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Biomedical subjects

W Hach

Publications and source records attributed to W Hach.

At least 19 recordsLinked to original sources
PubMed2006

Invasive therapeutic options in truncal varicosity of the great saphenous vein.

It is known from current pathophysiology that disease stages I and II of truncal varicosity of the great saphenous vein do not cause changes in venous pressure on dynamic phlebodynamometry. This is possibly also the case for mild cases of the disease in stage III. In pronounced cases of stage III and all cases of stage IV, however, venous hypertension occurs which triggers the symptoms of secondary deep venous insufficiency and all the complications of chronic venous insufficiency. From these facts the therapeutic consequence is inferred that in stages I and II and perhaps also in very mild cases of stage III disease, it is enough "merely" to remove varicose veins without expecting there to be any other serious complications in the patient's further life caused by the varicosity. Recurrence rates are not included in this analysis. In marked cases of disease stages III and IV of the great saphenous vein, however, secondary deep venous insufficiency is to be expected sooner or later. The classical operation with saphenofemoral high ligation ("crossectomy") and stripping strictly adheres to the recognized pathophysiologic principles. It also takes into account in the greatest detail aspects of minimally invasive surgery and esthetics. In the past few years, developments have been advanced to further minimize surgical trauma and to replace the stripping maneuver using occlusion of the trunk vein which is left in place. Obliteration of the vessel is subsequently performed via transmission of energy through an inserted catheter. This includes the techniques of radiofrequency ablation and endovenous laser treatment. High ligation is not performed as a matter of principle. In a similar way, sclerotherapy using microfoam is minimally invasive in character. All these procedures may be indicated for disease stages I and II, and with reservations also in mild forms of stage III disease. Perhaps high ligation previously constituted overtreatment in some cases. Targeted studies are still needed to prove whether secondary deep venous insufficiency can be avoided in advanced stages of varicose vein disease without high ligation and thus without exclusion of the whole recirculation circuit.

Angioplasty, Laser↗
PubMed2005

[Armand Trousseau, phlegmasia alba and gastric cancer].

Armand Trousseau (1801-1867) was one of the greatest doctors of our cultural heritage. He regarded medicine as an art form expressed through the individuality of the physician. While still a young man, he was appointed professor of therapeutics and pharmacology at the University of Paris. He was a master of rhetoric and lectured on general medicine and neurology at the bedside. Trousseau recognised that phlegmasia alba was frequently associated with malignant disease. His description of the causality in his most famous work Clinique médicale de l'Hôtel Dieu de Paris is impressive. When he later suffered phlebitis of the left arm, he correctly diagnosed stomach cancer, from which he died six months later.

Germany↗
PubMed2003

[Vascular manifestation of von Recklinghausen neurofibromatosis: case report of venous dysplasia].

We present the case report of a patient with neurofibromatosis and regional dysmorphism in the superficial femoral vein. Colour coded duplex sonography revealed an incidental finding: thickening of a short portion of the vein wall with calcification. This unusual finding strongly suggests a causal relationship. Pathological processes in the arteries have often been described in patients with von Recklinghausen's disease (neurofibromatosis). Dysplastic and hyperplastic reactions of the intramural nerve tissues and the smooth muscle elements in the vascular wall have been observed. This leads to the formation of aneurysms and arteriovenous fistulas and to stenosing processes in the peripheral, visceral and cerebral arteries. However, involvement of the veins in type 1 von Recklinghausen's neurofibromatosis has only been reported in old histopathological studies of medium-sized and small vessels.

Arteriovenous Malformations↗
PubMed2001

[Chronic venous compartment syndrome].

Various forms of compartment syndrome can now be distinguished. Acute compartment syndrome is the result of a discrepancy between the volume of the compartment and its contents. This leads to increased pressure at rest and during load, which cuts off the micro-circulation and hence destroys the intracompartmental structures. Chronic compartment syndrome had only been seen in athletes and soldiers up to now. The disease mainly affects the anterior compartment and the fibular muscle group, and only rarely the lateral muscle compartment. In the course of severe venous diseases, a chronic venous compartment syndrome develops which is fundamentally different from the clinical pictures previously known. The cicatricial destruction of the crural fascia exerts an effect on the intracompartmental pressure with every step the patient takes. In severe cases, this results in considerable changes in the muscles involving chronic ischaemia associated with necrosis and glycogen deficiency. Further investigations are necessary in order to define the clinical picture, particularly by measuring the intracompartmental pressure under dynamic and standardised conditions. We suggest also making a verbal distinction between the two forms: a chronic exertional compartmental syndrome and a chronic venous compartmental syndrome.

Chronic Disease↗
PubMed2001

[Richard von Volkmann and the Surgical School of Halle in 1867 to 1889].

Richard von Volkmann (1830-1889) was appointed senior consultant of the University Surgical Hospital in Halle at the young age of 36. On returning home from the war of 1870/1871, he saw traumatic fever rampant in his hospital. He became a rigorous advocate of Lister's method of antisepsis. There were a large number of very serious accidents in the up-coming industrial town of Halle. Acute and chronic inflammation of the joint led to severe disfigurements. By invention of large reconstructive operations von Volkmann was able to obtain impressive results. He was the founder of traumatology and orthopaedic surgery. Tuberculosis was regarded at that time as the most common cause of death. By means of surgery certain forms of the illness could be cured. Tuberculous coxitis and gonarthritis were the most common indications for orthopaedic surgery. Von Volkmann used his distraction method for tuberculous spondylitis.Many terms used in medical practice derive from Richard von Volkmann. He described Volkmann's triangle, ischaemic muscle contractures and resorption fever. He developed a whole range of new methods of surgical procedures and the concept of wound drainage. His name is associated with Volkmann's splint, Volkmann's "sharp spoon" and several other inventions. Richard von Volkmann was one of the founders of the Deutsche Gesellschaft für Chirurgie (German Surgical Society). His famous Träumereien an französischen Kaminen ("Reveries at French Firesides"), an anthology of fairy-tales for his children, played an important role in his life's work.

General Surgery↗
PubMed2000

[Development of large vein surgery in Europe].

Surgery of the great veins inevitably began with the surgical treatment of injuries, often involving the femoral vein. Because of the famous case presented by Roux in 1813, the prevailing opinion until almost the end of the nineteenth century was that ligation of the vein made death inevitable, but that the only way to control severe hemorrhaging from a vein was to ligate the femoral artery. Zaufal's principle (1880) consisted in the ligation and resection of great veins of the body and limbs in order to prevent sepsis in suppurative processes. This surgical method was still being used in the first half of the twentieth century in patients with perforated appendicitis or puerperal fever. In the limb, the congestion induced in the vein had a positive effect on the healing process. The surgical treatment of leg and pelvic deep vein thrombosis was initially (1931) aimed at achieving decompression in compartment syndromes. The first thrombectomy was performed in 1937, but several operations with a successful outcome were reported at the 61st annual meeting of the German Society of Surgery in the following year.

Europe↗
PubMed2000

The chronic venous compartment syndrome.

BACKGROUND: A chronic exertional compartment syndrome has only been observed in athletes and soldiers. In the vast majority, the disease affects the anterior compartment and the fibular muscle group, and only rarely the lateral and dorsal muscle compartments. Muscle tissue necrosis does not occur. In the course of venous diseases with a severe chronic venous stasis syndrome, a chronic venous compartment syndrome develops that differs considerably from the familiar functional syndrome. The predominant symptom is an uncurable cuff ulceration on the lower leg. PATIENTS AND METHODS: From 1993 to 1996 a total of 16 patients with a chronic fascial compression syndrome underwent surgery on 18 extremities. The crural fascia was resected and a mesh graft was applied. RESULTS: In the group of ten controls with healthy veins the average pressure in the deep compartment was 13.6 mmHg (range 9-17 mmHg) lying down and 29.9 mmHg (range 15-42 mmHg) standing up. In 14 patients with chronic fascial compression syndrome, the average pressure was higher, measuring 21.1 mmHg (range 8-47 mmHg) lying down and 62.5 mmHg (range 33-87) standing up. After surgery, the pressure dropped to 15.5 mmHg (range 5-24 mmHg) lying down and 34.5 mmHg (range 10-58 mmHg) standing up, but did not fall as low as the average values recorded in the control group or in the patient's healthy leg. The results from the standing up position were statistically significant (p = 0.003). Computed tomography showed major changes in the muscles indicating muscle atrophy and fatty degeneration. The crural fascia seemed to be incorporated in the scars of the subcutaneous tissue in large areas. After crural fasciectomy and healing of the ulceration, the tissue structure of the muscles recovered. CONCLUSIONS: In chronic fascial compression syndrome, the trellis arrangement of the collagen fibres becomes disordered. This results in a loss of flexibility during muscle contraction. Every step causes an increase of intracompartmental pressure and microstructural injury. The consequence is resection of the crural fascia.

Amputation, Surgical↗
PubMed1994

Acetylsalicylic acid--reocclusion--prophylaxis after angioplasty (ARPA-study). A randomized double-blind trial of two different dosages of ASA in patients with peripheral occlusive arterial disease.

We report on a randomized controlled clinical trial in patients with peripheral occlusive arterial disease who have been successfully treated with angioplasty. The efficacy and the rate of side effects of two doses of ASA (300 mg vs. 1000 mg daily) have been compared during a treatment period of 6 months after angioplasty. It was planned to include a total of 600 patients in the trial. A predefined interim analysis of 200 patients which was performed after the actual inclusion of 218 patients showed identical reocclusions rates and a very similar frequency of side effects in both treatment groups. The study was then terminated since it was not expected that further continuation would lead to a relevant difference between the two treatment groups concerning efficacy or side effects. Patients already included in the trial at the interim evaluation were included in the final analysis, leading to a total number of 223 patients. Finally 112 patients had been randomized to receive a daily dose of 300 mg ASA and 111 patients to receive 1000 mg ASA. Reocclusions occurred in 18 patients (16%) on 300 mg of ASA/day and in 20 patients (18%) receiving 1000 mg ASA/day. The study was interrupted because of side effects in 27 patients (24%) in the 300 mg/day group and in 27 patients (24%) in the 1000 mg/day group. Mostly subjective gastric complaints were the cause of interruption in 17 patients (15%) in the 300 mg group and in 21 patients (19%) receiving the higher dose regimen. So the reocclusion rate was identical in both dosage-groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1990

[Diagnosis of secondary popliteal and femoral venous insufficiency in truncal varicose veins].

Serious truncular varicosis causes, after a long period of time, changes in the deep veins known as secondary popliteal- and femoral vein incompetence. The ascending pressphlebography is the common diagnostic method. The continuous-wave sonography showing a sensitivity of 3% while being 100% specific is therefore not a suitable diagnostic method. The duplex-sonography proves to be the optimal screening method with a sensitivity of 100% while being 87% specific.

Adult↗
PubMed1989

[Instrumental and phlebography diagnosis of deep venous leg and pelvic vein thrombosis].

Since plethysmography was introduced as the earliest screening method of peripheral veins there was a constant improvement of apparatus and methods. Presently the color-coded Duplex sonography gives results more detailed than any other screening test and is comparable with the accuracy of phlebography. Nevertheless, since the introduction by Mahler of the "climbing pulse rate" as the best known clinical sign of thrombosis a fundamental problem still waits for the solution: diagnosis of the very beginning of thrombosis. Only when the initial symptoms of the disease are correctly interpreted the best suitable diagnostic methods can be carried out stepwise. A wrong interpretation of the patient's complaints still causes serious retardations of the induction of an adequate therapy.

Blood Flow Velocity↗
PubMed1989

[Evaluation and management of post-thrombotic syndrome].

The number of patients with postthrombotic syndrome subsequent to venous thrombosis is continuously increasing. The risk of venous thrombosis is increased by the increasing age of the population, through increasingly-extensive surgical intervention, through hormonal contraception and through prolonged airline flights and the risk appears diminished by modern thrombosis prophylaxis. The course of the disease can be divided into an acute phase of thrombosis with a duration of about one week, the subacute phase lasting from the second to the fourth week and the phase of the postthrombotic syndrome. Pathophysiology Thrombotic occlusion can be compensated for by recanalization and collateralization. Concomitant with the generation of the blood clot, fibrinolytic factors are activated which can serve to lyse the thrombus. After organization of the remaining clot, blood flow can be re-established. The extent of recanalization can be quantified radiologically. In 35.5% of the patients there is complete recanalization, in 53.4% partial and in 11.1% no recanalization. At nearly all sites of venous occlusion preformed collaterals can be found. A hemodynamically meaningful occlusion causes an increase in the peripheral venous pressure. On use of Doppler ultrasound examination, there is absence of respiratory modulation as well as a high-frequency continuous signal which disappears as soon as collateral function is optimal. As the venous circulation adapts, there is dilatation in the collateral vessels, initially with preserved coaptation of the valve leaflets. This stage is designated as compensatory phlebectasia; phlebography of the great saphenous vein shows the typical findings. If the venous valves are incompetent, under some conditions the direction of flow may be reversed. An example of secondary varicosities in the region of the great and lesser saphenous vein is shown in Figure 3. The most frequent causes of valve damage are over-extension of the valve ring through recoil pressure and volume waves during standing, coughing and pressing in addition to local thrombus formation and inflammatory processes. In association with thrombosis in the femoropopliteal region with compensatory phlebectasia of the great saphenous vein, respiratory modulation in this vein can be detected with Doppler ultrasound examination. With secondary varicosities, which have to be differentiated from compensatory phlebectasia, on use of the Valsalva test or calf compression test there is pathologic, persistent retrograde blood flow, the calf compression test shows diminished A-sounds. In contrast to primary varicosities, with secondary varicosities of the great saphenous vein the distal dilatation is more marked than that seen proximally. Retrograde blood flow can extend to the foot with no obstacles.(ABSTRACT TRUNCATED AT 400 WORDS)

Dissection↗
PubMed1988

[Diagnosis and surgical methods in primary varicose veins].

Modern surgery of varicose veins depends on a differentiated diagnostics. The planning and the type of operation have to take the particular hemodynamics into consideration. The main prerequisites are early operation to prevent secondary popliteal and femoral vein insufficiency and, on the other hand, a restrained tissue-sparing technique in order to preserve transplantable vein segments. Paratibial fasciotomy is a low-risk and technically uncomplicated method for the treatment of severe chronic venous congestion.

Humans↗