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Biomedical subjects

W Sandmann

Publications and source records attributed to W Sandmann.

At least 163 records · Page 9Linked to original sources
PubMed1980

[Subclavian-carotid transposition in the treatment of obstructive subclavian disease with steal syndrome].

Eleven patients with subclavian steal syndrome underwent end-to-side transposition of the subclavian into the common carotid artery. The post-operative evaluation was done in every case by neurological examination, brachial blood pressure measurement, transcutaneous Doppler examination and by angiography. The operative result of this reconstruction, which was performed mainly on high-risk patients, was excellent. The symptoms of subclavian steal disappeared. In all but one patient the brachial pressure raised to normal. After transposition a blood flow reduction of 20% was measured intraoperatively in the peripheral common carotid artery, while the vertebral blood flow reversed to its natural direction. The peripheral common carotid artery pressure measured simultaneously remained unchanged, and hemodynamic criteria of carotis steal were not detected. The blood flow quality at the anastomosis was measured by the turbulence index in patients with an ideal reconstruction. The amount of blood flow distortion caused by the anastomosis was negligible. Therefore a long patency is expected. In patients with occlusive disease of the proximal subclavian artery we like to recommend the transposition as the procedure of choice, because the method uses one single incision for the extrathoracic exposure and one anastomosis-only without any graft material.

Arterial Occlusive Diseases↗
PubMed1979

[Blood vessel sutures with absorbable suture material: roentgenological, hemodynamic, light and electron microscopy findings. I].

Simple end-to-end anastomoses were performed in the common carotid and femoral arteries and in the jugular and femoral veins of dogs. In other dogs, lateral sutures (running) consisting of absorbable material made from polyglycolic acid were inserted. No occlusions, aneurysms, or infections occurred in the arteries. Without heparin, the patency rate after up to 234 days was 98%. In veins, the observation period was 60 days and a patency rate of 83% was found. All vessels were studied by angiography and by light and electron microscopy. Additionally, an original method of hemodynamic assessment was used (Turbulence Index). The alternating effect of morphological variations in the vessel wall and the degree of blood flow disturbance was evident.

Angiography↗
PubMed1979

[Treatment of late occlusions and stenoses after an aortofemoral bypass operation].

Thirty-three patients with one or several late occlusions in 43 limbs of aortofemoral dacron grafts underwent 56 reconstructions because of impending limb loss. Thrombectomy alone with patch closure was less successful. Excision of the femoral anastomosis, resection of the distal part of the occluded prosthetic limb and replacement by a new velours graft tube together with profundaplasty and further downstream reconstruction revealed the best results. The early reocclusion rate was 10%, the late reocclusion rate was 10%. There was no operative mortality and no amputation. Two late deaths occurred, in one case due to grade III infection with sepsis. Another late graft infection was successfully managed by an extraanatomic bypass and excision of the infected limb. The reasons for late occlusions of aortofemoral grafts were found to be incomplete reconstruction of the outflow tract, technical failure at the time of primary reconstruction and progressive atherosclerosis. Hypertonus was common in all cases with progression of the disease. Technical details of the operative management for late occlusion are presented.

Adult↗
PubMed1978

[The effect of operation, anaesthesia and blood viscosity on haemodynamic during aortofemoral bypass operation (author's transl)].

Cardiac index, total peripheral resistance, blood, plasma and serum viscosity in patients with peripheral vascular disease were measured pre-, intra- and postoperatively. Besides plasma and serum viscosity, most obviously blood viscosity decreased during anaesthesia and operation. The decrease of blood viscosity is caused mainly by the falling haematocrit. Red blood cell aggregation occuring under low-flow conditions is decreased. Thus blood viscosity additionally is diminished at least in the area of low shear rates. Corresponding haemodynamic measurements revealed that decreasing viscosity improves cardiac index and total pressure resistance if normovolaemia exists, but in general is masked by anaesthesia and operation.

Anesthesia↗
PubMed1977

[Postoperative control of blood flow in arterial surgery: results of electromagnetic blood flow measurement (author's transl)].

An electromagnetic blood flow cuff probe was implanted up to 4 days in 50 patients to control basal blood flow through a femoro-popliteal vein graft. Patent grafts showed increasing blood flow due to hyperemia with maximum on the 2. p. op. day. The level of the postoperative hyperemia and the increase of blood flow caused by intraarterial papaverine injection during operation were in the same range. The method and the extension of analgesia influenced the degree of postoperative hyperemia. Pain and blood loss diminuished graft flow. Patients with epidural block and sufficient blood volume produced a significant higher graft flow than patients with morphine analgesia. 2 patients had early occlusion of the graft, 2 others showed occlusion at the distal anastomosis. These complications could be easily detected by blood flow measurement and were successfully corrected in two patients. Moreover, electromagnetic postoperative blood flow control may be helpful in patients with proximal a.v. shunt for hemodialysis.

Arterial Occlusive Diseases↗
PubMed1977

[Experimental findings in liver perfusion measurements using an ultransonic Doppler flowmeter].

1. The ultrasonic doubling method of bloodflow measurement is an experimental easily practicable and very exactly recording measurement arrangement. By this method data of other methods were extended and ensured. 2. Early inquested finding is attested that after inhibition of portal vein bloodflow and after portocaval anastomosis an increased arterial perfusion of liver through a. hepatica is following. Increasing bloodflow of a. hepatica is independent of cardiac output. 3. After diminution of arterial perfusion by occlusion of a. hepatica no increased portal bloodflow is following. 4. It is to suppose an "intrahepatic regulation of liver bloodflow". It seems economical that the perfusion part of the a. hepatica with her higher oxygen content is increasing when the general perfusion is decreasing by diminished portal bloodflow or diminished blood pressure. So far it is impossible to interpret whether this accomodation is based on a difficult "auto-regulation" or is originated pressure passive from the flow together of two systems are staying under different pressure.

Animals↗
PubMed1977

[Surgical aspects in arterial occlusion (author's transl)].

Acute arterial occlusion was found to be the most frequent emergency (10%) among vascular patients of the Department of Surgery of the University of Düsseldorf. Rheumatic heart diseases receded as etiological factors whereas atherosklerotic obstructive diseases exhibited a clear increasing tendency. Operation is urgent if acute ischemia is present. The best method is represented by embolectomy by means of the Fogarty-catheter, if it is performed within the first 6 to 12 hours after or vascular occlusion. Angiography is only indicated if ischemia is not complete or if the cartoid artery or great visceral arteries are involved. In cases of incomplete occlusion embolectomy may be successful even after days and weeks. Mortality after these operations is found to be 18 to 20%, the rate of amputation being 9%. The final results of operative results are better in arterial embolism than in arterial thrombosis.

Arterial Occlusive Diseases↗
PubMed1976

[Septic complications in vascular surgery: a review (author's transl)].

The importance of vascular infection is determined by localization and extension, by the type of graft, by the type of bacteria and by subsequent complications. Prophylactic measures are: strict selection of patients (in obesity, diabetes), unyielding attention to hygiene and asepsis in the operating theater, use of adhesive plastic skin coverings, instrument preparation, short operation time, meticulous blood coagulation, intraoperative control of the hemodynamic result and adequate wound drainage. Antibiotics can be given preoperatively; their usefulness in the prevention of wound infection is not generally accepted. The use of a prosthesis in the perforating vascular trauma should be avoided; extra-anatomic reconstruction may be performed as the primary procedure. When the graft is removed and extra-anatomic reconstruction performed definitive healing cannot always be expected.

Anti-Bacterial Agents↗
PubMed1976

[Postoperative analgesia with continous epidural analgesia and with dolantin (author's transl)].

Hemodynamic reactions to the discontinuation of epidural analgesia and to the injection of Dolantin were studied in 16 patients. One of every three patients reacted to the postoperative pain with an increase in mean arterial pressure(+30%) and in the mean pressure in the arteria pulmonalis (+40%) associated with an increase in stroke volume (+41%) and cardiac output (+49%). The administration of Dolantin did not influence either pressure measurement. In such cases the administration of antihypertensive drugs (alpha-blocking agents) or the reinstitution of epidural analgesia is neccessary.

Analgesics↗
PubMed1976

[Study of turbulence in the normal and stenotic vessel].

Velocity measurements were performed at the test bench, in dogs and in patients with pulsed ultrasound. A new zero crossing counter was used to measure the different frequencies of the doppler spectrum in real time. The ratio of the standard deviation of the radial mean velocity to the radial mean velocity expressed as a percentage proved to be a useful turbulence index to describe stability of flow.

Animals↗
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↗