[Autologous Bypass to Pedal Side Branches to Avoid a Major Amputation]. / Der autologe Bypass zu den pedalen Seitenästen zur Vermeidung der Majoramputation.

Background: In critical limb ischaemia (CLI), a pedal vein graft bypass offers good long-term results regarding function and limb salvage. However, some cases require bypasses to branches of pedal arteries based on angiographic findings. Methods: In a retrospective database we analysed all patients who received a vein graft bypass to branches of pedal arteries for treatment of critical limb ischaemia. Results: From January 1998 to June 2014 we performed bypasses to branches of pedal arteries in 72 patients (59 men and 13 women) out of a total of 534 patients who underwent pedal bypass surgery. The proximal bypass anastomosis was above the knee in 30 cases and below the knee in 42 patients. In 6 cases the bypass connection was made to the lateral tarsal artery, in 15 cases it was made to the lateral and in 24 cases to the medial plantar artery. In 27 patients a direct connection was made to the plantar bifurcation. All reconstructions were completely autologous. The limb salvage rate after 5 and 10 years was 82 %. Conclusion: A bypass to branches of pedal arteries is a procedure recommendable for limb salvage in cases of critical ischaemia where arteries with a larger diameter are no longer available.

[Propensity Score and Long-Term Survival Results after Open versus Endovascular Treatment of Abdominal Aortic Aneurysm]. / Propensity Score im Langzeitüberleben nach offener und endovaskulärer Therapie des Bauchaortenaneurysmas.

Background: There are not many publications on the long-term results of surgical treatment for abdominal aortic aneurysm (AAA) comparing open repair (OR) and endovascular aneurysm repair (EVAR). Method: Using a propensity score (PS), we matched cohorts which were eligible for both types of treatment and underwent an elective surgical procedure for infrarenal AAA between 2002 and 2008. The endpoint of the study was long-term survival without re-intervention. Results: From a total of 442 patients treated from 2002 to 2008, we identified 140 patients of whom 72 received a tube graft and 68 were treated by EVAR. Median observation time was 5 years (0.04-10.3). Mortality was zero in the EVAR group and 1 % in the OR group, with cumulative survival after 5 and 10 years being 82 (79 %) in the OR group and 80 (58 %) in the EVAR group. Three patients (4 %) out of 72 with open surgery and 23 patients (34 %) from the EVAR group had to undergo a repeat surgery. Conclusion: Both procedures are safe methods to eliminate aneurysms. However, the high rate of re-interventions or conversions in the EVAR group has to be considered in the selection of treatment.

A naturalistic comparison of adverse effects between slow titration and loading of divalproex sodium in psychiatric inpatients.

BACKGROUND: This study compares the incidence, severity and onset of treatment-emergent adverse effects between slow titration and loading of divalproex sodium in psychiatric inpatients. METHOD: Forty-seven patients were prescribed either loading or slow titration of divalproex sodium. Under single-blind conditions, adverse effects were assessed using a valproate adverse effects rating scale. Except for a statistically significant greater incidence of somnolence in the slow titration group, no statistically or clinically significant differences in incidence, severity or onset of treatment-emergent adverse effects were found between groups. RESULTS/CONCLUSION: Overall, adverse effects were well tolerated by both groups.

Mirtazapine: an antidepressant with noradrenergic and specific serotonergic effects.

Mirtazapine is a unique antidepressant that refines the specificity of effects on noradrenergic and serotonergic systems. It is an antagonist of presynaptic alpha 2-adrenergic autoreceptors and heteroreceptors on both norepinephrine and serotonin (5-HT) presynaptic axons, plus is a potent antagonist of postsynaptic 5-HT2 and 5-HT3 receptors. The net outcome of these effects is increased noradrenergic activity together with specific increased serotonergic activity, especially at 5-HT1A receptors. This mechanism of action maintains equivalent antidepressant efficacy but minimizes many of the adverse effects common to both tricyclic antidepressants and selective serotonin reuptake inhibitors. Mirtazapine has an onset of clinical effect in 2-4 weeks similar to other antidepressants, although sleep disturbances and anxiety symptoms may improve in the first week of treatment. It has minimal cardiovascular and anticholinergic effects, and essentially lacks serotonergic effects such as gastrointestinal symptoms, insomnia, and sexual dysfunction. Sedation, increased appetite, and weight gain are more common with mirtazapine than with placebo. An elimination half-life of 20-40 hours enables once-daily bedtime dosing. The recommended initial dosage is 15 mg once/day at bedtime, with an effective daily dosage range of 15-45 mg. Cases of overdose of up to 975 mg caused significant sedation but no cardiovascular or respiratory effects or seizures.