bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Low Molecular Weight Heparins in the Prevention and Treatment of Venous Thromboembolism after Surgery
Authors: Andaz S. , Shields D. A. , Scurr J. H. , Smith P. D. Coleridge 
Published: January 2017

Objective: To examine the effectiveness of low molecular weight heparins (LMWHs) in the prevention and treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE) following surgery. Design: A review of the results of randomized controlled trials of LMWHs in which LMWH was compared with placebo, dextran or unfractionated heparin. Methods: Published data from journals indexed in Index Medicus (Medline CD Rom) since 1984 or found in the reference lists of such journals. Main outcome measures: Incidence of DVT as assessed by isotope scanning and/or venography and the incidence of PE and bleeding complications. Results: Prophylaxis with LMWH causes a significant reduction in the incidence of DVT compared with placebo, dextran and unfractionated heparin in high-risk patients undergoing orthopaedic operations, but there is no conclusive evidence that they are better than unfractionated heparin in general surgery. There was inconclusive evidence that LMWHs reduced the incidence of PE compared with dextran or unfractionated heparin. LMWHs were at least as safe as unfractionated heparin in terms of major haemorrhage or postoperative blood loss. Conclusions: Current evidence suggests the use of LMWHs in high-risk orthopaedic patients as a means of thromboprophylaxis is cost-effective. More trials are necessary to justify the use of LMWHs over unfractionated heparin in general surgery.
A Prospective Study of the Long-Term Efficacy of Two Different Venoactive Drugs in Patients with Post-Thrombotic Syndrome
Authors: Monreal M. , Callejas J. M. , Martorell A. , Lisbona C. , Lerma R. 
Published: January 2017

Objective: In an open cross-over study, the effect of two different venoactive drugs was prospectively studied in a series of patients with post-thrombotic syndrome. Design: Prospective, open cross-over study. Patients: Twenty-nine patients with established unilateral deep venous insufficiency of at least 12 months duration, and a history of venography-proven deep venous thrombosis in the affected leg. Interventions: On entering the study, patients were randomly assigned to receive either Hidrosmina (Venosmil, FAES SA, Spain) 600 mg daily, or 0-(β-hydroxyethyl)-rutosides (Venoruton, Zyma SA, Switzerland) 900 mg daily. The drugs were taken for 6 months. At the end of this period, the drug was discontinued, and patients taking Hidrosmina changed to rutosides, or vice versa, for a further 6-month period. Finally, both drugs were discontinued, and patients were re-examined 3 and 6 months later. Results: During the first 6-month period, 12 out of 29 patients showed reduced tiredness and/or pain in the leg in comparison to the control visit. Furthermore, a slight reduction was found in mean circumferences of both the ankle and calf during this study period. During the second 6-month period of therapy, six additional patients improved their subjective symptoms, but there were three patients in whom these symptoms had increased. Six months after discontinuation of therapy, subjective symptoms increased in 10 out of 29 patients, and mean circumferences of both the ankle and calf returned to baseline values. Conclusions: In this pilot study our findings demonstrate that venoactive drugs may improve both objective and subjective symptoms in patients with post-thrombotic syndrome, and that these effects disappear after drug therapy is discontinued.
Plasma Lactoferrin as a Marker of White Cell Degranulation in Venous Disease
Authors: Shields D. A. , Andaz S. , Abeysinghe R. D. , Porter J. B. , Scurr J. H. , Smith P. D. Coleridge 
Published: January 2017

Objective: To measure plasma lactoferrin as a marker of neutrophil degranulation in groups of patients with varying severity of venous disease and compare with age- and sex-matched control subjects. Design: Prospective study of patients with varicose veins compared with a group of control subjects with no history or clinical findings of varicose veins. Setting: The Middlesex Hospital Vascular Laboratory, Mortimer Street, London WIN 8AA, UK. Patients: Patients referred to the Middlesex Hospital Vascular Laboratory for investigation of venous disease. Control subjects were obtained from within the laboratory and hospital staff, and from a group of Patients attending the London Foot Hospital for routine chiropody. Neither group had arterial disease nor any other illness or medication known to alter white cell activity. Interventions: 10 ml of blood taken from an arm vein into EDTA for a neutrophil count and measurement of Plasma lactoferrin using an ELISA. Results: Significantly raised plasma lactoferrin was found in all four groups of patients compared with their controls ( p = 0.0156 for uncomplicated varicose veins, P = 0.01 for lipodermatosclerosis, p = 0.0413 for active venous ulceration, and p = 0.0005 for healed ulcers, Mann-Whitney U-test). Differences between medians (95% confidence interval) for the four groups were 269 (62–603), 199 (60–314), 133 (44–218) and 215 (98–349) ng/ml respectively. There was no difference in the neutrophil count between the patient and control groups, and correcting plasma lactoferrin for the neutrophil count did not remove significance in any group. Conclusions: This study shows evidence of increased neutrophil activation as shown by increased degranulation in patients with venous disease.
An Investigation of the Vasa Venarum in a Canine Vein Using Radial Reflux Perfusion
Authors: Crotty T. P. 
Published: January 2017

Objective: A general investigation of the vasa venarum network in a segment of canine peripheral vein, isolated between cannulae in an amputated hindlimb. Technique: The vasa venarum were perfused with ink by reflux from the lumen of the segment. The technique worked only when the vein segment was actively constricted and its flow made turbulent. Results: Vasa venarum were found to have the potential to drain, by unvalved channels, directly into their parent segment, into neighbouring veins, into the vasa networks of neighbouring arteries, veins and lymphatics, and into the postcapillary networks of every tissue in the hindlimb. The network contained dedicated arteriovenous anastomoses which drained by valved channels into the parent segment. A feature of the perfusion technique was the production of acute experimental varices. Conclusions: The drainage of the vasa venarum is far more complex than it is believed to be at present. The demonstration that reflux is possible from a vein with competent valves and is associated with the production of varices may have clinical implications.
Phlebography in the Management of Recurrent Varicose Veins
Authors: Mosquera D. A. , Manns R. A. , Duffield R. G. M. 
Published: January 2017

Objectives: (1) To report the results of phlebography (varicography and venography) in the identification of important venous communications in patients with reurrent varicose veins. (2) To assess whether phlebography provides additional valuable information when compared with clinical and hand-held Doppler examination. Design: Retrospective review. Setting: Vascular unit, district general hospital. Patients: A consecutive series of 46 patients attending with recurrent varicose veins. Interventions: Clinical examination, hand-held Doppler, venography and varicography. Main outcome measures: (1) Sites of incompetent venous communications. (2) Assessment of value of preoperative phlebography when compared with clinical and hand-held Doppler examination. Results: Sixty-four venograms were performed on 46 patients of mean age 52 years, range 30–81 years. Calf perforator (88%) and mid-thigh perforator incompetence (38%) were common. Groin recurrence (33%) included examples of neovascularization, inadequate previous surgery and inadequate assessment. Popliteal recurrence (34%) secondary to incompetent gastrocnemius, popliteal fossa and short saphenous veins also present. Preoperative phlebography supplied valuable additional information in 75% of Patients. Conclusion: Phlebography of recurrent varicose veins provides useful information supplementary to that furnished from clinical examination alone.
Comparison of Three Exercises for Evaluation of the Calf Muscle Pump
Authors: Ohgi S. , Tanaka K. , Maeda T. , Kanaoka Y. , Ikebuchi M. , Hara H. , Mori T. 
Published: January 2017

Objective: To evaluate accurately the calf muscle pump in patients with venous insufficiency using foot vein pressure measurements during three different exercises. Design: Prospective study in three groups, comparing patients with venous disease with controls. Setting: Second Department of Surgery, Tottori University Faculty of Medicine. Patients: Twenty normal legs, 29 legs previously affected by deep vein thrombosis and 36 legs with primary varicose veins. Main outcome measures: The foot vein pressure was measured during ankle dorsiflexions, knee-bending and walking on the spot at 40 paces per minute during which minimum ambulatory venous pressure (AVP) and venous refilling time (VRT) were assessed. Results: The three groups differed significantly from each other in AVP and VRT after dorsiflexion and in AVP during walking on the spot, but not after knee-bending. Conclusion: Dorsiflexion is the most useful exercise distinguishing various severities of venous insufficiency, but walking on the spot is more useful for accurately evaluating the calf muscle pump.
The Role of Oedema Protective Drugs in the Treatment of Chronic Venous Insufficiency: A Review of Evidence Based on Placebo-Controlled Clinical Trials with Regard to Efficacy and Tolerance
Authors: Diehm C. 
Published: January 2017

Objective: To review the therapeutic efficacy and tolerability of oedema protective agents such as diosmin, horse chestnut extract and O-(β-hydroxyethyl)-rutosides in the treatment of chronic venous insufficiency (CVI). Data selection: Relevant clinical studies were selected if they were performed using a double-blind, placebo-controlled design with validated instrument measurement of objective criteria and measurement of subjective criteria by standardized methods. Data synthesis: Judgement of clinical effectiveness of drug treatment with venoprotective/venotropic agents was based on the signs and symptoms of CVI. Measurements; Accepted for consideration included reduction of leg oedema, related subjective symptoms, improvement of haemodynamics and microcirculation, and improved healing of venous ulcers. Tolerability of the compounds in therapeutic use was assessed by comparing the frequency of side-effects in treatment and placebo groups. Conclusion: Oedema protective agents such as diosmin, horse chestnut extract and O-(β-hydroxyethyl)-rutosides are an appropriate option in the management of CVI. The clinical efficacy can be measured objectively and quantified by assessing oedema reduction or in the case of venous ulcers by ulcer healing rates. The extent of oedema reduction in patients with CVI is equivalent to the reduction achieved by compression therapy with elastic stockings as seen in a recent clinical study. Combined treatment of oedema protective agents and compression therapy has a better clinical benefit compared with treatment with either alone. The compounds have a favourable benefit/risk ratio. They combine proven therapeutic efficacy with excellent safety of use confirmed in a large number of patients treated in clinical trials.
Cutaneous Blood Flow in Legs with Severe Chronic Venous Insufficiency Recorded before and after a Single Treatment Using Intermittent Pneumatic Compression
Authors: Malanin K. , Kolari P. J. , Haapanen A. , Helander I. , Havu V. K. 
Published: January 2017

Objective: To investigate the skin laser Doppler flux (LDF) in legs with severe chronic venous insufficiency (CVI). Design: Comparison of the legs with severe CVI with the healthy legs and with the patients' contralateral legs. Setting: Department of Dermatology, University of Turku, Turku, Finland. Patients and control subjects: Ten patients and eight age-matched subjects with healthy legs. Interventions: A single treatment using intermittent pneumatic compression (IPC) of 45 min duration. Main outcome measures: Laser Doppler flowmetry with the subjects in a recumbent and a sitting position. Results: The LDF values were higher for the legs with severe CVI than for the legs of healthy subjects ( p<0.001 in a recumbent and p<0.01 in a sitting position). A single IPC increased the LDF in a recumbent position in the patients' legs with severe CVI ( p=0.019) but had no significant effect on the LDF value in the sitting position. The venoarteriolar response was significantly better in the legs with severe CVI than in the legs of healthy subjects ( p<0.05). Conclusions: The LDF is increased in legs with severe CVI and a single IPC further increases it in a recumbent position. The venoarteriolar response is not impaired in legs with severe CVI.
Prevalence and Aetiology of Leg Ulcers in a Defined Population of Industrial Workers
Authors: Nelzén O. , Bergqvist D. , Fransson I. , Lindhagen A. 
Published: January 2017

Objective: To assess leg ulcer prevalence and aetiology in people below retirement age. Design: A validated cross-sectional questionnaire survey. Respondents with a history of leg ulcers were examined. Setting: A defined population of industrial workers. Subjects: All 2785 employees, aged 30–65 years, at the Volvo motor engine factories in Skövde were included. Men predominated (81%) and the median age was 44 years in both men and women. A questionnaire was used to select people with a history of ulceration. A leg ulcer was defined as ‘any wound below the knee (foot ulcers included) that did not heal within a 6-week period after onset of ulceration’. Main outcome measures: Point prevalence of open leg ulcers, overall prevalence of leg ulcer history and aetiological classification. Results: The overall response rate was 87%, and 131 out of 153 subjects with a ‘history of leg ulcers’ were examined (86%). In 98% of positive responders the answers were validated. The overall false-positive response rate was 64%. Fifty-four had a true history of ulcers, of whom 16 had open ulcers. Of the latter, 12 were self-caring (75%). Overall venous causation dominated (41%). The ratio of open to healed ulcers was 1:2. The point prevalence for open ulcers was 0.6% and the overall prevalence of ulcer history was 1.6%, if excluding pure traumatic ulcers. The point prevalence was tenfold higher in people aged below 50 years and seven times higher in the age decade 50–59 years if compared with previous estimates based on patients known to health-care professionals. Conclusion: Leg ulcer prevalence has been underestimated in people of working age because they are often self-caring. Since many ulcers have curable causes it is necessary to inform the public of the importance of seeking professional help early.
Venous Aneurysm of the Upper Limb
Authors: Rogers C. A. , Colin J. F. 
Published: January 2017

Objective: To report a case of primary venous aneurysm arising in the antecubital fossa. Design: Case report. Setting: Department of General Surgery, Norfolk & Norwich Hospital, Norwich. Patient: Patient with clinical and radiological evidence of venous aneurysm. Interventions: Surgical repair. Main outcome measures: Avoidance of pulmonary embolism. Results: Satisfactory post-operative recovery. No complications or subsequent pulmonary embolus.
A Pilot Study Comparing the Use of Below-Knee and Above-Knee Graduated Stockings in Patients with Superficial Venous Incompetence
Authors: Berridge D. C. , Mercer K. G. , Thornton C. , Weston M. J. , Scott D. J. A. 
Published: January 2017

Objective: Investigation of the effects of high- and low-ankle-pressure, above- and below-knee compression stockings on the haemodynamics of normal and superficially incompetent venous systems. Design: Prospective duplex study of a normal group and a venous incompetence group randomised to high- or low-pressure stockings. Setting: Vascular services of a University Hospital. Subjects: Six subjects with normal venous haemodynamics (12 limbs) and 12 patients with superficial venous incompetence (20 limbs). Methods: Subjects wore below-knee and then above-knee stockings for 1 week each. Duplex scans were performed at the outset and end of the study and on fitting and after wearing each stocking type. Main outcome measures: Duplex-derived femoral and popliteal venous velocities were measured and indexed against the initial velocity. Results: Below-knee stockings produced only minor changes. Above-knee stockings produced increased velocities in normal subjects. Similar changes were only seen with higher-pressure stockings in patients with incompetence. Conclusion: Above-knee, high-ankle-pressure stockings produce increased deep venous flow velocities.
Randomised Trial Comparing Two Four-Layer Bandage Systems in the Management of Chronic Leg Ulceration
Authors: Moffatt C. J. , Simon D. A. , Franks P. J. , Connolly M. , Fielden S. , Groarke L. , McCollum C. N. 
Published: January 2017

Objective: To compare a new four-layer bandage system (Profore) with the original 4LB in the closure of chronic leg ulceration. Design: Prospective randomised stratified parallel-groups open trial. Methods: Patients newly presenting to community leg ulcer services with chronic leg ulceration were screened for inclusion in this trial. Patients with arterial disease (ankle brachial pressure index <0.8) and causes of ulceration other than venous disease were excluded. In patients with bilateral ulceration, the limb with the larger area of ulceration was studied. The ulcer was dressed with a simple low-adherent dressing and all bandages were changed weekly unless required more frequently. Patients were randomised to receive either the original four-layer bandage or the newer system (Profore). Results: In all 233 patients were randomised, of whom 232 attended at least one follow-up visit (115 original, 117 Profore). At 12 weeks complete healing of the ulcerated limb, analysed by ‘intention-to-treat’ was 60% using the original 4LB compared with 72% using Profore. The difference of 11.8% (95% confidence interval (CI) −0.3% to 23.9%) had largely disappeared after 24 weeks, with 73% healed using the original 4LB and 76% using Profore, a difference of 3.0% (95% CI −8.2% to 14.2%). After 24 weeks of treatment the Kaplan-Meier estimate of complete healing was 82% using the original system and 84% using the Profore system. Overall, there was a higher healing rate for patients on Profore (hazard ratio = 1.18, 95% CI 0.87 to 1.59), but this did not achieve statistical significance ( p = 0.28). Conclusion: Ulcer healing using the newer Profore system is as good as with the original four-layer system.
A Non-Amphetamine Anorectic Agent: Preclinical Background and a Double-Blind Clinical Trial
Authors: Schwartz Louis N 
Published: January 2017

Preclinical data suggesting potential advantages for mazindol prompted the design of a double-blind comparative trial with 60 obese patients. In it, mazindol, 2 mg once a day, was compared for 12 weeks to placebo. Weight loss was significantly greater with mazindol than placebo throughout the trial. After the 12 weeks, the mazindol patients had lost an average of 18.5 lbs compared to 2.4 lbs with placebo. Constant efficacy at the fixed once-daily dosage was obtained with no signs of tolerance. No significant adverse effects or other signs of toxicity to mazindol were encountered. Extensive clinical evaluation of this drug in relation to the established anorectics is strongly recommended.
Tolmetin and G-6-PD Erythrocyte Deficiency: Research in Vitro
Authors: Passiu G , Piras M G , Perpignano G , Ibba G , Carcassi U 
Published: January 2017

In thirty-two patients, divided into four groups: normal, G-6-PD deficient, β-thalaxemic heterozygote and carriers of both anomalies, the variations in erythrocyte GSH were studied after incubation with APH and a nonsteroidal anti-inflammatory drug: tolmetin sodium. The results obtained show a considerable fall in GSH after incubation with APH above all in the G-6-PD deficient patients and in the carriers of both anomalies. On the other hand, after incubation with the drug under examination there were no significant variations in the erythrocyte GSH.
The Role of Mesna in the Treatment of Status Asthmaticus in Children
Authors: Kyncl V , Pokorný J , Mega J , Skondia V 
Published: January 2017

Status asthmaticus in children is a life-threatening condition that calls for a comprehensive set of therapeutic measures, viz. evacuation of tracheobronchial secretions, parenteral drug administration and improvement of alveolar gas exchange. In the authors' experience, that therapeutic procedure can be much improved by bronchial lavage with mesna. This is illustrated by the good results obtained in fourteen patients with status asthmaticus and in another forty-four cases of global respiratory insufficiency. Evaluation was by blood gas values and X-ray pictures. The method used for bronchial lavage is described.
A Double-Blind Study of Trazodone and Mianserin in the Treatment of Depression in General Practice
Authors: Richards H H , Midha R N , Miller S 
Published: January 2017

The antidepressant and anxiolytic efficacy of trazodone (100–200 mg daily), mianserin (60–120 mg daily) and diazepam (15–30 mg daily) was evaluated in ninety-three patients suffering from mild to moderate depression, with or without anxiety, over 6 weeks in a double-blind non-crossover general practice study. Efficacy was evaluated using the Hamilton Depression Rating Scale, Patient Self-Rating Visual Analogue scales, physician global assessments and the Zung Self-Rating Anxiety Scale. All three treatments significantly reduced symptoms of depression, as measured on the Hamilton Depression Rating Scale and the physician's assessment of Global Improvement. Trazodone was significantly superior to both mianserin and diazepam. As assessed using Visual Analogue Scales, trazodone was also shown to be significantly superior to diazepam in improving the patient's ability to concentrate and in reducing daytime tiredness. Although evidence of efficacy was found, there were no differences in activity between the treatment groups using the physician's assessment of Current Severity or on assessment of Therapeutic Effect. The treatments all caused a reduction in anxiety as assessed by the Zung Self-Rating Scale. The overall incidence of side-effects was similar between groups. For those side-effects considered to be significantly interfering with the patient's function, but not outweighing the therapeutic effect, a reduction of dosage was effective. Several patients complaining of drowsiness or lethargy as an unacceptable daytime side-effect were switched successfully from twice daily to night-time dosing. Significantly more patients with side-effects (outweighing therapeutic effect or in the presence of no improvement) were withdrawn from the mianserin group than from the trazodone or diazepam groups. Overall, the therapeutic efficacy in relation to the incidence of clinically significant side-effects, favoured trazodone for the treatment of general practice patients suffering from depression, with or without anxiety.