Clinical Hemorheology and Microcirculation - Volume 71, issue 2

Authors: Ahmed, M. | Lutze, S. | Tembulatow, M. | Daeschlein, G. | Jünger, M. | Arnold, A.

Article Type: Research Article

Abstract: BACKGROUND: Chronic venous disease (CVD) is extremely common worldwide with prevalence increasing with age. It is associated with a reduced quality of life, particularly in relation to pain, physical function and mobility. Symptomatic chronic venous insufficiency (CVI) with venous ulcer at its’ endpoint, indicates interventional surgery to cure venous reflux therewith promoting wound healing and preventing recurrence. In this retrospective, single-centre, consecutive case-control study in a single patient population of a university clinic in northern Germany a holistic evaluation of varicose vein surgeries has been undertaken. Part I covered postoperative complications in relation to co-morbidities, co-medication and clinical presentation. Part …II of this article presents now the hemodynamic results in relation to the perioperative evolution of CVI specific symptoms. METHODS: Records of n  = 429 (467 extremities) patients from 2009-2013 treated with open surgery were analysed with regards to perioperative hemodynamics. Evolution of CVI symptomology was accessed postoperatively with the help of a questionnaire and patient records in the case of complication development. Venous hemodynamics was analysed in the whole patient population and with regards to complication subgroups: no events (NE), neglectable adverse events (NAE) and non-neglectable adverse events (NNAE). RESULTS: Postoperatively, patients’ CVI-symptoms like pain (p  < 0.001), swelling (p  < 0.001) and itching (p  = 0.003) significantly improved. The venous refill time and venous pump capacity improved significantly after open vein surgery (p  < 0.05). Regardless of the development of postoperative complications there was a significant improvement of venous function at 6 weeks- and one-year postoperative in follow-up (p  < 0.05). Symptom regression was strongly correlated with hemodynamic improvement. CONCLUSION: A significant improvement of patients’ symptoms was achieved by means of open-surgery, regardless of postoperative complication development. This was in accordance with the improvement of venous hemodynamics. A strong correlation between symptom regression and improvement in venous hemodynamics could be proven. Show more

Keywords: Perioperative hemodynamics, perioperative symptomology, digital photoplethysmography

DOI: 10.3233/CH-189401

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 2, pp. 117-127, 2019

Authors: Mrowietz, C. | Franke, R.P. | Pindur, G. | Sternitzky, R. | Jung, F. | Wolf, U.

Article Type: Research Article

Abstract: BACKGROUND: The laser Doppler fluxmetry (LDF) is a non-invasive method to assess skin blood perfusion, measuring the flow of blood cells inside a tissue volume without harming the tissue. In the diagnosis of skin circulation disorders, the results of the LDF measurement are generally used in such a way that “normal” (or non-ill) or “pathological” values are achieved by comparison with a reference sample, for example of apparently healthy subjects. MATERIAL AND METHODS: In this study, the values of LDF for the diagnosis of microcirculatory disorders in patients with coronary artery disease (n  = 20) or in patients …with microcirculatory disorders, already diagnosed by capillary microscopy (n  = 46), were examined. RESULTS: The mean values of LD amplitudes in the four frequency windows for patients with coronary artery disease were in the reference range. However, some of the patients showed reduced LD values: in eleven of the twenty patients, one or more mean LD amplitudes were below the reference range. Four of the eleven patients had pathologically decreased capillary erythrocyte velocities of v ery  = 0.09–0.21 [mm/s], while the other seven patients had normal blood circulation at rest. For all patients with a proven cutaneous microcirculatory disorder, the mean LD amplitude in at least one of the frequency windows FF2 to FF4 was pathologically reduced. CONCLUSION: The Laser-Doppler fluxmetry method used in the study allows the reliable diagnosis of cutaneous microcirculatory disorders. Show more

Keywords: Laser-Doppler fluxmetry, cutaneous microcirculation, atherosclerosis

DOI: 10.3233/CH-189402

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 2, pp. 129-135, 2019

Authors: Chung, Ju-Hyun | Lee, Kyung Eun | Park, Jai-Wun | Shin, Eun-Seok

Article Type: Research Article

Abstract: While fractional flow reserve (FFR) is a good diagnostic index to assess the myocardial ischemia, coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) can be used to address microvascular status without any significant epicardial disease. The independent predictors for FFR and IMR are totally different and acts differently on the macro- and micro-vascular dysfunction. In high FFR patients, low CFR and high IMR which indicates the presence of overt microvascular disease demonstrated poor prognosis. Thus, comprehensive physiological assessments using FFR, CFR and IMR could improve the ability to discriminate patients at high risk of future events.

Keywords: Microvascular dysfunction, fractional flow reserve, coronary flow reserve, index of microcirculatory resistance

DOI: 10.3233/CH-189403

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 2, pp. 137-140, 2019

Authors: Negrão de Figueiredo, G. | Mueller-Peltzer, K. | Armbruster, M. | Rübenthaler, J. | Clevert, D.A.

Article Type: Research Article

Abstract: BACKGROUND: The first method of choice for gallbladder alteration detection is the conventional ultrasound. Due to some imaging limitations, contrast-enhanced ultrasound (CEUS) has been widely used in the last years. CEUS is an additional modality that is able to depict microvessels flow and elucidate suspicious findings. OBJECTIVE: The aim of this retrospective mono-center analysis study is to evaluate the performance of CEUS in gallbladder diseases and compare it to cross-sectional imaging modalities and histopathological results as gold standard. METHODS: The retrospective study analysed 37 patients with gallbladder diseases between 2009 and 2017. All patients underwent CEUS …examinations and additional cross-sectional imaging was also performed: CT imaging on 24 (64.9%) patients, MRI imaging on 18 (48.6%) patients, CT and MRI imaging on (28.7%). CEUS images were performed and interpreted by a single physician. RESULTS: CEUS imaging results of the gallbladder showed a sensitivity and specificity of 100%, a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 100%. CT imaging of the gallbladder showed a sensitivity of 100%, specificity of 75%, PPV of 100%, and NPV of 95%. MR imaging of the gallbladder showed a sensitivity of 100%, specificity of 93%, PPV of 75%, and NPV of 100%. CONCLUSION: Ultrasound imaging plays an essential role in the evaluation of gallbladder disease. Due to additional features of contrast-enhanced ultrasound, it is possible to differentiate gallbladder pathologic alterations by depicting its micro and macrocirculation and display important malignant features that recommends prompt management. Patients with contraindications to other cross-sectional imaging modalities benefit from this safe technique. Show more

Keywords: CEUS, gallbladder, cross-sectional imaging modalities, histopathological findings

DOI: 10.3233/CH-189404

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 2, pp. 141-149, 2019

Authors: Negrão de Figueiredo, G. | Mueller-Peltzer, K. | Zengel, P. | Armbruster, M. | Rübenthaler, J. | Clevert, D.A.

Article Type: Research Article

Abstract: BACKGROUND: Radiologic imaging, especially ultrasound has an important role in the assessment of gallbladder alteration. Contrast-enhanced ultrasound (CEUS) is an easy and fast imaging technique that overcomes the limitations of greyscale ultrasonography. It is a safe tool that can be used as an additional imaging modality in order to elucidate and differentiate gallbladder pathological findings. OBJECTIVE: The aim of this retrospective study analysis is to assess the diagnostic performance of CEUS in gallbladder alterations and compare the results to the histopathological findings. METHODS: A total of 17 patients between 2009 and 2017 with uncertain gallbladder …appearance were retrospectively analysed. A single experienced physician with more than fifteen years’ experience performed CEUS examinations by applying a second-generation blood pool agent (SonoVue® , Bracco, Milan, Italy). Archived images were interpreted by the same physician and compared to the histopathological findings. RESULTS: CEUS results, when correlated to the respectively pathologic findings, presented a sensitivity of 100%, a specificity of 100%, a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 100%. All patients were successfully examined without any adverse reaction. CONCLUSION: In conclusion, the excellent results in this study acknowledged that CEUS is a feasible alternative tool to differentiate gallbladder pathologic alterations. Show more

Keywords: CEUS, gallbladder, histopathological findings

DOI: 10.3233/CH-189405

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 2, pp. 151-158, 2019

Authors: Mueller-Peltzer, K. | Negrao de Figueiredo, G. | Graf, T. | Rübenthaler, J. | Clevert, D.-A.

Article Type: Research Article

Abstract: BACKGROUND: Renal cell carcinomas (RCC) represent a heterogeneous group of hypo- and hypervascularized malignancies. Using contrast-enhanced ultrasound (CEUS) specific imaging features of clear cell (ccRCC), papillary (pRCC) and chromophobe RCC (chRCC) subtypes have been demonstrated. However, some RCCs show atypical imaging features making it difficult to distinguish between the subtypes. OBJECTIVE: This study was performed to evaluate the observed enhancement features of pRCC in CEUS and to assess the sensitivity in the diagnosis of suspected renal malignancies in a 10 year retrospective analysis at our institution. METHODS: The study population consisted of 60 …patients with histologically confirmed pRCC. All patients underwent CEUS imaging between 2005 and 2015 as part of their diagnostic workup. RESULTS: In 45 out of 60 (75%) cases the examined pRCC showed typical hypoenhancement and wash-out. 15 out of 60 (25%) pRCC showed atypical enhancement features; in 14 cases the contrast enhancement indicated a ccRCC. 1 complex cyst was falsely reported as IIF lesion. 59 out of 60 malignancies were reported as malignant using CEUS resulting in a sensitivity of 98.4%. CONCLUSIONS: CEUS is an eligible imaging technique to visualize the contrast enhancement features of pRCC. However, up to 25% of pRCCs show an atypical enhancement pattern making it difficult to distinguish it from other renal lesions. Show more

Keywords: Contrast-enhanced ultrasound, CEUS, renal cell carcinoma, RCC, enhancement features

DOI: 10.3233/CH-189406

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 2, pp. 159-164, 2019

Authors: Schlenker, B. | Apfelbeck, M. | Armbruster, M. | Chaloupka, M. | Stief, C.G. | Clevert, D.-A.

Article Type: Research Article

Abstract: INTRODUCTION: We aimed to evaluate whether PIRADS 3 lesions in multiparametric MRI (mpMRI) represent a significant risk of prostate cancer (PCa) in a real-world setting of different referring radiologic institutes. MATERIALS AND METHODS: Between May 2015 and October 2017, a total of 408 patients were referred to our clinic for MRI-ultrasound fusion targeted biopsy of the prostate (FusPbx) due to suspected prostate cancer. In all patients, preoperatively an mpMRI of the prostate was performed by altogether 62 different radiologic institutes. Prostate lesions were classified according to the PIRADS system. A PIRADS 3 lesion was diagnosed in …41 patients. FusPbx was performed transrectally using a Philips EPIQ 7 (Philips Medical Systems, Bothell, WA) scanner with plane wise fusion of ultrasound and MRI image data. In addition to FusPbx in each patient a randomized 12-core transrectal ultrasound guided biopsy (USPbx) was performed. RESULTS: Mean PSA Level was 9.5 ng/ml (range: 1– 26 ng/ml), mean patients age was 66.1 years (48.6– 80.4). In 11/41 patients (26.8%) prostate cancer was diagnosed by FusPbx of the PIRADS 3 lesion. In the target lesion PCa was classified as Gleason Score 3+3 in 5 patients, as 3+4 in 3, 4+3 in 1, 4+4 in 1 and 4+5 in 1 patient. In patients with negative FusPbx USPbx revealed PCa in another 7 patients (17.1%). In 5 of these GS 3+3 PCa was found, in another 2 patients GS 3+4 PCa. CONCLUSIONS: PIRADS 3 lesion indicates an equivocal likelihood of significant prostate cancer. In our series the overall PCa detection rate was 26.8% and 14.6% for clinically significant cancer in PIRADS 3 lesions. This evokes the question, if PIRADS 3 lesions could be surveilled only. The findings should be confirmed in a larger series. Show more

Keywords: Prostate cancer, multiparametric MRI, image fusion, PIRADS score, MRI-ultrasound fusion biopsy

DOI: 10.3233/CH-189407

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 2, pp. 165-170, 2019

Authors: Motabbakani, Noura | Lehmann, Christian

Article Type: Research Article

Abstract: Arthritis often presents with serious pain of the affected joints. The pain results mainly from underlying inflammatory processes initiated by the immune response to the degenerative structural changes within the joints and is associated with microvascular vasodilation that increases articular blood flow. Laser Doppler-based methods facilitate reliable quantification of microvascular perfusion. We hypothesize that laser Doppler-based measurements of periarticular blood flux can be utilized for assessment of arthritis pain in patients.

DOI: 10.3233/CH-189408

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 2, pp. 171-174, 2019

Authors: Krüger-Genge, Anne | Fuhrmann, Rosemarie | Franke, Ralf-Peter | Jung, Friedrich

Article Type: Research Article

Abstract:  Polymers are often contaminated with lipopolysaccharides also known as endotoxins. Even small amounts of endotoxins can have strong effects on endothelial cell function so that the endothelialisation of cardiovascular implants might be hampered. An open question is how endothelial cells seeded on a body foreign substrate respond to shear load after adding Lipid A (LPA), the domain, which is responsible for much of the toxicity of gram-negative bacteria, and whether morphological changes of endothelial cells occur. LPA supplementation to the culture medium in increasing concentrations (5, 25 and 50μ g/ml) resulted in progressive reductions of the density of adherent …HUVEC after shear load (p  < 0.001). 48% of the HUVEC in control cultures (0μ g/ml LPA) were still adherent after 2 hours of shearing at 6 dyne/cm2 , while 80 minutes after addition of 50μ g/ml LPA, 88% of the HUVEC had already detached from the substrate and after 100 minutes no more HUVEC were attached. The results demonstrate that endotoxins are of extreme importance for the behavior of HUVEC and that in vivo pathologies can be increasingly simulated in vitro . Show more

Keywords: Endotoxin, endothelial cells, lipopolysaccharides

DOI: 10.3233/CH-189409

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 2, pp. 175-181, 2019

Authors: Reinthaler, Markus | Johansson, Johan Bäckemo | Braune, Steffen | Al-Hindwan, Haitham Saleh Ali | Lendlein, Andreas | Jung, Friedrich

Article Type: Research Article

Abstract: Circulating blood cells are prone to varying flow conditions when contacting cardiovascular devices. For a profound understanding of the complex interplay between the blood components/cells and cardiovascular implant surfaces, testing under varying shear conditions is required. Here, we study the influence of arterial and venous shear conditions on the in vitro evaluation of the thrombogenicity of polymer-based implant materials. Medical grade poly(dimethyl siloxane) (PDMS), polyethylene terephthalate (PET) and polytetrafluoroethylene (PTFE) films were included as reference materials. The polymers were exposed to whole blood from healthy humans. Blood was agitated orbitally at low (venous shear stress: 2.8 dyne · …cm–2 ) and high (arterial shear stress: 22.2 dyne · cm–2 ) agitation speeds in a well-plate based test system. Numbers of non-adherent platelets, platelet activation (P-Selectin positive platelets), platelet function (PFA100 closure times) and platelet adhesion (laser scanning microscopy (LSM)) were determined. Microscopic data and counting of the circulating cells revealed increasing numbers of material-surface adherent platelets with increasing agitation speed. Also, activation of the platelets was substantially increased when tested under the high shear conditions (P-Selectin levels, PFA-100 closure times). At low agitation speed, the platelet densities did not differ between the three materials. Tested at the high agitation speed, lowest platelet densities were observed on PDMS, intermediate levels on PET and highest on PTFE. While activation of the circulating platelets was affected by the implant surfaces in a similar manner, PFA closure times did not reflect this trend. Differences in the thrombogenicity of the studied polymers were more pronounced when tested at high agitation speed due to the induced shear stresses. Testing under varying shear stresses, thus, led to a different evaluation of the implant thrombogenicity, which emphasizes the need for testing under various flow conditions. Our data further confirmed earlier findings where the same reference implants were tested under static (and not dynamic) conditions and with fresh human platelet rich plasma instead of whole blood. This supports that the application of common reference materials may improve inter-study comparisons, even under varying test conditions. Show more

DOI: 10.3233/CH-189410

Citation: Clinical Hemorheology and Microcirculation, vol. 71, no. 2, pp. 183-191, 2019