[Thrombophlebitis and ulcus cruris caused by primary varicose veins of the lower extremity. Diagnostic and therapeutic consequences for the general practitioner].
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Adult↗
Biomedical subjects
M Bartel
Publications and source records attributed to M Bartel.
[Primary hyperparathyroidism. Pathogenesis--diagnosis--therapy].
A report is given on 33 patients with primary hyperparathyroidism who underwent surgical treatment in our institution in the period from 1980 to 1989. In 57 per cent of the cases a hypercalcaemic syndrome was present. The primary hyperparathyroidism manifested itself in 75 per cent at the kidneys in the form of nephrolithiasis. One third of the patients showed a renal manifestation form exclusively. Remarkable is the relatively high number of exclusively gastrointestinal manifestations (11 per cent). In all patients the diagnosis was established on the coincidence of hypercalcaemia and increased parathormone in the serum. Preoperative localization diagnostics by means of parathyroid sonography, computed tomography and scintigraphy yielded unsatisfactory results. A satisfactory accuracy with regard to the lateral localization of the hyperfunctioning parathyroid tissue can presently be achieved only by selective catheterization of the cervical vein with determination of the parathormone. 35 patients clinically suspected of having primary hyperparathyroidism were subjected to a total of 44 operative interventions, i.e., apart from 35 primary operations, 7 secondary and 2 tertiary interventions. Of the 35 primary operations, 10 (28.6 per cent) were without success. This was due to 2 misdiagnoses and 8 cases with insufficient intraoperative exploration and premature discontinuation of the operation. In 67 per cent of the cases, there was a predominance of the solitary parathyroid adenoma, which was chiefly located at the dorsal lower thyroid poles. In order to reduce the number of unsuccessful primary interventions, a surgically-tactical approach is recommended.
Adenoma↗
[Circular intrathoracic tracheal replacement by a devitalized artery in the dog].
Prepared artery (origin: human, calf, dog) with external or internal teflon-spiral-supporting was implanted in dogs (n = 10) as a circular intrathoracic tracheal substitute after cross-resection. Human arteries were rejected (n = 2). Calf arteries (n = 5) and dog arteries (n = 3) were incorporated fibrously. Central granulations appeared. The longest survival time was 36 days.
Animals↗
[Comparative experimental animal studies for testing the usefulness of formalin- and glutaraldehyde-pretreated umbilical cord veins as artery replacements].
Formalin-fixed (F) and glutaraldehyde-pretreated (G) umbilical veins (n = 24) were interposed in the infra-renal aorta of dogs. The follow-up period was 1 year. Early complications with significant differences included 2 occlusions and 3 deaths (41.6%) in group F, 1 occlusion and 1 death (16.6%) in group G. Ten animals of group G and 7 of group F were alive at 1 year, 7 transplants of each of both groups were angiographically and macroscopically patent (25%). Four aneurysms (33.3%) existed angiographically and showed good collateral circulation angiographically (25%). Four aneurysms (33.3%) existed angiographically and macroscopically in group F (statistically significant). Histologically, group G was found to have a delayed resorption and an earlier beginning of connective-tissue proliferation as compared to group F. Considering early and late findings, G-pretreatment is preferable to F-treatment of umbilical veins.
Animals↗
[Surgical intervention in stenoses and aneurysms of the renal artery].
Corrective vascular surgery was performed on 36 patients with renovascular hypertension and one patient with normal tension for 38 defective renal arteries, among them 58 per cent with arteriosclerosis and 35 per cent with fibromuscular dysplasia, in Jena, between 1969 and 1985. Follow-up checks were conducted six years from the operations (average) and revealed three major long-time results: Average blood pressure had declined from 211/121 mm Hg preoperatively to 152/95 mm Hg postoperatively. Renal functions were stabilised. Necessary antihypertensive medication could be reduced to 42 per cent of the preoperative values. Three revascularised kidneys had to be surgically removed in a second session. Four patients had died, the grey figure being one. Restenosation was recorded from three of 28 morphologically assessed arteries. Aneurysmal dilatation of a bridging graft was recorded in one case. Revascularisation proved necessary in another two. The point can be made that in cases of reno-arterial stenosis corrective vascular surgery has continued to be a valid therapeutic concept, adequate indication provided. It still is a real alternative to percutaneous transluminal angioplasty, nephrectomy or isolated therapeutic medication.
Adolescent↗
[Long-term results following femoro-popliteal vascular reconstruction].
All in all, 330 thromboendarterectomies (TEA) and 354 venous bypass operations (VBP) were performed on 550 patients. In 11.01 per cent of all cases in which VBP had been planned, veins were not in optimum condition. Repetitive interventions had to be applied to 111 patients. Successful reoperations could be performed on six cases with immediate TEA-closures (1.8 per cent) and another two after immediate VBP-closures (0.56 per cent). Postoperative lethality figures were 0.6 per cent after TEA and 0.28 per cent following VBP. Twenty-nine early TEA-closures (8.9 per cent) were corrected by secondary VBP in 16 cases (4.8 per cent). Three were corrected by femoral ablation and two by toe amputation in the border zone (1.7 per cent). Thirty-nine early VBP-closures (11.0 per cent) required repetitive VBP in two cases (0.5 per cent) and toe amputation in the border zone in another three instances (0.84 per cent). Eight patients each died within the first postoperative year from TEA (2.4 per cent) and after VBP (2.2 per cent). The following cumulative patency rates were recorded according to the life table method: after one year (TEA: 90.9 per cent, VBP: 88.9 per cent), after five years (TEA: 73.4 per cent, VBP: 84.6 per cent), after ten years (TEA: 38.2 per cent, VBP: 73.7 per cent), after 15 years (TEA: 9.8 per cent, VBP: 24.2 per cent). These differences were significant as early as five years from surgery. Late amputation rates were 2.1 per cent for TEA and 2.9 per cent for VBP. Late lethality rates were 28.8 per cent for TEA and 7.6 per cent for VBP.
Adult↗
[Comparative cinematographic, endoscopic and functional studies of the preoperative estimation of the severity of tracheal stenoses].
Structural tracheal stenoses have different functional effects according to degree, localization and extent of the stenosis. Further modifications are due to malacic components within the range of the stenosis or tracheal segments abutting on the stenosis. Nineteen patients with mainly cervical tracheal stenoses (12 patients) were investigated in order to examine if a functional X-ray-diagnostic procedure (X-ray-cinetracheobronchography--CTBG--of the central airways in several beam-directions during forced breathing, cough and Valsalva-maneuver after contrasting of the trachea and main-bronchi with powdered tantalum) yields an increase of findings in comparison with a static roentgenologic procedure (chest films p. a. and frontal; tomography) and an endoscopic examination. The judgement of the stenosis is made by measurement of the length and of the diameter compared with the normal trachea. Malacic components reveal themselves by changes of the stenosis-configuration during Valsalva-maneuver, forced breathing and strong coughing. In 11 of 19 patients there was evidence of a malacic stenosis-component and in 5 patients there was a mural weakness of abutting segments. In comparison with the endoscopic examination we found in 8 of 15 patients a diagnostic improvement by demonstration of unfixed stenotic compartments. Besides information about stenotic degree, configuration, localization and length, a CTBG offers the possibility of localizing and grading malacic stenotic components or of adjacent segments--provided that films are made in at least two planes. The application of CTBG in patients with tracheal stenosis is useful if there are signs of tracheomalacia or if the localization and the extent of the stenosis require a difficult reconstructive surgical intervention or if discrepancies between clinical aspect and stenosis-degree make it advisable to extend the field of diagnostic procedures.
Adult↗
[Effect of adjuvant infusion therapy of low molecular weight dextrans (Infukoll M 40) and deproteinized hemoderivate (Actovegin) in Fontaine stage IV chronic arterial occlusive diseases].
A selected group of 18 patients (among them 16 diabetics) with chronic disorders of arterial blood flow at Stage IV according to Fontaine received treatment by a standardised therapeutic scheme. None of the cases was suitable for reconstruction by vascular surgery. Infusion treatment, using Infukoll M 40 and Actovegin, was to be checked for its capability of providing sufficient improvement in blood flow and thus eliminating the need for imminent high-level amputation. Evaluation was undertaken on the basis of clinical and laboratory-chemical parameters. The rate of above-knee amputation was reduced by 14 per cent. Hence, the above therapeutic concept has proved to be suitable for treatment of Stage IV chronic arterial occlusion.
Adult↗
[The behavior of trace elements in bronchial carcinoma].
The analysis of the elements iron, zinc, copper, and magnesium in the serum allows no assertion on diagnosis and course of the adeno- and squamous cell carcinoma in the lung to the present date.
Adenocarcinoma↗
[Esophageal diverticulum--indications for surgical therapy and late results].
63 cases of oesophageal diverticulum were analysed, and surgical therapy was chosen for 45 of them. Most of them were located in the cervical region of the oesophagus (44.4 per cent). Cervical and intrathoracic diverticula or those causing pain and possible bleeding were indications for surgical treatment. No postoperative complications occurred to the above patients. Recurrence was observed in three of 28 cases, following surgery for Zenker's diverticulum. No complaints at all were recordable from 79 per cent of the patients in follow-up checks after surgery.
Adult↗
[Case report of the problem of diagnosis and therapy of mediastinal tumors with anterior venous obstruction].
At the instance of a patient with upper venous affluence blocking due to a space occupying process in the dorsal and medial mediastinum, the problems of differential diagnostics and therapy of this disease are discussed. In spite of intensive diagnostic efforts, the final diagnosis was only obtained at autopsy. A T-lymphoblastic non-Hodgkin-lymphoma was found.
Adult↗
[Celiac trunk compression syndrome].
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Adolescent↗
[Time-dependent changes in the lactic acid level of ischemic muscle tissue under conditions of arterial embolism, simulated in animal experiments].
It may be summarized that under the condition of embolism in animal experiments the lactate level is significantly changed depending on the duration of ischemia. Thus, for judgement of a hypoxic damage of muscle tissue this parameter appears to be useful. A more precise analysis would be imaginable, when the degree of tissue damage could be stated according to a certain lactate level. For this, however, the reported results must be compared with a randomized series of human patients suffering from arterial embolism, since the present studies concern the muscles of rats.
Animals↗
[The mineral composition of veins and arteries as a function of age].
In the present investigation the contents of sodium, potassium, calcium, magnesium, iron, copper, and zinc were determined in ashes of cadaver material from great saphenous veins and arteries.
Adolescent↗
[Results later many years after TEA in femoro-popliteal segment (author's transl)].
Our results later many years after 231 TEA in femoro-popliteal segment are based to examinate the indications of this reconstructive operation and to compare with other methods of arterial reconstruction. Resulted: the TEA is always a good method of biological worth without risk. This method authorized to indicate the reconstruction of chronical arterial occlusions. However the method is not to apply to all arterial occlusions without criticism only to selected patients.
Age Factors↗
[Late sequelae of rib fractures].
For an assessment of the late lesions after rib fractures 108 patients having had an accident between 1968 and 1973 were followed up. As to the individual signs observed, the patients were very heterogeneous. Radiodiagnostic, spirometric and scintigraphic data were compiled in order to characterize the late morphologic and functional lesions. By means of correlation and discrimination analyses as well as tests of significance we found that the extension of the late lesions depends either on the age of the patient nor on the number of fractured ribs but, instead, on concomitant intrathoracic lesions. The late morphologic lesions such as deformedly healed rib fractures and pleural thickening were the substrate for the ventilative and circulatory disturbances of the lung.
Adult↗
[Late complications of major vessels following shoulder joint injuries].
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Adolescent↗
[Vascular reconstructive procedures in patients with chronic occlusive arterial diseases and diabetes mellitus (author's transl)].
97 diabetic patients of 734 patients with a chronic occlusive arterial disease were observed in the years from 1968 to 1974. It was established the operability of arterial occlusions are influenced by heaviness, duration and setting in the diabetes mellitus only a little. The indication to operate is determined by the three-points-regulation at the diabetic patients, too. Vascular reconstructive procedures were only possible at each of a second or third patient independent of diabetes mellitus. 28 vascular reconstructive procedures in the femoro-popliteal reach were made at 22 diabetic patients. The results were successful in more about than 80 per cent by explorations from 1 to 5 years after operations.
Adult↗