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H Partsch

Publications and source records attributed to H Partsch.

At least 19 recordsLinked to original sources
PubMed2005

Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs--UIP consensus document. Part I. Basic principles.

OBJECTIVES: Duplex ultrasound investigation has become the reference standard in assessing the morphology and haemodynamics of the lower limb veins. The project described in this paper was an initiative of the Union Internationale de Phlébologie (UIP). The aim was to obtain a consensus of international experts on the methodology to be used for assessment of veins in the lower limb by ultrasound imaging. DESIGN: Consensus conference leading to a consensus document. METHODS: The authors invited a group of experts from a wide range of countries to participate in this project. Electronic submissions from the experts were made available to all participants via the UIP website. The authors prepared a draft document for discussion at a UIP Chapter meeting held in San Diego, USA in August 2003. Following this meeting a revised manuscript was circulated to all participants and further comments were received by the authors and included in subsequent versions of the manuscript. Eventually all participants agreed the final version of the paper. RESULTS: The experts have made detailed recommendations concerning the methods to be used for duplex ultrasound examination as well as the interpretation of images and measurements obtained. This document suggests a methodology for complete assessment of the superficial and perforating veins of the lower limbs, including recommendations on reporting results and training of personnel involved in these investigations. CONCLUSIONS: The authors and a large group of experts have agreed a methodology for the investigation of the lower limbs venous system by duplex ultrasonographpy.

Chronic Disease↗
PubMed2005

Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs--UIP consensus document. Part II. Anatomy.

OBJECTIVES: Duplex ultrasound investigation has become the reference standard in assessing the morphology and haemodynamics of the lower limb veins. The project described in this paper was an initiative of the Union Internationale de Phlébologie (UIP), The aim was to obtain a consensus of international experts on the methodology to be used for assessment of anatomy of superficial and perforating veins in the lower limb by ultrasound imaging. DESIGN: Consensus conference leading to a consensus document. METHODS: The authors performed a systematic review of the published literature on duplex anatomy of the superficial and perforating veins of the lower limbs; afterwards they invited a group of experts from a wide range of countries to participate in this project. Electronic submissions from the authors and the experts (text and images) were made available to all participants via the UIP website. The authors prepared a draft document for discussion at the UIP Chapter meeting held in San Diego, USA in August 2003. Following this meeting a revised manuscript was circulated to all participants and further comments were received by the authors and included in subsequent versions of the manuscript. Eventually, all participants agreed the final version of the paper. RESULTS: The experts have made detailed recommendations concerning the methods to be used for duplex ultrasound examination as well as the interpretation of images and measurements obtained. This document provides a detailed methodology for complete ultrasound assessment of the anatomy of the superficial and perforating veins in the lower limbs. CONCLUSIONS: The authors and a large group of experts have agreed a methodology for the investigation of the lower limbs venous system by duplex ultrasonography, with specific reference to the anatomy of the main superficial veins and perforators of the lower limbs in healthy and varicose subjects.

Chronic Disease↗
PubMed2005

The use of pressure change on standing as a surrogate measure of the stiffness of a compression bandage.

OBJECTIVES: To measure interface pressure and stiffness of short-stretch and long-stretch bandages applied with variable strength. These parameters have a deciding influence on the efficacy of compression therapy in chronic venous disease. DESIGN: Prospective experimental study. MATERIALS AND METHODS: Compression bandages constructed of different materials were applied with light, moderate and high pressure. Interface pressure was measured over the medial aspect of leg in 12 healthy individuals. Long-stretch bandages were compared to short-stretch bandages. The difference between standing and supine pressure was used to characterise stiffness. RESULTS: In the low pressure range the median pressure of the final bandage in the supine position was between 18 and 30 mmHg for the long-stretch and 25-33.5 mmHg for the short-stretch bandages (p<0.01, Mann-Whitney U-test). The median differences between standing and supine pressure were between 2.0 and 8.5 for the long-stretch and 6.0-10.5 mmHg for the short-stretch material. In the group of moderate pressure the median values in the supine position were in a range 33.0-58.0 mmHg, for long-stretch and 39.0-49.5 mmHg for short-stretch bandages, with an increase after standing of 6.0-7.0 mmHg with long-stretch, and 14.0-21.0 mmHg with short-stretch bandages (p<0.01, Mann-Whitney U-test). The median supine pressure values in the high pressure group were between 52.0 and 67.0 mmHg for long-stretch and 59.5-67.0 mmHg for short-stretch material. The median increase during standing ranged between 8.5 and 14.5 mmHg in the elastic group and 23.0-33.0 in the inelastic group (p<0.01, Mann-Whitney U-test). CONCLUSION: A bandage applied with light pressure corresponds to the moderate pressure category of stockings. The difference between the sub-bandage pressure from supine to standing can be used to characterise the stiffness of a bandage.

Adult↗
PubMed2005

The venous return simulator: an effective tool for investigating the effects of external compression on the venous hemodynamics--first results after thigh compression.

BACKGROUND: To present a virtual model, the venous return simulator (VRS), designed to compute venous hemodynamic variations when compression is applied to the leg. METHODS: The VRS defines a numerical network of the lower extremity and computes the dynamic variables (flow rate, venous diameter and internal pressure) for a defined external pressure. The VRS was based on physiological data from the literature and clinical studies on healthy subjects. Clinical correlations were required to confirm its validity; for this purpose, we carried out experiments simulating the conditions of a clinical trial, in which the diameter of superficial and deep veins was measured while increasing pressures (20, 40 and 60 mmHg.) were applied to the thighs of patients enduring deep valvular insufficiency and venous ulcers. The diameters and flow rates calculated using our VRS model were compared with the experimental data obtained at the same thigh compression levels. RESULTS: The numerical results of VRS are in good agreement with the clinical data obtained by Duplex, (R2 = 0.96). In accordance with the in vivo measurement the computed results show that only a pressure greater than 40 mmHg is able to reduce the venous diameter at thigh-level, both in the great saphenous vein and in the femoral vein. CONCLUSION: The venous return simulator computes lower limb hemodynamic parameters under static conditions. The good correlation existing between the VRS and the data obtained in a previous clinical study shows that this numerical approach could provide a useful means of predicting the hemodynamic consequences of compression therapy.

Bandages↗
PubMed2004

Results of a questionnaire regarding improvement of 'C' in the CEAP classification.

BACKGROUND: One of the shortcomings of the CEAP classification is that some of the clinical conditions in the original version were not defined and, therefore, were used in different ways by those who work with CEAP. AIM: To clarify the definitions of the seven clinical classes in the CEAP classification and to improve universal understanding of these in phlebology. METHODS: The authors prepared a short questionnaire regarding the 'C' part of CEAP with five main questions, dealing with definitions of clinical items: telangiectases, corona phlebectatica, reticular veins, varicose veins and the use of CEAP. The questionnaire was translated into 11 different languages and sent around the world by means of International Venous Digest by fax. Two hundred and six answers were received from 67 countries out of 3681 faxes sent (5.6%). RESULTS: There were a wide variety of opinions returned thus demonstrating that the same term is used with various meanings by different physicians. All physicians classify telangiectases of thigh and foot as class C1, but discrepant answers were obtained concerning the differences between reticular veins and reticular varicose veins as well as the diameter of small and large varicose veins. Sixty per cent of physicians answering this survey use the CEAP classification. CONCLUSION: Further clarification and refinement of the CEAP classification are necessary. The authors hope that this will result in broader acceptance of CEAP.

Humans↗
PubMed2004

Immediate mobilisation in acute vein thrombosis reduces post-thrombotic syndrome.

AIM: To investigate the effect of compression and immediate ambulation in the acute stage of deep vein thrombosis (DVT) on the development of postthrombotic syndrome (PTS). METHODS DESIGN: follow-up study of patients who previously have been enrolled in a randomized controlled trial. SETTING: outpatient department of a municipial hospital. SUBJECTS AND INTERVENTIONS: a follow-up was performed 2 years after 53 patients with acute proximal DVT had been enrolled into a randomized controlled trial, comparing bed rest and no compression (n=17), Unna boot bandages plus walking (n=18) and compression stockings plus walking (n=18). Telephone interviews could be conducted with 11 patients, 37 patients could be reinvestigated by independent observers (11 from the bed-rest group, 13 from the bandage group and 13 from the stocking group). Compression stockings up to the time of the follow-up were worn by 8/11 (73%) of the bed-rest patients and by 13/26 (50%) of the mobile patients. MAIN OUTCOME MEASURES: clinical and venous duplex investigation, pain assessment using visual analogue scale and Lowenberg test, leg circumference, clinical ''PTS-score'' combining 5 subjective symptoms with 6 objective signs (Villalta-Prandoni-scale). RESULTS: Duplex investigation of the deep veins and pain assessment by visual analogue scale showed no significant differences between the groups. Nine out of 11 patients after bed rest, but only 16/26 in the mobile groups showed a larger calf circumference on the diseased leg (n.s.). Judged by the Villalta-Prandoni-scale a significantly better outcome could be found in the mobile group (mean score 5.1) than in the bed-rest group (mean score 8.2), (p<0.01). (''Mild PTS'' = score 5-14, ''severe PTS'' score = or > 15). Eighteen out of 26 mobile patients, but only 2/11 bed-rest patients had a score = or < 5 (''no PTS''). CONCLUSIONS: Immediate mobilisation with compression in the acute stage of DVT reduces the incidence and the severity of PTS.

Acute Disease↗
PubMed2003

Leg compression and ambulation is better than bed rest for the treatment of acute deep venous thrombosis.

AIM: Treatment of acute deep venous thrombosis (DVT) with low-molecular-weight heparin and vitamin K-antagonists reduces the risk of thrombus progression and pulmonary embolism but has no immediate effect on signs and symptoms. We addressed the question whether adding compression and walking would lead to a more rapid clinical improvement than bed rest. METHODS: Fifty-three symptomatic outpatients with proximal DVT were randomly treated, in addition to dalteparin and phenprocoumon, with either firm inelastic bandages (n=18), elastic compression stockings (n=18), both combined with immediate deliberate ambulation, or bed rest without any compression (n=17). We assessed daily walking distance, well-being, quality of life, pain, swelling and clinical scores over a period of 9 days. Lung scans and ultrasound of the leg were performed on days 0 and 9. RESULTS: In the compression groups the walking distance increased with time to 4 km/day on average. Improvement of well-being and DVT-related quality of life was significantly faster and more pronounced with compression than with bed rest (p<0.05 for stockings, p<0.001 for bandages). Pain monitored by visual analogue scale decreased with time in a linear pattern in all groups (p<0.001). There was a significant difference between the groups (p<0.01), the best effect being achieved with bandages. Pain assessed by a provocation test was reduced by half on day 3 with bed rest but remained constantly present over the subsequent 6 days. With compression it was reduced to near baseline on day 3. Swelling was almost completely removed with compression and clinical scores also improved more than with bed rest (p<0.001). Thrombus progression, as studied with ultrasound, was less frequent and less pronounced in the compression groups than with bed rest. There was no difference of new pulmonary embolism on repeat lung scans. CONCLUSION: Leg compression combined with walking is the better alternative to bed rest for the treatment of symptomatic outpatients with proximal DVT.

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↗
PubMed2002

Lupus anticoagulant and venous leg ulceration.

BACKGROUND: Most leg ulcers occur in patients with venous insufficiency. However, not all patients with venous insufficiency develop leg ulcers. Recent studies have found that factors causing clotting abnormalities, e.g. anticardiolipin antibody (ACA), are associated with leg ulcers. Although lupus anticoagulant, like ACA, belongs to the group of antiphospholipid antibodies, its presence in patients with venous leg ulceration has not been previously reported. OBJECTIVES: To determine the presence of lupus anticoagulant in patients with venous leg ulceration. METHODS: We investigated the presence of lupus anticoagulant in 27 patients with venous leg ulcers and compared these data with controls. Lupus anticoagulant was evaluated in all subjects by the Russell's viper venom test. RESULTS: Of 27 patients with venous leg ulceration, 16 (59%) were shown to have lupus anticoagulant, while only one of 32 controls (3%) was found to have lupus anticoagulant. Thus, lupus anticoagulant was significantly more frequent in patients with venous leg ulcers than in controls (P < 0.001). CONCLUSIONS: We suggest that lupus anticoagulant could be a hitherto unknown factor contributing to the development of venous leg ulcers.

Aged↗
PubMed2002

Adventitial stripping of the radial and ulnar arteries in Raynaud's disease.

Adventitial stripping of the palmar arch, the palmar common digital arteries, or the proper digital arteries is a last resort in the treatment of refractory primary or secondary Raynaud's phenomenon. Seven patients who had adventitial stripping of the ulnar and radial arteries proximal to the wrist and resection of the nerve of Henle, if identifiable, are presented. All of them were evaluated by telethermography, acral rheography, and a questionnaire before and after surgery. All were asymptomatic after surgery with satisfactory healing of the ulcers at the fingertips. None of them relapsed during the follow-up time of 1.5 years.

Adult↗
PubMed2002

[Periarterial sympathectomy of the radial and ulnar arteries in Raynaud's phenomenon--a preliminary study].

PURPOSE: Assessment of the post-operative results of peripheral sympathectomy in Raynaud's phenomenon. METHODS: Six patients with therapy refractory Raynaud's phenomenon underwent a 4 cm long adventitial stripping of the radial and ulnar arteries proximal to the wrist. The nerve of Henle was followed up to the surface of the palmar arch and resected. The pre- and postoperative examinations were performed using the help of a questionnaire, telethermography and infra-red laser reflexion rheography. RESULTS: All but two patients (two hands) were free of complaints (four patients, six hands), the three ulcers on the finger tips healed well. According to the questionnaire there was a dramatic improvement in the quality of life of the patients. CONCLUSION: In the follow-up period of two years, there was no recurrence. Adventitial stripping of the radial and ulnar arteries and resection of the nerve of Henle proximal to the wrist have demonstrated favourable results in the treatment of therapy-resistant complaints in Raynaud's phenomenon.

Adult↗
PubMed2002

[Diagnosis and therapy of thrombophlebitis with special consideration of low molecular weight heparin].

The clinical diagnosis of superficial thrombophlebitis is characterized by the occurrence of painful and inflamed cords along superficial veins and varices. Duplex sonography is recommended to rule out asymptomatic deep vein thrombosis which may be present in about 20% and to check potential sources of entrance of the thrombotic process into deep veins, like the junctions of great and small saphenous veins. Classic therapy is based on firm compression therapy and walking exercises. Incisions with expression of clots and anti-inflammatory drugs may reduce pain and inflammation. When phlebitis involves also the thigh and especially the proximal part of the great saphenous vein surgical ligation of the junction and local thrombectomy can be considered, preferably on an outpatient basis. Recent data from one randomised controlled trial demonstrate the efficacy of unfractionated heparin in a dose of 12,500 I.U. s. c. twice a day in this indication. According to another randomised controlled trial low molecular weight heparin (LMWH) may reduce the development of thromboembolic complications and also the relatively frequent extension of the thrombi in the superficial veins. Therapeutic doses seem to be more effective than prophylactic doses. While conventional therapy with compression and walking is sufficient for the majority of cases, the additional use of low molecular heparin is recommended in increased thromboembolic risk and when the thigh is involved. In the few studies available treatment time of 6-12 days is reported. More studies with special focus on indication, dosage and duration of therapy with LMWH are needed for the recommendation of clear therapeutic guidelines.

Anticoagulants↗
PubMed2001

Multicentre, randomised controlled trial of four-layer bandaging versus short-stretch bandaging in the treatment of venous leg ulcers.

BACKGROUND: Aim of the study was to compare the healing rates of venous ulcers obtained with four-layer bandages (4LB) versus short stretch bandages (SSB). DESIGN: Multicentre, randomised controlled trial performed in 5 centres of the Netherlands and in 2 centres in Austria ("PADS-study" = Profore Austrian Dutch Study). PATIENTS AND METHODS: 112 patients (53 treated with 4LB and 59 treated with SSB) completed at least one post-treatment follow-up, 90 completed the study. Bandaging and ulcer assessment was performed at weekly intervals. Randomisation was carried out for each centre and was stratified according to the size (more or less than 10 cm2) of the ulcerated area. Local therapy consisted of plain absorbing, non-adherent dressings. Time to complete healing was recorded up to a maximum of 16 weeks. The two treatment-groups were comparable regarding their baseline-characteristics. RESULTS: In total 33/53 (62%) of ulcer-patients were healed in the 4LB group, compared with 43/59 (73%) in the SSB group (difference 11%, 95% CI -28% to 7%). 77% of the ulcers with an initial area less than 5 cm2 healed as compared with 33% of the larger ulcers. The different healing rates in the centres could be explained by the different sizes of the treated ulcers. Based on Kaplan-Meier estimates the median healing time was 57 days for the 4LB (95% CI 47-85 days) and 63 days for the SSB (95% CI 43-70 days). CONCLUSION: The ulcer healing rate and the median healing time did not differ among the two types of bandages. The main discriminant criterion for healing was the initial ulcer size. In centres who are experienced users of short-stretch bandages, no statistically significant different healing rates of venous ulcers could be found after 4LB or SSB.

Adult↗
PubMed2001

Therapy of deep vein thrombosis with low molecular weight heparin, leg compression and immediate ambulation.

BACKGROUND: Traditionally, patients with acute deep vein thrombosis (DVT) are treated with strict bed rest for several days to avoid clots from breaking off and causing pulmonary emboli. The purpose of this study is to give a precise estimate of short term complications like pulmonary embolism, bleeding, heparin-induced thrombocytopenia (HIT) and death in a cohort of consecutive patients who were admitted because of acute symptomatic DVT, all treated by compression and walking exercises instead of conventional bed-rest and nearly all by low-molecular-weight heparin. PATIENTS AND METHODS: In 1289 consecutive patients the following five endpoints were registered for the period of hospital-stay: 1. Frequency of pulmonary embolism (PE) at admission (V/Q lung scan), 2. Frequency of new PE's after 10 days (second lung scan), 3. Fatal events (autopsy), 4. Frequency of malignant disease, 5. Bleeding complications and HIT. RESULTS: 1. 190/356 (53.4% of iliofemoral, 355/675 (52.6%) of femoral and 84/239 (35.1%) of lower leg vein thrombosis showed PE (difference iliofemoral and femoral versus lower leg DVT p < 0.001). Two thirds of these PE were asymptomatic. 2. New PE after 10 days in comparison to the baseline scan occurred in 7.4%, 6.4% and 3.4% respectively. 3. Fatal events, all investigated by autopsy, were caused by PE in 3 patients aged over 76 years (0.23%), by malignant diseases in 12 (0.9%) and due to other causes in 2 (0.15%). 4. 232 patients (18%) had associated malignant diseases, from which 33% were detected by our screening. 5. Non-fatal bleeding complications were seen in 3.3%, including 5 patients (0.4%) with major bleeding. Three patients (0.2%) suffered from HIT II. CONCLUSION: The low incidence of recurrent and fatal pulmonary emboli in this series affirms the value of early ambulation with heavy leg compression in patients with symptomatic acute leg deep venous thrombosis. In addition, the presence of pulmonary emboli in one-third of those with calf vein thrombi emphasizes the importance of fully diagnosing and treating calf clots.

Adolescent↗
PubMed2001

[Mondor phlebitis associated with hepatitis C].

Mondor's disease in association with hepatitis C. We report a case of a 40 years old patient suffering from Mondor's disease. Neither a malignancy nor a disturbance of the clotting system was found. This case is remarkable for the association with hepatitis C.

Adult↗