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T Hupp

Publications and source records attributed to T Hupp.

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

[Determination of the degree of stenosis of the internal carotid artery in the surgical specimen after eversion TEA: comparison with angiography and c-w-Doppler ultrasound].

UNLABELLED: 22 carotid specimens following eversion-endarterectomy were compared with preoperative assessment of carotid stenosis obtained angiographically and by c-w-Doppler-sonography. The intact, unsplit specimens were perfused with a liquid plastic material (Palavit M). After hardening of the plastic material the specimens were removed. The local degree of carotid stenosis with respect to diameter reduction was assessed by direct measurement of the plastic specimens at the narrowest site compared with the diameter of the carotid eversion specimens at the place of the maximum stenosis. The distal degree of carotid stenosis was assessed by comparison of the diameter of the distal internal carotid artery obtained intraoperatively with the measurements of the plastic specimens (1 mm vascular wall thickness of distal internal carotid artery was taken into account). RESULTS: Both the local and the distal degree of carotid stenosis diameter (mean 84.7% +/- 8.4% and 82.1% +/- 9.1% respectively) were underestimated in the preoperative angiogram (79.8 +/- 9% by ECST-criteria and 69 +/- 10.3% by NASCET-criteria) in most of the cases. The difference of the diameter reduction was statistically significant (p < 0.05 and p < 0.01 respectively, Wilcoxon signed rank test). The c-w-Doppler assessments were 82.6 +/- 8.2% (n.s.). CONCLUSION: Our results suggest that the preoperative assessment of internal carotid stenosis obtained angiographically or by c-w-Doppler-sonography easily underestimate the true degree of carotid stenosis.

Adult↗
PubMed1995

[Dystopic goiter--aspects of definition and surgical therapy].

The incidence in the literature of dystopic goiter depends on classification of the false endothoracic goiter ("substernal goiter") as dystopic and varies from 2 to 20%. From November 1989 through April 1993 we operated on 530 patients with benign nodular goiters. In 84 patients (15.8%) the operation proved a dystopic goiter. We showed that difficulties in comparing our data with published series were due to misnomers of the dystopic goiter. The dystopic goiter comprises the true endothoracic goiters (alliata vera and isolata vera) as well as the false endothoracic goiters (substernal goiter). The precise classification of the dystopic goiter is crucial to an optimal operative strategy reducing postoperative morbidity.

Adolescent↗
PubMed1994

The role of the p53 protein in the apoptotic response.

When mammalian cells or tissues are exposed to DNA damaging agents a programmed cell death pathway is induced as well as a cell cycle arrest. In mice in which the p53 gene has been inactivated by homologous recombination this response is profoundly diminished. These mice develop normally so that developmentally induced apoptotic events do not require p53. The p53 gene product is a 393 amino acid nuclear protein that binds specifically to DNA and can act as a positive transcription factor. High levels of p53 can induce the transcription of gene products involved in the cell cycle arrest and apoptotic pathway. The p53 proteins activity is very tightly controlled both by allosteric regulation of its DNA binding function and by regulation of the protein's stability. These results are discussed in the context of the mutations in p53 found in human tumours and their implications for the treatment of the disease by the use of radiation and chemotherapeutic agents that target DNA.

Allosteric Regulation↗
PubMed1994

Revision of the proximal aortic anastomosis after aortic bifurcation surgery.

The implantation of an aortic bifurcation graft (ABG) for treatment of occlusive (OD) and aneurysmal (AD) aortoiliac disease is a standard technique with good long-term results and a relatively low incidence of complications. In a retrospective review of our patients from 1964 to 1993 only 36/1520 patients were identified who required reoperation at the proximal aortic anastomosis after ABG. Indications were graft occlusion (15/36) and graft stenoses (2/36), refractory to graft thrombectomy, proximal aortic anastomotic aneurysms (11/36) or graft infection (8/36). Graft occlusion or stenosis most frequently led to aortic reoperation in the OD-group (53.5%), recurrent aneurysmal disease (37.5%) and graft infection (37.5%) were the dominant indications in the AD-group. Mean time interval to reoperation was shorter in cases of graft infection (35 +/- 33 months) as compared with graft stenosis (66 +/- 58 months), graft occlusion (86 +/- 49 months) or aortic anastomotic aneurysms (152 +/- 90 months). Of the reoperations, 92% were done electively, 8% as emergency procedures. The perioperative course was uneventful in 67% of patients. Overall mortality rate after elective revisional surgery was 3% but reached 66% in emergencies. Postoperative morbidity and mortality was related to preoperative morbidity and the urgency of surgery, not with the mode of aortic intervention nor indication.

Anastomosis, Surgical↗
PubMed1994

[Diagnosis and therapy of perioperative lung embolism].

Pulmonary embolism is a major cause of postoperative problems, accounting for 12-20% postoperative deaths. 0.1% to 0.4% of all hospitalised patients die due to acute pulmonary embolism. Thus, pulmonary embolism should be included in the differential diagnostic considerations. Blood gas analysis, ECG, chest roentgenography, scintigraphy, pulmonary arterial catheterisation, echocardiography, digital subtraction angiography, and angiography are important diagnostic tools. When pulmonary embolism is not life-threatening, heparinisation may be an adequate therapeutic approach. In the case of severe cardiovascular instability, recanalisation of the pulmonary arterial tree has to be achieved. Recent studies show that preceding surgery may not be an absolute contraindication to thrombolysis. Recommendations for thrombolytic therapy include the bolus administration of 250,000 U of urokinase followed by a continuous infusion of 40-60,000 U per hour. In an emergency situation, a bolus dose of 1-2,000,000 U may be administered. A neurosurgical operation in the preceding 10 days is still considered an absolute contraindication to thrombolysis. Patient outcome in the case of cardiopulmonary resuscitation for massive pulmonary embolism may be improved by the bolus application of 2-3,000,000 U of urokinase. In addition or alternatively, mechanical thrombus fragmentation via catheter or surgical embolectomy may be used in certain hospitals.

Angiography, Digital Subtraction↗
PubMed1993

[Nonocclusive intestinal ischemia as a complication of hemodialysis treatment].

A 52-year-old man on haemodialysis treatment for chronic glomerulonephritis also had a nephrotic syndrome, hypercholesterolaemia, severe arterial hypertension and peripheral vascular disease in stage IIb. He also was a heavy smoker. Following a nonspecific diarrhoeal illness, which caused haemoconcentration, he developed abdominal pain and fever. WBC count (29,000/microliter) and serum lactate level (18.2 mmol/l) were elevated, and there were clinical signs of lower abdominal peritonitis. Laparotomy revealed multiple ischaemic segments. The arteries were not thrombosed but had severe atheromatous changes. There is an increasing incidence of such nonocclusive intestinal ischaemia because there are more elderly people and more patients with high-risk factors among those requiring dialysis.

Chronic Disease↗
PubMed1993

Tumour suppressor genes and molecular chaperones.

The two tumour suppressor genes that are most commonly inactivated in human cancer are the p53 gene on chromosome 17 and the retinoblastoma (Rb) gene on chromosome 11. Recent studies of both gene products suggest that they are able to act as powerful negative regulators of cell division. The Rb gene seems to exert this activity by physically complexing to a variety of specific transcription factors and inactivating their function. The capacity of Rb protein to bind these factors is regulated by phosphorylation. The Rb protein can therefore be seen to act as a chaperone for these factors. The p53 protein also may act in part by regulating transcription but may also interact directly with the DNA replication apparatus. The growth suppressive function of p53 is induced by DNA damage leading to an attractive model of p53 as an essential checkpoint control. The p53 protein interacts with members of the hsp70 chaperone family which we now show can regulate its function.

Genes, Retinoblastoma↗
PubMed1993

Renovascular hypertension: a perfusion disturbance that escaped recognition.

A bilateral, exercise-mediated, hippurate transport disturbance was previously described when patients with fixed renovascular hypertension were imaged with o-iodo-hippurate. This study sought to test the hypothesis that patients with an abnormal exercise scintigram have a perfusion abnormality characterized by dysregulation of renal blood flow. We imaged 23 patients with hypertension and angiographically documented renovascular disease in the supine position, as well as during upright exercise. Seven normotensive volunteers served as controls. We measured the resting glomerular filtration rate (GFR) and the effective renal plasma flow (ERPF) with a single compartment radiotracer infusion clearance. The clearance examination also included a measurement period with 25 watt ergometric exercise. Nine hypertensive patients had normal exercise renograms. These patients had age-appropriate clearance values at rest and during exercise, as well as age-appropriate best-organ (generally without stenosis) GFR and ERPF values. The filtration fraction (FF) was 0.21 at rest and 0.22 during exercise. Fourteen hypertensive patients had a bilateral, exercise-induced disturbance of hippurate transport. In these patients, the global resting GFRs and ERPFs were decreased 40% from age-appropriate predicted values. The FF remained at 0.20. Light exercise caused a pronounced contraction of GFR and a less severe reduction in the ERPF. During exercise the mean filtration fraction was only 0.12. The exercise-induced reduction in the clearance values was bilateral, which indicated that the perfusion of nonstenosed organs was compromised as well. We suggest that the described perfusion abnormality occupies a relevant position during the maintenance phase of fixed renovascular hypertension.

Adult↗
PubMed1992

[Animal experiment studies of carcinogen-induced tumor development in colotomies in relation to suture materials].

To assess the possible risk of cancer in the operated colon after stapling compared with vicryl sutures, the influence of the nickel-containing staples was tested in caecum-resected and carcinogen-treated rats. The nickel-containing staples were seen as a cocarcinogen. The aim of the study was to determine whether a higher incidence of cancer occurs at the anastomotic suture line depending on stapler vs. vicryl sutures after subcutaneous application of carcinogens (dimethylhydrazine). The results show that there is no increased risk of cancer following mechanical stapling.

1,2-Dimethylhydrazine↗
PubMed1992

Renal artery aneurysm: surgical indications and results.

The clinical course of 23 patients with 28 renal artery aneurysms (RAAs) is reported. The RAAs were recorded over a period of 10 years. Thirty-five per cent of the RAAs (eight of 23 patients) were detected during the investigation of hypertension, whereas 26% (six of 23 patients) were discovered incidentally while imaging atherosclerotic arterial disease in the aorto-iliac region by angiography. Twenty-two aneurysms were treated surgically and primary nephrectomy was necessary in one case. The surgical technique used was excision of the aneurysm with bypass grafting in 13 cases (seven Dacron, five vein, one arterial bypass), a running suture following aneurysm excision in four cases and an end-to-end anastomosis in two cases. The results (for a period of 1-10 years) were excellent in all but three cases: two early graft occlusions (vein interposition) and one late occlusion (Dacron bypass) in the course of a re-operation which had become necessary because of a ruptured aneurysm of the gastro-epiploic artery after 3 months. Three of 23 patients were treated by embolisation of four intraparenchymal aneurysms. The follow-up of a non-treated saccular aneurysm showed a total thrombosis of the aneurysm within 4 years and fixed renal hypertension developed later in this patient. We suggest surgical repair of an RAA regardless of its size and the clinical symptoms, in order to prevent microembolism into the renal parenchyma and to avoid the development of fixed renal hypertension. Intrarenal aneurysms can be treated by embolisation to stop severe haematuria thus preserving the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Concurrent vascular injuries in fractures in childhood].

Ten-year-analysis of blood vessel lesions present in eleven children with bone fractures revealed two major localizations: 1. In the lower extremity we observed vascular lesions in both open and closed fractures of femur and tibia. In cases with (complete) ischemia emergency operation had to be performed. 2. In the upper extremity the prevalent fracture localization was the supracondylar fracture of the elbow. Incomplete ischemia present in fractures with severe dislocation (Felsenreich III) could be salvaged by closed reposition and transcutaneous fixation by means of Kirschner wires. In those few cases open reposition was necessary, both exposure of vessels and fixation of the fracture was possible when medial incision was performed. Postoperative evaluation of patients included angiography (DSA) and ultrasound (Doppler).

Adolescent↗
PubMed1991

Renovascular hypertension: predicting surgical cure with exercise renography.

Renal artery stenosis with resultant renovascular hypertension has attracted clinical attention because the disease is potentially curable and because numerous diagnostic and therapeutic modalities compete for clinical acceptance. An exercise-mediated disturbance of renal hippurate transport was recently described, and has been implicated as having a role in nephrogenic fixed hypertension. To predict the final course of renovascular hypertension before operation we carried out a prospective study with the goal of verifying the predictive value of exercise hippurate scintigraphy. The study was to test the hypothesis that patients with disturbance of renal hippurate transport (pathologic renogram) induced by exercise would have stabilized hypertension and would continue to be hypertensive after operation. Thirty-one patients with hypertension who had unilateral or bilateral renovascular stenosis documented on angiography were referred to rest and exercise hippurate scintigrams before operation. The results of the examinations at rest served as standard and were compared with the exercise scintigrams. In 19 of the 31 (61%) patients a disturbance of transrenal hippurate transport evolved during exercise, whereas 12 (39%) patients failed to respond to exercise with altered hippurate kinetics. Twenty-six patients went on to renovascular operations; five had percutaneous transluminal angioplasty. Revascularization results differed markedly when the blood pressure response of patients with positive results on exercise (abnormal) and patients with negative results on exercise (normal) were compared. Ten of 12 patients with hypertension who had normal exercise renograms were cured. In comparison, blood pressure values were little influenced by therapy in patients with an abnormal response, where 17 of 19 patients continued to have hypertensive disease after therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1991

[Renal artery aneurysms].

Between 1980 and 1990, 21 patients with 26 renal artery aneurysms (0.4-16.5 cm in diameter) were diagnosed and treated at the Surgical Center, University of Heidelberg. Surgical reconstructive methods were applied to treat extrarenal and interventional embolization to treat intrarenal aneurysms. The most effective diagnostic method is selective intraarterial angiography. The etiology, age distribution, localization and clinical aspects are discussed. Four bleeding intrarenal aneurysms were embolized with full preservation of renal function (one solitary kidney). After surgical reconstruction of the aneurysmatic vessel, 80% of the hypertensive patients turned normotensive. Follow-up of a nontreated sacciform aneurysm showed total thrombosis within 4 years. In the same period, fixed renal hypertension developed in the patient because of recurrent microembolism in the renal parenchyma. Therefore, we suggest immediate treatment of a renal aneurysm to prevent the development of renal hypertension.

Adult↗
PubMed1990

[Computed tomographic detection of liver hemangiomas].

A 67-year old woman had noticed increasing growth of hair on the face and extremities for eight months. The testosterone level was raised at 2.6 micrograms/l and 24-hour urinary cortisol excretion was 160 micrograms. Ultrasound scanning showed a tumour measuring 14 x 10 x 10 cm in the left suprarenal, as well as several irregular space-occupying lesions in the liver, some of which were echo-rich. By computed tomography these structures were hypodense and did not concentrate any contrast medium. A provisional diagnosis of suprarenal carcinoma with hepatic metastases was accordingly made. After surgical removal of the suprarenal carcinoma the hormonal parameters unexpectedly returned to normal. Repetition of the computed tomography failed to elucidate the nature of the liver lesions. However, superselective hepatic angiography revealed the typical picture of haemangiomas of the liver. The existing computed tomograms were therefore reviewed. The diagnostic error was found to be due to incorrect timing of the interval between injection of contrast medium and performance of computed tomography.

Adrenal Gland Neoplasms↗
PubMed1990

Gastrointestinal tumours after stapler vs vicryl anastomoses in carcinogen-treated rats.

Since nickel is a potent carcinogen the influence of nickel-containing staples on the frequency of gastrointestinal tumour formation was tested in caecum-resected and carcinogen-treated rats. Tumour formation was elevated after stapling compared with simple laparotomy or vicryl sutures. This demonstrates a potential hazard of stapling techniques. In the vicryl group there was only one suture line carcinoma.

1,2-Dimethylhydrazine↗
PubMed1990

Hyperthermic limb perfusion for malignant melanoma and soft tissue sarcoma.

From 1982-1989, 113 hyperthermic limb perfusions were carried out in 102 patients. Ninety-three patients were treated for malignant melanoma and nine for soft tissue sarcoma. 47/93 patients had high-risk stage I melanoma with a 5-year survival rate of 89%. For the 46 patients treated for recurrent and metastatic melanoma the projected 5-year survival rate was 40%. The nine patients with soft tissue sarcoma were perfused for local recurrences or because of anatomically difficult tumor locations. 3/9 patients subsequently developed recurrent disease of the extremity; two of these patients had to be treated by amputation. The rate of major complications was low: no patient died in the postoperative course, an amputation due to toxic reaction was never required. Erythema and oedema (57%), severe skin reaction (6%) and transient nerve palsy (15%) were common side effects of therapy. Only two cases of leucopenia were observed (2%). The favourable results after hyperthermic limb perfusion show the efficacy of this method in the treatment of malignant melanoma and selected cases of soft tissue sarcoma.

Adolescent↗