Endovenous laser ablation of varicose veins with the 1470 nm diode laser using a radial fiber - 1-year follow-up.

BACKGROUND: Endovenous laser ablation is one of the most accepted treatment options for insufficient great and small saphenous veins. The aim of this study was to investigate the long-term efficacy and safety of the radial fiber (ELVeS-radial kit™) for the 1470 nm diode laser in a 1-year follow-up. METHODS: A total of 308 lower limbs with primary insufficiency of great and small saphenous veins or insufficient tributaries were included in the prospective observational cohort study. The primary efficacy endpoint of the study was ultrasonographic proven elimination of venous reflux after at least 1 year. Secondary efficacy and further safety end points after 1 year were as follows: (1) sonographic exclusion of recanalization of the treated vein segments, (2) deep vein thrombosis, clinical pulmonary embolism or superficial vein thrombosis as defined by objective testing, (3) death from any cause, (4) persistent clinical complaints such as pain and paresthesia, (5) recurrent varicose veins. Patient satisfaction was assessed using a CIVIQ-2 questionnaire after 1 year. RESULTS: Follow-up could be completed in 91.2% of the patients. Excellent efficacy numbers with 99.6% occlusion of the treated varicose veins as elimination of reflux could be demonstrated. After 1 year, 96% of the treated veins disappeared completely sonographically; one recanalization was observed. No deep vein thrombosis or pulmonary embolism occurred, three superficial vein thrombosis were diagnosed in follow-up examinations. Four patients died, not related to pulmonary embolism. No persistent pain or paresthesia occurred in the follow-up. Recurrent varicose veins were diagnosed in 10 patients (2.81%). CONCLUSION: One-year follow-up showed that endovenous laser treatment of varicose veins with 1470 nm diode laser using the radial fiber is highly effective, also regarding in a 1-year follow-up.

The reproducibility and validity of furcation measurements using a pressure-calibrated probe.

The furcation involvement of 100 molars in 25 patients suffering from moderate to advanced periodontitis was investigated. The horizontal probing attachment level (PAL-H) within the furcations was assessed 2x within 2 weeks using the pressure-calibrated (0.25 N) flexible plastic universal explorer version of the TPS probe (TPS). To determine the measurement error of PAL-H assessments, the standard deviation of single measurements was calculated. The measurements were repeated using a colour-coded Nabers probe and compared to the TPS assessments. 253 furcations were evaluated (100 buccal, 47 lingual, 53 mesiolingual and 53 distolingual, respectively). For buccal, lingual, mesiolingual and distolingual furcations, the standard deviations were 0.486 mm, 0.598 mm, 0.846 mm, 1.039 mm, respectively. Measurement error was less in buccal and lingual furcations than in mesiolingual and distolingual sites (p < 0.005). The agreement of replicate measurements of furcation degrees was excellent for buccal and lingual furcations (weighted kappa [standard error] 0.824 [0.076] and 0.779 [0.107], respectively), but only moderate for mesiolingual and distolingual furcations (weighted kappa 0.688 [0.096] and 0.544 [0.101], respectively). Only in distolingual sites there was a significant (p < 0.025; paired t-test) underestimation of PAL-H by the TPS as compared to the Nabers probe. At all locations the TPS underestimated furcation degrees significantly (p < 0.1; Stuart-Maxwell's chi 2) as compared to Nabers probe. Measurement error of mesiolingual and distolingual furcations was significantly higher than of buccal or lingual sites. The reproducibility of PAL-H measurements in furcations using TPS is comparable to data published for scorings with colour-coded Nabers probes. Through and through furcations are likely to be underestimated by using the flexible plastic version of the TPS probe. Hence, it seems to be unsuitable for a proper assessment of the degree of furcation involvement.

[Native radiologic staging of osteoporosis--CT densitometry of lumbar vertebral spongiosa. A correlation study]. / Nativradiologisches Osteoporosestaging--CT-Densitometrie der Wirbelkörperspongiosa. Eine Korrelationsstudie.

Lumbar spine radiographs in 47 patients with manifest or clinically suspected osteoporosis were evaluated, using a staging system, and correlated to quantitative computed tomography (QCT) of lumbar vertebrae. The accuracy of osteoporosis assessment, obtained with plain film analysis, was 60%, the sensitivity 67%, the specificity 56%. Statistical correlation showed high standard deviation of each of the QCT-mean values according to the respective stage groups, and altogether poor linear correlation between increasing morphological stages of osteoporosis and decreasing QCT-values. As our results show plain film differentiation of normal from reduced trabecular bone mineral content is unreliable, even by use of a staging system. The diagnostic value of spine radiographs therefore remains limited to demonstration of advanced osteoporotic changes.

[Color-coded Doppler sonography of the thyroid: an advance in carcinoma diagnosis?]. / Farbkodierte Doppler-Sonographie der Schilddrüse: ein Fortschritt in der Karzinomdiagnostik?

There are several papers suggesting that colour-coded Doppler sonography is a useful diagnostic tool for the differentiation of malignant and benign lesions of the thyroid gland. This hypothesis (hypervascularization of malignant nodules) is reconsidered by preoperative examination of 65 patients by using colour-coded Doppler sonography and scintigraphy. Among these patients 21 carcinomas and 2 malignant lymphomas of the thyroid gland were found histologically. Colour-coded Doppler sonography was true positive in 10 cases, true negative in 28 cases, false positive in 14 cases and false negative in 13 cases. Our conclusion is that colour-coded Doppler sonography cannot be used unconditionally for the detection of carcinoma of the thyroid gland.

Effects of Temperature and pH on Survival of Free Nuclear Polyhedrosis Virus of Autographa californica.

The effects of temperature and low pH on replication and survival of nonoccluded Autographa californica nuclear polyhedrosis virus were investigated. No virus replication or formation of polynuclear inclusion bodies occurred at 37 degrees C. The virus was immediately inactivated upon exposure to pH 2.0 and was inactivated within 1 h at pH 4.0. The virus titer slowly declined, a 3-orders of magnitude reduction in virus titer, at pH 5.0 during a 4-h exposure. Virus survival at pH 6.0 was equal to that of the control in cell culture medium 199 MK (pH 7.12).

Increased susceptibility of rainbow trout to infectious hematopoietic necrosis virus after exposure to copper.

Exposure of rainbow trout to sublethal levels of copper in water increased their susceptibility to infectious hematopoietic necrosis virus. In most instances, the percent mortality was twice as great in the stressed groups compared with those groups which were not stressed but received the same virus dose. Although the level of copper in the water influenced the mortality rates, the length of exposure did not prove to be critical, as similar results were obtained after 1, 3, 5, 7, or 9 days of exposure. When different virus challenges were employed, the percent mortalities were again greater in the stressed fish at all virus doses tested, and at one dose level mortalities were noted in the stressed group but not in the untreated group.

Colonization of the botanical environment by Klebsiella isolates of pathogenic origin.

Growth, survival, and pathogenicity of Klebsiella growing in and on environmental foci were examined. Total coliforms present in raw wastes from pulp mills were in excess of 10(5)/ml, and 60 to 80% were Klebsiella. Fecal coliform counts ranged from 10(1) to 10(5)/ml. Klebsiella isolates from industrial effluents and a variety of human and bovine mastitis origins multiplied in pulp waste and commonly exceeded 10(6) cells per ml. Pathogenic isolates also multiplied in dilute aqueous extracts of sawdust to comparable levels. Klebsiella strains from vegetable surfaces and human infections grew rapidly on the surfaces of potatoes and lettuce and exceeded 10(3) organisms per g of surface peel and leaf after a 24h incubation at room temperature. After 7 weeks on potatoes stored at 5 degrees C, some 10 to 30% of the day 1 Klebsiella counts were recoverable. Three Klebsiella isolates of pathogenic origin were passed 45 times through sterile pulp effluent (270 generations), and mean lethal dose levels in mice were periodically monitored. In two instances, a significant decrease in virulence was noted after 15 to 26 passes (90 to 156 generations). The third culture, of bovine mastitis origin, retained its original mean lethal dose value. Botanical milieu provided suitable habitats for the multiplication and colonization of Klebsiella isolates of disease origins in the same manner as indigenous isolates. Aquatic environments polluted with botanical material served as potential reservoirs for perpetuating the growth and spread of opportunistic Klebsiella pathogens that may ultimately colonize animals, humans, and aquatic organisms.

Potential pathogens in the environment: cultural reactions and nucleic acid studies on Klebsiella pneumoniae from clinical and environmental sources.

The phenotypic and nucleic acid properties of Klebsiella pneumoniae have been studied on cultures obtained from six different habitats (humans, vegetables, seeds, trees, rivers, and pulp mills). The 19 cultural reactions of 107 isolates varied significantly only in tryptophanase activity and dulcitol fermentation. The percentage of guanine plus cytosine base composition of 41 isolates varied from 53.9 to 59.2%. The range of percentage of guanine plus cytosine base composition for environmental klebsiellas was broader than that for the cultures of human origin. The range of deoxyribonucleic acid relative reassociation (homology) to the human K. pneumoniae reference strain extended from 5% to 100% and the chromosome molecular weights ranged from 2,200 x 10(6) to 3,000 x 10(6). The species of K. pneumoniae is thus molecularly more heterogeneous than previously thought and most isolates of human, pulp mill, and river origin are genetically indistinguishable. The presence of K. pneumoniae therefore represents a deterioration of the microbiological quality of the environment and should be considered of public health significance. At the present time the health significance of the molecularly more divergent strains, primarily of vegetable and seed origin, their relationship to klebsiellas of human origin, or to other genera of the Enterobacteriaceae is unclear.

Occurrence of Klebisiella pneumoniae in surface waters.

The occurrence of Klebsiella pneumoniae in surface waters was not found to be ubiquitous. When it was isolated, Escherichia coli could also be found. The fecal coliform to fecal streptococci ratio suggest that its origin could be human, animal, or mixed sources.