[Classification and nomenclature of current materials for compression therapy]. / Einteilung und Nomenklatur der aktuellen Materialien zur Kompressionstherapie.

Compression therapy has been an essential part of conservative therapy for people with chronic wounds and edema of the lower extremities for hundreds of years. The initiated therapy can be divided into the decongestion phase, maintenance phase, and prevention. The choice of the respective compression materials is based, among other factors, on these phases, the clinical stage and symptoms, the needs of the affected person and their physical abilities. Today, a wide range of different materials and methods are available for compression therapy. Thus, it is increasingly difficult to keep an overview of these treatment options, especially since the nomenclature used by the manufacturers is often inconsistent. Thus, the materials and methods for compression therapy currently available in German-speaking countries and their clinical indications are described in this review article. In addition, a uniform nomenclature is proposed, on the basis of which an appropriate exchange between all those involved in the care of people with compression therapy is guaranteed.

Biofilm increases permeate quality by organic carbon degradation in low pressure ultrafiltration.

We investigated the influence of biofouling of ultrafiltration membranes on the removal of organic model foulants and ultimately on the quality of permeate. Gravity Driven Membrane ultrafiltration (GDM) membrane systems were operated with modified river water during five weeks without control of the biofilm formation. Three GDM systems were studied: two systems with biofilms exposed to (A) variable or (B) constant load of organic foulants, and (C) one system operated without biofilm and exposed to constant foulant loading. Biodegradable dextran or non-biodegradable polystyrene sulfonate model foulants were tested. Substrate biodegradability was confirmed by Size Exclusion Chromatography (SEC) and by degradation batch tests (D). The GDM systems (A) and (B) were fed with pre-filtered river water supplemented with dextran (Dex) of 1, 150 or 2000 kDa, or polystyrene sulfonate (PSS) of 1 or 80 kDa at concentrations of 2-3.5 mgC L(-1). In exp. (C) the feed water consisted of deionized water with 25 mgC L(-1) of either PSS 1, 80 kDa or Dex 2000 kDa. The biofilm formation on UF membrane surfaces controlled the foulant permeation and thus the permeate quality. Biofilms exposed to continuous foulant loading (exp. B) degraded low molecular weight (LMW) biodegradable foulants (1 kDa Dex), which improved the permeate quality. For high molecular weight (HMW) substrates (150, 2000 kDa Dex), the improvement of the permeate quality was observed after 7 days of biofilm formation, and resulted from the foulant hydrolysis followed by degradation. For non-biodegradable foulants, an improvement of 20% of the retention was observed for the polystyrene (1, 80 kDa PSS) due to the presence of biofilms on membrane surfaces. For variable foulant loading (exp. A) the biofilms hydrolysed the large biodegradable foulants but did not degraded them fully, which resulted a deterioration of the permeate quality (except for the LMW dextran (1 kDa) that was fully degraded). Overall, the "biofilm + membrane" composite retained a larger amount of biodegradable foulant than the membrane alone, due to the activity of the biofilm. However, this resulted in an increased biofilm accumulation and reduced flux. In presence of the biofilm, the highest fluxes were observed for control (no foulant) and for small non-biodegradable foulants (PSS 1 kDa). Low fluxes were observed for the accumulating on membrane surface or degradable foulants (exp. B). But, the lowest fluxes were observed in absence of the biofilm (exp. C) due to physical accumulation of the foulants (PSS 80 kDa and Dextran 2000 kDa). Overall our study demonstrates that the presence of biofilms on membrane surfaces has some benefits: (i) biofilm helps to increase the permeate quality and (ii) biofilms protect the membrane from further fouling. Permeate flux stabilizes in the case of biofilm-membrane composite, while it continuously declines in the case of the membrane only.

A therapeutic option in nutcracker syndrome and ovarian vein insufficiency.

OBJECTIVES: The nutcracker syndrome (NS) may lead to insufficient perirenal collaterals as well as incompetence of the left ovarian vein with consecutive ovarian vein insufficiency. METHODS: A female patient with NS and severe genital varicosis was treated with dilation of the renal vein and coiling of a left perirenal collateral vein feeding an insufficient left ovarian vein (LOV) with pelvic vein varicosity. RESULTS: In re-evaluation 18 month later with left renal vein (LRV) and LOV phlebography, a widely patent LRV was found. The embolized LRV to LOV collateral was occluded. However, left hypogastric phlebography showed incompetent branches of the left hypogastric vein feeding the genital varicose veins. These were successfully embolized with coils and the genital varicosity decreased on follow-up. CONCLUSIONS: In our patient a combined therapeutic approach with balloon dilation of the NS and embolization of the genital varicose veins by left hypogastric vein coil was performed.

Comparison of PHMB-containing dressing and silver dressings in patients with critically colonised or locally infected wounds.

OBJECTIVE: This study compares treatment with a polihexanide-containing biocellulose wound dressing (BWD+PHMB) versus the best local standard of silver dressings (Ag) in painful, critically colonised (wounds-at-risk) or locally-infected wounds. METHOD: Patients with wounds of various aetiologies, a baseline VAS pain score >4 and a semi-quantitative bacterial load of ++ or higher were randomly allocated to receive treatment with either BWD+PHMB or Ag. Patients with systemic infections and/or using systemic antibiotics were excluded. The primary endpoint, patient-reported pain (VAS total pain, including the sub-scores pain at night, during the day, before, and 15min after dressing changes), was compared between treatment groups and scored on days 0, 1, 3, 7, 14, 21 and 28. Secondary outcomes of bacterial load, wound bed and periwound skin condition, quality of life and dressing handling were assessed at the same visits. RESULTS: Thirty-eight patients (BWD+PHMB, n=21 [24 wounds]; Ag, n=17 [18 wounds]) were included in the analyses. Baseline variables showed no significant differences. Wound pain was reduced significantly in both groups, with a better pain reduction noted for BWD+ PHMB (p<0.001) before dressing changes. Compared with Ag, in the BWD+PHMB group critical colonisation and local wound infection had been reduced significantly faster and better (p<0.001) over the 28-day study period. Improved quality of life, good tolerability and no adverse events were demonstrated for both groups. CONCLUSION: Both BWD+PHMB and AG were effective in reducing pain and bacterial burden. However, that BWD+PHMB was significantly faster and better in removing the critical bacterial load, makes this dressing an attractive therapeutic option to treat critically colonised and locally-infected wounds.

Tumescent anaesthesia in combination with femoral nerve block for surgery of varicose veins: prilocaine 0.1% versus 0.2%.

OBJECTIVE: Results of a prospective, randomized, double-blinded study about tumescent anaesthesia (TA) in combination with femoral nerve block (FNB) for surgery of varicose veins are reported. The aim is to compare two different concentrations of prilocaine in TA. METHOD: With approval of the ethical committee and informed consent, FNB (nerve stimulation, 20 mL prilocaine 0.75%) was performed followed by TA using prilocaine 0.1% versus 0.2% (groups P0.1 and P0.2). Further medication was standardized. Overall amount of prilocaine was recorded, plasma levels of 20 patients measured regularly. Side-effects, patient satisfaction and pain scores were compared (P < 0.05). RESULTS: Ninety patients were included. In one patient (P0.1), general anaesthesia was necessary. There was no difference in pain scores, need for rescue medication or patient satisfaction. More prilocaine was administered in P0.2 (P < 0.0001) with higher but far below toxic plasma levels. In three patients (P0.2) mild met-haemoglobinaemia was confirmed. CONCLUSION: TA with prilocaine 0.1% in combination with FNB is sufficient to provide high patient satisfaction during varicosis surgery.

[Recommendations for the use of polyhexanide-containing products for the treatment of wounds]. / Konsensus-Empfehlungen zum Einsatz polyhexanidhaltiger Produkte in der Behandlung von Wunden.

Polihexanide-containing wound products are often used for the treatment of acute and chronic wounds. Although information pertaining to the use of polihexanide can be found in the literature, the appropriate use of these products in clinical practice is not always clear. The goal of this short review is to provide clinically relevant recommendations to physicians and nurses treating patients with acute and chronic wounds. This review describes the clinically relevant characteristics of polihexanide and gives recommendations for the prophylaxis and treatment of wound infections.

Classification of wounds at risk and their antimicrobial treatment with polihexanide: a practice-oriented expert recommendation.

Currently, there are no generally accepted definitions for wounds at risk of infection. In clinical practice, too many chronic wounds are regarded as being at risk of infection, and therefore many topical antimicrobials - in terms of frequency and duration of use - are applied to wounds. Based on expert discussion and current knowledge, a clinical assessment score was developed. The objective of this wounds at risk (W.A.R.) score is to allow decision-making on the indication for the use of antiseptics on the basis of polihexanide. The proposed clinical classification of W.A.R. shall facilitate the decision for wound antisepsis and allow an appropriate general treatment regimen with the focus on the prevention of wound infection. The W.A.R. score is based on a clinically oriented risk assessment using concrete patient circumstances. The indication for the use of antiseptics results from the addition of differently weighted risk causes, for which points are assigned. Antimicrobial treatment is justified in the case of 3 or more points.

Unilateral leg swelling: deep vein thrombosis?

OBJECTIVE: We present two cases of a unilateral leg swelling of unusual aetiology as a reminder to the physician to consider causes of unilateral leg swelling other than deep vein thrombosis, lymphoedema and infectious diseases. CASE REPORTS: Both of our patients developed progressive leg swelling. Subsequent investigation revealed a lesion compressing the femoral vein. At exploration this was found to be a ganglion cyst. In one patient surgical removal of the cyst and in the other puncture of the cyst and instillation of steroid resulted in prompt resolution of the swelling. CONCLUSION: Venous compression due to external cystic lesions, although rare, is recognized. In strange cases this differential diagnosis should also be taken into account. Therapeutic options are the surgical removal or puncture of the cyst.

[Epidemiology of chronic venous insufficiency--Swiss survey with surprising results]. / Epidemiologie der chronisch venösen Insuffizienz--Schweizer Befragung liefert überraschende Ergebnisse.

Lower limb chronic venous insufficiency (CVI) is one of the most common diseases in western world adults with considerable socio-economic impact. Varicose veins of the legs are caused by a number of factors. Current data suggest that both lifestyle and environmental factors play a role in varicose vein occurrence. Nevertheless, environmental factors seem to play greater role than previously thought. This was also observed in a Swiss survey of 1099 participants carried out during summer 2008 in 40 different Swiss pharmacies.

[Acute mesenteric ischemia: value of computerized tomography diagnosis]. / Akute mesenteriale Ischämie: Stellenwert der computertomographischen Diagnostik.

Acute mesenteric ischemia (AMI) is an acute life-threatening vascular emergency. Clinical presentation is often unspecific. Rapid diagnosis and therapy are essential in survival. Contrast-enhanced spiral computed tomography is sensitive and highly specific in the diagnosis of AMI.

Determinants of left ventricular diastolic function during myocardial ischemia: influence of myocardial structure and pericardial constraint.

OBJECTIVE: To assess the influence of myocardial structure and pericardial constraint during exercise ischemia on regional left ventricular passive elastic properties. METHODS: Left ventricular regional function was assessed at rest and during exercise using biplane angiography and high-fidelity pressure measurements. Twenty patients with either normal (n = 7) or stenotic coronary arteries (n = 13) were studied before and after successful bypass surgery. At the time of surgery, left ventricular transmural biopsies were taken from a normally perfused and a hypoperfused left ventricular region. RESULTS: Regional stiffness increased in the ischemic zone during exercise, but remained unchanged after revascularization. Regional fibrosis was significantly enhanced in the ischemic region compared with that in the normally perfused zone. No correlation was found between structural data and regional passive elastic properties, but there was a significant correlation between right atrial pressure and the asymptote of the diastolic pressure--volume relationship. CONCLUSIONS: Acute regional diastolic dysfunction can be observed during exercise in patients with coronary artery disease. Structural changes seem to have a minor role in the occurrence of diastolic dysfunction in the absence of myocardial infarction. The observed upward shift of the pressure-volume relationship during ischemia can be attributed to pericardial constraint that is manifested by an increase in right arterial pressure.

Expression of alpha 4-1 and alpha 5 nicotinic cholinoceptor mRNA in the aging rat cerebral cortex.

Although important in neurodegeneration, systematic studies of nicotinic acetylcholine receptor expression in normal aging human brains are difficult to perform. We have studied the expression of nicotinic receptor alpha 4-1 and alpha 5 mRNA in the frontal and parietal isocortex of 3- (young adult), 24- (late middle aged), and 33-month-old (old) rats by nonisotopic in situ hybridization. In all groups transcripts were mainly present in layer II/III and V pyramidal neurons. The numerical densities of alpha 4-1 mRNA-containing neurons with respect to those of cresyl violet-stained neurons decreased with aging in the rat frontal and parietal cortex, while those of alpha 5 mRNA-containing neurons were not affected. These findings point to an age-related decrease of the percentages of numerical densities of alpha 4-1 mRNA-containing neurons, which has to be taken into account as a possible substrate for the well-known decrease of nicotine binding sites in the aging cerebral cortex.

Induction of enhanced postnatal expression of immunoreactive calbindin-D28k in rat forebrain by the calcium antagonist nimodipine.

The early postnatal development of immunoreactive calbindin-D28k (CaB-ir) containing neuronal systems in hippocampus and parietal cortex was studied in offspring of Wistar rats chronically treated with either the Ca(2+)-channel antagonist nimodipine or placebo food. The drug was applied to the mother animals during the last week of gestation and continued until the end of the experiment. The CaB-ir was investigated in the period of the highest rate of hippocampal and cortical fiber growth at postnatal days (PD), 5, 7, 10 and 20. In the dorsal hippocampus from PD5 to 20, the dentate granule cells and their mossy fiber connection expressed increasing CaB-ir in a topographically organized manner. In the parietal cortex at PD5, 7 and 10 interneurons and a few pyramidal cells gradually appeared immunoreactive for CaB with progressively increasing intensity and approached their adult-like pattern at PD20. Chronic nimodipine treatment resulted in a transient and markedly enhanced ir-CaB expression up to the age of PD10, which was quantified by cell counts and image analysis. Nimodipine induced a more than twofold increase in the number of CaB-ir neurons in the cortex at PD5-PD10. The developmental enhancement in the hippocampus appeared slightly earlier mainly at PD5 and 7. The findings indicate that the antihypoxic effect of nimodipine, previously found in the perinatal age, may be associated with an increased Ca2+ buffering capacity of neurons due to an enhanced expression of ir-CaB during the early postnatal period.

Postnatal development of hippocampal and neocortical cholinergic and serotonergic innervation in rat: effects of nitrite-induced prenatal hypoxia and nimodipine treatment.

Postnatal development of ingrowing cholinergic and serotonergic fiber patterns were studied in the rat hippocampus and parietal cortex employing a histochemical procedure for acetylcholinesterase as a cholinergic fiber marker, and immunocytochemistry of serotonin for serotonergic fiber staining. The rat pups were killed at postnatal days 1, 3, 5, 7, 10, and 20. The development of cholinergic and serotonergic innervation was described and the fiber density quantified under normal conditions and after long-term prenatal anemic hypoxia induced by chronic exposure to sodium nitrite. Furthermore, a third group was studied in which the nitrite hypoxia was combined with a simultaneous treatment with the Ca(2+)-entry blocker nimodipine to test the neuroprotective potential of this drug. Quantitative measurement of fiber density from postnatal day 1 to day 20 yielded the following results: (i) both neurotransmitter systems revealed an age-dependent and an anatomically-organized developmental pattern; (ii) the serotonergic innervation of the dorsal hippocampus preceded that of cholinergic afferentation in postnatal days 1-3; (iii) prenatal hypoxia induced a transient delay in the innervation of parietal neocortex and dentate gyrus for both neurotransmitter systems, but left the innervation of the cornu ammonis unaffected; and (iv) the hypoxia-induced retardation of cholinergic and serotonergic fiber development was prevented by concomitant application of the Ca(2+)-antagonist nimodipine during the hypoxia. The results indicate that prenatal hypoxia evokes a temporary delay in the cholinergic and serotonergic fiber outgrowth in cortical target areas in a region-specific manner. The hypoxia-induced growth inhibition is prevented by the calcium antagonist nimodipine, which supports the importance of the intracellular Ca2+ homeostasis of cells and growth cones in regulating axonal proliferation.

Beneficial effect of the Ca2+ antagonist, nimodipine, on existing diabetic neuropathy in the BB/Wor rat.

1. Neuropathy is a frequently diagnosed complication of diabetes mellitus. Effective pharmacotherapy is not available. 2. The spontaneously diabetic BB/Wor rats develop secondary complications like neuropathy as do human diabetic patients. 3. BB/Wor rats treated with insulin via a subcutaneous implant show a significant impairment of sensory and motor nerve conduction velocity 6 weeks after the onset of diabetes mellitus. 4. Intraperitoneal treatment of diabetic BB/Wor rats with the Ca2+ antagonist, nimodipine (20 mg kg-1), from week 6 onwards every 48 h for a period of 6 weeks resulted in a significant increase of sensory and motor nerve conduction velocity. 5. Twelve weeks after the onset of diabetes mellitus BB/Wor rats show a 40% impairment of sciatic nerve blood flow as compared to the non-diabetic age-matched controls. Treatment with nimodipine (20 mg kg-1) from week 6 onwards significantly increased the sciatic nerve blood flow as compared to placebo-treated diabetic BB/Wor rats. 6. The adrenergic responsiveness of the vasa nervorum of the sciatic nerve to tyramine and phenylephrine was investigated as a parameter for autonomic neuropathy. 7. The fact that nimodipine treatment restored the reduced response to tyramine independently of the reduced postsynaptic phenylephrine responsiveness indicates that nimodipine improves adrenergic responsiveness mainly at the presynaptic level.

Shock-induced ultrasonic vocalization in young adult rats: a model for testing putative anti-anxiety drugs.

A putative animal model of anxiety based on shock-induced ultrasonic vocalization was pharmacologically validated in young adult rats. Suppression of shock-induced ultrasonic vocalization was obtained with diazepam, chlordiazepoxide, meprobamate and pentobarbital; the serotonin (5-HT)1A receptor agonists 8-OH-DPAT [8-hydroxy-2-(di-n-propylamino)tetralin], buspirone, ipsapirone, gepirone and tandospirone; the nonselective 5-HT receptor agonists TFMPP [1-(3-trifluoromethylphenyl)piperazin], mCPP [1-(3-chlorophenyl)piperazin] and DOI (1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane); the NMDA antagonists PCP (phencyclidine) and MK-801; the alpha 2-adrenoceptor antagonists idazoxane, yohimbine and 1-PP (1-pyrimidinylpiperazine); and the atypical neuroleptic clozapine. The alpha 2-adrenoceptor agonist clonidine, the 5-HT2/5-HT1C antagonist ritanserin, the 5-HT3 antagonists ondansetron and ICS-205,930, and the 5-HT reuptake inhibitor fluoxetine did not, or only partially, reduce ultrasonic vocalization. Tricyclic and tetracyclic, as well as some atypical antidepressants and a monoamineoxidase (MAO) inhibitor, showed no ultrasonic vocalization reducing effects, or reduced ultrasonic vocalization only at high doses. An opiate, an antimuscarinic, (pro)convulsants and typical neuroleptics did not reduce ultrasonic vocalization. The present findings suggest that the ultrasonic vocalization model specifically measures anxiolytic effects. Because ultrasonic vocalization responding develops within five days, remains stable for at least three months and gives highly reproducible results, the test appears suitable for rapid and repeated testing of new anxiolytics in the same animals.

[The presynaptic metabolic modulation of the impulse-dependent release of 3H-serotonin from rat brain slices by ipsapirone (TVX Q 7821) and other serotonin agonists]. / Presinapticheskaia metabolicheskaia moduliatsiia impul'snogo vysvobozhdeniia 3H-serotonina srezami mozga krys ipsapironom (TVX Q 7821) i drugimi agonistami serotonina.

The experiments with thin slices of the cortex and dorsal raphe nucleus of rat midbrain which were incubated with [3H]-hydroxytryptamine ([3H-]HT) have established that serotonin and its agonists inhibit 3H-HT release from the electrically stimulated slices. The serotonin agonists ipsapirone (TVX Q 7821), buspirone, gepirone, and 8-OH-DPAT which mainly stimulate the Type 1A serotonin receptors of somatodendritic synapses inhibit the release of [3H]-HT from the dorsal raphe nucleus slices to a greater extent rather from those of the cortex. On the contrary, the serotonin agonists TFMPP, mCPP, and Ru 24969 which predominantly affect 1B-HT receptors largely inhibit [3H]-HT release from the electrically stimulated cortical slices. Ipsapirone-induced inhibition of the impulse-dependent release of [3H]-HT has been found to be associated with changes in intracellular cAMP levels and protein kinase activity. The nature of serotonin agonist-induced modulation of the impulse-dependent release of [3H]-HT from serotoninergic neurons is discussed in the paper.

Effects of nimodipine on the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced depletions in the biogenic amine levels in mice.

In view of the calcium hypothesis the effect of nimodipine (Bay e 9736, CAS 66085-59-4) on the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced depletions in dopamine and serotonin were investigated in C57-BL/6 mice. Oral treatment with nimodipine (5 mg/kg and 20 mg/kg b.i.d., respectively, for 9 days) prior to, during and following administration of MPTP appeared to attenuate MPTP-induced neurochemical changes in a dose-related manner. The results suggest that nimodipine reduces MPTP-induced damages, especially in the serotoninergic system, through its calcium antagonistic effects.