bluuebunny/crossref_metadata_2025 huggingface dataset:
The Response of Textured Yarn Properties to Process Variables in Relation to Barré
Authors: McGregor R. , Grady P. L. , Montgomery T. , Adeimy J.
Published: January 2017

A thermomechanical analysis technique has been used to characterize a set of false-twist pin-textured polyester yarns. These yams were generated under a wide range of texturing conditions from two distinct lots of fully-drawn feed yarn which differed in orientation. The analysis yielded a variety of thermomechanical yarn parameters. One set of parameters had some of the properties of an “effective yarn-texturing temperature.” A different set of parameters correlated with the tensile, shrinkage, or crimp parameters of the yarns and were sensitive to the effects of feed-yarn orientation differences. Other parameters correlated with textured yarn dyeability. Measurements of this type should prove valuable in the quality control of textured yarns and in the diagnosis of yarn faults.
Pressing a Range of Wools in Instrumented Minimum Volume Presses
Authors: Walls G. W.
Published: January 2017

Two instrumented presses are described in which eleven different types of wool, including coarse and fine fleeces and offsorts, were compressed to their minimum total volumes using a heat, press, out-of-press cool sequence. The final volume was the actual volume of all components with air excluded. Extrusion of grease and dirt during pressing resulted in higher yield products of lower weight and in-press densities over 1300 kg/m3. Frictional forces and transverse/in-line pressure ratios were deduced from side- and end-pressure measurements at 90°C and at 20°C for each of the two stages of biaxial pressing of these wools at final pressures of 3.1, 7.8, and 12.6 MPa. Densities of the compressed wools were monitored over a nine month storage period unrestrained under ambient conditions, and remained close to 1000 kg/m3 for those produced at the higher pressures.
TEM and X-Ray Photoelectron Spectroscopic Studies of Wool Fibers after Cuticle Removal
Authors: Dowling Lyndsay M. , Jones Leslie N. , Leaver Ian H. , Hughes Anthony E.
Published: January 2017

A method is described for cleanly separating the cortex and cuticle of wool fibers using water or an aqueous buffered solution as the immersion medium. Nearly complete removal of cuticle cells can be achieved in 2–3 hours when snippets of wool are vortex-mixed with a suspension containing both glass fiber snippets and glass beads. Examination of treated fibers (transverse sections) by transmission electron microscopy indicates removal of cuticle cell layers (endo- and exocuticle), together with associated membrane intracellular bands ( i-layers). The surface elemental composition of the fiber (determined using x-ray photoelectron spectroscopy) changes appreciably with cuticle removal. The sulfur content of the intracellular cortical proteins at the exposed surface is estimated to be 2%, compared to 9% for the epicuticle proteins at the surface of untreated wool.
The Microcomputer in Social-Psychophysiological Research: An Apple II/FIRST Laboratory
Authors: Marshall-Goodell Beverly , Gormezano I. , Scandrett John , Cacioppo John T.
Published: January 2017

An Apple II/FIRST microcomputing system has been established to control social-psychophysiological experiments, colled analog and digital data, and extract dependent variable measures for the monitored physiological, reportable, and behavioral processes. The inexpensive Apple II microcomputer has been augmented by a hardware floating-point processor and an A/D converter chip. In addition, the FIRST software system is employed. FIRST is an interactive, high-level, structured programming language that is sufficiently fast that tedious machine-language programming is seldom needed for stimulus control and data acquisition. The Apple II/FIRST microcomputing system, while presently employed by us in social psychophysiological research, was developed for use in animal classical conditioning research (Scandrett and Gormezano, 1980). Clearly, the system has the power and flexibility to be used in a wide variety of other laboratories.
Ruptured Tubal Gestation: An Unusual Presentation of Schistosoma Haematobium Infection of the Fallopian Tube
Authors: Mohammed A Z , Uzoho C C , Galadanc H S I , Ashimi A
Published: January 2017

An unusual mode of presentation of schistosomiasis in the form of a ruptured tubal pregnancy in a previously asymptomatic 23-year-old woman is described. Histological examination of the salpingectomy specimens demonstrated Schistosoma haematobium ova.
Use of Antenatal Cards for Literate Health Personnel and Illiterate Traditional Birth Attendants: An Overview
Authors: Chabot H T J , Rutten A M
Published: January 2017

A review of the existing literature on various risk-oriented antenatal cards developed during the last 15 years, makes apparent a multitude of action-oriented cards available for trained health personnel (obstetric nurses, midwives and doctors).

Few antenatal cards, however, have been developed for use by illiterate traditional birth attendants (TBAs).

A revised version of an illiterate antenatal card is presented, that has been developed over the past 3 years in Mali. It contains some important improvements, notably its use at the various levels of the health care pyramid both by illiterate TBAs and by trained midwives. It also includes specific ‘standing orders’, based on generally accepted ‘at-risk’ criteria.

Suggestions for its adaptation elsewhere in Africa as part of current Safe Motherhood policies are discussed.
The “Scary World” of the Nonviewer and Other Anomalies
Authors: Hirsch Paul M.
Published: January 2017

This article critically examines the statistical evidence presented by Gerbner et al. to support their assertion that television-viewing “cultivates” distorted perceptions of the “real world.” In Part I, I point out discrepancies in the items, samples, and coding categories employed, and show that when controls are applied simultaneously (rather than singly) there is no linear relationship between amount of viewing and the provision of “television answers.” This reanalysis concludes that the “cultivation” hypothesis lacks empirical support and that the very data presented in its support argue strongly for rejecting the assertion that it has any scientific basis in fact.
Chronic Asthma and Improvement with Relaxation Induced by Hypnotherapy
Authors: Morrison J B
Published: January 2017

Sixteen chronic asthmatic patients inadequately controlled by drugs had, after one year of hypnotherapy, a fall in admissions from 44 in the year before starting therapy to 13 in the year after. Duration of stay was reduced for 13 patients by 249 days; prednisolone was withdrawn in 6, reduced in 8 and increased in none. Side effects of drugs were reduced. Although 62% reported improvement on a visual analogue scale, observations of air flow gave variable results.
Incidence of Basic Concepts in the Directions of Five Commonly Used American Tests of Intelligence
Authors: Bracken Bruce A.
Published: January 2017

Five intelligence tests produced in the United States of America were reviewed to determine the incidence of basic concepts within the test directions. The 258 concepts assessed by the Bracken Basic Concept Scale were used to produce the frequency count and it was found that the directions of four of the five intelligence tests were replete with basic concepts. The Kaufman Assessment Battery for Children had only six concepts used in the test directions, and the instrument allows for task teaching and alternate wording. Threats to validity are discussed for the four American instruments that had the most concepts assumed by the test authors.
The Causal Attributions for Success and Failure of Problem and Non-Problem Secondary Pupils
Authors: Buck David N. , Clift Stephen M. , Povey Robert M.
Published: January 2017

A comparison was made between the causal attributions offered by fifty-two problem and fifty-six non-problem children of both sexes in relation to situations involving the success and failure of pupils on a number of classroom tests. The results confirmed some general findings of attribution research that effort is an important causal explanation and that success is attributed to internal causes while failure elicits more external responses. In addition different attribution patterns were found between achievement situations, consistent with earlier results. In contrast to previous studies, however, some expected differences between boys and girls and problem and non-problem groups were not confirmed. The usual finding that girls attribute successful outcomes to luck and neglect effort while at the same time attributing failure to lack of ability was not found. Also, an earlier report that problem children will be more external, unintentional and unstable in their pattern of attributions was not supported. The importance of interest as a causal explanation and the overriding effect of outcome in relation to pupils' attributions were significant findings in this study.
Thinking Aloud: Analysing Students' Mathematics Performance
Authors: Lawson Michael J. , Rice Donald N.
Published: January 2017

Psychologists, teachers and researchers have a common interest in understanding how students solve mathematics problems. We want, and need, to understand how solutions to problems are developed so that interactions with both successful and unsuccessful problem-solvers can become more effective. In order to build a more sophisticated understanding of problem-solving we must consider a number of major factors — the instructional setting, the nature of the problem-solver, the resources available, the structure of the mathematical content and the student's understanding of that, and the processes used in the solution. Also needed is a technique for identifying those processes in samples of students' mathematics performance. What we learn from using the technique influences the design of future instruction.
Work environments and workers’ grievances: Accounting for variation in wildcat strikes in the US coal mining industry, 1970–1977
Authors: Kim Hyun Woo
Published: January 2017

This article examines the role of work environments and workers’ grievances as factors generating wildcat strikes in the US coal mining industry from 1970 to 1977, a period of intense worker–management conflict. Drawing on historical and empirical evidence, it argues that the classical wage-bargaining model of authorized strike activity fails to account for variation in the incidence of wildcat strikes in general, and those in the coal mines in particular. The analysis employs a unique data set on wildcat strikes in the coal industry during the period. This article brings the analysis of the causes of wildcat strikes into closer dialogue with social and labor movement theory.
The impact of endorsements in intra-party elections: Evidence from open primaries in a new Portuguese party
Authors: Cancela João , Dias António Luís , Lisi Marco
Published: January 2017

What affects the prospects of candidates in open intra-party elections? This research article examines the determinants of candidate performance in the first open party primaries conducted by LIVRE, a newly emerged Portuguese party, in 2015. This innovative process of candidate selection allowed individuals from outside the party not only to vote but also to run for office. Through the construction of an original dataset and the use of social network analysis, this study shows that centrality in the network of endorsements has a significant impact on the probability to be selected in party lists. Our findings shed additional light on the determinants of success in candidate selection and open new insights into the dynamics behind party primaries.
“The Daily Me”: filtered business news services
Authors: Foster Pam
Published: January 2017

Pamela Foster worked as a librarian at Sheffield University and subsequently for several publishers, including Longmans and the Library Association, where she worked on British Technology Index. Now an Editor with Headland Business Information, she edits Online/CD-ROM Business Sourcebook and the publisher's related newsletters, Online/CD-ROM Business Information and What's New in Business Information.
First-language-constrained variability in the second-language acquisition of argument-structure-changing morphology with causative verbs
Authors: Montrul Silvina
Published: January 2017

This article presents three related experiments on the acquisition of two classes of causative verbs: physical change of state verbs with agentive subjects (e.g., English break) and psychological change of state verbs with experiencer objects (e.g., English frighten) in English, Spanish and Turkish as second languages by speakers whose native languages are English, Spanish, Turkish and Japanese. These verbs participate in the causative/inchoative alternation crosslinguistically, but the morphological expression of the alternation varies in the four languages. English has predominantly zero-morphology, Spanish has anticausative morphology, and Turkish and Japanese both have causative and anticausative morphology. Assuming the tenets of the Full Transfer/Full Access Hypothesis (Schwartz and Sprouse, 1996), results of a picture judgement task testing transitive and intransitive sentences and manipulating overt/non-overt morphology on the verbs show that morphological errors in the three languages are constrained by the morphological patterns of the learners’ first language (L1s). In addition to showing that formal features of morphemes transfer but morphophonological matrices do not, this study refines the role of L1 influence in the morphological domain by showing that the morphophonological shape of affixes transfers as well.
Telangiectases in Venous Insufficiency: Point of Reflux and Treatment Strategy
Authors: Mariani F. , Bianchi V. , Mancini S. , Mancini S.
Published: January 2017

Objective:

To verify the role of sources of non-saphenous reflux in the appearance of reticular varices and telangiectases in areas other than the lateral venous system of Albanese.

Setting:

Institute of General Surgery and Surgical Specialisations, Interdepartmental Centre of Research, Treatment and Phlebolymphological Rehabilitation, University of Siena.

Patients and methods:

The study was carried out on 106 women aged 18–65 years who were affected by chronic venous insufficiency (CVI) at the Cla-s Ep Asl stage, according to the CEAP classification. The patients had telangiectases (200 telangiectactic areas) and reticular varices of the lower limbs of type II and III of the classification of Weiss, with competent saphenous trunks and a normal deep venous system. Sclerotherapy was therefore performed, after clinical and duplex ultrasound examination. The records of 185 telangiectactic area treated 3 years earlier were reviewed.

Results:

In all cases reticular varices was found together with the telangiectases. In 73.5% (147/200 areas) one or more incompetent perforating veins was found (average diameter 1.6 mm) and in 83.6% (123/147 areas) it was possible to establish that the main source of reflux was in the base of the telangiectasia. Complete elimination of microvarices was achieved in 88% of cases (176/200 areas; average sessions: 3.5). The complications were haemosiderin pigmentation (1.5%, 3/200 areas) and matting (1%, 2/200 areas). In 24 areas resistant to the therapy it was not possible to demonstrate the presence of reflux, while in 24.5% of cases (49/200 areas, average surface 15.4 cm2) two sessions of sclerotherapy were sufficient eventually to obtain (about 4 weeks later) the disappearance of the micro-varices. Follow-up after 3 years revealed the appearance of new telangiectases in 58.9% of cases (109/185 check-ups). Of these 95.4% (104/109) arose in areas other than those treated and therefore only 4.6% (5/109) recurred in the area where the sclerosing treatment had been carried out.

Conclusion:

In CVI all telangiectases are accompanied by reticular varices, even when not visible on clinical examination; in most cases the sources of reflux are distinguishable as incompetent perforating veins and are situated beneath telangiectactic efflorescences.
Prevalence of Venous Insufficiency in French Adults of the SUVIMAX Cohort
Authors: Preziosi P. , Galan P. , Aissa M. , Hercberg S. , Boccalon H. , Berard H.
Published: January 2017

Background:

The symptoms of venous insufficiency of the lower limbs (VILL) include a feeling of heaviness in the legs, pain, and nocturnal cramps, which may be combined with organic disorder (varicose veins). The objective of this study was to determine the prevalence of VTLL in terms of both varicose veins and functional symptoms in the participants of the SUVIMAX cohort, which is representative of the French population for the age range under consideration (women: 35–60; men: 45–60).

Methods:

Information on the venous status of 3065 subjects in SUVIMAX cohort were collected from three different sources: yearly systematic clinical (1994-1996), monthly follow-up by a telematic network (1994–1998) and non-specific questionnaire (1997). Two mutually exclusive populations were thus denned on medically diagnosed varicose and venous insufficiency.

Results:

Venous insufficiency was medically diagnosed in 192 men (14.6%) and 584 women (33.6%), and varicose veins were diagnosed in 143 men (74.5%) and 317 women (54.2%) from this group. Prevalence reported symptoms of venous insufficiency and of varicose veins was 13.6% and 7.4% respectively in men and 28.2% and 12.4% in women. Sex, age, body mass index and number of pregnancies were found to be correlated with the risk of venous insufficiency.

Conclusions:

VILL is a very common disease in French adults both as varicose veins and as functional symptoms. Venotonics were the main type of treatment but not enough use is made of elastic compression stockings. [Int Angiol 1999;18.171–5]
The Epidemilogy of Chronic Venous Ulcer: Some Unanswered Questions
Authors: Ruckley C. V.
Published: January 2017

Objective:

To highlight gaps in knowledge concerning the epidemiology of chronic venous insufficiency and to indicate what future studies are required.

Methods:

Existing classifications are compared. Limitations of epidemiological studies are defined. Data from published series and from the Edinburgh Vein Study are presented.

Synthesis:

The Basle 1978 classification of chronic venous insufficiency (CVI) is a purely clinical classification in which the earliest grade is corona phlebectatica. The Porter 1988 classification of CVI attempted to correlate clinical grades with sites of venous incompe-tence. However, a consistent relationship does not exist. The CEAP classification separates the clinical grades (which do not include corona phlebectasia) from the anatomical segments. The CEAP clinical classification covers a range of venous manifestations but is not consistent. There is a need for further consideration of classifications. Published selected series of patients show that the frequency of incompetence in both deep and superficial systems increases in proportion to the severity of the clinical manifestations of venous disease. To understand the significance of these data we need to know the patterns of venous incompetence in the general population. Data from 1566 subjects between the ages of 18 and 64 years in the Edinburgh Vein Study, a randomly selected cross-section of members of the Edinburgh population, showed that the prevalence of CVI was age-related and was present in 9.2% of men and 6.6% of women. Men had a significantly higher frequency of reflux in the deep system than women. In order to direct therapeutic interventions where they are most appropriate we need to know which patients with the early stages of varicose veins progress to CVI and which patients with early CVI progress to the serious skin complications.

Conclusions:

Key information concerning the natural history of venous disease and its evolution in relation to haemodynamic abnormalities awaits the findings of longitudinal-cohort epidemiological studies which include the duplex scanning of large populations.
Surgical Treatment of the Superficial and Perforating Veins
Authors: Gloviczki P.
Published: January 2017

Objective:

To review the techniques and results of surgical treatment of the superficial and perforating veins in patients with chronic venous insufficiency.

Methods:

The current techniques used at the Mayo Clinic for treatment of simple varicose veins and venous ulcers are presented. Results of subfascial endoscopic perforator vein surgery (SEPS) are discussed and data from large centres are tabulated. Results are compared with those reported following non-operative management.

Synthesis:

High ligation and invagination stripping of the incompetent segment of the saphenous vein, with stab avulsion of branch varicosities, is the optimal surgical technique to ablate superficial venous incompetence. SEPS is safer than open perforator vein ligation and is the technique of choice to interrupt incompetent perforating veins. A review of 12 series on SEPS, that included 361 limbs, found an ulcer recurrence rate of 10% in those 211 patients who underwent ablation of superficial reflux together with SEPS. One hundred and fifty limbs had SEPS alone, without saphenous stripping: ulcer recurrence in this group at a mean of 23 months was 12%. Results in primary valvular incompetence were significantly better than in post-thrombotic syndrome.

Conclusions:

Ablation of superficial reflux remains the main surgical treatment of all forms of chronic venous insufficiency. SEPS is safe and effective to interrupt medial calf perforators and results in rapid ulcer healing and low recurrence in patients with primary valvular incompetence. The treatment of post-thrombotic syndrome remains a challenge. Results of the North American Venous Ulcer Surgery (NAVUS) trial, a prospective, randomised, multicentre study, will be required to provide level 1 evidence of the effectiveness of surgical treatment over medical therapy in the treatment of venous ulcers.
Iliac Venous Obstruction: Surgical Reconstruction
Authors: Mercier F. , Cormier F. , Fichelle J. M. , Duarte F. , Cormier J. M.
Published: January 2017

Aim:

To review the investigation and treatment of iliac vein obstruction.

Method:

A review of current literature in the field of management of iliac venous obstruction has been conducted.

Synthesis:

Iliac venous obstruction results in chronic or acute symptoms in the lower limb presenting as pain, swelling, oedema and discomfort of the lower limb. Intrinsic or extrinsic obstruction of the iliac veins may be the cause. Cockett syndrome is the classic aetiology for chronic intermittent or fixed left inferior limb venous obstruction. Other causes include tumours, vascular grafts or lymph node compression and retroperitoneal fibrosis. Duplex ultrasound imaging is now the first-choice investigation. CT scanning is useful where external vein compression is suspected. Phlebography is used when an endovascular procedure is to be done. The surgical treatment of Cockett syndrome described by Cormier is transposition of the common right iliac artery in the left internal iliac artery. This is being replaced by endovascular balloon venoplasty completed by stenting of the left iliac vein. We reviewed the experience of surgical correction of Cockett syndrome with Cormier's technique in 70 patients operated on between 1976 and 1990; 55 patients had a follow-up of 12-177 months. Anatomical and functional results were perfect for all patients except when endoluminal synechiae or iliac venous thrombosis were associated with postural compression. In this case a 50% success rate was achieved. The endovascular revolution offers a less invasive technique for treatment of chronic iliac venous obstruction. Follow-up is short at present in the few publications found in the literature.

Conclusions:

Iliac vein obstruction results in symptoms of swelling in the lower limbs. These may be managed conservatively. Where there is an indication for venous reconstruction, investigation by duplex ultrasonography is the first step. Endovascular procedures including stenting offer significant benefit. The long-term outcome of these interventions has yet to be established.
Compression Therapy: European Regulatory Affairs
Authors: Neumann H. A. M.
Published: January 2017

Objective:

Updating the status of the European standardisation for medical elastic compression stockings, including custom-made stockings (class 030606, EN29999), knitted from threads made of natural fibres or synthetic fibres and elastic threads.

Design:

Review of the literature.

Setting:

Department of Dermatology at the University Hospital of Maastricht (The Netherlands).

Methods:

Systematic review of the European regulations within the European Committee for Standardisation (CEN), by a special committee researching non-active medical devices (CEN/TC205). A special working group was set up for medical elastic compression stockings (CEN/TC205/WG2) and for anti-embolism stockings (CEN/TC205/WG2/P1) linked to the scientific background and literature on medical elastic compression stockings.

Results:

CEN/TC205 formalised a European prestandard (prEN12718) for medical elastic compression stockings. The pre-standard describes five compression classes, instructions for measurement, instructions for residual pressure and instructions for knitting. Still lacking is a good instrument for the comparison of laboratory measurements and a durability test. The problem of the elasticity coefficient is neglected in the standard.

Conclusions:

Normalisation of non-active medical devices is an important quality instrument. The medical profession should give attention to adequate compression classes, a good understanding of the elasticity coefficient and the durability of stockings.
A New Pragmatic Classification System for Varicose Veins
Authors: Michaels J. A. , Campbell W. B. , Rigby K. A. , Chan P. , Beard J. , Wood R. , Lonsdale R.J. , Sheriff S. , Palfreyman S. , Thompson J. , Allington K. , Brazier J. , Shackley P. , Niblett P. , Peters A. , Bickerton D.
Published: January 2017

Objective:

An anatomical classification system for varicose veins which has a direct and pragmatic bearing on treatment.

Methods:

A group of trial participants from the two vascular units involved met to design a system. A consensus on the form and content of the system was reached. This process included forming a set of ideal classification criteria, a literature review of existing classification systems and a pilot study of the proposed system.

Results:

The identified classification systems were felt to be unsatisfactory for a number of reasons including being difficult to understand and use, requiring special investigations and not linking through to clinical management options. The pilot study demonstrated consensus between clinicians when using our system.

Conclusion:

A system has been developed that is easy to learn, use and understand. It can be employed in a busy outpatient setting and produces an acceptable degree of agreement regarding the anatomical nature of varicose veins.
Ankle Motility is a Risk Factor for Healing of Chronic Venous Leg Ulcers
Authors: Barwell J. R. , Taylor M. , Deacon J. , Davies C. , Whyman M. R. , Poskitt K. R.
Published: January 2017

Objective:

To investigate the effect of ankle motility on chronic venous leg ulcer healing, and to relate this to calf pump function and muscle bulk.

Methods:

This was a prospective cohort study undertaken in a leg ulcer clinic. Ankle motility, calf-ankle circumference ratio and calf pump power (derived from digital photoplethysmography) were assessed as to their effect on ulcer healing rate. Thirty consecutive patients undergoing multi-layer compression bandaging for open chronic venous ulcers were included.

Results:

Ankle motility was an independent risk factor for ulcer healing ( p = 0.001, hazard ratio 1.08, 95% CI 1.03–1.13). Ankle motility correlated with calf-ankle circumference ratio ( r = 0.48, p<0.01). No relationship was found between photoplethysmography-derived calf pump power, ankle motility or ulcer healing rate.

Conclusions

Ulcers in legs with poor ankle motility are slower to heal and this may be related to reduced calf muscle bulk. Ankle exercises or physiotherapy could be considered in such patients.
Recurrent Varicose Veins in Surgical Practice
Authors: Alves C. Pereira , Neves J. , Soares T. , Pereira C.M. Alves , Negus David
Published: January 2017

Recurrent varicose veins are often regarded as inevitable. To confirm or refute this point we have analysed the last 20 patients operated on in our vascular unit.

Results have shown that majority of recurrences were due to inadequate primary treatment, with inadequate ligation of sapheno–femoral junction the most frequent cause.
Enzymatic and Isoenzymatic Study of Varicose Veins
Authors: García-Róspide V. , Peñafiel-Marfil R. , Moreno-Padilla F. , González-Ríos J. , Ramos-Bruno J.J. , Ros-Díe E.
Published: January 2017

The activities of lactate dehydrogenase (LDH), creatinine kinase (CK) and alkaline phosphatase (AP) enzymes were assessed in the venous wall according to the methods of Bergmeyer, Szasz and Bessey, respectively, in 50 varicose veins (44.7 ± 14.06 years mean age), and 51 control veins (65.7 ± 13.4 years mean age). We also assessed the activity of venous LDH and CK isoenzyme in both groups.

The most important finding was a significant decrease in LDH and CK in varicose veins, which may be of great importance in the study of varicose pathology.
The Cost of Day-Case Surgery for Varicose Veins
Authors: Price A. , Makin G. S.
Published: January 2017

A methodology is described to calculate the cost of day-case surgery at University Hospital, Nottingham during 1988/89, which may be suitable for use elsewhere. Day-case surgery for varicose veins is cheaper than the corresponding inpatient surgery.
Partial Versus Total Stripping of the Great Saphenous Vein Evaluated by Strain-Gauge Plethysmography
Authors: Helsted Morten , Hesselfeldt-Nielsen Jørgen , Mathiesen Frits R.
Published: January 2017

This study was undertaken in order to assess the necessity of stripping the great saphenous vein totally or partially in the treatment of varicose veins.

Thirty-four patients with varicose veins with no previous treatment were allocated to one of the two following treatments: sapheno–femoral ligation and complete stripping from the groin to the ankle with ligature of incompetent perforators and avulsion of visible varicose veins (group I); and partial stripping from the groin to 5 cm below the line of the knee joint and otherwise treated as mentioned above (group II).

All patients were examined clinically before and 3 months after surgery to assess their varicose veins and the sensitivity in the saphenous nerve area. They were all investigated by strain-gauge plethysmography, recording venous return-time (RT) and expelled volume (EV). The patients scored their subjective findings on visual analogue scales (VAS) assessing discomfort, swelling and visual appearance.

The Plethysmographic results of the two groups showed that RT increased by 25.5 and 22.5 s, respectively, to 53.4 and 63.6 s (median values) (normal RT > 42 s). The increment of the two groups, is significant, but a comparison does not show any significant difference. The EV-values showed nonsignificant changes. Saphenous nerve damage was found in five of 15 patients in group I and in one of 19 in group II, but this difference is not statistically significant ( P < 0.10).

The VAS scores showed a significant improvement in both groups, in terms of discomfort and visible appearance, but that they did not differ in these respects.

We conclude that partial stripping does not lead to a different outcome from total stripping, and that partial stripping seems to be the preferable treatment of primary varicose veins.
Leg Ulcer Patients: No Decreased Fibrinolytic Response but White Cell Trapping after Venous Occlusion of the Upper Limb
Authors: Vanscheidt W. , Kresse O. , Hach-Wunderle V. , Hasler K. , Scharrer I. , Wokalek H. , Schöpf E.
Published: January 2017

Objective:

To study changes in indicators of fibrinolytic activity and white cell trapping in response to raised venous pressure in the upper limbs of patients with chronic venous insufficiency.

Design:

Comparison of disease group versus control group study.

Setting:

Departments of Dermatology and Medicine, University of Freiburg.

Patient:

Thirty patients with chronic venous insufficiency and thirty control subjects of similar age with unrelated conditions.

Interventions:

The venous pressure was raised in one upper limb by application of a sphygmomanometer cuff around the upper arm for a period of 10 minutes.

Main outcome measures:

Red cell count, white cell count, plasminogen activator inhibitor, tissue plasminogen activator were measured in blood drawn from the arm subjected to raised venous pressure.

Results:

No significant changes were observed in the parameters of fibrinolytic activity. After 10 minutes of venous hypertension the white cell trapping in the disease group was 17.7% (interquartile range, 10.7–22), compared with 12.8% (interquartile range 4.9–16.1%) in the control group.

Conclusion:

The differences in white cell trapping parameters between healthy control subjects and patients with chronic venous insufficiency is probably attributable to systemic activation of white cells associated with their venous disease.
Lothian and Forth Valley Leg Ulcer Healing Trial, Part 1: Elastic versus Non-Elastic Bandaging in the Treatment of Chronic Leg Ulceration
Authors: Callam M. J. , Harper D. R. , Dale J. J. , Brown D. , Gibson B. , Prescott R. J. , Ruckley C. V.
Published: January 2017

Objective:

To determine whether elastic or non-elastic bandaging is more effective in healing chronic venous ulcers.

Design:

Randomized trial with factorial design and interaction analysis, enabling independent evaluation of both bandaging and dressings within the single-trial format. The duration of treatment was 12 weeks or until ulcer-healing, whichever occurred sooner.

Setting:

The Leg Ulcer Clinics of Edinburgh and Falkirk and District Royal Infirmaries, Scotland.

Patients:

132 patients with chronic leg ulcers and clinical evidence of chronic venous disease, and excluding those with Doppler ultrasound ankle/brachial pressure indices of less than 0.8, diabetes or rheumatoid disease. There were 28 withdrawals who were classified for analysis as treatment failures.

Interventions:

Elastic or non-elastic multilayer bandage systems were applied using similar application techniques by a team of trained nurse specialists. All other treatments were standardized, including the randomization of dressings to either a knitted viscose or a hydrocellular polyurethane dressing.

Main outcome measure:

Complete ulcer healing.

Results:

In the elastic group 35 out of 65 ulcers (54%) healed within 12 weeks compared with 19 out of 67 (28%) in the non-elastic group (95% confidence limits for percentage healed, 9% to 42%). Ulcer pain was also reported significantly less often in the elastic group (48% of visits versus 29%; p=0.03).

Conclusion:

When applied by similar multilayer bandaging techniques, elastic bandaging was significantly better than non-elastic bandaging in the treatment of chronic venous leg ulcer.
Bandaging of the Lower Leg
Authors: Gundersen J.
Published: January 2017

Objective:

To summarize the advantages of different bandaging techniques and their appropriateness in particular pathological condition.

Data Sources:

The author draws on his own considerable experience in the management of venous disease using bandaging techniques.

Conclusion:

The technique of bandaging is invaluable in the management of patients with lower limb oedema and venous disease. It should be learnt by all clinicians and nurses managing such patients.
Make it Easy: Duplex Examination of the Venous System
Authors: Kalodiki E. , Calahoras L. , Nicolaides A. N.
Published: January 2017

Objective:

A methodological report of duplex ultrasound examination of the venous system, with Particular consideration of the best position for examining the patient.

Design:

Single patient group, comparison of duplex ultrasound imaging with phlebography.

getting:

Teaching hospital vascular laboratory.

Patients:

Patients referred for assessment of their venous system.

Main outcome measures:

Duplex ultrasound scanning of the lower limb, ascending phlebography.

Results:

Our results of duplex ultrasound scanning in the diagnosis of deep vein thrombosis as compared with Phlebography show a sensitivity of 94% and a specificity of 91%.

Conclusions:

We found it advantageous to examine the Patient standing during proximal vein imaging and sitting for distal venous examination. Veins dilated as a result of gravitational effects are visualized more easily. The examiner, by resting the elbow on his/her distal Thigh, has a more stable hand, facilitating the test. The Patient, by resting the heel on the edge of the examiner's chair, relaxes the calf muscles, thus simplifying the augmentation manoeuvre. The inflation of a tourniquet applied to the distal thigh dilates the calf veins.
Calf Muscle Metabolism in Venous Insufficiency
Authors: Hands L. J. , Kemp G. J. , Zukowski A. , Nicolaides A. N. , Radda G. K.
Published: January 2017

Objectives:

To study the effect of deep venous insufficiency on calf muscle energy metabolism.

Design:

A paired study of affected and unaffected calf muscle in seven patients with unilateral lower limb deep venous insufficiency.

Investigations:

Phosphorus-31 magnetic resonance spectroscopy was used to study changes in vivo in pH, phosphocreatine and other phosphorus metabolites during and after exercise.

Results:

Glycolytic activity was increased in the affected muscle at the start of exercise but metabolic recovery following exercise was normal.

Conclusions:

Oxidative phosphorylation is impaired, at least at the start of exercise, but appears normal immediately after exercise. This may be due to inadequate blood flow, perhaps secondary to the rise in intramuscular pressure that occurs with exercise.
Recurrence and Late Sequelae after First-Time Deep Vein Thrombosis: Relationship to Initial Signs
Authors: Lagerstedt C. , Olsson C.-G. , Fagher B. , Norgren L. , Tengborn L.
Published: January 2017

Objective:

To investigate the relation between initial symptoms and long-term sequelae in first-time deep venous thrombosis (DVT).

Design:

Follow-up study of patients 6 years after an episode of suspected symptomatic DVT.

Setting:

Vascular laboratory, University Hospital of Lund.

Patients:

66 patients, 19 with femoral DVT, 20 with calf DVT and 27 with normal phlebograms at initial investigation.

Main outcome measures:

Symptoms and signs of chronic venous insufficiency (CVI), foot volumetry and measurement of plasminogen activator inhibitor 1 (PAI-1) activity. Initial clinical signs and results at phlebography were compared with findings at follow-up.

Results:

Of patients with DVT, 11 (28%) had been treated for a recurrent DVT during follow-up. No relation was found between initial signs of DVT and late signs of CVI. Patients with DVT had significantly more signs of CVI but symptoms did not differ between the groups. Mean levels of PAI-1 activity were similar in the three groups, and patients with recurrent DVT did not differ. Refilling flow was related to the clinical CVI-score, and expelled volume was inversely related to the extension of DVT at phlebography.

Conclusion:

The recurrence rate is high in first-time DVT, but symptoms are mostly mild as long as after 6 years. There is a poor correlation between symptoms of CVI and objective findings. The late development of CVI cannot be predicted from the clinical signs in the acute phase. Levels of PAI-1 do not correlate with the degree of CVI.
Assessment of Intermittent Pneumatic Compression by Strain-Gauge Plethysmography
Authors: Abu-Own A. , Scurr J. H. , Smith P. D. Coleridge
Published: January 2017

Objective:

To compare the physiological effects of a sequential gradient pneumatic compression device (SCD) with a single-chamber pneumatic compression device (Venodyne).

Design:

Single patient group with treatment crossover.

Setting:

Department of Surgery, University College and Middlesex Hospital, London, UK.

Subjects:

Thirty-four limbs of 17 normal adult volunteers were studied.

Interventions:

Sequential gradient compression was applied to one leg and single-chamber compression to the other lower limb for 10 min. The compression devices were then swapped to the opposite leg for a further 10 min period.

Outcome measures:

The increase in foot volume (distal venous distension) in response to each compression, and the subsequent decrease in foot volume (distal venous emptying), were measured. The overall reduction of foot volume (net effect) during the period of compression was calculated.

Results:

The results indicate the net effect was a decrease in foot volume (median decrease 0.35 ml%, 95% CI: 0.21% to 0.45%) with the SCD and no change with the Venodyne (median decrease 0.09 ml%, 95% CI: −0.25% to 0.22%).

Conclusion:

We conclude that sequential intermittent pneumatic compression of the calf and thigh is less likely to cause distal blood trapping and foot swelling than single-chamber calf compression.
Primary Venous Aneurysms of the Popliteal Fossa
Authors: Cheatle T. R. , Perrin M.
Published: January 2017

Objective:

To report five cases of primary venous aneurysm arising in the popliteal fossa.

Setting:

Unite de Pathologie Vasculaire Jean Kunlin, Clinique du Grand-Large, av. Leon-Blum, Decines Charpieu, France.

Patients:

Five patients with radiological evidence of venous aneurysm in the popliteal fossa.

Interventions:

Surgical repair in all cases.

Main outcome measures:

Avoidance of pulmonary embolism.

Results:

Satisfactory postoperative recovery in all. No complications or subsequent pulmonary emboli.
The Role of Elastic Compression Stockings in Prevention of Venous Dilatation Induced by a Reverse Trendelenburg Position
Authors: Arcelus J. I. , Caprini J. A. , Traverso C. I. , Size G. , Hasty J. H.
Published: January 2017

Objective:

To evaluate the response of the deep veins of the leg to an inclination from supine (reverse Trendelenburg) and assess the influence of gradient elastic compression stockings on such response.

Design:

Prospective study in healthy volunteers.

Setting:

University affiliated community hospital, Glenview, Illinois, USA.

Participants:

Ten healthy volunteers.

Interventions:

High-resolution ultrasound imaging was carried out to study the leg veins in the supine and 45° reverse Trendelenburg position, with and without thigh-length gradient elastic compression stockings. Main outcome measures: Vein cross-sectional area changes after the use of compression stockings in the supine position and after 30 and 60 min in a reverse Trendelenburg position.

Results:

Significant dilatation of the leg veins was observed during the reverse Trendelenburg position. This was partially prevented by the use of gradient elastic compression stockings.

Conclusion:

Elastic compression of the legs significantly reduces the dilatation of the medial gastrocnemius veins of the calf that occurs in healthy volunteers as a result of inclination from supine.
Role of Low Molecular Weight Heparins in the Prevention and Treatment of Venous Thromboembolism after Surgery
Authors: Andaz S. , Shields D. A. , Scurr J. H. , Smith P. D. Coleridge
Published: January 2017

Objective:

To examine the effectiveness of low molecular weight heparins (LMWHs) in the prevention and treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE) following surgery.

Design:

A review of the results of randomized controlled trials of LMWHs in which LMWH was compared with placebo, dextran or unfractionated heparin.

Methods:

Published data from journals indexed in Index Medicus (Medline CD Rom) since 1984 or found in the reference lists of such journals.

Main outcome measures:

Incidence of DVT as assessed by isotope scanning and/or venography and the incidence of PE and bleeding complications.

Results:

Prophylaxis with LMWH causes a significant reduction in the incidence of DVT compared with placebo, dextran and unfractionated heparin in high-risk patients undergoing orthopaedic operations, but there is no conclusive evidence that they are better than unfractionated heparin in general surgery. There was inconclusive evidence that LMWHs reduced the incidence of PE compared with dextran or unfractionated heparin. LMWHs were at least as safe as unfractionated heparin in terms of major haemorrhage or postoperative blood loss.

Conclusions:

Current evidence suggests the use of LMWHs in high-risk orthopaedic patients as a means of thromboprophylaxis is cost-effective. More trials are necessary to justify the use of LMWHs over unfractionated heparin in general surgery.
A Prospective Study of the Long-Term Efficacy of Two Different Venoactive Drugs in Patients with Post-Thrombotic Syndrome
Authors: Monreal M. , Callejas J. M. , Martorell A. , Lisbona C. , Lerma R.
Published: January 2017

Objective:

In an open cross-over study, the effect of two different venoactive drugs was prospectively studied in a series of patients with post-thrombotic syndrome.

Design:

Prospective, open cross-over study.

Patients:

Twenty-nine patients with established unilateral deep venous insufficiency of at least 12 months duration, and a history of venography-proven deep venous thrombosis in the affected leg.

Interventions:

On entering the study, patients were randomly assigned to receive either Hidrosmina (Venosmil, FAES SA, Spain) 600 mg daily, or 0-(β-hydroxyethyl)-rutosides (Venoruton, Zyma SA, Switzerland) 900 mg daily. The drugs were taken for 6 months. At the end of this period, the drug was discontinued, and patients taking Hidrosmina changed to rutosides, or vice versa, for a further 6-month period. Finally, both drugs were discontinued, and patients were re-examined 3 and 6 months later.

Results:

During the first 6-month period, 12 out of 29 patients showed reduced tiredness and/or pain in the leg in comparison to the control visit. Furthermore, a slight reduction was found in mean circumferences of both the ankle and calf during this study period. During the second 6-month period of therapy, six additional patients improved their subjective symptoms, but there were three patients in whom these symptoms had increased. Six months after discontinuation of therapy, subjective symptoms increased in 10 out of 29 patients, and mean circumferences of both the ankle and calf returned to baseline values.

Conclusions:

In this pilot study our findings demonstrate that venoactive drugs may improve both objective and subjective symptoms in patients with post-thrombotic syndrome, and that these effects disappear after drug therapy is discontinued.