bluuebunny/crossref_metadata_2025 huggingface dataset:
Diet Quality, a Term Subject to Change over Time
Authors: Elmadfa Ibrahim , Meyer Alexa L.
Published: February 2013

A high-quality diet is one of the foundations of health and well-being. For a long time in human history, diet was chiefly a source of energy and macronutrients meant to still hunger and give the strength for work and activities that were in general much harder than nowadays. Only few persons could afford to emphasize enjoyment. In the assessment of quality, organoleptic properties were major criteria to detect spoilage and oxidative deterioration of food. Today, food hygiene is a quality aspect that is often taken for granted by consumers, despite its lack being at the origin of most food-borne diseases. The discovery of micronutrients entailed fundamental changes of the concept of diet quality. However, non-essential food components with additional health functions were still barely known or not considered important until recently. With the high burden of obesity and its associated diseases on the rise, affluent, industrialized countries have developed an increased interest in these substances, which has led to the development of functional foods to optimize special body functions, reduce disease risk, or even contribute to therapeutic approaches. Indeed, nowadays, high contents of energy, fat, and sugar are factors associated with a lower quality of food, and products with reduced amounts of these components are valued by many consumers. At the same time, enjoyment and convenience are important quality factors, presenting food manufacturers with the dilemma of reconciling low fat content and applicability with good taste and appealing appearance. Functional foods offer an approach to address this challenge. Deeper insights into nutrient-gene interactions may enable personalized nutrition adapted to the special needs of individuals. However, so far, a varied healthy diet remains the best basis for health and well-being.
Nutritional and Cultural Aspects of the Mediterranean Diet
Authors: Serra-Majem Lluis , Bach-Faig Anna , Raidó-Quintana Blanca
Published: February 2013

The recent recognition by United Nations Educational, Scientific and Cultural Organization (UNESCO) of the Mediterranean diet as an Intangible Cultural Heritage of Humanity reinforces, together with the scientific evidence, the Mediterranean diet as a cultural and health model. The Mediterranean diet has numerous beneficial effects on among others the immune system, against allergies, on the psyche, or even on quality of life, topics that are currently fields of research. The Mediterranean diet has an international projection; it is regarded as the healthiest and the most sustainable eating pattern on the planet and is a key player in the public health nutrition field globally, but especially in the Mediterranean area. Moreover, this ancient cultural heritage should be preserved and promoted from different areas: public health, agriculture, culture, politics, and economic development.
Chemical and Biological Modulations of Food due to the Frying Process
Authors: Wagner Karl-Heinz , Elmadfa Ibrahim
Published: February 2013

The interactions between frying fat and fried foods are of great relevance for the nutritional quality of the final product. In particular, the amount of fat taken up can be positively influenced at the industrial but also at the household level by different pre- and post-frying conditions. The fat uptake during the frying process can also lead to a complete different fatty acid pattern of the product. The change is always towards the predominant fatty acids in the frying fat, which can be beneficial when replacing saturated fatty acids with monounsaturated fatty acids and polyunsaturated fatty acids, but can also be of disadvantage in the case of fish, when the initial content of n-3 fatty acids is significantly reduced. This has also to be considered for nutritional calculation so as not to misrepresent the nutrient composition of the fried product. There have been positive developments in producing frying fats which are low in trans-fatty acids, and fried products low in heat-induced compounds which can address toxicological concerns such as acrylamide formation.
Seafood: Nutritional Benefits and Risk Aspects
Authors: Oehlenschläger Jörg
Published: February 2013

Seafood, such as fish, crustacean and molluscan shellfish, and echinoderms, provides in the edible part (e. g., filet, abdominal muscle) many nutritional components beneficial for the human diet like n-3 polyunsaturated long chain fatty acids (PUFAs), namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), essential elements such as selenium and iodine, high potassium and low sodium concentrations, and the vitamins D, A, E, and B12, as well as taurine (2-aminoethanesulfonic acid) among others. Its protein is highly digestible due to low connective tissue content, and cholesterol content is also low in fish. Lean fish species are extremely low in fat content (<1 %), while fatty species are extremely rich in PUFAs. However, being subject to environmental influences from its habitat, seafood also entails water-borne health risks such as organic pollutants, toxins, parasites, and heavy metals. Nevertheless, the vast majority of experimental and epidemiological studies have proven that the benefits of fish intake exceed the potential risks even for vulnerable consumer groups.
Healthy Effects Exerted by Prebiotics, Probiotics, and Symbiotics with Special Reference to their Impact on the Immune System
Authors: Jirillo Emilio , Jirillo Felicita , Magrone Thea
Published: February 2013

Pre-, pro-, and symbiotics are endowed with a broad spectrum of beneficial effects when administered to animals and humans. A series of experimental and clinical studies have clearly demonstrated that prebiotics, probiotics, or their combination are very effective in attenuating chronic inflammatory conditions such as inflammatory bowel disease or obesity. In addition, these natural products are able to prevent or arrest tumor development, acting on the intestinal microbiota as well as potentiating the immune response.Aging is characterized by a dramatic reduction of both innate and adaptive immune responses, the so-called immunosenescence. This leads to an increased incidence of infections, autoimmune diseases, and cancer in the elderly. Pre-, pro-, and symbiotic administration has been shown to ameliorate the immune response in aging. In particular, administration of a symbiotic to free-living elderly was able to potentiate the release of interleukin-8, thus increasing neutrophils in the host, perhaps explaining the reduced frequency of winter infections in the elderly.
Towards a European Food Composition Data Interchange Platform
Authors: Bell Simone , Pakkala Heikki , Finglas Michael P.
Published: February 2013

Food composition data (FCD) comprises the description and identification of foods, as well as their nutrient content, other constituents, and food properties. FCD are required for a range of purposes including food labeling, supporting health claims, nutritional and clinical management, consumer information, and research. There have been differences within and beyond Europe in the way FCD are expressed with respect to food description, definition of nutrients and other food properties, and the methods used to generate data. One of the major goals of the EuroFIR NoE project (2005 - 10) was to provide tools to overcome existing differences among member states and parties with respect to documentation and interchange of FCD. The establishment of the CENs (European Committee for Standardisation) TC 387 project committee on Food Composition Data, led by the Swedish Standards Institute, and the preparation of the draft Food Data Standard, has addressed these deficiencies by enabling unambiguous identification and description of FCD and their quality, for dissemination and data interchange. Another major achievement of the EuroFIR NoE project was the development and dissemination of a single, authoritative source of FCD in Europe enabling the interchange and update of data between countries, and also giving access to users of FCD.
Food Safety Security: A new Concept for Enhancing Food Safety Measures
Authors: Iyengar Venkatesh , Elmadfa Ibrahim
Published: February 2013

The food safety security (FSS) concept is perceived as an early warning system for minimizing food safety (FS) breaches, and it functions in conjunction with existing FS measures. Essentially, the function of FS and FSS measures can be visualized in two parts: (i) the FS preventive measures as actions taken at the stem level, and (ii) the FSS interventions as actions taken at the root level, to enhance the impact of the implemented safety steps. In practice, along with FS, FSS also draws its support from (i) legislative directives and regulatory measures for enforcing verifiable, timely, and effective compliance; (ii) measurement systems in place for sustained quality assurance; and (iii) shared responsibility to ensure cohesion among all the stakeholders namely, policy makers, regulators, food producers, processors and distributors, and consumers. However, the functional framework of FSS differs from that of FS by way of: (i) retooling the vulnerable segments of the preventive features of existing FS measures; (ii) fine-tuning response systems to efficiently preempt the FS breaches; (iii) building a long-term nutrient and toxicant surveillance network based on validated measurement systems functioning in real time; (iv) focusing on crisp, clear, and correct communication that resonates among all the stakeholders; and (v) developing inter-disciplinary human resources to meet ever-increasing FS challenges. Important determinants of FSS include: (i) strengthening international dialogue for refining regulatory reforms and addressing emerging risks; (ii) developing innovative and strategic action points for intervention {in addition to Hazard Analysis and Critical Control Points (HACCP) procedures]; and (iii) introducing additional science-based tools such as metrology-based measurement systems.
The Origins of a Global Standard for Food Quality and Safety: Codex Alimentarius Austriacus and FAO/WHO Codex Alimentarius
Authors: Vojir Franz , Schübl Erwin , Elmadfa Ibrahim
Published: February 2013

In the second half of the 19th century the incidence of food adulterations increased very rapidly, prompting many European countries to put into force food laws to fight these practices. A number of parallel attempts were undertaken to establish a collection of instructions for the assessment of food samples to warrant the comparability of results obtained and interpreted by different experts. The first official steps towards such a standardization was made in 1891 at an international meeting of food chemists and microscopic scientists in Vienna. As a consequence, Austria installed a Scientific Commission in 1891, which drafted chapters for a future Codex Alimentarius Austriacus. In 1907, a Codex Commission was installed by the Ministry of Interior, but it took about four years, from 1907 to 1911, before the first edition of this compendium was published. So far, four editions have followed. The Codex Alimentarius Austriacus is a set of standards and guidelines for stakeholders, authorities, and law courts as a base for their activities. It has evolved over the past 100 years to become a flexible instrument, which has become indispensable for Austria. After 1945, attempts were made in different parts of the world to develop standardized rules for the testing of food samples to prevent trade barriers within the respective region. In Europe for instance, the development of a Codex Alimentarius Europaeus initiated by the Austrian Hans Frenzel, and based upon the model of the Codex Alimentarius Austriacus, made good progress. A number of other European countries were involved in this project. However, the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) of the United Nations were intent on impeding such regional activities to prevent trade barriers at a global level. Between 1960 and 1963, steps were taken to install a FAO/WHO Codex partly in close cooperation with the Codex Alimentarius Europaeus. Since 1963, the FAO/WHO Codex Commission has issued the FAO/WHO Codex Alimentarius, which took its name and some organizational aspects from Codex Alimentarius Europaeus, that was itself modeled after the Codex Alimentarius Austriacus. The Codex Alimentarius Europaeus was incorporated into the Codex Alimentarius Commission as the regional coordinating committee for Europe, thus providing a model for the six regional coordination committees of the Codex Alimentarius Commission existing today.
The Role of Polyphenols in the Modulation of Plasma Non-Enzymatic Antioxidant Capacity (NEAC)
Authors: Serafini Mauro , Morabito Giuseppa
Published: February 2013

Dietary polyphenols have been shown to scavenge free radicals, modulating cellular redox transcription factors in different in vitro and ex vivo models. Dietary intervention studies have shown that consumption of plant foods modulates plasma Non-Enzymatic Antioxidant Capacity (NEAC), a biomarker of the endogenous antioxidant network, in human subjects. However, the identification of the molecules responsible for this effect are yet to be obtained and evidences of an antioxidant in vivo action of polyphenols are conflicting. There is a clear discrepancy between polyphenols (PP) concentration in body fluids and the extent of increase of plasma NEAC. The low degree of absorption and the extensive metabolism of PP within the body have raised questions about their contribution to the endogenous antioxidant network. This work will discuss the role of polyphenols from galenic preparation, food extracts, and selected dietary sources as modulators of plasma NEAC in humans.
Physiological Requirements for Zinc
Authors: Hambidge  , Miller Leland V. , Krebs Nancy F.
Published: February 2013

The estimates of zinc physiological requirements by the International Zinc Nutrition Consultative Group (IZiNCG) in 2004 were conspicuously low in comparison with those estimated by the Institute of Medicine (IOM) in 2001. The objective of this review is to explore the reasons for this gap and to reflect on lessons learned. All estimates of inevitable losses of endogenous zinc, especially intestinal excretion of endogenous zinc, were reviewed. An error in zinc menstrual losses, as well as a minor error in the linear regression of endogenous fecal zinc (EFZ) vs. total daily zinc absorption (TAZ) by IOM, were corrected. The review revealed an error by IZiNCG in selecting two data points for the linear regression of EFZ on TAZ. A second major reason for the gap is attributable to weighting of the data in the regression analysis by number of subjects per study by IZiNCG. Adjusting for these factors, together with use of the same reference data for body weights, resulted in satisfactory agreement between the two estimates of physiological requirements. The lessons to be learned from this review are discussed together with suggestions for future action by IOM as well as a constructive role for IZiNCG.
Treatment of acute limb ischemia with focus on endovascular techniques
Authors: Zeller  , Tepe
Published: February 2013

Acute limb ischemia is still the most frequent cause of major limb loss. Timely and fast revascularization is the key for limb salvage and patient survival. Large randomized trials showed equivalency of surgical and endovascular revascularization by means of local lysis with urokinase (TOPAS, STILE). New lytic agents and their modified application such as via a pulse spray catheter or combined with an ultrasound catheter and the combination with glycoprotein IIb/IIIa receptor antagonists have increased the efficacy and speed of thrombolysis. Recently, mechanical thrombectomy devices have become more widespread because intervention time and bleeding complications can be reduced. This review article summarizes the clinical presentation of and the treatment options for acute arterial occlusive disease caused either by embolism or local thrombosis.
Thromboprophylaxis – Key points for the angiologist
Authors: Bauersachs  , Haas
Published: February 2013

The expertise and the advice of vascular specialists are important in diagnosis and treatment of venous thromboembolism (VTE) and equally important for thromboprophylaxis. Thus, vascular specialists are expected to have significant knowledge of the exposing and disposing risk factors for VTE. They are also expected to be familiar with the risk groups for VTE and the appropriate measures for thromboprophylaxis. Because different pharmacological prophylactic strategies are available, angiologists must be familiar with the properties, the specific labeling and the product information regarding their drugs of choice. Being familiar with the pharmacological profile and the potential risk of impaired renal function due to drug accumulation is essential for angiologists, both for the treatment and prophylaxis of VTE. Appropriate time intervals between application of thromboprophylaxis and spinal or epidural anaesthesia should be observed. This is also important for the recently available oral thrombin- and factor Xa-inhibitors. Presently available data do not support routine pharmacological prophylaxis for patients in the low VTE-risk group. Rather, individual risk benefit assessment is required in these patients. Patients with moderate or high VTE risk should receive pharmacological thromboprophylaxis. There is clear evidence and recommendation for prolonged administration of thromboprophylaxis over a 4-week period in patients following major orthopaedic surgery, such as hip replacement, hip fracture and in cancer surgery patients. Pulmonary embolism (PE) remains the most common preventable cause of death among hospitalized patients. Therefore, angiologists have a central role in ensuring adequate and consistent implementation of thromboprophylaxis, which is the number one strategy to improve patient safety in hospitals.
Common femoral artery intima-media thickness as marker for cardiovascular disease in asymptomatic adults
Authors: Giannoukas  , Antoniou  , Saleptsis  , Baros  , Griffin  , Nicolaides
Published: February 2013

Background: The common carotid intima-media thickness (IMT) is considered as a marker of cardiovascular disease, while the value of the common femoral IMT is not well defined. The aim of the present study was to investigate the value of common femoral IMT alone or in combination with the common carotid IMT as a marker of cardiovascular disease in asymptomatic adults. Patients and Methods: Eighty-three individuals with no history of cardiovascular disease were subjected to IMT measurement of both common carotid and common femoral arteries with high-resolution ultrasonography. The Framingham Heart Study (FHS) risk score was calculated for each subject (according to gender) and was correlated with the carotid IMT, femoral IMT, and the combined IMT measured at both arterial sites. Results: The carotid and femoral IMT separately and in combination were found to be correlated with the FHS risk score, calculated based on either the total cholesterol or low density lipoprotein plasma levels (carotid IMT: r = 0.28, p = 0.035, and r = 0.35, p = 0.007, respectively, femoral IMT: r = 0.38, p = 0.003, and r = 0.43, p = 0.001, respectively, carotid-femoral IMT: r = 0.37, p = 0.005, and r = 0.46, p = 0.0001, respectively). In addition, femoral IMT was found to be correlated with the carotid IMT (r = 0.41, p = 0.001). Conclusions: Common carotid and common femoral IMT showed similar correlation with the FHS risk score. Additionally, the combination of IMT from both arterial sites was found to have similar correlation with the FHS risk score to carotid IMT alone.
The influence of atorvastatin on walking performance in peripheral arterial disease
Authors: Bregar  , Poredoš  , Šabovič  , Jug  , Šebeštjen
Published: February 2013

Background: Recently it has been shown that statins can improve walking distance in patients with peripheral arterial disease. We examined whether statins used in moderate dosages with the aim of reaching the target levels for hypercholesterolemia could improve walking performance in patients with peripheral arterial disease. Patients and methods: 37 patients with hypercholesterolemia (LDL cholesterol = 3.46 ± 0.13 mmol/l), who had previously not been treated by statins, were randomized in a double-blind study to a group receiving either atorvastatin at 20 mg/day (N = 20) or placebo (N = 17). All patients had stable intermittent claudication (Fontaine class IIa or IIb). At baseline, after one and three months the pain-free walking distance was measured in all patients. Results: After 3 months patients in the treated group had reached target cholesterol values (LDL cholesterol = 2,34 ± 0.9 mmol/l), whereas no significant change in lipids was observed in the control group. The ankle-brachial pressure index (ABPI) did not change significantly in either group. After 3 months the pain-free walking distance was increased significantly (p < 0.001), but similarly in both groups (at entry: 56 (53–108) m vs 53 (53–106) m; after 3 months: 79 (53–108) m vs 106 (66–159) m, for the treated and placebo group, respectively). Therefore this effect had to be attributed to regular exercise and not to statin use. Conclusions: Our results show that routine treatment with statin (atorvastatin 20 mg/day), which is effective in reducing the level of cholesterol, does not produce an improvement in walking performance in patients with peripheral arterial disease.
Asymptomatic venous thrombosis in cancer patients – a problem often overlooked. Results of a retrospective and prospective study
Authors: Heidrich  , Konau  , Hesse
Published: February 2013

Background: Venous thrombosis with and without pulmonary embolism is a frequent complication of malignancies and second among the causes of death in tumour patients. Its incidence is reported to be 10 to 15%. Since for methodological reasons, this rate can be assumed to be too low and to disregard asymptomatic venous thrombosis, a combined retrospective and prospective study was performed to examine the actual frequency of venous thrombosis in tumour patients. Patients and methods: The histories of 409 patients (175 women, 234 men, mean age 69 years [19 to 96 years]) with different tumours, consecutively enrolled in the order of their altogether 426 inpatient treatments, were checked in retrospect for the frequency of venous thrombosis and pulmonary embolism. Subsequently, 97 tumour inpatients (36 women, 61 men, mean age 70 years [42 to 90 years]) were systematically screened, by means of duplex sonography and/or venography, for venous thromboses in the veins of the pelvis and both legs. Results: In the retrospective analysis, where no systematic screening for thromboses was performed and only symptomatic thrombosis was recorded, venous thrombosis was found in 6.6% of all tumour patients, whereas in the prospective examination with systematic duplex sonography and / or venography of all patients, the percentage was 33%. In the prospective study, 31.3% of venous thromboses were symptomatic and 68.7% asymptomatic. In 39.3% of the cases in the retrospective analysis and 25% in the prospective analysis, venous thrombosis occurred during chemotherapy, surgery or radiation therapy. Venous thrombosis was most often seen in metastasizing tumours and in colorectal carcinoma (40%), haematological system diseases (28.6%), gastric cancer (30%), bronchial, pancreas and ovarian carcinoma (28.6%), and carcinoma of the prostate (16.7%). Conclusion: Regular screening for thrombosis is indicated even in asymptomatic tumour patients because asymptomatic venous thrombosis is frequent, can lead to pulmonary embolism and has to be treated like symptomatic venous thrombosis. This is particularly true for metastasization during chemotherapy, surgical interventions, or radiation.
Tumors associated with superficial thrombophlebitis
Authors: Mouton  , Kienle  , Muggli  , Naef  , Wagner
Published: February 2013

Background: To assess the incidence of malignant tumors in patients with thrombophlebits of the leg with regard to potential early tumor detection. Patients and Methods: 140 consecutive patients were enrolled over a period of over 9 years in a retrospective follow-up study based on the electronic patient record. Results: There were 18 patients (12.9%) suffering from thrombophlebitis in association with a malignant tumor: breast cancer in seven patients, colon carcinoma and haematologic cancer in four, skin cancer in three patients and one case each of oesophageal, prostatic, kidney and neck cancer . In two patients thrombophlebitis preceded the diagnosis of the malignancy. Superficial thrombophlebitis may have been associated in four cases (2.9%) with a benign tumor. Conclusions: Breast, colonic, haematological and skin cancer were mainly associated with superficial thrombophlebitis in our patients. In case of a thrombophlebitis without a known malignancy a thorough clinical examination with special regard to skin, breast and abdomen is mandatory.
Severity of chronic venous disorders and its relationship to the calf muscle pump
Authors: Panny  , Ammer  , Kundi  , Katzenschlager  , Hirschl
Published: February 2013

Background: To investigate the relationship between the calf muscle pump and the clinical severity of chronic venous disorders (CVD) and of venous function parameters. Patients and methods: 84 limbs in 44 patients underwent duplex scan and digital photoplethysmography (DPPG), the range of ankle movement was measured by digital goniometry and strength of calf muscles was determined by dynamometry. Limbs were allocated on the basis of clinical signs of CVD (according to the CEAP classification) into 4 groups: controls (no signs and symptoms of CVD): 34 limbs, C1/2: 24 limbs, C3/4: 16 limbs, C6: 10 limbs. Results: A higher degree in clinical severity of CVD was related to shorter venous refilltime (VRT) and lower venous pump power (VPP) measured by DPPG. The strength of dorsiflexion was significantly reduced in group C6 compared to controls. There was a positive correlation between measurements of DPPG and the strength of dorsiflexion and also with total strength (p < 0.05). In limbs with pathological reflux (> 1 s) the strength of dorsiflexion, range of ankle plantarflexion movement and total range of ankle movement were significantly reduced compared to those without pathological reflux (p < 0,05). Strength of plantarflexion was significantly reduced in group C1/2 compared to control group (p < 0,05). Conclusions: Strength of dorsiflexion seems to be the main driving factor of normal venous flow and range of ankle movement is impaired in patients with pathological venous reflux. Further prospective studies should clarify if additional strengthening of ankle dorsiflexors should be included in well established venous training programs.
Traumatic vertebral artery aneurysm following blunt suboccipital trauma
Authors: Chiang  , Yeh  , Lo  , Hsieh  , Yang
Published: February 2013

Traumatic vertebral artery (VA) injury has been neglected and mistaken to be innocuous. Herein, we present a rare case with a as subarachnoid hemorrhage (SAH) following blunt suboccipital trauma. Initially, it was mistaken as a saccular aneurysm and was just coincident with traumatic SAH. Surgical clipping was performed by our senior neurosurgeon and looked secure. But massive bleeding occurred before complete closure of the dura wound. Opening the wound again, blood gushed out from the junction of the aneurysm and the parent artery. Because preoperative angiography evaluation had revealed good collateral flow from the contralateral VA, the involved segment of VA was trapped. The patient recovered well with uneventful course. Blunt suboccipital trauma may result in traumatic VA injury which may cause catastrophic complications if neglected. The incidence, risk factors, the pathophysiology of traumatic VA aneurysm, and the treatments are reviewed.
Successful revascularisation of a thrombosed renal artery aneurysm in a young man with solitary kidney and history of severe hypertension
Authors: Kuriata-Kordek  , Dorobisz  , Garcarek  , Porazko  , Kuźniar
Published: February 2013

Case report of a 18-year-old patient with long lasting hypertension, who developed acute renal failure, in course of an antihypertensive therapy modification, backgrounded by undiagnosed aneurysm of the solitary kidney renal artery. The acute renal function decrease was caused by single dose of ACE inhibitor causing an equivalent drop in serum ACE activity. Aneurysm excision followed by implantation of a venous bypass normalized restored renal function and blood pressure for over 24 months of observation.
Lymphoplasmacytic lymphoma with Waldenstrom’s macroglobulinemia as a reason for peripheral arterial perfusion disorders
Authors: Zgouras  , Engels  , Lindhoff-Last
Published: February 2013

Peripheral arterial perfusion disorders are often caused by embolism and thrombosis induced by diseases of the cardiovascular system. We report about a case of a 42-year-old female with peripheral arterial perfusion disturbances of the digital arteries caused by Waldenstrom´s disease due to high plasma viscosity. Our patient presented with elevated plasma viscosity (1.34 mPA) and therefore plasmapheresis was necessary. Plasma seperation is the most effective acute treatment for symptomatic hyperviscosity syndrome. In a second step patients with clinical symptoms of M. Waldenstrom have to be treated by chemotherapy.
Quality of life after acute type b dissection in the era of thoracic endovascular aortic repair
Authors: Dick  , Hirzel  , Immer  , Hinder  , Dai-Do  , Carrel  , Schmidli
Published: February 2013

Background: Conservative management of acute type B aortic dissection is currently being challenged by primary thoracic endovascular aortic repair. Aim was to assess outcome and quality of life after these different approaches using an adjusted standard population as benchmark. Patients and methods: Observational study of a prospectively collected (January 2000 to December 2005) consecutive series of 87 patients with acute type B aortic dissection. Patients were 63 ± 13 years old and 68 were men (78.2 %). Seventy-two were managed conservatively (83 %) and 15 invasively (12 by endovascular aortic repair). Follow-up was 36 ± 19 months. Endpoints were early and late morbidity and mortality, and long-term quality of life as assessed by the Short Form health survey questionnaire. Results: Patient cohorts were similar regarding age, risk profile and local disease. In the conservative cohort, four patients died during early (5.6 %) and eight during long-term follow-up (cumulative four years survival rate 79 %). Thirty-two patients needed secondary surgical management (44 %), i.e. delayed aortic repair (n = 11), or interventions on adjacent aortic sections or major branches (n = 21). In the surgical cohort no patient died, and no repeated interventions were necessary after the peri-operative period. Long-term quality of life scores were 100 (69-115) in conservatively and 94 (75-124) in invasively managed patients. Normal scores range from 85 to 115. Conclusions: Primary endovascular management of uncomplicated acute type B dissection is safe and leads to excellent long-term results, whereas secondary interventions were required with high incidence after initial conservative management. Long-term quality of life, however, returned to normal with any successful treatment strategy.
Treadmill test is limited in elderly patients with peripheral arterial disease
Authors: Wolosker  , Ritti-Dias  , Câmara  , Garcia  , Jacob-Filho  , Puech-Leao
Published: February 2013

Background: To describe the applicability and the performance of the treadmill test in elderly patients with peripheral arterial disease (PAD) and without PAD (non-PAD). Patients and methods: Fifty consecutive PAD and non-PAD elderly patients performed a progressive treadmill test. The proportion of patients who were unable to perform the test and the maximal walking distance were obtained. Results: The proportion of patients who were unable to perform the treadmill test was similar between PAD (16.6 %) and non-PAD patients (12.5 %), P = .57. Maximal walking time for patients who performed the treadmill test was not different between PAD (232 ± 218 s) and non-PAD patients (308 ± 289 s), P = .37. Conclusions: The treadmill test is limited in almost 20 % of elderly patients with PAD and non-PAD. These results highlight the need for other forms of exercise stress tests in order to assess the peripheral limitation of patients with PAD.
Bridging with enoxaparin using a half-therapeutic dose regimen: safety and efficacy
Authors: Klamroth  , Gottstein  , Essers  , Landgraf
Published: February 2013

Background: Low molecular weight heparin is widely used during the interruption of long-term oral anticoagulation in patients undergoing surgery. The optimal dose is still a matter of debate. The 8th ACCP Guidelines primarily recommend therapeutic-dose or low-dose low molecular weight heparin after stratification of the thromboembolic risk. We investigated the efficacy and safety of a standardized bridging therapy with enoxaparin in a half-therapeutic dose in patients with a target INR of 2,0 to 3,0. Patients and methods: In our prospective registry we studied 198 consecutive patients receiving oral anticoagulant therapy with phenprocuomon and a planned surgery. Phenprocoumon was stopped 7 days before surgery and after reaching an INR less than 2,0 all patients received enoxaparin in a half-therapeutic dose (1 × 1 mg / kg body weight (bw)/day) until the day before surgery. Enoxaparin was continued with the same dose split into 2 × 0,5 mg / kg bw / day after the procedure. Phenprocoumon was resumed within day 1 to 14 after surgery depending on the bleeding risk as determined by the surgeon. All patients were followed up for 28 days after surgery. Results: Major surgery was performed in 148 patients (75 %). 175 patients (88 % of the total) had an intermediate thromboembolic risk. On average, enoxaparin was administered for 19,5 days. One patient (0,5 %) experienced arterial thrombosis after surgery, and one patient (0,5 %) required a second surgical intervention due to severe bleeding. Conclusions: In patients receiving oral anticoagulant therapy with a target INR of 2,0-3,0 and at an intermediate risk of thromboembolic events who require interruption of oral anticoagulant therapy a half therapeutic dose of enoxaparin seems to be safe and effective for bridging.
1470 nm diode laser for endovenous ablation (EVLA) of incompetent saphenous veins - a prospective randomized pilot study comparing warm and cold tumescence anaesthesia
Authors: Pannier  , Rabe  , Maurins
Published: February 2013

Background: Major side effects after endovenous laser ablation (EVLA) are pain and bruising. Low temperature of the tumescence fluid might cause additional venous constriction and a cooling effect around the vein. The aim of this study was to show outcome and side effects after EVLA of incompetent great saphenous veins (GSV) with a 1470 nm Diode laser (Ceralas E, biolitec) using cold or warm tumescence fluid for anaesthesia. Patients and methods: Between August and November 2007, 85 consecutive patients (85 legs) with an incompetent GSV were treated by EVLA. The patients were randomized in two groups. In 42 patients (Group A) a warm (37 °C) and in 43 patients (Group B) a cold (5 °C) tumescence fluid (TF) was used for local anaesthesia in the track of GSV. All patients were re-examined after 1, 10 and 30 days clinically and by duplex for complications and occlusion in the treated vein segment. Patient’s satisfaction was assessed on a 0 to 4 points scale. Results: In each group one patient was lost to follow-up. There was no significant difference concerning gender, age, C of CEAP, BMI or diameter of the treated vein. In Group A a mean of 462 ml TF and in Group B a mean of 428 ml TF were used. In Group A the mean LEED (average linear endovenous energy density) was 114 J / cm and in Group B 115 J / cm. In both groups occlusion of the treated veins was achieved for all patients. The diameter of the GSV at 3 cm below the sapheno-femoral junction shrunk from 1.0 to 0.7 cm in both groups. The modified CEAP clinical score improved in Group A from 2.9 to 0.7 (mean value) and in Group B from 3.0 to 1.1. The mean pain score on a scale from 0 to 4 during day 2 to day 10 was 1.2 in Group A and 1.0 in Group B. At this time patients in Group A took a mean of 3.4 and in Group B 1.7 analgetic tablets. Ecchymoses were rare in both groups (4 in Group A, 7 in Group B). Conclusions: In this prospective randomized comparative study the temperature of the tumescence fluid did not influence the occlusion rate when a high LEED was used. In both groups pain and ecchymoses are less frequent in this study with a 1470 nm diode laser than reported in studies with 810-980 nm systems. Cold tumescence fluid reduced pain slightly and reduced the intake of analgetics significantly.
Long-term antiplatelet treatment for innominate vein aneurysm
Authors: Mikroulis  , Vretzakis  , Eleftheriadis  , Lazarides
Published: February 2013

Aneurysms of thoracic veins are rare lesions and their therapeutic management is not clearly determined. We present a 60-year old man with an asymptomatic right innominate vein aneurysm. The patient had been operated on 10 years ago for coronary artery bypass and was under antiplatelet treatment. In a retrospective inspection of his chest X-rays, we found that the aneurysm had been existent for at least 10 years. We suggested conservative treatment and over a 5-year follow-up, the patient has remained asymptomatic. Our patient is alive 15 years with thoracic vein aneurysm and antiplatelet treatment.
“Silent” thrombosis of an abdominal aortic aneurysm not producing acute limb ischemia
Authors: Moulakakis  , Maras  , Bountouris  , Pomoni  , Georgakis  , Andrikopoulos
Published: February 2013

Thrombosis of an abdominal aortic aneurysm is a rare devastating complication with an estimated mortality rate of 50%. Simultaneous acute pain, pallor and coldness of the lower limbs, mottling from the level of iliac crests or umbilicus, paraplegia and absence of femoral pulses are all manifestations of a sudden and acute interruption of blood flow through the aneurysmatic aorta. We report a case of an occlusion of an abdominal aortic aneurysm during hospitalization which was not manifested with symptoms of limb ischemia. In this case we feature the rare and unusually “silent” presentation of the event.
Stab injury of the superior mesenteric artery with life threatening bleeding - endovascular treatment with an unusual technique
Authors: Demirel  , Winter  , Rapprich  , Weigand  , Gamstätter
Published: February 2013

Endovascular microcoil embolization of the superior mesenteric artery (SMA) main trunk is not currently employed as a treatment for penetrating injury to the SMA in hemodynamically instable patients. Immediate laparotomy is the initial gold standard therapy. We report a case of successful SMA microcoil embolization with preservation of mesenteric perfusion by an unusual endovascular technique.
New possibilities of maximal revascularization of the foot as a limb salvage procedure in diabetics
Authors: Sauvant  , Hüttenmoser  , Soyka  , Rüttimann
Published: February 2013

Diabetics and patients with chronic renal insufficiency often have severe peripheral arterial disease of the distal lower limbs with obstructions of crural and pedal arteries and the imminent risk of critical ischemia and major amputation. Neuroischemic foot ulcers have been shown to fail to heal even after successful arterial revascularization. We report on two diabetic patients with the neuroischemic diabetic foot syndrome and different clinical outcomes after percutaneous transluminal angioplasty of chronic occluded crural arteries and discuss, whether endovascular revascularisation of infrapopliteal and pedal arteries, if possible with complete plantar arch, could promote ulcer healing in neuroischemic diabetic foot ulcers.
Neovascularisation after surgery for recurrent saphenofemoral incompetence: Does surgical dissection technique matter?
Authors: Mouton  , Marklewitz  , Friedli  , Zehnder  , Wagner  , Heim  , De Maeseneer
Published: February 2013

Background: The effect of the type of surgery on neovascularisation in the groin is unknown. The aim of the present study was to compare three different surgical techniques used for recurrent saphenofemoral incompetence in view of their effect on neovascularisation in the groin at short- and long-term follow-up after surgery. Patients and methods: 36 consecutive patients undergoing surgery for recurrent saphenofemoral incompetence were randomised. 12 patients underwent sharp dissection with knife or scissors and excision and ligation of scar tissue using absorbable suture material; 12 had dissection with electrocoagulation and 12 dissection with ultrasound (Ultracision Harmonic Scalpel). Clinical outcome was assessed using the venous clinical severity score and venous disability score, and the saphenofemoral junction was evaluated by means of duplex sonography three months and seven years after the operation respectively. If neovascularisation was present, the maximal diameter of new refluxing veins in the groin was measured. Results: There was no statistically significant difference between the three surgical techniques. Duplex ultrasound showed neovascularisation with an average maximal diameter (± standard error) of the newly formed refluxing vessel of respectively 2.00 (± 0.63) mm, 1.00 (± 0.45) mm and 0.50 (± 0.50) mm after three months and 4.29 (± 1.41) mm, 3.32 (± 0.90) mm and 3.00 (0.83) mm after seven years (no significant difference between groups). After seven years no reflux was detected in 8/36 patients, no varicose veins were found in 14/36 patients. The patients were less symptomatic than before our redo operation and no one needed reoperation within the seven years. Conclusions: Dissection techniques in the groin did not influence the clinical and sonographic result at 3 months and at 7 years after redo surgery for recurrent varicose veins.
Clinical relevance of musical murmurs in color-coded duplex sonography of peripheral and visceral vessels
Authors: Thalhammer  , Aschwanden  , Husmann  , Jeanneret  , Jacomella  , Clemens  , Stock  , Amann-Vesti
Published: February 2013

Background: Musical murmurs (MMs) are Doppler phenomena which sound like high-frequency musical sounds. They reflect high and turbulent flow within relevant stenoses and were first described in degenerated bioprosthetic valves and later in intracranial vessels and were associated either with high-grade arterial stenosis, small collateral arteries or carotid cavernous fistulas. Objective of this article is to illustrate the spectrum of imaging of MMs observed in renal, intestinal and peripheral vessels. Patients and methods: Four experienced vascular ultrasound laboratories had been asked to report their cases with documented musical tones in color coded duplex sonography (CCDS) within a two year observational period (2008 and 2009). Documented Doppler findings and corresponding clinical data were analyzed. Results: MMs were found in 18 patients with an incidence of 0.05 % and were observed in high grade stenosis in hemodialysis access (n = 5), in post-biopsy arteriovenous fistulas after renal transplantation (n = 3), in renal transplant artery (n = 1) and vein (n = 3), stenoses in peripheral (n = 2) and intestinal arterial disease (n = 2), and in peripheral veins (n = 2). Conclusions: The so called musical murmurs are a rare but potentially relevant finding in CCDS. They are caused by a variety of underlying pathologies with different clinical implications, however correct interpretation is mandatory since urgent therapy might be necessary.
Renal ablation in patients with end-stage renal disease
Authors: Hansch  , Pfeil  , Neumann  , Neumann  , Mayer  , Wolf
Published: February 2013

Background: Transarterial catheter embolization of the kidneys (TAE) is a minimally invasive, image-guided procedure. In this study outcome and TAE-related complications of the patients who underwent TAE of the kidneys were evaluated retrospectively. Patients and methods: Between August 2003 and August 2009, 11 patients underwent selective percutaneous transarterial renal embolization for end stage renal disease associated with uncontrolled hypertension, nephrotic syndrome, bleeding or malignancy. TAE of renal arteries was performed using different embolization agents. Results: Successful renal embolization was possible in all 21 kidneys. All patients became anuric. Non-target embolization was not detectable. Nevertheless, all patients developed some degree of postembolization symptoms including nausea, vomiting, fever or pain. A typical finding after embolization was an increase in the C-reactive protein Conclusions: Renal embolization is rarely done but should be considered as an alternative to surgical nephrectomy in patients with end stage renal disease due to the lesser invasiveness. Our study confirms the safety and effectivity of percutaneous renal embolization in patients with ESRD. We were able to control the hypertension, nephrotic syndrome, and bleeding caused by ESRD.
Gadofosveset enhanced MR phlebography for detecting pelvic and deep vein leg thrombosis
Authors: Partovi  , Aschwanden  , Staub  , Rasmus  , Zipp  , Rengier  , Jacobi  , Hügli  , Bilecen
Published: February 2013

Background: Deep venous thrombosis is mainly diagnosed by ultrasound today. In some instances diagnosis is challenging and magnetic resonance angiography could be an attractive alternative. Gadofosveset is a blood pool contrast agent with some favourable properties for this purpose. Patients and methods: We investigated eight patients with proven deep venous thrombosis by Gadofosveset enhanced MR phlebography. We performed a 3D gradient-echo sequence with an overall measurement time of 9 minutes and 6 seconds. One minute after injection of Gadofosveset in a concentration of 0.12 ml/kg body weight images were acquired. Thrombi were visualised by their lack of luminal contrast filling. Results: Thrombi were visualised in all patients. In one patient with extended thrombosis a previously undiagnosed ovarian adenocarcinoma was detected additionally. Conclusions: Deep venous thromboses in lower extremities can be visualised reliably by performing MR phlebography with blood pool contrast agent Gadofosveset. Visualisation of the complete venous system is feasible. This investigation method may be performed in patients difficult to investigate with ultrasound or may be used for planning interventional procedures.
Hand ischemia caused by solitary humeral exostosis irritating the brachial artery
Authors: Gyedu  , Arslan  , Koksoy
Published: February 2013

A 39-year-old woman presented with ischemia of the left hand. Angiography revealed thrombosis of forearm arteries. Surgical intervention was unsuccessful. CT angiography revealed an exostosis on the distal humerus close to the brachial artery which we believe was the cause of repetitive minor trauma to the brachial artery leading to embolic occlusion of the radial and ulnar arteries. Early diagnosis of the underlying cause is the key to successful treatment of hand ischemia. For patients without risk factors for arterial occlusive disease, imaging of bony structures must be performed in order not to miss the likely cause of an insidious repetitive vascular trauma.
Cavernous transformation of the portal vein in nephrotic syndrome
Authors: Bian  , Ge  , Jiang  , Wen
Published: February 2013

We report a 19-year-old man with thrombosis of the portal vein associated with a nephrotic syndrome. A computed tomography showed obstruction of the portal vein with prominent collaterals and cavernous transformation. This case is noteworthy as a report of nephrotic syndrome accompanied by extensive abdominal venous thrombosis and was cured successfully.