bluuebunny/crossref_metadata_2025_split huggingface dataset:
Upper ankle joint prostheses in haemophilia patients
Authors: Schott D. , Pagenstert G. , Pennekamp P. , Oldenburg J. , Wirtz D. C. , Seuser A. , Gravius S. , Berdel P. 
Published: March 2018

SummarySecondary arthrosis of the upper ankle joint (talocalcanean joint) is one of the most frequent forms of haemophilic arthropathy. It is a secondary form of arthrosis not only because of chronic synovitis and cartilage injury resulting from chronic recurrent intraarticular bleeds, but also due to the misalignment of the joint and abnormal joint stress. The consequences are manifest even in young patients and finally lead to subtalar joint ankylosis with the biomechanical disorder of foot drop (talipes equinus). In such clinical situations, implantation of a subtalar joint endoprosthesis is a viable alternative to arthrodesis. Case report:A man (age: 52 years), suffering from severe haemophilia A (residual FVIII activity < 1 %), no inhibitor formation. The patient has a history of several years of painful ankylosis of the right ankle joint and minor talipes equinus, and suffers from symptomatic talonavicular arthrosis. Open joint cleansing considerably improved mobility in the upper ankle joint and alleviated the pain in the talonavicular joint. However, the recovered mobility of the arthrotic upper ankle joint also activated the patient’s arthrosis, associated with severe pain. As there was no contraindication to upper ankle joint replacement, a cement-free prosthesis was implanted. Three months after surgery, the patient was mobile, with good foot rolling properties without orthopedic aids, and without pain in his upper joint ankle. Conclusion: In terms of biomechanics an upper ankle joint endoprosthesis is a superior alternative to arthrodesis in haemophilia patients. In order to minimize the complication rate, the treatment of haemophilia patients should be restricted to specially equipped interdisciplinary treatment centers with adequately trained and experienced surgeons as well as haemo -staseologists.
Screening for haemorrhagic disorders in paediatric patients by means of a questionnaire
Authors: Music I. , Novak M. , Acham-Roschitz B. , Muntean W. 
Published: March 2018

SummaryAim: In children, screening for haemorrhagic disorders is further complicated by the fact that infants and young children with mild disease in many cases most likely will not have a significant history of easy bruising or bleeding making the efficacy of a questionnaire even more questionable. Patients, methods: We compared the questionnaires of a group of 88 children in whom a haemorrhagic disorder was ruled out by rigorous laboratory investigation to a group of 38 children with mild von Willebrand disease (VWD). Questionnaires about child, mother and father were obtained prior to the laboratory diagnosis on the occasion of routine preoperative screening. Results: 23/38 children with mild VWD showed at least one positive question in the questionnaire, while 21/88 without laboratory signs showed at least one positive question. There was a trend to more specific symptoms in older children. Three or more positive questions were found only in VWD patients, but only in a few of the control group. The question about menstrual bleeding in mothers did not differ significantly. Sensitivity of the questionnaire for a hemostatic disorder was 0.60, while specifity was 0.76. The negative predictive value was 0.82, but the positive predictive value was only 0.52. Conclusions: Our small study shows, that a questionnaire yields good results to exclude a haemostatic disorder, but is not a sensitive tool to identify such a disorder.
Kompressionstherapie nach invasiven Maßnahmen in der Phlebologie
Authors: Nüllen H. , Noppeney T. 
Published: March 2018

ZusammenfassungDie Versorgung eines Patienten mit Kompressionsverbänden nach invasiver Therapie gehört in der Phlebologie zu den Standardprozeduren. In der aktuellen Leitlinie zur Therapie der Varikose wird die Kompression als Routinemaßnahme nach Varizenoperation empfohlen. Auch in der aktuellen Leitlinie zur Sklerotherapie wird die Kompressionstherapie nach Verödung von Besenreiservarizen zur Verbesserung der Ergebnisse empfohlen.Die diesen Empfehlungen zugrunde liegende Literatur besteht nur aus wenigen Stellen. Da-her wurde für die vorliegende Arbeit eine sys-temische Literaturrecherche in Medline und Pubmedcentral sowie in deutschsprachigen gefäßmedizinischen Journalen durchgeführt. Die Kompressionstherapie nach Varizenope-ration ist in der Lage postoperative Hämato-me und die Inzidenz einer Thrombophlebitis zu mindern, die Kompressionstherapie kann den postoperativen Schmerz verringern und sie reduziert das Beinvolumen postoperativ.Aus der Literatur geht nicht hervor, wie die op-timale Dauer der postoperativen Kompression ist. Nach endovenöser Therapie gibt es nur eine prospektiv randomisierte Studie nach endovenöser Lasertherapie die zeigen konnte, dass eine exzentrische Kompression den postoperativen Schmerz signifikant mindern kann. Zur Sklerotherapie von Besenreisern und retikulären Varizen liegen mehrere Studien vor, die zei-gen konnten, dass signifikant bessere Resultate erzielt werden können, wenn Kompressionstrümpfe nach Sklerotherapie getragen werden. Es finden sich ebenso deutlich geringere Pig-mentierungen und Hämatome. Die ideale Dauer der Kompression nach Sklerotherapie von Besenreisern und retikulären Varizen liegt wohl bei drei Wochen.
Kompressionstherapie – Theoretische Grundlagen
Authors: Noppeney T. , Nüllen H. 
Published: March 2018

ZusammenfassungDie einzig sinnvolle und effektive Therapie bei peripheren Ödemen ist die externe Kompressionstherapie. Die Kenntnis der wenigen physikalischen Gesetzmäßigkeiten, die bei der Kompressionstherapie gelten, ebenso wie die Kenntnis die Materialkunde der Kompressionsmittel sind zwingende Voraussetzung für den sachgemäßen und erfolgreichen Einsatz der physikalischen Therapie peripherer und fokaler Ödeme. Die physikalische Grundlage der Kompressionstherapie ist die Gleichung nach Laplace. Die Konsequenzen aus dieser Gleichung und die sich daraus abgrenzbaren unterschiedlichen Druckarten und Druckcharakteristiken sollen erläutert werden.
Lässt sich die Expression von EZM-Proteinen durch Kompression beeinflussen?
Authors: Brinckmann J. , Zillikens D. , Kahle B. , Gerdes O. 
Published: March 2018

ZusammenfassungHintergrund: In den fortgeschrittenen Stadien der chronischen venösen Insuffizienz (CVI) werden die Proteine Tenascin C, Fibrillin 2 und α-smooth muscle Actin (αSMA) vermehrt ex-primiert. Diese Proteine der Extrazellularmatrix werden im Rahmen der Wundheilung und in hypertrophen Narben verstärkt gebildet. Die pathologische Expression in hypertrophen Narben kann durch Kompression normalisiert werden.Fragestellung: Wird die Expression der Proteine Tenascin C, Fibrillin 2 und αSMA im Stadium C2 und C4 der CVI durch Kompression be-einflusst?Methode: Untersucht wurden 23 Patienten mit CVI (12 Stadium C2, 11 Stadium C4) ohne bisherige Kompressionstherapie. Sie erhielten für 2 bzw. 4 Wochen einen medizinischen Kompressionsstrumpf (Klasse II oder Klasse III). An Tag 1, 14 und 28 wurde jeweils eine Hautprobe am Innenknöchel entnommen.Ergebnisse: Im Stadium C2 liegt ein Expressionsmuster wie in normaler Haut vor. Im Stadium C4 variiert die Expression je nach kli-nischem Erscheinungsbild. Bei Dermatoliposklerose zeigt sich in der gesamten Dermis eine vermehrte Expression von Fibrillin 2 und Tenascin C. Bei Hyperpigmentierung oder Stauungsekzem zeigt sich in wenigen Fällen eine vermehrte Expression in der Tiefe bzw. entlang der Basalmembran. αSMA lässt sich nur in den Wänden der dermalen Gefäße darstellen. Die Kompressionstherapie bewirkt in dem Untersuchungszeitraum keine Änderung der Protein-expression.Schlussfolgerung: Fibrillin 2 und Tenascin C zei-gen sich erst im Falle einer bestehenden Sklerose. Ein potenzieller Einfluss von Kompression auf die Expression dieser Parameter muss in weiteren Studien untersucht werden.
Frequency and exact position of valves in the saphenofemoral junction
Authors: Morandini L. , Brenner E. , Mühlberger D. 
Published: March 2018

Summary
Background: Varicose veins are common. As venous valves are included in the pathological development of varices they have been studied by many authors. Nonetheless, the exact position of valves is unclear. Material and method: The exact position of the valves in the greater saphenous vein was studied macroscopically from the saphenofemoral junction up to 25 cm distally in situ on 72 cadavers with a total of 140 veins. Results: A terminal valve existed in 88.5% in the range of 0 to 1.4 cm and a preterminal valve was present in 89.2% in the range of 1.4 cm to 8.2 cm distally to the saphenofemoral junction. In about a fifth of the cases a third valve could be identified. Conclusion: Our results suggest, that the recent general agreement that there are always a terminal and a preterminal valve has to be negated.
Venoneuronale De- und Regeneration bei Varikogenese und Neovaskularisation
Authors: Noppeney T. , Winkler M. , Nüllen H. , Duczek C. , Meyer A.-J. , Gruber A. , Grobholz R. , Willeke F. , Rewerk S. 
Published: March 2018

Zusammenfassung
Ziel: Der Ausschluss von Neovaskulaten via S100-Protein ist ungenau. Geklärt werden sollte, ob NGF (nerve growth factor) valider ist, zumal eine angiogenetische Potenz besteht. Methode: Nervenfaserfärbung gesunder (n = 16), variköser (n = 110) und von Rezidivvenen der Krosse (n = 24) mit S100- und NGF-Antikörpern (AK). Semiquantitative Evaluation der jeweiligen Nervenfaserdichte, Quotientenbildung zur Darstellung der Unterschiede. Zusätzlich Evaluation des prozentualen Anteils gefärbter Präparate. Ergebnisse: In allen Gruppen Nachweisbarkeit adventitieller Nervenfasern mit beiden AK. In Kontroll- und Varikosisgruppe war die NGF-Faserdichte kleiner als bei S100. Bei Rezidiven erreichte die NGF-Faserdichte Werte wie bei S100. Gegensätzlich zur NGF-Faserdichte sind S100-Werte bei Rezidiven kleiner, als bei S100-Kontrollen. Geringste Faserdichte für beide Proteine in der Varikosisgruppe. S100-Rezidive hatten den geringsten Anteil anfärbbarer Fasern. Schlussfolgerung: NGF könnte die venoneuronale Regeneration triggern und als Marker spezifischer als S100 sein. Die Varikogenese könnte durch eine reduzierte Venenwandinnervation (venoneuronale Degeneration) induziert werden.
Werkzeuge für die optimale Dosierung von Phenprocoumon
Authors: Miller Th. , Walther-Berthold St. , Berthold W. 
Published: March 2018

ZusammenfassungBasierend auf der Erkenntnis, dass die INR-Werte (relative Prothrombinzeiten) exponentiell mit der Wirkkonzentration des Antikoagulans zusammenhängen, wurden für die optimale Dosierung von Phenprocoumon folgende Werkzeuge für die tägliche Praxis entwickelt: Ein einfacher (patentrechtlich geschützter) Dosisrechner in Form eines Rechenschiebers nach dem Prinzip einer Abtastregelung, eine Dokumentationshilfe in Form einer Tabelle mit Gebrauchsanweisung für die Ersteinstellung und Dosisanpassung, ein Funktionspapier zur Ermittlung der Zeitspanne, um die das Medikament vor einem geplanten chirurgischen Eingriff abgesetzt werden muss.Der echte Nutzen dieser Hilfsmittel muss sich jedoch erst in der Praxis beweisen. Immerhin erlaubt das technisch einfache Verfahren dem Anwender, es ohne großen Aufwand mit seinem üblichen Vorgehen bei der Antikoagulation zu vergleichen.
The treatment of venous leg ulcers with a specifically designed compression stocking kit
Authors: Mattaliano V. , Mosti G. , Gasbarro V. , Bucalossi M. , Blättler W. , Amsler F. , Mancini St. , Mariani F. 
Published: March 2018

SummaryTraditionally, venous leg ulcers are treated with firm nonelastic bandages. Medical compression stockings are not the first choice although comparative studies found them equally effective or superior to bandages. Patients, methods: We report on a multi-center randomized trial with 60 patients treated with either short stretch multi-layer bandages or a two-stocking system (Sigvaris® Ulcer X® kit). Three patients have been excluded because their ankle movement was restricted to the extent that they could not put on the stockings and 1 patient withdrew consent. Patient characteristics and ulcer features were evenly distributed. The proportion of ulcers healed within 4 months and the time to completion of healing were recorded. Subjective appraisal was assessed with a validated questionnaire. Results: Complete wound closure was achieved in 70.0% (21 of 30) with bandages and in 96.2% (25 of 26) with the ulcer X kit (p = 0.011). Ulcers with a diameter of up to about 4cm healed twice as rapidly, the larger ones as fast with the stocking kit as with bandages. The sum of problems encountered with bandages was significantly greater than that observed with the stocking kit (p < 0.0001). Pain at night and in the morning was absent with stockings but reported by 40% and 20% in the bandage group, respectively. The cardinal features associated with delayed or absent healing were ulcer size and pain. Conclusions: Common venous ulcers can readily be treated with the ulcer X compression kit provided the ankle movement allow its painless donning. Bandages, even when applied by the most experienced staff are less effective and cause more problems.
Histology of a varicose great saphenous vein treated with RFITT
Authors: Popp A. , Lahl W. , Sell M. , Zierau U. Th. 
Published: March 2018

SummaryEndovenous bipolar RFITT (RadioFrequency-Induced ThermoTherapy) is a new approach for the treatment of varicose veins. RFITT provokes a thermal effect on the vein wall due to bipolar energy delivery. An alternating high frequency current creates heat in the vessel enabling a controlled tissue shrinkage. Results: Histological examination showed circular dissection of the intima with intramural bleedings and beginning condensation of fibrin thrombus because of the destroyment of erythrocyte cells. Perforation or carbonisation of the vein wall was not be detected. Conclusion: The histological and duplex sonographic pictures of veins after RFITT are comparable to those seen after the application of other endovenous procedures.
Actual procedures of diagnostics and treatments of crural venous ulcer in specialized German praxis and clinics
Authors: Altmeyer P. , Stücker M. , Reich-Schupke S. 
Published: March 2018

Summary
Background: To evaluate the implementation of the guidelines of the German Society of Phlebology for venous crural ulcer a survey was conducted during the annual meeting of the German Society of Phlebology 2008 in Bochum. Methods: All 719 medical participants got an anonymized questionnaire asking for supply of crural ulcer in their institution. Results: The recurrent 66 questionnaires (9.2%) were filled by colleagues from practice or hospital, mostly surgeons, dermatologists, phlebologists and vascular surgeons. As basic diagnostics vein doppler (56.1%), duplex (75.8%) or measurement of brachial-ankleindex (83.3%) were performed. Compression therapy is used in all institutions. Mainly used wound dressings are polyurethane foam dressings, alginates, hydrocolloids and silver dressings. About 2/3 conduct surgical therapy of ulcers. Conclusion: Supply of ulcus cruris by the participants of the annual meeting of the DGP corresponds mainly, but not in all aspects to the guidelines. Further efforts for a spread of the guidelines are necessary.
Causes and the way of treatment of patients with chronic leg ulcers
Authors: Wax C. , Körber A. , Dissemond J. , Klode J. 
Published: March 2018

SummaryChronic leg ulcer may have various causes, which are currently not centrally recorded in Germany. It is also unclear who treats patients with chronic leg ulcers in Germany and how the basic implementation of diagnosis and treatment of these patients looks like. Patients, methods: Therefore, we started a survey of 1000 general practitioners and practising specialists in dermatology, surgery and phlebology in five different regions of Germany. We carried out the genesis of a total of 6275 patients from 62 different practising therapists, 33 specialists in dermatology, surgery or phlebology and 29 general practitioners. Results: In 66.1% of all patients we found a venous leg ulcer, in 9.1% a leg ulcer from peripheral arterial occlusive disease, and in 8.5% a mixture of both. Thus there suffered a total of 83.8% of patients on chronic venous insufficiency or peripheral arterial occlusive disease as a major factor in the genesis of the chronic leg ulcer. However, even the rarely diagnosed entities such as exogenous factors, vasculitis, pyoderma gangrenosum or infectious diseases are occur in summation in 16.2% of all patients and should therefore be known and excluded. In addition, the treatment periods and referral routes of patients with chronic leg ulcer should be identified. The analysis showed that the vast majority (86.8%) of patients with chronic ulcers who were investigated by us is treated by specialists. The treatment duration of general practitioners is 6.3 weeks (mean value) before the patient will be referred to a specialist. This treatment period is significantly shorter compared to the treatment period of the specialists, who treat their patients 14.1 weeks (mean value) before the patient will be referred to another specialist or to a clinic. Conclusion: Our results show the current aspects of aetiology and the way of treatment of patients with chronic leg ulcers in Germany.
Microangioarchitecture of haemorrhoids
Authors: Engelhardt V. , Böhler U. , Wienert V. , Lametschwandtner A. 
Published: March 2018

SummaryHaemorrhoids are normal physiological structures (vascular cushions), which lead to haemorrhoidal disease when they enlarge pathologically. These vascular cushions are located in the submucosa of the lower rectum and are an important part of the continence organ. The cushions contain enormously dilatable veins which, when filled, enable a gas- and water-tight closure of the anal canal. As vascular cushions require rapid filling and haemorrhoid-associated anorectal bleeding is bright red, it is suggested that dilated veins are filled with arterial blood delivered via arteriovenous (AV) anastomoses. To specify blood supply and microvascular anatomy of the anorectum we analyzed vascular corrosion casts of human recta made from excised post mortem specimens. We found wide dilated veins and venules in the submucosa. Dilatations were often associated with sphincters capable to block venous outflow. Though careful analyses of completely filled vascular corrosion casts we could not confirm the existence of large AV-anastomoses in the anorectum postulated by previous authors. Conclusion: From our findings we conclude that the swelling of the dilatable veins is rather the result of blockage of venous outflow from these veins by the sphincters found than their filling via arteriovenous anastomoses as proposed sofar.
Duplex sonography phlebologically accentuated
Authors: Marshall M. 
Published: March 2018

SummaryWithout any doubt colour duplex sonography was an enormous progress in angiological and/or phlebological diagnostics. Starting with the directional Doppler sonography, the large spectrum of phlebological diagnostics by colour duplex sonography is presented. Colour duplex sonography is used for a) the fundamental, morphologically and haemodynamically based diagnostics of deep vein thrombosis, of the insufficiency of subfascial and epifascial veins and for differential diagnostic delimitations (of arterial disorders, lip- and lymphedema, Baker-cysts, haematomas and so on), b) intrainterventional controls (steering of endovenous catheters and of foam sclerotherapy), c) the postinterventional assessment of results and disease course (definitively successful elimination of refluxes, relapses, complications as deep vein thrombosis and so on). Finally, the optimal position of the patient for duplex examination – supine or standing – is discussed, and methodical developments of the angiologic-phlebological diagnostics with ultrasound devices are described. Conclusion: In many cases duplexsonography avoids invasive examinations. It is part of the obligatory medical education in the field of phlebology.
Surgery of ulcus cruris venosum
Authors: Schwahn-Schreiber C. 
Published: March 2018

SummaryAdvanced chronic venous stasis syndrome is characterized by irreversible and self-perpetuating morphological alterations in the lower leg. A chronic inflammatory process results in sclerosis, which progresses from the skin to the subcutaneous tissue and ultimately the fascia, sometimes including muscle and ankle joint and leading to chronic compartment syndrome. To cure these severe alterations with non healing ulcers decompression of the compartments like paratibial fasciotomy with SEPS and crural fasciectomy or removal of sclerosis like shave therapy are successful surgical procedures. Indication should be adapted to the extension of ulcer. Indications of the operations and the techniques are described, complications and results are discussed. Due to ulcer extension especially shave therapy (removal of the sclerotic tissue epifascial) and crural fasciectomy (removal of sclerosis including fascia) are very successful with up to 80% healing rate, even in severe cases and even after long term (up to 8 years). Since shave therapy is easy, short and simple with short healing time, few complications and good aesthetical result it is the first choice of treatment for non healing leg ulcers. Fasci ectomy is reserved for special indications such as deep transfascial necrosis or failure of shave therapy.
The therapeutic impact of 18F-FDG whole body PET
Authors: Dietl B. , Marienhagen J. 
Published: March 2018

Summary
Aims: An explorative analysis of the diagnostic as well as therapeutic impact of 18F-FDG whole body PET on patients with various tumours in the setting of an university hospital radiation therapy was performed. Patients and methods: 222 FDG PET investigations (148 initial stagings, 74 restagings) in 176 patients with diverse tumour entities (37 lung carcinoma, 15 gastrointestinal tumours, 38 head and neck cancer, 30 lymphoma, 37 breast cancer, 19 sarcoma and 16 other carcinomas) were done. All PET scans were evaluated in an interdisciplinary approach and consecutively confirmed by other imaging modalities or biopsy. Unconfirmed PET findings were ignored. Proportions of verified PET findings, additional diagnostic information (diagnostic impact) and changes of the therapeutic concept intended and documented before PET with special emphasis on radiooncological decisions (therapeutic impact) were analysed. Results: 195/222 (88%) FDG-PET findings were verified, 104/222 (47%) FDG-PET scans yielded additional diagnostic information (38 distant, 30 additional metastasis, 11 local recurrencies, 10 primary tumours and 15 residual tumours after chemoptherapy). The results of 75/222 (34%) scans induced changes in cancer therapy and those of 58/222 (26%) scans induced modifications of radiotherapeutic treatment plan (esp. target volumes). Conclusion: 18F-FDG whole body PET is a valuable diagnostic tool for therapy planning in radiooncology with a high impact on therapeutic decisions in initial staging as well as in restaging. Especially in a curative setting it should be used for definition of target volumes.