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Biomedical subjects

J Vollmar

Publications and source records attributed to J Vollmar.

At least 91 records · Page 5Linked to original sources
PubMed1977

Surgical considerations in the treatment of renovascular hypertension.

The most frequent causes of postoperative failure in operations for stenosis of the renal artery are technical errors, that is, incomplete correction of renal inflow or outflow, or both, and incorrect selection of patients with additional damage to the parenchyma of the kidney. Several new principles ensure a high degree of security in the correction of impaired renal blood flow: one field correction; partial ex situ repair; improvement of the renal run-off by mechanical dilatation of the arterial branches, and one session repair of contralateral renal artery or other intraabdominal vascular lesions. Total segmental occlusions of the main artery, with or without impending uremia, should no longer be considered as a routine indication for nephrectomy, particularly when residual renal function and contralateral blood supply to the post-occlusive kidney can be demonstrated. Surgical revascularization may offer remarkably good results and achieve normalization of renovascular hypertension and kidney function.

Adult↗
PubMed1977

Reliability of a simple and rapid glucose measuring device in conducting oral glucose tolerance tests.

160 oral glucose tolerance tests (OGTTs) were carried out, the glucose measurements being performed with the rapid dry-lab device Reflomat/Reflotest-Glucose and the GOD-Perid method. In 151 patients (94.4%) the two methods of measuring glucose led to the same diagnoses (i.e. "normal", "suspect" or "diabetic"). This high conformity in the results suggests the reliability of the rapid device in conducting OGTTs. Only in 9 subjects (5.6%) were the clinical conclusions different, Reflotest-Glucose giving predominantly "more pathological" results. It is, however, not possible to say which method showed "falsely positive" and which one "falsely negative" results.

Blood Glucose↗
PubMed1976

[Diagnostic and clinical aspects of septic complications in vascular surgery (author's transl)].

The clinical symptoms of wound infection depend on the location and the tissue layer of the infectious process. The classic signs of inflammation are usually present if the subcutaneous tissue is involved. The diagnosis is based mainly on clinical signs. Deep wound infections, e.g. in the retroperitoneal space can progress unnoticed for days or even weeks, to be suddenly unmasked by a vascular complication (bleeding; aorto-enteric fistula). An early daignosis is essential for an aggressive surgical approach, i.e. early elimination of the septic focus in combination with an aseptic bypass procedure.

Aorta, Abdominal↗
PubMed1976

[A panel on vascular surgery (author's transl)].

For this second panel by correspondence, we have asked 3 distinguished experts to answer 7 questions and to comment on 3 case histories concerning vascular surgery. Although a direct discussion between the participants was not possible an impressive degree of agreement is here being demonstrated.

Aorta↗
PubMed1976

Surgical treatment of kinked internal carotid arteries.

Carotid artery insufficiency is caused by an abnormal kinked or coiled internal carotid artery in 15-20 per cent of symptomatic patients. Surgical correction should be considered if other causes for the neurological signs are excluded, a pronounced kinked or coiled area is demonstrated and if there is not a severe neurological deficit. As well as eliminating the elongation, surgical correction should include intraluminal inspection of the artery as, in 38-5 per cent of cases, a concomitant arteriosclerotic stenosis requires simultaneous correction.

Adult↗
PubMed1976

[Atypical aortic coarctation (author's transl)].

Special problems in the surgical treatment of aortic coarctation may be caused by unusual morphological findings as a long hypoplastic segment, the combination with pre- or poststenotic aneurysms or by atypical localisation of the stenosis in the aortic arch, the decreasing or abdominal aorta. A bypass procedure is considered as the method of choice for the repair of coarctation in the aortic arch or the "critical zone" of the abdominal aorta (renal- and suprarenal segment). The bypass-principle allows many variations of branching and avoids cross-clamping of the aorta. The involvement of important branches as is the left common carotid, the superior mesenteric or the renal artery, necessitates a vascular reconstruction in the same session. Probably the first report about a very rare combined lesions is presented: the combination of an aortic arch coarctation in association with a complete situs inversus (right descending aorta), a common carotid trunc, an aneurysm of the left subclavian artery (first branch of the arch) and congenital cysts of the right upper lobe of the lung (Case No. 1). Usually concomitant aneurysms are found in the pre- or poststenotic aortic segment. Some of the infrarenal fusiform aneurysms (Case No. 4 and 5) are occasionally of poststenotic origin, secondary to a longstanding infrarenal coarctation. In these cases the procedure of choice is the total exstirpation and the interposition of a Dacrongraft. Important branches (as the subclavian or renal artery) can be some times inserted directly in the vascular protheses. Using the bypass technic or the patch graftplastic of Vosschulte the risk of late operation (beyond the age of 30 years) may be remarkably reduced.

Adolescent↗
PubMed1976

Relevant diagnostic procedures in renovascular hypertension.

The validity of invasive preoperative diagnostic procedures in patients with unilateral renovascular hypertension was assessed. A significant lowering of blood pressure following reconstructive surgery can be predicted if following stimulation with Dihydralazine the renal-venous renin ratio of the involved to the noninvolved kidney is at least 2.0. Furthermore, it is of importance to determine the renal perfusion rate in the contralateral non-stenotic kidney which should be within normal limits. If these two criteria are met then in the majority of cases surgical intervention in unilateral hypertension is meaningful.

Adult↗
PubMed1976

Special technics in renovascular surgery.

Apart from the critical selection of patients, surgical results in renovascular surgery depend mainly on technical problems. To overcome most frequent technical handicaps, such as a deep abdominal cavity, intervening structures, additional distal stenoses and limited ischemic tolerance time, several technical principles may be recommended. An anterior transperitoneal approach usually ensures an optimal exposure. The 'one-field repair' and the 'partial ex situ repair', include the advantage of excellent exposure and a superficial operating field. Particularly in cases of renal artery stenosis of the fibromuscular type, the routinely performed distal 'run-off control' by mechanical dilatation of the arterial branches, allows a high degree security. As in other fields of surgery, renovascular interventions should be directed to the principle of technical simplicity. Following this surgical concept there is only limited indication for the use of 'total ex situ repair' with heterotopic kidney replantation. We feel that this major time-consuming procedure has only a very small place in renovascular surgery, but a very real place in the correction of intrarenal lesions.

Adult↗
PubMed1976

[Indicatory and technical faults as cause of postoperative complications in arterial surgery].

In all vascular surgery the technic and quality of the first operation is a factor of decisive importance for the long-term results. The need to perform a second or third operation considerably reduces the chances of success. Routine use of an intra-operative control method like arteriography or vascular endoscopy, makes a decisive contribution in the peripheral circulation of the limbs to the immediate detection of errors of operative technic and their correction during the same operation. A change of indication for occlusive processes in the femoropopliteal branch is evident: patients with claudication should be treated with profunda revascularisation combined with lumbal sympathectomy and patients with rest-pain and necrosis should be treated with venous autografts using a microsurgical technic. To avoid deep wound infections the selection of an incision line which does not damage the lymphatic channels, particularly in the groin, the short duration of operations and the use of a purely instrumental operative technic with minimal damage to the tissues are of decisive importance. Examples are used to illustrate errors of indication and technic and the post-operative sequelae of such errors.

Aortic Aneurysm↗
PubMed1976

[Angiodysplasia and the skeletal system].

1. Congenital angiodysplasias of the extremities are often associated with skeletal disorders, i.e., overgrowth (local giantism, hyperplasia) or reduced growth (hypoplasia). From a clinical point of view three types of combined lesions may be differentiated: (a) a secondary local giantism induced by hemodynamically active congenital a.v. fistulas, usually of intra- and extraosseous location (Weber-type); - (b) local giantism in combination with venous and/or lymphatic angiodysplasias; in this group skeletal overgrowth seems not to be caused by the vascular anomalies but represents more probably a coordinated "inborn error" of tissue composition and distribution (Klippel-Trenaunay-type); - (c) hemangiomatosis usually of venous (cavernous) type, affecting soft tissues as well as bones in association with skeletal hypoplasia. There is a retardation of bone growth by substitution and destruction of the epiphysial cartilages by the intraosseous hemangioma (Servelle-Martorelltype). In most cases (a-c) the use of special angiological investigations allows a clear diagnosis particularly concerning the pathogenesis of skeletal disorders. 2. In looking for an unequivocal terminology the clinical classification of these anomalies should be based on the leading clinical symptome, i.e., the giantism or the angiodysplasia. In this respect the vascular findings take on a predominant position. Paying regard to historical aspects the classification may be completed by the additional term "Klippel-Trenaunay" type, "Weber" type, "Servelle-Martorell" type. 3. An exact angiologic diagnosis gives further informations about prognosis and choice of treatment (group I: Early operative elimination or reduction of the a-v shuntvolume; group II and III: "wait and see!"; usually conservative treatment with compression bandages).

Angiomatosis↗
PubMed1975

[Bone fracture and vascular lesion (author's transl)].

Combined lesions of bone and blood vessels require a high degree of diagnostic skill and of therapeutic care (routine clinical examination of the vascular status and if necessary angiography). From a therapeutic point of view, all major vascular lesions proximal to the knee or elbow should have vascular continuity restored (artery and vein). Primary internal fixation of shortened long bones is an important technical principle which, in most cases, will allow direct vascular suture in a stable operating field.

Arm↗
PubMed1975

Testing the mutagenic potency of chemical substances in a linear host-mediated assay. I. Experimental microbiological basis.

By the use of the mutagenic substance hydrazine sulphate it is shown that the currently used single determination method for determining point mutations in host-mediated assays with calculation of mutation frequencies can lead to erroneous results. The microbiological basis for a linear-method is presented in which the population growth of the auxotrophic and substance-induced mutants used int he test can be described mathematically during their logarithmic growth phase with regression lines.

Animals↗