Biomedical subjects
Publications and source records attributed to V Puchmayer.
The question is: What is angiology? It is the branch of medical science studying blood and lymph vessels and their disorders. With the development of techniques, diagnostic and therapeutic methods and with the increasing morbidity and mortality on vascular diseases angiology became in the last decades an important specialization of medicine.
Some authors still doubt that the Buerger's disease is an independent disease entity and differs principally from obliterating atherosclerosis. This is why the author draws attention to many specific characteristics of this disease and differences which distinguish it from atherosclerosis of peripheral arteries. After some introductory notes the author presents that the prevalence of thrombangiitis in Europe ranges from 0.5 to 2% out of all ischemic diseases of limbs, while in Japan it reaches 20-30%. Previously the ratio of affliction of men and women was 100:1; presently some authors present the ratio being 10:1. The upper limbs are usually afflicted by this disease much more often than by obliterating atherosclerosis, and frequently already at the beginning of the disease. The main and only proved risk factor is smoking. However a predisposition is necessary (the predisposition is more frequent in the yellow race). The Buerger's disease is an autoimmune disease responding to the antigen-antibody complex. Laboratory results are positive in coincidence with inflammatory markers, especially in recurrent cases. Histology appoints to inflammatory vascular lesions, sometimes accompanied by a positive finding of IgG deposits, IgM, and immunocomplexes. Clinically, particularly peripheral vessels are afflicted, the disease is initiated usually before 40 years of age and is of a typical arteriographic pattern. It is also characteristic for its migrating phlebitis. The clinical picture has some specific features. The disease can be localized also in the coronary, cerebral and visceral arteries. Besides the general procedures in ischemic diseases of the limbs, the therapy must necessarily, respect also some particulars, as e.g. antiinflammatory therapy (antibiotics, antirheumatics, corticoids) and some specific surgical procedures. (Ref. 75.)
The author reviews contemporary knowledge of the pathogenesis of ischaemia of the lower extremities. As to therapeutic provision which influence in a favourable way pathological processes associated with the development of ischaemia an important place is held by pentoxiphylline (Trental) which reduces the pathologically raised adhesiveness and activity of leucocytes causing an excessive immune response; it reduces the viscosity of blood and procoagulation activity.
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Midodrine, marketed as Gutron by Hafslund Nycomed, was given at a dose of 2.5 mg three times daily always half an hour after the main meal for a period of 84 days to 8 women in the age of 25.42 years--average 34.5 yrs--and BMI of 19.8. These women with a blood pressure value below 100/60 mmHg most of the time displayed signs of neuroticism but had no organic and neurologic lesion. Clinical internal examination, Jarmatz-de Marée test, ECG-supine, standing, Holter dynamic ECG, ergometry, arterial and venous plethysmography, Doppler distal pressures-supine, standing, clinical neurological examination, EEG, perfusion brain tomography-supine, standing, urine examination--chemically and microscopically--, blood count, Na, K, Cl, glucose, urea, creatinine, uric acid, bilirubin, gamma-GT, alk. phosphatase, LDH, ALT, AST, thrombocyte index and the count of desquamated endothelia in blood before and after the end of 84-days Gutron therapy were carried out. It was ascertained that: (1) Gutron had no side effects; the marked subjective improvement reported by all patients persisted for months after the end of therapy. (2) No changes in biochemical parameters, ECG, Holter ECG monitoring, pulse rate, Doppler index and EEG were found. (3) Gutron did not raise the tendency to platelet aggregation and had no toxic effect on the vascular endothelium as demonstrated by unchanged thrombocyte index and endothelaemia. (4) Gutron administration was associated with a significant rise in upright diastolic pressure, especially when standing for prolonged periods--Jarmatz-de Marée test.(ABSTRACT TRUNCATED AT 250 WORDS)
We described a case of the malign course of the abdominal aorta bifurcation in a 75-year old woman with the case history of a successfully removed neurinom of the eleventh thoracic root on the left side. Despite a timely diagnosis with the recurrence of a spinal tumor being ruled out and followed by the streptokinase therapy, the course of the disease was lethal. Another six lethal cases of the thrombosis of the abdominal aorta studied retrospectively proved the necessity to improve both the diagnostics and the therapy of this disease. The possibilities of modern angiosurgery are, however, being put to very little use. In our opinion, it is better to use the term Lerich's syndrome to describe the chronic closure of the abdominal aorta bifurcation in men. In all other cases we recommend to use the descriptive term of the complete closure of the distal abdominal aorta. The complete thrombosis of the terminal abdominal aorta is not a very rare disease since it was found four times out of the total number of 4,746 dissections carried out in the period of five years (1986-1990). Reference is being made to the dissection materials of the 2nd Institute of Pathology and Anatomy of the 1st Medical Faculty of Charles University, Prague.
The author draws attention to the important position of different types of rehabilitation in the treatment of arterial, venous and lymphatic diseases. He mentions also different methodical procedures in the listed diseases. He emphasizes that rehabilitation, in particular intensive interval training, remains the main therapy of ischaemic disease of the lower extremities.
The authors examined the relationship between the ankle pressure, or pressure gradient on the one hand, and the walking distance and different actions, i.e. equalting and standing on tip toes, on the other hand. In 56 male patients with obliterating atherosclerosis, the first stage showed both pressure parameters as closely correlated to the final claudication distance, but not to the actions indicated above. At the second stage, 62 persons showed both the initial and final claudication distances as dependent on the poststenotic pressure as well as on the pressure gradient. Stepwise regression analysis showed a significant dependence of both distances on the lowest pressure measured on four crural arteries. The closest correlation [R = 0.98] was found between the initial and final claudication distances which persisted even after elimination of all pressure parameters.
The authors investigated the importance of ankle pressure indices (aPi), peroperative blood flow and angiographic findings on peripheral arteries for the long-term patency of F-P venous bypasses. They found that neither the preoperative value of aPi nor the size of the peroperative flow through the bypass has an impact on the long-term patency of the reconstruction. As a result of general factors which lead to progression of the atherothrombosis in the arterial circulation in the implanted bypass, obstructions of the reconstruction occur even in patients with high preoperative aPi values and with a major preoperative flow, with patent peripheral arteries at the time of operation. To improve long-term results after implantation of F-P venous bypasses therefore above all prevention of the progression of atherosclerosis is essential.
In 284 patients after angioplasty of the aortoiliac vessels postoperative angiography discovered complications in 63 cases (22%), most frequently in case of prostheses at the bifurcation. Late thrombosis was the prime complication. In 221 patients with reconstructions in the femoropopliteal region complications were found in 24.5% of the cases, most frequently in case of venous bypass (29%). As in the first group, late thrombosis prevailed.
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There was examined a total of 982 males with arterial occlusive disease (908 males with atherosclerosis obliterans, 59 with thromboangitis obliterans and 15 males with this disease of uncertain aetiology), 30 females with atherosclerosis obliterans, 411 control males and 50 control females. Among the controls there were significantly more frequently non-smokers and occasional smokers (the latter, however, having atherosclerosis obliterans--with the exception of females, and males having thromboangitis obliterans). In the complex of occlusive disease there were, on the other hand, more frequently present regular smokers smoking 31-40 years (in thromboangiitics for a period up to 10 years), smoking proportionally throughout the day and having their starting age of smoking before their 20th year of life. In the group of the arterial occlusive disease there was also a significantly higher number of those who discontinued smoking for 1-2 years in their life, while in the control group there were chiefly males who had discontinued smoking for a period longer than 5 years. Among stop-smokers there occurred significantly more frequently patients having only occlusions and significantly less frequently those having both occlusions and stenoses. There were no significant differences between the group with a pathological arterial process and the control one in the prevalence of cigar smokers or in the existence of their different smoking habits. The situation was similar also with pipe smokers with one exception: in the occlusive disease and/or atherosclerosis obliterans there were found more frequently mixed smokers of more than one package of tobacco weekly, smoking 31-40 years, namely proportionally throughout the day. As significant there proved to be chiefly cigarette smoking, and that in the amount over 16 cigarettes a day. As critical was found to be the period of exposition of 31-40 years. But when the relationship between the average daily number of cigarettes smoked and the total duration of smoking was compared, there was found in males with atherosclerosis obliterans as significant the smoking of already 11-15 cigarettes a day for a period of 31-40 years. With the rising number of cigarettes smoked per day there was getting shorter the critical period of exposition. Of importance is likewise the starting age of cigarette smoking before the 20th year of life and the proportional time distribution of smoking in the course of the whole day. In the complex of the arterial occlusive disease there were significantly more "rapid" smokers, i.e. those smoking their cigarette within a time up to 6 minutes and, further, those in whom, 5-8 years prior to the onse
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