Publications by authors named "Gerald Hackl"

32 Publications

Arylesterase Activity of HDL Associated Paraoxonase as a Potential Prognostic Marker in Patients With Sepsis and Septic Shock-A Prospective Pilot Study.

Front Med (Lausanne) 2020 22;7:579677. Epub 2020 Oct 22.

Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

High-density lipoprotein (HDL) plays an essential role in the immune system and shows effective antioxidative properties. We investigated correlations of lipid parameters with the sequential organ failure assessment (SOFA) score and the prognostic association with mortality in sepsis patients admitted to intensive care unit (ICU). We prospectively recruited consecutive adult patients with sepsis and septic shock, according to sepsis-3 criteria as well as non-sepsis ICU controls. Fifty-three patients with sepsis (49% with septic shock) and 25 ICU controls without sepsis were enrolled. Dyslipidemia (HDL-C < 40 mg/l) was more common in sepsis compared to non-sepsis patients (85 vs. 52%, = 0.002). Septic patients compared to controls had reduced HDL-C (14 vs. 39 mg/l, < 0.0001), lower arylesterase activity of the antioxidative paraoxonase of HDL (AEA) (67 vs. 111 mM/min/ml serum, < 0.0001), and a non-significant trend toward reduced cholesterol efflux capacity (9 vs. 10%, = 0.091). We observed a strong association between higher AEA and lower risk of 28-day [per 10 mM/min/ml serum increase in AEA: odds ratio (OR) = 0.76; 95% CI, 0.61-0.94; = 0.01) and ICU mortality (per 10 mM/min/ml serum increase in AEA: OR = 0.71, 95% CI, 0.56-0.90, = 0.004) in the sepsis cohort in univariable logistic regression analysis. AEA was confirmed as an independent predictor of 28-day and ICU mortality in multivariable analyses. AEA discriminated well-regarding 28-day/ICU mortality in area under the receiver operating characteristic curve (AUROC) analyses. In survival analysis, 28-day mortality estimates were 40 and 69% with AEA ≥/< the 25th percentile of AEA's distribution, respectively (log-rank = 0.0035). Both compositional and functional HDL parameters are profoundly altered during sepsis. In particular, the functionality parameter AEA shows promising prognostic potential in sepsis patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fmed.2020.579677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642222PMC
October 2020

SuPAR levels in BAL fluid from patients with acute respiratory distress syndrome-a pilot study.

Crit Care 2020 09 25;24(1):576. Epub 2020 Sep 25.

Department of Internal Medicine, Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13054-020-03299-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516241PMC
September 2020

Lessons of the month 3: Intravenous poppers abuse: case report, management and possible complications.

Clin Med (Lond) 2020 03;20(2):221-223

Medical University of Graz, Graz, Austria and Austrian Red Cross, Graz, Austria.

Background: Poppers are nitrite-containing liquids, which are inhaled for their aphrodisiac and hallucinogenic effects. Despite some cases of severe poisonings, poppers are often perceived as harmless by consumers. Inhalation and ingestion of poppers are well known, but, according to our literature review, intravenous abuse has not been reported before.

Case Presentation: A 34-year-old man injected poppers intravenously for recreational purposes. He then suffered from dyspnoea and general discomfort. Upon arrival of emergency medical services, the patient was dyspnoeic with blue-grey skin colour and oxygen saturation was 82% on ambient air. Non-invasive ventilation was necessary, and he was transferred to the intensive care unit. Toluidine blue was administered because of a methaemoglobinaemia of 40% and methaemoglobin levels dropped to 0.4%. He was discharged home after a 24-hour observation. We additionally analysed the contents of the poppers bottle: isopropyl nitrite, isopropanol and acetone were detected. Possible complications and the treatment regarding intravenous administration of poppers are discussed.

Conclusion: We present the first published case of intravenous poppers abuse. Our patient suffered from methaemoglobinaemia and was rapidly discharged after treatment with toluidine blue. No specific treatment regarding the contents of the poppers bottle, apart from isopropyl nitrite, was necessary.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7861/clinmed.2019-0469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081803PMC
March 2020

Manifestation of Zollinger-Ellison Syndrome With Hypovolemic Shock.

Am J Med 2020 09 19;133(9):e460-e462. Epub 2020 Feb 19.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjmed.2019.12.037DOI Listing
September 2020

[Update - intoxications in critical care medicine].

Dtsch Med Wochenschr 2020 02 4;145(3):161-165. Epub 2020 Feb 4.

Internistische Intensivstation, Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg, Standort Nord.

While monitoring and symptomatic care is sufficient for most intoxicated patients, some develop life threatening symptoms. We present recent changes in the recommendations of the treatment in patients with calcium channel blocker, beta blocker and high dose paracetamol intoxications. Additionally, new insights in the efficacy and safety of the use of physostigmine in anticholinergic patients and beta blockers in cocaine intoxication are discussed as well as the specific considerations in the resuscitation of intoxicated patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/a-0965-3203DOI Listing
February 2020

Diagnosis of acute intoxications in critically ill patients: focus on biomarkers - part 2: markers for specific intoxications.

Biomarkers 2020 Mar 10;25(2):112-125. Epub 2020 Feb 10.

Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

In medical intensive care units, acute intoxications contribute to a large proportion of all patients. Epidemiology and a basic overview on this topic were presented in part one. The purpose of this second part regarding toxicological biomarkers in the ICU setting focuses on specific poisons and toxins. Following the introduction of anion and osmol gap in part one, it's relevance in toxic alcohols and other biomarkers for these poisonings are presented within this publication. Furthermore, the role of markers in the blood, urine and cerebrospinal fluid for several intoxications is evaluated. Specific details are presented, amongst others, for cardiovascular drug poisoning, paracetamol (acetaminophen), ethanol, pesticides, ricin and yew tree intoxications. Detailed biomarkers and therapeutic decision tools are shown for carbon monoxide (CO) and cyanide (CN) poisoning. Also, biomarkers in environmental toxicological situations such as mushroom poisoning and scorpion stings are presented.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/1354750X.2020.1725787DOI Listing
March 2020

Distribution of Chemical Phenotypes (Chemotypes) in European Agricultural Hemp (Cannabis sativa L.) Cultivars.

J Forensic Sci 2020 May 26;65(3):715-721. Epub 2019 Nov 26.

Department of Forensic Science, Landeskriminalamt (LKA) Rheinland-Pfalz, Valenciaplatz 1-7, D-55118, Mainz, Germany.

In Europe, more than 50 approved cultivars of fiber hemp (Cannabis sativa L.) are in agricultural production. Their content of psychoactive tetrahydrocannabinol (THC) is legally restricted to <0.2% (%w/w in the dry, mature inflorescences). Cannabis strains with much higher THC contents are also grown, illegally or under license for drug production. Differentiation between these two groups relies on biochemical quantification of cannabinoid contents in mature floral material. For nonflowering material or tissue devoid of cannabinoids, the genetic prediction of the chemical phenotype (chemotype) provides a suitable method of distinction. Three discrete chemotypes, depending on the ratio of THC and the noneuphoric cannabidiol (CBD), can be distinguished: a "THC-predominant" type, a "CBD-predominant" type, and an intermediate chemotype. We present a systematic genetic prediction of chemotypes of 62 agricultural hemp cultivars grown in Europe. The survey reveals the presence of up to 35% B allele-carrying individuals (representing either a THC-predominant or an intermediate chemotype) in some cultivars-which is unexpected considering the legal THC limit of 0.2% THC. The fact that 100% of the seized drug-type seeds in this study revealed at least one B allele, reflects that plant breeding efforts have resulted in a fixation of the B allele in recreational Cannabis. To guarantee a sincere forensic application based on a genetic chemotype prediction, we recommend not to classify material of unknown origin if the samples size is below nine genetically independent individuals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/1556-4029.14242DOI Listing
May 2020

Diagnosis of acute intoxications in critically ill patients: focus on biomarkers - part 1: epidemiology, methodology and general overview.

Biomarkers 2020 Feb 26;25(1):9-19. Epub 2019 Nov 26.

Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

Acute intoxications account for a significant proportion of the patient population in intensive care units and sedative medications, ethanol, illicit drugs, inhalable poisons and mixed intoxications are the most common causes. The aim of this article is to describe biomarkers for screening and diagnosis of acute intoxications in critically ill patients. For this purpose, a survey of the relevant literature was conducted, and guidelines, case reports, expert assessments, and scientific publications were reviewed. In critical care, it should always be attempted to identify and quantify the poison or toxin with the assistance of enzyme immunoassay (EIA), chromatography, and mass spectrometry techniques and this section is critically appraised in this publication. The principles for anion gap, osmol gap and lactate gap and their usage in intoxications is shown. Basic rules in test methodology and pre-analytics are reviewed. Biomarkers in general are presented in part one and biomarkers for specific intoxications including ethanol, paracetamol, cardiovascular drugs and many others are presented in part two of these publications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/1354750X.2019.1694994DOI Listing
February 2020

The conundrum of postpartum thrombotic Microangiopathy: case report and considerations for management.

BMC Nephrol 2019 03 14;20(1):91. Epub 2019 Mar 14.

Department of Internal Medicine, Intensive Care Unit, Medical University Graz, Auenbruggerplatz 15, A-8036, Graz, Austria.

Background: Microangiopathic hemolytic anemias and thrombocytopenias in pregnant or postpartum women constitute an interdisciplinary diagnostic and therapeutic challenge in the evaluation of thrombotic microangiopathies (TMA), where urgent care must be considered.

Case Presentation: We here report the case of a 21-year-old Somali woman, who was delivered by emergency caesarean section at 35 weeks of gestational age with acute dyspnea, placental abruption and gross edema due to severe preeclampsia/HELLP syndrome. After delivery, she developed acute kidney failure and thrombotic microangiopathy as revealed by kidney biopsy. The lack of early response to plasma exchange prompted extensive laboratory workup. Ultimately, the patient completely recovered with negative fluid balance and control of severe hypertension.

Conclusions: This case report emphasizes the importance to differentiate between primary TMA syndromes and microangiopathic hemolytic anemias due to systemic disorders. Delayed recovery from preeclampsia/HELLP syndrome and malignant hypertension can clinically mimic primary TMA syndromes in the postpartum period.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12882-019-1286-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417121PMC
March 2019

Homoarginine/ADMA ratio and homoarginine/SDMA ratio as independent predictors of cardiovascular mortality and cardiovascular events in lower extremity arterial disease.

Sci Rep 2018 09 21;8(1):14197. Epub 2018 Sep 21.

Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria.

Endothelial dysfunction plays a key role in development of atherosclerosis and lower extremity arterial disease (LEAD). Homoarginine, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are sensitive markers for endothelial dysfunction and independent risk factors for cardiovascular death. However, homoarginine may influence the proatherogenic effects of ADMA and SDMA suggesting homoarginine/ADMA ratio or homoarginine/SDMA ratio as further predictors for cardiovascular mortality. Therefore, we investigated the predictive value of homoarginine/ADMA ratio and homoarginine/SDMA ratio related to cardiovascular mortality and cardiovascular events in claudicant patients with LEAD. 151 patients with intermittent claudication were included in a prospective observational study (observation time 7.7 ± 2.5 years) with cardiovascular mortality as main outcome parameter and the occurrence of cardiovascular events as secondary outcome parameter. Homoarginine, ADMA and SDMA were measured by high-performance liquid chromatography at baseline. Low homoarginine/ADMA ratio and homoarginine/SDMA ratio were independently associated with higher cardiovascular mortality (HR 2.803 [95% CI 1.178-6.674], p = 0.020; HR 2.782 [95% CI 1.061-7.290], p = 0.037, respectively) and higher incidence of cardiovascular events (HR 1.938 [95% CI 1.015-3.700], p = 0.045; HR 2.397 [95% CI 1.243-4.623], p = 0.009, respectively). We observed that homoarginine/ADMA ratio and homoarginine/SDMA ratio are independent predictors for long-term cardiovascular mortality and events in claudicant patients with LEAD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-018-32607-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6155043PMC
September 2018

Candida infection of membrane oxygenator during ECMO therapy.

J Infect 2019 01 24;78(1):75-86. Epub 2018 Aug 24.

Institute of Pathology, Medical University of Graz, Austria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jinf.2018.08.011DOI Listing
January 2019

Age-dependent effects of homocysteine and dimethylarginines on cardiovascular mortality in claudicant patients with lower extremity arterial disease.

Heart Vessels 2018 Dec 26;33(12):1453-1462. Epub 2018 Jun 26.

Division of Angiology, Department of Internal Medicine, Medical University Graz, Auenbruggerplatz 15, 8036, Graz, Austria.

The association among serum homocysteine (HCY), symmetric dimethylarginine (SDMA), and asymmetric dimethylarginine (ADMA) is of interest in endothelial dysfunction, although the underlying pathology is not fully elucidated. We investigated the relationship of HCY with SDMA and ADMA regarding their long-time outcome and the age dependency of HCY, SDMA, and ADMA values in claudicant patients with lower extremity arterial disease. 120 patients were included in a prospective observational study (observation time 7.96 ± 1.3 years) with cardiovascular mortality as the main outcome parameter. Patients with intermittent claudication prior to their first endovascular procedure were included. HCY, SDMA, and ADMA were measured by high-performance liquid chromatography. Cutoff values for HCY (≤/>15 µmol/l), SDMA (≤/>0.75 µmol/l), and ADMA (≤/>0.8 µmol/l) differed significantly regarding cardiovascular mortality (p < 0.001, p < 0.001, p = 0.017, respectively). Age correlated significantly with HCY (r = 0.393; p < 0.001), SDMA (r = 0.363; p < 0.001), and ADMA (r = 0.210; p = 0.021). HCY and SDMA (r = 0.295; p = 0.001) as well as SDMA and ADMA (r = 0.380; p < 0.001) correlated with each other, while HCY and ADMA did not correlate (r = 0.139; p = 0.130). Patients older than 65 years had higher values of HCY (p < 0.001) and SDMA (p = 0.01), but not of ADMA (p = 0.133). In multivariable linear regression, age was the only significant independent risk factor for cardiovascular death (beta coefficient 0.413; 95% CI 0.007-0.028; p = 0.001). Age correlated significantly with HCY, SDMA, and ADMA. However, only age was an independent predictor for cardiovascular death. Older patients have higher values of HCY and SDMA than younger subjects suggesting age-adjusted cutoff values of HCY and SDMA due to strong age dependency.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00380-018-1210-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267409PMC
December 2018

Calculation of HAS-BLED Score Is Useful for Early Identification of Venous Thromboembolism Patients at High Risk for Major Bleeding Events: A Prospective Outpatients Cohort Study.

Semin Thromb Hemost 2018 Jun 17;44(4):348-352. Epub 2017 Nov 17.

Department of Angiology, Medical University of Graz, Graz, Austria.

The aim of this study was prospective evaluation of the performance of the HAS-BLED score in predicting major bleeding complications in a real-world outpatient cohort, during long-term anticoagulation for venous thromboembolism (VTE), treated with a broad spectrum of anticoagulants. We analyzed 111 outpatients objectively diagnosed with VTE and treated long-term with various anticoagulants. Patients were grouped in three cohorts based on the anticoagulant regimen. Calculation of the HAS-BLED score and documentation of bleeding events were performed every 6 months for 1 year. Patients with a HAS-BLED score ≥ 3 had an increased risk for major bleeding events (odds ratio [OR]: 13.05, 95% confidence interval [CI]: 0.96-692.58,  = 0.028) and a trend to higher risk for minor bleeding events as well (OR: 2.25, 95% CI: 0.87-5.85,  = 0.091) when compared with patients with a HAS-BLED score < 3.This indicates that a HAS-BLED score ≥ 3 allows for identification of patients with VTE on long-term anticoagulation at an increased risk for major bleeding events, irrespective of the anticoagulant agent used.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1607433DOI Listing
June 2018

Auricular vagal nerve stimulation in peripheral arterial disease patients.

Vasa 2017 Oct 18;46(6):462-470. Epub 2017 Sep 18.

1 Division of Angiology, Medical University of Graz, Graz, Austria.

Background: Auricular nerve stimulation has been proven effective in different diseases. We investigated if a conservative therapeutic alternative for claudication in peripheral arterial occlusive disease (PAD) via electroacupuncture of the outer ear can be established.

Patients And Methods: In this prospective, double-blinded trial an ear acupuncture using an electroacupuncture device was carried out in 40 PAD patients in Fontaine stage IIb. Twenty patients were randomized to the verum group using a fully functional electroacupuncture device, the other 20 patients received a sham device (control group). Per patient, eight cycles (1 cycle = 1 week) of electroacupuncture were performed. The primary endpoint was defined as a significantly more frequent doubling of the absolute walking distance after eight cycles in the verum group compared to controls in a standardized treadmill testing. Secondary endpoints were a significant improvement of the total score of the Walking Impairment Questionnaire (WIQ) as well as improvements in health related quality of life using the Short Form 36 Health Survey (SF-36).

Results: There were no differences in baseline characteristics between the two groups. The initial walking distance significantly increased in both groups (verum group [means]: 182 [95 % CI 128-236] meters to 345 [95 % CI 227-463] meters [+ 90 %], p < 0.01; control group [means]: 159 [95 % CI 109-210] meters to 268 [95 % CI 182-366] meters [+ 69 %], p = 0.01). Twelve patients (60 %) in the verum group and five patients (25 %) in controls reached the primary endpoint of doubling walking distance (p = 0.05). The total score of WIQ significantly improved in the verum group (+ 22 %, p = 0.01) but not in controls (+ 8 %, p = 0.56). SF-36 showed significantly improvements in six out of eight categories in the verum group and only in one of eight in controls.

Conclusions: Electroacupuncture of the outer ear seems to be an easy-to-use therapeutic option in an age of increasingly invasive and mechanically complex treatments for PAD patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1024/0301-1526/a000660DOI Listing
October 2017

Renal failure caused by a partly calcified aortic aneurysm in a patient with dabigatran therapy: A case report.

Medicine (Baltimore) 2017 Apr;96(17):e6789

Division of Angiology, Department of Internal Medicine Division of Vascular Surgery, Department of Surgery Division of Vascular and Interventional Radiology, Department of Radiology Division of Intensive Care Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

Rationale: Abdominal aortic aneurysms (AAAs) are mostly asymptomatic. If aortic aneurysms become symptomatic, complications include peripheral embolization, acute aortic occlusion, and aortic rupture. However, there are also unusual complications caused by aortic aneurysms.

Patient Concerns: An 87-old male with dabigatran therapy presented with newly developed melena and acute renal failure. Radiological imaging revealed an AAA with thrombotic and calcified deposits which affected the renal arteries.

Diagnoses: Gastrointestinal bleeding and hypercoagulation caused by renal failure which was triggered in turn due to an AAA.

Interventions: Adapted antihypertensive therapy and initiation of simvastatin 40mg once daily as well as antiplatelet therapy with aspirin 50 mg once daily due to patient's refusal of any aneurysm intervention.

Outcome: Neither bleeding event nor aneurysm rupture occurred with the adapted antihypertensive therapy, simvastatin and aspirin.

Lessons: Nonruptured AAAs can cause rare, unusual, and even life-threatening complications depending on their size and anatomical position.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000006789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413283PMC
April 2017

Waterhouse-Friderichsen syndrome due to Neisseria meningitidis infection in a young adult with thrombotic microangiopathy and eculizumab treatment: case report and review of management.

Ann Hematol 2017 May 17;96(5):879-880. Epub 2017 Feb 17.

Department of Internal Medicine, Intensive Care Unit, Medical University of Graz, Auenbruggerplatz 15, A-8036, Graz, Austria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00277-017-2951-8DOI Listing
May 2017

Invasive Candida krusei infection and Candida vasculitis of a leg ulcer in an immunocompetent patient: A case report.

Int J Infect Dis 2017 Feb 16;55:96-98. Epub 2017 Jan 16.

Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

A 71year old female Caucasian farmer without any known immunosuppression presented with a painful ulcer of her right lower leg after a trauma caused by a wood billet. There was no response to empirical antibacterial treatment. An ulcer biopsy showed an invasive Candida infection of the soft tissue and leucocytoclastic vasculitis. Voriconazole treatment was followed by wound healing. Invasive Candida infection and localized Candida vasculitis represent a rare cause of persisting leg ulcers. The similar clinical picture of chronic venous leg ulcers might blur the true cause and refractory cases should therefore promptly be processed by histopathological diagnostics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijid.2017.01.010DOI Listing
February 2017

Successful Retrieval of an Embolized Vascular Closure Device (Angio-Seal) After Peripheral Angioplasty.

Cardiovasc Intervent Radiol 2017 Jun 18;40(6):942-946. Epub 2017 Jan 18.

Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.

A 55-year-old male with peripheral arterial disease underwent angioplasty of the right lower limb arteries via antegrade femoral access. Angio-Seal closure device was used to treat the puncture site, whereby the intravascular sealing anchor accidentally embolized into the malleolar region of the right posterior tibial artery. Successful retrieval of the anchor was accomplished by a SpiderFX embolic protection device. This technique may be a useful approach to retrieve embolized foreign bodies via endovascular access.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00270-017-1565-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409923PMC
June 2017

Risk Factors for Puncture Site Complications After Endovascular Procedures in Patients With Peripheral Arterial Disease.

Vasc Endovascular Surg 2015 Oct 30;49(7):160-5. Epub 2015 Sep 30.

Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

Objective: To compare femoral access site closure techniques and to highlight risk factors for puncture site complications after lower extremity endovascular procedures.

Methods: This retrospective study included 787 patients. Procedures were performed according to a standardized protocol. Puncture site complications within 24 hours were regarded as study end points.

Results: Ninety (11.5%) puncture site complications were registered. Conventional manual compression (n = 87, 11.1%) was significantly associated with puncture site complications (odds ratio [OR] 2.08, P = .03). Body mass index > 25 kg/m(2) (OR 0.54, P = .01) and prothrombin time > 70% (OR 0.38, P = .04) were protective. All bleeding occurred in procedures >45 minutes. Blood pressure >200 mm Hg and below the knee (BTK) procedures were strong predictors for access site complications (OR 4.21, P = .01 and OR 3.33, P = .02).

Conclusions: We observed an inferiority of conventional manual compression. Age, procedure duration > 45 minutes, BTK procedures, uncontrolled hypertension, and impaired coagulation were risk factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1538574415608268DOI Listing
October 2015

Graz Critical Limb Ischemia Score: A Risk Score for Critical Limb Ischemia in Peripheral Arterial Occlusive Disease.

Medicine (Baltimore) 2015 Jul;94(27):e1054

From the Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria.

Critical limb ischemia (CLI), a frequently encountered disorder, is associated with a high rate of limb amputation and mortality. To identify patients at high risk for CLI, we developed a simple risk score for peripheral arterial occlusive disease (PAOD).In our cross-sectional study, we first evaluated 1000 consecutive PAOD patients treated at our institution from 2005 to 2007, documenting clinical symptoms, comorbidities, and concomitant medication. We calculated odds ratios (OR) in a binary logistic regression model to find possible risk factors for CLI. We then verified the score in a second step that included the 1124 PAOD patients we treated between 2007 and 2011.In the first patient group, the greatest risk factors for CLI were age ≥75 years (OR 2.0), type 2 diabetes (OR 3.1), prior myocardial infarction (OR 2.5), and therapy with low molecular weight heparins (2.8). We scored 1 point for each of those conditions. One point was given for age between 65 and 75 years (OR 1.6) as well as for therapy with cardiac glycosides (OR 1.9) or loop diuretic therapy (OR 1.5). As statin therapy was protective for CLI with an OR of 0.5, we subtracted 1 point for those patients.In the second group, we could prove that frequency of CLI was significantly higher in patients with a high CLI score. The score correlated well with inflammatory parameters (c-reactive protein and fibrinogen). We were also able to define 3 different risk groups for low (score -1 to 1), intermediate (score 2-4), and high CLI risk (score >4).We developed a simple risk stratification scheme that is based on conditions that can be easily assessed from the medical history, without any laboratory parameters. This score should help to identify PAOD patients at high risk for CLI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000001054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504640PMC
July 2015

Elevated Blood Urea Nitrogen is Associated With Critical Limb Ischemia in Peripheral Arterial Disease Patients.

Medicine (Baltimore) 2015 Jun;94(24):e948

From the Division of Angiology (TG, FH, GH, PR, PE, MB); Division of Oncology (MP); and Division of Nephrology (GS), Department of Internal Medicine, Medical University Graz, Graz, Austria.

As renal function is often impaired in atherosclerosis patients, accelerating atherosclerosis per se and creating a vicious cycle, we investigated the association of blood urea nitrogen (BUN) and critical limb ischemia (CLI) in peripheral arterial occlusive disease (PAOD) patients. Our cross-sectional study included 1521 PAOD patients, with normal and impaired renal function treated at our institution from 2005 to 2010. Patients on renal replacement therapy were excluded. The cohort was divided into tertiles according to the serum BUN levels. An optimal cutoff value for the continuous BUN was calculated by applying a receiver-operating curve analysis to discriminate between CLI and non-CLI. In our cohort, CLI increased significantly with an increase in BUN (13.1% in the first tertile, 18.7% in the second tertile, 29.0% in the third tertile, P for trend < 0.001). A BUN of 17.7  mg/dL was identified as an optimal cutoff. Accordingly, there were 2 groups of patients: 636 patients with BUN ≤ 17.7 and 885 patients with BUN > 17.7. CLI was more frequent in BUN > 17.7 patients (342 [38.6%]) than in BUN  ≤ 17.7 patients (134 [21.1%]) (P < 0.001); the same applied to prior myocardial infarction (45 [5.1%] vs 15 [2.4%], P = 0.007) and congestive heart failure (86 [9.7%] vs 31 [4.9%], P < 0.001). A BUN > 17.7 was associated with an odds ratio of 1.6 (95% confidence interval: 1.3-1.9, P < 0.001) for CLI even after the adjustment for other established vascular risk factors such as age ≥ 75 and type 2 diabetes. An increased BUN is significantly associated with a high risk for CLI and other vascular endpoints. The BUN is an easily determinable, broadly available, and inexpensive marker that could be used to identify patients at high risk for vascular endpoints.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000000948DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616554PMC
June 2015

Association of the Derived Neutrophil-Lymphocyte Ratio With Critical Limb Ischemia.

Angiology 2016 Apr 9;67(4):350-4. Epub 2015 Jun 9.

Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria

Neutrophil and leukocyte counts are laboratory parameters that reflect the systemic inflammatory response in patients with atherosclerotic diseases. Based on the means of these parameters, the derived neutrophil-lymphocyte ratio (dNLR) can be calculated. We investigated a possible association of critical limb ischemia (CLI) and the dNLR in patients with peripheral arterial disease (PAD). We performed a retrospective data analysis including 1995 patients with PAD treated at our department in the years 2005 to 2010. The cohort was divided into tertiles according to dNLR. Higher dNLR values were associated with an increased CLI rate. In the tertile with lowest dNLR, the CLI rate was 20.4%, in the second tertile the CLI rate was 26.1%, and in the third tertile the CLI rate was 36.1%. Statistical significance was shown using a Jonckheere-Terpstra test (P < .001). A high dNLR is associated with an increased rate of CLI in patients with PAD. This might be a useful parameter to highlight patients at increased risk of CLI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0003319715590701DOI Listing
April 2016

Emergency Double-Stenting and Surgery for the Successful Management of Massive Upper Gastrointestinal Bleeding Caused by Mycotic Aortic Aneurysm.

Clin Gastroenterol Hepatol 2015 Dec 23;13(13):e171-2. Epub 2015 Apr 23.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cgh.2015.04.016DOI Listing
December 2015

Changes in lipid metabolism and extension of venous thromboembolism.

Ann Nutr Metab 2014 5;64(2):122-6. Epub 2014 Jul 5.

Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

Background/aims: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are common diseases with a vast number of acquired and congenital risk factors. Disorders of the lipid metabolism are not established risk factors for venous thromboembolism (VTE) so far. However, in recent literature, associations between VTE and the metabolic syndrome, especially with elevated lipid parameters, have been described. The aim of our study was to investigate the association between the extension of VTE and changes in the lipid profile.

Methods: We included 178 VTE patients in our study; 59 patients had isolated PE, 39 patients had isolated DVT of the leg and 80 patients had both (DVT and PE). Concerning PE, we distinguished between massive and submassive PE. We evaluated plasma lipids and lipoproteins in PE and DVT patients as well as in massive and submassive PE patients.

Results: PE patients had higher levels of plasma triglycerides [median (interquartile range): 162 (109-254) vs. 136.5 (96.5-162) mg/dl, p = 0.047] and lower levels of high-density lipoprotein cholesterol (HDL-C; 52.1 ± 17.2 vs. 63.9 ± 22.7 mg/dl, p = 0.004) than DVT patients. Furthermore, PE patients were significantly older than DVT patients (59.6 ± 16.9 vs. 52.2 ± 15.5 years, p = 0.02). We were not able to find differences in lipid parameters in patients with massive PE compared to those with submassive PE. However, patients with massive PE were more obese than patients with submassive PE (body mass index 29.1 ± 4.6 vs. 26.9 ± 4.9, p = 0.012).

Conclusions: Lipid parameters and lipoproteins differ between DVT and PE patients. PE patients had higher triglyceride and lower HDL-C levels compared with DVT patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000360484DOI Listing
May 2015

Exoseal for puncture site closure after antegrade procedures in peripheral arterial disease patients.

Diagn Interv Radiol 2014 Sep-Oct;20(5):426-31

Division of Angiology, Department of Internal Medicine, Medical University Graz, Styria, Austria.

Purpose: Exoseal is a vascular clo-sure device consisting of a plug applier and a bio-absorbent polyglycolic acid plug available in sizes 5 F, 6 F, and 7 F. In this study, we aimed to evaluate the effectiveness and safety of the Exoseal vascular closure device (Cordis Corporation, Bridgewater, New Jersey, USA) for puncture site closure after antegrade endovascular procedures in peripheral arterial occlusive disease (PAOD) patients.

Materials And Methods: In this retrospective study, a total of 168 consecutive patients who underwent an interventional procedure due to PAOD, were included. In each case, an antegrade peripheral endovascular procedure was performed via the common femoral artery using the Seldinger technique, and Exoseal 5 F, 6 F, or 7 F was used for access site closure. The primary endpoint was a technically successful application of Exoseal. All complications at the access site within 24 hours were registered as a secondary endpoint.

Results: In a group of 168 patients (64.9% men, average age 71.9±11.9 years), the technical application of Exoseal was successful in 166 patients (98.8%). Within the first 24 hours after the procedure, 12 complications (7.2%) were recorded including, three pseudoaneurysms (1.8%) and nine hematomas (5.4%). None of the complications required surgical intervention.

Conclusion: Exoseal is a safe and effective device with high technical success and acceptable complication rates for access site closure after antegrade peripheral endovascular procedures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/dir.2014.14002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463333PMC
October 2015

Idiopathic carotidynia.

Vasa 2014 Jul;43(4):287-92

Medical University, Department of Internal Medicine, Division of Angiology, Graz, Austria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1024/0301-1526/a000365DOI Listing
July 2014

The value of FDG-PET in the diagnosis of thromboangiitis obliterans--a case series.

Clin Rheumatol 2015 Apr 3;34(4):739-44. Epub 2014 May 3.

Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria,

Thromboangiitis obliterans (TAO) is an inflammatory vascular disease affecting dominantly the vessels of the extremities and is etiologically strongly associated with tobacco consumption. Different imaging techniques are generally used to exclude potential differential diagnoses. We investigated the value of (18) F-flourodeoxyglucose positron emission tomography ([(18) F]FDG-PET) in the diagnosis of TAO. All consecutive patients with diagnosed TAO between Nov 2001 and Nov 2003 at our institution who underwent [(18) F]FDG-PET in the diagnostic workup were analyzed retrospectively. Whole-body scans were conducted after a fasting period of at least 6 h and blood glucose levels lower than 180 mg/dl. The primary endpoint was defined as significantly increased vascular FDG uptake. Tracer uptake was visually determined and, in accordance with strength, divided into grades 0 to 3. In total, ten patients were statistically evaluated. The median patient age at the date of the first [(18) F]FDG-PET was 41.5 years. Repetitive FDG-PET imaging was performed in seven out of ten patients (70 %). The endpoint was objectified in one of the initial examinations (10 %) and in another one out of seven follow-up scans (14.3 %). One positive [(18) F]FDG-PET was observed in the pelvic vessels and the other in the infrapopliteal arteries. Therefore, increased tracer uptake could be observed in two examinations on two different patients (both with grade 3 tracer uptake) out of 17 conducted [(18) F]FDG-PETs in total. The [(18) F]FDG-PET was not a suitable investigative procedure for the diagnosis of TAO in the present patient cohort.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10067-014-2648-5DOI Listing
April 2015

Endothelial dysfunction and brachial intima-media thickness: long term cardiovascular risk with claudication related to peripheral arterial disease: a prospective analysis.

PLoS One 2014 16;9(4):e93357. Epub 2014 Apr 16.

Department of Internal Medicine, Division of Angiology, Medical University of Graz, Graz, Austria.

Objective: Endothelial dysfunction plays a key role in the development, progression, and clinical manifestation of atherosclerosis, and in symptomatic peripheral arterial disease, endothelial dysfunction and enlarged intima-media thickness might be associated with increased cardiovascular risk. Flow-mediated dilatation and serologic parameters are used to evaluate individual endothelial function. Brachial intima-media thickness, a less recognized parameter of cardiovascular risk, is independently associated with coronary artery disease. The aim of this study was to evaluate the prognostic value of ultrasound and serologic parameters of endothelial function in relation to cardiovascular mortality in peripheral arterial disease.

Design: monocentric, prospective cohort study.

Methods: Flow mediated dilatation and brachial intima-media thickness were assessed in 184 (124 male) patients with peripheral arterial disease (Rutherford stages 2-3). Serologic parameters of endothelial function included asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and L-homoarginine. Cardiovascular events were recorded during a follow-up of 99.1±11.1 months. Subjects who died of noncardiovascular causes were excluded from further analysis.

Results: Eighty-two patients (44.6%) died during follow-up after a mean duration of 49.7±28.3 months. There were 49 cardiovascular deaths (59.8%) and 33 other deaths (40.2%). Flow mediated dilatation was associated with cardiovascular death [1.17% (0.0, 4.3) vs. 4.1% (1.2, 6.4), p<0.001]. Intima-media thickness was greater in patients who succumbed to cardiovascular disease [0.37 mm (0.30, 0.41)] than in survivors [0.21 mm (0.15, 0.38), p<0.001]. Brachial intima-media thickness above 0.345 mm was most predictive of cardiovascular death, with sensitivity and specificity values of 0.714 and 0.657, respectively (p<0.001). Furthermore, ADMA levels above 0.745 µmol/l and SDMA levels above 0.825 µmol/l were significantly associated with cardiovascular death (p<0.001 and 0.030).

Conclusion: In symptomatic peripheral arterial disease, decreased flow mediated dilatation, enlarged intima-media thickness, and elevated levels of ADMA and SDMA were associated with increased cardiovascular risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0093357PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3989175PMC
January 2015

Progressive jugular vein thrombosis in cutaneous extramedullary plasmacytoma.

Eur J Haematol 2014 Aug 20;93(2):177-8. Epub 2014 Feb 20.

Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ejh.12281DOI Listing
August 2014