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Biomedical subjects

H Partsch

Publications and source records attributed to H Partsch.

At least 19 recordsLinked to original sources
PubMed1994

[Artificial edema of the extremity].

Our report describes a 46-year-old woman with self-inflicted oedema of the left leg and the left arm. She induced leg oedema by an elastic bandage tourniquet and arm oedema by holding her arm dependent and immobile. A preexisting disorder of the affected leg (postthrombotic syndrome) and of the affected arm (hypoesthesia subsequent to surgical injury of the plexus brachialis) delayed the diagnostic proceedings. Our case report shows that: Confirmed presence of organic disease does not exclude limb oedema of self-inflicted origin. Oedema resulting from a tourniquet and "hysterical oedema" can be developed by one and the same patient. Effective care of such patients is only possible if dermatologist and psychiatrist work together all the time (liaison psychiatry).

Diagnosis, Differential↗
PubMed1994

[The Bier block].

Explore the source record for details and available documents.

Anesthetics, Local↗
PubMed1994

[Tobacco and the skin].

Various skin changes are undoubtedly caused or at least promoted by smoking. The present literature seems to concentrate mainly on active cigarette smokers, rather than on other kinds of nicotine consumption or on the effects of passive smoking. Unquestionable sequelae of cigarette smoking are the occurrence of yellow fingers, enhanced wrinkling especially in the faces of females, precancerous lesions and squamous cell carcinomas on lips and oral mucosa, vasospasms and obliterations of large arteries as well as of small skin vessels. The toxicomania is often associated with other addictions as e.g. alcoholism. The main emphasis in medical care of our population should lie in facilitating smoking cessation as well as in an effective prevention.

Carcinoma, Squamous Cell↗
PubMed1994

[Involvement of the lymphatic system in post-thrombotic syndrome].

The involvement of the lymphatic drainage in patients with postthrombotic syndrome can be verified by (quantitative) isotopic lymphography (99m Tc labelled microcolloids) and by indirect lymphography (water-soluble contrast medium Iotrolan). Both methods point to an augmented praefascial lymph-transport. In the region of lipodermatosclerotic skin changes dermal backflow can be explained by a local damage of peripheral skin-lymphatics ("localized lymphoedema"). No working lymphatics can be found in the border of ulcers. As could be demonstrated by intramuscular injection of the radioactive tracer subfascial lymphtransport is decreased not only in the postthrombotic stage but already in the acute phase of a deep vein thrombosis. The alterations of the lymph-drainage in a postthrombotic syndrome may have some pathophysiological importance for the development of the tissue changes and may also explain some clinical signs.

Humans↗
PubMed1994

[Clinical features in post-thrombotic syndrome].

Signs which follow deep vein thrombosis and which develop as a feature of deep venous insufficiency caused by incomplete recanalization and of destruction of valves and endothelium are defined as a postthrombotic syndrome. The clinical symptoms range between no objective signs, severe oedema and ulceration. They depend on the amount of valvular and endothelial damage during the acute phase, localization of the deep vein thrombosis and on several other factors outside the venous macrocirculation which are poorly understood until now.

Acrodermatitis↗
PubMed1994

[From thrombosis to post-thrombotic syndrome--plethysmography studies of venous function].

46 patients with deep vein thrombosis have been investigated by strain gauge plethysmography and by foot-volumetry in the acute state, after 4 weeks, and after every year up to 5 years. The primary therapy consisted in anticoagulation, compression-bandages and walking exercises. Venous drainage measured by venous occlusion plethysmography showed in average a normalisation after one year, while expelled volume as a parameter for the venous pumping function (assessed by foot-volumetry) remained in the pathological range. Since the clinical outcome--ulceration in 6.5%, lipodermatosclerosis in 15% and no major signs in 78%--does not correspond to these functional findings it is concluded that venous refluxes which are the main cause for the impeded pumping function lead to skin changes only in specially predisposed cases.

Adult↗
PubMed1994

[Compression stockings in treatment of lower leg venous ulcer].

AIM: of the study was to evaluate the efficiency of medical compression stockings, which do not require special application techniques, compared with short stretch bandages for treating leg-ulcers. STUDY-DESIGN AND PATIENTS: Prospective trial on a total of 50 out-patients with leg-ulcers randomly allocated into two therapy-groups: 25 patients got firm compression bandages using short stretch material (Rosidal K), 25 patients were treated by medical compression stockings (Thrombo+Sigvaris 503). Due to the statistically significantly lower mean age and longer duration of the ulcers in the Sigvaris-group only restricted comparison of the treatment groups is possible. Local dressings in both groups consisted of a nonadherent, absorbing material (Vliwin) with an individually modelled rubber foam pad on top. The end-point was complete ulcer-healing, in a period of 3 months. METHODS: The following parameters were measured: area of ulceration, compression-pressure, tcPO2 and Laser-Doppler-Fluxmetry at the ulcer border before and after 3 minutes of arterial occlusion, venous volume and venous filling index by air plethysmography (APG) with and without compression. RESULTS: After 3 months 21 cases (84%) were healed in the Sigvaris-group and 13 (52)% in the Rosidal-group. This significant difference may be partly explained by the more favorable starting condition of the stocking-patients. However, one major advantage of stockings over short stretch bandages is the maintenance of an adequate pressure if they are not renewed for several days. CONCLUSION: Therapy of venous ulcers by medical compression stockings may be an effective approach for fit and cooperative patients.

Adult↗
PubMed1994

[Varicose ulcer: healing in conservative therapy. A prospective study].

In a prospective study 105 consecutive patients with leg ulcers were recruited (causes: 77% venous, 4% arterial, 9.5% mixed, 9.5% other). 70 (67%) had a history of previous ulceration. 83 patients could be followed for 1 year. The healing rate for the whole group was 41 (49%) after 3 months and 61 (73%) after 1 year. The corresponding figures for the 67 venous patients are 44 (66%) and 52 (78%) respectively. From 61 healed ulcers 18 (30%) reoccurred during the 1st year. At the primary examination several factors were investigated which might have influenced the healing rate. Age, ulcer-size, the duration of the ulcer, lateral localization, absence of foot-pulses and lymphoedematous skin changes on the forefoot could be shown to have negative influence on healing.

Adult↗
PubMed1993

Postocclusive reactive hyperemia and postural vasoconstriction in different kinds of leg ulcers--investigations with laser Doppler.

Laser-Doppler fluxmetry was performed in 42 patients with leg ulcers (18 venous, 8 arterial, 12 diabetic-arteriolar and 4 mixed arterio-venous) and in 9 healthy controls. Using a bipolar probe measurement was carried out at the ulcer border and on the dorsum of the foot in the supine and in the sitting position. Reactive hyperemia after three minute arterial occlusion was produced in both body-positions. In every ulcer-group resting and peak fluxes showed a statistically significant increase in the ulcer region as compared to normal skin of the lower leg in the control group, the quotient between peak and resting flux ("reactive hyperemia index" RHI) being significantly lower. The RHI values for four ulcer-patients with a dramatic deterioration worsening eight months later were close to one, while the unchanged and improved cases showed median values above 1,2. Sitting up was followed by a decrease of flux in all ulcer-groups as well as in the control group. On the dorsum of the foot there was an increase of the laser Doppler flux in patients with arterial occlusive disease, i.e. in the group with arterial and mixed ulcers. This study shows that the kind of microcirculatory flow damage is not different in various causes of ulcerations. The reduced reactive hyperemic response compared to the increased resting fluxes (amount of RHI-decrease) might be a useful predictor for healing or non-healing of the ulcer.

Adult↗
PubMed1993

[Retrograde intravenous perfusion: technique and different variants].

A retrograde intravenous infusion into an arterially occluded segment of an extremity is the most effective method to achieve maximal tissue concentrations of a drug. By application of contrast-medium it was shown that the injected fluid penetrates in retrograde direction into the foot inspite of primarily intact valves. Favourable clinical results were obtained with antibiotics in infected gangrene of the feet in diabetics and with urokinase in resistant leg ulcers.

Anesthetics↗
PubMed1993

[Urokinase in refractory lower leg ulcers: therapy with retrograde intravenous pressure infusion].

20 patients with large, resistant leg ulcers were treated by retrograde local intravenous pressure infusions containing 100,000 to 200,000 I.U. of urokinase 3 times per week for a total of up to 12 weeks. Laser-Doppler flowmetry and transcutaneous oxygen measurement at the ulcer borders showed highly pathological findings before therapy demonstrating a severe disturbance of local microcirculation in every case. After therapy the clinical condition was markedly improved in 17 cases. There was an increase of Laser-Doppler indices (peak flux/resting flux) and of tc pO2 and a statistically significant decrease of plasma viscosity and of plasma fibrinogen. The beneficial effects may be explained by fibrinolysis of intra- and extracapillary fibrin and by hemodynamic changes caused by repeated limb occlusions.

Aged↗
PubMed1993

[Nuclear medicine studies of tissue concentration and hemodynamic effects of retrograde intravenous pressure infusions].

In 12 patients with trophic foot-lesions (diabetic feet) retrograde intravenous pressure infusions (150 ml) containing radioactive tracers (99m Tc, 99m Tc labelled human serum albumin) were carried out. With the veins emptied time-activity curves over the legs reflect tissue concentrations after release of the occlusion. Tissue-concentration is about 3 times higher than after intraarterial and 7 times higher than after intravenous injection of the same dose. The high count-rates which can be measured in the wound-secretion demonstrate the "rinsing effect" of the injected fluid. Hemodynamic investigations have been performed in a double blind study. 8 patients received buflomedil and 9 got placebo 3 times per week by retrograde intravenous pressure infusions. After 3 weeks there was an increase of the peak-flow on the lower leg (venous occlusion plethysmography), an increase of transcutaneous oxygen pressure and a fall of peak flow-time and of plasma-viscosity, both for buflomedil and for placebo (without statistical significance). Preliminary investigations after an arterial occlusion for 1 hour showed an increase of flow-values measured by venous occlusion plethysmography which reached a maximum after 4 to 5 days.

Aged↗
PubMed1992

Frequency of pulmonary embolism in ambulant patients with pelvic vein thrombosis: a prospective study.

One hundred thirty-nine consecutive patients (average age 70.1 years) who were able to walk with a swollen leg were seen at the clinic where diagnosis of acute deep vein thrombosis (DVT) extending to the pelvis was confirmed by injecting microspheres labeled with technetium 99m into the dorsal foot vein (radionuclide venography). Thirty-nine (28%) of these patients had malignant disease. Perfusion lung scans performed immediately after radionuclide venography were supplemented by inhalation scans (99mTc-labeled diethylenetriamine pentaacetic acid aerosol) in case of perfusion defects. During scintigraphy patterns highly indicative of pulmonary embolism (PE) were found in 80 patients (58%), but only 11 (7.9%) had minor clinical symptoms. All patients were admitted to the ward, were given standard heparin subcutaneously (35,000 to 40,000 units/24 hr) and firm bandages, and were encouraged to walk. After 11 days pulmonary scintigraphy was repeated and revealed no change in 55 of 59 patients without PE and in 40 of 80 patients with PE. Thirty-three patients (23.7%) showed regression of perfusion defects. New PE developed in 11 patients (7.9%, four without and seven with previous PE). Autopsy revealed that one 80-year-old patient with prostatic carcinoma had died of massive PE. When comparing this frequency of newly developed PE during ambulation with the occurrence of PE after bed rest, according to the literature, it is no more dangerous for a mobile patient with proximal DVT to walk wearing a firm bandage than it is for the patient to be in bed. Therefore we recommend treating mobile patients with DVT by use of anticoagulation and firm compression bandages and without immobilization.

Adolescent↗
PubMed1991

Compression therapy of the legs. A review.

Compression therapy is a powerful method for the treatment of all sorts of swollen extremities. Its effects depend on several factors, including: underlying disease, exerted pressure and body position, and compression material.

Bandages↗