The frequency of venous thromboembolism is high in geriatric practicel-3, particularly among surgical geriatric patients .4, Pulmonary embolism is a major (in some series the most common) cause of death in the elderly. 4, 6 In spite of abundant information concerning venous thromboembolism, there are still many unsolved questions from pathogenetic and diagnostic, as well as therapeutic points of view.Although clinical diagnostic procedures, in particular the use of phlebography,7-14 have been of great importance for the elucidation of the frequency and extent of thromboembolic disease, autopsy studies are a necessary complement for detailed information in this respect. Such studies must include, besides a thorough investigation of the pulmonary arterial system with its smallest ramifications, a complete venous dissection of the lower extremities. However, extended dissections of this kind are cumbersome and time-consuming, and are associated with such great practical inconveniences that they have been performed thoroughly only by a few investigators. 4, 15In order to facilitate the pathoanatomical exploration of the veins of the lower leg for broad postmortem studies of the frequency and significance of venous thromboembolism, intraosseous phlebography has been adopted as a new procedure for postmortem purposes at the Stureby Vardhem Geriatric Unit. This method, first described by Drassner,16 has previously been applied in extensive clinical studies, particularly by Arnoldi and Bauer.lo~ ~1The aim of this communication is to describe the method for intraosseous postmortem phlebography and to present preliminary data from studies in which this method has been utilized for examinaton of frequency and localization of thrombosis in the legs in geriatric patients. A more comprehensive and extended analysis of the material will be published later.l7Studies based on autopsy data from a general hospital fail to reflect the incidence of terminal illness in the community if admission of aged people is restricted and the autopsy frequency is low.2 Custodial institutions, on the other hand, provide unique access to information regarding the general incidence of such diseases. The
Objectives Anodal transcranial direct current stimulation (tDCS) of primary motor cortex (M1) and cathodal of the primary sensory cortex (S1) have previously shown to modulate the sensory thresholds when administered with the reference electrode located over the contralateral supraorbital area (SO). Combining the two stimulation paradigms into one with simultaneous stimulation of the two brain areas (M1 + S1 − tDCS) may result in a synergistic effect inducing a prominent neuromodulation, noticeable in the pain thresholds. The aim of this study is to assess the efficacy of the novel M1 + S1 − tDCS montage compared to sham-stimulation in modulating the pain thresholds in healthy adults. Methods Thirty-nine (20 males) subjects were randomly assigned to either receiving 20 min. active M1 + S1 − tDCS or sham tDCS in a double-blinded single session study. Thermal and mechanical pain thresholds were assessed before and after the intervention. Results There were no significant differences in the pain thresholds within either group, or between the M1 + S1 − tDCS group and the Sham-tDCS group (p>0.05), indicating that the intervention was ineffective in inducing a neuromodulation of the somatosensory system. Conclusions Experimental investigations of novel tDCS electrode montages, that are scientifically based on existing studies or computational modelling, are essential to establish better tDCS protocols. Here simultaneous transcranial direct current stimulation of the primary motor cortex and primary sensory cortex showed no effect on the pain thresholds of the neck musculature in healthy subjects. This tDCS montage may have been ineffective due to how the electrical field reaches the targeted neurons, or may have been limited by the design of a single tDCS administration. The study adds to the existing literature of the studies investigating effects of new tDCS montages with the aim of establishing novel non-invasive brain stimulation interventions for chronic neck pain rehabilitation. North Denmark Region Committee on Health Research Ethics (VN-20180085) ClinicalTrials.gov (NCT04658485).
Short-term and long-term results with HR + AC indicated that patients with severe CLI and very poor prognosis benefited in terms of survival and limb salvage from initial therapy with HR infusion combined with long-term oral anticoagulation. Results of this combined treatment seem at least comparable with those with i.v. prostacyclin analogies.
Fluorescein angiography (FA) of the foot soles was performed in 119 patients with arterial disease of the legs. Fluorescein was injected rapidly intravenously and sequential photographs were taken of the foot soles. Densitometric measurements were performed on three areas of each foot image: the big toe, the foot pad (just proximal to the little toe) and the heel. The relationships between different FA measurements and systolic arterial pressure in the ankle or the big toe were analysed. The appearance times of fluorescence correlated inversely with ankle pressure (P less than 0.001). The initial slopes of the fluorescence-time curves at all three sites of measurement correlated with ankle pressure (P less than 0.001). The initial slopes of fluorescence-time curves of the big toe and the foot pad correlated with toe pressure (P less than 0.001). In 12 patients effective arterial pressure was lowered by elevation of the feet, and in eight patients external pressure was applied to the foot by enclosing it in a box. The changes in FA evoked by these manoeuvres further strengthened the relationship between arterial pressures and FA measurements. We conclude that FA is a good method for evaluating circulation in the foot when neither ankle nor toe pressure is obtainable. In addition, FA may be useful when vascular disease is suspected in the presence of normal pressures, because the fluorescence distribution pattern was clearly abnormal in 11 of 16 such feet.
In peripheral arterial occlusive disease (PAOD), and particularly in critical limb ischaemia, fluorescence recording of the skin after i.v. injection of sodium fluorescein provides an overviewing functional imaging of regional blood perfusion as revealed by a continuous, almost geographical, mapping of changes in the dynamic fluorescence pattern. Based on the previously used technique of rapid sequence flash photography introduced by Lund and Lund in 1973, a new video fluorescence imaging (VFI) technique has been developed and used in clinical routine. VFI has a broad versatility with non-touch access to areas of different size, such as the feet, hands or larger limb areas. Examples of application are the diagnosis of small artery disease, predictive prognosis of critical limb ischaemia, evaluation of distal outflow in connection with arterial reconstruction or pharmacotherapy of non-reconstructable critical ischaemia, as well as in decisions on amputation and assessment of amputation level. Thanks to its overviewing qualities with reproducible mapping of blood perfusion in standardized examination conditions, VFI would seem to have a well-justified role in angiology and above all in PAOD in both research and clinical routine work.
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