bluuebunny/crossref_metadata_2025 huggingface dataset:
Plazierung eines Pulmonaliskatheters über eine bis dahin unbekannte persistierende Vena cava superior sinistra
Authors: Stoiser  , Vorbeck  , Kofler  , Locker  , Burgmann
Published: January 2006

This case report describes a patient with persistent left superior vena cava (LSVC) as discovered by difficult placement of a pulmonary artery catheter via the left subclavian vein. After positioning in wedge position, chest x-ray showed a catheter route suggestive of persistent LSVC. Since this abnormality may yield potential clinical complications, this possibility should be considered in every difficult central venous access.
Andreas Grüntzigs Ballon-Katheter zur Angioplastie von peripheren Arterien (PTA) ist 25 Jahre alt
Authors: Bollinger  , Schlumpf
Published: January 2006

History of Andreas Grüntzig’s time spent in Angiology and Radiology of the Zürich University Hospital (1969–1975). First, the pioneer of catheter therapy discovered that the Achilles tendon reflex is significantly prolongued during claudication pain. Furthermore, he participated actively in the clinical evaluation of Doppler ultrasound. After a stay in the Aggertalklinik (Engelskirchen near Köln, Germany), where he learnt Charles Dotter’s original procedure with Eberhard Zeitler, he introduced catheter therapy of peripheral arteries in Zürich. In the same period he developed a new, rigid, sausage-shaped balloon catheter (polyvinylchloride), manufactered the device on his kitchen table together with his wife Michaela, Maria and Walter Schlumpf, and used it first on February 12, 1974 in a patient with intermittent claudication due to subtotal stenosis of the superficial femoral artery. The first successful dilatation of an iliac artery stenosis by his double-lumen catheter, which was modified later on into the famous coronary catheter, followed on January 23, 1975. Soon, the innovative catheter became commercially available (Cook and Schneider Companies). Andreas Grüntzig not only excelled in pioneering novel techniques, but also in patient care, in a prospective follow-up study of his own 242 patients lasting 15 years (results summarized in this article), in the teaching of Swiss scholars like Felix Mahler, Ernst Schneider and Bernhard Meier and many more in the world, and in organizing life demonstrations for large numbers of participants. His career in Cardiology, his work in Atlanta Georgia, USA, and his early tragic death in an airplane accident are briefly mentioned.
PTA der Arteria subclavia und des Truncus brachiocephalicus: Langzeitergebnisse
Authors: Körner  , Baumgartner  , Do  , Mahler  , Schroth
Published: January 2006

Background: To investigate the long-term clinical and duplex sonographic results of percutaneous transluminal angioplasty (PTA) of the subclavian and innominate arteries, and the potential of a new double balloon technique to avoid cerebrovascular thromboembolism. Patients and methods: Forty-three PTAs were performed on 38 subclavian, four innominate arteries and one subclavian-subclavian bypass in 37 patients. In three instances a protective double balloon technique was used. Indication for the intervention was: subclavian steal syndrome (n = 14 [38%]), upper extremity arterial insufficiency (n = 26 [70%]), peripheral thromboembolism (n=8 [22%]) and PRIND / stroke (n = 3 [8%]). Analysis of long-term follow-up (median 15, range 2 to 100 months) was possible of 28 patients including duplex sonographic assessment in 23 patients. The cumulative patency rate was calculated by means of life-table analysis. Results: Technical success was achieved in 36 endovascular procedures (84%). Minor peripheral catheter complications occurred in three interventions (7%), cerebrovascular thromboembolism in four (9%). No cerebrovascular complications were seen using the double balloon technique. On final check-up 4 patients (14%) suffered from subclavian steal syndrome, 3 (11%) from mild upper extremity arterial insufficiency and one (4%) from rest pain. Duplex sonography showed no stenosis in 12 of 23 patients (52%) and a stenosis of less than 50% in 8 (35%). The life-table analysis showed a secondary cumulative patency rate of 72% after 100 months with all restenoses occurring within 24 months. Conclusions: PTA of the subclavian and innominate arteries appears to be a useful alternative to surgery with a low complication rate. The long-term patency rate of 72% is comparable to results of other series. In high risk situations cerebrovascular complications may be reduced using the new double balloon technique.
Dosisabhängiger Anstieg der transkapillären Diffusion von Natriumfluoreszein nach Histamin-Mikroinjektionen
Authors: Läuchli  , Franzeck  , Leu  , Hoffmann
Published: January 2006

Background: To study the dose-dependent effects of histamine on capillary permeability in human skin, using the microinjection technique. Patients and methods: Eight healthy volunteers (2 w, 6 m; mean age 33 years) were included in the study. On two separate occasions, glass microcannulas with a tip diameter of 7 to 9 mum were inserted into the subepidermal layer of the skin at the distal medial tibia surface of each lower limb with a micromanipulator. In each subject, 0.5 mul of 3 different concentrations of histamine solution (0.1™, 0.01™ and 0.001™) were injected and compared to the solvent (0.9% NaCl). Transcapillary diffusion of intraveneously administered Na-fluorescein was assessed simultaneously using two fluorescence videomicroscopy systems. Off-line video densitometry was performed in an area of 0.56 mm2 around the injection sites and fluorescence light intensities were measured in arbitrary units (AU) at 10, 30, 60, 120 and 600 s after dye appearance. Results: Compared to the solvent histamine microinjections resulted in a dose-dependent increase of mean fluorescence light intensities (FLI). Whereas mean FLI for the 0.001™ histamine injection was only significantly elevated 10 min after dye appearence (p < 0.05) an increase of mean FLI was already observed 10 s after dye appearence following the 0.1™ histamine injection (p < 0.05), which was more pronounced at later time points (p < 0.001). Mean FLI’s for the 0.01™ histamine solution were in between and resulted in significantly elevated values 1 min to 10 min after dye appearence (p < 0.05). Conclusions: We conclude that the microinjection technique together with fluorescence videomicroscopy described previously [6] is able to document a dose-dependent effect of histamine microinjections on skin capillary permeability. The technique may facilitate to determine appropriate dosages not only of histamine in order to test the effect of antagonists on human skin capillary permeability.
Frühe und späte funktionelle und histopathologische Störungen nach Kälteschaden im Tierexperiment
Authors: Arvesen  , Mæhlen  , Rosén  , Aas
Published: January 2006

Background: These experiments aimed to study the in vivo short and long term neurovascular regeneration after frostbite. Methods: The rabbit central ear-artery was used as the experimental model. The effects on the noradrenergic innervation of the artery were measured in isolated vascular ring segments the first day and 2, 3–4, and 8–10 or 10–20 weeks following freezing at –9°C or –18°C for 15 min with slow rewarming for 7 min at room temperature. Results: Two days after freezing the sympathetic nerves were completely degenerated, as observed with glyoxylic acid-induced fluorescence. The vascular isometric tension responses to exogenous noradrenaline and endogenously released noradrenaline by electrical stimulation in vitro were abolished. A varying degree of necrosis of the vascular wall was observed. Two weeks after freezing at –18°C in vitro responses to exogenous noradrenaline and electrical stimulation were still abolished, then gradually approaching control levels after 10–20 weeks of in vivo regeneration. Eight and 10 weeks after injury at –9°C increased vascular tension responses to exogenous noradrenaline was found. In spite of a long regeneration period the total uptake and the spontaneous and K+ (75 mM) evoked releases of [3H]noradrenaline were persistently decreased after frostbite at –18°C, but they were regenerated to control levels already 10–20 weeks after –9°C. Regeneration of noradrenergic nerve function, expressed as [3H]noradrenaline uptake and release and responsiveness to electrical stimulation, expressed as vascular contraction, was slower than the regeneration of the vascular smooth muscle. Myointimal hyperplasia developed in response to –9°C and –18°C frostbite. The uptake and the K+ evoked release of [3H]noradrenaline were particularly sensitive parameters for autonomic nerve function. Conclusions: The present findings may demonstrate important neurovascular reactions to local frostbite and may explain human sequelae following frostbite
Nachweis differentieller Genexpression glatter vaskulärer Muskelzellen mittels RNA arbiträr geprimter Polymerasekettenreaktion
Authors: Alfke  , Stumm  , Schnieder  , Klose  , Schlegel
Published: January 2006

Background: Vascular smooth muscle cells (VSMC) play an important role in the development of restenotic lesions. However, regulation of proliferation, migration, and matrix synthesis of these cells is still poorly understood. The aim of this study was to analyze gene expression of differently stimulated bovine VSMC. Material and methods: RNA was isolated from stimulated bovine VSMC after different time periods. For stimulation we used growth factors (platelet-derived growth factors PDGF-AA, PDGF-BB, basic fibroblast growth factor) and a nitric oxide donating drug (sodium nitroprusside). Gene expression of stimulated and control cells was analyzed by non-radioactive RNA fingerprinting (RNA arbitrarily primed polymerase chain reaction, RAP-PCR) and standard gel electrophoresis. Polymorphic fragments were sequenced and further characterized. Results: By RAP-PCR we detected changes in the RNA fingerprint pattern of stimulated cells compared with unstimulated cells. Sequences of five fragments out of 12 showed high homology to known human genes (serine-methyl-transferase, DUTT1, laminin B2, a newly cloned translational regulator (p97), and a human expressed sequence tag). For laminin B2 we could confirm an upregulation after stimulation with growth factors at 1 and 6 hours and after stimulation with SNP at 1 hour in comparison to controls. For p97 we could show a downregulation after stimulation with SNP, bFGF and PDGF-BB but not PDGF-AA. Conclusion: RAP-PCR is well suited for analysis of VSMC gene expression in vitro. The laminin B2 and p97 gene are differently expressed after growth factor stimulation in bovine VSMC.
Serum Nitrat-Konzentrationen bei Patienten mit peripherer arterieller Verschlußkrankheit
Authors: Stoiser  , Maca  , Thalhammer  , Hollenstein  , El Menyawi  , Burgmann
Published: January 2006

Background: Nitric oxide (NO), an endogenous product of L-arginine oxidation, seems to account for the vasodilatatory effect of the endothelium-derived relaxing factor. It was the aim of the present study to measure serum nitrate concentrations, the degradation product of nitric oxide in patients with peripheral arterial occlusive disease (PAOD). Patients and methods: 20 patients with PAOD in Fontaine stage IIb, 10 patients in stage III and IV respectively were included in the study. Serum samples for determination of nitrate were taken at admission after fasting overnight. Nitrate concentrations were determined using a recently developed high performance liquid chromatography which allows direct measurement of nitrate. The control group comprised 14 age and risk factor matched volunteers. Results: We found significantly increased nitrate concentrations in patients with PAOD compared to the control group [stage IIb: 6.65 ± 1.58 mumol/l; stage III: 6.94 ± 1.85 mumol/l, stage IV: 7.05 ± 1.16 mumol/l; control: 4.41 ± 1.24 mumol/l], however no significance was calculated within the different PAOD groups. There was no association of either diabetes mellitus, hypertension and smoking behaviour with increased nitrate levels. Conclusion: These data might indicate that NO might be involved in adaptive vasodilatation already in the early phase of the disease. The source of nitrate in PAOD patients, however, remains unclear.
Vena caval filters in the prevention of pulmonary embolism
Authors: Winkler  , Slany
Published: January 2006

Alle derzeit verfügbaren Cavafilter können ohne größere Belastung für den Patienten perkutan in Lokalanästhesie implantiert werden. In den USA wurden von der FDA der Stahl Greenfield-Filter, der Titanium Greenfield-Filter, der Bird’s Nest-Filter, der LGM-Filter und der Simon Nitinol-Filter zugelassen. In Europa sind noch weitere Filter erhältlich, über die noch wenig Studien vorliegen. Am häufigsten verwendet wird der Greenfield-Filter, von dem die meisten Daten vorliegen. Kandidaten für einen Cavafilter sind Patienten mit tiefer Beinvenenthrombose und drohender Pulmonalembolie, bei denen eine Antikoagulation kontraindiziert ist, die eine schwere Komplikation unter Lyse oder Antikoagulation erlitten haben, die einer pulmonalen Embolektomie unterzogen werden und bei denen trotz adäquater Antikoagulation eine Rezidiv-Pulmonalembolie stattfand. Als Routine-Nachkontrolle sollte die farbkodierte Duplex-Sonographie der V. cava inferior und das Abdomen nativ Röntgen durchgeführt werden. Zur ergänzenden Abklärung eignen sich Computertomographie, Cavographie, Magnetresonanz bei neueren Filtermodellen und intravasaler Ultraschall. Mögliche Komplikationen sind: Rezidiv-Pulmonalembolie, Thrombose der V. cava, Migration, Filterbruch, Perforation von Filterstreben. Da klinisch relevante Komplikationen selten sind, ist bei genauer Indikationsstellung für die Implantation eines Cavafilters die Nutzen-Risiko-Relation als günstig zu bewerten.
Therapeutische Alternativen in der Behandlung schwerer Beinischämien: Erfahrungen bei 190 Patienten an einer Klinischen Abteilung für Angiologie
Authors: Gschwandtner  , Minar  , Ahmadi  , Haumer  , Hülsmann  , Maca  , Schnürer  , Willfort  , Polterauer  , Meissl  , Ehringer
Published: January 2006

Background: Different therapies in consecutive patients (1987–1992) with chronic critical limb ischemia at a department of medical angiology, their short- and long-term outcome were investigated. Patients and methods: 190 patients (112 males, 78 females; age: 67 ± 12 years); 78 in grade II, 112 in grade III according to Rutherford’s classification. Therapeutic regimen: 1. vascular recanalisation by percutaneous transluminal angioplasty [PTA], local or systemic lysis; 2. surgical vascular reconstruction in case of impossibility or failure of catheter procedures; 3. prostanoids and/or antibiotics; 4. local wound treatment including amputations. Results: Vascular recanalisation was attempted in 156/190 (82.1%): PTA in 116/190, surgical vascular reconstruction in 50/190, local in 24/190 and systemic lysis in 8/190 patients. Prostanoids were applied in 89/190 and antibiotics in 73/190 patients. At the time of dismissal 164/190 (86.3%) patients were clinically improved; 11/190 (5.8%) unchanged, 13/190 (6.8%) had undergone major amputations and 2/190 (1.1%) had died. After 2,6 ± 2,2 years 77 of the 141 patients, who were still alive, were reexamined. Among these 77 patients 84.4% were in grade 0 or I, 15.6% in chronic critical limb ischemia. Furthermore 13.0% had been amputated since dismissal. Forty-nine of 190 (25.8%) patients had died 3,2 ± 1,9 years after dismissal from hospital. Conclusion: Catheter techniques, mostly PTA, is possible in the majority of patients with chronic critical limb ischemia. Cooperation with vascular surgeons in case of technical impossibility or failure of catheter recanalisation is mandatory. Such a regimen yields satisfactory short- and long-term results and a low rate of complications.
Die Aplasie der Vena cava inferior als Ursache rezidivierender Bein- und Beckenvenenthrombosen
Authors: Tiesenhausen  , Amann  , Thalhammer  , Aschauer
Published: January 2006

Congenital anomalies of the caval vein are often associated with other abnormities such as heart defects, situs inversus or a polysplenia-asplenia-syndrome. An isolated, congenital malformation like aplasia of the inferior vena cava is a rare finding. A review of the embryology and abnormities, diagnostics, clinical signs and treatment is given together with the histories of two patients having thrombosis of the lower extremities and pelvic veins, caused by aplasia of the inferior vena cava. After thrombotic complications caused by vena cava aplasia there is high risk of recurrence. Those patients should be anticoagulated for lifetime.
Langanhaltende durch Tiklopidin ausgelöste Leukopenie eines an chronischer Hepatitis C und Immunozytom leidenden Patienten
Authors: Redlich  , Parschalk  , Ehringer  , Minar
Published: January 2006

Ticlopidine is increasingly used in the secondary prophylaxis in patients with arterial occlusive diseases. Neutropenia is a well known side effect of this drug. We report a case of a 73 year old woman who was admitted because of severe prolonged ticlopidine induced leucopenia. The past medical history included an immunocytoma of the IgM-kappa type diagnosed seven years ago with less than 10% infiltration of the bone marrow and a chronic hepatitis C. On admission the white cell count was 1000/muL. Ticlopidine was stopped. The white cell count did not increase within one week, thus filgastrim was applied on two consecutive days. The leucocyte count promptly increased to 6000/muL but consecutively dropped within the next fortnight again to levels below 500/muL forcing daily filgastrim application for another 9 days. Four months after the initation of the therapy with filgastrim the patient had a white cell count of 4300/muL. We therefore conclude that in patients with a history of potentially bone marrow suppressing diseases the use of ticlopidine has to be carefully weighed against possible myelosuppressive effects.
Gefäßchirurgie an der Jahrtausendwende
Authors: Polterauer  , Nanobachvili  , Fuegl  , Huk
Published: January 2006

Modern diagnostic modalities as well as ongoing improvement of vascular prosthetic material and surgical techniques have stimulated progress in vascular surgery. New discoveries concerning the mechanism of endothelial function, atherosclerosis, developments in gene therapy and endovascular techniques will expand the future therapeutic spectrum of vascular surgery. Endoluminal implantation of stent grafts for the treatment of aortic aneurysm may be a reasonable alternative to conventional surgery, especially in high-risk patients. Long-term results of this procedure, however, are not yet available. Stenting of internal carotid artery stenosis may be considered as an experimental method of treatment. Its feasibility, efficacy, safety and long-term results must be analyzed before the application of the method may be restricted or recommended. Endoluminal irradiation (brachytherapy) reduces intimal hyperplasia/restenosis and can improve the long-term results of percutaneous transluminal angioplasty. Anti-atherosclerotic and anti-aggregatory therapy (with statins, estrogens, antibiotics, nitric oxide precursor/donors, glycoprotein IIb/IIIa receptor inhibitors) will play an important role in the prevention of ischemic diseases and improve the results of surgical/interventional treatment by reducing intimal hyperplasia and restenosis. Gene therapy opens new vistas in vascular medicine. Angiogenetic factors can be used for the treatment of patients with distal occlusion of the peripheral arteries. Gene transfer may be useful in the conservative treatment of progressive aortic aneurysms. A more unified vision toward vascular medicine might be the key for research and development in the future.
Angiologic surveillance of infrainguinal arterial reconstructions
Authors: Müller-Kolck Ulrich
Published: January 2006

Die Übersichtsarbeit beschreibt den natürlichen Verlauf infrainguinaler Bypässe, die duplexsonographische Flußcharakteristiken von Bypass-Stenosen sowie den klinischen Stellenwert duplexsonographischer Kontrollen für die protokollgemäße oder individuell angepaßte Nachsorge nach Anlage eines infrainguinalen Bypasses. Die Revaskularisationstechnik, das Graftmaterial, die Art der distalen Anastomosierung, die distalen Abstromsverhältnisse, das Zeitintervall zwischen Stenosedetektion und Re-Operation sowie internistische Begleiterkrankungen beeinflussen die Bypassoffenheitsraten und die Beinerhaltungsraten. Duplexsonographische Kriterien einer Venenbypassdysfunktion können eine distale Flußgeschwindigkeit von < 45 cm/s, ein verbliebener Bypassfluß von 25 ml/ min sowie eine Reduktion des inneren Venendiameters unter 3 mm sein. Für die Stenosegraduierung eignen sich die intrastenotische mittlere systolische Spitzengeschwindigkeit und die Geschwindigkeitsratio (PVR = peak velocity ratio). Als vorläufige Entscheidungshilfe kennzeichnen eine mittlere Spitzengeschwindigkeit von 250 cm/s und eine PVR > 3.3 eine mindestens 70%ige Venenbypass-Stenose, eine mittlere Spitzengeschwindigkeit von 360 cm/s und eine PVR > 7.2 eine hochgradige Stenose.
Low-molecular-weight heparin therapy for venous thromboembolism
Authors: Haas Sylvia , Haas  , Creutzig
Published: January 2006

Niedermolekulare Heparine, deren Einsatz zur Thromboseprophylaxe heute praktisch zum Standard geworden ist, können seit kurzem auch für die Behandlung von tiefen Venenthrombosen verwendet werden. In dieser Übersichtsarbeit wird dargelegt, welche Gründe es dafür gibt und insbesondere welche Vorteile sich daraus im klinischen Alltag ergeben. Nach einer Beschreibung der verschiedenen prinzipiellen Ansätze zum therapeutischen Einsatz niedermolekularer Heparine werden die wesentlichen Ergebnisse bisher durchgeführter Studien angeführt. Sie zeigen, daß das bisher übliche Schema der initialen Behandlung mit intravenös gegebenem unfraktioniertem Heparin durch subkutane Gaben niedermolekularer Heparine ersetzt werden kann, wobei eine mindestens gleich gute Wirksamkeit bei besserer Verträglichkeit zu erwarten ist. Außerdem ermöglicht die Einfachheit dieses therapeutischen Regimes die ambulante Durchführung, die sowohl aus Sicht des Patienten als auch aus Kostengründen beträchtliche Vorteile bietet.
Keimbesiedlung von chronischen Ulcera cruris: Unterscheidet sich das diabetische vom venösen und arteriellen Geschwür?
Authors: Schmidt  , Debus  , Jeßberger  , Ziegler  , Thiede
Published: January 2006

Background: At the Surgical Department of Surgery of the University Hospital Würzburg microbiological examinations were performed of the ulcer grounds from patients with diabetic-neuropathic, diabetic-ischemic, venous, and arterial leg ulcers. The aim of the examination was to evaluate possible differences in the healing process of these ulcers based on the knowledge of their bacterial populations. Patients and methods: In a period of four months, 63 patients were consecutively examined by taking a bacteriological swab of their ulcer area. The healing process of their wounds was followed and related to the impact of bacterial colonisation and clinical signs of infection. Results: 95% of the venous and arterial leg ulcers had a positive smear, whereas only 70% of diabetic ulcers were positive for bacterial growth. Bacterial population of the three ulcer entities, however did not differ significantly. 100% of the clinically infected venous and arterial ulcers but only 80% of the diabetic wounds revealed a positive smear. On the other hand, only 22% of the venous ulcers with a positive smear developed a clinical infection in contrast to 70% of the arterial and diabetic. Venous ulcers showed only in a few patients prolonged healing, even in cases of marked bacterial contamination. Despite of clinical signs of infection however, diabetic wounds sometimes did not reveal a positive wound smear (20%). All infected venous, but only 20% of the infected ischemic ulcers healed satisfactorily. Arterial wounds with no bacterial growth healed significantly better than contaminated wounds. This difference was not significant in the other entities. Radical removal of the infection by minor amputation increased the healing rate in diabetic ulcers over 80%, whereas ischemic wounds did not profit from this therapy. Conclusions: A positive bacterial wound smear is not inevitably correlated with a protracted leg ulcer healing. Nevertheless a fulminant infection often developed in diabetic ulcers despite the initial inability to demonstrate bacterial growth. In order to start antibiotic treatment as early as possible, a wound smear should be obtained routinely from patients with diabetic ulcers. In chronic venous ulcers, a routine swab does not appear to be indicated as it bears no clinical consequences. The same applies to patients with surgically fully treated peripheral arterial occlusive disease. As ischemia presents the limiting factor, antibiotic therapy in case of infection will not prevent imminent amputation.
Doppelter Aortenbogen: Die Diagnose wurde 29 Jahre verpaßt
Authors: Brockes Christiane , Vogt  , Roth  , Turina
Published: January 2006

Double aortic arch is a rare vascular anomaly which causes tracheal and esophageal compression usually in the first months of life. Typical symptoms in the early childhood should lead to prompt diagnosis and surgical treatment of this malformation. In adults this anomaly is extremely rare. A case of a severely 29-year-old symptomatic woman is presented. Despite characteristic symptoms, the diagnosis was missed during childhood. The importance of different diagnostic procedures and operative therapy is discussed. Preoperative angiography can be replaced by the less invasive magnetic imaging and computed tomography. Surgical operation should also be performed in oligosymptomatic patients to prevent late complications.
Vasospasmus: Eine seltene Komplikation bei Homozystinurie
Authors: Katzenschlager Reinhold , Burgmann  , Ehringer  , Minar
Published: January 2006

We report about a patient suffering from multiple spastic stenoses of varying degree of both iliac arteries and from occlusion of the left tibiofibular trunc. Laboratory investigations revealed increased levels of homocysteine and the diagnosis of homocystinuria was confirmed by fibroblast cell culture. The spasms responded well to vasodilative therapy with nitroglycerine, molsidomine (cGMP mediated) and prostaglandine E1 but not with nifedipine (Ca influx blocker). Our review of literature demonstrated that this arterial spastic abnormality is a very rare complication in patients suffering from homocystinuria.
Aneurysmen der distalen Arteria carotis externa
Authors: Papavassiliou Vassilios G. , Liapis  , Kakissis  , Safioleas  , Kaperonis  , Gogas
Published: January 2006

Aneurysms of the distal branches of the external carotid artery are rare and usually traumatic in origin. We present two cases which were treated in our clinic. The first case is about a traumatic aneurysm of the left superficial temporal artery (STA) in a young boy 8 years old. The young patient developed a pulsatile mass above his left eyebrow ten days after a bite by a boy of the same age. The second case is referred in a 36-year old woman with a pulsatile mass behind the right ear, which was an aneurysm of the posterior auricular artery. The treatment was ligation and resection under local anesthesia in the first case and under general anesthesia in the latter. Surgeons’ familiarity with this entity is important for diagnosis and treatment.
Isoprostane normalisieren sich rasch nach Beendigung des Zigarettenrauchens bei gesunden Erwachsenen
Authors: Oguogho  , Lupattelli  , Palumbo  , Sinzinger Helmut
Published: January 2006

Background: Isoprostanes and in particular 8-epi-PGF2alpha have been claimed as a useful measure for in-vivo oxidation injury. While smokers show elevated 8-epi-PGF2alpha, the behaviour during quitting smoking is unknown. Methods and results: We determined 8-epi-PGF2alpha in 7 healthy adults ready to quit smoking in plasma, serum and urine by means of an enzyme immunoassay after extraction and purification before quitting smoking and during a follow-up period of 4 weeks. After quitting smoking, 8-epi-PGF2alpha shows a rapid decline within a few days almost completely normalizing within 4 weeks. Conclusion: The cigarette-smoking associated in-vivo oxidation injury almost completely disappears within 4 weeks of quitting smoking.
Veränderungen der Kapillarpermeabilität bei Patienten mit chronischer kritischer Extremitätenischämie und Ödem
Authors: Anvar  , Khiabani  , Kroese  , Stranden
Published: January 2006

Background: Oedema formation in lower limbs of patients with chronic critical limb ischaemia (CLI) is a common clinical feature. The rate of fluid filtration through the capillary wall depends on the capillary permeability, i.e. capillary filtration coefficient (CFC). In order to elucidate the pathogenesis of this ischaemic oedema, CFC was measured in the limbs with CLI and oedema and was compared with CFC measurements both in the contralateral sides and in the lower limbs of a control group. Patients and methods: Eleven women and 4 men, with a mean age of 75 ± 8.8 years, with unilateral CLI and leg and foot oedema were included. Leg and foot volume was measured with water displacement volumetry (WDV). CFC was measured in both limbs by strain-gauge plethysmography using a double-stranded mercury in silicone strain gauge around the middle portion of the foot. As a control group, 8 patients, 5 women and 3 men, with a mean age of 77 ± 7.6 years with a proximal femur fracture were included and the CFC in this group was measured in the foot of the non-fractured limb. Results: Mean CFC in the limbs with CLI and oedema was 0.0036 ± 0.001 ml/min · 100 ml · mmHg, significantly greater than both the contralateral limbs (0.0019 ± 0.0003 ml/min · 100 ml · mmHg, p < 0.01) and mean CFC in the control limbs (0.0017 ± 0.0002 ml/min · 100 ml · mmHg, p < 0.003). There was a mean volume difference of 13 ± 9 % between limbs with CLI and contralateral sides measured by WDV. There was no significant correlation between total leg-foot volume and CFC (p > 0.05). Conclusion: CFC in the ischaemic limb was twice as great as both the contralateral side and the limbs of the control group. It is therefore concluded that an increased CFC is probably one of the important factors in the development of this ischaemic oedema.
Angioplasty and stent implantation in intestinal ischemia
Authors: Segerer  , Mühlhöfer  , Gross Manfred , Kellner  , Spengel  , Pfeifer
Published: January 2006

Intestinale Durchblutungsstörungen stellen weiterhin eine Herausforderung dar, die eine besonders enge interdisziplinäre Zusammenarbeit zwischen Internisten, Chirurgen und Radiologen erfordert. Die klassischerweise invasive Diagnostik und chirurgische Therapie erfuhr in den letzten Jahren eine Ergänzung durch die Duplexsonographie und die perkutanen Verfahren der Angioplastie (PTA) und Stentimplantation. Ein 56jähriger griechischer Patient stellte sich zur Abklärung von postprandialen epigastrischen Schmerzen vor. Als Ursache konnte duplexsonographisch und angiographisch eine hochgradige Stenose der A. mesenterica superior bei fehlendem Fluß im Truncus coeliacus und der A. mesenterica inferior dokumentiert werden. Bei einseitigem Verschluß der A. carotis interna bestand ein hohes operatives Risiko, weshalb die Indikation für ein Katheterverfahren gestellt wurde. Es wurde eine PTA und Stentimplantation mit gutem Ergebnis durchgeführt. Bereits am ersten Tag nach der Intervention war eine schmerzfreie Nahrungsaufnahme möglich. 18 Monate nach dem Eingriff war der Patient von abdomineller Seite beschwerdefrei. Die perkutane Therapie von intestinalen Durchblutungsstörungen wurde bisher lediglich in Fallbeschreibungen und kleinen, meist retrospektiven Serien publiziert. Die Indikation beschränkt sich deshalb bisher im wesentlichen auf Patienten mit einem hohen Operationsrisiko.
Der infizierte Stentgraft – eine lebensbedrohliche Komplikation
Authors: Tiesenhausen Kurt , Amann  , Koch  , Hausegger  , Thalhammer
Published: January 2006

The implantation of covered stents or stentgrafts has increased greatly in the last few years for the endovascular reconstruction of arterial aneurysms. We report of three patients experiencing severe septic complications after stentgraft implantation. Endovascular stentgraft infection is a serious complication with high morbidity and mortality. General antibiotic prophylaxis seems to be indicated when implanting stentgrafts.
Ein Tennisspieler mit Claudicatio der Hand
Authors: Noël Bernard , Hayoz
Published: January 2006

The case of a professional tennis player presenting exercise-induced hand pain with late appearance of digital blanching is reported. A bilateral hypothenar hammer syndrome and stenosis of the common palmar digital arteries close to the head of the metacarpals where the racket handle exerts its maximal force was observed with arteriography. As the patient decided to stop tennis practice, the condition improved without any medication. Six months after stopping tennis he was symptom free. Three conclusions can be drawn from this case report: 1) arteries of both hands can be injured by intense tennis practice, 2) pain in the dominant hand during tennis practice can be due to arterial insufficiency even in the absence of digital blanching which is a sign of severity, 3) hypothenar hammer syndrome is the 05n cause but stenosis of the common palmar digital arteries can possibly contribute to the ischemic phenomenon. Early recognition is important to avoid ineffective treatment and permanent symptoms. Therefore, we recommend an arterial examination in tennis players suffering from exercise-induced hand pain even in the absence of digital blanching which can be only a late manifestation.
Die Auswirkung begleitender antithrombotischer Therapie auf die Durchgängigkeit peripherer Bypasses
Authors: Bucek Robert , Schnürer  , Ahmadi  , Polterauer  , Kretschmer  , Minar
Published: January 2006

Peripheral bypass surgery is a well-established treatment for symptomatic atherosclerotic disease of the legs. To improve the long-term patency antithrombotic drugs and other adjuvant treatment are applied. In this review we summarize the results of randomized studies concerning antithrombotic treatment for prophylaxis after peripheral bypass surgery. Heparin is used routinely intra- and perioperatively without strong data, and according to few data low molecular weight heparin may be superior in this situation. Aspirin had positive effects in placebo-controlled studies after infrainguinal PTFE-bypasses, furthermore it is recommended due to its general cardiovascular risk reduction. Ticlopidine improved long-term patency in one randomized study after venous bypass surgery. Otherwise there are some data that long-term oral anticoagulation may be preferable in patients after venous bypass surgery.
Druckgradient in den Beinvenen während der Betätigung der Wadenpumpe
Authors: Recek Cestmir , Pojer
Published: January 2006

Background: Neovascularization is an important cause of venous reflux recurrence after high ligation of the long saphenous vein. The pathogenesis of this phenomenon is so far obscure. It is possible that a hemodynamic factor – a pressure gradient between the femoral vein and the residual long saphenous vein – could be the trigger initiating the process of neovascularization. Patients and methods: Venous pressure measurements on eight patients with primary varicose veins were performed in the erect position in the insufficient long saphenous vein on the thigh. Mean pressures in the quiet standing position and ambulatory pressures were considered. By interrupting the saphenous reflux either distally or proximally to the point of measurement the pressure conditions either in the femoral or in the crural veins were simulated. Results: With the tourniquet placed distally to the point of measurement, the venous pressure in the upper interrupted segment of the long saphenous vein (equivalent to the pressure in the femoral vein) remained uninfluenced during ambulation. In contrast, by interrupting the reflux proximally to the point of measurement, a marked decrease of the ambulatory pressure in the lower part of the long saphenous vein (equivalent to the pressure in the crural veins) was noted. Conclusions: A pressure difference occurs between the veins of the thigh and the lower leg during the activation of the muscle venous pump. This fact may explain the tendency of recurrencies of varicose veins after high ligation of the long saphenous vein as well as the initiation of reflux.
Stellenwert von mikrozirkulatorischen Untersuchungsmethoden bei Patienten mit diabetischem Fuß-Syndrom
Authors: Lawall  , Amann  , Rottmann  , Angelkort
Published: January 2006

Background: Diabetic foot syndrome (DFS) is a frequent complication of long-standing diabetes mellitus, occurring in 10 to 30 percent of all diabetics with a vital risk for the affected limb and high mortality rates. Macroangiopathy, diabetic polyneuropathy and infections are trigger factors for DFS. Recent results imply a pathogenic role of functional and structural microcirculatory changes. The exact role of microangiopathy and the value of microcirculatory diagnostic methods in DFS have not yet been defined. Patients and methods: 78 patients with DFS (28 type I, 50 type II diabetics, mean age 63 years) were evaluated with video capillary microscopy, transcutaneous partial oxygen tension (tcpO2) measurement and laser Doppler fluxmetry (LDF) at the forefoot of the affected leg at admission and after revascularisation. Mean hospital stay was 28 ± 11.7 days. Patients were stratified according to the etiology of DFS in patients with neuropathic lesions, macroangiopathic ulcers and mixed neuropathic-angiopathic lesions. Results: All groups had impaired microcirculation, and significant differences between groups were found in respect to capillary density. Reactive hyperemia, LDF pattern and tcpO2 did not differ significantly. Microcirculatory examinations did not yield additional information to clinical and Doppler sonographic results. Conclusion: In clinical practice, the role of microcirculation evaluation techniques for diabetic foot syndrome is limited.
Infrapopliteale Arteriopathie und kritische Fußischämie: Behandlungsmöglichkeiten durch Bypasschirurgie und perkutane transluminale Angioplastie
Authors: Wölfle  , Bruijnen  , Reeps  , Reutemann  , Wack  , Campbell  , Loeprecht  , Häuser  , Bohndorf
Published: January 2006

Background: In a substantial number of mainly diabetic patients isolated crural arterial lesions are found to be the underlying cause for severe ischaemic foot lesions. Without revascularisation, patients with this specific occlusion pattern will inevitably face major amputation. To attain limb salvage in this setting, since the early eighties short vein grafts were used to bypass the occluded infrapopliteal arteries. More recently, percutaneous transluminal angioplasty (PTA) was also attempted to avoid limb loss in selected patients. Patients and methods: Since May 1986 in 125 patients 130 autologous bypass grafts from the BK-popliteal artery or the proximal tibioperoneal arteries to malleolar vessels were performed in the presence of extended crural arterial occlusions and critical foot ischaemia (rest pain 3, tissue loss 127). In another series in 89 limbs (rest pain 5, tissue loss 84) of 84 patients PTA was done to treat 168 focal stenoses of > 50% diameter reduction and 11 short occlusions in a total of 135 crural arteries. Results: Using life-table analysis, primary and secondary cumulative patency rates for short vein grafts with distal graft origin were 90% and 98% at 30 days, 76% and 83% at one year and 46% and 49% at seven years, respectively. The corresponding limb salvage rates amounted to 95%, 80% and 63%. Initial complete or partial technical success after PTA of crural arteries could be obtained in 93%: The limb salvage rates achieved were 95% at 30 days, 82% at one year and 63% at six years. Conclusion: Our results suggest that – depending on the extent of lesions – both short vein grafts as well as PTA are successful complementary treatment modalities to avoid limb loss in predominantly diabetic patients with infrapopliteal artery disease and critical ischaemia.
Acute acral ischemia in all fingers probably due to an infection with borrelias
Authors: Bär Heiko , Pöhlmann  , Figulla
Published: January 2006

Akute akrale Durchblutungsstörungen der Finger können sowohl Ausdruck eines embolischen Geschehens als auch Manifestation einer Vaskulitis oder Kollagenose sein. Häufig ist die Suche nach der Ursache schwierig. In vielen Fällen führt auch eine detaillierte serologische Suche nach Gerinnungsstörungen oder immunologischen Parametern sowie apparative Diagnostik nicht zu einer Klärung. Anhand eines Fallbeispiels möchten wir über einen möglichen Zusammenhang zwischen einer Borrelieninfektion Stadium III und akralen Durchblutungsstörungen berichten. Außer passager erhöhten Jo-1- und Skelettmuskel-Antikörper-Titern fand sich serologisch und klinisch kein Hinweis auf das Vorliegen einer Autoimmunerkrankung. Unter multimodaler Therapie (antibiotisch, rheologisch, immunsuppressiv) gelang es, die schweren akralen Durchblutungsstörungen zu beseitigen und damit akrale Nekrosen zu verhindern. Als Konsequenz unserer Beobachtung empfehlen wir bei drohenden akralen Nekrosen unklarer Genese auch die Bestimmung des Borrelien-Antikörper-Titers, um eine Borrelieninfektion nicht zu übersehen.
Schwellung in der Leiste als Spätkomplikation nach Hüftarthroplastik. Differentialdiagnose und Behandlung aus gefäßchirurgischer Sicht
Authors: Enzler Markus A. , Drobny  , Franzeck  , Inderbitzi  , Leu
Published: January 2006

We report on three patients with a symtomatic inguinal mass as a late complication of repetitive arthroplastic hip surgery. In one case, there was a false aneurysm and in two cases a so-called “synovial cyst”. A synovial cyst is usually an enlarged iliopsoas bursa in communication with the capsule of the hip joint. Hypersecretion in arthritic joints may cause expansion of this bursa. Compression of the common femoral and external iliac veins may lead to outflow obstruction and leg swelling. The most important diagnostic tools are plain films of the hip joint and ultrasound of the groin including colour-coded assessment of the femoral vessels. Symptomatic cysts usually need removing by an anterior approach. Loose arthroplastic components can be causative and should be replaced.
Temporäre Vena-Cava-Filter verhindern nicht immer eine tödliche Pulmonalembolie
Authors: Bucek Robert , Maca  , Ahmadi  , Minar
Published: January 2006

We describe the case of a young woman who developed fatal pulmonary embolism during thrombolytic therapy of a deep pelvic and leg vein thrombosis, despite the insertion of a temporary vena cava filter. So the opinion that the insertion of inferior vena cava filters always prevents lethal pulmonary embolism caused by thrombi of the deep vein system must be revised.
Ischämieprotektion der Nieren bei thorakoabdominalen Aortenrekonstruktionen: leistet Prostaglandin E1 mit Kühlung mehr als die alleinige Kühlung?
Authors: Reiher Lutz , Vosberg H. , Sandmann W.
Published: January 2006

Background: Prostaglandin E1 (PGE1) is known to have a positive effect on kidney function after kidney ischaemia due to aortic clamping. Side effects of PGE1 are a decrease of systemic blood pressure and prevention of thrombocyte clotting, both being undesired during repair of thoracoabominal aortic aneurysms (TAA). The aim of this study was to evaluate, whether intraoperative and intraarterial kidney perfusion with 4° Ringer’s lactate plus 1000 IU of heparin/l plus 20 mug PGE1/l is more effective in preventing postischaemic kidney dysfunction than cold perfusion without PGE1. Patients and methods: In the time period from I/1996 until X/1998 58 patients underwent aortic repair for TAA type II, III, or IV (Crawford’s classification). Ten patients fulfilled the criteria for this study: renal artery stenosis or occlusion was excluded by angiography pre- and postoperatively. By means of szintigraphy an at least 30% participation in renal function had to be proven for every kidney. Intraoperatively both kidneys had to be excluded from circulation simultaneously. The left kidney in each patient was perfused with 4° Ringer’s lactate plus 1000 IU of heparin/l plus 20 mug PGE1/l. The right kidney was perfused with a solution of the same temperature plus heparin but without PGE1. Results: There was an intermittent increase of creatinin and/or urea in each patient postoperatively. By renal szintigraphy, which was performed after a mean time of 9 (5–13) days postoperatively, a shift of renal function from one kidney to the other could be excluded. Conclusion: In this experimental setting no additional benefit for kidney function could be detected, when under conditions of ischaemia kidneys were perfused with 4° Ringer’s lactate plus 1000 IU of heparin/l plus 20 mg PGE1/l compared to kidneys perfused with the same solution without PGE
Preoperative ultrasonography in chronic venous insufficiency
Authors: Wuppermann Th. , Dittrich O.
Published: January 2006

Die Ultraschalluntersuchung der verschiedenen Formen chronischer venöser Insuffizienz hat gerade präoperativ erhebliche Vorteile gegenüber der Diagnostik mit dem konkurrierenden Phlebogramm. Wichtige Details, wie etwa Seitenäste im Bereich des Venensterns in der Leiste, Varianten des Parvaverlaufs und Perforansinsuffizienzen am Unterschenkel, die dem antegraden Routinephlebogramm zum Teil entgehen, bei der Operation aber unbedingt berücksichtigt werden müssen, um ein dauerhaft gutes Operationsergebnis zu erzielen, sind bei hinreichender Qualifikation des Untersuchers und bei Verwendung aller Ultraschalltechniken besser als mittels antegradem Phlebogramm zu erkennen. Für die Dokumentation bestehen klare Vorschriften. Bezüglich Kosten und Zeitaufwand ist die Ultraschalluntersuchung der chronischen venösen Insuffizienz dem antegraden Phlebogramm überlegen und jederzeit wiederholbar.
Hirnbeteiligung bei extrakraniellen Aneurysmata der A.	carotis interna
Authors: Ghilardi Giorgio , Massetto N. , Cattalini C. , Odero Jr A. , De Monti M. , Gobatti D. , Scorza R.
Published: January 2006

Background: No prospective study of extracranial internal carotid artery aneurysms (EICAA) has been reported to date. The aim of this study was to evaluate central nervous system complications associated with surgical intervention for EICAA. Patients and methods: A total of seven patients, representing all cases observed at our institution from December 1997 to December 1998, were entered in this prospective study. Three patients had bilateral involvement. The aneurysms were both atherosclerotic and dysplastic. All patients were males, with mean age of 70 years (range 65 to 74). Internal or common carotid artery to EICAAs diameter ratios were calculated on the angiograms. The transverse diameter as well as the craniocaudal extension of the lesions were accurately measured intraoperatively. Follow-up evaluations were performed at three, six and twelve months postoperatively, and consisted of a clinical evaluation by both a neurologist and a vascular surgeon who were not part of the primary surgical team. Results: Six patients presented with neurological symptoms ranging from non-hemispheric TIAs to hemispheric stroke. One patient was asymptomatic. The severity of symptoms was correlated with the size of the aneurysm. Preoperative symptoms were more severe in EICAAs of _ 3 cm in transverse diameter. One case had a postoperative stroke, no perioperative deaths occurred. All the internal carotid arteries operated on were patent during follow-up evaluations. No new neurologic event was observed during follow-up. Conclusions: The severity of central neurologic symptoms seems to depend on the size of the aneurysmatic lesion. Prompt surgical management of small EICAAs may reduce the occurrence of severe CNS complications, both preoperatively and postoperatively, due to the lower risk of embolization associated with small aneurysms compared to larger lesions.