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Biomedical subjects

S Horsch

Publications and source records attributed to S Horsch.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Monitoring somatosensory evoked potentials during carotid endarterectomy].

The tromboembolic and ischemic events during carotid endarterectomy can be avoided or detected with appropriate monitoring. Median nerve somatosensory evoked potentials recorded from the parietal cortex correlate with the blood flow in the middle cerebral artery. The good evoked responses after cross-clamping of the carotid artery indicate a sufficient collateral circulation, enabling a surgery without shunt, thus minimizing the risk of embolisation. Insufficient collateral circulation after cross-camping results in an amplitude reduction of the parietal N20-P25 complex of more than 50%. In this case an ischemic event can be prevented by shunting. As a total 83 carotid endarterectomies were done. In 65 cases (78.3%) the evoked potentials showed no significant alteration, and no postoperative neurological deficit occurred. Seven patients (8.45%) needed to be operated with a shunt, because of cross-clamping ischaemia. One of them presented a transient postoperative hemiparesis, which was predicted by the long-term loss of the SEP-s, and which resolved within 4 hours. Seven further patients (8.45%)--operated primarily with shunt, and 4 patients (4.8%)--monitored with transcranial Doppler sonography, showed no postoperative neurological deficit. We found that median nerve somatosensory evoked potential monitoring during carotid endarterectomy is a simple, sensitive and reliable method.

Arteriovenous Shunt, Surgical↗
PubMed1995

Significance of radiological diagnosis for detection and staging of inflammatory abdominal aortic aneurysm.

Operative morbidity and mortality are elevated in patients with inflammatory abdominal aortic aneurysm. Preoperative identification of inflammatory abdominal aortic aneurysm. the detection of the proximal level and of adhesions to adjacent structures are important for surgical management. The sensitivity and specificity of ultrasonography and computed tomography (CT) for identification and staging in 13 patients with inflammatory abdominal aortic aneurysm were studied. Preoperative radiological diagnoses were validated by intraoperative findings. Correct identification of inflammatory abdominal aortic aneurysm could be achieved in 85% by the use of CT and in 62% by ultrasonography. The proximal level of inflammatory abdominal aortic aneurysm was correctly determined by CT in all patients and by ultrasonography in 62%. Using a transperitoneal approach, the condition was considered inoperable in two patients as a result of the suprarenal extent of the aneurysm and because of unremovable adhesions in two other cases. In the latter pair, it was impossible to predict inoperability by radiological findings. Sensitivity (85%) and specificity (100%) of standard radiological techniques to identify inflammatory changes are high. Inoperability caused by suprarenal extent could be detected correctly by routine radiological procedures. However, identification of dense adhesions appears uncertain.

Adult↗
PubMed1995

Classification of congenital arterial and venous vascular malformations.

Arterial and venous vascular malformations due to congenital abnormalities rarely occur in the daily practice of vascular surgeons. These malformations represent a heterogeneous group of isolated or multiple congenital abnormalities, sometimes associated with complex congenital syndromes. Correct recognition and classification of these rare abnormalities may sometimes be difficult. No systematic classification of arterial and/or venous vascular malformations due to congenital abnormalities is currently available. On the basis of embryologic and pathophysiologic considerations, a rational and simple classification of arterial and venous vascular malformations due to congenital abnormalities can be performed. This contribution presents an appropriate classification of clinically important arterial and venous vascular malformations due to congenital abnormalities.

Abnormalities, Multiple↗
PubMed1995

F.P. Weber syndrome associated with a brachial artery aneurysm. A case report.

Klippel-Trenaunay syndrome is characterized by the triad of unilateral port-wine hemangiomas, varicose veins, and hypertrophy of bone and soft tissue affecting one or more limbs. The rare F.P. Weber syndrome describes the mentioned entity and additional arteriovenous malformations. The association of an arterial aneurysm with the F.P. Weber syndrome has never been described in the current literature. A case of a brachial artery aneurysm in a patient with F.P. Weber syndrome is presented and the etiology of arterial aneurysm combined with congenital vascular abnormalities is discussed.

Adult↗
PubMed1995

[Epidural electrostimulation of the spinal cord in obliterating diseases of the peripheral arteries].

Under study was the efficiency of epidural electrical stimulation of the spinal cord (ESSC) of 237 patients with obliterating diseases of the peripheral arteries. Reconstructive operations proved to be impossible in all the patients, and conservative treatment was not successful. The clinical status of 169 patients was determined as the 3rd stage, in 68 patients as the 4th stage after Fontain. The period of observation was 35.6 months at an average. High amputation was performed in 64 patients in spite of ESSC. In the other cases when the extremity could be kept safe, the intensity of pain was considerably relieved (more than 75%). We believe that ESSC can considerably relieve the intensity of the pain syndrome and improve the quality of life in patients with critical ischemia of the extremities when traditional methods of treatment are not possible.

Aged↗
PubMed1994

Epidural spinal cord stimulation in the treatment of severe peripheral arterial occlusive disease.

Epidural spinal cord stimulation (ESCS) has been suggested to improve microcirculatory blood flow and reduce amputation rates in patients with severe peripheral arterial occlusive disease (PAOD). Pain relief, limb salvage, and skin circulation were studied in 177 patients with ischemic pain caused by nonreconstructible PAOD who were receiving ESCS. Medical or surgical therapy had failed and vascular reconstruction was impossible in all cases. Clinical status was classified as Fontaine's stage III (chronic ischemic rest pain) in 114 patients and Fontaine's stage IV (ischemic pain and ulcers or dry gangrene) in 63 patients. PAOD was essentially due to arteriosclerosis, but 36 patients also had diabetic vascular disease. After a mean follow-up of 35.6 months, significant pain relief (> 75%) with limb salvage was achieved in 110 patients. In 11 patients with limb salvage, pain alleviation was determined to be between 50% and 70%. ESCS was ineffective in reducing pain, leading to major amputation in 56 patients. The cumulative limb salvage rate was 66% at 4 years. The systolic ankle/brachial blood pressure index did not change under stimulation. TcPO2 was assessed on the dorsum of the foot. Clinical improvement was associated with increased TcPO2, with limb salvage improving from 24.2 to 48.1 mm Hg in stage III (p < 0.02) and from 16.4 to 37.2 mm Hg in stage IV (p < 0.03) disease. A TcPO2 increase of more than 50% within the first 3 months after implantation was predictive of success. TcPO2 changes are correlated with the presence of adequate paresthesias in the painful area during the trial period.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Loops and folds of the carotid and vertebral arteries: indications for surgery].

We present our results of surgical correction of non-atheromatous redundant internal carotid arteries. From 1986 until 1992, we performed 1641 endarterectomies of the internal carotid artery, and in the same time we diagnosed 49 elongations in 42 patients. In 25 cases, indication for surgery was given and reconstruction was performed by shortening of the internal carotid artery, using resection and reanastomosis associated in one third of the cases with a patch. Nineteen patients (76%) were symptomatic, four patients (16%) presented a preoperative stroke and 2 patients (8%) were asymptomatic. All the patients were neurologically monitored by the use of somatosensory evoked potentials. One patient needed an intraluminal shunt because of loss of evoked potentials. No patient died in the postoperative period. One stroke occurred, concomitantly to a thrombosis of the internal carotid artery, but with totally reversible clinical symptoms after reoperation. We noted one transient ischaemic attack. We recommend operative treatment in symptomatic patients or when the stenosis is higher than 60%. A stenosis under 60% should be operated in the case of a contralateral occlusion. We propose a classification of redundant arteries based on the importance of the stenosis. The exact assessment of the stenosis is the determining factor in the diagnosis and is of primordial importance when indicating surgery.

Aged↗
PubMed1994

Intraoperative whole blood autotransfusion during venous thrombectomy.

OBJECTIVE: Intraoperative autotransfusion is currently performed using two different systems, the relatively expensive cell-saving device washes and concentrates red cells and the more simple, economical total disposable device for whole blood collection and retransfusion. Some institutions prefer the cell-saving device because of previously documented side-effects of whole blood autotransfusion. As some investigators more recently reported the application of whole blood autotransfusion without clinical complications, the potential hazards of whole blood autotransfusion are now being controversially discussed. MATERIALS AND METHODS: The potential side-effects using whole blood autotransfusion were studied in 100 patients prospectively undergoing venous thrombectomy. The effectiveness of homologous transfusion reduction was assessed in comparison with an historical patient group (n = 10, control group). RESULTS: In the study population a mean of 1064 ml shed blood (67% of total blood loss) was retransfused. A mean of 247 +/- 292 ml of homologous blood was transfused in the study group. In contrast, homologous blood requirement was significantly higher (1056 +/- 659 ml, p < 0.006) in the control group. No hematologic, hemeostatic, renal or pulmonary complications occurred after intraoperative whole blood autotransfusion. CONCLUSIONS: Whole blood autotransfusion is a safe, easy and economical procedure and highly effective in reducing homologous blood transfusions and costs.

Blood Loss, Surgical↗
PubMed1993

[Sonography of acute appendicitis. A 5-year prospective study of 2074 patients. 2].

High-resolution real-time ultrasound (US) with a 5 MHz transducer has proved to be an important method in the diagnosis of acute appendicitis. In a prospective study we examined 2074 unselected patients with suspected appendicitis to assess the diagnostic and epidemiological value of US. According to the clinical diagnosis females aged 10 to 30 represented the majority of suspected cases. Appendicitis was most often proved in male patients aged 15-30 years. The prevalence of acute appendicitis in childhood is lower (7%) than in elderly patients (33%). US enables the diagnosis of acute appendicitis with a sensitivity of 91%, a specificity of 98% and an overall accuracy of 97%. For differential diagnosis US demonstrates other diseases that mimic acute appendicitis. Thus it is possible to reduce the negative appendectomy rate particularly in children by revealing mesenteric lymphadenitis or terminal ileitis and in young women by directing attention to gynecological diseases.

Acute Disease↗
PubMed1993

[Extracranial aneurysm of the internal carotid artery. A case report].

The authors report a case of extracranial aneurysm of the internal carotid artery. This case of a 53-year-old man demonstrates how difficult an early and exact diagnosis can be, even in these days with their considerable variety of modern diagnostic techniques--depending on the order of their use. In comparable cases, we therefore postulate the early use of angiography, neuromonitoring during the operation and the ultrasound-examination of the complete arterial system in search for further aneurysms.

Aneurysm↗
PubMed1992

[Exulceratio simplex Dieulafoy].

"Exulceratio simplex Dieulafoy" is a rare cause of massive upper gastrointestinal haemorrhage from a submucosal artery. Dieulafoy's disease is rarely recognized. We present 9 cases of Dieulafoy's lesion and have collected 176 cases described in the literature.

Adolescent↗
PubMed1992

Evoked potential monitoring in carotid surgery: a review of 994 cases.

Intraoperative monitoring of brain function is desirable in carotid artery surgery to detect possible complications, but the monitoring methods must be simple to perform, sensitive, and reliable. Median nerve somatosensory evoked potential (SEP) monitoring fulfills these criteria. Between 1985 and 1990, we performed 994 operations of the carotid artery with SEP monitoring. In 92% of the cases, we were able to obtain viable SEP tracings. In seven cases, irreversible SEP loss was followed by a new neurologic deficit. In one case only, neurologic complications ensued without SEP loss. Although immediate intraoperative therapeutic options are limited, the monitoring enhances patient security by allowing intraoperative detection and postoperative analysis of complications. SEP monitoring appears to be at least as effective as conventional EEG monitoring. The viability, sensitivity, and reliability of newer methods, such as modified spectral EEG analysis, must be measured by this established procedure.

Carotid Arteries↗