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Biomedical subjects

H Partsch

Publications and source records attributed to H Partsch.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Clinical aspects of lymphedema and contrast medium lymphography].

Primary lymphedema of the lower extremities is a clinical entity often misdiagnosed, especially in its mild, distal forms. Its characteristics are: swelling, tightness of the skin, and deepening of the skin folds of one foot, mainly in young girls. Proximal forms with involvement of the lower leg and thigh are often congenital. In later years, these manifestations have to be distinguished from secondary lymphedema due to a block in the lymph nodes (e.g. in malignoma), starting with swelling of the proximal regions of the extremities and the genitalia. Indirect lymphography, especially with new contrast media, however, offer new diagnostic possibilities. The best routine method to confirm or exclude lymphedema is isotopic lymphography.

Contrast Media↗
PubMed1990

[Bier's occlusion. An unjustly neglected therapeutic possibility in resistant tissue defects of the extremities].

The retrograde intravenous pressure infusion into an arterially occluded segment of an extremity (Bier's technique) is the most effective method to achieve maximal tissue concentrations of a drug. This was proven by nuclear medical examinations. By application of contrast-medium it was shown that the injected fluid penetrates in a retrograde direction into the foot inspite of primarily intact valves. A second important mechanism of action is the haemodynamic consequence of an arterial occlusion which is characterized not only by an immediate reactive hyperaemic response but also by a delayed increase of blood flow after several days. Favourable clinical results were obtained with antibiotics in infected gangrene of the feet or in necrotizing erysipelas and with urokinase in resistant leg ulcers.

Anesthesia, Conduction↗
PubMed1990

[Diagnostic value and criteria for evaluating indirect lymphography in lymphedema].

To evaluate the deciding diagnostic criteria of indirect lymphography in lymphoedema of the leg, 91 investigations were reviewed. 72 examinations were from lymphoedematous legs as judged by clinical appearance and isotopic lymphography and 19 from healthy legs. After subepidermal infusion of adequate water soluble contrast media (e.g. Jotrolan) in healthy legs, 17 from 19 cases showed normal ellipsoid dye-deposits with normally structured lymph-collectors. In two cases pathological lymph-collectors were shown (specificity 89%). In the 72 legs with lymphoedema the most prominent pathological features were altered lymph-collectors and/or dermal backflow. Only two cases revealed a normal pattern (Sensitivity 97%). Indirect lymphography therefore may be recommended as a sensitive but less specific diagnostic tool for proving lymphoedema in a suspected clinical situation.

Adolescent↗
PubMed1989

[Lead poisoning caused by long-term use of Diachylon ointment].

A 64-year-old female patient, whose extensive bilateral leg ulcers had been treated by daily dressings with diachylon ointment for more than a year, developed lead intoxication associated with general weakness, loss of weight, anemia, hypotension, and neuropathy. The intoxication was proved by the increased levels of lead in blood (threefold) and urine (tenfold). Treatment with dimercaptopropane sulphonic acid (Dimaval) resulted in a considerable emptying of the lead deposits, and the symptoms of poisoning subsided. It is discussed if lead-containing ointments are still justified in modern dermatology.

Female↗
PubMed1989

Indirect lymphography with iotrolan.

Iotrolan was used in concentrations of 240 and 300 mg I/ml for indirect lymphography in a total of 70 patients, and permitted a diagnostic evaluation of the peripheral lymphatics in all cases. The contrast quality was found to correlate with the concentration used. The concentration of 300 mg I/ml Iotrolan was judged to provide the better contrast density and definition. Side effects were limited to transient local erythema and pain during the infusion in one patient and a protracted reaction resembling serum sickness in another patient (Iotrolan 240 mg I/ml). Because of its excellent tolerance, Iotrolan is particularly suitable after subepidermal infusion for indirect lymphography, during which the local lymph drainage of cutaneous regions of interest can be evaluated.

Clinical Trials as Topic↗
PubMed1989

[Indications-related use of stockings--measuring venous pump function].

In 48 patients (16 healthy persons, 16 patients with venous incompetence and 16 patients with phlebographic proved status after thrombosis) the effect of medical compression stockings of different compression pressure (Sigvaris Thrombo, Sigvaris 503, Sigvaris 504) on venous pumping function was studied by foot volumetry. In patients with varicosis and preexistent reduced pumping function the expelled volume in average ascended from 13.0 to 16.23 (+25%, Sigvaris 503), respectifly to 16.52 (+27%, Sigvaris 504) (p less than 0.05 Wilcox and Wilcoxon test). In patients in status after deep leg vein thrombosis with very reduced pumping function it came to an increase of expelled volume from 8.48 to 11.08 (+31%, Sigvaris 503) and to 12.55 (+48%, Sigvaris 504) (p less than 0.01). The hospital stocking Sigvaris Thrombo did not really improve the venous pumping function. So for the first time the common prescription of medical compression stockings class II in patients with varicosis and in mild cases of chronic venous incompetence and of stockings class III in patients in status after deep leg vein thrombosis is justified by measurement.

Adolescent↗
PubMed1988

Investigations on the pathogenesis of venous leg ulcers.

Based on a prospective study of 92 patients with DVT initiated in 1979, including a follow-up every year, the following investigations were performed: phlebography, Doppler-ultrasound, plethysmography (strain gauge and PPG) and foot-volumetry. In ulcer-patients skin blood flow was measured by Laser-Doppler and local oxygen supply by measurement of transcutaneous oxygen. Transcapillary protein-leakage was assessed by isotopic methods, local lymph-drainage by isotopic lymphography and indirect x-ray lymphography. From the results of these investigations the following course of events, which may be of importance for the development of venous ulceration, can be outlined: 1. Venous refluxes penetrating into the venules of the skin. 2. Chronic venous ambulatory hypertension (lack of pressure-fall during walking), waves of high pressure in the capillaries. 3. Protein-rich oedema. 4. Failure of fibrin clearance from the pericapillary space due to inadequate (exhausted?) fibrinolysis and deficient local lymph drainage. 5. Resulting changes in the ground substance, proliferation of fibres. 6. Local hypoxia due to a diffusion block by the impermeable pericapillary cuffs, partially due to a reduction of capillaries in the superficial layers.

Blood Proteins↗
PubMed1988

Clinical use of indirect lymphography in different forms of leg edema.

Indirect lymphography by subepidermal infusion of newly developed nonionic, dimeric contrast media (e.g., Iotrolan) opacifies peripheral lymphatics of the skin. Using this method we examined 159 patients with primary and secondary lymphedema, chronic venous insufficiency, and lipedema and compared the findings to normal individuals. A variety of characteristic patterns were uncovered. The technique causes little patient discomfort and takes on the average only 30 minutes.

Contrast Media↗
PubMed1988

[Congestive lymphostatic papillomatosis].

In seven patients with papillomatosis cutis in chronically congested lower extremities (lymphoedema, chronic venous insufficiency, chronic cardiac insufficiency) indirect lymphography revealed abnormalities of dermal lymph drainage. In four of these patients punch biopsies were taken from the papillomas. Microscopic examination revealed hyperplasia of the epidermis and dilated capillary-like vessels. Papillomatosis cutis in chronically congested lower extremities can be distinguished from pseudoepitheliomatose and carcinomatose alterations by both clinical and histological examination. Impaired local lymph transport seems to be the decisive trigger mechanism for the development of these papillomas.

Adult↗
PubMed1987

[Primary lymphedema in the nephrotic syndrome: case report].

The aim of this case report is to discuss possible connections between the development of a hypoproteinaemic oedema due to the nephrotic syndrome and the occurrence of lymphoedema. Two patients (a three year-old girl and a seven year-old boy) developed lymphoedema of one leg one year after the onset of the nephrotic syndrome. The case of the six year-old girl is presented. Malignancy was excluded by clinical investigation. Direct lymphography failed to show any peripheral lymph-vessels; indirect lymphography (i.c. infusion of a newly-developed contrast medium) revealed hypoplasia of the peripheral lymph-collectors. The development of lymphoedema 12-18 months after the appearance of the nephrotic syndrome supports the hypothesis that the increase in extravascular fluid, which is caused by a reduced oncotic pressure in the plasma, may trigger off the development of lymphoedema if there is a primary defect of the lymphatic system.

Child↗
PubMed1987

[Erysipelas and lymphedema--egg or hen?].

The initial lymphatics and peripheral lymph-collectors of both legs of 16 patients were visualized by means of indirect lymphography, after the patients had undergone a rash of erysipelas on their lower extremities. 14 out of 19 legs showed clinical signs of lymphedema after one or several erysipelas. In 16 out of 19 legs after erysipelas, but also in 6 out of 11 healthy contralateral extremities, we found pathological initial lymphatics and changes in size, irregularities of the course, and pathological stops of peripheral lymph-collectors. These findings indicate that in the majority of the patients with erysipelas--contrary to the common opinion--resulting lymphedema should not be termed as secondary. In fact, they are primary lymphedemas deteriorated by erysipelas, with the typical pathological findings in indirect lymphography, as they are seen in simple primary forms.

Adult↗
PubMed1987

Scanning electron microscopy of the initial lymphatics of the skin after use of the indirect application technique with glutaraldehyde and MERCOX as compared to clinical findings.

Certain phenomena in the region of the initial lymphatics during clinical examination (indirect lymphography and microlymphography)--namely build-up and course and filling and diffusion--have still to be elucidated. The glutaraldehyde and MERCOX methods were used to simulate indirect application conditions in clinical procedures in skin specimens (human and pig) which were then examined by scanning electron microscopy. The results presented include novel findings on the microtopography of these lymph vessels and the typology of filling refluxes which are of importance when indirect imaging techniques are employed. Various speeds of application were used and the function of the opening apparatus with previously undescribed structures (endothelial bridges and connective tissue trabeculae) was taken into consideration. Recommendations aimed at standardizing the nomenclature of parietal structures and sections of the lymphatics have been incorporated in the report.

Aldehydes↗