Subclavian vein thrombosis and backpacking.
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Adult↗
Biomedical subjects
K Kröger
Publications and source records attributed to K Kröger.
Buerger's disease: What has the last decade taught us?
Thrombangiitis obliterans (TAO), or Buerger's disease, is most likely an endarteritis that is introduced by T-cell-mediated cellular immunity and B-cell-mediated humoral immunity associated with the activation of macrophages or dendritic cells in the intima. There is no specific marker of the disease, and the diagnosis is based on clinical and angiographic criteria. The disease spontaneously leads to tissue loss and major amputations and is self-limiting in the 5th to 6th decades of life. Patients should quit smoking and be offered treatment with prostaglandin or prostacyclin, modern wound management, and pain-relieving drugs. Surgical revascularization may be indicated in elective patients, and amputation should only be the last option. It has been suggested that environmental factors may play a major role in the modification of the disease process. TAO is a typical lower class disease, the social and psychological components of which are widely unexplored. Unfortunately, the last decade has not taught us anything to enable us to improve the treatment of TAO patients.
Journal Article↗
[Epidemiology of peripheral arterial disease in Germany. What is evident, what remains unclear?].
The prevalence of the peripheral arterial disease (PAD) varies with the analysed population and the screening method. The prevalence of the symptomatic PAD, derived from questionnaires, ranges from around 1% within the 50 years-old up to 5% within the 80 years-old. Due to the low specificity of such questionnaires this method has lost its relevance. In epidemiologic studies determination of the ankle/brachial index (ABI) is recommended for screening. ABI >0.9 indicates PAD. Based on the ABI the prevalence of the PAD in Germany in women aged 45-49 years is 2.3% and in men 2.6%. It increases to 10.4% and 15.2% in 70-75 years old women and men respectively. Real prevalence of PAD is assumed to be even higher, because ABI determination is biased to select people with more severe PAD and misses those with excellent collateral perfusion. Patients suffering from PAD with a chronic critical limb ischaemia (CLI) are characterised by the worst prognosis regarding limb salvage and mortality. Although the exact prevalence of CLI is unknown, it is assumed that CLI affects more than 2% of all PAD patients.
Aged↗
[Systemic and regional fibrinolytic treatment of peripheral arterial occlusions: proven indications?].
Catheter-based treatment of intraarterial thrombus can be used successfully as a treatment to recanalize acutely occluded native arteries or bypasses associated with acute limb ischaemia. It should be used if the ischaemia not already caused sensory and/or paralytic disorders that require urgent open surgical treatment. Advantages of pursuing immediate angiography in patients with acute limb ischaemia include delineation of the limb arterial anatomy with visualization of both inflow and runoff vessels and clearing intraarterial thrombus from the distal runoff vessels. Thus, final treatment can be planned electively as an intervention of open surgery. A metaanalysis comparing lysis and surgery that included three randomized trials and case series concluded that lysis improved 6 to 12 months limb salvage and reduced mortality compared with surgery. The transformation of an acute arterial occlusion into a chronic one is not clearly defined. Thus, fibrinolytic therapy can be successfully used for occlusions supposed to be older than six months.
Angiography↗
Risk factors for venous thromboembolic events in cancer patients.
BACKGROUND: Cancer patients of the Department of Internal Medicine (Cancer Research) of the Essen University Medical School (Tumor Clinics), Germany, were examined and questioned with the aim of identifying those who run a high risk of deep vein thrombosis (DVT). PATIENTS AND METHODS: Between September 2002 and April 2003, cancer therapy and DVT risk factors of 507 cancer patients (53% males, 47% females, mean age 56+/-12 years) were documented. During a mean follow-up of 8+/-5 months, 60 patients (12%) suffered from new venous thromboembolic events (VTE): 28 at the lower limb, 25 at the upper limb and 13 pulmonary embolisms. RESULTS: The following factors were considered as predictive for an increased VTE risk: inpatient treatment (P<0.0001), prior DVT in medical history (P=0.0275), DVT in family (P=0.0598), chemotherapy (P=0.0080), fever (P=0.0093) and CRP (P<0.001). After combining factors in one variable (number of factors) the predicted VTE risk increased with the number of factors in both outpatients (OR 1.85, 95% CI 1.18-2.88, P=0.0071) and inpatients (OR 2.34, 95% CI 1.63-3.36, P<or=0.0001). In the absence of all these factors the predicted VTE risk was 2.3%, increasing to 72% if all were present. CONCLUSIONS: In cancer patients the risk of VTE steadily increases with the number of risk factors, and identification of patients at high risk is possible.
Anticoagulants↗
[Frequency of decubitus ulcer in patients of a university medical center. Combination of routine documentation and cross-sectional study].
BACKGROUND AND OBJECTIVE: Pressure ulcer is a relevant issue for quality management and cost containment of hospitals. Cross-sectional studies are the typical design to estimate the frequency of pressure ulcers. The derived point prevalence rate is not as good for a case related reference value as the period prevalence rate. The interdisciplinary pressure ulcer project at the University Clinics in Essen combined a routine documentation with a cross-sectional survey, thus providing both measurements for the first time. PATIENTS AND METHODS: The routine and computer-based collection of information about pressure ulcers started in March 2003, using the patient administration system medico//s from Siemens. Findings are presented from 49,904 admissions, starting on 91/03/2004, discharged by 31/03/2004. The mean age was 48.7 +/- 22.4 years; 51.2 % were males, 48.8 % females. Additionally, a decubitus team examined patients from randomly selected wards each work-day. The real period prevalence rate was calculated using the observed period prevalence rate, the sensitivity and the point prevalence rate. RESULTS: In the routine documentation, 700 pressure ulcers had been recorded from 49,904 inpatient cases (period prevalence rate 1.4 %). The decubitus team did 5,415 examinations and 294 times detected at least one pressure ulcer (point prevalence rate 5.4 %). Estimated results in three different period prevalence rates: 3.0 % using sensitivity of the routine documentation, 3.7 % using sensitivity stratified for departments, and 2.3 % using the point prevalence rate for cases with short, medium, and long length of stay. CONCLUSIONS: The project presents for the first time reference values for pressure ulcer frequency in university clinics. A comparison with international rates is hindered by unpublished sensitivity values. In view of the higher point prevalence rate of 10 % present in the literature, a period prevalence rate of 5 % is a realistic reference value.
Academic Medical Centers↗
[Primary prevention of deep vein thrombosis in non-surgical patients].
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Anticoagulants↗
[Thrombosis associated with the Port-a-Cath system].
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Acute Disease↗
[Nodular erythema of both feet].
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Adult↗
Intra-arterial injection of dissolved flunitrazepam tablets.
Intra-arterial application of dissolved tablets is associated with a high risk of tissue necrosis. An early active vasodilatating and recanalising treatment is necessary. We present the case of 21-year-old female who applied three dissolved Flunitrazepam tablets into the ulnar artery and was successfully treated with prostaglandin E1 and recombinant tissue plasminogen activator.
Adult↗
Effect of atorvastatin and clopidogrel on cellular immune function.
Lipid lowering therapy by statins and antiaggregation have become the basis of any anti-atherosclerotic prophylaxis either as primary or secondary prophylaxis. As several recent papers indicated immunosuppressive properties of statins we investigated changes in lymphocyte subpopulations, apoptosis markers, and cellular immune response towards mitogens after a short-term therapy with atorvastatin and clopidogrel. Nine healthy volunteers (four male, five female, age ranging from 26 to 43 years) were treated with 20 mg atorvastatin for 4 weeks and for 2 additional weeks with 20 mg atorvastatin and 75 mg clopidogrel after oral consent was given. Lymphocyte subpopulations were counted by flow cytometry. To assess cellular in vitro immune function, lymphocyte transformation tests with four mitogens (PHA, ConA, PWM, and OKT3) were performed. Absolute leucocyte counts remained unchanged as well as the granulocyte, monocyte, lymphocyte, and lymphocyte subpopulation counts. There were no detectable changes in markers of cell activation (HLA-DR, CD25, CD69, and CD86) or apoptosis (CD95, annexin). Cellular in vitro responses towards four mitogens did not show significant changes after atorvastatin nor after atorvastatin plus clopidogrel treatment.In conclusion, our data show that atorvastatin is not an immunosuppressive drug under therapeutical conditions.
Adult↗
Peripheral veins: influence of gender, body mass index, age and varicose veins on cross-sectional area.
To investigate changes in the size of the deep and superficial venous systems associated with gender, age, body mass index and varicose veins, changes to the cross-sectional area of the femoral and the long saphenous veins were analysed in the Duesseldorf/Essen civil servant study population. Between December 1989 and July 1993 a total of 9935 employees were recruited; 9261 were then evaluated for this analysis. Diameters of the long saphenous and femoral veins were determined 2-3 cm distal to the confluence in lying (after 15 min rest) and standing (after 5 min) positions. Cross-sectional areas (CSA) were calculated. A total of 63% of all people were assigned to CEAP (clinical, etiological, anatomical pathophysiological) class 0, 27% to class 1, 8.5% to class 2, while 1.5% belonged to higher CEAP classes. In people without varicose veins (CEAP class 0) the CSA of the femoral and long saphenous veins were smaller in females than in males. In people with a normal body mass index (BMI) (20-25) the mean CSA of the femoral and long saphenous veins in a standing position was similar from the third up to the sixth decade of life. The volume increase due to a standing position expressed as the absolute increase in CSA of the femoral and long saphenous veins was not age-related, either. The relative volume increase expressed as a ratio remained unchanged with age. There was a strong relationship between the CSA of both veins and increasing BMI. In a lying position, the CSA of the femoral and long saphenous veins increased only slightly with increasing CEAP classes. In a standing position, the CSA of both veins increased even in CEAP class 1 (p < 0.001). In a stepwise multivariate regression analysis, the CSA of both veins in a standing position was not age-related but associated with BMI, CEAP classes and gender. The absolute increase in CSA was influenced by all four variables, but BMI and gender were most important. In Conclusion, this study shows that aging is not necessarily associated with an increase in venous CSA of the deep and superficial venous system. BMI is the most important determinant for an increase in CSA in standing position. Varicosity of the superficial venous system is always associated with similar changes in the deep venous system.
Adult↗
Klippel-Trenaunay syndrome and pregnancy.
General recommendations on how to deal with pregnancy in patients with Klippel-Trenaunay syndrome (KTS) are rare. We describe the case of a 32-year-old female with KTS, involving the head and the left arm and leg, delivering a healthy female child, and are reviewing the recent literature. The risk to deliver an ill child is low in women with KTS. At the end of the 1st trimester a sonographic investigation can exclude angiodysplastic alterations of the fetus. If the fetus shows changes compatible with KTS, a termination can be discussed because the risk of fatal complications after delivery is high. During pregnancy the careful monitoring of coagulopathic disorders is necessary. Prior to delivery an MR-scan may be useful to detect angiodysplastic vascular structures next to the spinal cord, pelvic structures or the lower abdominal wall, which might complicate peridural anesthesia or caesarean section.
Adult↗
Follow-up after Port-a-cath-induced thrombosis.
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Catheters, Indwelling↗
Epitope-mapping of transglutaminase with parallel label-free optical detection.
The gastrointestinal disorder coeliac disease (CD) is induced by the ingestion of wheat gluten and is characterized by damage of the typical structure of the intestinal mucosa. The enzyme tissue transglutaminase (tTGase) was identified as the major target of disease-specific antibodies in-patients. We performed an epitope fine-mapping with a series of pentadecapeptides synthesized using parallel multiple peptide synthesis. For the detection of biomolecular interactions a label-free parallel method, reflectometric interference spectroscopy (RIfS), was used. This is the first optical label-free method adapted to a high throughput screening (HTS) format and the experimental results demonstrate its applicability as a biological screening device. A high titer of anti-tTGase antibodies is found in the serum of coeliac patients. We have taken the first step towards a fast non-surgical test for the detection of these antibodies. In order to identify and characterize a continuous epitope with high affinity against the anti-tTGase antibody a screening of 21 pentadecapeptides has been accomplished with the parallel RIfS system. A single channel RIfS-system with high resolution was used to determine binding constants of identified peptides with high affinity.
Animals↗
Recurrent exercise induced subclavian vein thrombosis in a conductor.
We present a case of a young male patient with recurrent subclavian vein thrombosis due to conducting after prior successful thrombolytic therapy. Musculoskeletal problems are common among musicians. A thoracic outlet syndrome associated to a profession induced thrombosis in a musician has not been described before. Surgical removal of the first rip can prevent recurrent thrombotic occlusion of the subclavian vein, but was not performed in this patient. Considering the specific situation of a young musician there is no information whether surgical or conservative treatment is suitable to allow a successful career as an active musician.
Adult↗
Value of transesophageal echocardiography, esophago-gastroduodenoscopy and retinoscopy prior to intra-arterial fibrinolytic therapy in patients with peripheral arterial disease.
BACKGROUND: We prospectively investigated the need for esophagogastroduodenoscopy (EGD), transesophageal echocardiography (TEE) and retinoscopy for pre-interventional screening in patients with peripheral arterial occlusive disease (PAD) prior to intraarterial fibrinolytic therapy. PATIENTS AND METHODS: 212 consecutive patients suffering from PAD (164 male and 48 female, mean age: 64 +/- 11 years, 161 patients stage II of Fontaine's classification, 10 patients at stage III and 41 patients at stage IV) referred for interventional treatment were included. 173 EGDs, 169 TEEs and 188 retinoscopies were performed within one week prior to fibrinolysis. 114 patients had all three examinations. RESULTS: Pathologic findings were detected in 56 (49%) of the 114 patients: 23 erosions, 12 ulcers, 2 esophagites, 1 gastric carcinomata, 3 intracardiac thrombi, 5 aortic thrombi, 11 diabetic and 5 hypertensive retinopathies and 1 with retinal aneurysms. 30 patients (25%) received fibrinolytic therapy, despite a contraindication: The one patient with ventricular thrombus was treated as an ultimate therapy, and amputation was prevented. Two patients showing plaques covered by large thrombi in the descending thoracic aorta were treated because cranial embolism should not occur. Four diabetic patients with multilevel disease, severe claudication and prior retinal bleeding were treated. Fibrinolytic therapy was started on 23 patients after complete healing of the mucosal lesions. CONCLUSION: TEE revealed potential sources of embolization in 4% of the patients and is justified to reduce the individual risk. Retinoscopy should be done in patients with diabetes mellitus and hypertension, and if prior bleeding is present fibrinolysis should be done only if other treatment-regimes are not available.
Aged↗
Thrombophlebitis associated with intravenous injection anaesthetics: influence of arm positioning.
BACKGROUND: Thrombophlebitis (TP) is a frequent complication of the intravenous application of injection anaesthetics. We investigated the influence of different arm positions on the incidence of such a complication in patients undergoing shoulder arthroscopy. PATIENTS AND METHODS: This prospective, randomised study was done in 86 consecutive major shoulder arthroscopies. In order to evaluate the influence of different arm positions, the arm not operated on was positioned either cranial (n = 31) or caudal (n = 55) to the level of the right atrium. The number of TP in the 5 days following the arthroscopy was detected clinically and proven by ultrasound studies. RESULTS: 8 TP occurred in the group of patients with caudal arm positioning and none in the other group. Statistically, the incidence of TP was not associated with the weight or the height of the patients nor with the duration of the anaesthesia or the doses of anaesthetics used in each patient (p < 0.05). CONCLUSION: An elevated position of the arm used for anaesthesia during shoulder arthroscopy is suggested in order to prevent TP.
Adult↗