[Pseudoaneurysm of the internal carotid artery following a peritonsillar abscess]. / Pseudoaneurysma der A. carotis interna nach Peritonsillarabszess.

A pseudoaneurysm of the internal carotid artery is a rare major complication of peritonsillar abscess. We present a 95-year-old women, who had a persistent bleeding from peritonsillar fossa after a routine tonsillectomy and ligation of the external carotid artery. Postoperative performed intraarterial angiography verify the diagnosis of a pseudoaneurysm of the internal carotid artery. Subsequent ligation of the internal carotid artery superior the bifurcation stops the hemorrhage. Review of literature demonstrate the importance of angiography in such cases.

[Macroangiopathy in diabetes mellitus]. / Makroangiopathie beim Diabetes mellitus.

Although there is no evidence of effectiveness of interventional trials concerning macroangiopathy in diabetes mellitus, the focus of primary prophylaxis is based on the treatment of risk factors and optimal adjustment of metabolic parameters. This should contain the prophylaxis of the diabetic foot (foot care, teaching, pressure bearing) in the neuro-ischaemic risk patient. In the secondary prophylaxis acetylsalicylic acid has been proven as effective in the cerebral, cardial, and peripheral vascular regions in different dosages. The aim of the symptomatic therapy is the improvement of the peripheral vascular disease symptoms, which could mean an improvement of the pain-free walking distance or the avoidance of an extremity-threatening ischaemic syndrome. The therapeutic range includes a structured exercise programme, conservative medical treatment, catheter procedures, and bypass surgery as well as amputation. The different procedures are mainly dependent on the general condition of the in many cases multimorbid patients, the clinical stage, the psychological burden and the angiologic status. There should be always an interdisciplinary discussion, which helps to find the right therapeutic decision. All the therapeutic activities should be seen under the guideline of an improvement in the quality of life.

[Results of local thrombolysis with special reference to diabetic metabolism]. / Ergebnisse der lokalen Thrombolyse unter besonderer Berücksichtigung einer diabetischen Stoffwechsellage.

The influence of diabetes on the primary and long-term success rate after 145 local thrombolyses in peripheral arterial disease stages III and IV was evaluated. 75 patients suffered from thrombotic, 62 patients from embolic occlusions, with eight patients suffering from thrombangitis obliterans. Regarding the localisation of vascular occlusion 0.6% suffered under an occlusion of the iliacal artery, 21% of the femoral artery, 16% of the popliteal artery, 7% of the vessel of the lower limb and 55.4% showed a combined occlusion of the femoral- and popliteal artery and the artery of the lower limb. In cases of embolic occlusions only marginal differences could be observed, while the primary success-rate of thrombotic occlusions showed greater differences between both groups (75% vs. 91%). During the follow-up, no differences between both groups could be established (patency-rate of 79% for both groups). The same applies to the prognostic factors: peripheral run off, length, duration of occlusion and the clinical stage (Fontaine IIb to IV). The remarkable differences between diabetic and non-diabetic patients in cases of occlusions of more than 16 cm (66% vs. 88% in primary and 55% vs. 77% in long-term success) can be explained by the high percentage of diabetic patients with poor run-off and microangiopathy. Regarding the above parameters, primary and long-term results seemed to be less in diabetic patients, even though a long-term patency could be observed in 2/3 of diabetic patients in stages IIb and IV with primary success.