Fibrinolytic treatment with ultra-high streptokinase infusion via the dorsalis pedis vein offers no advantage over systemic infusion via the brachial vein in patients with deep vein thrombosis of the leg.

The present study into the fibrinolytic therapy of deep vein thrombosis (DVT) considers whether streptokinase infusion into the dorsalis pedis vein of the affected leg (ipsipedal infusion) yields higher lysis rates than systemic infusion via the brachial vein (systemic infusion). In both cases the dosage regimen selected was a short-term ultra-high streptokinase (UHSK) infusion of 1.5 million IUSK/hour over a period of 6 hours (total SK dose: 9 million IU). A series of one to three UHSK infusions was given on one to three consecutive days. Forty patients were randomised to either systemic (Group S) or ipsipedal (Group IP) treatment. The distribution of important parameters determining a fibrinolytic response (e.g. the age, site and extent of DVT, and number of UHSK infusion series) was virtually identical in the two treatment groups. The rates for total and partial thrombolysis in the systemic infusion group were 50% and 10% respectively compared with 30% and 20% respectively in the ipsipedal group. The distribution of side-effects was approximately identical in the two groups. The results show that ipsipedal UHSK lysis via the dorsalis pedis vein confers no advantage over systemic infusion via the brachial vein.

Lysis block treatment: a new form of local thrombolysis.

Lysis block treatment (LBT) is a new form of fibrinolytic therapy for deep vein thrombosis and arterial occlusion in the distal parts of the limbs. Strictly local lysis was achieved by placing a cuff around the thigh or the upper arm, inflating the cuff to a pressure of 500 mmHg ("Bier's blockade"), and giving heparin and tissue plasminogen activator (rt-PA) by intravenous injection into the dorsal pedis or antecubital veins. Occlusion lasted for one hour. This new technique was demonstrated in 22 patients. Six patients presented with popliteal vein thromboses and 1 patient with a distal femoral vein thrombosis. In addition, 15 arterial occlusions were treated comprising 3 calf, 6 popliteal, 3 distal femoral, and 2 digital sites and 1 brachial site. Five of 7 venous and 9 of 15 arterial occlusions were partially or totally removed. The activated partial thromboplastin time remained nearly unchanged during LBT and only a limited and short-term lengthening was recorded after restoration of blood flow. This was of importance for patients with bleeding tendencies, which are normally a contraindication for systemic lysis. LBT may therefore be considered as a useful alternative to systemic fibrinolytic treatment.

[Lysis block technique--a new method of fibrinolytic treatment with tissue-type plasminogen activator (rt-PA)]. / Lyseblock-Technik--eine neue Methode der fibrinolytischen Behandlung mit Gewebeplasminogen-Aktivator (rt-PA).

With lysis-block technique an over-systolic tourniquet is put on the thigh or upper arm. The fibrinolytic substance is injected into a dorsal foot vein or forearm vein. By using this strictly local lysis it was possible to remove distal venous and arterial occlusions. During over-systolic blockade there was only a minimal link between the blocked part of the limb and systemic circulation. By choosing a lytic substance with a short half-life-period (rt-PA) the systemic effect after loosening the blockade was small. LBT is a new and interesting method for the fibrinolytic treatment of peripheral venous and arterial occlusions. The procedure is characterized by minimal systemic reactions and it can probably be applied in those patients with contraindications for systemic lysis.

[Systemic lysis in subacute arterial occlusion]. / Systemische Lyse bei subakuten Arterienverschlüssen.

The therapeutic regimen used consisted of an ultrahigh streptokinase dosage scheme with an infusion rate of 1.5 million units per hour over a period of 6 hours. Where no immediate clearance occurred or where residual stenoses persisted, a catheter dilation (PTA) was subsequently carried out. Favorable results were achieved in the group of up to 6 week old femoral occlusions with 2 or 3 calf arteries open and an occlusion length below 15 cm. Iliac occlusions responded well to lytic treatment if a 3 month history was not exceeded.

[Normal pressure hydrocephalus in geriatric patients--a treatable form of dementia]. / Normaldruckhydrozephalus bei geriatrischen Patienten--eine behandelbare Form der Demenz.

Six geriatric patients are presented who were treated because of normal pressure hydrocephalus. A tentative diagnosis was made if dementia, gait disturbance, and incontinence together with a typical CAT-scan were present. In these cases an operation was carried out. After ventriculo-peritoneal shunting clinical improvements were seen in four patients. Postoperative complications were hygromas in three patients and a shunt-dislocation in another patient. A chronic subdural bleeding was recorded also in one of these patients with only a temporary success in this case. Two patients showed no clinical improvement at any time. However, in these cases additional neurologic symptoms together with typical CAT-scan changes were present. Before making a decision for an operation vascular processes and Alzheimer's disease should be ruled out.

[Streptokinase therapy in a patient with lupus anticoagulant and thrombosis of the A. iliaca externa]. / Streptokinasetherapie bei einem Patienten mit Lupus-Anticoagulant und Thrombose der A.iliaca externa.

We report on a 26-year-old male who suffered from thrombocytopenia, factor V-deficiency and punctuate hemorrhages during the past. On admission the patient presented with acute left iliac artery occlusion. The walking distance was reduced to 200 m. Laboratory findings showed the existence of a lupus anticoagulant (LAC). As a therapeutical attempt a systemic lysis with high doses of streptokinase (9,250,000 I.E.) was carried out which was followed by a successful catheter lysis (250,000 I.E. streptokinase). During lysis the patient didn't show any unusual hemorrhagic events. Arterial thrombosis together with a lupus anticoagulant can be treated with high doses of streptokinase.

[Glucagon as an adjuvant to infusion cholecysto-cholangiography]. / Glukagon als Adjuvans zur Infusions-cholezystcholangiographie.

The effect of glucagon on the results of intravenous cholangio-cholecystography (IVC) was studied in a randomised trial on 246 patients. The injection of 1 mg. glucagon increased the speed of contrast excretion from the liver. This led to a significantly quicker demonstration of the gallbladder, with a tendency to more rapid filling of the biliary ducts. In patients with hyperbilirubinaemia there were somewhat fewer negative cholangiograms and significantly fewer negative cholecystograms. Considering the patients as a whole, the use of glucagon has the advantage of reducing the time taken for the examination and of a reduction of negative IVCs. Since glucagon has practically no side effects, our experience suggests that it can be recommended as an adjuvant to IVC. Improvements in IVCs are particularly significant since they are now only used for special indications.

Intracarotid slow bolus injection of nimodipine during angiography for treatment of cerebral vasospasm after SAH. A preliminary report.

Nimodipine was given as an intracarotid slow bolus injection in six patients with subarachnoid hemorrhage (SAH) due to rupture of a cerebral aneurysm, with angiographically demonstrated vasospasm. The patients were followed by serial angiograms for demonstration of the effect of nimodipine on vasospasm. After angiography, all patients were treated with a constant venous infusion of this new calcium antagonist. Although the therapeutic regimen was started only a few hours after onset of vasospasm, there was no change in cerebral vessel caliber detectable on angiograms following the intracarotid injection. Three patients died, two patients finally recovered with neurological deficits due to cerebral ischemia, and one patient with asymptomatic vasospasm remained symptom-free. Although nimodipine may act to prevent cerebral vasospasm after SAH, the authors believe that the intracarotid application is not effective after vasospasm has occurred.

[Radiotherapy of arteriovenous malformations of the brain]. / Die Radiotherapie arteriovenöser Malformationen des Hirnes.

Arterio-venous malformations of the brain are accompanied by a risk of hemorrhages which increases in the course of time. Thus a therapy is indicated as soon as the arterio-venous malformation is discovered. If surgical treatment is contra-indicated, radiotherapy can be applied with a high rate of success (obliteration of the arterio-venous malformation after two years in up to 88% of cases). Percutaneous radiotherapy has to be performed with a stereotaxic technique under controlled conditions. The stipulations for this treatment are described on the basis of our own method. Between August 1982 and July 1983, twenty patients have been treated without any complications due to therapy or to the disease. This form of radiotherapy using the bremsstrahlung of a linear accelerator can be considered as an alternative method with respect to proton irradiation.

[Radiation exposure in whole body and cranial CT studies in relation to parameters of the examination technic]. / Die Strahlenexposition bei Ganzkörper- und Schädel-CT-Untersuchungen in Abhängigkeit von untersuchungstechnischen Parametern.

The article gives the organ doses for whole body CT examinations of the thoracic region, the upper abdomen, the mesogastric and pelvic regions as well as of the lumbar vertebral column and for CT scanning of the skull. The examinations were performed using an Alderson-Rando phantom with the whole body computer tomograph Somatom DR2 supplied by Siemens and with the skull computer tomograph Siretom 2000, also supplied by Siemens. It was found that the magnitude of radiation exposure of the patient depends not only on instrument-specific properties, but also to a very large measure on the examination parameters and techniques which can vary considerably from one clinic to another.

Cerebral CT in fatal courses of resuscitated sudden infant death.

Three children revived after sudden infant death syndrome were observed by cerebral computed tomography (CT). The scans were correlated with clinical and electroencephalographic findings of brain deterioration. The salient features of the CT presentations are described. Necropsies performed in two of the three cases revealed liquefactive necrosis.

[The trichorhinophalangeal syndrome. Report of a family with 14 carriers of characteristics in 5 generations]. / Das trichorhinophalangeale Syndrom. Bericht über eine Familie mit 14 Merkmalsträgern in 5 Generationen.

This article reports on 14 cases of a trichorhinophalangeal syndrome in five successive generations. Besides the well-known characteristics of the TRPS the following symptoms observed in this family are new: Teething was considerably delayed, intelligence was reduced, and there were skin manifestations resembling eczema. Besides, struma colli and colitis ulcerosa were also observed. Subsequent observations have to clarify whether these symptoms are a facultative part of the TRPS pattern. The constant appearance of carriers of these characteristics during five generations points to dominant heredity.

[A comparison of radiation exposure of angiographers using an above-table or below-table image intensifier (author's transl)]. / Vergleich der Strahlenexposition des Untersuchers bei Angiographiearbeitsplätzen mit Obertischund-und Untertischbildverstärker.

Phantom measurements in the vicinity of an angiographic installation with the image intensifier below the table and subsequently with the intensifier above the table have shown that the former arrangement produces three times as much radiation to the head, gonads and leg during screening than when the intensifier is above the table. This has been confirmed in clinical practice during angioplastic procedures in other units. There is also a factor of 2.6 in favour of the above table intensifier applied to the lens of the eye of the investigator Radiation to the hand of the investigator is at least half with the above table arrangement.