Search PubMed⌕ Search

Biomedical subjects

C Diehm

Publications and source records attributed to C Diehm.

At least 19 recordsLinked to original sources
PubMed2004

Epidemiology of peripheral arterial disease.

Peripheral arterial disease (PAD) is not an uncommon but a commonly neglected condition by many medical practitioners. It is a disease that threatens not only the limb but also life itself! Atherosclerosis is the commonest cause of PAD in the western nations. The cardinal symptom is intermittent claudication (IC) but majority of the patients are asymptomatic. Ankle-brachial pressure index (ABI) is an effective screening tool for PAD. A diminished ABI (< 0.9) is a definite sign of PAD. Its prevalence steadily increases with age. In Germany almost a fifth of the patients aged over 65 years suffer from it. With increasing life expectancy the prevalence of PAD is on the increase. PAD is a manifestation of diffuse and severe atherosclerosis. It is a strong marker of cardiovascular disease; a very strong association exists between PAD and other atherosclerotic disorders such as coronary artery disease (CAD) and cerebrovascular disease (CVD). PAD is an independent predictor of high mortality in patients with CAD. Smoking, diabetes mellitus and advancing age are the cardinal risk factors. A relatively small number of PAD patients lose limbs by amputation. Most paitients with PAD die of either heart attacks or strokes and they die of the former conditions far earlier than controls. PAD still remains an esoteric disease and there is a significant lack of awareness of this condition by many physicians, and therefore under-diagnosed and underestimated. Measures to promote awareness of PAD among physicians and the society in general are needed. Since most patients are asymptomatic and carry potentially significant morbidity and mortality risks, screening for PAD should be made a routine practice at primary care level.

Age Distribution↗
PubMed2004

High prevalence of peripheral arterial disease and low treatment rates in elderly primary care patients with diabetes.

Representative data on peripheral arterial disease (PAD) in community-based office practice are scarce while at the same time of high interest. Thus, we aimed to determine the prevalence of peripheral arterial disease (PAD), comorbidity of atherothrombotic manifestations, and treatment intensity among elderly diabetic patients in primary care. In this monitored cross-sectional study, 344 general practitioners throughout Germany determined the ankle-brachial index (ABI) of 6880 consecutive, unselected patients aged 65 years or older with bilateral Doppler ultrasound measurements. PAD was defined according to the recent American Heart Association guidelines (using the higher of the 2 systolic ankle pressures: ABI < 0.9) or peripheral revascularisation, or amputation because of PAD. Coronary events (CAD) and cerebrovascular events (CVD) were taken from the patient's history without additional diagnostic measures. Diabetes was defined according to the clinical diagnosis of the physician and/or HbA1c > or = 6.5 % and/or intake of oral antidiabetic medication and/or application of insulin. 1.743 patients were classified as diabetics: the median disease duration was 6 years (1st; 3rd quartile: 2; 11), median HbA1c 6.6 % (5.9; 7.3), mean age 72.5 +/- 5.4 years, and 51.4 % were females. Diabetics had in comparison with non-diabetics a higher prevalence of PAD defined as ABI < 0.9 (26.3 % vs. 15.3 %, univariate odds ratio 2.0 [95 % confidence interval: 1.7; 2.3]), intermittent claudication (5.1 % vs. 2.1 %, OR: 2.5 [1.9; 3.4]), known CAD (16.1 % vs. 10.6 %, OR: 1.6 [1.4; 1.9]), and known CVD (6.8 % vs. 4.8 %; OR: 1.4 [1.2; 1.8]). 57.4 % of the diabetics with previously known PAD (as only atherothrombotic manifestation) received antiplatelet therapy (vs. 75.1 % with CAD and/or CVD only). The ABI was suitable as screening measure in the primary care setting. In elderly diabetics in comparison to non-diabetics, the prevalence of PAD was very high. Despite the known benefits of antiplatelet therapy, PAD patients were less intensively treated than patients with CAD or CVD.

Aged↗
PubMed2003

[Characteristics of diagnosis of peripheral arterial occlusive disease in diabetic patients. This pitfall should be avoided].

Doppler pressure measurement with determination of the ankle-arm indices, and duplex ultrasonography, together form the basis of the diagnostic investigation of the vascular system in diabetics. MR angiography and arteriography are not screening methods in suspected peripheral blood flow disorders. MR angiography should be applied only when findings are unclear and the therapeutic consequences uncertain. Invasive therapeutic measures (angioplasty, vascular surgery, amputation) must still be preceded by intra-arterial digital subtraction angiography as the method of choice.

Arterial Occlusive Diseases↗
PubMed2003

[Diagnosis of arterial vascular diseases with duplex sonography. Often better than angiography].

Color-coded duplex ultrasonography has decisively improved the noninvasive diagnostic possibilities in angiology. It is side effect-free, repeatable whenever required and, in experienced hands, can be performed within a reasonable time. In contrast, arterial angiography is a purely diagnostic but invasive procedure with an associated complication rate of 0.5% [25]. Color-coded duplex ultrasonography is an effective and inexpensive diagnostic method. The overall cost of such an examination is about 120 euros [25]; this contrasts with overall costs of 939 euros for MR angiography, and 1297 euros for an intra-arterial angiography.

Angiography↗
PubMed2003

[Repeated attacks of pain in the nipple of a pregnant woman. Unusual manifestation of Raynaud's phenomenon].

HISTORY AND FINDINGS: A 38-year-old woman, in her 13th week of pregnancy, presented for angiological investigation of repeated episodes of pain in the right index finger. She also reported painful paleness of the right nipple evoked particularly by cold. This was her fifth pregnancy; she had miscarried twice. The nipple pain occurred spasmodically and in three phases, while the left nipple was unaffected. The attacks lasted c. 15 min, progressing from an ischemic to a hyperemic phase, accompanied by unbearable pain. When first examined there was circumscribed, purplish network-patterned discoloration of the right hand with blackened discoloration of the distal nail-bed of the index finger. INVESTIGATIONS: Duplex-sonography revealed patency of the large arteries of the arm and hand. Transesophageal echocardiography showed a persistent foramen ovale and echo-density suspected to be a right atrial thrombus. Laboratory tests demonstrated anticardiolipin antibodies, suggesting an antiphospholipid syndrome. TREATMENT AND COURSE: On administration of low-molecular heparin, its dosage weight-adjusted, and 100 mg aspirin daily the discoloration of the finger quickly disappeared, but Raynaud's syndrome remained unchanged until she had stopped breast feeding (left breast only) after 8 months. A healthy girl had been delivered by cesarean section in the 39th week, weighing 3100 g. There were no further thromboembolic complications. CONCLUSION: This very rare case of Raynaud's phenomenon in a nipple was associated with an anti-phospholipid syndrome.

Adult↗
PubMed2003

Systemic scleroderma patients have improved skin perfusion after the transdermal application of PGE1 ethyl ester.

BACKGROUND: Patients with systemic scleroderma exhibit a noticeable slowing of blood cell velocities or even stasis in the capillaries of the skin. In this study the effects of transdermally applied prostaglandin PGE1 ethyl ester on nutritive cutaneous perfusion and on Raynaud's symptoms were investigated. PATIENTS AND METHODS: 24 patients with systemic scleroderma were treated transdermally over a period of 14 days with prostaglandin E1 ethyl ester patches. The response of blood cell velocity in the nailfold capillaries to cold exposure was tested in 20 patients, and all of the patients recorded the number of Raynaud's episodes in a journal over a period of two weeks. RESULTS: After the transdermal application of prostaglandin E1 ethyl ester there was an increase in blood cell velocity in the nutritive capillaries of systemic scleroderma patients (increase from 0.35 +/- 0.14 mm/s to 0.47 +/- 0.11 mm/s, (p < 0.05)). At the same time there was a decrease in the number of Raynaud's episodes (2.9 +/- 2.4 per day to 2.6 +/- 2.0 per day (p < 0.05)). CONCLUSION: The transdermal application of prostaglandin E1 ethyl ester was shown to have a favourable effect on nutritive blood flow in the capillaries of the skin in systemic scleroderma patients.

Administration, Cutaneous↗
PubMed2003

[DRG-based cost analysis of inpatient conservative treatment of stage III/IV peripheral arterial occlusive disease].

UNLABELLED: DRG-based cost analysis of inpatient conservative treatment of PAD stage III/IV BACKGROUND: In a prospective study carried out by the German Society of Angiology and the DRG Competence Center, Munich, the question was investigated whether the costs of conservative treatment of patients with PAOD stage III/IV (DRG F65) are adequately represented within the current G-DRG system. METHODS UND PATIENTS: Between September 1 and December 16, 2002, a total of 704 patients with DRG F65 (peripheral vascular diseases) were evaluated at 8 angiologic centers in Germany. Apart from the length of hospital stay, the total costs (cost equivalents) were calculated using a method developed by the DRG Research Group at the University of Münster. Moreover, the study population was compared with a German calculation sample for the DRGs F65A/B, as published by InEK. RESULTS: As it turned out, conservatively treated patients with PAOD stage III or IV (DRGs F65A/B) cause significantly (p < 0.001) higher costs and have significantly (p < 0.001) greater lengths of hospital stay than patients who were also assigned to DRG F65 because of other vascular diseases. At the same time it became clear that angiologic centers treat twice as many patients with critical limb ischemia in comparison with the German average. The reimbursement hitherto estimated by InEK covers not even half the cost actually produced by conservative treatment of PAD stage III/IV. CONCLUSION: To ensure a performance-related reimbursement, a new basis DRG for patients with PAD stage III/IV has to be created, as has ben proposed by the German Society of Angiology. Otherwise, adequate conservative therapy in accordance with existing guidelines, of patients who cannot be treated surgically or interventionally will not be possible any more in the future.

Arterial Occlusive Diseases↗
PubMed2003

Are elevated homocysteine plasma levels related to peripheral arterial disease? Results from a cross-sectional study of 6880 primary care patients.

BACKGROUND: It is still unclear whether the strength of the association between elevated plasma homocysteine (HC) levels and peripheral arterial disease (PAD), coronary artery disease (CAD) and cerebrovascular disease (CVD) is similar. METHODS: Fasting homocysteine plasma levels were measured in 6880 unselected primary care patients aged 65 years or older. Presence of PAD was determined with the ankle brachial index, and both CAD and CVD were recorded according to patient history. RESULTS: Median homocysteine levels in the total sample (58.0% females, mean age 72.5 years, mean body mass index 27.3 kg m-2) differed between patients with and without PAD: 15.2 micro mol L-1 (95% confidence interval [CI] 14.8; 15.7, vs. 13.9 micro mol L-1 (CI: 13.8; 14.1; P < 0.001). Peripheral arterial disease prevalence moderately increased from 13.0% in the lowest HC quintile to 24.3% in the highest quintile (crude odds ratio [OR], 2.1 [CI: 1.7; 2.6]). The frequency of atherothrombotic manifestations in the patients' history increased nearly linearly across the homocysteine quintiles in the univariate analysis. However, the association diminished substantially after adjusting for known interfering variables: the ORs between the HC highest fifth vs. lowest fifth (adjusted for age, gender, smoking status, diabetes, hypertension lipid disorders, and estimated glomerular filtration rate levels) for PAD decreased to 1.4, for CAD to 1.0 (NS), and for CVD to 1.1. (NS). CONCLUSIONS: Elevated HC is only slightly more related to PAD than to CAD and CVD. After adjustment for known risk factors, the effect size is small, and an association can no longer be observed between homocysteine and CAD and CVD.

Age Distribution↗
PubMed2003

Meta-analysis of clinical trials of Cyclo 3 Fort in the treatment of chronic venous insufficiency.

AIM: Chronic venous insufficiency (CVI) of the lower limbs is a major cause of morbidity and varicose veins affect 20% to 60% of adults in the western world. The treatment of patients with CVI attempts to reduce both clinical symptoms and the development of chronic venous disease. A meta-analysis using data from all clinical trials and studies of Cyclo 3 Fort, a combination of root extract of the Ruscus aculeatus plant (150 mg per capsule), hesperidin methyl chalcone (150 mg) and ascorbic acid (100 mg), was carried out to estimate the overall effect on the symptoms and severity of chronic venous insufficiency. METHODS: The meta-analysis included 20 placebo controlled, randomised, double blind studies and 5 randomised studies against a comparator drug. There were 6 single arm studies of Cyclo 3 Fort alone with no placebo arm. In all studies the response to Cyclo 3 Fort was compared to baseline values. In total there was information from 10,246 subjects. RESULTS: On a 4 point symptom severity scale, where 0 corresponds to no symptoms and 3 to severe symptoms, Cyclo 3 Fort significantly reduces the severity of pain by 0.44 (0.12) points; cramps 0.26 (0.08), heaviness 0.53 (0.11), and paraesthesia 0.29 (0.10) compared to placebo. There is also a significant reduction in venous capacity of 0.70 (0.19) ml/100 ml with Cyclo 3 Fort compared to placebo. We also found reductions in the severity of oedema 0.43 (0.20) points, and decreases in calf and ankle circumference, 0.73 (0.37) cms and 1.17 (0.83) cm, respectively, among patients treated with Cyclo 3 Fort compared to placebo which were not statistically significant. CONCLUSION: Despite questions surrounding the variability of data quality and sample size of some of the studies, we conclude that in patients with CVI Cyclo 3 Fort significantly reduces the severity of the symptoms compared to placebo. This study is a strong and objective demonstration of the clinical efficacy of Cyclo 3 Fort in treating patients with CVI.

Adult↗
PubMed2002

[Kneipp hydrotherapy, sclerotherapy, crossectomy. What really helps in varicose veins and spider veins?].

Varicose veins are irreversibly dilated epifascial and perforating veins resulting from degenerative vascular wall changes. Depending on etiology, they are classified into primary and secondary forms. The majority of the primary varicosities (75%) are hereditary. A clinical differentiation is made between varicosities of major vessels, side branch varicosities, varicosis of the perforating veins, reticular, and cutaneous vessel varicosities, with mixed forms also being known. Inspection and palpation are of predominant importance for the diagnosis, while Doppler and duplex ultrasonography serve mainly to document valvular incompetence. Treatment is determined by the findings, symptoms and the individual situation, and comprises, in addition to such general measures as activity, hot/cold foot baths, obliteration and surgery. A conservative alternative is rigorously applied compression treatment, which is also the most important concomitant measure to sclerotherapy and surgical operation.

Humans↗
PubMed2002

[Conservative management of thrombophlebitis. Cooling, wrapping and mobilizing the patient].

As the name implies, thrombophlebitis superficialis affects superficial extrafascial veins, and is thus to be differentiated from phlebothrombosis (thrombosis in the deep venous system). Special manifestations are varicophlebitis arising out of a varicosis, thrombophlebitis migrans or saltans as recidivating inflammation of non-varicose veins, and the rare Mondor's disease. On the basis of the typical clinical presentation with tenderness, reddening and warming of the skin over the hardened (palpation) vein, thrombophlebitis is relatively easy to diagnose. In uncertain cases, duplex ultrasonography serves to exclude involvement of the deep venous system. The leading therapeutic measure is compression. Whenever possible, the patient should be mobilized. Cold dressings, anti-inflammatory medication and, if indicated, a stab incision, help ameliorate pain.

Bandages↗
PubMed2002

[Deep venous thrombosis of the leg. Will it be acute ambulatory therapy in the future?].

Early diagnosis and treatment of deep venous thrombosis (DVT) in the leg is of decisive importance, in particular in view of the potentially life-threatening complication of pulmonary embolism. The establishment of the diagnosis if often difficult since in the early stage symptoms may be non-existent or few (50%). The most important therapeutic measure is compression. Acute medication is initiated within the first 24 hours with unfractionated conventional heparin administered as a continuous i.v. infusion or intermittent s.c. injections. An initial bolus injection is followed by continuous infusion of 30,000-40,000 units of heparin. More recent data show that low-molecular-weight heparins are as effective as conventional heparin and are easier to apply, making acute treatment on an ambulatory basis feasible. Conversion to anticoagulation treatment is effected with gradually increasing doses, and must overlap heparin for at least 4-5 days. The duration of treatment is determined by the nature of the thrombosis, with recommendations ranging from 3 to 12 months. A shortened in-hospital treatment with early mobilization is considered to be of benefit to the patient.

Acute Disease↗
PubMed2002

The efficacy and safety of a coumarin-/troxerutin-combination (SB-LOT) in patients with chronic venous insufficiency: a double blind placebo-controlled randomised study.

BACKGROUND: The objective was to evaluate the oedema-protective effect of a vasoactive drug (coumarin/troxerutin [SB-LOT]) plus compression stockings in patients suffering from chronic venous insufficiency after decongestion of the legs as recommended by the new guidelines. PATIENTS AND METHODS: 231 patients were randomly assigned medical compression stockings plus SB-LOT (90 mg coumarin and 540 mg troxerutin per day) or medical compression stockings plus placebo for the first 4 weeks and SB-LOT or placebo for the second 12 weeks of the study. The primary efficacy endpoint was the lower leg volume measured by well-established water plethysmometry. RESULTS: 226 patients were evaluated. After ceasing compression stockings, an edema protective effect was detected in the SB-LOT-group but not in the controls. Recurrence of leg volume increase was by 6.5 +/- 12.1 ml and by 36.7 +/- 12.1 ml in the SB-LOT and placebo group, respectively (p = 0.0402). The local complaint score and general aspects of quality of life were also superior for the SB-LOT-group (p = 0.0041). Significant differences were also observed with regard to clinical global impression and therapeutic effect. No serious adverse drug reaction or clinically relevant impairment of laboratory parameters occur. CONCLUSION: This study confirms the oedema-protective effect of SB-LOT in chronic venous insufficiency and provides a treatment option for patients who discontinue compression after a short time.

Administration, Oral↗