Browsing by Author "Bauer, V."

Aim: Superficial thrombophlebitis is a common complication of advanced varicosis. Besides the symptomatic complaints patients have a considerable risk of thromboembolic events. The aim therapy is the reduction of both the inflammatory pain and the thromboembolic risk. The two common types of surgical treatment are the ligation of the greater saphenous vein at the saphenofemoral junction or ligation plus stripping of the phlebitic vein. According to recent studies the latter shows better symptomatic outcomes. Patients and method: The present study describes an outpatient, primary operation technique using cryo-stripping. Between 1998 and 200165 patients were treated: 44 patients showed a stadium I according to Verrel, 20 patients a stadium II, and 1 patient a stadium IV. Results: No relevant complications after operation occurred. After one week 97% of the patients were almost free of complaints. In more than 90% of the cases the phlebitis was almost cured. Three patients needed additional stripping. After three months one woman developed a deep vein thrombosis. A factor V Leiden mutation was detected later. Conclusion: According to our data the outpatient stripping using cryo-technique is a safe and rapidly relieving treatment of superficial thrombophlebitis.

Background and objective: The gate-keeping role of general practitioners (GPs) is currently the topic of much debate in Germany. Currently it is possible for patients in Germany to see a specialist either through referral by their GP or directly through self-referral. To determine whether the gate-keeping role of GPs has a filtering effect, we compared patients referred by their Us with self-referred patients presenting with suspected chronic venous insufficiency (CVI) to a specialist practice. Patients and methods: From September to December 2001, we prospectively recruited 316 patients seen for suspected CVI in a specialist practice for vascular surgery and phlebology. Symptoms and clinical findings were recorded using a standardized form. Results: 58.2% of patients were referred by their GPs. These patients were on average 6 years older and presented at a more advanced stage of disease than self-referred patients. No difference was found between patients with and without referral with respect to the symptoms reported or the therapy recommended by the specialist. CVI was excluded in 7.1% of patients with a referral and in 6.8% of those without a referral. Conclusions: The majority of patients consulting a specialist were referred by their GP. The more advanced disease stage of these patients indicates that a filtering process occurs in referral by GPs. However, the share of patients without referrals in whom CVI could be excluded was low and not significantly different from that of patients with referrals. This indicates that misdiagnosis due to self-referral is relatively modest. A cost reduction effect in a gate-keeper system could therefore only be small.

Aim: We describe characteristics of patients with suspected deep vein thrombosis (DVT) referred to specialists by their general practitioner (GP) and the further proceeding by the specialist. Patients and method: From August 2001 to April 2003 all 114 patients (age 15 to 91, 72 women) with suspected symptoms of DVT were prospectively recruited in a specialist practice for vascular surgery/phlebology. Symptoms and clinical findings were documented by a standard procedure. Results: 40% of the patients received a compression therapy and 18% an anticoagulation with heparin by their GP. Pain (88%) and swelling (71%) were the leading patient complaints. Physical examination revealed calf pressure pain (40%) and differences in calf circumference (56%) as the dominant results. The clinical signs were not specific enough to exclude DVT. DVT was diagnosed in 12 patient (10.5%). Varicosis (30%) and (pseudo-) radikulaere pain (20%) were the most frequent differential diagnoses. Conclusion: The proportion of diagnosed DVT in patients referred by their GPs was low. Clinical examination alone turned out as unsuitable to detect DVT. Therefore, GPs are not capable to exclude the diagnosis DVT without technical diagnostics. The determination of D-dimer concentration in connection with clinical signs could be an alternative for GPs to reduce referrals, although this concept has not been evaluated yet.