative control and in the hand of an experienced surgeon.

Angiography↗
PubMed1999

[Learning and optimising minimally invasive techniques by operating on embalmed human corpses].

The expansion of minimally invasive surgery worldwide provokes an intensive interest of all surgical disciplines in gaining possibilities for research, learning and teaching by operating on human corpses. Despite the fact that German anatomical institutes in general have the infrastructure to realise such clinical cooperations, at present they may offer such opportunities only to a restricted degree, since the concentration on student teaching and anatomic research limits the capacity of the staff for a commitment in this field of applied science. To provide a basis for future estimations of the efforts necessary to perform solo surgery on the human cadaver, especially with emphasis on research, quality control and teaching, this article reports on practical experiences with such a project named "ANAtoMIC", identifying minimal conditions which have to be realised.

Cadaver↗
PubMed1999

Dural closure with nonpenetrating clips prevents meningoneural adhesions: an experimental study in dogs.

OBJECTIVE: Meningospinal and cranial dural adhesions were compared in a canine model, after duraplasty using nonpenetrating clips or penetrating needles and sutures. METHODS: Fourteen dogs underwent bilateral craniotomies and duraplasties, with implantation of dural prostheses (DuraGuard; Biovascular Corp., Minneapolis, MN), using either 6-0 silk sutures or titanium clips (DuraClose; Surgical Dynamics, Norwalk, CT). Fourteen other dogs underwent L3-L4 laminectomies; three longitudinal dural incisions were closed with 6-0 silk sutures, 6-0 polyglactin 910 (Vicryl) sutures, or clips. Groups of eight dogs (four cranially treated and four spinally treated) were killed 6, 12, 24, and 52 weeks after surgery, and specimens were collected for study after perfusion and fixation (two cranial and two spinal dural reconstructions at 52 wk). Evaluations included assessment of the appearance of approximated dural margins and responses to clips, sutures, and dural prostheses (inflammation, foreign body reaction, fibrosis, and severity of meningospinal/meningocerebral adhesions). Data were evaluated using the Wilcoxon signed-rank and McNemar tests. RESULTS: Duraplasties with clips displayed significantly less extensive acute and chronic inflammation, foreign body reaction, and meningoneural adhesions than did repairs with needles and sutures. CONCLUSION: This report is the first long-term experimental study comparing two fundamentally different methods for dural repair in a relevant animal model.

Animals↗
PubMed1998

[Acute abdomen in endemic sprue--a rare complication].

BACKGROUND: The celiac sprue, a small intestinal disease usually becoming apparent by a malabsorption syndrome, is caused by gluten respectively gliadin intolerance which leads to intestinal mucosal damage finally resulting in complete villous atrophy. CASE REPORT: A propos of the case of a 60-year old woman with an uneventful course of celiac sprue of many years we report about a rare complication of this disease. Investigating recurrent attacks of abdominal pain a barium contrast examination revealed an intestinal stenosis which clinically resulted in an acute abdomen finally requiring surgery. Histologically a chronic ulcerative jejunoileitis was found. The main differential diagnosis is a malignant intestinal lymphoma, this however couldn't be found. Regarding this differential diagnosis surgical removal of the diseased parts of the bowel is the therapy of choice. Because of the possible transition from ulcerative jejunoileitis to intestinal lymphoma a postoperative close follow-up is recommended.

Abdomen, Acute↗
PubMed1997

Efficacy of a new prostaglandin E1 regimen in outpatients with severe intermittent claudication: results of a multicenter placebo-controlled double-blind trial.

For the first time efficacy and safety of a new prostaglandin E1 (PGE1) regimen in the treatment of intermittent claudication were evaluated in a randomized, double-blind, placebo-controlled multicenter clinical trial. The study involved 213 outpatients with a maximum walking distance of 50 to 200 m measured on the treadmill (3 km/hr, 12% grade). After a 2-week run-in phase they received a 2-hour intravenous infusion of 60 micrograms PGE1 or placebo 5 days a week for 4 weeks. It was followed by a 4-week interval treatment with the same medication administered only twice a week. Patients were monitored for 3 months when they received no study medication. In the PGE1 group the intention-to-treat analysis (n = 208) revealed an increase in walking distance after 4 weeks of 75% (placebo, 43%). At the end of the interval treatment the walking distance had improved to 101% (placebo, 60%). The results remained virtually constant during follow-up (PGE1, 104%, placebo, 63%). Between-group comparisons showed significant differences in favor of PGE1 for all three time points of measurement (p < 0.05, p < 0.01, and p < 0.05). PGE1 was well tolerated; the rate of adverse reactions related to the treatment was 12.8% (placebo, 7.7%). In summary, these results show that the new PGE1 regimen is effective and safe in the treatment of outpatients with intermittent claudication.

Aged↗
PubMed1997

[Guidelines in vascular surgery--occlusion of the femoral artery].

Indications for reconstructive procedures in femoral artery occlusions depend only on the clinical symptoms which the patient presents. Because of the good prognosis in this arterial region the patient should be treated as conservatively as possible. An invasive therapy is rarely needed. The progressive basic character of the disease should be kept in mind, making routine monitoring at least twice a year mandatory. Only a well-skilled vascular surgeon in a well-equipped hospital is allowed to perform reconstructive vascular surgical procedures in this region.

Arterial Occlusive Diseases↗
PubMed1995

[Results of the 75selenium homotaurocholic acid retention test (SeHCAT test) in diagnosis of diarrhea].

PATIENTS AND METHOD: For that reason absorption of bile acids was investigated using the 75Se-homotaurocholate (SeHCAT) in 239 patients with diarrhoea. SeHCAT retention time was measured as 7 day retention time in a whole body counter. An intact bile acid absorption (negative SeHCAT test) was confirmed in 23 healthy volunteers within the range of 11 to 50% (mean +/- double standard deviation). RESULTS: In 135 patients with a possible type I bile salt malabsorption the SeHCAT test was positive in 78%, thus indicating bile salt malabsorption. The test is very sensitive detecting bile salt malabsorption in Crohn's disease, identifying ileal disease more precisely than radiology. The SeHCAT test ascertained type II primary bile salt malabsorption in 7 patients, as well as type III bile salt malabsorption in patients (9 out of 28) with cholecystectomy, vagotomy, partial gastrectomy and chronic pancreatitis. In addition, a positive SeHCAT test indicating bile acid malabsorption was found in 5 out of 11 patients with irritable syndrome, diarrhoeic form, and in 4 out of 12 patients with lactose intolerance. CONCLUSION: SeHCAT retention should be measured routinely in patients with chronic diarrhoea for which the cause is not obvious.

Adult↗
PubMed1993

[Postprandial serum bile acid level and 75SeHCAT retention in diagnosis of bile acid malabsorption syndrome. A comparative study].

Postprandial serum bile acids (expressed as integrated bile acid response [IR]) after a standardized test meal were compared with 75SeHCAT retention, measured in a whole body counter, in healthy controls (n = 20), in 44 patients with ileal disease or resection and in 23 patients with colitis without ileal involvement. In the controls the IR after 180 min was 736 +/- 186 mumol x min x 1(-1) (mean +/- standard deviation), the 75SeHCAT retention 31 +/- 9%. 80% of the patients with ileal disease or resection had a decreased 75SeHCAT retention, indicating bile acid malabsorption, but only 59% had a diminished IR. One of the 23 patients with colitis and radiologically normal ileum had a decreased 75SeHCAT retention but a normal IR, reflecting a dysfunction of the morphologically normal ileum. The characteristics of the two tests are: 75SeHCAT retention test: sensitivity 80%, specificity 98%, accuracy 89%; postprandial serum bile acids: sensitivity 64%, specificity 74%, accuracy 69%. With respect to chronic inflammatory bowel disease the positive predictive value of the 75SeHCAT retention test is 1.0%, for postprandial serum bile acids 0.1%, whereas the negative predictive values amount to 99% for both tests. Thus 75SeHCAT retention is more reliable in detecting bile acid malabsorption than the determination of postprandial serum bile acids, although both tests are not usefull for screening the population for ileal disease.

Adolescent↗
PubMed1993

[Edema after vascular surgery interventions and its therapy].

The incidence of lymphodemas after vascular surgical reconstructions is underestimated. In stage III and IV of PAOD 80% of our patients are suffering from lymphodemas, in stage II about 30%. In stage III and IV a postreconstructive edema occurs more often, in stage II the incidence of both, secondary lymphedema and postreconstructive edema is similar. A complex physical therapy (CPT) after a successful surgical reconstruction decreases the swelling of the legs by special lymphatic massage and the patients are earlier rehabilitated. The lymphatic massage should be applied only in patients with high degree lymphedematous legs. Because of the improvement of microcirculation a benefit for the healing of trophic lesions could be considered.

Adult↗