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Biomedical subjects

O Wagner

Publications and source records attributed to O Wagner.

At least 127 records · Page 7Linked to original sources
PubMed1982

The PTFE Y-graft: one year experience in 21 patients. A preliminary report.

21 patients had aortoiliac reconstructions for aortic aneurysms or occlusive disease with the new PTFE Y-graft during the past 12 months. 2 patients in the aneurysm group with additional renal artery reconstruction suffered postoperative myocardial infarction and subsequently died. 2 patients older than 80 years died after aneurysm repair in cause of graft infection, respectively respiratory insufficiency. All grafts (n=17) are functioning well or did so until death of the patient (n=4). The obvious advantage of the PTFE Y-graft is the fact, that there is no need of preclotting. Suture line--even using 4-0 material at the proximal anastomosis--and graft body is absolutely tight and no blood loss has to be expected from this site. However positioning of the left limb of the y-graft can be difficult in patients with right sided extraperitoneal approach and proximal side end anastomosis. Performing an end-end anastomosis can overcome this problem. For occlusion of the prosthesis limbs two vascular clamps on each side are needed to control blood flow within the rather stiff graft. Immediate and short term function is excellent. There was no material specific complication noted until now. Further longterm experience is necessary to evaluate the definitive quality of this new prosthetic material after some years.

Aged↗
PubMed1982

[Ischemia syndrome of the upper extremities not due to cardiac causes. Proximal arterial stenosis with embolization into the periphery].

Five cases are reported with the pathological entity of proximal arterial stenosis and embolization into the peripheral vascular bed. Therapeutic management, e.g. diagnostic work-up, eradication of the embolic source and embolectomy of the peripheral arterial tree - if technically feasible - seems beyond any doubt. Sometimes the diagnosis is difficult to obtain, since in the upper extremity microembolic seeds occur, posing a differential diagnosis problem. Once a partial sternotomy and in situ removal of the lesion was employed, in the remaining cases extrathoracic repair was done. In the left subclavian artery using a carotid-subclavian-anastomosis, we obtained satisfactory results, in the right subclavian and end-to-end-anastomosis was performed after resection of the diseased arterial segment.

Adult↗
PubMed1982

[Repair of internal carotid artery stenosis. Results of reconstruction in 129 patients].

128 Patients were operated upon consecutively since 1965 for lesions of the carotid bulb (stadium I.: n = 21;stadium II: n = 45;stadium III: n = 33; stadium IV:n - 29), a postoperative neurological deficit was noted in 4,7%, the cerebral lethality was 1,9%. The procedure was done in general anesthesia with moderate elevation of the systemic blood pressure. In case the pressure readings obtained in the stump of the internal carotid artery were below the level of 50 mm of mercury an intraluminal shunt was used. Considered an average lethality of 7% per year 48 patients died during follow-up, 5 for cerebral. 10 for internal medical reasons, in 33 cases the results of post mortem examination was not available. After a mean follow-up time of 7 years 41 patients were re-evaluated 4,8 recurrent stenoses, 2,4% intracranial and 9,4% changes in the contralateral carotid artery were detected. Only 4,8% showed abnormalities on neurological examination, which underscores the importance of non invasive diagnostic tools.

Adult↗
PubMed1981

[Problems arising in connection with surgical management of renovascular hypertension (author's transl)].

65 consecutive renal artery stenosis reconstructions for the treatment of severe renovascular hypertension are reported. 63% of the cases were males, 37% females. The disease was caused by arteriosclerosis in 66% of cases and in 23% by fibromuscular dysplasia or other pathological changes of the renal artery; the mean age was 47 in the former. and 31 years in the latter group. An aortorenal saphenous vein bypass was performed in 35% cases, a dacron graft was used in 29% and thrombendarteriectomy was carried out in 23% cases. Positive results were achieved in 68.8% of the patients. 63% of the females became normotensive. Operative mortality due to faulty technique was 4.9% initially. The operative mortality has been zero since 1973. nor have there been any therapeutic failures on a technical basis. No significant correlation was established between age of the patients and result of operation.

Adult↗
PubMed1981

[The value of intraoperative arteriography in detecting complications of vascular surgery in the femoro-popliteal and crural region (author's transl)].

The intraoperative angiography was employed in 307 vascular reconstructive procedures (thrombendarterectomies (TEA) n = 107 = 34.8%; Veinbypass (VBP) n = 145 = 47.2%; fabric grafts (KBP) n = 44 = 14.4%) within the femoro-popliteal and crural region. 11.7% unsuspected technical errors were detected (TEA 18.6%, VBP 8.2%; KBP:6.8%) by angiography and successfully revised prior to wound closure. Errors were most common after thrombendarterectomies followed by VBP and KBP. Revisions after immediate failures were performed successfully in 7.4% (TEA : 8.4%, VBP: 5.5%, KBP: 6.8%). Lesions on X-ray of questionable significance were accepted in 6.8%, and followed by 4 immediate occlusions (1.7%). In 3.6% of the angiogramms the film was not satisfactorily exposed from the technical point of view. We think intraoperative angiography is a valuable adjunct in peripheral vascular surgery helping to detect and correct technical errors.

Angiography↗
PubMed1981

Failure of cimetidine to prevent gastroduodenal ulceration and bleeding after renal transplantation.

Treatment of renal transplant patients with the H2-antagonist cimetidine has previously been assumed to be of reasonable prophylactic value in controlling the incidence of the postoperative complications of gastric or duodenal ulceration. We attempted to evaluate the performance of the drug in a controlled trial by treating transplant patients with either cimetidine or a placebo. Of the 59 patients accepted for the trial, four had to be excluded eventually because of irregularities in the administration of the drug and, in on case, nonfatal respiratory failure. Six of 27 from the cimetidine group had erosions or ulcers by the third day after surgery and two more had them by the end of the fourth week. Three of 28 placebo patients developed lesions after 3 days and three more developed them after 7 weeks. In the months after transplantation, one cimetidine and two placebo patients developed ulcers. Bleeding occurred three times with cimetidine and twice with the placebo. Renal function was similar in both groups as was the necessity of transplantectomy because of irreversible rejection. We conclude that cimetidine does not lower the incidence of gastroduodenal mucosal lesions and upper gastrointestinal bleeding after renal transplantation, nor does it influence rejection of the allograft.

Adolescent↗
PubMed1981

[Sparks grafts as arterial substitutes in the femoro-popliteal region with a postoperative follow-up of up to 54 months].

39 Sparks-Mandril grown grafts were implanted as arterial substitute in the femoropopliteal region and followed up for a minimum of 36 and a maximum of 57 months. At 7 instances it was not possible to perform the connecting procedure, 18.7% immediate occlusions, 28.2% early failures within the first postoperative year, 12.5% pseudoaneurysmal changes were noted. 13 patients (40.6%) demonstrated function for more than one year. Dilatation, elongation and parietal thrombosis over the whole length of the graft (2 cases) and late reocclusion turned out to be the main problems. Only 2 patients carry a properly functioning graft.

Aged↗
PubMed1980

[Enlargement and complications of symmetrical aneurysms of the femoral artery--a case report (author's transl)].

The enlargement of symmetrical aneurysms of the femoral artery was followed up angiographically in a 67 year-old patient. The left aneurysm caused compression of the femoral vein and disturbance of venous outflow; surgical removal of the aneurysm, followed by Gore Tex bypass, resulted in a normalisation of arterial inflow and venous outflow. Rupture of the right aneurysm was immediately treated as a surgical emergency and a Gore Tex bypass was implanted on this side too. This unusual case and its complications and treatment is compared with, and discussed in the light of reports of similar cases in the literature.

Aged↗
PubMed1980

[Comparison of effects of hydroxyethylstarch (HES 200/0.5) administered pre- and postoperatively in vascular surgery with dextran 40 (60) (author's transl)].

In a randomised study comprising 16 patients undergoing vascular surgery of the lower extremities blood replacement was performed after preinfusion of either 500 ml 10% hydroxyethylstarch (LMW-HES) or 10% dextran 40 (followed by dextran 60 intraoperatively). After infusion of 500 ml within 30 min preoperatively there was a significant rise in PCWP, PAP, RAP and CI accompanied by an increase in blood volume and colloid osmotic pressure, whereas hematocrit fell. No difference between the two plasmasubstitutres was found, prolonged infusion of HES, however, caused a lesser rise in cardiac pressures and blood volume. Overloading of the circulation could be ruled out by ECG, Frank-Starling curves, blood gases, observation of total pulmonary vascular resistance and vascular filtration pressure. The modified haemodilution technique suggested, using preoperative priming without blood drainage and subsequent dilution by blood replacement up to a total amount of 1,500 ml by HES or dextran thus seems to be free of risks and may be recommended. For monitoring purposes during prolonged operations not only filling pressures should serve as a guideline, determination of blood volume and fluid balance being imperative.

Blood Viscosity↗
PubMed1979

[The locked-in-syndrome (author's transl)].

On the basis of two cases some problems of the locked-in-syndrome are discussed. In most cases the cause of the syndrome is an infarct in the ventral part of the pons due to an occlusion of the vertebral or basilar artery. There is a total loss of movement exept for the movement of the eyes in all directions and the eye-closing. Although vigilance is almost not disturbed the complete loss of movement often results in a false diagnosis of cerebral coma. The EEG is an important diagnostic aid.

Adult↗
PubMed1978

[Spontaneous rupture of renal allografts (author's transl)].

Spontaneous rupture of an allografted kidney is not such a rare complication of kidney transplantation. In our series 5.2% of the transplanted kidneys ruptured spontaneously. The condition is an acute emergency characterized by the triad, acute abdomen, swelling in the region of the transplant and haemorrhagic shock. The aetiology of transplant rupture seems to be multifactorial, but the superimposition of an acute rejection episode on ischaemic tubular damage with acute renal failure was found to be the most important combination of events leading to transplant rupture in our patients. Exceptionally precise immunological monitoring in the early phases following transplantation and early aggressive therapy of an acute rejection crisis associated with acute renal failure should prevent allograft rupture.

Abdomen, Acute↗
PubMed1978

[Prolonged renal graft survival after repeated blood transfusions (author's transl)].

In order to investigate the influence of pretransplant blood transfusions on renal graft survival, the results in 43 recipients with 10 or more transfusion (group A) were compared with those in 48 recipients with less than 10 or no transfusions (group B). In both groups cadaveric kidneys with mainly 3 or more mismatched histocompatibility antigens were transplanted. The incidence of preformed cytotoxic antibodies was similar in both groups (25.6% and 22.9%, respectively). The cumulative renal graft survival rate was significantly higher in the poly-transfused group: 85.6% +/- 6.1% and 73.4 +/- 7.9% after 1 and 2 years, respectively, in group A in comparison with 73.9 +/- 6.6% and 63.3 +/- 8.1% after 1 and 2 years respectively, in group B (Wilcoxon rank sum test: p less than 0.05). Severe renal rejection with a serum creatinine above 3 mg/100 ml was more frequently observed in group B than in group A. Enhancement due to blocking antibodies must be assumed as a possible explanation for the favourable effect of repeated pretransplant transfusions on graft survival rates.

Antibodies↗