Biomedical subjects
Publications and source records attributed to S Weimann.
The etiology, diagnostic difficulties and treatment of five cases of aortointestinal fistulas are presented. In all of them, endoscopy played a major diagnostic role. Early diagnosis is essential for elective surgery since reconstruction in the massive bleeding stage has a mortality of up to 80%.
We report a case of traumatic renal artery occlusion treated successfully by reconstruction several years after the injury. Hypertension resulted in diagnostic investigation by means of excretory urography, computerized tomography, angiography and perfusion scintigraphy. Treatment consisted of a thin-walled polytetrafluoroethylene (Gore-Tex) bypass between the aorta and left renal artery near the hilus. When the patient was discharged from the hospital the creatinine level was normal and blood pressure was 180/90.
Between 1984 and 1986, 38 patients--25 males and 13 females--underwent treatment for proximal subclavian arteriosclerotic lesions. All of these patients presented with symptoms of the subclavian steal syndrome and 13 (34.2%) had additional claudication of the arm. Preoperative angiography showed distal filling of the subclavian artery via retrograde flow in the vertebral artery. 31 patients (81.5%) had total occlusion of the proximal subclavian artery and 7 (18.5%) presented with severe stenosis. 34 of these lesions were on the left (89.5%) and 4 on the right side (10.5%). Complete cerebral angiography was performed in each patient with emphasis on visualisation of the carotid bifurcation and selective opacification of the aortic arch vessels if indicated. Doppler ultrasound flow measurement in the vertebral artery yielded the basic data which were then used for comparative postoperative evaluation. The operation was performed under general anaesthesia and heparinisation. A shunt was not required while performing the direct end-to-side anastomosis between the transected subclavian and the common carotid artery. Arteriosclerotic plaques in the distal stump of the transected subclavian artery and occasionally the origin of the vertebral artery were dealt with by simple eversion endarterectomy. There was no operative mortality; the postoperative complication rate was 13.1% including palsy of the recurrent nerve in 3 patients, a lymphatic cyst of the neck in one patient and bleeding requiring re-exploration in another. Occlusion of the reconstructed artery or neurologic deficit did not occur. Post operatively all patients were treated with platelet inhibitors. The average follow-up period was 13 months, when the reconstructed arteries were found to be patent in 37 patients (97.4%).(ABSTRACT TRUNCATED AT 250 WORDS)
Arteriovenous fistulas between the common iliac vessels are rare; at the present time, only 56 cases have been reported. Forty-seven (83.9%) of these fistulas were secondary to either trauma or surgery for herniated intervertebral disks and nine (16.1%) were caused by aneurysmal disease. Physical examination is very difficult because only 30% of the patients with iliac artery aneurysms have palpable masses before rupture; approximately 60% of the patients already have ruptures at the time of diagnosis. Therefore a high degree of suspicion is necessary and early use of angiography is commendable. Surgical intervention consists of closure of the fistula, resection or ligation of the aneurysm, and restoration of vascular continuity. The survival rate after elective resection is 93%, whereas the operative mortality rate in patients operated on for ruptured iliac artery aneurysms is 52%.
A case of pulmonary embolism secondary to a clinically unsuspected aneurysm of the popliteal vein is presented. The importance of venography in establishing the source of pulmonary emboli is stressed in comparison to other diagnostic investigations such as ultrasonography, computed tomography or pletysmography. The aneurysm was suitable for local venous reconstruction. Previously reported cases are reviewed, etiology, diagnosis and treatment of this uncommon condition are discussed.
This is a report on a patient with a mycotic aneurysm of the superior mesenteric artery proved by histology. Because of a marked intolerance of contrast media we abstained from angiography. It is shown that real-time sonography gives a definite diagnosis, if the multiple vascular structures of the upper abdomen are precisely identified.
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On account of feared postoperative deterioration of the neurological condition and the high mortality, the indication for surgical therapy of a stroke of extracranial origin is often questioned. The mortality rate lies between 6.5% and 42%. Compared with the spontaneous healing process of the apoplectic insult by means of conservative therapy this demonstrates on average a smaller early mortality with a simultaneous higher remission rate of the neurological findings of maximally 70% compared with 48%. 90% of the predominantly arteriosclerotic carotid occlusions occur in the bifurcation area. 40% of the cases undergo additional stenosis or occlusion of the remaining arteries of the brain. Because of the knowledge of the pathogenesis and the pathophysiology of brain oedema on the remaining arteries of the brain. Because of the knowledge of the pathogenesis and the pathophysiology of brain oedema on the one hand, and the periodic relationship of carotid occlusion and incipient thrombosis on the other hand, the 6-hour limit is considered of great significance for operational success. The condition of angiographically-visible intracerebral collateralization and the strict elimination of all patients with unconsciousness or paralysis set forth further important criteria which must be fulfilled before operative procedures are contemplated. The performance of cerebral panangiography gives additional information about stenosis or occlusion of the other arteries. Indications for operation of extracerebral carotid occlusion must be determined individually on the basis of the above-mentioned guidelines.
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The operative results of 115 patients with pilonidal sinus are described. The patients were controlled in 1977, 2 to 11 years after surgery. Only small, non-infected pilonidal sinuses should be radically excised followed by primary suture and Redon-drainage. For extended sinuses and for recurrences the best results are obtained when the wound is left open or marsupialisation is applied. Pilonidal sinus-abscesses should be incised. This simple procedure resulted in primary healing in 23% of our patients.
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Problems of 39 patients with permanent colostomies/ileostomies are investigated one up to seven years after having got the anus praeternaturalis. The postoperative problems of everyday life are various and often serious, they are the more severe, the less patients had been informed preoperatively and the older the patients are. Younger and more intelligent patients integrate the colostomy easier and more quickly in their everyday life. Very useful for rehabilitation is the close contact between patient and the surgeon, respectively special colostomy-consulting hours.
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