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Biomedical subjects

J Sandermann

Publications and source records attributed to J Sandermann.

At least 19 recordsLinked to original sources
PubMed2002

The Danish specialist training in vascular surgery.

OBJECTIVE: to present the Danish training in vascular surgery compared with other European countries. METHODS: analysis of prospectively collected data. Data on number of procedures and supervision was obtained from the Danish Vascular Registry for eighteen trainees (fifteen males, three females) in vascular surgery. Demographic data were obtained by direct contact with the units and from EuReg-Vasc. Vascular surgery has been a mono-specialty in Denmark since 1983. RESULTS: in 2000 the median age of the 45 Danish vascular specialists was 48 years (IQR 45-54, range 40-58) and at end of training the age of the 18 vascular trainees was 42 years (IQR 40-43, range 38-51). Vascular surgery was confined to eleven vascular units - eight with trainees. All vascular procedures in Denmark, besides a few emergency cases, were performed at these units - all by vascular specialists or trainees. The 18 trainees were on average exposed to more than 400 surgical procedures over the three years - and over 300 of nine vascular index operations. The number of assisted, supervised and independent operations was unevenly distributed, with low numbers of certain index operations for some of the trainees. CONCLUSION: the structure of vascular surgery in Denmark as a mono-specialty has almost found its final form. Training is satisfactory overall, but with unacceptable variation among trainees with regard to the number of performed index procedures. A minimum number of index procedures must be defined and logbooks introduced. The relatively short weekly working hours in Denmark is not the prime problem.

Aged↗
PubMed2001

[Catheter-guided thrombolysis in peripheral arterial occlusion].

By catheter-directed, regional, intravascular thrombolysis a thrombus-dissolving enzyme is applied through a catheter placed at/in the occlusion. Non-fibrin-specific (streptokinase or urokinase) and fibrin-specific agents (tissue plasminogen activators) are available. The large randomised trials (TOPAS and STILE) have serious selection bias, which makes generalisation difficult. Other studies have incomparable data and thus meta-analysis is impossible. Consequently, a recent consensus document cannot recommend an agent or principle of infusion. Thrombolysis of late, but transitory (< 14 days), occlusions seems beneficial but long-term results are lacking and recurrences are common. Exclusion of preoperative thrombolysis in late and longer lasting occlusions (> 14 days) is debatable, because of a potential thrombolysis-caused improved run-off. Individual case selection is still needed, because thrombolysis is a promising, although experimental, treatment.

Arterial Occlusive Diseases↗
PubMed2001

[Ruptured popliteal aneurysm].

A 56-year-old man with Down's syndrome and a known popliteal aneurysm 6 cm in diameter was seen with a huge distal femoral mass which had been present for about two months. At operation, the original thrombus from a ruptured aneurysm was enucleated, the aneurysm excluded, and a femoropopliteal in situ bypass performed. At twelve months follow-up, the patient presented with a foot pulse and an unchanged peroneal nerve deficit.

Aneurysm, Ruptured↗
PubMed2001

Adventitial cystic disease in the common femoral artery.

The rare condition of adventitial cystic disease with massive cysts in the common femoral artery was treated in a 49-year old man. The symptoms were calf and thigh claudication. Angiography showed occlusion of the common femoral artery and the deep femoral artery. The condition was obvious peroperatively, and after clearing the deep artery, a bypass (ePTFE) to the two femoral run off vessels was needed. After an uneventful postoperative period, it was observed at three months' follow-up, that the patient had foot pulses.

Arterial Occlusive Diseases↗
PubMed1998

Effect of nitrendipine on renal function and on hormonal parameters after intravascular iopromide.

PURPOSE: To evaluate the effect of the low-molecular nonionic radiographic contrast agent iopromide (Ultravist) on renal function, vasoactive peptides (angiotensin II, aldosterone, arginine vasopressin, and atrial natriuretic factor (ANF)), and blood pressure, and to evaluate the influence of the calcium antagonist nitrendipine on these parameters. The findings were evaluated in a prospective double-blind and placebo-controlled randomized study. MATERIAL AND METHODS: Twenty-six patients undergoing routine aortofemoral arteriography for peripheral atherosclerotic disease were treated with nitrendipine tablets (10 mg) or placebo twice daily for a week. Angiography was performed on the fifth day of medication. Efficacy variables were determined on the day before and 2 days after arteriography. The glomerular filtration rate and renal plasma flow were measured by the constant infusion technique. Renal tubular function was estimated from the clearance of lithium. Hormones were measured by radioimmunoassays. RESULTS: Arteriography with iopromide did not change renal function. No differences between the nitrendipine and placebo groups were found in renal hemodynamics, tubular sodium handling, or blood pressure. Nitrendipine changed ANF (26.1%) compared to placebo (1.5%), whereas the other hormones were not affected. CONCLUSION: The use of iopromide for angiography did not affect renal function in normotensive patients with peripheral atherosclerotic disease. Short-term treatment with nitrendipine may lower the plasma levels of ANF but it had no effect on renal function or blood pressure. Treatment with calcium antagonists prior to arteriography with iopromide is not indicated in these patients.

Adult↗
PubMed1998

Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report.

BACKGROUND: The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits. CASE REPORT: A 70 year-old mildly hypertensive male without previous or present arteriosclerotic, pulmonary, or urological manifestations was subjected to endovascular treatment after his mass-screening diagnosed abdominal aortic aneurysm had expanded to above 5 cm in diameter, the aneurysm having been found by CT-scanning and arteriography to be endovascularly treatable. A Vanguard bifurcated aortic stent graft was implanted under epidural/spinal anaesthesia and covered by cephalosporine and heparin (8000 IE) protection. Apart from treatment of a groin haematoma and stenosis of the left superficial femoral artery, the postoperative period presented no problems. A few days before the monthly follow-up visit, the patient developed uraemia, gangrene of one foot and dyspnoea. Blood glucose and LDH was elevated. Deterioration led to death a month and a half after stent implantation. Autopsy showed extraordinary large, extensive soft, brown vegetations in the lower part of the thoracic aorta above the properly infrarenally-placed stent. Microscopic examination revealed multiple microemboli in the liver, spleen, pancreas, intestines, testes, and especially the kidneys. DISCUSSION: Early death from microemboli after aortic stent implantation has been reported. However, the present case developed fatal multiple microemboli so late that they could not have originated from the excluded mural thrombus. The sudden death of an otherwise healthy man of extensive microemboli is difficult to explain. The stent application may have altered the proximal flow and wall movements disposing to microemboli in the case of vegetations.

Aged↗
PubMed1997

Compartment syndrome and fasciotomy in vascular surgery. A review of 57 cases.

OBJECTIVE: To investigate the occurrence of compartment syndrome and the results of fasciotomy in vascular surgical patients. DESIGN: Retrospective study of case records from 1980-1994. MATERIALS: Fifty-seven limbs in 53 patients had fasciotomies following surgical revascularisation. Fifty-three (93%) limbs were acutely ischaemic, while four (7%) had undergone elective vascular surgery. Forty-four (77%) limbs had signs of compartment syndrome, while 13 (23%) fasciotomies were prophylactic. METHODS: The fasciotomies were done as subcutaneous procedures (n = 40), as double-incision fasciotomies (n = 11), or by an unknown method (n = 6). The skin incisions were closed primarily in 26 (46%) cases, delayed primarily in 11 (19%) cases, and by skin grafting in eight cases (14%). RESULTS: Five (13%) subcutaneous fasciotomies required revision. Surgical debridement was required in four (7%) limbs. At discharge, 36 (68%) patients had kept their limbs, 11 (21%) patients were amputated, and six (11%) had died. No complications relating to the fasciotomies were observed. CONCLUSIONS: Compartment syndrome is usually related to acute ischaemia and rarely following elective vascular surgery. Subcutaneous fasciotomy does not always ensure sufficient decompression of all four lower leg compartments. Complications related to fasciotomy are rare.

Adolescent↗
PubMed1994

[Prevention of postoperative pulmonary complications after heart-lung surgery. Comparison of 3 different mask physiotherapy regimens].

The object of the investigation was to compare the effect of three different physiotherapy masks on the incidence of postoperative complications after thoracic surgery. It was carried out as a prospective, consecutive, randomized comparison at a Department of Thoracic and Heart Surgery at a University Hospital. The therapy was performed by experienced and specially trained physiotherapists. One hundred and sixty patients were evaluated; 60 patients undergoing heart surgery, 59 patients having pulmonary resection, and 41 patients with exploratory thoracotomy. In each operative category the patients were treated with one of three face mask systems used in addition to routine chest physiotherapy. These were either continuous positive airway pressure (CPAP), positive expiratory pressure (PEP), or inspiratory resistance--positive expiratory pressure (IR-PEP). Postoperative pulmonary complications were assessed by forced vital capacity (FVC), arterial oxygen tension (PaO2), and chest X-ray examination, all parameters were measured preoperatively and on the fourth and ninth postoperative day. The patients filled in a questionnaire concerning their opinions about their mask treatment. IR-PEP showed a lesser decrease in PaO2 on day nine. Otherwise there was an equal decrease in FVC and PaO2, and equal frequency of atelectasis in the three mask treatments. It is therefore concluded that any of the three therapies: continuous positive airway pressure (CPAP), positive expiratory pressure (PEP), and inspiratory resistance--positive expiratory pressure (IR-PEP) may be used as supplement to standard chest physiotherapy.

Cardiac Surgical Procedures↗
PubMed1994

[Somatostatinoma in the pancreas].

A case of a pancreatic somatostatinoma in a 54 year old male is presented. A pancreatic carcinoma with hepatic metastases were primary diagnosed, and the patient had a palliative choledochoduodenostomy and gastroenteroanastomosis. As he was still alive four years later, the histological samples were reevaluated. Immunohistochemically the tumor was found positive for somatostatin, neuron-specific enolase and pancreatic polypeptide. Symptoms, diagnosis, pathology and treatment in relation to somatostatinomas are discussed.

Diagnosis, Differential↗
PubMed1994

[Spontaneous ventricular rupture in adults].

Since 1928, 60 cases of spontaneous gastric rupture have been described. One third of these cases were seen after vomiting, and two thirds were associated with gastric dilatation after a big meal, of which one third were combined with an intake of antacids. In five cases the patients were suffering from anorexia nervosa. Besides the above mentioned causes, gastric atrophy, "closed-loop" obstruction and postoperative atony are possible pathogenetic factors. Most often the ruptures are located to the lesser curvature. In the period before the rupture associated with dilatation takes place, the patient typically complains of abdominal pain and the abdomen is found asymmetrically distended. After rupture of the stomach the patient is found with very aggressive pain and in shock. The abdomen has become more symmetrically distended and most often free air within the abdominal cavity can be diagnosed on X-ray. The treatment consists of resection of the necrotic area of the stomach, and as the intensive care of the patients both before, during and after surgery has reached a very high priority and standard, the mortality has been reduced from 75% to 30%.

Adult↗
PubMed1993

Three different mask physiotherapy regimens for prevention of post-operative pulmonary complications after heart and pulmonary surgery.

OBJECTIVE: An investigation into the incidence of post-operative complications after thoracic surgery with 3 different physiotherapy masks. DESIGN: A prospective, consecutive, randomized comparison. SETTING: Department of Thoracic and Heart Surgery at a University Hospital. The treatments were performed by experienced and specially trained physiotherapists. PATIENTS: 160 patients were evaluated. 60 patients undergoing heart surgery, 59 patients having pulmonary resection, and 41 patients with exploratory thoracotomy. INTERVENTIONS: In each operative category the patients were treated with one of three face mask systems used in addition to routine chest physiotherapy. These were either continuous positive airway pressure (CPAP), positive expiratory pressure (PEP), or inspiratory resistance - positive expiratory pressure (IR-PEP). MEASUREMENTS AND RESULTS: Post-operative pulmonary complications were assessed by forced vital capacity (FVC), arterial oxygen tension (PaO2), and chest X-ray examination, all measured pre-operatively and on the fourth and ninth post-operative day. The patients filled in a questionnaire expressing their opinion about their mask treatment. There was an equal decrease in FVC, FVC%, and PaO2, and equal frequency of atelectasis in the 3 mask treatments. More patients with the PEP mask favoured their system than did those with the other 2 systems. CONCLUSION: There was no statistically significant difference between the treatments: continuous positive airway pressure (CPAP), positive expiratory pressure (PEP), and inspiratory resistance - positive expiratory pressure (IR-PEP) on post-operative complications. Any of the three treatments may be used as supplement to standard chest physiotherapy.

Blood Gas Analysis↗
PubMed1991

Retroperitoneal malignant cyst. Case report.

Forty years after removal of a benign mucinous cyst from the left retroperitoneal space, a malignant cyst with both sarcomatous and carcinomatous components was removed from the same site in a 75-year-old woman. Within 6 months the lesion recurred as a carcinoma penetrating the left colon and the abdominal wall.

Adult↗
PubMed1989

Traumatic anterior dislocation of the hip. Case report.

An unusual traumatic anterior dislocation of the hip in a 47-year-old woman is reported. The mechanism of trauma behind anterior hip dislocations and their diagnosis are described and the prognosis of hip dislocations in general is mentioned.

Accidents↗