Biomedical subjects

T Hupp

Publications and source records attributed to T Hupp.

41 records · Page 3Linked to original sources

PubMed1987

Predictive value of exercise renography for presurgical evaluation of nephrogenic hypertension.

Functional omicron-iodohippurate scintigrams were obtained in 18 hypertensive patients. Each patient was examined in the prone position and during exercise. An exercise-induced transient, bilateral, hippurate transport disturbance was sought as an expression of an exercise-mediated cortical perfusion abnormality. The study sought to test the hypothesis that patients who present evidence for an exercise-induced renal perfusion disturbance would have stabilized hypertension that was no longer surgically curable because of morphological changes of the peripheral vasculature. All 18 patients continued on to therapy: 13 proceeded to renovascular reconstructive surgery, 2 had a unilateral nephrectomy, and 3 were treated with percutaneous transluminal renal angioplasty. During preoperative exercise renography, evidence of bilateral renal dysfunction developed in 10 of 18 hypertensive patients during ergometric stress (abnormal exercise response). Following surgical therapy nine of these patients with abnormal exercise scintigrams continued to have hypertensive disease, while one patient was cured. The exercise renograms of eight hypertensive patients were not influenced by the exercise protocol, and operation cured seven of these eight patients. The results suggest that an accentuated vascular response to exercise occurs in the maintenance phase of renovascular hypertension, a disturbance not observed while the hypertension is curable by surgical therapy.

Antihypertensive Agents↗

PubMed1987

[Surgical therapy of radiation-induced arterial vascular damage].

Late complications following adjuvant or curative radiotherapy become clinically more evident with increasing duration of the observation period. Atherosclerotic disease secondary to radiation therapy is a rare complication. This is a report on 10 such cases requiring reconstructive vascular surgery between 1980 and January 1986. Previous radiotherapy was performed for malignancies in 9 patients and for thyroiditis in one patient. The time interval between radiation and onset of symptoms due to radiation induced atherosclerotic disease was on average 19.5 years (5-37 years). In order to reduce wound and graft infection to a minimum the extra-anatomical position of the graft was preferred. There was no major morbidity nor mortality postoperatively. During the mean follow-up of 22 months (1-63 months) one late graft occlusion was observed. Our results show that vascular reconstruction of radiation induced atherosclerotic disease is possible. Reconstructive surgery is clearly indicated for patients who underwent previous curative therapy for malignant disease.

Aged↗

PubMed1985

[Acute renal failure caused by renal artery occlusion. A surgical disease picture].

Out of 66 reconstructive operations of the renal arteries from 1980 to July 1984, 5 operations have been performed after a total occlusion of the renal artery. 3 patients were admitted with acute renal failure, all of them had a solitary kidney. The diagnosis could only be established by renographic examination, therefore a renal arteriography should be one of the first diagnostic procedures. Preexisting collateral vessels maintained a minimal blood flow of the kidney, the interval between the onset of the first symptoms and the operative revascularisation was between 24 hours and 5 days. Even if the ischemic tolerance time of the kidney exceeds 30-60 minutes, it does not necessarily lead to total organ damage because of those preexisting collateral vessels. On all 3 patients the renovasculary reconstruction was successful.

Acute Kidney Injury↗

PubMed1979

Course and spontaneous regression of acute pancreatitis in the rat.

Rat exocrine pancreatic function was studied structurally and biochemically after the in vivo production of actue interstitial pancreatitis by supramaximal stimulation with caerulein. Two major phases in the reaction of the gland were observed: During the first two days after cessation of the supramaximal stimulation a progressive infiltration of the interstitium and the pancreatic tissue with polymorphonuclear leucocytes, lymphocytes and macrophages occurred which led to further destruction of the gland and to decreased functional response. From two days after the cessation of the treatment, hypertrophy of centro-acinar cells and an increased rate of mitotic activity indicated regeneration of the pancreas. This was combined with an accelerated in vitro discharge of newly synthesized proteins over a period of four days. Between days three and six after the initial treatment mitotic activity was also observed in fully differentiated exocrine cells. Total structural and functional recovery of the pancreas was achieved nine to tweleve days after the cessation of the supramaximal stimulation.

Acute Disease↗

PubMedDate not supplied

Prospective study on the complication rate of carotid surgery.

BACKGROUND: Randomized trials of carotid endarterectomy for high-grade stenosis have shown a benefit for surgery under the condition of low perioperative complication rates. Concerns have been expressed that the complication rates of carotid surgery are higher in everyday practice and may vary considerably between centers. We prospectively established the complication rate for carotid surgery in a single institution. DESIGN: Prospective 2-year study. All patients received pre- and postoperative neurological evaluation. Laboratory tests included pre- and postoperative brain imaging, intracranial and neck vessel sonography, conventional angiography, magnetic resonance angiography, and intraoperative monitoring. PARTICIPANTS: 108 consecutive patients: 54 symptomatic patients fulfilling the inclusion criteria of the European Carotid Surgery Trial (ECST) and 54 asymptomatic patients fulfilling the inclusion criteria of the North American Trial on Asymptomatic Stenoses (ACAS). SETTING: Single academic center with a high volume of carotid endarterectomies (>50 per year). Participating center in ECST. MAIN OUTCOME MEASURES: Stroke or death as defined in the randomized trials. RESULTS: The overall complication rate was 8.3% (95% CI 4.1-15.6%). Complications were more frequent in patients with symptomatic stenosis (11.1%, CI 4.6-23.3%) than in asymptomatic cases (5.6%, CI 1.5-16.4%). Three patients died (2 strokes, 1 myocardial infarction). Disabling strokes were found in 2 patients (Rankin scale scores 3 and 4). Nondisabling strokes (Rankin scale score 1 and 2) occurred in 4 patients. The complication rates for symptomatic and asymptomatic patients were higher than the ones reported in the randomized trials, but 95% confidence intervals showed that the differences were not statistically significant. The point estimates of complication rates still supported a benefit of surgery for patients with symptomatic stenosis, but denied a positive effect of endarterectomy for patients with asymptomatic stenosis. CONCLUSION: In this center, a beneficial effect of carotid surgery for asymptomatic stenoses cannot be safely assumed.

Adult↗