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Knut Kröger, Gabor Gäbel, Benjamin Juntermanns Department of Vascular Medicine, HELIOS Clinic Krefeld, Krefeld, GermanyCorrespondence: Knut KrögerDepartment of Vascular Medicine, HELIOS Clinic Krefeld, Lutherplatz 40, Krefeld 47805, GermanyTel/Fax +49 2151 321669Email Knut.kroeger@helios-gesundheit.deAbstract: Wound healing is a complex and orchestrated process. Oxygen is one of the molecules that is required throughout the wound healing continuum for various underlying processes from innate immune response at the inflammatory phase to building of collagen type III at the remodelling phase. Therefore, it is not surprising that, due to primary diseases like venous insufficiency and diabetes mellitus, hypoxia caused by sustained lack of oxygen is common in chronic wounds. Adjunct to systemic therapies of the primary disease aimed at revascularizing the tissue, recently developed technologies are now available that provide topical oxygen-enhanced wound healing. Several devices are designed to provide pure oxygen directly to the wound either with or without pressure. Another approach to the provision of additional topical oxygen is to use haemoglobin to facilitate oxygen diffusion. This phenomenon was first shown more than 50 years ago, but it has only recently been discovered as a means of improving wound healing. In vitro and in vivo studies have shown that haemoglobin is capable of transporting oxygen outside of erythrocytes. Furthermore, several clinical studies have shown a beneficial effect on wound healing in different wound types. In this review, we summarise publicly available in vitro and in vivo clinical data and discuss the acceptability and ease of use of haemoglobin spray (Granulox®) in the management of chronic wounds. In conclusion, currently available data are promising, demonstrating that purified haemoglobin in an aqueous solution is able to serve as an oxygen shuttle by facilitating diffusion. No severe side effects have been reported in the literature, implying that it is a safe product. In clinical studies, it has been observed to improve the speed of healing of different types of chronic wounds. As a simple spray, it can be used as adjunct treatment in many standard-of-care settings with only a few limitations.Keywords: oxygen, hypoxia, facilitated diffusion, topical oxygen therapy, wound healing, oxygen carrier

SummaryVenous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0% were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5%). The diagnosis was deep-vein thrombosis (DVT) in 59.5% and pulmonary embolism (PE) in 40.5%. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5%), hypertension (42.3%) and dyslipidaemia (21.1%). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2%), almost half received a vitamin K antagonist (48.7%) and nearly a quarter received a DOAC (24.5%). Almost a quarter of all presentations were for recurrent VTE, with >80% of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes.

Background: The aim of the present case series was to study the presence of osteonecrosis of the lunate bone in patients with systemic sclerosis (SSc). Methods: 9 SSc patients (5 limited and 4 diffuse SSc) were evaluated by clinical examination, radiography of the hands, low-field magnetic resonance[for full text, please go to the a.m. URL], 42. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh); 28. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh); 24. wissenschaftliche Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR)

PURPOSE Of the study was to examine the ranking of radiographs and bone scans in the diagnosis of osteitis. PATIENTS AND METHODS 115 patients with arterial occlusive disease in stage Fontaine i.v. were referred for examination of the peripheral skeletal parts of the lower extremity. 126 radiographs and bone scans were taken. The time between the two examinations was 10 days maximum to enable direct comparison. Leukocyte scintigraphy was employed as gold standard. RESULTS The sensitivity of radiographs was 47% with a specificity of 91%. Sensitivity and specificity of bone scans was 78% for both values. The positive predictive values for radiographs and bone scans were 88% and 85%, the negative predictive values were between 80% and 97%. CONCLUSION In the majority of cases osteitis can be diagnosed with relatively inexpensive methods such as conventional x-rays and bone scans. Only in unclear cases further examinations such as leukocyte scintigraphy or magnetic resonance imaging should supplement the diagnosis.

The SERPENT Project, Scientific & Environmental ROV Partnership using Existing iNdustrialTechnology, is a collaboration between world leading scientific institutions and companiesassociated with the oil and gas industry. SERPENT is hosted at the National OceanographyCentre, Southampton (NOCS), one of the worlds’ largest research and teaching organisationsspecialising in deep-sea science and oceanography. SERPENT encompasses a scientific networkof academic partners across the world (USA, Canada, Brazil, Africa, Australia), linked to anetwork of major oil and gas operators and contractors. The project centres around theopportunistic use of ROVs (Remotely Operated Vehicles) in operational settings during periods ofstand-by time. The project also aims to maximise the scientific benefit of environmental datacollected as part of routine offshore operations and environmental surveys. Through access toROVs and such environmental data scientists at NOCS and from the wider SERPENT partnershipaim to improve the scientific understanding of the deep-sea's biodiversity in all its aspects. Thisdocument presents the cruise reports for SERPENT missions carried out from 2008 to 2010 andincludes a history of all previous SERPENT missions.

In case of clinical symptoms of subclavian vein thrombosis a phlebographic or color Doppler sonographic investigation should be performed. Phlebography is a sensitive method to exclude the thrombosis in the subclavian vein but not in the jugular vein. Color Doppler sonography additionally gives information about the surrounding tissue and the jugular vein. The authors analyze their color Doppler sonographic data, first, to evaluate the association of internal jugular and subclavian vein thrombosis and, second, to demonstrate the necessity for a color Doppler investigation. Of 213 patients who suffered from a thrombosis, 93 had a subclavian vein thrombosis, 64 had a combined thrombosis in the internal jugular and subclavian vein, and 56 had an isolated internal jugular vein thrombosis. There is a high association between subclavian and internal jugular vein thrombosis, and a color Doppler investigation of both the subclavian and internal jugular veins is necessary.

Arterienverletzungen als direkte Traumafolge fuhren meist zur Blutung oder Ischamie. Im Bereich der durch 2 Arterien versorgten Hand kann die akute Ischamie fehlen. Das Hypothenar-Hammer-Syndrom stellt einen Verschlus der distalen A. ulnaris als Folge eines Traumas dar. Abhangig von der Verletzungsart ist der klinische Beginn meist schleichend und erst eine gezielte duplexsonographische oder angiographische Untersuchung fuhren zur Diagnose. Bewahrte Therapieempfehlungen gibt es nicht. Die Diagnostik des Verschlus der Arteria ulnaris als Unfallfolge ist fur den Patienten wichtig und macht einen Therapieansatz erst moglich.

1. Upper limb venous thromboses are considered to be a rare event, but in large hospitals with a lot of patients who receive aggressive intravenous therapy the number of thromboses seem to increase. 2. We have analysed all the cases of upper limb venous thrombosis which occurred at the Essen University Hospital between the years of 1992–1996. All patients were examined using colour Doppler sonography. 3. Out of 827 patients that were examined, a thrombosis was diagnosed in 334 cases. The subclavian vein was involved in 69% of all thromboses. Isolated jugular vein thrombosis was found in 17% of the thromboses, combined thromboses of the jugular and subclavian vein in 19%. In 182 cases the patients were treated for primarily a malignant illness. In 96 cases we found an association with venous port-systems or central venous catheters. 4. More than 40000 patients a year were treated at the university hospital. Considering this huge number of patients the thrombosis of the upper limb is still rare. The use of colour Doppler sonography allows an early and safe diagnosis of the thrombosis without straining the patient.

Hintergrund: Chronische Venenleiden gehören in der westlichen Welt zu den häufigsten Erkrankungen. Es wurde die Wirkung von Entbindungen und der Einnahme weiblicher Sexualhormone auf die Inzidenz chronischer Venenerkrankungen untersucht. Material und Methoden: Es wurden Daten von 1110 Frauen (18-79 Jahre) der prospektiven bevölkerungsbasierten Bonner Venenstudie (2000-2008) verwendet. Inzidente Venenerkrankungen wurden während der Nachbeobachtung von durchschnittlich 6,6 Jahre nach der CEAP-Klassifikation eingeteilt. Eine Varikosis wurde definiert als Stadium C2-C6, primäre Ätiologie und mindestens eine Veränderung an subkutanen Venen. Eine chronisch-venöse Insuffizienz (CVI) bestand bei C3-C6. Schwere CVI wurde definiert als C4-C6. Venöser Reflux wurde mittels Duplex-Sonographie gemessen und ab 500 ms als pathologisch gewertet. Als Risikofaktoren wurden die Anzahl der Entbindungen und die Einnahme weiblicher Sexualhormone (orale Kontrazeptiva (OC) und postmenopausale Hormonersatztherapie (HRT)) untersucht. Krude und adjustierte Relative Risiken (RR) mit 95% Konfidenzintervall wurden mittels SPSS 19 berechnet. Ergebnisse: Zum Zeitpunkt der Basisuntersuchung hatten 775 Frauen keinen Reflux, 822 Frauen keine Varikosis und 915 Frauen keine CVI. Die Response für die Zweiterhebung betrug 84,6%. Nach Adjustierung für Alter und Bildung zeigt sich für Anzahl Entbindungen und CVI ein positiver Gradient: 1 Entbindung RR=1,54 (95%KI 0,71-3,34), 2 Entbindungen RR=2,06 (95%KI 0,99-4,28), 3 Entbindungen RR=2,22 (95% KI 0,94-5,21), 4+ Entbindungen RR=5,69 (95%KI 2,13-15,19). Ähnliche Trends finden sich für die Endpunkte Reflux und Varikosis. Nach Adjustierung für Alter, Bildung und BMI zeigt die Einnahme von OC einen Trend hin zu protektiven Effekten für alle Endpunkte: schwere CVI: RR=0,40 (95% KI 0,16-0,99), CVI insgesamt: RR=0,76 (95%KI 0,46-1,26), Varikosis RR=0,64 (95%KI 0,39-1,05), und venöser Reflux RR 0,87 (95%KI 0,52-1,45). Die Durchführung einer HRT ist mit einem erhöhten Risiko für Reflux assoziiert (RR=3,34, 95%KI 1,48-7,54). Diskussion: Eine hohe Anzahl von Entbindungen kann ein Risikofaktor für chronische Venenerkrankungen sein. Möglicherweise haben OC eine protektive Wirkung auf die Inzidenz von Venenerkrankungen.