[Morphological and hemodynamic indicators of early arteriosclerosis].
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Aged↗
Biomedical subjects
B Frauchiger
Publications and source records attributed to B Frauchiger.
[Conservative treatment of acute embolisms of the carotid bifurcation].
Embolic events of the carotid bifurcatin are a rare cause of cerebrovascular accidents. We observed two patients who showed a spontaneous recanalisation of an embolic occlusion of the extracranial vessels when treated with conservative procedure using heparin. Both patients had a near complete remission of the symptoms without impairment in their daily activities.
Acute Disease↗
Comparison of carotid arterial resistive indices with intima-media thickness as sonographic markers of atherosclerosis.
UNLABELLED: Background and Purpose-The intima-media thickness (IMT) of the carotid artery is a (morphological) sonographic parameter that depends on the degree of atherosclerosis. In the renal arteries, the value of the (hemodynamic) resistive index (RI) is correlated with the severity of atherosclerosis. In contrast to the well-known IMT, no study has yet applied the carotid RI to estimate generalized atherosclerosis. METHODS: -The SMART atherosclerosis risk score was determined in 157 patients (94 men and 63 women; mean age 63 [range 19 to 80] years) with at least 1 vascular risk factor or a known vascular disease. Duplex sonography of the common carotid (CCA) and internal carotid artery (ICA) was then performed, with determination of IMT and RI. RESULTS: -The mean risk score of all patients was 8.8+/-3.5 (range 1 to 17), the mean IMT value in the CCA was 0.727+/-0.161 mm, the mean RI in CCA was 0.79+/-0.066, and the mean RI in ICA was 0.661+/-0.082. Highly significant correlations were found between the score and IMT CCA and the score and RI ICA (r=0.62, P:<0.0001 and r=0.55, P:<0.0001). The score-RI CCA correlation was much less marked (r=0.354, P:<0.0001). The intraobserver and interobserver agreement was less for IMT than for RI CCA and ICA. The areas under the curve of the receiver operating curves to distinguish between low-risk and high-risk patients resulted in values of 0.86, 0.81, and 0.69 for IMT, RI ICA, and RI CCA, respectively. CONCLUSIONS: -Although RI reflects the atherosclerotic process in an indirect manner, the correlation between the RI ICA and the SMART atherosclerosis score as well as the ability to distinguish between low- and high-risk patients are comparable to those of the well-known IMT.
Adult↗
[Tick-borne meningoencephalitis in Thurgau Canton: a clinical and epidiomological analysis].
BACKGROUND: Tick-borne meningo-encephalitis (TBE) is caused by a flavivirus species that is transmitted from rodents to humans by Ixodes ticks. The clinical picture of central nervous system involvement varies from febrile headache to lethal encephalitis. To date no specific treatment exists, although protective active immunisation is available. METHODS: We present the clinical and epidemiological data from 73 patients with TBE who acquired the infection in Canton Thurgau in the years 1996-1999. RESULTS: Canton Thurgau is a state in eastern Switzerland with a population of 230,000. Within the last five years the reported cases of TBE have increased more than threefold. The area where infectious tick bites were registered has expanded from the western to the eastern part and now encompasses the entire state. The risk of infection is clearly related to frequent activities in wooded areas, though outdoor activities not in forests also carry a considerable risk. In > 80% of the cases a postviral neurasthenic syndrome develops involving absence from work for two months on average. In the elderly and patients who present with encephalitic symptoms, a worse outcome with persistent neurological symptoms or even death has been observed. CONCLUSION: The increasing incidence of TBE, the expansion of infectious ticks to the east and high morbidity justify active immunisation against TBE on a broad scale in Canton Thurgau.
Adolescent↗
Optimising the use of carotid duplex sonography.
AIM: We analysed factors influencing diagnostic yield and treatment and their potential for optimising the use of carotid duplex sonography (CDS). METHOD: Patients referred for CDS were divided into three groups: 1: high likelihood of carotid symptoms, 2: suspected presence of asymptomatic carotid lesions, 3: other indications. Clinical data, the grading of stenosis and the therapeutic consequences were analysed. The efficiency of diagnosis was tested with an algorithm. RESULTS: 344 patients were included. Groups 1, 2 and 3 contained > or = 1 pathological finding in the carotid or vertebral system in 68%, 86% and 55% respectively, whereas high-grade stenoses or occlusions of the internal carotid artery (ICA) were detected in 10.8%, 16% and 3.6% respectively. Age > 50, > 1 risk factor, carotid murmur and concomitant vascular disease were associated with a significantly higher diagnostic yield. Subsequent treatment in groups 1, 2 and 3 involved carotid thromboendarterectomy in 6.4%, 2% and 0.7% respectively and the start of treatment with a platelet aggregation inhibitor in 9%, 30% and 17% respectively. The optimisation algorithm would have saved 21% of CDS scans. CONCLUSION: Clinical pre-selection criteria determine the diagnostic yield of CDS. The potential for optimisation depends on the treatment regimen chosen for asymptomatic stenoses and secondary prophylaxis.
Age Factors↗
Duplex sonographic registration of age and diabetes-related loss of renal vasodilatory response to nitroglycerine.
BACKGROUND: Nitroglycerine effects dilatation of the vas afferens in the kidney by its active metabolite nitric oxide (NO). In diabetic nephropathy, NO appears to cause hyperfiltration and proteinuria. The aim of this study was to investigate the potential of duplex Doppler ultrasonography in recording changes in resistive indices following nitroglycerine and whether the extent of changes in diabetic nephropathy is reduced as a result of the arteriolar dilatation mediated by NO. METHODS: Fifty-three subjects made up three groups: group 1, 12 young healthy volunteers (5 male, 7 female, 28+/-6 years); group 2, 21 older healthy volunteers (7 male, 14 female, 62+/-8 years); group 3, 20 patients (13 male, 7 female, 56+/-18 years) with mild diabetic nephropathy. The resistive index (RI) was measured in the interlobar arteries before, and 1, 3 and 5 min after administration of 0.8 mg sublingual nitroglycerine. RESULTS: The initial RI of 0.592 decreased in group 1 by 10.8% (P<0. 01) after nitroglycerine, in group 2 the initial figure of 0.631 decreased by 5.9% (P<0.01), and in group 3 the initial figure of 0. 669 decreased by 3.4% (P<0.01). Initial RI values differed significantly between groups 1 and 3 (P<0.01) and groups 1 and 2 (P<0.01), as did values between all healthy volunteers (groups 1 and 2, n=33) and patients with nephropathy (P<0.005). The extent of DeltaRI differed significantly between groups 1 and 3 (P<0.01), 1 and 2 (P<0.02), and between all volunteers and group 3 (P<0.003). In groups 1 and 2 the initial RI was dependent on age (P<0.03), in group 3 on age and creatinine clearance (P<0.02 and P<0.05 respectively). DeltaRI correlated with age in the healthy subjects (P<0.01) and with duration of diabetes in diabetic nephropathy (P0. 03). CONCLUSIONS: Haemodynamic changes in renal perfusion caused by nitroglycerine can be detected using duplex ultrasonography. In healthy subjects, DeltaRI declines with increasing age. In diabetic nephropathy patients, the response to nitroglycerine is reduced. The increased initial RI in such patients suggests fixed arteriolar damage.
Adult↗
Assessment of collateral perfusion: a pharmacodynamic study with buflomedil hydrochloride.
The aim of the study was to assess the influence of Buflomedil hydrochloride on collateral function. Ten patients with isolated superficial femoral occlusions were investigated twice by duplex sonography with measurement sites at the common femoral artery (CF) and the popliteal artery (PA). After the second scan 200 mg of Buflomedil hydrochloride were infused; the infusion was followed by a third duplex examination. Endpoints assessed included the arterial diameter (D(CF), D(PA)), the systolic peak velocity (Vmax), the mean velocity of the maximum envelope (Vmean m.e.), the intensity weighted time average mean velocity (Vmean i.w.), the maximum reverse flow velocity (Vrev), the end-diastolic velocity (Venddiast), the calculated volume flow (Q), the pulsatility and the resistance indices (PI, RI), and PI and RI based segmental damping factors (DF(PI), DF(RI)). For the CF measurement site the infusion of Buflomedil hydrochloride resulted in a significant reduction in Vrev and PI (p<0.05), whereas trends in the opposite direction (increase) were observed for both measures of Vmean and for Q (0.1<p<0.05). No significant changes were reported for the PA measurement site. DF(PI) numerically decreased (0.1<p<0.05). The pattern of changes suggest that Buflomedil hydrochloride induces collateral vasodilation and thus improves collateral function.
Adult↗
Hyperventilation due to mitochondrial myopathy.
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Adult↗
[Thoracic pain and bloody diarrhea].
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Aged↗
[Headache, general malaise and left-side ptosis].
A 82-year-old female was admitted to hospital because of deteriorated general condition, severe diffuse headache and complete left-sided ptosis. A computed tomography scan of the head revealed no subarachnoid haemorrhage. Based on the hypothesis that the symptoms resulted from an infarction in the brain stem, the previous medication with Aspirin was continued. After repeated vomitus hypotensive dehydration developed and was adequately treated. Because of confusion, elevated white blood counts and signs of meningism, a spinal puncture was performed. Only the serology for Borrelia-IgG was positive, therefore the patient received Rocephin. During treatment only the ptosis persisted, therefore the substitution with sodium and the medication with Prednisone were stopped. Afterwards the symptoms reappeared and the laboratory results showed insufficiency of the pituitary. A magnetic resonance scan showed a microadenoma of the pituitary with local bleeding. Nine months after pituitary apoplexy, with hormonal substitution only a divergent strabism on the left side persisted. Clinical findings, course and therapy of pituitary apoplexy are discussed.
Aged↗
[Therapy-resistant lumbago].
The 71-year-old female patient was hospitalized owing to a therapy-resistant lumbo-spondylogenic syndrome. Radiology with increased infection parameters gave rise to the suspicion of a bacterial spondylodiscitis L1/L2. Puncture of the vertebral body as well as blood cultures established proof of yersinia enterocolitica. In spite of immediate adequate antibiosis, by means of "Ciprofloxacin" i.v. spondylodesis of the lumbar spine had to be carried out in order meet the threat of instability. Spondylodiscitis is an extremely rare manifestation of a yersinia infection, only few cases have been described so far in medical literature.
Aged↗
[Development of early-summer meningoencephalitis (FSME) in the Thurgau region 1990-1995--a new endemic area?].
Tick-borne encephalitis (TBE) is a viral infection transmitted by bites of infected ticks. The clinical course is mostly mild, but death occurs in 1-2% of TBE infections and nearly half of patients with meningitis/meningoencephalitis show residual disease, above all chronic headache. TBE-infected ticks occur only in endemic areas. A knowledge of the endemic areas is very important for immunoprophylaxis of TBE. In recent years between 26 and 97 cases of TBE have occurred in Switzerland. The largest endemic areas are in Canton Schaffhausen, the northern part of Canton Zurich and the north-west of Canton Thurgau. Another endemic area is known in the region of Thun in Canton Berne. Another possible endemic area is known in the Zurich Oberland around Elgg, only 7 km from Aadorf in Thurgau. Up to now, Diessenhofen in the north-west of Thurgau was the only known possible endemic area. In 1994 and 1995 we observed an accumulation of TBE infections in western Thurgau. The question was whether there are other endemic areas in Thurgau. In this retrospective analysis we studied the TBE cases in Thurgau between 1990 and 1995 with data derived from the cantonal health authorities reports. Clinical data were taken from case histories of the two cantonal hospitals in Frauenfeld and Münsterlingen, completed by data from family doctors and patients. Between 1990 and 1995 30 TBE infections (1990; 1, 1991: 4, 1992: 3, 1993: 1, 1994: 4 certain, 3 uncertain, 1995: 14) were observed. TBE infections appeared between May and October (maximum in May). 14 patients remembered a bite by a tick several weeks before onset of the illness. 7 bites occurred in the area of Frauenfeld/Aadorf. Only one bite occurred in Diessenhofen. 2 patients were infected in well-known endemic areas in Canton Zurich, a vicinal region in the west of Thurgau. In 1995 the incidence of TBE in Thurgau was 5.4/100000 population. In 9 of the 14 patients recalling a bite by a tick (64.4%), the bites occurred near their domicile. No bite was seen east of a line between Steckborn and Weinfelden. The incidence of TBE in Thurgau in 1995 was clearly higher than the average in Switzerland in recent years (0.46/100000), and higher than in the well-known endemic areas in the vicinity (Schaffhausen 3.95, Zurich 1.31). Based on our data, the region Frauenfeld/Aadorf must be declared a new endemic area for TBE. Probably the well-known endemic area in the Zurich Oberland in the vicinity of Elgg has spread eastward. Persons who are often in the forests of this region should be advised to be vaccinated.
Encephalitis, Tick-Borne↗
Prognostic significance of intrarenal resistance indices in patients with renal artery interventions: a preliminary duplex sonographic study.
No non-invasive test can predict the clinical outcome of renal revascularization procedures. Because duplex sonographic measurements of intrarenal flow patterns reflect the resistance to flow within the kidney, the prognostic value of the cortical end-diastolic to peak systolic (d/s) velocity ratio was investigated in patients undergoing intervention for renal artery stenosis. The clinical and duplex sonographic data on 32 patients with 35 interventions (30 percutaneous transluminal angioplasties and five operations) on 42 renal artery sides were analysed. Twenty-three patients had atherosclerotic renal artery stenosis and nine patients had fibromuscular dysplasia resulting in > or = 60% renal artery stenosis. Measurements of the renal to aortic velocity ratio and cortical d/s ratio were performed before and after intervention. In the atherosclerotic patients, three interventions were clinically and technically successful, eight were technically successful but clinical failures, and 14 were clinically and technically unsuccessful. In the fibromuscular dysplasia patients, eight interventions were clinically and technically successful, and two were clinically and technically unsuccessful. The difference between the corresponding d/s ratios for atherosclerotic and fibromuscular dysplasia sides was significant on both the treated and not-treated sides (P < 0.02, two-tailed unpaired t-test). None of the 11 clinically successful procedures had a d/s ratio below 0.3, compared with seven values below 0.3 in the 24 clinically unsuccessful interventions (P = 0.05, one-tailed Fisher's exact test). It is concluded that: (1), a d/s ratio below 0.3 correlates with clinical failure in subsequent treatment of hypertension by renal revascularization, while a value above 0.3 has no prognostic significance; (2), despite technical success, not all atherosclerotic patients have clinical success from renal artery interventions; (3), in fibromuscular dysplasia patients, all clinical failures of renal artery interventions are associated with technical failures; and (4), the difference in d/s ratio between atherosclerotic and fibromuscular dysplasia patients may be a consequence of the more advanced age, longer duration of hypertension and additional risk factors in atherosclerotic patients.
Adult↗
The value of different resistance parameters in distinguishing biopsy-proved dysfunction of renal allografts.
The data concerning the value of duplex sonography in diagnosing parenchymatous renal allograft dysfunction are controversial. Most early studies did not take into consideration the many factors influencing resistance parameters. We therefore performed a prospective, biopsy-controlled study with exclusion of all known sources of error regarding resistance parameters. Furthermore we investigated the value of a new resistance parameter, the systolic deceleration percentage. Forty-seven duplex sonographic studies were performed on 43 patients (30 male, 13 female, median age 47 years, range 7-70). Fourteen studies were done on normally functioning grafts (control group) an average of 33 days after transplantation. Thirty-three studies were performed on dysfunctional grafts immediately prior to biopsy. Grafts which had been transplanted more than a year previously or with vascular findings or any other clinical or sonographic pathology probably explaining function deterioration were excluded. In all patients, the resistive index (RI), pulsatility index (PI) and systolic deceleration percentage (DP) were calculated in the main renal artery and in the interlobar artery. Of the 33 grafts with dysfunction, nine had vascular rejection (VR), 11 interstitial rejection (IR), 11 cyclosporin A toxicity (CAT) and two other histologies (OR). The mean RI in normal grafts (NO) was 0.71 +/- 0.06 in the main artery and 0.68 +/- 0.06 in the interlobar artery, in VR 0.86 +/- 0.12 and 0.80 +/- 0.18, in IR 0.72 +/- 0.05 and 0.70 +/- 0.07, in CAT 0.67 +/- 0.06 and 0.65 +/- 0.07 and in OR 0.64 +/- 0.07 and 0.60 +/- 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Current trends in the treatment of deep venous thrombosis].
The therapeutic procedure in established deep venous thrombosis (DVT) is summarized. Proximal (2 to 4 levels), symptomatic, recent DVT of less than three weeks duration is still treated in the clinic. The patient receives heparin intravenously, 5000 IU as initial bolus and subsequently 25,000-30,000 IU (approximately 400 IU per kilo bodyweight)/24 hours as continuous infusion or, in particular cases, 15,000 to 20,000 IU subcutaneously two times in 24 hours). Oral anticoagulation is started on the 1st day. Mobilisation takes place when symptoms regress, usually after 2-3 days. If further studies with low molecular weight heparins (LMH) confirm the good efficacy and tolerance, these compounds could replace heparin-schemes by a single daily subcutaneous injection. Also admitted to the hospital institution are patients with DVT and suspicion of pulmonary embolism and patients in whom fibrinolysis or thrombectomy are considered. The less expensive induction of anticoagulation on an outpatient basis and the subsequent follow-up treatment is in our opinion justified in patients with distal DVT (1-2 levels), older proximal DVT (and superficial venous thrombosis reaching the deep vein) and in patients with a thrombosed subclavian vein.) These patients are mobilized immediately under 12,500 to 15,000 IU heparin b.i.d. administered subcutaneously or alternatively injection of LMH's s.c. once per day (200 anti Xa-units/kg), changing over rapidly to p.o. vitamin K antagonists. For ambulatory patients LMH's may replace heparin for a single daily application if further studies confirm efficacy, this for mostly practical reasons. Long term anticoagulation by LMH could be ideal as for instance in pregnant patients.
Anticoagulants↗
[Normal kidney function of the transplanted kidney in ipsilateral pelvic artery occlusion 15 years after transplantation. A case report].
A case of a 61-year-old women 15 years after right-sided renal transplantation is discussed. She suffered from rest pain in her right leg. Examinations revealed an occlusion of the right common iliac artery without signs of renal dysfunction or severe hypertension. After performing a extraanatomic femoro-femoral crossover bypass the patient had improved leg perfusion without a change in renal function.
Angiography↗
[The incidence of post-thrombotic syndrome].
To evaluate the clinical and socio-economic importance of the postthrombotic syndrome (PTS), the following epidemiologic parameters are to be known: The incidence of deep vein thrombosis (DVT) in the population, the incidence of PTS after DVT, the prevalence of the PTS, the socio-medical consequences and the mortality. The DVT-incidence in the literature is about 3/1000 per year in the adult population. In our own follow-up study we found a global PTS-incidence of 40% (10% with, 30% without ulcer) 13 years after DVT. The PTS-incidence was correlated with the initial DTV-extent. The risk of PTS after 3- and 4-level DVT is significantly reduced by a successful fibrinolysis in the acute stage (p = 0.01). The mortality of patients with PTS is 3 times higher than in the population. 4% of the patients with PTS get disabled. To our knowledge an adequate study with direct assessment of the PTS-prevalence does not exist, but the PTS-prevalence can be deduced from large epidemiologic studies, such as the Basel-Study, in which the global chronic venous insufficiency is assessed. It amounts in the adult population between 0.5 to 1% for the PTS with and 3 to 5% for the PTS without ulcer.
Adult↗
[Clinical aspects and diagnosis of arterial embolism of the upper extremity].
The upper limb embolus is rarely encountered (upper limb:lower limb emboli 1:4-5). Our problem was to determine in which way the paraclinical investigations influence the operation indication. In 1992, we have seen 10 consecutive patients with an upper limb embolus. The characteristics of our patient group are the advanced age and the cardiovascular morbidity. It was always possible to diagnose the emboli clinically. 7 duplex, 6 Dopplers and 2 angiographies were performed and have confirmed the clinical diagnosis and the clinically suspected localisation of the emboli. All the patients were operated in local anesthesy. An embolectomy with Fogarty catheter was done. After the operation, all our patients were asymptomatic. No amputation was done. We do think that when the clinic is clear enough to diagnose an embolus, no other investigations are necessary to the operation indication.
Aged↗