[Arterial occlusions following therapeutic radiation therapy].
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Adult↗
Biomedical subjects
E Pilger
Publications and source records attributed to E Pilger.
[Laser angioplasty of peripheral arterial occlusions. Experimental and clinical results].
The first in-vivo trials were carried out on arteries of the extremities which have a straight course and short segmental occlusions. Initial experience indicates that obstructions up to 20 cm in length can be overcome by burning through plaques and thrombotic material by means of a neodymium-YAG-laser and then recanalised. By using a 2.2 mm spherical sapphire, one obtains a channel of 2.5 mm diameter through the obstruction. Subsequently dilatation with a balloon catheter is necessary. Laser angioplasty does not complicate the procedure significantly as far as the patient is concerned, since both the laser catheter and the balloon can be introduced through the same No. 7 F introducer into the femoral artery. Peripheral emboli could not be demonstrated angiographically, nor were they clinically manifest. On the basis of present experience, it seems that recanalisation of occlusions in arteries in the extremities, using a neodymium-YAG-laser focused by a synthetic sapphire, is a feasible alternative to conventional mechanical recanalisation.
Arterial Occlusive Diseases↗
[Laser angioplasty: experimental principles].
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Arteriosclerosis↗
Intraarterial fibrinolysis: long-term results.
Intraarterial fibrinolytic therapy was performed in 136 patients suffering from arteriosclerotic thrombosis of the iliac and femoropopliteal arteries. The initial success rate was 78%. Despite anticoagulation therapy, early recurrent thrombosis was observed in 10% of the patients. The 2-year cumulative patency rate after recanalization was 81%. These results are competitive with those of reconstructive vascular surgery. Therefore, intraarterial fibrinolysis has become a viable alternative to surgery in treating segmental peripheral occlusions more than 4 cm in length that are less than 6-9 months in duration.
Adult↗
Intraarterial fibrinolysis: in vitro and prospective clinical evaluation of three thrombolytic agents.
In order to investigate and compare the fibrinolytic activity of streptokinase, streptokinase-Glutamine-plasminogen, and urokinase for intraarterial fibrinolysis, as in vitro test and a prospective trial were performed. For the in vitro demonstration of lytic activity, fibrin plates with plasminogen and fibrin plates without plasminogen were incubated with streptokinase; with streptokinase-plasminogen in molar proportions of 1:1, 1:2, and 2:1, and with urokinase. In order to examine the in vivo activity of the different lytic solutions, 98 patients suffering from peripheral arterial occlusions were divided into three homogeneous groups for treatment with streptokinase, streptokinase-plasminogen, and urokinase. Although urokinase was superior to streptokinase on the fibrin plate with plasminogen, no difference was demonstrated in vivo between the two lytic agents. Streptokinase-plasminogen in a molar proportion of 1:2 showed significantly higher fibrinolytic activity than any other solution. Therefore, the fibrinolytic agent of choice for intrathrombotic injections seems to be a 1:2 solution of streptokinase with plasminogen or with the lytic enzyme plasmin itself.
Aged↗
[Agenesis of the inferior vena cava].
A case of agenesia of 3 of the 4 segments the vena cava inferior is presented. The embryogenesis of the v. cava inferior is discussed in so far as is relevant for the malformation in this case. Exact diagnosis and classification can be made via intravenous and intraarterial DSA and computed tomography.
Adult↗
[Fibrinolytic therapy of peripheral arterial occlusive disease].
Occluded arterial segments can be recanalized by fibrinolytic drugs. In addition to systemic fibrinolysis another method of thrombolytic therapy has been established: Local thrombolytic therapy is carried out by infiltration of low dose of streptokinase into the thrombotic occlusion. According to the low dose streptokinase used and the short duration of therapy local thrombolysis is applicable in patients with high risks too. Therefore the range of indications to non-surgical recanalisations could be extended. The differential therapy depends on location, pathogenesis and clinical stage of the arterial occlusion.
Administration, Topical↗
Fibrinolysis in chronic arteriosclerotic occlusions: intrathrombotic injections of streptokinase. Work in progress.
Forty-seven patients with chronic arteriosclerotic occlusions of iliac and femoropopliteal arteries were treated by intrathrombotic fibrinolysis. The occlusions were 10-65 cm (mean, 22 cm) long and 6 weeks to 2 years (mean, 4.5 months) old. By means of consistent intrathrombotic injections of 2,500 units of streptokinase every 5 minutes, the thrombi were recanalized within 1-7 hours (mean, 2.5 hours). The primary recanalization rate was 75% (35/47), the patency rate after 2 weeks, 68%. In 29 patients (62%), a residual stenosis had to be dilated by balloon angioplasty. Because of the low total dose of streptokinase (mean, 70,000 units), the thrombin time was elevated up to twice the normal value in only one patient. Bleeding that required transfusions was observed in only two patients (4%). Advantages of intrathrombotic fibrinolysis include higher recanalization rate, lower total dose of streptokinase, fewer bleeding complications, and shorter therapy time than previously reported with other treatments.
Adult↗
Evidence of enhanced platelet aggregation and platelet sensitivity in migraine patients.
In fourteen untreated migraine patients with a mean age of 40 years platelet sensitivity to 5HT, EN and ADP was investigated during the prodromal phase (three patients), 12-48 h after headache (three patients) and during the headache-free period (eight patients). Platelet sensitivity was tested using an optical density method and was calculated by the percentage of disaggregation (%DA) occurring 3 min after the peak aggregation. Platelet release reaction was assessed using beta-thromboglobulin (beta-TG) as an indicator. Platelet sensitivity to low concentrations of 5HT, EN and ADP (0.3 X 10(-9) M/ml) was most marked during the headache and prodromal phases. The least platelet sensitivity in migraineurs was detected during the headache-free interval, but was still higher than in the control group. beta-TG levels were increased during the headache phase indicating platelet release reaction. A general hyperaggregability of platelets in migraineurs has been demonstrated and in addition a varying sensibility of platelets to low concentrations of 5HT, EN and ADP has been established.
5-Hydroxytryptophan↗
[Computer-assisted in vivo study of capillary permeability].
Terminal circulation can be studied in vivo using capillaroscopy. This paper presents the results of systematic investigations of capillary permeability (KPU) in the nailfold. In addition to the morphology of capillary loops, we investigated the transcapillary passage and interstitial distribution of sodium fluorescein (Na-flu) in healthy persons (42) and in patients suffering from functional microangiopathies (17) or organic vascular disease (58). The effects of various therapeutic measures on the microcirculation were also studied. First, dynamic processes at the capillary loops were recorded on a video system. The second step consisted of quantification of the pericapillary light intensities (FLI) at predetermined times using a computerized video-densitometer. The measured variables, i.e. maximal interstitial FLI, diameter of the juxtacapillary halo (IK-H) and distance between the intracapillary column of red cells and the interstitial peak of FLI, provided information about the permeability of the capillaries and the interstitial diffusion of Na-flu. In healthy subjects, the interstitial FLI reached its highest values 10 sec after the appearance of Na-flu in the capillary loop, the distance between the peak of FLI and the intracapillary column of erythrocytes increased continuously over a period of 2 min, whereas the diameter of the IK-H reached a constant value after 20 sec. In patients suffering from functional microangiopathy, an increased pericapillary FLI as well as an enlarged juxtacapillary zone with elevated Na-flu concentrations could be established as objective criteria in addition to the already known alterations of the morphology of the capillary loops. Similar observations, but of much greater extent, were made in patients suffering from microvessels disease associated with collagen disease. The regional variation in the pericapillary FLI supports the assumption that morphological changes are present in these patients. KPU in patients suffering from organic macroangiopathy revealed no changes in comparison to healthy persons. The effects of conventional therapy in patients with reduced peripheral arterial perfusion on the parameters measured by KPU were of variable magnitude. The increase in trans-capillary leakage and interstitial dispersion of Na-flu was significant during systemic fibrinolysis and during the intra-arterial application of PGE1. The changes in the measured parameters were considerably smaller during therapy with phenprocoumarol and heparin, whereas treatment with inhibitors of platelet aggregation left the results of KPU unchanged.(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗
Apolipoproteins: significance for lipid metabolism and for diagnosis of atherosclerotic disease.
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Apolipoproteins↗
[Acute peripheral ischemia syndrome].
The six "P" are characteristic clinical symptoms of acute peripheral ischemia. Diagnostic problems can be considered in approximately 33%. Doppler-ultrasound technique is the most frequent method used to verify the clinical diagnosis. Angiography was necessary only in 35% of our cases. Methods of recanalisation are individual and depend on aetiology and localisation of the occlusion. 60-90% of acute ischemic extremities can be saved by new techniques of fibrinolysis and surgery, if the therapy will be carried out within six hours.
Arterial Occlusive Diseases↗
[Preliminary results of prostaglandin E1 therapy in peripheral obliterating arteriopathy].
Prostaglandin E1 was given intraarterially to twenty persons with severe peripheral ischaemia at risk of requiring amputation of a limb for ischaemic ulcers or necrosis. All patients had received conventional therapy without success before PG E1 treatment. An average dose of 6.14 ng/kg/min of PG E1 was given intraarterially for 2 hrs daily over a period of six days. In fifteen cases PG E1 therapy resulted in complete or partial healing of the ulcers and necrotic areas while the patients no longer suffered from pain at rest. No beneficial effects of PG E1 treatment were seen in five patients. In these cases cases multiple arterial occlusions, caused by arteriosclerosis and diabetes mellitus, existed, in more than three levels. Side effects like pain in the infused limb and swelling of the extremity occurred in fourteen patients, but were reversible in each case.
Alprostadil↗
TSH, T3, rT3 and fT4 in maximal and submaximal physical exercise.
The response of various thyroid hormone parameters to maximal physical exercise (MPE) was investigated in 14 medium and long distance runners and 13 divers. The effects of submaximal long time physical exercise (SMPE) was examined in seven divers. The TSH-level decreases significantly during MPE and slightly rises again after the end of the exercise. In SMPE, however, TSH continuously rises until 15 min after the end of the exercise. The T3 level rises significantly in MPE and falls below the initial value 15 min after the exercise finishes, during SMPE it remains practically unchanged and slightly decreases after the finish. In MPE, the rT3 level does not change and slightly decreases after termination, while the fT4 level continuously decreases from the beginning till 15 min after the exercise period. The latter two parameters do not show any change in SMPE. As possible reasons for the changes of TSH levels a decrease (MPE) or an increase (SMPE) of pituitary secretion might play a role. Furthermore, in MPE the rise in T3 level might be related to hemoconcentration, and the decrease in fT4 level to an elevated cellular utilization.
Adult↗
Serum FSH, LH, and testosterone in humans after physical exercise.
The serum levels of FSH, LH, and testosterone were determined by radioimmunoassay in 63 men before, during, and after maximal and submaximal physical short- and long-term exercise (800-n running, climbing, 36-k cross-country skiing). In the 800-meter run, significant elevations of FSH, LH, and testosterone were observed, while in all other field and laboratory test (climbing, 36-km cross-country skiing, maximal stepwise bicycle and treadmill ergometry, 90-min submaximal bicycle ergometry) the hormone levels remained unchanged or were decreased. In contrast to FSH and LH, which did not show any clear modification with duration or intensity of exercise or with the state of training, changes of testosterone in the endurance field test (36-km cross-country skiing) seemed to be training dependent. In highly endurance-trained subjects, there was an increase and in less well-trained subjects a decrease of testosterone for equal distances and intensities of exercise.
Adolescent↗
[Lipoproteins in cochleovestibular disorders (author's transl)].
Forty-nine patients with neuro-otologic symptoms were examined with regard to their risk factors, especially their lipoproteins. No essential differences were found in the serum triglyceride and serum cholesterol levels. LDL-cholesterol and the quotient LDL-cholesterol/HDL-cholesterol were significantly higher in the group of patients. We consider this an indication for a relation between arteriopathy and cochleovestibular disorders.
Adult↗
[Clinical studies of familial hereditary factor VII deficiency (author's transl)].
The discovery of a severe factor VII deficiency with increased bleeding tendency resulted in investigations of 22 members of the family. In the propositus and in two of his siblings a severe hypoproconvertinemia was demonstrated, a partial deficiency was found in ten persons. Studies of the family confirmed that this disorder is transmitted by an autosomal gene with intermediate penetrance. The mutated gene produces a severe deficiency in the homozygote and partial deficiency in the heterozygote. The parents of the homozygote patients were consanguineous. Hemorrhagic diathesis was noted only in patients with a severe factor VII deficiency. Causes for the variability of the clinical manifestations are discussed.
Adult↗
[Effect of the antirheumatic drug Sulindac on thrombocyte function (author's transl)].
The effect of a treatment with the antirheumatic drug Sulindac (from 200 to 400 mg/day over 4 weeks) on thrombocyte function (bleeding time, platelet retention, platelet aggregation induced with suitable concentrations of ADP, epinephrine, collagen and Ristocetin) on thrombocyte count and thromboplastin time was investigated in 20 patients. In 10 healthy volunteers collagen-induced platelet aggregation was measured after oral application of 200 mg Sulindac. Analysis of the data obtained by the tests revealed no unwanted or harmful effects of Sulindac on platelet functions, platelet count and prothrombin time. No significant difference between the data before and during treatment was found. No medical drop out was registrated.
Collagen↗