bluuebunny/crossref_metadata_2025_split huggingface dataset:
The endovenous RFITT-treatment of varicose veins, a new method of interventional phlebology
Authors: Lahl W. , Zierau U. T. 
Published: March 2018

SummaryEndovenous bipolar RFITT (RadioFrequency-Induced ThermoTherapy) is a new approach for the treatment of chronic venous insufficiency. During treatment with RFITT (also known as the Celon method) a thermal effect on the vein walls is applied thanks to bipolar energy delivery. An alternating high frequency current creates heat in the vessel enabling a controlled tissue shrinkage. A continuous impedance measurement allows the controlled heat exposure on the vein wall. An acoustic signal guides the physician during the RFITT application. The Celon power control unit turns off automatically when the desired treatment result is achieved. Patients, method: In our clinic we have used the Celon method from October 9, 2007 through October 10, 2008 for the treatment of 331 varicose veins in 199 patients. 78% of these treatments were applied in the Vena saphena magna (VSM) whereas 22% concerned the Vena saphena parva (VSP). We have treated more than one large varicose vein simultaneously in 117 cases. In 31 varicose veins, which had been treated with laser and became recurrent again, we applied RFITT and were able to occlude the vein permanently. Results: In our patient population we achieved an occlusion rate of 97.6% at 12 months follow up. Five cases in the VSM and three cases in the VSP were recurrencies. We think that this – following to the guidance of the company – was caused by pulling back the RFITT applicator too fast in the vein (application time: 1.2–1.5 s/cm) and with an excessive energy amount of 20–22 W. Meanwhile, we have adapted our technique to a slower mode (18 W, application time 3.4 s/cm) and are achieving significantly better results. Conclusion: We are convinced that we have now found the optimal energy amount and pull-back speed.
A rare cause for discomfort of the legs
Authors: Hofer T. 
Published: March 2018

SummaryThis paper presents two women who visited the phlebology surgery in the opinion that varices would be responsible for their symptoms. Patient 1 complained of nocturnal pain that radiated from the posterior surface of the left thigh to the anterior and lateral surfaces of the knee and lateral aspect of the calf. This pain occurred whenever she changed position. Patient 2 felt numbness in her right foot and an annoying burning sensation in her right heel. She was known to have lumbar discopathy and stenosis of the spinal canal which however, according to neurological diagnosis, could not explain the symptoms. On clinical examination neither had visible nor palpable varices, nor any recognisable dermal signs of venous hypertension. However, it was conspicuous that the left foot of patient 1 barely reached the floor when she was sitting down. In patient 2 the circumference of the right calf was increased by 2 cm.In both cases a coarse, circumscribed thickening was palpable deep in the posterior surface of the thigh (patient 1) and the proximal calf (patient 2). This was responsible for the asymmetrical posture in sitting of patient 1. Doppler/duplex sonography did not reveal any pathological findings in either patient. Thanks to MRI scans the cause in both cases was found to be a subfascial tumour that was displacing the musculature, thus compressing nervous structures; once in the thigh (patient 1: 600 g), once in the calf (patient 2: 200 g). In both women the symptoms disappeared after surgical extirpation of the clinically and histologically verified lipomas.
The role of anti-endothelial cell antibodies in venous insufficiency
Authors: Akay T. H. , Bastürk B. , Özkan S. , Aslamaci S. , Aslim E. 
Published: March 2018

SummaryIt is a hypothesis that autoimmune factors directed against endothelial cells play a role in developing venous insufficiency. We investigated the association between anti-endothelial cell antibodies (AECA) and the development of venous insufficiency and varicose veins. Patients, methods: 44 patients were evaluated with clinical examination and duplex ultrasound for diagnosing chronic venous insufficiency and varicose veins and 120 healthy volunteers were assigned as the control group without evidence of chronic venous insufficiency and varicose veins. All sera samples were analysed by using slides, each containing biochips coated with frozen sections of HUVEC (human umblical vein endothelial cells) and capillary-rich tissue such as skeletal muscle (Euroimmun, FB 1960–1005–2, Germany). If a positive reaction is obtained, specific antibodies of class IgA, IgG, IgM attach to the antigens. In a second step, the bound antibodies are stained with fluorescein labeled antihuman antibodies and visualised by fluorescence microscopy. Results: AECA was positive in 24 out of 44 patients (54.54%) and in 30 out of 120 volunteers (25%). We detected that anti HUVEC antibody occurred significantly more frequent in patients with chronic venous insufficiency or varicose veins: p = 0.0007, OR: 3.60 (1.65 < 7.92). Discussion: The presence of antibodies directed against the endothelial structure causes inflammatory cells of the immune system to move towards the location by both forming antigen-antibody complex and activating the complement system. Tissue damage may occur due to inflammation. In our study we have found a statistically significant relationship between antiendothelial cell antibodies and chronic venous insufficiency. Conclusion: Early diagnosis or prediction of venous insufficiency and/or varicose veins before the occurrence of symptoms may prevent the damage or even help to establish a prophylactic treatment.
Results after radio frequency obliteration
Authors: Noppeney T. 
Published: March 2018

SummaryRadiofrequency obliteration for the treatment of varicosis was licensed in Europe in 1998. Many papers have been published on the outcome of radiofrequency obliteration. In most cases these were case series, although prospective, randomised, controlled studies and metaanalyses as well as reviews were also published. Methods: The first review by Schmedt and Steckmeier in 2006, analysed 2333 treated extremities. This paper deliberately waives a formal metaanalysis of the study results on file. Lübke et al. published a metaanalyses of radiofrequency obliteration in 2008. It comprised eight prospective, randomised studies with 225 treated extremities. Another review was also published in 2008 by Noppeney et al. This review included 516 treated extremities from case series, and 116 treated extremities from prospective, randomised studies. It also deliberately waived the techniques of metaanalysis. The last published metaanalysis is by van den Bos et al. 2009. This analysis included 19 publications containing reports on 2514 treated extremities. Two papers on the more recent radiofrequency obliteration methods, VNUS Closure Fast® and RFITT have been published to date. Results: The overall perioperative complication rate for radiofrequency obliteration is very low. The frequency of deep vein thrombosis and/or pulmonary embolism is given as between 0 and 1.4%. Perioperative transient para- and hypaesthesia are reported most often; the frequency here is between 0 and 15.9%. Schmedt and Steckmeier give the mean closure rate for the VNUS Closure Plus® procedure as over 89%, Lübke et al. quote between 81.25 and 100%, and Noppeney et al. cite 89.1% for case series and 87.1% for the prospective, randomised studies. The closure rate in the metaanalysis by van den Bos et al. is given as between 67 and 100%. The European multicentre study reports a closure rate of 96.7% 12 months after the VNUS Closure Fast® procedure. The closure rate 12 months after RFITT is given as 97.6%. Conclusion: The study results on file show that radiofrequency obliteration has become an established therapeutic alternative to traditional vein stripping. Its major benefit is the very low level of perioperative pain symptoms.
Valves of the gonadal veins
Authors: Heinz A. , Brenner E. 
Published: March 2018

Summary
Purpose: Varicocele seems not to rely on the number of valves within the pampiniform
plexus, the initial failure might be located on a higher level. Therefore, the failure should also occur in females. There is a comparable disease, Pelvic congestion syndrome, as result of pelvic venous engorgement due to gross dilatation and incompetence of ovarian veins.Thus, we need a detailed description of venous course, branching as well as frequencies and locations of valves within both genders. Page 3/23
Material and Methods: In 31 Caucasian formalin-fixed bodies (15 males, 16 females) we investigated course and valves from Ovaries or internal inguinal ring, respectively, up to termination into inferior vena cava or left renal vein, respectively. Specimens were documented photographically and by a distinct protocol.
Results: In general, we found one valve on each side (testicular vein right 41.93%, left 51.52%; ovarian vein right 51.61%, left 45.45%). Two specimens had two valves per vein, each in a left testicular vein, and 15 veins showed absent valves. Valves existed between 0.0–4.5 cm, mainly 0.0–1.0 cm. One corpse showed varicose ovarian veins.
Conclusion: If veins show varices, one would expect missing valves or insufficient function. In contrast, none of our 15 valve-less veins showed varices or even enlargement. Also surprising, the only case with varices had one valve on each side. The terminal segment in both genders was almost identical and the venous course was similar. Precisely: men frequently had (N=11) less valves then women (N=4).
Myocardial fatty acid utilisation during exercise induced ischemia in patients with coronary artery disease
Authors: Virtanen K. S. , Nikkinen P. , Lindroth L. , Kuikka J. T. 
Published: March 2018

Summary
Aim: Reversible or irreversible myocardial damage due to ischemia correlates with altered membrane functions of the cells. To compare myocardial free fatty acid (FFA) metabolism and flow during exercise induced ischemia we studied ten patients with coronary artery disease but without previous myocardial infarction. Methods: A series of post-exercise single-photon emission computed tomography (SPECT) measurements was performed after injection of 123I labelled heptadecanoic acid (HDA). Myocardial perfusion was estimated from the separately performed exercise-redistribution thallium study. Fatty acid metabolic rate, thallium uptake and washout were calculated for anterior, lateral, posterior and septal segments. Results: The more reduced post-exercise FFA metabolic rate (–63 ±18%, mean ±1 SD) compared to flow (–36 ±16%) was related to the severity of myocardial ischemia and wall motion abnormalities. Conclusion: In this small group of patients, the reduced post-exercise FFA metabolic rate tentatively suggests a parsimonious workload of the exercising myocardium by reducing oxygen consumption in patients with coronary artery disease.
Diagnosis of initial changes in patients suffering from rheumatoid arthritis
Authors: Treitl M. , Krolak C. , Becker-Gaab C. , Dresel S. , Weiss M. , Schattenkirchner M. , Hahn K. , Höpfner S. 
Published: March 2018

ZusammenfassungZur Diagnostik initialer Veränderungen bei rheumatoider Arthritis (RA) werden neben der Projektionsradiographie (PR) im bilddiagnostischen Stufenkonzept die 3-Phasen- Skelettszintigraphie (3P-Sz) und die Magnetresonanz- Tomographie (MRT) eingesetzt. Ziel dieser Studie war es, die neu entwickelte Niederfeld-MRT mit den etablierten Verfahren (PR, 3P-Sz) in der Initialdiagnostik der RA an der Hand zu vergleichen. Methode: Bei 65 Patienten (47 w, 18 m; 20-86 Jahre) wurden an einem Tag 3P-Sz (550 MBq Tc-99m DPD), Niederfeld-MRT und PR der Hände durchgeführt. Alle Bilder wurden von zwei erfahrenen Nuklearmedizinern/Radiologen geblindet befundet und unterteilt in a) rheumatypische, b) entzündliche, nicht rheumatypische und c) nicht entzündliche Veränderungen sowie der 3P-Sz als Goldstandard gegenüber gestellt. Ergebnisse: Im Vergleich zur 3P-Sz zeigt die Niederfeld-MRT bei nahezu gleicher Sensitivität gegenüber rheumatypischen und entzündlichen Veränderungen nur eine gering niedrigere Spezifität. Bei der PR war sowohl bei rheumatypischen als auch bei entzündlichen Veränderungen die Sensitivität vermindert bei gleicher Spezifität wie die Niederfeld-MRT. Die quantitative Auswertung der 3P-Sz mittels ROI-Technik ergab signifikant höhere Werte bei rheumatypischen Veränderungen. Schlussfolgerung: Die Niederfeld-MRT stellt ein der 3PSz vergleichbar sensitives Verfahren in der Initialdiagnostik zum Nachweis rheumatypischer und entzündlicher Veränderungen im Bereich der Hände dar. Neben der Basisuntersuchung der PR empfiehlt sich die 3P-Sz durch Erhebung eines Ganzkörperstatus sowie quantitativer ROI-Technik für die weiterführende Diagnostik bei Verdacht auf RA.
Hodgkin’s lymphoma in nuclear medicine: diagnostic and therapeutic aspects
Authors: Dietlein M. , Engert A. , Weihrauch M. R. , Schomäcker K. , Fischer Th. , Eschner W. , Borchmann P. , Diehl V. , Schicha H. , Schnell R. , Staak J. O. 
Published: March 2018

SummaryToday, diagnostic and therapeutic strategies of Hodgkin lymphoma (HL) with positrone emission tomography and radioiummunotherapy include state-of-the-art nuclear medicine which require the cooperation between oncology and nuclear medicine. The benefit of FDG-PET in HL patients with residual tumor masses consists of its high negative predictive value in the therapy control of the disease. The concept of waitful watching in patients with PET-negative residual masses after BEACOPPchemotherapy will be evaluated in a large multicenter trial of the GHSG (German Hodgkin Study Group). Radioimmunotherapy has been performed in patients with CD20-positive Non-Hodgkin lymphoma for 10 years with promising results. HL is also an excellent target for immunotherapy due to the expression of antigens such as CD25 and CD30. Thus, a new radio-immunoconstruct consisting of the murine anti-CD30 antibody Ki-4 labeled with iodine-131 was developed for patients with relapsed or refractory HL.
Nuklearmedizinischer Nachweis des ösophagealen Gallerefluxes
Authors: Meyer H-J , Creutzig H. , Pichlmayr R. , Hundeshagen H. , Gratz F.K. 
Published: March 2018

ZusammenfassungDer Reflux von Galle- und Pankreassekret wird als eine Ursache für das Auftreten von regionalen Entzündungen oder möglichen Karzinomen nach Magenoperationen diskutiert. Wir untersuchten mit einer Modifikation der Choleszintigrafie, die Aufnahmen des Epigastriums und des Thorax von ventral sowie eine Spätaufnahme mit hoher Flächen-Impuls-Dichte vor und nach einer Mahlzeit umfaßt, 38 Patienten nach Gastrektomie. Bei 4 von 29 Patienten ohne Beschwerden fand sich ein diskreter Reflux in den Magenersatz. Bei 9 Patienten mit einer refluxverdächtigen Symptomatik war die Untersuchung siebenmal auffällig; bei 6 von diesen ließ sich ein ösophagealer Gallereflux nachweisen, der bei der üblichen Choleszintigrafie nicht dargestellt war. Viermal lag als Rekonstruktionsverfahren eine Ösophago-Jejunostomie, zweimal eine Jejunum-Interposition nach Longmire vor. In einem Fall verblieb der Radiotracer im Magenersatz wegen einer distalen Ösophagusstenose. 2 Patienten hatten eine Ösophagitis III-IV mit zeitweiliger Stenosesymptomatik. Gallebestandteile im Ösophagus, die als Ursache der alkalischen Refluxösophagitis in Frage kommen, lassen sich demnach choleszintigrafisch sicher nachweisen. Vorzuziehen sind daher primär refluxverhütende Operationsverfahren. Andererseits sollte bei möglicherweise refluxbedingten Beschwerden eine szintigrafische Absicherung vor einer eventuellen Umwandlungsoperation erfolgen.
Uptake Mechanism of Interstitially Injected 99mTc-Labeled Antimony Trisulphide Colloid in the Popliteal Lymph Node of Rabbits
Authors: Senekowitsch R. , Sessler J. M. , Möllenstädt S. , Kriegel H. , Hör G. , Münz L. D. 
Published: March 2018

SummaryThe right popliteal lymph node was studied in rabbits by well counting, histoautoradiography and electron microscopy, after interstitial injection of 99mTc-labeled antimony trisulphide (Sb2S3) colloid into the right hind pad. The highest radioactivity concentration (96.8%/g) was measured 6 hr following injection. At 24 hr, the concentration had dropped to nearly half of the maximum (51.5%/g). At each time, only a single or a few lymph node sectors were found to contain 99mTc. Initially, the radioactivity distribution pattern in the draining lymph node was stripy. Beginning at 15 min p.i., there was a progressive change from stripy to focal radioactivity distribution pattern. Until 6 hr after injection, the bulk of radioactivity was trapped by macrophages in the lumen and wall of the lymph node sinus system, predominantly in medullary sinuses. Surprisingly, at 24 hr the majority of labeled cells were eosinophilic polymorphonuclear leukocytes located in medullary sinuses and medullary cords. Up to 24 hr p. i., no accumulation of radioactivity could be detected in the cortical and paracortical lymph node parenchyma. In conclusion, interstitially injected 99mTc-Sb2S3 colloid is not homogeneously draining lymph node. Moreover, both macrophages and eosinophilic polymorphonuclear leukocytes are involved in the filtration process
Ein Beitrag zur semiquantitativen Darstellung der regionalen Hirndurchblutung und neuronalen Funktion mittels N-isopropyl-(123J)-p-Jodoamphetamin (IMP) und Emissionstomographie
Authors: Bekier A. , Weder B. , Meili A. 
Published: March 2018

ZusammenfassungVon Juni 1983 bis März 1985 wurden 197 Patienten eines gemischten neurologischen Krankengutes mit der 123J-IMP-Szintigrafie untersucht. Das zum Vergleich herangezogene Normkollektiv umfaßte 14 Probanden. Mit der alleinigen visuellen Bildbetrachtung der ECT-Schnitte können pathologische Befunde übersehen werden; positive Befunde können außerdem nicht objektiviert werden. Es müssen deshalb weitere, semiquantitative Kriterien herangezogen werden, um die Zuverlässigkeit der Auswertung zu erhöhen. Als Referenzwert der globalen zerebralen Speicherung diente das Normkollektiv mit 35,6 ± 4,3 cts/pixel/ mCi/min und die Einzeichnung fixer, anatomisch gefäßbezogener ROIs in die entsprechenden ECT-Schnitte. Die Impulszahlen der insgesamt 14 ROIs erlaubten einen exakten Seitenvergleich korrespondierender Stromgebiete beider Hirnhemisphären und des Kleinhirns. Die Ausprägung der Asymmetrie (Standardabweichung <2%) gibt Hinweise über das Ausmaß einer Perfusionseinschränkung, vor allem in Verlaufsuntersuchungen nach Therapie. Zur Unterscheidung einer durch Minderdurchblutung der einen Seite oder Mehrbelegung der anderen Seite verursachten Asymmetrie wurden die ROI-Daten aller Regionen beider Hemisphären getrennt als cts/ROI/pixel/ mCi im Profil dargestellt. Der Vergleich der Patientendaten mit dem Normprofil unter Berücksichtigung der Standardabweichungen erlaubt eine Objektivierung von Speicherabnormitäten ohne Seitenvergleich, da diffuse Hirnprozesse oder bilaterale Perfusionsstörungen nicht notwendigerweise zu einer feststellbaren Asymmetrie führen.
Hypertrophic Cardiomyopathy: Non-Invasive Assessment of Diastolic and Systolic Functional Parameters in Relation to Heart Rate
Authors: Spielmann R. P. , Geiger M. , Clausen A. , Kuck K.-H. , Montz R. , Nienaber C. A. 
Published: March 2018

SummaryHypertrophic cardiomyopathy (HC) is characterized by reduced left ventricular compliance and subsequent filling abnormalities. To study the pathophysiologic changes in parameters of left ventricular systolic and diastolic performance as a function of increasing heart rate 14 patients with HC (32 ± 12 yrs; 11 M, 4 F) and 4 normal individuals were subjected to equilibrium radionuclide ventriculography (99mTc-labelled red blood cells) at rest and during incremental right atrial pacing; heart rate was increased in steps of 20 beats per min from basal state to the individual symptom-limited endpoint. Mean symptom-limited heart rate was 141 ± 28 in HC and 160 in normals (p <.01.). At each pacing level filling and ejection parameters as well as the left ventricular endsystolic (LVESV) and enddiastolic volume (LVEDV) were determined relative to resting volumes at a heart rate of 78 ± 8. At the individual maximal pacing rate HC revealed a decline in LVEDV to 61 ± 4 % (p C.001) and an increase in LVESV to 117 ± 14% (p <.001) resulting in decreasing ejection fractions at heart rates above 120. Peak LV filling rates initially increased but subsequently decreased steeply at heart rates above 100; peak LV ejection rates in HC showed a similar pattern with increasing frequency. Time inter- vais to peak ejection and peak filling rate did not differ from normal. Thus, patients with HC demonstrated combined left ventricular diastolic and systolic abnormalities with increasing heart rate leading into a low-input low-output circulatory state. This probably explains not only the symptoms associated with HC, but also supports the concept of “hemodynamic syncope” in HC.
Localization of Post-Infarction Myocardial Ischemia by 201T1 Emission Computed Tomography
Authors: Nienaber C. A. , Heinemann H. , Montz R. , Spielmann R. P. 
Published: March 2018

SummaryIn 41 patients with a history of a single myocardial infarction, the location of myocardial ischemia was studied by 201T1 emission computed tomography immediately and 3 h after intravenous dipyridamole. Distant ischemia was distinguished from periinfarctional ischemia by the presence of transient thallium defects in, or slow thallium washout from, myocardium not supplied by the infarct-related coronary artery. Distant ischemia occurred in 13 patients and was always accompanied by peri-infarctional ischemia. Peri-infarctional ischemia without distant ischemia was observed in 15 patients. The occurrence of distant ischemia was found to be dependent on the severity of stenosis in non-infarct coronary vessels. Twelve (86%) of 14 patients with non-infarct stenosis of 75% or greater had distant ischemia, but only 1 (4%) of 27 patients with non-infarct stenosis of less than 75%. In the presence of distant ischemia, peri-infarctional ischemia was in 11 patients (85%) associated with collaterals supplying the infarct zone, whereas in 13 (87%) of the patients with peri-infarctional ischemia only, incomplete obstruction of the infarct vessel was observed. It is concluded that, by the distinction between peri-infarctional and distant is-chemia, the presence of significant stenosis in non-infarct vessels can be non-invasively predicted from tomographic thallium scintigraphy with dipyridamole.Dedicated to Prof. Dr. med. C. Schneider on the occasion of his 60th birthday.