bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns of Incompetence in Patients with Recurrent Varicose Veins: A Duplex Ultrasound Study
Authors: Farrah J. , Shami S. K. 
Published: January 2017

Objectives: To identify the patterns of venous incompetence in patients with recurrent varicose veins using duplex ultrasound scanning. Setting: Oldchurch District General Hospital, Southeast England. Patients and methods: 836 patients (581 women, median age 51 years (range 22–86 years) and 255 men, median age 53 years (range 23–28 years) referred to the vascular laboratory for the assessment of recurrent varicose veins. Duplex ultrasonography was undertaken by an experienced operator to evaluate the venous system in the lower limbs. A total of 1254 limbs with recurrent varicose veins were studied. Results: Recurrent reflux was found at the sapheno-femoral (SFJ) or saphenopopliteal junction (SPJ) in 43% of cases. The source of recurrent varices was an unoperated SFJ or SPJ in 386 (31%) limbs. Thigh perforators accounted for varices in 16% of limbs. Conclusion: Nearly half of recurrences were attributable to inadequate surgical treatment at the initial operation or possible angiogenesis. Nearly a third of recurrences originated at previously unoperated sites, confirming a need for objective venous assessment before recurrent varicose vein surgery.
Which Vein Stripper, Metal or Plastic Disposable?
Authors: Corbett C.R.R. , Harries W.J. 
Published: January 2017

When stripping the long saphenous vein it is recommended that the stripper be passed from the groin downwards. If the stripper is passed from below the knee upwards, there is a possibility of it entering the deep veins. Cases are recorded of the consequent, inadvertent, stripping of the deep veins. Plastic ‘single use’ disposable strippers may be easier to handle than metal strippers and perhaps easier to pass against the valves. A prospective randomized trial was carried out in 80 limbs to compare the performance of plastic and metal strippers. In 37 of 40 limbs the metal stripper could be passed from the groin to below the knee and in 36 of 40 limbs the plastic stripper could also be passed in this way. Hence a stripper could be passed downwards in 73 of 80 (91%) limbs. However, the plastic strippers passed more quickly to below the knee, in a mean time of 24 s compared with 36 s for the metal strippers (Wilcoxon's test, P = 0.03). Against this is the cost of £8.00 for a pair of plastic disposable strippers.
Plication of the Sapheno–Femoral Junction: Effects on Incompetence after Two Years
Authors: Belcaro Giovanni V. 
Published: January 2017

Plication of the long saphenous vein at the sapheno–femoral junction (SFJ) is an alternative to flush ligation and stripping. This technique abolishes reflux at the SFJ without altering the vein; this may then be used for arterial surgery or coronary artery grafting. Candidates for plication were selected on the basis of ambulatory venous pressure measurements and duplex scanning. These tests indicate and quantify the degree of superficial venous incompetence. Plication of the SFJ reduces the calibre of the vein to 60–70% for a length of 1.5 cm, allowing the value cusps to close when flow in the femoral vein is reversed. In this study 20 limbs were evaluated (in 20 patients) 6, 12 and 24 months after plication. Venous reflux was significantly reduced and there was an improvement in signs and symptoms. Thus, SFJ plication seems to be an effective physiological alternative to flush ligation in some subjects. However, long-term results (> 5 years) must be still evaluated.
Non-Invasive Measurement of Venous Muscle Pump Function in the Supine Position
Authors: van Gerwen H. J. L. , Brakkee A. J. M. , Kuiper J. P. 
Published: January 2017

Objective: A new non-invasive procedure for testing venous muscle pump function in the horizontal position is presented. Design: The test is based on an indirect method we use for measuring ambulatory venous pressure by means of strain-gauge plethysmography. Setting: University Hospital Nijmegen, The Netherlands. Patients: The results of 28 limbs of 20 patients with deep venous insufficiency are compared with 32 limbs of 16 healthy volunteers. Interventions: The same test is performed in all patients and volunteers: in the supine position a raised venous pressure in the limb is induced by venous congestion. The reduction in venous volume after standardized leg movements is measured by strain-gauge plethysmography and, with an additionally obtained pressure-volume relation, this volume reduction is converted into a pressure reduction. Main outcome measure: The reduction by standardized leg movements of an increased venous pressure is a measure for calf muscle pump function. Results: The mean pressure reduction in the patient group was 47% (standard deviation (SD) = 8%), in the healthy group 77% (SD = 6%). Conclusions: The new ‘supine venous pump function test’ is a promising method for measuring the function of the deep veins. Since the whole procedure is performed in the horizontal positon, the method offers several important advantages.
Gravitational Reflux Does Not Correlate with Clinical Status of Venous Stasis
Authors: Moulton S. , Bergan J. J. , Beeman S. , Poppiti R. 
Published: January 2017

Objective: To quantify venous reflux by a standard duplex ultrasound technique and correlate the data obtained with clinical grades of severity of venous disease. Design: A prospective study in a single group of patients with venous insufficiency. Setting: Private practice in secondary and tertiary care. Patients: 133 inpatients undergoing investigation for venous disease. Patients with known venous obstruction, arterio-venous malformations or lymphoedema were excluded from the study. Main outcome measures: Duplex ultrasound scanning was performed to measure the cross-sectional area, severity and duration of venous reflux following calf compression using a standardized technique. Results: Clinical classification assigned to each limb correlated with the presence of venous reflux, but not the quantity, velocity or duration of reflux in the veins studied. Presence of reflux and diameter of the vein studied correlated ( p<0.001) in all the veins except the popliteal vein ( p > 0.03). Conclusion: Quantification of venous reflux obtained by cuff deflation does not correlate with clinical severity of venous stasis, but does detect reflux accurately. This allowed greater saphenous sparing in nine limbs in 41 patients but proved the need for saphenous removal in seven limbs not previously suspected clinically of requiring this procedure.
Surgical Options in Post-Thrombotic Syndrome
Authors: Cheatle T. R. , Perrin M. 
Published: January 2017

Objective: To review the outcome of surgical restoration of deep vein competence in 53 patients with post-thrombotic syndrome. Design: Single patient group. Setting: Unite de Pathologie Vasculaire Jean Kunlin, Clinique du Grand-Large, av. Leon-Blum, Decines Charpieu, France. Patients: Fifty-three patients with clinical and radiological evidence of post-thrombotic syndrome uncontrolled by conventional conservative treatment. Interventions: Surgical restoration of deep vein competence by one of four methods: valvuloplasty, vein transplantation, vein transposition, or Psathakis' sling procedure. Main outcome measures: Sustained ulcer healing, photoplethysmography (PPG) refilling times, abolition of venous reflux on duplex scanning, symptomatic improvement. Results: All four techniques led to sustained ulcer healing in approximately two-thirds of patients. There was a poor correlation between maintenance of ulcer healing and improvement in PPG refilling times or abolition of reflux on duplex ultrasound.
Maternal and Fetal Haemodynamics during Late Pregnancy: Effect of Compression Hosiery Treatment
Authors: Austrell C. , Nilsson L. , Norgren L. 
Published: January 2017

Objective: To study the effect of graduated compression on maternal and fetal haemodynamics. Design: Measurement of maternal and fetal heart rate and uterine artery flow velocity ( Vmax) in supine and standing positions with and without graduated compression hosiery (25 mmHg at the ankle). Setting: Department of Surgery, Lund University, S-22185 Lund, Sweden. Patients: Eighteen women in gestational week 32–38. Results: An increase in heart rate on standing was recorded for both mother and fetus. Graduated compression stockings decreased these changes. Cyclic heart rate changes were not frequent. Uterine artery flow velocity did not change during change of posture or after compression. Conclusion: The utero-vascular syndrome was not common in the patients studied. Graduated compression reduced the vascular response to standing, measured as an increase of heart frequency at standing.
Failure of Angioscopically Guided Sclerotherapy to Permanently Obliterate Greater Saphenous Varicosity
Authors: Biegeleisen K. , Nielsen R. D. 
Published: January 2017

Objective: To assess the long-term outcome of sclerotherapy. Design: Single group study of patients with incompetence of the long saphenous vein. Setting: All treatments were performed in a private office setting. Patients: Sixteen patients with untreated varicosities limited to the greater saphenous vein, which was 10 mm in diameter at the saphenofemoral junction in all cases. Interventions: Angioscopically guided sclerosis of the long saphenous vein. Main outcome measures: Colour-flow ultrasound was used to establish the presence of residual reflux after angioscopic treatment. Results: Total obliteration of saphenofemoral reflux was obtained in 12 veins with angioscopic sclerotherapy. All veins on which follow-up was available (nine veins in seven patients) had undergone substantial recanalization by 12 months after treatment. Conclusion: Angioscopically controlled sclerotherapy effectively obliterates the saphenophemoral junction. Recanalization of the sclerosed segment of vein occurs invariably within 12 months of treatment.
Relationship between Venous and Arterial Haemodynamics during Postural Changes in Venous Insufficiency
Authors: Duprez D. , De Buyzere M. , Randon C. , Dad M. , Clement D. L. 
Published: January 2017

Objective: To study the changes in central haemodynamics and the relationship between arterial blood pressure and the venous dynamics of the lower limbs in patients with venous insufficiency. Design: Prospective haemodynamic study during postural changes in 14 patients with venous insufficiency with no other concomitant cardiovascular disease or disturbances in autonomic nervous system. Setting: Department of Cardiology and Angiology, University Hospital, Gent, Belgium. Patients: Fourteen patients with venous valve insufficiency in the lower limbs. Interventions: Measurements of arterial blood pressure, heart rate, stroke volume and cardiac output were performed in the supine position after 30 min rest and 5, 15 and 30 min after standing and during the recovery. Venous pressure at the ankle and calf circumference were also measured. Main outcome measures: Changes in cardiac output and total peripheral vascular resistance in order to maintain blood pressure during postural changes. Results: Arterial blood pressure was maintained constant owing to an increase in total peripheral vascular resistance despite a decrease in cardiac output. Venous pressure is also related to arterial blood pressure. Conclusions: The arterial and venous systems, even in venous insufficiency, are integrated to maintain blood pressure constant during postural changes.
Air Plethysmography in the Detection of Suspected Acute Deep Vein Thrombosis
Authors: Labropoulos N. , Volteas N. , Leon M. , Volteas S. K. , Nicolaides A. N. 
Published: January 2017

Aim: To test the value of outflow fraction using air plethysmography (APG) in the detection of suspected acute deep vein thrombosis (DVT) extending proximal to the calf. Design: Prospective study in patients and normal volunteers. Setting: Academic Surgical Unit and Vascular Unit, St Mary's Hospital Medical School, London, UK. Material and methods: We prospectively examined 152 lower extremities of 150 patients with clinical suspicion of DVT. Patients were examined by APG (outflow fraction) and either ascending venography or colour flow duplex imaging (CFDI) as gold standards to establish the diagnosis. The reproducibility of outflow fraction was tested in two normal volunteers and was shown to have coefficients of variation of 6.1% and 8.2%, respectively. Results: On venography or CFDI, DVT was detected in 96 limbs. Proximal DVT was seen in 74; it was confined to the calf in 22. APG was 95% sensitive, 95% specific and 95% accurate in detecting proximal DVT whereas it was 45% sensitive, 95% specific and 81% accurate for calf DVT. Conclusions: Using air plethysmography, the outflow fraction is a highly reproducible and accurate measurement in detecting DVT proximal to the calf. The high positive predictive value means that if the test is positive, treatment can start immediately; if it is negative, duplex scanning is necessary to exclude proximal partially occluded thrombi or calf DVT.
Pharmacology of Oedema Protective Drugs
Authors: Markwardt F. 
Published: January 2017

Objective: To review the drugs used in the treatment of chronic venous diseases of the lower limb. Data sources: Published papers referring to the pharmacology of drugs used in the management of chronic venous insufficiency and varicose veins of the lower limb. Study selection: Sixty-four papers referring to the use of horse chestnut extract (aescin), flavonoids, tribnoside and calcium dobesilate have been included. Data extraction: Papers were examined to establish the mechanism of action of ‘oedema protective’ drugs. Data synthesis: Oedema protective drugs modify the permeability of the microcirculatory endothelium in animal models of oedema and probably in patients with venous disease to reduce transcapillary loss of fluid into the tissues. The exact mechanisms of action remain unclear. Conclusion: Animal and clinical studies demonstrate that drugs of the four types included in this review moderate the development of tissue oedema.
Edinburgh Vein Study: Methods and Response in a Survey of Venous Disease in the General Population
Authors: Evans C J. , Fowkes F. G. R. , Ruckley C. V. , Allan P. L. , Carson M. N. , Kerracher E. M. G. , Lee A. J. 
Published: January 2017

Objective: To describe the methods required to conduct a large epidemiological study of venous disease in the general population, and the resulting response. Design: Cross-sectional study. Setting: University of Edinburgh. Participants: Men and women aged 18–64 years, randomly selected from general practice registers. Methods: Subjects were invited for the following procedures: questionnaire, height and weight measurement, classification of varices and chronic venous insufficiency, duplex measurement of duration of venous reflux and venous blood sampling. A questionnaire survey of non-responders was carried out. Results of response: A total of 1566 subjects attended, a final response rate of 53.8%. The response rate increased with age. The distribution of ethnic origin and social class of attenders was similar to that of the general Edinburgh population. Study participants were generally older, from more affluent areas and more often female than non-responders ( p ≤ 0.001). Conclusions: Large epidemiological studies of venous disease in the community are feasible but the level of response illustrates the importance of obtaining information on the disease status of non-responders.
Expression and Distribution of Laminin, Fibronectin and Tenascin is Stage Dependently Modulated in the Skin of Chronic Venous Insufficiency
Authors: Peschen M. , Schild A. , Brand-Saberi B. , Rogers A. A. , Augustin M. , Schöpf E. , Vanscheidt W. 
Published: January 2017

Objective: The regulation of tissue remodelling is a function of extracellular matrix (ECM) deposition. Our aim was to determine the expression and distribution pattern of the ECM proteins laminin, fibronectin and tenascin in all stages of chronic venous insufficiency (CVI) from telangiectases to ulceration. Methods: In punch biopsies of 25 patients with various stages of CVI and five healthy volunteers, ECM proteins were stained using indirect immunofluroescence. The staining pattern in the affected skin was evaluated by two independent, double-blinded investigators by microscopic examination. Results: In specimens of healthy skin or skin with telangiectases or pigmentation, a faint and partly inhomogeneous ECM staining pattern was detected in the upper dermis. In venous eczema, lipodermatosclerosis and venous leg ulcers, an increased expression and a wide-meshed distribution pattern throughout the dermis was observed for laminin, fibronectin and tenascin. Fragmentation of ECM components was first observed in venous eczema, persisting in the more severe stages of CVI. Laminin staining revealed unusual streak-like distributions in the papillary dermis, pronounced in Pigmentation and lipodermatosclerosis and diminished in leg ulcers. Conclusions: Our results indicate an important role of laminin, fibronectin and tenascin, and in particular of their proteolytic fragments, in the early phases of CVI, such as venous eczema, by creating permissive environments for cell migration and differentiation, essential for wound healing.
A Randomised Trial of Different Compression Dressings following Varicose Vein Surgery
Authors: Bond R. , Whyman M. R. , Wilkins D. C. , Walker A. J. , Ashley S. 
Published: January 2017

Objective: TED antiembolism stockings, Panelast self-adhesive elasticated bandages and Medi Plus class II stockings are three different dressings commonly used to provide compression following surgery for varicose veins. The aim of this study was to determine which of the three dressings was most acceptable to patients. Design: Forty-two patients undergoing bilateral varicose vein surgery were randomised to receive a different dressing on each leg in order to determine if a particular type of dressing was superior in its ability to reduce postoperative pain and provide adequate comfort without reducing mobility. The dressings were worn for 1 week, during which daily pain scores were recorded for each leg followed by a simple questionnaire to determine comfort and mobility. Results: There was a significant reduction of mobility experienced by patients wearing Panelast bandages compared with the other two dressings ( p<0.05). However, there were no significant differences between the dressings with regard to the degree of postoperative pain experienced, and in all other respects the dressings were equally tolerated. Conclusion: The choice of compression dressings used for varicose vein surgery should depend primarily on the personal preference of surgeons as well as financial considerations.
Cerebral vascular structure in the motor cortex of adult mice is stable and is not altered by voluntary exercise
Authors: Cudmore Robert H , Dougherty Sarah E , Linden David J 
Published: January 2017

The cerebral vasculature provides blood flow throughout the brain, and local changes in blood flow are regulated to match the metabolic demands of the active brain regions. This neurovascular coupling is mediated by real-time changes in vessel diameter and depends on the underlying vascular network structure. Neurovascular structure is configured during development by genetic and activity-dependent factors. In adulthood, it can be altered by experiences such as prolonged hypoxia, sensory deprivation and seizure. Here, we have sought to determine whether exercise could alter cerebral vascular structure in the adult mouse. We performed repeated in vivo two-photon imaging in the motor cortex of adult transgenic mice expressing membrane-anchored green fluorescent protein in endothelial cells (tyrosine endothelial kinase 2 receptor (Tie2)-Cre:mTmG). This strategy allows for high-resolution imaging of the vessel walls throughout the lifespan. Vascular structure, as measured by capillary branch point number and position, segment diameter and length remained stable over a time scale of months as did pericyte number and position. Furthermore, we compared the vascular structure before, during, and after periods of voluntary wheel running and found no alterations in these same parameters. In both running and control mice, we observed a low rate of capillary segment subtraction. Interestingly, these rare subtraction events preferentially remove short vascular loops.
Floctafenine (IDARAC)—A New Analgesic: A Comparison with Placebo in Chronic Pain
Authors: Vickers M D , Akbar F Ali 
Published: January 2017

A double-blind cross-over trial was conducted in 23 patients comparing the analgesic effect of floctafenine 200 mg with placebo, in chronic pain, each being given for a period of 1 week. There was statistically significant evidence that floctafenine was more effective than placebo in the relief of pain. Miscellaneous side-effects, none of a serious nature, were reported.
A Retrospective Evaluation of Nifedipine Therapy in Prinzmetal's Angina
Authors: Battye Roy , Ordille Carol M 
Published: January 2017

A retrospective evaluation has been made of blood pressure, pulse rate, and number of anginal attacks per day in twenty-one patients diagnosed as Prinzmetal's A ngina and treated with the investigational drug nifedipine. The effect of combining nifedipine with short- and long-acting nitrates or with propranolol was also evaluated. In consideration of the statisically significant reduction in the number of anginal attacks per day, p<0.001, together with the non-significant mean changes in blood pressure and pulse rate as well as the compatability with the other drugs, it is concluded that nifedipine is a very useful drug, in a dose range of 30–120 mg per day, for the treatment of Prinzmetal's Angina. Recorded side-effects were of minimal severity and in no case caused nifedipine therapy to be discontinued.
Beclomethasone Dipropionate Aerosol in the Treatment of Asthma in Steroid-Independent Children
Authors: Chambers W B , Malfitan V A 
Published: January 2017

Sixty-eight steroid-independent children, whose asthma was poorly controlled by bronchodilators and other anti-asthmatic drugs, were treated for six weeks with 200 to 400 mcg per day of beclomethasone dipropionate aerosol. Symptoms of wheezing, blockage, and cough, reported by the children in a daily diary, improved in 80% of cases. Use of other anti-asthmatic medications, which the children were free to modify as they wished, decreased. Objective measurements of pulmonary function, VC, FEV1, and FEV%, evaluated by weekly spirometry, also improved in almost 80% of cases. The dosages used here had no effect on early morning plasma Cortisol levels and none of the children developed signs of oral candidiasis.
Droperidol in the Management of Hyperactivity, Self-Mutilation and Aggression in Mentally Handicapped Patients
Authors: Burns M E 
Published: January 2017

An assessment of the efficacy of long-term oral droperidol in the control of hyperactivity, self-mutilation, aggression and temper tantrums has been made by reference to the case history notes of sixteen mentally handicapped patients. Behavioural disorders were greatly improved in four patients, and improved in six, and two experienced accompanying marked beneficial personality changes. In all but two patients Parkinsonian side-effects were prevented by the concomitant administration of orphenadrine or benzhexol.