[Etiology and long-term course of subclavian vein thrombosis with reference to acute therapy]. / Atiologie und Langzeitverlauf bei Subclavia-Venenthrombose unter Berücksichtigung der Akuttherapie.

Contrary to deep venous thrombosis of the lower extremity, subclavian vein thrombosis (SVT) is rather rare. Although the problem has been known for more than 100 years, the rarity of its incidence accounts for the persistent uncertainty concerning the indication and modalities of acute therapy as well as the long-term course. In the majority of 96 patients observed between 1976 and 1983 SVT was due to central venous catheter, neoplasm and thoracic outlet syndrome. 2 of 96 patients developed pulmonary embolism. 45 patients without malignancy were available for follow-up studies. Acute therapy included anticoagulation in 27, fibrinolysis in 10 and rib resection in 8 cases. The mean follow-up averaged 6.3 years and confirmed a favorable course independent of the acute therapy modality. There were none of the trophic alterations so often found in the lower extremity and no patient was unable to work as a consequence of SVT. However, minor late sequelae occurred quite frequently: slight symptoms in one third, and minor incapacity for sport in 25% of the cases. 75% of the patients showed clinical signs of stasis, such as venous bypass circulation, edema and/or cyanosis. The average post-thrombotic score (1.3 out of a possible 4) confirms the minor significance of the findings. A rather important reduction in venous backflow was found by plethysmography in 4% of the patients. We favor immediate anticoagulation, mainly to cover the risk of pulmonary embolism. This should be continued for at least 3 months in order to prevent early recurrence of thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[A frequent problem in the laboratory control of heparinization: contamination of blood specimens with exogenous heparin]. / Ein häufiges Problem bei der Laborkontrolle der Heparinisierung: Kontamination der Blutproben mit exogenem Heparin.

If blood for monitoring of heparin therapy is collected through indwelling catheters it may be contaminated by exogenous heparin. A prospective study comparing thrombin times in plasma obtained by venipuncture and by collection through heparin perfused catheters showed that 26 out of 77 catheter samples were contaminated. In 16 of these 26 cases, overestimation of the heparin effect would have led to incorrect dosage recommendations. It is concluded that blood for laboratory monitoring of heparin treatment should be collected by venipuncture.

[Hypertriglyceridemia in intravenous hyperalimentation with glucose. Observations on patients treated with cyclosporin-A following bone marrow transplantation]. / Hypertriglyceridämie bei intravenöser Hyperalimentation mit Glucose. Beobachtungen bei cyclosporin-A-behandelten Patienten nach Knochenmarktransplantation.

The authors report marked hypertriglyceridaemia with peak values of up to 14 mmol/l in patients who have undergone bone marrow transplantation (BMT) and who are receiving 925 g/d glucose and 70 g/d crystalline amino acids for parenteral nutrition. Larger doses of insulin lead to only slightly better control of mean blood glucose level and to a clearly less marked increase in triglycerides (TG) in a series of patients otherwise treated identically. Only a slight increase in serum TG was seen in BMT patients receiving 325 g glucose per day. There was no increase in serum TG to values above normal in a small group of surgical patients receiving 700-900 g glucose/d and high doses of insulin. Peripheral insulin resistance is presumed to be the pathogenetic factor in this hypertriglyceridaemia, mia, which can be avoided by higher doses of insulin or decreased glucose load.

[Benign symmetric lipomatosis: a symptom of alcoholic liver disease?]. / Die benigne symmetrische Lipomatose: ein Symptom der äthylischen Hepatopathie?

Benign symmetric lipomatosis (BSL) leads to characteristic multiple lipomas of the neck and submandibular region. BSL is easily diagnosed by its typical feature, "Madelung's neck". However, the early stages are often missed or lead to futile diagnostic endeavours. A report is presented on 7 men with BSL aged 36--65 years who were investigated with regard to alcohol consumption, clinical findings and liver histology. This is the first time that liver histology has been systematically worked up in patients with BSL. All admitted long standing ethanol intake (x = 111 ml/day) prior to the development of BSL. The growth of the lipomas was irregular and occurred over a period of months. There was no correlation with overweight or hyperlipidemia. However, liver biopsy revealed features consistent with alcoholic liver disease in all subjects. It is suggested that BSL is a symptom of alcoholic liver disease mainly affecting middle-aged men.

[Benign symmetric lipomatosis--symptom of alcoholic liver disease]. / Die benigne symmetrische Lipomatose--ein Symptom der äthylischen Hepatopathie.

Benign symmetric lipomatosis (BSL) leads to characteristic multiple lipomas of the neck and submandibullar region. Seven men with BSL, aged 36--65 years, were investigated with regard to alcohol consumption, clinical findings and liver histology. They admitted a long standing ethanol intake (x = 107 ml/day) prior to the development of BSL. The growth of the lipomas was irregular and occurred over a period of months. There was no correlation with overweight or hyperlipidemia. However, liver biopsy revealed features consistent with alcoholic liver disease in all subjects. It is concluded that BSL represents a symptom of alcoholic liver disease affecting middle aged men.