Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis: 1-year follow-up data of a randomized-controlled trial

Essentials Acute iliofemoral deep vein thrombosis can be treated with catheter-directed thrombolysis (CDT). We performed a randomized trial comparing conventional CDT versus ultrasound-assisted CDT (USAT). Clinical and duplex sonographic outcomes at 12 months were similar in the CDT and USAT groups. In both groups, incidence of postthrombotic syndrome was very low with good quality of life.

SUMMARY

Background In patients with acute iliofemoral deep vein thrombosis (IFDVT), catheter-directed thrombolysis (CDT) aims to prevent the postthrombotic syndrome (PTS). Adding intravascular high-frequency, low-power ultrasound energy to CDT does not seem to improve the immediate thrombolysis results but its impact on clinical outcomes at 12 months is not known. Patients/Methods In this randomized-controlled trial, 48 patients (mean age 50 ± 21 years; 52% women) with acute IFDVT were randomized to conventional CDT (n = 24) or ultrasound-assisted CDT (USAT; n = 24). In both groups, a fixed-dose thrombolysis regimen (20 mg r-tPA over 15 h) was used, followed by routine stenting of residual venous obstruction. At 12 months, PTS and venous disease severity (Villalta score and revised Venous Clinical Severity Score [rVCSS]), disease-specific quality of live (QOL; CIVIQ-20) and duplex-sonographic outcomes were assessed. Results Among the 45 surviving patients, 40 (89%; 95% confidence interval [CI] 76-96%) patients were free from PTS (defined as Villalta score < 5 points; 83%, 95% CI 61-95% in the USAT and 96%, 95% CI 77-100% in the CDT group), with a similar mean total Villalta score of 2.3 ± 2.9 vs. 1.7 ± 1.6, and a mean total rVCSS of 3.0 ± 3.5 vs. 2.7 ± 2.9 in the USAT and the CDT groups, respectively. Both groups had good disease-specific QOL with a CIVIQ-20 score of 29.4 ± 11.8 vs. 26.1 ± 7.8, respectively. Primary (100% vs. 92%) and secondary (100% vs. 96%) iliofemoral patency rates and presence of femoro-popliteal venous reflux (39% vs. 33%) were similar in both groups. Conclusion The addition of intravascular ultrasound energy to conventional CDT for the treatment of acute IFDVT did not have any impact on relevant clinical or duplex sonographic outcomes, which were favorable in both study groups. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier:NCT01482273.

Material Requirements For High Voltage, High Power Igbt Devices

The two basic package types of current IGBT modules, which evolved from opposing requirements of traction and power transmission applications, are presented. It is shown that reliability and lifetime aspects given by traction puts most stringent limitations on the choice of materials at given cost targets. The materials used today for high power packaging and the future developments of high power IGBT-packages are discussed.

Arzneimittelgebrauch und gesundheitliche Selbsteinschätzung selbstständig lebender, älterer Hamburger

Self-perceived health as reported by elderly persons is of prognostic value and corresponds with morbidity and mortality. In the present study, information about the utilisation of medication, visits to the doctor, and self-perceived health was provided by standardised self-reports. The study sample included 804 independent community-dwelling persons 60 years and older. These persons were recruited from the patient lists of 14 general practices in Hamburg. Exclusion criteria were dementive disorders and the need of personal care. On average, there were 3 prescribed drugs and 1 over-the-counter medication per person. The number of medications corresponds to a mean of 2 chronic disorders. Almost 50% of the participants reported suffering from pain, with more than one-third rating their pain intensity as moderate or high. Furthermore, nearly half of the study population stated their self-reported health as moderate or poor, and one-fifth reported symptoms of depressed mood. There were discrepancies between the reports of pain or depressed mood and the corresponding use of medication. It seems that self-reported symptoms and self-perceived health in elderly persons should be considered more often in drug prescribing.

[Immunoadsorption of anti-B antibodies as preparation for an ABO-incompatible kidney transplantation]

AB0-incompatible kidney transplantation involves major risk of early acute vascular rejection. We report for the first time the successful preparation for renal homografting of a recipient of an HLA-haplotype identical, AB0 blood group B-incompatible renal homograft from a living related donor by immunoadsorption for removal of B blood group antibodies at days -4, -2 and -1. The iso-agglutinin anti-B titer was 1:256 before and 1:8 after three adsorption sessions in extracorporeal circuit. Before and after transplantation the splenectomized recipient was given azathioprine, prednisone and cyclosporine A. After homografting the anti-B iso-agglutinin and the anti-B isoimmune titers were mostly below 1:8 and never exceeded 1:32 and 1:64 respectively. 111 days after transplantation the recipient had a creatinine concentration in plasma of 160-180 mumol/l and was free of infectious complications. Thus the introduction of specific and convenient immunoadsorption of blood group antibodies by pheresis for preparation of renal homograft recipients may in future extend the indications for kidney transplantation in AB0-incompatible subjects, who have so far been denied the benefit of a living renal homograft.