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Biomedical subjects

H Heidrich

Publications and source records attributed to H Heidrich.

At least 19 recordsLinked to original sources
PubMed2004

Frequency of asymptomatic peripheral arterial disease in patients entering the department of general and internal medicine of a general-care hospital.

BACKGROUND: The fact that a high prevalence of asymptomatic peripheral arterial disease (PAD) in the population has repeatedly been noted in recent years, without there being data as to how often asymptomatic PAD has to be anticipated in inpatients treated for divergent internal diseases led us now to performing a screening study in a general-care hospital. PATIENTS AND METHODS: The study population consisted of 990 patients (51.8% women, 48.2% men) with a mean age of 65.2 years (40-93 years) who had to be treated in a hospital for various internal diseases in the period from January 1994 to January 1995. Their case histories were taken, and their clinical findings and the ankle/brachial indices as calculated from Doppler ultrasonographic measurements of the systolic pressures in the malleolar and brachial arteries were used to ascertain how many of the patients presented with asymptomatic and symptomatic PAD. Further the frequency of risk factors (smoking, hypertension, diabetes mellitus, lipid disorders) was recorded for either patient group. RESULTS: The study showed that 6% of the 990 patients suffered from symptomatic PAD and that of the remaining 931 patients, 43.7% were diagnosed, on the basis of the ankle/brachial index (ABI) (< or = 0.9), to have asymptomatic PAD, while 56.3% showed no indication of PAD. CONCLUSIONS: The high number of cases of asymptomatic PAD among inpatients who underwent internal treatment--a percentage well above the figures published so far for outpatients--allows the conclusion that the determination of the ABI is well suited to screen patients older than 50 years even in a hospital setting so that early secondary prophylaxis can be initiated.

Adult↗
PubMed2004

Frequency of non-vascular accompanying diseases in patients with peripheral arterial disease.

BACKGROUND: Since there are so far no relevant figures on the frequency of non-vascular associated diseases in patients with peripheral arterial disease (PAD), an analysis was carried out to determine how frequently co-morbidity is found in such patients. PATIENTS AND METHODS: In the course of a retrospective analysis, 1693 patients (55.4% men, 44.6% women/average 68.6years) with peripheral arterial diseases (PAD) of Fontaine stage II to IV were examined to find out how often cardiopulmonary, gastrointestinal, haematological, endocrinological, neurological, orthopaedic, urological-nephrological, psychiatric diseases and tumours were seen. RESULT: Coronary ischaemic heart disease was present in 63.1% of the cases, heart failure existed in 20.7%, hypertension in 57.9%, endocrine and metabolic diseases in 60.4%, gastrointestinal diseases in 14.8%, pulmonary diseases in 14.5%, psychological and behavioural deficiencies in 16.2%, orthopaedic diseases in 21.6%, haematological diseases in 9.0%, urological diseases in 16.9%, chronic renal insufficiency in 7.3% and malignant tumours in 5.8%. CONCLUSIONS: The frequency of non-vascular comorbidity in patients with PAD necessitates systematic interdisciplinary diagnosis prior to any therapy decision to take into account the patient's associated diseases, life expectancy and current quality of life.

Aged↗
PubMed2003

Hemostatic and fibrinolytic effects of systemic prostaglandin E1 therapy in patients with peripheral arterial disease.

BACKGROUND: The study was designed to evaluate if there is any evidence of a hyperfibrinolytic bleeding-risk under systemic treatment with prostaglandin E1 (PGE1) of patients with peripheral arterial disease (PAD). PATIENTS AND METHODS: The in vivo effect of PGE1 on the fibrinolytic and hemostatic process was tested on 15 patients before and after treatment with Alprostadil for 21 days using D-dimers (DD), fibrinogen, prothrombin time (PT), partial thromboplastin time (PTT), antithrombin (AT), ProC-Global, plasminogen, plasminogen activator inhibitor activity (PAI), alpha 2-antiplasmin, coagulation factor XII, basal and activated fibrinolytic capacity (fib. cap.). RESULTS: There was no significant difference in DD, fibrinogen, PT, PTT, AT, ProC-Global, plasminogen, PAI, alpha 2-antiplasmin, coagulation factor XII, basal and activated fibrinolytic capacity observed after the treatment. CONCLUSION: Summarizing this study there is no hyperfibrinolytic bleeding-risk after the systemic therapy with Alprostadil to be expected.

Aged↗
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↗
PubMed2000

Vital capillary microscopic findings in the nailfold of patients with diabetes mellitus.

BACKGROUND: Preliminary investigation done in 100 healthy adults and 20 healthy children had shown that the interpretation of significance of changes in capillary morphology need to be corrected, since capillary changes previously considered to be pathological are also to be found in large numbers in healthy subjects. Against this background, the question has now been investigated whether the capillary microscopic findings in diabetics deviates from those found in normals, and whether the duration of the diabetes, its treatment, its sequelae, or concomitant diseases have any influence on the capillary microscopic appearance. PATIENTS AND METHODS: In 100 patients aged between 44 and 88 years with type 2 diabetes vital capillary microscopy was carried out on all ten fingers in the usual manner. The evaluation of the video recordings was done only when all the examinations had been completed--by two examiners blinded to the clinical data. RESULTS: It was shown that 66% of the patients demonstrated pathological capillary microscopic findings. These findings included pathologically increased apical and non-apical dilatations (32%), haemorrhagic extravasations (20%) and branchings (45%). No differences were found between the therapy groups (insulin--oral medication) nor was any relationship between the appearance of capillary changes and the duration of diabetes observed. Diabetics with concomitant diabetic sequelae (polyneuropathy), demonstrated no differences in capillary morphology as compared with diabetics with no such sequelae. CONCLUSION: Diabetics are found to have an increased incidence of pathological capillary morphology taking the form of increased apical dilatations, branchings and haemorrhagic extravasations. Neither the treatment, nor the duration of the illness, nor diabetic sequelae appeared to have any influence on the capillary microscopic changes.

Adult↗
PubMed1999

[What is the value of determining walking distance in peripheral arterial occlusive disease on the treadmill and in daily life? Prospective correlation study].

AIM: To investigate the question whether and how walking distances measured under standardized conditions on the treadmill and on the level correlate with the patients walking ability under everyday conditions. PATIENTS AND METHOD: In 49 patients (33 men, 16 women, age 34 to 84 years) with Fontaine Stage II peripheral arterial occlusive disease the pain-free and absolute walking distance on the treadmill were measured under standardized conditions, as also the walking distance on the level at freely selected speed. RESULT: It was found that the pain-free walking distance under everyday conditions was about 2 to 3 times longer than that measured under standardized conditions on the treadmill.

Adult↗
PubMed1999

Randomized reliability study evaluating constant-load and graded-exercise treadmill test for intermittent claudication.

The aim of this randomized study was to compare the reliability of the treadmill test at constant-load (C-test, 3 km/hr; fixed grade of 12%) recommended in Germany with that of the graded-exercise test (G-test, 3 km/hr; increase in grade of 3.5% every 3 minutes) propagated in the United States. In 50 patients with an absolute claudication distance (ACD) in the C-test of between 50 and 400 m, the two treadmill tests were carried out in randomized order on one and the same day, and repeated on 3 days within 1 week. For the initial claudication distance (ICD), the intraclass correlation was 0.88 in the C-test and 0.87 in the G-test. For the ACD the coefficients were identical at 0.91. The within-subject variation (CVwithin) in the C-test and G-test was 25% and 27% for the ICD and for the ACD 24% and 21%, respectively. The between-subject variation was very similar with 72% and 73% (ICD) and with 78% and 68% (ACD). However, in ACDs below 100 m and between 100 to 150 m, the C-test showed significantly smaller coefficients of variation than the G-test: 13% vs 81% and 14% vs 50%, respectively. In conclusion, the results showed that both C-test and G-test are equally well reproducible.

Analysis of Variance↗
PubMed1998

[Heparin-induced thrombocytopenia with unfractionated heparin. A prospective study of inpatient treatment of internal medicine patients].

AIM: To investigate the influence of unfractionated heparin on heparin-induced thrombocytopenia (HIT) type II. PATIENTS AND METHOD: In 162 patients with internal diseases treated therapeutically of prophylactically with unfractionated heparin (heparin sodium, heparin calcium), we carried out a prospective study to determine the incidence of HIT type I and II. 55.6% of the patients were female (n = 90) with an average age of 76.5 years (range: 25 to 96 years) and 44.4% male (n = 72) with an average age of 67.5 years (range: 17 to 93 years). A platelet count was taken regularly before the start of heparin treatment, on the first day of treatment and then every second day from day 5 to 20. Whenever HIT II was suspected, an HIPA test was performed. RESULT: Type I HIT occurred in 10%, type II in 3% of the cases. Two of the 5 patients with type II developed severe thrombotic complications. CONCLUSION: In view of the high incidence of HIT, regular platelet counts should always be carried out in patients receiving heparin treatment.

Adult↗
PubMed1998

The Incidence of Occult Malignant Diseases in Patients With Deep Venous Thrombosis of the Pelvis and Lower Limb

In 318 patients (155 men, 163 women) with an average age of 58.8 years (range 16-97 years), a retrospective study was carried out to determine the incidence of occult malignancies in patients with deep venous thrombosis affecting the pelvis and lower limb, confirmed by phlebography or duplex ultrasonography. It was found that, overall, 7.5% of all patients had occult malignant diseases, the most common being bronchial carcinoma (16%), colonic and renal carcinomas (12% each), and prostatic and pancreatic carcinoma (8% each). Of the patients with occult malignancy, 88% were older than 55 years. This fact shows that acute phlebothromboses may be a paraneoplastic early syndrome more often than was previously thought, and that patients older than 50 should always be screened for the presence of a tumor.

Journal Article↗
PubMed1998

The Incidence of Heparin-Induced Thrombocytopenias

The incidence of heparin-induced thrombocytopenia (HIT) types I and II was investigated retrospectively in 500 heparin-treated patients. In our department of internal medicine 500 patients were treated with unfractionated, middle- or low-molecular heparin (s.c. or i.v.) during 1995 as inpatients. Excluded were patients with other known causes of thrombocytopenia. There were 306 females (61%), mean age 76 years (17-98 years) and 194 males (39%), mean age 73 years (24-93 years). The incidence of HI type I was 4.4% and of HIT type II 0.6% with a positive heparin-induced-platelet-activation test (HIPA test). In addition, HIT type II was suspected in another 1.4% of cases with negative or missing HIPA test. Because of our results on the incidence of HIT type I and type II a close control of thrombocyte count during heparin therapy is necessary. In the case of HIT type II disease, heparin therapy must be stopped immediately.

Journal Article↗
PubMed1998

Long-term follow-up of thromboangiitis obliterans.

BACKGROUND: To date there have been no clinical studies providing data on which to base a long-term medical and social prognosis of thromboangiitis obliterans (TAO). Against this background a retrospective investigation of the longterm course of patients with TAO, who attended the vascular clinic in the medical department of the Klinikum Westend of the Freien Universität Berlin (Free University of Berlin) or the Franziskus Hospital in Berlin was carried out during the period between 1970 and 1990. PATIENTS AND METHODS: The 69 patients making up the overall group included 53 males and 16 females whose average age at the time of initial manifestation of TAO was 34 years. The mean interval between the initial manifestation of the disease and the follow up investigation was 10.7 (range: 2-30) years. The assessment of the course over the long-term was based on a clinical follow-up survey or the data provided by a questionnaire. RESULTS: In 96% of the patients symptoms began in one of the lower limbs, predominantly in the forefoot. During the further course of the illness, 73% of the patients developed symptoms in at least one other limb, either upper or lower. Since the initial development of symptoms, the patients had experienced an average of 5.4 (range: 1-20) acute attacks, that is, episodes of more severe symptoms. The most common reason for hospitalisation was necrosis of the lower limbs, the usual site being the forefoot with primary involvement of the big toe in 57% of the cases. The mean duration of hospitalisation per hospital stay was 36.8 (range: 1-210) days. During the course of the disease 54 (78.2%) of the patients required an average of 3.7 (range: 1-17) operations, 40 (74%) undergoing one or more amputations. Most of the amputations were performed during the first five years after disease onset and the amputation rate was 26%. With the exception of a single lady, all the patients were smokers, and 40 (83.5%) of 48 smokers for whom the relevant information was available persisted with their habit after the onset of the disease. 8 (16.6%) of the 48 patients claimed to have stopped smoking during the course of their disease. Among the patients who continued to smoke, 65% required an amputation, which was almost twice that seen in those who stopped smoking. In terms of number of acute attacks, surgical procedures and smoking, no relationship was found between early age (< 35 years) at onset and progression of the disease. TAO had a pronounced influence on the working life of many of the patients. Twelve changed their jobs because of thromboangiitis obliterans, while 24 (34.8%) retired prematurely on a pension at the mean age of 42. CONCLUSION: The long-term investigation shows that TAO is associated with frequent hospitalisations and surgical procedures. Continued consumption of tobacco in particular was found to be associated with a multiplication of the amputation rate. An influence of patient age at disease onset on the progression of TAO was excluded. In 49 (71%) of the patients, the disease resulted in termination of the working life by either dismissal or premature retirement.

Adolescent↗
PubMed1998

Is the capillary microscopic determination of the visible capillary length a diagnostic criterion in thromboangiitis obliterans?

BACKGROUND: The diagnosis of thromboangiitis obliterans may be difficult to establish in the everyday clinical setting. PATIENTS AND METHODS: In 16 patients with thromboangiitis obliterans vital capillary microscopy was carried out on the nailfold on all ten digits. The longest visible capillary length was noted. As controls we employed 86 healthy subjects. RESULTS: The measurement of the respective longest visible capillary on the nailfold revealed a visible capillary length of more than 0.6 mm in 38% of all patients with thromboangiitis obliterans (n = 16), such capillary lengths were not to be found among healthy subjects (n = 86). CONCLUSIONS: Vital capillary microscopic determination of the visible capillary length is a simple-to-perform, non-invasive examination, which can help to establish the diagnosis.

Adult↗
PubMed1998

Does the measurement of digital arterial pressure using the Doppler ultrasonic technique without testing for vasospasm to detect digital arterial occlusions make good sense?

BACKGROUND: An attempt was made to determine whether measurement of the systolic pressure with the Doppler ultrasonic technique can be used to detect occlusions of the digital arteries. PATIENTS AND METHODS: A total of 92 patients (44 women, 48 men) with an average age of 47.5 years (range: 19-82 years) were investigated. Of these, 17 were diagnosed with a primary Raynaud's syndrome, 45 with a secondary, and 5 patients with a suspected secondary Raynaud's syndrome; 25 patients had digital occlusions of varying genesis. In all patients, the Doppler ultrasonic technique was applied to measure the systolic pressure of the digital arteries of both hands at a room temperature of 21-24 degrees Celsius without any additional thermal (warm or cold) provocation or use of vasodilatory agents; the results obtained were compared with arteriographs of the hands. RESULTS: While the sensitivity of the Doppler ultrasonic technique was a very low 55%, the specificity was a very high 95%. With a prevalence of 68%, the positive predictive value was 96%, the negative predictive value 50%. In the case of angiographically patent digital arteries with no spastic narrowing, the Doppler ultrasonic-measured systolic pressure was up to 30 mmHg above, and up to 25 mmHg below, the systolic pressure measured in the ipsilateral brachial artery. A pressure gradient between upper arm and digital arteries of this order of magnitude therefore does not exclude pathological changes. Only angiography was able reliably to detect vascular stenoses and occlusions. CONCLUSION: Reliable exclusion of digital arterial occlusions using the Doppler ultrasonic technique without testing for vasospasm is not possible. Only occlusions of digital arteries together with simultaneous occlusions of hand arteries can be reliably detected. Owing to the considerable scatter of the systolic blood pressure gradient between brachial and digital arteries, the Doppler ultrasonic technique cannot be used to distinguish between patent and occluded digital arteries without the use of additional vasodilation.

Adult↗
PubMed1997

[Occlusion of finger arteries and thrombotic angiopathy of the retina during adjuvant tamoxifen therapy of a mammary carcinoma].

HISTORY AND CLINICAL FINDINGS: A 57-year-old woman had undergone partial mastectomy with subsequent radiotherapy for cancer of the breast. About 8 weeks after starting adjuvant treatment with tamoxifen (20 mg daily) pain, cooling and livid discoloration developed in her fingers and toes. Skin necroses over finger tips occurred and she was found to have visual field defects and double images. INVESTIGATIONS: There was no clinical or laboratory evidence of recurrence of the breast cancer. Tests of clotting and for inflammatory disease and complement levels were within normal limits. The antinuclear antibody titre was low (1:320) and the measured value of the rheumatoid factor reached the fourfold of normal level. Ophthalmoscopy revealed signs of retinal ischaemia, unilateral papilloedema, reduced visual acuity, visual field and abduction weakness. Duplex sonography and angiography demonstrated multiple occlusions of the finger arteries. TREATMENT AND COURSE: After tamoxifen had been discontinued and prostaglandin E1 administered (40 micrograms over one hour twice daily for 21 days) the symptoms rapidly and markedly improved, the necroses of the finger tips healed and the ophthalmoscopic changes regressed almost completely. CONCLUSION: Tamoxifen, by inducing thrombophilia, can cause thromboembolic occlusions of peripheral arteries, and must in that case be discontinued.

Alprostadil↗
PubMed1997

Treadmill testing for evaluation of claudication: comparison of constant-load and graded-exercise tests.

OBJECTIVES: To compare the correlation and practicability of single-stage vs. graded treadmill protocols in the assessment of the absolute claudication distance (ACD). DESIGN: Randomized open study. MATERIAL AND METHODS: In 52 patients with peripheral arterial occlusive disease, the ACD on treadmill at 3 km/h and 12% grade (constant-load test = C-test) ranged form 50 to 400 m. The C-test and the graded-exercise test (walking on the treadmill at 3 km/h and 0% gradient for 3 min, with subsequent increase in gradient of 3.5% every 3 min = G-test) were carried out at random on the same day under standardized conditions. RESULTS: The ACD was higher in the G-test than in the C-test (360.4 +/- 208.8m vs. 166.5 +/- 93.6m; p < 0.001). The coefficients of variation were very similar (57.9% and 56.2%, respectively). In the subgroup of patients with an ACD of between 100 m and 150 m, a large difference was found both for the coefficient of variation (58.6% G-test, 9.6% C-test) and for the standard deviation (339.8 +/- 199.0m and 133.1 +/- 12.8m, respectively). CONCLUSIONS: For the assessment of the ACD in patients with severe claudication the C-test would seem to be more suitable than the G-test.

Exercise Test↗