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Biomedical subjects

L K Widmer

Publications and source records attributed to L K Widmer.

At least 19 recordsLinked to original sources
PubMed1994

[The incidence of post-thrombotic syndrome].

To evaluate the clinical and socio-economic importance of the postthrombotic syndrome (PTS), the following epidemiologic parameters are to be known: The incidence of deep vein thrombosis (DVT) in the population, the incidence of PTS after DVT, the prevalence of the PTS, the socio-medical consequences and the mortality. The DVT-incidence in the literature is about 3/1000 per year in the adult population. In our own follow-up study we found a global PTS-incidence of 40% (10% with, 30% without ulcer) 13 years after DVT. The PTS-incidence was correlated with the initial DTV-extent. The risk of PTS after 3- and 4-level DVT is significantly reduced by a successful fibrinolysis in the acute stage (p = 0.01). The mortality of patients with PTS is 3 times higher than in the population. 4% of the patients with PTS get disabled. To our knowledge an adequate study with direct assessment of the PTS-prevalence does not exist, but the PTS-prevalence can be deduced from large epidemiologic studies, such as the Basel-Study, in which the global chronic venous insufficiency is assessed. It amounts in the adult population between 0.5 to 1% for the PTS with and 3 to 5% for the PTS without ulcer.

Adult↗
PubMed1994

[Late sequelae of deep venous thrombosis: a 13-year follow-up of 223 patients].

To investigate late sequelae of deep vein thrombosis, 223 consecutive patients, 148 men, 75 women, aged 61.5 +/- 14.7 years, with phlebographically documented unilateral deep vein thrombosis were reexamined 13 years after the acute event. 29 had an isolated calf vein thrombosis, 45 a 2-level- (calf an popliteal), 72 a 3-level- (calf, popliteal and femoral), 62 a 4-level- (calf, popliteal, femoral and pelvic) thrombosis and 15 had a special location, for example an isolated popliteal or pelvic involvement. In the acute stage all patients were given full dose heparin followed by a six month period of oral anticoagulation. 144 were initially treated by thrombolytic treatment with streptokinase. Control phlebography 5-14 days after the onset of the treatment revealed no clearance in a so called negative group of 123 patients, aged 63.5 +/- 14.9 years, namely the 79 "only" anticoagulated and 44 unsuccessfully thrombolysed. In this negative group natural course of deep vein thrombosis can be studied. The positive group, comprising 100 patients, aged 59.4 +/- 13.9 years (25 with complete and 75 with partial lysis, after streptokinase), is compared with the negative group. The global incidence of postthrombotic syndrome in the natural course, 13 years after deep vein thrombosis, was 39%, 9.8% with and 29.2% without ulcer. Slight changes were noted in 25% and no change in 36%. The incidence of postthrombotic syndrome was correlated with the extent of the original thrombosis: 3.7% after isolated calf vein thrombosis vs. 55.2% after 4-level thrombosis. Moreover, the mortality after deep vein thrombosis and the frequency of recurrence in the interval and of venous symptoms were also correlated to the extent of the thrombosis. The incidence of post phlebitic syndrome in the positive group is significantly lower in patients with 3- and 4-level thrombosis (p = 0.01). Patients with complete and partial lysis also have less venous symptoms (for 3- and 4-level thrombosis p < 0.0001). Thus, the successful thrombolysis seems to be beneficial in long terms for patients with extended thrombosis. Therefore, in our hospital thrombolytic treatment is offered as an additional treatment to anticoagulation to patients with recent, less than 7 days old, 3- and 4-level-thrombosis without contraindications.

Adult↗
PubMed1992

[Classification of varices and venous insufficiency].

The problem of the classification of varicose veins is as old as phlebology itself. A number of attempts have been made to define and assess this anatomical entity, which is progressively better investigated and better treated. Chronic venous insufficiency is a more recent pathophysiological concept, which covers both superficial venous lesions and deep lesions, regardless of their cause and their expression, especially trophic, unequivocal and dominant. A brief review of the principal classifications clearly demonstrates the difficulty of reaching a consensus. The precise definition of varicose veins and chronic venous insufficiency suggests the proposal of a simple clinical classification into five stages of chronic venous insufficiency. Beyond stage II of symptomatic varicose veins, treatment is required and complementary investigations, especially functional, are justified.

Chronic Disease↗
PubMed1991

[Sequelae of venous thrombosis. Incidence in of the post-thrombosis syndrome after 5 years].

The authors report on an epidemiological study carried out in Basle, Switzerland, which prospectively included 341 consecutive patients (226 men, 115 women, mean age 52 +/- 16 years) who had developed deep venous thrombosis evidenced by phlebography. The treatment of the acute phase most often consisted in thrombolysis, conventional heparin being reserved for the contra-indications of thrombolysis. A second phlebographic examination allowed dividing up the series into two groups, ie. positive and negative, according to the presence or absence of a complete or partial return of patency. Each group was subdivided according to the location and extension of the thrombosis. Both groups (positive vs. negative) are different as regards the location and extent of the thrombosis. The selective comparison of both groups according to the objective subdivision demonstrated: the absence of post-phlebitis disease in sural phlebitis; the same risk of post-phlebitis disease in thrombosis extending to 4 levels, whether patency was restored or not; lower incidence of post-phlebitis disease in the positive group for single -, two - or three-level phlebitis. Leg ulcers occur within an average of 5.5 +/- 2.1 years after the acute episode in 6.7% of all patients. Complete return of patency is obtained in 23% of cases only.

Adult↗
PubMed1990

[Varicose veins and chronic venous insufficiency--minor disorder or disease? A critical review of the literature].

The controversial question of the incidence and significance of varicoses and chronic venous insufficiency is analysed by a critical review of epidemiological studies. It is seen that many of the results which initially appear to diverge are attributable to different, in part unsatisfactory epidemiological methods; e.g. patient groups of different ages and sex, different interview and examination techniques in addition to, above all, different weighting of varicosis. Thus, studies in general practice showed that the prevalence for varicoses in women was four times that in men; CVI was, in fact, 15 times more frequent than in epidemiological studies. The different weighting of varicoses and chronic venous insufficiency may well be one of the major reasons for the absent "unité de doctrine".

Cross-Sectional Studies↗
PubMed1989

[Etiology and long-term course of subclavian vein thrombosis with reference to acute therapy].

Contrary to deep venous thrombosis of the lower extremity, subclavian vein thrombosis (SVT) is rather rare. Although the problem has been known for more than 100 years, the rarity of its incidence accounts for the persistent uncertainty concerning the indication and modalities of acute therapy as well as the long-term course. In the majority of 96 patients observed between 1976 and 1983 SVT was due to central venous catheter, neoplasm and thoracic outlet syndrome. 2 of 96 patients developed pulmonary embolism. 45 patients without malignancy were available for follow-up studies. Acute therapy included anticoagulation in 27, fibrinolysis in 10 and rib resection in 8 cases. The mean follow-up averaged 6.3 years and confirmed a favorable course independent of the acute therapy modality. There were none of the trophic alterations so often found in the lower extremity and no patient was unable to work as a consequence of SVT. However, minor late sequelae occurred quite frequently: slight symptoms in one third, and minor incapacity for sport in 25% of the cases. 75% of the patients showed clinical signs of stasis, such as venous bypass circulation, edema and/or cyanosis. The average post-thrombotic score (1.3 out of a possible 4) confirms the minor significance of the findings. A rather important reduction in venous backflow was found by plethysmography in 4% of the patients. We favor immediate anticoagulation, mainly to cover the risk of pulmonary embolism. This should be continued for at least 3 months in order to prevent early recurrence of thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1989

[Diagnosis using ultrasound in peripheral arterial disorders: possibilities and limitations].

Ultrasound plays an increasingly important role in investigating peripheral vascular disease. Two major approaches, the Doppler technique and the (B-mode) imaging technique, are routinely used. Duplex scanning combines the two ultrasonic techniques taking advantage of both the hemodynamic and anatomic data that can be obtained. The simple conventional Doppler devices may be used to measure limb blood pressure at rest and after exercise and to assess velocity patterns. Recent advances in duplex technology allow non-invasive assessment of the vascular tree from the aorta to below the knee. Compared with arteriography duplex scanning has a sensitivity of 96% and a specificity of 81%. In selected cases duplex scanning can safely and reliably replace arteriography.

Arterial Occlusive Diseases↗
PubMed1988

[Mortality and cause of death in a 20-year follow-up of the Basel study].

The results of a mortality follow-up in the Basle Study (BS) for the period 1965-1986 are presented, involving data of 4224 males and 936 females. The autopsy rate was 60% and allowed confirmation of the death certificates. The mortality rate of BS men is considerably higher (22% = 928 male) than that of the - on the average younger-females (9.2% = 87 female). In the male cohort the age-specific 10-year mortality is lower than in the general Swiss population due to a lower incidence of various diseases and accidents with fatal outcome and a lower incidence of cardiovascular death. On the other hand, a higher tumor incidence in the BS cohort from the age of 55 years on can be noted. This is mainly due to a higher frequency of lung cancer. With increasing duration of the follow-up the difference between the mortality of the general Swiss population and the BS participants diminishes. The higher tumor incidence observed could be explained by more accurate diagnoses in the BS group. Consequently, the Basel study cohort could-in relation to mortality data-be considered representative of the Swiss population.

Adolescent↗