bluuebunny/crossref_metadata_2025 huggingface dataset:
Endovascular treatment for the spontaneous rupture of a non-aneurysmal subdiaphragmatic aorta
Authors: Lu  , Jiang  , Yang  , Lai  , Lu
Published: February 2013

The case of a patient who underwent an endovascular aortic repair for a spontaneous rupture of a non-aneurysmal subdiaphragmatic aorta without trauma, infection, or inflammation is reported. The patient is a 51-year-old male diagnosed with subdiaphragmatic aortic rupture and was in a state of hemorrhagic shock upon admission to the hospital. Intraoperative aortography revealed the abdominal aortic rupture site located above the celiac artery. A coated thoracic stent graft was used. Completion angiography showed a total exclusion with no endoleaks. After six months of follow-up, computed tomographic scans confirmed the absence of endoleaks or graft displacements.
Management of extensive venous thrombosis following cardiac surgery in a patient with Behcets disease
Authors: Ilhan  , Bozok  , Uguz  , Karamustafa  , Karakisi O. , Sener
Published: February 2013

Behçets disease is a multisystemic vasculitis of unknown etiology, which is characterized by recurrent urogenital ulceration, cutaneous eruptions, ocular manifestations, arthritis and vasculitis, and its diagnosis is based on clinical criteria. Herein, we report a case of a patient with Behcets disease, who was successfully managed with anticoagulant and anti-inflammatory therapy for disseminated venous thrombosis leading to pleural effusion, Budd-Chiari syndrome and central nervous system involvement following coronary artery bypass grafting surgery.
Current concepts of the interventional treatment of proximal supraaortic vessel stenosis
Authors: Ernemann  , Bender  , Melms  , Brechtel  , Kobba  , Balletshofer
Published: February 2013

Interventional therapies using angioplasty and stenting of symptomatic stenosis of the proximal supraaortic vessels have evolved as safe and effective treatment strategies. The aim of this paper is to summarize the current treatment concepts for stenosis in the subclavian and brachiocephalic artery with regard to clinical indication, interventional technique including selection of the appropriate vascular approach and type of stent, angiographic and clinical short-term and long-term results and follow-up. The role of hybrid interventions for tandem stenoses of the carotid bifurcation and brachiocephalic artery is analysed. A systematic review of data for angioplasty and stenting of symptomatic extracranial vertebral artery stenosis is discussed with a special focus on restenosis rate.
Risk factors, management and primary prevention of thrombotic complications related to the use of central venous catheters
Authors: Linnemann  , Lindhoff-Last
Published: February 2013

An adequate vascular access is of importance for the treatment of patients with cancer and complex illnesses in the intensive, perioperative or palliative care setting. Deep vein thrombosis and thrombotic occlusion are the most common complications attributed to central venous catheters in short-term and, especially, in long-term use. In this review we will focus on the risk factors, management and prevention strategies of catheter-related thrombosis and occlusion. Due to the lack of randomised controlled trials, there is still controversy about the optimal treatment of catheter-related thrombotic complications, and therapy has been widely adopted using the evidence concerning lower extremity deep vein thrombosis. Given the increasing use of central venous catheters in patients that require long-term intravenous therapy, the problem of upper extremity deep venous thrombosis can be expected to increase in the future. We provide data for establishing a more uniform strategy for preventing, diagnosing and treating catheter-related thrombotic complications.
Carotid artery intima-media thickness and brachial artery flow-mediated vasodilatation in patients with rheumatoid arthritis
Authors: Veselinovic V. , Zivkovic I. , Toncev  , Tasic  , Bogdanovic  , Djuric M. , Lj Jakovljevic
Published: February 2013

Background: Cardiovascular (CV) morbidity and mortality are increased in patients with rheumatoid arthritis (RA). Our study aim was to determine the relationship between carotid artery intima-media wall thickness (IMT) and flow-mediated endothelium-dependent vasodilatation (FMD) in a patients with RA, in context with clinical and laboratory measurements. Patients and methods: Fifty-two patients with RA and 30 matched healthy controls without clinically evident CV disease were studied. Brachial and carotid ultrasonography was performed to determine FMD and IMT, respectively. We also assayed immunological, inflammatory and metabolic laboratory markers. Results: IMT was significantly higher in RA patients (1.00 ± 0.16 mm) patients than in controls (0.89 ± 0.13 mm) (P = 0.001). FMD was significantly lower in RA (9.16 ± 7.03) as compared to controls (12.60 ± 5.49) (p = 0.005). RA patients had significant positive correlations between erythrocyte sedimentation rate (ESR) (r=0.395 p = 0.021) and IMT and negative correlation between visual analog scale (VAS) (r= -0.311, p= 0.025) and IMT. RA patients who used low doses of corticosteroids have, statistically, significantly better FMD, than those who do not use corticosteroids. Linear regression analysis revealed that IMT was related to tender joint count (p = 0.008), VAS (p < 0.001), ESR (p = 0.048) and total cholesterol/high density lipoprotein cholesterol ratio (p = 0.039). Conclusions: In patients with RA, FMD was impaired and IMT was increased, indicating early endothelial dysfunction and accelerated atherosclerosis. Early treatment of disease may reduce the risk of atherosclerosis in RA.
Predictors of atherosclerosis in rheumatoid arthritis
Authors: Ahmad  , Garg  , Dhar  , Srivastava  , Biswas  , Barthwal P. , Shirazi  , Srivastava
Published: February 2013

Background: Atherosclerosis is emerging as an important complication of rheumatoid arthritis (RA), with coronary artery disease being projected as the major cause of mortality in these patients.This study was undertaken to evaluate the presence of subclinical atherosclerosis and to identify the risk factors of atherosclerosis in patients with RA. Patients and methods: All consecutive in- and out-patients of rheumatoid arthritis (n = 100) irrespective of the disease duration were included in the study. A group of 100 age and sex matched controls were also studied. Increased carotid intima media thickness (beyond the 75th percentile for age and sex), presence of plaques, ankle brachial pressure index and QT dispersion were deemed as non-invasive measures of atherosclerotic burden. Results: Fifty patients (50.0 %) with RA had evidence of subclinical atherosclerosis as compared to the control group (n = 11, 11 %); plaques were observed in 26 patients. Eighteen (36 %) of these developed this evidence within 1 - 5 years of disease onset. Low HDL levels among the conventional risk factors and advanced patient age, longer disease duration, greater number of involved joint areas, steroid use and indices of inflammation in particular in RA, were associated with subclinical atherosclerosis. Sustained inflammation was observed throughout the sub-group with atherosclerosis irrespective of the disease duration. Conclusions: RA is a pro-atherogenic state with the process of atherosclerosis initiated in the early stage of the disease. Besides the traditional risk factors, sustained inflammation contributes to atherogenesis.
Varicose veins are a risk factor for deep venous thrombosis in general practice patients
Authors: Müller-Bühl  , Leutgeb  , Engeser  , Achankeng N. , Szecsenyi  , Laux
Published: February 2013

Background: The role of varicose veins (VV) as a risk factor for development of deep venous thrombosis (DVT) is still controversial. The aim of this study in primary care was to determine the impact of varicosity as a potential risk factor for developing DVT. Patients and methods: During the observation period between 01-Jan-2008 and 01-Jan-2011, all cases with VV (ICD code I83.9) and DVT (ICD codes I80.1 - I80.9) were identified out of the CONTENT primary care register (Heidelberg, Germany). The exposure of VV and DVT was based solely on ICD coding without regarding the accuracy of the diagnosis. The covariates age, gender, surgery, hospitalization, congestive heart failure, malignancy, pregnancy, hormonal therapy, and respiratory infection were extracted for each patient. Multivariate binary logistic regression was performed in order to assess potential risk factors for DVT. The SAS procedure PROC GENMOD (SAS version 9.2, 64-bit) was parameterised accordingly. A potential cluster effect (patients within practices) was regarded in the regression model. Results: There were 132 out of 2,357 (5.6 %) DVT episodes among patients with VV compared to 728 out of 80,588 (0.9 %) in the patient cohort without VV (p < 0.0001). An increased risk of DVT was associated with previous DVT (adjusted odds ratio (OR): 9.07, 95 % confidence interval (CI): 7.78 - 10.91), VV (OR 7.33 [CI 6.14 - 8.74]), hospitalization during the last 6 months (OR 1.69 [CI 1.29 - 2.22]), malignancy (OR 1.55 [CI 1.19 - 2.02]), and age (OR 1.02 [CI 1.01 - 1.03]). Conclusions: There are strong associations between VV and DVT in a general practice population with documented VV. Special medical attention is required for patients with VV, a history of previous venous thromboembolism, comorbid malignancy, and recent hospital discharge, particularly those with a combination of these factors.
Achenbachs syndrome revisited
Authors: Thies  , Beschorner  , Noory  , Zeller
Published: February 2013

Background: Achenbachs syndrome, also known as paroxysmal finger hematoma, is a rarely reported clinical disorder with recurring, sudden bruising of the volar part of a finger, appearing spontaneously or after minor trauma and resolving completely within days. Patients and methods: We report seven cases from our angiologic out-patient clinic. Results: The patients were asymptomatic between manifestations. The conditon was nevertheless reason for a referral. Conclusions: We stress the need for greater awareness among clinicians of the harmlessness of the condition in order to avoid misdiagnoses and dispensable diagnostic procedures.
Acute thromboembolic occlusion of the superior mesenteric artery following covered stent occlusion in the superior mesenteric artery: endovascular therapy using mechanical rotational thrombectomy
Authors: Goltz P. , Petritsch  , Spor  , Hahn  , Kickuth
Published: February 2013

Acute thromboembolic occlusion of the superior mesenteric artery is a rare and often fatal condition in which surgery represents the golden standard in therapy. We present a case in which a patient was treated with covered stent implantation for acute bleeding from the superior mesenteric artery following pancreatic resection, radiation, and embolization of a hepatic artery pseudoaneurysm. Some weeks later clinical signs were suggestive of acute thromboembolic occlusion of the superior mesenteric artery and digital subtraction angiography showed occlusion of the previously implanted covered stents. The patient was successfully treated transfemorally with percutaneous mechanical instent thrombectomy using a 6F Rotarex® catheter. We conclude that in selected cases percutaneous mechanical thrombectomy may represent a minimally-invasive alternative to open surgical thrombectomy for treatment of acute thromboembolic occlusion of the superior mesenteric artery.
Treatment of chronic wounds
Authors: Lawall
Published: February 2013

Treatment of underlying diseases is of paramount importance due to the complex genesis of chronic wounds. This should be followed by a stage-adapted wound treatment, which usually consists of a phase-adapted wound debridement, ensued by a moist wound treatment. In case of epithelialization, a phase-specific shift to dry wound treatment should be performed. Despite the growing number of new wound dressings and therapeutics, current scientific data is incomplete, and evidence for the effectiveness of these wound dressings is only sparse. No significant advantage of one wound dressing over the other exists. The status of negative pressure treatment is still controversial, and no clear evidence is present. In order to achieve a permanent treatment success, causal therapy of venous obstructions and/or arterial disorders is of importance. Systematic and consistent compression therapy is of utmost significance when treating venous wounds.
Drug-eluting stents and perioperative risk - more than matters of the heart?
Authors: Lanckohr  , Torsello  , Scheld Heinrich , Schieffer  , Theilmeier
Published: February 2013

The introduction of drug-eluting stents (DES) to interventional cardiology has been a breakthrough in the treatment of in-stent restenosis. However, the downside of reduced restenosis is a significantly prolonged and practically incalculable time to reendothelialization of thrombogenic stent-surfaces with an increased risk for coronary thrombosis. As the use of DES in non-coronary arteries (e.g. carotid, renal, infrainguinal and even cerebral arteries) is increasing, new vascular beds might be put at risk of ischemia. The practice of stopping antiplatelet drugs in a perioperative setting is highly problematic and contemporary guidelines released by scientific societies from different medical specialties have recently addressed this problem. While many case reports have reported alarming incidents of stent thrombosis, prospective clinical data are scarcely available to guide anticoagulation during the perioperative phase. This review summarizes information on the vascular biology of DES and associated adverse events based on a systematic search of the available literature in public data bases. An emphasis is put on the growing use of DES in non-coronary vessels and the associated danger of putting new vascular beds at risk of thrombotic complications.
Stenting of stenotic mesenteric arteries for symptomatic chronic mesenteric ischemia
Authors: Aschenbach  , Bergert  , Kerl  , Zangos  , Neumeister  , Schlosser  , Basche  , Vogl J.
Published: February 2013

Background: We report the results of our single center series of patients with chronic mesenteric ischemia (CMI) to determine the role of stenting in the management of patients. Patients and methods: We retrospectively reviewed all patients with CMI treated endovascularly with stent revascularisation from January 2008 to January 2011.CMI diagnosis was made according to clinical symptoms, including postprandial abdominal pain, food fear, and weight loss. Additionally, the diagnosis was confirmed by duplex ultrasonography and/or computed tomography angiography and/or contrast-enhanced magnetic resonance angiography. Results: All 45 patients presented with typical CMI symptoms: 45/45 (100 %) had postprandial pain, 31/45 (68.8 %) had a weight loss of more than 10 kilograms, and 11/45 (24.4 %) suffered from ischemic colitis combined with lower gastrointestinal bleeding. In three patients occlusion could not be crossed, therefore considered as technical failure. A total of 55 arteries were stented in the remaining 42 patients. Nineteen patients underwent SMA stenting alone, eight underwent celiac stenting, alone and three patients underwent stenting of inferior mesenteric artery (IMA) alone. We performed combined stenting of the celiac artery and superior mesenteric artery in ten patients, and one patient underwent a combined stenting of the celiac artery and the IMA. All three mesenteric arteries were stented in only one patient. Primary technical success was achieved in 42/45 (94.8 %) patients. Clinical symptom relief was achieved in 39/45 (86.6 %) patients with abdominal pain. Increased body weight was observed in 28/31 (90.3 %) patients with an average weight gain of 8.8 kilograms (5 - 12 kilograms), and 10/11 (90.9 %) patients recovered from ischaemic colitis/lower gastrointestinal bleeding. Conclusions: Stent revascularisation can be considered as the first-line therapy for patients with chronic mesenteric ischemia.
Determinants of intermediate term clinical outcome after endovascular below-knee interventions
Authors: Köhler  , Halbritter  , Stroszczynski  , Mahlmann  , Beyer-Westendorf  , Weiss
Published: February 2013

Background: To determine predictors of clinical outcome after endovascular interventions of crural arteries in patients with peripheral arterial disease. Patients and methods: We prospectively followed 154 limbs in 147 patients treated with below the knee endovascular interventions for critical limb ischemia (52 %) and severe claudication (48 %). Patient-immanent, hemodynamic-procedural and anatomic determinants of outcome were analyzed. Outcome was defined as event-free survival from the combined endpoint freedom from re-intervention, major amputation and death. Results: Cumulative event-free survival after 12 months was 65.1 %. During follow-up 42 patients (27.3 %) required re-intervention, 8 (5.2 %) underwent major amputation and 5 (3.2 %) died. In univariate analyses, the presence of critical limb ischemia, multilevel disease, age > 72 years, impaired renal function, and long lesions (> 65 mm) were significant determinants of the study endpoint. The anatomic location of the lesion, distal patency of treated artery below the ankle, cardiovascular risk factors or concomitant cardiovascular diseases, and the type of postinterventional antithrombotic treatment did not influence outcome. Conclusions: Below-knee interventions resulted in acceptable procedural mid-term results and high rates of amputation free survival. Multilevel disease, long lesions and impaired renal function were indicative of a worse outcome.
Readmissions of patients with diabetes mellitus and foot ulcers after infra-popliteal bypass surgery - attacking the problem by an integrated case management model
Authors: Rümenapf Gerhard , Geiger Sandra , Schneider Brigitte , Amendt Klaus , Wilhelm Norbert , Morbach Stephan , Nagel Norbert
Published: February 2013

Background: Patients with neuroischemic diabetic foot syndrome (DFS) may need arterial revascularization, minor amputations, débridements as well as meticulous wound care. Unfortunately, postoperative outpatient care is frequently inadequate. This is especially true for Germany, where the in- and outpatient sectors are funded and managed separately, with poor communication between the two. Thus, many patients may be readmitted to the hospital following successful treatment and discharge. In an attempt to overcome these problems, we looked at whether an integrated case management (CM) system for outpatient care according to in-hospital standards might improve patients care and avoid readmissions. In addition we analyzed the length of hospital stay (LOS) as well as hospital costs. Patients and methods: In this retrospective cohort study patients with DFS, bypass surgery and foot surgery after implementation of the CM (study group; n = 376) were compared with a matched historic control group (HCG; n = 190) including the flat rate revenues (G-DRG K01B). Following a standardized assessment, integrated trans-sectoral CM care was offered to 116 patients (CMP). Results: The proportion of patients who were readmitted to hospital was reduced in CMP compared to HCG (8.8 vs. 16.4 %; p < 0.01), with consequent reduction of case consolidations (9.7 % versus 17.8 %, p < 0.001). Although initially, the mean LOS was higher in the CMP patients, the reduction in readmissions meant that this integrated CM program improved the hospitals economic situation. Conclusions: A hospital-based integrated CM system significantly reduces the hospital readmissions in patients with neuroischemic DFS following bypass surgery, with lower hospital costs.
Combined immunosuppressive therapy including a TNF-alpha blocker induces remission in a difficult to treat patient with Takayasu arteriitis and coronary involvement
Authors: Mahlmann  , Pfluecke  , Ouda  , Simonis  , Weiss  , Kappert
Published: February 2013

A 40 year old woman presented with symptoms of a systemic inflammatory disease and obstruction of the left subclavian artery. Takayasu arteriitis (TA) was clinically diagnosed and confirmed by MR angiography and FDG-PET scan showing inflammation of the aortic arch and the left subclavian artery. Immunosuppression with glucocorticoids and methotrexate resulted in immediate clinical improvement and normalization of systemic markers of inflammation. Despite that the patient developed chest pain on exertion suggesting coronary involvement, which was confirmed by dobutamine stress echocardiography. After adding the TNF-alpha blocker infliximab coronary symptoms gradually improved and a clinically stable situation could be achieved for more than 6 months. Coronary angiography and aortography showed an occluded main stem of the left coronary artery, an occluded left subclavian artery, and stenoses of the brachiocephalic trunk and the left common carotid artery. Revascularization of the coronary artery and the aortic arch and its branches was performed. The patient returned to work two months after the operation. Immunosuppressive therapy with infliximab and methotrexate is continued, glucocorticoids were stopped after one year of treatment. This case shows that vascular progress in TA patients may occur even when systemic inflammation is controlled, therefore patients have to be carefully observed for new vascular manifestions. TNF-alpha blockers may be an additional treatment option in otherwise difficult to treat TA patients allowing to perform revascularization after a stable disease state has been achieved.
Crush implantation of a self-expanding interwoven stent over a subintimally recanalized standard stent in a TASC D lesion of the superficial femoral artery
Authors: Vogel  , Strothmeyer  , Cebola  , Katus A. , Blessing
Published: February 2013

We demonstrate feasibility of implantation of a self-expanding interwoven nitinol stent in a claudicant, where recanalization attempt of a heavily calcified, occluded superficial femoral artery (TASC D lesion) was complicated by a previously implanted, fractured standard stent. Wire passage through the occlusion and beyond the fractured stent could only be achieved through the subintimal space. A dedicated reentry device was used to allow distal wire entry into the true lumen at the level of the popliteal artery. Despite crushing of the fractured stent with a series of increasingly sized standard balloons, a significant recoil remainded in the area of the crushed stent. To secure patency of the femoro-popliteal artery we therefore decided to implant the novel self-expanding interwoven nitinol stent (Supera Veritas (TM), IDEV), whose unique feature is an exceptional high radial strength. Patient presented asymptomatic without any impairment of his walking capacity at three month follow up and duplex ultrasound confirmed patency of the stent. Subintimal recanalizations can be complicated by previously implanted stents, in particular in the presence of stent fracture, where intraluminal wire passage often can not be achieved. Considering the high radial strength and fracture resistance, interwoven nitinol stents represent a good treatment option in those challenging cases and they can be used to crush standard nitinol and ballonexpandable stents.
Influence of glucose metabolism on vascular smooth muscle cell proliferation
Authors: Chiong Mario , Morales Pablo E. , Torres Gloria , Gutiérrez Tomás , García Lorena , Ibacache Mauricio , Michea Luis
Published: February 2013

Differentiation of vascular smooth muscle cells (VSMC) is an essential process of vascular development. VSMC have biosynthetic, proliferative, and contractile roles in the vessel wall. Alterations in the differentiated state of the VSMC play a critical role in the pathogenesis of atherosclerosis and intimal hyperplasia, as well as in a variety of other human diseases, including hypertension, asthma, atherosclerosis and vascular aneurysm. This review provides an overview of the current state of knowledge of molecular mechanisms involved in controlling VSMC proliferation, with particular focus on glucose metabolism and its relationship with mitochondrial bioenergetics. Increased levels of glucose transporter 1 (GLUT1) are observed in VSMC after endothelial injury, suggesting a relationship between glucose uptake and VSMC proliferation. Mitochondrial dysfunction is a common feature in VSMC during atherosclerosis. Alterations in mitochondrial function can be produced by dysregulation of mitofusin-2, a small GTPase associated with mitochondrial fusion. Moreover, exacerbated proliferation was observed in VSMC from pulmonary arteries with hyperpolarized mitochondria and enhanced glycolysis/glucose oxidation ratio. Several lines of evidence highlight the relevance of glucose metabolism in the control of VSMC proliferation, indicating a new area to be explored in the control of vascular pathogenesis.
Novel applications of contrast-enhanced ultrasound imaging in vascular medicine
Authors: Staub Daniel , Partovi Sasan , Imfeld Stephan , Uthoff Heiko , Baldi Thomas , Aschwanden Markus , Jaeger Kurt A.
Published: February 2013

The use of contrast-enhanced ultrasound (CEUS) for vascular imaging indications has increased dramatically during the last decade. Ultrasound contrast agents are gas-filled microbubbles that are injected into the bloodstream and serve as strict intravascular reflectors of ultrasound waves. Numerous studies have addressed the potential clinical use of CEUS in different vascular fields including the carotid arteries, the abdominal aorta, renal arteries and the kidneys. In this review article we discuss the clinical value of contrast agents in vascular ultrasound by enhancing the vascular lumen, and more important, their role as a tool to deliver high resolution, real-time images of microvascular perfusion. Specifically, CEUS imaging of the carotid artery provides a novel, non-invasive method not only to improve the delineation of the vessel wall, but also for the assessment of the vasa vasorum and the ectopic vascularization of the atherosclerotic plaque (intraplaque neovascularization); probably providing a window to risk stratify atherosclerotic lesions and individuals by identifying vulnerable plaques prone to rupture causing vascular events. CEUS imaging has also emerged as a novel diagnostic tool in various aortic pathologies and particularly for the detection of endoleaks following endovascular treatment of abdominal aortic aneurysms. It is also a valuable tool for the assessment of the tissue perfusion in native and transplanted kidneys providing information on perfusion deficits of the parenchyma. Furthermore, a real-time CEUS method has recently been developed to assess the skeletal muscle microcirculation which could be used to study patients with peripheral arterial occlusive disease or diabetic microangiopathy. In the future, the use of targeted microbubbles could further enhance and expand the diagnostic capabilities of current vascular ultrasound imaging by detecting specific molecular processes that play a role in the pathophysiology of vascular disease.
The influence of thrombophilic risk factors on vascular access survival in chronic dialysis patients in a retrospective evaluation
Authors: Klamroth Robert , Orlovic Marija , Fritsche Ilona , Seibt Simone , Seibt Frank , Wegscheider Karl , Landgraf Helmut
Published: February 2013

Background: Vascular access by dialysis graft or fistula is of major importance for hemodialysis treatment. Vascular access occlusion is one main reason for hospitalization of patients on hemodialysis. Thrombophilic risk factors are discussed as one cause for occlusion. The aim of this study was to determine if the presence of thrombophilic factors is associated with a reduced survival rate of vascular dialysis access. Patients and methods: The following thrombophilic parameters were measured in every hemodialysis patient from five outpatient dialysis centers in Berlin: antithrombin, protein C, protein S, prothrombin mutation (G20210A), factor V mutation (G1691A), lupus anticoagulant, anticardiolipin antibodies, factor VIII, plasminogen activator inhibitor, homocysteine and lipoprotein(a). Vascular access characteristics such as vascular access material (PTFE graft or native fistula) and location were also recorded. Each patients medical history was documented. Results: 199 patients with a total of 499 vascular accesses in the past (311 native fistulas (62.3 %) and 188 PTFE grafts (33.7 %)) were included in this study. The type of vascular access played an important role, with mean survival times of 34.2 months for native fistulas versus 9.5 months for grafts. There was at least one thrombophilic risk factor present in 69.8 % of the patients. In the univariate analysis thrombophilia had a significant influence on vascular access survival. The effect persisted throughout the multivariate analysis. Multivariate Cox analysis showed that the presence of thrombophilic factors was associated with a 43 % (mild) to 105 % (severe thrombophilia) increased risk of occlusion of the vascular access, corresponding to a 45 % to 68 % reduction of native access survival time. The influence of thrombophilia was evident in fistulas as well as in PTFE grafts. Conclusions: Thrombophilia plays a role in vascular accesses survival in patients on hemodialysis. In hemodialysis patients with recurrent occlusions of vascular access thrombophilia testing should be performed.
Predictors of deep venous thrombosis in patients admitted to rehabilitation clinics after major orthopaedic surgery
Authors: Beyer-Westendorf Jan , Bogorad Vitalie , Tautenhahn Ingeborg , Marten Sandra , Schellong Sebastian M.
Published: February 2013

Background: Venous thromboembolism (VTE) is a frequent complication of major orthopaedic surgery; prolonged prophylaxis with anticoagulants is standard of care. However, late manifestation of VTE is common and little is known about the predictors of late deep vein thrombosis (DVT) and the distribution of proximal and distal DVT and isolated calf muscle vein thrombosis (MVT). Patients and methods: 482 patients admitted to a rehabilitation clinic (RC) after total hip or knee replacement (THR; TKR) or hip fracture surgery (HFS) underwent complete compression ultrasound (CCUS) screening for VTE within 72 hours after admission into RC. Predictors of VTE were evaluated. Results: DVT was prevalent in 74 events (14.7 %), consisting of 13 (2.7 %) proximal DVT, 17 (3.5 %) distal DVT and 41 (8.5 %) MVT, respectively. Multivariate analyses established history of VTE (OR for proximal DVT 7.0; 95 %-CI 1.9 - 25.9; OR for any DVT 3.9; 95 %-CI 1.7 - 8.9), female gender (OR 3.3; 95 %-CI 1.0 - 10.6), coronary artery disease (OR 3.8; 95 %-CI 1.1 - 12.9) and cancer (OR 8.0; 95 %-CI 1.8 - 35.5) as independent VTE predictors for proximal DVT. For MVT, age (OR 2.4; 95 %-CI 1.2 - 5.0) and a history of musculo-skeletal disease (OR 2.6; 95 %-CI 1.1 - 5.8) or autoimmune disease (OR 3.9; 95 %-CI 1.0 - 15.4) were found to be independent predictors. Conclusions: This study confirms well-known predictors of VTE and high rates of postoperative VTE despite optimal thromboprophylaxis. In addition, independent risk factors for proximal DVT and MVT were identified. The data support the concept or continuing thromboprophylaxis during rehabilitation after major orthopaedic surgery because a considerable percentage of patients had asymptomatic DVT at RC on admission. However, significant differences in the individual risk profile and the distribution pattern of DVT and MVT exist, which could be used for a more individualized thromboprophylaxis strategy.
Foam sclerotherapy with Enoxaparin prophylaxis in high-risk patients with postthrombotic syndrome
Authors: Reich-Schupke Stefanie , Doerler Martin , Altmeyer Peter , Stücker Markus
Published: February 2013

Background: According to the current guidelines for sclerotherapy hypercoagulability and thrombophilia with or without deep venous thrombosis are seen as relative contraindication for this treatment. But often such patients have an indication for a sclerotherapy. Recommendations for additional anticoagulation for sclerotherapy are missing. Patients and methods: In this retrospective analysis (2009 - 2010), 54 patients with deep venous thrombosis and/or pulmonal embolism in their medical history that had had foam-sclerotherapy of truncal or tributary veins with Polidocanol 0.5 - 3 % without prior anticoagulation therapy were included. In addition to compression treatment (23 - 32 mmHg) for 3 weeks patients were treated with Enoxaparine 40 mg once a day for 3 days after sclerotherapy. Clinical and duplex controls were conducted before every treatment and 2 - 3 weeks after the last injection. Results: Sclerotherapy was done on one (30/54) or on both (24/54) legs. In 2/54 legs a truncal vein and in all patients tributaries were treated. The volume per treatment session averaged 3.3 ml foam (2 - 6 ml). The patients had undergone an average of 4.9 treatments (1 - 11); altogether 262 sessions. There were no cases of deep venous thrombosis or symptomatic pulmonary embolism. In 7/262 treatments (2.7 %) symptomatic localized phlebitis occurred and in 2/262 (0.8 %) patients an ascending phlebitis beyond the sclerotherapy region was observed. Conclusions: Based on current data, foam sclerotherapy can be regarded as safe in patients with anamnestic thromboembolism when co-treated with compression therapy (23 - 32 mmHg) and Enoxaparin 40 mg once per day for 3 days post sclerotherapy. The current study is the first with a standardized regime. In view of the limitations of this study there should be urther randomized controlled trials.
Praxistätigkeit einer Advanced Practice Nurse im Schweizerischen Epilepsie-Zentrum
Authors: Müller Margrit , Jaggi Sabina , Kouriaichi Carina , Eggenschwiler Prisca , Mahrer-Imhof Romy
Published: February 2013

Epilepsie ist nach Schlaganfall die zweithäufigste neurologische Erkrankung mit einer Vielzahl von Ursachen, Symptomen und Behandlungsmöglichkeiten. In Epilepsie-Zentren gibt es zudem eine Gruppe von Patienten, die unter psychogenen, nicht-epileptischen Anfällen (PNEA) leiden. Menschen mit Epilepsie müssen die medikamentöse Therapie in ihren Alltag integrieren, mit Symptomen umgehen und anfallsprovozierende Faktoren vermeiden. Menschen mit PNEA müssen lernen psychotherapeutische Hilfe anzunehmen. Dazu benötigen die Betroffenen eine kompetente, kontinuierliche pflegerische Begleitung. Pflegende brauchen ein breites Fachwissen über diese Erkrankungen und ihre Therapien sowie vertiefte Fähigkeiten in der Begleitung und Beratung von Menschen mit Anfallserkrankungen und ihren Angehörigen. Das Ziel dieses Artikels ist, erste Erfahrungen der Praxistätigkeit einer Advanced Practice Nurse (APN) zu beschreiben. Die Aufgabenbereiche der APN und Veränderungen nach einem Jahr Erfahrung mit APN werden vorgestellt. Die Praxistätigkeit der APN bestand aus klinischer Tätigkeit und Projektarbeiten, Coaching von Pflegenden und Unterstützung der Stationsleitung. Die Veränderungen seit der Implementierung einer APN sind die Wissenserweiterung und zunehmende pflegerische Handlungskompetenz der Teammitglieder, sowie positive Äusserungen von Patienten zur pflegerischen Beratung und Betreuung. Die Erfahrung im Schweizerischen Epilepsie-Zentrum zeigt, dass die Integration einer APN in das Pflegeteam einer Station zur Pflegeentwicklung beitragen und die Betreuung von Menschen mit Epilepsie verbessern kann.
Breast Care Nurses – Pflegeexpertinnen für Brusterkrankungen. Ein Weg zur «Advanced Nursing Practice» in Deutschland?
Authors: Gerlach Anja , Wiedemann Regina
Published: February 2013

Die Rolle von Breast Care Nurses (BCN) wird seit der Zertifizierung von Brustzentren auch in Deutschland thematisiert. Die vorliegende Studie stellt das Konzept der Breast Care Nurse national und international dar und ordnet es in den Kontext von Advanced Nursing Practice (ANP) ein. Mit einer deskriptiven Querschnittstudie wurden erstmals Absolventinnen einer BCN-Weiterbildung in Deutschland mittels Fragebogen nach aktuellen Tätigkeitsfeldern, Schwerpunkten ihrer Tätigkeit als BCN, Rahmenbedingungen und erlebten Barrieren und unterstützenden Faktoren befragt. Es konnten 122 Fragebogen ausgewertet werden; der Rücklauf betrug 71 % (Gesamt n = 171). Die Ergebnisse zeigten, dass 58,1 % (n = 71) der Absolventinnen eine Stelle als Breast Care Nurse bekleideten; allerdings waren lediglich 28,1 % (n = 20) vollständig und 35,2 % (n = 25) teilweise in ihrer Tätigkeit als BCN freigestellt. Im klinischen Alltag fehlt es den BCNs an Rahmenbedingungen, wie beispielsweise einem eigenen Beratungsraum, Zugang zu Fachliteratur oder Vorlagen zur Dokumentation. In der Diskussion werden die Situation der BCNs in Deutschland und die Anforderungen an ANP-Konzepte aufgegriffen und daraus zukünftige Anforderungen an das Berufsbild abgeleitet.
Ein Jahr Advanced Nursing Practice in der Kinderkardiologie – ein erster Rückblick
Authors: Spitz-Köberich Christine , Steinle-Feser Bettina
Published: February 2013

Im Jahr 2008 wurde in der kinderkardiologischen Abteilung des Universitätsklinikums Freiburg i. Br. das patientenorientierte Konzept Advanced Nursing Practice (ANP) eingeführt, um den Bedürfnissen der dort behandelten, meist chronisch kranken Patienten zu begegnen. Ziel von ANP in diesem Bereich ist es, den Patienten und deren Eltern bzw. Familien eine erweiterte und vertiefte Betreuung und Pflege zu bieten. Die Advanced Practice Nurse (APN), eine Pflegende mit einem Masterabschluss in Pflegewissenschaft, arbeitete dabei in der direkten Betreuung von Patienten und Eltern. Im Rahmen von leitfadengestützten Fokusgesprächen sammelte die APN Themen für mögliche unterstützende Interventionen. Aus dieser Sammlung heraus erstellte sie Schulungs- und Beratungsprogramme wie die Medikamentenberatung vor der Entlassung und die Schulung der Eltern zum Erkennen von Herzinsuffizienzzeichen bei ihrem Kind. Die Beratungsprogramme sollen den Patienten und Eltern mehr Sicherheit geben und die Eltern in ihrer Dependenzpflegekompetenz unterstützen. Die bisherige Rückmeldung von Seiten der Patienten, Eltern und Mitarbeiter zur Umsetzung des ANP-Konzepts ist positiv, eine Evaluation steht noch aus. Es zeigte sich, dass die Implementierung und Umsetzung eines solchen Konzepts Zeit braucht und dass Rahmenbedingungen wie beispielsweise ein fachlich versiertes Pflegeteam vorhanden sein müssen. Um diese Rahmenbedingungen zu schaffen, musste die APN vor allem in den ersten Monaten, aber auch jetzt noch die fachliche Entwicklung der Pflegenden in ihren Fokus mit aufnehmen.
Advanced Nursing Practice in Großbritannien – eine persönliche Schilderung
Authors: Keinath Elke
Published: February 2013

Im Artikel werden persönliche Erfahrungen als Advanced Nurse Practitioner (ANP) in der Thoraxchirurgie im National Health Service (NHS) in Großbritannien geschildert. Die tägliche Routine wurde von sieben Kompetenzdomänen bestimmt, nämlich: Management des Gesundheits- und Krankheitszustandes des Patienten, Beziehungen zwischen Pflegeperson und Patient, Lehren und Unterrichten, professionelle Rolle, Leitung und Führung innerhalb der Patientenversorgung, Qualitätsmanagement sowie kulturelle und spirituelle Kompetenzen. Diese Elemente wurden durch die Zusatzqualifikation, selbstständig Medikamente verschreiben und verordnen zu dürfen, erweitert, was dazu beitrug, eine nahtlose Erbringung von Pflege- und Serviceleistungen zu gewähren. Die Position wurde zur zentralen Anlaufstelle im multi-professionellen Team und stellte eine kontinuierliche Weiterführung der Pflege von Patienten und ihren Familien sicher – auch über Krankenhausgrenzen hinweg.
Achtsamkeitspraxis und die Entwicklung von professioneller Gesundheitskompetenz in der Pflege
Authors: Brieskorn-Zinke Marianne
Published: February 2013

Gesundheitskompetenz ist nicht nur eine Voraussetzung zum persönlichen Gesundheitshandeln sondern ebenso zur Professionalisierung der Gesundheitsförderung. Gesundheitsförderung ist in der Pflege mittlerweile ein anerkanntes Tätigkeitsfeld und deshalb wird in dieser Arbeit der in der Gesundheitswissenschaft aktuell viel diskutierte Begriff Gesundheitskompetenz vorgestellt. Es handelt sich hier in erster Linie um eine wissensbasierte Konzeption, also um die Fähigkeit gesundheitliche Informationen Lesen, Verarbeiten und Verstehen zu können, um im täglichen Leben Entscheidungen treffen zu können, die sich positiv auf die Gesundheit auswirken. Diesem wissensbasierten Verständnis von Gesundheitskompetenz wird eine erfahrungsbasierte Ausrichtung hinzufügen, die auf den Fähigkeiten zum Wahrnehmen, Empfinden und Spüren aufbaut und als primäre Voraussetzung zur Selbstsorge betrachtet wird. Konzeptionell basiert diese Ausrichtung auf dem Leibkonzept, welches bereits in anderen Zusammenhängen als fruchtbares Konzept für die Pflegewissenschaft diskutiert wurde.
Was ist Sterben und wann beginnt es? Eine Analyse deutschsprachiger Lehrbücher der Pflege
Authors: Pleschberger Sabine , Hornek Alexandra
Published: February 2013

Lehrbücher sind eine wichtige Referenz für die Grundausbildung in der Pflege. Ziel der Studie war es, Umfang und Inhalte zum Thema Sterben in deutschsprachigen Pflegelehrbüchern zu erfassen. Dazu wurde eine quantitative und qualitative Analyse relevanter Inhalte aller Pflegelehrbücher (n = 65) durchgeführt. 29.2 % der Werke weisen keine Inhalte auf, 44.5 % hingegen ein eigenes Kapitel zu dem Thema. Der Umfang beträgt durchschnittlich 1.34 %. Die Fachgebiete Chirurgie oder Innere Medizin weisen die geringsten, die Onkologie den höchsten Anteil auf. 41.53 % aller untersuchten Werke enthalten eine Definition des Begriffes «Sterben», wobei ein breites Spektrum an Ansätzen zugrunde liegt. Kriterien des Erkennens führen 23 Bücher an, 21 davon verweisen auf die Zeichen des nahenden Todes. Zu 84 % wird Bezug auf die Sterbeforscherin Elisabeth Kübler-Ross genommen. Im internationalen Vergleich kann der Anteil des Themas in den Lehrbüchern als gering bezeichnet werden. Problematisch sind eine konzeptionelle Engführung auf die physiologischen Zeichen des nahenden Todes und die fehlende Bezugnahme auf bestehende Theorien. Die Integration des ganzheitlichen Konzepts Palliative Care in alle Fachbereiche ist dringend erforderlich. Weiters bedarf es einer stärkeren konzeptionellen Auseinandersetzung, um die Kommunikation über Sterben in Lehre und Praxis zu entwickeln.
Die Häufigkeit der Bettpfannenbenutzung im Akutspital
Authors: Saxer Susi , Gattinger Heidrun A. , Dopler Raffaela , Scheffel Sonja , Werner Birgit
Published: February 2013

Die Bettpfanne ist ein alltäglicher Gegenstand der pflegerischen Praxis, der jedoch bisher kaum erforscht wurde. Patientinnen und Patienten erleben die Benutzung der Bettpfanne oft als unbequem und schmerzhaft. Untersuchungen zeigen, dass diese Situation für die Betroffenen sehr beschämend ist und ihre Privatsphäre erheblich verletzt. In einer quantitativen deskriptiven Querschnittstudie wurde erhoben, wie häufig und wie lange die Bettpfanne in der Akutpflege benutzt wird. In die Studie einbezogen waren 362 Frauen und 367 Männer, 18,2 % der Patientinnen waren während kürzerer oder längerer Zeit auf die Bettpfanne angewiesen. Die Bettpfanne wurde während der Nacht häufiger eingesetzt als tagsüber, abteilungsspezifische Unterschiede wurden ebenfalls festgestellt. Am häufigsten wurde die Bettpfanne für die Urinausscheidung auf den orthopädischen und medizinischen Stationen sowie der Pränatalstation verwendet (Frauen). Männer benutzten die Bettpfanne am häufigsten auf den chirurgischen Stationen (12,3 %), an zweiter Stelle folgten die medizinischen Stationen (8,3 %). Die meisten Patientinnen und Patienten benötigen Unterstützung beim Gebrauch der Bettpfanne. Die daraus entstehende Arbeitsbelastung für die Pflegenden ist nicht zu unterschätzen. Die Einführung alternativer Urinableitungssysteme könnte zu mehr Selbstständigkeit der Patientinnen führen und die Arbeitsbelastung der Pflegenden reduzieren.
Die Auswirkungen der Verstehenden Diagnostik auf das Belastungserleben Pflegender im Umgang mit Menschen mit Demenz in der stationären Altenhilfe
Authors: Holle Daniela , Halek Margareta , Mayer Herbert , Bartholomeyczik Sabine
Published: February 2013

Die Versorgung von Menschen mit Demenz in der stationären Altenhilfe erfordert hohe fachliche Kompetenzen an professionell Pflegende. Hinzu kommt, dass der Umgang mit herausforderndem Verhalten von demenziell erkrankten Personen oftmals als belastend von den Pflegenden erlebt wird und sie vor große Schwierigkeiten stellt. Die «Verstehende Diagnostik» als Teil der pflegerischen Rahmenempfehlungen bietet Pflegenden eine Möglichkeit, herausforderndem Verhalten von Menschen mit Demenz zu begegnen. Im Mittelpunkt der «Verstehenden Diagnostik» steht das Bemühen um ein Verstehen des Verhaltens. Die Studie hat zum Ziel, das Konzept mithilfe von strukturierten Fallbesprechungen und dem Asssessment IdA erstmalig in Altenheimen zu implementieren und zu evaluieren. Pflegende aus 15 Stationären Altenhilfeeinrichtungen in NRW wurden zu den Inhalten und der Anwendung der «Verstehenden Diagnostik» fortgebildet. Das Belastungserleben der Pflegenden wurde vor (n = 106) und nach (n = 71) der Intervention (9 Monate) erfasst. Die Ergebnisse der Studie zeigen positive Effekte auf das Belastungserleben der Pflegenden. Sie stützen den Einsatz von strukturierten Fallbesprechungen und des Assessments IdA, um das Verhalten der Bewohner mit Demenz zu verstehen. Die Umsetzung der «Verstehenden Diagnostik» bietet Pflegenden eine Möglichkeit, herausforderndem Verhalten von Menschen mit Demenz zu begegnen.
Malnutrition und Gewichtsverlust - Erfassen des Ernährungsstatus und Beratung durch Pflegende: Das Erleben von Patienten mit einer neu diagnostizierten oder rezidivierten Tumorerkrankung
Authors: Kröner  , Stoll  , Spichiger
Published: February 2013

Patienten mit einer Tumorerkrankung leiden oft schon bei Diagnosestellung und mit Therapiebeginn unter Ernährungsproblemen und Gewichtsverlust, ausgelöst durch das Anorexie-Kachexie-Syndrom. Im onkologischen Ambulatorium eines Schweizer Universitätsspitals werden daher mit einem Assessmentinstrument frühzeitig Ernährungszustand sowie Ernährungsprobleme erfasst und die Patienten in Bezug auf mögliche Maßnahmen beraten. Mit dieser qualitativen Studie wurde untersucht, wie Patienten Gewichtsverlust und Ernährungsprobleme sowie das Durchführen von Assessment und Beratung erleben. Mittels Leitfadeninterviews wurden 12 Patienten befragt. Zur Datenauswertung wurde die qualitative Inhaltsanalyse eingesetzt. Die Resultate zeigen, dass Patienten den frühzeitigen Gewichtsverlust kaum wahrnahmen und nicht als bedrohlich empfanden. Dennoch änderten sie bereits mit der Diagnosestellung und vor der Beratung durch Pflegende ihre Ernährungsgewohnheiten und versuchten, sich gesund zu ernähren. Die Durchführung des Assessments wurde nicht als störend empfunden; die Beratung wurde geschätzt und die wichtigsten Aspekte derselben wurden von den Patienten umgesetzt. Die Studie zeigt auf, wie wichtig es ist, Patienten bereits frühzeitig im Krankheitsverlauf über Gewichtsverlust und richtige Ernährung aufzuklären, da sie selber Probleme zu diesem frühen Zeitpunkt nicht wahrnehmen und nicht über die nötigen Fachinformationen verfügen. Ein Assessment und eine Beratung bieten den Pflegenden eine Möglichkeit, gezielte Maßnahmen zu treffen, um Malnutrition und massivem Gewichtsverlust vorzubeugen.