bluuebunny/crossref_metadata_2025 huggingface dataset:
Stickstoffmonoxid inhibiert die durch basischen Fibroblastenwachstumsfaktor induzierte Migration von bovinen, glatten Gefäßmuskelzellen in vitro
Authors: Alfke Heiko , Kleb  , Klose
Published: January 2006

Background: The purpose of this study was to evaluate the effect of nitric oxide (NO) on basic fibroblast growth factor (bFGF)-stimulated migration of bovine VSMC in vitro. Methods: For the migration assay 50,000 cells from passages 4 to 8 were put into a migration chamber and stimulated with 10 ng bFGF/ml (control group). For another experiment, the NO donator sodium nitroprusside (SNP) (10-6, 10-8, 10-10 M), the second messenger of NO 8-bromo-cGMP (10-6, 10-8, 10-10 M) and 100 U of superoxide dismutase (SOD) were added. Migration of cells was quantified after fixing and staining of the cells by means of light microscopy. Results: Cell migration was significantly inhibited by SNP in a dose dependent manner (p < 0.01 with t-test). This effect was mirrored by 8-bromo-cGMP and not significantly inhibited by SOD, confirming this to be an NO mediated effect and excluding side-effects of superoxide-derived oxidation products. Conclusion: Nitric oxide inhibits the basic fibroblast growth factor stimulated migration of bovine vascular smooth muscle cells in vitro
Veränderungen der extrazellulären Matrix in der Venenwand – Ursache der primären Varikosis?
Authors: Kirsch Delia , Dienes  , Küchle  , Duschner  , Wahl  , Böttger  , Junginger
Published: January 2006

Background: Conflicting theories on the development of primary varicosis have led to the molecular biological investigation of the vein wall or, more accurately, of the extracellular matrix. It was the aim of this study to quantify matrix expression and to compare pathological changes in the vein wall with valve-orientated staging of varicosis, in order to determine indicators of the primary cause of varicosis. Materials and methods: Three hundred seventy-two tissue specimens of greater saphenous veins were obtained from 17 patients with varicosities and categorised according to Hach stage and procurement site. The specimens were compared with 36 specimens collected from six patients without varicosities, incubated with fluorescence-stained antibodies for collagen 4, laminin, fibronectin and tenascin prior to being assessed with confocal laser scan microscopy. In addition, 22 vein specimens (16 varicose, 6 normal veins) serving as negative controls were investigated. Results: Image analysis and statistical evaluation showed that compared with normal veins, varicose veins are associated with a significant increase in matrix protein expression for collagen 4, laminin and tenascin. A trend towards an increase in matrix expression was further observed for fibronectin. There was, however, no difference between varicose veins and clinically healthy vein segments inferior to a varicose segment. Conclusion: If the findings of the present investigation can be confirmed by other studies, alterations in the vein wall may be regarded as the primary cause of varicosis and valvular insufficiency as the result of these changes.
Prostaglandin E1-Therapie vermindert zirkulierende Adhäsionsmoleküle (ICAM, E-Selectin, VCAM-1) bei Patienten mit peripherer arterieller Verschlusskrankheit
Authors: Palumbo  , Oguogho  , Fitscha  , Sinzinger Helmut
Published: January 2006

Background: It has been postulated that adhesion molecules (AM) may be involved in development and progression of human atherosclerosis. We examined whether prostaglandin (PG) E1 affects circulating levels of the AM (ICAM-1, VCAM-1 and E-selectin) in peripheral vascular disease (PVD) patients. Methods and results: AM are significantly (p < 0.01) increased in PVD (n = 65) as compared to controls (n = 31). There was no influence of risk factors. 26 PVD-patients received 2 different schemes of PGE1-therapy (group A [n = 17]; 5 ng PGE1/kg/min × 6 h × 5 d × 4 wk; group B [n = 9]; 60 mug PGE1/2 h × 5 d × 2 wk). PGE1 decreases all the AM significantly (p < 0.01) using both therapeutic schemes. Stopping PGE1-therapy reverses values within about 4 weeks. Details on therapeutic regimens (dose, duration, route, etc.) and individual response still need to be assessed. Conclusion: Our results indicate that PGE1-treatment of PVD is associated with a significant benefit on circulating AM. These findings are in line with the described anti-inflammatory actions of PGE1 and may represent a further contributing factor to the great variety of beneficial actions of PGE1 on human atherosclerosis.
Die segmentale Manifestation der peripheren Atherosklerose und ihre Assoziation zu Risikofaktoren
Authors: Kröger  , Buss  , Renzing-Köhler  , Santosa  , Rudofsky
Published: January 2006

Background: To prove whether the aortoiliac, femoropopliteal or crural segments of the peripheral arteries might have a different sensitivity to a risk profile we did a statistical analysis of segmental peripheral atherosclerosis and risk factors. Patients and methods: In 132 patients (mean age 61 ± 13 years) with peripheral arterial occlusions the arterial segments with occlusion or stenosis were angiographically documented: 17 had occluded or stenosed aortoiliac, 45 femoropopliteal and 25 crural arteries and 45 patients had multiple manifestations. Analysis of total cholesterol, HDL- and LDL-cholesterol, triglyceride, lipoprotein a, fibrinogen, uric acid, homocystein, hematocrit, erythrocyte sedimentation rate, HBA1, IgG- and IgM-antibodies versus Cytomegalovirus, Herpes simplex-virus, Chlamydia pneumoniae and Helicobacter pylori were done and nicotine abuse, arterial hypertension and obesity were evaluated. Results: Age of the patients had the strongest correlation with isolated segmental manifestation (p < 0.0001). Patients with isolated aortoiliac manifestation were younger than patients without this manifestation (54 ± 9 years versus 62 ± 13 years). Patients with isolated femoropopliteal manifestation were older than patients without this manifestation (66 ± 11 years versus 58 ± 13 years). None of the investigated risk factors showed a correlation with these age related differences. Independent from the age related differences for the nicotine abuse a p-value of 0.08 was estimated, but in smokers a diffuse manifestation was most frequent. Conclusion: There are age dependent differences of the prevalence of isolated aortoiliac or femoropopliteal atherosclerotic occlusions or stenosis. An association of these differences to a specific risk profile was not found.
Kontinuierliches kontralaterales Säure-, Basen- und Blutgas Monitoring während Karotis-Endarterektomie
Authors: Vretzakis  , Papadimitriou  , Koutsias Stylianos , Christopoulos  , Volteas  , Pitoulias  , Zervas  , Papaziogas
Published: January 2006

Background: The aim of this study is to evaluate the intravascular multiparameter sensor Paratrend 7 (P7) for continuous acid-base and blood gas monitoring after retrograde jugular catheterization during carotid endarterectomy. Patients and methods: We studied 11 patients with history of smoking (72.7%), coronary artery disease (72.7%), hypertension (100%), diabetes mellitus (55.5%) and TIA’s and/or nondisabling stroke (90.9%). The contralateral internal jugular vein was punctured retrogradely and the calibrated P7 sensor was introduced. The sensor was removed after surgery. The P7 provides continuous graphical display of pH, pCO2, and pO2, while temperature, oxygen saturation, HCO3 concentration and base excess are displayed numerically. Results: Mean duration of carotid cross-clamping was 17.0 ± 6.2 min. Mean stump pressure was 50.2 ± 12.9 mmHg. Intraluminal shunting was not used in any operation. All sensors were easily inserted. During clamping, pH became persistently more acidic (7.31 to 7.28; p < 0.05), pCO2 was elevated (44.7 to 49.8 mmHg; p < 0.05) while, in the majority of the patients, there was a non significant decrease in pjvO2/SjvO2. Declamping was followed by a short period of decrease of pH and elevation of pCO2 reminiscent of wash out phenomena. PjvO2 was significantly elevated (53.8 ± 5.2 to 59.0 ± 5.8 mmHg; p < 0.001) after the restoration of flow. In one case, P7 was diagnostic for unsuccessful endarterectomy. Conclusions: P7 is useful during carotid endarterectomy providing continuous and «on-line» information on brain metabolism. It is a simple and powerful technique, which should be further investigated
Selektive Embolisierung eines Aneurysmas der A. renalis
Authors: Halloul Zuhir , Buerger  , Grote  , Meyer
Published: January 2006

The treatment modalities for renal artery aneurysm have changed. The aim in the presented case was to evaluate the endovascular therapy in a 52-year-old woman (with hematuria as the only symptom) with a saccular aneurysm at the first bifurcation of the right main renal artery, which was diagnosed with contrast-enhanced computerized tomography and angiography. We approached the aneurysm with minimally invasive supraselective embolization. There were no postoperative complications, as confirmed with control angiography, during the intervention and after an interval of 4 weeks. In conclusion, selective coil embolization as first-line therapy to treat saccular renal artery aneurysm is feasible. In this case, minimally invasive procedure provided maximum functioning kidney tissue.
Proteinkonzentration in der interstitiellen Flüssigkeit von Patienten mit kritischer Extremitätenischämie und Ödem
Authors: Anvar M.D. , Khiabani H.Z. , Lande K. , Kroese A.J. , Stranden E.
Published: January 2006

Background: Many of chronic critical limb ischaemia (CLI) patients have distal leg and foot oedema. Previous electronmicroscopic studies have shown that chronic severe ischaemia may cause hypoxic damage of the capillary endothelium, including morphological changes i.e. multiplicated/thickened basal lamina, and formation of interendothelial gaps. To assess the functional consequences of these morphologic derangements, where proteins can leak through, we investigated the composition of the interstitial fluid in oedematous ischaemic limbs. Patients and methods: Nine female and 3 male patients with a mean age of 79 ± 7.9 years were included. All had unilateral CLI and peripheral pitting oedema. Leg and foot volume was measured with water displacement volumetry. Blister suction technique was used to collect subcutaneous interstitial fluid. The concentration of albumin, transferin, immunoglobulin G and alpha2-macroglobulin in plasma and blister fluid was measured by immunoturbidimetry. Nine patients, 8 women and 1 man with a mean age of 83 ± 5.5 years with a proximal femur fracture served as an age-matched control group. Results: The mean concentration of albumin in blister fluid was significantly lower in the patients, whereas the mean concentration of alpha2-macroglobulin in blister fluid did not differ between patients and controls. Mean ratio between concentrations in blister and serum of albumin, transferin and immunoglobulin G in the limbs with CLI and oedema were significantly lower than respective values in the control group. However, there was no significant difference in the ratio of alpha2-macroglobulin between these groups. Conclusion: A higher transcapillary concentration gradient for proteins in CLI limbs signifies an increase in the net osmotic pressure gradient across the capillary wall, which may be a potential oedema limiting factor.
Follow-up von Patienten mit persistierender APC-Resistenz ohne Faktor V Leiden
Authors: Schwarz T. , Siegert G. , Mikulin U. , Gehrisch S. , Runge E. , Berg L.P. , Koch R. , Schellong S.M.
Published: January 2006

Background: Activated protein C (APC) resistance and factor V Leiden mutation are major risk factors for deep venous thrombosis. Previous work has led to the view that the coagulation phenotype and the genetic defect are associated in almost all patients. It has been reported about single APC-resistant patients without associated factor V Leiden, but significance and thrombotic risk of this constellation have not yet been established. Patients and methods: We tested 486 consecutive patients with deep venous thrombosis, arterial disease or other than vascular disease for APC-resistance with a factor VIII based assay. Results: 149 patients (31%) showed a pathological APC-ratio. Sensitivity and specificity for detection of factor V Leiden were 100% and 40%, respectively. At 6 months follow-up APC-ratio returned to normal in 55% of the patients with initial pathological APC-resistance. At 12 months follow-up 91% of the patients with persistent APC-resistance showed a pathological ratio as well. Conclusions: Patients with APC-resistance not due to factor V Leiden can be attributed to one subset with reversible APC-resistance – possibly due to a hypercoagulable state in an acute thrombotic situation, and to another with persistent APC-resistance.
Stellenwert der Duplexsonographie der Brachialarterie zur Überwachung von vaskulären Zugängen bei Hämodialysepatienten
Authors: Depairon Michèle , Ferrier C.P. , Tutta P. , Descombes E. , van Melle G. , Wauters J.-P.
Published: January 2006

Background: Vascular access (VA) stenosis with subsequent thrombosis remains one of the major causes of morbidity and hospitalization in haemodialysis patients. The present cross-sectional study was planned in order to analyze the usefulness of brachial artery duplex ultrasound for detection and prediction of vascular access stenoses. Methods: Color duplex ultrasound (Apogée Cx 200, sectorial probe 7.5 MHz) was used to obtain the anatomical pattern of the VA and flow velocity waveforms of the brachial artery in 77 non-selected VA (47 Ciminio-Brescia fistulae and 30 PTFE grafts). In each VA, the resistance index (RI), the mean blood flow rate (Q) and the blood flow ratio index (QI) (QI = VA flow rate/contralateral flow rate) were calculated at the level of the brachial artery. The sensitivity and specificity of these brachial Doppler parameters were calculated for the detection of VA stenosis. In normal VA, positive (PPV) and negative predictive (NPV) values were calculated for the development of clinical stenotic complications 3 months post ultrasound examination. Results: Thirteen of the 77 VA (17%) were identified as stenosed by duplex ultrasound and confirmed by fistulography and/or during surgical exploration. The best screening tests for VA stenosis detection were a QI threshold < 4.0 with a sensitivity and specificity of 69 and 69% and an RI > 0.55 with a sensitivity and specificity of 62 and 66%, respectively. In the VA considered as normal by ultrasound, the prediction of subsequent stenosis within three months post-ultrasound examination gave a PPV of only 18% and 19% for RI and QI, respectively. NPV for RI and QI were 90% and 88%. Conclusions: While Doppler ultrasound is a useful non-invasive test for the detection of prevalent VA stenosis, our results do not confirm that abnormal brachial Doppler flow parameters can predict short term development of VA stenosis.
Gefäßtumore, die eine obliterierende Gefäßkrankheit simulieren
Authors: Schröder Alfred , Peters A. , Larena A. , Meierling S. , Mentzel T. , Katenkamp D. , Imig H.
Published: January 2006

Two cases of vascular tumors of large vessels with intraluminal growth simulating venous thrombosis and arterial occlusive disease are reported. One was a borderline malignant epithelioid hemangioendothelioma of the femoral vein and the other a malignant epithelioid angiosarcoma of the carotid artery. Immuno-histochemical studies permitted to classify the tumors. Treatment consisted in surgical resection. No recurrence and no metastasis are noted at 24 months. Uncertainty regarding biological behaviour of vascular tumors and treatment persists.
Eine bislang nicht beschriebene venöse vakuoläre Myopathie ohne mukoide Degeneration in einer varikösen Vena saphena eines Kindes
Authors: Ersoy Ü , Güvener Murat , Kaplan S. , Özkaya Ö. , Uzunalimoglu B.
Published: January 2006

Varicose vein abnormalities involving the lesser saphenous vein of a 7-year-old boy are presented. The histopathology of the vein wall revealed a vacuolar degeneration without mucoid deposits of the muscle cells, which has not been described previously in the literature in congenital varices.
Recurrent coumarin necrosis in a patient with heterozygous protein S deficiency type II
Authors: Seyfarth Hans-Jürgen , Siegemund A. , Helling L. , Woinke M. , Pfeiffer D. , Rühlmann Ch.
Published: January 2006

Die Cumarinnekrose ist eine seltene, aber klinisch bedeutsame Komplikation der Therapie mit Cumarinderivaten. Wir berichten über einen Patienten, der in der Einstellungsphase auf Phenprocoumon eine Cumarinnekrose erlitt. Als Ursache fand sich ein heterozygoter Protein S-Mangel vom Typ II. Anhand wichtiger Literaturdaten werden diagnostische Probleme und therapeutische Alternativen der Antikoagulation nach Cumarinnekrose diskutiert.
Die unterschiedliche Ausdehnung der Übergangszone in der Karotisgabel
Authors: Janzen J. , Lanzer P. , Rothenberger-Janzen K. , Vuong P.N.
Published: January 2006

Background: The goal of our study was to demonstrate the extension of the transitional zone (TZ) between elastic and muscular medial structure in carotid artery tripod. Patients and methods: A histologic study of 56 probes from 8 carotid artery tripods was performed. The probes were obtained from autopsies of 4 adults (mean age: 47.5 years, range 38 to 55 years) and were taken from 7 different topographic sites. Results: At each level of the CCA (at 1 cm and 2 cm proximal to the bifurcation as well as at the bifurcation) we observed an elastic arterial type in 24 (42.8%) probes with 11 to 20 (medium 15.0) elastic fibers per view field (200 ¥ magnification) in the media. In contrast the histologic structure of the ICA and ECA varied as follows: in 8 sections (14.3%) elastic arterial type with 11 to 16 (medium 13.1) elastic fibers, in 11 sections (19.6%) muscular arterial type with 2 to 5 (medium 3.5) elastic fibers and in 9 sections (16.1%) a transitional arterial type with 6 to 8 (medium 6.7) elastic fibers in the media. Atherosclerotic lesions have prevented the assessment of the arterial type in 4 probes (7.1%). The TZ in the medial structure of carotid artery tripods is exclusively localized in the ICA/ECA but not in the CCA. The ICA/ECA presented a TZ with a length up to 0.5 cm (4 probes; 25%), up to 1.5 cm (4 probes; 25%) and longer than 1.5 cm (6 probes; 37.5%). Conclusions: In this study we confirmed that in the carotid artery tripod, a TZ – an arterial segment with transition from elastic to muscular type – does exist, involving a variable length. Furthermore studies on the impact of the biomechanical properties of the TZ as a potential factor in atherosclerotic disease are justified. In addition, the complex biomechanical behavior of the TZ should be considered prior to interventional procedures.
Perforation von Handschuhen in der Gefäßchirurgie: ein Vergleich zwischen einfachen und doppelten Handschuhen
Authors: Aarnio P. , Laine T.
Published: January 2006

Background: In surgery intact gloves act as a sterile barrier between surgeon and patient. The impermeable gloves protect the surgeon from bloodborne pathogens such as HIV, hepatitis B, and hepatitis C. On the other hand, the surgical wound is protected from micro-organisms from the skin of the surgeon. One objective of this study was to compare puncture rates between the double gloving color indication system and single-use gloves and the other to determine the extent to which glove perforations remain undetected during the course of vascular surgical operations. Patients and methods: The study material comprised all gloves used in vascular surgical operations at Satakunta Central Hospital for a period of two months. The analysis was made by the glove type in a prospective and randomised manner. Gloves were tested immediately after the surgical procedure using the approved standardized water-leak method. With this method the glove is filled with water using a special filling tube, and the water-filled glove is then checked for two minutes to detect any holes. The gloves used in this study were either double gloves with indicator, or the standard glove used at our hospital. Results: In 73 operations altogether 200 gloves were tested, half of them were double gloves and half were single gloves. The perforation occurred in the double gloves 3 times and with single gloves 12 times. The overall perforation rate was 15 out of 200 gloves (7.5%). The detection of perforation during surgery was 60%. Most frequently the perforation was located in the second finger of the left hand, 9 out of 15 perforations. Conclusion: In view of the critical importance of safety at work both transmitting the pathogens from the skin of the surgeon to the wound and transmitting the bloodborne pathogens from the patient to the surgeon, it is very important to use double gloving at least in operations where there is a high risk of glove perforation.
Macroangiopathy in diabetes mellitus
Authors: Birrer Manuela
Published: January 2006

Histologisch und histochemisch gibt es keine Anhaltspunkte für eine «diabetesspezifische» Arteriopathie, so dass man heute davon ausgeht, dass es sich um eine zeitlich vorverlegte, besonders schwere Form der Arteriosklerose handelt. Als pathogenetisch wichtigster Faktor bei der Entstehung der Makro-und insbesondere der Mikroangiopathie beim Diabetes mellitus wird die Hyperglykämie angesehen. Diese scheint einerseits über den Mechanismus einer vermehrten Ansammlung von irreversiblen Glykosylierungs-Endprodukten und andererseits einer Endothel-Dysfunktion einen direkt toxischen Einfluss auf die Gefäßwand zu haben. Die beim Diabetiker häufig auftretenden Fußläsionen sind primär neuropathisch bedingt. Es kann jedoch eine periphere arterielle Verschlusskrankheit (PAVK) assoziiert sein. Diabetiker haben ein bis zu 4-fach erhöhtes Risiko an einer PAVK zu erkranken. In der Regel handelt es sich dabei um einen vorwiegend distalen Befall (krurale Arterien), wo oft ein rekonstruktiver Eingriff erschwert oder gar unmöglich ist. Diabetes mellitus gilt als unabhängiger Risikofaktor, nicht nur für die Entstehung einer koronaren Herzkrankheit, sondern auch für das Auftreten eines Hirnschlages. So haben Diabetiker im Vergleich zu Nichtdiabetiker eine fast 2-fach so hohe Reinfarktrate und das relative Risiko für einen ischämischen Insult ist bis zu 3,7-fach erhöht. Warum dem so ist, und wie ein Diabetiker optimal behandelt werden sollte, wird in diesem Übersichtsartikel eingehend diskutiert. Bis anhin konnte noch nicht eindeutig erwiesen werden, dass eine optimale Blutzucker-Kontrolle das Risiko einer KHK, Hirnschlages oder einer PAVK nachweislich senkt. Jedoch wurde mit einer strengen Blutzuckereinstellung eine Verringerung der mikro-vaskulären Veränderungen erzielt. Eine signifikante Wirkung auf makrovaskuläre Veränderungen blieb jedoch aus. Dennoch empfiehlt sich auf jeden Fall eine strenge Kontrolle der Serum-Glukose.
Thrombangitis obliterans: Subpopulationen der Leukozyten und zirkulierende Immunkomplexe
Authors: Kröger Knut , Kreuzfelder E. , Moser C. , Santosa F. , Buss C. , Grosse-Wilde H.
Published: January 2006

Background: The etiology of thrombangitis obliterans is still unclear. Although cellular infiltration of the vessel wall is known, no studies on peripheral blood mononuclear cells are reported. Therefore, we assessed leucocyte subpopulations and circulating immune complexes in patients with thrombangitis obliterans and a control group of normal people. Patients and methods: 31 patients (40 ± 2 years, 24 male, 7 female) with thrombangitis obliterans were included, based on the following criteria: age of manifestation, acral ischemia in legs and arms, previous thrombophlebitis or phlebitis saltans. Manifestation of atherosclerosis or other vasculitic manifestations were excluded. Leucocyte subpopulations, levels of C-reactive protein (CRP) and circulating immune complexes (CIC) were investigated. An age-matched control group (n = 25) was recruited from voluntary blood donors. Results: Leucocyte counts in the thrombangitis group (mean ± SD: 10839 ± 782/nl) were significantly different from the control group (6205 ± 414/nl, p < 0.0001). The same was true for absolute counts of granulocytes, monocytes and lymphocytes. The results were independent from CRP, which was elevated only in 6 patients. Relative counts of naive helper T-cells were significantly lower in the patient group. HLA-DR expression on B-cells was lower on the patients’ lymphocytes. The concentrations of IgA, IgG and IgM in CIC were higher in the thrombangitis patients compared to the control group. C1q-binding capacity and phosphatidylserine antibodies showed no differences. Conclusions: Patients suffering from thrombangitis obliterans show alterations of leucocyte counts and their subpopulations as well as alterations of the humoral (IgCIC) immune system.
Therapie der tiefen Venenthrombose mit niedermolekularem Heparin, Beinkompression und sofortigem Gehen
Authors: Partsch H.
Published: January 2006

Background: Traditionally, patients with acute deep vein thrombosis (DVT) are treated with strict bed rest for several days to avoid clots from breaking off and causing pulmonary emboli. The purpose of this study is to give a precise estimate of short term complications like pulmonary embolism, bleeding, heparin-induced thrombocytopenia (HIT) and death in a cohort of consecutive patients who were admitted because of acute symptomatic DVT, all treated by compression and walking exercises instead of conventional bed-rest and nearly all by low-molecular-weight heparin. Patients and methods: In 1289 consecutive patients the following five endpoints were registered for the period of hospital-stay: 1. Frequency of pulmonary embolism (PE ) at admission (V/Q lung scan), 2. Frequency of new PE’s after 10 days (second lung scan), 3. Fatal events (autopsy), 4. Frequency of malignant disease, 5. Bleeding complications and HIT. Results: 1. 190/356 (53.4% of iliofemoral, 355/675 (52.6%) of femoral and 84/239 (35.1%) of lower leg vein thrombosis showed PE (difference iliofemoral and femoral versus lower leg DVT p < 0.001). Two thirds of these PE were asymptomatic. 2. New PE after 10 days in comparison to the baseline scan occurred in 7.4%, 6.4% and 3.4% respectively. 3. Fatal events, all investigated by autopsy, were caused by PE in 3 patients aged over 76 years (0.23%), by malignant diseases in 12 (0.9%) and due to other causes in 2 (0.15%). 4. 232 patients (18%) had associated malignant diseases, from which 33% were detected by our screening. 5. Non-fatal bleeding complications were seen in 3.3%, including 5 patients (0.4%) with major bleeding. Three patients (0,2%) suffered from HIT II. Conclusion: The low incidence of recurrent and fatal pulmonary emboli in this series affirms the value of early ambulation with heavy leg compression in patients with symptomatic acute leg deep venous thrombosis. In addition, the presence of pulmonary emboli in one-third of those with calf vein thrombi emphasizes the importance of fully diagnosing and treating calf clots.
Transcatheter embolization of a superior gluteal pseudoaneurysm
Authors: Moll R. , Franke S. , Schindler G.
Published: January 2006

Während die operative Behandlung eines Aneurysma der Glutealarterien von chirurgischer Seite einen transglutealen und einen retroperitonealen Zugang erfordert, ist die radiologische Behandlung nur wenig invasiv. Sie erfolgt über einen von kontralateral eingeführten Katheter mit der Möglichkeit der Embolisation mit flüssigen und festen Partikeln oder Spiralen. Die Erfolgsrate ist hoch, die Komplikationsrate gering und der Krankenhausaufenthalt kurz. Beide Behandlungsmöglichkeiten können auch ergänzend eingesetzt werden. Im Falle einer schwer zu beherrschenden, akuten Blutung sollte der radiologischen Intervention die erste Priorität eingeräumt werden.
Compression of the posterior circumflex humeral artery in a volleyball player
Authors: Stänz K. , Wedler Volker , Köpfli P. , Künzi W. , Pfammatter T.
Published: January 2006

Das Kompressionssyndrom der A. circumflexa humeri posterior ist eine seltene Differentialdiagnose des Thoracic outlet- und des Hypothenar-Hammer-Syndroms. Die Diagnose setzt eine gründliche Anamnese und eine regelrecht durchgeführte transfemorale Armarteriographie voraus. Wir berichten über einen betroffenen Volleyballspieler, den möglichen Pathomechanismus, der zu diesem Krankheitsbild führt, und die aktuelle Literatur.
Spiral-CT Angiographie vor endovaskulärer Versorgung bei Patienten mit rupturiertem aortoiliakalem Aneurysma
Authors: Willmann J.-K. , Lachat Mario L. , v. Smekal A. , Turina M. I. , Pfammatter T.
Published: January 2006

Background: To evaluate spiral computed tomography (SCT) angiography for assessment of feasibility of endovascular aneurysm repair (EVAR) in patients with ruptured aortoiliac aneurysm (AAA). Patients and methods: 24 patients (mean age 74 years; range, 69 to 82 years) with suspicion of ruptured AAA and stable hemodynamics were preoperatively examined by using a SCT scanner in the emergency room. SCT angiography was performed from the suprarenal aorta to the femoral bifurcation after a fixed injection delay time of 30 seconds. After that a venous phase SCT scan, beginning at the last image position and ending at the upper thoracic aperture, was performed. Results: The mean acquisition time of the SCT scan was 80 seconds (range 70 to 100 seconds), the mean overall procedure time, including image reconstruction, 5 minutes (range, 4 to 6 minutes). 2D images were directly evaluated during CT data acquisition, and 3D image reconstructions within 10 minutes (range, 8 to 11 minutes) after the SCT scan. AAA rupture was assessed in 14/24 patients (58%): in 10/14 patients (71%) rupture was contained to the retroperitoneum, and in 4/14 patients (29%) intraperitoneal rupture was observed. Successful EVAR was performed in 6/14 patients (43%) with ruptured AAA, and in 8/10 patients (80%) without ruptured AAA. Open surgery was exclusively performed in 6/24 patients (25%) with inappropriate anatomy for EVAR and in 4/24 patients (17%) with intraperitoneal rupture. Conclusions: Spiral computed tomography angiography is a reliable technique to assess feasibility of endovascular aneurysm repair in patients with ruptured aortic aneurysm. However, it can only be recommended for patients with stable hemodynamics, despite of the short acquisition time.
Akute Nebennierenrindeninsuffizienz als Folge einer heparin-induzierten Thrombozytopenie mit bilateralem hämorrhagischem Nebenniereninfarkt
Authors: Weyrich P. , Balletshofer B. , Hoeft S. , Häring Hans-Ulrich , Nawroth P. P.
Published: January 2006

A 56 year old male developed bilateral massive adrenal haemorrhage (BMAH) resulting in chronic adrenal insufficiency in the course of heparin-induced thrombocytopenia (HIT)-syndrome. Thrombosis of the central adrenal vein (CAV) with subsequent adrenal haemorrhagic infarction is the most probable cause of the rare association of HIT and BMAH. The exorbitantly high catecholamine plasma levels within the CAV in addition to immunogenic platelet activation are discussed as possible underlying pathophysiological mechanisms.
Mondor’s disease in association with hepatitis C
Authors: Holle-Robatsch Sylvia , Fink A. M. , Schubert C. , Steiner A. , Partsch H.
Published: January 2006

Wir berichten von einer 40-jährigen Patientin mit Mondorphlebitis, die zur Durchuntersuchung stationär aufgenommen war. Es konnte kein Zusammenhang mit einem Malignom oder einer erhöhten Gerinnungsbereitschaft gezeigt werden. Allerdings ist dieser Fall besonders wegen seiner Assoziation mit Hepatitis C interessant.
The fate of the ischaemic limb in diabetes: it is neuropathy that makes the difference
Authors: Chantelau
Published: January 2006

Evidence is presented of the deleterious effects of sensory and autonomic polyneuropathy on coexisting peripheral arterial occlusive disease (PAOD) in diabetes mellitus. Autonomic neuropathy triggers medial arterial calcification in the lower leg, which affects arterial haemodynamics, and aggravates preexisting PAOD. Calcificated arteries are incompressible and give false blood pressure readings by sphygmomanometry, with subsequent underestimation of PAOD. Sensory neuropathy leads to loss of protective pain sensation, and precludes the timely diagnosis and treatment of limb ischaemia (no claudication, no rest pain). Absent pain perception is also critical for the outcome of surgical interventions, as wound infections and other complications will occur unnoticed. These features have consequences for the detection of high-risk patients, and for the safety of surgery as well.
Decreasing incidence of major amputations in people with diabetes
Authors: Holstein  , Ellitsgaard  , Bornefeldt Olsen  , Ellitsgaard
Published: January 2006

Aims/hypothesis. To assess the results of the strategy used in avoiding major amputations in patients with diabetes mellitus. Methods. A retrospective study for the years 1981 to 1995 in a central district hospital in Copenhagen with a catchment area population of about 178000. Results. There were 463 major leg amputations and the incidence decreased from 27.2 to 6.9/100000 population (minus 75%). The decrease in patients with Type I diabetes mellitus was from 10.0 to 4.1 (minus 59%) and in Type II diabetes mellitus from 17.2 to 2.8/100000 people (minus 84% ). Analysis showed that the diabetic population remained constant despite a considerable fall in the number of older people. During the study period infra-popliteal arterial bypass was introduced for the treatment of critical lower limb ischaemia and in diabetic patients the number of bypasses increased from 0 to 13/100000 population. The total number of revascularisation procedures in people with diabetes increased from 2.6 to 19.2/100000 population. Moreover, a multidisciplinary diabetic foot clinic was established. Conclusion/interpretation. A 75% reduction in the incidence of major amputations coincided with a sevenfold increase in revascularization procedures and the establishment of a multidisciplinary diabetic foot clinic suggesting these measures are important in the prevention of diabetic leg amputations.
Treatment strategy in diabetic patients with deep foot infection: the situation in Moscow 2000
Authors: Mitish  , Svetuchin  , Galstyan
Published: January 2006

The paper reports on surgical strategies to treat the diabetic foot syndrome at the Vishnevsky Institute , and presents preliminary data on the effectiveness of a diabetic foot clinic at the Russian National Centre for Endocrinology. The potential impact of both institutions on a rising amputation rate in the city of Moscow is emphasized.
Does oral anticoagulation improve femoropedal graft patency in diabetic patients? Lessons from the Dutch BOA Study
Authors: Chantelau
Published: January 2006

Graft patency rates after arterial reconstruction benefit from aspirin treatment. The Dutch Bypass Oral anticoagulant or Aspirin (BOA) Study, a randomized controlled trial, compared the use of oral anticoagulants (e.g. phenprocoumon) versus aspirin in a large sample of patients after infrainguinal arterial bypass surgery. Graft occlusion was the primary endpoint. A total of 2650 bypasses were performed, 531 of which were femorocrural or femoropedal grafts. Of the latter, 194 (37%) were carried out in the subgroup of 700 diabetic patients (i.e. 26% of the total study population). There was no significant difference in patency rates of these particular grafts with either drug. Hence, aspirin 100 mg/day is as effective as oral anticoagulation to benefit patency rates in femorocrural and femoropedal bypass grafts, irrespective of the diabetic status of the patients. Aspirin is sufficient, and oral anticoagulation is not required for this particular type of reconstruction.
Reduction of major amputations in the diabetic ischaemic foot: A strategy to "take control" with conservative care as well as revascularisation
Authors: Edmonds  , Foster
Published: January 2006

The diabetic ischaemic foot has become an increasingly frequent problem over the last decade. However, we report a new approach consisting of a basic classification, a simple staging system of the natural history and a treatment plan for each stage, within a multi-disciplinary framework. This approach of "taking control" consists of two parts: 1. long-term conservative care including debridement of ulcers (to obtain wound control), eradication of sepsis (micribiological control), and provision of therapeutic footwear (mechanical control), and 2. revascularisation by angioplasty and arterial bypass (vascular control). This approach has led to a 50% reduction in the rate of major amputations in patients attending with ischaemic ulceration and absent foot pulses from 1989 to 1999 (from 4.6% to 2.3% per year). Patients who underwent angioplasty increased from 6% to 13%. Arterial bypass similarly increased from 3% to 7% of cases. However, even with an increased rate of revascularisation, 80% of patients responded to conservative care alone. This,we conclude, is an essential part of the management of all patients with ischaemic feet.
Effekte eines körperlichen Trainings auf funktionelle Kapazität und Lebensqualität bei Patienten mit Claudicatio intermittens
Authors: Gartenmann  , Kirchberger  , Herzig  , Baumgartner  , Saner  , Mahler  , Meyer
Published: January 2006

Background: In patients with peripheral arterial occlusive disease (PAOD) stage II, exercise training seems to be important to reduce symptoms and improve functional capacity. We evaluated the effects of an outpatient treatment program on walking distance (standardized treadmill testing), training exercise capacity, and disease specific quality of life (PAVK-86 questionnaire). Methods and results: Thirty-one patients aged 70 ± 2 with intermittent claudicatio in stage IIa/IIb according to Fontaine (n = 18/13) underwent a supervised 12 week exercise training and education outpatient program. During course of intervention, patients demonstrated improvements in pain-free training walking distance (p<0.001) and repetitions of tiptoe standing (p < 0.05). In standardized treadmill testing, pain-free walking distance was improved by 182% (129 ± 19 m → 364 ± 53 m; p < 0.001), and maximum walking distance by 76% (311 ± 42 m → 546 ± 63 m; p < 0.01). Before training, mean subscale scores of the PAVK-86 demonstrated distinct impairments concerning pain and functional status. After 12 weeks of intervention, with exception of the subscale complaints, all dimensions of quality of life assessed have improved significantly. The highest effect size was observed for the subscales pain, mood, and functional status. Improvement in the subscale anxiety and pain-free walking distance (treadmill test) correlated significantly (r = 0.46) as well as improvement in the subscale mood and maximum walking distance (r = 0.45). Conclusion: In patients with PAOD stage II considerable effects on functional capacity and important dimensions of quality of life can be achieved by a short exercise and education program.
Chirurgische Behandlung von Protheseninfektionen; vergleichende retrospektive Analyse von 30 Fällen
Authors: Gassel  , Klein  , Steger  , Kellersmann  , Hamelmann  , Franke  , Thiede
Published: January 2006

Background: Graft infection after vascular prosthetic reconstruction for the treatment of peripheral arterial occlusive disease (PAOD) is a rare but severe complication with poor outcome. The options for surgical treatment are not uniformly accepted and remain controversial. Patients and methods: We retrospectively analyzed the histories of 30 patients treated for prosthetic graft infection (Szilagyi grade III) in our hospital between 1994 and 1999 to determine which forms of treatment were best suited for which types of patient. In the majority of cases the initial treatment was lower-extremity bypass surgery. The most frequent location of infection was the groin (73%). Staphylococci (13% of which were methicillin resistant) were the most common type of bacteria. The overall incidence of prosthetic infection was 2.3%. Results: After confirmation of the infection by computed tomography (CT) or white blood cell scintigraphy, one of the following 5 forms of surgical treatment was performed: 1. Removal of the infected prosthesis and its simultaneous replacement by an autologous vein bypass. 2. Bypass removal and secondary replacement by an autologous vein. 3. Extra-anatomical replacement. 4. Graft removal and primary amputation. 5. Local therapy with debridement and secondary wound healing. In some patients primary amputation after graft infection was necessary to prevent further deterioration with fulminant sepsis. The overall mortality was 17%, the amputation rate was 60%. Conclusions: The best results were achieved by early complete removal of the alloplastic material and one-step replacement by either an autologous vein or extra-anatomic bypass. This resulted in a limb salvage rate of 54% and 40% and mortality rates of 9% and 0%, respectively.
Acute limb ischemia in a drug addict
Authors: Schulz  , Aksü  , Igde  , Hengstmann
Published: January 2006

Zwei Stunden nach Injektion von aufgelösten Flunitrazepam-Tabletten in die linke Leiste kommt ein 39-jähriger Mann mit rasch zunehmenden Schmerzenim gesamten linken Bein zur Aufnahme. Es besteht ein langjähriger i.v. Drogenabusus. Das linke Bein ist massiv livide marmoriert, deutlich kühler als das rechte und paretisch. Die Hautverfärbung setzt sich über das Leistenband fort in den Bereich des linken Unterbauches bis zur Flanke. Die Fußpulse sind schwach tastbar. Farbduplex-sonographisch zeigt sich an den Bauch-, Becken- und Beinarterien guter Fluß mit unauffälligen Frequenzspektren bis ganz distal und eine bekannte teilrekanalisierte Thrombose der Beinvenen. Im EKG findet sich ein Sinusrhythmus. Echokardiographisch ist keine Emboliequelle nachweisbar. Bei den Laborwerten fällt initial lediglich eine Anämie mit einem Hb von 9,6 g/dl (nomozytär, normochrom) auf. Da von einer toxischen Gefäßschädigung nach intraarterieller Injektion auszugehen ist, erhält der Patient neben Analgetika Cortison, eine systemische Antikoagulation und Calciumantagonisten. Unter dieser Therapie ist das Bein nach zwei Tagen wieder normal warm. Die Parese bíldet sich zurück und nach 7 Tagen sind auch die Hautverfärbungen an Bauch und Bein kaum mehr nachweisbar. Nur die Zehen bleiben in unterschiedlichem Ausmaß livide. Im Verlauf kommt es vom 2.–10. Tag zu den Zeichen einer Rhabdomyolyse, wobei insbesondere der Unterschenkel betroffen ist. Schließlich demarkieren sich einige Zehen und es muß nach 6 Wochen eine Grenzzonenamputation erfolgen. Die Injektion von Drogen in die Leistenarterien kann zum klinischen Bild eines akuten arteriellen Verschlusses führen, ohne dass an den großen Arterien Flussbehinderungen nachweisbar wären. Benzodiazepine scheinen besonders ausgeprägte Schädigungen hervorzurufen, insbesondere wenn aufgelöste Tabletten injiziert werden. Eine umgehende farbduplexsonographische Untersuchung verhindert in solchen Fällen eine ineffektive gefäßchirurgische Intervention.
Acute occlusion of digital arteries due to a sport injury
Authors: Pöhlmann  , Bär  , Siegmund  , Eidner  , Figulla
Published: January 2006

In unserer Notaufnahme stellte sich eine 33-jährige Patientin mit schwersten Durchblutungsstörungen der Finger I und II der rechten Hand vor. Die Patientin gab an, vor zehn Tagen während eines Volleyballspiel die rechte Hand beim Ballaufschlag hyperretroflektiert zu haben. Vier Tage später kam es relativ plötzlich zu Weißfärbung aller, insbesondere des 1. und 2. Fingers rechts, Sensibilitätsstörungen und heftigsten Schmerzen sowie circumscripten palmaren Ischämiearealen. Letztere waren bei Aufnahme in unserer Klinik nicht mehr vorhanden. Die initiale Dopplerdruckmessung zeigte am ersten und zweiten Finger peripher keine Signale. Initial erhielt die Patientin 500 mg ASS als Bolusinjektion und eine «Vollheparinisierung» mit LMWH in gewichtsadaptierter therapeutischer Dosis. Wegen des engen Zeitfensters seit Auftreten der Beschwerden und dem Zeitpunkt der Hospitalisation entschlossen wir uns zur Durchführung einer retrograden i.v. Perfusion mit dem Ziel einer intraarteriellen Lyse. Drei Tage nach dieser Therapie waren annähernd normale Druckwerte an den Fingerspitzen ableitbar. Begleitende therapeutische Maßnahmen waren tägliche Prostaglandininfusionen. Innerhalb einer 7-tägigen Behandlung konnte ein Gewebsuntergang verhindert werden. Zum Behandlungsabschluss war lediglich am Endglied Dig. II die Epithelschicht mit Tendenz zur Desquamation leicht erhaben.
Eine seltene Ursache einer arteriellen Embolie: Ruptur einer kardialen Echinokokkenzyste
Authors: Ceyran  , Tasdemir  , Tezcaner  , Asgun  , Karahan  , Emirogullar>=  , Andac
Published: January 2006

One of the important unfavorable events that occur during the course of the cardiac hydatid cyst is rupture of the cyst and embolism of the germinative membrane. Peripheral arterial embolism of this germinative membrane is uncommon but is a potential risk due to the nature of the disease. Ruptured cardiac hydatid cyst should be suspected in young patients who have a peripheral arterial embolism and come from sheep-raising areas and/or if they have a suspected embolectomy material resembling germinative membrane. Following the embolectomy and reconstruction of the circulation in the involved extremity, ruptured cardiac hydatid cyst should be diagnosed immediately and excision of the cardiac cyst should be performed as quickly as possible. In this case report, we present two patients who had lower extremity embolism originating from the ruptured cardiac hydatid cyst and were operated on for cardiac cyst excision.
Successfull reoperation of a ruptured aortic arch aneurysm in a patient with takayasu’s disease
Authors: Wöhleke  , Martens  , Doss  , Wimmer-Greinecker  , Moritz
Published: January 2006

Die Takayasu-Erkrankung ist eine entzündliche Arteriopathie, die mit Stenosen oder aneurysmatischen Erweiterungen vornehmlich im Bereich des Aortenbogens einhergeht. Hierbei sind Aneurysmata in der Aorta ascendens eher selten. Wir beschreiben den Fall einer 33-jährigen Patientin mit einem rupturierten Aneurysma der Aorta ascendens, das durch eine vorangegangene truncobicarotidale Bypassoperation sowie durch massiv grobschollige Verkalkungen kompliziert war. Die Patientin konnte nach Ascendens- und komplettem Aortenbogenersatz in tiefer Hypothermie und Kreislaufstillstand ohne Komplikationen am 11. postoperativen Tag entlassen werden.
Frühzeitige Ruptur der proximalen Anastomose eines axillofemoralen PTFE Bypasses
Authors: Arvanitis  , Georgopoulos  , Dervisis  , Xanthopoulos  , Lazarides
Published: January 2006

Exertional disruption of axillary anastomosis is a well documented, although rare, complication of axillofemoral grafts. Comprehension of causative mechanisms is of great importance, so that precautions can be taken against it. Here, a case of an early disruption of proximal anastomosis of an axillofemoral graft is reported. Use of crutches was incriminated as the responsible mechanism.
Physiology and pathophysiology of the vascular endothelin system: clinical implications
Authors: Wagner  , Wieczorek  , Plug  , Kruse
Published: January 2006

Das vom vaskulären Endothel gebildete Polypeptid Endothelin-1 ist einer der stärksten endogenen Vasokonstriktoren. Die biologischen Wirkungen des Endothelin-1 auf vaskuläre und nicht-vaskuläre Zellen werden über spezifische Rezeptoren vermittelt. Über den vasokonstriktorischen Effekt auf glatte Gefäßmuskelzellen hinaus weist Endothelin-1 mitogene und pro-inflammatorische Eigenschaften auf, wegen derer dem Peptid eine pathogenetische Rolle bei einer Reihe kardiovaskulärer Erkrankungen mit entzündlicher Komponente zugeschrieben wird. Die vorliegende Übersichtsarbeit geht ein auf die aktuelle wissenschaftliche Datenlage unter besonderer Berücksichtigung der möglichen klinischen Relevanz des Endothelinsystems für diese Erkrankungen und diskutiert therapeutische Perspektiven einer Anti-Endothelin Strategie.