H.-J. Florek’s research while affiliated with Städtisches Krankenhaus Kiel and other places

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Publications (17)


[Cardiovascular risk in arterial vascular surgery reconstruction]
  • Article

December 1999

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4 Reads

Zeitschrift für ärztliche Fortbildung und Qualität im Gesundheitswesen - German Journal for Quality in Health Care

C Wunderlich

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E Altmann

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H J Florek

Perioperative cardiac complications can limit the outcome after major vascular surgery where the underlying severe coronary artery disease is considered to be the main source. We describe the results of a prospective study including 201 patients undergoing elective vascular surgery. After looking at the encouraging low complication rate (mortality 0.99%, non-fatal myocardial infarction 2.98%, cardiac complications 9.95%) we would recommend the discussed diagnostic strategy. Specialized and expensive cardiac testing should be reserved for a few cases.



Shunt: Immer, nie oder wann und warum?

January 1999

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12 Reads

In mehreren großangelegten Multicenterstudien konnte eindeutig geklärt werden, ob und welche Patienten unter welchen Bedingungen ein Benefit von einer Carotis-desobliteration haben. Für die symptomatischen Patienten wurde durch die NAS-CET-Studie (2) eine relative Risikominimierung der operierten Patienten gegenüber den nur medikamentös behandelten Patienten von 65 % erreicht. Ebenso überzeugend zeigt unter anderem die ACAS-Studie (1) eine relative Risikominderung der asymptomatischen Patienten, einen Schlaganfall zu erleiden, von über 50 % gegenüber der konservativen Gruppe. Auf diesen Ergebnissen bauen wir heute unsere Operationsindikation auf. Aber nach wie vor ist eine Frage ungeklärt und oft auch strittig. Bei welcher Patientengruppe oder unter welchen Bedingungen muß intraoperativ zur Hirnprotektion ein intraluminaler Shunt eingelegt werden.


Alterationen der somatosensorisch evozierten Potentiale (SEP) bei 482 Karotisrekonstruktionen

February 1998

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1 Read

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1 Citation

Gefässchirurgie

The use of somato-sensory evoked potentials (SEP) in supraaortal reconstructions has been well accepted. However, reports about incidence and clinical significance of ischaemic SEP alterations differ widely. In a prospective study we registered SEP alterations during 482 operations done on 419 patients between 1 July 1994, and 31 December 1996. Incidence, risk factors and clinical relevance were investigated. In only 1.7% of cases SEP examination was inadequate. During 406 operations SEP were altered minimally or not at all. Significant changes were dedected during 65 interventions (13.5%). The clinical outcome was poor when alteration was found during carotid dissection (five events, three deficits). Cross-clamping ischaemia was the common reason for alterations (81.5%); they were generally reversible after shunting and without clinical significance. As risk factor for cross-clamping ischaemia, only contralateral carotid occlusion was identified.


Alterations of somato-sensory evoked potentials during 482 carotid endarterectomy procedures: incidence, risk factors and clinical relevance: Häufigkeit, Risikofaktoren und klinische Relevanz

February 1998

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2 Reads

Gefässchirurgie

The use of somato-sensory evoked potentials (SEP) in supraaortal reconstructions has been well accepted. However, reports about incidence and clinical significance of ischaemic SEP alterations differ widely. In a prospective study we registered SEP alterations during 482 operations done on 419 patients between 1 July 1994, and 31 December 1996. Incidence, risk factors and clinical relevance were investigated. In only 1.7% of cases SEP examination was inadequate. During 406 operations SEP were altered minimally or not at all. Significant changes were dedected during 65 interventions (13.5%). The clinical outcome was poor when alteration was found during carotid dissection (five events, three deficits). Cross-clamping ischaemia was the common reason for alterations (81.5%); they were generally reversible after shunting and without clinical significance. As risk factor for cross- clamping ischaemia, only contralateral carotid occlusion was identified. Only 9 of 22 new neurological deficits - 8 (1.7%) permanent and 14 (2.9%) transient - were associated with intraoperative SEP alterations. In three cases with immediate deficit the reason for inadequate intraoperative SEP findings remains unknown. SEP are useful to demonstrate clamping ischaemia with high sensitivity and specificity and are helpful to minimize shunting frequency to prevent complications.


[Carotid surgery--reliable and speculative aspects]

February 1998

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4 Reads

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1 Citation

Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress

The current status of endarterectomy in carotid artery stenosis is evaluated in prospective randomized studies. The results are very good and high quality. Endovascular therapy is in feasibility studies, and the complication rate is too high compared with the gold standard endarterectomy.


Carotischirurgie — Gesichertes und Spekulatives

January 1998

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4 Reads

The current status of endarterectomy in carotid artery stenosis is evaluated in prospective randomized studies. The results are very good and high quality. Endovascular therapy is in feasibility studies, and the complication rate is too high compared with the gold standard endarterectomy.



[Ultrasound angiography in diagnosis of deep venous thrombosis and post-thrombotic syndrome. A prospective comparative study].

May 1997

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6 Reads

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6 Citations

Ultraschall in der Medizin

Aim of the present study was to establish the value of ultrasound angiography compared with colour duplex sonography and phlebography in the diagnosis of deep venous thrombosis of the leg and insufficiency of the perforating vein. Sixty-two patients with deep venous thrombosis of the leg and 30 patients with post-thrombotic syndrome and perforating vein insufficiency underwent diagnostic examination by colour duplex sonography, ultrasound angiography and phlebography. Endoscopic varicose surgery was taken as the gold standard for diagnosis of perforating vein insufficiency. In the diagnosis of deep venous thrombosis, the specificity of colour duplex sonography was 92% in the thigh, 100% in the popliteal area and 89% in the lower leg. Colour angiography showed higher specificity. 95%, in the lower leg. In a diagnosis of perforating vein insufficiency, accuracy specificity of the three procedures was 60% for colour duplex sonography, 47% for phlebography and 80% for ultrasound angiography. The diagnosis of venous thromboses in the lower leg can be further improved by means of ultrasound angiography. Ultrasound angiography is the best method for demonstrating insufficiency of the perforating vein.


Ultraschallangiographie zur Diagnostik der tiefen Beinvenenthrombose und des postthrombotischen Syndroms

April 1997

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8 Reads

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4 Citations

Ultraschall in der Medizin

Purpose: Aim of the present study was to establish the value of ultrasound angiography compared with colour duplex sonography and phlebography in the diagnosis of deep venous thrombosis of the leg and insufficiency of the perforating vein. Method: Sixty-two patients with deep venous thrombosis of the leg and 30 patients with post-thrombotic syndrome and perforating vein insufficiency underwent diagnostic examination by colour duplex sonography, ultrasound angiography and phlebography. Endoscopic varicose surgery was taken as the gold standard for diagnosis of perforating vein insufficiency. Results: In the diagnosis of deep venous thrombosis, the specificity of colour duplex sonography was 92% in the thigh, 100% in the popliteal area and 89% in the lower leg. Colour angiography showed higher specificity. 95%, in the lower leg. In a diagnosis of perforating vein insufficiency, accuracy specificity of the three procedures was 60% for colour duplex sonography, 47% for phlebography and 80% for ultrasound angiography. Conclusions: The diagnosis of venous thromboses in the lower leg can be further improved by means of ultrasound angiography. Ultrasound angiography is the best method for demonstrating insufficiency of the perforating vein.


Citations (1)


... Furthermore, the comparison of different thrombolytic regimens with high versus low doses of intra-arterial thrombolytic agents have also been studied in RCTs during the 1990s. 8e10, 16 However, the quality is also limited by low sample sizes. A multicenter observational study design has the advantages of including various patients with ALI without the strict boundaries and smaller focus of an RCT, which would otherwise be limited by the heterogeneity of ALI patients. ...

Reference:

Study Protocol of a Prospective Multicenter Observational Study Evaluating Acute Lower Limb Ischemia
Comparison of tissue plasminogen activator and urokinase in the local infiltration thrombolysis of peripheral arterial occlusions
  • Citing Article
  • June 1996

European Journal of Radiology

Johannes Schweizer

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Ernst Altmann

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F Stösslein

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[...]

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Romy Kaulen