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H Heidrich

Publications and source records attributed to H Heidrich.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1997

Colour coded duplex sonography in ischemic finger artery disease--a comparison with hand arteriography.

BACKGROUND: A reliable non-invasive diagnostic procedure is desirable to exclude arterial pathology in patients with pain in their fingers. PATIENTS AND METHODS: The results of colour coded duplex sonography (CCDS) in 450 finger arteries (45 hands/41 patients) were compared with findings obtained by intra-arterial digital subtraction arteriography (i.a.-DSA). The population consisted of symptomatic patients with a high risk for finger artery pathologies. RESULTS: Arteriography of the hand documented finger artery occlusion in 35.6% of these patients. CCDS is capable of detecting pathological alterations in finger arteries with high accuracy and can differentiate them from regular arteries. In patients with several diseases of the finger arteries, the ultrasound diagnosis concurred with arteriography in 93.1% of patent arteries. In patients with occluded arteries the accuracy of CCDS was 86.3%. CONCLUSION: When assessing diseases of finger arteries non-invasive CCDS should be used routinely before referring the patient to arteriography. The latter is only indicated when there is a need to image the whole arterial trunk of the upper extremity or the hand, or in case of equivocal results of CCDS.

Adult↗
PubMed1996

[Development of an illness-specific instrument for assessment of quality of life in patients with arterial occlusive disease (Peripheral Arterial Occlusive Disease 86 Questionnaire)].

Impairment in health-related quality of life in patients with peripheral arterial occlusive disease (PAOD) are well-known to clinicians, but due to the lack of disease specific assessment instruments, have not been systematically investigated. We describe the development and psychometric testing of a 86-items patient-based questionnaire for the assessment of the quality of life in PAOD containing 7 dimensions: functional status, pain, symptoms, mood, disease related anxiety, social life and treatment evaluation. The questionnaire was included along with standard questionnaires in a prospective study with 308 patients suffering from PAOD in Fontaine stages I to IV before and one week into treatment. Psychometric testing pertained to reliability (internal consistency, retest), validity (convergent, discriminant) and sensitivity (treatment-related change over time). In addition patient acceptance of the questionnaire was assessed. Psychometric testing yield exellent results regarding scale structure and reliability of the newly developed questionnaire. Validity was reflected in high correlations with standard generic questionnaires and in discriminating in quality of life between patients according to disease severity. The sensitivity was reflected in improved quality of life ratings in patients with improved treadmill performance. Patients needed 20 minutes for responding and rated the questionnaire to be easily understandable and not exhausting. These results show that the newly developed PAVK-86 questionnaire is a reliable, valid and sensitive instrument for the assessment of quality of life in patients with arterial occlusive disease which can be used in clinical studies, epidemiological research and quality assurance programs.

Activities of Daily Living↗
PubMed1995

[Quality of life in peripheral arterial occlusive disease. Multicenter study of quality of life characteristics with a newly developed disease-specific questionnaire].

AIM: Owing to a lack of disease-specific measuring instruments, no systematic investigations of the impairment of the quality of life in patients with peripheral arterial occlusive disease (PAOD) have so far been possible. The aim of the present study, therefore, was to develop an appropriate questionnaire and to submit it to a psychometric test in a sufficiently large number of patients. PATIENTS AND METHOD: A disease-specific questionnaire comprising 86 individual items was developed (PAVK 86) and was tested in a longitudinal study involving 308 patients with confirmed peripheral arterial occlusive disease, Fontaines's stages I to IV. At the same time, three established generic questionnaires were also employed (SF 36, NHP, Every Day Life). RESULTS: Analysis showed that, in comparison with a normal population, the quality of life in patients with PAOD is considerably impaired, in particular by pain, anxiety, general complaints and reduced physical mobility and performance, and is comparable with that of patients suffering from renal carcinoma. In Fontaine's stage III and IV, the quality of life is significantly more greatly impaired than in patients with stage II disease. No differences in quality of life were to be found between Fontaine's stages III and IV. The psychometric test revealed that the PAVK 86 questionnaire is a sensitive, reliable, valid and practicable measuring instrument. CONCLUSION: The PAVK 86 questionnaire is suitable for determining the course and outcome of therapeutic measures on the quality of life of PAOD patients, and can therefore be included in clinical studies. In addition, its use in combination with established generic questionnaires also permits a comparison with age-matched healthy control groups, and is thus also of importance for the assessment of aspects of health economics.

Activities of Daily Living↗
PubMed1993

[Transcutaneous oxygen partial pressure and systolic malleolar artery pressure in patients with peripheral arterial occlusive disease. Longitudinal measurements over 14 days].

BACKGROUND AND METHODS: In 40 legs of 35 patients with Fontaine's stage I to IV peripheral arterial occlusive disease aged between 41 and 77 years, tcPO2 and malleolar artery systolic pressure were measured over a period of two weeks. RESULTS: It was found that the tcPO2 on the dorsum of the foot varied between 10.2 and 18.9 mm Hg, in the lower leg between 13.4 and 22.0 mm Hg, and in the thigh between 10.8 and 14.5 mm Hg as compared with the baseline value. In contrast, the dorsal pedis and anterior tibial arterial blood pressures showed no significant variation over time. CONCLUSION: The range of variation of tcPO2 in feet, lower legs and thighs must be taken into account in long-term measurements.

Adult↗
PubMed1993

[Color-coded duplex ultrasound of lower leg arteries--image reliability with reference to Fontaine stages].

We examined the accuracy of colour flow detection of lower limb arteries in relation to Fontaine's criteria of obstructed peripheral circulation. Assessments were conducted in relation to stages I and II as well as to stages III and IV and compared to the corresponding i. a.-DSA: On comparing the total of all ultrasound results in stages (I-IV) with those of arteriography (92 calf arteries) we found a sensitivity between 80 and 90% and a specificity between 90 and 97%. Results did not differ from these values in the subgroups Fontaine II-IV. Especially in the stages III/IV in comparison to stage II we could not find any disadvantages of colour coded vessel imaging. With sufficient reliability we succeeded in demonstrating calf arteries in endangiitis (Bürger's disease) and in diabetics with mediasclerosis.

Adult↗
PubMed1993

[Leiomyosarcoma in the area of the pelvic vein].

A 37-year-old patient presented with relapsing edema of the left leg lasting for 3 months. The radiological investigations indicated a thrombotic occlusion of the pelvic veins. Surgery revealed a neoplastic growth within the common femoral vein. Histology corresponded to a leiomyosarcoma of the venous wall with intraluminal growth and no indication for penetration of the wall and invasion of the surrounding tissue. In a second operation the tumor-bearing parts of the profound and superficial femoral vein and the external iliac vein were removed. A postoperative infection with involvement of the superficial femoral artery necessitated resection of the artery and replacement by a bypass. Three months after the intervention the patients fares well. The swelling tendency of the left leg is minimal. A local recurrence of the tumor could not be detected so far. Chemotherapy was refused by the patient.

Adult↗
PubMed1992

[Correlation studies of the validity of hemodynamic measuring techniques in peripheral arterial occlusive diseases].

With the aim of validating the methodology employed for Fontaine's classification, haemodynamic correlation investigations were carried out on a group of 35 patients suffering from stage I to IV peripheral arterial occlusive disease and in six healthy patients. These investigations showed that the measurement of tcPO2 at +44 degrees C, capillaroscopy in the foot, measurement of the arterial blood pressure in the ankle by Doppler ultrasound, and measurement of peak flow in the lower limb using venous plethysmography are suitable for distinguishing normal from abnormal blood flow states. A comparison of the various methods made it clear that determination of Fontaine's stages is best achieved by a combination of arterial systolic blood pressure measurement at the ankle with Doppler ultrasound and vital capillaroscopy in the foot. Used alone, vital capillaroscopy, tcPO2 measurement and plethysmography all failed to differentiate Fontaine's stages with adequate reliability.

Adult↗