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Biomedical subjects

K Grabitz

Publications and source records attributed to K Grabitz.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Abdominal aortic aneurysm--is surgical therapy in over 80-year-old patients justified?].

Abdominal aortic aneurysm repair in patients of 80 years and older has been performed in 51 patients over a period of ten years from 1985 to 1995; one-third of these patients underwent emergency operation for ruptures. The low mortality rate of 3.2% for the elective repair and the good long time survival expectancy, which does not differ very much from the life expectancy of the general population over 80 years, justify the elective abdominal aortic aneurysm repair in octogenarians. The high mortality rate of 69.2% in the case of rupture emphasizes the importance of elective aneurysm repair.

Aged↗
PubMed1995

Surgical treatment of septic deep venous thrombosis.

BACKGROUND: Septic deep venous thrombosis (SDVT) is an uncommon but occasionally lethal disease caused by systemic complications. In most cases reported in the literature SDVT is caused by intravenous drug abuse or transvenous catheter lines. Conservative management with antibiotic drugs and systemic anticoagulation is usually successful, and the surgical approach is regarded as not indicated or unnecessary. Occasionally, however, conservative management fails, thrombosis progresses, and septic embolism develops. METHODS: In a 7-year period five patients (three male and two female; mean age, 21.2 years), three with severe systemic complications of SDVT (femoropopliteal, 1; iliofemoral, 1; iliofemoral+vena cava, 3), were treated by venous thrombectomy in addition to intravenous antibiotic administration. Simultaneous transabdominal caval thrombectomy was performed twice. RESULTS: Two patients suffered from respiratory failure caused by previous septic embolization. One patient had experienced multiorgan failure before thrombectomy was performed. Intensive care was necessary for all patients (mean, 28 days). All patients survived. CONCLUSIONS: In complicated cases of SDVT without improvement or even impairment after conservative management, venous thrombectomy is a lifesaving treatment.

Adolescent↗
PubMed1995

[Surgical treatment of thoraco-abdominal aneurysm. Indications and results].

Aortic replacement for thoraco-abdominal aneurysms remains a major challenge in vascular surgery. Related symptoms, maximal diameter > 6 cm, progression, aneurysm sac containing none or excentric thrombi and uncontrollable hypertension are factors in favour of surgery, if the general condition of the patient allows the operation. Patients with aneurysms < 5 cm maximal diameter, tube-size aneurysms, heavy calcification of the aortic wall, concentric thrombi within the aneurysmal sac and significant cardiopulmonary risks should be treated conservatively. Patients in good general condition with aneurysms around 5 cm maximal diameter should be controlled by computed tomography in 6 to 12 months intervals and in the case of progression surgery can be recommended despite missing symptoms. Crawford developed the 'graft-inclusion-technique', which combines the 'ingraft'-technique with reattachment of renal, visceral and segmental arteries. The 'clamp and repair' principle is used in patients with sufficient cardiac function. Otherwise shunt or left sided heart bypass are used to reduce cardiac afterload. According to the literature local cooling (flush perfusion), cytoprotective drugs and numerous methods to maintain or ameliorate distal aortic perfusion during clamping ischemia have been used in patients successfully for prevention of ischemic spinal complications. In physiological settings these methods may prove valuable, but under pathophysiological conditions of TAAA-repair one must doubt the efficacy, because the individual risk is difficult to assess. In our hands flush perfusion and cooling of the kidneys proved to be helpful. In animal experiments we have shown prolongation of ischemia tolerance time using eicosanoides to protect the kidneys and the spinal cord. If shunt or left-sided heart bypass can protect the spinal cord during clamping, is unknown, because the risk of paraplegia in the individual patient can be known only, if the function of the spinal cord is monitored. We have developed a spinal neuromonitoring system and found, that only one third of all TAAA-patients is at high risk to develop paraplegia during aortic clamping. The surgeon is guided by continuous recording of spinal evoked somatosensory potentials and can adapt the operative technique by early reimplantation and eventually subsequent separate reimplantation of segmental arteries supplying blood to the spinal cord, in order to reduce spinal ischemia time. Our results in 260 TAAA-patients are presented. In a high-risk population of patients with aneurysms type I-III (Crawford's classification) it was possible, to reduce the paraplegia rate from 7 to 3.5%, the risk of paraparesis from 15 to 6%, while the operative mortality was only reduced from 19 to 10%.

Adult↗
PubMed1994

[Fresh homologous arterial transplant as aorto-iliac-femoral vascular replacement in prosthesis infection].

A patient with late graft infection in the groin following aorto-bifemoral-Dacron-bypass and recurrent infection of extra-anatomic bypasses is presented. Despite the evidence or graft infection (by preoperative imaging studies and intraoperative perigraft purulence) cultures did not identify the infective organism. Retrospectively a graft infection with Staphylococcus epidermidis is supposed as the most likely cause. A graft replacement with freshly harvested, not cryopreserved arterial homograft was performed. The perfusion of the extremities was excellent, the wounds healed perfectly. In special indications freshly harvested cadaveric arterial homografts are an acceptable substitute for infected aorto-femoral grafts.

Aorta, Abdominal↗
PubMed1994

[Subclavian-carotid transposition--experience in the treatment of arteriosclerotic lesions of the carotid artery near its origin].

Symptomatic atherosclerotic lesions of the subclavian artery are rare. A special treatment is necessary and consists today of various extrathoracic bypass procedures or a subclavian-carotid-transposition. The latter is our preferred kind of therapy. 116 patients (57 female, 59 male, mean age 59.1 years, 116 operations) underwent subclavian-carotid-transposition for symptomatic subclavian artery lesion of the first segment. In 33.6% a thrombendarterectomy of the ipsilateral carotid bifurcation and in 19% an open or eversion thrombendarterectomy of the second segment of the subclavian artery and/or the vertebral artery had to be performed. 3 patients (2.6%) died perioperatively (myocardial infarction 2, cerebral infarction 1). In 3 out of 4 early postop, thrombosed transpositions patency was restored successfully. 70 patients (74.5% of the patients alive) were followed for in the mean 58.6 +/- 41.5 months. The transposition was found to be patent in 67 (95.7%) patients, a mild stenosis presented 2, an occlusion 1 (occluded perioperatively). The cumulative patency rate (126 months) was 95%. Subclavian-carotid transposition is in contrast to bypass procedures a more difficile treatment for symptomatic subclavian lesions with various advantages. Besides an orthograde inflow to subclavian and vertebral artery and the construction of simply one anastomosis with wall segments of identical compliance the main advantage is the avoidance of any autogenous or artificial bypass material. Excellent long-term results underline that this therapy is the more elegant and better concept treating subclavian artery lesions of the first segment.

Adult↗
PubMed1993

Thrombectomy with arteriovenous fistula for embolizing deep venous thrombosis: an alternative therapy for prevention of recurrent pulmonary embolism.

Thrombectomy with arteriovenous fistula was performed between 1977 and 1988 in 103 patients (41 females, 62 males, mean age 46.7 years, 114 involved extremities) with embolizing deep-vein thrombosis (DVT). The sole aim of the surgical procedure was prevention of recurrent embolization. On the basis of the proximal extent of the thrombosis the source of embolization was identified as the iliac veins or inferior vena cava in 63% of the patients; 48% presented with a post-phlebitic vein and/or an older thrombosis, and 46% had already had recurrent pulmonary emboli. Unsuccessful aggressive procedures had been carried out previously in 11%. The rate of intraoperative pulmonary embolism (PE) was 3% (one fatal case). The perioperative mortality was 6.8%, but only one death was related to the surgical treatment itself. During follow-up (8-140 months postoperatively, mean 55 +/- 34 months) late recurrent PE was confirmed in two patients (antithrombin III deficiency, contralateral DVT) and was reported as the suspected cause of death in a third (3.6%). Venous thrombectomy with arteriovenous fistula is a reliable and effective procedure for management of embolizing DVT and is indicated especially in young patients. The rates of early- and late-recurrent PE are low, introduction of artificial material into the vein can be avoided, and long-term preservation of valve function is occasionally possible.

Adolescent↗
PubMed1993

Spinal evoked potential in patients undergoing thoracoabdominal aortic reconstruction: a prognostic indicator of postoperative motor deficit.

We studied 76 patients who had thoracoabdominal aortic reconstruction between January 1981 and March 1991. Evoked potential monitoring of the spinal cord (peridural bipolar catheter stimulation at level L4-L5, recording via a second bipolar catheter at level Th4) was used to predict intraoperatively a possible motor deficit. There was a close linear correlation of r = 0.892 between postoperative motor deficit (normal, paraparesis, paraplegia) and the time from declamping to reappearance of the potential. Forty-three of 76 patients received prostaglandin E1 (5 ng/kg/min) for pharmacologic protection of the spinal cord 15 minutes before onset of clamping and through the entire clamping period. Patients with protection had a loss of their potential significantly later (20.2 min; p < 0.05) than those patients who had not received any pharmacologic treatment (15.2 min). Pharmacologic protection also resulted in a reduced incidence of postoperative neurologic deficit and paraplegia when compared with patients receiving no treatment (25% vs 5%). These data suggest that spinal evoked potentials may be very useful for monitoring during these hazardous cases. They also suggest that pharmacologic protection before clamping may help preserve the function of the spinal cord during aortic clamping.

Aged↗
PubMed1993

Somatosensory evoked potential, a prognostic tool for the recovery of motor function following malperfusion of the spinal cord: studies in dogs.

The potential usefulness of somatosensory evoked potential monitoring during aortic cross-clamping is slowly being realized. In addition, the protection of endangered spinal nervous tissue during aortic cross-clamping has not been sufficiently evaluated. To test the pharmacologic protective efficacy of various agents, we recorded spinal evoked somatosensory potentials (bipolar epidural catheter) in dogs under controlled conditions (N2O/O2-enflurane anesthesia) following clamping of the aorta for 1 hour. There were 5 groups of animals: those treated with different medications, such as prostaglandin E1 (PGE1), prostacyclin (PGI2), superoxide dismutase (SOD), and PGE1 plus SOD for pharmacologic protection during ischemia, and the controls. The time to recovery of evoked potentials during the reperfusion period was 36 minutes in the controls, 15.9 minutes in the SOD group (p < 0.01), 12.5 minutes in the PGE1 group (p < 0.001), 10.8 minutes in the PGI2 group (p < 0.001), and 3.8 minutes in the combination group (p < 0.001). In addition, treatment resulted in a better neurologic outcome on the seventh postoperative day when compared with the control group. While in the control group only 1 animal could walk (9%), 7 of 12 in the PGE1 group (58%), 4 of 12 in the SOD group (33.8%), 8 of 12 in the PGI2 group (66.7%), and all animals in the combination group (100%) could walk. We computed an exponential correlation that related the mean time of potential recovery during reperfusion with Tarlov scoring (grade 0 = paraplegia; grade 1 = paraplegia with little movements; grade 2 = paraparesis; grade 3 = paraparesis with some problems; grade 4 = normal motor function) in the various groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Alprostadil↗
PubMed1993

Use of the electrospinogram for predicting harmful spinal cord ischemia during repair of thoracic or thoracoabdominal aortic aneurysms.

BACKGROUND: To reduce the incidence of misleading assessments, and to derive criteria for critical spinal cord ischemia during thoracic or thoracoabdominal aortic aneurysm repair, the authors epidurally stimulated and recorded somatosensory evoked potentials (ESEP) below and above, respectively, the spinal segment at risk (electrospinogram). METHODS: Epidural somatosensory evoked potentials were analyzed in 100 consecutive patients undergoing resection of aortic aneurysms using two bipolar catheters (stimulation at the L2 level and recording at the T3 level) for the following criteria: 1) the time until ESEP disappeared completely after cross clamping, 2) the duration of complete ESEP loss during and after cross clamping, and 3) the time until ESEP recovered after declamping. Postoperatively, neurologic deficits were evaluated by a neurologist who was unaware of the ESEP recordings. RESULTS: Three types of patients could be identified. First, thirty-one patients neither showed ESEP loss nor neurologic deficits. Second, ESEP loss occurring later than 15 min after cross clamping was associated with a neurologic deficit in 2 of 29 patients (6.9%). And, third, 12 of 40 patients (30%) presented a neurologic deficit when ESEP loss occurred within 15 min after cross clamping. Further indicators of an impending risk were a total ESEP loss greater than 40 min (sensitivity 100%, specificity 68%, positive predictive value [PPV] 35%, and negative predictive value [NPV] 100%), and a recovery of ESEP later than 20 min after declamping (sensitivity 93%, specificity 86%, PPV 52%, and NPV 99%). CONCLUSIONS: Epidural somatosensory evoked potentials appeared to be a reasonable intraoperative predictor of postoperative neurologic outcome, and informs surgeons and anesthesiologists about the impending danger at an early state of the operation.

Adult↗
PubMed1990

Does prostaglandin E1 and superoxide dismutase prevent ischaemic spinal cord injury after thoracic aortic cross-clamping?

The beneficial use of prostaglandin E1 (PGE1) and superoxide dismutase (SOD) on the tolerance to ischaemia of the spinal cord was evaluated following thoracic aortic cross-clamping in dogs. Aside from spinally evoked somatosensory potential (SEP) by means of a bipolar epidural catheter, postoperative evaluation of motor deficits was used to determine the efficiency of pharmacological protection when compared with controls. The animals were divided into four groups. Group I (n = 12) served as controls. The dogs of Group II (n = 12) were treated with PGE1 (100 ng/kg/min) during clamping and the first hour after declamping. In the third group (n = 12) SOD was given as an intra-arterial bolus (1 mg/kg) prior to declamping which was followed by a continuous perfusion (0.4 mg/kg/min) into the carotid artery for 25 min. In Group IV (n = 12) the dogs were treated with a combination of PGE1 and SOD in the same manner as in Groups 3 and 4. Results after pharmacological protection were significantly better than controls. In Group I all animals but one (92%) were paraplegic, as were five in Group II (42%) and eight in Group III (67%). In contrast no dog in Group IV developed paraplegia. There was a close correlation of SEP and postoperative recovery. The group with combination therapy (PGE1 plus SOD) was characterised by a loss of the evoked potential for a mean of 15 min, the PGE1 group for 45.8 min and the SOD group for 58.5 min. While the control group was characterised by a loss of 72.7 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Alprostadil↗
PubMed1990

Results of surgical treatment for atherosclerotic renovascular occlusive disease.

In this study we retrospectively examined the results of surgery for atherosclerotic renal artery lesions and analysed the factors that may affect postoperative blood pressure response, changes in renal function and late mortality. A total of 326 patients were operated on over a 15 year period and were followed up for periods from 4 to 165 months (mean follow-up time: 37.2 months). An extra renal vascular area was also involved in 91.4% of cases and in 187 (57.3%) a significant involvement of both renal arteries was found and simultaneously treated. Combined revascularisation of other arteries was performed in 50.3% of patients. The indications for surgery were the treatment of extreme hypertension in 243 patients (74.5%), the improvement of renal function in 45 with renal insufficiency, and preservation of the kidney in 38 (11.7%). The preferred method of reconstruction was transaortic endarterectomy (236 cases, i.e. 72.4%) and postoperative angiography demonstrated a normal patent renal artery in 319 of 338 studied renal arteries (94.4%). There were no deaths in the early postoperative period after isolated renal artery reconstruction. Of the 164 patients with simultaneous renal and aortic reconstruction however 14 died during the early postoperative phase. The overall early mortality was thus 4.3% (14 out of 326 patients) and correlated significantly with the extent of the atherosclerotic disease, the age of the patients, the operative technique used and the different intra- and postoperative management during the two different periods of our experience (1974-1980 v. 1981-1989).(ABSTRACT TRUNCATED AT 250 WORDS)

Arteriosclerosis↗
PubMed1990

[Surgical treatment of peripheral arterial occlusive disease in diabetes mellitus; in situ saphenous vein bypass versus reverse bypass procedure--a retrospective study].

The scope of reconstructive possibilities in the treatment of patients with peripheral occlusive arterial disease and diabetes mellitus had been increased thanks to further development of surgical methods. It is especially the in-situ-bypass procedure which has opened the path to new anastomotic sites at the level of the foot. Our own experience with 86 bypass procedures in 84 patients has given us an early patency rate of 82% in non-diabetic arterial occlusions and of 80% in diabetics. The amputation rate was 7% in the former group, 14% in diabetics with atherosclerotic occlusion. In comparison to the reversed bypass the early graft occlusion rate fell from 26% to 14% and the amputation rate from 13 to 9%. Thus, operative mortality fell from 9 to 2.4%, although the average age had risen from 61 to 67 years and the percentage of stage IV disease from 38% to 51%. Patency of bypass procedures with anastomosis to distal calf arteries was 83% und rose to 92% if the distal anastomosis was to arteries in the vicinity of the ankle. The caveat in this study is the fact that an apparent superiority of the in-situ-bypass is based on retrospective comparison of somewhat widely separated historical groups.

Aged↗
PubMed1988

[Surgical treatment of thoraco-abdominal and suprarenal aortic aneurysm].

Ninety-nine patients underwent surgery for thoraco-abdominal (n = 73) or suprarenal (n = 26) aortic aneurysm, between January 1, 1981 and May 10, 1988. The in-graft technique was combined with re-implantation of renal, visceral, and segmental arteries, using the method proposed by Crawford. Ischaemic tolerance of kidneys was extended by means of flush cooling and was more recently manipulated by means of prostaglandin E1. Spinal cord function had been monitored since 1985 by means of the authors' method of spino-electrogram reading, with intercostal arteries being re-implanted in cases of need. The intervention was survived by 79 patients, with ruptures in 69 per cent of all cases and no ruptures in 82 per cent. The rate of paraplegia amounted to seven per cent (with 2.5 per cent of survivors. 25 per cent of deaths, 18 per cent with dissecting aneurysm, and five per cent without dissection), and it depended on the extent of aortic replacement (Types I, II, and III for 773 patients and Types IV and V for 0/26). While the incidence of postoperative disorders of renal function, including temporary dialysis, was also somewhat related to the extent of aortic replacement (Types I, II, and III 22 per cent and Types IV and V eight per cent), it was clearly affected to a greater extent by the general condition of patients (ruptures in 50 per cent, intact and without dissection in nine per cent). Spinal monitoring and protection against ischaemia have substantially contributed to much better surgical results, in recent years. Surgical treatment, therefore, is recommended for patients with aneurysmol symptoms as well as for advanced cases of aneurysm, the more as rupture-related mortality has proved to be extremely high in spontaneous courses without surgical action.

Adult↗