bluuebunny/crossref_metadata_2025 huggingface dataset:
Veränderungen der extrazellulären Matrix in der varikösen Venenwand
Authors: Kirsch  , Schreiber  , Dienes  , Böttger  , Junginger
Published: January 2006

Background: Investigation of changes in normal veins which result in the formation of varicosis led to examination of the histological organisation of the vessel wall and to histomorphological alterations in the region of the extracellular matrix. Patients and methods: The expression pattern of the matrix proteins collagen IV, fibronectin, laminin, tenascin, and undulin as well as the structure and orientation of elastic fibres were determined by means of immunohistochemical staining. Results: All varices exhibited an increased expression pattern in comparison to healthy veins. The venous vessel wall was often non-homogeneously enlarged. The intima was always more involved than the media and showed enhanced accumulation, whereas, the adventitia was not influenced by the pathological process. Collagen IV exhibited an early accumulation, especially in the subendothelial region. The other matrix proteins demonstrated an increase in fibre propagation parallel to the enlargement of the vessel wall. Essentially, an augmented de novo synthesis of fibres with an irregular arrangement and the formation of local plaques was found. Elastic fibres were enhanced by slight involvement of the vessel wall and were reduced and fragmented during increased involvement of the venous wall which explained the rigidity of varices in contrast to normal veins.
Lokalapplikation des Fibrin-stabilisierenden Faktors beim venösen Ulkus: experimentelle Untersuchung zum Effekt auf die Gefäßpermeabilität
Authors: Wozniak  , Noll  , Brunner  , Hehrlein
Published: January 2006

Background: The clinical observation of distinct reduction of wound secretion tendency during treatment of venous leg ulcer with topically applied factor XIII let us speculate that this enzyme may be involved in modulation of vascular permeability. Methods: For experimental study porcine aortic endothelial cells were cultured on filter membrane to confluent monolayer. Endothelial covered filters then were used in a two-compartment modell creating an artificial luminal and abluminal compartment. To investigate the influence of factor XIII on endothelial barrier function, we measured the flux of trypan blue-labeled albumin through endothelial monolayers by spectrophotometer. Results: Monolayers that were exposed to factor XIII showed a distinct (n = 10, p < 0.05) decrease of albumin flux in contrast to control. This effect was not dependent on serum substrates. Partially, the permeability reducing effect was due to a certain amount of albumin that is a stabilizing component of Fibrogammin®HS. Conclusion: Although the mechanism is unclear at the moment, we conclude that reduction of endothelial permeability can be achieved by factor XIII which may play an important role in wound healing of venous leg ulcer.
Gefäßdarstellung mit 131I-low-density Lipoprotein bei Patienten mit Hypertonie und frühen atherosklerotischen Läsionen der Arteria carotis
Authors: Lupattelli  , Siepi  , Palumbo  , Fedeli  , Ciuffetti  , Palumbo  , Sinzinger  , Mannarino
Published: January 2006

Background: The reinjection of autologous 131I-labelled low-density lipoprotein (LDL) followed by vascular scintigraphy has been used to investigate lipid-containing plaques, but no information is available on the early stages of plaques in hypertensives. Vascular scintigraphy after re-injection of autologous 131I-labelled LDL was used to investigate early atherosclerotic lesions visualized by sonography in the carotid arteries of patients with hypertension. Patients and methods: 10 male patients (4 smokers; mean age 56 ± 8 years;) with early carotid atherosclerosis (mono- or bilateral; intima-media-thickness ranging from 1.5 to 3.5mm) as shown by sonography were studied. All these normolipemic patients suffered from primary hypertension and were treated with diuretics. As controls 6 healthy male subjects (3 smokers; mean age 54 ± 9 years;), with normal blood pressure and lipid pattern were recruited. Results: Hot spots appeared in the areas with early atherosclerosis in 7 patients, while none were seen in controls. Positive kinetic curves were observed in 4 patients. No significant differences emerged in the target/non-target ratios. Conclusions: Vascular lipoprotein uptake in hypertensive patients is apparently late and rather limited; the uptake pattern may depend on plaque composition.
Auswirkungen von Körperhaltung und Bewegungen von Kompressionsstrümpfen an verschiedenen Stellen an den Beinen
Authors: Hirai
Published: January 2006

Background: In compression therapy, the importance of the degree of pressure has been emphasized. The aim of this study was to examine the influence of posture and exercise on the compression at different sites of the leg. Patients and methods: In 16 normal volunteers, the pressure was determined simultaneously at 5 sites on the leg during lying, sitting, standing, walking, running, knee-bending exercise and squatting using an air pack type analyzer. Pressure was measured under 3 experimental conditions: with a thigh-length gradient stocking, with foam rubber pads included under the elastic stocking, and after removal of both elastic stocking and compression pads. Results: When the stocking was worn, a pressure gradient was observed in the proximal direction during the sequence from the supine position to running. When the pads were included, the pressure in the supine position was significantly elevated at all sites examined, and the graduated pressure drop was also maintained from supine position to running. However, the pressure at the tibia was significantly higher than that at the gastrocnemius in both supine and sitting positions when the pads were used, while no significant difference was observed between both sites in the standing position. A marked increase in pressure at the ankle, gastrocnemius, and hollow of the knee was observed during squatting when the stocking was worn either with or without pads, while a significant decrease in pressure was observed at the tibia. Conclusion: The pressure exerted by elastic stockings varies with the posture and exercise. Furthermore, the changes in pressure vary from site to site.
Das Economy Class Syndrome – eine Untersuchung an 19 Fällen
Authors: Sinzinger  , Karanikas  , Kritz  , O’Grady  , Vinazzer
Published: January 2006

Background: Thromboembolic events during or immediately after long-distance flights (economy class syndrome – ECS) are gaining more importance due to the rapidly increasing number of flights. Systematic data on haemostatic parameters in these patients are not available yet. Patients and methods: We were therefore analyzing the anamnestic, laboratory and clinical findings in 19 patients (17 males, 2 females, aged 33–75 years) with the final clinical diagnosis ECS. Results: Symptoms commenced either immediately or up to 93 hours after disembarkation (mean 42.3 hours). In the great majority (84.2%) myocardial infarction was the initial diagnosis. No defect in the coagulation and/or prostaglandin system was discovered in either of the patients. Prevalence of smoking (26.3%) was even lower than in the normal population. No predisposing factors were found. Apparent anamnestic similarities were flu and fever (47.4%) while 4 of the patients (26.3%) had severe diarrhoea and dehydration before the flight. Almost all the patients (78.9%) were drinking alcohol during the flight and not actively moving their legs (84.2%). ECS occurred also in business and first class passengers. Conclusion: Surprisingly the onset of ECS is definitely not associated with haemostatic defects and not necessarily associated with the clinical risk factors reported.
Die transfemorale endovaskuläre Behandlung thorakaler Aneurysmen in Lokalanästhesie: eine einfache, sichere und zeitsparende Technik
Authors: Lachat  , Pfammatter  , Turina
Published: January 2006

Background: Endovascular aneurysm grafting of the descending thoracic aorta is a minimally invasive catheter technique, which is performed under general anesthesia. We describe a technique allowing to perform transfemoral endovascular repair of thoracic aortic repair under local anesthesia. Patients and methods: In 9 consecutive patients local anesthesia was performed in order to gain an opened femoral artery access for the delivery system, and a percutaneous access to the left brachial artery. A pigtail catheter was then placed through the left brachial artery for the location of the origin of the left subclavian artery and/or the aneurysm and self-expanding endoprothesis was released under fluoroscopic guidance. For the deployment of the endograft a short period of controlled hypotension with nitroglycerin bolus application was produced. Results: All the aneurysms could be successfully sealed with the intended endovascular technique. There was no vascular access complication or pulmonary or ischemic (cardiac, cerebral or peripheral) complication. In the follow-up period of 6 ± 3 months one patient needed a redo endovascular procedure because of the development of a severe and symptomatic distal endoleak 6 weeks postoperative. This procedure was again performed under local anesthesia. Conclusions: From a technical point of view, transfemoral endovascular repair of thoracic aneurysm can be performed under local anesthesia. This is a very simple and fast track procedure which combines a minimally invasive catheter technique and a less invasive anesthetic management.
Naftidrofuryl kann die Lebensqualität von Patienten mit Claudicatio intermittens verbessern
Authors: Spengel  , Brown  , Poth  , Lehert
Published: January 2006

Background: Using a disease specific questionnaire, the CLAU-S, we undertook a double blind, placebo controlled study in patients with intermittent claudication to determine whether the increase in the pain-free walking distance, previously demonstrated with naftidrofuryl, is reflected as an improvement in the patients’ quality of life. Patients and methods: 287 patients, with stable intermittent claudication for at least 3 months were entered into the study. Following an initial one month placebo run-in, patients were randomised to either naftidrofuryl, at a dosage of 200 mg three times daily, or matching placebo, for 6 months. All patients completed the self-administered CLAU-S questionnaire which is divided into 6 dimensions, before the start of treatment, at 3 and 6 months. Statistical analysis was undertaken on an intention-to-treat (ITT) basis which included all patients know to have taken at least one dose of the drug and to have provided key data on at least one occasion after baseline. For each of the CLAU-S dimensions the two groups were compared with respect to difference between the initial and final values. Results: 255 patients (133 naftidrofuryl, 122 placebo) were eligible for the ITT analysis. Significant improvements, in favour of the active medication, were seen for the dimensions “daily living”, “pain”, “disease specific anxiety” and “mood”. A multivariate analysis of covariance, which took into account such factors as initial score, age and sex confirmed the global superiority of naftidrofuryl (p = 0.004). Conclusions: In this placebo controlled study, using a disease specific questionnaire, naftidrofuryl has been shown to significantly improve several aspects of the quality of life of patients with intermittent claudication.
Quality assurance in phlebography of the extremities
Authors: Weber
Published: January 2006

In Zusammenarbeit mit den Fachgesellschaften Deutsche Röntgengesellschaft, Deutsche Gesellschaft für Phlebologie und Deutsche Gesellschaft für Gefäßchirurgie wurden Empfehlungen zur Indikationsstellung, Untersuchungstechnik und Qualitätssicherung der Extremitätenphlebographie erstellt. Für die speziellen klinischen Fragestellungen bei primärer Varikose, bei der akuten Phlebothrombose und beim Postthrombotischen Syndrom werden die Qualitätsmerkmale für die Dokumentation und Befundung nach morphologischen und funktionellen Gesichtspunkten tabellarisch zusammgenfaßt.
Carbon dioxide digital subtraction angiography
Authors: Barbey  , Farber  , Marienhoff  , Gmelin
Published: January 2006

Die Gefäßdarstellung mit Kohlendioxid (CO2) stellt ein potentes Alternativverfahren zur herkömmlichen Kontrastmittelangiographie dar, das auch den Einsatz bei Risikopatienten erlaubt. Aufgrund des gasförmigen Aggregatzustandes, der geringen Dichte sowie der physiko-chemischen Eigenschaften werden spezielle Anforderungen an Untersucher, Röntgenanlage, Injektor und Kathetermaterial gestellt. Die folgende Übersichtsarbeit stellt die historische Entwicklung, die physikalischen und physiologischen Grundlagen, Indikationen sowie Kontraindikationen, klinischen Einsatz sowie Nebenwirkungen und Komplikationen der CO2-Angiographie vor dem Hintergrund der aktuellen Literatur dar.
Verteilung des Ödems von Patienten mit chronischer kritischer Ischämie: Eine computertomographische Studie
Authors: Khiabani  , Anvar  , Rostad  , Stranden  , Kroese
Published: January 2006

Background: A substantial number of patients with chronic critical limb ischaemia (CLI) have considerable oedema at the distal leg and foot of non deep venous thrombosis origin. The primary aim of the pre-sent study was to quantify the distribution of oedema in the different tissues of the leg and foot by applying computed tomography and planimetry. The interstitial fluid hydrostatic pressure (Pif) in the subcutaneous tissue was measured to evaluate the effect of oedema on local tissue pressure. Patients and methods: Six men and 12 women with unilateral CLI and peripheral pitting oedema were included. Cross sectional areas (CSA) of subcutaneous tissue, muscle and bone were measured by computer tomography combined with planimetry to assess the distribution of oedema within the soft tissues. Pif was measured by “wick-in-needle” technique. Results: The median total CSA of soft tissue, subcutaneous and muscle tissues at the foot level were respectively 17%, 34% and 9% greater in the limbs with CLI compared to the contralateral limb (p < 0.001). At ankle level these differences were 13%, 30% and 4%, respectively (p < 0.001). At the level of the calf these differences were not significant. Mean Pif in the limbs with CLI was 0.3 mmHg, significantly higher than in limbs without CLI (–1.8 mmHg), (p < 0.003). Conclusion: The study verified oedema of considerable magnitude at the ankle and foot. The great part of the oedema was located within the subcutaneous tissue, which was associated with a relatively moderate, but significant increase in Pif confirming the high compliance of the subcutaneous tissue. The combination of the excessive fluid and increased Pif in the interstitial tissue might aggravate the microcirculation. The aetiology of oedema formation is probably multifactorial.
Veränderungen zerebrovaskulärer Perfusionsindices nach Karotis-Thrombendarterektomie
Authors: Müller  , Behnke  , Walter
Published: January 2006

Background: To study the pattern of cerebral blood flow velocity and cerebral resistance changes after carotid endarterectomy. Patients and methods: In 81 patients (mean age ± SD, 64 ± 8 years) with unilateral carotid endarterectomy (CEA) the systolic, diastolic and mean blood velocities, and the pulsatility index (PI) were recorded in both middle cerebral arteries preoperatively and repetitively postoperatively with the use of transcranial Doppler ultrasound (TCD). Results: In the middle cerebral artery ipsilateral to CEA mean blood velocity was increased 6 hours (64 ± 25 cm/sec; p < 0.005) and 7 days (54 ± 15 cm/sec; p < 0.05) after CEA and had returned to the preoperative level (49 ± 11 cm/sec) after 3 months. Compared to preoperatively (0.86 ±. 22), the PI was significantly increased at 6 hours examination (1.03 ±. 23, p < 0.005), and remained increased thereafter. A pathologically increased mean blood velocity (> 83 cm/sec) 6 hours after CEA occurred in 11 patients, two of them developed a slight hyperperfusion syndrome. In the contralateral middle cerebral artery, only the diastolic blood velocity showed significant changes (preoperatively, 35 ± 12 cm/sec; 3 months after CEA, 33 ± 8 cm/sec; p < 0.05). Conclusions: Using TCD, hemodynamic changes occur predominantly in the middle cerebral arteries ipsilateral to CEA. Early postoperative TCD studies may be of help to identify patients at risk to develop a hyperperfusion syndrome.
Der extraanatomische Bypass zur Behandlung einer Gefäßprotheseninfektion in der Leiste
Authors: Meyer  , Schweiger  , Lang
Published: January 2006

Background: Infection of an alloplastic vascular graft is a serious complication and often involves the groin. We propose a therapeutic concept using extraanatomic bypass to avoid the septic groin in case of an infected alloplastic vascular reconstruction. Patients and methods: The course of 25 patients (18 men, 7 women, mean age 61 years) with a grade III inguinal infection following placement of an aortic or femoro-distal synthetic graft made of Dacron or PTFE was analysed. The treatment consisted of excision of the infected graft material and extraanatomic reconstruction with ringed PTFE grafts in all patients. Mean follow-up after the extraanatomic procedure was 21 months (1–91 months). Results: Direct surgical exploration definitely secured graft infection in almost three-quarters of the cases. The most common organism isolated was Staphylococcus aureus (13/22 = 59%). At the time of infection 60% of the patients had critical limb ischemia necessitating vascular reconstruction simultaneously with total or partial excision of the infected graft. Complications of the extraanatomic bypass occurred in 7 cases (overall morbidity 28%). Postoperatively, one patient required major amputation. Hospital mortality was 8%. Primary patency and secondary patency rates of extraanatomic grafts amounted to 78.0% (± 10.0 SD) and 84.1% (± 8.7 SD) respectively after two years. Limb salvage rated 78.4% (± 11.6 SD) after 2 years, the 2-year-survival rate was 73.8% (± 9.3 SD). Conclusions: According to the favourable long-term limb salvage and survival rates, we support simultaneous vascular reconstruction by extraanatomic bypass and explantation of the infected graft material in case of grade III inguinal infection of alloplastic vascular reconstructions.
Resultate von Ballonangioplastie und Stenting nach Clips- und Nahtarteriestenosen: Eine experimentelle Studie
Authors: Dimakakos  , Kotsis  , Doufas  , Pafiti-Condi  , Tsiligiris  , Antoniou  , Mourikis
Published: January 2006

Background: Comparative evaluation of balloon angioplasty following intravascular stenting after experimental stenoses caused by arterial reconstruction with vascular clips and conventional sutures. Materials and methods: A total of 24 arteriotomies were carried out at the carotid and common iliac arteries of pigs following a 10mm longitudinal arteriotomy and provocation of stenosis. Twelve of the arteries were reconstructed with vascular clips and 12 with conventional suture. Ultrasonography revealed stenosis fluctuating from 60–95% (PSV: 1.8–3.5 m/sec EDV: 1.3–1.47 m/sec PSV ratio > 3.5). After 8 weeks, following digital subtraction angiography, which revealed > 50% stenosis in all of the cases, balloon angioplasty followed by placement of intravascular stent was carried out. Results: All the angioplasties remained angiographically and macroscopically patent two months after without thrombus formation. Rupture during dilatation occurred in one of the sutured cases. Histologically no degenerative changes, necrosis or remarkable intimal thickness were observed in either method. Focal inflammatory reaction was seen in 2 sutured and in 1 clipped cases while intimal ulceration was observed in 2 sutured cases. All cases with clips presented an intact endothelial surface. Conclusion: Early experimental results suggested that arterial stenosis provoked by clipped reconstruction could be managed successfully by balloon angioplasty followed by placement of intravascular stent.
Die schnelle intermittierende Kompression verbessert die Hautzirkulation des chronisch ischämischen Beins mit Wadenarterienverschlüssen
Authors: van Bemmelen Paul S. , Weiss-Olmanni  , Ricotta
Published: January 2006

Background: Intermittent pneumatic compression (IPC) has been shown, by duplex, to increase popliteal artery flow in normal legs and in legs with superficial femoral artery occlusion. The objective of this study was to see if IPC improves distal circulation in legs with severe infra-popliteal disease. Patients and methods: Sixteen chronically ischemic legs with arteriographically demonstrated crural or pedal disease were studied during compression with an ArtAssist® compression-device. This device delivers rapid compression of the foot and calf. Cutaneous laser-Doppler flux was measured continuously at the dorsal aspect of the distal forefoot. The findings were compared to those in thirteen normal controls of similar age. Results: In ischemic legs, the spontaneous changes in skin-flux are minimal: mean resting flux in sitting position was 0.87 ± 0.46 AU (Arbitrary Units). Upon activation of the compression device the maximum flux increased to 4.55 ± 1.35 AU. The difference was statistically significant (p < 0.001). This response was similar to that in normal controls. Conclusion: Arterial flow augmentation upon compression is associated with increased skin-flux. This response remains present in severe disease of the crural outflow-arteries. Further investigation to define the role of intermittent compression for management of chronic arterial disease is warranted.
Effekte der Vakuum-Kompressions-Behandlung auf die Hautmikrozirkulation von Patienten mit peripherer arterieller Verschlußkrankheit
Authors: Ubbink  , van der Oord  , Sobotka  , Jacobs
Published: January 2006

Background: We investigated the short-term effect of vacuum compression (VC) treatment on skin microcirculatory perfusion in the foot of patients with lower limb ischaemia and healthy controls. Patients and Methods: Ten patients with intermittent claudication or rest pain and 5 healthy controls underwent vacuum-compression treatment for half an hour. The leg was positioned in an air-tight plexiglass cylinder in which hypobaric (–115 mm Hg) and hyperbaric (75 mm Hg) pressure could be generated alternately, in order to improve peripheral circulation. The effect on skin microcirculation was investigated using nailfold capillary microscopy (measuring nutritive perfusion), laser Doppler fluxmetry (LDF) (total skin perfusion) and transcutaneous oxygen tension measurements (TcpO2). Results: A few patients experienced ischaemic symptoms during VC, probably because the leg was pinched off through inflation of the cuff. In both patients and controls capillary microscopic parameters did not change significantly. In some cases, microcirculatory perfusion decreased because the leg had cooled during the treatment. Application of a heating matrass annihilated this effect. Only in the patient group a few LDF- and TcpO2 parameters improved slightly, but significantly. Conclusion: Vacuum-compression therapy only slightly improves total skin perfusion and oxygenation, but not the nutritive microcirculation, being an essential factor in the occurrence of ischaemic symptoms. We therefore conclude that this instrument in its present form is not an aid in the treatment of lower limb ischaemia.
Der Pole-Pressure-Test: Eine einfache Alternative bei Patienten mit ischämischen Beinen und inkompressiblen Arterien
Authors: Jachertz  , Stappler  , Do  , Mahler
Published: January 2006

Background: Systolic ankle artery pressure measured classically by cuff-manometry and Doppler ultrasound in patients with severely ischemic legs may be falsely elevated because of impaired compressibility of the arteries. We evaluated a hydrostatic blood pressure or so-called pole pressure test by correlating the ankle artery pressure as well as tcpO2 with the pole pressure. Patients and methods: We enrolled 29 patients (18 male, 11 female, 10 diabetics) with critical leg ischaemia. The pole pressure was obtained by elevating the leg, and measuring the height at which the Doppler signal disappears by means of a calibrated pole (recalculating cm H2O for mmHg). We used an 8 MHz cw-Doppler device. Only pole pressure values up to 70 cm H2O were included. In addition tcpO2 at 45°C was recorded at the forefoot of the same leg. Results: When we included the values of the ten diabetic patients the pole pressure of 57.9 ± 16.2 mmHg (mean ± SD) was significantly lower by 40.7 mmHg than the ankle pressure of 98. ± 38.4 mmHg, p < 0.0001 (paired t-test). Without the diabetics the difference was 33.7 mmHg. The correlation coefficient between pole pressure and ankle pressure was 0.546 including the patients with diabetes, and 0.609 excluding the diabetics. The correlation of tcpO2 with the pole pressure, however, was 0.624 regardless of the inclusion of diabetics, while that between tcpO2 and ankle pressure was only 0.250. Conclusions: The pole pressure test is an easy, inexpensive and fast method providing a meaningful, quantitative measure independent of the compressibility of the arteries.
Hämangiosarkom der linken Hand bei einem Patienten mit der seltenen Kombination eines Maffucci’s mit einem Stewart Treves Syndrom
Authors: Bach  , Walgenbach  , Horch Raymund E.
Published: January 2006

We describe a patient with the previously unseen combination of Maffucci’s and Stewart Treves syndrome who presented with an angiosarcoma of the hand. Maffucci’s syndrome is characterized by the presence of multiple enchondroma and soft tissue hemangioma. The syndrome is a rare nonhereditary condition with a usual onset in childhood. Malignant transformations are a common feature of this syndrome. In 1948, Stewart and Treves first described six cases of lymphangiosarcoma after radical mastectomy. This syndrome is an unusual form of angiosarcoma occuring as a complication of lymphedema. Chronic lymphedema and lymphangiectasia preceding lymphangiosarcoma may not only be induced by radical mastectomy with axillary lymph node dissection and postoperative radiation therapy. Posttraumatic, congenital or spontaneous chronic lymphedema may also be associated with lymphangiosarcoma. A time interval of many years seems to be required before malignant transformation develops. Generally the syndrome has a very poor prognosis. Both syndromes described above are of a rare frequency. We report this case because of prior unknown coincidence of both syndromes.
Das Ganglion des Hüftgelenkes als Differentialdiagnose eines pulsierenden Leistentumors
Authors: Cassina Paolo Claudio , Hauser  , Kossmann  , Brunner
Published: January 2006

Ganglion cysts of the hip joint are uncommon synovial-lined fluid-filled juxtaarticular groin lesions. Whereas in the past the correct diagnosis was often made only at surgery there are now valuable imaging methods used for the diagnostic work-up. In experienced hands ultrasonography (US) combined with colour duplex Doppler ultrasonography (CDDS) as a real-time imaging technique easily performed at the patient’s bedside is a valid alternative to more expensive or invasive investigations. We report on a patient who presented with a ganglion cyst and in whom first supported by conventional US an aneurysm of the femoral artery was suspected. The diagnosis of a juxtaarticular ganglion was subsequently correctly made at our institution by CDDS and magnetic resonance imaging, respectively, and the cyst was exstirpated successfully. The differential diagnosis of a pulsating groin mass as well as the most useful and specific imaging methods in the diagnostic work-up in this clinical setting are discussed.
Subclavian artery transposition and endovascular stentgraft placement for the treatment of acute aortic dissection type B
Authors: Tiesenhausen Kurt , Amann  , Koch  , Hausegger  , Tauss  , Oberwalder
Published: January 2006

Wir berichten über eine Patientin mit einem thorakalen Aortenaneurysma im Rahmen einer akuten Typ B Dissektion. Auf Grund der Begleiterkrankungen mit deutlich erhöhtem Operationsrisiko erfolgte eine endovaskuläre Rekonstruktion mittels Stentgraft Implantation (Talent, World Medical Systems, Sunrise FL) nach Transposition der linken Arteria subclavia, um einen ausreichend langen Aneurysmahals zur proximalen Prothesenverankerung zu schaffen. Die endoluminale Therapie akuter Aortendissektionen stellt eine vielversprechende, zur offenen Operation alternative Behandlungsmethode dar.
Kardiovaskuläre Interventionen bei Tumoroperationen: technische Prinzipien und mittelfristige Resultate
Authors: Carrel  , Berdat  , Schmidli
Published: January 2006

Background: While the veins are primarly affected by compressing or invasive tumors, the arteries usually undergo only a less pronounced stenosis, due to the higher internal pressure. However, some tumors infiltrate the arterial adventitia which should be resected or might be injured in cases where radical surgery is attempted. Patients and methods: We report some technical principles utilized in various vascular localizations and mid-term survival observed in a group of 35 patients in whom a vascular reconstruction was performed during the surgical treatment of a malignant tumor. The following vessels were involved: carotid artery (n=5), superior vena cava (n=9), aortic arch (n=1), subclavian artery (n=1), right atrium ± inferior vena cava (n=6), abdominal aorta (n=3) and finally iliac artery and/or vein (n=10). The following surgical techniques were employed: extra-anatomic bypass (n=3), in situ reconstruction (n=23) using either prosthetic graft or saphenous vein interposition, patch angioplasty with autologous vein or xenopericardium and ligature of the involved artery or vein (n=4). In 5 patients suffering from hypernephroma with a tumor thrombus, cardiopulmonary bypass was used to allow radical intracardiac excision. Results: There was no intraoperative mortality despite the fact that a majority of these vascular procedures was performed after incidental and unexpected finding during surgery. Two patients died before hospital discharge (one from pneumonia, the second one from sepsis). Mid-term survival was satisfactory with 45% of the patients still alive after a mean follow-up of 4.5 years – all tumor types confounded. Conclusions: This series demonstrates that an aggressive approach might be justified in appropriate patients who otherwise might not be considered as operative candidates.
Stenting zur Erhaltung der Nierendurchblutung bei akuter Aortendissektion: Implantation und Verlauf
Authors: Behrendt  , Do  , Baumgartner  , Triller  , Kniemeyer  , Mahler
Published: January 2006

Two patients with renal artery involvement in type B dissection of the aorta were treated by percutaneous stent implantation. Both of them were hypertensive and showed increasing serum creatinine levels. After stent implantation in the renal arteries blood pressure and renal function improved, and the renal arteries were patent in duplex ultrasound 15 and 30 months after treatment respectively.
Die Übergangszone in der Tunica media der Nierenarterie mit einer maximalen Länge von 10 Millimetern
Authors: Janzen Jan , Lanzer  , Rothenberger-Janzen  , Vuong
Published: January 2006

Background: The goal of our study was to demonstrate and to determine the length of the transitional zone in the tunica media in renal arteries. The majority of renal artery atherosclerotic stenotic lesions occurs in this segment. Patients and methods: Anatomical and histological studies were performed on 26 renal arteries from 13 adults at autopsy (mean age 61.6 years, range 33 to 87 years). Results: In the macroscopical examination the right renal arteries (RRA) were longer with a median 53.8 mm (range 38 to 65 mm) than the left renal arteries (LRA) with a median 47.6 mm (range 35 to 63 mm), the circumferences were nearly the same: RRA 10.9 mm (range 5 mm to 15 mm) and LRA 11 mm (range 5 mm to 15 mm). Probes for histological examinations were taken from three different regions of each renal artery (origin, 5 mm and 10 mm distal to the origin). We observed a typical elastic arterial structure at the origin and muscular types at the distal 10 mm region. At the distal 5 mm region variable ratios of elastic tissue (ET) and smooth muscle cells (SMC) were found as follows: 15 arteries presented an equal ratio of EM : SMC, 7 arteries presented ET > SMC and 4 arteries presented ET < SMC ratios. Conclusions: In this study we confirmed that in renal arteries, a transitional zone (TZ) that is an arterial segment with transition from elastic to muscular type, does exist, involving the maximal length of 10 mm. Further studies on the impact of the biomechanical properties of the transitional zone as a potential localizing factor in renal atherosclerotic disease are justified. In addition, the complex biomechanical behavior of the TZ of the arterial wall should be taken into consideration when interventional procedures are planned.
FloSeal®: Ein neuartiges Hämostyptikum in der peripheren Gefäßchirurgie
Authors: Reuthebuch Oliver , Lachat  , Vogt  , Schurr  , Turina
Published: January 2006

Background: Bleeding is a common and often severe side-effect in vascular surgery. The use of glue is widely accepted to achieve a dry surgical field. The application of sealant is limited when the surface is covered with blood. Aim of this study was to evaluate a new sealant (FloSeal®) in patients undergoing vascular surgery. Patients and methods: Between June 1998 and July 1999 a total of 17 patients with peripheral vascular interventions was included in this investigation. Effectiveness was measured by bleeding severity prior and after application, time to hemostasis, amount of fusion matrix necessary for hemostasis, the potential need for additional hemostatic measures, or the need for reoperations to control the bleeding. Results: In 15 out of 17 patients bleeding was controlled with FloSeal® alone, two patients required further surgical or hemostatic treatment. There were no local or systemic complications after use of this product. Conclusion: FloSeal® is an advantageous hemostatic tool.
Eine multivariate Faktorenanalyse der Offenheitsrate nach femoropoplitealer und femorodistaler Arterienrekonstruktion
Authors: Ljungman  , Ulus  , Almgren  , Bergström  , Hellberg  , Bergqvist  , Karacagil
Published: January 2006

Background: The most important factors that determine the outcome after femoropopliteal and femorodistal arterial reconstruction are still controversial. This report analysis the factors that determine the early and late patency of distal arterial reconstruction. Patients and methods: A retrospective analysis of patency after femorodistal arterial reconstruction with a new method for evaluation of angiographic runoff was performed for 336 arterial reconstructions. The different pre-, per- and postoperative risk factors were analysed in a Cox proportional hazards model. Result: The patency was significantly better for vein grafts in comparison to composite grafts and prosthetic grafts. It was 74% for vein, 46% for composite and 43% for prosthetic reconstructions, respectively, at 12 months after arterial reconstruction. The cumulative life table patency rate in extremities with good, intermediate and poor runoff was 62, 30 and 10%, respectively at 36 months. The patency rates for extremities operated on for claudication was significantly better than for extremities operated on for critical ischaemia. The multivariate analysis of different factors in a Cox analysis revealed that only the status of distal runoff, the graft material and the site of the distal anastomosis independently and significantly influenced the patency rates. Conclusions: A new model for evaluation of distal runoff proved to predict the patency rate of femoropopliteal and femorodistal arterial reconstructions reasonably well in this retrospective analysis.
Acquired nevus flammeus (Fegeler syndrome)
Authors: Senti  , Trüeb
Published: January 2006

Wir berichten über einen 37-jährigen Patienten, bei dem nach einem Skiunfall im Bereich der rechten Schulter ein Nävus flammeus auftrat. Dieses ungewöhnliche Krankheitsbild wurde erstmals durch Fegeler 1949 bei einem Soldaten mit Schädelhirntrauma beschrieben. Der Nävus flammeus trat damals im Trigeminusbereich auf. Seit diesem Zeitpunkt wurden wiederholt ähnliche Kasuistiken publiziert. Das typische Bild erlaubt eine klinische Differenzierung zum unilateralen nävoiden Teleangiektasiesyndrom, den eruptiven unilateralen Teleangiektasien und den eruptiven Spidernävi.
Postmenopausale Hormonsubstitutionstherapie und die Gefäßwand: Epidemiologie und klinische Studien
Authors: Joswig Martina , Hach-Wunderle  , v. Holst  , Nawroth
Published: January 2006

The clinical relevance of estrogen’s multiple acute and more delayed effects on vascular wall structure and function is incompletely understood. This review attempts to reevaluate epidemiological findings and clinical studies concerning the vascular actions of estrogens and gives implications for strategies in postmenopausal hormone replacement therapy (HRT). There is large evidence from observational studies that HRT reduces the risk of cardiovascular mortality and morbidity in postmenopausal women. However, according to the only large randomized, placebo-controlled, secondary prevention Heart and Estrogen/progestin Replacement Study (HERS), women with prevalent cardiovascular disease (CVD) have increased CVD events within the first year after onset of HRT. The net effects of HRT on atherosclerosis, coagulation, fibrinolysis or the inflammatory response are unproven. Randomized trials of intermediate outcomes reveal that HRT has favorable effects on isolated cardiovascular risk factors, e.g. lipoproteins, carbohydrate metabolism and vasodilatation, but the impact of this effects on clinical endpoints is still not clear. The basis of “evidenced based medicine” is currently not sufficient to provide exact recommendation who will benefit from HRT and who might not. Therefore, the decision about hormone use should consider individual benefit-risk profiles.
Erfahrungen mit einer Hydrofaser in der Behandlung von chronischen Wunden, insbesondere beim diabetischen Fuss
Authors: Brunner Urs , Eberlein
Published: January 2006

Background: Chronic wounds are an everyday problem in general medicine. Likewise, their persistence, painfulness and frequency of relapse are everyday problems which strain the stamina of patients and doctors to the point of desperation. Over recent years, the moist therapy concept has proven to be a major advance in wound treatment. The introduction of innovative wound dressings in the 1990’s made it possible to substantially accelerate wound healing and couple it with a simultaneous alleviation of pain. Patients:In the scope of our team’s experience one such product is the hydrofibre. This paper offers information on the possibilities for using this material on the basis of 135 wound situations, 44% of which are within the context of diabetes mellitus. Results: There was a positive influence on wound healing in 92% of the cases. This treatment result is analysed in terms of causal, topographic and iconographic aspects. Conclusion: Given the main focal points of our group of patients, it may be stated that hydrofibres are suitable for diabetic wounds.
Vitalkapillarmikroskopische Befunde am Nagelfalz bei Diabetes mellitus
Authors: Fahrig Clemens , Breitinger  , Heidrich
Published: January 2006

Background: Preliminary investigation done in 100 healthy adults and 20 healthy children had shown that the interpretation of significance of changes in capillary morphology need to be corrected, since capillary changes previously considered to be pathological are also to be found in large numbers in healthy subjects. Against this background, the question has now been investigated whether the capillary microscopic findings in diabetics deviates from those found in normals, and whether the duration of the diabetes, its treatment, its sequelae, or concomitant diseases have any influence on the capillary microscopic appearance. Patients and methods: In 100 patients aged between 44 and 88 years with type 2 diabetes vital capillary microscopy was carried out on all ten fingers in the usual manner. The evaluation of the video recordings was done only when all the examinations had been completed – by two examiners blinded to the clinical data. Results: It was shown that 66% of the patients demonstrated pathological capillary microscopic findings. These findings included pathologically increased apical and non-apical dilatations (32%), haemorrhagic extravasations (20%) and branchings (45%). No differences were found between the therapy groups (insulin – oral medication) nor was any relationship between the appearance of capillary changes and the duration of diabetes observed. Diabetics with concomitant diabetic sequelae (polyneuropathy), demonstrated no differences in capillary morphology as compared with diabetics with no such sequelae. Conclusion: Diabetics are found to have an increased incidence of pathological capillary morphology taking the form of increased apical dilatations, branchings and haemorrhagic extravasations. Neither the treatment, nor the duration of the illness, nor diabetic sequelae appeared to have any influence on the capillary microscopic changes.
Die klinische Wertigkeit des routinemäßigen Screenings nach abdominellen Aortenaneurysmen während der Echokardiographie
Authors: Seelig Matthias H. , Malouf  , Klingler  , Oldenburg  , Atkinson
Published: January 2006

Background: The aim of this study was to determine the clinical utility of transthoracic echocardiography (TTE) as a screening method for the detection of abdominal aortic aneurysms (AAA). Patients and methods: Each patient who was referred to the echocardiography laboratory TTE was included into the study. After complete cardiac assessment the abdominal aorta was evaluated. Patients with a known, a clinically suspected, or a previously operated AAA were excluded. Results: During the study period, 14876 patients underwent TTE. 13166 (88.5%) of the patients were 50 years and older. Of these 6953 (52.8%) were men and 6213 (47.2%) were women. A total of 108 (0.82%; 95% confidence interval (CI) 0.67–0.99) clinically unsuspected AAA of at least 3 cm in diameter (range 3 cm – 6.8 cm) were detected. There were 93 (86.1%) men and 15 (13.9%) women with a mean age of 73.8 years (range 59–90). In 7 patients an AAA was suspected by TTE but not verified on subsequent abdominal ultrasound, as the diameter of the abdominal aorta was less than 3 cm. The prevalence of an AAA in patients 50 years and older was 1.34% (95% CI 1.08–1.64) for men and 0.24% (95% CI 0.14–0.40) for women. In patients less than 50 years old no aneurysm was detected. Seventeen patients who were found to have an AAA with a mean diameter of 4.4 cm (range 3–6 cm) underwent successful elective conventional AAA repair after a mean interval of 13.9 months (range 0.2–49 months) following the initial diagnosis. Conclusions: TTE performed in a highly selected cardiac patient group in a tertiary referral center is not a useful tool to screen for clinically unsuspected abdominal aortic aneurysms due to the low prevalence. The detection of an aneurysm should be confirmed by conventional abdominal ultrasound.
Prävalenz und Charakteristika von Muskelkrämpfen bei Patienten mit Varikosis
Authors: Hirai Masafumi
Published: January 2006

Background: It has been suggested that limb circulation may be disturbed in patients with muscle cramps due to leg venous hypertension. The aim of this study was to examine the incidence and characteristics of muscle cramps from venous insufficiency. Patients and methods: The incidence and characteristics of muscle cramps, which were investigated by a questionnaire, were compared between 288 patients with incompetence of the long or short saphenous vein and 550 age-matched individuals from the general population. Results: The patient group showed a significantly higher incidence of muscle cramps in the last year than the general population group, 67% and 53%, respectively (p < 0.001). The incidence of calf cramps was significantly higher in the patient group than in the general population group, 91% and 75%, respectively (p < 0.001). Although most subjects reported symptoms occurring only at night, the incidence was significantly higher in the patient group than in the general population group, 78% and 52%, respectively (p < 0.001). There was no significant difference in the duration or severity of muscle cramps between the groups. The patient group showed a significantly higher incidence of more than 12 episodes per year than the general population group (p < 0.001). Conclusions: Muscle cramps in patients with varicose veins occur more frequently and more often at night and in the calf in comparison with those from the general population.
Intraluminale Kalkbildung der abdominalen Aorta
Authors: Lassen  , Bismuth Jean , Bækgaard  , Christoffersen
Published: January 2006

A patient who had no evidence of atherosclerotic disease and had never been hypertensive, presented with symptoms usually associated with gallstone disease. A large intraluminal calcification in the juxtarenal aorta was found to be the probable cause of these symptoms. The aorta was otherwise free of atherosclerotic changes. Although it could not be identified with certainty, this calcification could have developed secondary to a single ulcerated atheroma.
Die «galoppierende» Geschichte der Claudicatio intermittens
Authors: Bollinger Alfred , Eckert  , Rüttimann  , Becker
Published: January 2006

Intermittent claudication (IC) due to arterial occlusive disease was first diagnosed by the French veterinary surgeon Jean-François Bouley jeune in a horse drawing a cabriolet in the streets of Paris as early as 1831. The animal was repeatedly exercised and always started to limp with the hind legs at similar work loads. Autopsy revealed partially thrombosed aneurysm of the abdominal aorta and occlusions of both femoral arteries which were correctly identified as the cause of IC. In 1858 the famous neurologist Jean-Martin Charcot working at the Salpêtrière in Paris first discovered the condition in a patient, who was wounded by a bullet during the conquest of Algery and developed iliac artery aneurysm obliterated by a thrombus. He was aware of the first description in veterinary medicine. In Germany IC was also first mentioned in horses (Rademacher, 1838). 13 reports of patients were contributed by the neurologist Heinrich Erb in 1898 and 1904. Some interesting features of the phenomenon of IC like the amount of exercise necessary to provoke it, localization, social relevance, prolongation of the Achilles tendon reflex, decrease of maximal plantar flexion force of the foot and production of “Lewis factor p” are summarized. In human patients arteriosclerosis is the well recognized principal cause of arterial obstructions, in horses, however, the lesions are due to infection by the roundworm Strongylus vulgaris. In the fascinating life cycle the larvae migrate into the intima of small and large arteries and provoke aneurysms and intravascular thrombosis.