Biomedical subjects
Publications and source records attributed to S Horsch.
"Exulceratio simplex Dieulafoy" is a rare cause of massive upper gastrointestinal haemorrhage from a submucosal artery. Dieulafoy's disease is rarely recognized. We present 9 cases of Dieulafoy's lesion and have collected 176 cases described in the literature.
Intraoperative monitoring of brain function is desirable in carotid artery surgery to detect possible complications, but the monitoring methods must be simple to perform, sensitive, and reliable. Median nerve somatosensory evoked potential (SEP) monitoring fulfills these criteria. Between 1985 and 1990, we performed 994 operations of the carotid artery with SEP monitoring. In 92% of the cases, we were able to obtain viable SEP tracings. In seven cases, irreversible SEP loss was followed by a new neurologic deficit. In one case only, neurologic complications ensued without SEP loss. Although immediate intraoperative therapeutic options are limited, the monitoring enhances patient security by allowing intraoperative detection and postoperative analysis of complications. SEP monitoring appears to be at least as effective as conventional EEG monitoring. The viability, sensitivity, and reliability of newer methods, such as modified spectral EEG analysis, must be measured by this established procedure.
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A synthetic, monofilament, absorbable suture material, polytrimethylene carbonate, was tested to determine its suitability for use in arterial anastomoses. The material studied is a copolymer made of trimethylene carbonate and polyglycolic acid, with a retention time in the tissue of up to six months. In an experimental group of 12 mongrel dogs, using simple end-to-end anastomoses, aortic and femoral patch grafts of bovine heterograft material and iliofemoral bypass implants of 5 mm of expanded polytetrafluoroethylene prostheses were performed and arteriographically and histologically documented. Direct intraindividual comparisons were made with the absorbable (polytrimethylene carbonate) and nonabsorbable (polypropylene, expanded polytetrafluoroethylene suture) materials, a total of 108 anastomoses. No suture material-related complications such as ruptures or suture line aneurysms occurred. Polytrimethylene carbonate sutures led to less inflammation and scar tissue formation than polypropylene sutures. Complete absorption of the suture material by hydrolytic decomposition was followed by an almost complete regeneration in all layers of the vessel wall. Regeneration of the connective tissue structures of the media was noted. Initial associated reactions in the intima eventually disappeared. Both suture materials were equivalent histologically in the early months of the study, but after 10 month follow-up differences were observed, especially in the structure of the media, apart from the fact that polytrimethylene carbonate is absorbed completely after four to seven months.
Clinically implanted prostheses of biological origin have recently been shown to develop aneurysms within several years. To study this process, recently developed bovine heterografts that were implanted in canine ilio-femoral arteries for 27 to 45 months, were studied in vivo and in vitro. Seven out of seven grafts were patent with only one showing evidence of focal aneurysm. Measurements of mechanical properties, including water permeability, compliance, and burst pressure, and of heat shrink temperature and dry weight were obtained before and after a period of controlled exposure to bacterial collagenase; all data suggested that much of the original graft had been replaced with host tissue. However, enzyme susceptibility was less than that of fresh bovine arteries, indicating that at least some of the grafts' crosslinked collagen was preserved. The compliance of these explants was similar to that reported for autogenous vein. Histological examination of the graft wall revealed cellular "intimal" and adventitial zones containing host-generated collagen surrounding a central zone devoid of cellular infiltration, which appears to be unmodified graft "media" highly resistant to degradation. We conclude that, when properly processed, biological prostheses can act as a bioresorbable scaffold for the orderly replacement of structural elements during healing, promoting continued mechanical integrity of the graft. These promising results encourage the further development of prostheses of biological origin.
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Percutaneous transluminal angioplasty (PTA) is an accepted technique in the treatment of occlusive vascular disease. We report complications associated with balloon catheter dilatation and their treatment in the period from 1. 1. 1986 to 31. 3. 1990. Complications were found at the site of dilatation and the site of insertion of the catheter, mostly in the pelvic and femoral region. Surgical correction was successful in all patients, however three patients died postoperatively of acute myocardial ischemia. To avoid these complications close co-operation between the radiologist performing the dilatation and the vascular surgeon managing the complications should be assured.
The appendectomy-rate in the Federal Republic of Germany is decreasing. German surgeons have begun to refuse appendectomy if there are no signs of acute inflammation. Preoperative assessment of patients with right lower quadrant pain has acquired new significance. The authors report on 2 years of experience with routine use of high-resolution ultrasonography in 669 cases of suspected acute appendicitis. Only 101 patients (= 15.1%) turned out to be suffering from acute appendicitis. Ultrasonography evaluation was found to have a sensitivity of 84.2%, a specificity of 96.8% and an overall accuracy of 94.9%. Ultrasonography was also useful in detecting mimicking diseases of acute appendicitis. Sonography should help to rule out severe disease in the frequent cases of functional abdominal pain.
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A review of the embryology, pathophysiology semiotics and surgical treatment of malformations of the inferior vena cava is given based on 3 clinical histories. The cases consisted of a typical membrane occlusion, an atresia of the infrarenal segment and of a hitherto not described combination of several malformations of the inferior vena cava: membrane occlusion, aplasia of the infrarenal segment of the vena cava inferior and multiple aneurysms of the iliac vein. The symptomatology of malformations of the vena cava inferior depends on the compensation by the collateral or the persisting embryonic veins, respectively, and on the localization and the degree of the obliteration. The varying hemodynamic reactions are described. The following surgical methods for the treatment of inferior vena cava occlusions in the hepatic segment are available: The so called conservative interventions for the creation of collaterals, the direct or indirect recanalization and the bypass operation. Congenital infrarenal atresias of the vena cava are corrected by homologous or prosthetic interposition. The venous replacement with a bovine heterograft presented here, has not yet been described in the literature.
Results of animal experiments are presented on the applicability in the low pressure system of a collagen prosthesis, which has been used successfully, for considerable time, in the arterial replacement in patients and dogs. Grafts of up to 7 cm in length were implanted into the suprarenal segment of the inferior vena cava (v. cava caudalis) in dogs and observed clinically over a period of more than 500 days. Histological investigations were made. With some limitations the results obtained are considered as good and point towards the applicability of the examined graft material in the low pressure system.
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A pedunculate patch, obtained from a disconnected segment of jejunum, was implanted into the longitudinal incision of the ductus choledochus. Intra-operatively, the findings were based upon direct cholecystocholangiography; postoperatively, upon laboratory tests. After an observation period of 12 months a new cholangiography of the transplant was made along with a selective picture of the mesenteric arteries. The choledochus duct with the transplant was examined histologically. Three dogs died immediately postoperatively of peritonitis due to suture insufficiency. Five dogs died of invaginate ileus. These animals, as well as the remaining 8 dogs showed macroscopically and microscopically a smooth and uneventful healing of the transplant at the end of the observation period. Radiographies showed free flow of the biliary duct system. The selective mesenteric arteriographies evidenced beginning anastomosis between the transplant and the capillaries of the bile duct. Based on the results presented, the pedunculate jejunal graft can be considered well suited as an expansion graft for the bile duct.