Die Marginalvene – nach wie vor eine seltene Entität: Fallserie von 16 Patienten

BACKGROUND: The marginal vein (MV) is a congenital, predominantly venous vascular malformation, which is based on a lack of regression of the embryonic venous system in the lower extremities and is associated with a variety of complications. So far, no uniform treatment regimens have been described in the literature. OBJECTIVE: What are the treatment strategies and outcomes in patients with a MV? MATERIAL AND METHODS: In the period from 1 January 2008 to 31 December 2020, all patients treated at the University Hospital Augsburg with MV were retrospectively reviewed. RESULTS: The median age at the time of diagnosis was 14.8 years (3–42 years). Out of 16 patients 12 had a leg length difference, 75% of patients (12/16) already had chronic venous insufficiency (CVI) at the time of diagnosis of MV. Open surgical removal of MV was performed as first-line treatment in 31.3% (5/16) patients. The MV was primarily closed by endovenous laser therapy (EVLT) in 1/16 patients, 15/16 patients were treated with redo procedures and 2.6 ± 2.4 (mean±SD) redo procedures were performed per patient in follow-up. The mean follow-up was 8.1 years. DISCUSSION: In order to prevent/avoid progression of CVI and thrombosis prophylaxis, the MV should be closed/removed promptly after diagnosis. The use of conventional surgical techniques for the removal of MV seems to have an advantage over treatment with minimally invasive procedures in terms of the number of secondary interventions required

Mean muscle attenuation correlates with severe acute pancreatitis unlike visceral adipose tissue and subcutaneous adipose tissue

Background: Acute pancreatitis (AP) is a frequent disorder with considerable morbidity and mortality. Obesity has previously been reported to influence disease severity. Objective The aim of this study was to investigate the association of adipose and muscle parameters with the severity grade of AP. Methods: In total 454 patients were recruited. The first contrast-enhanced computed tomography of each patient was reviewed for adipose and muscle tissue parameters at L3 level. Associations with disease severity were analysed through logistic regression analysis. The predictive capacity of the parameters was investigated using receiver operating characteristic (ROC) curves. Results: No distinct variation was found between the AP severity groups in either adipose tissue parameters (visceral adipose tissue and subcutaneous adipose tissue) or visceral muscle ratio. However, muscle mass and mean muscle attenuation differed significantly with p-values of 0.037 and 0.003 respectively. In multivariate analysis, low muscle attenuation was associated with severe AP with an odds ratio of 4.09 (95% confidence intervals: 1.61-10.36, p-value 0.003). No body parameter presented sufficient predictive capability in ROC-curve analysis. Conclusions: Our results demonstrate that a low muscle attenuation level is associated with an increased risk of severe AP. Future prospective studies will help identify the underlying mechanisms and characterise the influence of body composition parameters on AP.Peer reviewe

Total area of spontaneous portosystemic shunts independently predicts hepatic encephalopathy and mortality in liver cirrhosis

Background & Aims: Spontaneous portosystemic shunts (SPSS) frequently develop in liver cirrhosis. Recent data suggested that the presence of a single large SPSS is associated with complications, especially overt hepatic encephalopathy (oHE). However, the presence of >1 SPSS is common. This study evaluates the impact of total cross-sectional SPSS area (TSA) on outcomes in patients with liver cirrhosis. Methods: In this retrospective international multicentric study, CT scans of 908 cirrhotic patients with SPSS were evaluated for TSA. Clinical and laboratory data were recorded. Each detected SPSS radius was measured and TSA calculated. One-year survival was the primary endpoint and acute decompensation (oHE, variceal bleeding, ascites) was the secondary endpoint. Results: A total of 301 patients (169 male) were included in the training cohort. Thirty percent of all patients presented with >1 SPSS. A TSA cut-off of 83 mm2 was used to classify patients with small or large TSA (S-/L-TSA). Patients with L-TSA presented with higher model for end-stage liver disease score (11 vs. 14) and more commonly had a history of oHE (12% vs. 21%, p <0.05). During follow-up, patients with L-TSA experienced more oHE episodes (33% vs. 47%, p <0.05) and had lower 1-year survival than those with S-TSA (84% vs. 69%, p <0.001). Multivariate analysis identified L-TSA (hazard ratio 1.66; 95% CI 1.02–2.70, p <0.05) as an independent predictor of mortality. An independent multicentric validation cohort of 607 patients confirmed that patients with L-TSA had lower 1-year survival (77% vs. 64%, p <0.001) and more oHE development (35% vs. 49%, p <0.001) than those with S-TSA. Conclusion: This study suggests that TSA >83 mm2 increases the risk for oHE and mortality in patients with cirrhosis. Our results support the clinical use of TSA/SPSS for risk stratification and decision-making in the management of patients with cirrhosis. Lay summary: The prevalence of spontaneous portosystemic shunts (SPSS) is higher in patients with more advanced chronic liver disease. The presence of more than 1 SPSS is common in advanced chronic liver disease and is associated with the development of hepatic encephalopathy. This study shows that total cross-sectional SPSS area (rather than diameter of the single largest SPSS) predicts survival in patients with advanced chronic liver disease. Our results support the clinical use of total cross-sectional SPSS area for risk stratification and decision-making in the management of SPSS.Jonel Trebicka is supported by grants from the Deutsche Forschungsgemeinschaft (SFB TRR57, CRC1382), Cellex Foundation and European Union’s Horizon 2020 research and innovation program GALAXY study (No. 668031), LIVERHOPE (No. 731875) and MICROB-PREDICT (No. 825694) and the Cellex Foundation. Joan Genescà is a recipient of a Research Intensification grant from Instituto de Salud Carlos III, Spain. The study was partially funded by grants PI15/00066, and PI18/00947 from Instituto de Salud Carlos III and co-funded by European Union (ERDF/ESF, “Investing in your future”). Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivasis supported by Instituto de Salud Carlos III. Macarena Simón-Talero is a recipient of the grant JR 17/00029 from Instituto de Salud Carlos II

Biomechanische in-vitro-Untersuchung des Stabilisierungspotentials des Gamma-3-Nagels und des Proximalen Femurnagels bei der Versorgung der pertrochantären Fraktur unter zyklischer physiologischer Belastung

In der vorliegenden Arbeit wurden anhand einer in-vitro-Untersuchung das Stabilisierungspotential von Gamma-3-Nagel und PFNA paarweise in humanen Kadaverfemura miteinander verglichen. Die biomechanische Testung erfolgte in einem eigens entwickelten Prüfstand, der ein menschliches Gangbild simuliert. Hierbei wird der resultierende Kraftvektor auf dem Femurkopf dynamisch simuliert, und kann bezüglich der Kraftstärke eingestellt werden. Die Grundlage dafür ist eine aus der physiologischen Gangbildkurve (Bergmann et al.) abgeleitete winkelgerechte Belastungsfunktion. Die auftretenden Verformungen in Form von Rotation und Cut-out (Kippwinkel) wurden optisch über Infrarotkameras erfasst. Am Knochenimplantatverbund angebrachte Positionsmarker erlauben die Verformungen kontinuierlich zu zu messen. Die erste Gruppe der zu vergleichenden humanen Spenderfemura, mit A2.2 Fraktur nach AO, wurden jeweils mit einem Gamma-Nagel und einem PFNA in exakt zentrischer Position versorgt. Um eine genaue Positionierung zu garantieren, wurde diese röntgenographisch vor und nach den Versuchen kontrolliert. Die Belastung erfolgte in festgelegten Belastungsstufen bis zu einer Maximallast von 1150 N. Diese Belastung entsprach im Mittel einer Last von 0,7-1.3 BW. Dabei zeigte sich, dass kein signifikanter Unterschied zwischen dem Verhalten des PFNA und des Gamma 3 besteht. Unabhängig vom Nageltyp treten innerhalb der ersten 1000 Zyklen die größten Winkelveränderungen (Rotation und Cutout) auf. Danach steigen mit zunehmender Laststufe die Winkel an und erreichen für die Rotation ein Maximum von 6º und der Kippwinkel (Cutout) einen Maximalwert von 4 º. Implantatversagen trat nicht auf. Die Femura der zweiten Gruppe wurden ebenfalls mit zentrischer Klingenposition versorgt, allerdings wurden die Belastungsniveaus, dem jeweiligen Spenderknochen angepaßt, auf 1,4-2,3 BW erhöht. Die resultierenden Winkelveränderungen zeigten aber ebenfalls keine signifikant meßbaren Unterschiede im Stabilisierungspotential der beiden Implantattypen. Bei der dritten Gruppe wurde die Klinge stark exzentrisch eingebracht. Diese Position sollte eine eventuelle operative Ungenauigkeit simulieren. Um die Grenzen des Implantats auszuloten wurde bei einem Teil der Femura in dieser Gruppe zusätzlich zur A2.2 Fraktur ein Frakturspalt der Breite von 5-7 mm angebracht. Die außermittige Lage des Kraftträgers und der weite Frakturspalt simulieren eine worst case Situation. Bezüglich des Cut-out ergaben sich auch hier keine nennenswerten Unterschiede. Die Winkelveränderungen fielen mit Werten unter 5º auch bei höheren Belastungen vergleichsweise gering aus. Allerdings scheint der Gamma-Nagel bezüglich Rotationsstabilität insbesondere bei höheren Belastungsstufen, ab BW 2,3, dem PFNA unterlegen zu sein. Während beim PFNA mit zunehmender Zyklenzahl und damit Belastung der Rotationswinkel kontinuierlich gering zunimmt, stieg er beim Gamma 3 zwischen dem Belastungszyklus 9000 und 10000 von 7º auf 27º an, was einen Hinweis auf eine erhöhte Instabilität ist . Beim PFNA wurde ein Maximalwert von 17º, allerdings erst viel später bei höheren Lasten nach ca. 25000 Zyklen, erreicht. Die statistische Auswertung der Hauptgruppen ergab einen hochsignifikanten Unterschied der Hauptgruppen und einen signifikanten Unterschied der Untergruppen bezüglich der Versagenswahrscheinlichkeit. Einen wesentlichen Beitrag zur Stabilisierung scheint eine mögliche Abstützung zu leisten. Bei fehlender Abstützung des Femurkopfes auf den Schaft treten deutlich größere Rotationen auf

Effects of Prenatal Treatment with Betamethasone, L-Carnitine, or Betamethasone-L-Carnitine Combinations on the Phosphatidylcholine Content and Composition of the Foetal and Maternal Rat Lung

Peer Reviewe

Glucocorticoids dexamethasone and prednisolone suppress fibroblast growth factor 23 (FGF23)

Fibroblast growth factor 23 (FGF23) is a hormone mainly secreted by bone cells. Its most prominent effects are the regulation of renal phosphate reabsorption and calcitriol (active vitamin D, 1,25(OH

Coherence and wavefront characterization of Si-111 monochromators using double-grating interferometry

A study of the coherence and wavefront properties of a pseudo-channel-cut monochromator in comparison with a double-crystal monochromator is presented. Using a double-grating interferometer designed for the hard X-ray regime, the complex coherence factor was measured and the wavefront distortions at the sample position were analyzed. A transverse coherence length was found in the vertical direction that was a factor of two larger for the channel-cut monochromator owing to its higher mechanical stability. The wavefront distortions after different optical elements in the beam, such as monochromators and mirrors, were also quantified. This work is particularly relevant for coherent diffraction imaging experiments with synchrotron sources. (C) 2010 International Union of Crystallography Printed in Singapore - all rights reserve

Safety and effectiveness of percutaneous sclerotherapy for venous disorders of the labia majora in patients with vascular malformations

Objective: The aim of this study was to evaluate the safety and clinical outcomes of percutaneous sclerotherapy of venous disorders of the labia majora in patients with vascular malformations of the lower limbs. Methods: Thirty percutaneous sclerotherapy treatments were performed over a 6-year period among 17 female patients with symptomatic venous malformation (VM) or secondary varicosis of the labia majora. Four patients were treated with sclerotherapy alone, 13 patients had additional procedures to control the VM before sclerotherapy. Polidocanol was used as sclerosant. Indications for sclerotherapy included pain, bleeding, thrombophlebitis, and swelling. Genitourinary symptoms were recorded. The number of treatments and procedure-related complications were registered. Complications were classified according to the Society of Interventional Radiology (SIR) classification system (grade A-E). The 3-month postintervention follow-up included magnetic resonance imaging, clinical examination, and a symptom-related questionnaire. If no reintervention was necessary, consultation was scheduled biannually. Results: All patients had local swelling and pain; only a fraction of the patients had further symptoms with bleeding or thrombophlebitis (47% each). Eight patients required reintervention. No major complications were observed; minor complications such as postprocedural swelling occurred in 29% (SIR grade A), pain occurred in 17% (SIR grade B), and skin blistering developed in 5% (SIR grade B). Upon follow-up examination after a median of 40 months, 76% showed complete relief of symptoms, and 23% reported partial relief. All patients reported a substantial reduction in pain (75% >5 points in visual analogue scale) and swelling (88% complete cessation). Conclusions: Percutaneous sclerotherapy is a safe and effective treatment option of VM and secondary varicosis of the labia majora