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Biomedical subjects

L Gürke

Publications and source records attributed to L Gürke.

At least 19 recordsLinked to original sources
PubMed2002

Does fibrin glue reduce complications after femoral artery surgery? A randomised trial.

OBJECTIVES: to determine whether application of fibrin glue before closure of inguinal wounds reduces the incidence of lymphatic complications. DESIGN: we a prospective randomised trial. MATERIALS AND METHODS: 224 consecutive patients were enrolled. The wounds were randomly assigned to standard closure (group A, n = 134) or closure with application of fibrin glue (group B, n = 132). The incidence of local lymphatic and non-lymphatic complications, the amount of lymphatic fluid collected, and the time to drain removal were compared in the groups. RESULTS: the incidence of lymphatic complications was 19% in group A and 10% in group B (p = 0.027). The average drain output and the time to drain removal did not differ in the two groups. The total incidence of non-lymphatic local complications was 10% and did not differ in the two groups. CONCLUSIONS: fibrin glue application is associated with a significant reduction in lymphatic complications.

Adult↗
PubMed2002

Infrainguinal arterial reconstruction: female gender as risk factor for outcome.

OBJECTIVES: the effect of gender on the long-term results of infrainguinal arterial reconstruction are poorly investigated. METHODS: all patients undergoing infrainguinal arterial reconstruction with an autogenous vein are as 11 years period was prospectively evaluated. RESULTS: four hundred and fifty reconstructions (292 man, 160 women) were performed as on 416 patients. Thirty-day mortality was 1.1% (n=5). Women were on average older (74 vs 68; p<0.001) and disease was more advanced (81 vs 68%,p =0.013 with stage of critical ischaemia). Primary (58 vs 61%) and primary assisted patency rates (82 vs 84%) were comparable. Limb salvage and survival after 60 months were not different. On multivariate analysis age and stage of the disease were independent variables for patency and survival. Diabetes and gender reached statistical significance as predictors of limb salvage only. CONCLUSION: age and stage of the disease were independent predictors for patency and survival, diabetes and gender for limb salvage.

Adolescent↗
PubMed2001

Reduction of groin lymphatic complications by application of fibrin glue: preliminary results of a randomized study.

Lymphoceles and lymph fistulas are common complications after exposure of the common femoral artery in the Scarpa triangle because of operative transsection of overlying lymphatics. The purpose of this prospective randomized study was to determine the incidence of groin lymphatic complications and to assess the impact of routine application of fibrin glue on lymphatic structures and subcutaneous tissue prior to closure. All patients undergoing exposure of the common femoral artery in the Scarpa triangle were included in this study. They were divided into two groups according to closure technique. In group A, closure was performed without fibrin glue. In Group B, fibrin glue was applied to lymphatic structures prior to closure. The efficacy of fibrin glue application was estimated on the basis of two criteria: incidence of local complications and amount of lymphatic fluid in the Redon drain. The preliminary findings suggest that application of fibrin glue leads to a significant reduction in the incidence of lymphatic complications after femoral artery exposure in the Scarpa triangle.

Adult↗
PubMed2001

[Differential diagnosis of groin pain: isolated, symptomatic dissection of the infrarenal aorta and iliac arteries].

INTRODUCTION: Pelvic and inguinal pain are a rare manifestation of arterial disease. METHODS: Description of four patients with acute or chronic pelvic or inguinal pain due to symptomatic dissection of the infrarenal aorta and/or iliac arteries. RESULTS: In two cases the dissection was limited to the left iliac artery with an entry at the beginning of the common iliac artery. The re-entry was located in the distal external iliac or common femoral artery. In one patient additionally a infrarenal abdominal aortic aneurysm was found. In the other two patients the entry of the spontaneous dissection was in the position of the infrarenal aorta, with extension in one iliac artery. In two patients the diagnosis of Erdheim-Gsell media necrosis was histologically confirmed. CONCLUSIONS: Spontaneous arterial dissection should be considered in patients with pelvic or inguinal pain. Absence of thoracic symptoms is possible if the entry of the dissection is distal, within the infrarenal aorta or iliac arteries. Prompt diagnosis with duplex sonography, CT, arteriography or MRA is indicated. The type of reconstruction depends on the extent of the dissection and the concomitant arterial disease.

Abdominal Pain↗
PubMed2001

Cervical nerve injury after carotid endarterectomy.

OBJECTIVE: to determine the extent and direct significance of cervical nerve injury after carotid endarterectomy. MATERIAL AND METHODS: fifty-two patients (61 operations) were followed by means of patient history and neurological examination between 3 and 55 months following carotid endarterectomy. RESULTS: sixteen operated sites showed normal sensitivity. Patients assessed 3-6 months after surgery showed on average a neurological loss of 3.4 points (scale from 0-4). Patients assessed after 7-12 months had on average a deficit of 2.1 points. After 13-24 months the score was at 1.4 and after the second postoperative year the score yielded only 0.4 points. CONCLUSION: loss of cervical nerve sensation is always present after carotid endarterectomy but tends to improve with time. However, the timing and extent of this improvement is unpredictable. Patients are usually not disturbed by these changes.

Aged↗
PubMed2001

Long-term results of infrainguinal arterial reconstruction with spliced veins are equal to results with non-spliced veins.

OBJECTIVES: to determine the long term patency of spliced and non-spliced infrainguinal vein grafts. METHODS: a prospective registry of all patients undergoing infrainguinal arterial reconstruction with autogenous vein material was retrospectively interrogated. RESULTS: between October 1988 and August 2000, 515 infrainguinal arterial reconstructions were performed on 472 patients. A total of 429 bypasses were performed with uninterrupted greater saphenous vein, 86 reconstructions using spliced vein segments. There was no significant difference in primary (63% vs 57%) and primary assisted patency (81% vs 81%) of limb salvage (88% vs 91%) at 5 years. Limb salvage was not different (88% and 91% respectively). CONCLUSION the splicing of vein grafts does not compromise patency of limb salvage.

Aged↗
PubMed2001

Athletes with lower limb ischaemia.

The case of a young healthy sportsman and acute exacerbation of chronic infragenicular pain is presented. Further investigation revealed an obstruction of the tibiofibular trunk due to an osteochondroma, arising from the fibula, which was immediately resected. Osteochondroma is observed in 1-2% of the population and may present with vascular complications. In young patients and athletes, leg pain may be of vascular origin due to an entrapment or compression and should always be considered.

Adult↗
PubMed2001

The effect of pretreatment with ischaemic preconditioning or cromakalim on perfusion in skeletal muscle during ischaemia-reperfusion injury.

BACKGROUND: Ischaemia-induced damage of skeletal muscle may lead to side effects in orthopaedic and reconstructive surgery where tourniquet ischaemia is applied to ensure a bloodless operative field. In this study we investigated the effect of ischaemia-reperfusion injury with and without preconditioning by studying the skeletal muscle microcirculation. A further aim was to establish whether ischaemic preconditioning or pretreatment with cromakalim, a potassium channel opener reduces ischaemia-reperfusion injury. METHODS: Twenty-eight Wistar rats were randomised into four groups (n=7 per group). Group 1, control with no treatment; Group 2, two and a half hours tourniquet ischaemia followed by two hours of reperfusion to the left hindlimb. Furthermore, we pre-treated two groups prior to the ischaemia-reperfusion period; Group 3 with three short cycles of ischaemia-reperfusion (5'/5') and Group 4 pre treated with cromakalim (100 microg/kg bw). We monitored the gastrocnemius muscle blood flow in vivo. RESULTS: There were no significant changes in the skeletal muscle microcirculation and temperature at the baseline in the four groups (p=0.110). In the ischaemic reperfusion, ischaemia preconditioning and cromakalim groups, the recorded skeletal muscle microcirculation during ischaemia decreased significantly (p<0.001) with respect to the baseline. In Group 2 the microcirculation recovered rapidly after release of the tourniquet, but was significantly lower (37 percent of baseline value, p<0.001) within two hours of reperfusion. In the ischaemia preconditioning group the microcirculation as in the ischaemia-reperfusion group recovered rapidly after release of the tourniquet, although failing to reach the baseline value within two hours of reperfusion. The mean microcirculation value of the left limb was slightly higher than Group 2 but significantly lower compared to the baseline after two hours of reperfusion (p<0.001). The change in the skeletal muscle microcirculation with cromakalim after two hours of reperfusion was not significant when compared to baseline values (p>0.05). The cromakalim group after two hours reperfusion had significantly higher microcirculation values when compared with Groups 2 and 3 (p<0.001). During ischaemia-reperfusion in Groups 2-4, there was no significant alteration in the systemic haemodynamic circulation. CONCLUSIONS: This study supports the hypothesis that cromakalim reduces postischaemic skeletal muscle damage and reperfusion injury.

Animals↗
PubMed2000

Mechanisms of ischemic preconditioning in skeletal muscle.

BACKGROUND: Ischemic preconditioning (IP) (one or more cycles each consisting of a short period of ischemia and a short period of reperfusion, before the sustained ischemia) reduces ischemia-related organ damage in heart and skeletal muscle but the underlying mechanisms are not clear. This study was intended to assess the possible involvement of K(ATP) channels and of adenosine receptors in IP of skeletal muscle in a rat model of skeletal muscle ischemia. MATERIALS AND METHODS: Groups of 8-15 rats were given the following in vivo treatments: ischemia-reperfusion (I-R: 2.5 h tourniquet-induced ischemia of the right hindlimb, then 2 h reperfusion); IP (three cycles of 5 min ischemia, then 5 min reperfusion) before I-R; cromakalim and I-R; glibenclamide, cromakalim, and I-R; glibenclamide, IP, and I-R; [R]-N(6)-[1-methyl-2-phenylethyl]adenosine (R-PIA) and I-R; adenosine and I-R; and glibenclamide, IP, and I-R. Parameters of muscle function (postischemic maximal force, performance, contraction index, and force after 1 min of stimulation) were then assessed in vitro in the extensor digitorum longus muscle. RESULTS: Pretreatment with either IP or the K(ATP) channel opener cromakalim significantly improved postischemic muscle function. The protective effect of cromakalim was not seen when the K(ATP) channel blocker glibenclamide was added. Glibenclamide, however, did not block IP-induced protection. Pretreatment with the adenosine A(1) receptor agonist 8-(p-sulfophenyl)-theophyllin (8-SPT) or with adenosine did not improve postischemic muscle function. The adenosine receptor agonist did not block IP-induced protection against ischemic damage. CONCLUSIONS: The results show significant improvements in postischemic skeletal muscle function after IP or cromakalim pretreatment but they do not support a role for K(ATP) channels or for adenosine receptors in IP of skeletal muscle.

Animals↗
PubMed2000

Function of fast- and slow-twitch rat skeletal muscle following ischemia and reperfusion at different intramuscular temperatures.

Fast- (peroneal) and slow-twitch (soleus) skeletal muscles of anesthetized Wistar rats were subjected to 3 h of tourniquet ischemia. The intramuscular temperature of the leg was adjusted to 22, 30 or 35 degrees C (n = 12 per group) during ischemia. After 2 h of reperfusion, the muscles were electrically stimulated in vitro and muscular function was analyzed for maximal force, performance, contractility and fatigue. Contralateral nonischemic muscles served as controls. Three hours of ischemia at 30 degrees C did not reduce the function of the peroneal muscles compared to nonischemic controls. The same ischemic stress significantly reduced the function of the soleus muscles compared to nonischemic controls. The postischemic function of the soleus muscles declined with increasing temperature. The postischemic function of the 35 degrees C group of peroneal muscles was significantly reduced compared to the 22 and the 30 degrees C groups, which did not differ. These results provide evidence that fast-twitch muscles are more resistant to ischemia than slow-twitch muscles. They furthermore show a fiber type-specific dependency of postischemic muscle function on intramuscular temperature during ischemia. Hypothermia-sensitive fast-twitch fibers predominate in the skeletal muscles of the extremities. Mild hypothermia could, therefore, reduce tourniquet ischemia-induced injury after surgery of the extremities.

Animals↗
PubMed2000

Preconditioning with short cycles improves ischemic tolerance in rat fast- and slow-twitch skeletal muscle.

AIM: The aim of this study was to investigate whether the efficacy of ischemic preconditioning (IP) in rat skeletal muscle depends on the duration of the preconditioning cycles. METHODS: Rats were divided into four groups (n = 10 each). The right hindlimb of rats in group A were subjected to 2.5 h of tourniquet ischemia followed by 2 h of reperfusion (I-R). Thereafter, muscular function was analyzed in vitro and high-energy phosphates (HEP) were determined by HPLC. Before I-R, right hindlimbs of rats in groups B-D subjected to IP with three cycles each consisting of 2.5, 5 or 10 min of ischemia followed by reperfusion for the same duration. RESULTS: Postischemic function of the extensor muscle was significantly improved with all three preconditioning protocols. Postischemic function of the soleus muscle was only improved by IP with three cycles of 5 min of ischemia and 5 min of reperfusion. Postischemic HEP tissue levels were not influenced by IP. CONCLUSION: This study shows for the first time that IP increases ischemic tolerance not only of fast-twitch but also of slow-twitch skeletal muscle. The efficacy of IP seems to be less dependent on the duration of the single preconditioning cycle than on the number of cycles performed. Three cycles each of 2.5, 5 or 10 min ischemia and reperfusion significantly improved postischemic skeletal muscle function. Tissue levels of HEPs, however, were not influenced by IP indicating that preservation of HEPs does not play a major role in the effects of IP on rodent skeletal muscle.

Adaptation, Physiological↗
PubMed1999

[Graphical analysis and operative technique of single-cut osteotomy for complex femur deformities].

The correction of complex long bone deformities with concurrent bending, twisting and shortening is primarily based on complex preoperative planning. Up to now, wedge-shaped cortico-spongiose osteotomy has usually been performed. The single cut osteotomy requires more complex mathematical calculations and was therefore less frequently undertaken. In this paper, we present a graphical approach to define the plane of the single-cut osteotomy without any calculations. The resulting osteotomy allows a simultaneous correction of a deformation in the coronal and sagittal planes, as well as a coexisting torsional error. The advantages of this graphical approach are evident. Preoperative planning is significantly simplified and abbreviated as mathematical calculations are no longer needed. Furthermore, the precision by which the osteotomy plane is defined is not decreased by application of this method. However, the osteotomy should be done preoperatively in a model.

Bone Malalignment↗
PubMed1998

[Is infra-inguinal venous bypass less successful in the woman?].

In the present study the influence of gender in peripheral arterial reconstructions was evaluated. Between 1986 and 1990 we performed 173 infrainguinal vein bypass procedures in 117 men and 56 women. All procedures were carried out for chronic critical leg ischaemia. Bypasses in men were femoral to popliteal in 68%, and femoral to infragenicular in 32% in cases. The corresponding values in women were 52% and 48%. Perioperative 30-day mortality was 2% in men and 2% in women. Long-term survival at 5 years was 50% in men and 44% in women. Life-table primary 5-year patency rates were 81% for men and 74% for women. Limb salvage results at 5 years were 87% for men and 84% for women. The results indicate that in our experience with autogenous vein longterm graft patency and limb salvage results in women are identical to those obtained in men. Infrainguinal arterial reconstruction can be performed in women with mortality rates similar to those of men.

Adult↗
PubMed1998

[Superficial femoral vein as vascular graft in surgical therapy of mycotic aneurysm of the common iliac artery].

A 38-year-old polytoxicomanic male patient developed an occlusion of both popliteal arteries associated with an aneurysm of the right common iliac artery. A septic cause was suspected and an antimycotic therapy was instituted, but the diameter of the aneurysm increased to 3 cm during 6 months. Moreover, multiple periarterial abscesses occurred. The aneurysm was resected and the iliacal axis reconstructed in situ, using a superficial femoral vein interposition. Six months after operation, patency was confirmed by duplex sonography. Phlebodynamic examinations showed normal flow functions at the donor site.

Adult↗
PubMed1998

Misleading symptoms after a minor blunt chest trauma. Thoracoscopic treatment of diaphragmatic rupture.

We present a case of missed diaphragmatic rupture which was treated thoracoscopically. Rupture of the diaphragm is a serious complication of blunt trauma. The diaphragmatic injury can easily be overlooked. This report illustrates the diagnostic dilemma in a patient where the injury was missed at the time of initial presentation. The role of thoracoscopy both for diagnosis and therapy is discussed.

Accidents, Traffic↗
PubMed1998

Energy metabolism and interstitial fluid displacement in human gastrocnemius during short ischemic cycles.

Energy metabolism and interstitial fluid displacement were studied in the human gastrocnemius during three subsequent 5-min ischemia-reperfusion periods [ischemic preconditioning (IP)]. The muscle energy balance was assessed by combining near-infrared spectroscopy (NIRS) and 31P-nuclear magnetic resonance spectroscopy (31P-NMRS). The interstitial fluid displacement was determined by combining NIRS and 23Na-NMRS. No changes in total energy consumption or in the fractional contribution of the underlying energy sources (aerobic glycolysis, anaerobic glycolysis, and Lohmann reaction) were observed in the muscle during the tested IP protocol. Oxygen consumption in the muscle region of interest, as estimated by NIRS, was approximately 8 micromol . 100 g-1 . min-1 and did not change during IP. Phosphocreatine and ATP concentrations did not change over the whole experimental period. A slight but significant (P < 0.05) increase in intracellular pH was observed. Compared with the control, a 10% greater interstitial fluid content per muscle unit volume was observed at the end of the IP protocol. It is concluded that, at variance with cardiac muscle, repeated 5-min ischemia-reperfusion cycles do not induce metabolic changes in human gastrocnemius but alter the interstitial fluid readjustment. The techniques developed in the present study may be useful in identifying protocols suitable for skeletal muscle preconditioning and to explain the functional basis of this procedure.

Adenosine Triphosphate↗