Zeitschrift für Kardiologie
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Review Comparative Study
[Endovascular stent-graft prosthesis in aortic aneurysm].
Descending thoracic and abdominal aortic aneurysms represent a potential life-threatening situation. Resection and graft replacement of the pathologically altered aorta used to be the preferred method of treatment. ⋯ Postoperative complications, such as paraplegia, renal and pulmonary disease, contribute to prolonged hospital stay and higher medical cost. In this review we report on a promising alternative approach to the surgical treatment of thoracic and abdominal aortic aneurysms, namely the currently emerging utilization of the endovascular stent-graft prosthesis in both thoracic and abdominal aneurysm.
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Case Reports
[Acute thrombosis of pelvic and leg veins in agenesis of the renal segment of the inferior vena cava].
A 19-year-old, otherwise asymptomatic man presented to the hospital of orthopaedic surgery with acute severe pain like lumbago. Symptomatic treatment was performed after extensive orthopaedic diagnostic procedures. On the third day after admission he showed clinical signs of deep vein thrombosis with painful swelling and livid discoloration of both legs. ⋯ Permanent oral anticoagulation with phenprocoumon is indicated to decrease the high rate of recurrent thrombosis. Compression stockings were prescribed. To prevent thrombosis, additional risk factors like smoking, immobilization and unusual physical activity should be strictly avoided.
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Review Comparative Study
[Homocysteine, endothelial dysfunction and cardiovascular risk: pathomechanisms and therapeutic options].
Elevated homocyst(e)ine plasma concentrations are an independent risk factor for cardiovascular disease. Hyperhomocyst(e)inaemia is common in patients with peripheral arterial occlusive disease, coronary heart disease, cerebrovascular disease, carotid artery stenosis and venous thromboembolism. Endothelial dysfunction may be one underlying cause leading to proatherogenic effects associated with hyperhomocyst(e)inaemia. ⋯ No clinical studies are available to date to prove whether reducing homocyst(e)ine levels to the normal range by supplementary B vitamins will also beneficially affect vascular function or cardiovascular risk. Furthermore it is unknown whether moderately elevated homocyst(e)ine concentrations per se may predispose to development of vascular disease, or whether homocyst(e)ine is an indirect marker of cardiovascular disease. Further investigations will be necessary to elucidate the causal relationship between elevated homocyst(e)ine plasma concentrations and the incidence of cardiovascular events, especially since the therapeutic strategies in hyperhomocyst(e)inaemia would differ depending on the underlying pathophysiological mechanisms.
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Late results after surgery for acute infectious aortic endocarditis using allografts are compared with those achieved with bioprostheses or mechanical heart valves. Cryopreserved allografts were used in 74 (22%) and prosthetic heart valve in 262 out of 336 (78%) patients presenting acute aortic endocarditis. Prosthetic (p = 0.001) and destructive endocarditis (p = 0.001) were more frequent in patients receiving allografts. ⋯ Acute infection at the time of surgery predicted early and late death; however, surgery is indicated prior to secondary involvement of the mitral valve. The duration of preoperative antibiotic treatment did not affect outcome. A thorough surgical technique directly influences early and late survival.