Single-stage vascular surgery for a ruptured inflammatory abdominal aortic aneurysm associated with septicaemia.
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Biomedical subjects
Publications and source records attributed to S O Hofer.
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OBJECTIVE: To determine a critical skeletal muscle oxygen tension (PO2) value below which a tissue oxygen debt develops. DESIGN: Descriptive study of oxygen transport values in relation to skeletal muscle PO2 throughout progressive ischemia by means of arterial blood flow reductions in an isolated hindlimb model in the pig. SETTING: Surgical Research department of the University of Amsterdam. SUBJECTS: Six female Yorkshire pigs weighing 26 to 35 kg (average 33). INTERVENTIONS: Controlled blood flow to the isolated hindlimb was achieved by means of extracorporeal circulation. The hindlimb was studied during progressive flow reduction. MEASUREMENTS AND MAIN RESULTS: Oxygen delivery (DO2) and oxygen consumption were calculated as the product of extracorporeal blood flow and, respectively, arterial oxygen content and arterial-venous oxygen content difference. In this fashion, an oxygen supply dependency could be determined in all animals. A critical DO2 value was determined below which a tissue oxygen debt developed. Skeletal muscle PO2 was measured continuously, using a Clark-type polarographic oxygen sensor. Combining the critical DO2 value with the corresponding skeletal muscle PO2 value resulted in a critical skeletal muscle PO2 value of 15.2 +/- 0.4 torr (2.0 +/- 0.1 kPa). CONCLUSION: In this pig model, a critical skeletal muscle PO2 value could be determined below which a tissue oxygen debt presumably developed.
A continuous intramuscular oxygen tension sensor was compared, with transcutaneous oximetry and laser Doppler flowmetry, during periods of arterial flow alterations in an isolated hindlimb model in the pig. The intramuscular oxygen tension sensor correlated well with bloodflow and was superior to the other two methods.
An intravascular oxygen tension (PO2) sensor (Continucath 1000) was used to assess flap viability in microsurgically revascularized free flaps for 36 hours postoperatively. In vitro, long term stability, linearity, and response time of the PO2 sensor proved to be excellent. In 14 patients with sound flaps tissue PO2 values were found to be between 15 and 35 mm Hg. In three cases a failing flap needed reexploration. In these cases the PO2 sensor was accurate in detecting circulatory failure while in other cases it traced a number of physiological changes. The device holds promise for free flap monitoring but further studies are indicated.
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An overview is given of the various aspects of idiopathic proctitis. Special emphasis is given on the diagnostic possibilities especially the endoscopic appearances. The list of other inflammatory conditions to be considered in the differential diagnosis is long and includes especially infectious disorders, Crohn's disease, post-radiation abnormalities, caustic damage and ischaemic damage. The mainstay of therapy is topical application of measalazine and corticosteroids. In general measalazine appears to be equally effective as corticosteroids.
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