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Biomedical subjects

W Sandmann

Publications and source records attributed to W Sandmann.

At least 109 records · Page 6Linked to original sources
PubMed1990

[Transmetatarsal border zone amputation in arterial blood supply disorders].

Transmetatarsal amputations (TA) were performed in 32 patients (22 men, 10 women; mean age 64 [40-91] years) with occlusive arterial disease. Previous revascularization procedures (bypass, thrombendarterectomy, embolectomy) had been performed in 26 patients. Surgical results of TA after one year were good in 16, satisfactory in seven, and unsatisfactory in nine. Further amputations became necessary after a mean of 52 (4-221) days in four of the six patients without and five of 26 with previous revascularization. Follow-up examination 1-6 years after discharge found that six had died, 16 were able to walk and fully rehabilitated, while in ten walking was limited and they required help in walking.

Adult↗
PubMed1990

Does prostaglandin E1 and superoxide dismutase prevent ischaemic spinal cord injury after thoracic aortic cross-clamping?

The beneficial use of prostaglandin E1 (PGE1) and superoxide dismutase (SOD) on the tolerance to ischaemia of the spinal cord was evaluated following thoracic aortic cross-clamping in dogs. Aside from spinally evoked somatosensory potential (SEP) by means of a bipolar epidural catheter, postoperative evaluation of motor deficits was used to determine the efficiency of pharmacological protection when compared with controls. The animals were divided into four groups. Group I (n = 12) served as controls. The dogs of Group II (n = 12) were treated with PGE1 (100 ng/kg/min) during clamping and the first hour after declamping. In the third group (n = 12) SOD was given as an intra-arterial bolus (1 mg/kg) prior to declamping which was followed by a continuous perfusion (0.4 mg/kg/min) into the carotid artery for 25 min. In Group IV (n = 12) the dogs were treated with a combination of PGE1 and SOD in the same manner as in Groups 3 and 4. Results after pharmacological protection were significantly better than controls. In Group I all animals but one (92%) were paraplegic, as were five in Group II (42%) and eight in Group III (67%). In contrast no dog in Group IV developed paraplegia. There was a close correlation of SEP and postoperative recovery. The group with combination therapy (PGE1 plus SOD) was characterised by a loss of the evoked potential for a mean of 15 min, the PGE1 group for 45.8 min and the SOD group for 58.5 min. While the control group was characterised by a loss of 72.7 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Alprostadil↗
PubMed1990

Results of surgical treatment for atherosclerotic renovascular occlusive disease.

In this study we retrospectively examined the results of surgery for atherosclerotic renal artery lesions and analysed the factors that may affect postoperative blood pressure response, changes in renal function and late mortality. A total of 326 patients were operated on over a 15 year period and were followed up for periods from 4 to 165 months (mean follow-up time: 37.2 months). An extra renal vascular area was also involved in 91.4% of cases and in 187 (57.3%) a significant involvement of both renal arteries was found and simultaneously treated. Combined revascularisation of other arteries was performed in 50.3% of patients. The indications for surgery were the treatment of extreme hypertension in 243 patients (74.5%), the improvement of renal function in 45 with renal insufficiency, and preservation of the kidney in 38 (11.7%). The preferred method of reconstruction was transaortic endarterectomy (236 cases, i.e. 72.4%) and postoperative angiography demonstrated a normal patent renal artery in 319 of 338 studied renal arteries (94.4%). There were no deaths in the early postoperative period after isolated renal artery reconstruction. Of the 164 patients with simultaneous renal and aortic reconstruction however 14 died during the early postoperative phase. The overall early mortality was thus 4.3% (14 out of 326 patients) and correlated significantly with the extent of the atherosclerotic disease, the age of the patients, the operative technique used and the different intra- and postoperative management during the two different periods of our experience (1974-1980 v. 1981-1989).(ABSTRACT TRUNCATED AT 250 WORDS)

Arteriosclerosis↗
PubMed1990

["Inflammatory aneurysm" of the aorta. Diagnosis, therapy, results].

From 1970 to 1987 among 964 patients with aortic aneurysms 52 (5.4%) underwent aortic graft replacement for inflammatory aortic aneurysm. 79.2% were symptomatic, 18.9% ruptured at the time of admission. CT-scan is of main diagnostic value. The perioperative mortality rate was 15.1%. At follow-up (28 months mean) 35 of 38 living patients (92.7%) were examined clinically, by sonography and in most cases by CT-scan. The late complication rate was 20% (n = 7, atrophic kidney 3, anastomotic aneurysms 4). In contrast to abdominal aortic aneurysms inflammatory aneurysms present an elevated morbidity and mortality rate which has to be reduced by exact preoperative diagnosis and modified surgical technique.

Aged↗
PubMed1990

[Results of therapy following lumbar sympathectomy. A retrospective study over the course of 10 years].

In a retrospective study we report about 142 patients who had 159 lumbar sympathectomies from 1975-1985. The angiological status was evaluated with a clinical examination or a questionnaire. In 96% we saw the clinical stages III and IV. The clinic lethality was 3.5%. Besides the sympathectomies 62 reconstructive procedures were necessary which were performed mostly before the sympathectomy. The higher the occlusion resp. stenosis the worse the prognosis after sympathectomy. A postoperative abstinence of smoking improves the prognosis. The amputation rate was 35.8% including minor amputations (n = 20) and loss of the extremity (n = 37). The high number of minor amputations shows that the sympathectomy is an appropriate procedure to shift the amputation to the periphery. The older the patient the higher the amputation rate. The analysis of the clinical examination or the questionnaire shows that a third of the patients has a long-term profit from the sympathectomy.

Adult↗
PubMed1990

[Surgical treatment of peripheral arterial occlusive disease in diabetes mellitus; in situ saphenous vein bypass versus reverse bypass procedure--a retrospective study].

The scope of reconstructive possibilities in the treatment of patients with peripheral occlusive arterial disease and diabetes mellitus had been increased thanks to further development of surgical methods. It is especially the in-situ-bypass procedure which has opened the path to new anastomotic sites at the level of the foot. Our own experience with 86 bypass procedures in 84 patients has given us an early patency rate of 82% in non-diabetic arterial occlusions and of 80% in diabetics. The amputation rate was 7% in the former group, 14% in diabetics with atherosclerotic occlusion. In comparison to the reversed bypass the early graft occlusion rate fell from 26% to 14% and the amputation rate from 13 to 9%. Thus, operative mortality fell from 9 to 2.4%, although the average age had risen from 61 to 67 years and the percentage of stage IV disease from 38% to 51%. Patency of bypass procedures with anastomosis to distal calf arteries was 83% und rose to 92% if the distal anastomosis was to arteries in the vicinity of the ankle. The caveat in this study is the fact that an apparent superiority of the in-situ-bypass is based on retrospective comparison of somewhat widely separated historical groups.

Aged↗
PubMed1989

Winner of the ESVS Prize 1988. Effects of prostaglandin E1 (PGE1) on experimental renal ischaemia.

A persisting incidence of acute renal failure has been observed after operative treatment of thoracoabdominal aortic aneurysm, ruptured abdominal aortic aneurysm and renal artery occlusive disease in patients with preoperative impairment of renal function. Because preservation of kidney function can play an important role in the outcome of these patients, the effects of prostaglandin E1 (PGE1) to prevent ischaemic renal failure were studied in an experimental model. Twenty dogs were exposed to 3 h warm ischaemia by clamping of the supra- and infrarenal aorta and both renal arteries. In 10 dogs PGE1 was given intravenously (100 ng/kg/min) for 15 min before clamping. Ten dogs treated with normal saline served as controls. Glomerular filtration rate, renal plasma flow, plasma creatinine, blood urea nitrogen, urine volume, free water clearance and renovascular resistance were calculated before and after renal ischaemia for both groups. The dogs were followed-up for 2 weeks and radionuclide studies with Tc-99m-MAG3, I-131-OIH and In-113m-DTPA were performed on the third postoperative day to calculate global and split renal clearance, tracer extraction fraction and mean transport time. After renal ischemia 9 dogs of the control group and 3 dogs of the PGE1-group developed acute renal failure (P less than 0.05 due to Fisher's exact text). PGE1 infusion significantly attenuated the postischaemic fall in glomerular filtration rate and renal concentrating ability as well as the postischaemic increase of plasma creatinine and blood urea nitrogen induced by 3 h warm renal ischaemia (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1988

[Surgical treatment of thoraco-abdominal and suprarenal aortic aneurysm].

Ninety-nine patients underwent surgery for thoraco-abdominal (n = 73) or suprarenal (n = 26) aortic aneurysm, between January 1, 1981 and May 10, 1988. The in-graft technique was combined with re-implantation of renal, visceral, and segmental arteries, using the method proposed by Crawford. Ischaemic tolerance of kidneys was extended by means of flush cooling and was more recently manipulated by means of prostaglandin E1. Spinal cord function had been monitored since 1985 by means of the authors' method of spino-electrogram reading, with intercostal arteries being re-implanted in cases of need. The intervention was survived by 79 patients, with ruptures in 69 per cent of all cases and no ruptures in 82 per cent. The rate of paraplegia amounted to seven per cent (with 2.5 per cent of survivors. 25 per cent of deaths, 18 per cent with dissecting aneurysm, and five per cent without dissection), and it depended on the extent of aortic replacement (Types I, II, and III for 773 patients and Types IV and V for 0/26). While the incidence of postoperative disorders of renal function, including temporary dialysis, was also somewhat related to the extent of aortic replacement (Types I, II, and III 22 per cent and Types IV and V eight per cent), it was clearly affected to a greater extent by the general condition of patients (ruptures in 50 per cent, intact and without dissection in nine per cent). Spinal monitoring and protection against ischaemia have substantially contributed to much better surgical results, in recent years. Surgical treatment, therefore, is recommended for patients with aneurysmol symptoms as well as for advanced cases of aneurysm, the more as rupture-related mortality has proved to be extremely high in spontaneous courses without surgical action.

Adult↗
PubMed1987

[Abdominal aortic aneurysm--is a conservative attitude still justified? Experiences with 56 emergency and 128 elective surgical patients from the anesthesiological and vascular surgery viewpoints].

A retrospective analysis was undertaken of a consecutive series of 184 patients operated on between 1.1. 1984 and 31. 12. 1985 for aneurysm of the abdominal aorta. Rupture of the aneurysm had occurred in 56 patients (aged 70 +/- 9 yrs), 47 (aged 66 +/- 9 yrs) had symptoms of an aneurysm, and 81 (aged 66 +/- 5 yrs) were operated on electively. The highest peri-operative hospital mortality rate, of 35.9%, was among the group with rupture (compared with 8.5% for the symptomatic group and 1.2% for the elective one). The period of intensive care in surviving patients was highest in the rupture group, at 8 +/- 17 days, compared with 3 +/- 2 in the symptomatic and 3 +/- 3 days in the elective group. Duration of postoperative hospital stay was 20 +/- 13, 15 +/- 7 and 13 +/- 6 days, respectively, in the three groups. Half of the patients also had arterial obstructive disease, arterial hypertension and/or coronary heart disease (25% had had an infarct according to the history, 8% more than one). A third of the patients received or should have received treatment for lung or respiratory tract disease, heart failure and/or cardiac arrhythmias. The thirty-fold increase in mortality rate for an emergency operation over that for elective surgery, together with the higher costs and longer hospital treatment, as well as the reduced probability of survival with conservative treatment speak for an aggressive approach towards elective surgery after optimal pre-operative treatment.

Adult↗
PubMed1987

Absorbable polydioxanone suture for venous anastomoses: experimental studies using venography and transluminal angioscopy.

Because of their increased tendency to stenosis and spasm and thrombosis, results after venous anastomoses are often unsatisfactory. Nonabsorbable sutures and a continuous suture technique have been suggested to have a negative effect on the compliance of vascular anastomoses. Eighty venous anastomoses were performed with either an interrupted or continuous suture technique, using polypropylene or polydioxanone (PDS) sutures, according to a randomised experimental model. The anastomoses were divided in four groups: (1) Nonabsorbable suture material, continuous suture technique; (2) Nonabsorbable suture material, interrupted suture technique; (3) Absorbable suture material, continuous suture technique; and (4) Absorbable suture material, interrupted suture technique. The morphology of the anastomoses was controlled by venography directly after closure of the wound and at weekly intervals for 2 months and monthly intervals thereafter until 2 years had passed. In 10 cases venography was followed by transluminal angioscopy in the early postoperative period and after 1, 2, 4, 8 and 12 weeks. In the first 2 months moderate and high degree stenoses were found in all 4 groups by venography. After 8 weeks there was a significant decrease in the incidence of stenosis in all groups with the exception of the group, in which continuous nonabsorbable suture had been used. Using angioscopy a marked swelling of the intima at the site of the anastomoses could be detected in the early postoperative period in all experimental groups. After 2 months no significant narrowing could be identified in groups 2, 3 and 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1987

Ten years experience with reconstruction of the chronic totally occluded renal artery.

The criteria for selection of patients who may benefit from reconstruction of totally occluded renal arteries are not well defined. Of those patients who underwent renal artery reconstruction for renal artery occlusive disease at our institution 13% (52/397) had a chronic renal artery occlusion at preoperative arteriography. In 38 cases (73%) the contralateral renal artery had a significant (greater than 70%) stenosis, which was reconstructed simultaneously. Renovascular hypertension alone (n = 27;52%) or in combination with impaired renal function (n = 25;48%) was the indication for surgical treatment and transaortic thromboendarterectomy was the preferred method of reconstruction (n = 38;73%). Operative mortality was 5.7% and during follow-up (38 +/- 31 months) 4 patients died from myocardial infarction (n = 2), aortic dissection (n = 1) or cerebral haemorrhage (n = 1). Postoperatively 20 patients (44.5%) had a normal blood pressure; in a further 20 (44.5%) the hypertension was easier to control and medication could be reduced. Five patients (11%) remained hypertensive. Postoperative arteriography showed a normal patent renal artery in 40 cases (89%). Postoperative plasma creatinine levels ranged from 0.8 to 3.4 mg% (1.32 +/- 0.74) which was a significant reduction from preoperative levels. Two patients with severe uraemia improved to an extent where haemodialysis could be discontinued. Radionuclide scan and the measurements of plasma renin activity before and after administration of a converting enzyme inhibitor (Captopril) were the most reliable diagnostic methods for preoperative patient selection and postoperative follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic Disease↗
PubMed1987

The role of subclavian-carotid transposition in surgery for supra-aortic occlusive disease.

From 1977 through 1985, 1043 patients underwent operation for supra-aortic occlusive disease. One hundred thirty-four of these patients (13%) with 146 lesions of the aortic arch branches (innominate, 25; subclavian, 103; and multiple, 10) had one or more symptoms of subclavian steal (78%), transient ischemic attacks (37%), arm ischemia (37%), and others (7%). However, according to results of a critical prospective neurologic examination, the classic steal syndrome appeared in only 13 patients (10%), vertebrobasilar insufficiency in 32 patients (24%), and hemispheric symptoms in 48 patients (36%). Symptomatic and/or significant internal carotid occlusive disease was present, ipsilateral in 28% and contralateral in 31% of the patients. Other supra-aortic vessels were involved in 49% of the patients. During the same period 192 patients with supra-aortic occlusive disease were treated without surgical intervention for various reasons. Fifty-five patients (27%) were completely asymptomatic except for the presence of reversed flow within the vertebral artery. The surgical approach in 138 operations was extrathoracic (ET) in 71% of patients (innominate artery, 2; subclavian artery, 95; and arch syndrome, 1) and transthoracic (TT) in 29% of patients (innominate artery, 23; subclavian artery, 8; and arch syndrome, 9). Generally, bypass procedures were preferred, but for 72 (71%) of the subclavian lesions subclavian-carotid transposition (SCT) was performed. Three patients had been referred for complications of previous carotid-subclavian bypass. The grafts were removed and vertebral and arm circulation restored by SCT. Carotid end-arterectomy was performed simultaneously (20%) or staged (3%) in 8% of the innominate procedures and 25% of the subclavian reconstructive procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Thrombectomy with AV fistula in embolizing deep venous thrombosis--better therapeutic concepts].

From 1977 to March 1986 69 patients with embolizing deep vein thrombosis underwent thrombectomy plus av-fistula. The perioperative mortality rate was 7.2%, the rate of recurrent pulmonary embolism during follow up (28 +/- 24 months) 4.7% - all minor non-significant emboly-including those with an embolizing thrombosis of the contralateral deep venous system. In 62% preservation of valve competence was successful. As intracaval filter devices for prevention of recurrent pulmonary embolism have many severe complications, out of which the embolisation by the filter itself seems to be the most problematic, the first step of surgical management must be the removal of the embolizing source--thrombectomy plus routine av-fistula.

Aged↗