Biomedical subjects

R O HEIMBECKER

Publications and source records attributed to R O HEIMBECKER.

At least 19 recordsLinked to original sources

PubMed1965

CLINICAL RESULTS OF THROMBOENDARTERECTOMY FOR PERIPHERAL ATHEROSCLEROTIC OCCLUSIVE DISEASE.

Thromboendarterectory of atherosclerotic vessels may restore luminal flow by removal of the occluding thrombus and thickened, ulcerated intima. This operation has been performed on 43 occasions for aortoiliac and femoropopliteal occlusive lesions with significant distal ischemia. The early and late results have been entirely satisfactory, confirming the worth and durability of the procedure, particularly for limb salvage. The widespread and progressive character of the atherosclerotic process, however, may compromise the operative and late results by involvement of vital arteries or distal small vessels. Complete angiographic assessment from the abdominal aorta to beyond the popliteal bifurcation is essential in the proper selection of patients. Thrombo-endarterectomy is recommended for the management of segmental occlusive lesions primarily, but gratifying results may be obtained in extensively diseased arteries unsuitable for bypass grafting.

Angiography↗

PubMed1965

THE SURGICAL TREATMENT OF 71 PATIENTS WITH ESOPHAGEAL VARICES.

The clinical course of 71 patients with esophageal varices who were treated surgically at the Toronto General Hospital in the 17-year period 1947-1964 was reviewed. Forty-five portacaval anastomoses, 19 splenorenal anastomoses and seven transesophageal ligations were performed. The splenorenal shunt was 62% effective and the portacaval shunt 89% effective in preventing further hemorrhage. The end-to-side portacaval shunt was the preferred operation. The overall hospital mortality from a shunting procedure (including emergency procedures) was 17%. The mortality rate was much lower in patients with reasonably normal liver function than in those with elevated serum bilirubin, lowered serum albumin, or refractory ascites. Over 70% of the patients were still alive three years after surgical treatment of the portal hypertension.

Ascites↗

PubMed1965

AN EVALUATION OF THE LATE RESULTS OF AORTIC VALVE REPAIR.

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Aortic Valve↗

PubMed1964

AN AORTIC TAMPON FOR EMERGENCY CONTROL OF RUPTURED ABDOMINAL ANEURYSM.

Ruptured abdominal aneurysm has now become a common surgical emergency, frequently amenable to successful resection and cure. The final result is often marred, however, by the effects of renal, coronary or cerebral ischemia resulting from dangerous hypotension during transportation of the patient to a vascular centre.An aortic catheter has been developed which is passed by way of a brachial artery cut-down so that it rests in the abdominal aorta. The balloon at its tip is then filled with sodium diatrizoate (Hypaque) so that it completely obstructs the aortic lumen just above the level of the aneurysm. Accurate positioning of the balloon to carefully preserve renal blood flow is facilitated by fluoroscopic control. The use of this procedure in three patients has been very satisfactory, with a dramatic return of consciousness and of normal blood pressure, without the need for further blood replacement. Subsequent surgery with dissection of the aneurysm was aided by the presence of the palpable inflated balloon.

Abdomen↗

PubMed1964

THE IMPLANTABLE CARDIAC PACEMAKER.

The transistorized implanted pacemaker is proving to be an effective and reliable method for long-term pacing of the heart. All patients suffering from Stokes-Adams seizures were first given a trial period of conservative therapy, including isoproterenol (Isuprel), ephedrine, atropine and steroids. Twenty-four pacemaker implants were performed on 23 patients over a 21-month period. The preoperative insertion of a pacemaker cardiac catheter was a very valuable safety precaution. In this way the heart could be safely and reliably paced during the period of preoperative assessment and during the critical periods of anesthetic induction and thoracotomy. Infection did not occur, probably because of careful gas sterilization of the units. Various models of pacemakers are compared, and the reasons for two pacemaker failures are presented. There were two early deaths and one late death in the series. The relationship of progressive coronary disease to recent infarction is stressed. Patients having intermittent heart block frequently showed the picture of "competing pacemakers" postoperatively, but without deleterious effect. Twenty patients, between 54 and 88 years of age, are alive and well at the time of reporting, with excellent pacemaker response and no further Stokes-Adams attacks.

Adams-Stokes Syndrome↗

PubMed1964