Search PubMed⌕ Search

Biomedical subjects

M V Inberg

Publications and source records attributed to M V Inberg.

At least 55 records · Page 3Linked to original sources
PubMed1979

Insulin test after selective gastric and truncal vagotomy. Test response and acid secretion in the early and late postoperative phase.

Altogether 540 succesful insulin tests were performed on 377 patients after vagotomy, on 316 patients less than three months after the operation (early phase) and on 182 patients between three months and nine years after (late phase). The proportion of positive insulin test responses after vagotomy and antral resection was similar in the selective gastric (SV) and truncal vagotomy (TV) groups (10.7% and 11.8% respectively in the early phase) and remained the same during follow-up (12.5% and 9.3% in the late phase). In the vagotomy and drainage group there were significantly fewer positive test responses in the early phase after SV (15.6%) than after TV (36.4%), but in the late phase the incidence was similar (56.7% and 55.6%). There was a significant rise in the number of positive responses after SV and drainage during follow-up (from 15.6% to 56.7%). Insulin-stimulated peak acid output (I-PAO) was about the same in the vagotomy and drainage group after SV and TV (3.52 and 5.03 mmol/h in the early phase and 4.20 and 4.93 mmol/h in the late phase). Although the number of Hollander positive insulin tests after vagotomy and drainage increased during follow-up, no corresponding changes were seen in I-PAO. There was no evidence of vagal reinnervation.

Drainage↗
PubMed1978

The immediate effect of lumbar sympathectomy on arterial blood flow measured by electromagnetic flowmetry.

The immediate effect of lumbar sympathectomy on arterial blood flow was studied in 51 patients with peripheral arterial disease by means of electromagnetic flowmetry. Concomitant arterial reconstruction was performed in 37 cases. The measurement was made on the reconstructed segment or on the bypass graft, and on the femoral artery when sympathectomy alone was performed. The flow increase varied considerably from case to case and was rather unpredictable. There was no significant correlation between the effect of sympathectomy and peripheral arterial disease or the condition of the outflow tract. Thus, on the basis of these measurements, it is difficult to determine the significance of lumbar sympathectomy as a method of increasing blood flow.

Adult↗
PubMed1977

Effect of different respirator adjustments on central haemodynamics in open-heart surgery patients.

Changes in cardiac index (CI) mean pulmonary artery pressure (PAP), mean pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), and pulmonary artery vascular resistance (PVR), associated with spontaneous respiration (SR) and two different types of intermittent positive pressure ventilation (IPPPV and IPNPV) were studied in a total of 17 patients undergoing aortic valve replacement or myocardial revascularization. Swan-Ganz thermodilution pulmonary artery cardiac output catheters were used and the aim was to determine: whether postoperative cardiac output may paradoxically be greater during IPPPV than during IPNPV or SR; whether the use of "negative" pressure in the expiratory phase during controlled ventilation may be responsible for bringing about the central haemodynamic conditions prevailing during spontaneous respiration; and whether, in weaning from postoperative IPPPV to SR, there is a risk of pulmonary congestion as a consequence of possible autotransfusion. IPPPV connected with anaesthesia induction caused a highly significant deterioration central haemodynamics. The use of positive end-expiratory pressure (PEEP) is not to be recommended for such patients at this stage. On the first postoperative day, the mean CI was lower during IPPPV than during IPNPV (P less than 0.1) or during SR (P less than 0.05). The changes observed in CI, were, however, so slight that the authors consider the routine use of PEEP to be beneficial during controlled ventilation following major open-heart surgery. In some patients, the CI was paradoxically higher during IPPPV than during IPNPV or SR. The mean CI was nearly the same during IPNPV (3.32) as during SR (3.38). However, PAP, PCWP and PVR values were significantly higher during SR than during IPNPV. Thus, according to this study, the use of "negative" end-expiratory pressure during controlled ventilation did not in these patients produce central pressure conditions corresponding to spontaneous respiration. The present study supports the finding that in weaning from controlled ventilation with PEEP to SR there is a danger of pulmonary congestion. This could be predicted by measurement of pulmonary wedge pressure, but not by measurement of central venous pressure.

Adult↗
PubMed1977

Surgical treatment of aneurysms of the ascending aorta. With special reference to cystic medial necrosis of the aorta.

The clinical series comprised 14 patients with aneurysms of the ascending aorta. In the autopsy series, there were additionally 19 patients, who had died suddenly as a results of free perforation or dissection of the ascending aorta. In the clinical series, the cause of the aneurysmal formation was cystic medial necrosis in 10 patients, 8 of whom had severe aortic valve insufficiency. Twelve patients were operated on using extracorporeal circulation, Both the ascending aorta and aortic valve were replaced with prosthesis in 6 cases. Three patients underwent emergency surgery due to pericardial tamponade. All three died, despite a technically successful operation. One patient out of 9 electively operated upon died. A follow-up examination was carried out on the 5 surviving cystic medial necrosis patients. Aneurysms of the sinuses of Valsalva developed after supracoronary resection in 2 patients. The results showed that elective operations in the event of aneurysms of the ascending aorta can be carried out with an acceptably low mortality rate. However, after supracoronary resection, in cases of cystic medial necrosis, the risk of developing aneurysms of the proximal aortic remnant seems obvious. Therefore, in patients in whom the whole aortic root is involved, total removal of the ascending aorta and re-implantation of the coronary ostia into the prosthetic tube is preferable.

Adolescent↗
PubMed1977

Acute effects of truncal vagotomy on gastric wall tissue gases in the dog.

Acute effects of truncal vagotomy on gastric wall tissue gases were studied in the dog by means of implanted Silastic tonometers. It was concluded that vagal denervation produces a significant fall of tissue PO2 in both corpus and antrum. Simultaneously, corpus PCO2 markedly decreases whereas antral PCO2 remains unchanged. The findings may be explained by a dual mechanism: reduced gastric blood flow and decreased metabolic activity in the parietal cell area. It is possible that reduction in CO2 accumulation decreases the supply of carbonic acid to the anhydrase system, thereby reducing the formation of hydrogen ions for acid production.

Animals↗
PubMed1977

Femoro-femoral cross-over grafting. A limb-saving operation in poor-risk patients with obliterative arteriosclerosis.

A series of 12 femoro-femoral cross-over grafting procedures is reported. Eleven patients were operated on for severe ischaemia and one for disabling claudication. Nine of the reconstructions were profunda revascularizations. Concomitant femorotibial reconstruction was carried out in one case. There were no operative deaths or postoperative complications. Peroperative blood flow measurements and clinical symptoms gave no evidence of any "steal" phenomenon. One graft became occluded primarily, but the others remained patent during an observation period ranging from two months to four years and ten months. Despite a functioning graft, one major amputation was necessary due to severe distal arteriosclerotic lesions. In all other patients, either the limb was saved or claudication was relieved. This operation seems to be suitable for poor-risk patients with predominantly unilateral iliac arteriosclerosis together with impending gangrene or disabling claudication.

Aged↗
PubMed1976

[Thymectomy in myasthenia gravis (author's transl)].

10 myasthenia patients were treated surgically during a four year period, 1970 TO 1973. Thymectomy was only resorted to in the most severe cases of the disease. A sternum splitting incision was preferred. Postoperative diffculties were usually avoided by routine use of a volume-controlled respirator. Oro-tracheal intubation was preferred to tracheostomy in order to avoid infection. In 9 patients it was possible to reduce the daily dose of medicine. Clinical improvement, sometimes delayed, occurred in 8 patients. All the patients had been incapacitated preoperatively but in 6 cases they were able to return to work. The mortality rate was nil. There was one case of postoperative pneumonia and one delayed sternal union.

Evaluation Studies as Topic↗
PubMed1976

Experiences with the Björk-Shiley tilting disc valve in aortic and mitral valve surgery.

During a four-year period, aortic or mitral valve replacements with the Björk-Shiley tilting disc valve were performed in 114 cases. The series comprises 75 aortic, 34 mitral and 5 double valve replacements. In the aortic valve group (AVR) concomitant resection of the ascending aorta (cystic medial necrosis aneurysm)) was carried out in 5 cases, aortocoronary bypass in 2 cases and closure of a VSD in one case. Antibiotic prophylaxis and postoperative anticoagulant treatment were used routinely. The hospital mortality rates were6 8.0% in the AVR-group (single aortic valve mortality 7.1 %), 8.8% in the MVR-group and 60% in the double valve group. Late mortality in the AVR-group was 2.8%. There were no late thromboembolic complications in this group. Aortography showed grade II--III regurgitation (paravalvular leaks) in 15 % of the cases. In the MVR-group the late mortality was 9.7%. One patient died because of malfunction (thrombosis) of the prosthesis. The thrombotic complication was obviously caused by discontinuation of anticoagulant therapy. The clinically estimated functional capacity NYHA classification) improved considerably, especially in the MVR-group.

Adolescent↗
PubMed1975

Hiatal hernia. A follow-up study.

A series of 68 patients who had been surgically treated for hiatal hernia were followed up and re-studied. Several repair procedures were used, but an antireflux operation was carried out in 80% (49 Nissen-Rossetti fundoplications and 6 Belsey Mark IV repairs). The primary hospital mortality rate was 3%. Late results were evaluated by studying the patients with endoscopy, cineradiography, and intraluminal pH probe. The overall clinical late results were good in 96%, excluding the 3% primary mortality rate. To achieve these results, however, several secondary operations were necessary. Good primary results after antireflux procedures were obtained in 89%. The present surgical principles are: (1) the hernias of the good-risk normoacid patients are repaired with a Belsey Mark IV procedure, (2) the hernias of hyperacidity patients are repaired with transabdominal fundoplication combined with parietal cell vagotomy without drainage and (3) moderate oesophageal strictures with an antireflux procedure followed by periodical oesophageal dilatation. Resection of oesophagus is reserved for advanced strictures only.

Adult↗
PubMed1975

Aorto-ilicofemoral arterial reconstructive surgery. With special reference to profunda revascularization.

A series of 177 patients undergoing 190 reconstructions for aorto-ilicofemoral arterial occlusive disease are reported. Operative procedures were carried out on a total of 294 limbs. On 87 of these, profunda revascularization was performed. The indication for surgery was advanced ischemia in 50% of the profunda revascularization patients and in 20.5% of the patients with superficial femoral arteries open or reconstructed. Dacron bypass graft was used in 99 reconstructions and ilicofemoral or femorofemoral vein graft in 8 cases. Endarterectomy was carried out in 83 cases. The overall operative mortality rate was 5.3%, renal failure being the most common cause of death. The 5-year survival rate was 73.5%. The rate of primary thrombosis was 2.6%. The 5-year cumulative patency rate of all aorto-ilicofemoral reconstructions was 91.3%. In the profunda revascularization group the corresponding percentage was 82.1%. There was no difference in the patency rate between reconstructions using Dacron graft or endarterectomy. The symptomatic results were good also in the profunda revascularization group, 93% of patients having relieved symptoms as an initial result of surgery. There were seven major amputations in 6 patients during the follow-up time and 5 patients needed further femoropopliteal reconstruction. It can be said that in most cases profunda revascularization is sufficient for satisfactory clinical results.

Adult↗
PubMed1975

Massive haemorrhage from gastroduodenal ulcer. A series of 149 casees operated on.

A series of 149 patients operated on for massive haemorrhage from gastroduodenal ulcer is presented. The patients were divided into two groups, emergency (70 patients) and semi-emergency (79 patients). In the emergency group the cause of bleeding was GU in 67% and DU in 26%; in the semi-emergency group the corresponding figures were GU 30% and DU 63%. In DU vagotomy + antral resection or pyloroplasty were the usual procedures. GU patients usually underwent a classical resection. The operative mortality rate in the emergency group was 14% and in the semi-emergency group 2.5%. In the whole series the mortality rate was 8.0%. Bleeding recurred in 8 patients (5.4%) and of these eight, five died. The causes of death and the postoperative complications were analysed. In the treatment of massively bleeding duodenal ulcer vagotomy + antral resection is recommended in the case of "good risk" patients and vagotomy + pyloroplasty in the case of "poor risk" patients. For treatment of bleeding gastric ulcer, the procedure recommended with "good risk" patients is still antrectomy, but in cases where the ulcer is situated high up near the cardia and for "poor risk" patients, excision, vagotomy and pyloroplasty should be carried out.

Acute Disease↗
PubMed1975

Femoropopliteal and femorotibial arterial reconstructive surgery. Special reference to the autogenous venous bypass procedure using unreversed vein after eversion valvectomy.

The outcome of 127 femoropopliteal and 23 femorotibial arterial reconstructions carried out between January 1960 and December 1972 has been reviewed. The operative method was autogenous saphenous vein bypass in 109 cases, 82 of which were performed using unreversed vein with eversion valvectomy. The indication for reconstruction was advanced ischemia in 39%. Two patients died primarily and 23 late deaths have occurred subsequently. 19 grafts or reconstructed segments became occluded primarily. Most of them were femorotibial reconstructions of Dacron bypass reconstructions. Most of the failures occurred within 1 year of surgery. Using eversion valvectomy technique, the 1- and 5-year patency rates were 57 and 50% respectively. In femorotibial reconstructions the 1-year patency rate was 36%. There was a distinct difference in patency between the cases with excellent of good outflow and those with fiar or poor outflow. The difference was less distinct between patients with claudication and those with advanced ischemia. Eight limbs needed major amputation.

Adult↗