Kornelia Böhler

Primary defect in α‐adrenergic responsiveness in patients with varicose veins

Responsiveness of superficial hand veins to local infusions of noradrenaline was compared in patients with primary varicose veins and in healthy volunteers by use of the dorsal hand vein technique. Patients with varicose veins required significantly higher doses of noradrenaline for half‐maximal venoconstriction than the dose required by control subjects (geometric mean, 11.6 ng/min in patients compared with 4.8 ng/min in control subjects; p = 0.006). Noradrenaline responsiveness in varicose veins was not significantly different from hand vein responsiveness in the same patients. Our findings indicate a constitutional decrease in venous a‐adrenergic receptor responsiveness in patients with varicosities. Dilation of varicose veins does not further affect noradrenaline‐induced venoconstriction.

Paraneoplastic pemphigus in association with hepatocellular carcinoma

Paraneoplastic pemphigus (PNP) is an autoimmune mucocutaneous blistering disease associated with neoplasms, most frequently of the lymphoproliferative type. Rare PNP cases related to nonhematological solid tumors have been reported. The patient in this report presented with severe mucocutaneous involvement of PNP associated with hepatocellular carcinoma. Histopathology showed vacuolar interface dermatitis with keratinocyte necrosis and intraepidermal acantholysis. Direct immunofluorescence exhibited deposition of intercellular IgG and complement and granular complement at the dermoepidermal junction. Indirect immunofluorescence testing showed a typical intercellular staining on monkey esophagus and rat bladder epithelium. Immunoprecipitation showed characteristic target antigens of 250, 210, and 190 kDa molecular weights. This patient met all diagnostic criteria for paraneoplastic pemphigus and is, to our knowledge, the first report of a case associated with hepatocellular carcinoma.

Treatment of traumatic tattoos with various sterile brushes

BACKGROUND Various types of brushes are efficient for the removal of foreign material accidentally projected into the skin by explosive or abrasive trauma. OBJECTIVE To evaluate how different times between injury and treatment influenced esthetic results, we retrospectively evaluated 14 patients subjected to the brushing technique. METHODS Two groups were identified. Group I had been treated within 24 hours of injury. In group II debridement had been performed later. RESULTS Cosmetic results were strikingly better in group I. CONCLUSION Our results demonstrate that debridement of traumatic tattoos should be carried out as soon as possible to achieve favorable cosmetic results.

Studies on the effect of short-term oral dihydroergotamine and troxerutin in patients with varicose veins

To evaluate the clinical efficacy and pharmacologic effects of dihydroergotamine and troxerutin on varicose veins.

Surgical treatment of large vascular leg ulcers: a retrospective review evaluating risk factors for healing and recurrence.

BACKGROUND Superficial reflux ablation and revascularization improve the long-term prognosis of venous and arterial leg ulcers but do not solve the problem of protracted healing of large chronic wounds. Skin grafting has been shown to successfully heal chronic leg ulcers. OBJECTIVE To identify risk factors for ulcer healing and recurrence after shave therapy and split-skin grafting in patients with large ulcers treated surgically for venous insufficiency. METHODS Single-center retrospective cohort study involving 72 chronic leg ulcers with a mean area of 77 ± 132 cm2. Healing and recurrence rates were determined using life-table analysis. Clinical, demographic, and hemodynamic parameters were correlated with healing and recurrence using Cox regression analysis. RESULTS Sixty ulcers (83%) healed after a mean of 1.9 months and 15 ulcers (25%) recurred after a mean of 12.7 months. Healing was positively associated with compression treatment (hazard ratio [HR]: 2.02, 95% confidence interval [CI]: 1.14–3.59) and negatively associated with ulcer duration (HR: 0.99, 95% CI: 0.98–1.0). Male sex, ulcer duration, and deep venous reflux were identified as significant risk factors for ulcer recurrence (HR: 0.14, 95% CI: 0.03–0.73; HR: 1.02, 95% CI: 1.0–1.04; and HR: 5.4, 95% CI: 1.30–22.31). CONCLUSION Early surgical intervention improves healing and reduces the risk of ulcer recurrence.

Systemic activation of coagulation and fibrinolysis during varicose vein stripping

BACKGROUND Elevation of activation markers of blood coagulation (thrombin‐antithrombin complex [TAT], prothrombin fragment 1 + 2 [F1 + 2], D‐Dimer] has not only been found in clinically avert thrombosis but also reflects a prethrombotic state. OBJECTIVE The purpose of our study was to evaluate whether varicose vein stripping, an operative procedure with an extremely low risk of postoperative thromboembolism, induces a prethrombotic state by activation of the hemostatic system. METHODS In a prospective, observational study we compared the baseline and postoperative values of TAT, Fl + 2, and D‐Dimers in 15 patients undergoing varicose vein stripping and in 11 control patients undergoing surgical procedures associated with only minor soft tissue trauma. RESULTS A highly significant postoperative elevation of TAT (P < 0.001), Fl + 2 (P = 0.006), and D‐Dimer (P < 0.001) was observed in the varicose vein stripping group. No significant postoperative change of the respective parameters was detected in the control group. CONCLUSION We therefore conclude that varicose vein stripping induces a significant hemostatic system activation although postoperative thrombotic events are rare.

Does Endovenous Laser Ablation Induce Endothelial Damage at the Saphenofemoral Junction

BACKGROUND AND OBJECTIVE One of the possible complications of endovenous laser ablation (EVLA) is thrombus progression into the common femoral vein or popliteal vein with the potential risk of pulmonary embolism or stroke. We set out to investigate the effect of laser energy applied under standardized treatment conditions on biomarkers of platelet and endothelial activation and on the hemostatic system. METHODS Twenty patients with incompetence of the great saphenous vein were included in this prospective study. Blood samples of the iliofemoral and anticubital veins were collected before, during, and after EVLA. Plasma levels of soluble (s) P‐selectin, soluble thrombomodulin (sTM), prothrombin fragment F1+2 (F1+2), and d‐dimer were measured. (s) P‐selectin and sTM were analyzed as surrogate markers of endothelial and platelet activation. F1+2 and d‐dimer were monitored to quantify the degree of surgical trauma. RESULTS Whereas there was no immediate rise of (s) P‐selectin and sTM plasma concentrations in iliofemoral or anticubital blood, plasma levels of F1+2 and d‐dimer increased significantly after EVLA. CONCLUSION Pulsed mode laser ablation with an 810‐nm fiber does not induce measurable platelet and endothelium activation in the iliofemoral or systemic blood. Furthermore, the immediate surgical trauma associated with EVLA appears to be modest. The authors have indicated no significant interest with commercial supporters.

Präoperative Bildgebung bei primärer Varikose und Rezidivvarikose: Phlebographie vs. farbkodierte Duplexsonographie

ZusammenfassungGrundlagen: Die Evaluation der diagnostischen Möglichkeiten von aszendierender Preßphlebographie (APP) und farbkodierter Duplexsonographie (FKDS) bei primärer Varikose bzw. Rezidivvarikose. Methodik: 155 Beine von 130 konsekutiven Patienten wurden mittels APP (inklusive Varikographie in 48 Fällen) und FKDS untersucht, die Resultate mit den Operationsergebnissen korreliert. Ergebnisse: Bei primärer Varikose (n=131) wurden venöse Normvarianten (n=21) 2mal von der APP übersehen und 4mal als inkonklusiv von der FKDS beurteilt. Inkomplette Stammvarikosen (n=49) wurden in 3 Fällen phlebographisch und in 7 Fällen mittels FKDS falsch interpretiert, die FKDS war zusätzlich bei 2 komplexen Normvarianten inkonklusiv. Bei Rezidivvarikose (n=24) war die FKDS in 8 Fällen inkonklusiv, die APP einmal. Die APP war überlegen in der Beurteilung postthrombotischer Veränderungen. Es fand sich eine exzellente Übereinstimmung in der Beurteilung des Varikose-Schweregrades. Die APP entdeckte mehr inkompetente Perforansvenen als die FKDS verglichen mit dem chirurgischen Situs, die FKDS erlaubt hingegen das präoperative Markieren der Perforantes. Schlußfolgerungen: Die FKDS ist eine zur präoperativen Varizendiagnostik taugliche Methode und kann die APP partiell ersetzen. Patienten mit Rezidivvarikosen, inkompletten Stammvarikosen bzw. unklaren FKDS-Ergebnissen sollten einer APP zugeführt werden.SummaryBackground: Purpose of this study was the evaluation of the diagnostic possibilities of ascending venography (AVG) compared to color coded duplex sonography (CCDS) in primary and recurrent varicosis. Methods: We prospectively examined 155 limbs in 130 consecutive patients with clinical evidence of severe varicosis by CCDS and AVG (including varicography in 48 limbs). Results: In 131 limbs of primary varicosis variant venous anatomy (n=21) was missed in two limbs by AVG compared to surgery. CCDS was inconclusive in 4 cases. Variant varicosis (n=49) was inconclusive in 3 cases by AVG and in 7 cases by CCDS. CCDS was inconclusive in 8/24 cases of recurrent varicosis, AVG once. AVG was slightly superior to CCDS in the detection of postphlebitic changes. Excellent agreement was found between AVG and CCDS in the grading of saphenous vein reflux. There were more incompetent perforating veins detected by AVG (and varicography) than by CCDS, but CCDS allows direct preoperative marking of the skin, which is beneficial for the surgeon. Conclusions: We conclude that CCDS is a valuable imaging tool before venous stripping which is partially capable of replacing AVG. Patients with recurrent varicosis, variant venous anatomy or inconclusive CCDS results should proceed to AVG.

Varikose: Schönheitsfehler oder Erkrankung?

ZusammenfassungVarizen, gleich welcher Ausprägungsform, werden in Abhängigkeit von der subjektiven Einschätzung des Varizenträgers als Schönheitsmakel empfunden. Etwa 60% der Bevölkerung weisen Minimalformen der Varikose auf. In diesen Fällen besteht keine gesundheitliche Beeinträchtigung. In einem gewissen Prozentsatz entwickelt sich eine fortschreitende Erkrankung, die vor allem in ihrer Maximalvariante, dem Ulcus cruris, einen erheblichen Leidensdruck mit sich bringt. Auch die Therapieansätze berücksichtigen zunehmend, solange keine fortgeschrittene venöse Insuffizienz besteht, den Wunsch des Patienten nach einem kosmetisch zufriedenstellenden Ergebnis. Vor allem die neuen endoluminalen Therapieverfahren werden diesem Wunsch gerecht, ohne einen Verlust an Effektivität in Kauf zu nehmen. Für die fortgeschrittene venöse Insuffizienz haben kosmetische Überlegungen keine Relevanz. Etwa 70% venöser Ulzera werden durch eine primäre Varikose verursacht. Eine radikale chirurgische Sanierung aller zugänglichen pathologischen Refluxe ist für die Rezidivprophylaxe wesentlich. Die Kompression hat große Bedeutung in der Prophylaxe der chronisch-venösen Insuffizienz und der Therapie des venösen Ulkus. Über 60% heilen unter Kompressionstherapie innerhalb von 24 Wochen ab.AbstractAccording to ones subjective appraisal varicose veins will be perceived as more or less disfiguring. About 60% of the population suffer from only minor variants of varicose veins which bear no risk to health. A certain percentage will develop progressive disease with the venous ulcer representing the worst variant of chronic venous insufficiency. As long as there is no progressive disease, therapeutic modalities also account for a superior cosmetic appearance. Endoluminal procedures in particular meet with the claim for a superior treatment result with respect to cosmetic outcome without diminution of efficiency. In case of progressive venous insufficiency appearance is of inferior importance. About 70% of venous ulcers are due to primary varicose veins. Surgery of all accessible superficial refluxing veins is important to prevent recurrence. Compression treatment is highly effective in preventing chronic venous insufficiency and in venous ulcer treatment. About 60% of venous ulcers heal within a 24-week treatment period.

Varikose: Schönheitsfehler oder Erkrankung?@@@Varicose Veins: Disfigurement or Disease?

ZusammenfassungVarizen, gleich welcher Ausprägungsform, werden in Abhängigkeit von der subjektiven Einschätzung des Varizenträgers als Schönheitsmakel empfunden. Etwa 60% der Bevölkerung weisen Minimalformen der Varikose auf. In diesen Fällen besteht keine gesundheitliche Beeinträchtigung. In einem gewissen Prozentsatz entwickelt sich eine fortschreitende Erkrankung, die vor allem in ihrer Maximalvariante, dem Ulcus cruris, einen erheblichen Leidensdruck mit sich bringt. Auch die Therapieansätze berücksichtigen zunehmend, solange keine fortgeschrittene venöse Insuffizienz besteht, den Wunsch des Patienten nach einem kosmetisch zufriedenstellenden Ergebnis. Vor allem die neuen endoluminalen Therapieverfahren werden diesem Wunsch gerecht, ohne einen Verlust an Effektivität in Kauf zu nehmen. Für die fortgeschrittene venöse Insuffizienz haben kosmetische Überlegungen keine Relevanz. Etwa 70% venöser Ulzera werden durch eine primäre Varikose verursacht. Eine radikale chirurgische Sanierung aller zugänglichen pathologischen Refluxe ist für die Rezidivprophylaxe wesentlich. Die Kompression hat große Bedeutung in der Prophylaxe der chronisch-venösen Insuffizienz und der Therapie des venösen Ulkus. Über 60% heilen unter Kompressionstherapie innerhalb von 24 Wochen ab.AbstractAccording to ones subjective appraisal varicose veins will be perceived as more or less disfiguring. About 60% of the population suffer from only minor variants of varicose veins which bear no risk to health. A certain percentage will develop progressive disease with the venous ulcer representing the worst variant of chronic venous insufficiency. As long as there is no progressive disease, therapeutic modalities also account for a superior cosmetic appearance. Endoluminal procedures in particular meet with the claim for a superior treatment result with respect to cosmetic outcome without diminution of efficiency. In case of progressive venous insufficiency appearance is of inferior importance. About 70% of venous ulcers are due to primary varicose veins. Surgery of all accessible superficial refluxing veins is important to prevent recurrence. Compression treatment is highly effective in preventing chronic venous insufficiency and in venous ulcer treatment. About 60% of venous ulcers heal within a 24-week treatment period.