bluuebunny/crossref_metadata_2025 huggingface dataset:
Varikose der V. saphena accessoria lateralis: Darstellung des Rezirkulationskreislaufs durch präoperative Phlebographie
Authors: Weber Jürgen , Lambrecht J.
Published: January 2006

Background: The incidence of varicosis of the anterior side branch of the long saphenous vein clinically ranges about 8 to 10% of descending venous decompensation, originating at the level of the thigh. Its incidence in women showing significant overweight is clearly pronounced. Mostly torturous and enlarged varicosed segments of the accessorial lateral saphenous vein can be seen clinically crossing the anterior middle of the thigh. The indications for surgical radical extirpation of the entire varicosed side branch depends from pain, phlebitic complications, peripheral venous dysfunction including cosmetic aspects. Patients: In a clientel of 138 patients (females: 114, males: 24) the phlebographic demonstration of the entire recirculation pathways was performed prior to surgery. Results: Ascending leg phlebography was found sufficient in 7.7% of cases only. Combined with varicography however, in further 90,7% of patients a clear demonstration of the upper and lower points of venous insufficiency was possible. The extent of functional disorders was calculated by additional peripheral venous pressure measurements. Conclusions: This clientel clearly shows that long-term reflux via the varicosed side branch increases the tendency of peripheral functional decompensation along the lower leg. Adequate surgical therapy depends from a clear demonstration of the varicosed veins beeing involved, and this can be realized by combined phlebography and varicography.
In vivo Evaluation einer intravaskulären Empfangsspule für MRI bei 1,0 Tesla
Authors: Matschl V. , Heverhagen J.T. , Kalinowski M. , Alfke A. , Jaensch H.J. , Wagner H.J. , Klose K.J.
Published: January 2006

Background: Evaluation of the applicability of intravascular radiofrequency receiver coils by means of a pig in-vivo-experiment for the detection of vessel wall structures at 1.0 Tesla. Materials and methods: The intravascular receiver coil was constructed according to a well evaluated single-loop-design, which was mounted onto a balloon catheter for angioplasty. Under fluoroscopy control the balloon catheter was placed in the common carotid artery of a porcine. Images were obtained in a 1.0 Tesla clinical scanner using a fast-spin-echo-, a gradient-echo- and a high resolution spin-echo-sequence. Histological examinations were obtained to detect any vessel wall damage associated with the use of the receiver coil. Results: High qualtity images with a resolution up to 0.16*0.12 mm2 could be acquired in aquisition times of about 5 minutes. Subtle intra- and extra-vascular structures such as the balloon, irregularities of the vessel wall or bordering structures could be visualized. The histological examination showed no vessel damage due to the application of the intravascular receiver coil. Conclusions: The application of intravascular receiver coils for the visualization of the vessel wall is feasible at 1.0 Tesla without histologically detectable trauma to the vessel wall.
Purulent arthritis of the knee joint and septic foot microembolism as postreconstructive complication of an infected femoral anastomotic aneurysm
Authors: Arvanitis Dimitrios P. , Dervisis K.I. , Georgopoulos S.H. , Weiher U.E. , Argeitis V.P.
Published: January 2006

Postrekonstruktive Infekte mit septischen peripheren Embolien nach gefäßchirurgischen Eingriffen der Inguinalregion werden immer wieder sporadisch publiziert. Das gleichzeitige Vorkommen eines Pyarthros des Kniegelenkes mit septischen Mikroembolien am Fuß als Folge eines infizierten femoralen Anastomosenaneurysmas scheint jedoch eine Seltenheit zu sein. Wir berichten über einen solchen erfolgreich behandelten Fall. Nach «in situ repair» eines postrekonstruktiven, rupturierten falschen Aneurysmas der A. femoralis communis kam es erneut zu einem infizierten falschen Aneurysma der distalen Anastomose, welches zu einem Pyarthros vom Kniegelenk mit diffusen, zum Teil abszedierenden Hautnekrosen an der Ferse und am lateralen Fußrand führte. Das notfallmäßige chirurgische Vorgehen erfolgte in einer Sitzung und bestand aus folgenden Schritten: a) extraanatomische Revaskularisation mittels ringverstärkter ePTFE-Prothese, b) totale Entfernung der alten infizierten Prothese mit periprothetischem Gewebe, c) Arthrotomie des Kniegelenkes, Entleerung des Eiters und mechanische Gelenksspülung. Vier Jahre danach bleibt der Patient ohne Infektrezidiv, mit völlig eingeheilter Kunststoffprothese, palpablen Fußpulsen und einer geringgradigen permanenten Einschränkung der Flexion im Kniegelenk.
Chirurgische Versorgung der retroaortalen linksseitigen Nierenvene bei kombiniertem Eingriff an der Bauchaorta und den Herzkranzgefäßen
Authors: Drabe N. , Zund Gregor , Hoerstrup S.P. , Jockenhövel S. , Vogt P.R. , Turina M.
Published: January 2006

Although generally retro-aortic left renal vein is a rare anatomic finding, it occurs in 0.8% of the patients admitted for abdominal aortic aneurysm surgery. Surgeons fear fatal bleeding during clamping of the aorta, caused by a more caudal insertion of the retro-aortic left renal vein and a greater vulnerability of the anomalous tissue. Once such a complication occurs, a reconstruction of the retro-aortic left renal vein using a synthetic graft should be performed to obtain adequate renal venous flow and maintain renal function.
Parameter der Koagulation und Fibrinolyse bei Patienten mit chronischer venöser Insuffizienz
Authors: Blomgren Lena , Johansson G. , Siegbahn A. , Bergqvist D.
Published: January 2006

Background: Varicose veins (VV) are common, but only some patients will develop chronic venous insufficiency (CVI) with skin changes or venous ulcer. The pathophysiology of venous ulcer development is complex, and may involve abnormalities in coagulation, fibrinolysis and proinflammatory cytokines. The purpose of this study was to correlate plasma markers within these systems and skin pathology. Method: A group of twenty consecutive patients with active or recent venous ulcer were matched for sex and age with further three groups of individuals i.e. controls and patients with VV with and without skin changes respectively. Blood samples were analysed for hemoglobin (HB), total platelet count (TPC), C-reactive protein (CRP), activated partial thromboplastin time (APTT), prothrombin complex (PT), fibrinogen, interleukin-1 beta (IL-1beta), tumor necrosis factor a (TNFalpha), D-dimer, tissue plasminogen activator (t-PA), plasminogen activator inhibitor 1(PAI-1), prothrombin fragments 1 and 2 (F1+2), and thrombin antithrombin III complex (TAT). Results and conclusion: There was an increase of systemic levels of PAI-1 activity and tPA with progressive skin pathology in patients with CVI, and in the group with active ulcer there was an elevation of F 1+2. Those findings could reflect a defect fibrinolysis, a thrombotic potential or a damaged endothelium.
Management therapierefraktärer hypovaskularisierter Wunden durch freie Muskelverpflanzung
Authors: Walgenbach Klaus-Jürgen , Voigt M. , Andree C. , Stark G. B. , Horch R. E.
Published: January 2006

Background: Chronic ulceration as a complication of arteriosclerotic disease, venous congestion or diabetes mellitus is still a serious clinical problem, resulting in immobilization, extended hospitalization and cost-intensive treatment. Other than standard conservative treatment protocols or early amputation, microsurgical free transfer of well vascularized muscle tissue onto chronic wounds can induce angiogenesis and improve wound healing even in the hypovascularized wound. Patients: From 1993–1999 we treated 12 patients (mean age: 46 years) with vascular ulcers of the lower extremity with free muscle or fasciocutaneous tissue transfer. Results: The average hospitalization was 51.4 days. The perioperative mortality was zero. In one patient with factor V deficiency a partial flap necrosis occurred. Two revisions of the micro anastomoses had to be performed. Two seromas occurred at the donor site. No secondary flap loss was observed. Extremity or stump length preservation was achieved in all cases. Conclusions: Optimal postoperative treatment with physiotherapy and orthopaedic shoe support is important. If all these factors are present and if the patient is highly motivated a reintegration into normal life can be achieved.
Zungennekrose und unilaterale Erblindung infolge Arteritis temporalis
Authors: Cikes Alec , Depairon M. , Jolidon R.-M. , Wyss P. , Lang H.-J.
Published: January 2006

While blindness is one of the typical clinical presentations of temporal arteritis, tongue necrosis, on the other hand, is an unusual complication of the disease. An 80 year old male patient presenting a sudden massive swelling of the tongue was admitted to the Hospital of Yverdon. The swelling rapidly progressed to a complete necrosis of the tongue within a few days. The clinical presentation, the dramatic evolution of the necrosis, and sudden unilateral blindness despite prompt treatment confirmed our diagnosis of temporal arteritis. However, all the examinations, including biopsy of the right temporal artery, remained non-specific for the disease. Our diagnosis was based on the unusual clinical presentation of the disease.
Einsatz des niederenergetischen Laser bei Patienten mit primärem und sekundärem Raynaud-Phänomen
Authors: Al-Awami Mahdi , Schillinger M. , Gschwandtner M. E. , Maca T. , Haumer M. , Minar E.
Published: January 2006

Background: Patients who had been treated with low level laser (LLL) for their digital ulcers reported an impressive improvement of their symptoms of episodic digital ischaemia. Therefore this pilot study was performed to evaluate the efficacy of LLL as a new non-drug non-invasive treatment for patients with primary and secondary Raynaud’s phenomenon (RP). Patients and methods: Forty patients (29 female, 11 male, mean age 51 years) with active primary (28%) and secondary (72%) Raynaud’s phenomenon received 10 sessions of LLL distant irradiation during winter months. Assessment of subjective and objective parameters was performed at baseline, one week after the last session and three months later. Variations of subjective parameters as number of daily acute episodes and severity of discomfort were assessed by a coloured visual analogue scale. A standardised cold challenge test using computed thermography of continuous temperature recordings by means of infrared telethermography was used to assess the digital blood flow. Results: A significant improvement was noticed clinically and thermographically after 6 weeks and 3 months, respectively (p < 0.0001). Conclusions: These data suggest that LLL treatment has a good short and medium term effectiveness in patients with Raynaud’s phenomenon.
Necrotizing colitis as primary manifestation of Buerger’s disease
Authors: Münch Dirk , Altmann E.
Published: January 2006

Wir berichten über den Krankheitsverlauf einer 41-jährigen Patientin mit exzessivem langjährigem Nikotinabusus, die sich wegen einer Claudicatio intermittens bei Thrombangiitis obliterans der unteren Extremitäten in unserer Behandlung befand. Drei Jahre zuvor wurde bei der Patientin aufgrund einer nekrotisierenden Kolitis eine Hemikolektomie durchgeführt. Die klinischen, angiografischen und histologischen Befunde werden vorgestellt. Die Häufigkeit der intestinalen Thrombangiitis und deren Verlaufsformen werden diskutiert.
Critical limb ischaemia in diabetes: definition, assessment, prognosis
Authors: Luther
Published: January 2006

In diabetic foot disease, critical limb ischaemia (CLI) cannot be precisely described using established definitions. For clinical use, the Fontaine classification complemented with any objective verification of a reduced arterial circulation is sufficient for decision making. For scientific purposes, objective measurement criteria should be reported. Assessment of CLI should rely on the physical examination of the limb arteries, complemented by laboratory tests like the shape of the PVR curve at ankle or toe levels, and arteriography. The prognosis of CLI in diabetic foot disease depends on the success of arterial reconstruction. The best prognosis for the patients is with a preserved limb. Reconstructive surgery is the best choice for the majority of patients.
Is the revascularisation of pedal arteries worthwhile in diabetic gangrene?
Authors: Luther  , Pillny  , Müller  , Lance  , Sandmann
Published: January 2006

The potential of arterial reconstructions at the foot level is a matter of debate. A series of 119 pedal arterial bypass grafts in 114 patients (77 diabetic and 37 non-diabetic patients, mean age 66 years) is reviewed retrospectively, after a mean follow-up 31 months. Of the patients, 91% had foot lesions regarded as Fontaine stage IV, and 97% had occlusions of all crural arteries with patent malleolar or pedal arteries. Autologous vein bypasses were grafted between pedal and either femoral (57%), popliteal (35%), or crural(8%) arteries. Results: the 30-day mortality was 4.4%, and the total mortality after 31 months was 21%. Postoperative graft failure resulted in 22 amputations above the ankle (in 12% of the diabetic, and in 32% of the nondiabetic patients). The one-year primary (secondary) graft patency rates were 67% (69%) in the diabetic patients, and 51% (59%) in the nondiabetic patients. Limb salvage rate was 82% (D) versus 62% (ND) after 1 year, and 64% (D) versus 55% (ND) after 31 months. Conclusion: nearly two thirds of diabetic patients with partial foot gangrene will benefit from timely pedal arterial reconstruction, and more than half of nondiabetic patients.
Septic complications of surgery at the diabetic leg
Authors: Arens  , Hankemeier  , Zimny  , Kollig  , Möllenhof  , Muhr
Published: January 2006

Traditionally in the surgical field the diabetic patient is supposed to offer ideal host conditions for bacterial adhesion, multiplication and finally infection. Although a conditio sine qua non for infection microorganisms are only one aspect in the multifactorial aetiology of surgical infection – unfortunately frequently overemphasised. The aim of this paper is to present the current pathophysiological model on the aetiology of postoperative infection under the particular aspect of surgery at the diabetic leg. Illustrated by clinical experiences and published examples of typical septical complications approaches for prophylaxis and therapy of postoperative infection at the diabetic foot and leg will be discussed.
Integrierte Diagnostik bei Verdacht auf tiefe Venenthromben und Lungenembolie
Authors: Bounameaux
Published: January 2006

Diagnosing deep vein thrombosis and pulmonary embolism has become definitely easier and more reliable over the past fifteen years, especially thanks the development of lower limbs venous compression ultrasonography and fibrin D-Dimer measurement. These tests allowed reducing the requirement for venography and pulmonary angiography to a small minority of patients. Simultaneously, ventilation/perfusion lung scan criteria have been standardized, and the performance of spiral computed tomography has been analyzed in an appropriate way. New sequential, mainly noninvasive strategies could be developed that proved to be safe in large-scale prospective cohort studies with prolonged follow-up. They should now be implemented in daily practice according to cost-effectiveness analyses as well as local facilities and expertise.
Indikationen und Limitationen des Gehtrainings bei Patienten mit Cladicatio intermittens
Authors: Ohta Takashi , Sugimoto  , Takeuchi  , Hosaka  , Ishibashi
Published: January 2006

Background: The selection of candidates for exercise training among patients with intermittent claudication is still a matter of debate. Patients and methods: Forty-nine patients with intermittent claudication due to arteriosclerosis obliterans were tested. Forty-six patients were men and 3 were women, with an average age of 65 years (range, 46 to 76 years). The patients walked on a treadmill at 2.4 km/h on a 12% upgrade followed by an appropriate period of rest for 30 minutes twice a day during a 3-week hospitalization. Programs were individualized for each patient. Four parameters were assessed after exercise training: (1) Ankle-brachial index (ABI) at rest, (2) Fall in ABI after 40 m of treadmill walking (ABI Fall 40), (3) the recovery time (RT 40) required for the ABI to return to resting levels after 40 m of walking, and (4) the maximal walking distance (MWD) on the treadmill. Results: The average ABI at rest before the 3-week training period was 0.60 ± 0.02 (mean ± SE), and after training it was 0.62 ± 0.02. There was a small although not statistically significant increase in the ABI after training. This increase in the ABI did not exceed 0.21. The average ABI Fall 40 before training was 0.36 ± 0.01, and after training it was 0.30 ± 0.02. The average RT 40 before training was 9.9 ± 0.8 min, and after training it was 6.2 ± 0.6 min. There were significant decreases in the ABI Fall 40 and RT 40 after training (p < 0.01 and p < 0.001, respectively). The MWD increased after training in 48 of the 49 patients. The average MWD increased from 134 ± 13 m to 226 ± 32 m after training (p < 0.001). The occlusion levels did not influence the results as training effects and hemodynamic parameters. Fourteen of 49 patients desired arterial reconstruction after exercise training. Conclusions: Patients with shorter RT 40’s before training achieved greater increases in the MWD after training. In patients with an RT 40 under 12 min, exercise training is indicated. However, there is some discrepancy between the increase in MWD and the degree of satisfaction in individual patients.
Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit
Authors: Bucek . , Hudak  , Schnürer  , Ahmadi  , Wolfram  , Minar
Published: January 2006

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.
Prospektiver Verlauf von 36 Patienten mit 46 Poplitealaneurysmata unter konservativer Therapie
Authors: Stiegler H. , Mendler  , Baumann
Published: January 2006

Background: There is a lack of prospective studies with popliteal aneurysms (PAA) < 2 cm and the very few information about the natural cause of the disease. Patients and methods: Between 1995 and 2000 46 patients having 65 popliteal artery aneurysms have been examined. The mean diameter was 1.9 cm (0.8–4 cm). In 41% of the cases PAA were bilateral, additional extrapopliteal aneurysms were found in 37%. The PAA was occluded in 8 patients at the initial examination (mean diameter 2.4 cm: 1.4–4 cm). One of these patients had to be amputated (long-term diabetes, dialysis and severe generalized peripheral arteriosclerosis). Since no information could be obtained from two patients, it was possible to prospectively monitor 36 patients with 46 PAA (30 m, 6 f) over a period of 2.5 years. 19 patients were treated with platelet inhibitors, 16 with coumarin and one refused any thromboembolic prophylaxis. The patients were examinated every year by telefone interview and duplexsonography. Results: During the monitoring period there occurred two complete occlusions and one distal arterial progression, while 2 patients died, but no amputation. The total complication rate was 6.5% with a higher incidence in PAA > 2 cm of diameter (14.2 vs. 3.1 %). All complications were found in PAA with mural thromboses. Coumarin seems to be superior platelet aggregation inhibitors with a complication rate of 0% vs. 14.3%. The mean increase in diameter during follow-up was dependent on PAA size, 1.5 mm/year for PAA > 2 cm vs. 0.7 mm/year for PAA < 2 cm. Conclusion: This prospective study emphasises the necessity of a prophylactical surgery in patients with an aneurysm diameter > 2 cm. In view of the low rate of complications of the natural course of PAA (6.5% of all PAA or 14.2% for PAA > 2 cm/2.5 years), the bypass surgery should be performed by an experienced vascular department. Patients with PAA < 2 cm or patients with contraindication for peripheral bypass should receive anticoagulation.
Farbduplexsonographische Befunde an den Leistengefäßen von Drogenabhängigen
Authors: Schulz  , Beckenbach  , Philipp  , Hengstmann
Published: January 2006

Background: During recent years increasing numbers of intravenous drug addicts with severe damage to the groin vessels were examined in our angiological ultrasound laboratory. The value of color duplex sonography for the clinical evaluation of these findings is the subject of the present study. Patients and methods: Over the course of six years every drug addict admitted to our hospital who either complained of pain or discomfort in the inguinal region or showed conspicuous clinical findings in this area was examined in our ultrasound laboratory. First by B-mode, the diameter, wall structure and compressibility of the vessels were evaluated and the surrounding tissue was checked for abnormalities. Then the blood flow of the femoral vessels was examined by color coded duplex. If an abscess was suspected, a computed tomography of the groin was obtained before surgery in most cases. Results: A total number of 77 patients was examined with pathologic results in all cases. The most frequent finding was venous thrombosis: In 63 patients complete thrombotic occlusion of the femoral vein at the injection site was observed. We registered 14 partial thromboses. 30 patients showed vessel wall alterations to variable extents in which 23 cases referred to veins and 10 cases to arteries. 7 patients showed an occlusion of the femoral artery. In 4 patients we found a false aneurysm and 3 had an arteriovenous fistula. Chronic tissue alterations were present to a certain extent in all cases rendering evaluation frequently difficult. Especially problematic to evaluation were those 34 patients where one or more surgical interventions had been performed previously. The results of an additional computed tomography had little effect on the therapeutic decisions. In 11 patients an abscess incision had to be done during the course of their hospital stay. Conclusion: Extensive damage of the groin vessels is seen in i.v. drug addicts. There is no other patient group with such a diversity of different findings. In almost every case these findings involve veins and arteries as well as the surrounding tissues.
Lokale Gefäßkomplikationen nach Einsatz des hämostatischen Verschlussystems Angio-SealTM
Authors: Kirchhof  , Schickel  , Schmidt-Lucke  , Schmidt-Lucke
Published: January 2006

Background: As an alternative to manual pressure techniques new systems for achieving arterial hemostasis after cardiac catheterization were developed. Here we report about the diagnosis and therapy of femoral artery complications after use of the closure device Angio-SealTM, consisting of an intraarterial anchor and extravascular collagen plug. Patients and methods: Angio-SealTM was deployed in 350 patients undergoing cardiac catheterization. Vascular investigations after device application consisted of ankle/brachial-pressure-index measurement, duplex sonography, and angiography. Results: Vascular complications occurred in 10 of 350 patients. In two patients complete occlusions of the superficial femoral artery required immediate vascular surgery. Stenoses of the superficial (five patients) and the common (three patients) femoral arteries were diagnosed in 8 cases. Of these 10 patients eight were obese, in 2 cases there was a further catheterization with Angio-SealTM device application via the same femoral approach. Until now six patients underwent successful surgery: in 4 cases the whole Angio-SealTMdevice was located intraarterially, there was 1 case of intima-dissection, and 1 case remained unclear due to a diagnostic delay of 7 months. In three patients with stenoses of the common femoral arteries without hemodynamic relevance no therapy was required. Conclusions: Occlusions or stenoses of femoral arteries after use of Angio-SealTM can be diagnosed easily by duplex sonography. All hemodynamic relevant complications (n = 7 of 350 [2%]) concerned a puncture of superficial femoral arteries. In these patients vascular surgery seems to be an adequate therapy.
Häufigkeit von Bauchwandhernien bei Patienten, die einer Aortenoperation wegen Aneurysma oder Verschlusskrankheit unterzogen wurden
Authors: Papadimitriou  , Pitoulias  , Papaziogas  , Koutsias  , Vretzakis  , Argiriadou  , Papaziogas
Published: January 2006

Background: The aim of this study was to compare the incidence of abdominal and incisional hernias in patients with abdominal aortic aneurysm (AAA) versus patients with aortoiliac occlusive disease (AOD). Patients and methods: The study included retrospectively 121 patients, who underwent elective aortic surgery due to AAA (n = 63) or AOD (n = 58) in the period between January 1998 and January 2000. The patients were examined for the presence of abdominal hernias upon admission, as well as for the development of incisional hernias on follow-up. Results: The incidence of inguinal hernias was significantly higher in the group AAA (21/6–33.3%) compared to the group with AOD (6/58–10,3%) (p < 0.01). The incidence of other abdominal wall hernias (umbilical, epigastric or miscellaneous hernias) was also significant higher in AAA group. Furthermore, the incidence of inguinal hernias was significantly higher in the subgroup of patients with an aneurysm diameter more than 6 cm (41.5% vs 18.2%, p < 0.05). The mean follow-up of the patients was 1.7 ± 0.3 years. 7 cases of incisional hernia were noted in the AAA group (11.1%) and only 2 cases in the AOD group (3.4%) (p < 0.05). The size of the aneurysm had no influence on the incidence of incisional hernias in the AAA group. Conclusion: We conclude that there seems to be an increased incidence of abdominal wall hernias as well as postoperative incisional hernias in patients undergoing aortic surgery for aneurysm disease compared with aortoiliac occlusive disease.
LDL-Oxidation und -Subgruppenverteilung bei normo- und hypertensiven Patienten mit und ohne familiäre hypertonische Belastung
Authors: Brockes  , Locher  , Böttcher  , Schmitz  , Vetter
Published: January 2006

Objectives: Oxidative modification of low-density-lipoprotein (LDL) increases its atherogenic potential to induce the accumulation of lipids and cells in the vascular wall. Patients have different lipoprotein profiles according to their LDL-subgroup pattern. The subgroup of LDL, which is most susceptible to oxidation, is most likely the dense LDL3 subfraction. In order to study an assumed association between hypertension, LDL subgroup distribution and the susceptibility of LDL to oxidation, 14 normotensive patients without family histories of hypertension (NT), 13 normotensive patients with family histories of hypertension (NT-FH), 10 hypertensive patients without family histories of (HT) and 11 hypertensive patients with family histories of hypertension (HT-FH) were evaluated. Patients and methods: LDL was oxidatively modified by incubation with copper ions (1.6 muM/L). The course of LDL-oxidation was measured in vitro by continuous photometric monitoring and the quantitative distribution of 3 LDL-subgroups by capillary isotachophoresis (ITP). Results: The lag-phases of NT-FH and hypertensive patients were shorter than those of the control group (NT: 116 ± 36 minutes; NT-FH 92 ± 32 minutes, p < 0.05; HT: 95 ± 41 minutes; HT-FH: 76 ± 33 minutes, p < 0.05). Compared to NT a significant difference in the relative preponderance of LDL3 subgroup was observed for HT-FH (23.5 ± 4.6% versus NT: 19.3 ± 6.6%), additionally, statistical analysis showed a similar trend amongst the other patient groups (NT-FH: 20.4 ± 7.4%, HT: 21.4 ± 4.6%). Conclusions: The increased occurence of the LDL3 subgroup might contribute to a higher susceptibility to LDL oxidation and therefore create an increased risk of vascular disease in the genotypic and phenotypic hypertensive patient population.
Eindeutige Beziehung zwischen mittlerem Erythrozytenvolumen und dem anatomischen Verteilungstyp der peripheren arteriellen Verschlusskrankheit
Authors: Mueller  , Luft  , Haidinger  , Poelz  , Haltmayer
Published: January 2006

Background: Elevated erythrocyte mean corpuscular volume (MCV) has been suggested to be a risk factor for peripheral arterial disease (PAD). The aim of the present study was to evaluate whether MCV was associated with a distinct pattern of severe atherosclerosis (lumen reductions >= 75%) in patients with symptomatic PAD, as measured by angiography. Patients and methods: 100 consecutively admitted male PAD patients with iliac, femoral-popliteal and crural disease manifestation were compared with 100 male age-matched control subjects without PAD on the basis of angiographically determined lumen reductions >= 75%. Results: The pattern of severe atherosclerosis was as follows: 41 PAD patients displayed stenoses/occlusions in the iliac segment, 68 in the femoral-popliteal and 15 in the crural segment. When comparing the PAD patients with the controls by multivariate conditional logistic regression analysis, MCV was an independent predictor of severe atherosclerosis in the iliac (OR = 2.72 for an increment of 5 fl, 95% CI = 1.15–6.40) and the femoral-popliteal segment (OR = 3.13 for an increment of 5 fl, 95% CI = 1.51–6.49) but not in the crural site. This pattern was similar to the impact of smoking. Conclusion: Higher MCV values contributed to lumen reductions >= 75% of the proximal segments in patients with symptomatic PAD. This observation could be clinically important since revascularisation procedures are done predominantly in these segments. As a consequence, observance of elevated MCV values should be considered in PAD patients.
Homozysteinspiegel von Patienten mit Raynaud-Phänomen
Authors: Al-Awami  , Schillinger  , Maca  , Gschwandtner  , Bieglmayer  , Wagner  , Minar
Published: January 2006

Background: Patients with Raynaud’s phenomenon (RP) have vasomotor dysregulation, mainly caused by dysfunction of the endothelium. Since homocysteine has been found to be damaging to endothelial cells, we investigated the concentrations of plasma homocysteine, folate and vitamin B12 in patients with primary or secondary RP compared to healthy individuals. Patients and methods: We measured the concentrations of plasma fasting homocysteine, folate and vitamin B12 in a group of healthy individuals (n = 45) and in patients with primary (n = 26) or secondary RP (n = 42). Results: Median homocysteine levels in healthy controls and in patients with primary RP, secondary RP were 7.9 (IQR 4.1 to 11.8) 9.8 (IQR 5.1 to14.4), and 10.6 (6.0 to15.3) mumol/L, respectively. Patients with primary and secondary RP had significantly higher homocysteine concentration compared to healthy controls (Kruskal Wallis p = 0.01). After matching for age and sex, patients with either primary or secondary RP showed significantly higher homocysteine levels (Wilcoxon p < 0.0001). No significant differences between the three groups were found concerning serum levels of vitamin B12 (p = 0.9 ) and serum folate levels (p = 0.2). Conclusion: These data demonstrate that patients with RP have higher plasma levels of homocysteine. No significant differences in folate and vitamin B12 levels were found between patients with primary RP, secondary RP, and healthy individuals.These data suggest that homocysteine may play a role in RP and may provide new clues in understanding of the vasomotor dysregulation.
Doppelblinde, randomisierte, placebokontrollierte Low-Level-Laser Therapiestudie bei Patienten mit primärem Raynaudphänomen
Authors: Hirschl  , Katzenschlager  , Ammer  , Melnizky  , Rathkolb  , Kundi
Published: January 2006

Background: No causal treatment of primary Raynaud’s phenomenon is available due to its unclear aetiology. Low level laser therapy (LLLT) is applied in a multitude of medical conditions often without sufficient evidence of efficacy and established mechanisms. To asses the effect of this therapy in patients with primary Raynaud’s phenomenon a randomised, double blind, placebo controlled cross over study was designed. Patients and methods: Absolute and relative frequency and intensity of vasospastic attacks during three weeks of either LLLT or placebo therapy and results of infrared thermography before onset and at the end of both therapy sequences were evaluated in 15 patients with primary Raynaud’s phenomenon. Results: Frequency of Raynaud’s attacks was not significantly affected by low level laser therapy. Compared to placebo a significantly lower intensity of attacks during laser irradiation was observed, but no transfer effect occurred. Additionally the mean temperature gradient after cold exposure was reduced after laser irradiation, while the number of fingers showing prolonged rewarming was unaffected. Conclusion: Though further studies are necessary to confirm these results we could demonstrate for the first time in a double blind placebo controlled clinical trial that low laser therapy is a potential candidate for an effective therapy of Raynaud`s phenomenon, although effects seem to be of short duration.
Wirksamkeit und Sicherheit einer Cumarin-/Troxerutin-Kombination (SB-LOT) bei Patienten mit chronischer venöser Insuffizienz: Eine doppelblinde, placebo-kontrollierte, randomisierte klinische Studie
Authors: Vanscheidt  , Rabe  , Naser-Hijazi  , Ramelet  , Partsch  , Diehm  , Schultz-Ehrenburg  , Spengel  , Wirsching  , Götz  , Schnitker  , Henneicke-von Zepelin
Published: January 2006

Background: The objective was to evaluate the oedema-protective effect of a vasoactive drug (coumarin/ troxerutin [SB-LOT]) plus compression stockings in patients suffering from chronic venous insufficiency after decongestion of the legs as recommended by the new guidelines. Patients and methods: 231 patients were randomly assigned medical compression stockings plus SB-LOT (90 mg coumarin and 540 mg troxerutin per day) or medical compression stockings plus placebo for the first 4 weeks and SB-LOT or placebo for the second 12 weeks of the study. The primary efficacy endpoint was the lower leg volume measured by well-established water plethysmometry. Results: 226 patients were evaluated. After ceasing compression stockings, an edema protective effect was detected in the SB-LOT-group but not in the controls. Recurrence of leg volume increase was by 6.5 ± 12.1 ml and by 36.7 ± 12.1 ml in the SB-LOT and placebo group, respectively (p = 0.0402). The local complaint score and general aspects of quality of life were also superior for the SB-LOT-group (p = 0.0041). Significant differences were also observed with regard to clinical global impression and therapeutic effect. No serious adverse drug reaction or clinically relevant impairment of laboratory parameters occur. Conclusion: This study confirms the oedema-protective effect of SB-LOT in chronic venous insufficiency and provides a treatment option for patients who discontinue compression after a short time.
Akutes Wandhämatom des Truncus coeliacus
Authors: Kruse  , Weise  , Nuytinck  , De Paepe  , Schellong
Published: January 2006

The report describes a previously healthy 24-year-old women presenting with acute abdominal pain following a hyperextension manoeuvre. The key finding of a continuous bruit with systolic and diastolic components in the epigastric region subsequently led to the diagnosis of an intramural haematoma of the coeliac artery, that caused a subtotal occlusion of the artery. The diagnosis was achieved by both colour-coded duplex sonography and magnetic resonance angiography. The case shows that a conservative management rather than operative reconstruction is justified in an oligo-symptomatic situation with no signs of end-organ damage as in this patient.
Rezidivierende Subklaviathrombose bei einem Dirigenten
Authors: Pratikto  , Zwetschke  , Goyen  , Kröger
Published: January 2006

We present a case of a young male patient with recurrent subclavian vein thrombosis due to conducting after prior successful thrombolytic therapy. Musculoskeletal problems are common among musicians. A thoracic outlet syndrome associated to a profession induced thrombosis in a musician has not been described before. Surgical removal of the first rip can prevent recurrent thrombotic occlusion of the subclavian vein, but was not performed in this patient. Considering the specific situation of a young musician there is no information whether surgical or conservative treatment is suitable to allow a successful career as an active musician.
Periphere arterielle Verschlusskrankheit bei Diabetes mellitus Typ 1 und Typ 2: Unterscheiden sich die Risikofaktoren?
Authors: Zander  , Heinke  , Reindel  , Kohnert  , Kairies  , Braun  , Eckel  , Kerner
Published: January 2006

Background : Diabetic patients have increased prevalence of peripheral arterial disease (PAD). It is not clearly shown whether the prognostic factors are identical in relation to the type of diabetes. This study was done to compare the associations of PAD with risk factors and with micro-and macrovascular complications of inpatients with type 1 and type 2 diabetes. Methods: In a retrospective cross-sectional study 1087 patients with type 1 diabetes and 1060 patients with type 2 diabetes were examined. PAD was diagnosed when ankle-brachial-pressure-index (ABI) was < 1.0. In cases with incompressible arteries (mediasclerosis) pulse wave formes were analyzed. Multivariate logistic regression analysis was applied to evaluate the impact of different variables on PAD risk , after adjusting for different variables separately. Results: In both types of diabetes (type 1 vs. type 2) PAD risk (odds ratio; OR) was increased in the presence of coronary heart disease (OR 9.3 vs. 3.5), diabetic nephropathy (OR 3.0 vs.2.8), neuropathy (OR 7.9 vs. 1.8), foot ulceration (OR 8.9 vs. 5.5), increased daily insulin requirement > 0.6 m/kg b.w. (OR 5.2 vs. 2.9), diabetes duration of 20–29 years (OR 28.9) and > 30 years (OR 51.1) in type 1 diabetes, and diabetes duration of 10–19 years (OR 3.8) and > 20 years (OR 4.3) in type 2 diabetes. In type 2 diabetes, PAD risk was associated with microalbuminuria (OR 2.1), macroalbuminuria (OR 3.3), background retinopathy (OR 1.9), proliferative retinopathy (OR 2.8), increased triglycerides (TG) (OR 1.7) and decreased HDL-cholesterol (HDL-C > 0.90 mmol/l: OR 0.49). Conclusions: PAD risk factors and micro- and macrovascular comorbidity are very similar in type 1 and type 2 diabetes.
Wertigkeit der transösophagealen Echokardiographie, Ösophagogastroduodenoskopie und Retinoskopie vor intra-arterieller Fibrinolyse bei Patienten mit AVK
Authors: Kröger  , Biro  , Zeeh  , Bartel  , Vij  , Goyen  , Ruehm  , Santosa
Published: January 2006

Background: We prospectively investigated the need for esophagogastroduodenoscopy (EGD), transesophageal echocardiography (TEE) and retinoscopy for pre-interventional screening in patients with peripheral arterial occlusive disease (PAD) prior to intra-arterial fibrinolytic therapy. Patients and methods: 212 consecutive patients suffering from PAD (164 male and 48 female, mean age: 64 ± 11 years, 161 patients stage II of Fontaine’s classification, 10 patients at stage III and 41 patients at stage IV) referred for interventional treatment were included. 173 EGDs, 169 TEEs and 188 retinoscopies were performed within one week prior to fibrinolysis. 114 patients had all three examinations. Results: Pathologic findings were detected in 56 (49%) of the 114 patients: 23 erosions, 12 ulcers, 2 esophagites, 1 gastric carcinomata, 3 intracardiac thrombi, 5 aortic thrombi, 11 diabetic and 5 hypertensive retinopathies and 1 with retinal aneurysms. 30 patients (25%) received fibrinolytic therapy, despite a contraindication: The one patient with ventricular thrombus was treated as an ultimate therapy, and amputation was prevented. Two patients showing plaques covered by large thrombi in the descending thoracic aorta were treated because cranial embolism should not occur. Four diabetic patients with multilevel disease, severe claudication and prior retinal bleeding were treated. Fibrinolytic therapy was started on 23 patients after complete healing of the mucosal lesions. Conclusion: TEE revealed potential sources of embolization in 4% of the patients and is justified to reduce the individual risk. Retinoscopy should be done in patients with diabetes mellitus and hypertension, and if prior bleeding is present fibrinolysis should be done only if other treatment-regimes are not available.
Digitale Durchblutungsstörungen und Parvovirus B19 Infektion
Authors: Kern
Published: January 2006

We report a case of a 37-year-old white woman, who presented with digital arterial occlusions associated with parvovirus B19 infection. Two other member of the family presented acute febrile illness, polyarthralgia (husband), and erythema infectiosum (son) during the same month. This new report gives weight to the concept that acute human parvovirus infection could become part of the differential diagnosis of acute digital occlusive arteriopathy.
Rezidivierende isolierte Unterschenkelmuskelvenenthrombose bei Soleusvenenaneurysma
Authors: Schwarz  , Zimmermann  , Hänig  , Schröder  , Schellong
Published: January 2006

A rare case of venous aneurysm involving the soleal muscle vein in an 18-year-old woman is presented. The patient showed three episodes of ultrasonographically proven calf muscle thrombosis within 2 years. After a short course of low-molecular-weight heparin at a therapeutic dosage, complete thrombus recanalization was achieved. To prevent further thrombotic episodes, surgery including ligation and resection of the aneurysm was performed. At the 3-month follow-up study the patient had completely recovered.
Perioperative Antithrombinaktivität und Venenthromben nach Hüftersatz
Authors: Urbach  , Matzen  , Heitmann  , Neumann
Published: January 2006

Background: The purpose of the study was to evaluate whether the postoperative depletion or the preoperative antithrombin (AT) activity is related to the occurrence of deep vein thrombosis (DVT) in patients receiving low-molecular-weight heparin for DVT prevention after elective hip replacement surgery. Patients and methods: In 93 patients AT-activity and standard laboratory parameter were determined on the preoperative day and daily for one week after operation. Furthermore, a color-coded compression sonography was performed before and 8–10 days after surgery. The amount of blood loss and blood transfusions was evaluated. Patients were divided into two groups in respect to the occurrence of a postoperative DVT. Results: The overall incidence of DVT was 8.6% (n = 8). Patients with DVT had a significantly lower preoperative AT-activity (80.6 ± 3.31%) compared to those without DVT (98.1 ± 1.12%, p < 0.001), how-ever, without being predictive for DVT (positive predictive value 0.71). There was no association between postoperative fall of AT, the lowest postoperative AT activity, blood loss or blood substitution and DVT. Conclusions: It has to be expected that a small fraction of patients for elective hip surgery present with AT-activity levels possibly being insufficient for a therapeutic effect of low-molecular-weight heparin even preoperatively. Those patients are subject to a significant higher risk of DVT postoperatively.
Beeinflussen Infektionen die Amputationsrate bei der chronisch kritischen Extremitätenischämie?
Authors: Kummer  , Widmer  , Plüss  , Willenberg  , Vögele  , Mahler  , Baumgartner
Published: January 2006

Background: Aim was to analyze the association between local infection and amputation rate in patients with chronic critical limb ischemia (CLI) with or without successful revascularization. Patients and methods: We performed a retrospective analysis of 56 consecutive patients with 57 critically ischemic legs seen at the University Hospital Bern. Patients with CLI were selected if ischemic lesions and follow-up of more than 2 months were documented. Infection was suggested when 2 of the following criterion were present: temperature > 37°C, C-reactive protein > 50 mg/L, leukocytes > 10×103/mul (“2 of 3” criterion), or a putrid secretion was documented (“secretion” criterion). Results: In patients with successful revascularization (n = 39), there was a significant shift from 10.3% major to 33.3% minor amputations (Chi Square p value = 0.014) as compared to patients without or with failed revascularization (n = 18) with 44.4% and 11.1% (Chi Square p value = 0.008), respectively. An infection was suggested in 22 of 53 limbs (41.5%) according to the “2 of 3” criterion, and 30 of 57 limbs (52.6%) satisfying the “secretion” criterion. Both criteria, were significantly more common in patients undergoing amputation as compared to patients without amputation (p = 0.001). Multiple lesions were more common in patients with major amputations (p = 0.026). Conclusion: Successful revascularization effectively reduces major amputations and leads to healing of ischemic ulcers. Secondary foot infections are frequent. Infections are associated with a significantly higher rate of minor and major amputations, also in patients with successful revascularization, and should be treated adequately as well as in time with antibiotics.
Grenade-splinter injury mimicing a superficial thrombophlebitis
Authors: Gaber
Published: January 2006

Zwei Patienten mit einer Granatsplitterverletzung unter dem klinischen Bild einer ulzerierten Thrombophlebitis bzw. Phlebitis mit Periphlebitis werden vorgestellt. Überraschend stellte sich heraus, dass es sich bei den vermeintlichen Thromben um metallische Fremdkörper handelte. Beide Patienten erinnerten sich an Granatsplitterverletzungen in den Jahren 1944/ 1945, diese seien damals nicht entfernt worden. Nach einem mehr als fünf Jahrzehnten stummen Verlauf kam es nun zu Spätkomplikationen durch Fremdkörperwanderung.