Krankheitsspezifische Lebensqualität im Vergleich dreier operativer Therapien der V.-saphena-magna-Varikose

Background

Endoluminal thermic ablation of varicosis of the great saphenous vein (GSV) is often said to be connected to a better perioperative quality of life (QOL). However, in the clinical experience of the authors, this hypothesis cannot be generally applied. Results contesting this postulate can also be found in the literature. However, the majority of studies have inadequate statistical power.

Objectives

In a prospective randomized controlled intervention trial, crossectomy (high ligation)/stripping (C/S), endoluminal laser therapy (laser) and a combination of both (laser/C) were compared in terms of phlebological disease-related QOL. Patients’ QOL was assessed using a standardized questionnaire (Freiburg Life Quality Assessment-vein, FLQA-v).

Materials and methods

The FLQA-v was presented to 449 patients 2 months after surgery. The FLQA-v comprises 81 questions in the categories physical ailments, everyday life, social life, psychological wellbeing, therapy, satisfaction and occupation. The minimum number of answers to items of each scale was 75?%. The FLQA-v scales were evaluated in terms of mean, standard deviation (SD) and 95?% confidence intervals (CI). The different therapeutic strategies were compared in terms of both the FLQA-v scales and a global score.

Results

The FLQA-v was completed by 343 patients. With mean values lower than 2.5, the scales indicated good QOL. The average global score of patients in the C/S group was 1.7?±?0.5 (95?% CI 1.6–1.8), in the laser group 1.7?±?0.4 (95?% CI 1.6–1.7) and in the laser/C group 1.8?±?0.5 (95?% CI 1.7–1.8). Neither the scales nor the global score revealed a statistically significant difference between the three groups (p?=?0.782 physical ailments, p?=?0.706 everyday life, p?=?0.919 social life, p?=?0.523 psychological wellbeing, p?=?0.418 therapy, p?=?0.158 satisfaction and p?=?0.307 global score). The scale occupation was rejected because of >?25?% missing values.

Conclusion

The C/S, laser and laser/C therapeutic strategies all achieved a vast improvement in QOL compared to the preoperative situation. During the perioperative period (up to 2 months), QOL was similar for all strategies. The results are similar to those found in the literature, where, with one exception, no differences between the procedures in terms of QOL were documented, independent of the measurement instrument applied.     

Clinical characteristics and functional outcome of patients with West Nile neuroinvasive disease in Serbia

Neurologic manifestations are prominent characteristic of West Nile virus (WNV) infection. The aim of this article was to describe neurological manifestations in patients with WNV neuroinvasive disease and their functional outcome at discharge in the first human outbreak of WNV infection in Serbia. The study enrolled patients treated in the Clinic for Infectious and Tropical Diseases, Clinical Center Serbia in Belgrade, with serological evidence of acute WNV infection who presented with meningitis, encephalitis and/or acute flaccid paralyses (AFP). Functional outcome at discharge was assessed using modified Rankin Scale (mRS) and Barthel index. Fifty-two patients were analysed. Forty-four (84.6 %) patients had encephalitis, eight (15.4 %) had meningitis, and 13 (25 %) had AFP. Among patients with AFP, 12 resembled poliomyelitis and one had clinical and electrodiagnostic findings consistent with polyradiculoneuritis. Among patients with encephalitis, 17 (32.7 %) had clinical signs of rhombencephalitis, and eight (15.4 %) presented with cerebellitis. Respiratory failure with subsequent mechanical ventilation developed in 13 patients with WNE (29.5 %). Nine (17.3 %) patients died, five (9.6 %) were functionally dependent (mRS 3–5), and 38 (73.1 %) were functionally independent at discharge (mRS 0–2). In univariate analysis, the presence of AFP, respiratory failure and consciousness impairment were found to be predictors of fatal outcome in patients with WNV neuroinvasive disease (p < 0.001, p < 0.001, p = 0.018, respectively). The outbreak of human WNV infection in Serbia caused a notable case fatality ratio, especially in patients with AFP, respiratory failure and consciousness impairment. Rhombencephalitis and cerebellitis could be underestimated presentations of WNV neuroinvasive disease.     

Survival assessment of the extended-wear insulin infusion set featuring lantern technology in adults with type 1 diabetes by the glucose clamp technique

Maintaining good glycaemic control with the same infusion set for longer than 3 days may improve the quality of life of insulin pump users. The aim of the current study was to assess the efficacy and safety of the novel, extended-wear infusion set over 7 days of wear in adults with type 1 diabetes. Sixteen participants completed three identical 8-hour euglycaemic clamp experiments on Days 1, 4 and 7 of infusion set wear. Between the experiments, the participants were discharged home for routine diabetes management while wearing the same extended-wear infusion set throughout the study. Time to reach the maximum glucose infusion rate (T_GIRmax) on Day 7 was reduced by 67% compared with Day 1 (p < .001). The corresponding area under the glucose infusion rate curve (AUC_GIR) was comparable for the first 2 h of the clamp (p = .891) but decreased by 28% over time (p < .008). While the extent of insulin absorption decreased with prolonged wear, it was accompanied by an increase in insulin absorption rate. The infusion set survival rate was 100% without leakages, occlusion alarms, severe hypoglycaemia or ketoacidosis. The extended-wear infusion set proved safe and effective during prolonged wear in real-life conditions.     

Endoscopic retrograde cholangiopancreatography and liver biopsy in the evaluation of elevated liver function tests after liver transplantation

BACKGROUND Abnormal liver function tests(LFTs) in post-liver transplant(LT) patients pose a challenge in the timing and selection of diagnostic modalities.There are little data regarding the accuracy of endoscopic retrograde cholangiopancreatography(ERCP) and liver biopsy(LB) in diagnosing post-transplant complications.AIM To evaluate the diagnostic performance of ERCP and LB in patients with nonvascular post-LT complications.METHODS This single-center retrospective study evaluated patients undergoing both ERCP and LB for evaluation of elevated LFTs within 6 mo of LT from 2000 to 2017.Diagnostic operating characteristics including accuracy,sensitivity and specificity for various diagnoses were calculated for ERCP and LB.The R factor(ratio of alkaline phosphatase to alanine aminotransferase) was also calculated for each patient.RESULTS Of the 1284 patients who underwent LT,91 patients(74.7% males,mean age of 51)were analyzed.Anastomotic strictures(AS,24.2 %),acute cellular rejection(ACR,11 %) and concurrent AS/ACR(14.3 %) were the most common diagnoses.ERCP carried an accuracy of 79.1%(95 % CI:69.3-86.9),LB had an accuracy of 93.4%(95 % CI:86.2-97.5),and the combination of the two had an accuracy of 100%(95 % CI:96-100).There was no difference between patients with AS and ACR in mean R factor(AS:1.9 vs ACR:1.1, P=0.24).Adverse events did not differ between the two tests(ERCP:3.1% vs LB:1.1%,P=0.31).CONCLUSION In patients with abnormal LFTs after LT without vascular complications,the combination of LB and ERCP carries low risk and improves diagnostic accuracy over either test alone.     

The Rheometric Analysis of the Polymer Modifier’s Properties in the Environment of Hydrated Cement

This paper investigates the effect of polymer modifiers (re-dispersible powder, multifunctional additives, methylhydroxyethylcellulose) on the rheological behavior of emulsions, saturated of calcium hydrosilicates to simulate a hydrating cement structure. The subjects of the study were modified emulsions which had varied concentrations of each additive and they were examined comparatively to a base emulsion. Tests were performed with a CR-rheometer (“Himpribor-1”, Tula, Russia) applying the Searle measuring principle at various shear rates to characterize viscosity properties. The performance of modified mixtures within the operating period was analyzed by using two parameters—effective viscosity (η) and the proportion of structural failure (|m|). The test results showed that the most important factor influencing rheological characteristics is the addition of methylhydroxyethylcellulose additive—the higher additive amount in the emulsion, the higher the viscosity. Furthermore it was noted in the work that adding olefin sulfonate sodium salt causes reduced viscosities as well as lower shear moduli. If ethylhydroxyethylcellulose and ethylene vinyl acetate additives are used in the same mixture together, the rate of structural failure |m| can be relatively similar and low regardless of whether the mixture has large or small viscosity values.     

Factors influencing outcome and incidence of long-term complications in children who underwent autologous stem cell transplantation for acute myeloid leukemia in first complete remission

To evaluate factors influencing outcome and incidence of long-term complications, we analyzed, in a retrospective, multicenter study, 387 children who underwent autologous hematopoietic stem cell transplantation (HSCT) for acute myeloid leukemia (AML) in first complete remission (CR). Median follow-up time from transplantation was 60 months. Transplantation of bone marrow cells was performed in 318 children, whereas in 60 patients peripheral blood progenitor cells (PBPCs) were used. In multivariate analysis, we investigated the variables influencing probability of hematopoietic recovery, transplantation-related mortality (TRM), relapse, and leukemia-free survival (LFS). We found that use of PBPCs as stem cell sources and use of BCNU (N,N-bis[2-chloroethyl]-N-nitrosourea), amsacrine, VP-16, and cytosine arabinoside (BAVC) as a preparative regimen were associated with faster neutrophil recovery. Infusion of PBPCs, young age of patients, use of BAVCs, and absence of marrow purging predicted an accelerated platelet reconstitution. The 5-year Kaplan-Meier estimates of TRM, relapse, and LFS were 3% +/- 1%, 39% +/- 3% and 60% +/- 3%, respectively. Relapse probability was increased in children given the BAVC regimen, and it was decreased after in vitro purging of hematopoietic progenitors and in children with a French-American-British classification of M3 and a time interval of 170 days or more between CR and HSCT. These 2 latter variables favorably influenced the probability of LFS, which was, by contrast, reduced with the BAVC regimen. Thirty-three percent of patients surviving more than 18 months experienced at least one late sequela; use of total body irradiation was the only predictive factor. The results obtained in this analysis can be of help in designing prospective studies of autologous HSCT in children with AML in first CR.     

One-Year Follow-up of Duodenal Ulcers after 1-Wk Triple Therapy for Helicobacter pylori

Objective : to study the ulcer recurrence rate of Helicobacter pylori-positive duodenal ulcers at 1 yr after eradication of the bacteria by triple therapy. Method : Patients with H. pylori-positive duodenal ulcers were randomized to receive either triple therapy for 1 wk plus omeprazole for 4 wk (THple+OMP) (n = 78), or omeprazole alone (OMP) for 4 wk (N = 77). Patients were followed up every 3 months for symptom enquiry. At 1 yr, all asymptomatic patients were invited to attend for gastroscopy. Results : At 8 wk, 16 patients in the OMP group and four in the Triple+OMP group had an ulcer. During the 1-yr period, 12 patients in the OMP group and no patient in the Triple+OMP group developed symptomatic ulcers. At follow-up endoscopy at 1 yr, another 10 ulcers were detected in the OMP group and two in the Triple+OMP group. Fifteen patients in the OMP group and 13 in the Triple+OMP group were lost to follow-up. In total, ulcers were de-tected in 39 of 61 (64%) assessahle patients in the OMP group, and in six of 65 (97o) assessahle patients in the Triple+OMP group after I yr (χ² test: p < 0.001). Of the patients whose H, pytori were successfully eradicated hy Triple+OMP at 8 wk, 90% remained H. pylori negative at 1 yr. Conclusion : Triple therapy for 1 wk eradicates H, pylori infection and significantly reduces duodenal ulcer relapses.