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Biomedical subjects

L Sunder-Plassmann

Publications and source records attributed to L Sunder-Plassmann.

At least 37 records · Page 2Linked to original sources
PubMed2001

Endovascular grafting of traumatic aortic aneurysms in contaminated fields.

PURPOSE: To evaluate the potential of endovascular stent-grafts to treat traumatic aortic lesions in contaminated areas. METHODS: Four patients (3 women; ages 26-78 years) underwent stent-grafting to repair an aortic rupture sustained in a motorcycle accident, aortic lacerations secondary to surgical treatment of spondylitis in 2 patients, and an aortobronchial fistula following surgical thoracic aortic repair 10 years earlier. Stent-grafts (2 Corvita, 1 Talent, and 1 Vanguard) were placed endoluminally into the infected areas via a transfemoral approach. Follow-up included erythrocyte sedimentation rate, white blood count, C-reactive protein, blood cultures, and computed tomography (CT). RESULTS: The stent-grafts were successfully placed in all cases and excluded the aortic lesion. Under supportive antibiotic therapy, inflammation parameters returned to normal. CT imaging showed no evidence of paraprosthetic infection, nor were there any other complications over a follow-up that ranged from 3 to 34 months. CONCLUSIONS: Endovascular therapy may be an alternative in the acute management of aortic ruptures in the setting of infection. Long-term results are required for definitive evaluation of the method.

Adult↗
PubMed2000

[Pneumothorax].

Explore the source record for details and available documents.

Humans↗
PubMed2000

[Effects of carotid artery thrombendarterectomy on pulsatile ocular blood flow].

UNLABELLED: Successful operations of clinically significant carotid artery stenosis by carotid endarterectomy (CEA) are leading to a better perfusion in the region of this artery. It still creates problems to make a statement about cerebral and ocular perfusion during the operation. METHODS: In 10 patients who underwent a CEA the pulse amplitude (PA) of the intraocular pressure (IOP) was measured intraoperatively by a pneumotomography (OBF-Systems, U.K.) and the so called pulsatile ocular blood flow (pOBF) was determined. The middle arterial blood pressure (MAP) was taken invasively during the operation. RESULTS: During the clamping phases no PA could be recorded. PA (p = 0.04) and pOBF (p = 0.028) increased on the side which had been operated on. No correlations of PA and pOBF to MAP were found. CONCLUSION: This method can prove an increased pulsatile ocular blood flow after successful CEA.

Aged↗
PubMed2000

How useful is positron emission tomography for lymphnode staging in non-small-cell lung cancer?

UNLABELLED: The introduction of positron emission tomography (PET) raises the question of the new method's capabilities in the staging of mediastinal lymphnodes, since PET differentiates between metabolically active and inactive tissues. 80 patients with histologically confirmed non-small-cell lung cancer (NSCLC) underwent PET scanning with 18-F-marked fluorodeoxyglucose (FDG). Extensive dissection of mediastinal lymphnodes (18-28 lymphnodes recovered) was performed in 78 cases. Metastasis to mediastinal lymphnodes were observed in 25 patients (N2: 22; N3: 3). RESULTS: Primary Tumor: FDG-PET showed significant enhancement of the primary tumor in 78 of 80 patients (sensitivity: 97%). Lymphnode Involvement: FDG-PET was positive in 23 of 25 patients with surgically confirmed lymphnode involvement (sensitivity: 92%). After a median follow up interval of 18 months, 11 patients with false positive lymphnode uptake were still alive; 10 of them showed no tumor recurrency. On the basis of these findings, enlarged mediastinal lymphnodes visualized at CT, but negative at FDG-PET are free of metastatic involvement with a sensitivity of 92%. FDG uptake of mediastinal lymphnodes at PET, however, should not be interpreted as proof of malignancy.

Adult↗
PubMed2000

Treatment of leaks after endovascular repair of aortic aneurysms.

PURPOSE: To evaluate leaks after the endovascular repair of aortic aneurysms and treat them with occlusive therapy. MATERIALS AND METHODS: Seventy patients (11 women, 59 men), aged 26-82 years (mean, 69.2 years), underwent transfemoral insertion of endoluminal stent-grafts for treatment of aortic aneurysms. Indications were traumatic pseudoaneurysms (n = 5) or arteriosclerotic aneurysms (n = 65). Aneurysms were thoracic (n = 5) or infrarenal (n = 65). To exclude the possibility of leaks, spiral computed tomography (CT) was performed at 3-month intervals. Patients with leaks that persisted unchanged longer than 3 months were referred for angiography and occlusive therapy. RESULTS: At CT, 21 leaks were identified in 17 of 70 patients (24%). Only 11 of those 17 patients (65%) had leaks identified with conventional aortography. Selective angiography, however, depicted all of these. Eighteen of 21 leaks proved amenable to occlusive treatment: surgery (n = 1), further stent implantation (n = 4), or embolization (n = 13). In one leak, spontaneous occlusion occurred after 3 months. Two leaks in either the iliolumbar or the median sacral artery were inaccessible; one remained untreated, and the other was unsuccessfully treated. Mean follow-up of occlusive therapy was 6.8 months (range, 2-14 months). CONCLUSION: Successful occlusion of perigraft leaks is feasible in most cases and can be performed without major complications.

Adult↗
PubMed2000

Malpositioned or dislocated aortic endoprostheses: repositioning using percutaneous pull-down maneuvers.

PURPOSE: To present the capabilities and potential complications of 2 percutaneous techniques for repositioning malpositioned or dislodged aortic endografts. METHODS: Seven male patients (median age 67.9 years, range 59 to 78) required correction of misplaced or dislocated endografts in the thoracic (n = 1) or infrarenal abdominal aorta (n = 6). In 1 patient, an infrarenal bifurcated stent-graft was mistakenly deployed across a renal artery; repositioning was accomplished by tugging caudally on a guidewire placed across the endograft bifurcation and exteriorized from both femoral arteries. An inflated balloon catheter was used to reposition 3 dislocated aortic devices (1 thoracic, 2 infrarenal) and 3 iliac graft limbs that had disconnected from the main graft body 6 to 12 months after implantation. RESULTS: Repositioning maneuvers were successful in all cases, with the devices being moved from 5 to 27 mm (median 7.8 mm). There were no procedure-related complications. CONCLUSIONS: Nonsurgical repositioning of misplaced aortic prostheses is technically feasible in individual cases. The risk associated with the procedure, however, cannot yet be evaluated.

Aged↗
PubMed2000

Embolization of type II endoleaks fed by the inferior mesenteric artery: using the superior mesenteric artery approach.

PURPOSE: To evaluate the use of a superior mesenteric artery (SMA) approach to embolize type II endoleaks arising from the inferior mesenteric artery (IMA). TECHNIQUE: When reperfusion of the aneurysmal sac via the SMA occurs through the IMA, as shown by computed tomography (CT) and angiography, the IMA origin can be accessed via the marginal artery or the anastomosis of Riolan. The SMA is catheterized with a 5-F catheter, and a coaxial catheter is advanced to the leak to deliver 2- to 8-mm-diameter minicoils to embolize the IMA origin and entire aneurysmal sac. Embolization usually requires from 1 to 2 hours to complete. In our experience with this technique in 11 cases, complications have not occurred, and there has been only one very small residual leak that sealed the next day. Over a 24.5-month follow-up (range 12-39), the endoleaks have remained sealed according to serial color duplex scans. CONCLUSIONS: Successful percutaneous treatment of type II endoleak due to IMA inflow can be accomplished using an SMA access via the Riolan anastomosis or marginal artery. The procedure appears to be safe and has no adverse effects.

Aged↗
PubMed2000

Expression of myosin heavy chain isoforms in skeletal muscle of patients with peripheral arterial occlusive disease.

PURPOSE: Peripheral arterial occlusive diseases (PAODs) not only compromise blood flow but lead to a series of subsequent metabolic and structural changes in the relevant muscles. Changes in myofibrillar proteins (eg, of myosin heavy chain [MHC] isoforms), one of the determinants of muscle structure as well as of muscular function, have not been reported in patients with PAOD and were therefore the aim of this study. METHODS: Thirteen consecutive patients with PAOD were examined (clinical stage according to Fontaine II, three patients; III, three patients, and IV, seven patients) and compared with five age-matched control patients who had been in traffic accidents. A calf muscle sample (gastrocnemius muscle) in the ischemic region was taken for MHC isoform analysis by sodium dodecyl sulfate polyacrylamide gel electrophoresis and silver stain, and the relative content of MHC isoforms was measured. RESULTS: Compared with the control patients, there was no significant change of MHC isoforms in patients with PAOD II. In patients with PAOD III, MHC IIb decreased significantly (P <.05) although MHC IIa remained unchanged; in patients with PAOD IV, both MHC IIa and IIb decreased significantly (P <.05). Accordingly, there was a progressive increase of the relative amount of MHC I with more critical ischemia in PAOD. CONCLUSION: In patients with PAOD, the content of MHC II decreased with a higher grade of ischemia. That seems to be consistent with an increased resistance to ischemia for myosin isoforms in the order of I more than in IIa more than IIb. Whether the decrease of MHC II in patients with PAOD is related to atrophy of muscle fibers or to muscle-fiber transition must be investigated further.

Aged↗
PubMed1999

[In Process Citation]

Since 1996 thoracic surgery has been invoiced according to fixed reimbursement rates (Sonderentgelte, SE). The legislator argues that fixed reimbursement rates cover operation costs and justify a 20% reduction in reimbursement for nursing. In order to examine this assumption we performed a cost analysis of thoracic surgery. Taking into account the staff, equipment, and operating theatre supplies, we analyzed 30 cases of five different types of operation prospectivly: wedge resections with more than three wedges (AR: n = 8), lobectomies (LE: n = 8), pneumonectomies (PE: n = 5), thoracoscopic wedge resections (VR: n = 6) and resections of mediastinal tumors (MR: n = 3). Then we calculated the overall costs for each operation. The costs for a LE amounted to DM 9,927, which is DM 4,904 more than the corresponding fixed reimbursement rate. The costs were DM 11,562 for a PE, DM 12,477 for a VR and DM 7,532 for a MR. Thus the costs were DM 5,539, DM 2,435 or DM 1,907 higher than the corresponding fixed reimbursement rates. The fixed reimbursement rate for an AR was DM 866 higher than the actual cost of DM 6,922. Only for a small number of cases do the fixed reimbursement rates cover the actual costs of thoracic surgery. Thus operation costs still need to be at least partly covered by the reimbursement for nursing.

Journal Article↗
PubMed1999

Endoluminal grafting of infrarenal aortic aneurysms.

BACKGROUND: The department policy regarding therapy fo infrarenal aortic aneurysms is reviewed, based on the treatment results of a 12-months period. METHODS: From October 1996 to August 1997, 60 patients with infrarenal aortic aneurysms were admitted to our department. Of these 31 (52%) were found to be anatomically or pathomorphologically suitable for endovascular treatment, based on the premises that: 1. Whenever the anatomy is suitable and confirmed with CT or angiography, repair is by means of stent placement. 2. In emergencies and in cases where the anatomical relationships are unfavourable, patients undergo conventional open surgery. RESULTS: In all 31 patients treated endovascularly, stent placement was technically successful. Procedure-associated mortality was zero. The following stenting complications occurred: seven endoleaks, one thrombotic iliac occlusion, one femoral arterial dissection, two puncture-related inguinal hematomas. Elective open surgery was performed in the other 29 patients. One of these died from the effects of renal failure. CONCLUSIONS: This comparison shows that endovascular treatment of infrarenal aortic aneuryms is possible in a large proportion of patients and is not associated with an unfavourable rate of complications. Endovascular treatment can significantly reduce patients' postoperative hospitalization (three days) and time spent in intensive care.

Aged↗
PubMed1999

Leakages after endovascular repair of aortic aneurysms: classification based on findings at CT, angiography, and radiography.

PURPOSE: To ascertain whether the configuration and location of leakages identified at computed tomography (CT) could provide evidence of their angiographically and fluoroscopically confirmed causes. MATERIALS AND METHODS: Fifty patients aged 26-79 years underwent endovascular repair of traumatic (n = 4) or arteriosclerotic (n = 46) aortic aneurysms (four thoracic, 46 infrarenal). Radiographic examinations in three planes and helical CT were performed 1 week after implantation and every 3 months thereafter. Angiography was performed when there was evidence of a leakage at CT. RESULTS: CT demonstrated evidence of leakages in 13 patients. Broad-based leakages immediately adjacent to the prosthesis were termed "perigraft leakages." If the area most affected by the leakage lay along the border of the aneurysm, then retrograde leakages were apparent at angiography. If the leakage was ventral to the prosthesis, then its source was the inferior mesenteric artery; if it was dorsolateral, then it was supplied by either the lumbar arteries or the median sacral artery through the hypogastric artery. One circumferential leakage could not be evaluated adequately at CT or angiography. Radiography depicted a rupture of the stent mesh in the middle of the prosthesis. Selective angiography demonstrated all types of leakages and permitted CT classification. CONCLUSION: The cause of a leakage can be determined with CT on the basis of its configuration and location in the majority of cases.

Adult↗
PubMed1999

Endovascular repair of aortic aneurysms: treatment of complications.

PURPOSE: To evaluate the use of interventional procedures for treating complications following endovascular repair of aortic aneurysms. METHODS: Fifty-five patients (49 men; mean age 67.5 years) underwent endoluminal stent-graft repair of traumatic (n = 4) or arteriosclerotic (n = 51) aortic aneurysms in the thoracic (n = 3) or infrarenal (n = 52) aorta. Follow-up of therapeutic success included periodic clinical examination, angiography, and spiral computed tomography. RESULTS: Discounting the 25 (45%) cases of postimplantation syndrome that did not require treatment, there were 22 complications observed in 20 (36%) patients over a mean 10-month follow-up (range 1 to 27). There were 2 transrenal endograft maldeployments, 1 case of twisted graft limbs, 2 access site problems (1 patient), 12 endoleaks (11 patients), 1 late graft limb thrombosis, 1 symptomatic internal iliac artery occlusion, 2 myocardial infarctions, and 1 transient psychosis. Seven (13%) patients did not undergo specific therapy, while 4 (7%) required operation (2 crossover bypass grafts, 1 suture revision, and 1 graft replacement). Among 9 (16%) patients treated with interventional techniques, 7 underwent percutaneous coil embolization for 8 endoleaks (7 successfully resolved). One late stent-graft disconnection required an additional stent-graft, and 1 of the 2 malpositioned endografts was repositioned. All patients remain alive with no increase in the diameter of the aneurysm in any patient. CONCLUSIONS: Technical problems resulting from the endovascular repair of aortic aneurysms often respond to interventional treatment.

Adult↗
PubMed1999

[Stent implantation after thrombectomy of pelvic veins. Indications, results].

PURPOSE: Retrospective study on frequency of iliac venous stenoses that are cause (venous spur) or consequence (postoperative or postthrombotic) of iliofemoral thrombosis, and on the results of interventional treatment. METHODS: From 1990 through 1996, 76 patients were operated on for acute iliac vein thromboses. All patients had transfemoral venous thrombectomy with creation of an inguinal av-fistula. Immediate results of thrombectomy were documented by intraoperative completion venogram. Since 1995 venous spurs eventually detected during thrombectomy were immediately treated by stent implantation. Before scheduled closure of the av-fistula at three months, cross-over arteriovenography was performed. Additional significant iliofemoral venous stenoses were also treated interventionally at this time. RESULTS: 42 hemodynamically significant iliofemoral venous stenoses were found in 38 (50%) patients. Intraoperative phlebography revealed left common iliac vein obstructions suggestive of venous spurs in 30 patients (49% of left-sided thromboses). At three months, five patients (7%) had postthrombotic iliac vein stenoses, and seven patients (9%) had postoperative common femoral vein stenoses. A total of 26 stents were implanted into 20 stenoses (eight spurs, all postthrombotic and postoperative stenoses). There was an acute re-occlusion due to a technical error during stent implantation. In all other patients, the venous lumen could be completely restored. Three of four re-stenoses (at 3, 4, 7, and 12 months) were successfully treated by another intervention. We observed one late failure at 60 months. Cumulative primary (secondary) five-year patency rate (Kaplan-Meier) is 72% (88%). CONCLUSION: For venous spurs as well as for postthrombotic or postoperative venous stenoses, stent implantation can be recommended as a simple, safe, and durable means to prevent rethrombosis.

Adolescent↗
PubMed1998

[Pleural empyema].

Thoracic empyema may be based on four different etiologic mechanisms of infection: (1) parapneumonic, (2) posttraumatic, (3) postspecific, (4) postsurgical. According to morphologic processes, three different time-dependent stages may be present: (1) exudative phase, (2) fibrino-purulent phase, (3) organization and pleural peel formation. Diagnosis and pleural puncture are based on the findings of thoracic CT and transthoracic ultrasonography. Thoracocentesis, however--even if performed repeatedly--is not an appropriate treatment of empyema. Chest tube drainage and irrigation of the pleural cavity is appropriate only in stage I and early stage II disease to re-establish total lung inflation and healing without pleural peel formation. Selected stage II cases may benefit from video-assisted debridement, but a 30% conversion rate to open thoracotomy has to be assumed. Residual organized cavities, loculated peels etc. require open thoracotomy and empyemectomy, decortication or combined maneuvers. For treatment quality and outcome it is not only decisive to remove the source of infection but also to reexpand the entire lung without remaining restrictive peels and without relevant leaks.

Chest Tubes↗
PubMed1998

Left iliac venous thrombosis caused by venous spur: treatment with thrombectomy and stent implantation.

PURPOSE: To determine the frequency of iliac venous spurs in left iliofemoral venous thrombosis and to report the results of interventional management of venous spurs after transfemoral venous thrombectomy. METHODS: From 1990 through 1996, 77 patients with acute iliac venous thrombosis (61 left and 16 right) underwent surgical treatment. Patients with malignant disease were excluded from this series. All patients had transfemoral venous thrombectomy with construction of an inguinal arteriovenous fistula and perioperative anticoagulation with heparin with a switch to warfarin sodium for at least 12 postoperative months. Immediate results of thrombectomy were documented by means of intraoperative completion venography. Arteriovenous fistulas were ligated 3 months after control arteriovenography. Since 1995 venous spurs eventually detected during thrombectomy were treated immediately by means of stent implantation. RESULTS: Among 61 patients with left-sided thrombosis, intraoperative phlebography revealed common iliac venous obstruction suggestive of venous spurs in 30 patients (49%). In 16 of 22 patients (73%) with untreated spurs, postoperative rethrombosis of the iliac vein was documented despite adequate anticoagulation. Only one of eight patients (13%) with stented spurs had reocclusion (chi2 test P < .01). CONCLUSION: Venous spurs are found among about half of patients with left-sided iliac venous thrombosis. As long as the underlying venous pathologic process is left untreated, thrombectomy will not restore patency. Stent implantation is a simple and safe means to correct central venous strictures and provides excellent long-term results.

Anticoagulants↗
PubMed1998

Emergent endoluminal repair of delayed abdominal aortic rupture after blunt trauma.

PURPOSE: To report the emergency repair of a traumatic abdominal aortic rupture using endoluminal techniques. METHODS AND RESULTS: A 25-year-old female sustained multiple head, chest, and abdominal injuries in a motorcycle accident. Six days after emergency treatment (including splenectomy and repair of a superficial hepatic rupture and lacerations to the stomach, small bowel, and colon), she became hemodynamically unstable. A massive retroperitoneal hematoma had evolved from a distal aortic rupture. Owing to a hostile abdomen and possibility of bacterial contamination, a self-expanding stent-graft was inserted transfemorally to repair the aortic injury. The patient recovered uneventfully and continues in good health with a patent endograft repair 2 years after treatment. CONCLUSIONS: This experience would support the efficacy of endograft implantation for emergent repair of trauma aortic injuries; however, proper facilities, an experienced interventional team, and an assortment of endografts and stents must be available.

Adult↗
PubMed1998

[Monitoring ischemia-/reperfusion syndrome in abdominal aortic aneurysm--conventional operation versus stent implantation].

From a biochemical point of view, our study corroborates the suggestion that implantation of a stent graft is less invasive than conventional surgery for infrarenal aortic aneurysm. In general, ischemia during open aortic surgery lasts shorter but affects a much greater part of the body than stent implantation. Eventration before, and more pronounced reperfusion following conventional repair cause marked intra-operative increases in TxB2, 6-keto-PGF1 alpha, and sICAM-1 levels. Thromboxane obviously is generated mainly in the reperfused tissues, whereas 6-keto-PGF1 alpha is produced in the eventrated bowel. sICAM-1 is released from both.

Aortic Aneurysm, Abdominal↗