Peter Scheffler

Paget-Schroetter Syndrome in Sports Activities Case Study and Literature Review

The authors report 7 patients with thromboses in the upper extremity resembling Paget- Schroetter syndrome. According to their case histories, all patients had a temporal and causal relationship between partially unusual sports activities and the genesis of the thrombosis. The cause of this condition is a strain on the subclavian and axillary veins by retroversion or hyper- abduction of the arm. This can entail microtraumatizations of the venous intima, consequently leading to a consecutive local activation of coagulation and to a possible thrombosis of the vessel. A mechanical compression of the vein by adjoining bone, ligament, and muscle struc tures can intensify the effects. Further primary diseases and risk factors as secondary causes for thromboses where taken into consideration when examining the patients. The Paget- Schroetter syndrome should be considered as a possible cause for unspecified trouble in the upper extremity reported by athletes. If such prolapses occur, they can be categorized as accidents by private and statutory insurance companies that cover accidents.

Randomized reliability study evaluating constant-load and graded-exercise treadmill test for intermittent claudication.

The aim of this randomized study was to compare the reliability of the treadmill test at constant-load (C-test, 3 km/hr; fixed grade of 12%) recommended in Germany with that of the graded-exercise test (G-test, 3 km/hr; increase in grade of 3.5% every 3 minutes) propagated in the United States. In 50 patients with an absolute claudication distance (ACD) in the C-test of between 50 and 400 m, the two treadmill tests were carried out in randomized order on one and the same day, and repeated on 3 days within 1 week. For the initial claudication distance (ICD), the intraclass correlation was 0.88 in the C-test and 0.87 in the G-test. For the ACD the coefficients were identical at 0.91. The within-subject variation (CVwithin) in the C-test and G-test was 25% and 27% for the ICD and for the ACD 24% and 21%, respectively. The between-subject variation was very similar with 72% and 73% (ICD) and with 78% and 68% (ACD). However, in ACDs below 100 m and between 100 to 150 m, the C-test showed significantly smaller coefficients of variation than the G-test: 13% vs 81% and 14% vs 50%, respectively. In conclusion, the results showed that both C-test and G-test are equally well reproducible.

Cardiopulmonary effects and safety of prostaglandin E1: A review

Intraarterial and intravenous infusion of prostaglandin E1 (PGE1) is established treatment for severe peripheral arterial occlusive disease, particularly in Europe and Japan. In this critical appraisal, experimental and clinical studies are reviewed, with special emphasis on cardiopulmonary effects and drug safety. The pulmonary data all indicate dose-dependent dilation of the pulmonary vessels with a reduction in pulmonary resistance. The known hemodynamic effects of PGE1 on the heart include an increase in stroke volume, cardiac index, and left ventricular ejection fraction, and a reduction in left ventricular filling pressure. Analysis of clinical trials shows a low rate of adverse effects, in particular a low incidence of cardiopulmonary side effects. If the recommendations for high-risk patients are observed, PGE1 is both an efficacious and safe therapeutic principle.

Therapeutic Efficacy of Intravenous Prostaglandin E1 Versus Pentoxifylline in Patients with Intermittent Claudication

As a rule, walking training is undoubtedly the treatment of choice for patients with arterial occlusive disease at the intermittent claudication stage (stage IIb). The adaptation of the cardiovascular and nervous system and of skeletal muscle induced by walking training increases the endurance of these patients [3]. Drug treatment is considered for patients who are not suitable candidates for, or who do not show an adequate response to, programmed exercising.

Wirksamkeit und Verträglichkeit von Prostaglandin E1 bei kurzen Infusionszeiten. Eine kontrollierte Studie bei Patienten mit Claudicatio intermittens

Zusammenfassung Die empfohlene Infusionszeit für die i.v.-Prostaglandin E1 (PGE1)-Therapie beträgt dosisabhängig 2 bzw. 3 h. In der multizentrischen Studie sollte erstmals bei Patienten mit Claudicatio inter- mittens geprüft werden, ob die Dosierung von 60 µg PGE1 auch bei kürzeren Infusionszeiten wirksam und verträglich ist. Randomisiert erhielten 118 Patienten mit Claudicatio intermittens und einer schmerzfreien Gehstrecke zwischen 50 und 200 m (3 km/h, 12%) über 4 Wochen einmal täglich eine i.v.-Infusion von 3 Amp. Prostavasin® (60 µg PGE1) über einen Zeitraum von 1 bzw. 2 h. Als Zielparameter wurde die schmerzfreie Gehstrecke sowie die Verträglichkeit, gemessen an der Häufigkeit von unerwünschten Ereignissen und dem Blutdruckverhalten, bestimmt. Die Wirksamkeit war in beiden Gruppen vergleichbar. Bei der 1-h-Infusion stieg die schmerzfreie Gehstrecke von 87 auf 135 m, bei der 2-h-Infusion von 88 auf 147 m. Die maximale Gehstrecke zeigte einen Zuwachs von 124 auf 200 m bzw. von 147 auf 238 m. Die Unterschiede zwischen beiden Gruppen waren nicht signifikant, allerdings ergab eine Subgruppenanalyse bei Ausgangswerten der schmerzfreien Gehstrecke <80 m einen signifikanten Unterschied zugunsten der 2-stündigen PGE1-Infusion (Gehstreckenzuwachs 58 gegenüber 22 m), Blutdruckverhalten und Häufigkeit von unerwünschten Ereignissen waren in beiden Gruppen vergleichbar. Insgesamt zeigen sowohl die 1- als auch 2-stündige PGE1- Infusion bei Claudicatio intermittens gleich gute Wirksamkeit und Verträglichkeit. Patienten mit initialen schmerzfreien Gehstrecken unter 80 m scheinen jedoch von der 2-stündigen PGE1-Infusion mehr zu profitieren.Abstract The recommended infusion time for i.v. prostaglandin E 1 (PGE1) therapy is 2 or 3 h, depending on the dose. The aim of the present multicentre study was to investigate, for the first time, whether the dose of 60 µg PGE1 is effective and well tolerated with shorter infusion times. A total of 118 patients with intermittent claudication and a pain-free walking distance between 50 and 200 m (3 km/h, 12%) were randomized to receive an i.v. infusion of 3 ampoules Prostavasin® (60 µg PGE1) administered for either 1 or 2 h, once a day for 4 weeks. Primary variables were pain-free walking distance as well as safety, determined by the frequency of adverse events and the course of blood pressure. The efficacy was comparable in the two groups. In the 1-h infusion group, the pain-free walking distance increased from 87 to 135 m, and in the 2-h group from 88 to 147 m, while the absolute walking distance increased from 124 to 200 m and from 147 to 238 m, respectively. The differences between the two groups were not significant, although an analysis of subgroups with initial pain-free walking distances of less than 80 m indicated a significant difference in favour of the 2-h PGE1 infusion (increase in walking distance 58 m as compared with 22 m). Course of blood pressure and frequency of adverse events were comparable in the two groups. Altogether, in intermittent claudication both the 1-h and the 2-h PGE1 infusion show comparably good results in terms of efficacy and safety. Patients with an initial pain-free walking distance of less than 80 m seem to reveal a major benefit after a 2-h PGE1 infusion.

Therapeutische Wirksamkeit von Prostaglandin E1 im Stadium IIb der AVK

The clinical efficacy of PGE1, i.v. administered, on intermittent claudication was evaluated in a randomized multicenter study of 195 patients. Either 40 μg PGE1 or 200 mg Pentoxifylline were given twice daily as 2-h intravenous infusion in 250 ml saline. The treatment lasted for 4 weeks, including a daily standardized walking training on the tread mill.