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Biomedical subjects

W Blättler

Publications and source records attributed to W Blättler.

At least 19 recordsLinked to original sources
PubMed1999

Relief of obstructive pelvic venous symptoms with endoluminal stenting.

PURPOSE: To select patients for percutaneous transluminal stenting of chronic postthrombotic pelvic venous obstructions (CPPVO), we evaluated the clinical symptoms in a cohort of candidates and in a series of successfully treated patients. METHODS: The symptoms of 42 patients (39 women) with CPPVO (38 left iliac; average history, 18 years) were recorded, and the venous anatomy was studied by means of duplex scanning, subtraction venography, and computed tomography or magnetic resonance imaging. Successfully stented patients were controlled by means of duplex scanning and assessment of symptoms. RESULTS: The typical symptoms of CPPVO were reported spontaneously by 24% of patients and uncovered by means of a targeted interview in an additional 47%. Of 42 patients, 15 had venous claudication, four had neurogenic claudication (caused by dilated veins in the spinal canal that arise from the collateral circulation), and 11 had both symptoms. Twelve patients had no specific symptoms. Placement of a stent was found to be technically feasible in 25 patients (60%), was attempted in 14 patients, and was primarily successful in 12 patients. One stent occluded within the first week. All other stents were fully patent after a mean of 15 months (range, 1 to 43 months). Satisfaction was high in the patients who had the typical symptoms, but low in those who lacked them. CONCLUSION: Venous claudication and neurogenic claudication caused by venous collaterals in the spinal canal are typical clinical features of CPPVO. We recommend searching for these symptoms, because recanalization by means of stenting is often feasible and rewarding.

Adult↗
PubMed1999

[Aspects of cost effectiveness in therapy of acute leg/pelvic vein thrombosis].

Out-patient or home treatment of acute proximal deep venous thrombosis (DVT) has not made its way yet. In this article, we review the data published on this form of management with regard to effectiveness and costs. We find that more than 80% of patients with DVT need not be admitted to the hospital and that the rate of secondary hospitalization is < 2%. Home treatment requires professional assistance in 15 to 74% of cases, while out-patient management with elastic leg compression and deliberate ambulation goes completely without it. The effect on objectivity assessed clinical symptoms, absence from work and patients' acceptance is significantly better and the costs are 2.5- to 3.2-fold lower with home or outpatient treatment than with treatment in the hospital. However, we found outpatient treatment associated with a reduced general well-being resulting from a probably frightening information which mentioned the possibility of experiencing an eventually fatal pulmonary embolism despite treatment. Management with deliberate ambulation in compression hosiery lead to a slower relief of subjective leg symptoms than initial immobilisation. We conclude that outpatient treatment of DVT is highly cost-effective. The problems still encountered are of a psychological nature and also have to do with treatment by leg compression and ambulation. These measures have to be optimized.

Acute Disease↗
PubMed1998

[Comparison of ambulatory and inpatient treatment of acute deep venous thrombosis of the leg: subjective and economic aspects].

The frequency of clinical recurrence and pulmonary embolism in patients with acute deep venous thrombosis is reduced to the same extent by hospital treatment (with unfractionated heparin) as by treatment at home (with low-molecular-weight heparin). Very few data on subjective parameters of effectiveness have been published. We performed a prospective randomized trial comparing outpatient with in-hospital treatment in 28 patients. Six clinical and quality-of-life related parameters of effectiveness were assessed quantitatively: clinical course (with a score system), pain of venous congestion of the calf muscles (with Lowenberg's test), subjective perception of pain and general well-being (with visual analogue scales), satisfaction with the care provided, and absence from work. Subjective effectiveness was compared with the costs of each form of treatment. Outpatient treatment was significantly more effective than in-hospital treatment with regard to the objective parameters. It was, however, associated with less well-being and more pain than in-hospital treatment. The discrepancy is explained by eventually insufficient adjuvant treatment measures (which consisted of external leg compression by stockings and forced walking) and by anxiety brought on by the information that potentially lethal pulmonary embolism could occur despite anticoagulant therapy. Outpatient treatment was less costly. On the average and per patient it was CHF 3944 less expensive than treatment in hospital. An estimation reveals that the Swiss health care system would save about CHF 25 million per year if the 85% of patients with deep-vein thrombosis suitable for home care were given this form of treatment. We conclude that outpatient management is subjectively cost-effective but should be optimised to eliminate certain drawbacks associated with it.

Adult↗
PubMed1996

[Sequelae of proximal venous stenosis].

We describe three typical consequences of chronic or subacute proximal vein obstruction: venous claudication, narrowing of the spinal canal by dilated veins that function as collaterals, and hypovolemia caused by trapping of blood in the periphery and slow return. Venous claudication is a well recognized clinical entity. We emphasize that the syndrome is often diagnosed in patients who do not remember acute thrombosis and that the signs on the skin of chronic venous insufficiency are typically absent in these patients. Venous drainage after proximal thrombosis often involves the veins of the spinal canal. Under the condition of sustained physical activity these veins become dilated and occupy space causing the syndrome of a narrow spinal canal. The clinical features differ from those encountered in other forms of a narrow spinal canal; the symptoms appear only after prolonged and strenuous exercise, do barely depend on the posture of the spine and do not disappear readily with cessation of the effort. In patients with bilateral pelvic vein occlusions we regularly found evidence for a shock-like syndrome that follows vigorous exercise. The patients experience sudden weakness and dizziness, with sweats, pallor and tachycardia and have to interrupt the effort to prevent collapse and fainting. The clinical features depend on the anatomical localisation of the obstruction as well as on the pathways of the collaterals. In patients with typical symptoms a venographic workup may be indicated to assess the possibility of recanalisation by endoluminal stenting. The presence of peripheral valve incompetence may be regarded as a contraindication to stenting since it may increase the volume overload and make the chronic venous insufficiency worse.

Constriction, Pathologic↗
PubMed1993

[Complications of superficial thrombophlebitis].

Phlebitis and varicophlebitis are regarded as harmless diseases easily treated by compression and local measures such as incisions and applications. However, recent experience has revealed that they are often complicated by growth of the superficial thrombus into the deep veins, by noncontiguous calf thrombosis, and by usually asymptomatic pulmonary embolism. We prospectively examined 25 consecutive patients using duplex scanning (21x) and/or ascending venography (15x). The phlebitic process involved a varicose greater saphenous vein or a branch thereof (19x), the lesser saphenous vein (3x) or a nonvaricose superficial vein (3x). In 11 cases (44%) we found direct extension to involve the deep vein system and/or noncontiguous isolated calf or popliteal vein thrombosis. The presence of risk factors for deep vein thrombosis and a painful calf muscle were good clinical indicators of such complications. Patients with complications were anticoagulated on an outpatient basis. The course was uneventful in most cases. Our study confirms the notion that superficial thrombophlebitis is often part of a more extended thromboembolic process. This implies diagnostic and therapeutic consequences, although the prognostic significance of such complications is not clear at the moment.

Adult↗
PubMed1991

[Practical proposals for overcoming problems with phlebography].

Venography is considered the gold standard in the diagnosis of venous disease. In the everyday practice, however, it is not used according to this attribute. The article scrutinizes the reasons for the discrepancy, emphasizes the possibilities wrongly renounced to and gives advice to a better indication for and execution of venography. Arguments not to use venography regularly to diagnose or exclude deep venous thrombosis, include claims that it would be superfluous, not readily available, invasive and expensive. Such considerations do not take into account that the clinical diagnosis it not better than tossing a coin. Real difficulties may occur in the evaluation of complicated superficial disease and the postthrombotic syndrome. The problems are minimized by using a methodology based on pathophysiologic knowledge and strictly aimed to solve specific therapeutic questions. The article stresses the need for a proper prevenographic work-up and for a technique tailored to the clinical situation of each individual patient.

Humans↗
PubMed1988

[Spinal claudication following ileocaval venous thrombosis].

The case is reported of a young male who presented with intermittent claudication after thrombosis of the right common femoral, iliac and caval vein. The symptoms were explained by the severe proximal venous obstruction. The patient, however, also complained of lumbar pain during and long after walking, and showed signs of irritation of nerve roots L4 to S1 on the right side. Venography and CT-scan disclosed venous collateral circulation leading through the spinal canal. The blood drained through the foramina intervertebralia to the caval vein, causing compression of the nerve roots depending on their filling. Thus, the claudication was "venous" in two ways, muscular (due to inadequate drainage) and spinal (due to intermittent compression of lumbar nerve roots by the collateral circulation).

Adult↗
PubMed1988

[Psychological findings in alleged phlebologic disorders of the leg].

Twenty-six female patients with restless legs underwent psychiatric investigation as part of a pilot study. Most exhibited a depressive-anxious-hypochondric syndrome. The development of physical symptoms in connection with psychic disturbances and the treatment of patients with restless legs are discussed.

Adult↗
PubMed1983

[Restless legs].

Explore the source record for details and available documents.

Diagnosis, Differential↗
PubMed1982

Pyruvate kinase: is the mechanism of phospho transfer associative or dissociative?

To test for the possibility that pyruvate kinase proceeds via a dissociative path, we have investigated whether the complex enzyme . ADP . metaphosphate is transiently formed from the complex enzyme . ATP. It is shown that when highly purified pyruvate kinase is used, the rate of positional oxygen isotope exchange in ATP (beta, gamma bridge and beta nonbridge) is about 10(4) times slower in the absence of the cosubstrate pyruvate than it is in the presence of pyruvate. Further, the rate of racemization of the gamma-phospho group of [gamma (S)-16O,17O,18O]-ATP is undetectable, being at least 30 times slower even than the rate of positional isotope exchange. These tests thus provide no evidence that pyruvate kinase follows a dissociative mechanism. Indeed, it is argued that the available data are more consistent with an associative path. Evidence is presented that the single, associative, transition state is symmetrical, in which bond making and bond breaking processes are rather precisely balanced.

Adenosine Diphosphate↗
PubMed1982

[Restless legs and nocturnal leg spasms--forgotten facts in diagnosis--new facts for therapy].

An angiologist's experience with the symptom of restless legs is reported. The condition was diagnosed in 103 patients presenting with pain in their legs occurring predominantly at rest and vanishing with walking. Organic lesions could not be identified (in 76%) or were not responsible for the discomfort (in 24%). A depressive state, most often masked, was recognized in 67%. In 42% anxiety was present alone, and in 49% frank depression was diagnosed. In 9% psychiatric treatment was mandatory. Patients with no depression were either not treated (33%) or were given type I-antiarrhythmic drugs (mostly disopyramide) with good results. These drugs were only transiently effective in depressed patients since anxiety was often intensified when the symptom of restless legs disappeared. Antidepressant agents, though ineffective when given alone, were most helpful when administered together with disopyramide.

Adult↗
PubMed1979

[The effect of 1-deamino-8-D-arginine vasopressin (DDAVP) on blood coagulation in patients with hemophilia A and in healthy men].

DDAVP, a synthetic vasopressin analogue, causes a sustained increase of factor VIII in blood. The drug (0.4 micrograms/kg) was repeatedly infused into 13 hemophilics and 5 healthy men in order to study the kinetics of the elicited antihemophilic factor (AHF). The AHF increase and disappearance were found to be strictly related to the severity of the coagulation defect. Thus, data were obtained which will form a basis for rational therapeutic use of DDAVP in hemophilia. The DDAVP effect was completely independent of the presence of AHF in the circulation and was not associated with activation of clotting or platelets.

Arginine Vasopressin↗
PubMed1979

[Primary thrombocythemia: clinical, pathophysiology and therapeutic possibilities].

The course of primary thrombocythemia has been observed in 22 patients over a period of 1-19 years. In contrast to experience with primary thrombocythemia in the literature, thrombotic complications were far more common than hemorrhage. 20 out of 22 patients complained of pain in toes and fingers due to disturbances of microcirculation, whereas bleeding disorders were present only in 5. Studies on spontaneous aggregation of platelets revealed a close association between platelet hyperaggregability and ischemic attacks. 500 mg acetylsalicylic acid every second day normalized the hyperaggregability in vitro and removed pain completely. The indication for antiaggregating substances in the therapy of primary thrombocythemia is discussed.

Adult↗