bluuebunny/crossref_metadata_2025 huggingface dataset:
Short-Segment Hirschsprung's Disease
Authors: Momoh John T
Published: January 2017

The clinical features and treatment of 15 children with short-segment Hirscbsprung's disease were reviewed. It accounted for 25% of all Hirschsprung's cases seen 1975–84. The symptomatology, which was generally mild, consisted of slowly progressive abdominal distension with one of three defaecating patterns: persistent or intermittent diarrhoea; 2–3 normal daily motions; and constipated stool passed infrequently. Diagnosis was based mainly on the clinical features and barium enema findings. Eight patients had formal sphincterectomy and 3 had rectal muscle biopsy; follow up to 2½ years in some of the patients with sphincterectomy showed satisfactory results. Factors that would expedite clinical diagnosis are discussed.
A Simple Transfixion — Ligation Treatment of Haemorrhoids
Authors: Aina A O , Omo-Dare P
Published: January 2017

The complications which may occur after existing haemorrhoidectomy procedures are enumerated.

A new cost-effective operative procedure which requires minimal facilities and entails anal dilatation with simple transfixion-ligation of all primary and secondary haemorrhoids in one operating session is described.

The preoperative and postoperative progress of 56 patients with 2nd to 4th degree haemorrhoids managed by transfixion-ligation of the individual haemorrhoids are presented and evaluated.

Postoperative complications were few and mild. Pain and duration of hospitalization were consider-ably reduced and anal stenosis/fibrosis, faecal/ permanent flatus incontinence and recurrence of haemorrhoids were absent.

The procedure is recommended for the treatment of all degrees of haemorrhoids especially in developing countries where patients' average income is low, hospitals have few experienced surgical personnel, inadequately equipped operating theatres and an insufficient number of beds.
Five Hundred Consecutive Sigmoidoscopies for Frank Rectal Bleeding: An Analysis
Authors: Udezue N O
Published: January 2017

Sigmoidoscopy was performed for haematochezia in 500 consecutive patients. Haemorrhoidal disease was the most frequent cause of haematochezia. Neoplastic disease of the colorectum caused haematochezia in 5°7o of the patients; and in 1% of patients, neoplastic disease co-existed with haemorrhoidal disease.
Antisnakevenom: An Overused Medication
Authors: Thachil R T , Tony J C , Jude E , Ross C , Vincent N D John , Sridhar C B
Published: January 2017

Fifty-five cases of snakebite were retrospectively analysed for the indications for the use of antisnakevenom (ASV). Sixty-seven per cent of patients received treatment with ASV. Of these, 47% had features of systemic envenoming, 30% had features of local envenoming and 22% had no features of envenoming, either systemic or local. When WHO guidelines were strictly applied, it was found that in 44% of cases, ASV was used without adequate indication.
Obstetric Uterine Ruptures in a Rural Area in Zaïre
Authors: Longombe Ahuka Ona , Lusi K M , Nickson P
Published: January 2017

Uterine ruptures with their deplorable sequelae constitute a major obstetrical problem in the rural areas of Africa. The maternal and perinatal mortality remain high as a result, mainly due to the lack of early and adequate care for these patients. Grandemultiparity is one of the major predisposing factors. Prevention must necessarily include the availability of family planning advice, improved organization of and access to maternal care, and good supervision during delivery and the post-partum period. The general improvement of the overall socio-economic condition is a pre-condition to the improvement of access to care.
Growing Up on an Appalachian Farm
Authors: Holston Ezra C. , Callen Bonnie
Published: January 2017

Background

Research on centenarians to date has focused on areas with a high population of centenarians. However, there is limited literature on centenarians’ perspectives about growing up on farms from the heartland of Appalachia in Eastern Tennessee.

Purpose

This qualitative descriptive study was designed to characterize the role of a farming childhood by exploring the viewpoints of community-dwelling centenarians who grew up on farms in south central Appalachia.

Methods

A qualitative descriptive design was used with a convenience sample ( n = 16). Cognitive status was determined with the Short Portable Mental Status Questionnaire. Demographic data were collected. Interviews were transcribed and analyzed with the Neuendorf method of content analysis.

Results

Main emerging themes were the farm, the family, and the environment.

Conclusion

The farm was at the center of these centenarians’ childhood, influencing their family, community relations, and social interactions, which provided lessons that they utilized throughout their long lives.
Rethinking Informed Consent: The Case for Shared Medical Decision-Making
Authors: King Jaime Staples , Moulton Benjamin W.
Published: January 2017

In law, with rare exception such as legislative action, change is evolutionary and methodical. Unlike biomedical science where a breakthrough can quickly lead to dramatic changes in medical practice, legal precedent is more adherent and must evolve either through the legislative process or on a court by court basis in case law. Nevertheless, compelling evidence will pave the road to change within the law. Health care research conducted over the last three decades has produced a body of empirical evidence that suggests an overhaul of our current legal standards of informed consent is overdue.

This article uses health services research to examine the fundamental assumptions of our current informed consent laws and propose legal reform. Much has been written on how to bring the law to bear on medical practice in order to improve patient rights and protect physicians, but far less has been done to bring the practice of medicine to inform our legal standards. Prior legal scholarship on informed consent has made arguments regarding reform from both ethical and legal perspectives; however, only a small few have incorporated clinical and health services research as well as ethical and legal principles to analyze informed consent.
The Mental Health Paradigm and the MacArthur Study: Emerging Issues Challenging the Competence of Juveniles in Delinquency Systems
Authors: Katner David R.
Published: January 2017

Understanding the factors that impact a juvenile's adjudicative competence in delinquency and criminal proceedings today requires some familiarity with mental illness, mental retardation, and developmental immaturity. Current research and studies shed new light on these factors that juvenile advocates, prosecutors, judges, and policymakers must routinely confront. This article discusses some of the issues involved in competency determinations of juveniles awaiting trial; addressing both the more traditional factors, such as mental illness and mental retardation, and some of the more recent studies and literature identifying developmental immaturity as an emerging basis for challenging the competency of juveniles to stand trial.

Juvenile justice systems routinely presume that adolescents accused of delinquent or criminal misconduct are competent to stand trial. Adults charged with criminal misconduct are also presumed to be competent. Competency requires that citizens accused of criminal misconduct understand the charges against them, have rudimentary understanding of the court process, be able to understand and answer questions posed to them by their counsel, and be able to make decisions about their trial such as whether to testify, and whether to accept or reject plea bargains.
My Computer, My Doctor: A Constitutional Call for Federal Regulation of Cybermedicine
Authors: Lewis Carmen E.
Published: January 2017

Color it green. In a health care era driven by consumer demand, consumers are increasingly seeking Internet-based health services. Every day approximately seventy-three million Americans access the Internet in search of health information, with an average of six-million people seeking health advice. At present, a supply of over one-hundred thousand health-related websites serve the public’s demand for information and advice, with an average of one-thousand five hundred new sites added monthly. Surprisingly, consumers and students make up more than 30% of all healthrelated website users.4 From this union of cyberspace and the medical field, cybermedicine has emerged.

What does cybermedicine encompass? Cybermedicine is “the science of applying Internet and global networking technologies to medicine and public health, of studying the impact and implications of the Internet, and of evaluating opportunities and the challenges for health care.” General use of the Internet under this definition encompasses exploration and exploitation of the Internet for consumer health education, patient self-support, and professional medical education and research.
Delivering Drugs to the Poor: Will the TRIPS Amendment Help?
Authors: Dutfield Graham
Published: January 2017

Many of the diseases and health conditions that account for a large part of the disease burden in low- and middle-income countries are far less common in high-income countries. These burdens are primarily associated with infectious diseases, reproductive health, and childhood illnesses. Just eight diseases and conditions account for 29 percent of all deaths in low- and middle-income countries: TB, HIV/AIDS, diarrheal diseases, vaccine-preventable diseases of childhood, malaria, respiratory infections, maternal conditions, and neonatal deaths.

Approximately 17.6 million people in low- and middle-income countries die each year from communicable diseases and maternal and neonatal conditions. Both the occurrence of and the death rates from such diseases and conditions are far lower in all high-income countries.

Millions of people in developing countries die of diseases for which treatments exist that can relieve suffering and save, or at least prolong, people’s lives. High-profile pandemics like HIV/AIDS understandably attract considerable attention. Millions of people have died of this terrible disease - 2.6 million in 2003 and 2.8 million in 2005, of which Sub-Saharan Africa contributed 1.9 million and 2.0 million respectively. As the above quote makes clear, there are a whole host of diseases that have particularly devastating impacts on the poor.
Think Globally, Prescribe Locally: How Rational Pharmaceutical Policy in the U.S. Can Improve Global Access to Essential Medicines
Authors: Kesselheim Aaron S.
Published: January 2017

Improving access to essential medicines in low- and middle-income countries (LMICs) has become a critical health policy issue. Millions more people die each year in poorer countries from diseases that are treated by pharmaceutical agents currently available in higher income nations. Recent medical innovation has tended to focus on problems affecting populations in developed countries and avoid those found exclusively or predominantly in LMICs. The etiology of these disparities is multifactorial, and can include high costs of products, inadequate cooperation between governments and aid agencies, rigid protection of intellectual property rights, and poor local health leadership regarding dissemination of products.

Over the past two decades, there have been growing efforts to reduce global disparities in availability of essential medicines. At the forefront of these efforts have been international agencies such as the World Health Organization, or groups like Médicins Sans Frontières and Partners in Health, which have helped set international health priorities and sought to improve local health care delivery systems.
Intellectual Property and Development at WHO and WIPO
Authors: Lerner Jack
Published: January 2017

Recent activity at major intergovernmental organizations reflects a renewed emphasis on making the international intellectual property system work to foster global health in developing countries. The World Intellectual Property Organization (“WIPO”) recently approved a historic “Development Agenda” – a wide-ranging set of reforms that reorients WIPO towards development and reconfigures how the organization makes policy, provides technical assistance, and is administered. Such an initiative may seem natural for the only inter-governmental organization (IGO) that is focused primarily on intellectual property, but such reforms are not restricted to WIPO. The World Health Organization (“WHO”) has launched its own development agenda of sorts – an Intergovernmental Working Group on Public Health, Innovation and Intellectual Property (“IGWG”) that is tasked with preparing “a global strategy and plan of action” aimed at “securing an enhanced and sustainable basis for needs-driven, essential health research and development relevant to diseases that disproportionately affect developing countries, proposing clear objectives and priorities for research and development, and estimating funding needs in this area.”
Ending Drug Registration Apartheid: Taming Data Exclusivity and Patent/Registration Linkage
Authors: Baker Brook K.
Published: January 2017

The pharmaceutical industry's dependence on intellectual property rights (IPRs), especially patents, to exclude competitors and thereby recoup past expenditures, incentivize future investments in research and development (R&D), and maximize profits is well known. Although initially content to solidify patent rights in the rich-country markets of North America, Europe, and Japan, in the last quarter of the 20th century the industry has increasingly turned its attention to emerging markets in Latin America, Asia, and even Africa as sites of future market expansion. Big middle-income countries like Brazil, India, China, and Indonesia have growing middle classes that increasingly favor allopathic medicine over the more traditional medicines of their elders. Obtaining monopoly rights in these growing markets could help the pharmaceutical industry weather the storm of increased consumer, business, and government blow-back against supra-competitive drug prices charged in rich country markets.
Disability, Ambivalence, and the Law
Authors: Muller John F.
Published: January 2017

In this Article, I advance a new frame through which to organize discourse on disability and the law: the notion of ambivalence. I make two claims, one descriptive and one normative. Descriptively, I argue that ambivalence pervades encounters with disability. Disability attracts because it is a force that makes us human and disability repels because it is a force that threatens our humanity. The tension between these sentiments is not easily tolerated and tends to prompt denials of ambivalence; we embrace a conscious view of disability that belies our mixed sentiments and we suppress reactions to disability that conflict with this conscious view. Normatively, I argue that the law should express and expose ambivalence about disability. When we deny ambivalence, I argue, we cannot account for our genuine sentiments and we cannot prevent suppressed sentiments from emerging, intensified, in harmful and unanticipated forms. To avoid these dangers, the law should prevent the embrace of unequivocal views of disability as valued, devalued, or neutral, and seek to expose ambivalence about disability to the public. This prescription calls into question the prevailing orthodoxies of disability law.
Reproductive Choices and Informed Consent: Fetal Interests, Women's Identity, and Relational Autonomy
Authors: Laufer-Ukeles Pamela
Published: January 2017

In this Article, I describe and examine the severe shortcomings in women's autonomy in the context of reproductive choices in the medical arena. The reproductive choices I explore are those choices that involve gestation: abortion, fertility treatments, and interventions during pregnancy. Due to state and medical interests in the fetus, I describe how information conveyed to patients making reproductive choices is biased towards fetal interests, relies on female stereotypes, and is still conveyed with the objective authority of the medical profession. Moreover, reproductive choices implicate women's values and identity interests that reach beyond medical concerns, which are not part of the informed consent doctrine at all. The narrow, individualistic informed consent torts doctrine intended to protect patient autonomy does not do enough in this context to balance bias nor does it mandate discussion of important identity interests and values. Accordingly, I argue that when faced with reproductive choices, women are not provided the balanced and comprehensive information needed to promote their autonomy.

In response to the breakdown in patient autonomy I describe, instead of leaving women alone to make choices or regulating in order to protect them from their choices, a broader framework for supporting reproductive choices should be established. In light of the interdependence of woman and fetus, as well as the broader social context shaping these decisions, I argue that a more contextual, relational perspective of autonomy should be the goal of informed consent in the context of reproductive choices. I suggest a number of reforms that aim to optimize patient autonomy from a relational perspective. I suggest a broad, deliberative doctor-patient consultation and legal reforms that create more balance between the pull towards intervention and fetal protection on the one hand, and non-intervention and protection of women's personal identity interests on the other.
From voice to voices: identifying a plurality of Muslim sources in the news media
Authors: Munnik Michael B
Published: January 2017

This article identifies a qualitative change in the diversity of actors who represent Muslims in British news media. Hitherto, the literature discussing Muslims and the media has tended to characterize media organizations as institutions which portray Muslims in an essentialized, monolithic way. In contrast, I propose in this article that the process of representation is more complex, including greater agency and engaging a wider diversity of Muslims than the prevailing literature suggests. Sociological studies distinguish between official and unofficial sources who help determine the representations that journalists employ in their texts, and I apply this to Muslim communities in Glasgow. Using qualitative methods drawn from media production analysis, including participant-observation and ethnographic interviews, I identify a shift from a ‘gatekeeper’ model of representing the community to that of a plurality of sources, which reveals and insists on the diversity of Muslim communities and voices. I will show why a wider range of actors emerged to speak publicly, what differentiates them and how they position themselves as representatives of Muslims. This focus on producers and on source strategies brings fresh insights into a field dominated by content analysis and a ‘media-centric’ approach.
Disciplinary practices, metaparenting, and the quality of parent–child relationships in African-American, Mexican-American, and European-American mothers
Authors: Holden George W. , Hawk Carol Kozak , Smith Margaret M. , Singh Jimmy P. , Ashraf Rose
Published: January 2017

Coercive responses to children’s behavior are well recognized to be problematic for children’s adjustment. Less well understood is how parental social cognition is linked to discipline. In this study we sought to link metaparenting—parents’ thoughts about their parenting—to the use of coercive discipline. We predicted that mothers who engaged in more metaparenting, thus reflecting more deliberate parenting, would use corporal punishment less frequently and instead engage in non-coercive discipline. We also expected that mothers who engaged in more metaparenting would report closer relationships with their children. In order to assess a diverse sample, data were collected from approximately equal numbers of African-American, European-American, and Mexican-American mothers. Participants included 113 mothers with target children in three age groups, ranging from 2 to 12 years. The results indicated reports of corporal punishment as well as non-coercive discipline did not significantly differ across child sex and child age groups, but did differ significantly across race/ethnicity. Reports of frequency of metaparenting also differed across racial/ethnic groups; African-American mothers reported more metaparenting than European-American mothers on three of four subscales. Metaparenting was significantly related to reports of the mother–child relationship but in the opposite direction than predicted. Based on these results, future research directions linking parental social cognition to discipline are proposed.
Bridge to transplant or recovery in cardiogenic shock in a developing country
Authors: Villavicencio Mauricio A , Larraín Ernesto , Larrea Ricardo , Peralta Juan Pablo , Lim Jong S , Rojo Pamela , Donoso Erika , Gajardo Francesca , Hurtado Margarita , Rossel Víctor
Published: January 2017

Background

Durable mechanical support devices are prohibitively expensive in our health system and may be unsuitable for critically ill patients. CentriMag is an alternative bridge to transplantation or recovery.

Methods

We retrospectively reviewed 28 patients (23 males) aged 13–60 years who received CentriMag support. The etiology was ischemic in 13 (46%), dilated cardiomyopathy in 8 (29%), and others in 7 (25%). All patients were in Interagency Registry for Mechanically Assisted Circulatory Support class I, and 27 (96%) had multiorgan failure; 2 (7%) were post-cardiotomy and 12 (43%) had a previous cardiac arrest (mean arrest time 21 ± 17 min).

Results

Thirty-day post-implant survival was 79% (22 patients). Twenty (71%) patients were successfully bridged to transplantation or recovery. The mean support time was 40 days; 12 (43%) patients had >4-weeks’ support (longest was 292 days). Eight (29%) patients died on support. Complications included bleeding in 10 (36%) cases, immediate stroke in 4 (14%), and dialysis in 8 (29%). There was no stroke during subsequent support. Eighteen (64%) patients underwent transplantation, and 17 of them were discharged. Two (7%) patients recovered and were discharged. Two-year survival was 62% ± 10%. Mean follow-up was 21 months (total follow-up 579 months). Two (7%) patients died during follow-up. All survivors were in New York Heart Association class I.

Conclusions

CentriMag is useful for medium-term support for cardiogenic shock in a developing country. Support for >4 weeks is feasible. The stroke rate is low during support. The major drawback is prolonged intensive care unit stay.
Off-pump grafting does not reduce postoperative pulmonary dysfunction
Authors: Izzat Mohammad Bashar , Almohammad Farouk , Raslan Ahmad Fahed
Published: January 2017

Objectives

Pulmonary dysfunction is a recognized postoperative complication that may be linked to use of cardiopulmonary bypass. The off-pump technique of coronary artery bypass aims to avoid some of the complications that may be related to cardiopulmonary bypass. In this study, we compared the influence of on-pump or off-pump coronary artery bypass on pulmonary gas exchange following routine surgery.

Methods

Fifty patients (mean age 60.4 ± 8.4 years) with no preexisting lung disease and good left ventricular function undergoing primary coronary artery bypass grafting were prospectively randomized to undergo surgery with or without cardiopulmonary bypass. Alveolar/arterial oxygen pressure gradients were calculated prior to induction of anesthesia while the patients were breathing room air, and repeated postoperatively during mechanical ventilation and after extubation while inspiring 3 specific fractions of oxygen.

Results

Baseline preoperative arterial blood gases and alveolar/arterial oxygen pressure gradients were similar in both groups. At both postoperative stages, the partial pressure of arterial oxygen and alveolar/arterial oxygen pressure gradients increased with increasing fraction of inspired oxygen, but there were no statistically significant differences between patients who underwent surgery with or without cardiopulmonary bypass, either during ventilation or after extubation.

Conclusions

Off-pump surgery is not associated with superior pulmonary gas exchange in the early postoperative period following routine coronary artery bypass grafting in patients with good left ventricular function and no preexisting lung disease.
Valsalva maneuver in phlebologic practice
Authors: Ricci Stefano , Moro Leo , Minotti Girolamo C , Incalzi Raffaele A , De Maeseneer Marianne
Published: January 2017

Forced expiration against an airway obstruction was originally described as a method for inflating the Eustachian tubes and is accredited to Antonio Maria Valsalva (1666–1723). The Valsalva maneuver is commonly applied for different diagnostic purposes. Its use for phlebologic diagnosis is the object this review. Venous reflux is the most frequent pathophysiologic mechanism in chronic venous disease. Reflux is easily visualized by duplex ultrasound when properly elicited, in standing position. A simple way to elicit reflux is the so-called “compression-release maneuver”: by emptying the muscle reservoir, it determines a centrifugal gradient, dependent on hydrostatic pressure, creating an aspiration system from the superficial to the deep system. The same results are obtained with dynamics tests activating calf muscles. The Valsalva maneuver elicits reflux by a different mechanism, increasing the downstream pressure and, thus, highlighting any connection between the source of reflux and the refluxing vessel. The Valsalva maneuver is typically used to investigate the saphenofemoral junction. When the maneuver is performed correctly, it is very useful to analyse several conditions and different hemodynamic behaviours of the valvular system at the saphenofemoral junction. Negative Valsalva maneuver always indicates valvular competence at the saphenofemoral junction. Reverse flow lasting during the whole strain (positive Valsalva maneuver) indicates incompetence or absence of proximal valves. Coupling Valsalva maneuver to compression-release maneuver, with the sample volume in different saphenofemoral junction sections, may reveal different hemodynamic situations at the saphenofemoral junction, which can be analysed in detail.
Lower limbs venous kinetics and consequent impact on drainage direction
Authors: Gianesini Sergio , Sisini Francesco , Di Domenico Giovanni , Secchiero Joel , Malagoni Anna Maria , Menegatti Erica , Gambaccini Mauro , Zamboni Paolo
Published: January 2017

Background

Literature concerning the lower limbs physiological venous haemodynamics is still lacking of reference velocity values and consequent impact on drainage direction. Aim of the present study is to assess the flow velocities in the different venous compartments, evaluating the possible Venturi effect role, thus finding clues for the identification of the physical model governing the flow direction.

Methods

Thirty-six lower limbs underwent a velocity and diameters echo-color-Doppler assessment in several anatomical point of analysis along both the deep and superficial venous systems. The investigation protocol included and compared two different manoeuvres to elicit the flow: manual calf compression/relaxation (CR) and active foot dorsiflexion (AFD). Both peak systolic (PSV) and time average velocities (TAV) were measured.

Results

The different venous segments demonstrated an overlap among the velocity values and the anatomical subdivision of the deep and superficial compartments. At the CR, TAV was 34 ± 12 cm/s in the deep venous system (N1), 15 ± 7 cm/s in the saphenous system (N2), 5 ± 2 cm/s in the saphenous tributaries (N3); PSV was 89 ± 35 cm/s in N1, 34 ± 16 cm/s in N2, 11 ± 4 cm/s in N3, p < 0.05. At the AFD, TAV was 33 ± 13 cm/s in N1, 15 ± 7 in N2, 9 ± 5 in N3; PSV was 83 ± 35 in N1, 32 ± 17 in N2, 15 ± 4 in N3, p < 0.05. A diameter decrease was reported from N1 to N3 ( p < 0.05).

Conclusion

This investigation provides evidences of the velocity decrease from the deepest to the most superficial compartments. These data introduce the Venturi effect as potential factor in the flow aspiration from the tributary to the deeper veins. The reported data represent a first step towards an objective evaluation of the physic laws governing the drainage. These values can constitute the basis for further investigations in pathological and post-procedural scenarios.
Congenital Angiodysplasia of the Lower Limb: The Klippel—Trenaunay Syndrome and Arteriovenous Fistulae
Authors: Lendorf Axel , Struckmann Jan , Strange-Vognsen Hans H. , Nielsen S. Levin
Published: January 2017

During a 10-year period 13 patients were admitted on suspicion of congenital arteriovenous fistulae. Two patients turned out to have a Klippel-Trenaunay syndrome without evidence of arteriovenous fistula and two patients had agenesis of the venous drainage system. Evaluation by noninvasive methods for classification of this rare condition is of the microsphere injection technique before arteriography and venous emptying measurement before venography. From our experience only the microsphere technique is recommended to evaluate the severity of the shunting.

The possibility of a partial excision of the angiodysplasia is the task of the surgeon facing the impossibility of radical operation. Therefore arteriograms should guide the surgeon in his attempt to reduce the hemodynamic consequence of shunting. Patients having a normal arteriogram should have a venogram before surgical exploration is attempted. In the series three patients turned out to have venous defects and removal of superficial varicosities would have aggravated the situation.
Effects of Micronization on Digestive Absorption of Diosmin
Authors: Johnston A. M. , Paul H. J. , Young C. G.
Published: January 2017

Objective:

To investigate the effect of diosmin particle size on the rate and extent of absorption and excretion of total radioactivity, following oral administration of micronized and non-micronized [14C]-diosmin to New Zealand White rabbits.

Design:

This study was conducted in a 2 x 12 cross-over design at a uniform target dose level of 10 mg/kg, and was conducted according to Good Laboratory Practice. The micronized formulation was prepared using a Microdismembrator II, and all prepared doses were suspended in 0.5% w/v aqueous methylcellulose at a target concentration of 5 mg/ml. Particle size analysis indicated that in the micronized formulation, 90% of particles were ≤2 <m, and in the non-micronized formulation, more than 75% of particles were ≥3 <m.

Results:

Analysis of percentage dose excreted via urine post-dose indicated a higher urinary output in the animals that received micronized diosmin (mean of 72% dose in both 0–48 h and 0–168 h) compared with means of 16% dose and 17% dose, respectively, in animals that received the non-micronized formulation. Statistical analysis showed these differences to be highly significant ( p < 0.0001), with no evidence of sequence or phase effects.

Conclusion:

Reduction of particle size of [14C]-diosmin when administered orally as a suspension to rabbits resulted in a marked increase in the proportion of the dose excreted in urine. This increase was considered to reflect an increased absorption of radiolabelled components from the micronized dose.
Differences Between Upper and Lower Limbs in Venous Endothelial Reactivity in Humans
Authors: Bailliart O. , Boudaoud L. , Bonnin Ph. , Sollier C. Bal Dit , Roussi J. , Carayon A. , Martineaud J. P. , Drouet L. O.
Published: January 2017

Objective:

To determine the variability of endothelial reactivity to venostasis in the upper and lower limbs of healthy subjects.

Participants:

Ten healthy volunteers were investigated twice, at an interval of 1-week.

Main outcome measures:

Plasma concentrations of substances released from endothelial cells were determined in each limb after 10 min of venostasis in a sequential manner. Tissue plasminogen activator (tPA), plasminogen activator inhibiting factor (PAI-1), thrombin–antithrombin complexes (TAT) and D-dimers (D-Di) were used as indicators of the thrombotic process and its reactions; angiotensin converting enzyme (ACE) and endothelin-1 (ET1) were related to endothelial cell activity involved in vascular tone regulation.

Results:

No difference was observed in endothelial cell recovery following venostasis after an interval of 1 week. A significant difference in endothelial cell release was found between the upper and lower limbs and between the right and left legs.

Conclusions:

Excellent reproducibility of measurements was observed. In keeping with the higher frequency of venous thrombosis in the lower limbs, the left leg seemed to be less reactive after venostasis, and the endothelium was more reactive in the upper than in the lower limbs.
Physiology of Lymphatic Oedema
Authors: Cossio J. A. Jimenez
Published: January 2017

Objective:

To describe the physiological mechanisms implicated in lymph formation and drainage, and the pathophysiology of lymphoedema.

Design:

Historical steps leading to the current understanding of the physiology and pathophysiology of lymph formation.

Data extraction:

Selection of relevant articles from the literature.

Data synthesis:

After a summary of the anatomical structures involved in the lymphatic system, the physiology of lymph formation and transport is described with special emphasis on recent hypotheses. The pathophysiology of lymphoedema is explained based on a combination of two factors: protein content and fluid movements within the lymphatic system.

Conclusion:

The pathophysiology of lymphoedema is currently better understood, even if some aspects remain unclear. This can lead to an improved therapeutic management of lymphoedema.
Control of Lymphatic Pumping: Interest of Daflon 500 mg
Authors: Mchale N. G. , Hollywood M. A.
Published: January 2017

Objective:

To determine the effects of Daflon 500 mg on lymph flow, known to be modulated by lymph formation and contractility of the collecting ducts.

Experimental design:

The effect of Daflon 500 mg was investigated in vitro on isolated rings of sheep mesenteric lymphatics, at concentrations of 10-7 M and higher. In vivo, lymph flow was measured in unanaesthetized sheep before and after 5 days of administration of Daflon 500 mg at the oral dose of 10 mg/kg/day.

Results:

Daflon 500 mg significantly increased the frequency of spontaneous contractions in vitro, and in vivo increased the lymph flow when compared with pre-drug levels.

Conclusion:

It is suggested that Daflon 500 mg increases lymph flow under these conditions by stimulating the lymph pump directly, a result that is consistent with previous studies.
Action of Dation 500 mg on the Principal Inflammatory Mediators
Authors: Lerond L.
Published: January 2017

Objective:

To review the in vivo and in vitro studies having elicited an action of Daflon 500 mg*, a purified micronized flavonoid fraction, on inflammatory processes.

Design:

Antioedematous and antichemotactic effects were investigated in rats in three studies. Moreover, the effect of Daflon 500 mg on free radicals, lipoperoxide and arachidonic acid metabolites known as inflammatory mediators was studied mainly in vitro to help understand mechanisms responsible for the anti-inflammatory activity.

Results:

The in vivo studies demonstrated that at the single oral dose of 100 mg/kg, Daflon 500 mg inhibited oedema induced by carrageenan injection into the plantar tissue of a hind paw. On a more chronic inflammatory condition, administered at the same dose during the 15 days preceding subcutaneous implantation of sponges and continued until sacrifice, it reduced granuloma weights (reflecting plasma extravasation) and density of phagocytic cells, and at a dose of 300 mg/kg/day for 1 month it mitigated mononuclear infiltration in the pancreas of diabetic rats. On the other hand, Daflon 500 mg in vitro elicited antiradical activity by inhibition of chemiluminesence, inhibited lipid peroxidation induced after hypoxia/reoxygenation in bovine aorto-endothelial cells and after UVA exposure in human fibroblasts. Besides, Daflon 500 mg decreased leukotriene production in rat stimulated mast cells as well as prostaglandins (PGE2, PGF2α) and thromboxane (TxB2) in a granuloma model.

Conclusion:

The effects of Daflon 500 mg on experimental oedema probably result from interference with inflammatory mediators as demonstrated using in vivo and in vitro models, and may serve as a rational basis to explain its efficacy in diseases such as chronic venous insufficiency and more specifically in haemorrhoidal attacks.
Anatomical Patterns in Varicose Vein Disease: A Duplex Scanning Study
Authors: Guex J. J. , Hiltbrand B. , Bayon J. M. , Henri F. , Allaert F. A. , Perrin M.
Published: January 2017

Objectives:

To determine symptomatology, clinical class, and topographic patterns of varicose veins in a consecutive series of patients with venous complaints.

Methods:

We performed clinical examination and duplex scanning of 498 lower limbs in 317 patients with obvious varicose veins for whom no previous treatment had been undertaken.

Results:

Classes of chronic venous insufficiency (CVI) in 498 legs: grade 0: 117 (23.5%); gr 1: 310 (62.2%); gr 2: 47 (9.4%); gr 3: 24 (4.8%). Duplex-detected venous reflux was found in the greater saphenous vein territory (junction or trunk or related perforator or main tributary) in 423 limbs (85.3%) the sapheno-femoral junction was incompetent in only 342 legs (68.7%). Reflux was found in the lesser saphenous vein territory in 100 limbs (20.1%) and in sapheno-popliteal junction in 92 (18.5%). Strictly non saphenous origin of varicosities was found in 31 limbs (6.2%). Deep venous incompetence was found in 48 legs (9.6%).

Conclusions:

These findings yield data on the distribution and occurence of lower limbs venous lesions in patients with varicose disease.
An Investigation of Radial Reflux in an Isolated Peripheral Canine Vein Segment
Authors: Crotty T. P.
Published: January 2017

Objective:

To investigate the effects of flow from the vein lumen into the vasa venarum (radial reflux) and the factors regulating it.

Design:

In vivo and in vitro animal study.

Setting:

University Department of Physiology.

Materials:

Segments of canine vein were perfused in vitro ( n = 84) and in situ ( n = 60).

Main outcome measures:

Specimens were studied by conventional histology using light microscopy.

Results:

Radial reflux caused dilatation of constricted segments and when associated with turbulent flow resulted in the formation of acute short-lived varices, marked dilatation of sinusoidal venules at the medioadventitial junction of the segments and of sinusoidal venules in the paradventitial tissue.

Conclusion:

During laminar flow radial reflux operated as a feedback to regulate venoconstrictor tone. During turbulent flow it caused more widespread vascular changes and inhibited adrenergic activity. The changes are of particular interest because they mimicked those that characterize the early stage of varicose veins.
Venous Insufficiency 4 Years after an Episode of Deep Vein Thrombosis: A Clinical and Plethysmographic Investigation
Authors: Nordström M. , Lindblad B. , Åkesson H. , Bergqvist D. , Kjellström T.
Published: January 2017

Objective:

To evaluate the frequency of venous insufficiency following deep vein thrombosis (DVT).

Design:

Follow-up 4 years after a verified DVT.

Setting:

University hospital in Malmö.

Patients:

Eighty-seven subjects with venographically verified DVT.

Main outcome measure:

To compare venous function in legs, with and without previous DVT, by venous straingauge plethysmography and its correlation with clinical symptoms and signs.

Results:

Fifty-two per cent of patients described general discomfort from the thrombotic leg at follow-up. Active leg ulcers were found in three patients (3%); there were no signs of venous insufficiency in 33% at clinical examination. Thirty-seven patients (75%) with ≥ 1 cm difference in calf circumference between the thrombotic and contralateral leg had suffered a proximal DVT. The refilling time T90 was pathological in 67% and the muscle pump function (RV) in 55%. In the nonthrombotic leg the corresponding figures were 53% and 40%. Nevertheless a positive correlation was found between RV of the thrombotic leg and the contralateral leg ( r = 0.33) but an even stronger correlation was found for T90 ( r = 0.74).

Conclusion:

Venous insufficiency was found in 60% of legs 4 years after DVT but was also found in 14% of legs without previous thrombosis. This may be caused not only by effects of the thrombosis but also by the ageing process.
Venous Leg Ulcer Healing: A Randomized Prospective Study of Long-Stretch versus Short-Stretch Compression Bandages
Authors: Danielsen L. , Madsen S. M. , Henriksen L.
Published: January 2017

Objective:

To compare the efficacy of a long-stretch bandage with that of a short-stretch compression bandage.

Design:

Prospective evaluation of healing of venous leg ulcers in blindly randomized groups of patients.

Setting:

Bispebjerg Hospital, Copenhagen, Denmark.

Patients:

Forty-three patients with venous leg ulcers were included. Forty legs in 40 patients were evaluated at 1 month (34 patients), 6 months (32 patients) or 12 months (27 patients).

Interventions:

Both types of bandage were used at a width of 10 cm and applied using the same spiral bandaging technique.

Main outcome measures:

Ulcer healing and ulcer area reduction.

Results:

Healed ulcers after 1 month were observed in 27% of the long-stretch group and in 5% of the short-stretch group ( p = 0.15); after 6 months the corresponding figures were 50% and 36% ( p = 0.49) and after 12 months 71% and 30% ( p = 0.06). Using life-table analysis the predicted healing rate in the long-stretch group after 12 months was 81% and for the short-stretch group 31% ( p = 0.03). The mean of relative ulcer areas at 1 month was 0.45 for the long-stretch group and 0.72 for the short-stretch group ( p = 0.07), at 6 months the corresponding figures were 0.81 and 0.60 ( p = 0.25) and at 12 months 0.25 and 0.95 ( p = 0.01).

Conclusions:

The present study appears to indicate a Positive influence of the elasticity of a compression bandage on venous ulcer healing.
Clinical Relevance of Neovascularisation on Duplex Ultrasound in the Long-Term Follow-up after Varicose Vein Operation
Authors: De Maeseneer M. G. , Tielliu I. F. , Van Schil P. E. , De Hert S. G. , Eyskens E. J.
Published: January 2017

Objective:

To evaluate the clinical relevance of neovascularisation at the saphenous ligation site.

Design:

Long-term follow-up after previous varicose vein surgery in a single patient group.

Setting:

Vascular clinic of a university hospital.

Patients:

Eighty-two patients (106 limbs) with a mean follow-up period of 56 months after correct saphenous ligation were submitted to duplex scanning.

Intervention:

Clinical assessment and colour duplex scanning of all the operated limbs. Reintervention in 15 limbs with perioperative evaluation of recurrent veins.

Main outcome measures:

Limbs with and without recurrent varicose veins were classified according to the degree of neovascularisation: grade 0 = no new communicating veins, grade 1 = tiny new vein with diameter <4 mm, grade 2 = new communicating vein with diameter >4 mm and pathological reflux. On reintervention the presence of neovascular veins at the site of the previous ligation was checked.

Results:

In 68 limbs without recurrent varicose veins, grade 0 was observed in 50 limbs (74%), grade 1 in 12 limbs (18%) and grade 2 in six limbs (9%). In 38 limbs with recurrent varicose veins, grade 0 was diagnosed in eight limbs (21%), grade 1 in four limbs (11%) and grade 2 in 26 limbs (68%). In 15 limbs with recurrent varicose veins and grade 2 neovascularisation, reintervention confirmed the duplex findings.

Conclusions:

The presence of grade 2 neovascularisation was associated with the recurrence of varicose veins, suggesting a causal relationship.
Crossed cerebellar diaschisis in acute ischemic stroke: Impact on morphologic and functional outcome
Authors: Kunz Wolfgang G , Sommer Wieland H , Höhne Christopher , Fabritius Matthias P , Schuler Felix , Dorn Franziska , Othman Ahmed E , Meinel Felix G , von Baumgarten Louisa , Reiser Maximilian F , Ertl-Wagner Birgit , Thierfelder Kolja M
Published: January 2017

Crossed cerebellar diaschisis (CCD) is the phenomenon of hypoperfusion and hypometabolism of the contralateral cerebellar hemisphere caused by dysfunction of the related supratentorial region. Our aim was to analyze its influence on morphologic and functional outcome in acute ischemic stroke. Subjects with stroke caused by a large vessel occlusion of the anterior circulation were selected from an initial cohort of 1644 consecutive patients who underwent multiparametric CT including whole-brain CT perfusion. Two experienced readers evaluated the posterior fossa in terms of CCD absence (CCD−) or presence (CCD+). A total of 156 patients formed the study cohort with 102 patients (65.4%) categorized as CCD− and 54 (34.6%) as CCD+. In linear and logistic regression analyses, no significant association between CCD and final infarction volume (β = −0.440, p = 0.972), discharge mRS ≤ 2 (OR = 1.897, p = 0.320), or 90-day mRS ≤ 2 (OR = 0.531, p = 0.492) was detected. CCD+ patients had larger supratentorial cerebral blood flow deficits (median: 164 ml vs. 115 ml; p = 0.001) compared to CCD−patients. Regarding complications, CCD was associated with a higher rate of parenchymal hematomas (OR = 4.793, p = 0.035). In conclusion, CCD is frequently encountered in acute ischemic stroke caused by large vessel occlusion of the anterior circulation. CCD was associated with the occurrence of parenchymal hematoma in the ipsilateral cerebral infarction but did not prove to significantly influence patient outcome.
Diagnostic accuracy of diffusion restriction in intraductal papillary mucinous neoplasm of the pancreas in comparison with “high-risk stigmata” of the 2012 international consensus guidelines for prediction of the malignancy and invasiveness
Authors: Kim Mimi , Mi Jang Kyung , Kim Seong Hyun , Doo Song Kyoung , Jeong Woo Kyoung , Kang Tae Wook , Kim Young Kon , Cha Dong Ik , Kim Kyunga , Yoo Heejin
Published: January 2017

Background

It is debated whether diagnostic performance of diffusion-weighted imaging (DWI), which is widely used for detection and characterization of various malignant tumors, is comparable with high-risk stigmata of 2012 international consensus guidelines (ICG) for diagnosis of intraductal papillary mucinous neoplasms (IPMNs).

Purpose

To evaluate the diagnostic accuracy of diffusion restriction in IPMNs for prediction of malignancy and invasiveness in comparison with high-risk stigmata of 2012 ICG.

Material and Methods

This retrospective study was institutional review board approved and informed consent was waived. A total of 132 patients with surgically proven IPMNs (49 malignant, 83 benign) who underwent gadoxetic acid-enhanced magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and DWI with a b-value of 0, 100, and 800 s/mm2 using a 3.0 T MR system were included. Two radiologists independently evaluated imaging parameters of high-risk stigmata and worrisome features of 2012 ICG and diffusion restriction in IPMNs. Univariate and multivariate logistic regression analyses and McNemar’s test were used for statistical analysis.

Results

The presence of diffusion restriction in IPMNs was the only independent imaging parameter for prediction of malignancy (odds ratio [OR], 11.98; 95% confidence interval [CI], 3.60–39.87; P < 0.001) and invasiveness (OR, 17.92; 95% CI, 3.91–82.03; P < 0.001) on multivariate analysis. The diagnostic accuracy and specificity of diffusion restriction were significantly improved compared to high-risk stigmata of 2012 ICG to prediction of malignant ( P = 0.006 and P < 0.001, respectively) or invasive IPMNs ( P = 0.009 and P = 0.015, respectively).

Conclusion

The diffusion restriction in IPMNs could be considered as another high-risk stigma of malignancy and predictor for invasiveness.