An isolated double-crush-syndrome in posttraumatic thoracic outlet syndrome - A case report.

Thoracic outlet Syndrome (TOS) includes all disorders caused by compression of all neurovascular Structures in the upper thoracic outlet (Ross and Owners, 1966, Bürger and Arterien, 2014, Sanders and Annest, 2017). The Double-Crush-Syndrome (DBS) defines multilevel lesions along a neurovascular trunk caused by mechanical compression in different areas. Pectoralis-minor-syndrome (PMS) is also classified in the disorders of he upper thoracic outlet and was also known as hyperabductionsyndrome or subcoracoidal-syndrome. Between 2015-2019 our department treatet 488 patients suffering from neurological, vascular or combined TOS. Surgical treatment, depending on clinical and specific diagnostics was performed in 175 cases via transaxillary approach, including cervical rib resection, first rib resection, neurolysis of plexus brachialis, thoracal sympathectomy or vascular reconstruction. In all this year just a single patient with double crush syndrome was present. CASE PRESENTATION AND METHODS: We report a case of a 28-years old female patient, reported in line with the SCARE criteria [13], suffering from neurvascular compression in the upper thoracic outlet after surgically treated clavicula fracture. She developed typical symptomes of a Thoracic Outlet Syndrome. CONCLUSION: Double-Crush-Syndrome in patients with Thoracic Outlet Syndrome are very rare, case reports seldomly exist. The diagnosis requires a specific clinical testing and x-ray radiography. Furthermore dynamic tests like ultrasound and angiography and neurophysiological testing requires a high degree of experience, so the compressed area can be detected. Treatment includes an attempt of best medical and physical therapy, in case of failure a surgical treatment is necessary.

Bone regeneration induced by a 3D architectured hydrogel in a rat critical-size calvarial defect.

Bone regeneration can be stimulated by implantation of biomaterials, which is especially important for larger bone defects. Here, healing potency of the porous ArcGel was evaluated in a critical-size calvarial bone defect in rats in comparison with clinical standard autologous bone and Bio-Oss® Collagen (BioOss), a bone graft material frequently used in clinics. Bone healing and metabolic processes involved were monitored longitudinally by [18F]-fluoride and [18F]-FDG µ-PET/CT 1d, 3d, 3w, 6w, and 12w post implantation. Differences in quality of bone healing were assessed by ex vivo µ-CT, mechanical tests and histomorphometry. The amount of bone formed after implantation of ArcGel was comparable to autologous bone and superior to BioOss (histomorphometry). Furthermore, microarchitecture of newly formed bone was more physiological and better functional in case of ArcGel (push-out tests). [18F]-FDG uptake increased until 3d after implantation, and decreased until 12w for both ArcGel and BioOss. [18F]-fluoride uptake increased until 3w post implantation for all materials, but persisted significantly longer at higher levels for BioOss, which indicates a prolonged remodelling phase. The study demonstrates the potential of ArcGel to induce restitutio ad integrum comparable with clinical standard autologous bone and better bone regeneration in large defects compared to a commercial state-of-the-art biomaterial.

[Venous Aneurysms of the Lower Extremities - Clinical Significance and Therapy]. / Klinische Bedeutung und Therapie venöser Aneurysmen der unteren Extremitäten.

Isolated venous aneurysms are very rare. In clinical practice it is predominantly seen in the course of a random diagnosis to find the cause of pulmonary embolism or venous thrombosis. Due to an increased use of duplex scans there is also an increase in the number of diagnoses of venous aneurysms even if patients are still asymptomatic. The precise prevalence is yet unknown. The choice of therapeutic procedure is dependent on each individual clinic as well as the size and morphology (fusiform or saccular) of the aneurysm. At present, the available data are still insufficient. We discuss our own surgical treatment of 7 patients with primary aneurysms involving the vena cava, iliac vein, great saphenous vein junction and popliteal vein in consideration of the latest literature.

[Amputation in vascular surgery--a subject in this time?]. / Amputationen in der Gefässchirurgie--Ein Thema in der heutigen Zeit?

The peripheral limb amputations represent a current topic in spite of the medical and technical improvement, which also nowadays payed too little attention. We are not only concerned about limb amputations themselves in the present. They were always regarded as the most fatal mutilate procedure in surgery. In time the medical aspects came into the centre of attention. Because of enormous improvements in vascular diagnostic and therapy it is possible to preserve a great number of amputation threatened limbs and to keep a high measure of daily-life-quality for those patients [10]. Nevertheless a great number of our vascular surgery patients must be amputated today since local conditions, limited therapeutic possibilities, accompanying-illnesses and infections as well as an increasing multimorbidity do not enable to preserve the limb. In the following article our own dates and causes are will be analyzed and further consequences for the future will be point out.

[Vena cava filter -- is there an indication for implantation?]. / Kavafilter -- gibt es eine Indikation zur Implantation?

The indication of vena cava filter implantation is controversially discussed. On the basis of the available literature and our own results a critical analysis of this issue is given. Between 1994 and 2003, we inserted a total of 29 vena cava filters; 24 temporary and 5 permanent filters. In twelve patients, the placement of the filter was indicated due to pulmonary embolism and a contra-indication to dose adjusted heparin therapy. Seven additional patients experienced a recurrent pulmonary embolism despite adequate heparin therapy. An additional prophylactic filter insertion was carried out in ten patients. The temporary vena cava filters were left in place between 7 to 38 days with an average of 17 days. Total implantation time of temporary filters was scheduled until complete mobilisation of the patients, generally in conjunction with an effective dosage of oral anticoagulants. No patient died in connection with the insertion of the filter and no further pulmonary embolisms occurred. One case of inferior vena cava thrombosis occurred in each group of temporary and permanent filters. In one third of the removed filter systems, thrombi in the filter were found. Local infections of the catheter and introducer sets were observed in two patients. Moreover, in one case the strut of a temporary filter broke and subsequently dislocated 17 days after insertion. However, there is little evidence concerning vena cava filters, and further investigations are necessary. Until additional data are available, filters should generally be restricted to patients with deep venous thrombosis and pulmonary embolism who cannot receive anticoagulation, and highly selected cases.

[Management of postoperative compartment syndrome -- case report]. / Management des postoperativen lagerungsbedingten Kompartmentsyndroms -- Kasuistik.

AIM: Differential diagnosis and management of the lower extremity compartment syndrome as a potentially devastating complication of prolonged surgery in the lithotomy position. CASE REPORT: A 55-year-old patient underwent radical cystoprostatovesiculourethrectomy including reconstruction of an ileal conduit because of a multifocal recurrent tumor of the urinary bladder (operating time > 8 hours). On the first postoperative day, the patient complained about swelling within the right calf leading to the suspicion of a deep vein thrombosis. Phlebography of the right leg revealed: i) thrombosis-untypical occlusion of the distal popliteal vein and ii) no detection of the deep vein within the right calf (femoral and iliac veins were with no pathological finding). Tissue pressure was as follows: right, 55 mmHg/left, 11 mmHg, underlining clinical suspicion of compartment syndrome. The patient underwent a fasciotomy of the right calf. Over the following 5 days, muscle edema decreased, allowing subsequent mobilization of the patient. On the 8 (th) postoperative day, the patient died unexpectedly due to an acute myocardial infarction. CONCLUSION: In case of a swelling of the lower extremity after long-lasting surgical interventions performed in lithotomy position, a compartment syndrome is one of the possible differential diagnoses, the consequences of which can be avoided by an early diagnostic and adequate treatment.

[The use of v.a.C.-system in wound management for borderline indications]. / Der Einsatz des V.A.C(R)-Systems im Wundmanagement bei Grenzindikationen.

Vacuum sealing has increasingly become established as a method adapted to treat acute and chronic wounds. Temporary sealing of the open abdomen represents an alternative therapeutic approach. The principle of inverse tissue expansion prevents ventral herniae from developing in the course of delayed abdominal-wall closure. In patients undergoing vascular surgery, the method can be uneventfully adopted in treating chronic ulcer following revascularisation. The accelerated healing process, while reducing the duration of therapy, turns out to be cost-efficient.

[Interventional and vascular surgical management for inflammatory arrosion hemorrhage from visceral arteries following pancreatic surgery]. / Entzündliche Arrosionsblutungen aus ViszeralarterienInterventionelles und gefässchirurgisches Management nach vorwiegend pankreaschirurgischen Eingriffen.

Spontaneous or postoperative hemorrhage into the abdominal cavity due to inflammatory vessel arrosion represents an uncommon but menacing situation. According to the literature, such hemorrhage is associated with a lethality of nearly 2%. Therapeutical options include reoperation and interventional radiological techniques such as endovascular catheter techniques with stent graft implantation or the embolization of vessels. We report on the management of seven cases with hemorrhage either from the gastroduodenal artery ( n=5) following pancreatic surgery for pancreatic carcinoma, liposarcoma, and chronic pancreatitis or from the common hepatic artery ( n=1) and the superior mesenteric artery ( n=1) following chronic pancreatitis. The present article describes our experiences with stent graft implantation (hemobahn prosthesis) in four cases. Based on these experiences, we see the advantages of stent grafts in primary hemostasis without any contact to infected tissue and the preservation of regular perfusion. However, further clinical data are required focussing on indication, technical success rates, stent-related complications, and long-term outcome.

[Experimental investigations onto the biocompatibility of coated vascular grafts as a function of the primary disease in various patients groups]. / Experimentelle Untersuchungen zur Biokompatibilität beschichteter Gefässprothesen in Abhängigkeit von der Grundkrankheit verschiedener Patientenkollektive.

INTRODUCTION: This work presents initial experimental results obtained with co-incubation of human neutrophilic granulocytes from patients with various diseases (5 patients each group) and collagen- or silver-coated polyester grafts (25 patients each graft). METHODS: After two-hour co-cultivation of the graft with human granulocytes of different patients (normal controls; peripheral occlusive vascular disease; diabetes mellitus; carcinoma/chemotherapy; sepsis), the following parameters were determined by flow cytometry: CD11b, CD62L, fMLP, CXCR2. RESULTS: The change in the receptor expression was taken as a measure of responsiveness, with statistically significant differences seen within and between the groups. For the silver-coated graft, such differences were mainly noted for the fMLP receptor (p=0.01). For the two-hour incubation with collagen coating, the receptors CD62L and CXCR2 were indicative of differences between the various diseases (CD62L p=0.01; CXCR2 p=0.01). Comparison between the grafts revealed statistically significant differences for the CXCR2 and the fMLP receptors (CXCR2 p=0.00; fMLP p=0.03). CONCLUSIONS: The differences noted between the grafts and between the patients groups are suggestive of an altered responsiveness of the granulocytes to the grafts. This enables new aspects with respect to the genesis of accompanying clinical symptoms.

Combination chemotherapy with docetaxel and cisplatin for locally advanced and metastatic gastric cancer.

BACKGROUND: Poor treatment results obtained with palliative chemotherapy for advanced gastric cancer indicate the need for new effective and well-tolerated regimens. PATIENTS AND METHODS: Forty-three patients with locally advanced or metastatic gastric cancer were enrolled in a phase II study to evaluate the efficacy and safety of combination chemotherapy with doxetacel 75 mg/m2 and cisplatin 75 mg/m2 given every three weeks. RESULTS: Thirty-nine patients were evaluable for response. Four achieved a complete response and twelve a partial response, for an overall response rate of 37.2% (16 of 43 patients; 95% confidence interval (CI): 22.98-53.72). Median time to progression was 6.1 months and median overall survival 10.4 months. Forty-two percent of all patients were still alive at one year and twelve percent at two years. The major toxicity was leukopenia which reached grade 3-4 in 18.6% (n = 8) of the patients. However, no febrile neutropenia occurred. Non-haematological toxicities were usually mild to moderate. Grade 3 toxicities included diarrhea (9% of the patients), nausea and vomiting (7%), and alopecia (7%). Severe ototoxicity with or without peripheral neuropathy developed after completion of chemotherapy in two patients. CONCLUSIONS: These results suggest that the combination of docetaxel and cisplatin has moderate toxicity and is an effective regimen for the treatment of advanced gastric cancer, both with regard to response rate and survival.

Three pheromone-binding proteins in olfactory sensilla of the two silkmoth species Antheraea polyphemus and Antheraea pernyi.

Females of the sibling silkmoth species Antheraea polyphemus and A. pernyi use the same three sex pheromone components in different ratios to attract conspecific males. Accordingly, the sensory hairs on the antennae of males contain three receptor cells sensitive to each of the pheromone components. In agreement with the number of pheromones used, three different pheromone-binding proteins (PBPs) could be identified in pheromone-sensitive hairs of both species by combining biochemical and molecular cloning techniques. MALDI-TOF MS of sensillum lymph droplets from pheromone-sensitive sensilla trichodea of male A. polyphemus revealed the presence of three major peaks with m/z of 15702, 15752 and 15780 and two minor peaks of m/z 15963 and 15983. In Western blots with four antisera raised against different silkmoth odorant-binding proteins, immunoreactivity was found only with an anti-(Apol PBP) serum. Free-flow IEF, ion-exchange chromatography and Western blot analyses revealed at least three anti-(Apol PBP) immunoreactive proteins with pI values between 4.4 and 4.7. N-Terminal sequencing of these three proteins revealed two proteins (Apol PBP1a and Apol PBP1b) identical in the first 49 amino acids to the already known PBP (Apol PBP1) [Raming, K. , Krieger, J. & Breer, H. (1989) FEBS Lett. 256, 2215-2218] and a new PBP having only 57% identity with this amino-acid region. Screening of antennal cDNA libraries with an oligonucleotide probe corresponding to the N-terminal end of the new A. polyphemus PBP, led to the discovery of full length clones encoding this protein in A. polyphemus (Apol PBP3) and in A. pernyi (Aper PBP3). By screening the antennal cDNA library of A. polyphemus with a digoxigenin-labelled A. pernyi PBP2 cDNA [Krieger, J., Raming, K. & Breer, H. (1991) Biochim. Biophys. Acta 1088, 277-284] a homologous PBP (Apol PBP2) was cloned. Binding studies with the two main pheromone components of A. polyphemus and A. pernyi, the (E,Z)-6, 11-hexadecadienyl acetate (AC1) and the (E,Z)-6,11-hexadecadienal (ALD), revealed that in A. polyphemus both Apol PBP1a and the new Apol PBP3 bound the 3H-labelled acetate, whereas no binding of the 3H-labelled aldehyde was found. In A. pernyi two PBPs from sensory hair homogenates showed binding affinity for the AC1 (Aper PBP1) and the ALD (Aper PBP2), respectively.

Decyl-thio-trifluoropropanone, a competitive inhibitor of moth pheromone receptors.

An earlier study (Pophof 1998) showed that the esterase inhibitor decyl-thio-trifluoropropanone inhibited the responses of two receptor neurons of the moth Antheraea tuned to straight-chain pheromone components, an acetate and an aldehyde, respectively. Here we report that decyl-thio-trifluoropropanone also inhibited the responses of two pheromone receptor neurons of Bombyx mori to bombykol and bombykal. In contrast, decyl-thio-trifluoropropanone activated receptor neurons of the moth Imbrasia cyrtherea tuned to the pheromone component (Z)-5-decenyl 3-methyl-butanoate. However, decyl-thio-trifluoropropanone did not affect the responses of two receptor neurons of B. mori females specialized to the plant volatiles benzoic acid and linalool, respectively. These results indicate that decyl-thio-trifluoropropanone, besides inhibiting the sensillar esterase, interferes with proteins involved specifically in the excitation of pheromone receptor neurons. In binding studies with radiolabelled decyl-thio-trifuoroproparopnone, the inhibitor was bound by the pheromone-binding protein of A. polyphemus. However, the amount of decyl-thio-trifluoropropanone causing response inhibition was 300 times lower than the amount of pheromone-binding protein present in the sensilla. Since the amount of decyl-thio-trifluoropropanone adsorbed corresponded to about the maximum number of receptor molecules calculated per sensillum, we expect that decyl-thio-trifluoropropanone, probably in complex with pheromone-binding protein, competitively inhibits the pheromone receptor molecules.

[Locoregional and systemic therapy of advanced pancreatic carcinoma]. / Lokoregionäre und systemische Therapie beim fortgeschrittenen Pankreaskarzinom.

Pancreatic cancer has a very poor prognosis despite surgical resection or chemotherapy. For patients with a pancreatic cancer stage III or IV, locoregional or systemic chemotherapy is often the only chance for treatment. In our opinion, locoregional treatment is currently the best concept.

[Ca 125 during normal and pathologic pregnancy]. / Ca 125 v prubehu fyziologického a patologického tehotenství.

In 44 women in the first trimester of pregnancy a single examination of the Ca 125 serum level was made. In 10 women of the control group after mini-interruptions of pregnancy almost in all instances serum concentrations within the normal range were recorded. In 23 women with the diagnosis of spontaneous abortion in the first trimester a mean concentration of 58 U/ml of this protein was found. In a group of 11 women with the diagnosis of imminent abortion with a favourable prognosis, on the other hand, the mean serum concentration was only 42 U/ml, which is close to the mean concentration recorded in the control group of healthy pregnant women (46 U/ml). The difference between the two groups of pathological pregnancies is, however, not statistically significant.