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Biomedical subjects

E Gmelin

Publications and source records attributed to E Gmelin.

At least 37 records · Page 2Linked to original sources
PubMed1993

Insufficient hemodialysis access fistulas: 18 months' experience in laser-supported dilation.

Patients with end-stage renal failure disease frequently develop venous stenoses or occlusions in their hemodialysis access fistulas caused by intimal fibrosis. A complete dilation with high pressure balloons up to 20 atm may be unsuccessful in those cases. We investigated two new pulsed dye laser devices for the ablation of obstructions, which were not adequately treatable with a previous balloon angioplasty. From November 1990 to April 1992 a total of 154 percutaneous transluminal angioplasties (PTAs) of hemodialysis access fistulas were performed. In 23 of them an additive laser angioplasty was necessary. Twenty patients with Cimino fistulas presented 28 stenoses and two occlusions, and three Goretex loops presented all occlusions. Two pulsed dye laser devices emitting at 504 nm and 595 nm wavelength were tested. Technical success was achieved in 22/23 cases, but clinical success was obtained in 20/23 patients because two early reocclusions caused by thrombosis appeared. Five restenoses occurred 2, 3, 10, and in two cases 14 months after angioplasty with a mean follow-up period of 13.5 (5-18) months. Pulsed dye laser ablation in hemodialysis access fistula lesions due to intimal fibrosis is a valuable enrichment of radiological recanalization techniques and an alternative to surgery if stand alone balloon PTA fails.

Angioplasty, Laser↗
PubMed1993

[Thrombotic and thromboembolic occlusions of leg arteries and bypasses. Short-term versus long-term lysis].

Since thrombolytic therapy is less invasive than operative thrombectomy, it is often used as initial treatment for thrombotic or thrombo-embolic occlusions of lower limb arteries or by-passes. We compared four patient groups with acute and subacute occlusions: 1. 19 patients with occluded by-passes treated by rapid lysis using 15.5 (2.5-35) mg rt-PA. 2. 12 patients with by-pass occlusions treated with initial rt-PA in a dose of 6.5 (2.5-12.5) mg followed by prolonged lysis with 5.6 (2.5-10) x 10(6) units of urokinase. 3. 16 patients with arterial occlusions treated by rapid lysis with 15 (2.5-25) mg rt-PA. 4. 14 patients with arterial occlusions given 10.5 (2.5-60) mg rt-PA followed by overnight treatment with 5.9 (2.5-15) x 10(6) units of urokinase. For by-pass recanalisation, prolonged lysis overnight had a success rate of 83% (10/12) which was better than short term lysis with a success rate of 74% (14/19). Similar results were obtained in arterial occlusions with a success rate of 86% (12/14) compared with 69% (11/16). Long term lysis did, however, have significantly more complications. In about one-third of cases further procedures had to be used in addition to lytic therapy.

Aged↗
PubMed1993

[The laser-assisted balloon angioplasty of insufficient hemodialysis-access fistulae].

Patients with end-stage renal failure frequently develop venous stenoses or occlusions in their haemodialysis access fistulas caused by intimal fibrosis. A complete dilation with high pressure balloons up to 20 atm may be unsuccessful in such cases. We investigated two pulsed dye laser devices for the ablation of obstructions, which were not adequately treatable with a previous balloon angioplasty. From 11/90 to 4/92 a total amount of 154 PTAs of haemodialysis access fistulas were performed. In 23 of them additive laser angioplasty was necessary. 20 patients with Cimino fistulas presented 28 stenoses and two occlusions, whereas all the three patients with Goretex loops presented with occlusions. Two pulsed dye laser devices emitted at the wavelengths 504 nm (green) and 595 nm (red). Technical success was achieved in 22/23 cases, but clinical success was obtained in only 20/23 patients, due to two early reocclusions caused by thrombosis. 5 restenoses occurred two, three, 10, and twice 14 months after angioplasty with a mean follow-up period of 13.5 (5-18) months. Pulsed dye laser ablation in haemodialysis access fistula lesions due to intimal fibrosis greatly enriches radiological recanalisation techniques and is a valuable alternative to surgery if stand-alone balloon PTA fails.

Angioplasty, Balloon, Laser-Assisted↗
PubMed1993

[Diagnosis of thrombophlebitis of the leg using duplex sonography].

In a prospective study 113 extremities of 98 patients with suspected lower extremity deep venous thrombosis were examined by duplex sonography and phlebography. In 66 examinations phlebography demonstrated fresh thromboses which were limited to the calf in 14 cases. In all other cases thrombosis was partially or totally localized above the knee. Duplex sonography had a sensitivity in detection of thromboses of 91% (calf veins) up to 94% (proximal veins) and a specificity of 95% and 97%, respectively. Duplex sonography is a reliable method in diagnosis of thrombosis in the popliteal, superficial and common femoral und distal iliac vein. If phlebography is contraindicated, duplex sonography is the method of choice. It should also be performed additionally to phlebography to visualise surrounding tissue and detect the possible cause of thrombosis and clinical symptoms. Duplex sonography can also visualise veins that are not shown phlebographically.

Adolescent↗
PubMed1992

[Plain CT of venous thromboses of the leg].

In 41 patients with deep vein thrombosis which had been demonstrated by duplex sonography, non-enhanced CT was performed at various levels before phlebography was carried out. Clots judged clinically to be fresh (1-7 days) show predominantly hyperdense thrombus material (60-80 Hu). With longer histories, on the other hand, the majority of thrombi were hypodense (50 Hu or less). Non-enhanced CT provided a rough indication of the age of a thrombus and may aid in deciding whether to use fibrinolysis. Dilatation of veins was found in 80% of the hyperdense early thrombi, but also in the presence of loose and old thrombi. This phenomenon and the presence of perivascular and soft tissue oedema does not indicate the type or age of the thrombus. These findings may be expected to occur also in other vascular areas.

Dilatation, Pathologic↗
PubMed1991

[Normal wall thickness and neoplastic wall changes in the gastrointestinal tract as shown by computed tomography].

55 patients with tumours of the gastrointestinal tract were examined by CT, using a paraffin emulsion as a negative oral contrast medium. These were compared with 119 normal patients. The appearance of normal and tumour bearing portions of the gut wall against the contrast medium was studied. Under hypotonic conditions the gut wall could regularly be distinguished from surrounding organs and gut content. Mural thickness of the oesophagus greater than 7 mm and of the stomach and colon greater than 8 mm must be regarded as abnormal. Benign diseases cannot be distinguished from malignant conditions on the basis of wall thickness. Artifacts, such as are caused by positive oral contrast, were of less significance when using paraffin emulsion.

Adult↗
PubMed1990

[Imaging diagnosis of parotid diseases--a comparison of methods].

Thirty-five patients with parotid gland disorders were ultrasonographically examined with a "small parts" scanner, as well as with high-resolution computed tomography, and conventional and digital subtracted sialography. The results were compared with clinical, surgical, and pathomorphological data. In cases of parotid gland masses, the sensitivity of sonography, CT, and sialography was 100%, 81%, and 70% respectively, while in cases of sialadenitis, sensitivity was 38%, 50%, and 75%. The image-quality of digital subtracted sialography was superior to conventional sialography in 94% of cases, the same in 6%, and inferior in none of the cases. It is concluded that in all cases of parotid gland diseases ultrasound should be the first imaging method. If a tumor is confirmed, no further pretherapeutic imaging will be necessary in most cases. If a tumor is not confirmed, digital subtracted sialography should be employed to visualize inflammatory changes.

Adenoma↗
PubMed1990

[Radiologic recanalization of veins, vascular prostheses and arteries in cases of insufficient dialysis fistulas].

Two hundred and sixty-five radiological recanalisations have been carried out in 196 patients with stenoses or occlusions of haemodialysis shunts (167 Cimino shunts, 29 prosthetic shunts). Balloon dilatation was successful in 93% (144 out of 155) stenoses of the shunt vein; redilatation was occasionally necessary, but at six, 12 and 24 months, the patency rate was 75% (56/75), 62% (40/64) and 34% (19/55). Eighty occlusions of shunt veins or prosthetic shunts in 71 patients were treated by a combination of a local fibrinolysis and balloon dilatation or by balloon dilatation alone. Primary recanalisation rate was 56% (14/25) and 65% (36/55), respectively; the six, 12 and 24 months patency rates were 73% (22/30), 54% (7/13) and 14% (1/7). All six recanalisations of the shunt artery--five stenoses and one occlusion--proved successful. In 19 patients with oedema of the arm, 30 dilatations of central veins were performed (18 stenoses, one occlusion). The recanalisation rate was 97% (29/30), the six months patency rate was 57% (8/14). The long-term results of radiological recanalisation are comparable with surgical revision by patch plasty or thrombectomy, but the radiological techniques are simpler, can be carried out on out patients and can be repeated if necessary.

Arteriovenous Shunt, Surgical↗
PubMed1990

[Selective catheter angiography using a translumbar technic].

By using a new 5-F-needle-sheath system for translumbar aortic puncture, it was possible to introduce 4-F-catheters of different lengths and shapes. In nine patients 19 vessels were selectively catheterised. There were no complications. The trans-lumbar approach to selective angiography is a simple and safe alternative to the more dangerous trans-brachial method.

Aged↗