bluuebunny/crossref_metadata_2025_split huggingface dataset:
No differences in support of thrombin generation by neonatal or adult platelets
Authors: Bernhard H. , Rosenkranz A. , Novak M. , Leschnik B. , Petritsch M. , Rehak T. , Köfeler H. , Ulrich D. , Muntean W. 
Published: March 2018

SummaryNewborns have, despite low clotting factors and poor in vitro platelet function, a well functioning hemostasis. The reason for this is still not completely clear. The aim of our study was to investigate whether phospholipids in neonatal platelets differ from those in adult platelets in their total amount, in their exposure on the platelet surface, and their effect on thrombin generation (TG). Methods: Clotting times of newborn and adult platelet-rich plasma were measured. Effect of newborn and adult platelets on TG was measured by means of CAT (calibrated automated thrombography). In addition, the effect of newborn and adult platelets with or without stimulation by ionophor on TG was measured in a purified prothrombinase complex. Phosphatidylserine-exposure (PS) of newborn and adult platelets was measured by flow cytometry of annexin V binding. The amount of phospholipids (PL) was determined by means of mass spectrometry. Results: Clotting times of platelet-rich plasma (PRP) of newborns stimulated with ionophor showed a significant lower reduction of clotting time than in adult PRP. No differences in the support of TG between neonatal and adult platelets were found in neonatal or adult plasma by means of CAT. In the purified system TG was increased by adding ionophor stimulated platelets but no difference was evident between stimulated newborn and adult platelets. Flow cytometric analysis showed no difference in annexin V binding between adult and newborn platelets. The results of mass spectrometry showed a very similar amount and pattern of PL of adult and newborns platelets. Conclusion: Our results do not provide any evidence that a different PL content or expression of neonatal platelets may alter TG in neonates.
Malignant stroke in an adolescent with a homozygous MTHFR 677CT mutation and intake of hormonal contraceptives
Authors: Pfurtscheller K. , Senning B. , Bernhard H. , Novak M. , Zobel G. , Plecko B. , Muntean W. 
Published: March 2018

SummarySevere stroke in children and adolescents with its devastating long term consequences remains a rare disorder with many open questions. Beside the well known risk factors such as infection or congenital and acquired heart disease, coagulation disorders have to be considered in the differential work up of the underlying aetiology. Here we report the case of an adolescent with a homozygote MTHFR 677CT mutation suffering a malignant stroke shortly after the start of oral contraceptives. Conclusion: Since prevention seems easily feasible, general screening for MTHFR mutations might be worthwhile in women before starting oral contraceptives.
Pseudo tumours in haemophilia patients
Authors: Gravius S. , Weber O. , Goldmann G. , Pennekamp P. , Oldenburg J. , Pagenstert G. , Wirtz D. C. , Seuser A. , Berdel P. 
Published: March 2018

SummaryPseudo tumours are amongst the rare yet pathognomonic complications of haemophilia. They are old, encapsulated haematomas which due to their sometimes enormous size can cause massive complaints. These haematomas are surrounded by a thick fibrous capsule. They are attributed to persistent bleedings. The pathophysiology of pseudo tumors is not conclusively established yet. Some believe that they originate from bone material or the periosteum, while others suggest their development from soft tissue. They spread aggressively, displace the surrounding tissue, and cause secondary periosteal erosion of the bone. This results in bone resorption and destruction of surrounding muscular and soft tissue. Pseudo tumours develop slowly over many years. They occur primarily in adults and are largely unresponsive to conservative treatment. Case:A 48-year-old man with moderate hemophilia A (FVIII : C 2%) and no FVIII inhibitor. Due to recurrent bleeding into the muscle of the right thigh diagnosis of two pseudo tumours (psoas, adductor magnus). In 2004 tumour extirpation with subsequent relapse; because of high local bleeding tendency (despite permanent prophylaxis with FVIII concentrate and adjusted lifestyle) surgical revision in 02/2008. Postoperatively, no recurrent bleeding; the patient is fully fit for work three months later. Conclusion: In order to reduce the complication rate when a pseudo tumor is suspected, patients should be treated in a specially equipped interdisciplinary center with adequately trained and experienced surgeons and haemostaseologists.
Radiosynoviorthesis in children with haemophilia
Authors: Mancuso M. E. , Perfetto O. S. , Solimeno L. P. , Pasta G. 
Published: March 2018

SummaryRecurrent bleeding into joints represents the clinical hallmark of haemophilia and, if not adequately treated, it may cause chronic synovitis and degenerative arthropathy. The first treatment option of recurrent haemarthroses and/or chronic synovitis is represented by synoviorthesis, both chemical and radioisotopic, with a success rate of approximately 80% for both. However, radioisotopic synoviorthesis should be preferred because it makes it possible to obtain complete synovial fibrosis usually in one session, without the need for repeated injections, thus reducing the risk of bleeding complications and concentrate consumption. For all these reasons this procedure should be implemented and supported, particularly in developing countries.
Die Antistase, ein vernachlässigtes Therapieprinzip bei der tiefen Beinvenenthrombose
Authors: Partsch H. 
Published: March 2018

ZusammenfassungAntikoagulation ist die Basis der konservativen Behandlung der tiefen Venenthrombose (TVT). Die phlebographischen Ergebnisse mit konventionellen intravenösen Infusionen von unfraktioniertem Heparin, die Bettruhe erforderten, waren nicht sehr zufriedenstellend, konnten aber durch die Einführung von niedermolekularen Heparinen (NMH) verbessert werden. NMH werden subkutan verabreicht. Die Bettruhe kann entfallen, sogar eine Heimtherapie wird möglich. Die besseren Ergebnisse sind wohl auch durch die frühe Mobiliserung der Patienten entsprechend den Prinzipien der Antistase zu erklären. Eine ambulatorische Behandlung der proximalen TVT mit NMH und Kompression führt nicht zu einem erhöhten Risiko von klinisch relevanten Lungenembolien. Gehübungen mit guter Kompression (Verbände oder Kompressionsstrümpfe) bewirken eine raschere und effektivere Reduktion von Schmerzen und Schwellung als Bettruhe.Wenn ein TVT-Patient kommt, liegen sehr häufig szintigraphisch nachweisbare Lungenembolien vor, die meistens klinisch stumm sind. Unter therapeutischer NMHDosierung, fester Kompression und Gehübungen sind neue Pulmonalembolien selten. Die Inzidenz einer tödlichen Pulmonalembolie betrug 3 von 1289 bei so behandelten, konsekutiven Patienten. Zusätzliche antistatische Maßnahmen zur Antikoagulation ergeben bessere Resultate als alleinige Antikoagulation, ohne dabei die Gefahr einer gefährlichen Lungenembolie zu erhöhen. Deshalb sollten mobile TVT-Patienten exakt antikoaguliert werden (in der Initialphase bevorzugt beginnend mit NMH) und mit guter Beinkompression angehalten werden, möglichst viel zu gehen, unabhängig davon, ob sie zu Hause oder im Krankenhaus behandelt werden.
Haemophilia and knee function
Authors: Schumpe G. , Schuhmacher M. , Lehmacher K. , Oldenburg J. , Berdel P. , Seuser A. 
Published: March 2018

SummaryWith early prophylactic treatment our haemophilic children grow up in good health. Nevertheless, we cannot prevent every bleeding. Those bleedings may be just subclinical but they could lead to overloading of the knee and more and more of the ankle joint in the long term. Motion analysis can help to understand this process and prevent it. A comparison of the gait function of haemophilic and healthy children of the age 3–18 years showed distinct functional differences especially in the youngest age group (3–6 years). Apparently, the coordination skill gait rhythm was significantly worse in the heamophilic group. All measured functional deficits can be treated with physiotherapy. Possible reasons for these early functional differences are overprotection and/or early subclinical bleedings.
Die Wirkung der Kompressions-therapie auf die lokale Mikrozirkulation und Histomorphologie beim Ulcus cruris venosum
Authors: Gehl B. , Aust M. C. , Meyer-Marcotty M. , Altintas M. A. , Altintas A. A. 
Published: March 2018

ZusammenfassungHintergrund: Die Wirkung der Kompressionstherapie auf die lokale Mikrozirkulation und Histomorphologie ist bisher nicht ausreichend belegt. Die konfokale Laser-Scanning-Mikroskopie (KLSM) ermöglicht eine in-vivo-Untersuchung der menschlichen Haut auf zellulärer Ebene.Methode: Neunzehn Patienten mit Ulcus cruris venosum wurden folgenden Therapien zugeführt. Gruppe A: medizinische Kompressionstherapie, inaktive Wundauflage; Gruppe B: inaktive Wundauflage. Vor und 4 Wochen nach Therapiebeginn wurden folgende Parameter mittels KLSM evaluiert: zellulärer Blutfluss, Epidermisdicke, epidermale Zellgrößen, Quantität von Entzündungszellen.Ergebnisse: In Gruppe A stieg nach vierwöchiger Kompressionstherapie der zelluläre Blutfluss signifikant an, in Gruppe B nur insignifikant. Die Epidermisdicke nahm in Gruppe A mehr ab als in Gruppe B. Die epidermalen Zellen veränderten sich in beiden Gruppen nur insignifikant. Die Quantität der Entzündungszellen nahm in Gruppe A von massiv auf vereinzelt und in Gruppe B von massiv auf vermehrt ab.Conclusio: Mit der KLSM konnte die positive Wirkung der medizinischen Kompressionstherapie auf die lokale Mikrozirkulation und His-tomorphologie beim Ulcus cruris venosum nachgewiesen werden.
Therapeutischer Nutzen von niedermolekularem Heparin bei Frauen mit rezidivierenden Aborten
Authors: Kiesewetter H. , Radtke H. , Schmidt F. P. , Becker R. , Maas S. , Ristau B. , Baumgarten S. , Pruß A. , Körber K. 
Published: March 2018

ZusammenfassungRezidivierende Aborte sind leider häufig. Möglicherweise hilft eine Therapie mit niedermolekularem Heparin (NMH), eine weitere Schwangerschaft erfolgreich auszutragen. Bei Frauen mit rezidivierenden Aborten werden eine systemische, inflammatorische Immunantwort und vermehrt vaskuläre Thrombosen in der Plazenta nachgewiesen. Weil Heparine sowohl eine antikoagulatorische als auch eine antiinflammatorische Komponente besitzen, untersuchten wir die Wirksamkeit einer Thera-pie mit NMH.Patienten und Methode: Die Wirksamkeit einer Monotherapie mit NMH (5 000 I.E. täglich) bei Frauen mit mindestens zwei Frühaborten oder einem Spätabort in der Anamnese wurde retrospektiv untersucht. Dazu wur-den die Daten von 147 Schwangerschaften ausgewertet. Zielvariable war die Lebendgeburtenrate. Zudem wurde untersucht, ob bestimmte Faktoren die Wahrscheinlichkeit eines Abortes erhöhen.Ergebnisse: Es wurde eine Lebendgeburtenrate von 86,4 % erreicht. Es sind keine schwer- wiegenden Nebenwirkungen des Heparins aufgetreten. Als Risikofaktoren, trotz Therapie einen Abort zu erleiden, fanden wir eine im ers-ten Trimenon erhöhte Protein S-Aktivität und eine erniedrigte Faktor VIII-Aktivität sowie einen aktiven Nikotinabusus.Schlussfolgerung: Es wurde eine Lebendgeburtenrate erreicht (86,4 %), die der von gesunden Frauen (87,2 %) entspricht. Dabei ist es unwesentlich, ob die Frauen Träger thrombophiler Genpolymorphismen sind oder nicht. Trotz einer Therapie mit NMH stellen aktiver Nikotinabusus und fehlende schwangerschaftstypische Veränderungen der Gerinnung, Risikofaktoren für einen Abort dar. Wir empfehlen diese Werte in Risikoschwangerschaften zu kontrollieren.
Skin necrosis after hook phlebectomy of varicose veins
Authors: Krobisch P. P. 
Published: March 2018

Summary
Background: Hook phlebectomy is usually performed under local anaesthesia. Several modifications of local anaesthesia have been proposed, including the reduction of the concentration of the local anaesthetic, the increase of the volume, the addition of norepinephrine and sodium bicarbonate. Patients, method: Three episodes are reported of painless skin necrosis after local anaesthesia using mepivacain (0.5 or 1%) with added sodium bicarbonate (8.4%, 1 : 10). Results: Degradation of the solution used for local anaesthesia was the cause of the necroses. The stopcock securing the bottle containing the stock solution of sodium bicarbonate allowed CO2to evaporate leaving sodium carbonate in the vial with a pH of 11. This solution was diluted 1 in 10 with mepivacain. The injections were painless and the necroses only were detected after three days when the bandages were removed. Discussion: Risks are inherent to even small changes of remedies. Conclusion: Home-made solutions must meet pharmaceutical standards in order to guarantee safety.
Die Tumeszenzlokalanästhesie in der Varizenchirurgie
Authors: Tauscher K. , Schonath M. , Schattenkirchner St. 
Published: March 2018

ZusammenfassungDie Tumeszenzlokalanästhesie (TLA) wird seit Anfang der 1990er Jahre im Bereich der Phlebochirurgie eingesetzt. Sämtliche Routineeingriffe (inguinale und popliteale Krossektomien, Exhairese der V. saphena magna /parva, lokale Phlebektomien, Perforans-Ligaturen, minichirurgische Phlebektomien ) können problemlos in TLA mittels einer mechanischen Rollpumpe erfolgen. Auch erschwerte Operationen wie inguinale bzw. popliteale Krossenrevisionen, Befunde mit (sub)akuten Thrombophlebitiden oder Eingriffe bei Dermatoliposklerose und Ulcus cruris venosum können mit dieser Technik teils in Kombination mit einer intravenösen Anästhesie durchgeführt werden.Vorteile der TLA sind die unkomplizierte Applikation, die sofort einsetzende und postoperativ langanhaltende Analgesie, die reduzierte intraoperative Blutungsneigung und konsekutiv reduzierte postoperative Hämatombildung, das minimale Thrombose- und Embolierisikio, die antibakterielle Wirkung sowie die durch den so genannten Hydrodissektionseffekt erleichtere Präparation. Die TLA stellt eine sichere, komfortable und wirkungsvolle Methode der Lokalanästhesie in der Phlebochirurgie ohne die Nachteile anderer Anästhesieformen dar.
Die oberflächliche Thrombophlebitis, ein Nicht-der-Rede-wert-Krankheitsbild?
Authors: Schwahn-Schreiber Chr. , Marshall M. 
Published: March 2018

ZusammenfassungEs werden Klinik, Diagnostik und Therapie der Thrombophlebitis superficialis in ihren verschiedenen Erscheinungsformen dargestellt. Die grundlegende Therapie der oberflächlichen Venenentzündung (Thrombophlebitis und Varikophlebitis) hat sich nicht geändert. Geändert haben sich die Prognosebeurteilung und die Anforderungen an eine angemessene Diagnostik: Bei einer Magna- oder Parvaphlebitis kann der Entzündungsprozess mit Thrombosierung deutlich weiter nach proximal reichen als der klinische Befund dies vermuten lässt mit der Gefahr des Übergreifens der oberflächlichen Phlebitis über die Mündung der Stammvenen auf das tiefe Venensystem (sapheno-femorale Thrombose). Die Koinzidenz zwischen oberflächlicher Venenentzündung und tiefer Venenthrombose liegt bei rund 10 bis 40%. Daher sind duplexsonographische Kontrollen zum Ausschluss einer zusätzlichen tiefen Venenthrombose und/oder einer Aszension der Entzündung in den Mündungsbereich der Stammvenen erforderlich.Die grundlegende Therapie der Thrombophlebitis superficialis ist die Kompressionsbehandlung mit Mobilisierung. Niedermolekulares Heparin wird inzwischen häufig eingesetzt, obwohl der Stellenwert noch nicht ausreichend definiert ist (Anwendung ohne Beweis). Als Behandlungsdauer wird gegebenenfalls in den vorliegenden Studien ein Monat vorgegeben. Die Indikation zur „Notfall-Krossektomie” bei mündungsnaher Magna-Phlebitis bedarf weiterer Abklärung. Nach dem heutigen Kenntnisstand ist die oberflächliche Thrombophlebitis ein ernst zu nehmendes Krankheitsbild mit dringlicher Betreuungsindikation.
Neovascularisation
Authors: Creton D. 
Published: March 2018

SummaryThere are different causes of neovascularisation: vascular endothelial growth factor, inflammatory process, hypertrophy of pre-existant vessels (lymph node veins), haematomas revascularisation, and high difference in pressure. The latter 3 depend directly on the way the operation is performed hence on the surgeon.Concerning the primary varices patch saphenoplasty do not abolish neovascularisation. It is of first importance to perform a flush ligation only in case of incontinent terminal and pre-terminal valves. In that case an incision as small as possible must be carried out with minimal dissection and with tumescence to limit the bleeding and hematomas. When the terminal valve is competent it is better to choose endovascular technique.Concerning re-do it is mandatory to avoid useless re-do, the best choice is foam sclerotherapy. I am convinced that neovascularisation are produced by the complications which are induced by a large dissection. The barrier technique are, probably, not as useful as we was told 10 years ago. The lack of aggressiveness during the operation is certainly far more important: “Doing less in the groin to do better for the recurrence and re-recurrence”
Foam sclerotherapy
Authors: Morrison N. 
Published: March 2018

SummaryMethods to improve the efficacy of foam sclerotherapy might include: more vigorous agitation methods to produce more stable foam with smaller bubble size, increasing the volume and/or concentration of the sclerosing agent, use of an intravenous catheter, and leg elevation to evacuate as much blood as possible. Methods to improve the safety of foam sclerotherapy might include: use of an intravenous indwelling catheter; saphenofemoral junction occlusion; low foam volume; use of low silicon syringes; use of non airbased foam; avoidance of high concentration sclerosing agents in patients with duplicated femoral vein segments; leg elevation before or after injection of foam; and maintaining patient immobility after injection.A series of studies and exercises are described which call into question many methods proposed to limit the dispersal of injected foam. The use of non air-based foam may reduce the incidence of side effects.
Non-linear analysis of skin blood flow in patients suffering from chronic venous leg ulcers
Authors: Bräuer K. , Radke C. , Strölin A. , Häfner H.-M. 
Published: March 2018

SummaryThe elevated ambulatory pressure in the peripheral venous system in patients suffering from chronic venous insufficiency manifests itself not only in the form of disturbed macrocirculation but also and particularly in microangiopathic changes. Laser Doppler fluxmetry is a well established method to measure cutaneous blood flow. Aim of the study was to investigate the cutaneous vasomotion at the inner ankle in patients suffering from chronic venous insufficiency in the clinical stadium C6 compared to healthy subjects. Patients, methods: In 38 patients suffering from venous ulcer and in 33 healthy subjects continous time series of Laser Doppler fluxmetry (LDF) data were recorded with a sampling frequency of 50 Hz over a period of 15 min. The patients were supine and LDF was measured at the inner ankle. Time series were analyzed using newly developed methods (wavelet analysis and biorthogenal decomposition). Results: There was a statistically significant difference in mean LDF between patients and healthy controls (94 SD 65 AU [C6] vs. 28 SD 13 AU (C0), p < 0.001). There also were statistically significant differences in the scaling levels using wavelet analysis corresponding to sympathetic activity, corresponding to myogenic activity in the vessel wall and corresponding to the heart beat. Conclusion: There are changes in vasomotion between patients with venous ulcers and healthy controls. We found a vasale neuropathy and a high degree in dysregulating skin perfusion. The new innovative strategies are suited for describing microcirculation and controlling therapies.
High ligation of the saphenofemoral junction is necessary!
Authors: Hummel T. , Burger P. , Frings N. , Hartmann M. , Broermann M. , Schwahn-Schreiber C. , Stenger D. , Stücker M. , Mumme A. 
Published: March 2018

SummaryNeovascularisation can compromise the success of high ligation and resection of the greater saphenous vein. Studies using duplexultrasound to classify recurrent groin veins have described rates of neovascularisation as high as 60% and raised the question whether high ligation is actually able to prevent groin recurrences. In the present study, recurrent groin veins were excised and examined histologically in order to prove whether neovascularisation is the main cause for sapheno-femoral recurrences. Patients, methods: 419 patients accounting for 458 legs with clinically symptomatic groin recurrences were included in a country-wide multicenter study. The recurrent groin veins were excised in a standardized fashion and subsequently divided into the different types of recurrence based on histopathological criteria. Results: 427 specimen (93%) were available for histopathological examination. In 69 cases (16.2%) a neovascularisation was found to be the cause of recurrence. 311 specimen (72.8%) contained a long residual stump of the greater saphenous vein, out of which 32 (7.5%) showed additional neovascularisation at the site of the ligation. In 29 cases (6.8%) a venous side branch was found to be the recurrent groin vein. 11 specimen (2.6%) did not contain any evidence of venous material and in another 7 cases (1.6%) it was not possible to clearly identify the cause of recurrence during the histo pathological workup. Conclusion: The high rates of neovascularisation described in several duplex ultrasound studies could not be confirmed in our investigation. Recurrences seem to be mainly caused by a technically incorrect initial operation which leaves a long residual stump of the saphenous vein in place. Following a technically correct high ligation, clinically relevant recurrences appear to be rare. This finding underlines the necessity of a high ligation of the saphenous vein according to current guidelines.
Visual wound-assessment by population groups with different educational backgrounds
Authors: Körber A. , Cesko E. , Dissemond J. 
Published: March 2018

SummaryThe documentation of chronic wounds is presently carried out by a number of different occupational groups, partly with considerable differences in knowledge. Besides testing the quality of judgement, the aim of our clinical study was therefore also to test the reproducibility of the visual wound assessment by population groups with different educational backgrounds. Participants, material, methods: The subjects, belonging to population groups; experts, doctors, nursing services, hospital nursing staff and laities, were required to assess all relevant parameters of wound assessment at two different points in time. A newly developed digital, colorimetric wound documentation system was used as an objective reference. Results: The wound assessment was evaluated both intra-individually as well as inter-individually. A noticeably better quality of assessment of objective parameters, such as length, breadth, surface, wound stage and wound infection, was shown by the population groups with previous experience, both in the single and two phase analysis. The wound coating assessments of all population groups were equally inaccurate at both points in time. Conclusion: Consequently, it may be concluded that it is not possible to attain sufficient, reliable and adequate wound documentation without technical aids, for example a digital photo documentation. Especially the assessment of the wound surface and coating is of an insufficient standard, whether carried out at a specific point in time or in a sequence.