[Clinical, functional and morphological late results of venous thrombectomy].
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Adolescent↗
Biomedical subjects
E Minar
Publications and source records attributed to E Minar.
[Cystic renal changes in chronic hemodialysed patients].
In this study we investigated the appearance of renal cysts in 43 chronic hemodialyzed patients using ultrasound (3.5 MHz-sector scanner). The mean age of the patients was 45 years, and the mean duration of dialysis was 26.3 months. In 21 patients (= 49%) cysts could be found. In 10 of these patients a former investigation at beginning of dialysis did not demonstrate any cystic lesions. The diameter of the cysts varied between 5 and 30 mm. Considering the duration of dialysis, in 9 (= 39%) out of 23 patients with a maximum duration of dialysis of 2 years cysts could be demonstrated by ultrasound, and in 12 (= 60%) of 20 patients, who had been dialysed for more than 2 years. The clinical impact of the demonstration of such cysts was recently reported in cases which developed complications like tumour formation or severe bleeding.
Adult↗
[Recurrence of spontaneous kidney rupture in a dialysis patient].
The case is reported of a 35-year-old man who had been treated with hemodialysis for five years because of renal insufficiency due to chronic glomerulonephritis. Renal cystic disease acquired during maintenance dialysis was complicated by bilateral kidney rupture within an interval of two months. Development of cystic changes of kidneys during long-term hemodialysis was first reported in 1977. The main complications of this cystic transformation are, according to the literature, development of neoplasms and hemorrhage into the cysts. In the present case the clinical symptomatology consisted of episodes of severe pain in the flank, hematuria, hypotension and lowering of hematocrit. An ultrasound study demonstrated enlargement of some cysts compared to another study some months ago, and internal echoes due to hemorrhage could be seen in some of the cysts. Because of the danger of spontaneous kidney rupture with consecutive life-threatening hemorrhage, surgery is indicated in such cases.
Adult↗
[Acute venous thrombosis: localization, extent and aetiology with special consideration of paraneoplasia].
Among 279 consecutive patients (average age 53.8 years) with acute venous thrombosis, "complete" or "nearly complete" search for neoplasm was undertaken in 93 (average 60.6 years), "not complete" search in 186 (average 50.1 years). Subsequently the patients were followed regularly for possible malignant tumour (average follow-up period 36.9 months). In the group as a whole the following causes of thrombosis were identified: contraceptives 9.3%; post-operative 9%; malignant tumour diagnosed immediately or within 12 months 5.8%; traumatic 5%; immobilization 3.2%; post-partum 2.9%; diverse other causes 8.2%; unknown 59.5%. Neoplasm was found in 12.9% of 93 somewhat older "completely" examined patients. Taking into account age, 7.8% of all patients over 50 years developed thrombosis in association with neoplasm. In 6 of 16 patients with malignant tumour the venous thrombosis followed a particular course. Extensive thromboses in several bouts predominated. In 48.4% there were three-bout thromboses, in a further 27.4% four-bout thromboses involving also the pelvic vein. Isolated lower-leg venous thrombosis occurred in 9.2%, while the remaining one or multiple-bout thromboses occurred only in a few. Massive pelvic and leg vein thrombosis occurred in 43% of patients with malignant neoplasm, much more frequently than in those without neoplasm.
Acute Disease↗
[Mirizzi syndrome (author's transl)].
The Mirizzi syndrome consists of the trial cystic duct stone, cholecystitis and benign hepatic duct stenosis. The differentiation between intra- and extrahepatic cholestasis can be made sonographically in almost 100% of cases. In a high percentage of cases the ultrasound investigation can localise the level of the block. However, the additional use of endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiography (PTC) is necessary for an exact pre-operative diagnosis. The most efficient diagnostic plan is illustrated by a case presentation of a patient with Mirizzi syndrome.
Adult↗
[Value and limitations of cross sectional echocardiography in the diagnosis of infective endocarditis (author's transl)].
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Aortic Valve↗
[Atypical variant of a hepatocellular carcinoma with a favourable course (author's transl)].
The case of a 51 years old man with a hepatocellular carcinoma (HCC) is reported. Though the tumor is of multifocal origin and widespread the disease takes a favourable course. Histology revealed a well differentiated HCC with clusters of polygonal tumor cells and fibrous stroma, the pattern of which reminds of focal nodular hyperplasia (FNH). HCC has developed in a non cirrhotic liver. Clinically, the patient is in a good condition 22 months after diagnosis of the tumor. The value of all possible methods--invasive and not invasive--for diagnosis of HCC is assessed and compared with literature. According to the literature the survival time comes to 3 to 6 months on average, only single cases take a more favourable course. Correlation of morphology and biological behaviour of tumor is lacking. In our case the pattern of fibrosis similar to FNH is striking and points to a development of carcinoma in preexisting FNH. In literature, however, evidence for a malignant transformation of FNH is lacking.
Angiography↗
[Emergency endoscopy in patients with chronic alcohol abuse].
In this study we evaluated the findings of emergency endoscopy--carried out because of acute bleeding in the upper gastrointestinal tract--in 58 patients with chronic abuse of alcohol. These findings were compared with those bleeding sources which were seen within the emergency endoscopy of 199 patients without abuse of alcohol. Among the collective of the chronic alcoholics in 37,9% the bleeding lesion was found in the esophagus. In one third of the alcoholics with proved liver cirrhosis and esophageal varices another bleeding source than esophageal varices existed. In two patients of this collective, besides bleeding esophageal varices another more distally located bleeding source could be found. This shows the necessity to examine also stomach and duodenum in order to exclude an additional bleeding lesion, even when bleeding out of these varices is endoscopically proved. Erosive alterations in the area of the stomach and duodenum were observed very frequently when multiple lesions existed.
Alcoholism↗
[Transaminase increase: a largely unknown side-effect of heparin treatment (author's transl)].
GOT, GPT and some other enzyme levels were measured systematically in 46 patients receiving subcutaneous heparin treatment. The heparin dosage varied between 5,000 and 15,000 IU, given every eight hours. During heparinisation a rise in GPT (average maximal values 67.0 +/- 7.3 U/l on the eighth treatment day) occurred in 89% of patients, while a rise in GOT (mean maximal values 39.7 +/- 3.9 U/l on the fifth treatment day) occurred in 82%. On reaching maximal value, enzyme activity decreased to the initial value despite continuing heparin treatment. A certain dependence of the incidence and (or) extent of the transaminase increase on heparin dosage was noted, especially comparing low-dose and full heparinisation. An increase in gamma-GT during subcutaneous heparinisation occurred in 37% of patients, while there was no significant change in alkaline phosphatase and lactate dehydrogenase.
Adolescent↗
Carotid stenting in a case of combined kinking and stenosis.
Endarterectomy is currently the preferred treatment for severe carotid stenosis. The technique of eversion endarterectomy allows correction of severe vessel elongation and kinking. The latter is generally believed to be a relative contraindication for endovascular stent placement. We report successful percutaneous transluminal angioplasty and stenting of a left internal carotid artery with high-grade stenosis and severe kinking which was not amenable to endarterectomy because of the distal location of the stenosis. Advanced stent technology with flexible materials makes endovascular treatment of carotid stenosis feasible even in cases of kinking.
Angioplasty, Balloon↗
PTA versus carbofilm-coated stents in infrapopliteal arteries: pilot study.
PURPOSE: To determine the primary success and short-term patency of stent application as a primary treatment modality for high-grade lesions of the infrapopliteal arteries compared with treatment with percutaneous transluminal angioplasty (PTA) in critical limb ischemia in a randomized prospective study. METHODS: Endovascular therapy was performed on 95 lesions in 51 patients (mean age 72.0 years, range 47-80 years) who presented clinically with Fontaine stages III and IV. One patient underwent treatment in both limbs. After angiographic lesion identification, patients were randomized for treatment by PTA (53 lesions in 27 patients) or stent application (42 lesions in 24 patients). Follow-up by clinical investigation and conventional angiography or spiral CT angiography was performed in 37 patients (57 lesions) 6 to 12 months after the procedure, or when clinically indicated. Evaluation was performed by two observers, double-blinded, with thresholds for lesion restenosis of 50% and 70%. Statistical evaluation was performed on a lesion basis by Kaplan-Meier estimated probability rates, and log-rank and Wilcoxon tests. The primary endpoint was the angiographic patency rate of treated lesions. RESULTS: The inter-reader agreement was high (kappa = 0.82). For the stent group the cumulative primary patency at 6 months was 83.7% at the 70% restenosis threshold, and 79.7% at the 50% restenosis threshold. For PTA, the primary patency at 6 months was 61.1% at the 70% restenosis threshold and 45.6% at the 50% restenosis threshold. Both results were statistically significant (p < 0.05). CONCLUSION: Infrapopliteal stent application is an effective treatment modality for high-grade lesions in chronic critical limb ischemia. Compared with PTA, higher patency rates can be expected after 6 months.
Aged↗
[Fibronectin and other immunologic parameters in chronic polyarthritis].
In 20 patients with rheumatoid arthritis the plasma fibronectin concentrations were measured and correlated with the levels of C-reactive protein, alpha 1-antitrypsin, alpha 2-macroglobulin, fibrinogen, C3, C4 complement fractions and alpha 2-antiplasmin in serum respectively plasma. Patients with rheumatoid arthritis showed plasma fibronectin concentrations within reference levels. However, the concentrations of C-reactive protein, alpha 1-antitrypsin, alpha 2-antiplasmin, fibrinogen and C3-complement fraction were significantly higher in comparison to the healthy controls. The results indicate that fibronectin does not belong to the group of "acute phase proteins". Measurement of plasma fibronectin give no additional information about the activity of rheumatoid arthritis.
Adult↗