bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathogenese des zerebralen ischämischen Insults: eine interdisziplinäre Studie
Authors: Becker Elke Ingeborg , Jung A. , Völler H. , Wegscheider K. , Vogel H.-P. , Landgraf H.
Published: January 2006

Background: It is essential to understand the pathogenesis of ischemic stroke to ensure rational acute therapy and secondary prevention. We wanted to know the distribution of pathogenesis in patients of a city hospital and the differences in risk factors, neurologic deficits, disability, and delay in clinical admittance. Patients and methods: During a period of one year, 222 patients (mean age 76,6 years; 59% women) with complete acute ischemic stroke were admitted and underwent complete clinical and diagnostic procedures: CCT/MRI; Doppler- and color-coded duplex and transcranial sonography; echocardiography; use of the NINCDS stroke scale and the Oxford disability scale; study of risk factors, and exploration of delay in admittance. Results: The following percentages of etiologies were evident: 31% cardiogenic embolism (60% with atrial fibrillation), 13% microangiopathy, 9% macroangiopathy, 11% cerebellar or brain stem infarction, 18% more than one cause and 18% no cause found. The patients with cardiogenic embolism showed significantly the highest scores on the stroke scale and the disability scale and had the shortest delay in admittance (57% were admitted within 3 hours). Conclusions: In a city hospital, cardiogenic embolism is the main cause of ischemic stroke. These patients suffer significantly the most severe neurologic deficits, dependence, and requirement of daily nursing care. These patients have the shortest delay in clinical admittance and the best chance of benefiting from acute therapy and early secondary prevention.
Akuter Verschluss der linken Iliakalarterie bei einem Marathonläufer
Authors: Schmidt O. , Thaler K.H. , Lang Werner
Published: January 2006

We report a case of spontaneous iliac occlusion in a 44-year-old male patient after long-distance running. Atherogenic risk factors like hypertension, diabetes, hypercholesterolemia and smoking were missing. Spontaneous iliac occlusion is extremely rare and only a few cases have been documented. Angiography showed occlusion of the left iliac artery with collateral flow via the obturator artery to the common femoral artery. Thrombectomy was performed but reocclusion occured. An iliacofemoral bypass, arterial lysis and bypass thrombectomy was necessary within a few months. At the last follow-up visit two years afterwards the patient was symptom-free. This case indicates that exercise-dependent blood flow disturbances in long-distance-runners could produce changes of the intima.
Multizentrische randomisierte und kontrollierte Studie zum Vergleich von Four layer Bandagen und Kurzzugbinden des venösen Ulkus
Authors: Partsch H. , Damstra R.J. , Tazelaar D.J. , Schuller-Petrovic S. , Velders A.J. , de Rooij M.J.M. , Tjon Lim Sang R.R.M. , Quinlan D.
Published: January 2006

Background: Aim of the study was to compare the healing rates of venous ulcers obtained with four-layer bandages (4LB) versus short stretch bandages (SSB). Design: Multicentre, randomised controlled trial performed in 5 centres of the Netherlands and in 2 centres in Austria ("PADS-study" = Profore™ Austrian Dutch Study). Patients and methods: 112 patients (53 treated with 4LB and 59 treated with SSB) completed at least one post-treatment follow-up, 90 completed the study. Bandaging and ulcer assessment was performed at weekly intervals. Randomisation was carried out for each centre and was stratified according to the size (more or less than 10 cm2) of the ulcerated area. Local therapy consisted of plain absorbing, non-adherent dressings. Time to complete healing was recorded up to a maximum of 16 weeks. The two treatment-groups were comparable regarding their baseline-characteristics. Results: In total 33/53 (62%) of ulcer-patients were healed in the 4LB group, compared with 43/59 (73%) in the SSB group (difference 11%, 95% CI –28% to 7%). 77% of the ulcers with an initial area less than 5cm2 healed as compared with 33% of the larger ulcers. The different healing rates in the centres could be explained by the different sizes of the treated ulcers. Based on Kaplan-Meier estimates the median healing time was 57 days for the 4LB (95% CI 47–85 days) and 63 days for the SSB (95% CI 43–70 days). Conclusion: The ulcer healing rate and the median healing time did not differ among the two types of bandages. The main discriminant criterion for healing was the initial ulcer size. In centres who are experienced users of short-stretch bandages, no statistically significant different healing rates of venous ulcers could be found after 4LB or SSB.
Notfallmäßige Carotis Endarterektomie im Stadium progredienter neurologischer Defizite
Authors: Brandl R. , Brauer R.B. , Maurer P.C.
Published: January 2006

Background: Carotid endarterectomy (CEA) is well established as the elective treatment for moderate or severe carotid stenoses with a history of neurologic symptoms. In contrast, the merits of carotid revascularisation performed in emergency in patients with acute stroke or fluctuating neurological deficit remain controversial. Patients and methods: A total of 445 CEAs were performed on 424 patients for 212 (48%) asymptomatic and 233 (52%) symptomatic carotid stenoses within a 5 years period between January, 1995, and December, 1999. Of the latter, CEA was performed in emergency on 16 patients (3.8%) within 4 to 24 hours after the onset of symptoms. Patients selected for urgent surgery fulfilled the following criteria: acute onset of fluctuating hemispheric neurological symptoms, significant carotid pathology, absence of cerebral hemorrhage, uncompromised vigilance and stable cardiopulmonary conditions. Selected patients presented with a crescendo-TIA (n = 7) or fluctuating neurological deficits (n = 9) corresponding to a contralateral carotid stenosis. Results: Following CEA, the neurological deficits improved instantaneously to complete recovery in 9 patients. The symptoms of 4 patients improved to non-disabling deficits, remained unchanged in one and worsened in 2 patients from hemihypaesthesia to hemiparesis. 14/16 patients were discharged within 8 days after admission. The neurologic status after discharge did not deteriorate in any of the patients during follow up of 19.3 ± 13 months, but improved in 4 of the patients. Conclusion: Our retrospective study suggests that rescue CEA may be beneficial for selected patients with stroke in evolution and fluctuating neurological deficits. Careful adherence to selection criteria, intraoperative shunting, intensive care post surgery surveillance and an experienced team are recommended.
Ruptured inguinal aneurysm misdiagnosed as groin hernia
Authors: Cosentini E.P. , Hölzenbein T. , Riegler M. , Kretschmer G.
Published: January 2006

Anastomosenaneurysmen zählen mit einer Häufigkeit zwischen 0,5–5,0% zu den bekannten Komplikationen arterieller Rekonstruktionen, insbesonders solchen, bei denen Kunststoffe im Leistenbereich implantiert worden sind. Es wird ein männlicher 64-jähriger Patient vorgestellt, bei dem 10 Jahre nach Implantation eines femoro-cruralen Venenbypass eine Schwellung im Bereich der Leiste auffiel, die für eine inkarzerierte Leistenhernie gehalten wurde. Durch klinische Untersuchung, Duplex-Sonographie und CT wurde die Diagnose eines Nahtaneurysmas von 13 cm im Querdurchmesser gesichert. Die Behandlung bestand in Resektion des Aneurysmas, Interposition eines femoro-profundalen Venenbypass und Musculus sartorius Plombe. Der postoperative Verlauf war ungestört. Üblicherweise ist die Diagnose klinisch zu vermuten und mit Duplex-Sonographie zu sichern. Die Ätiologie solcher Aneurysmen wird als multifaktoriell angesehen; hier scheint die Progredienz der Grundkrankheit nach über 10 Jahren Laufzeit wahrscheinlich gewesen zu sein. Therapeutisch stehen die üblichen Methoden der Behandlung komplizierter Aneurysmen – autologe in situ Rekonstruktionen oder extraanatomische Umleitungen – meist mit alloplastischem Material – zur Wiederherstellung der arteriellen Strombahn sowie die biologische Deckung der Leistenregion zur Wahl.
One case of hypothenar-hammer-syndrome
Authors: Mürrle G.A. , Tenholt M. , Voss E.U.
Published: January 2006

Die unilateralen distalen Gefäßveränderungen werfen insbesondere bei jungen Patienten differentialdiagnostische Probleme auf. Wir berichten über einen 45-jährigen Mann mit einem Aneurysma der distalen A. ulnaris und des Arcus palmaris superficialis. Eine chronische berufsbedingte permanente Traumatisierung der Arterie führte zum Hypothenar-Hammer-Syndrom.
Gefäßkomplikationen nach der Behandlung mit dem Ilizarov-Ringfixateur
Authors: Polak Wojciech G. , Pawlowski S. , Skora J. , Morasiewicz L. , Janczak D. , Oleszkiewicz M. , Szyber P.
Published: January 2006

Iatrogenic vascular injuries from external fixation in orthopaedics and traumatology are frequent. Three cases of vascular injuries after the treatment with Ilizarov external fixators were treated at our institution. These include two cases of pseudoaneurysms and one case of acute ischaemia of the lower limb. Two patients became symptomatic only after removal of the fixator. In all cases, the diagnosis was made by color flow duplex sonography. All vascular injuries needed surgical repair.
Orale Antikoagulation bei chronischer Beinischämie
Authors: Mueller-Kolck U.
Published: January 2006

This review article summarizes clinical data on adjuvant long-term oral anticoagulation therapy (OAC) of peripheral arterial disease (PAD). It analyzes the underlying risk model of oral anticoagulation. Definitions of runoff patterns, of major and minor bleeding complications, of predictors of major bleedings as well as a classification of patient risk groups are described. The indication for OAC treatment of chronic limb ischemia remains still due to an individual decision. Clinical decision making is facilitated by the risk model. Improved oral anticoagulation control results in fewer bleeding complications. Studies on patient weekly self-testing and self-dosing which support this hypothesis are reviewed in the context of adjuvant OAC therapy.
Cystic adventitial degeneration
Authors: Stautner Anette , Tsounis A. , Stiegler H.
Published: January 2006

Bei der zystischen Adventitiadegeneration handelt es sich um eine zwar seltene, aber wichtige Differentialdiagnose der Claudicatio intermittens. Die Patienten berichten meist über akut aufgetretene Claudicatio-Beschwerden, die in Abhängigkeit vom Füllungszustand der Zysten unterschiedlich sein können und bei komplettem Verschluss des Gefäßes eine kritische Ischämie verursachen können. Am ehesten handelt es sich hierbei um echte Ganglienbildung mit oder ohne Verbindung zu den meist naheliegenden Gelenken, wobei die meist in der Adventitia liegenden uni- oder multilokulären Zysten eine gelbliche, visköse Flüssigkeit enthalten. Die diagnostische Abklärung erfolgt primär durch die Duplexsonographie. Therapeutisch wurden bislang gefäßchirurgische Eingriffe favorisiert (gefäßerhaltendes oder resezierendes Verfahren), während dank der neuen Untersuchungstechniken die ultraschallgesteuerte Punktion ein erfolgversprechendes Verfahren zu sein scheint. Krankheitsbild, Diagnostik, Therapie und Verlauf werden an vier Fällen dargestellt.
Zusammenhang zwischen flussassoziierter (endothelabhängiger) Vasodilatation und TSH-Spiegeln bei jungen, normotensiven und normoglykämischen Personen
Authors: Balletshofer B.M. , Rittig K. , Rett K. , Häring H.U. , Nawroth P.P.
Published: January 2006

Background: Endothelial dysfunction (ED) is regarded as an early step in the development of atherosclerosis. Recent experimental data showed a crosstalk between endothelial NO-synthase activity and thyrotropin production. Therfore we studied whether basal TSH can predict flow associated vasodilation (FAD) in a cohort of healthy young subjects with normal TSH levels. Patients and methods: FAD was evaluated in 60 normotensive and normoglycemic subjects (mean age 34 years; range 18–50). The mean thyroptropin level was 1.43 ± 0.11 muU/ml (range 0.18–3.52 muU/ml). Results: Comparing subjects in the upper, middle and lower tertile of TSH (2.38 ± 0.14 muU/ml, 1.23 ± 0.04 muU/ml and 0.65 ± 0.06 muU/ml respectively) there was no difference in terms of the classical cardiovascular risk factor profiles (24 h blood pressure, HDL- and LDL-cholesterol, triglycerides, oral glucose load and body fat content). Regarding the vascular parameters, we could neither find an independent association with FAD (7.0 ± 1.1%, 6.4 ± 1.0% and 5.8 ± 1.1% respectively) nor with endothelial independent vasodilation (after application of glycerol trinitrate GTN, 17.3 ± 1.9%, 18.4 ± 1.7% bzw. 17.5 ± 1.6% respectively) between the groups. Furthermore, we could not find a significant association between free thyroid hormones (fT3/ fT4) and FAD or GTN-induced vasodilation. Conclusion: TSH has no predictive value towards endothelial dysfunction in subjects with thyrotropin levels within the normal range.
Nicht-atherosklerotische Erkrankungen der Halsarterien: Möglichkeiten sonographischer Diagnostik
Authors: Arming Christian
Published: January 2006

On the basis of morphological and hemodynamic criteria, color-coded duplex sonography enables diagnostic evaluation of non-atheromatous lesions of the cervical arteries. Ultrasonography is the method of first choice for Takayasu’s arteritis, radiation angiopathy, and common carotid artery dissections. Internal carotid and vertebral artery dissections are detected in up to 95% and 79%, respectively; in some of these cases, however, ultrasonography delivers unspecific findings so that dissections can only be confirmed when typical clinical symptoms are present, too. Detection of vasospasms of the cranial arteries is extremely difficult, on account of their tendency for rapid regression; however, sonography is in principle a suitable method. In cases of fibromuscular dysplasia ultrasound has furnished less positive results on account of the unfavourable localisation for duplex sonography. As the disease has a relatively good prognosis, only symptomatic cases need to be detected. On the whole, sonography is a suitable method for the diagnosis of non-atherosclerotic diseases of the cervical arteries.
Myointimale Hyperplasie und sympathische Reinervation der Ohrarterie des Kaninchens nach lokalem Kälteschaden und schneller Wiedererwärmung
Authors: Arvesen A. , Mæhlen J. , Rosén L. , Aas Pål
Published: January 2006

Background: Functional and pathological improvements following rapid rewarming in 42°C water was compared with alterations following slow thawing at room temperature (22°C) after frostbite (–9°C, 15 minutes) in vivo of the rabbit central ear artery. Methods: Following two to ten weeks of in vivo regeneration, vascular segments were tested in vitro. Maximal and dose-dependent isometric contractions were induced by exogenous noradrenaline. Sympathetic nerves in the vascular wall were stained with glyoxylic acid. Vascular ring segments were stained with haematoxylin and eosin. Results: Following slow thawing, the total uptake, the K+ evoked and the spontaneous release of [3H]noradrenaline in the sympathetic nervous system were strongly reduced two weeks after freezing, with a subsequent increase to control level within 3–4 weeks. After rapid rewarming the total uptake, the spontaneous release and the K+ evoked release of [3H]noradrenaline commenced earlier such that after ten weeks the level was twice as high as following slow rewarming. The glyoxylic acid induced catecholamine fluorescence in sympathetic nerves, revealed an earlier regeneration after rapid rewarming. Haematoxylin and eosin-stained segments revealed less intimal hyperplasia three to 20 weeks after rapid rewarming than after slow thawing. Conclusion: Rapid rewarming of in vivo frozen arteries in warm water (42°C) did not prevent immediate vasoparalysis and degeneration of sympathetic nerves. However, nerve regeneration occurred earlier and with higher tissue nerve densities as compared to tissue that had been slowly rewarmed. Myointimal hyperplasia was less pronounced after rapid rewarming. Abnormal sympathetic nerve function and myointimal hyperplasia, as observed in this study, may contribute to a greater understanding of sequelae in the human body following frostbite.
Langzeitergebnisse der systemischen Thrombolysetherapie bei aorto-iliakaler Verschlusskrankheit
Authors: Bucek Robert A. , Schnürer G. , Haumer M. , Reiter M. , Ahmadi A. , Minar E.
Published: January 2006

Background: Long term results of systemic lysis therapy with ultrahigh-dose urokinase (UHUK) in reopening aorto-iliac occlusive disease have not yet been evaluated. This prospective trial investigates the long-term primary patency rate, the rate of complications and assesses the role of different expected influence parameters on the primary patency rate. Patients and methods: 72 patients with aorto-iliac occlusive disease received daily intravenous infusions of UHUK either until reperfusion or – after at least 3 cycles – no progress in recanalization could be stated on two consecutive days by duplex scanning. Results: Systemic lysis therapy was morphological at least partially successful in 44 patients (61.1%). Concomitant percutaneous transluminal angioplasty was performed in 41 patients (56.9%), surgery in 7 patients (9.7%) and both in further 5 patients (6.9%). In patients without surgery hemodynamical success could be achieved in 39 patients (54.2%) and even more important clinical success in 51 patients (70.8%). Compared to baseline results patients improved significantly in ankle/brachial pressure index and in Fontaine stages (p < 0,001), the same results could be seen after a mean follow-up period of 62 months. Thrombolysis was complicated in 4 patients (5.6%) by macroembolizations but no major bleedings or deaths occurred. Primary patency was 76%, 64%, and 43% after 1, 5 and 10 years. Male sex and distal localization were significantly correlated with lower primary clinical patency. Conclusion: Systemic lysis therapy is an alternative to surgical intervention in acute and subacute aorto-iliac occlusive disease, because it offers acceptable long-term results with a low rate of complications.
Die aberrierende Arteria subclavia dextra (Arteria lusoria) als seltene Ursache von Dysphagie und Dyspnoe bei einer 79-jährigen Patientin mit rechts-mediastinaler und retrotrachealer Raumforderung sowie ko-existenter koronarer Herzkrankheit
Authors: Störk Thomas , Gareis R. , Krumbholz K. , Eichstädt H.
Published: January 2006

A rare case of a 79-year old women with dysphagia and dyspnea secondary to compression of the esophagus by an aberrant right subclavian artery (ARSA, A. lusoria) is presented. This abnormality is generally silent and often an incidental x-ray finding. Computed tomography and intraarterial angiography, including direct catheterization of the ARSA, established the diagnosis. The interdependence with a co-existing coronary artery disease is discussed. Thus, ARSA has to be taken into account in patients with abnormal x-ray findings presenting with dysphagia and dyspnea.
Die prophylaktische Endarteriektomie der Arteria carotis interna beim symptomatischen Patienten als dringliche Indikation
Authors: Peiper Christian , Nowack J. , Ktenidis K. , Hopstein S. , Keresztury G. , Horsch S.
Published: January 2006

Background: The symptomatic patient showing a string sign or ulcerative stenosis of the internal carotid artery (ICA) is subject to a high risk of arterial thrombosis or persisting intracranial embolization during the waiting period before operative revascularization. Patients and methods: During one year 186 operative revascularization procedures of the ICA were performed on the symptomatic patient. 26 of them fulfilled the prophylactic urgency criteria: symptoms of the cerebrovascular insufficiency and a string sign or ulcerative stenosis of the ICA with ulceration greater than 2 mm in depth. These results were compared to the control group of the 157 procedures under elective circumstances. Results: Mean clamping time of the urgency and the elective patients were 23.8 min vs. 24.5 min and operation time 50.1 min vs. 54.3 min. None of our urgency patients presented new neurological defects in the postoperative phase, while this occurred in 3.8% in the elective group. Mortality rate in the elective group was 2.7% and 0% in the urgency group. Furthermore, there were fewer local complications in the urgency group. Conclusion: The urgent indication for the desobliteration of the ICA showing a symptomatic string sign or ulcerative stenosis can be recommended. Early thrombosis or neurological defects during the waiting period may be prevented without increasing complication rates.
Die vollständige Kompressionssonographie zur Diagnose der proximalen und distalen Venenthrombose – eine retrospektive Untersuchung
Authors: Schellong Sebastian M. , Schwarz T. , Pudollek T. , Schmidt B. , Schroeder H. E.
Published: January 2006

Background: Compression ultrasound is considered the preferred test for the diagnosis of deep vein thrombosis of the leg (DVT). Since sensitivity for distal thrombosis is low additional tests are required. We developed a protocol of complete compression ultrasound of all venous segments of the leg (CCUS). A retrospective outcome study was performed to get an estimate of the rate of indeterminate results necessitating repeated testing as well as for the clinical safety of CCUS in a cohort of consecutive, unselected patients. Patients and methods: Case records of all patients referred for clinical suspicion of deep vein thrombosis within a three months period were reviewed. Patients with negative CCUS were followed directly or via the general practitioner in order to know whether an episode of venous thromboembolism had been documented since the initial CCUS. Results: 132 inpatients and 154 outpatients were identified. Clinical probability was high in 50 patients, medium in 142, and low in 94. The first CCUS was negative in 209 cases. Five patients (1,8%) had repeated CCUS within the next 7 days because of incomplete visualisation of the distal veins and turned out to be negative as well. Of all 214 patients with negative CCUS a clinical follow-up information was obtained after 168 ± 25 days. Five patients had died, none due to pulmonary embolism. In two patients deep vein thrombosis had been documented (0,9% [95% CI: 0,1–3,3%]) 148 and 172 days after CCUS, respectively. Conclusion: CCUS for diagnosis of DVT needs to be repeated in very few cases only. Clinical safety seems to fall into the same range as with combined algorithms and should be tested in a prospective design. Patients with medium and high probability showed a very low incidence of DVT within three months following CCUS; therefore, they may be included in a prospective outcome study.
Zur Inzidenz von Phlebothrombosen nach einer Thorakotomie
Authors: Saarinen Jukka , Kallio T. , Sisto T.
Published: January 2006

Background: Incidence of deep venous thrombosis (DVT) after thoracotomy has not been widely studied. DVT is a frequent complication in major surgery involving abdominal and pelvic areas and lower extremities. The aim of the present study was to evaluate the rate of postoperative DVTs after surgery of the lung. Methods: In this prospective study with 25 patients undergoing thoracotomy both legs were studied with venous duplex imaging (VDI) preoperatively and on the second postoperative day. Clinically manifest thromboembolic events during one-month postoperative period were reviewed from the patients’ records. DVT prophylaxis included compression stockings and early mobilization without low-molecular weight heparin. Results: Frequency of postoperative DVTs was 4%. There were no clinically manifest thromboembolic events during one-month postoperative period. In 8% of the patients an old DVT was found preoperatively. Conclusions: Based on this material, incidence of DVT is low after thoracotomy. Early mobilization and the use of compression stockings may be a sufficient form of prophylaxis in these patients. The relatively small sample size and the use of ultrasound as a screening method should be noted in judging the results.
Kosteneffektivität des Screenings bei familiärem abdominellem Aortenaneurysma
Authors: Soisalon-Soininen Sari , Rissanen P. , Pentikäinen T. , Mattila T. , Salo J. A.
Published: January 2006

Background: Screening for familial abdominal aortic aneurysms (AAA) is widely recommended. To analyze cost-effectiveness of screening for familial AAAs incremental cost-effectiveness (C/E) analysis based on an ultrasound screening among relatives and a decision model of screening program was compared to a baseline situation without systematic screening. Patients and methods: 74% (238/322) of first-degree relatives of 150 consecutive AAA patients were screened at HUCH (Helsinki University Central Hospital). Effectiveness and costs of treatment were assessed using the Finnish Hospital Discharge Register and from survival analysis of 1130 AAA patients who underwent elective or emergency surgery in HUCH. To form incremental C/E-ratios the existing clinical practice was compared to a screening program for male siblings. Hypothetical screened and control cohorts of 1000 male relatives were used to create the decision model. Parameters in C/E-analyses were derived from our own data except for growth and rupture rates. A sensitivity analysis was carried out. Results: The incremental effectiveness in life-years gained by the screening of male siblings was 92 years with incremental C/E-ratio of FIM 33000 ($ 6200). According to sensitivity analysis the C/E-ratios were robust for all variables tested. Conclusions: Screening of male siblings of AAA patients produces incremental life-years at low cost thus screening of male siblings is highly recommended.
Chronische venöse Insuffizienz in einer Minderzahl von Patienten mit Ulcus cruris infolge einer Sichelzellanämie
Authors: Chalchal H. , Rodino W. , Hussain S. , Haq I. , Panetta I. , Solomon W. , Gillette P. , Braverman Albert S.
Published: January 2006

Background: Chronic or recurrent leg ulceration occurs in 25% of sickle cell anemia patients, but not in the remaining 75%. Doppler studies of venous function were normal in 16 sickle cell anemia patients with leg ulcers. Patients and methods: Venous Duplex Ultrasound was used to study 33 sickle cell anemia patients with chronic leg ulcers. Results: Six of the 33 patients had venous reflux in at least one leg. Conclusions: Venous insufficiency may contribute to the development of leg ulcers in a minority of sickle cell anemia patients. A minority of sickle cell anemia patients with chronic leg ulcers can be shown to have leg venous reflux by duplex ultrasound imaging.
Simultaneous treatment of Salmonella typhimurium-induced symptomatic abdominal aortic aneurysm with associated spondylitis
Authors: Tautenhahn J. , Fahlke J. , Halloul Z. , Graßhoff H. , Bürger Th.
Published: January 2006

Bakteriell infizierte Aneurysmata in Kombination mit einer lokalen Spondylitis stellen ein lebensbedrohliches Krankheitsbild dar und sind sowohl für den Gefäßchirurgen als auch Orthopäden eine operative Herausforderung. Das gleichzeitige Auftreten einer Infektion mit Salmonella typhimurium als Erreger ist dabei eine Seltenheit. In einer Kasuistik wird das simultane gefäßchirurgisch-orthopädische Vorgehen dargestellt. Primär erfolgte die Resektion des unmittelbar subrenalen mykotischen Aneurysmas. Die Wiederherstellung der Kontinuität der Aorta erfolgte zentral durch ein autogenes Aortentransplantat mit kaudaler Anastomosierung an eine Dacronprothese. Diese wurde zunächst überlang dimensioniert, um das operative Vorgehen der Orthopäden zu erleichtern. Nach beendeter Stabilisierungsoperation der Wirbelsäule wurde die Dacronprothese auf die erforderliche Länge gekürzt und das transperitoneale Vorgehen durch eine biologische Sicherungsoperation (Omentum-majus-Plastik) abgeschlossen. Während der Nachbeobachtungszeit von 18 Monaten traten keine Komplikationen auf.
Angiographie, Computer- und Magnetresonanztomographie eines hohen Vena cava inferior-Verschlusses bei einem Patienten mit Morbus Hirschsprung
Authors: Alter Peter , Walthers E. M. , Schaefer J. R. , Maisch B.
Published: January 2006

We report on a high vena cava inferior interruption immediately at the insertion to the right atrium in a patient with Hirschsprung disease assessed by angiography, CT, and MRI. Hirschsprung disease is frequently associated with Down, Undine, Waardenburg, Bardet-Biedl, Smith-Lemli-Opitz and Goldberg-Sphrintzen syndromes. We suggest that the association of these two malformations are most likely interrelated and should be considered as a new syndrome.
Amputation in fictional literature: the case of Hippolyte in Madame Bovary
Authors: Kauss
Published: January 2006

In his famous novel, published in 1856, Flaubert describes the circumstances of a failed surgical procedure ending up in a major amputation. Flaubert, whose father was a physician in Rouen/France, mocks at the medical profession and its victims and proves himself to be compassionate at the same time. About his writing, he explained: "I only measure shit into doses." ("Je ne fais autre chose que de doser de la merde.")
Infrapopliteal arterial occlusive disease in diabetics with critical foot ischaemia: The role of distal-origin bypass grafts
Authors: Woelfle  , Bruijnen  , Loeprecht
Published: January 2006

Background: The underlying cause for severe ischaemic foot lesions in diabetics is not infrequently a specific occlusion pattern exclusively involving infrapopliteal arteries. To attain limb salvage in this setting, since the early eighties short vein grafts originating from infragenicular arteries (distal-origin bypasses) were used to bypass the occluded crural vessels. This presentation describes our 15-year experience with this strategy and, in addition, assesses the outcome in patients suffering from end stage renal disease (ESRD). Patients and methods: Since May 1986, 135 diabetic patients underwent 143 so-called "distal-origin bypasses" in the presence of extended infrapopliteal arterial occlusions and critical foot ischaemia (rest pain 3, tissue loss 140). The mean age in this group was 70,1 years. 43 patients had impaired renal function including 16 cases with ESRD. Results: The 30 day mortality in our series was 2.1%. During the follow-up a total of 82 patients died, mainly from cardiovascular causes. Using life-table analysis, primary and secondary patency rates for these bypasses with distal graft origination were 90% and 97% at 30 days, 76% and 83% at 1 year and 46% and 51% at 7 years, respectively. The corresponding limb salvage rates for the whole group amounted to 94%, 80% and 64%. Comparing patients having normal or slightly impaired renal function with those diagnosed of ESRD, a significantly different result with higher limb salvage rates in favour of the first patient subgroup was noted after 5 years (77% vs. 39%; p = 0.0023). Conclusion: In our series, the importance of short vein grafts to avoid limb loss in diabetic patients with infrapopliteal artery occlusions and critical foot ischaemia has been well established. Despite poorer limb salvage rates achieved in ESRD-patients, our results suggest, that even these high risk patients should not be denied arterial reconstruction.
Fulminante intrakardiale Thrombose bei Budd-Chiari-Syndrom und Thrombose der Vena cava inferior
Authors: Eckel F. , Huber  , Heidecke  , Moessmer  , Berger  , Holper  , Dietrich  , Lersch  , Siewert
Published: January 2006

The most common cause of edema of the legs and dyspnea is congestive heart failure. Further differential diagnosis such as renal or hepatic failure have to be considered. We report the case of a previous healthy 65-year-old woman who developed dyspnea and massive edema of the legs followed by acute hepatic and renal failure. Imaging studies showed a thrombosis of the inferior vena cava (IVC) caused by a tumor between the right kidney and the IVC. Histological examination revealed a leiomyosarcoma of the IVC. Hepatic failure due to venous outflow obstruction (Budd-Chiari syndrome, BCS) was diagnosed. Coagulation profile showed a complex disorder due to acute hepatic failure. Factor V Leiden and prothrombin gene mutation G20210A could be excluded. The thrombosis extended from the femoral veins up to the right atrium. After 11 days of anticoagulation with heparin platelet counts decreased by more than 50%. Suspecting a heparin-induced thrombocytopenia the patient was placed on recombinant hirudin (lepirudin) for anticoagulation. Hepatic venogram showed a thrombosis of the hepatic vein orifices but not of the hepatic veins. The tumor and the thrombi were removed surgically. When the cardiopulmonary bypass was terminated new intracardiac thrombi occurred. Despite immediate surgical intervention the patient finally died due to right ventricular failure cuased by the fulminate intracardiac thrombosis. In conclusion, thrombosis of the IVC may mimic congestive heart failure and may cause BCS. Neoplasms and coagulation disorders may cause thrombosis of the IVC.
Zusammenhang zwischen Gehstrecke und Dopplerdruck-Parametern bei Patienten mit symptomatischer peripherer arterieller Verschlusskrankheit
Authors: Leder  , Saul  , Frankenstein  , Krack  , Baer  , Poehlmann  , Figulla
Published: January 2006

Background: Doppler pressure measurements are a useful diagnostic tool in peripheral arterial obstructive disease. The aim of our study was to determine whether these pressure values do predict the degree of impairment of the walking capacity in symptomatic patients. Patients and methods: We compared the claudication distances (CDI: initial claudication distance, CDA: absolute claudication distance) of 939 patients (63 ± 11 years) with stable intermittent claudication (Fontaine IIb) with the ankle pressure values at rest (APR) and after exercise (APE), with the ankle/brachial pressure index at rest (ABIR) and after exercise (ABIE), and with the ratio (ABIRATIO = ABIE/ABIR). Ankle systolic pressures were obtained using an 8 MHz Doppler probe. CD was measured by a treadmill test at constant-load conditions (3 km/hr; inclination 12%). Brachial systolic pressures were obtained using an automated blood pressure monitor. The values of the objectively worse leg were correlated with CDI and CDA. Results: Low Doppler pressure values were not accompanied by significantly shorter walking distances in symptomatic patients. The resting pressure values (APR, ABIR) did not correlate with the claudication distances (CDI: 54 ± 31 m; CDA: 87 ± 41 m). For the exercise values (APE, ABIE), even a very slight inverse correlation with the claudication distances was found. In addition, the correlation between the pressure index ratio and the walking distances (ABIRATIO vs. CDI: r = –0.25, p < 0.01; ABIRATIO vs. CDA: r = –0.20, p < 0.01) was inverse, too, but slightly more pronounced. Conclusions: In patients with intermittent claudication the ankle artery pressures and the indices derived from these pressure values do not predict the walking distance. Therefore, the decision for angioplasty or bypass surgery should be made with regards to the impairment of quality of life rather than Doppler pressure values.
Spontaneous dissection of the external iliac artery due to fibromuscular dysplasia
Authors: Lück  , Hanschke  , Geißler  , Gruß
Published: January 2006

Bei einem 45-jährigen Mann wurde im Rahmen der Abklärung einer neu aufgetretenen Claudicatio intermittens eine Spontandissektion der rechten A.iliaca externa diagnostiziert. Nach primär konservativem Vorgehen erfolgte aufgrund einer nach distal progredienten Dissektion nun die operative Sanierung, angesichts des jungen Alters des Patienten in Form einer retrograden TEA über einen Führungsdraht. Die intraoperative Angiographie zeigte ein gutes Rekonstruktionsergebnis der A.iliaca externa re. bei unauffälliger A.iliaca communis sowie ebenfalls unauffälliger infrarenaler Aorta. Histologisch fand sich ursächlich für die spontane Dissektion eine fibromuskuläre Dysplasie der Media. Postoperativ waren rechtsseitig beide Fußpulse kräftig tastbar bei einem Dopplerindex von 1,0. Nach unauffälligem postoperativem Verlauf wurde der Patient beschwerdefrei mit unbegrenzter Gehstrecke wieder nach Hause entlassen. Wenig später beklagte der Patient erneut belastungsabhängige Schmerzen des rechten Beines. Ursächlich fand sich nun eine umschriebene Stenose der A.iliaca communis rechts sowie eine retrograde Dissektion der rechten A.iliaca communis bis in die terminale Aorta reichend. Vom vorbehandelnden Heimatkrankenhaus wurde dem Patienten zunächst zu einer konservativen Therapie geraten. Der Befund ist klinisch und sonographisch seit sechs Monaten unverändert.
Herz- und Veneninsuffizienz als Folge einer arteriovenösen Fistel nach Schussverletzung vor 15 Jahren
Authors: Erdöl  , Baykan  , Gökçe  , Çelik  , Sari  , Uzun  , Altun  , Özcan
Published: January 2006

We present a 65-year-old man who had a significant arteriovenous fistula between the right arteria profunda femoralis and vena profunda femoralis. He had evidence of chronic venous insufficiency and chronic leg ulcers on his right leg, and he had clinical findings of congestive heart failure. An arteriovenous fistula was responsible for all of clinical situation that had been caused by a shotgun wound 15 years ago. Using ultrasonography, after palpating a marked thrill and mass during physical examination, established the diagnosis of arteriovenous fistula. Angiography was performed both to delineate the suspected vascular anatomy and to show the coronary arteries. The patient was operated on and no complication was experienced during or after the procedure. Dramatic improvement was seen in the clinical picture just after surgery, and heart size markedly reduced both on chest X-ray and echocardiographic examination.
Manuelle Kompressionssanierung von Aneurysmata falsa: Eine Alternative zur ultraschallgesteuerten Kompressionssanierung?
Authors: Theiss  , Schreiber  , Schömig
Published: January 2006

Background: It is unknown, whether direct guidance by ultrasound is essential for the safety and efficacy of ultrasound-guided compression repair (UGCR) of pseudoaneurysms. We therefore tested, whether clinically guided manual compression repair (MCR) without continuous ultrasound control may represent an equally effective alternative. Methods: After ultrasound diagnosis of a pseudoaneurysm, direct manual compression was applied to the lesion until the characteristic clinical signs disappeared or for a maximum of 1 hour. Then a compression bandage was applied for 24 hours. If the pseudoaneurysm persisted, MCR was repeated up to a maximum of three times. Results: Of 96 consecutive patients with pseudoaneurysms, ten patients were referred to primary surgery; one patient refused any therapy. The remaining 85 patients (89%) were treated by MCR. MCR was successful in 74 patients (87%). Of these, 74% were cured at the first attempt, while 16% resp. 10% required 2 resp. 3 compression manoeuvers for definite cure. The success rate tended to be somewhat lower in patients on anticoagulants (78%) than in those on aspirin (91%) or those without any antithrombotic medication (89%) (p = 0.14). No major complications were observed. Of the 11 patients in whom MCR was unsuccessful, five patients underwent surgical repair; in four patients the pseudoaneurysms thrombosed spontaneously within 1–3 months and 2 pseudoaneurysms persist without complications. Conclusions: Our results with MCR are comparable to those published for UGCR. Since MCR requires less technical equipment and seems to be less painful for the patient, a prospective comparison of both methods appears warranted.
The current role of endovascular therapy in the femoropopliteal segment in patients with chronic peripheral arterial disease
Authors: Wagner
Published: January 2006

Der technische Erfolg endovaskulärer Maßnahmen im femoropoplitealen Gefäßsegment ist durch die Einführung neuer Technologien (hydrophile Führungsdrähte, Stents, Stentgrafts) im letzten Jahrzehnt auf Raten über 90% angestiegen. Gelingt die initiale Rekanalisation (auch langstreckiger Okklusionen), so gestattet das Armamentarium der modernen Interventionsradiologie in aller Regel zumindest akut das Gefäß offen zu halten. Der Beweis, dass der akute Erfolg der revaskularisierenden Maßnahme zu einer anhaltenden Verbesserung der klinischen Symptomatik, gemessen an klinisch relevanten Endpunkten (Steigerung der Gehstrecke, Zunahme der Extremitätenerhaltung und Verlängerung der Überlebenszeit) führt, steht noch aus. Mehrere prospektiv randomisierte Studien konnten bei chronischen femoropoplitealen Obstruktionen im Stadium II b gegenüber einer konservativen Therapie mit Gehtraining zwar eine Verbesserung der Gehstrecke nach einem Jahr Nachbeobachtungszeit, nicht aber nach zwei Jahren follow-up zeigen. Im Vergleich zu den herkömmlichen chirurgischen Revaskularisationsverfahren konnten die beiden einzigen prospektiven und randomisierten Studien keinen Vorteil für eine der beiden Techniken, sowohl im Stadium IIb als auch bei kritischer chronischer Ischämie, zeigen. Das transatlantische interdisziplinäre Konsensuspapier (TASC) empfiehlt im femoropoplitealen Abschnitt als Therapie der Wahl den endovaskulären Eingriff nur bei singulären Stenosen < 3 cm Länge und hält die primäre Stentimplantation nicht für indiziert. Für die weitere klinische Forschung zur Evaluation endovaskulärer Therapieverfahren im femoropoplitealen Bereich sind Outcome-Studien zu fordern, die sorgfältig klinisch relevante Endpunkte wie Verbesserung der Gehstrecke, Amputationsrate und Überlebenszeit untersuchen, vor allem aber auch krankheitszentrierte Lebensqualitätsevaluationen mit einschließen. Hier haben mehrere Metaanalysen in den letzten Jahren gezeigt, dass die endovaskuläre Therapie sicher einen festen Stellenwert im femoropoplitealen Segment besitzt, der aber am individuellen Fall aufgrund der spezifischen Befund- und Symptomkonstellation evaluiert werden muss.
Endovascular repair of infrarenal aortic aneurysms. Report on 4291 patients of the Eurostar database
Authors: Enzler  , van Marrewijk  , Buth  , Harris
Published: January 2006

Hintergrund: Das Eurostar Projekt unterhält eine Datenbank zur multizentrischen Erfassung endovaskulärer Behandlungen von infrarenalen Aortenaneurysmen und deren Resultaten. Patienten und Methoden: Die Patientendaten müssen dem Registrier-Zentrum schon vor der Durchführung einer endovaskulären Therapie übermittelt werden. Dadurch wird das Risiko einer selektiven Erfassung eliminiert. Präoperativ werden demografische Daten der Patienten sowie die anatomischen Merkmale des Aneurysmas übermittelt. Postoperativ werden Informationen über den Eingriff und die verwendeten Implantate sowie über peri- und postoperative Komplikationen mitgeteilt. Im weiteren Verlauf werden computertomografische Kontrollen nach 1, 3, 6, 12, 18 und 24 Monaten und danach jährlich durchgeführt. Todesfälle (jeglicher Ursache) und sekundäre Interventionen werden in Form von Kaplan-Meier-Überlebenstabellen dargestellt. Ergebnisse: Bis Ende März 2002 wurden 4291 Aneurysmen durch Stenting versorgt. Bei 3797 Patienten wurden Bifurkationsgrafts verwendet. 3220 Eingriffe erfolgten in Allgemeinanästhesie, 922 in Regionalanästhesie und 149 in Lokalanästhesie. Bei 4195 Patienten (97,8%) wurde die Implantation erfolgreich abgeschlossen. Bei 1,3% erfolgte eine «primäre» Konversion zu einer offenen Operation. Die intraoperative Abschluss-Angiografie zeigte Austritt von Kontrastmittel in den Aneurysmasack bei 725 Patienten (771 «Endoleaks»). Die 30-Tage-Mortalität betrug 2,4%. Die mediane Beobachtungszeit betrug 12 Monate, die maximale 8 Jahre. Das Risiko einer späten Konversion zu einer offenen Operation lag bei 2% pro Jahr. Bei 35 Patienten (0,8%) trat im Verlauf eine Aorten-Ruptur auf. Hoch signifikante Risikofaktoren (p < 0.001) waren Endolecks der Typen I und III sowie Dislokation und Abknickung des Implantates. Schlussfolgerung: Die endovaskuläre Therapie infrarenaler Aortenaneurysmen mit Implantaten der ersten und zweiten Generation beinhaltet die Risiken einer späten Ruptur oder Konversion von zusammen über 3%.
Hochauflösende Kontrastmittel verstärkte MR-Angiographie der Handarterien: erste Erfahrungen
Authors: Krause  , Pabst  , Kenn  , Hahn
Published: January 2006

Background: In contrast to magnetic-resonance-angiography (MRA) of the peripheral vessels of the lower extremity, which gains more and more clinical application, MRA of the hand arteries is still exceptional. Our objective was to introduce an appropriate protocol for high resolution contrast-enhanced MR-angiography of the hand arteries. Patients and methods: 7 healthy volunteers and 13 patients with suspected hand artery obstructions underwent MRA. The examinations were performed on a 1.5 T system equipped with a flexible surface coil. A modified 3D-gradient-echo sequence was used. Criteria for image analysis were the overall image quality, vessel visibility and the timing of the contrast material bolus. Results: In the volunteer group delineation of the superficial or deep palmar arch, common palmar digital arteries and of the proximal and middle segments of the digital arteries was possible. No pathologic findings were seen in the volunteer group. In 10 patients MRA revealed pathologic findings. In 9 examinations bolus-timing was correct, 7 examinations showed incomplete arterial enhancement, 4 examinations showed venous overlay. Conclusions: Contrast enhanced MR-angiography of the hand arteries in the described technique is a promising method. Compared to intraarterial digital subtraction angiography (IA-DSA) MRA still has limitations concerning spatial and temporal resolution. For clinical evaluation comparative studies with IA-DSA are necessary.
Pseudoaneurysm of gastric artery
Authors: Moll  , Debus  , Franke  , Schindler
Published: January 2006

Das seltene Pseudoaneurysma der Arteria gastrica dextra ist meistens eine Komplikation einer Pankreatitis. Die Klinik kann blande sein, aber auch als hämorrhagischer Schock bei Aneurysmaruptur imponieren. Die Diagnostik erfolgt mit der Sonographie, Farbdopplersonographie, Computertomographie bzw. Angiographie. Während endoskopisch keine Therapie möglich ist, bietet die interventionelle Radiologie mit der Embolisation ein schnelles, sicheres und komplikationsarmes Verfahren, das auch im Falle einer akuten Blutung als eine Alternative zur Notfalloperation eingesetzt werden kann.
Funktionsanalyse des Netzhautgefäßdurchmessers bei artifizieller Augeninnendrucksteigerung bei Glaukompatienten mit und ohne Therapie mit Dorzolamide
Authors: Nagel  , Vilser  , Lanzl
Published: January 2006

Background: Examination of the influence of dorzolamide on the autoregulation of retinal vessel diameter in glaucoma patients. Patients and methods: Eleven patients with primary open angle glaucoma (age 60 ± 11) without medication and four weeks after starting therapy with dorzolamid eye drops three times daily were examined in the study. Short-time rise of intraocular pressure (IOP) was obtained via suction-cup. Functional reaction of the diameter of a segment of a retinal artery and corresponding vein were assessed by retinal vessel analyzer. Results: Dorzolamid lowered the IOP from 23.3 ± 1.3 to 17.6 ± 2.2 mmHg (p = 0.004). Therapy did not influence the absolute diameter of retinal vessels regarding maximal dilatation caused by the pressure rising provocation. In eyes with treatment the diameter decreased faster to baseline values (arteries 100 sec, veins 220 sec) compared to those without treatment (arteries 350 sec, veins 480 sec). Conclusion: Dorzolamid might possibly be able to accelerate autoregulation of retinal vessels in response to short term artificial IOP increase.