Effect of a public awareness campaign on the incidence of symptomatic objectively confirmed deep vein thrombosis: a controlled study.

BACKGROUND: Although there have been attempts to raise public awareness about deep vein thrombosis (DVT), their influence on identifying confirmed cases is unknown. OBJECTIVE: To determine the effect and its duration of a public awareness campaign about venous thromboembolism. PATIENTS/METHODS: A campaign to raise public awareness of DVT was conducted during one year in an urban population of approximately 100,000 (pop A). A comparison urban population of approximately 1,574,000 (pop B) was not exposed to this campaign. Patients symptomatic for DVT in both populations were referred by general practitioners for a standardized compression ultrasound (CUS) of the whole leg at no charge. Positive CUS examinations documented by photographs were analyzed by an independent adjudication committee blinded to the population. Pop A was followed for 8 months after the information campaign ended. RESULTS AND CONCLUSIONS: Symptomatic objectively confirmed DVT was found in 48 of 800 subjects tested in pop A and 226 of 2384 tested in pop B. The 1-year incidence of confirmed DVT (proximal and distal) was 46/100,000 (95% CI, 33-59) in A and 14/100,000 (95% CI, 12-16) in B (P < 0.001). The increase in pop A was due to distal DVT (36/100,000 vs. 5/100,000 in pop B, P < 0.001). The DVT rate for pop A in an 8-month follow-up period was 12/100,000, significantly lower than in the first 8 months of the study period (34/100,000/8 months) (P = 0.001). The public awareness campaign significantly increased the diagnosis of distal DVT. When the campaign ended, DVT rates returned to community baseline.

Skin own bacteria may aggravate inflammatory and occlusive changes in atherosclerotic arteries of lower limbs.

AIM: Seroepidemiological studies have given rise to the hypothesis that microorganisms like Chlamydia pneumoniae (CP), Helicobacter pylori (HP), cytomegalovirus (CMV), HCV types 1 and 2, and bacteria involved in dental or other unspecified infection sites may initiate or maintain the atherosclerotic process in lower limb arteries. However, not much attention has been attached to the patient's own limb skin and deep tissues bacterial flora, activated in ischemic tissues. This flora may enhance the inflammatory and thrombotic process in the atherosclerotic arteries. Lower limb tissues are exposed to microorganisms from the environment (foot) and microbes on floating epidermal cells from the perineal and anal regions. The aim of this paper was to identify microbial cells and their DNA in perivascular tissues and arterial walls of lower limbs. METHODS: Bacterial cultures and PCR method for detection of 16sRNA and immunohistopathological staining for identification of immune cells infiltrating vascular bundles. RESULTS: 1) specimens of atherosclerotic calf and femoral arteries contained bacterial isolates and/or their DNA, whereas, in control normal cadaveric organ donors' limb arteries or patients' carotid arteries and aorta bacteria they were detected only sporadically; 2) lower limb lymphatics contained bacterial cells in 76% of specimens, whereas controls only in 10%; 3) isolates from limb arteries and lymphatics belonged in majority to the coagulase-negative staphylococci and S.aureus, however, other highly pathogenic strains were also detected; 4) immunohistopathological evaluation arterial walls showed dense focal infiltrates of granulocytes and macrophages. CONCLUSION: Own bacterial isolates can be responsible for dense neutrophil and macrophage inflitrates of atherosclerotic walls and periarterial tissue in lower limbs and aggravate the ischemic changes.

Significance of cytomegalovirus infection in the failure of native arteriovenous fistula.

High cytomegalovirus (CMV) IgG levels have been identified as a risk factor for arteriovenous fistula (AVF) failure. None of the 68 patents in our study were CMV IgM positive, although 96% were CMV IgG positive. CMV antigens were detected in the radial artery or cephalic vein of 46% of patients who received an AVF. The presence of CMV antigens or high serum CMV IgG levels had no prognostic value for AVF failure.

[Studies of internal carotid artery anomalies]. / Badania nad wadami tetnic szyjnych wewnetrznych.

The results of experimental and clinical studies on internal carotid artery anomalies are presented. In the experimental studies it was found that only kinking caused considerable flow disturbances in the segment above the lesion. Loops and elongation of the artery caused no such disturbances. The clinical studies have shown that internal carotid artery anomalies are found in 32.7% of the patients in whom carotid and aortic arch arteriography was performed for various reasons. In 52 patients operated on for internal carotid artery anomalies, the final diagnosis was made on the basis of arteriography. Doppler and USG examinations proved to be of little usefulness in the diagnosis of internal carotid artery anomalies. Early good result of the operation was found in 43 patients (82.6%). Two patients died (3.8%). Thirty-five patients (67.3%) came for control examination. Good remote result of the operation was found in 29 patients (82.9%).

[Prophylactic use of ampicillin and sulbactam in colonic surgery]. / Zapobiegawcze zastosowanie ampicyliny i sulbaktamu w chirurgii jelita grubego.

UNLABELLED: The purpose of the work was an evaluation of the effectiveness of ampicillin and sulbactam administered parenterally in the prophylaxis of infections in patients after colonic surgery. The group of patients treated with ampicillin and sulbactam was compared with the control group in which penicillin, gentamicin and metronidazole were given prophylactically. Surgical wound infections were found in the group receiving ampicillin and sulbactam in 20% of cases, and in the control group in 13.3% of patients. This difference was not statistically significant (p > 0.05). In both groups infections of all perineal wounds were observed after abdominoperineal operations. No allergic reactions nor side effects were found in the group treated with ampicillin and sulbactam. CONCLUSION: Prophylactic administration of ampicillin and sulbactam in colonic surgery is similar in its effectiveness to prophylactic administration of penicillin, gentamicin and metronidazole.

[Delayed results after implantation of bifurcated prosthesis in aorto-iliac incompetence]. / Odlegle wyniki leczenia niedroznosci aortalno-biodrowej wszczepieniem rozwidlonej protezy.

Early results and those seen after a 5-year follow up are discussed. Three hundred fifty one patients with aortoiliac incompetence were treated with the implantation of bifurcated aortoiliac prosthesis. Very favourable early result was achieved in 284 (81%) patients. Very favourable delayed effect was noted in 133 patients, i.e. in 75% of patients who reported for the control examination. In the follow up period, amputation of the limb was performed in 30 (8.5%) patients because of progressing ischemia. Hundred thirty seven (39%) followed up patients died during 5 years. Causes of so high mortality rate are discussed in view of risk factors and postoperative complications.

[Comparison of early and delayed results of unilateral patency restoration and transplantation in aortoiliac obstruction]. / Porównanie wyników wczesnych i odleglych po jednostronnych zwezeniach i przeszczepach w niedroznosci aortalno-biodrowej.

Early and delayed results of the treatment of aortoiliac unilateral incompetence in 144 patients were compared. Eighty seven (60%) patients were treated with aortoiliac prosthesis whereas 57 (40%) with arterial patency restoration. Fifty seven patients of group I reported to the control examination. Favourable effect was found in 47 (82.5%) patients, i.e. in 54% of all operated patients. Thirty six patients of group II reported to the control examination. Favourable effect was noted in 27 (75%) patients, i.e. in 47.4% of all treated patients. Twenty two (25.3%) of patients of group I and 9 (15.8%) of group II died. It was noted also that in 20% of operated patients with unilateral aortoiliac incompetence the disorders in the opposite limb develop despite the type of surgery. Therefore, indications to the implantation of bifurcated prostheses should be extended in some cases.

[Indications for and results of treatment of carotid artery stenosis]. / Wskazania i wyniki leczenia miazdzycowych zwezen tetnic szyjnych.

The authors discuss own experience with the treatment of carotid artery stenosis. Diagnostic principles and indications to surgical treatment, technique of block anesthesia, an operation and obtained results are also discussed. Internal carotid artery stenosis was treated surgically in 90 patients within 1985-1988. Block anesthesia enabling intraoperational control of patients' consciousness was used in 72 cases. Satisfactory early results were noted in 92.9% of patients. Two patients died after surgery whereas 5 patients suffered from neurological complications. Favourable late results (follow-up period ranged from 6 to 48 months) were noted in 64 out of 70 patients which reported to clinical examination (91.4%).