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M Bartel

Publications and source records attributed to M Bartel.

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

[Endoluminal stent prosthesis implantation in thoracic aneurysm of the descending aorta--a case report].

We report on a 72-year old male with a large aneurysm of descending thoracic aorta which was treated by implantation of a Dacron-covered self-expanding Nitinol stent graft (Talent, HOSMED). The patient was unfit for surgical aneurysm resection because of generalised atherosclerosis and cardiomyopathy. We think that stent implantation for descending thoracic aortic aneurysms is an attractive alternative to surgical aneurysm resection, especially in patients with enhanced operative risk. However, further experience, and especially long term-results, are required before more widespread application of intra-luminal stent implantation in the management of thoracic aortic aneurysms can be recommended.

Aged↗
PubMed1998

[Traumatic peripheral vascular injuries].

2-4% of vascular injuries need operative reconstruction. In polytraumatized patients the rate is even 10%. Arterial vascular repair should precede venous reconstruction and orthopaedic stabilization due to limb threatening ischemia. Penetration or blunt vascular trauma result either in acute blood loss, ischemia or compartmental compression. Reperfusion syndrome leads to vital threat of patient. Clinical assessment, measurement of limb pressures using a Doppler device and use of duplex ultrasonography are reliable adjuncts in the rapid evaluation. Arteriography is rarely indicated and should be spared for patients with abnormal physical examination. Minimizing ischemia (6-8 h) is an important factor in maximizing limb salvage. Vascular repair include direct anastomosis or lateral suture repair mostly combined with primary shortening of the extremity. In most cases autogenous vein graft is required. Rethrombosis, arteriovenous fistula and pseudoaneurysms are possible complications. Stabilisation of the fracture has priority over vascular reconstruction. The initial steps to success are surgical debridement, adequate bony stabilization mostly by external fixation, revascularisation of vascular injury, immediate fascial decompression and early soft-tissue reconstruction. The best results are obtained when a multidisciplinary approach is used combining expertise in orthopedic surgery, vascular surgery and plastic surgery.

Arteries↗
PubMed1997

[Recurrence after curative operation of non-small-cell bronchial carcinoma].

The poor prognosis of bronchial carcinoma is reflected among other things in a high recurrence rate. In general, recurrence is inoperable and only suitable for conservative/palliative management. The rate of curative surgical reintervention may be increased by early identification of recurrence. The value of tumour follow-up and the role of reoperation need to be assessed. 150 patients who underwent curative resection of non-small-cell lung cancer were followed-up for a mean of 4.5 years as part of a comprehensive after-care program. Fifty patients (33%) developed a recurrence at a mean of 13 months after operation. A second curative resection was possible in 9 patients (6%) with a mean survival of 22 months. Six of these patients had re-thoracotomy (completion pneumonectomy in 4 for local recurrence, mediastinal metastasectomy in 2), and in 3 patients a solitary cerebral metastasis was excised. Our results show that with focused, schematic tumour follow-up early recognition of recurrence is possible. Despite this, reoperation is only indicated in a selected group of patients because of multifocal recurrence, or local or functional inoperability. Further intensification of tumour follow-up is limited by personnel, logistical, and financial considerations. As an alternative, individualised, function-oriented tumour after-care could be considered.

Adult↗
PubMed1997

[Value of thoracoscopy in thoracic trauma--initial experiences].

The aim of this study was to assess the role of thoracoscopy in the evaluation of the cause of persistent intrathoracic bleeding, air leak, or nuclear basal opacification after blunt thoracic trauma. As a result, a decision to proceed to early thoracotomy could be made, or an attempt of thoracoscopic haemostasis, haematoma evacuation, or fistula closure was possible. Twelve patients (9 male, 3 female, mean age 33,7 years) with blunt thoracic trauma underwent video-assisted thoracoscopy under general anaesthesia with double-lumen endotracheal intubation and one-lung ventilation. The indication for operation was made after assessment of chest X-ray and CT findings, pleural ultrasound, and the volume and quality of pleural drainage. Persistent pneumothorax was shown to be due to traumatic rupture of a bulla in two cases and to parenchymal air-leak from a small lung laceration in two cases, all of which were treated endoscopically. In two cases a diaphragmatic rupture was confirmed as the cause of basal shadowing and in one case a major lower lobe laceration was identified as the cause of a persistent haemopneumothorax. In three cases, a fluid collection which could not be evacuated through a pleural drain was shown to be an organised haematoma and was removed endoscopically. Video-assisted thoracoscopy is helpful in the diagnosis and treatment of thoracic trauma, allowing early recognition of injuries that require thoracotomy. It is indicated for persistent (but not life-threatening) intrathoracic bleeding, unresolving pneumothorax, and unclear basal opacification. Therapeutic parenchymal tissue glue application and suturing as well as local resection and haematoma evacuation can be performed with this technique.

Adult↗
PubMed1996

[Results of revision and new operation in arteriovenous shunt complications].

Over a 10 years period 260 arterio-venous fistulas have been performed and followed up. The Brescia-Ciminoshunt was the most frequent type (n = 174). This type of fistula has been performed in about 85.2% of all cases as primary operation method. In secondary formations the saphena-interposition was used most frequently (49.4% of all cases). A shunt revision should be performed in cases of immediate thrombosis although a shorter life time of revisioned shunts compared with new formations is known. The new formation of a shunt should be considered if terminal thrombotic changes have been detected as well as in cases of shunt infection or shunt insufficiency.

Arteriovenous Shunt, Surgical↗
PubMed1992

[Primary hyperparathyroidism. Pathogenesis--diagnosis--therapy].

A report is given on 33 patients with primary hyperparathyroidism who underwent surgical treatment in our institution in the period from 1980 to 1989. In 57 per cent of the cases a hypercalcaemic syndrome was present. The primary hyperparathyroidism manifested itself in 75 per cent at the kidneys in the form of nephrolithiasis. One third of the patients showed a renal manifestation form exclusively. Remarkable is the relatively high number of exclusively gastrointestinal manifestations (11 per cent). In all patients the diagnosis was established on the coincidence of hypercalcaemia and increased parathormone in the serum. Preoperative localization diagnostics by means of parathyroid sonography, computed tomography and scintigraphy yielded unsatisfactory results. A satisfactory accuracy with regard to the lateral localization of the hyperfunctioning parathyroid tissue can presently be achieved only by selective catheterization of the cervical vein with determination of the parathormone. 35 patients clinically suspected of having primary hyperparathyroidism were subjected to a total of 44 operative interventions, i.e., apart from 35 primary operations, 7 secondary and 2 tertiary interventions. Of the 35 primary operations, 10 (28.6 per cent) were without success. This was due to 2 misdiagnoses and 8 cases with insufficient intraoperative exploration and premature discontinuation of the operation. In 67 per cent of the cases, there was a predominance of the solitary parathyroid adenoma, which was chiefly located at the dorsal lower thyroid poles. In order to reduce the number of unsuccessful primary interventions, a surgically-tactical approach is recommended.

Adenoma↗
PubMed1990

[Circular intrathoracic tracheal replacement by a devitalized artery in the dog].

Prepared artery (origin: human, calf, dog) with external or internal teflon-spiral-supporting was implanted in dogs (n = 10) as a circular intrathoracic tracheal substitute after cross-resection. Human arteries were rejected (n = 2). Calf arteries (n = 5) and dog arteries (n = 3) were incorporated fibrously. Central granulations appeared. The longest survival time was 36 days.

Animals↗
PubMed1990

[Comparative experimental animal studies for testing the usefulness of formalin- and glutaraldehyde-pretreated umbilical cord veins as artery replacements].

Formalin-fixed (F) and glutaraldehyde-pretreated (G) umbilical veins (n = 24) were interposed in the infra-renal aorta of dogs. The follow-up period was 1 year. Early complications with significant differences included 2 occlusions and 3 deaths (41.6%) in group F, 1 occlusion and 1 death (16.6%) in group G. Ten animals of group G and 7 of group F were alive at 1 year, 7 transplants of each of both groups were angiographically and macroscopically patent (25%). Four aneurysms (33.3%) existed angiographically and showed good collateral circulation angiographically (25%). Four aneurysms (33.3%) existed angiographically and macroscopically in group F (statistically significant). Histologically, group G was found to have a delayed resorption and an earlier beginning of connective-tissue proliferation as compared to group F. Considering early and late findings, G-pretreatment is preferable to F-treatment of umbilical veins.

Animals↗
PubMed1989

[Surgical intervention in stenoses and aneurysms of the renal artery].

Corrective vascular surgery was performed on 36 patients with renovascular hypertension and one patient with normal tension for 38 defective renal arteries, among them 58 per cent with arteriosclerosis and 35 per cent with fibromuscular dysplasia, in Jena, between 1969 and 1985. Follow-up checks were conducted six years from the operations (average) and revealed three major long-time results: Average blood pressure had declined from 211/121 mm Hg preoperatively to 152/95 mm Hg postoperatively. Renal functions were stabilised. Necessary antihypertensive medication could be reduced to 42 per cent of the preoperative values. Three revascularised kidneys had to be surgically removed in a second session. Four patients had died, the grey figure being one. Restenosation was recorded from three of 28 morphologically assessed arteries. Aneurysmal dilatation of a bridging graft was recorded in one case. Revascularisation proved necessary in another two. The point can be made that in cases of reno-arterial stenosis corrective vascular surgery has continued to be a valid therapeutic concept, adequate indication provided. It still is a real alternative to percutaneous transluminal angioplasty, nephrectomy or isolated therapeutic medication.

Adolescent↗
PubMed1989

[Long-term results following femoro-popliteal vascular reconstruction].

All in all, 330 thromboendarterectomies (TEA) and 354 venous bypass operations (VBP) were performed on 550 patients. In 11.01 per cent of all cases in which VBP had been planned, veins were not in optimum condition. Repetitive interventions had to be applied to 111 patients. Successful reoperations could be performed on six cases with immediate TEA-closures (1.8 per cent) and another two after immediate VBP-closures (0.56 per cent). Postoperative lethality figures were 0.6 per cent after TEA and 0.28 per cent following VBP. Twenty-nine early TEA-closures (8.9 per cent) were corrected by secondary VBP in 16 cases (4.8 per cent). Three were corrected by femoral ablation and two by toe amputation in the border zone (1.7 per cent). Thirty-nine early VBP-closures (11.0 per cent) required repetitive VBP in two cases (0.5 per cent) and toe amputation in the border zone in another three instances (0.84 per cent). Eight patients each died within the first postoperative year from TEA (2.4 per cent) and after VBP (2.2 per cent). The following cumulative patency rates were recorded according to the life table method: after one year (TEA: 90.9 per cent, VBP: 88.9 per cent), after five years (TEA: 73.4 per cent, VBP: 84.6 per cent), after ten years (TEA: 38.2 per cent, VBP: 73.7 per cent), after 15 years (TEA: 9.8 per cent, VBP: 24.2 per cent). These differences were significant as early as five years from surgery. Late amputation rates were 2.1 per cent for TEA and 2.9 per cent for VBP. Late lethality rates were 28.8 per cent for TEA and 7.6 per cent for VBP.

Adult↗
PubMed1989

[Comparative cinematographic, endoscopic and functional studies of the preoperative estimation of the severity of tracheal stenoses].

Structural tracheal stenoses have different functional effects according to degree, localization and extent of the stenosis. Further modifications are due to malacic components within the range of the stenosis or tracheal segments abutting on the stenosis. Nineteen patients with mainly cervical tracheal stenoses (12 patients) were investigated in order to examine if a functional X-ray-diagnostic procedure (X-ray-cinetracheobronchography--CTBG--of the central airways in several beam-directions during forced breathing, cough and Valsalva-maneuver after contrasting of the trachea and main-bronchi with powdered tantalum) yields an increase of findings in comparison with a static roentgenologic procedure (chest films p. a. and frontal; tomography) and an endoscopic examination. The judgement of the stenosis is made by measurement of the length and of the diameter compared with the normal trachea. Malacic components reveal themselves by changes of the stenosis-configuration during Valsalva-maneuver, forced breathing and strong coughing. In 11 of 19 patients there was evidence of a malacic stenosis-component and in 5 patients there was a mural weakness of abutting segments. In comparison with the endoscopic examination we found in 8 of 15 patients a diagnostic improvement by demonstration of unfixed stenotic compartments. Besides information about stenotic degree, configuration, localization and length, a CTBG offers the possibility of localizing and grading malacic stenotic components or of adjacent segments--provided that films are made in at least two planes. The application of CTBG in patients with tracheal stenosis is useful if there are signs of tracheomalacia or if the localization and the extent of the stenosis require a difficult reconstructive surgical intervention or if discrepancies between clinical aspect and stenosis-degree make it advisable to extend the field of diagnostic procedures.

Adult↗
PubMed1988

[Effect of adjuvant infusion therapy of low molecular weight dextrans (Infukoll M 40) and deproteinized hemoderivate (Actovegin) in Fontaine stage IV chronic arterial occlusive diseases].

A selected group of 18 patients (among them 16 diabetics) with chronic disorders of arterial blood flow at Stage IV according to Fontaine received treatment by a standardised therapeutic scheme. None of the cases was suitable for reconstruction by vascular surgery. Infusion treatment, using Infukoll M 40 and Actovegin, was to be checked for its capability of providing sufficient improvement in blood flow and thus eliminating the need for imminent high-level amputation. Evaluation was undertaken on the basis of clinical and laboratory-chemical parameters. The rate of above-knee amputation was reduced by 14 per cent. Hence, the above therapeutic concept has proved to be suitable for treatment of Stage IV chronic arterial occlusion.

Adult↗
PubMed1987

[Esophageal diverticulum--indications for surgical therapy and late results].

63 cases of oesophageal diverticulum were analysed, and surgical therapy was chosen for 45 of them. Most of them were located in the cervical region of the oesophagus (44.4 per cent). Cervical and intrathoracic diverticula or those causing pain and possible bleeding were indications for surgical treatment. No postoperative complications occurred to the above patients. Recurrence was observed in three of 28 cases, following surgery for Zenker's diverticulum. No complaints at all were recordable from 79 per cent of the patients in follow-up checks after surgery.

Adult↗
PubMed1983

[Current problems in breast cancer].

From 1951 to 1975 1087 patients (1075 women, 12 men) suffering from breast cancer were seen at the Surgical Clinic of Jena (GDR). Late results of 988 patients could now be evaluated. Adjuvant chemotherapy becomes increasingly important due to early metastatic spread after radical surgery. Long-term studies, however, have to be waited for until a final assessment of efficiency can be made.

Breast Neoplasms↗