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  • 1
    Digitale Medien
    Digitale Medien
    Oxford, UK; Malden, USA : Blackwell Science Inc
    Wound repair and regeneration 13 (2005), S. 0 
    ISSN: 1524-475X
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Objective:  There is no consensus of objective information to determine the indication for lower extremity amputation and the lowest amputation level that will heal. In this report, we studied amputation for the lower extremity ischemia.Objects and Methods:  We measured transcutaneous oxygen tension (tcPO2) in seven patients who had have ischemic disease of the lower extremity, two patients were in Buerger's disease and five patients were in arteriosclerosis obliterans (ASO). Of these patients, in regard to complications, four patients had diabetes mellitus (DM) and two patients underwent hemodialysis because of chronic renal failure. Six patients of them were men and only one patient was woman, mean age was 59 years old (25∼76 years old).Results:  Two patients who had Buerger's disease underwent primary amputation. All another five patients who had ASO underwent secondary amputation. Selections of lower extremity amputation levels were above-knee amputations in three patients, below-knee amputations in two patients and toe amputation in two patients. There were incurable infections in two patients.Conclusions:  It is generally said that if patients have had critical limb ischemia without providing hemodynamic improvement, it is necessary for them to be performed lower extremity amputations within 12 months, In concrete terms, segmental Doppler systolic blood pressures are below 50 mmHg and tcPO2 are below 30 mmHg. However in this our study, primary healing rate was 75% when the tcPO2 was above 20 mmHg.
    Materialart: Digitale Medien
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  • 2
    Digitale Medien
    Digitale Medien
    Oxford, UK : Blackwell Publishing Ltd
    International journal of urology 5 (1998), S. 0 
    ISSN: 1442-2042
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: A cutaneous hemangioma of the penis extending from the proximal portion of the glans to the prepuce of an 18-year-old man was successfully treated by sclerotherapy with polidocanol and interrupted ligation of the hemangioma.
    Materialart: Digitale Medien
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  • 3
    ISSN: 1436-2813
    Schlagwort(e): vasculogenic impotence ; hip claudication ; internal iliac reconstruction ; Doppler assessment of rectal blood flow
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The standard surgical treatment of vasculogenic impotence or hip claudication involves repairing vascular lesions, especially in the internal iliac arteries. It is difficult, however, to make a definite diagnosis or an accurate judgement of the therapeutic effects of this treatment due to the trouble in ruling out any other disorders. During the last five years, 19 patients with impotence and associated apparent internal iliac artery stenosis or occlusion and 2 patients with hip claudication, underwent internal iliac arterial reconstruction. The patients’ ages ranged from 37 to 70 with a mean age of 63.7 and the main procedure performed in all patients was aorto-iliac to femoral bypass grafting, or abdominal aortic aneurysmectomy. A retrospective study revealed that 74 per cent of those treated regained penile erectile activity postoperatively, and that hip claudication disappeared completely in all cases. One of the patients received percutaneous transluminal angioplasty (PTA) for the treatment of vasculogenic impotence, after which his postoperative penile brachial pressure index (PBPI) improved, demonstrating a statistically significant difference compared to the preoperative value. Trans-anal Doppler measurement also proved useful in providing complication-free perioperative understanding of pelvic circulation.
    Materialart: Digitale Medien
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  • 4
    ISSN: 1436-2813
    Schlagwort(e): Key words Carbohydrate antigen 19-9 ; Small intestinal cancer ; Lewis antigen
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract We report herein the case of an 81-year-old woman found to have small intestinal carcinoma producing carbohydrate antigen (CA)19-9, in whom recurrence on the abdominal wall was strongly suspected 4 months after resection. She presented to our hospital with acute abdominal pain with severe anemia. Marked serum elevation of CA19-9 to 164.8 U/ml suggested a progression to malignancy. A fluorography using an ileus tube revealed an abnormal mucosal pattern. An exploratory laparotomy showed an incomplete annular constrictive Borrmann type 2 tumor, located approximately 190 cm from Treitz's ligament, without any signs of peritoneal or hepatic metastases. Histological examination confirmed a diagnosis of papillotubular adenocarcinoma without metastases of the regional lymph nodes. CA19-9 antigenicity was detected in the cytoplasm and on the surface of the cancer cells, using the monoclonal CA19-9 antibody, NS19-9. In this report, we demonstrate the CA19-9 productivity and distribution of the cancer tissues in relation to their prognosis.
    Materialart: Digitale Medien
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  • 5
    ISSN: 1436-2813
    Schlagwort(e): visceral artery aneurysms ; gastroepiploic artery ; ileocecal branch of the superior mesenteric artery ; migrating abdominal bruit
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Multiple aneurysms of the gastroepiploic artery and the ileocecal branch of the superior mesenteric artery were found in a 68-year-old male patient by angiography. The patient presented with one-hour postprandial epigastric pain of 10 years duration. Abdominal bruit was auscultated at the two different sites, one of which shifted downwards upon upright position. From the freely movable nature of the great omentum, this bruit, migrating upon postural change, was most likely from the gastroepiploic artery aneurysms. The aneurysms were excised and the abdominal bruit disappeared. The etiology of the aneurysms was suggested to be arterial fibrodysplasia histologically. From this experience, it was stressed that postural change should be added to a routine physical examination to rule out an aneurysm from the freely movable great omentum.
    Materialart: Digitale Medien
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  • 6
    ISSN: 1436-2813
    Schlagwort(e): juxtarenal aortic occlusion ; thromboendarterectomy (TEA) ; suprarenal aortic clamping ; ischemic insult to the kidney ; renal embolization ; bypass grafting ; distal run-off
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract From 1974 to 1976, four patients with juxtarenal aortic occlusion were operated upon with no surgical mortality. Thromboendarterectomy (TEA) of the aorta with renal revascularization was performed in one patient, and TEA with grafting in three. Intraoperative renal protection was particularly important, since suprarenal aortic clamping was often required in these cases. Possible renal embolism developed in one patient postoperatively. In order to prevent renal embolism and to minimize ischemic insult to the kidney, the value of the following procedures was stressed; (a) irrigation of aortic lumen with saline after TEA under suprarenal aortic clamping with renal arteries kept occluded, and (b) re-application of aortic clamp below the renal arteries after irrigation. Since the most distal level of occlusive process was the common femoral artery in our series, the patient with this desease entity should be treated more actively.
    Materialart: Digitale Medien
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  • 7
    ISSN: 1436-2813
    Schlagwort(e): transcutaneous partial pressure of oxygen (PtcO2) ; noninvasive monitoring ; vascular reconstruction ; early operative failure
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract The intraoperative transcutaneous partial pressure of oxygen (PtcO2) was used to monitor 58 vascular reconstructive surgery procedures in 54 patients. The study comprised three groups: Group A (24 limbs without any ischemic symptoms or signs), Group B (45 limbs with intermittent claudication), and Group C (12 limbs with ischemic rest pain, ulceration, and gangrene). In addition in 31 patients the chest wall was monitored simultaneously as a control. The results showed that the PtcO2 values increased immediately and significantly to varying degrees and at varying speeds after unclamping. The controls had higher values than Group A (P〉0.05), Group B (P〈0.05), and Group C (P〈0.05) patients. Further study showed that there were no significant differences between the maximal values in the limbs with good distal vessel run-off in Groups A, B, and C, and in the controls (P〉0.05). It is thus concluded that effective vascular reconstruction in the limbs is indicated by a rapid and marked increase of both the PtcO2 value and the response value, while with a slow and low increase of the value, early graft failure and poor distal vessel run-off should be suspected. We believe that this monitoring method dynamically reflects the functional state during vascular reconstruction and is clinically valid.
    Materialart: Digitale Medien
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  • 8
    ISSN: 1436-2813
    Schlagwort(e): duplex ultrasonography ; infrainguinal vascular reconstructions ; postoperative graft surveillance ; peak systolic velocity ; peak-to-peak pulsatility index
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract While duplex scanning has been advocated as the most accurate modality for postoperative graft surveillance, it is time-consuming for evaluating the entire graft. The aim of the present study was to determine which parameter predicts graft failure most simply and precisely, by examining 62 men and 1 woman who collectively underwent 71 infrainguinal arterial bypasses. A total of 212 scannings were obtained using a duplex scanner, and the peak systolic velocity (PSV), PSV ratio, and peak-to-peak pulsatility index (PPI) were analyzed. This analysis revealed 7 occlusions, 9 stenoses, and 1 arteriovenous fistula. When a PSV 〈 45 cm/s and/or a PSV ratio 〉2.0 was defined as graft failure, the sensitivity was 84.0% and the specificity was 81.8%; however, a PPI 〈 7.0 at the midgraft, indicating graft failure, showed a sensitivity of 100% and a specificity of 83.3%. The PPI exhibited better sensitivity and specificity than the PSV, even though the PPI needs only to be measured at the midgraft whereas the PSV should be measured at at least two points. Thus, we believe that the PPI could be the most useful and simple parameter to assess infrainguinal bypass grafts.
    Materialart: Digitale Medien
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  • 9
    Digitale Medien
    Digitale Medien
    Springer
    Surgery today 29 (1999), S. 948-952 
    ISSN: 1436-2813
    Schlagwort(e): Key Words: celiac artery aneurysm ; 3-dimensional CT angiography ; vascular reconstruction ; end-to-end anastomosis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Materialart: Digitale Medien
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 10
    Digitale Medien
    Digitale Medien
    Springer
    Surgery today 29 (1999), S. 948-952 
    ISSN: 1436-2813
    Schlagwort(e): celiac artery aneurysm ; 3-dimensional CT angiography ; vascular reconstruction ; end-to-end anastomosis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Celiac artery aneurysms are uncommon and only 21 cases have been reported in Japan. We present herein two cases of celiac artery aneurysm treated by aneurysmectomy and vascular reconstruction, and review the Japanese literature documented between 1969 and 1997. Our two patients were asymptomatic, and their aneurysms were detected incidentally by abdominal computed tomography (CT) and ultrasonography during investigations of other disorders. The celiac trunk was imaged well by three-dimensional CT angiography, which proved very effective for determining the best surgical approach and type of operation. Aneurysmectomy and reconstruction of the common hepatic and splenic arteries with direct end-to-end anastomosis was performed successfully in both patients. Pathological examination revealed medial degeneration with loss of elastic fibers and atherosclerotic changes that were probably secondary. In Japan, 13 patients (61.9%) have been surgically treated and several methods of vascular reconstruction with grafting have been reported; however, there have been no previous reports of an end-to-end anastomosis without grafting as described herein.
    Materialart: Digitale Medien
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