Administration of semisynthetic diosmin during 30 days results in significant improvement of clinical signs, quality of life and CEAP stage of HVI.
Early diagnosis and treatment of mesenteric blood vessel arteriovenous fistula prevents portal hypertension development and its complications.
The infection of the previously implanted vascular graft at the groin, is associated with great mortality and morbidity rate [1]. The authors present a retrospective study in which they analyzed management of infected vascular prostheses at the groin, using obturator bypass in 26 cases, and "lateral" bypass in 15 cases. The indications for obturator bypass reconstructions included: 20 infections of aorto-femoral grafts, two infected pseudoaneurysms in the groin after PTA of the superficial femoral artery, and 4 infections of iliac-femoral grafts. The indications for lateral bypass reconstructions were: infections after aorto-femoral reconstructions--8 cases; infection after femoro-popliteal reconstructions--4 cases; infection after iliac-femoral reconstruction--2 patients, and one infected pseudoaneurysm in the groin after PTA of the superficial femoral artery. In 3 subjects obturator bypass was performed using extraperitoneal approach, while in other 23 patients transperitoneal approach was done by donor's artery. The obturator bypass was performed using a PTFE graft in 3 cases, and Dacron graft in 23. The donor's artery used for obturator bypass was a noninfected proximal part of aortofemoral graft in 20 cases, and iliac artery in 6 patients. The superficial femoral artery was recipient artery for obturator bypass in 3 cases, deep femoral artery in one case, and above the knee popliteal artery in 22 cases (Figure 1). In two patients transperitoneal approach to donors artery for "lateral" bypass has been used, and in 13 cases extraperitoneal. The proximal noninfected part of aorto femoral graft was used as a donor's artery for lateral bypass in 8 patients, while common iliac artery in 7 subjects. In 5 cases reconstructions were performed using PTFE grafts, in 3 using autologous saphenous vein grafts, and in 7 using Dacron grafts. The recipient artery for "lateral" bypass was deep femoral in 8 cases, superficial femoral in three patients and above the knee popliteal artery in 4 subjects. After both types of reconstruction, extirpation of infected grafts from the groin was performed (Figure 2). The control examination was performed using physical and Doppler ultrasonographic examinations, one, 3, 6, 12 months, and then every year after the operation. In cases with suspected graft infection or thrombosis, control angiography was also performed. One intraoperative perforation of the urinary bladder has been done accidentally during obturator bypass reconstruction. The mean follow-up period for patients with obturator bypasses was 2.3 years, while 2.1 years for patients with "lateral" bypasses. Comparing with "lateral" bypass, obturator bypass showed statistically significant lower (p < 0.05) 30-day mortality and early graft infection rate, as well as statistically significant better early and total limb salvage rate. There were no statistically significant differences (p > 0.05) between obturator and "lateral" bypass procedures, having in mind, late graft infection rate, as well as early and late graft patency (Figu...
The authors present surgical techniques and distant results of the operative treatment in patients with occlusive lesions of the supraaortic branches. The study included 29 men (55.8%) and 23 women (44.2%), with the average age of 54 years. The majority of patients--44 (84.6%) had symptoms and signs of the upper extremities ischemia while 25 (48.1%) had symptoms and signs of cerebral ischemia (the posterior circulation mainly). Among seven patients with isolated cerebral ischemia of the anterior circulation, four of them developed transient ischemic attack (TIA) and three had cerebrovascular insult (CVI). All patients were examined ultrasonographically and angiographically. Operative treatment was performed under general anesthesia. In eight cases the anatomic, and in 44 extraanatomic procedure was applied. Following reconstructive procedures were used: endarterectomy and patch of the brachiocephalic trunk--2, bypass from ascending aorta--7, carotid to subclavian bypass--31, subclavian to carotid bypass--7, subclavian artery transposition--3, axillo-axillary bypass--2. During the follow-up period (10-228 months), eight out of 52 patients exhibited the occlusion of the graft. Six occlusions developed after carotid-subclavian bypass: in two patients reconstructions were performed using Dacron grafts, in three using PTFE grafts and in one patient using autologous vein graft. Two occlusions developed after subclavio-carotid bypass. In both cases the vein graft was used: one was coming from the ipsilateral and the other one from the contralateral subclavian artery. The mean period from the operation to the occlusion of the graft (the mean lasting of the primary flow) was 14.72 years (SE = 1.41; 95% CI = 11.96-17.48). There was no statistically significant difference in primary patency and survival without symptoms between patients treated with the anatomic and those treated with the extraanatomic approach. Practically, this means that both approaches were equally good, so that the decision about the approach should be made individually, according to the loading factors of each patient. In the case of the carotid-subclavian bypass, according to our results, we recomend the use of the PTFE graft.
Zusammenfassung. Die gigantozellulare Arteritis (GZA)ist eine Systemerkrankung, die bei Patienten auftritt, die mehr als 55 Jahre alt sind. GZA greift meistens mittelgroBe Haupt-, Herz-and Augengefal3e an. Die Manifestationsarten dieser Erkrankung im Auge umfassen die vordere ischamische optische Neuropathie, die Okklusion der zentralen retinalen Arterien and gelegentlich vorkommende Lahmungen der oculomotorischen Hirnnerven. Neue Studien zeigen, dass eine Claudication im Kiefer sowie Schmerzen im Schulterbereich, and eine erhohte Blutsenkung (von 47 bis 107 mm/h) bzw. ein erhohtes C-reaktives Protein (CRP) von uber 2,45 mg/dl stark mit einem positiven Befund bei der Biopsie der Temporalarterie korreliert. Wir beschreiben den Fall eines unserer Patienten, der eine Okklusion der Arteria centralis retinae sowie eine erhohte Blutsenkung von 100 mm/h, ein erhohtes CRP von 11 mg/L and ein Fibrinogen von 9,6 g/L vorwies. Die endgultige Diagnose der gigantozellularen Arteritis wurde durch eine Biopsie der rechten Temporalarterie bestatigt. Schlusselworter: Gigantozellulare Arteritis, Okklusion derArteria centralis in der Netzhaut, Biopsie der Temporalarterie. Central retinal artery occlusion as manifestation of giant cell arteritis Summary. Giant cell arteritis (GCA) is a systemic diseasethat affects patients over the age of 55 years. GCA predominantly involves medium sized blood vessels of the cranium, heart and eye. Ocular manifestations of this desease include anterior ischaemic optic neuropathy, central retinal artery occlusion (CRAO), and less commonly, cranial nerve palsies. Recent studies revealed that claudication in the jaw, shoulder and neck pain, ESR of 47-107 mm/hr, C-reactive protein (CRP) above 2.45 mg/dl show a high correlation to positive temporal artery biopsy. We present a patient with a CRAO, elevated ESR (100 mm/hr), elevated CRP (11 mg/L), and elevated fibrinogen (9.6 g/L). The definite diagnosis of GCA was confirmed by temporal artery biopsy. EinfahrungDie gigantozellulare Arteritis (GZA) ist eine Systemerkrankung, die bei Patienten auftritt die mehr als 55 Jahre alt sind. GZA greift meistens mittelgroBe Haupt-, Herz-and Augengefal3e an. Die Auspragung dieser Erkrankung der arteriellen BlutgefaBe ist direkt proportional der Menge des elastischen Gewebes, das sich in der Tunica media and der Tunica adventitia der GefaBwande befindet. Die hinteren ciliaren Arterien and die Temporalarterie sind reich an solchem elastischen Gewebe. Dies fuhrt dazu, dass diese BlutgefaBe haufiger von GZA betroffen sind [1].Die Manifestationsarten dieser Erkrankung im Auge umfassen die vordere ischamische optische Neuropathie, die Okklusion der zentralen retinalen Arterien and gelegentlich vorkommende Lahmungen der oculomotorischen Hirnnerven. Bei den betroffenen Patienten auf3ert sich diese Erkrankung als ein starker and dauerhafter Sehverlust an einem Auge. Das andere Auge wird, wenn die Erkrankung nicht fruh genug erkannt and dementsprechend behandelt wird, normalerweise binnen einiger Tage bzw. einiger Wochen auch er...
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