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A Creutzig

Publications and source records attributed to A Creutzig.

At least 55 records · Page 3Linked to original sources
PubMed1995

[How often is thrombolytic therapy of deep pelvic-leg venous thrombosis indicated?].

BACKGROUND: For patients with deep vein thrombosis new thrombolytic regimes are being proposed and demand evaluation in controlled studies. We tested prospectively, how many patients in internal medicine are candidates for thrombolysis. PATIENTS AND METHODS: All available patients with the diagnosis of deep vein thrombosis (DVT) in lower extremities who were admitted to the service of internal medicine in a medium-sized hospital during one year were prospectively evaluated for the indication of fibrinolysis therapy according to the established criteria. RESULTS: A total of 62 patients were enrolled. Fibrinolysis was not proposed in 25 patients aged over 70 years nor in another 9 patients in whom the thrombosis was restricted to calf veins. Nine additional cases had a recurrence of DVT (n = 4) or a history of more than 14 days. Among the remaining 19 patients, fibrinolysis was not performed in 11 because of advanced malignomas (n =4) or other diseases (n = 3) with limited life expectance, enhanced probability of haemorrhage (n = 3) and obvious non-compliance (n = 1). Eight patients were offered thrombolytic therapy, but 5 of them denied consent after being comprehensively informed. CONCLUSION: Obviously by far most of patients admitted to internal medicine for DVT are candidates for standard heparin therapy only.

Adult↗
PubMed1995

[Angiology update].

Explore the source record for details and available documents.

Angioplasty, Balloon↗
PubMed1995

[Traumatically-induced ischemia of the hands].

BACKGROUND: The widely unknown hypothenar hammer syndrome (HHS) is caused by chronic mechanical trauma; in these cases the hypothenar is used as a tool. This may cause intimal lesions of the ulnar artery usually near the hamate bone resulting in thrombosis or aneurysms. PATIENTS: Six patients with HHS are presented. In four cases occupational activities were most probable cause for HHS, in two patients sport activities. DIAGNOSIS: Clinical examination already indicates insufficient blood supply in the supply area of the ulnar artery. Non invasive methods of examination are doppler measurements of hand arteries and occlusion plethysmography of finger arteries. For differential diagnosis capillaroscopy, laboratory tests and hand arteriography can be necessary. THERAPY: Avoiding the releasing cause is main part in therapy of HHS. Only in few patients special medical treatment is indicated. CONCLUSION: Positive evidence of causal relationship between occupational exposure and appearance of HHS has to be acknowledged as occupational disease.

Adult↗
PubMed1995

[A nomogram of duplex ultrasound quantification of peripheral arterial stenoses. Studies of the cardiovascular model and in angiography patients].

BACKGROUND AND METHODS: Blood flow velocity measurements were performed with duplex ultrasound in vitro (flow phantom) and in 62 patients who underwent angiography due to peripheral vascular disease. RESULTS: Intrastenotic peak systolic velocity (PSV) divided by proximally recorded PSV (peak velocity ratio, PVR) exhibited a strong correlation with percent diameter reduction: r2 = 0.86; N = 106 stenoses. A PVR value > or = 2.4 indicated a more than 50% stenosis with a sensitivity of 87% and a specificity of 94%. Calculation of PVR may normalize for patient variation and allow noninvasive quantification of lumen narrowing with high sensitivity and specificity. The intraobserver variability (95% CI) of stenosis quantification using PVR values was 10%. A nomogram simplifies estimation of lumen narrowing after measurement of intrastenotic and proximal PSV values. CONCLUSION: Quantification of peripheral artery stenoses can be performed easily and noninvasively with duplex ultrasound using the peak velocity ratio (PVR).

Aged↗
PubMed1995

Vascular responses to 17 beta-oestradiol in postmenopausal women.

The vascular responses to 17 beta-oestradiol were examined in 23 postmenopausal women (59 +/- 7 years [mean +/- SD]) using a placebo-controlled double-blind crossover design. All women received 1 mg 17 beta-oestradiol or placebo (P) sublingually on consecutive days in random order. Axial diameters and blood flow rates of the left common femoral arteries were determined before and 60-80 min after application of verum or placebo as well as 10-30 min after 10 mg isosorbide dinitrate (ISDN) with a quantitative duplex ultrasound technique. Oestradiol induced a vasodilation of femoral arteries (+6.4 +/- 4.1% of basal, P < 0.001 vs. basal and P), the vessel diameter was unchanged with placebo (+0.7 +/- 2.1%). The blood flow rate increased significantly after oestradiol application (+30 +/- 28%, P < 0.05 vs. basal and P), but not after placebo (+11 +/- 21%). Mean blood pressure and heart rate remained constant with both drugs. Despite its vasodilatory effect, ISDN significantly reduced the arterial blood flow after pretreatment with oestradiol and placebo, probably through cardiac preload reduction. In conclusion, 17 beta-oestradiol alters the vascular tone of systemic arteries resulting in a vasodilation and increase of blood flow. We suggest that these direct vascular actions may contribute to the preventive properties of oestrogens on cardiovascular diseases in postmenopausal women.

Aged↗
PubMed1995

Skin oxygen pressure histograms in patients with peripheral arterial occlusive disease during intraarterial and intravenous prostaglandin E1 infusions of different dosages and their prognostic value.

Skin surface oxygen pressure fields (tcPO2 [37 degrees C]) reproducibly characterize skin microcirculation in patients with peripheral arterial occlusive disease. These appear suited for investigation of short- and long-term effects of vasoactive drug treatment. The authors studied whether skin surface oxygen pressure histograms change depending on dosage and route of administration of prostaglandin E1 (PGE1), whether they are of predictive value for patients' clinical outcome, and whether they normalize after therapy with PGE1. The authors investigated 15 patients with various degrees of disease and measured forefoot oxygen histograms consisting of at least 80 single tcPO2 (37 degrees C) values before and during intraarterial infusion (1.5, 3, or 6 ng/kg/minute) and intravenous infusion (4.5, or 9 ng/kg/minute). The measurements were repeated two and six hours after the end of intraarterial application of 1.5 ng/kg/minute. Furthermore, the orthostatic vasoconstrictor response was tested. Skin oxygen pressure histograms were controlled after a period of twenty-two (mean) days of intraarterial PGE1 therapy. Resting histograms were left shifted with median tcPO2 (37 degrees C) between 1 and 7 mm Hg. During intraarterial application, histograms were shifted to lower tcPO2 (37 degrees C) values in most patients. Only in 3 diabetic subjects with proximal or acral obliterations was a marked increase observed. The alterations were detectable at least two hours after the end of the infusion. During intravenous infusion, histograms did not change in most cases. After long-term therapy, histograms were substantially unchanged. A pathologic vasoconstrictor response, which was present in 10 patients, could not be restored. Despite a marked deterioration of the histograms the clinical outcome was favorable in 7 patients. Patients with a high resting tcPO2 (37 degrees C) (median 4 mm Hg and more) and those with a vasoconstriction on orthostasis are likely to respond to PGE1 therapy.

Adult↗
PubMed1995

Influence of diabetic neuropathy on skin microcirculation assessed by transcutaneous oxymetry.

Skin microcirculation was investigated in 45 patients with long term diabetes and with severe, moderate or no neuropathy, and in 15 controls. Transcutaneous oxygen pressure (tcPO2) measurements on the forefoot were performed at 37 degrees C to assess local capillary flow at rest, during leg dependency and reactive hyperaemia, and also at 44 degrees C, including the response to oxygen inhalation. TcPO2 (37 degrees C) at rest was significantly elevated with an increasing degree of neuropathy (Controls: 4.8 +/- 3.7; patients without neuropathy: 4.2 +/- 2.9; with moderate neuropathy: 6.0 +/- 2.9 (p < 0.01); with severe neuropathy: 7.2 +/- 4.2 mmHg (p < 0.001)). Leg dependency resulted in a decrease of tcPO2 in the controls, while an increase was observed in 18.6% of the measurements in patients, reflecting a disturbed vasoconstrictor response. Regardless of neuropathy, absolute tcPO2 values during reactive hyperaemia were reduced in all patient groups as well as tcPO2 (44 degrees C) and its increase during oxygen breathing. Diabetic neuropathy is likely to increase local capillary flow, while the other differences to healthy controls may be contributed to a microcirculation disorder independent of neuropathy.

Adult↗
PubMed1994

Controlled trial of high- versus low-dose aspirin treatment after percutaneous transluminal angioplasty in patients with peripheral vascular disease.

Percutaneous transluminal angioplasty of aortoiliac and femoropopliteal atherosclerotic lesions can provide long-lasting hemodynamic improvement. High-dose aspirin is commonly prescribed as reocclusion prophylaxis, but low doses would be preferable because of fewer adverse effects. We performed a double-blind, randomized, controlled clinical trial in patients with peripheral vascular disease with lesions appropriate for angioplasty. We compared the efficacy and side effects of two doses of aspirin (50 mg vs. 900 mg daily) during a period of 12 months after angioplasty. A total of 359 patients were evaluated: 175 were randomly assigned to treatment with 900 mg aspirin daily and 184 to 50 mg aspirin daily. Thirty-nine patients developed restenosis at the angioplasty site; the cumulative percentage of event-free survival after 1 year (patency rate) was 85% in 900 mg group and 84% in 50 mg group. An equivalence test showed the two groups equivalent with respect to restenosis rates (P = 0.0003 for an equivalence region of < 10% difference. Nine patients (5%) in the 900 mg group had serious gastrointestinal side effects (peptic ulcer, 8; erosive gastritis requiring transfusion, 1) compared to two ( peptic ulcer) in the 50 mg group (P = 0.03). The results of our study show that a dose of 50 mg aspirin a day is as effective as 900 mg for the prevention of restenoses after lower limb angioplasty, and that severe gastrointestinal side effects are less frequent.

Aged↗
PubMed1994

L-arginine infusion decreases peripheral arterial resistance and inhibits platelet aggregation in healthy subjects.

1. L-Arginine is the physiological precursor of nitric oxide which induces vasodilatation and inhibits platelet aggregation by the formation of cyclic GMP. 2. In the present study we investigated the effects of an intravenous infusion of L-arginine (30 g, 30 min) compared with placebo on blood pressure, heart rate and peripheral haemodynamics in ten healthy male subjects. Cyclic GMP, NO2- and NO3- were determined in plasma and urine to assess NO production in vivo by a new, highly specific and sensitive gas chromatography-mass spectrometry method. 3. L-Arginine significantly decreased mean arterial blood pressure and increased heart rate. The effect was more pronounced on diastolic than on systolic blood pressure. This was due to a decreased peripheral arteriolar resistance, as in femoral artery Doppler sonography the arterial diameter was unchanged but blood flow was increased. These haemodynamic effects were not observed after placebo administration. 4. Urinary excretion of cyclic GMP increased by 65.4% after L-arginine and by 25.1 after placebo. Urinary NO2- excretion was near the threshold of detection. Urinary NO3- excretion increased by 79.7% after L-arginine. Plasma arginine levels increased nearly ten-fold after the L-arginine infusion, and plasma cyclic GMP increased by a similar rate as in urine. However, plasma NO2- and NO3- remained unchanged after both treatments, as did plasma alpha-atrial natriuretic peptide levels. 5. Platelet aggregation was inhibited by 32.7% after L-arginine (P < 0.05), but was unchanged after placebo. Platelet intracellular cyclic GMP was increased by 43.0% after L-arginine, but not after placebo (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Dose-dependent side effects of acetylsalicylic acid therapy. Results of a prospective randomized clinical study in patients with peripheral arterial occlusive disease].

BACKGROUND AND METHODS: In 359 patients with peripheral arterial occlusive disease who had undergone percutaneous transluminal angioplasty (PTA), a randomized double-blind, controlled clinical study was done to investigate the tolerability of acetyl salicylic acid (ASA) given for reocclusion prophylaxis. A comparison was made between a conventional daily dose of 900 mg ASA and a dose of 50 mg ASA. RESULTS: Within an observation period of one year following PTA, 35 patients (20%) in the 900 mg group, and 32 patients (17%) in the 50 mg group left the trial because of side effects (p = NS). Under the higher dose, however, severe gastrointestinal side effects (ulcer, haemorrhagic gastritis requiring transfusion) were significantly more common (nine patients delta 5.1% vs two patients delta 1.1%, respectively; p = 0.03). Overall, 107 patients (30%) reported subjective side effects such as upper abdominal pain, a sensation of fullness or nausea during the course of the trial. 62 of these patients were from the 900 mg group (35%) as compared with 45 patients (24%) in the 50 mg group (p = 0.02). Self-scoring of epigastric pain on the basis of a visual analogue scale revealed a score of 1.3 (95% confidence interval 0.9 to 1.6) in the 900 mg group and 0.8 (95% confidence interval 0.6 to 1.0) in the 50 mg group. The subjective pain intensity showed a uniform time course for all three types of symptom, with a maximum after three months. CONCLUSION: Our results confirm the superior tolerability of the lower dose, in particular in elderly patients. For long-term treatment, the smallest possible effective dose should be chosen.

Aged↗
PubMed1993

Dose-dependent effect of aspirin on carotid atherosclerosis.

BACKGROUND: Antiplatelet treatment with aspirin is well established as secondary prophylaxis after a transient ischemic attack or minor ischemic stroke, but the effect of aspirin treatment on the course of carotid atherosclerosis is unknown. We investigated the effect of aspirin on the initial stages of carotid atherosclerosis. METHODS AND RESULTS: Patients were recruited from a prospective, randomized, double-blind clinical trial to compare two doses of aspirin (900 mg versus 50 mg daily) with regard to restenoses after lower limb angioplasty. Of the 383 patients admitted to the angioplasty trial, 27 patients with 104 small carotid atheroma (< 50% lumen narrowing) were examined at entry and after 1 year of aspirin treatment with the use of a high-resolution ultrasound duplex system. Disease progression and regression were defined by a change of maximal plaque area (as measured by longitudinal ultrasound sections) of more than 2 SDs of the method. The change in plaque area was significantly different for the treatment groups: Average plaque size remained unchanged after treatment with 900 mg aspirin daily but increased markedly after treatment with 50 mg aspirin daily (p = 0.011). There were significantly more lesions in the 50-mg group showing progression than in the 900-mg group (23 plaques [47%] versus 13 plaques [24%], p = 0.025). Ultrasonic disappearance of a lesion was observed only in the 900-mg group in nine cases (seven soft plaques and two ulcerative plaques, p = 0.018). The six patients on 50 mg aspirin who continued smoking during the study showed significantly more progression compared with the seven nonsmokers in the 50-mg group (17 plaques [59%] versus six plaques [30%], p = 0.038). CONCLUSIONS: The results of our study indicate that aspirin treatment slows carotid plaque growth in a dose-dependent fashion, with a dose of 900 mg daily more efficient than 50 mg daily.

Aspirin↗
PubMed1993

[Thrombophlebitis--basic principles of treatment].

Therapeutic strategies in deep vein thrombosis are yielding possible prevention of life-threatening pulmonary thromboembolism and extension of thrombosis. In order to prevent long term sequelae, i.e., the postthrombotic syndrome, recanalization is necessary before venous valves have been destroyed. Therapeutical guidelines comprise immobilization (except isolated calf vein thrombosis), compression therapy and anticoagulation. Thrombolysis may be performed in patients in whom extension and localization of thrombosis may result in a postthrombotic syndrome, if thrombosis is not older than 1-2 weeks, if there are no concomitant diseases which make it uncertain for the patient to experience postthrombotic syndrome, and in the absence of contraindications.

Bandages↗