Search PubMed⌕ Search

Biomedical subjects

A S Hermreck

Publications and source records attributed to A S Hermreck.

At least 55 records · Page 3Linked to original sources
PubMed1984

Trends in reconstruction for atherosclerotic renal vascular disease.

Twenty-eight patients underwent renal vascular reconstruction for atherosclerotic renal vascular stenosis. Ten patients had therapeutic renal artery reconstruction for isolated renal artery stenosis causing severe hypertension, nine patients had therapeutic renal artery reconstruction for severe hypertension combined with simultaneous aortic reconstruction, and nine patients had prophylactic renal artery reconstruction for renal artery stenosis combined with simultaneous aortic reconstruction. Ninety percent of patients undergoing therapeutic renal revascularization procedures for hypertension were cured or improved. The 10 patients undergoing prophylactic renal artery reconstruction combined with aortic reconstruction had an average 72 percent reduction in the diameter of the vessel. Dacron side grafts sutured to the aortic graft were used for revascularization in each of the patients with prophylactic revascularization and was found to be an expedient means of reconstruction with good patency rates. No increased morbidity or mortality rate was noted in the prophylactic group. We believe that prophylactic revascularization should be carried out in patients with atherosclerotic high-grade stenosis of the renal arteries to prevent hypertension and preserve renal function.

Aged↗
PubMed1984

Subtotal parathyroidectomy for secondary hyperparathyroidism.

Controversy exists regarding the relative merits of subtotal parathyroidectomy (SPTX) versus total parathyroidectomy with autotransplantation in the treatment of secondary hyperparathyroidism (HPT). Fourteen patients who underwent SPTX for secondary HPT were evaluated to determine the efficacy of this treatment in view of modern dialysis, diet, and drug treatment. Indications for operation included intractable symptoms (two patients), progressive renal osteodystrophy (eight patients), or both (four patients). Duration of renal failure ranged from 3 to 15 years (mean 7.8 years) before SPTX. The operative serum calcium level was normal in 10 patients, elevated in three patients, and low in one patient. Preoperative parathyroid hormone (PTH) levels ranged from 3.9 to 144 ng/ml (average 41 ng/ml) and decreased after operation to an average of 3.6 ng/ml (normal PTH less than 1 ng/ml). There were no deaths or major postoperative complications. Clinical or radiographic improvement occurred in 80% of patients but did not correlate with absolute reductions in PTH levels. Our results reveal that SPTX is a simple and effective treatment in the initial surgical management of uremic, secondary HPT and appears to be comparable to those obtained with more complicated surgical approaches such as total parathyroidectomy and autotransplantation.

Adult↗
PubMed1983

Renal microembolization syndrome. A cause for renal dysfunction after abdominal aortic reconstruction.

Moderate renal dysfunction due to renal microembolization developed in eight patients who underwent abdominal aortic reconstruction for aneurysmal or occlusive disease. In each patient, the aorta around the renal arteries was thrombus-lined or severely ulcerated and was therefore the source of embolization, and aortic clamping near the renal arteries was required and provided the mechanism for embolization. Renal failure was moderate and did not require dialysis. Renal dysfunction appeared to be largely reversible, although some degree of permanent damage did occur. Similar changes in renal function were noted in a dog model of renal microembolization. Prevention of this complication depends on awareness of aortic lesions that increase the risk of renal embolization.

Acute Kidney Injury↗
PubMed1983

Aortoiliac reconstruction combined with nonvascular operations.

Seventy-six patients with aortoiliac reconstruction and associated intraabdominal procedures were compared with 445 patients with aortoiliac revascularization alone to provide information about the associated morbidity and mortality of adding a nonvascular procedure to aortic reconstruction. Patients with aortoiliac reconstruction for limb salvage had a significant increase in complications when an abdominal procedure was performed in association with aortoiliac reconstruction (66 percent versus 14 percent, p less than 0.01). Additionally, patients with elective aortoiliac reconstruction had a significant increase in mortality when an abdominal procedure was performed in addition to aortoiliac reconstruction (9 percent versus 3 percent, p less than 0.01). A small bowel obstruction and a pancreatic pseudocyst occurred as a direct result of the associated abdominal procedure. None of the deaths could be directly attributed to a concomitant abdominal procedure. The demonstration of an increase in morbidity and mortality with the addition of nonvascular procedures to aortoiliac reconstruction, even though certain subgroups of patients underwent aortic revascularization, suggest that the surgeon must carefully weigh the benefits and risks before combining vascular and nonvascular operations.

Adult↗
PubMed1983

Glomerular ultrafiltration coefficient after ischemic renal injury in dogs.

Micropuncture studies of acute renal failure after ischemic renal injury suggest that glomerular ultrafiltration coefficient may remain normal in the period immediately after ischemia and decline significantly during the following 18-24 hours. The present series of in vitro experiments was designed to evaluate glomerular ultrafiltration coefficient and glomerular oncometric and rheological properties in ischemic acute renal failure in dogs. To obtain glomeruli prior to ischemia, a right nephrectomy was performed and glomeruli were isolated for studies of filtration and cell and extracellular spaces. The left renal pedicle then was occluded for 90 minutes; glomeruli isolated from biopsies of this kidney were studied at intervals up to 48 hours after ischemia. Glomeruli were isolated by sieving renal cortical fragments, and filtration was induced by an oncotic gradient. The glomerular ultrafiltration coefficient remained near control levels for the first hour after ischemia, but declined significantly at 24 and 48 hours. Specifically, glomerular ultrafiltration coefficient of glomeruli isolated from normal kidneys was 16.5 +/- 0.9 nl/min per mm Hg (n = 15). Immediately following ischemia, glomerular ultrafiltration coefficient remained essentially unchanged (15.9 +/- 1.1 nl/min per mm Hg, n = 4). At 1 hour, there was a small decrease in glomerular ultrafiltration coefficient (14.4 +/- 1.3 nl/min per mm Hg, n = 4). At 24 hours, glomerular ultrafiltration coefficient was significantly decreased (9.8 +/- 0.5 nl/min per mm Hg, n = 9, P less than 0.01) and remained at that level at 48 hours (9.5 +/- 0.5 nl/min per mm Hg, n = 8, P less than 0.001). In experimental glomeruli, the oncometric response was diminished and erythrocyte movement along glomerular capillaries was impaired. Total water and inulin spaces were measured in glomeruli from control and 48-hour postischemic periods, and glomerular morphology was studied by transmission and scanning electron microscopy at the same time.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1983

Transmesocolic omentoplasty.

Transmesocolic omentoplasty is a simple technique for covering prosthetic aortic grafts and preventing aortoenteric fistulas. It is especially valuable in repeat aortic procedures when mobilization of periaortic tissues and graft coverage may be impossible.

Aorta↗
PubMed1983

Open renal biopsy. Surgical technique and results.

This report describes our experience with a new modified approach for open renal biopsy. The biopsy is performed under general anesthesia through a small anterior incision and extraperitoneal approach. A generous incisional biopsy of the lower pole is obtained, and bleeding is controlled with mattress sutures. Thirty biopsies were obtained in 30 patients. The pathologic diagnoses included glomerulonephropathy (16), necrotizing vasculitis (5), degenerative phase of acute tubular necrosis (4), congenital nephrotic syndrome (2), interstitial nephritis (1), renal invasion by reticulum cell sarcoma (1), and juxtaglomerular cell hyperplasia (1). Ages ranged from 12 months to 75 years. There were no intra- or postoperative complications. There was one late postoperative death secondary to a ventricular arrhythmia. This approach is rapid, safe, and provides more adequate tissue for histologic and electron microscopic examination than does percutaneous needle biopsy.

Adolescent↗
PubMed1982

Evaluation of end-to-side v end-to-end proximal anastomosis in aortobifemoral bypass.

The cumulative graft-limb patency rate was significantly higher after aortobifemoral bypass with a proximal end-to-end anastomosis (E-E-AN) than with a proximal end-to-side anastomosis (E-S-AN), 100% v 93%, respectively, after 1.5 years in a consecutive series of 38 E-S-ANs followed by 41 E-E-ANs. The two operations were equally effective in relieving hip claudication, but impotence occurred more frequently after E-E-AN (27%) than after E-S-AN (13%). This difference was not significant, but six of ten patients with E-E-AN who became impotent had arteriographic patterns predicting that graft flow into hypogastric arteries might be compromised. Intraoperative studies demonstrated that acute bilateral occlusion of hypogastric arteries significantly decreases penile BP, but branches of the external iliac arteries also contribute to penile flow and may become the major route of supply in patients with hypogastric occlusive disease.

Aortic Diseases↗
PubMed1981

Extrahepatic biliary obstruction secondary to metastatic cancer.

Thirty patients with extrahepatic biliary obstruction secondary to metastatic cancer were reviewed to determine the sites of the primary tumor, diagnostic methods, therapy and success of palliation. Colon carcinoma was the most common primary tumor, and the common bile duct was most often obstructed. Both percutaneous transhepatic and surgical decompression of the biliary tract were employed. Twenty-seven (90 percent) of the patients obtained successful palliation. The length of survival averaged 270 +/- 49 days in patients treated surgically compared with 60 +/- 11 days in patients who underwent decompression by radiologic techniques. Mortality was not increased in patients undergoing operative biliary drainage. Surgical decompression may be the best method for managing patients with biliary obstruction secondary to metastatic cancer.

Adult↗
PubMed1980

Prognosis of nerve injuries incurred during acute trauma to peripheral arteries.

Fifty-nine cases of civilian traumatic injury of peripheral arteries were analyzed to determine the frequency, site and mode of accompanying nerve injury. Fifty-one percent of the patients sustained concomitant injury to one or more peripheral nerves. Nerve injury was more common with trauma in the arm (71 percent of cases) than in the leg (32 percent of cases). LOss of an extremity due to failure of vascular repair occurred in 10 percent of the patients. In contrast, 44 percent of patients had some permanent functional impairment of an extremity because of associated nerve injury. The importance of nerve injury in peripheral vascular trauma is discussed and recommendations for management are presented.

Adolescent↗
PubMed1980

Revision of gastric bypass.

In this series, 90.6 percent of the patients who had revision of their original gastric bypass for failure to lose satisfactory weight had a significant additional weight loss. The postoperative complication rate was 21.4 percent, and there were no postoperative deaths. After proper evaluation of the patient, revision of a gastric bypass may be undertaken with expectation of a satisfactory result and an acceptable rate of complications.

Female↗
PubMed1980

Results of the Hill antireflux operation.

Fifty-three consecutive patients underwent Hill hiatal hernia operation for esophageal reflux. Eight patients had failure or complications of previous non-Hill repairs, 14 patients had severe esophagitis (with dilatable stricture in 11), and the remaining 31 patients, many of whom had repair while undergoing abdominal operation for other diseases, had only moderate reflux symptoms. Ninety-six percent of the patients are either symptom-free or have had improvement in their symptoms during a mean follow-up of 3.9 years. Acute transient symptoms referable to the hiatal hernia repair occurred in 22 patients, while 8 patients had persistent symptoms. No serious acute complications, long-term disabling symptoms or reoperations for herniorrhaphy-related problems have occurred. It is concluded that the Hill antireflux procedure is highly effective and free of troublesome repair-related complications.

Adolescent↗
PubMed1980

Hickman-Broviac catheters. Indications and results.

The records of 84 patients in whom 98 Hickman-Broviac catheters were inserted were reviewed. The most common indication for catheter insertion was for administration of parenteral nutrition. Forty-four patients (52 percent) had catheters inserted for chemotherapy or combined chemotherapy and parenteranal nutrition. Thirteen patients had Hickman-Broviac catheters inserted for the administration of antibiotics. The majority of the patients (56 percent) had malignant disease. The insertion of Hickman-Broviac catheters was uncomplicated, especially through the external jugular vein. Catheter-related complications occurred in 20 percent of the patients, but none were fatal. The most common complications were thrombotic catheter occlusion and catheter related sepsis. The catheter-related sepsis rate was 8/6,308 catheter-days. These rates compare favorably with those reported by other investigators. Any patient with potential vascular access difficulty or obliterated or thrombosed veins who requires parenteral medication should be considered a candidate for insertion of a Hickman or Broviac catheter.

Adolescent↗
PubMed1979

Computed tomographic staging of malignant gastric neoplasms.

Eight patients with proved gastric carcinoma and 3 with gastric lymphoma were studied preoperatively with computed tomography. CT accurately identified abnormal stomach wall thickening and intra-abdominal tumor extension. Mural thickening was seen on the CT scan when a moderately distended stomach had a wall more than 10 mm thick. CT was useful for assessing surgical resectability, evaluating tumor response to chemotherapy or radiotherapy, and detecting postoperative recurrence. Fourteen patients with an abnormal barium study suggesting gastric malignancy were also studied with CT, which correctly demonstrated a normal stomach or identified the reason for the abnormal barium study, such as an unusual placed spleen or a pancreatic carcinoma invading the stomach.

Carcinoma↗