Edema control in the management of disabling chronic venous insufficiency.

This study was undertaken to assess the biomedical and socioeconomic rationale of edema control in disabling chronic venous insufficiency (CVI). In this 15-year retrospective survey (1974 through 1988) edema control was achieved by use of Unna's boot for leg ulcerations and by compressive hosiery for prevention of ulcerations. The study included 2,317 self- or physician-referred patients with disabling CVI, of whom 998 presented with venous stasis ulcers, many with recurrent ulcerations. Two hundred thirty-six patients were seen and treated only once and never returned. They were listed as not healed. Including patients who never returned after the first visit, the overall healing rate was 60.9%. Excluding the nonreturning patients, the overall rate of verified healing was 73.3%. The healing rate was 91% for first ulcers of complaint patients (patients treated at least 12 times in 32 weeks). The Unna's boot, being a functional substitute for the failing muscle pump in CVI, is a noninvasive and ambulatory method of controlling edema and treating ulcers in CVI. It does not interfere with patients' activities, it is inexpensive, and it is adaptable to middle aged and elderly ambulatory populations.

A clinical computer database entry form for an intraoperative anesthesiology-based transesophageal echocardiography monitoring service.

Transesophageal echocardiography (TEE) has been increasingly applied to supplement and, in instances, to supplant conventional intraoperative cardiac monitoring. Our body of experience (> 1600 intraoperative TEE procedures), combined with insights gleaned from an intramural quality assurance study, and clinical implications of certain recent advances in the field, led us to develop the following TEE computer database entry form. The form, completed intraoperatively, consists of a patient and surgical procedure demographics section, followed by fields based on the TEE examination. The scans encompass transverse plane basal short axis, long axis, and transgastric views of the heart and great vessels. The two-dimensional echocardiographic, saline-contrast, color flow and pulsed Doppler data represent both right and left ventricular performance, valvular function and specific lesions. This database entry form is intended to serve as a guide for performance of a nominally complete intraoperative study and facilitate maintenance of a TEE archive consistent with current advances.

An integrated software system for quality assurance-related kappa coefficient analysis of intraoperative transesophageal echocardiography interpretive skills.

This report describes the development of a quality assurance-oriented integrated software system designed for an anesthesiology-based intraoperative transesophageal echocardiography service. Entry data include patient and operation demographics, two-dimensional echocardiographic, saline-contrast, and color flow/pulsed Doppler assessments of the heart and great vessels, presented in a defined sequence. A statistical analysis component (kappa coefficient analysis) allows for comparison of intraoperative real-time interpretations with laboratory interpretations made by experienced full-time echocardiographers on a field-by-field basis. This provides a means of quantifying expertise in each individual aspect of the patient examination sequence. We believe that such self-appraisal data are essential for delineating the status and tracking the progress of service being provided.

Intraoperative two-dimensional echocardiography and color flow Doppler imaging: a basic transesophageal single plane patient examination sequence.

Recent advances in technology have allowed application of transesophageal echocardiography to intraoperative care of critically ill patients. Early clinical application primarily involved evaluation of left ventricular regional wall motion. However, valid intraoperative use of transesophageal echocardiography should also encompass systematic assessment of the entire heart as well as the great vessels. This report describes a 10-step sequence of single plane, two-dimensional echocardiographic views which constitute a basic patient examination capable of being performed by a practitioner whose primary responsibility is the delivery of anesthesia care. A 5-step color flow Doppler examination sequence is also presented. These views complement the two-dimensional echocardiographic steps. Representations of methods for grading Doppler-defined valvular regurgitation complete the report.

Patent foramen ovale and paradoxical embolization: a historical perspective.

The use of transesophageal echocardiography for intraoperative management of critically ill patients allows for routine evaluation of foramen ovale patency. The high prevalence of preoperatively unrecognized flow-patency of this structure has led investigators to emphasize the potential for paradoxical embolization in any patient undergoing anesthesia. This perspective led us to research earliest documentation of paradoxical embolization through a patent foramen ovale as a historical issue with present day relevance. This report examines the 1877 text of Julius Cohnheim in which he described a fatal case of paradoxical embolization to the middle meningeal artery. The 1880 manuscript of Moritz Litten documenting paradoxical embolization to the lower extremity is also presented. Both translations, to our knowledge, represent the first such representations of both the original 1877 edition of Cohnheim's work and Litten's journal article.

[On the question of a diurnal rhythm of the arterial oxygen tension (pO2a) (author's transl)]. / Zur Frage einer Tagesrhythmik des arteriellen Ruhe-pO2a.

In connection to our clinical examination of the so-called "Oxygen-Multistep-Therapy" (02-MT) was to clear, if the pO2a could be affected with a diurnal rhythm over the daytime between 7 a.m. and 5 p.m. The results, which were found at 66 healthy persons of different age and sex show an independence of the pO2 measured values from the daytime. Further, the action of Finalgon upon the earlap, and the variation of pO2a in dependence on age and sex were established, and a correlation between the arterial blood pressure and pO2a is discussed.

[Preliminary results of a pilot study on the optimisation and clinical examination of the "oxygen-multistep-therapy (O2Mt)" (author's transl)]. / Zwischenresultate einer Pilotstudie zur Optimierung und klinischen Prüfung der "Sauerstoff-Mehrschritt-Therapie (O2MT)".

It is reported about the preliminary results of a first clinical examination of O2MT in 46 patients. The "regeneration effect of O2MT" (v. Ardenne) is represented as an increase of resting values of arterial oxygen tension (PO2a), which demonstrable in about 2/3 of the patients. This effect continues more than 3 months after the end of O2MT. It is succeeded by "prophylactic and therapeutic effects, which were discussed as an improvement of cardiorespiratory and cardiovascular efficiency. The O2MT is suggested as a new treatment-method in premorbidities, who evolved out a "latent hypoxemia", especially for the use of preventive-treatment and gerontology-therapy.