Biomedical subjects
Publications and source records attributed to R Rettmann.
We report a case of inferior vena cava resection and reconstruction for recidivant renal cell carcinoma. We describe the collateral circulation of the renal veins and its importance in the treatment of inferior vena cava involvement. We debate of the indications and of the different surgical techniques for reconstruction of the inferior vena cava.
We report a case of renal adenocarcinoma with contralateral stenosis of the renal artery. We describe the causes of hypertension in renal cancer and investigative techniques leading to the discover of a vascular implication in hypertension. We debate of the different surgical techniques for renal revascularisation with special regard to splenorenal anastomose. This is the method of revascularisation used in this case.
We report 2 cases of surgically treated heterolateral adrenal metastasis from renal cell carcinoma. The value of the CT-scan in the diagnosis of adrenal pathology is debated. The substitutive hormonal treatment post bilateral adrenalectomy is discussed.
Four groups of experiments were focused on two problems: first, the replacement of the substracted amount of blood, and second, the correction of the peripheral reactions to substantial blood loss, namely vasoconstriction and acidosis. We stuck to a simple plan in our experiments: lost blood was entirely collected and retransfused. In 26 cases out of 37, we used isoproterenol hydrochloride (Isuprel - WINTHROP) to open the peripheral vascular bed. In six different groups, we followed the response to variations of retranfusion and administration of isoproterenol. Several parameters were studied: arterial blood pressure, central venous pressure, rectal temperature and pH. The association of blood transfusion with injection of isoproterenol, in adequate amounts to correct hypovolemia and to prevent vasoconstriction, is undoubtedly the best treatment of hemorrhagic shock.
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Aortoenteric fistulas are rare. Located at various level of the gastrointestinal tract - from the esophagus to the rectum - the most frequent are aortoduodenal, secondary to abdominal aortic aneurysms. Two new cases, successfully treated, are reported. The characteristic clinical symptoms are abdominal aortic aneurysm, pain and gastrointestinal bleeding; recurrent bleeding is usual; endoscopy is the accuratest method of early diagnosis. Aggressive surgical approach is mandatory: in addition to a prosthesis in uninfected area, even in extra-anatomical position, epiplooplasty between the graft and the gastrointestinal tract is recommended.