bluuebunny/crossref_metadata_2025 huggingface dataset:
Microangiopathy in Chronic Venous Insufficiency before and after Sclerotherapy and Compression Treatment: Results of a One-Year Follow-up Study
Authors: Leu A. J. , Yanar A. , Geiger M. , Franzeck U. K. , Bollinger A.
Published: January 2017

Objective:

To characterize microangiopathy in patients with chronic venous insufficiency (CVI) of a moderate to severe stage and to evaluate improvement of the microcirculatory parameters after sclerotherapy of incompetent perforators and compression therapy.

Design:

Fluorescence videomicroscopy (Na-fluore-scein), laser Doppler fluxmetry and tc Po2 measurements (43°C) at the medial ankle in healthy controls and patients. Laser Doppler flux and tc Po2 were recorded in supine and sitting position in order to evaluate postural vasoconstriction. The measurements were repeated 6 and 12 months after sclerotherapy of incompetent perforators (Polidocanol 40 mg/ml) and compression therapy by below-knee class II or III stockings (Sigvaris®).

Setting:

Department of Internal Medicine, Angiology Division, University Hospital, Zurich, Switzerland.

Patients, participants:

15 healthy subjects (15 legs, mean age 53.3 years) and 15 patients with CVI of a moderate to severe stage (17 legs, mean age 56.8 years).

Results:

Microangiopathy in CVI is characterized by significantly enlarged, elongated and dilated capillaries with increased diameters of the pericapillary spaces (‘halos’). Single capillaries may be thrombosed. Laser Doppler flux is increased and tc Po2 is decreased. After therapy, there was a trend to decreased laser Doppler flux and an increase in tc Po2, but the differences were not statistically significant. Capillary thromboses were no longer detected. Mean halo diameters tended to decrease, but this difference was not statistically significant.

Conclusions:

Microangiopathy in CVI is characterized by morphological and functional changes. Beneficial changes induced by therapy develop slowly and emphasize the importance of long-lasting treatment.
Long-Term Clinical Results following Correction of Incompetent Superficial and Perforating Veins in Patients with Deep Venous Incompetence and Ulcers
Authors: Åkesson H.
Published: January 2017

Objectives:

To assess the presence of venous ulcers following stripping of the saphenous vein and ligation of perforating veins in patients with deep venous incompetence.

Design:

Retrospective follow-up after a median of 41 months following surgery.

Patients:

Thirty operated limbs in 25 patients with venous ulcers, originally entering a prospective study of physiological changes following surgery for venous insufficiency.

Interventions:

An interview regarding absence of ulcers, expressed as a percentage of the follow-up time after surgery – the ‘ulcer-free period’. Correlation with ambulatory venous pressure (AVP) and foot volumetric measures following surgery.

Main outcome measures:

The presence or absence of venous ulcers.

Results:

The ulcer-free period for the whole group was 76%. There was a significant (p<0.05) difference in the ulcer-free period in limbs with an AVP below 60 mmHg (89%) compared with limbs with a higher AVP (70%).

Conclusion:

Failure to normalize AVP with surgery results in persistent high venous pressure and an increased risk of venous ulceration recurrences.
Venoscopy in Varicose Vein Surgery: Initial Experience
Authors: Gradman W. S. , Segalowitz J. , Grundfest W.
Published: January 2017

Objective:

To determine the number and function of valves and the location of perforators and tributaries in patients with varicose veins as a result of saphenofemoral or saphenopopliteal reflux.

Design:

Prospective endovascular evaluation of greater and lesser saphenous veins during varicose vein surgery.

Setting:

Cedars-Sinai Medical Center, Los Angeles, California, USA.

Patients:

Thirty-one limbs in 25 patients undergoing varicose vein surgery.

Intervention:

Patients underwent retrograde passage of a 2.3 mm angioscope from the junction of the saphenous and deep vein distally to the first competent valve.

Main outcome measures:

Based on intraoperative findings, the greater saphenous vein was preserved in eight out of 25 cases. Preoperative assessment of lesser saphenous reflux was incorrect in three out of six cases.

Results:

An incompetent subterminal valve was found in 16 out of 25 greater saphenous veins. In 13 out of 25 limbs, no other valves were seen to the knee. Four patients had competent thigh valves.

Conclusions:

Retrograde venoscopy may be of benefit in varicose vein surgery.
Lower Limb Neutrophil Oxygen Radical Production is Increased in Venous Hypertension
Authors: Whiston R. J. , Hallet M. B. , Lane I. F. , Harding K. G.
Published: January 2017

Objective:

To investigate neutrophil free radical production in patients with venous hypertension.

Patients:

Thirteen legs in patients with venous ulceration were compared with seven legs in patients suffering from lipodermatosclerosis (LDS) only and nine normal controls.

Design:

Leg and arm venous blood samples were obtained from each patient after a period of 30 min of leg dependency followed by elevation to the horizontal for a further 5 min. Neutrophils were isolated and free radical production assessed by luminol-dependen t chemiluminescence following stimulation with the chemotactic peptide FMLP.

Results:

The ratio of leg to arm luminescence was significantly higher in patients with venous ulceration (median 1.61; 95% confidence interval (CI) 1.20–3.05; p=0.0002) and those with LDS (median 1.36; 95% CI 1.05–2.01; p=0.0036) when compared with the controls (median 0.97; 95% CI 0.70–1.12).

Conclusions:

Neutrophil free radical production is increased in the legs of patients with venous hypertension and may be implicated in the underlying pathogenesis of this disease.
Extravascular Masses Masquerading as Deep Venous Thrombosis
Authors: Thulesius O. , Thurin A.
Published: January 2017

Objective:

To determine the incidence and characteristics of extravascular masses (EVM) giving rise to symptoms and signs of deep venous thrombosis (DVT).

Design and technique:

Routine ultrasound colour duplex scanning during a 6-month period.

Patients:

Three hundred and two inpatients and outpatients investigated on suspicion of DVT.

Setting:

Department of Clinical Physiology, which is the central non-invasive diagnostic unit of the county.

Results:

A diagnostis of DVT was made in 33%. EVM were detected in 14 patients (5%). In most cases the characteristic appearance on scanning was spindle-shaped (like a ‘mouse’) and mostly confined to the upper calf. These EVM were regarded as intramuscular haematoma or ruptured popliteal cysts.

Conclusion:

EVM of the leg are (1) a frequent cause of ‘pseudothrombosis' and can positively be identified by duplex ultrasound scanning: (2) most frequently found in the medial aspect of the right calf; and (3) often detected in patients with rheumatoid arthritis or patients on anticoagulant therapy and may give rise to signs and symptoms identical to DVT.
The Role of External Banding Valvuloplasty in the Surgical Management of Chronic Deep Venous Disease
Authors: Schanzer H. , Skladany M. , Peirce E. C.
Published: January 2017

Objective:

Correction of venous reflux by perivalvular banding in patients suffering from chronic venous stasis secondary to primary valvular incompetence.

Design:

Prospective study in a group of patients with severe venous insufficiency. One patient (one extremity) was lost to follow-up.

Setting:

Tertiary care teaching hospital.

Patients:

Twelve patients (13 extremities) with severe or moderate venous insufficiency.

Interventions:

Correction of valvular incompetence by narrowing a valvular ring with an external band. Twenty-seven bands were fitted to incompetent valves of 13 extremities.

Main outcome measures:

Abolition of reflux and improvement of muscle pump measured by clinical, plethysmographic and venographic criteria.

Results:

Symptomatic improvement was found in 10 extremities (77%) and complete correction of reflux on venography in eight extremities (67%). Plethysmographically measured reflux improved in 6 extremities (50%) and muscle pump function improved in 7 extremities (58%). No correlation was found between plethysmographic and clinical or venographic outcome.

Conclusion:

Perivalvular banding can correct reflux and alleviate clinical symptoms of chronic venous stasis in patients with primary valvular incompetence. Selection of patients, valves to be corrected, necessary degree of valvular ring narrowing and need for additional interventions should be further investigated.
Investigation of Popliteal Fossa Venous Reflux
Authors: Cheatle T. R. , Perrin M. , Hiltbrand B. , Bayon J. M. , Genevois A. , Michel C.
Published: January 2017

Objective:

To assess the relative diagnostic merits of duplex scanning (DS) and dynamic popliteal phlebography (DPP) in the investigation of popliteal fossa venous reflux.

Design:

Prospective single patient study.

Setting:

Departments of Vascular Surgery, Radiology and Angiology, Jean Kunlin Unit of Vascular Pathology, Clinique du Grand-Large, Declines Charpieu, France.

Patients:

Eighteen consecutive patients with venous reflux in the popliteal fossa as demonstrated by hand-held Doppler insonation.

Interventions:

All limbs were investigated by DS and DPP before undergoing surgical exploration of the Popliteal fossa.

Main outcome measures:

The findings of the two modes of investigation were compared with the operative findings.

Results:

Both tests showed good specificity (98% DPP, 96% DS), but only moderate sensitivity (83% DPP, 87.5% DS). Both tests were wrong in two limbs.

Conclusion:

Phlebography can be reserved for cases where duplex scanning is inconclusive. Unsuspected anomalies will occasionally be found at operation despite exhaustive investigation.
Objective Evaluation of Compression Therapy for Deep Vein Thrombosis by Ambulatory Strain-Gauge Plethysmography
Authors: Ohgi S. , Kanaoka Y. , Mori T.
Published: January 2017

Objective:

To evaluate objectively the effect of compression therapy in patients with different degrees of calf muscle pump impairment following deep vein thrombosis.

Design:

Prospective study.

Setting:

Second Department of Surgery, Tottori University School of Medicine, Yonago, Japan.

Patients:

Twenty-one lower extremities in 16 patients and 23 lower extremities in 13 healthy control subjects.

Intervention:

Application of standard compression elastic stockings (30–40 mmHg compression at the ankle) and high compression elastic stockings (40–50 mmHg at the ankle) (Sigvaris, Sweden).

Main outcome measures:

Comparison of expelled volume measured by ambulatory strain-gauge plethysmography.

Results:

Calf pump function after deep vein thrombosis was classified into three grades (normal, compensated and failed) by the expelled volume. The expelled volume increased from 0.4 ml/dl (SD 0.2) to 0.9 ml/dl (SD 0.5) following the application of strong compression.

Conclusion:

Compression therapy is haemodynamically effective only when using strong compression (40–50 mmHg) in patients with post-thrombotic syndrome.
Morphological Changes in Lipodermatosclerosis and Venous Ulcers: Light Microscopy, Immunohistochemistry and Electron Microscopy
Authors: Tronnier M. , Schmeller W. , Wolff H. H.
Published: January 2017

Objectives:

To demonstrate morphological changes in lipodermatosclerosis (LDS) and venous ulcers by histology, immunohistochemistry, electron microscopy and immunoelectron microscopy.

Design:

Single patient group study in patients with trophic skin changes in chronic venous insufficiency.

Setting:

Department of Dermatology, Medical University of Lübeck.

Patients:

Ten patients with venous leg ulcers.

Interventions:

Biopsies were taken from areas of LDS and compared with clinically normal-appearing skin of the affected leg and with ulcer tissue.

Main outcome measures:

Comparison of the morphological features on light and electron microscopy.

Results:

Superficial dermis. Histologically, the ulcer tissue and LDS skin show dilated tortuous vessels in a glomerulus-like arrangement in the superficial parts of the dermis. Ultrastructurally, the superficial vessels are surrounded by a cuff, which contains amorphous and basal membrane material and is most pronounced in LDS. Immunofluorescence studies reveal ill-defined perivascular staining after incubation with antibodies against fibrin(ogen), laminin and type IV collagen. The exact ultrastructural localization of type IV collagen within the perivascular cuff is observed by immunoelectron microscopy. Deep dermis. In deeper parts of the dermis, the vessels of both ulcer tissue and LDS are surrounded by cellular cuffs with pericytes, fibroblasts and compact collagen bundles.

Conclusions:

We suggest that the severe morphological changes in LDS and ulcer tissue play an important role in the pathogenesis of venous ulceration.
Community Leg Ulcer Clinics: Effect on Quality of Life
Authors: Franks P. J. , Moffatt C. J. , Connolly M. , Bosanquet N. , Oldroyd M. , Greenhalgh R. M. , McCollum C. N.
Published: January 2017

Objective:

To investigate changes in the quality of life of patients with leg ulcers being treated in community leg ulcer clinics.

Design:

Patients were interviewed using a standard questionnaire, and then reinterviewed after 12 weeks of compression bandaging to observe changes.

Setting:

Community ulcer clinics held in health centres within Riverside Health District.

Patients:

All new patients presenting to community leg ulcer clinics up to 6 months from the start of a clinic and treated with four-layer compression bandaging.

Main outcome measures:

Changes in quality of life, interference in daily activities caused by leg ulceration and general health after 12 weeks of treatment.

Results:

Treatment over 12 weeks resulted in a mean reduction in anxiety (2.79 v 1.73, p < 0.001), depression (2.61 v 1.89, p < 0.001), hostility (1.59 v 1.00, p < 0.001) and cognition (1.29 v 0.87, p = 0.015). Pain significantly improved following treatment (χ2 trend = 103.7, 1d.f., p < 0.001). Changes in depression and hostility were related to complete ulcer healing.

Conclusions:

There were clear changes in quality of life following 12 weeks in a community leg ulcer clinic, which were related to the healing of the ulcer. Systems of care that offer rapid healing and improve patients' well-being must be considered when planning an effective leg ulcer service.
Effect of Compression Stockings on the Skin Microcirculation in Chronic Venous Insufficiency
Authors: Abu-Own A. , Scurr J. H. , Smith P. D. Coleridge
Published: January 2017

Objective:

To use a single fibre laser Doppler fluxmeter to assess the microcirculatory effects of compression stockings.

Design:

Controlled study comprising patient and control groups.

Setting:

Department of Surgery, University College London Medical School, London, UK.

Patients and participants:

Ten patients with lipodermatosclerosis caused by chronic venous insufficiency and 10 control subjects.

Interventions:

Measurements were made from the liposclerotic skin of patients and 8 cm above the medial malleolus in controls. Laser Doppler flux (LDF), blood ce velocity (BCV) and concentration of moving blood cells (CMBC) were recorded with the subject lying supine. A class II graduated compression stocking was applied to the leg and laser Doppler recordings were repeated. The protocol was repeated with the subject sitting.

Main outcome measures:

The effects of a compression stocking on LDF, BCV and CMBC in the horizontal and sitting positions were measured.

Results:

In patients in the supine position, the compression stocking resulted in a 28% median increase in LDF ( p = 0.03), with a corresponding 29% median increase in BCV. There was no significant change in CMBC. In the sitting position, the compression stocking caused a 105% median increase in LDF ( p < 0.01) due to a corresponding 89% median increase in BCV ( p = 0.01); there was only 25% median increase in CMBC. The effects of compression in controls were similar to those in patients.

Conclusion:

Compression stockings may be effective in the treatment of chronic venous insufficiency by increasing the microcirculatory flow velocity.
Epidemiology of Chronic Venous Insufficiency
Authors: Fowkes F. G. R.
Published: January 2017

Objective:

To determine the prevalence of chronic venous insufficiency in the general population and its association with varicose veins.

Data sources:

MEDLINE search 1980–94 plus scanning of reference lists in articles obtained.

Study selection:

Studies on venous disease in subjects not attending health services.

Data synthesis:

A formal systematic review of metaanalysis was not carried out because of the heterogeneity of the few available studies. Skin changes were found to occur in over 3% of adults, more so in women than men. The prevalence was higher in subjects with varicose veins and depended on the definition of skin changes and the severity of varicose veins. Approximately 0.3% of adults had an open varicose ulcer, and around 1% had an open or healed ulcer. Prevalence was higher in women and increased with age.

Conclusions:

The prevalence of chronic venous insufficiency was found to be common in the general population, but more studies of distribution and aetiology are required.
The Use of Intermittent Pneumatic Calf Compression in Isolated Femoral Vein Reconstruction
Authors: Qureshi A. , Roberts N. , Wilkinson A. R.
Published: January 2017

Objective:

To report two cases of isolated femoral vein injury reconstruction and a review of the literature.

Design:

Case report.

Setting:

Hull Royal Infirmary, Kingston Upon Hull.

Patients:

Two patients presenting with civilian trauma.

Interventions:

Spiral vein graft interposition and postoperative intermittent pneumatic calf compression.

Main outcome measure:

Limb salvage, vein patency and limb swelling.

Results:

Satisfactory limb salvage, femoral vein patency and absent limb swelling in both cases.
Leucocyte Activity in Volunteers in Response to Experimental Venous Hypertension
Authors: Saharay M. , Shields D. A. , Porter J. B. , Scurr J. H. , Smith P. D. Coleridge
Published: January 2017

Objective:

To investigate leucocyte activation in normal volunteers subjected to short-term venous hypertension by measuring the cell surface expression of the integrin CD11b and the selectin CD62L on neutrophils and monocytes before and after short-term venous hypertension. Plasma levels of L-selectin, which is shed by leucocytes upon activation, were also measured.

Design:

Prospective study, measuring white cell count, neutrophil and monocyte surface CD11b and L-selectin expression in whole blood using a fluorescent-labelled monoclonal antibody in a flow cytometer, and plasma L-selectin by a commercially available ELISA.

Setting:

The Middlesex Hospital Vascular Laboratory, a referral centre for the investigation of venous diseases.

Subjects:

Twenty-five normal volunteers without any history or clinical finding of venous disease.

Results:

There was a significant fall in the white cell: red cell ratio ( p = 0.03, Wilcoxon) in response to venous hypertension, followed by a significant increase ( p < 0.001, Wilcoxon) when the venous hypertension was reversed. Neutrophil and monocyte CD11b levels fell significantly ( p < 0.001 and p < 0.001, Wilcoxon) in response to venous hypertension. On reversing the venous hypertension a significant increase of CD11b expression was noted in both neutrophils and monocytes ( p < 0.001 and p < 0.01, Wilcoxon). Surface L-selectin expression, however, showed a significant sustained fall in both neutrophils and monocytes (neutrophils, p = 0.05 and p = 0.02; monocytes, p = 0.04 and p = n.s., Wilcoxon) throughout the experiment. There was a significant rise in soluble L-selectin in the plasma following venous hypertension ( p < 0.001, Wilcoxon).

Conclusion:

This study demonstrates both neutrophil and monocyte activation in the microcirculation of normal volunteers in response to short-term venous hypertension.
Graduated Compression Treatment in Patients with Chronic Venous Insufficiency: A Study Comparing Low and Medium Grade Compression Stockings
Authors: Jungbeck C. , Thulin I. , Darenheim C. , Norgren L.
Published: January 2017

Objective:

Patients with chronic venous insufficiency (CVI) benefit subjectively from treatment with graduated compression stockings. Usually, class II compression is used in patients with CVI grade II. The present study investigates possible differences between graduated compression of classes I and II.

Design:

Randomized study.

Setting:

Department of Vascular Surgery and Vascular Laboratory, University Hospital, Lund.

Patients and Methods:

Thirty-one patients, nine male and 22 female (59 legs), all with grade II CVI. Foot volumetry and a visual analogue scale (VAS) were used to assess symptoms. Patients were randomized to either class I or class II graduated compression, and the examinations were repeated after 8 weeks of treatment.

Results:

The VAS assessment showed that all patients benefited to the same extent and there were no differences between the two compression classes. An increase of the expelled volume with compression was recorded, to a significant degree with class I compression. Reflux values were not significantly influenced by either grade of compression.

Conclusion:

Class I graduated compression did not show any difference in subjective effect or objective parameters compared with Class II. Class I compression can be recommended instead of class II compression, especially in patients who find that the higher pressure on the leg causes discomfort.
Venous Thrombectomy in Pregnancy: A Follow-up Study
Authors: Eriksen L. , Pachler J. , Christoffersen J. Krogh , Bækgaard N. , Mantoni M. , Lund J. O. , Lenstrup C. , Jacobsen B.
Published: January 2017

Objective:

To evaluate women who have been treated by venous thrombectomy in pregnancy because of iliofemoral venous thrombosis, reporting the outcome of their pregnancy and frequency of objectively measured venous insufficiency.

Design:

A retrospective study. The patients were assessed by questionnaire, clinical examination, tests of venous function and ultrasonography.

Setting:

Department of Vascular Surgery, Gentofte Hospital, University of Copenhagen.

Patients:

Nineteen women treated previously by venous thrombectomy during pregnancy, with a subsequent pregnancy.

Results:

None of the women had complications during subsequent pregnancies or deliveries, 47% had an occluded iliac segment and 53% had dilated or varicose veins. None had ulcers or skin changes. None of the women showed signs of of re-thrombosis.

Conclusion:

Women who have been treated for deep venous thrombosis in pregnancy by thrombectomy and arteriovenous fistula followed by anticoagulant therapy may undergo further pregnancies with a very low risk of obstetric complications and a low risk of developing re-thrombosis or chronic venous insufficiency.
Effect of Compression Stockings on Leg Volume in Patients with Varicose Veins
Authors: Müller-Bühl U. , Heim B. , Fischbach U. , Windeler J. , Finkenstädt Th. , Schläfer M.
Published: January 2017

Objective:

To evaluate the effect of thigh-length compression stockings on the venous blood pool and interstitial oedema in patients with varicose veins.

Setting:

Department of General Medicine, University of Heidelberg, Germany.

Patients:

Forty-six patients with unilateral long saphenous varicose veins.

Main outcome measures:

The effects of compression stockings on optoelectronically measured volumes of normal legs and legs with varicose veins in supine and upright positions.

Results:

Changing body position from a supine to an upright position leads to an increased leg volume by venous blood pooling (236.5 ml and 255.5 ml, respectively, p < 0.001). The volume difference between normal legs and legs with varicose veins in the supine position was 172.5 ml, and in the upright position 187.0 ml ( p < 0.001). After putting on compression thigh-length stockings, the volume of both normal legs and legs with varicose veins decreased by 314.5 ml and 358.0 ml (acute compression effect). Elastic compression for 8 h produced no significant additional reduction in the leg volumes. Wearing the stockings for 7 successive days failed to reduce the volume in the normal legs, whereas a further reduction in the legs with varicose veins was measured (supine position 61.0 ml, p < 0.05; upright position 72.0 ml, p < 0.05) (long-term compression effect).

Conclusions:

Wearing compression stockings rapidly reduces venous blood pools of the legs. Long-term wear is necessary to mobilize the interstitial limb oedema in patients with superficial venous insufficiency.
Higher Migratory Activity of Arterial Smooth Muscle Cells Than of Venous Smooth Muscle Cells on Different Collagen Matrices
Authors: Jimi S. , Takebayashi S. , Ryu S. , Saku K. , Sakata N.
Published: January 2017

Objective:

To examine the biological differences between arteries and veins, we compared the migratory activities of arterial and venous smooth muscle cells (SMCs) using a modified Boyden chamber method.

Design:

Migratory activities of porcine arterial and venous smooth muscle cells (SMCs) were compared by a modified Boyden chamber method using coated filters with type I, III, IV and V collagens.

Results:

At the basal level of migration activity without stimulation, arterial SMCs showed greater migratory activity than venous SMCs in all of the substrata. When platelet-derived growth factor was added to the lower wells, all of the migration activities increased, and arterial SMCs showed significantly higher activity than venous SMCs. When cell-associated fibronectin was determined by an enzyme-linked immunoassay and immunohistochemistry, arterial SMCs secreted significantly more cell-associated fibronectin than venous SMCs. Type IV collagen had the greatest positive effect, and also induced the lowest level of cell-associated fibronectin.

Conclusion:

These in-vitro results indicate that fibronectin secreted by vascular smooth muscle is an important regulatory protein for cell migration even when SMCs migrate on collagen substrates. Arterial SMCs have higher migratory activities than venous SMCs as a result of their lower production of fibronectin.
The Influence of Minimal-Stretch and Elasticated Bandages on Calf Muscle Pump Function in Patients with Chronic Venous Disease
Authors: Yang D. , Vandongen Y. K. , Stacey M. C.
Published: January 2017

Objective:

To evaluate the influence of minimal-stretch and elasticated bandages on calf muscle pump function in patients with chronic venous disease.

Design:

An open, randomised, crossover study.

Setting:

University Department of Surgery, Fremantle Hospital, Perth, Australia.

Subjects:

Twenty patients with chronic venous disease and recently healed chronic venous ulcers.

Method:

Five different bandaging regimens were applied on each patient, and calf muscle pump function was assessed by using air plethysmography.

Results:

There was no significant difference in the venous filling index (VFI) and ejection fraction (EF) between the five different bandage regimens, and also no significant difference in four of the five bandage regimens over a 7-day period ( p>0.05). However, the VFI was significantly reduced and the EF was not significantly altered after the application of both elasticated and minimal-stretch bandages ( p<0.05, = p>0.05 respectively).

Conclusion:

All the bandage regimens used in this study have a similar influence on calf muscle pump function, and may therefore have a similar effect on the healing of chronic venous ulcers.
The Physiological Effect of Graded Compression Stockings on Blood Flow in the Lower Limb: An Assessment with Colour Doppler Ultrasound
Authors: Benkö T. , Kalik I. , Chetty M. N.
Published: January 2017

Objectives:

To assess the physiological effect of low-pressure graded compression stockings (GCS) on the blood flow of the lower limb with the use of colour Doppler.

Design:

A randomised controlled study.

Setting:

X-ray Department in a teaching hospital.

Patients:

Forty-five healthy, adult, voluntary subjects.

Method:

Subjects were randomised into three groups to either wear thigh- or knee-length GCS of the same type or no stockings. The diameter and cross-sectional area of the femoral and popliteal veins and the peak venous velocities were measured with colour Doppler before the application of GCS and after 20 min bed rest with the stockings in situ.

Results:

Measurements showed a significant increase of the peak velocity in the femoral vein with thigh-length GCS ( p<0.002). There was a significant decrease of the popliteal vein diameter and cross-sectional area with thigh-length GCS ( p<0.05). There was no significant change in the knee-length GCS group and the control group, in which patients did not wear stockings. A paired t-test was used to determine the significance of the changes.

Conclusions:

Thigh-length GCS have an effect of increasing venous peak velocity in the femoral vein, hence decreasing venous stasis. Furthermore, they decrease the dilatation of the popliteal vein, which may reduce the risk of intimal tears occurring, which may contribute to venous thrombogenesis. Other methods can given more information in assessing the effect of various lengths of stocking on venous stasis.
The Beneficial Augmentative Effect of Micronised Purified Flavonoid Fraction (MPFF) on the Healing of Leg Ulcers: An Open, Multicentre, Controlled, Randomised Study
Authors: Gliński W. , Chodynicka B. , Roszkiewicz J. , Bogdanowski T. , Lecewicz-Toruń B. , Kaszuba A. , Bowszyc J. , Nowak A. , Wnorowski J. , Wąsik F. , Glińska-Ferenz M. , Błaszczyk M. , Strzyga P. , Pachocki R.
Published: January 2017

Objective:

To determine the increase in healing rate of venous ulcer in patients receiving a micronised purified flavonoid fraction (MPFF) as supplementation to standard local care.

Design:

A randomised, open, controlled, multicentre study.

Setting:

Departments of Dermatology and University Outpatients Clinics.

Patients:

One hundred and forty patients with chronic venous insufficiency and venous ulcers.

Intervention:

Patients received standard compressive therapy plus external treatment alone or 2 tablets of MPFF daily in addition to the above treatment for 24 weeks.

Main outcome measure:

Healing of ulcers and their reduction in size after 24 weeks of treatment.

Results:

The percentage of patients whose ulcers healed completely was found to be markedly higher in those receiving MPFF in addition to standard external and compressive treatment than in those treated with conventional therapy alone (46.5% vs 27.5%; p<0.05, OR = 2.3, 95% CI 1.1–4.6). Ulcers with diameters <3 cm were cured in 71% of patients in the MPFF group and in 50% of patients in the control group, whereas ulcers between 3 and 6 cm in diameter were cured in 60% and 32% of patients ( p<0.05), respectively. The mean reduction in ulcer size was also found to be greater in patients treated with MPFF (80%) than in the control group (65%) ( p<0.05). The cost-effectiveness ratio (cost per healed ulcer) in the MPFF group was €1026.2 compared with €1871.8 in the control group.

Conclusions:

These results indicate that MPFF significantly improves the cure rate in patients with chronic venous insufficiency.
Lycra Support Tights: Are They Effective?
Authors: de Boer E. M. , Broekhuijsen R. W. , Nieboer C. , Bezemer P. D.
Published: January 2017

Objective:

To investigate the effect of two Lycra support panty hose (8 and 12 mmHg) on the development of oedema of the lower legs and on feelings such as tiredness, heaviness and burning or pain in the legs.

Design:

Prospective study.

Setting:

Department of Dermatology, Free University Hospital, Amsterdam, The Netherlands.

Subjects:

One hundred and eight healthy women, 20–60 years of age, who had no signs of chronic venous insufficiency on examination (including Doppler ultrasound) and who worked full-time.

Main outcome measures:

Diurnal lower leg volume changes (DVC) recorded by opto-electronic volume measurements and questionnaires on subjective feelings while wearing a control panty hose in comparison with the support panty hose.

Results:

The mean DVC with control panty hose was +2.7%. With both types of support panty hose the mean DVC was significantly decreased to 2.3% ( p < 0.001). At inclusion complaints were common (81%). Support panty hose A (8 mmHg) decreased feelings of heaviness and tiredness significantly. No relation between the reduction in DVC and a decrease in complaints was shown. Support panty hose B was often ill-fitting due to an inadequate size-table.

Conclusion:

Both types of support panty hose reduced the normal diurnal volume increase significantly and equally. Further investigations are needed in order to find the minimum compression for (almost) complete prevention of oedema. The decrease in subjective unpleasant feelings, significant for tiredness and heaviness in the case of panty hose A, was unrelated to a reduction in DVC.
Problems in Predicting Drug Effects across Species Lines
Authors: Smith Charles G , Poutsiaka John W , Schreiber Eric C
Published: January 2017

During the course of drug development, there are many instances where extrapolation of data from animals to man is difficult because the toxicologic and metabolic responses induced by drugs may be significantly different between the laboratory species. In cases where the drug in question has a potentially major therapeutic use in man, it is suggested that the data be evaluated on the basis of a pragmatic benefit-to-risk ratio, rather than zero-toxicity. In this way, we may provide drug therapy for those patients for whom adequate treatment does not exist, as well as protect those individuals who may be exposed to some hazard from the use of medicines.
A Clinical Evaluation of a Delayed Release Preparation of Metformin
Authors: Campbell I W , Clarke B F , Duncan L J P
Published: January 2017

The efficacy of a delayed release preparation of metformin (‘Obin’)† has been evaluated in 60 diabetic patients either obese and uncontrolled by diet alone or true primary or secondary failures to sulphonylurea treatment. The results show no difference in the therapeutic response between single and twice daily administration of ‘Obin’; likewise there was no difference in frequency of side-effects.
A Pain Clinic Assessment of Syndol in Headache
Authors: Marsh B T , Mennie A T , Samarasinghe J , Robbie D S
Published: January 2017

Syndol, a formulation containing paracetamol, codeine phosphate, caffeine and doxylamine succinate, was evaluated in the Pain Clinic Unit of the Royal Marsden Hospital. In a single dose pilot study with eleven patients, 81% had speedy and effective relief from their headache for up to four hours. In a multiple-dose study over one week with twenty-four patients, seventeen patients ( 85%) had a 50% or greater relief from pain. No abnormal haematological or biochemical results were seen in this group of patients. Over 70% of these patients suffered from headaches in the afternoon and evening, with a peak incidence between 9 pm and midnight. This may indicate a separate sub-group of patients with tension headache who should do well on sedative-analgesic medication. The most common side-effect was drowsiness and sedation reported by fourteen patients ( 63%). The sedative-analgesic action of Syndol was well recognized by the patient and premedication on retiring to bed proved useful in those patients awoken during the night or waking in the morning with Tension Headache.
Oxypertine (Integrin) in the Treatment of Morbid Anxiety. Report of a New Low Dosage Schedule
Authors: Murphy J E , Donald J F , Molla A L
Published: January 2017

One hundred patients were admitted to a double-blind group comparative trial of two doses of oxypertine (Integrin) in the treatment of morbid anxiety in a general practice setting. The two dosage regimes were 10 mg thrice daily and 5 mg thrice daily respectively, patients being allocated in a random manner to one or other of these. Physicians assessment were made on a modified Hamilton Anxiety Rating Scale on admission and after two and four weeks treatment. A patient's self-rating scale was also carried out on these occasions using a nine item visual analogue scale embracing some symptoms of anxiety states.

Eighty-nine completed case records were available for analysis. Each dosage regime brought about a similar and highly significant improvement after both two and four weeks of treatment.

In both the magnitude of clinical response and rapidity of onset of action the lower dose regime was found to compare favourably with the higher dosage. Each was well tolerated and associated with a very low incidence of undesirable effects.
Timolol Maleate (MK 950) in the Treatment of Essential Hypertension
Authors: Poole-Wilson Philip A
Published: January 2017

To thirteen patients with essential hypertension timolol was given in a single-blind trial. A dosage of 15 mg three times a day produced a fall in diastolic blood pressure in all patients. The mean diastolic blood pressure was reduced by 15 and 14 mm Hg in the lying and standing positions respectively. Changes in the systolic blood pressure were variable but a significant mean reduction occurred.
Drug Profile: Fortral Suppositories
Authors: Murphy J Eric
Published: January 2017

The traditional British resistance to the rectal administration of medicines is now slowly losing ground. That the patient's attitude has been reflected in the doctor's is surprising considering the obvious advantages of this route for patients unable to swallow tablets, prone to gastric irritation or suffering distress from frequent injections.

The recent availability of suppositories containing the powerful analgesic Fortral (pentazocine) is particularly welcome as it simplifies the control of severe pain in elderly, debilitated and incapacitated patients in hospital and at home.

Eleven Continental trials testifying to the effectiveness of Fortral Suppositories have been followed this year by two British papers (de Choisy 1973 and Flavell Matts 1973), whose authors both welcome the prospect of a form of potent analgesic that can be self-administered so easily even in the absence of a qualified attendant. One author (de Choisy 1973) concludes: ‘Fortral Suppositories provided good analgesia with a low incidence of side-effects. There were no reports of local irritation. The suppositories were well accepted as a source of treatment’.
A Study to Show the Effect of Pituitary Stalk-Section upon Urinary, Hypothalamic and Pituitary Hypocalcaemic Activities
Authors: Zileli M S , Küçüksu N , Kanra G , Ürünay G , Adalar N
Published: January 2017

The effect of pituitary stalk-section on the hypocalcaemic activity in urine, hypothalamus and pituitary gland was investigated in rats.

Intact rats and rats with pituitary stalk-section were made hypercalcaemic and their urines were injected to bio-assay rats. A hypocalcaemic factor was present in the urine of intact hypercalcaemic rats and on the contrary, this factor was absent from the urine of hypercalcaemic rats with pituitary stalk-section.

Hypothalamic and pituitary gland extracts obtained twenty-four hours after stalk-section, from guinea pigs, were injected to bio-assay rats. Pituitary extract had no hypocalcaemic activity, whereas hypothalamic extracts produced hypocalcaemia. Neither the injection of pituitary or hypothalamic extracts to TPTX rats produced hypocalcaemic effect.
A Clinical Trial of Hydrocortisone-17-Butyrate with Chlorquinaldol in the Treatment of Infected Dermatoses
Authors: Gibson E O , Maneksha S , Wright Trevor
Published: January 2017

A clinical trial of hydrocortisone-17-butyrate in combination with chlorquinaldol in the treatment of infected dermatoses is reported. A total of 64 patients was treated of which 22 were children up to the age of 10 years. The results indicate this corticosteroid, in combination with chlorquinaldol, to be of substantial clinical value with a wide margin of proven clinical safety.
A Controlled Comparative Trial of a Combination of Opipramol and Clomipramine and a Higher Dose of Clomipramine Alone
Authors: Murphy J E , Donald J F , Beaumont G
Published: January 2017

Sixty patients suffering from mixed anxiety depressive states were admitted to a comparative controlled clinical trial of a free combination of opipramol 50 mg and clomipramine 10 mg and clomipramine 25 mg. A double-dummy technique was used to ensure blindness and both regimes were administered three times daily. A stratified randomization technique was employed but this did not work effectively as far as severity was concerned producing some imbalance in the groups.

Thirty-one patients received the combination therapy and 29 clomipramine alone. Twenty-eight patients on the combination regime and 24 on clomipramine alone completed the study.

Amongst the completers the total score, on a 17 symptom rating scale, fell from 19·6 to 6·6 in the combination group and from 23·6 to 9·3 in the clomipramine alone group after 4 weeks treatment. Significantly more side-effects, especially dry mouth, were seen in the clomipramine alone group. After 2 weeks the opipramol/clomipramine regime was significantly more effective in the relief of anxiety whereas the clomipramine higher dose regime brought about a significantly greater improvement in the symptom depressed mood.
A Continuous Release Aminophylline Tablet (Phyllocontin) in Patients with Airways Obstruction
Authors: Harris P G
Published: January 2017

Thirty male patients with bronchospasm, all of whom were smokers, were admitted to a clinical trial and were randomly allocated to treatment with either tablets of aminophylline BP 100 mg three times daily or tablets of Phyllocontin 225 mg twice daily. Duration of treatment was 2 weeks.

Phyllocontin tablets were well accepted by the majority of patients and were found to be more acceptable than the conventional aminophylline tablets when the choice arose. At the end of the trial the vast majority of the Phyllocontin treated patients did not wish to return to the therapy they were on prior to commencement of the study, in contradistinction to those taking aminophylline tablets. Side-effects did not prove to be a problem.
Treatment of Amoebic Rectocolitis: Comparison of the Efficacy of Tinidazole and Metronidazole with High Dosage over a Short Term
Authors: Manrique Elias Corral , Gallegos G Librado , Verdin Federico , Montero Sergio
Published: January 2017

The therapeutic efficacy of tinidazole administered over a two-day period was assessed in a group of patients with amoebic rectocolitis and compared to the activity of metronidazole administered to a test group, with the same condition, over the same period of time at equivalent dosage. Twenty patients participated in the study and were randomly assigned to two groups of ten. The therapeutic efficacy of both drugs was similar at equivalent doses, however tinidazole was quicker in healing the distal and proximal colonic lesions caused by the vegetative forms of the parasite.
Initial Experience with a New Long-Acting Beta-Blocker, Nadolol, in Hypertensive Patients
Authors: Hitzenberger Gerhard
Published: January 2017

Nadolol, a new beta-blocker that is not metabolized and has a uniquely long pharmacological half-life (up to 24 hours) was employed as the sole drug therapy for thirty-one patients with mild to moderately severe essential hypertension. Twenty-two patients had a reduction over 3 months of 10% or more in supine diastolic pressure, including twelve who became normotensive. Daily dosage, administered in two divided doses, ranged up to 640 mg; however, twenty patients required 160 mg or less. Twenty-three patients continued therapy for a median additional period of 15 months, during which satisfactory control was maintained in seventeen patients. Side-effects of nadolol caused termination of therapy in only one patient.
Euhypnos® Forte (Temazepam) for Resistant Insomnia: Post-Marketing Surveillance, an Interim Report
Authors: Fowler L K
Published: January 2017

An interim report at six months of a post-marketing surveillance study of Euhypnos® Forte, a new high-dose temazepam preparation for the treatment of insomniac patients resistant to conventional hypnotic dosage. The analysis includes 2,043 First Reports (FRs) of two weeks treatment and 669 Second Reports (SRs) of three months treatment. More than 95% of the patients took a nightly dose of two capsules, temazepam 40 mg. Adverse reactions were generally acceptable, consisting mainly of headache, vivid dreams, gastro-intestinal disturbances and hangover effects. The preparation was effective in 88.6% of patients at two weeks and 95.8% at three months. All patients had previously found other hypnotics ineffective. Euhypnos Forte was rated effective by 85.5% of the 874 patients who had previously found nitrazepam unsatisfactory, and by 90.0% of the 201 who found barbiturates unsatisfactory.
Comparison of Diazepam and Flurazepam in the Treatment of Insomnia in General Practice
Authors: MacPhail Ian , Ogilvie W Alasdair , Purvis C R
Published: January 2017

In a double-blind crossover study in general practice, flurazepam was shown to be significantly better (p<0.001) than diazepam in treating sleep disturbance. Fewer patients reported side-effects on flurazepam.
Effects of Drugs on Mucus Glycoproteins and Water in Bronchial Secretion
Authors: Medici T C , Radielovic P
Published: January 2017

The result of chemical analysis of the bronchial secretion is simple; up to 95% of the secretion is made up of water, and up to 5% is composed of ash, protein, carbohydrate, lipid, nitrogen and desoxyribonucleic acid. More complicated is the question of how bronchial secretion is formed and of which active biological components it is composed. Bronchial secretion is the result of the different processes, secretion, transudation, exudation and exfoliation from a highly differentiated bronchial mucosa. To those substances secreted belong, amongst others, constituents important for the flow properties and the transportability of the secretion: the bronchial mucus glycoproteins and water.

The bronchial glycoproteins are the most important group, constituting 50–80% of the macromolecules. They are formed and secreted by the bronchial mucosa. The synthesis and secretion of bronchial glycoproteins are influenced by drugs in different ways. Beta-adrenergic stimulants do not alter these processes in in vitro studies on human glands, although an increase in mucus of glycoprotein production has been demonstrated in animal experiments and indirectly in man. Cyclic adenosine monophosphate and the methylxanthines stimulate mucus glycoprotein production, anticholinergic agents reduce but do not completely supress this process. Anti-allergic agents do not alter the production of bronchial glycoproteins with the exception of the corticosteroids which partially inhibit the synthesis and secretion. Neither expectorants nor mucolytic agents influence the production of mucus glycoproteins in human bronchial glands as opposed to animal experiments, in which these compounds produce an increase in the output of the bronchial fluid.

Water constitutes 95% of the bronchial secretion and the water content considerably influences mucociliary function. An osmotic gradient, the result of active sodium and chloride ion transport across the bronchial epithelium, ensures on the one hand that water diffuses through epithelium on to the epithelial surface where it forms the serous sol layer in which the cilia beat. On the other hand water is probably transported in the same way across the mucosal glands where it mixes with the extremely hydrophilic mucus glycoproteins.

The ion and water transport is influenced by drugs. Acetylcholine, histamine and terbutaline stimulate the ion and thereby water transport. Atropine, diphenylhydramine, an H1-antagonist, propranolol, a beta-blocker andfurosemide inhibit these transport mechanisms. Whether ketotifen, a new antihistaminic drug used in the treatment of bronchial asthma, will affect these processes, decreasing the water content of bronchial mucus, remains to be seen.