Med Klin
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Local vascular complications after transfemoral cardiac catheterization occur with an incidence of 5%. Most commonly these lesions are pseudoaneurysms, av-fistulas, arterial dissections or direct vascular injuries. Undiagnosed vascular lesions can lead to fatal consequences especially in patients with chronic heart failure by av-fistula with significant shunt volume. ⋯ The suspicion of a vascular lesion after vascular catheterization should immediately lead to color Doppler ultrasound. Noninvasive duplexsonography will lead to early diagnosis of vascular complications and prompt further surgical or conservative intervention with reduction of long-term sequela and morbidity.
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Ten patients with adult onset of Still's disease (AOSD) were examined one to nine years after the established diagnosis. Clinical symptoms, laboratory parameters and the outcome of the cases are presented and compared to international literature and to Yamagushi's in 1992 proposed diagnostic criteria. Nine patients were reexamined in our out-patient clinic. The chart of one additional patient, who died 10 month after the initial symptoms was also available for data analysis. Retrospectively, it was investigated whether any parameters were predictive for a chronic or severe form of the disease. ⋯ Predicting parameters for a chronic course of the disease could not be found. Each patient's diagnosis retrospectively could be confirmed using the Yamagushi's diagnostic criteria. Thus, these criteria appear helpful in the difficult diagnostic process of this disease.
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Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique to remove large molecular weight substances. Since the late seventies TPE was used in a variety of diseases in which humoral factors may play a part in the pathogenesis. Today, accepted indications only exist for a few entities in defined situations: Anti-glomerular basement membrane antibody mediated disease, TTP/HUS, Guillain-Barré-syndrome, hyperviscosity syndrome, chronic polyneuropathy associated with IgG and IgA gammopathy, chronic inflammatory demyelinating polyneuropathy and myasthenia gravis.