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Biomedical subjects

T Schmitz-Rixen

Publications and source records attributed to T Schmitz-Rixen.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Chemical pleurodesis with iodized talcum in persistent therapy refractory bronchocutaneous fistula].

The common therapy of a persistent bronchocutaneous fistula is the operative endoscopic repair of the leak, the parietal pleurectomy or the endoscopic pleurodesis with different agents. Therefore the thoracotomy with all the risks for the patient can be avoid. Complications seen in the thoracoscopic treatment are low and often the result of techniqual problems. However there must be an alternative therapy for patients with a high operational risk. In our case we treated a bronchocutaneous persistent fistula by the instillation of iodized talc effectively. Although talc and others agents are used in the therapy of malignant pleural effusions, the talc poudrage in the therapy of bronchocutaneous fistulas is a good alternative treatment for patients in a bad condition.

Bronchial Fistula↗
PubMed1993

Compliance of vascular anastomoses with polybutester and polypropylene sutures.

PURPOSE: Polybutester suture is more easily stretched than other vascular sutures and may produce more compliant anastomoses. The effects of using polybutester and polypropylene sutures were compared acutely in arterial autografts and in chronic implants of cephalic vein grafts into the femoral arteries of dogs. METHODS: Paraanastomotic profiles of diameter and compliance were measured with echo-tracked ultrasonography, and profiles of intimal thickening were generated from histologic sections of the vessels harvested after 3 months. RESULTS: Polybutester produced more compliant anastomoses, compared with polypropylene, in arterial autografts (in vitro: 5.9% +/- 2.0% vs 3.3% +/- 0.6% diameter change/100 mm Hg, p < 0.01; in vivo: 3.1% +/- 1.1% vs 1.6% +/- 0.5%, p < 0.05), but this difference was not observed with vein as the graft material, either initially (1.1% +/- 1.2% vs 1.7% +/- 0.5%) or after 3 months (2.1% +/- 1.2% vs 2.4% +/- 0.8%). This dichotomy may reflect a governing influence of the stiffer veingrafts, compared with host artery (2.6% +/- 1.0% vs 5.4% +/- 1.2%), or the use of suboptimal tension on the polybutester suture when creating the anastomosis. CONCLUSIONS: Both sutures produced similar compliance and thickness profiles. Polybutester initially produces a more compliant anastomosis when both artery and graft are compliant, reducing anastomotic compliance mismatch. However, this benefit may not apply when the anastomosis includes a vessel of low compliance.

Anastomosis, Surgical↗
PubMed1993

[An aneurysm of the portal vein].

Portal vein aneurysms are rare. We describe a patient with an aneurysmal dilatation (3 x 4.5 cm) of the right portal vein. Real-time ultrasonography revealed an anechoic lesion communicating with the portal vein, suggesting a portal vein aneurysm. Colour Doppler, contrast-enhanced computed tomography, and portal venography confirmed the diagnosis. No evidence of portal hypertension was found. Follow-up examinations did not reveal a significant change in the size of the aneurysm after 18 months.

Adult↗
PubMed1992

[Necrotizing fasciitis. Case report and review of the literature].

The necrotizing fasciitis is an infection with no or only a small trauma. It is a rapidly progressing process especially with necrosis and edema of subcutaneous fat and adjacent fascia underlined by systemic toxicity but spearing of skin and muscle by the initial process. Late recognition and lack of immediate aggressive surgical treatment contribute to the distressingly high mortality. Early and complete debridement offers the best chance for cure.

Adult↗
PubMed1991

Vascular anastomoses with absorbable suture material: an experimental study.

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.

Anastomosis, Surgical↗
PubMed1991

Longterm study of a compliant biological vascular graft.

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.

Animals↗
PubMed1990

[The significance of sonography and computed tomography for the diagnosis of the intraperitoneal spread of tumors. Findings in 307 cases of peritoneal carcinosis].

Taking the results of 307 cases with peritoneal carcinomatosis, the diagnostic value of ultrasonography and computerized tomography in the detection of peritoneal spread of gynaecological and gastrointestinal tumors is discussed. Ascites is the most important, though nonspecific, symptom which can be detected with the greatest accuracy. Peritoneal nodular lesions as well as omental and/or mesenteric involvement can easily be missed by both methods. Thus, staging-laparotomy cannot be replaced in the management of gynecologic malignancies.

Female↗
PubMed1989

[Leg-/pelvic vein thrombosis from the viewpoint of the surgeon].

The pathogenesis of venous thrombosis is far less clear than that of arterial thrombosis. In spite of physical and medical prophylaxis, there is still a risk of thrombosis of approx. 5% left after elective abdominal surgery. Ascending phlebography cannot be dispensed with in case of an active therapeutic procedure such as fibrinolysis or venous thromectomy. In order to settle the question of thrombolysis or thrombectomy, we have to consider (1) the extent of the thrombosis, (2) the time of existence of the thrombosis, and (3) possible contra-indication of either method. Thus the two techniques do not compete with each other but are complementary. Because of the heterogeinity of the patients and the different indications for treatment, the results obtained in these two methods are hardly comparable.

Adolescent↗
PubMed1988

[Treatment of arterial occlusions of the lower extremities using 2-stage local application of urokinase].

We report the results of a 2-phase urokinase protocol for treatment of 28 arterial occlusions of the lower extremities. 26 patients, aged 43-86, with up to 6 weeks old occlusions were treated. In Phase I (average duration 2.7 h) the urokinase solution was injected in intervals directly into the occlusion-material via a F-5 catheter (120,000 U/h). In the following phase II (average duration 26.1 h) 100,000 U/h were given as a continuous arterial infusion and a full heparin regimen was started. In 86% of the treatments there was an improvement as shown by angiography. 75% of the patients could be released from the hospital without a further surgical revascularisation. Alterations of the systemic coagulation-system and bleeding-complications at the puncture site must be expected.

Aged↗
PubMed1988

Prediction of aneurysm formation in vascular grafts of biologic origin.

Other than review of clinical experience, no assay exists that can reliably predict the long-term potential for aneurysm formation in an arterial prosthesis of biologic origin. Since mural degeneration probably results from proteolytic digestion, an in vitro assay was devised that used graft perfusion with 1% collagenase to induce rapid changes in mechanical properties. The effect of enzyme on graft diameter, compliance, permeability, and burst pressure was measured in ficin-digested, adipoyl chloride and glutaraldehyde-tanned bovine carotid artery and glutaraldehyde-tanned human umbilical vein. Both grafts have recently been reported to have a significant incidence of aneurysm within several years of implantation. Compliance and diameter were also measured noninvasively in patients with bovine carotid artery and human umbilical vein for more than 40 weeks after implantation. In vitro, the response to enzyme could be categorized into three groups. In group III, a diameter increase of more than 14% was associated with a significantly decreased compliance, and this paralleled the results found in aneurysmal grafts in vivo. In both grafts there was a strong correlation between postenzyme compliance change and initial compliance, loss of compliance being significantly greater in grafts with group III responses (p less than 0.01). This response may be a good predictor of a graft's overall susceptibility to aneurysmal degeneration, and initial compliance measurement may effectively identify inadequate fixation. Thus measurement of compliance may prove useful in quality control of a fixation process used in mass production. In conclusion, measurement of mechanical properties of biologic vascular grafts before and after collagenase exposure forms the basis for an effective in vitro assay of aneurysm susceptibility.

Aneurysm↗
PubMed1988

Immunosuppressive treatment of aortic allografts.

Immunosuppression with cyclosporine (CsA) was explored as a means of preventing arterial allograft rejection and failure. Aortic allografts across the major histocompatibility barrier were studied in Brown-Norway and Lewis inbred rats. Grafts 1 cm long were interposed into the infra-abdominal aorta of Lewis recipients; five groups included two groups of untreated isograft and allograft control animals and three groups had allograft-CsA treatment regimens. The grafts were examined at 30, 60, and 100 days for patency, aneurysmal dilation, gross structural changes, inflammatory responses, and infiltration of W3/25- and OX8-positive lymphocytes. Only three allograft controls became occluded; the rest showed significant dilation (p less than 0.01), medial thinning and necrosis, intimal proliferation, and prominent cellular infiltration at 30 days. With all CsA regimens, aneurysmal dilation was significantly reduced or prevented (p less than 0.01), correlating with medial smooth muscle cell preservation. Cellular infiltration was delayed by an average daily dose of 5 to 10 mg/kg subcutaneous CsA for 30 days and was suppressed at 100 days by a continuous 5 mg/kg dose every 4 days. Intimal thickening in the graft was delayed but not prevented. We conclude that a low maintenance dose of CsA provides effective immunosuppression, thereby preventing aneurysm formation, and that the potential use of arterial allografts in vascular surgery may need to be readdressed.

Animals↗
PubMed1985

[Early morbidity and fatality following carotid disobliteration].

At the University Hospital of Cologne-Lindenthal 260 patients underwent carotid endarterectomy during a period of 10 years. 9 patients died, representing an operative mortality rate of 2.9%. 80% of our patients with an acute stroke died. We see no indication for surgery in acute stroke. Postoperatively, 20 patients had a neurologic deficit, transient deficits occurred in 3,6% (11 patients) permanent deficits in 3% (9 patients). Carotid endarterectomy may be complicated by cranial nerve damage. The importance of these injuries is evident if bilateral carotid endarterectomy is being considered.

Carotid Artery Diseases↗