bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanisms of anti-ischemic action of prostaglandin E1 in peripheral arterial occlusive disease
Authors: Schrör  , Hohlfeld
Published: January 2006

The mechanisms of anti-ischemic effects of PGE1 in patients with peripheral arterial occlusive disease (PAD) are probably complex and clearly not limited to a direct vasodilator action. In addition to the known effects on blood flow, viscosity, fibrinolysis and platelet aggregation, the compound also inhibits monocyte and neutrophil function, suggesting that PGE1 will also have anti-inflammatory effects. Recent research has detected additional actions of PGE1 and prostacyclin analogs which might be relevant to its clinical efficacy. This includes inhibition of expression of adhesion molecules (E-selectin, ICAM-1, and VCAM-1), release of inflammatory cytokines (TNFalpha, MCP-1), matrix components and generation and release of growth factors (CYR61, CTGF). These actions may also contribute to the long-term effects of PGE1, particularly in more advanced stages of PAD. Gene-expression experiments with chemically stable prostacyclins and PGE1 suggest that several genes in vascular smooth muscle cells and fibroblasts are modified by prostaglandins at the transcriptional level. This includes TNFalpha-induced VCAM expression in vascular smooth muscle cells which appears to be inhibited via the prostaglandin EP2 receptor as well as IL-1-induced expression of the type-I collagen gene in fibroblasts. Thus, regulation of gene transcription by PGE1 may contribute to tissue protection in critical ischemia of the lower limbs.
Effects of intravenous prostaglandin E1 on arterial compliance: a randomized controlled trial
Authors: Mlekusch  , Schillinger  , Sabeti  , Al-Awami  , Gschwandtner  , Minar
Published: January 2006

Background: Prostanoids are in widespread use for the treatment of critical limb ischemia and are suggested to improve arterial compliance. However, dose- and time-dependency of these drug effects are indeterminate. We investigated the influence of intravenous application of prostanoids on arterial compliance parameters in patients with critical limb ischemia due to peripheral artery disease (PAD). Patients and methods: We included 82 consecutive patients with PAD Fontaine stage III and IV in a patient-blinded, randomized controlled trial. Patients were randomly assigned to either single dose intravenous treatment with 40 mug (n = 29) or 60 mug (n = 27) of Alprostadil (PGE1) in 250 ml 0.9% saline over 2 hours, or 250 ml 0.9% saline solution as a placebo group (n = 26). Large and small artery compliance was measured by peripheral pulse contour analysis at baseline, at one hour during intravenous infusion of Alprostadil, immediately after and 24 hours after the end of the infusion. For study purpose the patients received Alprostadil only once during the observation period of 2 days. Results: Large artery compliance, blood pressure, heart rate and cardiac output were unaffected by PGE1 administration irrespectively of drug-dosage or time interval. Small artery compliance increased at 1 hour during intravenous application of Alprostadil (40 mug Alprostadil p = 0.001; 60 mug Alprostadil p < 0.0001) compared to placebo and increased median +47% (IQR +5% to +100%) after administration of 40 mug Alprostadil and median +32% (IQR –11% to +88%) after 60 mug Alprostadil (p = 0.5). Immediately after the end of Alprostadil infusion small artery compliance decreased to baseline levels. Conclusions: Prostaglandin E1 causes a significant improvement of small artery compliance during the time of intravenous application. However, this effect rapidly diminishes after the end of administration and no dose-dependency between 40 mug and 60 mug Alprostadil is observed.
Meta-analysis of randomised controlled prostaglandin E1 studies in peripheral arterial occlusive disease stages III and IV
Authors: Creutzig  , Lehmacher  , Elze
Published: January 2006

Background: The relevance of Prostaglandin E1 (PGE1) in the treatment of peripheral arterial occlusive disease stage III and IV was to be evaluated for the first time by a meta-analysis. Patients and methods: Altogether, 643 patients were analyzed from seven randomized, controlled PGE1 studies that were comparable with regard to patient selection, study design and endpoints. Of these, only placebo-controlled studies (n = 254) were included in the formal meta-analysis using the method of DerSimonian and Laird. Additionally, the response rate and the rate of adverse events were determined for the pooled groups of all studies. Results: At the end of treatment, PGE1 showed a significantly better response (ulcer healing and/or pain reduction) as compared to placebo (47.8% for PGE1 vs. 25.2% for placebo, p = 0.0294). A significant difference in favor of PGE1 was also seen for the combined endpoint “major amputation or death” after 6-month follow-up (22.6% for PGE1 vs. 36.2% for placebo, p = 0.0150). The response rate (ulcer healing and/or pain relief) of the pooled treatment groups was 60.2% for PGE1, 25.2% for placebo, and 53.6% for iloprost. The adverse events rate of the pooled treatment groups showed good tolerability for PGE1 with a rate of 39.6% in comparison to 73.9% for iloprost and 15.4% for placebo. Conclusion: For patients with peripheral arterial occlusive disease stage III or IV not eligible for arterial reconstruction, PGE1 therapy not only has significant beneficial effects over placebo on ulcer healing and pain relief, but also increases the rate of patients surviving with both legs after 6-months follow-up.
Frequency of non-vascular accompanying diseases in patients with peripheral arterial disease
Authors: Heidrich
Published: January 2006

Background: Since there are so far no relevant figures on the frequency of non-vascular associated diseases in patients with peripheral arterial disease (PAD), an analysis was carried out to determine how frequently co-morbidity is found in such patients. Patients and methods: In the course of a retrospective analysis, 1693 patients (55.4% men, 44.6% women/average 68.6 years) with peripheral arterial diseases (PAD) of Fontaine stage II to IV were examined to find out how often cardiopulmonary, gastrointestinal, haematological, endocrinological, neurological, orthopaedic, urological-nephrological, psychiatric diseases and tumours were seen. Result: Coronary ischaemic heart disease was present in 63.1% of the cases, heart failure existed in 20.7%, hypertension in 57.9%, endocrine and metabolic diseases in 60.4%, gastrointestinal diseases in 14.8%, pulmonary diseases in 14.5%, psychological and behavioural deficiencies in 16.2%, orthopaedic diseases in 21.6%, haematological diseases in 9.0%, urological diseases in 16.9%, chronic renal insufficiency in 7.3% and malignant tumours in 5.8%. Conclusions: The frequency of non-vascular co-morbidity in patients with PAD necessitates systematic interdisciplinary diagnosis prior to any therapy decision to take into account the patient’s associated diseases, life expectancy and current quality of life.
Incidence of varicose veins in Finland
Authors: Mäkivaara  , Jukkola  , Sisto  , Luukkaala  , Hakama  , Laurikka
Published: January 2006

Background: Incidence of varicose veins in the population is unknown. The study aimed at estimating the incidence of varicose veins in complete cohorts of 40–60 year-olds in a general population. Patients and methods: The study was conducted in the city of Tampere, Finland. A validated questionnaire (with 93% sensitivity and 92% specificity) was used in a general population of 6874 individuals (aged 40, 50 or 60). Initially, 3065 of them had no varicose veins and 78% were followed-up for 5 years. Results: 157 individuals reported new varicose veins during the follow-up. The overall incidence was 13.5 per 1000 person years (8.5 for men and 19.2 for women). Female sex was an independent and statistically significant risk indicator of varicose veins (adjusted odds ratio, OR 2.4). The incidence was significantly higher at the age of 50–55 years (OR 1.6). Higher body mass index seemed to be related to higher risk of new varicose veins (OR 1.2–1.8), but the association failed to reach statistical significance. The level of education did not affect the incidence. Conclusions: New varicose veins appear also in the middle-aged population, and the rate is linked with the female gender, especially at the beginning of the 6th decade.
Species-dependent premature degradation of absorbable suture materials caused by infection – Impact on the choice of thread in vascular surgery
Authors: Larena-Avellaneda  , Debus  , Diener  , Dietz  , Franke  , Thiede
Published: January 2006

Background: In case of infection after vascular reconstruction, preference is often given to absorbable suture material with the aim of preventing persistence of infection. We have investigated the functional deficit of absorbable sutures on incubation with various different bacteria. Material and methods: Four suture materials – Dexon bicolor®, Vicryl®, Maxon® and PDS II® – were placed in contact with reference bacterial cultures (Staphylococcus aureus, Pseudomonas aeroginosa, E. coli, coagulase-negative staphylococci and Proteus mirabilis). The bacteria were incubated for 7 days at 37°C, together with the suture material. A logarithmic phase (Group A) and a static phase (Group B) were simulated. The linear tensile strength (LTS) of the suture material was measured (Instron Tensiometer). Results: In the case of Staphylococcus aureus, a significant decrease in LTS was established for Dexon bicolor® (group A: 31%, group B: 22%), and Vicryl® (53% and 43%), but not for the monofilament threads. With regard to the other bacteria, a considerably more dramatic effect was observed: in both groups the braided sutures had completely disintegrated after 7 days. The monofilament sutures also revealed a significant loss of function (Maxon®: 88%, PDS II® 66%). Conclusions: The absorbable sutures revealed a premature, species-dependent loss of function due to the presence of the bacteria. On the basis of our results, the use of absorbable threads for vessel sutures in case of infection cannot be recommended, with the exception of monofilament material in a monocultural Staphylococcus aureus infection.
Epidemiology of peripheral arterial disease
Authors: Diehm  , Kareem  , Lawall
Published: January 2006

Peripheral arterial disease (PAD) is not an uncommon but a commonly neglected condition by many medical practitioners. It is a disease that threatens not only the limb but also life itself! Atherosclerosis is the commonest cause of PAD in the western nations. The cardinal symptom is intermittent claudication (IC) but majority of the patients are asymptomatic. Ankle-brachial pressure index (ABI) is an effective screening tool for PAD. A diminished ABI (< 0.9) is a definite sign of PAD. Its prevalence steadily increases with age. In Germany almost a fifth of the patients aged over 65 years suffer from it. With increasing life expectancy the prevalence of PAD is on the increase. PAD is a manifestation of diffuse and severe atherosclerosis. It is a strong marker of cardiovascular disease; a very strong association exists between PAD and other atherosclerotic disorders such as coronary artery disease (CAD) and cerebrovascular disease (CVD). PAD is an independent predictor of high mortality in patients with CAD. Smoking, diabetes mellitus and advancing age are the cardinal risk factors. A relatively small number of PAD patients lose limbs by amputation. Most patients with PAD die of either heart attacks or strokes and they die of the former conditions far earlier than controls. PAD still remains an esoteric disease and there is a significant lack of awareness of this condition by many physicians, and therefore under-diagnosed and underestimated. Measures to promote awareness of PAD among physicians and the society in general are needed. Since most patients are asymptomatic and carry potentially significant morbidity and mortality risks, screening for PAD should be made a routine practice at primary care level.
The influence of oxidative stress on permeability of capillary vessels in the cheek pouch of hamsters with alloxan-induced diabetes
Authors: Ciechanowski  , Kedzierska  , Golembiewska  , Miklaszewicz  , Domanski  , Bober  , Dutkiewicz
Published: January 2006

Background: The aim of the study was to assess the influence of oxidative stress on the increase of permeability of capillary vessels in animals with alloxan-induced diabetes. Material and methods: The studies were performed in microcirculation system of hamster cheek pouch. After the blockade of histamine receptors and administration of diamine oxidase (DAO) and histamine into circulation fluorescein angiography was done. In addition, the influence of superoxide dismutase, aminoguanidine (DAO inhibitor) and trascolan (protease inhibitor) on vascular permeability caused by superoxide radical generation in DAO/histamine system was assessed. Results: The number of extravasal leakages in the group receiving HA and DAO was significantly higher (p < 0.001) than in the groups receiving potential vascular "sealers", e.g. SOD, aminoguanidine or trascolan. In the group receiving aminoguanidine the number of leakages was significantly lower (p < 0.05) compared to the group receiving SOD or trascolan. Conclusions: The protective effect of aminoguanidine, superoxide dismutase or trascolan decreasing the vascular permeability, suggests that the increased vascular permeability is a result of superoxide radical generation by diamine oxidase.
Renal artery surgery in the era of endovascular intervention
Authors: Senekowitsch  , Assadian  , Wlk  , Assadian  , Ptakovsky  , Hagmüller
Published: January 2006

Background: In the last decade the therapeutic concept of renovascular disease has changed. The numbers of primary surgical revascularisations have fallen substantially due to the invention of percutaneous transluminal angioplasty (PTA). Patients and methods: Retrospective data analysis. From September 1992 to December 2001, 42 patients were operated on 49 renal arteries at our institution. During the same period, 166 PTA of renal arteries alone and 92 PTA with stent were performed. Twenty-five patients and 27 renal arteries were operated encompassing an aortic reconstruction due to atherosclerosis (aortic occlusion 14, aortic aneurysm 11). The median age at operation was 61 years (range 47 years to 76 years). Four patients were operated on because of renal artery aneurysms with a diameter of more than 2.5 cm. The median age of these patients was 68.5 years (range 60 years to 77 years). Seven patients presented with atherosclerotic changes of the renal artery without aorto-iliac involvement. Their median age was 62.8 years at operation (range 39 years to 77 years). Of these, one suffered from rupture of the renal artery during PTA and needed emergency surgery. Six patients and 11 renal arteries with FMD were surgically reconstructed. Results: The primary patency rate of all reconstructed renal arteries of surviving patients after 5 years was 92%, the secondary patency rate after 5 years was 98%. Two patients died perioperatively (4.7%). One patient had presented with a symptomatic thoraco-abdominal aneurysm and died ultimately because of a stroke. The second patient had an infrarenal AAA and died after a myocardial infarction. Twenty (47.7%) of all surgically treated patients had had at least one PTA preoperatively. Conclusion: During the last decade, primary surgical renal artery reconstruction was performed in about half of the cases. The decrease of primary open surgery of the renal arteries was most striking in patients with aorto-iliac occlusive disease. From 1996 on no patient of this group underwent open surgery without having had prior PTA of the renal arteries.
The brachial artery as approach for catheter interventions – indications, results, complications
Authors: Basche  , Eger  , Aschenbach
Published: January 2006

Background: Evaluation of the technical practicability of the acute results and complications with transbrachial catheter interventions. Patients and methods: Retrospective investigation of 156 catheter interventions with 147 patients within the period of 4/2000 to 12/2003. Target vessel, technical success, complications and in- or out-patient' practicability received special consideration. Results: The intervention was technically successful in 94%, 10 times segment obliterations of the distal femoral artery could not be recanalised. Renal arteries and mesenteric arteries going off steeply, processes of the femoral bifurcation, bypass stenosis, bilateral distal vascular processes as well as difficult puncturable or not puncturable inguinal arteries are particularly suitable for transbrachial procedure. Three complications arose, two haematoma, conservatively treated, and one cerebrovascular insult. Conclusions: Many vascular processes can be treated without any problem by transbrachial approach. The technical success rates are very high. The interventions can be realized without hopitalisation of the patient, except for some special cases (renal arteries and mesenteric arteries). The complication rate is low, condition is a large experience of the examiner.
Endovascular treatment of subclavian pseudoaneurysm causing delayed brachial plexus paralysis
Authors: Schellhammer  , Müller
Published: January 2006

Pseudoaneurysms of the subclavian artery are rarities. Due to their close relationship to the brachial plexus in the shoulder girdle, delayed lesions of the brachial plexus are possible. We report a case of a subclavian pseudoaneurysm following fracture of the clavicle, and the endovascular treatment using a balloon-expandable stent-graft.
Histological verification of non-specific aorta-arteritis (Takayasu's arteritis) using percutaneous transluminal atherectomy
Authors: Zeller  , Koch  , Frank  , Bürgelin  , Schwarzwälder  , Müller  , Rastan  , Amantea  , Neumann
Published: January 2006

Diagnosis of non-specific aorto-arteritis (NSAA, Takaysu's arteritis) is typically based on clinical and investigational parameters. We report here about two patients with clinically suspected diagnosis of a Takayasu's arteritis already under anti-inflammatory therapy in whom percutaneous transluminal atherectomy of subclavian and axillary artery stenoses was performed to relief the patients from symptoms – intermittent dyspraxia of the arms – and to verify the clinical diagnosis by histology. In the first case aorto-arteritis could be histologically confirmed through the analysis of plaque material including media structures excised from the subclavian and axillary arteries using a new device for atherectomy. The biopsy showed diffuse inflammation and granulomatous lesions with giant cells typically for Takayasu's disease. In the second patient, biopsy showed no acute or chronic inflammatory signs but only atherosclerotic lesions. Percutaneous transluminal atherectomy is therefore not only an interventional but also a diagnostic tool and should be used in every case of interventional therapy of suspected aorto-arteritis to make the clinical diagnosis and as a major consequence the initiation of an aggressive anti-inflammatory medical therapy more reliable.
Acute limb ischemia after femoral arterial closure with a vascular sealing device: Successful endovascular treatment
Authors: Schiele  , Rademacher  , Meissner  , Klauss  , Hoffmann
Published: January 2006

We report on successful catheter therapy of acute occlusions of popliteal and crural arteries due to distal embolization from a vascular sealing device. A 45 years-old male patient underwent percutaneous coronary angiography. After primary successful closure of the right femoral artery by a sealing device the patient developed acute ipsilateral lower limb ischemia, most probably due to embolization of a collagen/thrombin plug. Occlusions of the popliteal and crural vessels were successfully treated by percutaneous thrombectomy, thrombolysis and ballon angioplasty. Combined percutaneous catheter therapy is a therapeutic option for occlusions of popliteal and crural vessels due to embolization from a vascular sealing device.
Unusual cause of intermittent claudication
Authors: Thalhammer  , Aschwanden  , Blum  , Labs  , Jaeger
Published: January 2006

Spontaneous dissection of a peripheral artery is a rare event. We report a case of a spontaneous, non-atherosclerotic and non-aneurysmal dissection limited to the external iliac artery in a 60-year-old woman who was admitted with a left calf claudication. Non-invasive examination documented signs of leg ischemia due to a floating wall dissection of the external iliac artery. After medical treatment over eight weeks the dissection membrane had been adapted to the vessel wall. A similar case of a spontaneous dissection limited to the external iliac artery, followed by a spontaneous healing has not been reported in the literature.
Determination of amputation level in ischaemic limbs using tcPO2 measurement
Authors: Poredos  , Rakovec  , Guzic-Salobir
Published: January 2006

Background: Determination of the optimal amputation level is essential for patients, morbidity and rehabilitation. Various non-invasive procedures have been proposed to determine the optimal level of amputation. There is no consensus on the minimal tcPO2 level that is required to predict the healing of the stump. Therefore we aimed to rank the probability of primary wound healing at the most distal level and to answer the question if there is a lower limit of tcPO2 below which healing cannot occur. Patients and methods: 56 consecutive patients undergoing amputation below the knee for ischaemic gangrene of limbs were prospectively enrolled in the study. 39 were men (18 of whom were diabetics) and 17 women (8 diabetics) whose ages ranged from 45 to 87 years (mean 73 years). The total of 71 amputations was performed on the 56 patients: 39 below-knee with primary healing and, in 16 patients the above-knee reamputation was performed, due to the non-healing wound on the below-knee stump. The level of the amputation (below or above the knee) was in all cases decided solely on clinical grounds. TcPO2 was measured on each patient prior to amputation, on the dorsum of the foot and 10 cm below the knee. Results: The median tcPO2 value on the dorsum of the foot of diseased legs before amputation was 12 mm Hg (range from 0 to 22 mm Hg). At the anticipated level of the amputation of the shank, the median value of tcPO2 was 28 mm Hg (8–56 mm Hg). Patients with primary healing of postoperative wounds had significantly higher values of tcPO2 than patients with failure to heal (37mm Hg; range15–56mm Hg vs.18 mm Hg; range 8–36 mm Hg, p < 0.01). The success rate increased with higher tcPO2 values at the level of amputation. The 15% prevalence of reamputations was obtained for tcPO2 values between 25 and 36 mm Hg (median value 33 mm Hg) and the threshold value of tcPO2 below which the stump failed to heal was 15 mm Hg. Conclusions: Our study showed that tcPO2 is a reliable indicator of local ischemia. The integration of this parameter with other personal clinical criteria may be a valuable help to the surgeon in decision making.
Celiac artery aneurysm associated with atherosclerotic common hepatic artery stenosis
Authors: Papadimitriou  , Pitoulias  , Tachtsi  , Aslanidou  , Lazaridis  , Alexandrakis
Published: January 2006

Celiac artery aneurysms are rare vascular lesions and represent 4% of all splanchnic aneurysms. Media degeneration and atherosclerosis are the most common underlying etiologic factors. The risk of rupture and the associated mortality rate are 13% and 40% respectively. In contrast, elective repair carries a low mortality rate of 5%. Most of celiac artery aneurysms are asymptomatic and in the past nearly 80% of the cases were diagnosed when ruptured. Recently, there is an increased recognition of all splanchnic aneurysm types, probably because of better diagnostic techniques. We report a case of celiac artery aneurysm with severe atherosclerotic stenosis of the common hepatic artery. We performed, through a midline supraumbilical laparotomy, extended partial aneurysmectomy and common hepatic artery ostium endarterectomy. For the closure we used Dacron patch. The uncomplicated postoperative patient’s course, with no evidence of liver dysfunction and excellent patency of the common hepatic artery, suggests that this technique offered good results and minimized the perioperative risk.
Aortic and vena caval reconstruction with retroperitoneal lymph node dissection for metastatic germ cell tumor
Authors: Tsuji  , Matsuda  , Hara  , Yoshimura  , Okita
Published: January 2006

A 49-year-old man who had a huge testicular tumor with retroperitoneal lymph node metastasis and bilateral multiple pulmonary metastases was referred to our hospital. Firstly orchiectomy was done obtaining the pathological diagnosis of mixed type germ cell tumor. After cisplatin-based chemotherapy, he underwent resection of the retroperitoneal lymph node involving the abdominal aorta and the inferior vena cava. Both great vessels were resected with the tumor and reconstructed with prosthetic grafts. Two months after the laparotomy, 12 metastatic nodules in the left lung were resected. Seven months later, he furthermore underwent resection of 4 metastatic nodules in the right lung. Microscopically, all resected metastatic tumors were diagnosed to be mature teratoma without viable malignant cells. The patient remains well 30 months after the first operation. Follow-up CT scan demonstrates patency of aortic and vena caval bypass grafts without local recurrence or distant metastasis.
Adult vascular progenitor cells and tissue regeneration in metabolic syndrome
Authors: Humpert  , Eichler  , Lammert  , Hammes  , Nawroth  , Bierhaus
Published: January 2006

Adult vascular progenitor cells (for example endothelial progenitor cells, EPC) have been studied for their contribution to vascular repair and angiogenesis. These cells can differentiate from bone marrow cells as well as circulating cells carrying hematopoetic stem cell markers. In vivo, they take part in vasculogenesis in different animal models of limb ischemia, myocardial infarction and wound healing. In metabolic disease, the outgrowth and function of EPC in vitro is defective and numbers of EPC correlate with classical risk factors of cardiovascular disease suggesting a role of EPC in the development of vascular complications. Pilot studies for the treatment of myocardial infarction and limb ischemia with autologous bone marrow showed a distinct therapeutic benefit that is presumably mediated by vasculogenesis in damaged tissues. However, little is known about the nature of EPC and their capability to differentiate into functional cells for tissue regeneration. In this article, we review and discuss the hitherto identified physiological function of EPC, the mechanisms leading to dysfunction of these cells and potential therapeutic applications in patients with metabolic syndrome or diabetes mellitus and vascular complications.
Revision of the CEAP classification for chronic venous disorders: a consensus statement
Authors: Eklöf  , Rutherford  , Bergan  , Carpentier  , Gloviczki  , Kistner  , Meissner  , Moneta  , Myers  , Padberg  , Perrin  , Ruckley  , Coleridge Smith  , Wakefield
Published: January 2006

The CEAP classification for chronic venous disorders (CVD) was developed in 1994 by an international ad hoc committee of the American Venous Forum (AVF), endorsed by the Society for Vascular Surgery and incorporated into "Reporting standards in venous disease" in 1995. Today most published clinical papers on CVD use all or portions of CEAP. Rather than have it stand as a static classification system, an ad hoc committee of the AVF, working with an international liaison committee, has recommended a number of practical changes which are detailed in this consensus report. These include: refinements of several definitions used in describing CVD; refinement of the C-classes of CEAP; addition of the descriptor n (no venous abnormality identified); elaboration of the date of classification and level of investigation, and as a simpler alternative to the full (advanced) CEAP classification, introduction of a "basic" CEAP version. It is important to stress that CEAP is a descriptive classification, while venous severity scoring and quality of life scores are instruments for longitudinal research to assess outcomes.
Chlamydia pneumoniae, Herpes simplex virus and Cytomegalovirus in symptomatic and asymptomatic high-grade internal carotid artery stenosis. Does infection influence plaque stability?
Authors: Müller  , Huber  , Henrich  , Adams  , Berns  , Siebler  , Jander  , Müller  , Loncar  , Godehardt  , Sandmann
Published: January 2006

Background: Current debates are focused on inflammatory processes in atherosclerotic lesions as a possible pathomechanism for destabilization and thrombembolism. In this prospective study the role of systemic and local infection in patients with high-grade internal carotid artery stenosis (ICA) was evaluated. Patients and methods: Serum antibody titers of 109 consecutive patients, who underwent surgery for ICA stenosis (asymptomatic n = 40, symptomatic n = 69) were prospectively measured for Chlamydia pneumoniae (Cpn) (IgA and IgG), Herpes simplex virus (HSV) (IgG, IgM) and Cytomegalovirus (CMV) (IgG, IgM) respectively. 53 carotis plaques of this group (asymptomatic n = 17, symptomatic n = 36) could be analyzed by polymerase chain reaction (PCR) for Cpn-, HSV- and CMV-DNA presence. Results: Seropositivity was found in 61,5% for Cpn, 91,7% for HSV and 72,5% CMV respectively. No significant relation was found between symptomatic and asymptomatic patients as well as no difference was seen for presence of IgA antibodies against Cpn comparing both groups. Plaque-PCR revealed Cpn in 7 cases (13,2%), HSV in 2 cases (3,8%) and no CMV had been detected. Again, no significant relationship was found concerning symptomatic and asymptomatic patients. All 9 PCR-positive plaques displayed lesions of "complicated atherosclerosis" as central fibrous necrosis and calcification or plaque bleeding and surface thrombosis. Conclusions: Our results do not support the hypothesis that systemic Cpn, HSV or CMV- infection or evidence of Cpn-, HSV- or CMV-DNA in carotid plaques causes plaque destabilization and cerebral thromboembolism. Plaque infection could only be observed in cases with advanced atherosclerosis.
Transluminal angioplasty of isolated crural arterial lesions in diabetics with critical limb ischemia
Authors: Sigala  , Menenakos  , Sigalas  , Baunach  , Langer  , Papalambros  , Hepp
Published: January 2006

Background: We investigated the long-term clinical results of transluminal angioplasty of isolated infrapopliteal arteries in diabetic patients with severe ischaemic foot lesions and the influence of different parameters on primary success, the long-term outcome and the survival rate. Patients and methods: Between January 2001 and May 2004 we performed 50 transluminal angioplasties in 52 (10 female, 42 male, mean age 69.3 years) diabetics with isolated lesions of crural arteries (tibio-peroneal trunk 41, anterior tibial 13, posterior tibial 5, peroneal artery 14) and limb threatening ischaemia (rest pain 12, tissue loss 40). In two patients the dilatation could not be performed due to vessel perforation and impossibility to catheter localization. The morphological classification of infrapopliteal lesions was determined according to guidelines provided by TransAtlantic Inter-Society Consensus (TASC) (17 type A, 16 type B, 13 type C, 4 type D). Results: Initial technical success after angioplasty of crural arteries could be obtained in 96%.Kaplan-Meier analysis showed a cumulative limb salvage of 92%,85% and 68, 9% after 6 months,one and two years, respectively. Patients falling in TASC group C had significantly higher risk of amputation. Overall survival at 1 year was calculated at 85% and at 2 years at 65%. Conclusion: Our results suggest that depending on the extent of lesions transluminal angioplasty of infrapopliteal artery stenoses and occlusions is considered as an effective and save therapy modality to avoid limb loss in diabetics with critical ischemia.
Pseudoaneurysm of the brachial artey in two infants following accidental artertial puncture
Authors: Yilmaz  , Dogan  , Tok  , Hazirolan  , Guvener  , Haliloglu  , Demircin
Published: January 2006

A pseudoaneurysm is defined as an aneurysmatic sac surrounded by fibrous tissue instead of other vascular layers such as the muscular one. It is a rare incident in infants especially in the brachial artery. Blunt trauma and vascular access attempts are the most common etiologic factors. We present two infants with brachial artery pseudoaneurysm in the antecubital region following accidental arterial puncture.
Akuter Gefäßverschluss der oberen Extremität nach stumpfem Trauma
Authors: Pecinska  , Nussbaumer  , Furrer
Published: January 2006

Vollständige Intimarupturen nach stumpfen Traumata ohne Gelenksluxationen sind selten. Wir berichten über einen 62-jährigen Patienten mit Kribbelparästhesien im Ausbreitungsgebiet des Nervus medianus sowie einer kühlen linken Hand nach einem stumpfen Trauma des Oberarms. Die nicht-invasive angiologische Abklärung zeigte eine thrombotisch verschlossene Arteria axillaris, die Revaskularisation erfolgte bei zirkulärem Intimaabriss mit einem Veneninterponat.
Kalziphylaxie bei terminaler Niereninsuffizienz als seltene Ursache für Ulcera crurum
Authors: Klode  , Winzer  , Böhmer  , Heisterkamp  , Dissemond
Published: January 2006

Die Kalziphylaxie ist eine potentiell lebensbedrohliche Erkrankung, die als Komplikation bei bis zu 4% der Patienten mit terminaler Niereninsuffizienz und sekundärem Hyperparathyreodismus auftritt. Die Kardinalsymptome der Kalziphylaxie sind schmerzhafte livide Erytheme, die als Folge von Kalkablagerungen in den kleineren und mittleren Arterien des subkutanen Fettgewebes sekundär exulcerieren. Die Mortalität der Erkrankung beträgt 87% hervorgerufen durch Wundinfektion und Sepsis. Wir berichten über eine 59-jährige Patientin mit dialysepflichtiger terminaler Niereninsuffizienz und normwertigem Kalzium-Phosphatprodukt, bei der als seltene Ursache für Ulcera crurum eine Kalziphylaxie diagnostiziert werden konnte. Trotz frühzeitiger Intervention in Form einer Parathyreoidektomie und temporärer vollständiger Abheilung der Ulcerationen konnte mittelfristig ein letaler Verlauf der Kalziphylaxie nicht verhindert werden.
Percutaneous embolization of renal arteriovenous fistula
Authors: Sendi  , Toia  , Nussbaumer
Published: January 2006

Acquired renal arteriovenous fistula is a rare complication following a nephrectomy and its diagnosis may be made many years after the intervention. The closure of the fistula is advisable in most cases, since it represents a risk for heart failure and rupture of the vessel. There are an increasing number of publications describing different techniques of occlusion. The case of a 70-year-old woman with abdominal discomfort due to a large renal arteriovenous fistula, 45 years after nephrectomy, is presented and current literature is reviewed. Percutaneous embolization was performed by placing an occluding balloon through the draining vein followed by the release of nine coils through arterial access. One day after successful occlusion of the fistula, clinical symptoms disappeared.
The response of skin perfusion and of rheological and immunological variables to intravenous prostanoid administration in Raynaud’s phenomenon secondary to collagenosis
Authors: Drinda  , Neumann  , Pöhlmann  , Vogelsang  , Stein  , Wolf  , Hein
Published: January 2006

Background: Prostanoids are used in the treatment of Raynaud’s phenomenon and acral perfusion disorders secondary to collagenosis. In subjective terms, intravenous administration of these agents produces success in more than 50% of patients. The therapeutic outcome of clinical administration of alprostadil or iloprost may vary from individual to individual. Patients and methods: The following variables were analysed in a cross-over study in 27 patients with collagenosis and Raynaud’s phenomenon: plasma viscosity and erythrocyte aggregation (rheological variables), partial pressure of oxygen and laser Doppler flowmetry in the finger region, and lymphocyte phenotyping and interleukin (IL) determinations (immunological variables). Results: Laser Doppler flowmetry revealed significant differences between patients with secondary Raynaud’s phenomenon and a control group of 25 healthy subjects. Laser Doppler readings did not change significantly as a result of the treatments. Therapy with iloprost produced a reduction in IL-1beta, L-selectin (CD 62 L) and IL-6. Conclusion: The change in immunological variables due to iloprost may explain the long-term effects of prostaglandins in the treatment of Raynaud’s phenomenon. From our results it is not possible to infer any preference for iloprost or alprostadil.
Lysability of arterial thrombi assessed by magnetic resonance imaging
Authors: Kozak  , Mikac  , Blinc  , Sersa
Published: January 2006

Background: Intravascular thrombi change in time due to retraction and organization, which is reflected in the appearance of magnetic resonance images of clots. We have hypothesized that MRI has the potential to improve patient selection for thrombolytic treatment. The aim of our study was to analyze occlusive arterial thrombi with MRI, and to correlate the MRI parameters with the therapeutic outcome in patients with occlusive atherothrombotic disease of the superficial femoral artery who were treated with catheter-directed thrombolysis by streptokinase. Patients and methods: We included 13 patients with subacute (2 weeks to 3 months old) occlusive arterial thrombi and 4 patients with chronic (more than 6 months old) arterial occlusions. We measured the MRI signal intensity on gradient echo images of 98 axial slices of the subacute occlusive thrombi and in 45 slices of 4 chronic thrombi. Following MRI, the patients with subacute history were treated with catheter-directed thrombolysis. Results: Thrombolysis was successful in 11/13 patients. The normalized MRI signal intensity was significantly higher in the unsuccessfully treated thrombi than in the successfully treated thrombi (1.10 ± 0.08 vs. 0.72 ± 0.17, p < 0.003), but the subacute and chronic thrombi did not differ in signal intensity. Conclusions: High signal intensity of arterial thrombi on gradient echo MRI might predict resistance to thrombolytic therapy.
Ultrasonographic and FDG-PET imaging in active giant cell arteritis of the carotid arteries
Authors: Pfadenhauer  , Rüll
Published: January 2006

Inflammation of the arterial wall has been demonstrated by 18 Fluoro-Deoxyglucose PET imaging in patients with Takayasu’s and temporal arteritis. We used ultrasonography and FDG-PET for structural and metabolic imaging of the carotid artery to diagnose giant cell arteritis without biopsy. In a 72 years old patient with isolated clinical and paraclinical signs of severe systemic inflammation ultrasonogaphy showed concentric hypoechogenic mural thickening of the carotid arteries and high FDG uptake in the left carotid, both axillary and subclavian arteries and the aorta. Clinical and paraclinical abnormalities showed a typical response to steroid treatment. In conclusion a combined approach using ultrasound and FDG-PET seems to be helpful in the diagnosis of GCA of large arteries particularily in patients with atypical manifestations of the disease and negative or unavailable biopsy of the temporal artery.
Intraaortic balloon pump counterpulsation after implantation of infrarenal and thoracoabdominal aortic protheses
Authors: Marktanner  , Feindt  , Ghodsizad  , Klein  , Gams  , Grabitz  , Sandmann
Published: January 2006

Highly complex vascular surgery interventions have nowadays become possible due to sophisticated operative techniques and modern intra- and postoperative anesthesiological strategies. Accordingly, the number of high risk vascular surgery interventions rises continuously and thus, the number of secondary complications after high risk interventions increases as well and requires likewise extraordinary treatment concepts. We report of a 68-year old patient who 6 months previously was operated on a ruptured abdominal aneurysm, before he was admitted to our institution for the treatment of a type IIIb (Crawford classification) thoracoabdominal aneurysm. Intraoperatively we implanted a 26 mm Dacron prosthesis which was anastomosed with the previously existing infrarenal graft. Postoperatively the patient suffered from a hemodynamically significant myocardial infarction and acute coronary catheter intervention was necessary. However, circulatory stability could not be reestablished by interventional measures and we therefore decided to implant the intraaortic balloon pump despite the presence of two synthetic aortic grafts. However, the chance of success of such a manoeuver as well as the effectiveness of intraprosthetic counterpulsation was unclear and our literature research undertaken to predict the risk of such a manouver was unsatisfactory. We therefore want to report this case and compile the literature dealing with perceptions and complications of intraaortic counterpulsation after the implantation of synthetic aortic prostheses, since such a treatment option comes to an increased clinical application in comparable constellations.
Aknetherapie mit Folgen – Pseudotumor cerebri durch Hypervitaminose A
Authors: Boltshauser  , Landau
Published: January 2006

Le syndrome de la pseudotumeur cérébrale (PTC) consiste en une élévation anormale de la pression intracrânienne dont les causes probablement multifactorielles ne sont souvent pas élucidées. Nous décrivons le cas d'une jeune fille de 15 ans souffrant d'un syndrome PTC après un traitement prolongé à l'Arovit® (vitamin A) pour cause d'acné. Le diagnostic a été posé après qu'une élévation anormale de la pression intracrânienne ait été vérifiée et qu'un processus expansif intracrânien ainsi qu'une thrombose veineuse cérébrale aient été exclus. Une concentration plasmatique élevée de vitamine A confirme l'hypothèse que l'hypervitaminose A est à l'origine du syndrome de PTC chez cette patiente. Le traitement a consisté en des ponctions lombaires répétées et à l'administration d'acétazolamide (Diamox®). Le syndrome de PTC suite à une hypervitaminose A est une complication grave, pouvant conduire à une altération irréversible de la fonction visuelle. Les patients sous traitement aux rétinoïdes doivent faire l'objet d'un suivi médical.
Begleitsymptome und relevante Begleiterkrankungen beim idiopathischen Parkinsonsyndrom
Authors: Lisitchkina  , Ludin
Published: January 2006

A côté des quatre symptômes cardinaux, les patients parkinsoniens se plaignent d'une multitude de symptômes accompagnateurs qui, d'une part influence de façon négative la qualité de vie et, d'autre part, exigent souvent des approches thérapeutiques ciblées. Comme on peut s'y attendre chez les personnes d'un certain âge, les parkinsoniens présentent souvent d'autres maladies qui nécessitent un traitement. Il est important que les différents traitements soient évalués dans leur ensemble pour éviter des interactions indésirables.
Vegetative Störungen beim idiopathischen Parkinsonsyndrom: diagnostische Relevanz und therapeutische Möglichkeiten
Authors: Braune
Published: January 2006

La participation du système nerveux autonome dans la maladie de Parkinson est un exemple du caractère multisystémique qui dépasse le système extrapyramidal de cette maladie. Les symptômes qui sont provoqués par celle-ci apparaissent chez 40 à 60% des patients et provoquent une diminution importante de la qualité de vie. La cause en est principalement une lésion postganglionnaire du système nerveux autonome. La scintigraphie avec metaiodebenzylguanidine (MIBG) met en évidence une atteinte précoce du système nerveux et peut être utilisée pour le diagnostic différentiel entre la maladie de Parkinson et d'autres maladies neurodégénératives déjà durant la phase précoce. Cet examen a une sensibilité d'au moins 89.7% et une spécificité de 94.6% pour la différentiation d'une atrophie multisystémique. Un symptôme trop souvent négligé d'une insuffisance autonome est l'hypotension orthostatique. La vérification du diagnostic et l'investigation des causes peuvent être effectuées avec des méthodes cliniques simples; des options physiothérapeutiques et médicamenteuses sont à disposition pour le traitement.
Müdigkeit, Tagesschläfrigkeit und Schlafstörungen bei Parkinsonpatienten
Authors: Ludin
Published: January 2006

Beaucoup de patients atteints du syndrome de Parkinson souffrent de fatigue et de somnolence diurne. Durant ces dernières années, l'attention a été portée sur des «attaques de sommeil» pour lesquelles les antagonistes de la dopamine seraient responsables. Le sommeil nocturne est également perturbé. Il est important pour chaque cas de rechercher la ou les causes qui peuvent être très diverses pour un traitement qui doit être spécifique que possible.
Einfluss von Begleitsymptomen und Begleiterkrankungen auf Behandlungsstrategien beim idiopathischen Parkinsonsyndrom
Authors: Gutknecht
Published: January 2006

Le traitement des symptômes moteurs sont au premier plan lors du stade initial de la maladie de Parkinson. Durant l'évolution de la maladie et avec l'âge les maladies concomitantes cérébrales et extra-cérébrales ainsi que les symptômes non-moteurs deviennent plus importants pour les parkinsoniens. Ces facteurs ont des conséquences thérapeutiques s'ils dépassent de simples troubles passagers du bien-être. Des options thérapeutiques modifiées comportent tant le traitement propre de la maladie de Parkinson que celui des symptômes accompagnateurs ou des maladies concomitantes et devraient être considérées.
Notfalltransporte bei respiratorischen Problemen: eine prospektive Auswertung
Authors: Cathomas  , Rade  , Reinhart  , Kuhn
Published: January 2006

Le but de cette étude est d'analyser de façon prospective tous les transports en urgence des patients avec des problèmes respiratoires. La fréquence des différentes causes et le traitement effectué durant le transport en urgence, en particulier les inhalations, ont été évalués. Durant l'année 2000 tous les patients qui ont été transportés par le service d'urgences «Realü» de la région de Coire (population d'environ 100000 personnes) en raison de troubles respiratoires ont été évalués de façon prospective selon des critères définis. Le protocole d'urgence ainsi que le protocole médical ont été étudiés. Un total de 137 patients en 2000 ont été inclus de façon prospective. Ceci correspond à 8% de tous les patients transportés par le service «Realü» (total 1675 patients). L'âge moyen était de 66 ans (2–98 ans). L'exacerbation d'une bronchite chronique, une embolie pulmonaire et une dyspnée d'origine cardiaque ont compté chacune pour un cinquième des cas. 6 patients (5%) ont été transportés en urgence en raison d'un asthme bronchique. Dans seulement 41% des cas pour lesquels une inhalation aurait été indiquée, une telle thérapie a été effectuée. En résumé, notre expérience démontre que l'asthme bronchique n'est le diagnostic principal que pour 6% des patients qui nécessitent un transport en urgence en raison de troubles respiratoires. Le traitement anti-obstructif n'a été effectué que chez 41% des patients avec une exacerbation de leur syndrome obstructif chronique durant leur transport. L'utilisation de ce traitement simple et efficace doit être encouragée.
Therapieresistente Hypertonie: Abklärung und Behandlung
Authors: Käser  , Klainguti  , Vetter
Published: January 2006

Une cause fréquente d'hypertension résistante au traitement est la non-compliance. Son diagnostic et sa prise en charge ainsi que les autres causes importantes (les médicaments antirhumatismaux, l'éthylisme, l'obésité sévère, les accidents vasculaires cérébraux, d'autres formes d'hypertension secondaire) sont décrites dans ce travail avec une attention particulière pour les interactions et les effets secondaires des médicaments. Les formes d'hypertension secondaire sont présentées d'après leur fréquence, leurs symptômes principaux et l'approche diagnostique appropriée. Finalement les étapes thérapeutiques de médecine générale et du traitement médicamenteux sont discutées.