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Biomedical subjects

M Köcher

Publications and source records attributed to M Köcher.

At least 19 recordsLinked to original sources
PubMed2002

[Arteriovenous fistula as a complication of renal biopsy].

Renal biopsy is nowadays considered a relatively safe and routine examination method in nephrology. Its development was made possible by extension of sonography and introduction of modern automatic bioptic sets. Relatively frequent complications of biopsy include macrohaematuria, perirenal haematomas and AV fistulae. The majority of complications is unimportant from the clinical aspect. Some 30% fistulae do not recede spontaneously and gradual remodelling of the circulation near the fistula may lead to the development of complications. In the submitted paper the authors inform on the case of a 55-year-old woman where 24 hours after biopsy of a renal graft a sonographically revealed arteriovenous fistula closed spontaneously within one month; the case of a 40-year-old woman where 5 days after biopsy progression of a subcapsular haematoma and manifestation of a fistula occurred, and a 35-year-old man who developed 6 years after biopsy gradually an arteriovenous fistula with uncontrollable hypertension, hypercirculation syndrome and functional deterioration of the transplanted kidney. Superselective embolization led to improvement of the circulatory sequelae of the vascular shunt but did not have a favourable impact on renal function. Analysis of hitherto assembled experience indicates that direct ultrasound control of biopsy is effective. Because the manifestation of possible complications of biopsy need not follow immediately after the operation ultrasound follow up of native and transplanted kidneys after biopsy is justified even after a longer time interval after the operation.

Adult↗
PubMed2000

[Induction of myocardial neoangiogenesis by human growth factors. A new therapeutic approach in coronary heart disease].

Currently available approaches for treating human coronary heart disease aim to relieve symptoms and the risk of myocardial infarction either by reducing myocardial oxygen demand, preventing further disease progression, restoring coronary blood flow pharmacologically or mechanically, or bypassing the stenotic lesions and obstructed coronary artery segments. Gene therapy, especially using angiogenic growth factors, has emerged recently as a potential new treatment for cardiovascular disease. Following extensive experimental research on angiogenic growth factors, the first clinical studies on patients with coronary heart disease and peripheral vascular lesions have been performed. The polypeptides fibroblast growth factor (FGF) and vascular endothelial growth factor (VEGF) appear to be particularly effective in initiating neovascularization (neoangiogenesis) in hypoxic or ischemic tissues. The first clinical study on patients with coronary heart disease treated by local intramyocardial injection of FGF-1 showed a 3-fold increase of capillary density mediated by the growth factor. Also, angiogenic growth factor injection intramyocardially as sole therapy for end-stage coronary disease showed an improvement of myocardial perfusion in the target areas as well as a reduction of symptoms and an increase in working capacity. Angiogenic therapy of the human myocardium introduces a new modality of treatment for coronary heart disease in terms of regulation of blood vessel growth. Beyond drug therapy, angioplasty and bypass surgery, this new approach may evolve into a fourth principle of treatment of atherosclerotic cardiovascular disease.

Angiogenesis Inducing Agents↗
PubMed2000

[Use of the internal jugular vein as the outflow tract in arteriovenous shunts for hemodialysis] .

In the presence of a long stenosis or an occlusion in the axillo-subclavian venous tract, the vena jugularis interna can be useful as an outflow tract in arteriovenous shunts for haemodialysis. The use of this vein was indicated for primary shunts with vascular grafts and also for treatment of venous hypertension of the upper limb. In both these indications a 6 mm ePTFE (GORE) prosthesis was used. Regular follow-up by Doppler ultrasound was useful for diagnosis of a developing of stenosis in these shunts. With early treatment of these stenoses the long-term function of these shunts could be ensured.

Arteriovenous Shunt, Surgical↗
PubMed1999

Aneurysm of the subclavian artery.

In this case report about a female patient with a true aneurysm of the left subclavian artery (SAA), the authors would like to present the symptoms, possibilities of diagnostics and management of this rarely appearing pathology. The diagnosis of a randomly found aneurysm in a symptom free patient was confirmed by spiral AGCT. Classical surgical procedure was indicated for the patient. With a combined supra- infraclavicular approach the partial resection of the aneurysm and its revascularization by a ePTFE prosthetic interposition were performed. A histological investigation showed nonspecific changes in the aneurysm wall. Two years after the operation the patient is without any complications and with complete functional vascular reconstruction and optimal limb function.

Aneurysm↗
PubMed1999

[Late infections of aortic prostheses].

The authors present their experience in late infection of aortoilliacofemoral reconstruction by means of the Dacron vascular prosthesis. They found such complication in 8 of 620 (1.5%) reconstructions in that region in period 1988-1998. There is essential position of scintigraphy (Le 99mTc-HMPAO) and CT in diagnostic of location and extent of an affection. Conservative approach and local surgery were not permanently successful. The alternative approach is radical removing of the whole graft. The alternative of aortofemoral reconstruction is axillobifemoral bypass using ePTFE graft in case of an infection of the bifurcation graft.

Aged↗
PubMed1998

[Importance of examination of the portal circulation using contrast media when there are indications for surgical anastomosis].

In a group of 79 patients hospitalized on account of haemorrhage associated with portal hypertension the authors evaluate the diagnostic yield of radiological and sonographic methods. Sonography is a non-invasive procedure and is useful for routine checks of the function of the anastomosis. Direct contrast examinations are essential in preoperative reflections and for evaluation of possible complications of an already established shunt. Indirect procedures are in the latter two instances inadequate and unreliable.

Contrast Media↗
PubMed1998

[Palliative treatment of inoperable esophageal stenoses using stents: long-term results, complications].

The authors evaluate the effectiveness of palliative treatment of inoperable oesophageal stenoses by means of self-expandable stents in a group of 102 patients and discuss complications. In all patients after implantation of the stent dysphagia improved by at least two degrees. Eighty nine patients of the group died, the mean period of survival was 107 days. At the time of evaluation 13 patients survive, the mean survival period being 175 days. As to complications the authors recorded incomplete expansion of the stent (n = 1), fissuring of the tumour (n = 1), migration of the stent (n = 8), oesophagorespiratory decubital fistula (n = 4), ingrowth of the tumour into the stent (n = 4), obstruction of the stent by food (n = 7) and arterial haemorrhage (n = 1). The effectiveness of palliative treatment of inoperable oesophageal stenoses by self-expanding stents is high and prompt. The total number of complications is 22%, the mortality after surgery is zero. The majority of complications is easily resolved by methods of interventional radiology.

Esophageal Neoplasms↗
PubMed1997

[The role of the portosystemic shunt in modern treatment of portal hypertension].

The authors discuss the importance of portosystemic anastomoses in contemporary treatment of portal hypertension, in particular in relation to TIPS. As a basis they use their own experience with 28 portosystemic anastomoses during the last five years and conclude that a correctly indicated anastomosis has certain advantages over TIPS. The basic requirements for indication of surgical peripheral portosystemic anastomoses are: 1. stage Child A (or onset of B), 2. posthaemorrhagic conditions, 3. satisfactory general condition, 4. stabilized liver disease and planned surgery.

Humans↗
PubMed1996

[Establishment of arteriovenous anastomoses with interposition of ePTFE (Goretex) prostheses].

The authors remind of the possibility to establish an arteriovenous anastomosis by interposition of an ePTFE prosthesis into the subclavian to brachial artery with an outflow into the subclavian or internal jugular vein. The method is suitable for case when the autologous circulation is exhausted and calls for perfect peroperative evaluation of the vascular system of the patient with subsequent careful monitoring of the function of the anastomosis.

Adult↗
PubMed1996

[Present possibilities of correction of biliary tract injuries].

The authors discuss and evaluate contemporary possibilities of repair of injured biliary pathways. As a basis they use their own experience of surgical treatment, endoscopic and percutaneous approach. They present groups of 43 patients treated by surgery, 9 treated by the endoscopic and 7 treated by the percutaneous approach. During treatment classical biliodigestive anastomoses were used, nasobiliary drainage, dilatation and stents. From comparison of the different groups and the therapeutic results the authors conclude that modern endoscopic and percutaneous methods are a great asset to the treatment of injured biliary pathways but only in case of their precise indication. Perfect interdisciplinary collaboration is essential.

Biliary Tract↗
PubMed1994

New possibilities of miniinvasive treatment of esophageal stenoses.

We report our first very good experiences with the treatment of inoperable, especially malignant stenoses of the esophagus, with perorally inserted metallic self-expanding stents. During the period since August 1993 up to now, we have introduced 17 stents in 15 patients. We have compared the introduction of stents with other modalities of palliative treatment of esophageal stenoses, as actinotherapy, contact or focused laser, palliative by-pass surgery, classic surgical or endoscopical stenose-pertubation. In the last place for the patient stands the dismal nutrition-gastrostomy. From this point of view, the miniinvasive treatment with metallic stents is very successful, easy, well tolerated by the patients, and practically without complications. The therapeutical effect, elimination of severe swallowing-discomfort, allows especially to patient with malignancies to live terminal months of life with a relatively maximum quality of deglutition.

Catheterization↗