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Biomedical subjects

W Hepp

Publications and source records attributed to W Hepp.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Autogenous reconstruction in mycotic inguinal aneurysm--long-term result].

A ruptured mycotic aneurysm of the left femoral artery in the groin area in a 44-year-old man had to be surgically treated in 1990 by an autogenous in-situ-repair consisting of aneurysmectomy including the femoral bifurcation, autologous vein interposition using medium-term absorbable suture material, and local application of an antibiotic bonded collagen. The infection could be checked in a short time. Three years after the operation the check-up gave evidence of an excellent local result with good arterial circulation in both legs. Autogenous in-situ-repair appears to be the most efficient procedure for treatment of an arterial infection or an infected graft. Especially in the area of bifurcations (i.e. inguinal and popliteal as well) this management is preferable to the aseptic extra-anatomic bypass procedure, since only this method can preserve the orthograde perfusion of the bifurcation branches.

Adult↗
PubMed1993

[Which factors have an effect on primary and long-term results in carotid surgery].

In a 2 1/2 years period between 1.1.1984 and 30.6.1986 292 carotid endarterectomies were carried out on 235 patients. The aim of this study was to find out prognostic factors influencing early results and long term patency. Therefore we worked on 33 parameters for statistical significance. A high statistical correlation was found in three working hypotheses: 1. Higher incidence of neurological troubles when coincidence with stenosis in the rear brain arteries. 2. Shorter life expectancy if previous insults occurred. 3. Higher rate of restenosis when preoperatively high grade stenosis. A lower statistical correlation was found in the following hypotheses: 1. Older patients have more concomitant risk factors for arteriosclerosis than younger. 2. Older patients present preoperatively a more severe degree of arteriosclerosis. 3. Risk of severe insult is correlating with age. For the rest of the 33 parameters no statistical significance was found. The results are presented in detail.

Adult↗
PubMed1992

[Catheter-induced femoral artery lesions: diagnosis with B-mode ultrasound, Doppler ultrasound and color Doppler ultrasound].

A total of 44 patients were evaluated to compare the value of B-mode sonography, Doppler sonography and colour coded Doppler sonography. All patients were studied because of suspected lesions of the femoral arteries following diagnostic and/or therapeutic cardiac catheterisation. B-mode sonography was unable to reliably differentiate between haematoma and pseudo-aneurysms, a.v.-fistula or combined lesions. Colour coded Doppler sonography can better demonstrate haematoma and thrombi in pseudo-aneurysms. The neck of a pseudoaneurysm can be exactly depicted by colour coded Doppler sonography. A.v.-fistula is shown by colour coded Doppler sonography based on typical colour coding and the Doppler spectrum. Combined lesions of pseudo-aneurysm and a.v.-fistula cannot reliably be detected by colour coded Doppler sonography, duplex sonography and B-mode sonography.

Adult↗
PubMed1992

[Catheter-induced vascular lesions: a comparison of the diagnostic value of Doppler color sonography versus angiography].

One hundred and thirty-two patients with suspected lesions of the femoral arteries following diagnostic and/or therapeutic cardiac catheterisation were studied by colour Doppler sonography (CDS) and digital subtraction angiography (DSA) and the results were compared. CDS was unable to demonstrate 5 out of 23 av fistulae. Intra-arterial DSA showed all av fistulae found at operation. CDS showed lower reliability (95%) than DSA (100%) for the demonstration of pseudoaneurysms. CDS can indicate hematoma and thrombi in pseudo-aneurysms and their exact extent is better shown by sonography. Arterial dissections (2 cases) and intra-luminal thromboses or occlusions of the femoral artery (4 cases) are shown equally well by the two procedures.

Adult↗
PubMed1992

Acetazolamide stimulation test in patients with unilateral internal carotid artery obstructions using transcranial Doppler and 99mTc-HM-PAO-Spect.

Fifteen patients with symptoms of cerebral ischaemia and angiographically confirmed unilateral stenoses or occlusions of the extracranial internal carotid artery (ICA) and 20 controls were studied by a 2 MHz transcranial Doppler (TCD) at rest and after stimulation with 1 g acetazolamide i.v., a cerebral vasodilator. In addition, the patients underwent 99mTc-HM-PAO-Spect measurement of regional cerebral blood flow (rCBF) at rest and after stimulation with 1 g acetazolamide. In 10 patients with ICA stenoses greater than 80% or occlusions, time-mean velocity (Vmean) increase and pulsatility index (PI) decrease in the postobstructive middle cerebral artery (MCA) as well as the increase of the ipsilateral rCBF were reduced in comparison with the contralateral side. The remaining 5 patients showed a normal Vmean increase and PI decrease in TCD.

Acetazolamide↗
PubMed1992

[Measuring model for intraoperative determination of vascular resistance in crural vascular surgery].

The measurement of the vascular outflow resistance during reconstructive vascular operations was applied since 1989 on 45 subjects with reliable results. This measurement is an aid for decision of additional treatment increasing the outflow, like a jump- or sequential bypass or a pharmacological therapy. The principle of measurement is based on the injection of a known volume of saline in the vessel and the integration of the intravascular pressure during this injection. In the prototype used, the pressure integration was performed by means of a modified analog/digital conversion method, hereby the results could be achieved directly as numerical values. Further an automatic, microcomputer based implementation of the outflow resistance measurement, showed remarkable improvements of accuracy in laboratory tests.

Foot↗
PubMed1992

[Effect of vascular resistance on results in crural artery surgery].

Between February 1989 and June 1991 the peripheral outflow resistance was measured at 45 patients during infragenual bypass surgery. In order to find out whether there is a correlation between successful bypass grafting and measured outflow resistance, all patients were controlled regularly. There was a significant difference in mean resistance between those grafts remaining patent and those that failed. 8 out of 11 bypasses, that failed up to one month after operation, had measured peripheral resistance higher than 1.1 mmHg x min/ml. 12 out of 15 bypass grafts remained patent for more than one month and had an outflow resistance less than 0.55 mmHg x min/ml. There is no definite correlation between a measured outflow resistance from 0.55 to 1.1 mmHg x min/ml because of the low number of patients in this group. The purpose of resistance measurement during peripheral vascular surgery was to determine a final value for a decision, if additional surgical or non surgical treatment for a better runoff is necessary. In our study this value is 1.1 mmHg x min/ml. Additional treatments are the peripheral AV-fistula and a jump- or sequential-graft. Another possibility is the intra- and postoperative application of Prostaglandin, which is in an experimental study in our clinic.

Aged↗
PubMed1991

[Problems and results of treatment of vascular injuries--a 20-year analysis].

From 1.1.1971 until 31.12.1990 we observed and provided 331 patients with 344 acute injuries of arteries. Reasons was iatrogenic and traumatic injuries. In 94% of iatrogenic injuries and in 67.7% of traumatic injuries a full restitutio could be achieved. In 11.9% the extremity was saved with a resting functional deficit, in 11.9% an amputation was required, 9.5% hat a letal outcome.

Arteries↗
PubMed1991

Vascular graft infection: detection by 123I-labeled antigranulocyte antibody (anti-NCA95) scintigraphy.

A total of 40 scintigraphic examinations were performed after vascular reconstructive surgery in 27 patients in whom there was a clinical suspicion of vascular graft infection. Whole-body gamma camera images were obtained at 4 and 24 h after i.v. administration of 111 MBq 123I-labeled antigranulocyte antibody Anti-NCA95. Scan results were interpreted without clinical information and were subsequently correlated with computed tomography. Prosthetic vascular graft infection was confirmed in 9 patients and excluded in 18 by surgical findings, bacteriology and/or clinical course. Scintigraphy revealed true-positive results in 16 of 40 and false-negative results in 1 of 40 examinations. True-negative results were found in 19 and 16, false-positive results in 4 and 7 examinations at 4 and 24 h p.i., resp. The sensitivity was calculated to be 94% for both early (4 h) and late (24 h) images whereas the specificity was 83% and 70%, resp. In all cases the application of the murine antibody was safe and no side effects or complications were noted. Limitations of this diagnostic procedure are accumulations of granulocytes in hematomas which may be observed in the non-complicated early course following reconstructive surgery.

Aged↗
PubMed1991

[Vascular stenosis of the branches of the aortic arch. Surgical treatment and long-term follow-up].

Since 1971 69 patients have been operated on for lesions of branches of the aortic arch (71 surgical procedures). In 80% of the patients extrathoracic reconstructions were performed, mainly carotid-subclavian bypasses (64%) using knitted dacron grafts (6 mm and 8 mm diameter). A transthoracic approach was used in 20% of the patients. No patient died after operation and no ischemic neurological deficit occurred. The cumulative survival rate was 89% after five and 59% after ten years. The cumulative patency rate in the survivors was 100% after transthoracic approach after five and ten years. Identical patency rates were observed after extrathoracic carotid-subclavian bypass using 8 mm dacron grafts, whereas in 6 mm grafts the patency rate was only 67% after five and ten years. 85% of all patients were symptom-free and additional 10% improved. These results confirm that carotid-subclavian bypass using 8 mm dacron grafts has a long term patency rate identical to those after anatomical transthoracic procedures.

Female↗
PubMed1990

[Surgery for asymptomatic carotid stenosis: a contribution to a controversial discussion].

From 1 January 1982 to 30. June 1986, 436 operations on the internal carotid artery were performed: 164 were asymptomatic (37.6%). Morphologic indication was stenoses greater than 70% only. Supra-aortic multivessel disease played a major role. The operative mortality amounted to 0.6% (total 0.9%) and the perioperative mortality, 1.8%. The cumulative morbidity was 1.6% after the first and 1.8% after the second year, whereas the cumulative survival rate measured 89.8% after one and 80.4% after three years. Therefore surgery for asymptomatic carotid internal stenoses is justified under conditions of the restrictive indication. It also seems to be more favorable as regards early and late results.

Brain Ischemia↗