Biomedical subjects
Publications and source records attributed to P A Vogt.
The potentially fatal, surgical, and aesthetic complications of suction-assisted lipoplasty are discussed in this article. Prevention through early detection and risk management will be emphasized.
The technique of suction-assisted lipoplasty has opened up a whole new world of treatment possibilities for our patients. If patients are properly evaluated and properly informed, good results can be achieved on a routine basis. Preoperative evaluation and assessment are of utmost importance. A factual representation of the technique and its possibilities is essential preoperatively as with any other surgical technique. If the surgical principals and techniques are carefully followed, the morbidity of this procedure is very low.
Between 1960 and 1983, 38 patients underwent multiple operations for treatment of recurrent renovascular hypertension. There were 23 women and 15 men who ranged in age from eight to 69 years old (a mean of 48.5 years). The cause of hypertension requiring repeat operation was determined roentgenographically, three patients had new disease of the contralateral nonoperated renal artery, 21 patients had a new lesion of the ipsilateral (previously operated) renal artery and 14 patients had new lesions of both the previously operated and nonoperated renal arteries. Thirty patients underwent a secondary unilateral operation and eight had a bilateral operation. Sixteen patients had unilateral renal artery revascularization, 14 had unilateral nephrectomy, three had bilateral revascularization and five had unilateral revascularization with contralateral nephrectomy. There were three operative deaths (an operative mortality of 7.9 per cent). At hospital dismissal, 30 of 35 patients were improved. Follow-up study ranged from seven months to 23 years (a mean of 7.2 years). There were eight (22.9 per cent) late deaths. Secondary revascularization alone produced improvement in 77 per cent. Nephrectomy alone produced improvement in 80 per cent. We conclude that secondary revascularization is the treatment of choice in patients with recurrent renal artery stenosis. Nephrectomy should be reserved for patients who cannot undergo a revascularization procedure for technical or medical reasons.
Between 1970 and 1982, 50 patients (38 male and 12 female) underwent revascularization of 51 occluded renal arteries. Ages ranged from 8 to 71 years (mean 54.6 years). Occlusion was caused by atherosclerosis in 43 patients, fibromuscular dysplasia in three, chronic dissection in two, abdominal aortic coarctation in one, and neurofibromatosis in one. Contralateral renal artery occlusive disease occurred in 22 patients. Extrarenal atherosclerosis occurred in 44 patients. Mean preoperative serum creatinine level ranged from 0.5 to 8.4 mg/dl (mean 1.9 mg/dl). No patient required preoperative dialysis. Length of the involved kidney ranged from 8.4 to 14.5 cm (mean 11.5 cm). Indication for renal revascularization was hypertension in 49 patients and preservation of renal function in one. Renal artery bypass was performed in 36 patients, renal artery endarterectomy in six, transaortic endarterectomy in five, and reimplantation of the renal artery in three. Simultaneous revascularization of the contralateral renal artery was performed in 20 patients. There were three operative deaths. At hospital dismissal, hypertension had improved in 45 of 46 patients. Follow-up periods ranged from 4 months to 12 years (mean 50.2 months). Thirty-four patients remained normotensive, five still had less hypertension, and seven became worse. These data demonstrate that revascularization of an occluded renal artery can be effective in controlling hypertension and that this effect is durable in the majority of patients.
The subject of this paper is a study designed to compare power-assisted lipoplasty (PAL) to traditional lipoplasty (TL) in 30 patients. PAL was used on one side and TL was used on the matching contralateral body area. In PAL, a cannula powered by medical-grade nitrogen (N(2)) reciprocates between 2000 and 4000 cpm with a 2-mm stroke. The device is commercially offered by MicroAire Surgical Instruments. While there was no difference in the speed of recovery or in the aesthetic quality of the result between the two sides, PAL was found considerably superior as far as ease of fat extraction.
We report a patient with aortic regurgitation and ischemic heart disease in whom normal, effortless micturition repeatly precipitated angina. To our knowledge, only one other case of micturition angina has been reported in English literature since the first such case was recorded in the 17th century. The mechanism of production of this syndrome remains obscure.