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Biomedical subjects

B Nachbur

Publications and source records attributed to B Nachbur.

At least 73 records · Page 4Linked to original sources
PubMed1982

[Prognostic factors in percutaneous transluminal dilatation of the renal arteries in renovascular hypertension].

In 59 percutaneous transluminal dilatations (PTD) the coaxial double catheter system was chiefly used, and only in one case was the axillary approach necessary. Clinically relevant complications were 1 dissection of the dilated renal artery (re-dilated successfully) and 2 hemorrhages at the femoral puncture site (1 surgical repair). In 32 patients (follow-up 2-52 months, mean 20 months) blood pressure was lowered from 187/108 to 150/91 mm Hg despite reduced antihypertensive therapy (p less than 0.001). Out of 15 patients with atherosclerotic stenoses blood pressure was normalized by PTD in 2 cases (unilateral) and improved in another 8 cases. Out of 11 patients with fibromuscular dysplasia blood pressure was normalized in 7 cases (all unilateral), improved in 3 and unchanged in 1 (bilateral). Among 6 patients with miscellaneous disease (vasculitis, renal insufficiency) only 2 were improved. Thus, PTD of renal arteries is a useful alternative in the management of renovascular hypertension, mainly in patients with fibromuscular dysplasia, unilateral stenosis and elevated renal vein renin ratio. Long-term results are comparable to the surgical results. However, since no surgical dissection is necessary, morbidity is low and long and costly hospital stays can be avoided. The procedure can be repeated in relapsing cases. For rare complications a vascular surgery team should be available.

Adult↗
PubMed1980

[Therapy and follow-up in pheochromocytoma].

Following a brief presentation of signs and symptoms in 13 patients with pheochromocytoma, the modern procedures for correct diagnosis and tumor localization are outlined. The importance of adequate preoperative treatment with alpha- and, if necessary, beta-adrenergic receptor blocking agents is stressed. The authors also show how the sudden life-threatening blood pressure changes which used to occur frequently during surgical manipulation of the tumor can now be reliably avoided. Pheochromocytoma may arise multifocally; moreover, because the coincidence of pheochromocytoma and associated tumors such as medullary carcinoma of the thyroid gland, adenoma of the parathyroid gland, mucosal neuroma, neurofibroma and chemodectoma is considerably higher amongst these patients and their relatives, it is essential to follow up not only patients with pheochromocytoma but also their relatives, in order to detect recurrences or other neoplasms in time.

Adrenal Gland Neoplasms↗
PubMed1980

[Indications and results of surgical treatment of spontaneous pneumothorax].

Our own collective of patients parietal pleurectomy in complicated spontaneous pneumothorax during the last 15 years (between 1963-1978) is investigated. There were 253 cases of spontaneous pneumothorax 48 of which (19%) have been operated. Indication for operation followed individual aspects, primarily recurrence, persistent pneumothorax, hematopneumothorax and simultaneous bilateral pneumothorax gave reason for operation. The morbidity (17%) is analysed, long-term results and reasons of recurrence regarding cases of diffuse bullous lung disease are illustrated in two patients. Simple dry sponge abrasio is discussed as an alternative to parietal pleurectomy.

Adolescent↗
PubMed1979

[Determination of the conditions of extra-anatomical arterial cross-over-shunts].

Extra anatomical cross-over-shunts are feasible even when the lending extremity is itself afflicted by obliterative arterial disease provided that 1. global irrigation of the lending extremity exceeds perfusion of the borrowing extremity, 2. pulse-volume-recording (PVR) corresponds to categories 1--3 as defined by Raines, 3. ankle pressure of the lending extremity is not less than 70 mm of mercury or 4. ankle pressure of the leading extremity corresponds to 60% or more than the systemic blood pressure.

Arterial Occlusive Diseases↗
PubMed1979

The mechanisms of severe arterial injury in surgery of the hip joint.

Vascular accidents occurring in the course of hip surgery may reach potentially catastrophic dimensions by posing an immediate and sudden threat to life and limb. This is a report of 15 cases with severe arterial injury representing 0.2--0.3% of all reconstructive hip operations performed during an 8 year period. In 6 cases perforation of either the external iliac artery, the common femoral artery of main branches of the lateral and medial circumflex femoral artery were caused by the tip of a narrow-pointed Hohmann retractor used to expose the hip joint. Other mechanisms were: intimal tear with appositional thrombosis, probably caused by mechanical strain imposed on atherosclerotic arteries, giving rise to complete limb ischemia (2 cases); the dangers associated with the entry of bone cement through a defective acetabulum into the pelvis causing thrombotic occlusion due to polymerization heat (one case) or intimate adhesion of artificial bone to the external iliac artery subsequently being ripped open during replacement of the cup (one case); the increased hazards of replacing firmly embedded hip prosthesis (3 cases of direct arterial injury with chisel, knife and cutting edge of protruding bone); and the complications associated with the development of a false aneurysm (2 cases). Fourteen of the 15 extremities were salvaged. Above-knee amputation was unavoidable in one case owing to delay of vascular repair. There was no immediate operative mortality. Knowledge of the causative mechanisms prevents arterial injury during hip surgery. The relatively low rate of vascular complications in spite of vicinity of main vessels gives credit to the well standardized technique of hip surgery, especially hip replacement. However, it is suggested that the surgeon should be sufficiently acquainted with the exposure of the main vessels above and below the groin to be able to control life threatening hemorrhage at all times. A McBurney incision with retroperitoneal exposure and clamping of the external iliac artery will suffice to diminish bleeding considerably. Thereupon careful dissection and placement of snares around the common femoral artery, the arteria profunda femoris, and whenever necessary, the lateral or medial circumflex femoral artery will enable closure of the lacerated artery. For hemorrhage resulting during replacement of firmly embedded hip prosthesis it might become necessary to ligate the internal iliac artery. Reconstruction of obliterated arteries should call for the cooperation of the vascular surgeon for eventual angioplasty. Angiologic examination of the lower extremities is mandatory whenever severe arterial trauma has occurred in the course of hip surgery and is best performed by measuring the ankle blood pressure with a Doppler ultrasound probe.

Adult↗
PubMed1978

[Could the outcome of therapy of deep thrombophlebitis be improved with a combination of surgical thrombectomy and regional fibrinolysis?].

A new mode of treatment of extensive acute and subacute deep venous thrombosis of the lower extremities is introduced. For this purpose the beneficial effects of surgical thrombectomy and of thrombolysis with streptokinase are combined during the course of a single surgical intervention. Rapid-flow regional perfusion is the vehicle used for administration of streptokinase and probably represents the third arm of this therapeutic approach by adding a hemodynamic wash-out effect. Because the thrombolytic agent is rinsed out of the circuit at the end of regional perfusion the usual side effects and contra-indications of this drug are avoided. Early and late results of this treatment are assessed clinically and with repeat venograms in a group of six unselected patients. Highly satisfactory results were obtained in four patients with complete anatomical and functional restoration of deep veins along their entire length in three cases. It is felt that continued use of this method is warranted.

Adult↗