[Does venous thrombectomy still play a role in the treatment of Paget-von-Schroetter-Syndrome?]. / Ist die venöse Thrombektomie beim Paget-von-Schroetter-Syndrom auch heute noch eine therapeutische Option?

In a retrospective study we reviewed 24 patients treated by venous thrombectomy for acute thrombosis of the axillary vein during the past 23 years. We performed 25 venous thrombectomies without any complications. Complete recanalisation could be achieved in all cases of acute thrombosis. Whereas similar clinical results can be achieved by thrombolytic therapy, complete recanalisation by thrombolytic therapy is only achieved in 60% of cases.

Dacron vs. polytetrafluoroethylene grafts for femoropopliteal bypass: a prospective randomised multicentre trial.

OBJECTIVES: To compare the patency of PTFE (Polytetrafluoroethylene) and unsealed knitted Dacron femoro-popliteal bypasses. DESIGN: Multi-centre prospective randomised trial. MATERIALS AND METHODS: Of 203 patients randomised, 194 were included in the final analysis (103 Dacron grafts and 91 PTFE grafts). The median follow-up was 36 months (range: 6-72 months); the distal anastomosis was above-knee in 141 and below-knee in 53 cases. Univariate comparisons of patency were made by the Kaplan-Meier method, multivariate calculations on the effects of covariables by a Cox regression analysis. RESULTS: There was no difference regarding primary and secondary patency or limb salvage between Dacron and PTFE. The primary 3-year patency for Dacron grafts was 64% (95% confidence interval [C.I.] 55-74%) and for PTFE grafts 61% (C.I. 49-72%). The corresponding 3-year secondary patency was 81% (C.I. 73-89%) and 75% (C.I. 65-86%) respectively, the limb salvage rate 90% (C.I. 84-96%) and 91% (C.I. 84-97%). Upon multivariate analysis below-knee anastomosis was the principal independent predictor of primary graft failure (risk ratio 1.7 [C.I. 1.05-2.8]), impaired secondary patency was associated with infragenicular bypass (risk ratio 3.3 [C.I. 1.8-6.3]) and distal gangrene (risk ratio [C.I. 1.01-3.8]p=0.048), major amputation was independently predicted by below-knee bypass, tissue necrosis, and poor run-off index. CONCLUSIONS: PTFE and Dacron are equally suitable for femoro-popliteal bypass.

Sustained attention modulates the immediate effect of de-afferentation on the cortical representation of the digits: source localization of somatosensory evoked potentials in humans.

Long-term cortical reorganization of the somatotopic arrangement of the digits after alterations of the peripheral input is well established. Studies on the immediate effects of manipulating peripheral input have shown conflicting results indicating that additional factors might modulate cortical reorganization. We present a source localization study using somatosensory evoked potentials (SEP) following electric stimulation of digits one and five before and during anaesthesia of digits two, three and four in 10 normal volunteers. When attention was directed to a stimulus at the dorsal hand, the 3D-distance between digits one and five decreased during as compared to before anaesthesia. In contrast, this distance enlarged when subjects were not attending a particular stimulus. In this condition most subjects focused their attention on the clear sensation of the de-afferented hand region. These results indicate that attention modulates the effect of immediate cortical reorganization of the hand area during partial deafferentation. As an hypothesis: it may be speculated that the sensation of the de-afferentation results in increased synchronized activity of the de-afferented somatosensory cortex and, thus, to its enlarged representation. Conversely, if attention is directed to a different hand region, the representations of the neighboring digits may expand into the de-afferented cortex.