Comparison of Long-term Outcomes of Heparin Bonded Polytetrafluoroethylene and Autologous Vein Below Knee Femoropopliteal Bypasses in Patients with Critical Limb Ischaemia.

OBJECTIVE/BACKGROUND: Endovascular first is the preferred therapy approach to critical limb ischaemia (CLI). However, in spite of new endovascular techniques, bypass surgery still plays an important role, especially in patients with complex anatomy in whom endovascular therapy is not considered feasible, or has failed. The goal of this study was to analyse the outcomes of prosthetic or autologous vein for femoropopliteal (P3) bypasses performed under the abovementioned conditions. METHODS: A retrospective analysis of patients who underwent a femoropopliteal (P3) bypass for CLI (March 2007-December 2015) was conducted. Endovascular therapy was not possible. Patency rates, limb salvage, major adverse limb event (MALE) free survival, and survival after 5 years were analysed. RESULTS: In total, 151 cases were included in the analysis (rest pain 35.8%, ulcer/gangrene 64.3%). The graft material was autologous vein in 76 cases (vein group) and heparin bonded expanded polytetrafluoroethylene (HePTFE) in 75 cases (HePTFE group). Indications, risk factors, previous revascularisation procedures, and runoff vessels were similar in both groups. Thirty day mortality was 6.6% in the vein group and 5.3% in the HePTFE group (p = .508), early graft occlusion (6.6% vs. 5.3%; p = .508) and 30 day major amputation rate (0% vs. 2.7%; p = .245) were similar between the two groups. Overall primary patency was 51.7% (55.5% [vein group] vs. 51.7% [HePTFE group]; p = .897) and overall secondary patency was 64.2% (74.6% [vein group] vs. 55.6% [HePTFE group]; p = .119), all without significance after 5 years. However, limb salvage (79.1%) was significantly different (90.0% [vein group] vs. 62.9% [HePTFE group]; p = .021). Survival was similar between the groups (47.3% vs. 42.9%; p = .582) as well as MALE free survival (69.4% vs. 55.0%; p = .348). CONCLUSION: Bypasses to the below knee popliteal artery show good results in patients with CLI unsuitable for endovascular therapy. Vein is still the first line graft material.

The Motor Unit Number Index (MUNIX) in sarcopenic patients.

INTRODUCTION: The cause of sarcopenia is still not fully understood. A multifactorial aetiology is discussed. Neurodegenerative aspects in the genesis of sarcopenia, such as loss of motoneurons, have not yet been explored to a sufficient extent. METHOD: The Motor Unit Number Index (MUNIX) is a method for assessing the number and size (Motor Unit Size Index - MUSIX) of Motor Units (MUs) using the Compound Muscle Action Potential (CMAP) and the Surface electromyographic Interference Pattern (SIP). This method was used to study the hypothenar muscle in the right hand of 27 sarcopenic patients. RESULTS: The mean MUNIX (111±51) of all investigated sarcopenic patients lies between the mean MUNIX of healthy persons and the mean MUNIX of ALS patients. 25% of sarcopenic patients exhibit pathologic values for both MUNIX (<80) and MUSIX (>100 µV). A strong correlation (r=0.75, p<0.001) between MUSIX and the reciprocal value of MUNIX was identified. CONCLUSION: It was demonstrated for the first time by applying the MUNIX technique that loss of motoneurons plays a pathogenic role in the onset of sarcopenia. This was shown in 25% of sarcopenic participants who exhibited pathologic values for both MUNIX and MUSIX. Nerve sprouting seems to be an important mechanism of compensation for loss of motoneurons, reflected by the strong correlation between MUNIX and MUSIX. Use of MUNIX leads to the identification of a distinct subgroup of sarcopenic patients, which might have a major impact on future diagnostic and therapeutic concepts.

Langmuir supercells: a mechanism for sediment resuspension and transport in shallow seas.

Recent measurements at a cabled sea-floor node in 15 meters of water off the coast of New Jersey suggest that Langmuir supercells, Langmuir circulations that achieve vertical scales equal to the water depth under extended storms, are an important mechanism for major sediment resuspension events on the extensive shallow shelves off the eastern U.S. coast. Because sediment resuspension is a prelude to transport, supercell events are a necessary condition for major sediment transport. Such events may also contribute to shelf-sea exchange and to offshore gradation of benthic community structure in shallow seas.

Blood pressure and heart rate dynamics during and after exercise in an unselected population.

It has been suggested that the systolic blood pressure (SBP) response to exercise may be useful in predicting future hypertension. However, controversy exists as to whether the SBP response to exercise in borderline hypertensives is actually greater than normotensives or merely increases equally but from a higher resting value. Our aim was to determine the influence of resting SBP, age and sex on changes of SSP during exercise for both healthy subjects and untreated mild hypertensives. Three hundred and eighteen (230 males) underwent a self limited exercise protocol. SBP was measured at baseline and between the 2nd and 3rd minutes of each exercise stage. Age was positively related to SBP at rest and during exercise. The magnitude of SBP change induced by exercise was similar irrespective of the level of resting SBP. The relationship between resting SBP and the absolute SBP change which occurred during exercise was independent of sex. Our findings indicate that (i) age is positively related to SBP at rest and during exercise, (ii) SBP rises equally during exercise irrespective of its resting level and (iii) males and females have a similar pattern of BP response to exercise.

Short-term strenuous exercise training: effects on blood pressure and hormonal levels in mild hypertension.

The effect of a six-week strenuous exercise training programme (modified Bruce protocol, treadmill, three times per week) on resting and exercising blood pressure, heart rate, plasma catecholamines, chromogranin A, renin activity and aldosterone levels was investigated in 15 patients with mild hypertension. An identical exercise test was conducted at baseline and study close (six weeks). At follow-up, seven to ten days after study close, patients completed an exercise test of equivalent intensity to that at baseline, achieving comparable heart rate levels at maximal exercise. On each occasion, blood pressure, heart rate and hormonal variables were measured at rest (supine), maximal exercise and ten minutes after stopping exercise. Resting and exercising blood pressure and heart rate were reduced by the six-week exercise regimen. There was a trend, although not statistically significant, for resting plasma noradrenaline levels to be lower at study close. The reduction in blood pressure and heart rate at maximal exercise was associated with a significant attenuation of the plasma renin response to exercise. Plasma catecholamines also appeared to be lower after exercise training, although this effect was not statistically significant. Plasma levels of chromogranin A and aldosterone measured at rest and maximal exercise were not influenced by the exercise regimen. Further controlled studies are required to corroborate the results of this preliminary study.

Sciatica caused by isolated non-Hodgkin's lymphoma of the spinal epidural space: a report of two cases.

Two patients are described in whom sciatica was caused by non-Hodgkin's lymphoma involving the spinal epidural space. Systematic investigation revealed no evidence of lymphoma in other sites.

[Aortobronchopulmonary fistula following a pulmonary contained aortic rupture in patients with a thoracic aortic aneurysm and severe aortic sclerosis]. / Aortobronchopulmonale Fisteln nach pulmonal gedeckter Aortenruptur bei thorakalen Aortenaneurysmen und schwerer Aortensklerose.

Rupture of the thoracic aorta is usually widespread and fatal. Rupture limited by the lung and aorto-bronchopulmonary fistula are rare. We report two patients with a contained perforation of the thoracic aorta, who presented with haemoptysis. Chest radiographs demonstrated an aortic aneurysm and pulmonary haemorrhage in the first, while in the other perforation of an atherosclerotic aorta with a pulmonary haematoma was misinterpreted as bronchial carcinoma. In both cases contrast enhanced CT clearly demonstrated the abnormality in the aorta and the pulmonary haemorrhage. Since aortography often fails to demonstrate a perforation, CT or MRI should be performed early in patients with suspected rupture of the thoracic aorta.

Strenuous short-term dynamic exercise: effects on heart rate, blood pressure, potassium homeostasis, and packed cell volume in mild hypertension.

This study examined the effect of strenuous short-term dynamic exercise on the heart rate, blood pressure, plasma potassium and packed cell volume in mildly hypertensive subjects. At baseline a symptom-limited Bruce Exercise Protocol was carried out with blood pressure, heart rate, plasma potassium and packed cell volume measurements at fixed time points at rest and during and after the exercise. After 6 weeks of taking exercise sessions (Bruce protocol) to fatigue three times a week, the subjects were restudied. Blood pressure and the heart rate fell significantly at rest and during and after exercise. The packed cell volume was higher at all study points and plasma potassium was higher in the postexercise period after the exercise conditioning. Strenuous short-term exercise has a beneficial antihypertensive effect, raises packed cell volume and has a favourable effect on plasma potassium homeostasis.

[Problems of social adaptation of children in a changing environment (author's transl)]. / Zur Frage der sozialen Adaptation von Kindern bei Umweltwechsel.

Results of investigations in the German Democratic Republic, USSR and PR Bulgaria concerning infants going first time to a childrens creech are reviewed. Different phenomenons of social adaptation are shown. Author feels the need to build up social relations of the little child to individuals beyond the family in an early time of life.