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Biomedical subjects

W Hepp

Publications and source records attributed to W Hepp.

At least 55 records · Page 3Linked to original sources
PubMed1990

[When is there an indication for primary femoral amputation in patients with vascular disease?].

Every patient suffering from arterial occlusive disease has to be considered a candidate for a bilateral amputation. Below-knee amputation is preferable if at all possible. Poor wound healing and reamputation at a higher level are factors to be expected in 20-30% of these patients. Therefore primary above-knee amputation is indicated only if a more distal amputation level is not possible, or if lower amputation offers no advantage to the patient. The question must be answered in each individual case.

Amputation, Surgical↗
PubMed1989

[Treatment of infections of the deep soft tissues in reconstructive vascular surgery].

After 685 reconstructive vascular operations (1982-1984) on account of arterial occlusive disease in the supra-aortic arteries as well as in the aorto-iliac and femoro-popliteal segments there occurred 9 deep infections (1.31%); most infected by-passes were extra-anatomical type. In 2 cases an aseptic by-pass was performed; in 4 cases an open local treatment was performed (early broad splitting of the soft tissues and laying open the entire infected graft, surgical wound debridement and local application of antiseptic solution); in 3 cases there was no other possibility than to remove the implant and amputate the leg. Each of the 2 methods described has its specific indications: the aseptic by-pass has to be performed in retroperitoneal and inguinal infections; the open local treatment has to be performed in cases of extra-anatomical by-passes and operations in the femoro-popliteal-cruralis or supra-aortic region. The correct use of these 2 treatment modalities, with their specific indications, allows a conservative management of deep tissue infections.

Adult↗
PubMed1989

[When is primary amputation of the upper leg indicated?].

Every patient suffering from arterial occlusive disease has to be considered a candidate for a bilateral amputation. Infragenual amputation is preferable if at all possible. Poor wound healing and reamputation at a higher level are factors to be expected in 20-30% of these patients. Therefore primary above-knee amputation is indicated only if a more distal amputation level is not possible, or if lower amputation offers no advantage to the patient. The question must be answered in each individual case.

Amputation, Surgical↗
PubMed1989

[Postoperative computed tomography control of allogeneic vascular prostheses].

33 CT-studies of 26 patients with alloplastic vascular prostheses were evaluated and compared with postoperative digital subtraction-angiography in 16 cases. 13 patients had no pathologic findings confirmed by further clinical development. In 4 cases bypass infection was diagnosed, which CT findings were perigraft gas (2/4), perigraft fluid (4/4), cm-enhancement (4/4) and fistulas (2/4). 10-21 d. post.-op. sterile hematomas were found in 3 patients. Further 3 cases had 5 weeks-2 post.-op. perigraft seromas. CT was method of first choice for diagnostic of perivascular alterations after bypass surgery. DSA was complementary to CT and should be performed to detect vascular complications.

Aged↗
PubMed1989

[Change in the therapeutic concept of deep wound infection following vascular surgery interventions].

Aseptic bypass graft and graft-preserving open local treatment have proved to be the two suitable procedures for therapy of infected grafts in vascular surgery (stage III Szilagyi). 18 deep wound infections in vascular surgery were treated 1982-1986; rate of infection was 1.2%. The infection was successfully treated with preservation of life and limb in 66.7%. Amputation was unavoidable in 5 patients (27.8%). 2 patients (11.1%) died. By applying the above-discussed principles of management the results could be drastically improved.

Amputation, Surgical↗
PubMed1988

Shock-wave lithotripsy of gallbladder stones. The first 175 patients.

To substantiate the early results of extracorporeal shock-wave fragmentation of gallstones, we used this nonsurgical procedure to treat 175 patients with radiolucent gallbladder calculi. Chenodeoxycholic acid and ursodeoxycholic acid were administered as adjuvant litholytic therapy. The gallstones disintegrated in all patients except one and completely disappeared in 30 percent of all patients within 2 months after lithotripsy, in 48 percent at 2 to 4 months, in 63 percent at 4 to 8 months, in 78 percent at 8 to 12 months, and in 91 percent at 12 to 18 months. In patients with solitary stones up to 20 mm in diameter, the corresponding values were 45, 69, 78, 86, and 95 percent, respectively. Shock-wave therapy had no adverse effects except cutaneous petechiae (14 percent) and transient gross hematuria (3 percent). One third of the patients had one or more episodes of biliary colic before all the fragments disappeared. Two patients had mild pancreatitis, which necessitated endoscopic sphincterotomy in one. The patient with insufficient stone fragmentation underwent elective cholecystectomy; no additional operations were necessary. Extracorporeal shock-wave lithotripsy combined with medical therapy for stone dissolution is a safe and effective treatment in selected patients with radiolucent gallbladder calculi.

Adolescent↗
PubMed1987

[Acute ischemia syndrome of the lower extremity: a disease picture with unsatisfactory treatment results].

The acute ischemia of the lower extremities represents a serious threat for limb and life and needs emergency treatment. The results of surgical therapy concerning a twelve year period were demonstrated (172 lower extremities in 156 patients). There was an operative mortality of 37.8% and an amputation rate of 9.6%, 2 years survival rate was 48.3% and run up to 37.1% after 5 years. Regarding to outcome age, primary disease, preexisting arterial occlusive disease, early reocclusion and prolongation of ischemic interval have proved as limiting factor resulting in unsatisfactory early results.

Aged↗
PubMed1987

[Thrombendarterectomy in pelvic artery sections: an wrongly neglected therapeutic procedure?!].

Surgical repair was applied to the aortofemoral region in 491 cases, between 1975 and 1984, including 48.5 per cent of in situ approaches. The ratio were 2.2:1 for aortofemoral thrombendarteriectomy and 4:1 in relation to revascularised extremities. Surgical lethality, postoperative complications, and amputations following aortofemoral thrombendarteriectomy did not differ with significance from conditions in the wake of bypass procedures. Long-time functional results were good to satisfactory in 90.3 per cent of all cases and thus compared well with results obtained from bypass procedures which were of comparable quality in 89.1 per cent. Aortofemoral thrombendarteriectomy, today, is found to be a method which had certainly suffered unwarranted neglect in the past.

Amputation, Surgical↗
PubMed1986

Fragmentation of gallstones by extracorporeal shock waves.

We treated nine patients with functioning gallbladders containing one to three symptomatic radiolucent stones not larger than 25 mm in diameter, as well as five patients with stones in the common bile duct that were not removable by endoscopic procedures, by means of extracorporeally generated shock waves during general anesthesia. The patients with gallbladder stones received adjuvant treatment with a combination of ursodeoxycholic acid and chenodeoxycholic acid. All gallbladder stones were disintegrated into sludge or fragments with diameters of no more than 8 mm. In six of the nine patients the fragments disappeared completely within 1 to 25 weeks. No adverse effects were detected during a follow-up period of 10 to 34 weeks, except transient biliary pain in two patients, with mild pancreatitis in one. In four of the five patients with common-bile-duct stones, shock-wave treatment permitted stone disintegration and successful endoscopic extraction or spontaneous passage of fragments. We conclude that gallstone disease may be treated successfully and without serious adverse effects by extracorporeally generated shock waves in selected patients.

Adult↗
PubMed1986

Diagnostics of extra-cranial carotid stenoses. Comparison of CW-Doppler sonography and intravenous digital subtraction angiography.

In 98 internal carotid arteries, continuous-wave ultrasound Doppler sonography (USD) and i.v. digital subtraction angiography (DSA) of the internal carotid arteries were performed. The findings were compared with each other prospectively and on the basis of conventional angiography findings. The aim of this investigation was to clarify, whether DSA would show stenoses with lumen restriction of less than 50% more precisely than USD, or whether it would enable clearer localization of any vascular lesions. The results revealed that in cases of haemodynamic effective stenoses and occlusions both procedures correlated well with each other and also with catheter angiography. However, USD and DSA showed increasing discrepancies of findings with decreasing degree of severity of the stenosis. The accuracy for localization of stenoses also decreased markedly for both methods with increasing distance from the carotid bifurcation. In the case of congruent findings of USD and DSA in haemodynamic effective stenoses (degree of stenosis more than 75%) or occlusions conventional angiography did not increase the diagnostic information, and it seems therefore dispensable for vascular surgical decisions. However, in cases with existing clinical symptoms with contradictory or negative USD and DSA findings angiography is still indicated.

Adult↗
PubMed1986

The management of infected grafts in reconstructive vascular surgery.

Aseptic bypass graft and graft-preserving open local treatment have proved to be the 2 suitable procedures for therapy of infected grafts in vascular surgery (stage III Szilagyi) with preservation of the limb extremity. After 685 reconstructive operations (1982 to 1984) for chronic arterial occlusive disease in the supraaortic as well as in the iliac and femoral segments, 9 infections involving the graft (1.31%) occurred. These infections were more common in superficial extra-anatomical bypass. The incidence of inguinal infection was 0.44%. In 2 cases an aseptic bypass with abandonment of the infected vascular segment and in 4 cases open local treatment of the infected graft proved successful in treating the infection and led to secondary wound healing. The transplant had to be abandoned and an amputation performed in 3 patients, one of whom died. That is to say, the infection was successfully treated (with respect to the original aim of the operation) in 66.7% of cases. The aforementioned methods do not represent alternative procedures: the aseptic bypass is considered in retroperitoneal and inguinal infections, whereas the open local treatment is used in cases of superficial extra-anatomical bypass grafts and in the infrainguinal and supraaortic artery segments. The success of the latter treatment, however, depends on several preconditions. In former years, loss of the limb extremity was almost unavoidable and, because of septicemia, the outcome often lethal. By applying the above-discussed principles of management this could be drastically improved.

Adult↗
PubMed1986

[Angiomorphology of arteriosclerotic changes in the area of the carotid bifurcation].

100 intravenous digital subtraction angiograms of bifurcations were compared to one hundred plain film arteriograms. Both types of examinations were of excellent image quality. Arteriosclerotic lesions in the posterior circumference of the internal carotid artery were found in 55% plain film angiograms and in 49% of intravenous DSA examinations. Plain film angiography was significantly more accurate in the evaluation of arteriosclerotic ulcerations than i.v. DSA. The total amounts of arteriosclerotic stenoses with a smooth or rough surface were equal with both methods. The interindividual comparative study demonstrated that in respect of diagnosis of ulcerative lesions, i.v.. DSA is inferior to plain film angiography, even if an excellent image quality for all projections is achieved in i.v. DSA.

Aged↗