bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Posture on the Pressure Exerted by Below-Knee Class II Compression Stockings on Normal Subjects
Authors: Aryal K. , Dodds S. R. , Chukwulobelu R. 
Published: January 2017

Background: Below-knee elastic compression stockings are widely used for the treatment of chronic venous insufficiency. The exact amount of pressure exerted by these stockings on different parts of leg and in different postures remains controversial. Objective: To examine the pressure exerted by correctly fitted class II below knee compression stockings at different levels and postures in normal subjects. Methods: Seven healthy human volunteers (mean age 38 years) were fitted with CEN class II below-knee compression stockings. Interface pressure measurements were recorded at 4 cm intervals from the malleolus to the top of the stocking on the medial and lateral aspects of the leg in supine, sitting and standing postures. Results: The interface pressure at 4 cm and 32 cm above the medial malleolus was not significantly different from the recommended values for class II socks and did not change significantly with posture. In the supine position the pressure at the mid-calf (12 cm) was greater than at the ankle (p < 0.05), creating a reverse pressure gradient, which increased further on standing (p < 0.05). Conclusion: The pressure profile under correctly fitted class II socks varies with posture due to the change in shape of the leg. The resulting profile deviates from the theoretical ideal of a graduated pressure gradient that adapts with posture. The clinical significance of this effect is not known.
The Quality of Local Anaesthesia Associated with Intravenous Administration of Ketoprofen in Radical Operations for Leg Varicose Veins
Authors: Glinka M. , Urbaniak A. , Kalemba J. 
Published: January 2017

Objective: To evaluate the use of intravenous ketoprofen administration during varicose vein surgery undertaken under local anaesthesia. Setting: Regional general hospital in Poland. Patients: One hundred and six patients presenting with primary long saphenous varicose veins, including those with skin changes and leg ulceration. Interventions: Patients underwent sapheno-femoral ligation and long saphenous stripping under local anaesthesia including femoral nerve block, having first received an intravenous infusion of ketoprofen. Outcome measures: Patients recorded their level of discomfort or pain on a five-point scale. Blood pressure and pulse were also recorded. Results: One hundred and two patients found the level of analgesia produced by this technique to be acceptable, and 75 reported no discomfort at all. Conclusions: The combined use of intravenous ketoprofen and local anaesthesia allowed the treatment of all patients with superficial venous incompetence irrespective of their fitness for general anaesthesia.
Leg Ulcers: A Cross-Sectional Survey of Management Practices and Treatment Costs in Ireland
Authors: O'Brien J. F. , Clarke-Moloney M. , Grace P. A. , Perry I. J. , Burk P. E. 
Published: January 2017

Objective: To review the management and the cost of leg ulcers. Design: Cross-sectional survey based on a questionnaire completed by healthcare workers caring for patients with leg ulcers in a defined population. Setting: The Mid-Western Health Board area in Ireland with a population of 317069. Patients: All patients receiving healthcare for active leg ulceration. Results: Leg ulcers were recorded for 389 individuals and public health nurses primarily provided care (n = 283). Patients had open ulcers for a median period of 8 months (interquartile range: 3 months — 2 years) with almost half (n = 181) reporting previous episodes of ulceration. Fifty different dressing products were used to treat leg ulcers in the region. Only 52.2% (203/389) of patients had the aetiology of their leg ulcers properly investigated and evidence-based care was generally apparent in this group. Otherwise, care appeared haphazard and at times inappropriate. The estimated annual direct cost of dressing leg ulcers was £585 660. Conclusion: A regional strategy for managing leg ulcers needs to be clarified and implemented if practitioners are to incorporate evidence-based care into routine work.
Cost-Effectiveness of Venous Thromboembolism Prophylaxis after Total Hip Replacement
Authors: Caprini J. A. , Arcelus J. I. , Kudraa J. C. , Sehgal L. R. , Oyslender M. , Maksimovic D. , MacDougall A. 
Published: January 2017

Objective: To determine the cost-effectiveness of three strategies used for the prevention of venous thromboem-bolism (VTE) in patients undergoing total hip replace-ment (THR), and to perform a sensitivity analysis comparing VTE rates based on different methods of detection. Methods: In this cost-effectiveness analysis, three strategies of prophylaxis of postoperative VTE and THR were compared: (1) low-molecular-weight heparin (LMWH); Enoxaparin, (2) warfarin and (3) a combination of warfarin, heparin (UFH), graduated stockings and sequential long-leg pneumatic compression devices. The model estimates were based on pooled data from the published literature and from personal data in our series of hip replacement patients. Expected direct costs of VTE care, including prophylaxis, diagnosis and manage-ment of thromboembolic and hemorrhagic complications, were estimated for a hypothetical cohort of 100 patients in 2001 US dollars from data available for patients hospitalized at Evanston Northwestern Health-care. A sensitivity analysis was performed with different rates of VTE based on routine venography, routine duplex ultrasound, or selective diagnosis and treatment of symptomatic patients. Results: When venography was used to diagnose VTE, the cost of warfarin or LMWH treatment was $118 422 and $104 732 per 100 patients, respectively, providing cost savings of $ 13 690 per hundred patients for LMWH. When VTE rates were based on duplex ultrasound diagnoses, LMWH resulted in cost savings of $4602 and $1345 per 100 patients compared with the use of warfarin or the combined approach, respectively. However, when the rates of VTE were based on confirmed symptomatic cases, the use of LMWH resulted in an increased cost of $4486 and $10015 per 100 patients compared with warfarin and the combined approach, respectively. Conclusions: The use of LMWH for the prevention of VTE after THR was more cost-effective than using warfarin or the combined approach, when the VTE rate was based on routine venography or duplex ultrasound. However, the combined approach was more cost-effective than the use of warfarin or LMWH alone when only patients with confirmed, symptomatic VTE were treated.
Anticardiolipin Antibodies and Protein S Deficiency: Two Case Reports
Authors: de Godoy J. M. P. , Braile D. M. , Ruiz M. A. 
Published: January 2017

Objective: To describe episodes of venous thrombosis in two young patients with combined congenital and acquired thrombophilias. Patients: Two patients attending a university hospital with episodes of deep vein thrombosis presenting at an unusually young age were studied. Tests for thrombo-philias showed these patients had protein S deficiency combined with high titres of cardiolipin antibodies. Interventions: The patients were anticoagulated with oral anticoagulants. Results: No further episode of thrombosis was seen in either patient over the following 2 years. Cnclusions: A detailed search for inherited and acquired thrombophilias should be undertaken in patients presenting with extensive venous thrombosis at an unusually young age. Oral anticoagulants are effective in managing this clinical problem. Indefinite anticoagulation may be required in patients presenting with combined thrombophilias.
Endothelium and Venotropic Drugs in Chronic Venous Insufficiency: A Review
Authors: Michiels C. , Remacle J. , Bouaziz N. 
Published: January 2017

Objective: To review the literature concerning chronic venous disease of the leg and the mechanisms of action of venotropic drugs. Methods: The authors identified relevant papers from their own collection and from medical literature databases. Synthesis: Endothelial cell activation caused by ex-posure to the hypoxic conditions that develop during blood stasis in chronic venous insufficiency patients is proposed to be one factor initiating a pro-inflammatory process in the leg veins. Recruited and activated neutrophils would then be responsible for alterations of the venous wall, typical of what is observed in varicose veins. Venotropic drugs used in the treatment of chronic venous insufficiency patients have long been known to decrease vascular permeability and increase venous tone. Recently, it has been shown that they are also able to prevent endothelial cell activation by hypoxia and a precise biochemical target common to all of them has been identified: the mitochondrial respiratory chain. Conclusion: The influence of venotropic drugs on the mitochondrial respiratory chain provides a rational explanation for the therapeutic benefit to patients of this class of drugs.
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.
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.
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.