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Biomedical subjects

W Sandmann

Publications and source records attributed to W Sandmann.

179 records · Page 10Linked to original sources
PubMed1976

[Wound infection following arterial surgery in the pelvis-leg region].

In a series of 581 reconstructions of the aorta to the leg arteries, 28 cases (4.8%) developed wound infection with positive microbiological identification. There were 24 monoinfections with significant prevalence of Staphylococcus aureus and S. epidermis. Thirteen patients with prosthetic implants and one patient with autologous saphenous vein bypass showed graft infection, which occurred in 13 patients as a complication of reoperation for bleeding or graft occlusion in the early postoperative period. The incidence of vascular infection in patients without reoperation was 0.4%. The risk of wound infection could not be lowered by the use of prophylactic broad spectrum antibiotics. Five (33%) patients with graft infection died because of sepsis and/or rupture of anastomosis. In the group of 9 survivors there were 3 patients with excision of the graft and limb preservation without reconstruction, and 3 patients with partial or total excision of the graft and successful simultaneous axillofemoral or obturator bypass. From this study it is assumed that improvement of indication and operative technique in reconstructive procedures is more promising in preventing wound infection than the extended administration of prophylactic antibiotic drugs. In case of vascular infection the excision of the graft is very urgent and consequent "extraanatomic" reconstruction can prevent loss of limb and life.

Adult↗
PubMed1976

[Ischemic necroses of the colon and rectum following alloplastic vessel substitution of the abdominal aorta].

Arterial insufficiency to the colon and rectum followed by ischemic necrosis of this bowel portion is considered to be a rare complication after resection of abdominal aortic aneurysms and alloplastic replacement of the abdominal aorta in arterial occlusive disease. The main symptom is diarrhea and mucus or blood in stool. Sigmoidoscopic examination is of diagnostic value; the treatment of choice has to be colostomy and resection. A causative factor for the development of large bowel necrosis is diminution of collateral blood supply, which is discussed in detail.

Aged↗
PubMed1976

[Lymph flow disorders following arterial surgery of the leg].

In a series of 342 arterial reconstructions of the iliacolic to popliteal arteries 24 patients with lymph vessel damage were observed. The diagnosis of lymphedema was established in 18 patients by clinical findings and in 2 of them the diagnosis was confirmed by lymphography with followup of 1 year. Three patients developed an internal lymphogenic cyst, 3 showed an external lymph fistula, and 1 patient developed an infection of a dacron bifurcation graft. The infection occurred when an additional occlusion of the left femoral artery was bypassed with an autologous saphenous vein graft and a lymph cyst in the groin, which was excised several times, became infected. The patient was treated successfully by excising the graft and performing an axillofemoral bypass. Although cases of surgical damage to lymph vessels following arterial reconstructions are rare in the literature, it is assumed that this complication occurs more often than reported, because of lack of lymphographic information.

Arterial Occlusive Diseases↗
PubMed1976

[Leiomyoma of the portal vein].

A case report of a 34-year-old female with leiomyoma of the portal vein is presented. The tumor was found accidentally, when laparatomy with diagnosis of cholelithiasis was performed. Total excision of the leiomyoma including a part of the anterior wall of the portal vein was necessary and could be carried out. The continuity of the portal vein could be preserved using continuous vascular suture. Microscopical examination of the tumor showed an increased proliferation rate in the leiomyoma; therefore the tumor was classified "semimalignant". A review of the literature concerning leiomyoma and leiomyosarcoma of the central and the peripheral veins showed 91 published cases and no other report of portal vein leiomyoma. The tumors of the vena cava inferior, which have been observed mostly, are listed in particular.

Adult↗
PubMed1975

[Surgical problems in the treatment of aneurysm of femoral artery bifurcation].

The different types and causes of aneurysm in the region of the femoral artery bifurication as well as the possibilities of surgical treatment are discussed on the basis of 4 patients, each with a differnt type of aneurysm. The examples show clearly that the basic of 4 patients, each with a different type of aneurysm. The examples show clearly that the basic disease can prevent successful surgical reconstruction of the arterial blood circulation. The use of synthetic prostheses is not possible in case of infection in this area because of the deleterious subsequences unless the entire infected area can be avoided with a bypass. (Fig. 2a). Trials with autologous veins and arteries, are , therefore, justified. The technical procedure for the use of the greater saphenous vein or deep femoral artery is described. In the authors' patients as well as those reported in the literature, it is clear than aneurysms in the region of the femoral artery bifurcation are sometimes difficult to treat. Hwerver, their localisation near the surface should allow early diagnosis and prompt treatment.

Aneurysm↗
PubMedDate not supplied

Incidence of asymptomatic extracranial arterial disease.

Investigations of the incidence and the extent of the asymptomatic early stages of extracranial arterial disease (EAD) have been restricted for methodical reasons. Direct Continuous Wave-Doppler examination has given highly accurate results in the location and correct estimation of the degree of EAD both for the carotid (97%) and the vertebral arteries (90%), as shown from a detailed comparison with carotid (n = 604) and vertebral (n = 426) angiograms. Compared with this degree of reliability, the validity of normal auscultation for the diagnosis of EAD is shown to be poor: if bruits are taken as the only signs of associated EAD in patients with systemic atherosclerosis, only 27.6% in a group of 123 patients would have been correctly diagnosed. This parallels the number of false-positives (22.6%) in patients with normal results. The frequency and degree of EAD was studied by the use of direct Doppler examination in 2009 neurologically asymptomatic patients admitted either with severe vascular (n = 375) or coronary atherosclerosis (n = 262) or with high-risk factors (n = 1370). The frequency was significantly higher (32.8%) in patients with peripheral vascular disease than in those with coronary artery disease (6.8%) and in risk-factor patients (5.9%). The combination and degree of vessel involvement are presented in detail and their possible prognostic significance discussed.

Aged↗
PubMedDate not supplied

Limits of coronary artery surgery. Clinical and postmortem findings.

In the first series of 90 continuous patients with coronary artery disease 9 patients died after aorto-coronary bypass procedures (10%). There were 7 operative deaths, and 2 postoperative deaths (respiratory failure after bronchopneumonia and bleeding duodenal ulcer; acute necrosis of the liver following hepatitis). The study of the deceased patients made evident that postoperative impairment of left ventricular function is caused by ventricular aneurysms. This fact can be shown by the poor ventricular function with an elevated left ventricular enddiastolic pressure (LVEDP) of more than 18 mm Hg. The results in patients with congestive heart failure could not be improved by multiple bypass-grafts. Probably the prolonged surgical intervention may cause additional stress to the predamaged myocardium. So, in our group the indication for using multiple grafts in cases with ventricular aneurysm is confirmed with great caution.

Autopsy↗
PubMedDate not supplied

Effects of renal artery reconstruction on kidney perfusion and tubular function measured by new radionuclide techniques.

Therapeutic effects of renal artery reconstruction on kidney perfusion and function were studied in 36 patients using new methods for analyzing radionuclide studies. Effective renal plasma flow, glomerular filtration fraction and parameters indicating perfusion and tubular transport improved significantly in patients with postoperative normalization of blood pressure. Patients with a patent renal artery on angiogram but without normalization of blood pressure showed an improvement of parameters such as effective renal plasma flow, glomerular filtration fraction and tubular transport time, whereas the perfusion index remained unchanged. In the group with re-stenosis or re-occlusion all parameters deteriorated after surgery. Discriminant analysis of preoperative data showed that success of surgery could be predicted with high degree of certainty (65% for improvement and 92% for no improvement). The results indicate, that radionuclide methods and arteriography are complementary in the evaluation of the hemodynamic consequences of a renal artery stenosis. They also help to assess the effects of reconstructive surgery and to predict operative success.

Glomerular Filtration Rate↗
PubMedDate not supplied

Subclavian-carotid transposition. Experience in 33 cases.

Thirty-three patients with a lesion of the proximal subclavian artery are treated by transposition of this endarterectomised vessel into the common carotid artery. The main advantages of this technique are the short operative time, the extra-thoracic approach, the absence of prosthetic material and the construction of an hemodynamic favorable anastomosis. There was a low morbidity and zero mortality in this series. All patients were selected by careful extensive continuous wave ultrasound Doppler examination of the extracranial arteries. Angiography is only required in case of an unclear Doppler finding, a multivessel extracranial or a peripheral arterial disease and in case of a redo-subclavian surgery. Good results of the technique can only be guaranteed if the donor arterial system is free of hemodynamically significant lesions. If not so, these lesions should be repaired first. Vertebral blood-flow is normalized in 97% of the patients (32/33 patients). Because of the excellent hemodynamic and clinical results, the subclavian artery transposition is the method of choice in the operative treatment of the proximal subclavian lesions.

Adult↗
PubMedDate not supplied

Reevaluation of surgical therapy in acute deep venous thrombosis of the lower limbs.

Surgical treatment of phlebothrombosis is not uniformly accepted. The presented results in a series of 53 patients, show nevertheless that thrombectomy and valvular destruction are no longer synonyms. Adequate "vein-respecting" technique - and severe patient selection guarantee better results than thrombolytic or heparin therapy as well in relation to patency as valvular function. Surgical therapy consists of a venous thrombectomy and a distal arterio-venous fistula. The importance of the ultra-doppler-sonography (UDS) in pre- and postoperative examinations is stressed. Forty-seven of the 53 patients had a complete repermeabilization of the venous system (90 %). Forty-four patients with complete repermeabilization could be followed-up for 1 to 3 1/2 years. Ninety-four per cent (42 patients) have an adequate valvular function reflected in a good clinical result. All normalized UDS-curves of the early postoperative period remained unchanged at repetitive postoperative controls up to 3 1/2 years and guaranteed a good clinical results. Phlebographic resolution of the thrombi doesn't mean a restored venous function, the post-thrombotic syndrome can only be avoided in case of competent venous valvular function. Any treatment of acute deep phlebothrombosis should therefore be evaluated functionally by UDS rather than by phlebography.

Acute Disease↗