bluuebunny/crossref_metadata_2025 huggingface dataset:
Fate of the Testis following Epididymitis: A Clinical and Ultrasound Study
Authors: Desai K M , Gingell J C , Haworth J M
Published: January 2017

The progress of 33 men suffering from acute epididymitis, the majority of whom were treated as hospital inpatients, was prospectively monitored in order to determine the incidence of complications, and to assess the prognostic implications of clinical and scrotal ultrasound features found at initial presentation. Serious testicular complications resulting in frank infarction, suppurative necrosis and late atrophy developed in 39%. Three factors were shown to have significant discriminant value in predicting an adverse outcome: severe degree of inflammation with induration of the spermatic cord; the presence of a coexistent bacterial urinary infection; and a uniformly reduced testicular echo pattern on the affected side as visualized on ultrasound. A more aggressive approach in addition to medical measures appears to be indicated in these patients. The rationale of early surgical decompression by epididymotomy and spermatic fasciotomy is discussed. Scrotal ultrasound should be considered as a routine investigation in the management of epididymitis.
Changes in Biliary Lipid Concentrations in Bile Duct Obstruction: An Experimental Study
Authors: Guorong Xu , Kirk C J C , Goode A W
Published: January 2017

Changes in biliary concentrations of bile acids, phospholipids and cholesterol and biliary pressures were measured in dogs. These parameters were studied during 7-day periods of partial biliary obstruction, of varying degrees, and after 24-hour and 48-hour periods of complete obstruction. The samples were obtained via an exteriorized but intact enterohepatic circulation allowing the introduction of varying degrees of obstruction and bile sampling.

Biliary obstruction reduced the concentration of all biliary lipids especially when the obstruction produced pressures in excess of 75% of the maximum biliary secretion pressure. Only immediately after the release of a 48-hour period of complete obstruction did the risk of cholesterol supersaturation of bile occur. However, at that time there was a greatly reduced concentration of lipids in the bile and the amount of cholesterol that could potentially have precipitated was very small. It is suggested that this supersaturation would not play a significant role in the formation of gallstones.
Experience with Nalbuphine, a New Opioid Analgesic, in Acute Myocardial Infarction
Authors: Greenbaum R A , Kaye G , Mason P D
Published: January 2017

A total of 141 patients admitted to hospital with a diagnosis of suspected myocardial infarction were randomized to treatment with intravenous diamorphine (71) or nalbuphine (70). Myocardial infarction was subsequently confirmed in 109 patients. Both drugs provided good analgesia. Heart rate, blood pressure, respiratory rate, peak flow and minute volume were measured over a three-hour study period. Except for a slight fall in systolic blood pressure in the nalbuphine-treated group, there were no statistically significant differences between the groups. The nalbuphine-treated group had higher levels of aspartate aminotransferase and hydroxybutyric acid dehydrogenase but not creatine phosphokinase. The haemodynamic outcome and mortality at three months of the two groups were similar. It is concluded that nalbuphine provides effective analgesia coupled with few adverse circulatory or respiratory effects.
Possible Origin of Synovial Lining Cell Hyperplasia in Rheumatoid Arthritis
Authors: Howat D W
Published: January 2017

A perplexing feature of rheumatoid arthritis is the increase in the number of synovial lining cells with no mitotic activity. This feature has been investigated in the rabbit model. Rabbits with the established condition were injected into the affected joint with tritiated thymidine and killed either up to 24 hours later, or at 3 or 7 days. The location of labelled cells, detected by autoradiography, showed the label predominantly in the stroma in the former, and mainly in the lining cells in the latter, indicating that the lining cells were derived by recruitment from active cells deep in the stroma.
Pathogenic Role of Bacillus Cereus in Wound Infections in the Tropics
Authors: Dryden M S
Published: January 2017

A bacteriological survey was undertaken on clinically infected traumatic wounds amongst a group of young and fit Operation Raleigh members, who were living and working in a remote area of Costa Rican rain forest. All infected wounds were swabbed before treatment and, where possible, at intervals during treatment. Swabs were also obtained from the nose and throat of each patient. All swabs were stored by desiccation in sterile silica gel for culture at a later date. Culture revealed a high rate of isolation of Bacillus cereus from the wounds. The organism was commonly isolated in pure and heavy growth. Contamination by B. cereus was considered and excluded experimentally. Preliminary toxological studies have shown that the majority of the isolates produce a necrotic exotoxin, in keeping with the clinical findings. These results suggest that B. cereus caused significant sepsis in this series of traumatic wounds.
Effect of Two Disinfectant Treatments on Laboratory Analyses
Authors: Ball M J
Published: January 2017

Inactivation of human immunodeficiency virus (HIV), the retrovirus associated with the acquired immune deficiency syndrome (AIDS), can be achieved both by heating at 56°C and by chemical disinfection with beta-propiolactone (BPL). Such treatment of specimens from patients with suspected AIDS or antibodies to HIV could reduce any occupational risk to laboratory staff. This study demonstrates the effects of these treatments on laboratory analyses. Heat treatment of plasma caused clinically insignificant alteration in the results of electrolyte, urea, creatinine, albumin and glucose concentration, but significant alteration to total protein estimation and the activities of many enzymes. Haemolysis and cell agglutination occurred in many specimens of whole blood, making them unsuitable for haematological analyses. BPL caused less reduction of enzyme activities, and assay of many analytes, including electrolytes, plasma proteins, haemoglobin, white cell and platelet counts, was not significantly affected.
Why is Plasma Angiotensin-Converting Enzyme Activity Elevated in Hyperthyroidism?
Authors: Roulston J E , Gold A , Wright M , Walker S W
Published: January 2017

The elevation in plasma angiotensin-converting enzyme (ACE) levels observed in patients with hyperthyroidism is unexplained. In this study three hypotheses were investigated. Results from a study using rats treated with thyroid hormones indicated that the increased ACE was not due to increased cleavages of enzyme from lung endothelia. Data from patients with specific tissue damage argue against a nonspecific release of ACE from damaged cells. Data from cultured cell experiments, however, strongly support a direct effect of thyroid hormones upon ACE synthesis and secretion.
Alcohol Consumption of Patients Attending Two Accident and Emergency Departments in North-West England
Authors: Yates D W , Hadfield J M , Peters K
Published: January 2017

The impact of alcohol use on the workload of two accident & emergency departments in north-west England was assessed by blood alcohol concentration (BAC) measurement, inspection of clinical records and interview of all patients aged 16 and over attending throughout a two-week period. The frequency of intoxication was similar to the previous reported rate in Scotland: 13.2% of all patients had a positive BAC. Inebriated injured patients arrived at all times of the day — varying in frequency from 2.5% of midday attenders to 78% of those presenting after midnight. The incidence of alcohol-related industrial accidents was low, but 60% of all assaulted patients were inebriated, many having sustained head injuries. Of patients attending within 2 hours of an accident at home, 19% also had a positive BAC, but 92% of those with ankle sprains were sober. Patients in lower social classes reported higher rates of alcohol consumption. The popularity of beer in comparison to wines and spirits was inversely related to age and unrelated to social class.

Alcohol abuse is commonly associated with injuries sustained at home and with assaults occurring in public places. Prevention campaigns directed at the reduction of these types of incidents should be as concerned with the inebriation of the patient as with the architectural, environmental and legal framework within which the ‘accident’ occurs.
Fulminant Ulcerative Colitis in Late Pregnancy and the Puerperium
Authors: Anderson J B , Turner G M , Williamson R C N
Published: January 2017

Four patients underwent emergency colectomy during pregnancy or the puerperium for complications of ulcerative proctocolitis. Three had inactive colitis at conception, while in the fourth the disease started during pregnancy. Three patients required subtotal colectomy and ileostomy for toxic dilatation during the third trimester or within 5 days of delivery, and the fourth underwent proctocolectomy postpartum for intractable colitis. There were no maternal deaths but 2 of 4 infants died. One child weighing 1.4 kg survived vaginal delivery during the 33rd week of pregnancy, 2 weeks after his mother had undergone emergency colectomy.
The ‘Think Test’: A Further Technique to Elicit Hyperventilation
Authors: Nixon P G F , Freeman L J
Published: January 2017

Hyperventilation can undermine cardiovascular homeostasis by generating autonomic imbalance, sympathetic dominance, hypokalemia, and intracellular alkalosis with calcium ion shifts. The role of hyperventilation in episodic disorders such as arrhythmia and coronary vasospasm can be difficult to identify if the patient does not present in an attack and so a provocation challenge is required. Today, the standard challenge is the forced hyperventilation provocation test (FHPT). A capnograph enables the resting end-tidal PCO2 to be compared with the level 3 min after the period of overbreathing.

We report the use of a patient-specific challenge. After the FHPT, the subject is invited to close his eyes and think about the circumstances of an attack, feelings and sensations experienced (breathing is not mentioned) or topics that were seen to disturb the rhythm of breathing when the medical history was taken. A fall of end-tidal PCO2 of 10 mmHg or more lasting at least one minute was taken as a positive response. Out of 57 patients with cardiovascular symptoms suggesting a hypocapnic influence, resting hypocapnia (end-tidal Pco2=30 mmHg) was present in 3 (5%). Of the remaining 54, the FHPT was positive in 16 (30%) and the ‘think test’ in 33 (61%). This suggests that patient-specific stimulation has advantages over an unspecific challenge in testing for episodic hypocapnia.
Selective Dysacusis — A Preliminary Report
Authors: Narula A A , Mason S M
Published: January 2017

The symptom of poor speech discrimination in the presence of background noise is a well-recognized feature of elevated hearing thresholds due to cochlear damage. Similar symptoms occasionally occur in patients with no detectable audiological abnormality. In a study to evaluate the frequency selectivity of such patients consistent abnormalities were found using an electrophysiological technique based on extratympanic electrocochleography. These findings indicated that frequency specific responsiveness of the cochlea may be affected before conventional behavioural tests reveal abnormalities. This syndrome has been described as selective dysacusis.
Liaison Psychiatry in a Breast Cancer Unit
Authors: Ramirez A J
Published: January 2017

The first 50 referrals to a newly established liaison psychiatry service for the breast cancer unit at Guy's Hospital, London, have been examined. The majority of referrals were for psychological reactions to malignant disease, most of these were mood disturbances. Patients with sustained psychological reactions to their malignant disease were more likely to have had treatment for previous psychiatric illness and to lack a confiding relationship compared with those whose psychological reactions were transient.

Teaching doctors and nurses to deal effectively with the transient psychological reactions of patients to their malignant disease is an important task of liaison psychiatry.
Adenocarcinoma of the Appendix
Authors: Burgess P , Done H J
Published: January 2017

Patients presenting with adenocarcinoma of the vermiform appendix at the Royal Preston and Chorley District General Hospitals were reviewed for the 15 year period 1972–1986. Eleven cases were identified, representing a rate of 1 in 956 for all appendicectomies performed.

A third of the cases presented as acute appendicitis. However, of 8 patients who initially had an appendicectomy, only 4 subsequently underwent further surgery (right hemicolectomy). One patient died of recurrent disease. Five of the patients presenting were under 60 years of age.

During the same period, the total number of appendicectomies performed annually declined by 50%.

The study highlights the need to subject all appendicectomy specimens to histological examination, and that the disease presents in a younger age group than commonly seen for malignant colonic neoplasms.
Folate Deficiency Due to Giardiasis
Authors: Ambrose N S , Hutchison S , Tejan J
Published: January 2017

Giardiasis is an unusual cause of symptoms in this country in anyone who has not travelled abroad. Symptoms may be vague and the diagnosis unclear until the protozoan is discovered. We report an unusual case of anaemia with an unusual history and a satisfactory outcome following intensive investigation.
‘Benign Thoracic Pain’ Syndrome: Role of Magnetic Resonance Imaging in the Detection and Localization of Thoracic Disc Disease
Authors: Bruckner F E , Greco A , Leung A W L
Published: January 2017

The syndrome of ‘benign thoracic pain’ is seen in young women who have pain and tenderness in the mid-thoracic spine radiating around the chest and aggravated by spinal movement. Ten consecutive patients with this syndrome and 15 controls were evaluated with magnetic resonance imaging (MRI). This showed thoracic intervertebral disc dehydration with no associated prolapse in 90% of the patients and 13% of the controls. We postulate that the clinical features are due to impaired shock absorption of these degenerate discs rather than direct compression of surrounding structures. MRI is non-invasive and does not use ionizing radiation; it allows direct visualization of the entire thoracic spine and cord, and accurate detection of early disc degeneration. Thus, it is the imaging modality of choice for defining the subtle intervertebral disc abnormalities that characterize the ‘benign thoracic pain’ syndrome.
Serious Adverse Drug Reactions to Pyrimethamine-Sulphadoxine, Pyrimethamine-Dapsone and to Amodiaquine in Britain
Authors: Phillips-Howard P A , West L J
Published: January 2017

All reports of adverse reactions with pyrimethamine-sulphadoxine (Fansidar), pyrimethamine-dapsone (Maloprim), and amodiaquine spontaneously reported through the UK national post-marketing system were reviewed. Retrospective reporting rates of serious reactions associated with these drugs were analysed using prescription data from the Department of Health, derived from the Prescription Pricing Authority, and relevant pharmaceutical companies. Whilst interpretation of these data requires caution, they allowed comparison with reporting rates from other studies. The reported rate for all serious reactions to pyrimethamine-sulphadoxine was 1 : 2100 prescriptions, and for cutaneous reactions was 1 : 4900 prescriptions, with a fatality rate of 1 : 11 100. The reported rate for serious reactions to pyrimethamine-dapsone was 1 : 9100 prescriptions, and for blood dyscrasias was 1 : 20 000 prescriptions, with a fatality rate of 1 : 75 000. The reported rate of blood dyscrasias associated with amodiaquine was 1 : 2100 users with a fatality rate of 1 : 31 000. Serious hepatic disorders occurred in 1 : 11 1000 pyrimethamine-sulphadoxine prescriptions, 1 : 75 200 pyrimethamine-dapsone prescriptions, and in 1 : 15 650 amodiaquine users. 35% of cases received these drugs needlessly as they were not exposed to drug resistant strains of Plasmodium falciparum. Since few serious reactions have been reported to chloroquine plus proguanil, these data support guidelines which restrict the use of reviewed drugs for those at greatest risk of infection. Dosage data indicated that fatalities had taken higher doses and continued prophylaxis after onset of symptoms. Two thirds of serious reactions to the compound antimalarials were reported in females.
Bowel Distress and Emotional Conflict
Authors: Brook A
Published: January 2017

A psychodynamic assessment of 60 women with functional bowel disorder seen at St Mark's, a specialist hospital for disorders of the colon and rectum, has shown that most were trapped in severe emotional conflicts with which they were unable to cope. In many the bodily illnesses appeared to be an expression of these conflicts as well as a defence against experiencing them. The illnesses were then partly, or entirely, emotional conflicts that had become medicalized-emotional conflicts in illnesses clothing. The illnesses, usually precipitated by significant life events, often had their roots in emotional conflicts in infancy or childhood at which time a high proportion of the women had experienced a severe life trauma. The study also indicated that the conflicts that appeared to contribute to the illnesses were associated with emotional difficulties in fulfilling themselves as women.
A Computational Method for Obtaining the z-Transform from the s-Transform
Authors: Dan-Isa Ado , Atherton D. P.
Published: January 2017

This paper presents a method for the numerical determination of the z-transform and the modified z-transform of a proper rational function expressed in the Laplace transform complex variables. The method is easy to implement on a computer using any high-level language and does not necessarily require the poles of the s-domain function to be found. The method is equally applicable to single-loop and multi-loop systems.
Performance Decrement in Institutionalized Mentally Retarded Persons
Authors: Spreat Scott , Isett Robert
Published: January 2017

Developmental growth patterns of institutionalized mentally retarded persons were examined through the use of repeated administrations of the AAMD Adaptive Behavior Scale. Contrary to earlier research, developmental growth curves were not found to be asymptotic for all groups of subjects. The tendency for growth curves to become asymptotic appeared only for those individuals who had lived in institutions for extended periods of time and who tended to be older and more retarded.
P.S.R.O., Quality of Care, and Research
Authors: Goldstein Richard
Published: January 2017

A necessary condition for achieving the legislative goals of Public Law 92-603, which created the Professional Standards Review Organizations, is the proper evaluation of the system of providing medical care. Peer review as currently constituted does not provide a proper evaluation. This article shows why present practices are not satisfactory, presents an outline of a minimally satisfactory evaluation system, and concludes by showing that many of the criticisms made of P.S.R.O.s are deficient, and that peer review has the potential for resulting in some improvement in the quality of medical care.
High on Walking: Conquering Everyday Life
Authors: Martinsen Bente , Haahr Anita , Dreyer Pia , Norlyk Annelise
Published: January 2017

The aim of this study is to discuss the meaning of walking impairment among people who have previously been able to walk on their own. The study is based on findings from three different life situations: older people recovering after admission in intermediate care, people who have lost a leg, and people who live with Parkinson’s disease. The analysis of the data is inspired by Paul Ricoeur’s philosophy of interpretation. Four themes were identified: (a) I feel high in two ways; (b) Walking has to be automatic; (c) Every Monday, I walk with the girls in the park; and (d) I dream of walking along the street without sticks and things like that. The findings demonstrate that inability to walk profoundly affected the participants’ lives. Other problems seemed small by comparison because walking impairment was at the same time experienced as a concrete physical limit and an existential deficit.
Trends in Mediation Analysis in Nursing Research: Improving Current Practice
Authors: Hertzog Melody
Published: January 2017

The purpose of this study was to describe common approaches used by nursing researchers to test mediation models and evaluate them within the context of current methodological advances. MEDLINE was used to locate studies testing a mediation model and published from 2004 to 2015 in nursing journals. Design (experimental/correlation, cross-sectional/longitudinal, model complexity) and analysis (method, inclusion of test of mediated effect, violations/discussion of assumptions, sample size/power) characteristics were coded for 456 studies. General trends were identified using descriptive statistics. Consistent with findings of reviews in other disciplines, evidence was found that nursing researchers may not be aware of the strong assumptions and serious limitations of their analyses. Suggestions for strengthening the rigor of such studies and an overview of current methods for testing more complex models, including longitudinal mediation processes, are presented.
Finiteness and verb placement in second language acquisition
Authors: Parodi Teresa
Published: January 2017

The relationship between finiteness and verb placement has often been studied in both first language (L1) and second language (L2) acquisition and many studies claim that, while there is a correlation between finiteness and verb placement in L1 acquisition, these areas represent separate learning tasks in second language acquisition (SLA). The purpose of this article is to provide a new perspective on this elusive question, analysing data from speakers of Romance languages learning German as a second language (L2). Verbs are classified as thematic and nonthematic and analysed with respect to overt subject–verb agreement and verb placement as seen in negation patterns. A clear association between subject–verb agreement and verb placement is seen for nonthematic verbs: they are in most cases morphologically finite and show the syntactical distribution of finite verbs. These verbs are interpreted as a spell-out of agreement features, differing both from the speakers' L1 and from the L2, but conforming to a universal grammar (UG) option.
Mental design and (second) language epistemology: adjectival restrictions of wh-quantifiers and tense in English-French interlanguage
Authors: Dekydtspotter Laurent , Sprouse Rex A.
Published: January 2017

This study addresses the issue of second language (L2) epistemology assuming Chomsky’s (1995) discussion of the place of Universal Grammar (UG) in mental design: i.e., the optimal solution to the mental design problem for language in the sense of Minimalist theory. Aspects of interpretation of continuous and discontinuous interrogatives of the form qui de AP (‘who (of) AP’) in first language and L2 acquisition appear to follow from principles of economy in mental design and language-dependent hypotheses. We argue that such knowledge is guaranteed to arise in the absence of relevant input only if a grammar is a realization of language-dependent hypotheses and basic principles of grammar, but crucially not if it consists of a set of (derivative) grammatical theorems not constrained by principles of optimal design.
Performance consistency in second language acquisition and language testing research: a conceptual gap
Authors: Douglas Dan
Published: January 2017

Arguing from the premise that a language test is a special case of a second language acquisition (SLA) elicitation device, I suggest that SLA and language testing share much common ground in terms of research methods, which have similar properties in that they are both used to make systematic observations of language performances from which inferences can be made about the state of a learner’s interlanguage ability underlying the performance. However, I also argue that whereas the concept of demonstrating validity and reliability has been integrated into how language testing research is conducted, SLA researchers have generally failed to recognize the need to demonstrate these qualities. I compare examples of SLA and language testing research articles in terms of their treatment of validity and reliability and argue:

• that it is important for SLA researchers to provide evidence that the methods they employ to elicit data are appropriate for the purposes intended;

• that the procedures provide stable and consistent data; and, consequently

• that the interpretations they make of the results are justified.
Day Case Varicose Vein Surgery: Patient Health Outcome
Authors: Sweeney K. J. , Cheema T. , O'Keefe S. , Johnston S. , Burke P. , Grace P. A.
Published: January 2017

Background:

The success of day case varicose vein surgery (DCWS) is traditionally denned clinically. However, the patient's perception of his or her own health prior to and following DCWS has not been established. This study prospectively measured the health status of patients with varicose veins, compared this with established population norms and assessed the impact of DCWS on both general health perception and varicose vein symptoms.

Method:

Fifty-three consecutive patients undergoing DCWS over a 9 month period were enrolled in this study. The SF-36 health assessment questionnaire and a vein-symptom-specific questionnaire were administered on the morning of surgery, 7 weeks postoperatively and 1 year following surgery. All patients in this study underwent a standard varicose vein operation and followed a standard protocol of postoperative management.

Results:

DCWS population health scores were lower than general population norms preoperatively. There was a significant improvement in the 7 week postoperative group in physical function and health perception (p<0.05). One year after surgery physical function, health perception, mental health and physical role were significantly improved from preoperative scores (p<0.05). Symptom-specific scores demonstrated a sustained trend towards improvement over the postoperative year.

Conclusion:

Varicose veins are associated with diminished well-being. Day case varicose vein surgery improves patient health perception and symptoms and is the treatment of choice for suitable patients with varicose veins.
Evidence-Based Follow-up after Varicose Vein Surgery
Authors: Bailey C. M. H. , Perkins J. M. T. , Garnett S. , Libertiny G. , Umeh H. , Magee T. R. , Galland R. B.
Published: January 2017

Objective:

To determine the optimum timing and need for outpatient follow-up of patients after varicose vein operations.

Methods:

Ninety-six consecutive patients undergoing varicose vein operations were enrolled. Patients completed linear analogue scales to record pain, bruising and swelling on postoperative days 1 to 10, 12, 14, 21 and 28. Return to daily activities, visits to the general practitioner (GP) and outpatient review at 6 weeks were recorded.

Results:

Maximum scores were on day 2 for swelling, day 4 for bruising, and days 1 and 6 for pain. Median time to return to work was 14 days (range 1-42 days). During the postoperative period 29 patients visited their GP, 24 (83%) within 2 weeks of operation. Median length of outpatient consultation at 6 weeks was 5 min. Although 57 patients found the appointment reassuring, none required further treatment.

Conclusions:

Outpatient follow-up after varicose vein operations cannot be justified on clinical grounds. The majority of patients who have postoperative problems develop them within the first 2 weeks, coinciding with the peaks of pain, swelling and bruising, and these problems can be dealt with in the community.
Treatment of Chronic Leg Ulcers in the Community: A Comparative Trial of Scherisorb and Iodosorb
Authors: Stewart A.J. , Leaper D.J.
Published: January 2017

Ninety-five patients with chronic leg ulcers have been recruited from the community and randomized to have Scherisorb or Iodosorb dressings for the care of their ulcers. The overall healing rate at 10 weeks was 29% with no difference being found in the two dressing groups. The ulcers which healed had statistically significant higher basal temperature at entry to the trial (P< 0.05), were significantly smaller (P< 0.01), and had been present for the shorter time (P<0.01) compared with those which did not heal. Similar frequencies of dressing changes and time taken were found in both groups but the cost of treating a patient with Scherisorb was £3.33 compared with £4.68 for Iodosorb. We conclude that an acceptable healing rate was found with both dressings which is comparable with other community trials but that the addition of iodine as an antiseptic does not increase the chances of healing.
Multiple Physiological Indices in the Management of Chronic Leg Ulcers
Authors: Lucarotti Michele , Lancaster John , Hewitt Helen , Leaper David
Published: January 2017

Transcutaneous oximetry (Tc Po2), laser Doppler flowmetry (LDV) and arterial Doppler index (DI) have been used to predict healing in 20 patients with chronic leg ulcers. This study showed that patients with improving or healed ulcers had significantly higher Tc Po2 levels adjacent to the ulcer ( P < 0.02) and lower LDV ( P < 0.05) and a tendency to higher DI than worsening or static ones.
Value of Lightweight Elastic Tights in Standing Occupations
Authors: Dinn Elizabeth , Henry Mary
Published: January 2017

A two year study was conducted to evaluate the compression given by lightweight support tights in 461 women employed in standing occupations. The results suggest that 74% of volunteers experience relief of mild symptoms of venous disease or lessening of moderate-or-severe symptoms and that in approximately 6%, control of small superficial varicies was attained.
Histopathological Studies of the Valves of Varicose Veins
Authors: Obitsu Y. , Ishimaru S. , Furukawa K. , Yoshihama I.
Published: January 2017

In order to elucidate the cause and pathology of varicose veins in the lower limb, the terminal valves of the long saphenous vein in 36 patients with varicose veins and ten control cases have been examined by light and transmission electron microscopy. Valve failure in the varicose group was thought to start with a depression in the valvular commissure and to proceed to extension of this depression and expansion of the space between the two valves. It was further thought that, in this group, reversal and tortuosity of the valve cusps, hyperplasia of the collagen fibres and irregularity of the course of elastic fibre layers represented secondary changes.

In almost all cases, intimal fibrous thickening was present in the vein wall, and this was histologically similar to so-called phlebosclerosis. It was further confirmed that the degree of intimal thickening was correlated to the disease period, with greater thickening noted at the region under greater pressure load. Phlebosclerosis seemed to be proportional to the size of stress and pressure load time.
A Comparison of the Effects of Electrical Calf Muscle Stimulation and the Venous Foot Pump on Venous Blood Flow in the Lower Leg
Authors: Laverick M. D. , McGivern R. C. , Crone M. D. , Mollan R. A. B.
Published: January 2017

The pattern of popliteal blood flow following electrical calf muscle stimulation and activation of the venous foot pump were studied using duplex ultrasound scanning in volunteers. The increase in velocity was of a similar magnitude for both methods, but the pattern was different, suggesting that the venous foot pump may not empty the soleal venous sinuses. Dynamic venography confirmed this hypothesis.
Deep Vein Reflux is Reduced by Compression of the Foot Venous Plexus
Authors: Cheatle T. R. , McMullin G. M. , Scurr J. H. , Negus David
Published: January 2017

A venous pump exists on the lateral side of the foot. Eleven patients with popliteal vein reflux were examined using Duplex scanning. The ratio of retrograde to antegrade flow in the popliteal vein following compression of the calf muscles was compared to the ratio following compression of the lateral side of the foot. Nine of the eleven patients studied exhibited proportionately less popliteal vein reflux following foot compression than calf compression ( P < 0.02). The reasons are not clear but the findings raise the possibility that augmentation of venous return by foot compression may be beneficial in patients with deep venous insufficiency.
Effect of Time and Posture on Pressure Profiles Obtained by Three Different Types of Compression
Authors: Callam M. J. , Haiart D. , Farouk M. , Brown D. , Prescott R. J. , Ruckley C. V.
Published: January 2017

There is controversy concerning the merits and safety of elastic versus inelastic compression in the treatment of venous leg ulceration. Thirty legs were randomized to elastic, minimal stretch and non-elastic (Circaid®) bandages. Pressure profiles (repeated thrice) were measured with the Borgnis MST device on bandage application and at 4 h, in both the standing and lying positions.

All bandages produced significant graduated compression in the leg ( P < 0.001), in the standing position, with no significant difference in gradient between the bandages ( P = 0.5). However, 4 h after application the bandages collectively exerted less pressure than on application, though gradients were maintained. Elastic bandages, at 4 h, recorded a mean 94% of the initial level compared to 70% for minimal stretch and 63% for non-elastic ( P < 0.001) in the standing position. In the lying position the decrease at 4 h was 72% for elastic, 59% for minimal stretch and 44% for non-elastic compression ( P < 0.001).

Elastic bandages provided the most sustained compression, but with the smallest margin of safety (least reduction of pressure on lying).
The Long-Term Effect of Elastic Compression on the Venous Haemodynamics of the Leg
Authors: Christopoulos D. , Nicolaides A. N. , Belcaro G.
Published: January 2017

The long-term haemodynamic effect of elastic compression has been evaluated in 16 patients (20 limbs) with superficial venous incompetence. Ambulatory venous pressure (AVP) and pressure recovery time (RT90) were measured with foot vein canulation. Air-plethysmography was used to measure venous volume, venous reflux and the ejecting capacity of the calf muscle pump, before and after the application of graduated elastic stockings, for 4 weeks. Limbs were tested without the stockings.

Elastic compression for 4 weeks produced a significant reduction in the venous volume ( P < 0.01), a significant decrease in venous reflux and an increase in the ejecting capacity of the calf muscle pump ( P < 0.01). The above changes explain the significant reduction in AVP and prolongation of RT90 ( P < 0.01) which was observed.

The results indicate that there is a considerable improvement in venous haemodynamics after 4 weeks support with graduated elastic compression.
Which Way Does Blood Flow in the Perforating Veins of the Leg?
Authors: McMullin G. M. , Smith P. D. Coleridge , Scurr J. H.
Published: January 2017

There is controversy about the precise role of calf perforating veins in venous disease. Previous studies have shown that the direction of flow is principally inward and that outward flow may be used as a means of diagnosing perforator ‘incompetence’. Fifty-six perforating veins in 25 patients with clinical evidence of venous disease were examined using duplex ultrasound imaging. Only one perforating vein showed outward flow on distal compression of the limb, whereas local compression elicited outward flow in 38. Distal limb compression cannot be used to assess the ‘competence’ of calf perforating veins.
Endoscopic Exploration of the Subfascial Space of the Lower Leg with Perforator Vein Interruption Using Laparoscopic Equipment: A Preliminary Report
Authors: Conrad P.
Published: January 2017

Objective:

To describe a method of endoscopic exploration of the medial subfascial space of the lower leg using laparoscopic equipment and dividing incompetent perforating veins crossing this space with diathermy.

Design:

Prospective study in seven patients with significant perforating vein incompetence in the medial lower leg.

Setting:

Department of Surgery, Nepean Hospital, New South Wales, Australia.

Intervention:

Laparoscopic equipment is used to explore endoscopically the medial subfascial space of the lower leg. Incompetent perforating veins preoperatively marked by duplex examination are identified and divided by endoscopic diathermy.

Main outcome measures:

The endoscopic division close to their source from the deep veins of incompetent perforating veins of the medial compartment of the lower leg.

Results:

Endoscopic interruption of incompetent perforators in the medial compartments of seven legs achieved with minimal morbidity.

Conclusions:

Endoscopic diathermy interruption of incompetent perforators in the medial compartment of the lower leg using laparoscopic equipment is a rapid and accurate procedure with minimal morbidity, as shown in a small series of seven legs.
Changes of Skin Microcirculation in Patients with Chronic Venous Insufficiency Assessed by Laser Doppler Fluxmetry and Transcutaneous Oxymetry
Authors: Creutzig A. , Caspary L. , Alexander K.
Published: January 2017

Objective:

To evaluate whether microcirculatory disturbances of the skin in patients with chronic venous insufficiency are a generalized phenomenon or restricted to visible skin changes.

Design:

Open, prospective study in patients and healthy, age-matched subjects.

Setting:

Department of Angiology, Hannover Medical School.

Patients:

Seventy-one patients with chronic venous insufficiency.

Measurements:

Transcutaneous oxygen pressure (tc Po2) at electrode core temperatures of 37°C and 44°C and laser Doppler flux (LDF) were measured simultaneously in different regions of the legs.

Results:

On the forefoot, tc Po2 (37°C) at rest and tc Po2 (44°C) during arterial ischaemia were significantly higher in patients ( P<0.05), increasing with the severity of chronic venous insufficiency.

Conclusions:

Cutaneous capillary flow on the forefoot is increased in patients with chronic venous insufficiency, demonstrating the general effect of venous hypertension.
Chronic Venous Disease May Delay the Diagnosis of Malignant Ulceration of the Leg
Authors: Lagattolla N. R. F. , Burnand K. G.
Published: January 2017

Objective:

To emphasize the association of cutaneous malignancy and chronic venous disease of the lower limb.

Design:

A descriptive study, reporting six cases, with a discussion of the literature.

Setting:

St Thomas' Hospital Outpatient Department.

Patients:

Six outpatients.

Conclusions:

The development of both squamous carcinoma and basal cell carcinoma may be associated with chronic venous disease of the lower limb. Modest dimensions or a healthy appearance that are out of keeping with a protracted course may be signs of malignancy in a leg ulcer. A punch biopsy under local anaesthesia in the outpatient department provides accurate diagnosis of a malignant ulcer allowing prompt treatment.
Venous Reflux at the Sapheno-Femoral Junction
Authors: Somjen G. M. , Donlan J. , Hurse J. , Bartholomew J. , Johnston A. H. , Royle J. P.
Published: January 2017

Objectives:

To clarify reflux patterns in the sapheno-femoral junction in legs with varicose veins that display incompetence in the proximal long saphenous vein on duplex scan examination.

Patients and method:

One hundred consecutive extremities were selected for ultrasound studies. Venous reflux was examined in the common femoral vein and long saphenous vein at five selected levels in the vicinity of the sapheno-femoral junction.

Results:

Duplex ultrasound examination confirmed that in 44 extremities reflux was detectable both in the long saphenous vein and common femoral vein indicating ‘true’ sapheno-femoral incompetence. In 56 legs reflux was limited to the long saphenous vein, whilst the first saphenous valve remained competent. The ultrasound examination suggested that in these cases the reflux originated from the numerous tributaries of the proximal long saphenous vein.

Conclusion:

Our findings emphasize the transfascial escape (reflux from the deep veins) is not a necessary precondition of long saphenous vein incompetence and related varicose veins.
The Effects of Long Term Graduated Compression Treatment on Venous Function during Pregnancy
Authors: Austrell C. , Thulin I. , Norgren L.
Published: January 2017

Objectives:

To evaluate venous function during pregnancy and to compare two levels of graduated compression.

Design:

Prospective, randomized study.

Setting:

Vascular Surgery and Vascular Laboratory, University Hospital.

Patients:

Fifty pregnant women using graduated compression with pantyhose stockings exerting either 25 or 13 mmHg ankle pressure. Eight pregnant women acting as controls.

Interventions:

Foot volumetry to determine venous function (venous emptying during exercise and reflux) close to week 20, week 33 and post-partum.

Results:

The expelled volume increased significantly when graduated compression stockings were used. Refilling flow did not change significantly. Few patients with reflux were found.

Conclusion:

Graduated compression stockings of pantyhose type are effective in increasing venous emptying during pregnancy. Stockings exerting an ankle pressure of 13 mmHg at the ankle level were as effective as those exerting 25 mmHg.
Soluble Markers of Leucocyte Adhesion in Patients with Venous Disease
Authors: Shields D. A. , Andaz S. K. , Porter J. B. , Scurr J. H. , Smith P. D. Coleridge
Published: January 2017

Objective:

To measure soluble CD54 (ICAM-1) and CD62E (E-selectin) as markers of neutrophil adhesion in four groups of patients with varying severity of venous disease and compare the values obtained with those in age- and sex-matched control subjects.

Design:

Prospective study of patients with varicose veins compared with a group of control subjects with no history or clinical findings of varicose veins.

Setting:

The Middlesex Hospital Vascular Laboratory, London.

Patients:

Patients referred to the Middlesex Hospital Vascular Laboratory for investigation of venous disease. Neither patients nor controls had arterial disease, any other systemic illness, or were on any medication known to alter white cell activity.

Interventions:

Ten millimetres of blood taken from an arm vein into EDTA for a neutrophil count and soluble CD54 and CD62E, measured using an ELISA.

Results:

Similar levels of soluble CD54 and CD62E were found in all four groups of patients compared with their controls ( p = 0.71 for soluble CD54 for all patients compared with all controls, and p = 0.65 for soluble CD62E, Mann–Whitney U-test). There was no difference in the neutrophil count between the controls and patients in any group ( p = 0.74 for all subjects, Mann–Whitney U-test).

Conclusion:

This study shows no evidence of increased soluble CD54 or CD2E or CD62E in patients with venous disease, despite previous work showing increased CD54 and neutrophil degranulation in patients with venous disease. The reason for this is currently unknown.
Magnetic Resonance Imaging of Deep Venous Thrombosis with Anomalous Inferior Vena Cava
Authors: Liddicoat A. J. , Moody A. R. , London N. J. M.
Published: January 2017

Design:

Case report.

Setting:

Leicester Royal Infirmary.

Patients:

A 17-year-old male patient presenting with postoperative deep venous thrombosis secondary to anomalous inferior vena cava.

Interventions:

Imaging to establish the diagnosis, anticoagulation and follow-up.

Main outcome measures:

Serial magnetic resonance imaging and the clinical condition of the patient were assessed.

Results:

The patient made a good recovery and did not require a laparotomy.

Conclusions:

Magnetic resonance imaging is very useful in the detection of central deep venous thrombosis and anomalous inferior vena cava and should be considered in young patients with postoperative deep venous thrombosis.
Evaluation of the Jobst UlcerCare System for the Treatment of Venous Ulcers
Authors: Baccaglini U. , Giraldi E. , Spreafico G. , Sorrentino P. , Castoro C. , Penzo S. , Pavei P. , Pignataro M.
Published: January 2017

Objective:

To test the Jobst ulcer care system (JUCS), a combination of two elastic stockings and a dressing, for the treatment of venous ulcers.

Design:

Cohort study.

Setting:

Therapy was performed at home by the patient with weekly visits to the outpatient clinic at the teaching hospital of the University of Padua.

Patients:

Thirty-one consecutive ambulatory patients with confirmed venous ulcer.

Treatment:

Patients were instructed to wear the low-compression stocking (liner) day and night and the higher compression stocking (therapeutic stocking with zipper) during the day. The wound dressing (Cutinova foam) was changed as judged by the patient.

Main outcome measures:

Healing of the ulcer, and tolerance, safety and ease of using the JUCS by the patient.

Results:

Twenty-four patients completed the study; 23 Patients showed complete healing of the ulcer within 16 weeks and in the 24th patient the healing was completed in 18 weeks. The mean healing time was 5.8 weeks.

Conclusions:

The Jobst ulcer care system is effective in achieving ulcer healing and the elastic stockings showed no significant side-effects and were easy to use.
A Comparative Trial of Opipramol and Chlordiazepoxide in the Treatment of Anxiety
Authors: Jepson K , Beaumont G
Published: January 2017

A daily dose of 200 mg of opipramol (Insidon, Geigy) and 30 mg of chlordiazepoxide (Librium, Roche) were compared in a clinical trial in general practice. The trial was double blind and a stratified randomisation technique was employed. Twenty four patients received opipramol and twenty six chlordiazepoxide for four weeks. A total anxiety score and separate ‘psychic’ anxiety and ‘somatic’ anxiety scores were recorded, using a rating scale initially and after two and four weeks treatment. No overall difference in efficacy was found between the two drugs—opipramol producing a 76% improvement and chlordiazepoxide 64% by the end of the study. There was no difference in the relief of psychic anxiety. Although opipramol appeared to give more relief of somatic anxiety, the difference was not statistically significant. Again although opipramol relieved more individual symptoms than chlordiazepoxide, none of the differences were significant. 70% of patients on opipramol and 74% of those on chlordiazepoxide were classified ‘better’ globally by both doctor and patient by the end of the trial. The total number of side effects recorded was similar on both drugs although drowsiness occurred twice as frequently on chlordiazepoxide as it did on opipramol.
Influence of Ibuprofen on Haemostasis in Patients on Anticoagulant Therapy
Authors: Goncalves L
Published: January 2017

A group of 50 patients on warfarin sodium were studied for possible adverse effects on anticoagulant action when ibuprofen was administered concomitantly. Factors II, VII and X were determined before starting and after seven days on ibuprofen therapy. Ibuprofen was not found to adversely affect the anticoagulant activity of warfarin.

A further study in 30 normal volunteers (on no drugs) suggests that 600 mg ibuprofen daily for 3 days has no action of its own in the plasma phase of haemostasis.
Amoxycillin in the Treatment of Childhood Pneumonia
Authors: Khan A A
Published: January 2017

Amoxycillin ('Amoxil') a new semi-synthetic penicillin was used in the treatment of pneumonia in 30 children. A very satisfactory clinical cure was effected in all cases on a dosage requirement of 125 mg eight hourly for 5-8 days.

There were no side-effects. In view of its regimen of three times daily dosage, proven efficacy and facility of administration with food it should be usefully recommended for routine out-patient/in-patient therapy of childhood pneumonia.