[The effect of glycerol trinitrate on the arterial pressure of the fingers]. / Einfluss von Glyceroltrinitrat auf den Fingerarteriendruck.

In 35 patients with healthy vessels, 52 patients with vasospasm and 42 patients with stenoses or obliteration of the finger arteries with the help of the Parks-ultrasound-Doppler device model 806-A and a finger cuff of the size of 3.5 X 5 cm the systolic pressure of the finger arteries was measured before and after the administration of glycerol trinitrate. Since in test persons with healthy vessels no significant differences of the radial and ulnar volar finger artery, of the single fingers of one hand or in the comparison of the sides of the two hands was found, a concentration could be done. The relative and absolute increase of the pressure of the finger artery under glycerol trinitrate was most conspicuous in patients with vasospasm. No essential changes, as we expected, occurred in patients with organic disturbances of the arterial blood supply. Under variation of the lower limits of the norm of the pressure of the finger arteries the high values of the sensitivity, specificity and efficiency which are characteristic for the ultrasound-Doppler pressure measurement, lying over 0.90 particularly after pharmacologic vasodilation.

[Findings of pulse palpation and non-invasively measured blood pressure values of the posterior tibial artery in arterial occlusive disease]. / Pulstastbefund und nichtinvasiv gemessene Blutdruckwerte der A. tibialis posterior bei arterieller Verschlusskrankheit.

In 37 test persons with healthy vessels and 103 patients with arterial obstructive disease the clinical findings of the pulse palpation were related to the results of the systolic Doppler pressure measurement in the region of the posterior tibial artery. The experience of the investigator, physical influences, local extravascular factors as well as parameters of the central haemodynamics proved to be significant. A palpation of the pulse was successful in peripheral systolic pressure values lying higher than 90 Torr, so that here a judgement of the function alone became possible with the help of the palpatory pressure measurement of the posterior tibial artery. Unfavourable local conditions, however, can be followed by negative tactile findings of the pulse also in higher pressure values.

[Differential diagnosis of inflammation-induced arterial vascular diseases]. / Zur Differentialdiagnose entzündlich bedingter arterieller Gefässerkrankungen.

The clarification of non-arteriosclerotic inflammatory vascular diseases is based on angiological, angiographical, immunological and immunohistological methods and parameters. As causes of the arterial occlusive disease of younger patients are taken into consideration the obliterating endangiitis and Takayasu's aortoarteriitis. To the clinical manifestations of the giant cell arteriitis belong the temporal arteriitis and the rheumatic polymyalgia. Hypersensitivity and panangiitides are to be delimited from the group of the pathergic granulomatoses. The secondary Raynaud's syndrome on the basis of a digital arteriitis is of differential-diagnostic and prognostic importance in collagenoses and rheumatoid arthritis.

[Hemorheologic studies for evaluating microcirculation in patients with peripheral arterial circulatory disorders and diabetes mellitus]. / Hämorheologische Untersuchungen zur Beurteilung der Mikrozirkulation bei Patienten mit peripheren arteriellen Durchblutungsstörungen und Diabetes mellitus.

Haemorheological investigations in 73 male patients with chronic disturbances of the arterial blood supply of the lower extremities and 54 male non-insulin-requiring (type-II-) diabetics with and without micro- and macroangiopathy resulted in significant changes of the flow properties of the blood in contrast to 20 comparable clinically healthy males. In all groups of patients a clear increase of the aggregation of erythrocytes and the viscosity of plasma as well as a decrease of the deformability of erythrocytes were to be proved. The size of the deviations of all three parameters from the normal correlated with the degree of severity of the arterial obstructive disease and in diabetics with the occurrence of vascular complications (macroangiopathy, retinopathy) as well as with the situation of metabolism. The decreased fluidity of blood may lead to the development of further enlargement of disturbances of microcirculation. Therefore, haemorheological viewpoints should be included into the total diagnostic and therapeutic concept of the arterial obstructive disease and the diabetes mellitus.

[Kasabach-Merritt syndrome]. / Das Kasabach-Merritt-Syndrom.

The Kasabach-Merritt syndrome is a rare, congenital disease, characterized by giant haemangiomatosis and disseminated intravasal coagulation. It is reported on an at present 34-year-old patient with such a disease and the long-term course is described. Complications with haemorrhages can be prevented by means of anticoagulants.

[Theses on the evaluation of arterial circulatory disorders of the extremities]. / Thesen zur Begutachtung arterieller Durchblutungsstörungen der Extremitäten.

In an expert opinion of disturbance of the arterial blood supply concerning invalidity the vascular disease must be proved with sufficient ascertainment as well as the functional capacity remained must be estimated. Every expert opinion should contain as far as possible concrete data already in the angiologic-diagnostic minimum programme. In problematic cases supplementations by a special angiological diagnostics are necessary. The criteria of evaluation of arterial obstructive diseases for an expert opinion concerning invalidity are also summarized in theses. Also the relations between disturbances of the peripheral blood supply and effects of injury are discussed. The paper concludes with references to the acknowledgement of a disability card in arterial obstructive diseases and to the motor-car driving ability of patients with vascular diseases.

[Clinical aspects and differential diagnosis of primary and secondary microangiopathies]. / Klinik und Differentialdiagnose der primären und sekundären Mikroangiopathien.

Diseases of the terminal vascular system are of particular diagnostic and differential-diagnostic importance in clinical angiology. While in the functional microangiopathies of the skin as a rule disturbances of the vasomotor function without an essential value of the disease are concerned, secondary organic changes of the wall of the vessel not infrequently determine the course and the prognosis of the basic disease (rheumatoid arthritis, collagenoses, hypertension and diabetes). Vasomotor trophic disturbances are observed also post-traumatically, post-operatively, after exposition to cold, in a lesion of the central nervous system and vertebra nerve irritations. For the allergic hyperergic vasculitides, which show an extraordinary polymorphism in the clinical picture in characteristic histological findings, an auto-immune pathogenesis is to be supposed. The chronic arterial hypertension leads to arteriolosclerosis and necrosis with adequate organic symptoms. In the diabetic microangiopathy we may demarcate functional pre-stages from irreversible structural changes of the vessels, in which case apart from the peripheral microangiopathy of the skin the retinopathy and nephropathy are to be classified as particularly important clinical manifestations.

[Differential diagnostic problems in secondary acral circulatory disorders]. / Differentialdiagnostische Probleme bei den sekundären akralen Durchblutungsstörungen.

The broadly subdivided symptomatology of disturbances of the secondary acral blood supply, in which Raynaud's syndrome with its variants occupies a preferred position, demands solid basic knowledge of the physician, since triggering function or supporting permanent disturbance belong to a great number of basic diseases or primary disturbing factors. Thus the practicing physician has to do with comprehensive differential-diagnostic considerations with the aim of the correct recognition of the primary basic disease or noxa for the purpose of consequent induction of therapy. Angiological basis examinations, simple functional tests, a fundamental general physical examination, X-ray pictures granted for necessary and ECG-records as well as chemical laboratory findings alleviate the finding of the diagnosis like an exactly got anamnesis. In this therapeutic management subspecialists have then certainly only for a smaller part the task of further diagnostic clarification and therapeutic advice.

[Diagnostically relevant effect and disturbance factors in Doppler ultrasound studies of the arterial system]. / Diagnostisch relevant Einfluss- und Störfaktoren der Ultraschall-Doppler-Untersuchung im arteriellen Gefässbereich.

For the clinical use of the Doppler-sonography besides the knowledge of evident criteria of judgment also the consideration of important sources of error and factors of influence is necessary. Functional effects of obstructions of the arterial system depend on the actual flow time volume, the elasticity of the arteries and on the peripheral flow resistance. The derivation and registration of the Doppler-signals must be performed under standardized conditions. Particularly important are multifactorial changes of the width of the vessels and of the resistance in the regions of the arterioles which influence the poststenotic pressure-flow-behaviour and the results of Doppler-sonographic measurements. Apart from the central haemodynamics the functional changes depending on age concern the elasticity of the vessels and the degree of efficacy of the muscular blood supply. Patients with hypertension react on stimuli increasing the blood supply with a smaller increase of their functionally effective cross-section of the vessels. Disturbances of the peripheral haemodynamics in diabetics are to be referred to a deficit of the tonus of sympathetic vasoconstrictors due to an autonomous and may, moreover, be regarded as vasomotor compensation mechanisms in primarily haemorheologically conditioned disturbance of the microcirculation.

[Differential diagnosis of endangiitis and arteriosclerosis obliterans]. / Zur Differentialdiagnose der Endangiitis und Arteriosclerosis obliterans.

41 males at the age from 20 to 40 years with chronic obstruction of the arteries of the extremities were on the basis of anamnestic and clinical findings subdivided into the groups obliterating endangiitis (group I = 20 patients) and obliterating arteriosclerosis (group II = 11 patients). In 10 patients in this way no decision for one of the two diagnoses could be made (group III). By multidimensional variance and discriminance analysis of various clinico-chemical parameters the separation of the groups I and II could be proved. The efficiency was 93.6% in the discrimination with 10 characteristics. With the help of the calculated non-elementary, linear characteristics of discriminance the patients could be classified into the group III. 7 patients could be classified into the group II and 3 patients into the group I. Thus we succeeded in differing 23 patients with obliterating endangiitis from 18 patients who as arteriosclerotics belong to the metabolic syndrome.

[Vascular functional disorders in insulin-dependent diabetes]. / Vaskuläre Funktionsstörungen beim insulinabhängigen Diabetes.

In 60 patients with manifest diabetes mellitus of juvenile onset type in whom no peripheral macroangiopathy was present for objectifying disturbances of the vascular function angiological measurements in rest and after pedal-ergometric load were performed in the region of the lower extremity. In comparison to test persons with healthy metabolism diabetes showed significantly shorter pulse were times due to decreased elasticity of arteries. The behaviour of the rheographic and doppler-sonographic parameters corresponded to a larger and longer lasting dilatation of the muscular arterioles after load. Correlations between these functional changes and the severity of a microangiopathy (retinopathy) or their ascertained influence factors could not be proved in the examined number of patients. Disturbances of the haemodynamic vasomotor function are in diabetes above all to be evaluated as signs of the autonomous neuropathy. Moreover, the regulation of the blood supply changed under muscle work is connected with an increased catecholamine-conditioned stimulation of adrenergic beta 2-receptors of the vascular wall and further local metabolic as well as haemorheologic deviations.

[Factors having an effect on Doppler-sonographic blood pressure determinations and their clinical significance]. / Einflussfaktoren doppler-sonographischer Blutdruckmessungen und deren klinische Bedeutung.

In indirect measurements of the blood pressure with the help of the ultrasound-Doppler-method important influence factors and sources of errors are to be taken into consideration. In order to estimate the importance of restricted vascular compressibility, changed tissue conditions and different position of the body, pressure measurements in patients with arterial obstructive disease and in test persons with healthy vessels were performed. The mediasclerosis leads to an extensive rigidity of the arterial wall so that falsely high measuring values could be established which were lying significantly above the intravasal pressure. For examination in the femoral region of a cuff of the standard breadth in relation to the volume of the extremity is too narrow to guarantee a lossless transmission of the pressure on the artery. After passive change of the position also in the poststenotic region significant changes of the pressure can be proved. As is shown by the results the desired diagnostic evidence with the help of the Doppler pressure is to be got only in such a case, when relevant influence factors are considered and the measurement is performed under standardized conditions.

[Thrombosis of the vena cava inferior. Etiological and clinical contribution]. / Vena-cava-inferior-Thrombose. -- Ein ätiologischer und klinischer Beitrag.

On the basis of two observations of courses is demonstrated that not in the least only hypercoagulability and retardation of the movement of the blood but also contusions of the femoral and hip region by fall and thrown which first of all appear as harmless may become the starting-point for alterations of the venous wall with extended thromboses of the veins of leg and pelvis under inclusion of the infrarenal section of the lower vena cava with a distinct picture of the postthrombotic condition of the lower extremities and a threatening embolism of the lungs. The author deal with expert's problems of the restriction of the function conditioned by accident. For the collateral venous circulation in the thrombosis of the vena cava inferior several accessory ways are at disposal of which the superficial collateral veins of the abdominal wall have diagnostically a high valency, haemodynamically they are, however, only of little importance. In partial thrombosis in the region of the lower vena cava clinically evident collateral circulations may stay away due to good possibilities of compensation as it is proved at a postoperative complication of thrombosis by oligosymptomatology.

[Evaluation of disordered peripheral hemodynamics after ergometric load]. / Die Beurteilung der gestörn peripheren Hämodynamik nach ergometrischer Belastung.

In 23 patients with arterial obstructive disease of type of femoropopliteal localization (stage I and II after Fontaine) comparative oscillographic and doppler-sonographic examinations were performed in rest and after standardized dynamic muscle work. Depending upon the haemodynamic importance of the present obstructions of the arterial system after load a significant increase of the systolic pressure gradient could be proved with decrease of the oscillometric indices. The determination of haemodynamic parameters after ergometric load serves to the objective judgment of the function in vascularly conditioned claudication and it is, moreover, important for the recognition of early changes (asymptomatic stage I). Load tests are indicated always in such cases when the findings under conditions of rest do not allow an unequivocal judgment or discrepancies between subjective functional capacity and ischaemically conditioned restriction of the function are to be supposed.

[Extracardiac hemodynamic effects of the calcium antagonist nifedipine]. / Extrakardiale hämodynamische Wirkungen des Kalziumantagonisten Nifedipin.

For the purpose of testing extracardial haemodynamic effects of the calcium antagonist nifedipine (corinfar) in 15 patients with arterial obstructive disease and in a control group plethysmographic and doppler-sonographic measurements before and after oral application of the substance were performed. In these cases after the application of nifedipine a significant increase of the blood flow in the crural region developed. At the same time a slight decrease of the systolic pressure could be established at the upper and lower extremity. In patients with arterial obstructive disease these haemodynamic reactions had a less significant result. They correspond to an arterial vasodilatation with decrease of the peripheral resistance and simultaneously they explain a part of the antianginous effect of the calcium antagonist. The increase of the blood flow which is to be objectified after the application of nifedipine also in poststenotic areas might be of clinical importance particularly in the combined occurrence of atherosclerotically conditioned disturbances of the blood supply of the coronary and peripheral vascular system.

[Evaluation of function in the clinically early stages of arterial occlusive disease]. / Funktionsbeurteilung in klinischen Frühstadien der arteriellen Verschlusskrankheit.

In order to prove inhibitions of the arterial system in the region of the lower extremities and for the judgement of their haemodynamic efficacy Doppler-sonographic measurements of the systolic pressure in patients in the asymptomatic stage I after Fontaine were performed. With regard to the early recognition and judgment of the function the behaviour of the peripheral blood pressure concerning the standardized work of the muscles of the arterial ischaemia, measured at size and duration of the induced decrease of pressure, proved to be particularly evident. Diagnostic informations going beyond the examination under conditions of rest could be brought so that the functional test is particularly suitable for the recognition of early clinical stages the arterial obturation disease in the region of the extremities.

[Poststenotic systolic pressure and blood flow measurements during intra-arterial and vasoactive therapy]. / Poststenotische systolische Druck- und Blutflussmessungen unter intraarterieller und vasoaktiver Therapie.

In 34 male patients with peripheral arterial occlusive disease of the lower extremities the individual responsibility to an intraarterial adenosine triphosphate infusion was tested with the help of Doppler-sonographic poststenotic measurements of the systolic blood pressure as well as comparatively to this by determination of the arterial blood-flow in rest in the region of the calf. While the greater part of the patients with occlusive disease reacted with a significant increase of the blood supply, nearly with the same frequency a decrease of pressure or no change could be established concerning the behaviour of the peripheral pressure. For the judgment of the efficacy of an intraarterial infusion treatment in the acute experiment plethysmographic measurements of the blood-flow are, therefore, more suitable and should be preferred to Doppler-sonographic pressure parameters. As to the controls of long-term therapy under conservative treatment as well as for the judgment of the success in the reconstructive surgery of vessels, however, the post-stenotic measurements of the pressure stood the test apart from further methods in clinical practice.

[Observations on polymyalgia rheumatica]. / Beobachtungen bei der Polymyalgia rheumatica.

The polyalgia rheumatica, which appears in one part of the patients together with a giant cell arteritis of the region of shoulder girdle and pelvic girdle. Also intensive temporal artery, is manifest with severe pains of their headache may be dominant in the disease. Observations on 14 own patients who belong to this picture of the disease confirm the initially existing and under glucocorticoids rapidly reversible severe general humoral reactions. Up to now the incompletely tested immunological phenomena are not specific for the polyalgia rheumatica and must be supplemented by further examinations.

[Disorders of the arterial blood supply in the upper extremities]. / Arterielle Durchblutungsstörungen der oberen Extremitäten.

Arteriopathies of the upper half of the body may lead to considerable functional disturbances of the arm and severe deficits on the part of the central nervous system. Due to good comparison they scarcely cause or do not cause any complaints in a no unconsiderable part. The clinical material consisting of 4,162 patients from five annual courses had in 9.2% occlusion and stenoses localized in the supraaortic and brachial region. The in most cases systemic angiopathy here explains the frequently combined appearance with arterial processes in the pelvic and the leg region. According to the height of the occlusion we clinically differ types of carotis, shoulder girdle, upper arm and peripheral-acral obliteration, which in each case show differences concerning frequency, age of manifestation, etiology, distribution of sex and clinical degree of severity. The angiological basic diagnostics is based on the inspection, palpation of the arteries, auscultation of the vessels, bilateral measuring of the blood pressure after Riva-Rocci and functional examinations, such as fist closure test and Allen test, as well as clinical proofs or exclusions of neurovascular syndromes of the shoulder girdle. The special apparative angiological methods comprise the oscillo-, rheo- and vein occlusion plethysmography, the Doppler ultrasound technique, estimations of the ophthalmic pressure, isotopic methods and angiographic exploration. --The individual angiological examination methods are of different importance according to the height localisation of the angioorganopathy. --The incomplete syndrome of the aortic arch is taken into consideration. In short the author adopts a definite attitude to the demands of therapy.

[Functional peripheral ischemia]. / Funktionelle periphere Durchblutungsstörungen.

The terminal circulation which plays an important role in the thermoregulation particularly at the periphery of the extremities is not infrequently irritated by false multifactorial regulations. As their sequela an increased tonus of vasoconstrictors and pathological vasodilatation lead to idiopathic and symptomatic functional angiolopathies. Transitions into organic vascular processes are no rarity. From the extreme functional behaviour patterns complaints and symptoms of the individual angiolopathies may be derived. Clinic, differential diagnostics and therapeutic possibilities of the angiopathic reaction position, of the acrocyanosis and its variants, of the intermittent functional acrosyndromes and of the erythromelalgia are treated from practical points of view. In contrast to the secondary functional angiolopathies, in which the basic disease is of decisive importance in questions concerning expertise, the idiopathic forms alone are scarcely of high significance concerning the restriction of the physical function.