Immunological cross-reactivity between a glycoprotein isolated from Trichophyton mentagrophytes and human isoantigen A.

A glycoprotein isolated from the cell wall of Trichophyton mentagrophytes was assessed for its cross-reaction with human blood group isoantigens. Rabbit antiglycoprotein antibodies agglutinated human erythrocytes of blood groups A1 and A2, and precipitated Blood Group Substance A in agarose gels. Erythrocytes of blood group B were only slightly agglutinated, and O(Rho+) and O(Rho-) erythrocytes were not. Additionally, the glycoprotein was shown to specifically inhibit isoagglutination of erythrocytes of group A. Partial identity between the glycoprotein and a crude extract of the fungus was demonstrated by immunodiffusion. Analyses revealed the glycoprotein to be composed of approximately 17% protein and 80% carbohydrate. The glycoprotein was found by indirect immunofluorescence to be located in the mycelial cell wall. The possibility that cross-reacting antigens may lead to a chronic, spreading infection is discussed.

Semiquantitative assessment of lower limb atherosclerosis from routine angiographic images.

In the present report a score system is introduced with the aim of analysing routine angiographic images. The system consists of a vectorial score, which codes the pattern of occlusions, stenoses and plaques, and of an additive score describing the severity of the lesions visualised. The technique is suitable for computerised data analysis.

Results of low speed rotational angioplasty for chronic peripheral occlusions.

After experimental investigation using postmortem human arteries, 19 patients with chronic peripheral artery occlusions were treated with a new angioplasty technique between December 1986 and October 1987. In 17 patients the superficial femoral artery and in 2 patients the popliteal artery were completely occluded. The length of the occlusions ranged between 5 and 25 cm (mean 11). The duration--estimated according to patients' history--was 5 to 48 months (mean 17). In 5 patients, durations of up to 30 months had been documented by angiography. A flexible, blunt, motor-driven rotating catheter was introduced through an 8 or 9Fr sheath and rotational angioplasty was performed at low speeds (up to 200 rpm). In 11 of 14 patients in whom this new technique was used as the primary intervention, the occlusions could be successfully reopened. In 2 patients after failure of conventional techniques the rotating catheter could not bypass the preexisting dissections in the same intervention. In 2 of 3 further patients after failure of conventional techniques the occlusions could be successfully reopened in a second intervention after several weeks. In none of the 19 patients did a perforation occur. It is concluded that with the new technique chronic peripheral artery occlusions can be reopened with a high success rate and without the danger of arterial wall perforation. The method can also be used in patients in whom conventional techniques have failed.

[Percutaneous transluminal angioplasty of the deep femoral artery. Retrospective evaluation of early technical and clinical results in 196 cases of catheterization]. / Perkutane transluminale Angioplastie der Arteria profunda femoris. Retrospektive Auswertung der technischen und klinischen Frühergebnisse von 196 Katheterbehandlungen.

AIM: Stenosis of the deep femoral artery with simultaneous occlusion of the superficial femoral artery usually is considered to be a classical indication for vascular surgery. Angioplastic therapy of this vessel is rarely reported. Retrospective analysis of the technical and clinical results following catheter treatment of the deep femoral artery was performed to demonstrate the possibilities of this less invasive method. MATERIAL AND METHOD: 196 angioplasties in 174 patients were performed. 77 patients (39%) suffered from stage II disease according to Fontaine classification (grade I category 2/3 [Rutherford]), 36 (18%) from stage III (grade II category 4) and 75 (38%) from stage IV (grade III category 5). RESULTS: Catheter treatment was successfully performed in 77% (151/196) of the cases. Clinical improvement was seen following 61% (96/196) of the treatments. The complication rate was 3.4% (7/196: thrombosis of the CFA, ascending occlusion of the SFA, occlusion/spasm of the arteria circumflexa femoris lateralis, pulmonary embolism). CONCLUSION: Catheter treatment is a minimal invasive, cost-effective alternative to surgical reconstruction of the deep femoral artery.

[The indications for rotation angioplasty of the a. femoralis superficialis and the a. poplitea. The treatment results in 75 complicated chronic arterial vascular occlusions]. / Indikationen zur Rotationsangioplastie der A. femoralis superficialis und der A. poplitea. Behandlungsergebnisse bei 75 komplizierten chronisch-arteriellen Gefässverschlüssen.

75 patients with difficult occlusions in the superficial and popliteal arteries were treated by the "Rotacs" system. This technique is efficient in treating occlusions longer than 10 cm, with an initial success rate of 60.5%. In primary failed conventional angioplasties Rotacs-PTA was successfully employed in 56% as a second intervention. This is considered to be an advance in PTA technique. In stage II disease the PTA results are better than in diseases of the stages III and IV, which agrees with conventional catheter treatment. In the femoropopliteal overlapping segment the initial successful PTA of short, hard, mostly calcified occlusions was only 33%. The complication rate of Rotacs technique compares with that of the conventional methods.

[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.

[The angiographic demonstration of a primary sarcoma of the pulmonary artery]. / Angiographische Darstellung eines primären Sarkoms der Arteria pulmonalis

Following the findings of a primary sarcoma of the pulmonary artery and its angiographic demonstration, a search was made of the literature for this rare condition. Angiography is usually performed because a pulmonary embolism is suspected. It is best to inject contrast medium into the right atrium or ventricle. If an unusually large defect is demonstrated in the pulmonary artery, a primary malignant neoplasm should be considered in the differential diagnosis, particularly if the mass projects into the outflow tract of the right ventricle.

[Angiographic examinations of the stomach following Billroth II resections with special reference to the gastro-jejunostomy (author's transl)]. / Angiographische Untersuchungen am Billroth II resezierten Magen mit besonderer Berücksichtigung der Gastrojejunostomie.

The arterial blood supply of the anastomosis in 6 stomach resected dogs (Billroth II) is examined by common angiographic technique in vivo, microangiography, and microscopy. In all animals there are at the site of the gastrojejunostomy bizarre tortuous vessels which cross the anastomosis. These arteries have a diameter between 50 to 2000 mu. They are newly formed vessels which cannot be demonstrated by common coeliaco- and mesentericography in animal experiments or in patients.

Repeated percutaneous transluminal catheter-treatment. Primary results.

An advantage of angioplasty lies in the repeatability of this method in the same vascular section, if reobliteration or restenosis occur. In 154 patients second PTA was performed in 159 extremities, in 26 third and in 4 fourth PTA. The best results of repeated PTA were observed in stenoses, as well in the iliac region as in the femoro-popliteal section. Because a reocclusion has unfavorable chances for a renewed PTA it is advisable to watch the patients. As soon as the patient suffers of more claudication, a new angiography is to be performed. The results of repeated PTA in state IV are worse than in state II, third PTA had only pour chances. Therefore a repeated PTA more than twice especially in obliterations is hardly justifiable.

Seldom indications for angioplasty.

Rare applications and localisations of angioplasty are presented. The technique, the primary results and the complications of angioplasty of the visceral arteries, the branches of the aortic arch, the aorta and the venous bypass graft are discussed. The angioplasty is also a good therapeutic principle in the treatment of obstructive arterial vascular disease in these arterial areas.

Catheter-lysis: indications and primary results.

Catheter-lysis--local low-dose fibrinolytic therapy--extends the indication to catheter-treatment. Occlusions longer than 10 cm younger than 3 months may be treated by this method. This treatment is primarily indicated for Fontaine stage III/IV occlusions. The complication of acute embolism or acute reocclusion during routine angioplasty can be treated satisfactorily by catheter-lysis. The primary result of low-dose fibrinolysis depends on the clinical stage, peripheral outflow, age and length of the occlusion.

[Changes in systemic fibrinolysis and blood coagulation parameters in local thrombolysis with tissue plasminogen activator (rt-PA)]. / Anderungen systemischer Fibrinolyse- und Gerinnungsparameter während der lokalen Lyse mit Tissue Plasminogen Activator (rt-PA).

During the local fibrinolysis with rt-PA (2.5 mg/h) systemic plasminogen and alpha 2-antiplasmin activities slightly decrease, but the fibrinolytic system is compensated during the whole treatment. The d-dimer plasma levels increase dependently on the mass of thrombus. Despite the administration of high doses of heparin during the fibrinolysis thrombin is formed, measured as thrombin-antithrombin III complex (TAT).

[Possibilities and limits of interventional therapy in chronic peripheral arterial occlusive disease]. / Möglichkeiten und Grenzen der Interventionellen Therapie bei der chronischen peripheren arteriellen Verschlusskrankheit.

In the therapy of the chronic peripheral vascular occlusion, angioplasty is rarely used to treat the infra-renal aortic stenosis, whereas the stenosis and the short occlusion of the iliac artery is a classical indication. Primarily, stenoses and occlusions of the iliac artery should be treated with balloon angioplasty exclusively. Only secondarily, when the result of angioplasty was insufficient, e.g. remaining stenosis or dissection, stent implantation is appropriate. Angioplasty is most frequently applied in the obliteration of the femoro-popliteal artery. It can be stated that early- and long-term results are the better, the shorter the occlusion is. Stent implantation in the femoro-popliteal artery should be avoided because of poor results. Only with the intention of limb salvage, when there is no opportunity for surgical treatment, a stent implantation should be considered. In case of recurrent stenoses after stent implantation, angioplasty can be reapplied with great success. The indication for any vascular intervention should be a decision of both, the interventional radiologist and the vascular surgeon, because both kinds of treatment are palliative and not causal. It is the task of the angiologist to do clinical diagnostics and the after-treatment. Quality monitoring is indispensable. It consists of documentation of pre-angioplasty diagnostics and should be able to prove the correct indication for the intervention. The result of the intervention should also be documented by angiography and functional tests. Regular control of the patient after the intervention is necessary for the early recognition of recurrent stenoses.

[Duplex sonographic determination of blood pressure gradient in iliac artery stenoses. Comparison with invasive measurement]. / Duplexsonographische Bestimmung des Druckabfalls über Iliakaarterienstenosen. Vergleich mit der invasiven Messung.

The present study investigates the validity and accuracy of the simplified Bernoulli equation in the duplex-derived determination of pressure gradients across iliac artery stenoses. 28 patients presenting with iliac artery stenoses were examined by both duplex scanning and intraarterial catheter pressure measurement. The catheter-determined and duplex-derived mean pressure gradient was 16 +/- 7 and 14 +/- 7 mmHg, respectively. There was a fairly good correlation between the mean pressure gradients assessed nonsimultaneously by both methods (r = 0.77). The catheter-determined and duplex-derived maximum instantaneous pressure gradient was 53 +/- 16 and 52 +/- 21 mmHg, respectively. The correlation coefficient (r) for the maximum instantaneous pressure drop values determined by the two methods was r = 0.79. The results show that duplex ultrasound predicts mean and maximal-instantaneous pressure gradients with acceptable approximation in patients with iliac artery stenoses.

[Reopening chronic arterial occlusions]. / Wiedereröffnung chronischer Arterienverschlüsse.

Chronic complete occlusions still represent the major technical limitation of percutaneous transluminal balloon angioplasty, both in peripheral and coronary vessels. The clinical use of low speed rotational angioplasty (ROTACS) started in 1986 for the peripheral and in 1987 for the coronary vessels, and has already become part of the clinical routine in several centers. Up to now, more than 300 patients with peripheral and more than 200 patients with coronary occlusions were treated in Frankfurt. In peripheral occlusions the acute success rate was more than 80% if used as the first attempt; after failure of conventional techniques still more than 60% of the vessels could be recanalized successfully. In addition to occlusions of the arteries of the lower limbs, the indication now includes the iliac artery and several other indications are under investigation. In each of the patients with chronic coronary occlusions an attempt with conventional techniques had failed before. Following a learning curve, which was also influenced by a better understanding of morphological preconditions, the acute success rate has now reached 70%. Both in patients with peripheral and those with coronary occlusions no deaths occurred. First angiographically documented long-term results in both indications are comparable to conventional balloon angioplasty. It is concluded that the use of low speed rotational angioplasty (ROTACS) can improve the results of nonoperative invasive treatment, both in peripheral and in coronary arteries.