Clinical Hemorheology and Microcirculation - Volume 86, issue 1-2

Authors: Greiner, Barbara | Kaiser, Ulrich | Hammer, Simone | Platz Batista da Silva, Natascha | Stroszczynski, Christian | Jung, Ernst Michael

Article Type: Research Article

Abstract: AIM: To evaluate the usefulness of handheld ultrasound in comparison with high-end ultrasound for lesion evaluation before and after sclerotherapy in pediatric patients with venous malformations (VMs). MATERIAL AND METHODS: 10 pediatric patients prior to and after sclerotherapy were scanned by an experienced examiner using handheld ultrasound (Vscan AirTM ) and high-end ultrasound (LOGIQ E9/E10) as reference. Patients with associated venous thromboses and intralesional aneurysms had been excluded. Results were interpreted independently by two readers in consensus. RESULTS: 10 patients (4-17 years; 10.0±4.32 years; female n  = 6, male n  = 4) with 10 VMs …(4 of the head and neck region, 4 of the upper and 2 of the lower extremities) were examined. 7 phleboliths were detected. The average rating score achieved by the high-end device never was less than 4, by Vscan AirTM never less than 3. An exception was the assessment of AV fistulas. In comparison with the evaluation of variables examined, we found a significant difference between the high-end scanner and the handheld device regarding the achieved image quality. CONCLUSION: Vscan AirTM ultrasound device allows new possibilities for procedure planning and post-procedural control of pediatric patients with VMs. Show more

Keywords: Handheld ultrasound, Vscan Air, pediatric, venous malformations

DOI: 10.3233/CH-238106

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 121-131, 2024

Authors: Luderer, V. | Jung, F. | Brandenstein, M. | Stroszczynski, C. | Jung, E.M.

Article Type: Research Article

Abstract: AIM: First assessment of flow changes in the jugular veins using high resolution ultrasound vector flow. MATERIAL UND METHODS: 15 patients (8 males, 7 females) with an age range of 35 to 82 years (mean age 58.53±12.26 years) were examined by an experienced examiner using high power ultrasound equipment (Resona R9, Mindray) with probe technology (Mindray L9-3U Linear Array transducer, 2.5 to 9.0 MHz). This group was compared with five healthy subjects (mean age 35.4±13.79 years) as a reference. To assess flow changes, the color-coded duplex sonography and the novel vector flow technique were used. The evaluation was …performed of vector morphology changes, turbulence, and wall resistance measurements. RESULTS: There were changes after acute and chronic thrombosis in 9 cases, and venous compression in 7 cases. Turbulence was measurable from 0.01 % to 64.44 %, the average turbulence was 19.73±22.06 %. Wall resistance measurement showed values from 0.01 Pa to 3.14 Pa, depending on the age of the thrombosis or compression. The reference veins showed turbulence of 0.94±1.5 % and a mean wall resistance of 0.05±0.05 Pa. There are statistically significant differences between normal and thrombotic or compressed veins in terms of maximum wall stress (p  = 0.006) and mean degree of turbulence (p  = 0.012), while the difference in mean wall stress is not statistically significant (p  = 0.058). CONCLUSION: Despite still existing technical limitations, the combination of V-flow and wall stress measurements in jugular vein changes suggests a high diagnostic potential. Show more

Keywords: Thrombosis, vector-flow-imaging, high resolution ultrasound, color-coded duplex sonography

DOI: 10.3233/CH-238117

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 133-142, 2024

Authors: Strauss, Catharina | Fodor, Katharina J. | Anker, Alexandra | Kemper, Robert | Prantl, Lukas | Brébant, Vanessa | Bosselmann, Talia | Geis, Sebastian

Article Type: Research Article

Abstract: BACKGROUND: Monitoring replanted digits remains a challenging task in microsurgical units. Previous studies have indicated the perfusion index (PI), a parameter directly proportional to the blood flow, might be a useful tool. OBJECTIVE: The PI is evaluated as a monitoring tool in patients with replanted digits. METHODS: This prospective, non-interventional study includes 31 patients with revascularized or replanted digits. After successful revascularization or replantation, the PI and peripheral oxygen saturation of the affected finger and its contralateral equivalent were measured simultaneously. The values were detected by the device Radical-97® Pulse CO-Oximeter® (Masimo Corporation, 52 Discovery, Irvine, …CA 92618, USA). RESULTS: The median PI of affected fingers was 3.5±0.56 for revascularized and 2.2±0.8 for replanted fingers. The difference between the PI values of replanted digits and the healthy contralateral side was highly significant (p  < 0.0001). The area under the curve in the receiver operating characteristics was 0.92 for a PI difference > 80.49% and predicted a loss of replant with a specificity of 100% and a sensitivity of 75%. CONCLUSION: The assessment of the PI in patients with reperfusion of a vascular compromised digit is a useful tool to continuously monitor peripheral perfusion. The dynamic behavior of the PI is essential to detect perfusion disturbance. Show more

Keywords: Replanted digits, microsurgery, perfusion index, monitoring

DOI: 10.3233/CH-238120

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 143-152, 2024

Authors: Biermann, Niklas | Eschenbacher, Elisabeth | Brébant, Vanessa | Heine, Norbert | Brix, Eva | Prantl, Lukas | Anker, Alexandra M.

Article Type: Research Article

Abstract: BACKGROUND: The use of dyes like Indocyanine green (ICG) and Patent blue facilitates the identification of lymphatic vessels during lymphaticovenous anastomosis (LVA) surgery. However, some patients experience “staining failure”. In these cases, no stained lymphatic vessels can be detected, making supermicrosurgical LVA even more complex. OBJECTIVE: This study aims to investigate patient-related factors that may interfere with lymphatic vessel staining during LVA. METHODS: A retrospective study was conducted on 30 patient charts, focusing on patient characteristics and the staining quality of ICG and Patent blue dye. Statistical analyses were performed to identify correlations between variables. …RESULTS: Significant correlations were found between higher age and secondary lymphedema, longer duration of lymphedema in male patients until surgery and reoccurring cellulitis and Patent blue staining. Notably, recurrent infections to the lymphatic system resulted in inferior staining ability during LVA surgery. CONCLUSIONS: Due to staining failure the detection of functional lymphatic vessels remains challenging in LVA surgery. A more extensive preoperative workup is recommended for patients with recurrent cellulitis to optimize surgical feasibility and procedure quality in LVA treatment for lymphedema. Show more

Keywords: Lymphedema, lymphedema surgery, lymphaticovenous anastomosis, lymphaticovenous bypass, LVA, Indocyanine green, Patent blue dye, blue dye, lymphography

DOI: 10.3233/CH-238112

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 153-158, 2024

Authors: Kammerer, Sarah | Nowak, Elisabeth | Mantke, René | Jung, Friedrich | Küpper, Jan-Heiner

Article Type: Research Article

Abstract: BACKGROUND: Liver biotransformation is the major route for drug metabolism in humans, often catalysed by cytochrome P450 (CYP) enzymes. This first-pass effect can lead to hepatotoxicity and influences the bioavailability of drugs. OBJECTIVE: We aimed to establish in vitro culture systems simulating the liver first-pass to study effects of the proteasome inhibitor MG-132 simultaneously on hepatocytes and cancer cells. METHODS: The first-pass effect was simulated by conditioned medium transfer (CMT) from pre-treated HepG2 CYP3A4-overexpressing cells to either pancreatic cancer cell line PANC-1 or primary colon cancer cells, and by indirect co-culture (CC) …of liver and cancer cells in a shared medium compartment. Experimental proteasome inhibitor MG-132 was used as test substance as it is detoxified by CYP3A4. RESULTS: Cancer cells showed higher viabilities in the first-pass simulation by CMT and CC formats when compared to monocultures indicating effective detoxification of MG-132 by HepG2 CYP3A4-overexpressing cells. HepG2-CYP3A4 cells showed reduced viabilites after treatment with MG-132. CONCLUSIONS: We successfully established two different culture systems to simulate the liver first-pass effect in vitro . Such systems easily allow to study drug effects simultaneously on liver and on target cancer cells. They are of great value in pre-clinical cancer research, pharmaceutical research and drug development. Show more

Keywords: Liver biotransformation, first-pass effect, CYP3A4, MG-132, cancer cells, in vitro culture systems

DOI: 10.3233/CH-238108

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 159-168, 2024

Authors: Brébant, Vanessa | Eschenbacher, Elisabeth | Hitzenbichler, Florian | Pemmerl, Sylvia | Prantl, Lukas | Pawlik, Michael

Article Type: Research Article

Abstract: BACKGROUND: Necrotizing fasciitis (NF) is a rare but life-threatening condition in which extensive soft tissue destruction can occur very quickly if left untreated. Therefore, timely broad-spectrum antibiotic administration is of prognostic importance in addition to radical surgical debridement. AIM: This study evaluates the cases of NF in our hospital during the last ten years retrospectively with respect to the pathogens involved and their antimicrobial resistance. This approach aims to provide guidance regarding the most targeted initial antibiotic therapy. METHODS: We performed a retrospective microbiological study evaluating pathogen detection and resistance patterns including susceptibility testing of 42 …patients with NF. RESULTS: Type 1 NF (polymicrobial infection) occurred in 45% of the patients; 31% presented type 2 NF (monomicrobial infection). The most common pathogens detected were E. coli, staphylococci such as Staphylococcus aureus and Staphylococcus epidermidis, Proteus mirabilis, enterococci, and streptococci such as Streptococcus pyogenes. Twelve percent presented an additional fungus infection (type 4). Ten percent showed no cultivation. Two percent (one patient) presented cocci without specification. CONCLUSION: Most pathogens were sensitive to antibiotics recommended by guidelines. This confirms the targeting accuracy of the guidelines. Further studies are necessary to identify risk factors associated with multidrug resistant infections requiring early vancomycin/meropenem administration. Show more

DOI: 10.3233/CH-238119

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 169-181, 2024

Authors: Unbehaun, P. | Prantl, L. | Langer, S. | Spindler, N.

Article Type: Research Article

Abstract: The choice of antibiotics and length of administration in the treatment of deep sternal wound infections (DSWI) is unclear. The reason for this is the lack of studies and local differences in resistance. An increase in resistance can be observed in gram-positive cocci, which are the most frequently detected in deep sternal infections. The duration of administration is often 2- 6 weeks or longer, although the benefit of prolonged antibiotic administration has not been confirmed by studies. We evaluated the antibiotic treatment during surgical treatment, consisting of surgical wound debridement and plastic chest reconstruction. METHODS: Retrospective analysis of …patients (n  = 260) who underwent reconstructive surgery in the Department of Plastic Surgery at Leipzig University Hospital from 01.05.2012 - 31.12.2020. The duration of intake, results of microbiological swabs and resistance were investigated. RESULTS: At the time of discharge, closed wound conditions were noted in 177 of 260 cases (68.1%). The largest proportion of patients (n  = 238) was treated with a latissimus dorsi flap (91.5%). Antibiotic treatment was conducted in 206 of 260 cases (79.2%). The mean duration of antibiotic administration was 21.4 days (±17.6). Prolonged treatment over 14 days did not alter outcome (p  = 0.226), in contrast, the number of multidrug resistances (p  < 0.001). There was no prove of resistance against linezolid which is effective against the most common found infectious agents Staphylococcus epidermidis (n  = 93; 24.0 %) & Staphylococcus aureus (n  = 47; 12.1 %). CONCLUSION: There is no evidence of benefit from antibiotic therapy over 14 days, whereas multidrug resistance increases with prolonged antibiotic use. In the absence of infectious agents or clinical signs of inflammation, surgical treatment without additional antibiotic treatment is effective. Linezolid is a suitable antibiotic in the treatment of gram-positive infections which are the most frequent in DSWI. Show more

Keywords: Deep sternal wound infections, DSWI, antibiotic treatment, surgical treatment

DOI: 10.3233/CH-238121

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 183-194, 2024

Authors: Tessmann, V. | Klepetko, J. | Brochhausen, C. | Gleißner, S. | Prantl, L. | Kempa, S.

Article Type: Research Article

Abstract: BACKGROUND: Biocompatibility describes the influence of materials on their biological environment. Implant material in the human body can cause a foreign body reaction and the formation of a capsule around the foreign material. Since capsular formation is the most frequent issue after breast-implant insertion, knowledge and awareness of biocompatibility is crucial, especially since worldwide, breast augmentation continues to be the most popular plastic surgery, with over 1.6 million procedures performed in 2020, according to surveys by the International Society of Aesthetic Plastic Surgery (ISAPS). MATERIAL AND METHODS: This study includes 80 capsular samples of female patients who underwent …revision surgery after breast-implant insertion at the University Hospital Regensburg. Capsules of breast implants with different surface structures (smooth, textured and polyurethane-coated) and shapes (round-shaped, anatomically-shaped) were analyzed histologically after hematoxylin-eosin-staining in respect to capsular thickness and layer formation. RESULTS: Capsular thickness and layering showed a statistically significant difference between polyurethane-coated and smooth as well as polyurethane-coated and textured implants. Capsules around polyurethane-coated implants presented greater thickness. However, the difference between smooth and textured implants was not statistically significant. Furthermore, the shape of the implants also indicated a statistically significant difference in capsular thickness. Implants of anatomical shape resulted in a thinner capsule than round-shaped breast-implants. CONCLUSION: In conclusion, this study demonstrated a thicker capsule around polyurethane-coated breast implants and no difference in capsular thickness between smooth and textured breast implants. Anatomically shaped breast-implants presented a thinner capsule than round shaped breast-implants. Show more

Keywords: Breast implants, capsular fibrosis, histological examinations, polyurethane

DOI: 10.3233/CH-238113

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 195-203, 2024

Authors: Nghinaunye, T. | Waldeck, P. | Jung, C.G.H. | Küpper, J.-H. | Jung, F. | Braune, S.

Article Type: Research Article

Abstract: The growth of cyanobacteria can vary considerably depending on the ambient temperature. Since the optimal growth temperature for Arthrospira platensis (strain SAG21.99) is not yet known, this was investigated in the present study. The study revealed that a process temperature of 30 °C seems to be optimal for the Arthrospira strain SAG21.99 cultivation in terms of a maximum biomass productivity. This was also true for the phycocyanin content which was at 30 °C significantly higher than at 20 or 40 °C.

Keywords: Arthrospira platensis, growth, temperature, bioreactor

DOI: 10.3233/CH-238104

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 205-211, 2024

Authors: Senk, Karin | Rio Bartulos, Carolina | Wilcke, Juliane | Einspieler, Ingo | Luerken, Lukas | Baeumler, Wolf | Stroszczynski, Christian | Wiggermann, Philipp

Article Type: Research Article

Abstract: BACKGROUND: Local ablation is an important treatment for liver cancer in cases of cirrhosis. Liver failure may occur after ablation, especially in advanced liver diseases. Currently, there is no standardization for peri-interventional risk assessment. The liver maximum capacity test (LiMAx) is used to assess functional liver capacity, but there is a lack of exploration of its use in this context. OBJECTIVE: The aim of this study was to retrospectively evaluate the usefulness of peri-interventional LiMAx measurements in patients with primary or secondary liver cancer who underwent ablation treatment. METHODS: A LiMAx test was …performed at 24 hours pre- and postablation in 49 patients. Blood parameters were collected to determine liver function using MELD and ALBI scores. The results of the LiMAx test were related with these scores and to critical postintervention LiMAx values. RESULTS: LiMAx values correlated strongly with MELD and ALBI scores before the intervention and reflected the change in liver function, as shown by an increase in scores after the intervention. Notably, LiMAx values decreased during the intervention. AUC analysis for patients at risk of reaching a critical liver level after the intervention showed a cutoff value of 186μg/kg/h. CONCLUSIONS: The LiMAx test may be a valuable tool in liver ablation for both peri-interventional monitoring of liver function and preintervention risk assessment. Show more

Keywords: Liver function, ablation, liver maximum capacity test (LiMAx), Hepatocellular carcinoma, ALBI, MELD

DOI: 10.3233/CH-238107

Citation: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 213-224, 2024