[The postoperative swollen leg: use for color-coded duplex ultrasound].
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Biomedical subjects
Publications and source records attributed to H Rabl.
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A sudden onset of unilateral swelling and tenderness on pressure of the calf with no history of trauma is suggestive of vein thrombosis. Baker cysts, especially if ruptured, mimic the clinical picture of deep vein leg thrombosis. The examination method of choice is duplex sonography. We report on a 30-year-old man who was admitted to our hospital with signs of deep vein leg thrombosis. Phlebography revealed normal venous circulation. Examination by duplex sonography showed a ruptured Baker cyst. No intra-articular lesions of the knee joint were revealed by arthroscopy. Histological examination of the biopsy specimens of the synovia showed no specific pathologic condition. The clinical signs improved with conservative treatment.
Plasma levels of neopterin were determined in patients with different clinical stages of atherosclerosis. Non-hospitalized patients with atherosclerosis had serum and plasma neopterin levels within the normal range of the assay (6 +/- 2 nM). These values were not significantly different from those reported for healthy blood donors (5 +/- 2 nM). In contrast, about 50% (29 out of 61) of hospitalized patients undergoing conservative or surgical therapy had neopterin plasma levels, which exceeded the normal range (greater than 10 nM) up to 10-fold. The two groups differ on a significance level of P less than 0.01. For further evaluation hospitalized patients were subgrouped according to neopterin levels. In the subgroup with elevated neopterin levels patients with higher Frederickson types of atherosclerosis were overrepresented compared to patients with normal neopterin levels. Type 4 differed significantly from patients without pathological changes of lipoprotein (P less than 0.05). Only 3 patients suffered from minimal skin necrosis, two of them had elevated neopterin levels. Significantly more patients with peripheral artery occlusions had elevated neopterin levels than patients with occlusions of central arteries (P less than 0.05). All other criteria used for comparison (sex, age, smoking, antioxidant status, diabetes, hypertension, adipositas, hyperuricemia) did not vary significantly in both subgroups. These data indicate that neopterin plasma levels might be a valuable parameter in activity staging and therapeutic follow up of atherosclerotic patients. Additionally, an involvement of the nonspecific immune system in atherogenesis is suggested by the increased plasma neopterin concentrations.
Cystic adventitial disease is a rare condition resulting in arterial occlusive symptoms. The characteristic clinical and angiographic findings suggest the diagnosis cystic adventitial disease. The presented case shows, that sonography can demonstrate the adventitial cyst and the resulting stenosis and confirm the diagnosis.
Human low density lipoprotein (LDL) with a molecular mass of 2.5 million contains on average 1300 molecules of polyunsaturated fatty acids (PUFAs) bound in the different lipid classes. The predominant antioxidant in LDL is alpha-tocopherol, with an average of 6 molecules in each LDL particle. The other substances with potential antioxidant activity are: gamma-tocopherol, beta-carotene, alpha-carotene, lycopene, cryptoxanthin, cantaxanthin, phytofluene and ubiquinol-10. Each is present in amounts of only 1/20th to 1/300th of that of alpha-tocopherol. If LDL is exposed to oxidative conditions (Cu++ ions, macrophages) a lag phase precedes the oxidation of PUFAs. During the lag phase the antioxidants disappear with alpha-tocopherol the first to go and beta-carotene the last. The lag phase, which can readily be determined, is an index of the oxidation resistance of LDL. If LDL is loaded with vitamin E in vitro its oxidation resistance increases linearly with its alpha-tocopherol content according to the equation, y = kx+a. The same relationship is applicable if the alpha-tocopherol content of LDL is increased by taking oral vitamin E. Daily doses of 150, 225, 800 and 1200 IU RRR-alpha-tocopherol increased the LDL alpha-tocopherol on average to 138%, 158%, 144% and 215% of the initial value, the oxidation resistance being increased to 118%, 156%, 135% and 175%, respectively. The efficiency of vitamin E-dependent (= k) and the vitamin independent (= a) oxidation resistance seem to be subject specific with strong individual variation.(ABSTRACT TRUNCATED AT 250 WORDS)
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The established surgical procedure in the treatment of mammary cancer today is, without any doubt the modified radical mastectomy (Patey, Dyson). The adjuvant radiation therapy, following modified radical mastectomy, could not improve the all over survival of mammary cancer patients. Within the last years the breast conserving surgical procedures went more and more into the field of interest, especially of the patients. That is the reason, why these treatment-schedules should be considered very carefully according to thorough oncological principles. The radiation therapy within the conserving treatment is necessary as primary treatment in addition to surgery.
The authors report a case of fatal Candida septicaemia in a seven year-old female patient who had been undergoing cytostatic therapy for the previous four years for acute lymphoblastic leukaemia. The condition was histologically identified by means of special staining methods and immunocytochemistry. Since secondary mycoses--like in the present case--are frequently missed clinically, this report serves to emphasize their great importance.
The objective of this study was to evaluate the antioxidative properties of the multivitamin cocktail Omnibionta (alpha-tocopherol, ascorbic acid, retinol, vitamin B complex) in terms of diminishing lipid peroxidation with improvement of leg edema performance after limb revascularization operations in humans. Fifty-one subjects were selected; the control group contained 27 patients and the treatment group 24 patients, who received the vitamin cocktail intravenously before the start of reperfusion. All patients suffered from acute or chronic arterial occlusive disease, except two subjects with arterial trauma. MDA-TBARS in plasma, quantified by HPLC, taken as a measure of lipid peroxidation was significantly increased (p < 0.001) in the control group 1 hour after reperfusion onset and decreased to its baseline value within the following 2 hours (0.73 +/- 0.26, 1.21 +/- 0.48, 0.99 +/- 0.48, 0.73 +/- 0.33 nmol/ml). In contrast, in the treatment group MDA-TBARS did not exceed the baseline value during the reperfusion period (0.93 +/- 0.30, 0.70 +/- 0.29, 0.65 +/- 0.23, 0.70 +/- 0.37 nmol/ml). Leg edema, expressed by extremity circumference, was significantly (p < 0.008) elevated in the control group (30.7 +/- 4.04 cm versus 35.35 +/- 4.12 cm) compared to a lack of increase in the treatment group (29.25 +/- 5.13 cm versus 29.76 +/- 5.70 cm). These results suggest that antioxidative vitamin treatment might be valuable in preventing lipid peroxidation and decreasing extremity edema.
Experience with 46 patients diagnosed with liver abscesses over a 13-year period was reviewed to ascertain the impact of percutaneous versus surgical drainage. In most of the cases the abscesses were diagnosed by sonography or computed tomography. The most common pathogenetic mechanism was ascending biliary tract infection. Of the 46 total patients, 27 were primarily treated surgically, whereas 19 underwent percutaneous drainage. In the surgical group five (18.5%) patients required reoperation. Percutaneous drainage failed in four patients (21.1%). Multivariate stepwise logistic regression analysis revealed that a high APACHE II score, low hemoglobin level, and high serum bilirubin level were significant predictors of a complicated clinical course. Death was related more closely to the overall condition of the patient, as expressed by a high APACHE II score, and the underlying disease (malignancy) than to the mode of therapy.
A 26-year-old man with acute deterioration of recurrent abdominal pain was admitted to the hospital. Plain film (abdominal radiographs), spiral computed tomography (CT), and barium contrast studies were performed. A left paraduodenal hernia causing acute jejunal obstruction was identified on upper gastrointestinal barium studies and spiral CT. Pre- and postsurgery examinations were compared, and relevant radiological findings were identified. Spiral CT provided excellent visualization of the pathognomonic displacement of the inferior mesenteric vein.