bluuebunny/crossref_metadata_2025_split huggingface dataset:
EMLA Anaesthetic Cream for Sharp Debridement of Venous Leg Ulcers: A Double-Masked, Placebo-Controlled Study
Authors: Agrifoglio G. , Domanin M. , Baggio E. , Cao P. , Alberti A. N. , Bonn F. , Todini A. R. , Becchi G. , Caserini M. 
Published: January 2017

Objective: The aim of this double-masked, placebo-controlled trial was to confirm the anaesthetic effect of EMLA cream compared with placebo when used for sharp debridement of venous leg ulcers and to test its feasibility with respect to the usual procedure. Methods: One hundred and ten patients with venous ulcers were randomised to EMLA or placebo cream treatment for 30-45 min. Pain from debridement was evaluated by the patient on a 100 mm visual analogue scale (VAS) and by the physician on a verbal scale. Results: The median VAS scores were 16.5 and 52 in EMLA- and placebo-treated patients, respectively (p<0.00001), a clinically relevant difference. On the vertebral scale 61% of EMLA patients and 21% of placebo patients were placed in the category of no pain (pO.OOOl). The physicians found debridement with EMLA easier to perform (p<0.01). Conclusion: Debridement of venous leg ulcers using topical anaesthesia is easy and safe, with adequate pain relief in both in- and outpatients.
Surgical Management of Leg Ulcers Associated with Pulsatile Varicose Veins and Tricuspid Regurgitation
Authors: Erel E. , Wijesinghe L. D. , McCollum P. T. 
Published: January 2017

Design: Case report. Setting: Vascular Surgery Department, Hull Royal Infirmary, UK. Patients: A 79-year-old man with a history of right leg ulcer and pulsatile veins. Investigations and interventions: Clinical examination revealed findings of tricuspid regurgitation. Investigations included duplex scans, CT scan, arteriography and both trans-thoracic and trans-oesophageal echocardio-graphy. These all proved inconclusive. High sapheno-femoral ligation and stripping of long saphenous vein ligation procedure resulted in healing of his ulcers within six months Conclusion: Pulsatile veins in the leg may be due to tricuspid regurgitation or AV malformation. Echocardiogram, duplex scan and angiograms can help to differentiate between the two diagnoses. In this case, the above investigations were misleading and clinical examination here played the key role.
Leg Ulcers: Economic Aspects
Authors: Nelzèn O. 
Published: January 2017

Objective: To review what is known about the cost of leg ulcers, and venous leg ulcers in particular. Method: Searches of the Medline and Cochrane Library databases. Reviewing reference lists of personally gathered articles in the field of chronic leg ulcers. Synthesis: Most publications dealing with the economics of leg ulcers are cost studies assessing the cost of different dressings or bandages, and only a few have given estimates of the total costs of leg ulcer management. The latter, in conjunction with accurate epidemio-logical data, are essential to estimate the nationwide costs of leg ulcer management. The costs consist of direct and indirect costs for society. Direct costs are mainly staff costs for managing dressing-changes. Based on the few estimates made, approximately 1% of the total health care costs in the western world are likely to be used for management of chronic leg ulcers. To reduce the costs of leg ulcer management a reduction in the frequency of dressing-change is recommended. Improved use of high technology, such as duplex Doppler diagnostics and varicose vein surgery, is also likely to be cost-effective. On the basis of two health economic analyses leg ulcer clinics alone do not appear to reduce the costs of leg ulcer management, mainly because of an inability to prevent recurrent ulceration. Conclusion: The cost implications of chronic leg ulcers are insufficiently studied but there is no doubt that managing patients with leg ulcers takes a substantial proportion of the health care budget. More health economic analyses are needed to define the best treatment in order to reduce total costs.
Prophylaxis of Perioperative Venous Thrombosis: Role of Venous Compression
Authors: Silleran-Chassany J. , Safran D. 
Published: January 2017

Aim: To review the role of compression treatments in the prevention of perioperative deep venous thrombosis. Method: A review of current literature in the field of prevention of deep venous thrombosis following general and orthopaedic surgery has been conducted. Synthesis: There is a considerable risk of deep venous thrombosis following surgical treatment in hospital. This is particularly high following joint replacement in the lower limb. This may lead to fatal pulmonary embolism or chronic venous insufficiency of the lower limb with leg ulceration and disability. Perioperative deep venous thrombosis may be prevented by a number of drugs. The most frequently used is heparin or the more modern low-molecular-weight heparins (LMWH). Vitamin K antagonists are also commonly used, but have a long duration of action. Dextrans and aspirin have an effect in preventing perioperative venous thrombosis, but this is much less than heparin. Mechanical methods of prevention have the advantage of preventing venous thrombosis without increased risk of bleeding complications. Conclusion: Heparin and LMWH continue to be the most frequently used means of preventing peri-operative deep venous thrombosis in France. There is reliable to evidence to show that mechanical methods of prevention including graduated elastic compression and intermittent pneumatic compression of the lower limb are also effective. These may be used in combination with heparin for increased protection or as an alternative to anticoagulant drugs where there is a risk of bleeding. They are also effective when used alone.
Leg Ulcers: Biochemical Factors
Authors: Smith P. D. Coleridge 
Published: January 2017

Objective: To review the biochemical mechanisms underlying the development of skin changes leading to ulceration in patients with chronic venous disease. Methods: Searches of Medline and Embase medical literature databases were undertaken. Cochrane Reviews were studied for relevant articles. Hand-searching of non-indexed journals was undertaken. Synthesis: Increased leucocyte activation has been shown in patients with venous disease as well as increased expression of soluble endothelial adhesion molecules. Histological studies of the skin in patients with chronic venous disease show a pervascular infiltration of the capillaries of the papillary plexus (the most superficial part of the dermis) with monocytes, macrophages and connective tissue proteins including fibrin. Fibrosis of the skin and subcutaneous tissues may be initiated by increased gene expression and production of transforming growth factor-beta1. Vascular endothelial growth factor may be involved in the capillary proliferation that has been reported in the skin by a number of authors. Increased expression of several tissue metalloproteinases (MMPs) has been reported both in lipsclerotic skin and peri-ulcer skin. The tissue inhibitors of metalloproteinases (TIMPs) are also increased and the net result is unclear. Treatment of venous disease using micronised purified flavonoid fraction moderates some of the inflammatory markers, including leucocyte ligand expression and endothelial adhesion molecule shedding. These compounds have also been shown to reduce leucocyte-endothelial adhesion in animal models of ischaemia-reperfusion injury. Conclusions: Many inflammatory processes have now been shown to be involved in the development of the skin changes in patients with chronic venous disease. However, the precise sequence of events which leads to leg ulceration is still unclear. Pharmacological treatments aimed at moderating some of these inflammatory processes are now under investigation as potential ways of treating patients with the more advanced stages of venous disease.
First Validation of a Placebo Compression Stocking
Authors: Vayssairat M. , Houot B. 
Published: January 2017

Objective: To validate a placebo compression stocking. Design: Subjects were asked to identify as the same or different, placebo (P) and medical compression stockings (MCS) presented in a controlled randomised masked manner. Setting: A university hospital in Paris, France, and Innothera Laboratory. Patients, participants: One hundred and twenty-seven volunteers. Main outcome measures: Recognition of P versus MCS. Results: The false response rates in the visual test were 46.6% for physicians and 47.6% for non-physicians; in the touch test, 19.7% and 34.5% respectively, and in the wearing test, performed by non-physicians, 25.4%. Conclusions: P was valid in the visual part of the study but not in its touching or wearing parts. However, the large number of false responses in the non-physician group indicates that the use of a placebo stocking would be a methodological improvement compared with the usual open studies.
Compression Therapy in Aeronautic Medicine
Authors: Gourbat J. P. 
Published: January 2017

Aim: To review the influences of air and space travel on the venous side of the circulation and to assess the consequences for air and space travellers. Method: A review of current literature in the field of aeronautical travel has been conducted, with particular reference to the effects on the venous system and use of compression garments. Synthesis: The venous system is particularly sensitive to gravitational and pressure changes encountered during air and space travel due to the low pressures normally present in this part of the circulation. The symptoms experienced by air crew may be countered by the use of venous compression stockings, amongst other measures. More sophisticated techniques are required for fighter aviation and space flights. Aircraft and spacecraft travel in a hostile environment in which it is not possible for man to survive without sophisticated layers of protection. In addition, forces of acceleration generated by aircraft flight combine with those of the environment hazarding the safety and the health of navigators. Continuing technical advances allow increased performance towards ever greater speed, better acceleration, a greater range of action and longer periods of time in space. Conclusion: Increasingly, the limiting factor in air and space travel appears to be man, who has difficulty in tolerating the environment to which he is exposed. The immediate risk is loss of consciousness and in time there is the risk of health deterioration. The cardiovascular system as a whole is at the centre of this problem and seems to be one of the limiting factors in the design of more advanced aircraft, especially those used for military purposes.
Investigation of Venous Disease
Authors: Smith P. D. Coleridge 
Published: January 2017

Aim: To review the investigations which are performed in patients presenting with varicose veins prior to treatment. Method: A review of current literature in the field of the investigation of venous disease of the lower limb has been conducted using MedLine. Synthesis: Continuous wave (CW) Doppler is effective in detecting venous reflux in the sapheno-femoral junction and the long saphenous vein. In the popliteal fossa, for perforating veins and for the deep veins this technique has reduced accuracy. Duplex ultrasonography is widely used in the management of venous disease of the lower limb. This investigation provides reliable anatomical information but limited functional data about the veins. Phlebography and varicography are effective investigations but are being replaced by duplex ultrasonography. Plethysmographic tests assess venous function but are poor at anatomical identification of the problem. They may be used in the monitoring of venous function during treatment and in identifying the contribution of superficial venous reflux in patients with combined deep and superficial venous disease. Conclusion: Clinical examination is no longer sufficient to assess patients with venous disease of the lower limb prior to surgery. CW Doppler is the minimum investigation but duplex ultrasonography is the most effective non-invasive investigation. Plethysmographic tests have limited application in the management of varicose veins.
Results after Re-Operation in the Groin for Recurrent Varices of the Long Saphenous Vein
Authors: Jessen N. , Bækgaard N. 
Published: January 2017

Objective: To evaluate the outcome of re-operation in the groin for recurrent varicose veins. Design: Retropective follow-up study Setting: Department of Vascular Surgery, Gentofte University Hospital, Copenhagen, Denmark. Methods and materials: Thirty-two patients with 43 operated legs. Operations were performed between January 1996 and the end of April 1997 and solely as a groin dissection; no stripping was done. Follow-up consisted of a clinical examination and duplex scanning with an ATL HDI 5000 scanner. Results: Sixteen cured legs, 17 with reflux beginning at mid-thigh, mainly a Hunter's perforating vein, and 10 with remaining reflux at the sapheno-femoral junction. Conclusion: Recurrence rate in the groin is acceptable. Stripping of the long saphenous vein is mandatory to bring down the recurrence rate from mid-thigh perforating veins. This is now standard procedure in our department.
Recurrence following Varicose Vein Surgery
Authors: Wright D. D. I. , Rose K. G. , Young E. , McCollum C. N. 
Published: January 2017

Objective: To determine the site-specific rates of recurrence following varicose vein surgery. Design: Postal questionnaire followed up by telephone enquiries. Full clinical review, including continuous wave and duplex Doppler investigations were carried out for all patients with responses suggesting recurrence. Setting: Surgicare Manchester, an independent provider of specialist varicose vein treatments. All procedures were guided by Doppler ultrasound and performed by surgeons working to the same protocol. Subjects: A consecutive series of 250 operations on 246 Patients. Of these, 208 (85%) could be contacted for follow-up. Mean time to re-examination was 27 months. Results: Twelve patients returned spontaneously and 51 were recalled for examination based on questionnaire responses. Recurrences were divided into ‘site’, ‘perforator’ or ‘new site’ recurrence. Primary surgery to the sapheno-femoral junction (SFJ) had the lowest ‘site’ recurrence rate of 2.3% compared with 9.5% for SFJ re-operation. Primary surgery and re-operation of the sapheno-popliteal junction (SPJ) had higher recurrence rates of 8.3% and 7.8% respectively. New incompetence was detected in 5% and 2% of previously competent SFJ and SPJ respectively. Minor perforator incompetence was found in a further 14%. Conclusions: Varicose veins were progressive in some individuals, with new sites of incompetence appearing over time. However, ‘cure’ remains possible for most Patients and major recurrence can be reduced by Doppler diagnosis and precise surgery.
Effects of Compression Hosiery in Female Workers with a Standing Profession
Authors: Jungbeck C. , Peterson K. , Danielsson G. , Norgren L. 
Published: January 2017

Objective: To evaluate the effect of compression hosiery during standing work. Design: An open study, comparing symptoms and plethysmographic findings before and after treatment. Setting: University hospital, vascular surgery. Subjects: Forty-eight female volunteers with a standing profession. Methods: Visual analogue scale to evaluate symptoms and foot volumetry to study venous function before and after 4 weeks use of compression hosiery (20–30 mmHg). Result: All scores for symptoms were significantly reduced after treatment. Only 21% of the study subjects had minor abnormalities on foot volumetry. The expelled volume was significantly higher after work at 4 weeks than at the first measurement at inclusion, while the refilling rate was significantly lower after work at 4 weeks than at the corresponding measurement at inclusion. Conclusion: Symptomatic improvement was recorded after compression treatment. Limited effects were seen with the objective measurement, although the most important factor, the refilling rate, diminished significantly during the treatment period. Compression treatment reduces lower limb symptoms following standing work.
Late Thrombogenicity of Grafts in the Venous System
Authors: Plate Gunnar , Hollier Larry H. , Dewanjee Mrinal K. , Kaye Michael P. 
Published: January 2017

Although some previous experiments have demonstrated encouraging early results with venous vascular prosthesis, the long-term results have not been sufficiently investigated. The late thrombogenicity of 12 autogenous vein grafts and eight polytetrafluoroethylene (PTFE) grafts, three of which had been subjected to endothelial seeding, was evaluated 6 months after implantation in the canine venous system by determination of the survival time of the indium-labelled autogenous platelets and of the light and electron microscopic appearance of the graft-to-blood interface. Twelve dogs receiving autogenous vein grafts had a platelet half-life of 64 ± 13 (mean ± s.d.) hours and a completely thrombus-free internal graft surface covered by a smooth endothelium. The platelet half-life in five dogs with non-seeded PTFE grafts was significantly ( P < 0.01) shorter (44 ± 11h). The PTFE-to-blood interface consisted of a 100- to 170-μm-thick pseudointima with a thrombus-free surface area of 25-90% and substantial endothelial coverage in only two animals. Three dogs receiving endothelial-seeded PTFE grafts had a platelet half-life of 38, 46 and 53h, respectively, a 10- to 80-μm-thick pseudointima covered with typical endothelium, and a thrombus-free surface area of 90-100%. Our results demonstrate that PTFE grafts are still thrombogenic at 6 months following implantation in the canine venous system. Therefore, additional measures are required to maintain graft patency. Our limited experience with endothelial seeding does not allow any definite conclusions, but our findings indicate that this procedure might be beneficial.
A Comparison of the Histochemical Enzyme Pattern in Normal and Varicose Veins
Authors: Haardt Bernhardt 
Published: January 2017

In order to study enzyme activity in the walls of healthy and diseased veins, sections were taken from the stripped varicose long saphenous veins of eight patients. These were subjected to histochemical enzyme investigations. These methods were used to determine levels and localization of lactate dehydrogenase, alkaline phosphatase, adenosine triphosphatase and the lysosomal enzymes, β-glucuronidase, non-specific esterases and acid phosphatase. The method and our findings are described. The results of these histochemical investigations demonstrate an increase in lysosomal enzyme activity in the walls of varicose veins as compared to that of normal veins. This increase is greater in the media than in the intima. Enzymes responsible for energy metabolism demonstrated contradictory behaviour, with decline in the activity of such enzymes in the walls of varicose veins. This decline in enzyme activity was more marked in the intima than in the media and was especially noticeable in the histochemical demonstration of Ca++-adenosine triphosphatase.
The Greenfield Filter: A Five-Year Experience
Authors: Coleman Catherine , Broe P.J. , Bouchier-Hayes D.J. 
Published: January 2017

During a 5-year period, 1982–1986 inclusive, 30 patients were referred for Greenfield filter placement. The indications for filter insertion were: (1) contraindications to anticoagulation (13 patients), (2) recurrent pulmonary emboli in the presence of adequate anticoagulation (14 patients), (3) complications of anticoagulant therapy (three patients). The contraindications to anticoagulants included subarachnoid haemorrhage, duodenal ulcer, multiple trauma and afibrinogenaemia and a group of patients in whom standard methods of prophylaxis were unsuitable. The jugular or femoral approach was used for filter placement and in two technical failures a De Weese clip was applied. One patient died from a myocardial infarction within 3 days of filter placement and the six other deaths were due to underlying malignant disease. A follow-up ultrasound study of the inferior vena cava (IVC) among 19 of 21 survivors demonstrated patency in 14, thrombus in the filter in two and an occluded IVC in two.
Iliocaval Compression Syndrome
Authors: Taheri Syde A. , Nowakowski Paul , Pendergast David , Cullen Julie , Pisano Steve , Soman Lars 
Published: January 2017

The iliocaval compression syndrome is a disorder, frequently found in young women, in which extrinsic compression of the left iliocaval junction produces signs and symptoms of lower extremity venous insufficiency. The anatomic variant which gives rise to this syndrome consists of compression of the left common iliac vein by the overlying right common iliac artery, near its junction with the vena cava. Additional reduction of outflow results from intraluminal venous webs and tight adhesions between the iliac artery and vein. Pain, swelling, pigmentation, and venous claudication characterize this syndrome, which affects predominantly the left leg. The syndrome may progress to iliofemoral thrombosis, phlegmasia cerulea dolens, and venous gangrene. Longstanding iliocaval stenosis may produce valvular incompetence. Exercise plethysmography is a non-invasive test useful in screening patients for iliocaval compression. The definitive diagnosis is made by venography, both ascending and descending, to determine the degree of outflow stenosis. Iliocaval patch angioplasty with retrocaval positioning of the right iliac artery, decreases venous hypertension and leads to improvement in the clinical condition. To date, we have performed iliocaval angioplasty, with retrocaval repositioning of the right common iliac artery, on 18 patients. Of these, 83% have had good results as determined by hemodynamic and clinical assessment.
Clinical Trials in Venous Disease: With Particular Reference to Life Table Analysis
Authors: Franks P. J. , Wright D. D. I. 
Published: January 2017

Over recent years surgeons have adopted an increasingly scientific approach to determine the best treatment for their patients. For venous disease there have been trials comparing surgery with sclerotherapy,1−3 the use of stockings to relieve symptoms,4 therapeutic benefits of drugs5,6 and dressings for ulcer healing.7,8 The term ‘trial’ is often used in reporting medical research, but frequently it is used inappropriately. This paper gives an overview of the considerations necessary to run a meaningful clinical trial and some of the common pitfalls in trials of venous disease.
The Effect of the Lastosheer Stocking on Venous Insufficiency
Authors: Grønbæk Karin , Rasmussen Ann Lise , Struckmann Jan , Mathiesen F.R. 
Published: January 2017

A controlled study on the effect of the newly introduced Lastosheer stocking on superficial venous insufficiency, assessed by ambulatory strain-gauge plethysmography and clinical evaluation, is presented. Seventeen patients were wearing the stockings for 6 weeks and 13 served as controls. The effect was assessed by ambulatory strain-gauge plethysmography (i.e. the venous return time and expelled volume) and by an improvement in symptoms. In the stocking group a significant reduction in complaints of fullness, cramps and swelling was reported, whereas no improvement was reported in the control group. Moreover, the venous return time was significantly increased after 6 weeks in the stocking group, even after the stocking was removed from the leg. No significant change in expelled volume was found. In the control group no changes were noted, neither in return time nor in expelled volume.