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Biomedical subjects

H Nier

Publications and source records attributed to H Nier.

At least 37 records · Page 2Linked to original sources
PubMed1980

Traumatic mediastinal emphysema.

The traumatic mediastinal emphysema occurs along with severe combined injuries. A typical feature is the subcutaneous emphysema as well as crackling sounds and frequently a pneumothorax. The radiography of the chest shows air in the mediastinum surrounding the mediastinal structures. The pleura drainage could be done as an emergency performance in cases of pneumothorax. In cases of an increasing subcutaneous and mediastinal emphysema as well as circulatory failure a cervical mediastinotomy should be carried out. The tracheobronchial tree should be examined bronchoscopically for possible ruptures. Esophagus injuries will be detected by the distribution of a contrast fluid. Even a thoracotomy may be necessary.

Accidents, Traffic↗
PubMed1979

[Post-traumatic aneurysm of the thoracic aorta; the results of surgical repair (author's transl)].

29 patients aged 11-55 years underwent surgery an aneurysm of the descending part of the thoracic aorta that had developed after a blunt chest trauma. In all patients continuity of the vessel was restored by interposition of a prosthesis. Surgery was performed during the acute stage in 5 patients, two of whom died postoperatively due to infection of the prosthesis and shock lung respectively. One of the 24 patients who were operated on during the chronic stage died on the 16th postoperative day of apoplexy. One of the 26 patients who were discharged from hospital after the operation died of a spurious aneurysm that had developed at the site of the prosthesis. Follow-up examinations of 21 patients showed normal postoperative function. In 5 cases there was an angiographically demonstrable slight narrowing at the site of the anastomosis; the pressure gradient, measured intravascularly, did not exceed 30 mm Hg.

Adolescent↗
PubMed1979

[Treatment of late occlusions and stenoses after an aortofemoral bypass operation].

Thirty-three patients with one or several late occlusions in 43 limbs of aortofemoral dacron grafts underwent 56 reconstructions because of impending limb loss. Thrombectomy alone with patch closure was less successful. Excision of the femoral anastomosis, resection of the distal part of the occluded prosthetic limb and replacement by a new velours graft tube together with profundaplasty and further downstream reconstruction revealed the best results. The early reocclusion rate was 10%, the late reocclusion rate was 10%. There was no operative mortality and no amputation. Two late deaths occurred, in one case due to grade III infection with sepsis. Another late graft infection was successfully managed by an extraanatomic bypass and excision of the infected limb. The reasons for late occlusions of aortofemoral grafts were found to be incomplete reconstruction of the outflow tract, technical failure at the time of primary reconstruction and progressive atherosclerosis. Hypertonus was common in all cases with progression of the disease. Technical details of the operative management for late occlusion are presented.

Adult↗
PubMed1978

[Hyperbaric oxygen treatment in gas gangrene (author's transl)].

Among 100 patients with proven gas gangrene surgical treatment was undertaken in 34 who also received 30--60 mega-units of penicillin, in addition to appropriate shock treatment. Since 1967, additional treatment in a hyperbaric chamber was undertaken in 66 patients. There was no clear-cut advantage of hyperbaric oxygenation as far as the death-rate was concerned. There was merely a moderate decrease in the amputation rate after limb injuries. Wide incision of the wound and radical surgical excision of all tissue affected by gas gangrene continues to be an essential form of treatment.

Amputation, Surgical↗
PubMed1978

[Diagnosis and therapy of acute penetrating myocardial injury (author's transl)].

Clinical signs of an acute penetrating wound of the heart not always are clear. Because of hemorrhage and reduced cardiac output during heart tamponade venous pressure not necessarily must be increased. If by pericardiocentesis an aspiration of blood is possible, diagnosis of a penetrating heart wound is of high probability; otherwise there is no diagnostic value of a negative pericardiocentesis. Only in a case of a very small cardiac wound pericardial drainage can be used as a sole therapeutic proceeding; clinical observation is mandatory and an emergency operation at all time must be possible. In most cases immediately thoracotomy with suture of the cardiac wound should be performed. Attention is necessary because of an injury of a coronary artery. Following this principle prognosis is good if the patient is reaching clinical treatment alive. Lethal outcome in 2 of our 12 reported cases in one of them is caused by refusing immediate surgical intervention by the patient himself, in the other by development of ischemic cardiac necrosis involving a papillary muscle after suturing a cardiac wound.

Acute Disease↗
PubMed1977

[Clinically undiagnosed glycogen storage disease type I as cause of postoperative death (author's transl)].

A 30-year-old patient was admitted to hospital for cholecystectomy with a diagnosis of complete obstruction of the cystic duct. The preoperative clinical and chemical findings were normal. Following cholecystectomy the patient recovered normally from the anaesthetic. Three hours later sudden cardiac arrest occurred. Necropsy revealed glycogen storage disease type I. Hypoglycaemia and metabolic acidosis had probably led to hypokalaemia which is considered as the cause of cardiac failure.

Adult↗
PubMed1976

[Early complications and long-term results after total gastrectomy. A contribution to finding a method of gastric replacement, based on own observations (author's transl)].

In the years 1963 up to 1973 in the Department of Surgery of the University of Düsseldorf a total gastrectomy was performed in 53 patients. For reconstitution of gastrointestinal continuity in 22 cases we interposed a single jejunal loop between the esophagus and duodenum, in 15 patients we performed an esophagojejunostomy with a long enteroanastomosis between the afferent and efferent loop. The procedure described by Tomoda was done in 11 patients. An esophagojejunostomy Roux-en-Y we used in 3 and an esophagoduodenostomy in only 2 cases. The hospital mortality was 21%, the cause of which were predominantly complications of the lung. A dehiscence of an anastomosis never was a cause of death. A follow-up we could perform in 15 patients. On the basis of clinical, roentgenological and chemical data received in the follow-up we prefer at this time the interposition of a single jejunal loop, the length of which should be no less than 40 cm.

Body Weight↗
PubMed1975

[Pulmonary embolism: indication for and results of embolectomy under cardio-pulmonary bypass (author's transl)].

Pulmonary embolectomy under cardio-pulmonary bypass was performed in five patients with massive embolism. Two survived and were ultimately discharged; two died after 40 and 101 days, respectively, of the underlying disease; one patient--operated on under a mistaken diagnosis--was maintained under assisted circulation but died after four days of the underlying disease (cardiac failure). Indications for pulmonary embolectomy under cardiopulmonary bypass should be widened, as it is the only life-saving measure in most cases. After moderately severe pulmonary embolism (lobar embolism) indications for surgical intervention must be individualised from case to case.

Aged↗