[Transition in pediatric rheumatology-experiences from the pediatric rheumatism center Sankt Augustin]. / Transition in der Kinderrheumatologie ­ Erfahrungen aus dem Kinderrheumazentrum Sankt Augustin.

BACKGROUND: Transition is a joint effort of the young patients, their families and the attending pediatric and adult rheumatologists. The quality of the transitional process for patients with rheumatic diseases was retrospectively reviewed using a standardized questionnaire. Patients were transferred to rheumatologists for adult care through personal contact, if possible. METHODS: Inclusion criteria were: diagnosis of chronic inflammatory rheumatic joint disease or systemic rheumatic disease, duration of care for >2 years in the pediatric rheumatology center and ≥2 presentations at the age of 17-18 years. A telephone interview was performed using a standardized questionnaire on the type of care, medication, diagnosis, satisfaction with the care and the transition process. RESULTS: Of the 62 enrolled patients 50 (81%) had juvenile idiopathic arthritis (JIA). In total, 40 patients (65%) were seen by an adult rheumatologist on a regular basis. Reasons for discontinuation of medical care were mainly freedom of symptoms, lack of time and non-compliance. Before and after transition, 15 and 9 patients, respectively were treated with conventional disease-modifying antirheumatic drugs (DMARD) and 27 and 27, respectively with biologics. The subjective assessment of medical care in pediatric rheumatology was (mean ± SD) 9.3 ± 1.05, in adult rheumatology 7.6 ± 1.1 and the satisfaction with the transition process was 7.7 ± 2.1. Problem issues mentioned by some patients were lack of time with the rheumatologist and long waiting periods for appointments. DISCUSSION: Individual transfer of patients from pediatric to adult rheumatology care was associated with a high degree of satisfaction in this analysis. Change of diagnosis or an unexpected termination of rheumatology treatment was not detected.

Long-term follow-up after percutaneous transluminal angioplasty of the distal abdominal aorta.

Aortoiliac disease can be either treated with surgery-endarterectomy for localized aortic disease or with bypass graft placement for more extensive aortoiliac disease--or with percutaneous transluminal angioplasty (PTA), which has become an established method. Long term results of surgery are well documented in literature, but long term results of distal aortic PTA are scarce, furthermore angiographic follow-up is very uncommon. We report about a patient with isolated aorta abdominalis stenosis due to atherosclerotic disease who underwent PTA in 1982 and had an angiographic follow-up four and twenty years later, thus we demonstrate that patency can be obtained even after twenty years.

[Percutaneous transluminal angioplasty in the region of the renal artery--indications, technic and results]. / Perkutane transluminale Angioplastie (PTA) im Bereich der Arteria renalis--Indikation, Technik und Ergebnisse.

The paper reports the results obtained by percutaneous transluminal angioplasty (PTA) in the treatment of renal artery stenosis in 25 patients with secondary hypertension and discusses indications and the technique used. The follow-up period ranged from 0.5 to 12 months. All interventions were performed with the Olbert catheter system. Following PTA a significant decrease in systolic, diastolic and mean arterial pressure was observed in nearly all patients. The response of the plasma renin activity (PRA) to orthostatic stimulation and pharmacological stimulation by furosemide was determined in a subset of 15 patients before and after PTA. A significant decrease in both basal and stimulated PRA values was observed subsequent to PTA. The decrease in PRA values after successful PTA did not, however, correlate with the extent of the blood pressure changes.

[Percutaneous transluminal sclerotherapy of the spermatic vein in idiopathic varicocele]. / Die perkutane transluminale Sklerosierung der Vena spermatica bei idiopathischr Varikozele.

Percutaneous sclerotherapy of the spermatic vein has become a very efficacious and safe treatment and is also a real alternative to surgery.

[Transcatheter therapy in the icterus patient: extracorporeal drainage--endoprosthesis]. / Transkathetertherapie beim ikterischen Patienten: extrakorporale Drainage--Endoprothese.

Percutaneous transhepatic cholangiography, as well as the therapeutic possibility of extracorporeal biliary tract drainage and insertion of an endoprosthesis are discussed in this paper. The results are presented of 19 patients treated by extracorporeal drainage and of 12 patients treated by insertion of an endoprosthesis, with a successful outcome in each group. The clinical parameters, the reduction in bilirubin values after treatment and improvement in the patient's condition and general well-being are discussed.

[Percutaneous transluminal vasodilatation. Long-term results and report on experiences with a new system of catheters: transaxillary technic]. / Perkutane transluminale Gefässdilatation. Langzeitergebnisse und Erfahrungsbericht mit einem neuen Kathetersystem: transaxilläre Technik.

A report is given on the result of 567 transluminal vasodilatations, some of which have been followed up for more than five years. The results of conventional techniques were compared with a new catheter technique. The complication rate with the newly-adopted system is much lower than with conventional ones, while the reocclusion rate is only about 10%, which is about half of the figure obtained in the period up to July 1981 when the new technique was introduced.

Intra-arterial infusion therapy for pulmonary tumours.

On a total of 47 patients with pulmonary tumours (45 carcinomas and two pulmonary sarcomas) intra-arterial infusion therapy was performed via the bronchial artery (34 cases), the pulmonary artery (11 cases), the internal thoracic artery (1 case) and the intercostal artery (1 case). Cytostatic drugs were given to 43 patients (mainly in the form of single-drug therapy) and four patients received a preparation of proteolytic enzymes. In the majority of cases (34 of 47 patients) intra-arterial therapy was followed by intravenous cytostatic treatment. We can evaluate the effect of the intra-arterial therapy on the basis of the number and extent of tumour remissions, as well as of acute or subacute side effects. Effects over longer period and the survival times of patients can only be evaluated to a limited extent. We observed one complete tumour remission, five partial remissions (size of tumour reduced by more than 50%) and eight minor remissions (reduction by less than 50%); in 18 cases there was no measurable change in the tumour and in nine cases progression was observed (six cases cannot be evaluated.) Complete or partial remissions were observed only after treatment via the bronchial artery and after cytostatic therapy. These tumours were rather poorly vascularised and remissions occurred irrespective of cell type. There are certain indications that intra-arterial chemotherapy may be superior to equivalent intravenous chemotherapy, but the evidence so far available is not conclusive.

[Pelvic lipomatosis--its appearance on radiography and computed tomography (author's transl)]. / Die Beckenlipomatose im Röntgenbild und in der Computertomographie.

Case report on a case of pelvic lipomatosis, the 21. case published in the world literature. The typical radiographic findings, such as deformity of the urinary bladder and the abnormal course of the sigma, were seen. Computed tomography confirms the diagnosis.

[Therapy of acute bleeding from esophagus varices (author's transl)]. / Therapietaktik bei der akuten Osophagusvarizenblutung.

Acute bleeding from esophagus varices in portal hypertension is still a considerable therapeutic problem, and quite different approached to treatment are being followed. We use the following approach general procedures like treatment of shock, treatment of coagulation disorders etc.; emergency endoscopy; submucosal sclerosing if varices can be identified endoscopically as the source of bleeding. If bleeding cannot be stopped in this way a Sengstaken probe is applied for 4-6 hours, and after that sclerosing of the bleeding area is tried again. If bleeding does not stop at that time yet, the vena coronaria ventriculi or the venae gastricae breves are sclerosed by the transhepatic route. In almost all cases bleeding can be stopped successfully if this sequence of procedures is followed. After bleeding has been stopped, surgery establishing a portacaval shunt may be taken into account.