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Biomedical subjects

K H Orend

Publications and source records attributed to K H Orend.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Value of stent-assisted aneurysm treatment].

The aim of this study was to compare the outcome of consecutive patients with abdominal aortic aneurysms treated by open operation and endoluminal procedure. Between October 1996 and April 1998 consecutive patients with abdominal aortic aneurysms underwent surgical repair. Of these, 50 patients had conventional open repair, and 48 patients were treated endoluminally. Follow-up was made by clinical examination in the operation group; the stent group was controlled by spiral CT and angiography 1, 3, 6, and 12 months after operation. No significant difference was found in the perioperative mortality rate between the open repair group and the stent group. This study suggests that the endovascular procedure is safe and results in a shorter length of hospital stay and a shorter length of intensive care unit stay. As there are no long-term results, the endoluminal method requires a careful follow-up.

Angioplasty, Balloon↗
PubMed1997

Inferior pancreaticoduodenal artery aneurysm as a consequence of traumatic acute pancreatitis. A case report and review of the literature.

Inferior pancreaticoduodenal artery (PDA) aneurysms are rare: To date, only 88 cases have been reported in the English literature. Although atherosclerosis represents the most common histological finding (60%), the pathogenetic mechanism consists usually of vessel erosion owing to acute or chronic pancreatitis. Most of these lesions are undetectable until symptoms of rupture occur. Rupture occurs typically in association with an episode of pancreatitis (60%) and caries a high mortality rate (50%), making diagnosis and early treatment essential. Angiography and computed tomography (CT) readily confirm the diagnosis. Ligation or resection of the aneurysm represents the definitive and radical therapy, but in an emergency, entails a high mortality rate (50%). Transcatheter embolization is a valid alternative to control bleeding (80%) in order to stabilize the patient; in some cases, it represents a definitive treatment. We present a case of an aneurysm that developed in a patient who had had posttraumatic acute pancreatitis. A surgical procedure with proximal and distal ligation of the aneurysm was performed successfully.

Acute Disease↗
PubMed1997

[Paraganglioma of the carotid bifurcation. Diagnostic and therapeutic strategy].

The carotid body tumors are semimalignant tumors. According to our results, the best diagnostic procedure is a combination of Doppler color flow imaging ultrasound, computed tomography and selective angiography. In our opinion, the treatment of choice is radical resection of the tumor with the carotid bifurcation, especially to reduce recurrence of the tumor. Considering the problems in recurrent tumors, consequent monitoring of the patients is necessary.

Carotid Body Tumor↗
PubMed1996

Histomorphological examination of endoluminal stent grafting in the descending aorta in a sheep model.

Experiments were designed to examine the wound healing characteristics at the aorta-endograft interface. Thoracic aneurysms were induced in sheep and excluded by endovascular placement of a selfexpanding stent graft (Corvita Endovascular Graft). After a follow-up of 1, 4, or 12 weeks sheep were sacrificed and the corresponding segments of the aorta were subjected to histological examinations. Histomorphological evaluation of all groups underlined sufficient exclusion of lesions of the aortic wall by endovascular grafting. There was no evidence of proximal or distal leakage, graft dislocation or migration. The results appeared to be evidence that the endoluminal stent graft may be incorporated by the host aortic tissue.

Animals↗
PubMed1996

[Cervical sympathetic paraganglioma].

A 24-year-old man presented with a long-standing history of Horner's complex and a slowly growing cervical mass. Duplex-sonography, angiography, and computed tomography revealed a hypervascularized tumor with well defined borders displacing the left carotid bifurcation medially. Operative and histological findings confirmed the preoperative diagnosis of cervical sympathetic paraganglioma.

Adult↗
PubMed1996

[Prophylactic indications in thoracic aortic aneurysm].

Prophylactic operations of aneurysms of the descending thoracic aorta have to take into consideration the expansion rate, probability of rupture and individual life expectancy of patients > 70 years of age as well as the individual risk of operation. Candidates for elective surgery are those with large aneurysms and low operative risk from low comorbidity who are expected to experience death from acute rupture unless operated on in a prophylactic way. Endoluminal stent grafts--though very attractive in this aortic segment--are still in statu nascendi and not recommended for general use.

Aged↗
PubMed1995

[Aneurysm of the descending thoracic aorta in tertiary syphilis].

A 53-year-old female presented with septicaemia caused by left ureteric obstruction due to ureterolithiasis. Further diagnostic work-up for left mediastinal widening revealed an asymptomatic aneurysm of the descending aorta. Serologic tests for syphilis were highly positive (TPHA 1:10240, 19s-IgM-FTA-Abs 1:20, Cardiolipin KBR 1:72 IU/ml). After a three weeks course of Penicillin G, 19s-IgM-FTA-Abs was negative. A successful tube resection of the aneurysm was performed. The diagnosis of luetic aneurysm of the descending aorta was confirmed histologically. Although rare today, tertiary syphilis should be considered in the differential diagnosis of thoracic aneurysm in middle-aged patients lacking classical risk factors for atherosclerosis. The immune pathogenesis of cardiovascular syphilis still remains subject of controversy.

Aorta, Thoracic↗
PubMed1994

[Percutaneous aspiration thromboembolectomy in the treatment of acute occlusion of the lower leg arteries].

Percutaneous aspiration thrombembolectomy (PAT) is a very suitable method for the recanalization of the popliteal and lower limb arteries after embolic occlusion. In thrombotic occlusion in patients with arteriosclerotic disease, PAT can easily be combined with other interventional procedures, yielding good results. With the use of PAT the dose of regionally effective fibrinolytic drugs, which may be additionally administered, can be significantly reduced.

Adult↗
PubMed1993

[Carotid angiography by magnetic resonance].

Using magnetic resonance imaging, arteriosclerotic lesions of the supra-aortic vessels may be well demonstrated. The comparison between 3 magnetic resonance angiography (MRA) techniques (Spin Echo, Gradient Echo 2D FLASH, Gradient Echo 3D FISP) and Digital Subtraction Angiography (DSA) as reference in 50 patients suspicious of stenotic lesions proved the high reliability of these methods. Specially in determining the degree of stenosis, a good correlation between DSA and SE in 87%, between DSA and 2D FLASH in 78% and between DSA and 3D FISP in 83% could be assessed. Since 3D technique may exaggerate the degree of stenosis, we didn't observe any false negative result in severe stenosis. Therefore we think that the 3D technique is a safe technique which enables a good overview of the supra-aortic vessels and could therefore be suitable for screening.

Aged↗
PubMed1992

Prognostic value of deoxyribonucleic acid aneuploidy in primary non-small-cell lung carcinomas and their metastases.

The ploidy status of the deoxyribonucleic acid of a malignant lung tumor provides additional information besides histologic grading and tumor staging according to lymph node infiltration and tumor metastasis. Ninety-nine surgical specimens from patients with non-small-cell lung carcinoma were investigated by flow cytometry. Deoxyribonucleic acid aneuploidy was found in 48% of the primary tumors. Patients with deoxyribonucleic acid-euploid tumors showed better survival (p < 0.01) than those with deoxyribonucleic acid-aneuploid carcinomas independent of tumor stage. Deoxyribonucleic acid ploidy status of the primary tumor was compared with that of N2 lymph node metastases in 29 cases. Seven samples showed a change from deoxyribonucleic acid aneuploidy in the primary tumor to deoxyribonucleic acid euploidy in the lymph node metastases. Survival was significantly better for patients with euploid primary tumors and lymph node metastases, followed by patients with deoxyribonucleic acid-aneuploid primary tumors and euploid lymph node metastases. Survival was poorest in patients with deoxyribonucleic acid-aneuploid primary tumors and lymph node metastases. It was observed that only the simultaneous determination of deoxyribonucleic acid ploidy of primary tumors and lymph node metastases permits accurate prognostic evaluation in case of lymph node infiltration.

Actuarial Analysis↗
PubMed1985

Crural arterial reconstruction with an adjunct arteriovenous fistula for limb salvage.

Twenty-one femoro-crural bypass procedures with a distal arteriovenous fistula (dAVF) were constructed in 20 patients with severe leg ischemia (Fontaine stage III, IV). They were followed-up for 3 to 22 months, with a mean of 8 months. The 15 patients with patent grafts and fistulas no longer had pain at rest; ischemic necroses healed. Telethermography showed a considerable augmentation of the distal limb perfusion. The mean increase of the transcutaneous oxygen pressure was 30 mmHg. One early postoperative amputation was necessary due to graft infection. Another patient lost her leg because of bypass occlusion 9 months after arterial reconstruction. Four patients with late graft occlusion kept their regained mobility and alleviation. Our data confirm experimental results suggesting that femoro-crural bypass with a dAVF improves distal leg perfusion by reversal venous blood flow and stimulation of a collateral network. Femoro-crural bypass with a dAVF may be of benefit in selected cases when only one crural artery is patent and pedal arch vessels are absent.

Adult↗
PubMed1978

Prenatal diagnosis of beta-thalassemia using selective hemolysis of maternal cells contaminating fetal blood sample.

The prenatal diagnosis of the severe, hereditary anemias may be impossible when a placental blood sample which contains a high percentage of maternal rather than fetal cells is obtained. An incubation system described by Boyer et al. [3] with minor modifications, was applied to mixtures of blood from prematures and adults in order to increase the proportion of premature cells. After 40 min incubation, 95% or more of adult red cells were destroyed, whereas 30-60% of premature red cells were recovered, as determined by several independent methods. In a pregnancy at risk for beta-thalassemia, a placental blood sample which was purely fetal was obtained. Complete lack of in vitro beta-globin synthesis showed the fetus to have homozygous beta-thalassemia. When fetal blood was mixed with maternal blood in a ratio of 1:15, beta-globin synthesis in the mixture was comparable to that of normal fetuses. In contrast, when the cell mixture was subjected to selective hemolysis prior to separation of globins, beta-globin synthesis again was not detectable. Thus, using selective hemolysis, the correct diagnosis could be established from a blood sample containing only about 6% of fetal cells.

Female↗
PubMedDate not supplied

Endovascular exclusion of thoracic aortic aneurysms: mid-term results of elective treatment and in contained rupture.

PURPOSE: The purpose is to present results of endovascular exclusion (stent-graft treatment) of aneurysms of the descending thoracic aorta both in elective cases and in emergencies. METHODS: Indications for stent-graft treatment were dependent on multislice angio-CT evaluation revealing a proximal neck of at least 10 mm between the left common carotid artery and the onset of aneurysm. All stent grafts were inserted in the operating room; 43 transfemoral, 2 transiliac. The stent grafts used were Corvita, Stenford, Vanguard, AneuRx, Talent, and Excluder. Deployment was achieved under fluoroscopic control, endoleaks were checked for with D S A on the operating table and postoperatively by angio-CT. Long-term follow-up consisted of evaluation with angio-CT after 6 and 12 months, and from there on once a year and with plain chest X-rays. Follow-up was achieved in all patients. RESULTS: Mean follow-up is 21 months (1-66); 30-day mortality is 3/45, no permanent neurologic deficit. Thirty patients were treated electively, 15 with contained rupture. Left subclavian artery overstenting proved to be necessary in 12 patients for proper proximal sealing of the aneurysm, type I endoleaks were observed in 10 patients, one early conversion, 7 proximal extension cuffs, one sealed spontaneously, one still at risk. Among patients where LSA had been overstented only one wanted a transposition, all others did well without left-hand ischemia or subclavian steal syndrome. CONCLUSION: Endovascular treatment is less invasive and has reasonable mortality and morbidity but is limited to well-defined morphologies. Mid-term results are promising but it has to be observed whether these will translate into long-term durability.

Aged↗
PubMedDate not supplied

Management of descending aortic dissection.

The optimal timing of surgery with Stanford type B aortic dissection remains controversal. In acute-phase cases, surgical mortality is so high that medical treatment is preferable unless there are major complications. To guide the choice of medical versus surgical therapy we use survival analysis in patients with acute uncomplicated/complicated and chronic uncomplicated/complicated descending aortic dissection. Between 1992 and 1993 49 patients were diagnosed with Stanford type B aortic dissection. Emergent surgery was performed in 4 patients for rupture or impending rupture, elective surgery was done in 12 patients. The remaining 33 patients were treated medically. Our results support the continued use of medical management as the primary treatment for uncomplicated acute aortic dissection, with surgical therapy being reserved for those patients with complications such as rupture, expansion, continuing pain or ischemia of distal vascular beds.

Aortic Dissection↗