bluuebunny/crossref_metadata_2025 huggingface dataset:
Prophylaxis of Postoperative Thromboembolism with Heparin-Dihydroergotamine Combination
Authors: Sándor Tamás , László Elöd , Magyary Ferenc , Turcsányi Gábor , Hetényi Lajos , Izinger Endre , Jakab Imre , Csuha Lajos
Published: January 2017

The effect and safety of a fixed combination — 5000 iu of heparin + 0.5 mg of dihydroergotamine every 12 h subcutaneously (HDHE) versus 5000 iu of heparin every 8 h subcutaneously (LDH) for prophylaxis of postoperative venous thromboembolism was evaluated in a prospective randomized clinical trial involving 142 patients undergoing major abdominal surgery. Using the radiofibrinogen uptake test postoperative deep venous thrombosis was detected in 10% of 70 patients in the HDHE group and in 14% of 72 patients of the LDH group. Seven patients died. Neither fatal, nor contributory pulmonary emboli were found at autopsy. Pulmonary microembolism diagnosed with lung perfusion scintigraphy and chest radiography developed in three patients treated with LDH and in one patient treated with HDHE. Significantly more wound haematomas and injection site bruises were observed in the LDH group. The conclusion drawn was that the 12-hourly regimen of heparin with DHE was as effective in preventing venous thromboembosis as the 8-hourly heparin regimen. The lowering of the heparin dose significantly reduced both the number of wound haematomas and injection site bruising.
Do Compression Stockings Potentiate the Fibrinolytic Capacity of the Lower Limbs?
Authors: Berridge D.C. , Westby J.C. , Makin G.S. , Hopkinson B.R.
Published: January 2017

Patients with varicose veins and liposclerosis have been shown to have impaired fibrinolytic activity1. Furthermore, fibrinolytic activity is much reduced in the lower than in the upper limbs, probably due to the difference in hydrostatic pressure. After 2–10 days bed rest a significant increase in potential is observed2. Compression support stockings can exert 30–40 mmHg of pressure which is 50% of the normal hydrostatic pressure. Therefore does the long term use of such stockings cause a significant increase in fibrinolytic potential?

Seventeen patients (10 male, 7 female; mean age 52.8 +/— 9.8 yrs) with features of liposclerosis were studied. Pre- and post-euglobulin clot lysis times (ELT) were measured in the right arm and both legs using a 10 min occlusion time. The patients contralateral leg served as the control. Sigvaris stockings were made for each patient to wear on the designated leg only. Measurements were repeated after 1 and 3 months of use with the stocking in situ and after 30 min bed rest. Patients were instructed to wear the stockings at all times during the day.

There were no significant differences in the pre-occlusion values between the arm or the lower limb groups throughout the study. Lower limb post occlusion ELT values were significantly higher in both the affected limb ( p < 0.002) and the patients control limb ( p < 0.002), than in the arm. This relationship was constant throughout the study period. No significant potentiation was seen after either 1 or 3 months of use.

There were no new areas of ulceration throughout the study period. Thus any clinical benefit arising from the use of compression stockings is not from potentiation of local fibrinolysis.
Support Stockings in Practical Management of Varicose Veins
Authors: Chant A.D.B. , Davies L.J. , Pike J.M. , Sparks M.J.
Published: January 2017

Sixty six patients were studied in a randomized trial comparing two types of pressure graduated stockings. The variables studied were age, sex, grip strength and stocking type. These variables were correlated with the patient's willingness to wear support hose (compliance with treatment as judged by random home visit). Of the 66 patients prescribed stockings, 40 patients (18 Medi Plus and 22 Sigvaris) completed the study. Overall compliance with treatment was only 32%. Increasing age correlated positively with usage of stockings. Other variables (including grip strength) had no significant effect in determining likelihood of compliance. Willingness to comply with treatment proved to be a greater problem than ability to do so.
Cavernous Haemangioma of the Left Brachiocephalic Vein
Authors: Quinn F.M.J. , McIlrath E.M. , D'Sa A.A.B. Barros
Published: January 2017

A rare cavernous haemangioma of the left brachiocephalic vein in an adult was carefully identified by radiological study and removed with-out difficulty using a ‘trap-door’ approach following which he made an uncomplicated recovery. The literature is reviewed.
Three Tests of Microcirculatory Function in the Evaluation of Treatment for Chronic Venous Insufficiency
Authors: Cheatle T. R. , McMullin G. M. , Farrah J. , Smith P. D. Coleridge , Scurr J. H.
Published: January 2017

No investigation exists which has been shown to detect accurately microcirculatory improvement following treatment for chronic venous insufficiency. This study examines three possible techniques for doing so.

Fourteen patients with chronic venous insufficiency and fourteen controls underwent measurement of transcutaneous PO2, 133xenon clearance from the skin and subcutaneous tissues and laser–Doppler flowmetry in the gaiter region. Patients with venous disease then followed a regime of intermittent pneumatic compression for 4 h each day for 4 weeks. The same measurements were then repeated. Xenon clearance from subcutaneous fat and the time taken to reach maximal laser–Doppler flow after release of a tourniquet showed a significant improvement after compression treatment. These tests may be useful as parameters in the objective monitoring of response to treatment in patients with liposclerotic skin.
The Effect of Antiseptics and the Moist Wound Environment on Ulcer Healing: An Experimental and Biochemical Study
Authors: Lucarotti M. E. , Morgan A. P. , Leaper D. J.
Published: January 2017

The effect of topical aqueous chlorhexidine (0.5% and 5%) and Eusol has been studied on the healing of 2 cm skin defects in rats, with measurements of DNA and collagen synthesis as biochemical markers. Healing was also compared under an occlusive dressing (Comfeel Ulcer Dressing, Coloplast) and a non-occlusive dressing (Jelonet, Smith and Nephew).

Healing was significantly delayed under Jelonet dressings compared with the Comfeel groups. The hydroxyproline levels, 4 d after wounding were: chlorhexidine 5% 1.82 μg mg−1 (1.46–11.57), Eusol 1.78 (1.13–3.52), Jelonet 2.04 (1.89–3.91), Comfeel 3.21 (1.99–3.46), Comfeel–saline 3.09 (1.99–3.46), chlorhexidine 5% 3.61 (1.47–6.28). The moist wound environment provided by the Comfeel dressings was the most conducive to healing in this study. Chlorhexidine, at a recommended strength of 0.5% (or less), did not impair healing and can safely be used if an antimicrobial is required.
Pulsatile Varicose Veins Caused by Tricuspid Valve Regurgitation
Authors: Dayantas J. , Liatas A.C. , Lazarides M.
Published: January 2017

We report an uncommon case of pulsatile varicose veins in a young woman caused by tricuspid valve insufficiency of rheumatic origin combined with an incompetent valve at the sapheno–femoral junction. She was treated with limited stripping of the great saphenous vein and local varicosities were excised. Postoperative recovery was complicated by a large haematoma in the thigh. Following our recent experience we believe that patients like this, with elevated venous pressure and requiring anticoagulant therapy for prosthetic valves, should be treated with sapheno–femoral dissociation alone.
Axillary/Subclavian Vein Thrombosis: A Clinical and Radiological Evaluation of Conservative Management
Authors: Galea M. H. , Berridge D. C. , Gregson R. H. S. , Hopkinson B. R. , Makin G. S.
Published: January 2017

Over a 10-year period 23 patients had a clinical diagnosis of axillary/subclavian vein thrombosis; excluded from the study are those thromboses secondary to carcinomatosis, local surgery or radiotherapy. At a median follow-up of 16 months (range 3–120), six patients had died and five patients had moved away. Twelve patients were reviewed (nine male and three female) with a median age of 30 years (range 18–62). All had been managed conservatively with arm elevation, heparinization and warfarin therapy. Five patients (42%) were clinically symptomatic, necessitating a change in employment in three patients (25%). Objective signs of chronic venous insufficiency were demonstrable in the same five patients (42%). Repeat venography was obtained in 11 patients, seven of whom were asymptomatic. Evidence of recanalization was seen in nine patients (82%); however, there was no correlation between clinical symptoms and radiographic findings. This disparity highlights the importance of clinical examination over persistent venographic changes in the evaluation of new treatment methods attempting to reduce the morbidity of this condition.
Cutaneous B-Cell Lymphoma Mimicking Ulcus Cruris Venosum
Authors: Damstra R. J. , Toonstra J.
Published: January 2017

Objective:

Case report to illustrate that non-healing ulcers should be rigorously investigated to exclude the possibility of malignant neoplasm.

Setting:

University Hospital, Utrecht, The Netherlands.

Patients:

One 62-year-old patient presenting with a 3 month history of leg ulcer.

Interventions:

Diagnostic biopsy followed by radiotherapy and chemotherapy.

Results:

Histological examination of the biopsy demonstrated a B-cell lymphoma which showed no recurrence during an 8-year follow up-period after treatment.

Conclusion:

Primary cutaneous lymphoma is a rare cause of malignancy mimicking venous leg ulceration.
The Post-Thrombotic Syndrome: A Review
Authors: Janssen M. C. H. , Wollersheim H. , van Asten W. N. J. C. , de Rooij M. J. M. , Nováková I. R. O. , Thien Th.
Published: January 2017

Objective:

A review of the published data on epidemiology, pathophysiology, diagnostic techniques and prevention of the post-thrombotic syndrome (PTS).

Study selection:

Studies, published between 1966 and 1996, identified through the medline database, and references cited in identified articles were included.

Data synthesis:

Deep venous thrombosis (DVT) may cause outflow obstruction and valve incompetence, resulting in venous hypertension. PTS is probably the effect of venous hypertension on the microcirculation. For qualitative anatomical and functional assessment of the venous system, duplex scanning is required, and for quantitative functional assessment, plethysmographic methods are the most suitable. The best treatment of PTS is its prevention by optimizing diagnosis and treatment of DVT and by prescribing and wearing elastic compression stockings. Until valid follow-up studies have been performed, distal DVT should not be neglected when assessing the PTS risk.

Conclusions:

PTS is a serious problem in terms of prevalence, complications (venous ulcers) and treatment with considerable socio-economic consequences. Duplex and plethysmography are valuable tools in its diagnosis and might be appropriate to identify patients at risk of developing PTS.
A Study of the Mechanisms by Which Haemodynamic Function Improves following Long Saphenous Vein-Saving Surgery
Authors: Hammarsten J. , Bernland P. , Campanello M. , Falkenberg M. , Henrikson O. , Jensen J.
Published: January 2017

Objective:

To study the mechanisms by which haemodynamic function improves following long saphenous vein-saving surgery.

Design:

Cohort study.

Patients:

Twenty patients, 14 women and six men, with primary varicose veins.

Interventions:

Varicose vein surgery by the long saphenous vein-saving technique.

Main outcome measures:

Preoperative investigation by physical examination, strain-gauge plethysmography, phlebography and measurements of the long saphenous vein diameter at four different locations using high-resolution, real-time ultrasound. Three months following vein-saving surgery, the patients were reassessed with physical examination, strain-gauge plethysmography and measurements of the long saphenous vein diameter.

Results:

All patients but one showed excellent or good results following surgery. The preoperative diameter of the long saphenous vein was reduced by 40% at four different levels in the operated legs ( p<0.01). The venous return time of the same legs increased 2.4 times ( p<0.001). The decrease of the long saphenous vein diameter correlated positively with the increase in venous return time (t-50), ( r=0.50, p=0.04).

Conclusion:

The results suggest that the development of incompetent perforators is an early major event in the formation of primary varicose veins. The results also suggest that the long saphenous vein valvular incompetence in varicose veins is attributable to venous wall dilatation rather than degeneration of the valves. The results support the hypothesis that the improvement in haemodynamic function following long saphenous vein-saving surgery is due, at least partly, to a reduction of the long saphenous vein diameter, which in turn tends to restore valvular competence.
Treatment of Benign Venous Strictures with the Wallstent Endoprosthesis
Authors: Scott-Mackie P. L. , Irvine A. T. , Burnand K. G.
Published: January 2017

Objective:

Treatment of benign venous strictures with the Wallstent endoprosthesis.

Design:

A retrospective study of a patient group with benign venous strictures.

Setting:

Departments of Radiology and Surgery in a London teaching hospital.

Patients:

Three patients with clinically significant benign venous strictures.

Interventions:

Successful placement of the Wallstent endoprosthesis following failed angioplasty.

Main outcome measures:

Maintained clinical stent patency at follow-up.

Results:

All patients reported a good symptomatic improvement and this was confirmed by reduction in swelling of the affected limb on clinical examination Doppler examination in one case confirmed stent patency at 1 year.

Conclusion:

The role of the Wallstent endoprosthesis in the treatment of benign venous strictures deserves evaluation by prospective study. The successful outcome in the three patients reported indicates its clinical application.
Postural Microvascular Reactivity in Chronic Venous Insufficiency
Authors: Pasqualini L. , Fuscaldo G. , Vaudo G. , Piccioni N. , Malagigi V. , Innocente S. , Mannarino E.
Published: January 2017

Objective:

To investigate microcirculatory functional abnormalities in non-ulcerated limbs with chronic venous insufficiency (CVI).

Design:

A case-control study.

Setting:

Outpatient clinic of a university hospital.

Materials:

Laser-Doppler was used to evaluate skin blood flow and the veno-arteriolar response (VAR) in 12 limbs with perimalleolar oedema and venous dilatation (CVI stage I), 12 with lipodermatosclerosis and hyperpigmentation (CVI stage II) and 12 healthy limbs. Resting flow (RF), blood volume and velocity were evaluated with the patient supine. After 2 min in the sitting position, blood flow (SF) was determined and the VAR was calculated.

Main results:

Compared with controls, blood volume was significantly increased and velocity reduced ( p<0.05) in both groups; RF and SF were significantly increased ( p<0.05) and the VAR was significantly reduced in stage II CVI patients.

Conclusion:

Venous microangiopathy and impaired orthostatic reactivity, as indicated by the alteration in the VAR, are present in non-ulcerated limbs with CVI.
Duplex Ultrasound Scanning for Chronic Venous Disease: The Frequency of Reflux in the Crural Veins
Authors: Ziegenbein R. W. , Myers K. A. , Zeng G. H. , Matthews P. G.
Published: January 2017

Objective:

To use duplex ultrasound scanning to determine the frequency of reflux in crural veins and its relation to the presentation, reflux in superficial and other deep veins, and outward flow in perforators in patients referred for assessment of chronic venous disease.

Design:

Scanning of superficial, deep and perforator veins.

Setting:

A vascular diagnostic laboratory in Melbourne, Australia.

Patients:

A study of 2590 lower limbs in 1684 consecutive patients.

Main outcome measure:

The frequency of reflux in crural veins.

Results:

The posterior tibial, anterior tibial and peroneal veins were identified in 98%, 95% and 95% and reflux was observed in 5%, 2% and 3%, respectively. Posterior tibial reflux was twice as frequent as reflux in the anterior tibial and/or peroneal veins alone. Posterior tibial reflux was significantly more frequent if there were clinical complications (19% of limbs with previous ulceration or lipodermatosclerosis), short saphenous reflux alone (8%) or both long and short saphenous reflux (11%), popliteal reflux (28%), or outward flow in medial calf perforators (6%) ( p<0.0001 for each). Posterior tibial reflux was no more frequent if there was Jong saphenous reflux alone or femoral reflux alone. Anterior tibial and/or peroneal reflux without posterior tibial reflux was not significantly related to the clinical presentation or reflux at any other site.

Conclusions:

The association of posterior tibial reflux with clinical complications, short saphenous reflux (alone or associated with long saphenous reflux), popliteal reflux or outward flow in perforators observed with duplex scanning contrasted with the lack of any such associations for anterior tibial or peroneal reflux without posterior tibial reflux. Scanning the anterior tibial and peroneal veins may add little to the examination.
Inherited Protein S Deficiency in Venous Leg Ulcer Disease
Authors: Munkvad S. , Karlsmark T.
Published: January 2017

Design:

Case report.

Setting:

University Hospital of Copenhagen.

Patients:

One patient presenting with venous ulceration of the leg after recurrent episodes of deep vein thrombosis which started at the age of 15 years.

Interventions:

Oral anticoagulation treatment and standard management of leg ulceration.

Main outcome measures:

Protein C, protein S and anti-thrombin III plasma levels were measured in the patient and her asymptomatic sister.

Results:

Plasma protein S levels were reduced in the index patient and her sister.

Conclusions:

We suggest that patients with venous leg ulcers attributable to post-thrombotic syndrome are investigated for abnormalities of the coagulation system.
The Value of Light Reflection Rheography for the Diagnosis of Superficial Venous Insufficiency: A Study in Patients with Primary Varicose Veins and in Workers with a Standing Occupation
Authors: de Boer E. M. , Krijnen R. M. A. , Hebeda C. L. , Mackaay A. J. C.
Published: January 2017

Objective:

To study the value of light reflection rheography (LRR) as a diagnostic tool in subjects with varicose veins and venous insufficiency.

Design:

A prospective study comparing patients and workers with an occupation necessitating standing.

Setting:

Departments of Dermatology and Vascular Surgery, University Hospital VU, Amsterdam, The Netherlands and several manufacturing plants throughout the country.

Subjects:

Group I: 123 patients (168 legs) with a history of primary varicose veins attending the outpatient clinic; Group II: 374 male workers (748 legs) with an occupation necessitating standing.

Methods:

A questionnaire on venous disorders was administered, followed by clinical investigation, continuous-wave (c/w) Doppler ultrasound and LRR examination. LRR measurements were performed above the medial malleolus. A refilling time of at least 25 s after 10 dorsiflexions at the ankle was considered normal. In the case of shorter refilling times the procedure was repeated with a tourniquet above the probe. Normalization of the refilling time indicates an incompetent superficial venous system and a normal deep system. If there was no change we concluded deep venous insufficiency was present. Furthermore, in group I, duplex investigation of the venous system was performed.

Main outcome measures:

The diagnostic conclusions of the LRR measurements were compared with the diagnosis based on duplex investigation (group I) and clinical examination combined with c/w Doppler investigation (group II).

Results:

Group I: duplex investigation showed 156 cases of superficial venous insufficiency; LRR, 33. Sensitivity of LRR: 20%. Group II: Clinical and c/w Doppler examination showed 189 cases of superficial venous reflux; LRR, 29. Sensitivity of LRR: 7%.

Conclusion:

LRR has no apparent additive value in diagnosing superficial varicose veins in patients with a history of primary varicosities nor in screening a population for the presence of venous insufficiency.
Does a Varicose Saphenous Vein Exist?
Authors: Zamboni P. , Cappelli M. , Marcellino M. G. , Murgia A. P. , Pisano L. , Fabi P.
Published: January 2017

Objective:

Duplex ultrasound evaluation of the clinically diagnosed varicose long saphenous vein (LSV).

Design:

Prospective, single patient group study.

Setting:

Department of Surgery, University of Ferrara, Italy (teaching hospital).

Patients:

378 patients, 509 limbs with primary varicose veins; 94 patients, 103 limbs with a visible, superficial varicose vein trunk on the medial aspect of the thigh.

Main outcome measure:

Duplex ultrasound detection of a varicose saphenous vein and/or segmental saphenous dilatation and their relationship to saphenous reflux.

Results:

In 98% of cases the varicose trunk visible in the thigh was demonstrated to be a tributary of the saphenous vein; 34% of the observed saphenous veins exhibited segmental dilatations in the thigh. This finding was related in every case to saphenous vein reflux with high velocity and turbulence ( p < 0.0001).

Conclusions:

High-resolution ultrasonography demonstrated that when a dilated varicose longitudinal vein trunk is visible and palpable on the medial aspect of the thigh it is most likely to be a tributary rather than the LSV. In addition, a varicose saphenous vein along its entire length essentially does not exist. However, when a dilated saphenous segment occurs, it seems to be related to high diastolic flow velocity and turbulence.
Disinhibition of the rat prelimbic cortex promotes serotonergic activation of the dorsal raphe nucleus and panicolytic-like behavioral effects
Authors: Yamashita Paula SM , Spiacci Ailton , Hassel James E , Lowry Christopher A , Zangrossi Helio
Published: January 2017

Several studies have shown that serotonin plays a dual role in the modulation of defensive behaviors related to anxiety and panic. A major source of serotonergic projections to limbic structures responsible for this modulation is the dorsal raphe nucleus (DR). Anatomical studies indicate that the prelimbic (PL) cortex sends dense glutamatergic projections to the DR, leading to stimulation or inhibition of serotonin release in structures innervated by the DR. The objective of the present study was to investigate if GABAergic disinhibition of the PL by means of local administration of picrotoxin (PIC), a chloride channel blocker, can affect serotonergic tone and the expression of defensive behaviors related to anxiety and panic. We used the elevated T-maze model and Vogel conflict test to evaluate defensive responses associated with anxiety or panic. The results showed that intra-PL PIC caused an increase in c-Fos activation in serotonergic cells in DR subregions. Furthermore, the intra-PL injection of PIC induced a panicolytic-like effect without affecting behaviors associated with anxiety. Our findings suggest that the PL-DR pathway, through DR serotonergic stimulation, is involved in the control of panic-related behaviors by control of serotonin release in structures that modulate panic responses, such as the dorsal periaqueductal gray.
Microdose acquisition in adolescent leg length discrepancy using a low-dose biplane imaging system
Authors: Jensen Janni , Mussmann Bo R , Hjarbæk John , Al-Aubaidi Zaid , Pedersen Niels W , Gerke Oke , Torfing Trine
Published: January 2017

Background

Children with leg length discrepancy often undergo repeat imaging. Therefore, every effort to reduce radiation dose is important. Using low dose preview images and noise reduction software rather than diagnostic images for length measurements might contribute to reducing dose.

Purpose

To compare leg length measurements performed on diagnostic images and low dose preview images both acquired using a low-dose bi-planar imaging system.

Material and Methods

Preview and diagnostic images from 22 patients were retrospectively collected (14 girls, 8 boys; mean age, 12.8 years; age range, 10–15 years). All images were anonymized and measured independently by two musculoskeletal radiologists. Three sets of measurements were performed on all images; the mechanical axis lines of the femur and the tibia as well as the anatomical line of the entire extremity. Statistical significance was tested with a paired t-test.

Results

No statistically significant difference was found between measurements performed on the preview and on the diagnostic image. The mean tibial length difference between the observers was −0.06 cm (95% confidence interval [CI], −0.12 to 0.01) and −0.08 cm (95% CI, −0.21 to 0.05), respectively; 0.10 cm (95% CI, 0.02–0.17) and 0.06 cm (95% CI, −0.02 to 0.14) for the femoral measurements and 0.12 cm (95% CI, −0.05 to 0.26) and 0.08 cm (95% CI, −0.02 to 0.19) for total leg length discrepancy. ICCs were >0.99 indicating excellent inter- and intra-rater reliability.

Conclusion

The data strongly imply that leg length measurements performed on preview images from a low-dose bi-planar imaging system are comparable to measurements performed on diagnostic images.
CT, MRI, and 18F-FDG PET/CT findings of malignant peripheral nerve sheath tumor of the head and neck
Authors: Kim Ha Youn , Hwang Ji Young , Kim Hyung-Jin , Kim Yi Kyung , Cha Jihoon , Park Gyeong Min , Kim Sung Tae
Published: January 2017

Background

Malignant peripheral nerve sheath tumor (MPNST) is a highly malignant tumor and rarely occurs in the head and neck.

Purpose

To describe the imaging features of MPNST of the head and neck.

Material and Methods

We retrospectively analyzed computed tomography (CT; n = 14), magnetic resonance imaging (MRI; n = 16), and 18F-FDG PET/CT (n = 5) imaging features of 18 MPNSTs of the head and neck in 17 patients. Special attention was paid to determine the nerve of origin from which the tumor might have arisen.

Results

All lesions were well-defined (n = 3) or ill-defined (n = 15) masses (mean, 6.1 cm). Lesions were at various locations but most commonly the neck (n = 8), followed by the intracranial cavity (n = 3), paranasal sinus (n = 2), and orbit (n = 2). The nerve of origin was inferred for 11 lesions: seven in the neck, two in the orbit, one in the cerebellopontine angle, and one on the parietal scalp. Attenuation, signal intensity, and enhancement pattern of the lesions on CT and MRI were non-specific. Necrosis/hemorrhage/cystic change within the lesion was considered to be present on images in 13 and bone change in nine. On 18F-FDG PET/CT images, all five lesions demonstrated various hypermetabolic foci with maximum standard uptake value (SUVmax) from 3.2 to 14.6 (mean, 7.16 ± 4.57).

Conclusion

MPNSTs can arise from various locations in the head and neck. Though non-specific, a mass with an ill-defined margin along the presumed course of the cranial nerves may aid the diagnosis of MPSNT in the head and neck.
Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem – stem or cup positioning?
Authors: Al-Amiry Bariq , Mahmood Sarwar , Krupic Ferid , Sayed-Noor Arkan
Published: January 2017

Background

Restoration of femoral offset (FO) and leg length is an important goal in total hip arthroplasty (THA) as it improves functional outcome.

Purpose

To analyze whether the problem of postoperative leg lengthening and FO reduction is related to the femoral stem or acetabular cup positioning or both.

Material and Methods

Between September 2010 and April 2013, 172 patients with unilateral primary osteoarthritis treated with THA were included. Postoperative leg-length discrepancy (LLD) and global FO (summation of cup and FO) were measured by two observers using a standardized protocol for evaluation of antero-posterior plain hip radiographs. Patients with postoperative leg lengthening ≥10 mm (n = 41) or with reduced global FO >5 mm (n = 58) were further studied by comparing the stem and cup length of the operated side with the contralateral side in the lengthening group, and by comparing the stem and cup offset of the operated side with the contralateral side in the FO reduction group. We evaluated also the inter-observer and intra-observer reliability of the radiological measurements.

Results

Both observers found that leg lengthening was related to the stem positioning while FO reduction was related to the positioning of both the femoral stem and acetabular cup. Both inter-observer reliability and intra-observer reproducibility were moderate to excellent (intra-class correlation co-efficient, ICC ≥0.69).

Conclusion

Post THA leg lengthening was mainly caused by improper femoral stem positioning while global FO reduction resulted from improper positioning of both the femoral stem and the acetabular cup.
Three-dimensional power Doppler ultrasound in the early assessment of response to concurrent chemo-radiotherapy for advanced cervical cancer
Authors: Xu Yan , Zhu Lijing , Ru Tong , Wang Huanhuan , He Jian , Zhou Zhengyang , Yang Xiaofeng
Published: January 2017

Background

Three-dimensional power Doppler ultrasound (3D-PDU) imaging has been widely applied to the differentiation of benign and malignant cervical lesions; however, its potential value for predicting response to chemo-radiotherapy has not been fully explored.

Purpose

To investigate the feasibility of 3D-PDU imaging in predicting treatment response in patients receiving concurrent chemo-radiotherapy (CCRT) for advanced cervical cancer.

Material and Methods

Fifty-two patients with advanced cervical cancer who received CCRT underwent 3D-PDU examinations at four timepoints: pre-therapy (baseline), 1 week and 2 weeks during, as well as immediately post CCRT. Final tumor response was determined by change in tumor size using magnetic resonance imaging (MRI). Cervical tumor volumes and vascular indices were calculated and compared with the clinical outcome.

Results

Of the 52 patients, 32 patients who completed all four examinations were included in the analyses: 21 were classified as complete response (CR) and 11 as partial response (PR). During the treatment, the CR group showed that 3D vascular indices (VI and VFI) significantly increased at 1 week ( P = 0.028, P = 0.017, respectively) then decreased at 2 weeks and obviously decreased at therapy completion (both P < 0.001), whereas tumors significantly decreased in volume at 2 weeks after therapy initiation ( P < 0.05). However, no significant differences in 3D vascular indices values were seen in the PR group during the treatment course (all P > 0.05).

Conclusion

Prospective longitudinal 3D-PDU imaging may have potentials in monitoring early therapeutic response to CCRT in patients with cervical cancer.
A Long Term Double-Blind Clinical Trial of Ibuprofen and Indomethacin in Rheumatoid Arthritis
Authors: Royer G L , Moxley T E , Hearron M S , Miyara A , Shenker B M
Published: January 2017

Two-hundred and eighteen individuals with rheumatoid arthritis were randomly assigned to six months treatment with ibuprofen (900-1800 mg/day) or indomethacin (75-150 mg/day). The drugs were equally effective in the treatment of rheumatoid arthritis while the incidence of indomethacin side-effects was 1·5 times greater than the incidence of ibuprofen side-effects.
An Analgesic Comparison of Floctafenine (Idarac) and Dihydrocodeine in Post-Operative Pain
Authors: Lipton S , Conway M , Akbar F Ali
Published: January 2017

A double-blind crossover study comparing floctafenine 200 mg, a new analgesic drug, and dihydrocodeine 60 mg, was performed on 72 patients suffering from post-operative pain. Degree of pain relief by floctafenine was similar to that of dihydrocodeine but the relief afforded by the former was of longer duration. Side-effects associated with dihydrocodeine were statistically higher than those associated with floctafenine. Floctafenine was demonstrated to be an effective analgesic with an insignificant incidence of untoward side-effects.
A Comparison of Mazindol (Teronac) with Diethylpropion in the Treatment of Exogenous Obesity
Authors: Murphy J E , Donald J F , Molla A L , Crowder D
Published: January 2017

Fifty obese patients were entered into a 12-week parallel group study of mazindol with diethylpropion in a general practice group. Both drugs produced weight loss, but patients on mazindol lost 19·9 lbs in 12 weeks, while those on diethylpropion lost 11·6 lbs, a statistically significant difference (p > 0·01). At each visit during the trial, patients had lost more weight with mazindol, but this was only significant statistically in the period 8-12 weeks (p > 0·01). Patients developed tolerance to the effect of diethylpropion in the last period (8·12 weeks) but this was not evident in those patients taking mazindol. The number of side-effects was less in the mazindol group and mainly of an adrenergic, peripheral type, while those in the diethylpropion group are mainly of the central stimulant type.
Clinical Experience with Ro 5-3350 (Bromazepam)
Authors: Draper R
Published: January 2017

A pilot study using Ro 5-3350 was followed by a double-blind trial comparing Ro 5-3350 and chlordiazepoxide in a total of 25 patients who were either hospital in-patients or previous in-patients attending an out-patients follow-up clinic. The patients all had a long history of obsessive-compulsive or phobic symptoms. The visual analogue scale, the Taylor Manifest Anxiety Scale and clinical ratings were used to measure the response to treatment. In all three rating methods used, those patients who had received Ro 5-3350, chlordiazepoxide and then Ro 5-3350 in that order, consistently favoured Ro 5-3350. When the clinical ratings were examined by diagnostic groups, it was found that the phobic patients all gave favourable responses to Ro 5-3350. Two of the six patients with severe anxiety or agoraphobic states who had been treated with Ro 5-3350 over periods ranging from three to five years received the medication during the whole term of pregnancy and they were delivered of full-term normal babies. The results suggest that Ro 5-3350 (bromazepam) is a potent anxiolytic most likely to be effective in the relief of visceral manifestations of anxiety. The incidence of side-effects was low and there were no toxic effects reported.
Psychometric Assessment of the Therapeutic Efficiency of Antidepressant Agents
Authors: Elwan Osamah , Souief Mostafa , Hassan Mahassen Aly , Allam Mahmoud
Published: January 2017

A clinical trial of four weeks duration was conducted involving a tota of thirty depressed patients, of both sexes, aged between twenty and thirty-four years. The total number of patients was divided into three groups of ten patients each. One group received amitriptyline, the second group was administered noxiptyline and the third group was given dibenzepine. All drugs were administered orally.

Patients were submitted to psychometric testing before and after drug administration. The tests used included the ‘Hamilton Rating Scale for Depression', the ‘Hildreth Feeling Scale’ and the ‘D Scale’ and the ‘Trail Making Test’ for the evaluation of psychomotor retardation.

It was concluded that the Hamilton Rating Scale was the most relatively sensitive test utilized in assessing the depressive state and its improvement.

Amitriptyline was found to be mostly anxiolytic; noxiptyline controlled both depression and anxiety to approximately the same extent; and dibenzepine was found to be a mood-elevating drug with an energizing action.
The Addition of Visken to Methyldopa Therapy in Hypertension: A Multicentre Study
Authors: Murphy J E
Published: January 2017

Forty-one patients completed the study where Visken was added to the treatment regimen of patients whose blood pressures were poorly controlled on methyldopa or who were experiencing side-effects with methyldopa. Supine blood pressure was reduced from 177/108 mm Hg before Visken therapy to 159/96 mm Hg after twelve weeks of taking Visken. The dose of methyldopa was reduced from a mean 921 mg at the start to 445 mg at the end. Fourteen patients were able to stop methyldopa therapy. The number of side-effects reported was reduced as the study continued and fifteen patients commented that they felt better on Visken. Nine patients did not complete the trial, three of these because of side-effects, viz insomnia, lethargy and sleep disturbances.
A Clinical Trial of Temazepam, a Sleep Inducer, in Hospital Patients
Authors: Pines A , Nandi A R , Rahman M , Raafat H , Rooney J F F
Published: January 2017

Temazepam, a common metabolite of diazepam and oxazepam, was evaluated as a sleep inducer. A dose of 20 mg, in a Scherer capsule formulation, was compared with 200 mg of amylobarbitone sodium in a between-patients, randomized study. Patient and staff assessments were used. No statistically significant difference as to onset of sleep, duration or quality of sleep or morning drowsiness was found using the patients' assessments. The staff recorded significantly less daytime dozing and morning hangover in patients receiving temazepam. Side-effects were mild and confined mainly to drowsiness on awakening. Two patients, both on amylobarbitone sodium, withdrew from the study because of increasing confusion.
Acute Intermittent Porphyria on Withdrawal of Oral Contraceptives
Authors: Gerlis L S
Published: January 2017

A rare presentation of Acute Intermittent Porphyria is described, in which withdrawal of an oral contraceptive (Gynovlar 21®) provoked the first acute attack.
Amikacin in the Treatment of Genito-Urinary Tract Infections in Cancer Patients
Authors: Sherif M , Aboul-Enein M , Soliman O
Published: January 2017

Amikacin was used in the treatment of severe urinary tract infections in twenty-five seriously ill patients. In twenty-four of the patients, cystitis or pyelonephritis complicated carcinoma of the bladder. Structural changes in the urinary tract, resulting from schistosomiasis, presented additional obstacles to treatment in many of the patients. The most commonly isolated pathogens were Escherichia coli and Pseudomonas. Most patients received 500 mg of amikacin every twelve hours. Three patients experienced adverse renal reactions which showed subsequent improvement. Amikacin effected twenty-one (84%) complete cures and four (16%) clinical cures in the twenty-five patients. This represents 100% clinical success in this study.
Netilmicin: A Review of Toxicity in Laboratory Animals
Authors: Luft Friedrich C
Published: January 2017

The data on the toxicity of netilmicin in laboratory animals as well as preliminary data in man are reviewed. Netilmicin is less toxic to the VIIIth nerve than is gentamicin in all species tested. The data suggest that it probably is less ototoxic than tobramycin, although confirmatory studies should by performed. Netilmicin is also less nephrotoxic than gentamicin in all species tested. It is less nephrotoxic than tobramycin in the rat and dog. Comparisons in the rat suggest that netilmicin has aflat dose – response curve that resembles the curve produced by streptomycin. In animals, netilmicin produces more neuromuscular blockade than gentamicin; however, neuromuscular blockade with aminoglycosides in man is rare and thus far no episodes have been associated with netilmicin during clinical investigation. Initial clinical studies in man indicate that netilmicin is efficacious and well tolerated. Presently available data suggest that netilmicin offers distinct advantages over older aminoglycosides. Final conclusions must await prospective randomized double-blind trials in man.
A Double-Blind Crossover Evaluation of Ketoprofen (Orudis®) and Placebo in Rheumatoid Arthritis with Assessment of Long-Term Tolerance
Authors: Howard D L G
Published: January 2017

A two-week double-blind crossover study of ketoprofen, a non-steroidal antiinflammatory agent, and placebo was done in ten patients with active rheumatoid arthritis in order to obtain a preliminary efficacy estimate of this new drug. Even after only one week of treatment, joint activity was significantly reduced while other parameters of disease activity showed strong clinical trends in favour of the drug. Only one adverse reaction (mild nausea) was reported during ketoprofen therapy.

At the conclusion of the double-blind study, seven patients volunteered to continue on ketoprofen to evaluate the tolerance of the drug during protracted administration. All patients completed over twelve months of treatment. Overall, ketoprofen gave good control of pain and inflammation, gastro-intestinal disturbance was reported in a single instance and laboratory values were not adversely affected by the drug.
Double-Blind Comparison of Butorphanol and Meperidine in the Treatment of Post-Surgical Pain
Authors: Stehling Linda C , Zauder Howard L
Published: January 2017

The efficacy and safety of butorphanol tartrate were compared in a double-blind manner to meperidine hydrochloride in 299 patients with moderate to severe post-operative pain. When analgesia was requested, patients were medicated with butorphanol (1.0 or 2.0 mg) or meperidine (40 or 80 mg) administered intramuscularly according to a pre-determined computer-generated random schedule.

Evaluation of pain relief data showed no significant differences between butorphanol and meperidine at the low doses and at the high dose levels. Onset of analgesia, peak effect (thirty to sixty minutes) and duration of action (approximately four hours) were comparable. Thus, the data support a 40:1 butorphanol to meperidine potency ratio.

There was little difference between the drugs with respect to adverse reactions, effects on vital signs, and variations in laboratory values. The incidence of nausea and vomiting was more common in the meperidine-treated patients. Respiratory depression occurred in three patients who received meperidine and in one to whom butorphanol was administered. One meperidine-treated patient experienced hallucinations, a phenomenon not observed following butorphanol.

On the basis of these data, butorphanol appears to be a safe, well tolerated and highly effective analgesic for the treatment of moderate to severe postoperative pain.
Comparative Haemodynamic Studies with Mepindolol-Sulphate(SH E 222) and Propranolol (Inderal®, Dociton®) in the Isoproterenol Test
Authors: Bonelli J
Published: January 2017

The haemodynamic effects of a β-receptor blockade with mepindolol-sulphate and propranolol were studied under basal conditions and under an increasing dose of isoproterenol in 6 subjects aged between 25 and 30 years.

Special attention was paid to possible differences between the two substances as regards their affinity for the various β1 and β2 -receptors. The cardiac output (HMV) was determined with the aid of the Swan-Ganz-thermodilution method, the blood pressure was measured wet. The results led to the following conclusions:

A decrease in the heart rate (HR) occurs under basal conditions after propranolol, but not after administration of mepindolol-sulphate. The lack of an effect of mepindolol-sulphate on the HR at rest can be explained by its intrinsic activity. A reduction of the stroke volume (SV) occurs under basal conditions after propranolol, whereas no effect on the SV was observed under mepindolol-sulphate. Three properties of mepindolol-sulphate are responsible for this lack of effect on the S V, namely its only slight quinidine-like effect compared with propranolol, its intrinsic activity and its only slight affinity for the inotropism receptors at the heart. An infusion of isoproterenol leads to a decrease in the pulmonary capillary pressures (Pc pressures). This effect can be competitively suppressed both with propranolol and with mepindolol-sulphate. This effect has been explained by the fact that isoproterenol leads to dilatation of the venous capacity vessels as a result of stimulation of the β2 -receptors in the periphery. Blockade of the β2 -receptors can prevent this dilatation. The affinities of propranolol for the frequency and inotropism receptors at the heart and for the β2 -receptors in the peripheral vessels are of the same magnitude. In contrast to this, the affinity of mepindolol-sulphate for the inotropism receptors at the heart is considerably less than for the frequency receptors and the β2 -receptors in the periphery.
A Clinical Comparison of Triazolam with Placebo and with Secobarbital in Insomniac Patients
Authors: Okawa K Kay , Allen George S
Published: January 2017

Seventy-six out-patient insomniacs participated in three different two-night, double-blind crossover trials investigating the hypnotic efficacy and safety of triazolam. Triazolam 0.5 mg was compared to placebo in one trial conducted by K Kay Okawa, MD, and triazolam 0.5 mg was compared to secobarbital 100 mg in trials conducted by K Kay Okawa, MD and George S Allen, MD. The results of the latter two studies were combined and the data analyzed jointly. Triazolam 0.5 mg was found to be preferred and to be significantly better than both placebo and secobarbital 100 mg in the treatment of insomnia. Analysis of sleep questionnaire data showed triazolam to be superior to either placebo or secobarbital on the following parameters: how much the medication helped the patient sleep; onset of sleep; duration of sleep; and number of nocturnal awakenings. No differences were observed between treatments in any trial with regard to the patient's feeling of alertness the next morning. The side-effects reported for all treatments did not significantly interfere with the patients' ability to function.
The Palatability of Colloidal Bulk Forming Agents
Authors: Flaherty E V , O'Doherty J , Fielding J F
Published: January 2017

The palatability of three bulk additives was studied in volunteers under 40 and over 60 years of age. Women highly significantly preferred Normaeol Special® (Norgine) to Fybogel® (Reckitt & Colman) and Celevac Granules® (W.B.P.). On both preference and palatability score Normacol Special was significantly preferred to Celevac Granules, as it was in the under 40's on palatability; score and in the over 60's on preference, but in the latter, sex may have accounted for the difference observed. Volunteers under the age of 40 gave Celevac a significantly higher palatability score than Fybogel; the reverse occurred in the over 60's.

These results have therapeutic implications in patients with different gastrointestinal disorders.
Comparative Study with Piroxicam and Ibuprofen versus Placebo in the Supportive Treatment of Minor Sports Injuries
Authors: Santilli G , Tuccimei U , Cannistrà F M
Published: January 2017

Piroxicam (20 mg o.d.), ibuprofen (300 mg t.i.d.) or placebo were added to the conventional treatment in three different groups of professional athletes with soft-tissue injuries. The piroxicam-treated group showed, with a once-a-day only administration, a statistically significant better improvement of various subjective and objective signs of functional damage.
Fenoprofen in the Treatment of Osteoarthrosis of Hips and Knee Joints in the Elderly
Authors: Chakravorty N K , Annan G
Published: January 2017

Twenty-one patients between the ages of 68 and 89 years with osteoarthrosis of hips and/or knee joints were studied. One group was treated with fenoprofen 300 mg t.d.s. for 5 days, and the other group with 600 mg t.d.s. for 5 days. No therapeutic advantage was found with the higher dose, and the side-effects were minimal on either dosage. Treatment of elderly patients with the smaller dose is recommended.
Effect of Ibuprofen or Aspirin on Probenecid-Induced Uricosuria
Authors: Brooks Carter D , Ulrich Joyce E
Published: January 2017

We dosed eight normal volunteers with single doses of probenecid alone and with aspirin or ibuprofen. Urinary urate clearance was increased by probenecid. This increase was partially inhibited by aspirin but not by ibuprofen.