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Biomedical subjects

W Blättler

Publications and source records attributed to W Blättler.

At least 19 recordsLinked to original sources
PubMed2003

[Peripheral arterial occlusive diseases: opinion of lay audience].

An audience of about 500 elderly people were interviewed about their knowledge and therapeutic opinion on peripheral vascular disease. After a brief introduction by vascular surgeons 12 questions were presented for vote and answered with the use of a poll system. The audience proved well informed about the risk factors but confounded the symptoms. The participants declined to accept any limitation of their walking ability, overestimated the mid-term results of an eventual revascularisation and underestimated their risks and costs. 80% asked for a stop of smoking as a prerequisite for an intervention and again 80% were willing to pay by them-selves if the insurances would not reimburse them for an operation that would just improve their quality of life status. The honorarium for the surgeon was put up high. The poll shows that an audience can be enabled within a short period of time to deliberate therapeutic decisions and socio-economic problems. The answers reflect an overestimation of the medical possibilities but also a willingness to ask for and make personal contributions to a treatment which is not compelling in many cases.

Aged↗
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

Therapeutic concept for acute leg and pelvic venous thrombosis.

Combination treatment in acute deep venous thrombosis essentially consists of a highly dosed locoregional thrombolysis of the valve-carrying crurofemoral axis and a mechanical thrombectomy of the valveless pelvic axis by Fogarty catheter. The success of this method is due to the fact that it largely eliminates the disadvantages of systemic thrombolysis, as well as those at conventional surgical thrombectomy, whilst retaining the advantages. Using combination treatment in acute leg and pelvic venous thrombosis within the first 7 days can result in restitutio ad integrum, i.e. complete desobliteration with maintained valve function in more than 80% of the cases.

Fibrinolytic Agents↗
PubMed2001

[Combination therapy of venous thrombosis with local thrombolysis and surgical thrombectomy].

Combination therapy in acute deep venous thrombosis essentially consists of a highly dosed locoregional thrombolysis of the valve carrying crurofemoral axis and a mechanical thrombectomy of the valveless pelvic axis by Fogarty catheter. The success of this method is due to the fact that it largely eliminates the disadvantages of systemic thrombolysis as well as conventional surgical thrombectomy whilst retaining the advantages. Using combination therapy within the first 7 days in acute leg and pelvic venous thrombosis can result in restutio ad integrum, i.e. complete desobliteration with maintained valve function (more than 80% of cases).

Combined Modality Therapy↗
PubMed2000

Practicability and quality of outpatient management of acute deep venous thrombosis.

PURPOSE: The purpose of this study was to review the practicability and quality of a standardized management approach of deep venous thrombosis (DVT) provided by private practices. METHODS: There were 152 consecutive patients and 156 episodes. We determined the patients' diagnoses with estimation of clinical probability, D-dimers, duplex ultrasound scan, and venography. Patients were treated on an outpatient basis on principle, with dalteparin, phenprocoumon, different modalities of external leg compression, and deliberate ambulation. We followed up at 4 weeks. RESULTS: Proximal DVT was diagnosed in 101 episodes (65%). Results of the D-dimer test were false-negative in 6%, and venography was indicated in 15%. Calf vein thrombosis was found in 55 patients. Results of the D-dimer test were false-negative in 30%, and venography was required in 37%. Eleven patients were hospitalized (9 for thrombectomy or thrombolysis), and 145 episodes (93%) were treated according to our standardized approach (provided by the referring physicians alone in 43%). For 5 days, dalteparin was injected by the patients themselves or their relatives, in 78% of the cases. The international normalized ratio values were more than 2 in 88% of the cases, with no difference between providers. In all but two cases, external leg compression was applied immediately: a modified Unna's boot in 28% and compressing stockings in 72% (Sigvaris 503 in 91%; calf length in 100% of distal DVT, and 83% of proximal DVT). During follow-up, there was no clinical evidence of recurrence or progression, 1 possible pulmonary embolism, 1 injection site hematoma, and 1 hospitalization unrelated to the DVT. CONCLUSION: Diagnosis of proximal DVT is straightforward, but calf DVT often requires venographic confirmation because of discrepancies among clinical probability, D-dimer estimation, and ultrasound scan. Outpatient treatment can be offered to patients who can comply with the regimen. The quality of anticoagulation is in accordance with published data, and compliance with external leg compression is almost perfect.

Acute Disease↗
PubMed2000

Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin.

OBJECTIVE: The purpose of this randomized controlled trial was to evaluate the benefits of compression and walking exercises in comparison with bed rest in the acute stage of proximal deep venous thrombosis (DVT). METHODS: Forty-five patients with proximal DVT that was proved with compression ultrasound scan or phlebography were randomized into three groups. Group A consisted of 15 patients who received inelastic compression bandages (Unna boots on the lower leg, adhesive bandages on the thigh), and group B consisted of 15 patients who received thigh-length compression stockings, class II. Group C consisted of 15 patients who underwent bed rest and no compression. All patients received dalteparin, 200 IU/kg per body weight, subcutaneously every 24 hours. The clinical characteristics of the three groups were comparable. Primary end points were the reduction of pain assessed daily with the Visual Analogue Scale and the Lowenberg test, the reduction of leg circumference at the ankle and calf levels, and the improvement of clinical scores. The daily walking distance was measured with a pedometer. Safety parameters were ventilation-perfusion scans and duplex ultrasound scans performed on days 0 and 9. RESULTS: The daily walking distance was between 600 and 12,000 m in the compression groups and averaged 66 m in the bed rest group. The pain level showed a statistically significant reduction starting after the second day in the compression groups (A and B) and after 9 days in the bed rest group C (P <.05). The same was true for the measurement of leg circumference. Improvement of the clinical scores was significantly better in the compression groups compared with the bed rest group (P <.01). There was no significant difference concerning the occurrence of new pulmonary emboli and regression of thrombus diameter. Progression of thrombi in the femoral vein was greater and occurred more frequently in the bed rest group than in the other two groups (P = not significant). CONCLUSION: Mobile patients with acute proximal DVT treated with low molecular weight heparin should be encouraged to walk with compression bandages or medical compression stockings. The rate of resolution of pain and swelling is significantly faster when the patient ambulates with compression. The risk of pulmonary embolism is not significantly increased by this approach.

Acute Disease↗
PubMed1999

Relief of obstructive pelvic venous symptoms with endoluminal stenting.

PURPOSE: To select patients for percutaneous transluminal stenting of chronic postthrombotic pelvic venous obstructions (CPPVO), we evaluated the clinical symptoms in a cohort of candidates and in a series of successfully treated patients. METHODS: The symptoms of 42 patients (39 women) with CPPVO (38 left iliac; average history, 18 years) were recorded, and the venous anatomy was studied by means of duplex scanning, subtraction venography, and computed tomography or magnetic resonance imaging. Successfully stented patients were controlled by means of duplex scanning and assessment of symptoms. RESULTS: The typical symptoms of CPPVO were reported spontaneously by 24% of patients and uncovered by means of a targeted interview in an additional 47%. Of 42 patients, 15 had venous claudication, four had neurogenic claudication (caused by dilated veins in the spinal canal that arise from the collateral circulation), and 11 had both symptoms. Twelve patients had no specific symptoms. Placement of a stent was found to be technically feasible in 25 patients (60%), was attempted in 14 patients, and was primarily successful in 12 patients. One stent occluded within the first week. All other stents were fully patent after a mean of 15 months (range, 1 to 43 months). Satisfaction was high in the patients who had the typical symptoms, but low in those who lacked them. CONCLUSION: Venous claudication and neurogenic claudication caused by venous collaterals in the spinal canal are typical clinical features of CPPVO. We recommend searching for these symptoms, because recanalization by means of stenting is often feasible and rewarding.

Adult↗
PubMed1999

[Aspects of cost effectiveness in therapy of acute leg/pelvic vein thrombosis].

Out-patient or home treatment of acute proximal deep venous thrombosis (DVT) has not made its way yet. In this article, we review the data published on this form of management with regard to effectiveness and costs. We find that more than 80% of patients with DVT need not be admitted to the hospital and that the rate of secondary hospitalization is < 2%. Home treatment requires professional assistance in 15 to 74% of cases, while out-patient management with elastic leg compression and deliberate ambulation goes completely without it. The effect on objectivity assessed clinical symptoms, absence from work and patients' acceptance is significantly better and the costs are 2.5- to 3.2-fold lower with home or outpatient treatment than with treatment in the hospital. However, we found outpatient treatment associated with a reduced general well-being resulting from a probably frightening information which mentioned the possibility of experiencing an eventually fatal pulmonary embolism despite treatment. Management with deliberate ambulation in compression hosiery lead to a slower relief of subjective leg symptoms than initial immobilisation. We conclude that outpatient treatment of DVT is highly cost-effective. The problems still encountered are of a psychological nature and also have to do with treatment by leg compression and ambulation. These measures have to be optimized.

Acute Disease↗
PubMed1998

[Comparison of ambulatory and inpatient treatment of acute deep venous thrombosis of the leg: subjective and economic aspects].

The frequency of clinical recurrence and pulmonary embolism in patients with acute deep venous thrombosis is reduced to the same extent by hospital treatment (with unfractionated heparin) as by treatment at home (with low-molecular-weight heparin). Very few data on subjective parameters of effectiveness have been published. We performed a prospective randomized trial comparing outpatient with in-hospital treatment in 28 patients. Six clinical and quality-of-life related parameters of effectiveness were assessed quantitatively: clinical course (with a score system), pain of venous congestion of the calf muscles (with Lowenberg's test), subjective perception of pain and general well-being (with visual analogue scales), satisfaction with the care provided, and absence from work. Subjective effectiveness was compared with the costs of each form of treatment. Outpatient treatment was significantly more effective than in-hospital treatment with regard to the objective parameters. It was, however, associated with less well-being and more pain than in-hospital treatment. The discrepancy is explained by eventually insufficient adjuvant treatment measures (which consisted of external leg compression by stockings and forced walking) and by anxiety brought on by the information that potentially lethal pulmonary embolism could occur despite anticoagulant therapy. Outpatient treatment was less costly. On the average and per patient it was CHF 3944 less expensive than treatment in hospital. An estimation reveals that the Swiss health care system would save about CHF 25 million per year if the 85% of patients with deep-vein thrombosis suitable for home care were given this form of treatment. We conclude that outpatient management is subjectively cost-effective but should be optimised to eliminate certain drawbacks associated with it.

Adult↗
PubMed1996

[Sequelae of proximal venous stenosis].

We describe three typical consequences of chronic or subacute proximal vein obstruction: venous claudication, narrowing of the spinal canal by dilated veins that function as collaterals, and hypovolemia caused by trapping of blood in the periphery and slow return. Venous claudication is a well recognized clinical entity. We emphasize that the syndrome is often diagnosed in patients who do not remember acute thrombosis and that the signs on the skin of chronic venous insufficiency are typically absent in these patients. Venous drainage after proximal thrombosis often involves the veins of the spinal canal. Under the condition of sustained physical activity these veins become dilated and occupy space causing the syndrome of a narrow spinal canal. The clinical features differ from those encountered in other forms of a narrow spinal canal; the symptoms appear only after prolonged and strenuous exercise, do barely depend on the posture of the spine and do not disappear readily with cessation of the effort. In patients with bilateral pelvic vein occlusions we regularly found evidence for a shock-like syndrome that follows vigorous exercise. The patients experience sudden weakness and dizziness, with sweats, pallor and tachycardia and have to interrupt the effort to prevent collapse and fainting. The clinical features depend on the anatomical localisation of the obstruction as well as on the pathways of the collaterals. In patients with typical symptoms a venographic workup may be indicated to assess the possibility of recanalisation by endoluminal stenting. The presence of peripheral valve incompetence may be regarded as a contraindication to stenting since it may increase the volume overload and make the chronic venous insufficiency worse.

Constriction, Pathologic↗
PubMed1993

[Complications of superficial thrombophlebitis].

Phlebitis and varicophlebitis are regarded as harmless diseases easily treated by compression and local measures such as incisions and applications. However, recent experience has revealed that they are often complicated by growth of the superficial thrombus into the deep veins, by noncontiguous calf thrombosis, and by usually asymptomatic pulmonary embolism. We prospectively examined 25 consecutive patients using duplex scanning (21x) and/or ascending venography (15x). The phlebitic process involved a varicose greater saphenous vein or a branch thereof (19x), the lesser saphenous vein (3x) or a nonvaricose superficial vein (3x). In 11 cases (44%) we found direct extension to involve the deep vein system and/or noncontiguous isolated calf or popliteal vein thrombosis. The presence of risk factors for deep vein thrombosis and a painful calf muscle were good clinical indicators of such complications. Patients with complications were anticoagulated on an outpatient basis. The course was uneventful in most cases. Our study confirms the notion that superficial thrombophlebitis is often part of a more extended thromboembolic process. This implies diagnostic and therapeutic consequences, although the prognostic significance of such complications is not clear at the moment.

Adult↗
PubMed1991

[Practical proposals for overcoming problems with phlebography].

Venography is considered the gold standard in the diagnosis of venous disease. In the everyday practice, however, it is not used according to this attribute. The article scrutinizes the reasons for the discrepancy, emphasizes the possibilities wrongly renounced to and gives advice to a better indication for and execution of venography. Arguments not to use venography regularly to diagnose or exclude deep venous thrombosis, include claims that it would be superfluous, not readily available, invasive and expensive. Such considerations do not take into account that the clinical diagnosis it not better than tossing a coin. Real difficulties may occur in the evaluation of complicated superficial disease and the postthrombotic syndrome. The problems are minimized by using a methodology based on pathophysiologic knowledge and strictly aimed to solve specific therapeutic questions. The article stresses the need for a proper prevenographic work-up and for a technique tailored to the clinical situation of each individual patient.

Humans↗
PubMed1988

[Spinal claudication following ileocaval venous thrombosis].

The case is reported of a young male who presented with intermittent claudication after thrombosis of the right common femoral, iliac and caval vein. The symptoms were explained by the severe proximal venous obstruction. The patient, however, also complained of lumbar pain during and long after walking, and showed signs of irritation of nerve roots L4 to S1 on the right side. Venography and CT-scan disclosed venous collateral circulation leading through the spinal canal. The blood drained through the foramina intervertebralia to the caval vein, causing compression of the nerve roots depending on their filling. Thus, the claudication was "venous" in two ways, muscular (due to inadequate drainage) and spinal (due to intermittent compression of lumbar nerve roots by the collateral circulation).

Adult↗
PubMed1988

[Psychological findings in alleged phlebologic disorders of the leg].

Twenty-six female patients with restless legs underwent psychiatric investigation as part of a pilot study. Most exhibited a depressive-anxious-hypochondric syndrome. The development of physical symptoms in connection with psychic disturbances and the treatment of patients with restless legs are discussed.

Adult↗