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Changes in the coagulability or rheology of the blood are supposed to cause an increased frequency of thrombosis in patients with a malignant tumor. These procoagulopathic disorders may not only increase the frequency of thrombosis but may also enlarge the extent of the thrombosis. The authors retrospectively analyzed, therefore, the extension of thrombosis in patients with and without a malignant tumor. From 1991 to 1995 in the University Hospital Essen 489 consecutive cases of thrombosis were diagnosed. The diagnosis was made by color Doppler sonography or phlebography; 230 patients (47%) suffered from a malignant tumor (110 men, 120 women). To exclude the influence of the patient's age on the extension of the thrombosis the authors distinguished three different age groups. In the tumor group aged from 21 to 40 years they found 10 large (iliacal, femoral, and crural veins), six medium (femoral and crural veins), and four small thromboses (crural veins). In the tumor group aged from 41 to 60 years they found 38 large, 24 medium, and 27 small thromboses. In the group without a tumor aged from 21 to 40 years they found seven large, 13 medium, and 28 small thromboses, and in the group aged from 41 to 60 years, 12 large, 29 medium, and 41 small thromboses. The difference between the two groups supports the assumption that in patients suffering from a malignant tumor, thromboses tend to be more extended than in patients without a malignant tumor.

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 40,000 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 patients.

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.

Vascularization of venous thrombosis. The degree of organisation of an intravenous thrombus is important for therapeutic interventions and the postthrombotic damage. Changes in echogenicity have already been described in B-mode sonography. We investigated 7 thrombosis in the jugular vein looking for intra-thrombotic vessels that occur during the organisation. In 3 thrombosis arterial vessels were found from the 12th to the 17th day. Such arterial vessels appeared only in a short range of time and only in circumscript areas of the thrombus. The intra-vitam documentation of arterial vessels in an organizating intravenous thrombus may give information about the mechanism of thrombogenesis and about the degree of organisation.

Behçet's disease is a systemic vasculitis of unknown cause. In 1937 Behçet described 3 patients with oral and genital ulceration and hypopyon iritis. The disease shows worldwide distribution with the highest prevalence in the eastern Mediterranean region and Japan. The most common manifestation is recurrent oral ulceration. Other manifestations include genital ulceration, eye lesions, skin lesion, arthritis or arthralgia, and cerebral lesions. Venous thrombosis and thrombophlebitis are also recorded as manifestations. One of the causes of superior caval vein obstruction is Behçet's disease. Especially in Turkey, this association is common. Management must be directed against the primary disease plus the caval vein obstruction. The authors describe a patient with multisymptomatic presentation of Behçet's disease with thrombosis of the superior caval veins and successful lysis with streptokinase.

Vena cava-filters are implanted where there is a risk of pulmonary embolisation as cases of thrombosis. Permanent vena cava-filters can induce various complications during the remainder of the patient's life. A case of a 32-year-old woman who became pregnant seven years after the implantation of a Kimray-Greenfield-Filter and gave birth to a healthy child is presented. During pregnancy and after the birth of a healthy child she suffered from two new thrombotic events. After the delivery, a complete thrombosis of the vena cava inferior, both venae iliacae communes and the right vena renalis were shown by computer-tomography and phlebography. Inspite of these longterm complications, pregnancy is not contraindicated after implantation of a permanent vena cava-filter.

Purpose: To determine if ultrasound angioplasty in a percutaneous approach was capable of recanalizing occluded arteries in acute and subacute peripheral arterial occlusions.Materials and Methods: We applied an ultrasound angioplasty device in a percutaneous approach in 9 patients with peripheral arterial occlusions. All patients suffered from severe leg ischemia due to subacute thrombotic occlusions.Results: The ultrasound transmitter easily created a channel within the occlusive material. To further reduce the mass of the occlusive material, an aspiration thrombectomy was performed in all cases, leading to a complete recanalization in 7 cases. In 2 cases, a remaining stenosis was successfully dilated.Conclusion: Intravascular ultrasonic devices can be useful for recanalization of occluded peripheral arteries. In particular, if thrombolytic therapy of longer peripheral arterial occlusions fails or is contraindicated, ultrasound angioplasty may be a new approach for recanalization. [ABSTRACT FROM AUTHOR]