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Biomedical subjects

G Rudofsky

Publications and source records attributed to G Rudofsky.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Diagnosis and therapy of hypothenar hammer syndrome].

Traumatic injuries of arteries lead to acute bleeding or ischemia. In the hand, which is perfused by two arteries, this symptom could be missed. The hypothenar hammer syndrome is a traumatic occlusion of the distal arteria ulnaris. Dependent on the mechanism of the trauma the clinical symptoms may appear late. A specific angiographic or duplex sonographic diagnostic investigation is necessary to show the arterial occlusion. There is no proven therapeutic procedure. Exact diagnosis of the occlusion as an effect of the trauma is important for the patient and is the basis of any therapeutic intervention.

Adult↗
PubMed1998

SieScape: a new sonographic dimension with fictive images.

SieScape is a new data processor that produces continuous sonographic images of large structures. It works without mechanical control of position and can be used with any transducer. Its accuracy and reproducibility is relevant for measurements and has to be investigated. With the ultrasound equipment of Siemens, type Elegra (5- and 7-MHz linear array transducer), we did repetitive measurements of linear superficial distances, curved circumferences and diameters of human legs. Finally, we tried to do continuous investigations of vascular structures to produce SieScape images. The linear superficial distances of 150 mm were underestimated (147.4+/-3.3 mm). Diameter measurements of the calf, with an adjusted depth of 40 mm, tended to give more accurate values than measurements with a depth of 70 mm, which were all overestimated. The circumferences of the calf measured between superficial markers were calculated as too small. SieScape really provides new sonographic documentation. The SieScape images are fictive, because they do not exactly reproduce anatomic dimensions.

Algorithms↗
PubMed1998

The use of the echo-enhancing agent Levovist does not influence the estimation of the degree of vascular stenosis calculated from peak systolic velocity ratio, diameter reduction and cross section area reduction.

Levovist, a new echo-enhancing agent, is proclaimed to give more information about blood flow and therefore might be supposed to show the true intravascular lumen. Thus, it has to be shown whether such an echo-enhancing agent influences the sonographic estimation of vascular stenosis. We investigated 32 patients with PAOD and a single stenosis in the iliacal or femoral arteries (mean age 54+/-13 years) using a color Doppler sonographic equipment with a 5.4 or 7.3 MHz linear transducer. Levovist was given in a concentration of 200 mg/ml i.v with a total dose of 4 g. We did two measurements before the application of Levovist. Peak systolic velocity ratio (PSVR) was 6.5+/-3.6 and 6.4+/-3.8 before and 6.3+/-4.2 after application of Levovist. Sonographic diameter reduction was 59+/-15 and 62+/-16% before, and 60+/-16% after application. Diameter reduction in angiography was 65+/-13%. Reduction of the cross section area was 81+/-14 and 83+/-15% before, and 83+/-16% after application. The use of the echo-enhancing agent Levovist does not influence the calculation of the peak systolic velocity ratio, diameter reduction or cross section area reduction. The degree of the stenosis calculated from the sonographic reduction in diameter tended to be smaller than in angiography either with or without Levovist.

Angiography↗
PubMed1998

Colour Doppler sonographic diagnosis of upper limb venous thromboses.

1. Upper limb venous thromboses are considered to be a rare event, but in large hospitals with a lot of patients who receive aggressive intravenous therapy the number of thromboses seem to increase. 2. We have analysed all the cases of upper limb venous thrombosis which occurred at the Essen University Hospital between the years of 1992-1996. All patients were examined using colour Doppler sonography. 3. Out of 827 patients that were examined, a thrombosis was diagnosed in 334 cases. The subclavian vein was involved in 69% of all thromboses. Isolated jugular vein thrombosis was found in 17% of the thromboses, combined thromboses of the jugular and subclavian vein in 19%. In 182 cases the patients were treated for primarily a malignant illness. In 96 cases we found an association with venous port-systems or central venous catheters. 4. More than 40,000 patients a year were treated at the university hospital. Considering this huge number of patients the thrombosis of the upper limb is still rare. The use of colour Doppler sonography allows an early and safe diagnosis of the thrombosis without straining the patients.

Adolescent↗
PubMed1998

[Osteitis diagnosis in a group of angiology patients: a comparison of X-ray and nuclear medicine studies].

PURPOSE: Of the study was to examine the ranking of radiographs and bone scans in the diagnosis of osteitis. PATIENTS AND METHODS: 115 patients with arterial occlusive disease in stage Fontaine i.v. were referred for examination of the peripheral skeletal parts of the lower extremity. 126 radiographs and bone scans were taken. The time between the two examinations was 10 days maximum to enable direct comparison. Leukocyte scintigraphy was employed as gold standard. RESULTS: The sensitivity of radiographs was 47% with a specificity of 91%. Sensitivity and specificity of bone scans was 78% for both values. The positive predictive values for radiographs and bone scans were 88% and 85%, the negative predictive values were between 80% and 97%. CONCLUSION: In the majority of cases osteitis can be diagnosed with relatively inexpensive methods such as conventional x-rays and bone scans. Only in unclear cases further examinations such as leukocyte scintigraphy or magnetic resonance imaging should supplement the diagnosis.

Adult↗
PubMed1998

Association of subclavian and jugular vein thrombosis: color doppler sonographic evaluation.

In case of clinical symptoms of subclavian vein thrombosis a phlebographic or color Doppler sonographic investigation should be performed. Phlebography is a sensitive method to exclude the thrombosis in the subclavian vein but not in the jugular vein. Color Doppler sonography additionally gives information about the surrounding tissue and the jugular vein. The authors analyze their color Doppler sonographic data, first, to evaluate the association of internal jugular and subclavian vein thrombosis and, second, to demonstrate the necessity for a color Doppler investigation. Of 213 patients who suffered from a thrombosis, 93 had a subclavian vein thrombosis, 64 had a combined thrombosis in the internal jugular and subclavian vein, and 56 had an isolated internal jugular vein thrombosis. There is a high association between subclavian and internal jugular vein thrombosis, and a color Doppler investigation of both the subclavian and internal jugular veins is necessary.

Adult↗
PubMed1998

Patients with a malignant tumor have more extended thrombosis than patients without.

Changes in the coagulability or rheology of the blood are supposed to cause an increased frequency of thrombosis in patients with a malignant tumor. These procoagulopathic disorders may not only increase the frequency of thrombosis but may also enlarge the extent of the thrombosis. The authors retrospectively analyzed, therefore, the extension of thrombosis in patients with and without a malignant tumor. From 1991 to 1995 in the University Hospital Essen 489 consecutive cases of thrombosis were diagnosed. The diagnosis was made by color Doppler sonography or phlebography; 230 patients (47%) suffered from a malignant tumor (110 men, 120 women). To exclude the influence of the patient's age on the extension of the thrombosis the authors distinguished three different age groups. In the tumor group aged from 21 to 40 years they found 10 large (iliacal, femoral, and crural veins), six medium (femoral and crural veins), and four small thromboses (crural veins). In the tumor group aged from 41 to 60 years they found 38 large, 24 medium, and 27 small thromboses. In the group without a tumor aged from 21 to 40 years they found seven large, 13 medium, and 28 small thromboses, and in the group aged from 41 to 60 years, 12 large, 29 medium, and 41 small thromboses. The difference between the two groups supports the assumption that in patients suffering from a malignant tumor, thromboses tend to be more extended than in patients without a malignant tumor.

Adult↗
PubMed1998

Recanalization of chronic peripheral arterial occlusions by alternating intra-arterial rt-PA and PGE1.

BACKGROUND: Recanalization of femoral artery occlusions is difficult and different forms of intra-arterial lysis or mechanical procedures have been described. We investigated the effectiveness of a prolonged intra-arterial lysis with rt-pa in combination with PGE1 followed by angioplasty. PATIENTS AND METHODS: 43 patients (age 60.4 +/- 14.3 years) with peripheral arterial occlusions older than 3 months and longer than 10 cm were treated with intra-arterial rt-pa (3 mg in 3 h) followed by PGE1 (2.1 ml/h for 3 h, concentration: 20 micrograms/50 ml NaCl) in alternating order. Treatment times ranged from 1 to 7 days (2.9 +/- 1.6). Doses of 26.5 +/- 21.9 mg rt-PA and 20.4 +/- 16 micrograms PGE1 were used. If necessary, angioplasty was performed after a wire was passed through the lumen. RESULTS: Recanalization was achieved in 47 out of 85 arterial segments with reocclusion in 9 segments. The arterial perfusion deteriorated once due to peripheral embolism. Other adverse effects included one case of retroperitoneal and one case of intracrural bleeding and one aneurysma spurium. CONCLUSION: In chronic arterial occlusions which do not respond to conventional angioplasty and/or short term fibrinolysis recanalization may be achieved in about 50% by means of prolonged alternating application of rt-pa and PGE1.

Adult↗
PubMed1998

Prevention of deep venous thrombosis associated with superficial thrombophlebitis of the leg by early saphenous vein ligation.

BACKGROUND: Thrombophlebitis of the superficial veins of the leg used to be regarded as a mild and uncomplicated disease, particularly in German speaking countries. PATIENTS AND METHODS: In a retrospective clinical study from 6/91 until 12/96 we followed the progress of all patients (n = 398) with thrombophlebitis of the vena saphena magna or parva. Parameters of interest were: the incidence of concomitant deep vein thrombosis and subsequent pulmonary embolism. All patients underwent colour duplex scanning, most of them repeatedly. In cases of proven ascending superficial thrombosis, or involvement of the saphenofemoral junction, proximal saphenous vein ligation was performed (n = 56, 49 vena saphena magna and 7 vena saphena parva). Among these groups, there were 10 patients with malignant disease (18%), ten with a history of thrombosis (18%), another five comprised diabetes, recent major surgery and organ transplantation. RESULTS: In 56 operations we found free-floating thrombi 6x (11%), 19x the sapheno-femoral junction was involved (33%), 24x the saphenous vein close to the junction (43%). Three patients develop deep vein thrombosis, despite surgery (0.75% of all and 5% of the operated cases). 2 patients suffered from (non-lethal) pulmonary embolism (0.5% and 3.5%, respectively). One embolism occurred before vein ligation. Perioperative morbidity amounted to 8.5% (superficial wound infection, hematoma). CONCLUSION: Venous ligation is probably effective in reducing the rate of fatal pulmonary embolism.

Adult↗
PubMed1998

Influence of changes in arterial blood pressure and peripheral arterial resistance on peak systolic velocity ratio.

BACKGROUND: Peak systolic velocity ratio has been described as a parameter to determine the degree of arterial stenosis. But there is very little information about the influence of changes in arterial blood pressure or peripheral arterial resistance during exercise on the peak systolic velocity ratio. PATIENTS AND METHODS: Peak systolic velocity was calculated before and in arterial stenosis in 35 patients with only single stenosis in the femoral or iliacal arteries under 4 different conditions: a) twice under resting conditions as a control, b) increased blood pressure by arm activation but unchanged peripheral vascular resistance, c) increased blood pressure by leg activation with a reduced peripheral vascular resistance by metabolic vasodilatation, d) decreased blood pressure associated with pharmacologically reduced peripheral resistance (10 mg nifedipine). RESULTS: Peak systolic velocity ratio was: a) 5.8 +/- 3.7 and 5.7 +/- 3.3, b) 5.6 +/- 3.6 (the increase in systolic arterial blood pressure was 20 +/- 3 mmHg), c) 6.3 +/- 4.4 (increase in systolic arterial blood pressure was 21 +/- 3 mmHg), d) 5.6 +/- 3.4 (decrease in systolic arterial blood pressure was 18 +/- 8 mmHg) without being significantly different from each other. The correlation factors of the peak systolic velocity ratios to the angiographic diameter reduction were between 0.737 and 0.847. Although the mean values suggest that there is no influence from the different exercise tests or nifedipine application on the peak systolic velocity ratio single stenosis demonstrated large reproducible differences. CONCLUSION: The influence of changes in arterial blood pressure and peripheral resistance on peak systolic velocity ratio appeared small. But a single stenosis showed large increases or decreases of peak systolic velocity ratio possibly due to vasomotion of the prestenotic or stenotic arterial segment.

Adult↗
PubMed1998

Duplex sonography of vascularization of venous thrombosis.

BACKGROUND: Changes in the echogenicity of an ageing intravenous thrombus have already been described in B-mode sonography. We tried to investigate the phenomena of vascularisation of the intravenous thrombotic material during the organisation using colour Doppler sonography. METHODS: We carried out a prospective investigation of 8 jugular vein, 6 femoral vein and 1 inferior caval vein thrombosis. The thromboses were investigated with a colour Doppler sonographic device from Siemens, type Elegra, every second or third day for 4 weeks after making the diagnosis. We looked for intrathrombotic colour Doppler signals with an arterial pulsatile blood flow in the pulsed Doppler mode. RESULTS: We found arterial signals in the intravenous thrombus in 8 of the 15 patients. Such arterial Doppler signals were supposed to be arterial vessels which develop during the organisation of the thrombotic material. The arterial vessels appeared only in a short range of time from the 11th to the 25th day and were present in circumscribed areas of the thrombus. Arterial blood vessels in the surrounding tissue of the veins which may supply blood to the intrathrombotic vessels could not be demonstrated. CONCLUSIONS: Thus the intravenous documentation of arterial vessels in an organising intravenous thrombus is possible. This may give information about the mechanism of thrombogenesis and about the degree of organisation and may also help in determining the age of the thrombosis.

Adult↗
PubMed1997

[The radial artery as an approach to diagnostic coronary angiography].

Radial artery canulation is described as a way of diagnostic coronary angiography or coronary angioplasty. Because of the small diameter of the radial artery and the varying arterial perfusion of the hand we suggest some points to reduce the interventional risk. The perfusion of the hand should not depend on the radial artery demonstrated by Doppler or duplex-sonographic investigation. After canulation a local angiography of the punctured radial artery is useful to prove the correct position of the canule and to demonstrate the perfusion of the hand. If there is an ischemia of the hand after instrumentation a decanulation is not the first choice in every case. The perforation in the radial artery limits an intraarterial lysis which may be the adequate therapy.

Angioplasty, Balloon, Coronary↗
PubMed1997

Duplex sonography of venous stasis.

The major reasons for venous thrombosis are inflammation, increased blood coagulability, and blood stasis. Investigation of these processes in vivo in a particular vein is difficult. Blood stasis in the peripheral veins is assumed to increase the risk of thrombosis during immobilization. By duplex sonography the authors were able to demonstrate different echogenicity in single veins of the lower limb in healthy subjects in a sitting position. Of 25 subjects, 7 presented a high echogenicity of the venous blood similar to that of the surrounding tissue. An additional 5 subjects presented this phenomenon after venous blood flow was stopped by a pressure cuff. The remaining 13 subjects still presented a dark lumen of the veins. Duplex sonography can discriminate different compositions of resting venous blood associated with venous stasis. Whether these findings correlate with an increased risk of thrombosis is not known.

Blood↗
PubMed1997

Postoperative thrombosis of the superior caval vein in a patient with primary asymptomatic Behçet's disease. A case report.

Behçet's disease is a systemic vasculitis of unknown cause. In 1937 Behçet described 3 patients with oral and genital ulceration and hypopyon iritis. The disease shows worldwide distribution with the highest prevalence in the eastern Mediterranean region and Japan. The most common manifestation is recurrent oral ulceration. Other manifestations include genital ulceration, eye lesions, skin lesion, arthritis or arthralgia, and cerebral lesions. Venous thrombosis and thrombophlebitis are also recorded as manifestations. One of the causes of superior caval vein obstruction is Behçet's disease. Especially in Turkey, this association is common. Management must be directed against the primary disease plus the caval vein obstruction. The authors describe a patient with multisymptomatic presentation of Behçet's disease with thrombosis of the superior caval veins and successful lysis with streptokinase.

Adult↗
PubMed1997

[Ischemia of the arm with finger necroses: differential carpal tunnel syndrome and thoracic outlet syndrome diagnosis].

Upper extremity ischemia with finger necrosis: carpal-tunnel syndrome or thoracic outlet syndrome? A 26-year-old male patient complained of pain paraesthesia in the right upper extremity while working with the arm elevated. After electrophysiological diagnosis of a carpal-tunnel-syndrome the patient received surgical treatment. Following this treatment he developed acral necrosis at the fingers. Additional diagnostic effort let to the diagnosis of a thoracic-outlet-syndrome due to a cervical rib. This case report and a review of the literature show that electrophysiological investigations alone can not differentiate the carpal-tunnel-syndrome from the thoracic-outlet-syndrome. Thus an operative release of a carpal-tunnel should not be performed until the arterial perfusion of the upper extremity has been judged.

Adult↗
PubMed1997

[Duplex ultrasound imaging of vascularization in venous thrombosis].

Vascularization of venous thrombosis. The degree of organisation of an intravenous thrombus is important for therapeutic interventions and the postthrombotic damage. Changes in echogenicity have already been described in B-mode sonography. We investigated 7 thrombosis in the jugular vein looking for intra-thrombotic vessels that occur during the organisation. In 3 thrombosis arterial vessels were found from the 12th to the 17th day. Such arterial vessels appeared only in a short range of time and only in circumscript areas of the thrombus. The intra-vitam documentation of arterial vessels in an organizating intravenous thrombus may give information about the mechanism of thrombogenesis and about the degree of organisation.

Adult↗
PubMed1997

[Crossectomy in ascending superficial thrombophlebitis of the leg veins].

Ascending thrombophlebitis of the superficial leg veins is known to propagate into the deep leg veins and to embolize. In a prospective study we followed up 44 patients with sonographically diagnosed ascending thrombophlebitis into the deep veins (V. saphena magna n = 40, V. saphena parva n = 4). In 15 of 44 cases (34%) thrombosis of the crossing veins was found intraoperatively and 6 of 44 crossings were filled with floating thrombi into the deep vein lumina (14%). Among complications of treatment (11.4%) recurrence of thrombi in the ligated superficial residual vein stump was seen in 2 of 44 cases. One of these patients suffered a symptomatic, non-fulminant pulmonary embolism. The other patient developed a femoral vein thrombosis. 1 patient had an abscess and 1 a seroma of the groin. In 11% of all cases ascending thrombophlebitis diagnosed duplex sonographically was not effective in preventing propagation of thrombi into the deep veins thromboembolism remains a complication of ascending thrombophlebitis.

Adult↗