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Biomedical subjects

G Rudofsky

Publications and source records attributed to G Rudofsky.

At least 37 records · Page 2Linked to original sources
PubMed2002

Symptoms in individuals with small cutaneous veins.

The clinical relevance of small cutaneous veins (SCV) is still being discussed. In the Duesseldorf/Essen civil servants study, the prevalence of SCV and the individual symptoms and age-dependent changes were analysed. This cross-sectional study recruited 9935 employees; 9100 could be finally evaluated for this analysis. All volunteers were asked to fill out the questionnaire and were clinically examined. Primarily the clinical findings were documented, adapted to the Basel Study and later modified according to the CEAP classification: (a) class 0 - no visible or palpable clinical signs of venous disease, (b) class 1 - small cutaneous veins, (c) class 1 - reticular veins, (d) class 2 - varicose veins. In all, 64% of the volunteers had no signs of venous disease (class 0: age 41+/-10 years); 10% had small cutaneous veins (class 1: age 44+/-10 years). SCV was more frequent in females (25%) than in males (6%). Only 5% of those with SCV had already consulted a physician. A striking result was that individuals with SCV generally complained about more leg symptoms, of which 'leg swelling' and 'muscle cramps during the night' were the most frequent. 'Continual leg swelling' was reported by 24% of individuals with SCV as opposed to 10% of those without. 'Leg cramps' and 'restless legs' also were more often documented in individuals with SCV (29% vs 22% and 10% vs 7%). These findings were all statistically significant (p<0.001). After adjusting for age and sex, though, there were few or no differences between groups (leg swelling: odds ratio (OR) 1.3; 95% confidence interval (95% CI) 1.1-1.6 and cramps: OR 1.1; 95% CI 0.9-1.3). A gender separate estimation of the rates showed that females suffer more often from any symptom. Regarding 'leg cramps', 'restless legs' and 'itching', the OR were not different for females and males. For 'leg swelling' the age-adjusted OR were significant for women (OR 1.4; 95% Cl 1.1-1.7) compared with men (OR 1.1; 95% Cl 0.7-2). Individuals with SCV seem to have more symptoms compared with healthy people. However, this analysis shows that age and sex are the most relevant explanations for these symptoms.

Adult↗
PubMed2001

[Mechanical stimulation of venous blood flow in below-the-knee plaster cast].

Physical methods became recently more important as an alternative to anticoagulation for prophylaxis of thromboembolism and were studied for their efficacy. The AV-impulse-system proved efficient in reducing thromboembolic complications in patients undergoing hip surgery by increasing the return of venous blood in the deep veins of the leg. In a preclinical trial we studied the influence of the AV-impulse-system and of active forefoot movement on venous blood return in 12 lower extremities of 6 healthy individuals immobilized in below the knee plaster casts. Our results show a significant increase in venous blood flow caused by the AV-impulse-system (p < 0.05) and by active forefoot movements (p < 0.05). Prevention of thromboembolic complications in trauma and orthopaedic patients immobilized in plaster cast seems possible by using the AV-impulse-system which significantly increases the venous blood flow independent from patient compliance.

Adult↗
PubMed2000

["Panorama images" with ultrasound. A computer program joins individual images to make a continuous image].

SieScape is a novel method that enables the investigator to obtain continuous ultrasonographic images of extensive structures. Its ease of use and rapidity of deployment make SieScape the method of choice for the documentation and monitoring of large superficial lesions, for example hematomas following arterial puncture. With the aid of Color Sie Scape, not only views can be obtained in any desired plane, but also the relationship of the hematoma to the vascular structures can be documented.

Abdominal Muscles↗
PubMed2000

Effect of hemodynamic conditions on sonographic measurements of peak systolic velocity and arterial diameter in patients with peripheral arterial stenosis.

PURPOSE: We measured changes in peak systolic velocity ratio and sonogaphic vascular diameter during different hemodynamic conditions in patients with femoral or iliac artery stenosis. METHODS: In 35 patients with isolated femoral or iliac artery stenosis, prestenotic and intrastenotic peak systolic velocity and inner vascular diameter were calculated using color Doppler sonography and gray-scale sonography, respectively. The measurements were performed with the patient at rest (baseline), after leg exercise, and again after oral administration of 10 mg of the vasodilator nifedipine. RESULTS: The mean prestenotic and intrastenotic peak systolic velocity and the peak systolic velocity ratio (intrastenotic/prestenotic peak systolic velocity) were 70 +/- 31 cm/second, 360 +/- 130 cm/second, and 6.5 +/- 3.6 at baseline; 78 +/- 37 cm/second, 404 +/- 171 cm/second, and 6.6 +/- 4.2 after leg exercise; and 71 +/- 30 cm/second, 353 +/- 109 cm/second, and 5.9 +/- 3.2 after nifedipine administration. The mean prestenotic and intrastenotic diameter and percentage of diameter reduction were 5.9 +/- 3.2 mm, 2.3 +/- 1.1 mm, and 59 +/- 13% at baseline; 4.8 +/- 2.4 mm, 2.0 +/- 1.3 mm, and 62 +/- 13% after leg exercise; and 5.9 +/- 2.9 mm, 2.5 +/- 1.0 mm, and 54 +/- 14% after nifedipine administration. Only the difference in intrastenotic diameter after leg exercise was significantly different from baseline. CONCLUSIONS: The peak systolic velocity ratio in peripheral arterial stenosis seems to be relatively independent of the hemodynamic conditions and cannot be used for investigations of vasomotion of stenotic arterial segments during different hemodynamic conditions.

Administration, Oral↗
PubMed2000

Interventional therapy of vascular complications caused by the hemostatic puncture closure device angio-seal.

The hemostatic puncture closure device Angio-Seal is a quick, safe, and easy-to-use system, allowing rapid sealing of the vascular access site following coronary angiography and interventional procedures. It is advantageous for patients in whom early mobilization is desired and may therefore decrease hospital costs. Despite the documented low complication rate, there are some specific problems. Reporting on five cases, we describe problems in diagnosis and possible interventional therapy of Angio-Seal-associated complications such as stenosis, occlusion, or peripheral embolism. Our experience led to the concept of precise diagnosis in any patient with leg symptoms and early interventional treatment with the aim of complete removal of the intra-arterial parts of the Angio-Seal device. Any delay in diagnosis and treatment increases the risk of additional thrombotic occlusion. Spontaneous dissolution of the Angio-Seal sponge limits interventional possibilities of complete removal. Cathet. Cardiovasc. Intervent. 49:142-147, 2000.

Adult↗
PubMed2000

Segmental manifestation of peripheral atherosclerosis and its association to risk factors.

BACKGROUND: To prove whether the aortoiliac, femoropopliteal or crural segments of the peripheral arteries might have a different sensitivity to a risk profile we did a statistical analysis of segmental peripheral atherosclerosis and risk factors. PATIENTS AND METHODS: In 132 patients (mean age 61 +/- 13 years) with peripheral arterial occlusions the arterial segments with occlusion or stenosis were angiographically documented: 17 had occluded or stenosed aortoiliac, 45 femoropopliteal and 25 crural arteries and 45 patients had multiple manifestations. Analysis of total cholesterol, HDL- and LDL-cholesterol, triglyceride, lipoprotein a, fibrinogen, uric acid, homocysteine, hematocrit, erythrocyte sedimentation rate, HBA1, IgG- and IgM-antibodies versus Cytomegalovirus, Herpes simplex-virus, Chlamydia pneumoniae and Helicobacter pylori were done and nicotine abuse, arterial hypertension and obesity were evaluated. RESULTS: Age of the patients had the strongest correlation with isolated segmental manifestation (p < 0.0001). Patients with isolated aortoiliac manifestation were younger than patients without this manifestation (54 +/- 9 years versus 62 +/- 13 years). Patients with isolated femoropopliteal manifestation were older than patients without this manifestation (66 +/- 11 years versus 58 +/- 13 years). None of the investigated risk factors showed a correlation with these age related differences. Independent from the age related differences for the nicotine abuse a p-value of 0.08 was estimated, but in smokers a diffuse manifestation was most frequent. CONCLUSION: There are age dependent differences of the prevalence of isolated aortoiliac or femoropopliteal atherosclerotic occlusions or stenosis. An association of these differences to a specific risk profile was not found.

Adult↗
PubMed2000

Intravascular ultrasound angioplasty in peripheral arterial occlusion. Preliminary experience.

PURPOSE: To determine if ultrasound angioplasty in a percutaneous approach was capable of recanalizing occluded arteries in acute and subacute peripheral arterial occlusions. MATERIALS AND METHODS: We applied an ultrasound angioplasty device in a percutaneous approach in 9 patients with peripheral arterial occlusions. All patients suffered from severe leg ischemia due to subacute thrombotic occlusions. RESULTS: The ultrasound transmitter easily created a channel within the occlusive material. To further reduce the mass of the occlusive material, an aspiration thrombectomy was performed in all cases, leading to a complete recanalization in 7 cases. In 2 cases, a remaining stenosis was successfully dilated. CONCLUSION: Intravascular ultrasonic devices can be useful for recanalization of occluded peripheral arteries. In particular, if thrombolytic therapy of longer peripheral arterial occlusions fails or is contraindicated, ultrasound angioplasty may be a new approach for recanalization.

Acute Disease↗
PubMed2000

Retrospective analysis of Rt-pa thrombolysis combined with PGE1 in patients with peripheral arterial occlusions.

Although thrombolysis has been established for recanalization of acute and in part chronic peripheral artery occlusions, only smaller studies exist regarding the use of long-term rt-pa infiltration-thrombolysis. The objective of this study was to evaluate the benefit of additional long-term thrombolysis in patients with peripheral arterial occlusions for whom acute thrombolysis failed. From 1992 to 1997, 323 patients with peripheral arterial occlusions were treated with rt-pa (recombinant tissue-type plasminogen activator). When the thrombolysis failed during the first 3 hours, the thrombolytic therapy was continued as a long-term treatment with 3 mg rt-pa alternated by PGE1 (2.1 mL/hr for 3 hours, concentration: 20 microg/50 mL NaCl) every 3 hours. Additional heparin was applied in doses of 15,000 IE/24 hr or more to slightly increase the partial thromboplastin time. Angiographic controls were performed every 24 hours. If necessary, a final angioplasty was performed. In 142 of the 323 patients the occlusions were recanalized during the first 3 hours; 119 patients were treated with a long-term thrombolysis and in 72 (61%) a recanalization was ultimately achieved. Thus, the recanalization rate increased to 214 of 323 patients (p < 0.02). Mean treatment time was 2.8 +/- 2.2 days, range: 1 to 13 days. The rates of recanalization were not different in iliac, femoral, or crural arteries. Fibrinogen levels did not decrease during thrombolysis. Severe bleeding (with a decrease of more than 3 g/dL hemoglobin requiring transfusion) occurred in four patients after finishing the thrombolysis with short-term and in six with long-term therapy; two required surgical treatment. The 1-, 2-, and 3-year cumulative patency rates were respectively 90.1%, 74.2% and 64.9%. Patency rates in patients with acute or long-term thrombolysis were not different. A composite thrombolytic treatment using low-dose rt-pa in combination with PGE1 offers significantly better results than an acute thrombolytic treatment alone. It can be an effective and practicable regimen in about 60% of patients in whom acute thrombolysis fails.

Adult↗
PubMed2000

Risk factors in young patients with peripheral atherosclerosis.

BACKGROUND: Risk factors and especially the combination of multiple risk factors are associated with the development of atherosclerosis. Therefore, patients with an early manifestation of atherosclerotic disease are likely to show an extraordinary risk profile. We analysed the frequencies and severity of risk factors in young patients with manifest peripheral arterial occlusive disease as compared to old patients. METHODS: We analysed the risk profiles in 303 patients who were sent for interventional treatment of a symptomatic peripheral arterial occlusive disease. The risk profiles were described for different age groups (54 patients under 50 years of age, 194 patients from 51 to 74 years, 55 patients over 75 years). Multiple linear regression analysis and analysis of variance were performed to look for age-dependent effects. RESULTS: Elevated total cholesterol, and triglyceride levels and nicotine abuse were more frequent in patients younger than 50 years. Diabetes mellitus and hypertension were more frequent in patients older than 75 years. The different frequencies for smoking, diabetes mellitus and hypertension were age-related (p<0.05). Concerning laboratory parameters such as HDL- and LDL-cholesterol, fibrinogen, lipoprotein(a) and homocysteine there were no relevant age-related differences in frequency nor in absolute values with the exception of the hematocrit and uric acid. The coincidence with clinically manifest myocardial infarction was 11.15% in the patients under 50 years compared to 20.6% in those aged 51-74 years and 16.4% in those over 75 years, for cerebral stroke it was 5.6%, 17.5% and 14.5%, respectively. Patients under 50 years with peripheral arterial occlusive disease and a history of myocardial infarction were characterised by high levels of total cholesterol, triglyceride and lipoprotein(a). Excluding patients with prior myocardial infarction patients did not show any difference in risk profile between the three age groups. CONCLUSIONS: In a population suffering from manifest peripheral arterial occlusive disease the risk profile in patients under 50 years is not different from that in older patients. In contrast an additional myocardial infarction in such a population is associated with pathological lipid profiles.

Adult↗
PubMed2000

Color Doppler sonography of arteries associated with perforating veins.

BACKGROUND: It has been known for some time that perforating veins had associated perforating arteries. There has been no way to investigate these arteries preoperatively. The newer high resolution ultrasonic devices enable us to investigate these arteries. We are able to localize, determine the frequency, and measure the size of the arteries associated with perforating veins of the lower extremities. METHODS: All patients were studied in our clinical vascular laboratory. PATIENTS: 55 patients with different degrees of varicosities were studied. MEASURES: Each patient had their perforating veins and arteries investigated with a 7.5 MHz linear array transducer (Siemens, Type Elegra). RESULTS: 73% of the 233 perforating veins identified had an associated perforating artery. No preferred localization of the perforating veins was noted. The number of location did not correlate with the presence or absence of incompetence of the veins. The perforating arteries were located in close proximity to the perforating veins but did not go far into the subcutaneous fat. The maximum systolic velocity was 12+/-8 cm/sec. CONCLUSIONS: The preoperative detection of perforating arteries associated with perforating veins is possible using a color Doppler scanner. Their pathophysiological function and its relation to bleeding complications, wound healing and ulcer healing can be studied using this tool.

Adult↗
PubMed1999

[Difficulties in the detection of heparin-induced thrombocytopenia type II].

We report about a 29 year old female who developed right-sided leg vein thrombosis over three levels. Thrombectomy was attempted followed by intravenous anticoagulation with heparin. The platelet count dropped acutely from 176,000/microliter to 11,000/microliter after the sixth day. A lung perfusion-ventilation-scintigraphy suggested recent pulmonary embolism by lateral, predominantly right-sided perfusion deficits. ACT scan of the pelvic region showed rethrombosis of the right common iliac vein. The clinical suspicion of heparin-induced thrombocytopenia (HIT) type II was confirmed by a positive heparin-induced platelet aggregation test and the detection of antibodies by heparin-platelet factor 4-ELISA. The patient was treated with lepirudin at body-weight-adapted dose. After recovery of the platelet count to 102,000/microliter within seven days the treatment was changed to Orgaran after exclusion of immunologic cross reactivity. An overlapping oral anticoagulation with Marcoumar was initiated. Although HIT type II usually develops over a few days, acute thrombopenia can also occur. There is therefore no safe diagnostic interval permitting a timely detection.

Adult↗
PubMed1999

Ergotamine-induced intermittent claudication.

We report about a female patient with intermittent claudication caused by ergotamine. She used ergotamine as a treatment for migraine headaches for more than 4 years. The claudication began 7 month before admission. Colour Doppler sonography and angiography showed severe stenosis of the left external iliac and superficial femoral artery. The patient was treated with phenprocoumon for one year after withdrawal of ergotamine. After that the superficial femoral stenosis disappeared completely, but the external iliac stenosis was still present and was consequently successfully treated by atherectomy. The histology showed a fibrosis of the intima and a hypertrophy of the media.

Adult↗
PubMed1999

Stenosis-jet can cause a dissection of the superficial femoral artery.

A dissection of the superficial femoral artery mainly occurs due to trauma or manipulation of the artery by means of interventional procedures. In contrast to dissections of the carotid arteries which are known to occur spontaneously we present the case of a stenosis of the superficial femoral artery that led to a dissection caused by the stenosis-jet. The dissection on the other hand caused an appositional thrombus which led to the embolic occlusion of the pedal-arteries. In case of peripheral embolisms in patients with or without history of peripheral arterial occlusion disease it is important to look for a causing arterial pathology preferably by duplex sonography.

Adult↗
PubMed1999

Atherosclerotic lesions are more frequent in femoral arteries than in carotid arteries independent of increasing number of risk factors.

The authors investigated the prevalence of atherosclerotic lesions in carotid and femoral arteries in people with varying risk factors. They searched for differences in the region of manifestation of atherosclerosis due to different risk factors. Over 5 years they investigated 4,200 people (2,600 men, 1,600 women aged 20 to 70 years) who reported feeling healthy. They did a B-mode sonography of the internal, external, and common carotid artery; and the common, the proximal superficial, and profundal femoral artery. They questioned the people regarding hypertension, hypercholesterolemia, diabetes mellitus, and smoking habits. Isolated carotid artery atherosclerosis was found in 2.8% of the men and 1.6% of the women; 10.9% of the men and 4.4% of the women had isolated femoral artery lesions. A combination of atherosclerotic lesions in both arteries was present in 8.3% of the men and 4.0% of the women. When only one risk factor was present atherosclerotic lesions of the femoral arteries were predominant. Diffuse atherosclerosis dominated with increasing number of risk factors. The rate of people with isolated carotid atherosclerosis was highest when no risk factor was present and decreased to a fixed rate of 12% to 17% independent of the number of risk factors. An increasing number of risk factors can be associated with a diffuse manifestation of atherosclerotic lesions. However, there are a certain number of people who demonstrate only carotid artery or femoral artery atherosclerosis independent of the number of risk factors.

Adult↗
PubMed1999

Different prevalence of asymptomatic atherosclerotic lesions in males and females.

The detection of atherosclerotic lesions in asymptomatic healthy subjects is possible using ultrasound. Populations can be investigated in order to detect differences in early and asymptomatic atherosclerosis due to gender and risk factors. This study investigated 2605 male (21-69 years) and 1601 female (20-70 years) employees and civil servants of the city of Düsseldorf, Germany. The ultrasound investigations were performed with an ATL device, type Ultramark 4 plus, and a 7.5-MHz linear transducer on the carotid and proximal femoral arteries. An atherosclerotic lesion was defined as visibly different from the intima by its echogenicity and by being larger than 1 mm. A thickening of the intima media complex was not considered to be atherosclerosis. The prevalence of atherosclerotic lesions in male subjects was higher than those in female subjects regardless of age. In male subjects it was 5.3% (30-39 years), 19.8% (40-49 years), 36.7% (50-59 years) and 47.7% (60-70 years). The female subjects had a prevalence of 2.1%, 8.4%, 17.5% and 37.7% in the corresponding age groups. Risk factors such as smoking, hypertension and hypercholesterolemia were higher in men than in women. The increase of atherosclerotic lesions from one decade to another was highest in women between 50 and 59 years and 60 and 70 years. This large increase could not be explained by a similar increase in risk factors. It was therefore concluded that male subjects had a higher prevalence of atherosclerosis at earlier ages than females, but female subjects showed a postmenopausal rise in prevalence.

Adult↗
PubMed1999

[Therapeutic ultrasound for the recanalization of peripheral vascular occlusions].

Since the development of percutaneous transluminal angioplasty several techniques such as laser or atherectomy devices have been developed for recanalization of peripheral arterial occlusions. In a first clinical study we investigated if also the application of intravascular ultrasound can be useful for recanalization of occluded peripheral arteries. We applied an ultrasound angioplasty device (ACOLYSIS, ANGIOSONICS, USA) in a percutaneous approach in 8 patients with peripheral arterial occlusions (7 femoro-popliteal segments, 1 external iliac artery-occlusion). All patients suffered from severe leg ischemia due to subacute thrombotic occlusions. The ultrasound transmitter was introduced and advanced under fluoroscopic guidance to the site of the lesion. After activation the ultrasound transmitter was slowly advanced into the occlusion easily creating a channel within the occlusive material. Depending on the length of the occlusion (5-16 cm) treatment times ranged from 120-480 s. To further reduce the mass of the occlusive material an aspiration thrombectomy was performed in all cases leading to a complete recanalization in 6 cases. In 2 cases a remaining stenosis was successfully dilated. Intra-vascular ultrasonic devices can be useful for recanalization of occluded peripheral arteries. With the use of high-energy ultrasound a selective injury of the occlusive material can be induced without damaging the surrounding arterial wall. This selectivity is based on the differences in elasticity between the atherosclerotic plaque and the media layers. Especially if thrombolytic therapy of longer peripheral arterial occlusions fails or is contraindicated ultrasound angioplasty may be a new approach for recanalization.

Aged↗