bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morphological Changes in Lipodermatosclerosis and Venous Ulcers: Light Microscopy, Immunohistochemistry and Electron Microscopy
Authors: Tronnier M. , Schmeller W. , Wolff H. H. 
Published: January 2017

Objectives: To demonstrate morphological changes in lipodermatosclerosis (LDS) and venous ulcers by histology, immunohistochemistry, electron microscopy and immunoelectron microscopy. Design: Single patient group study in patients with trophic skin changes in chronic venous insufficiency. Setting: Department of Dermatology, Medical University of Lübeck. Patients: Ten patients with venous leg ulcers. Interventions: Biopsies were taken from areas of LDS and compared with clinically normal-appearing skin of the affected leg and with ulcer tissue. Main outcome measures: Comparison of the morphological features on light and electron microscopy. Results: Superficial dermis. Histologically, the ulcer tissue and LDS skin show dilated tortuous vessels in a glomerulus-like arrangement in the superficial parts of the dermis. Ultrastructurally, the superficial vessels are surrounded by a cuff, which contains amorphous and basal membrane material and is most pronounced in LDS. Immunofluorescence studies reveal ill-defined perivascular staining after incubation with antibodies against fibrin(ogen), laminin and type IV collagen. The exact ultrastructural localization of type IV collagen within the perivascular cuff is observed by immunoelectron microscopy. Deep dermis. In deeper parts of the dermis, the vessels of both ulcer tissue and LDS are surrounded by cellular cuffs with pericytes, fibroblasts and compact collagen bundles. Conclusions: We suggest that the severe morphological changes in LDS and ulcer tissue play an important role in the pathogenesis of venous ulceration.
Community Leg Ulcer Clinics: Effect on Quality of Life
Authors: Franks P. J. , Moffatt C. J. , Connolly M. , Bosanquet N. , Oldroyd M. , Greenhalgh R. M. , McCollum C. N. 
Published: January 2017

Objective: To investigate changes in the quality of life of patients with leg ulcers being treated in community leg ulcer clinics. Design: Patients were interviewed using a standard questionnaire, and then reinterviewed after 12 weeks of compression bandaging to observe changes. Setting: Community ulcer clinics held in health centres within Riverside Health District. Patients: All new patients presenting to community leg ulcer clinics up to 6 months from the start of a clinic and treated with four-layer compression bandaging. Main outcome measures: Changes in quality of life, interference in daily activities caused by leg ulceration and general health after 12 weeks of treatment. Results: Treatment over 12 weeks resulted in a mean reduction in anxiety (2.79 v 1.73, p < 0.001), depression (2.61 v 1.89, p < 0.001), hostility (1.59 v 1.00, p < 0.001) and cognition (1.29 v 0.87, p = 0.015). Pain significantly improved following treatment (χ2 trend = 103.7, 1d.f., p < 0.001). Changes in depression and hostility were related to complete ulcer healing. Conclusions: There were clear changes in quality of life following 12 weeks in a community leg ulcer clinic, which were related to the healing of the ulcer. Systems of care that offer rapid healing and improve patients' well-being must be considered when planning an effective leg ulcer service.
Effect of Compression Stockings on the Skin Microcirculation in Chronic Venous Insufficiency
Authors: Abu-Own A. , Scurr J. H. , Smith P. D. Coleridge 
Published: January 2017

Objective: To use a single fibre laser Doppler fluxmeter to assess the microcirculatory effects of compression stockings. Design: Controlled study comprising patient and control groups. Setting: Department of Surgery, University College London Medical School, London, UK. Patients and participants: Ten patients with lipodermatosclerosis caused by chronic venous insufficiency and 10 control subjects. Interventions: Measurements were made from the liposclerotic skin of patients and 8 cm above the medial malleolus in controls. Laser Doppler flux (LDF), blood ce velocity (BCV) and concentration of moving blood cells (CMBC) were recorded with the subject lying supine. A class II graduated compression stocking was applied to the leg and laser Doppler recordings were repeated. The protocol was repeated with the subject sitting. Main outcome measures: The effects of a compression stocking on LDF, BCV and CMBC in the horizontal and sitting positions were measured. Results: In patients in the supine position, the compression stocking resulted in a 28% median increase in LDF ( p = 0.03), with a corresponding 29% median increase in BCV. There was no significant change in CMBC. In the sitting position, the compression stocking caused a 105% median increase in LDF ( p < 0.01) due to a corresponding 89% median increase in BCV ( p = 0.01); there was only 25% median increase in CMBC. The effects of compression in controls were similar to those in patients. Conclusion: Compression stockings may be effective in the treatment of chronic venous insufficiency by increasing the microcirculatory flow velocity.
Epidemiology of Chronic Venous Insufficiency
Authors: Fowkes F. G. R. 
Published: January 2017

Objective: To determine the prevalence of chronic venous insufficiency in the general population and its association with varicose veins. Data sources: MEDLINE search 1980–94 plus scanning of reference lists in articles obtained. Study selection: Studies on venous disease in subjects not attending health services. Data synthesis: A formal systematic review of metaanalysis was not carried out because of the heterogeneity of the few available studies. Skin changes were found to occur in over 3% of adults, more so in women than men. The prevalence was higher in subjects with varicose veins and depended on the definition of skin changes and the severity of varicose veins. Approximately 0.3% of adults had an open varicose ulcer, and around 1% had an open or healed ulcer. Prevalence was higher in women and increased with age. Conclusions: The prevalence of chronic venous insufficiency was found to be common in the general population, but more studies of distribution and aetiology are required.
The Use of Intermittent Pneumatic Calf Compression in Isolated Femoral Vein Reconstruction
Authors: Qureshi A. , Roberts N. , Wilkinson A. R. 
Published: January 2017

Objective: To report two cases of isolated femoral vein injury reconstruction and a review of the literature. Design: Case report. Setting: Hull Royal Infirmary, Kingston Upon Hull. Patients: Two patients presenting with civilian trauma. Interventions: Spiral vein graft interposition and postoperative intermittent pneumatic calf compression. Main outcome measure: Limb salvage, vein patency and limb swelling. Results: Satisfactory limb salvage, femoral vein patency and absent limb swelling in both cases.
Leucocyte Activity in Volunteers in Response to Experimental Venous Hypertension
Authors: Saharay M. , Shields D. A. , Porter J. B. , Scurr J. H. , Smith P. D. Coleridge 
Published: January 2017

Objective: To investigate leucocyte activation in normal volunteers subjected to short-term venous hypertension by measuring the cell surface expression of the integrin CD11b and the selectin CD62L on neutrophils and monocytes before and after short-term venous hypertension. Plasma levels of L-selectin, which is shed by leucocytes upon activation, were also measured. Design: Prospective study, measuring white cell count, neutrophil and monocyte surface CD11b and L-selectin expression in whole blood using a fluorescent-labelled monoclonal antibody in a flow cytometer, and plasma L-selectin by a commercially available ELISA. Setting: The Middlesex Hospital Vascular Laboratory, a referral centre for the investigation of venous diseases. Subjects: Twenty-five normal volunteers without any history or clinical finding of venous disease. Results: There was a significant fall in the white cell: red cell ratio ( p = 0.03, Wilcoxon) in response to venous hypertension, followed by a significant increase ( p < 0.001, Wilcoxon) when the venous hypertension was reversed. Neutrophil and monocyte CD11b levels fell significantly ( p < 0.001 and p < 0.001, Wilcoxon) in response to venous hypertension. On reversing the venous hypertension a significant increase of CD11b expression was noted in both neutrophils and monocytes ( p < 0.001 and p < 0.01, Wilcoxon). Surface L-selectin expression, however, showed a significant sustained fall in both neutrophils and monocytes (neutrophils, p = 0.05 and p = 0.02; monocytes, p = 0.04 and p = n.s., Wilcoxon) throughout the experiment. There was a significant rise in soluble L-selectin in the plasma following venous hypertension ( p < 0.001, Wilcoxon). Conclusion: This study demonstrates both neutrophil and monocyte activation in the microcirculation of normal volunteers in response to short-term venous hypertension.
Graduated Compression Treatment in Patients with Chronic Venous Insufficiency: A Study Comparing Low and Medium Grade Compression Stockings
Authors: Jungbeck C. , Thulin I. , Darenheim C. , Norgren L. 
Published: January 2017

Objective: Patients with chronic venous insufficiency (CVI) benefit subjectively from treatment with graduated compression stockings. Usually, class II compression is used in patients with CVI grade II. The present study investigates possible differences between graduated compression of classes I and II. Design: Randomized study. Setting: Department of Vascular Surgery and Vascular Laboratory, University Hospital, Lund. Patients and Methods: Thirty-one patients, nine male and 22 female (59 legs), all with grade II CVI. Foot volumetry and a visual analogue scale (VAS) were used to assess symptoms. Patients were randomized to either class I or class II graduated compression, and the examinations were repeated after 8 weeks of treatment. Results: The VAS assessment showed that all patients benefited to the same extent and there were no differences between the two compression classes. An increase of the expelled volume with compression was recorded, to a significant degree with class I compression. Reflux values were not significantly influenced by either grade of compression. Conclusion: Class I graduated compression did not show any difference in subjective effect or objective parameters compared with Class II. Class I compression can be recommended instead of class II compression, especially in patients who find that the higher pressure on the leg causes discomfort.
Venous Thrombectomy in Pregnancy: A Follow-up Study
Authors: Eriksen L. , Pachler J. , Christoffersen J. Krogh , Bækgaard N. , Mantoni M. , Lund J. O. , Lenstrup C. , Jacobsen B. 
Published: January 2017

Objective: To evaluate women who have been treated by venous thrombectomy in pregnancy because of iliofemoral venous thrombosis, reporting the outcome of their pregnancy and frequency of objectively measured venous insufficiency. Design: A retrospective study. The patients were assessed by questionnaire, clinical examination, tests of venous function and ultrasonography. Setting: Department of Vascular Surgery, Gentofte Hospital, University of Copenhagen. Patients: Nineteen women treated previously by venous thrombectomy during pregnancy, with a subsequent pregnancy. Results: None of the women had complications during subsequent pregnancies or deliveries, 47% had an occluded iliac segment and 53% had dilated or varicose veins. None had ulcers or skin changes. None of the women showed signs of of re-thrombosis. Conclusion: Women who have been treated for deep venous thrombosis in pregnancy by thrombectomy and arteriovenous fistula followed by anticoagulant therapy may undergo further pregnancies with a very low risk of obstetric complications and a low risk of developing re-thrombosis or chronic venous insufficiency.
Effect of Compression Stockings on Leg Volume in Patients with Varicose Veins
Authors: Müller-Bühl U. , Heim B. , Fischbach U. , Windeler J. , Finkenstädt Th. , Schläfer M. 
Published: January 2017

Objective: To evaluate the effect of thigh-length compression stockings on the venous blood pool and interstitial oedema in patients with varicose veins. Setting: Department of General Medicine, University of Heidelberg, Germany. Patients: Forty-six patients with unilateral long saphenous varicose veins. Main outcome measures: The effects of compression stockings on optoelectronically measured volumes of normal legs and legs with varicose veins in supine and upright positions. Results: Changing body position from a supine to an upright position leads to an increased leg volume by venous blood pooling (236.5 ml and 255.5 ml, respectively, p < 0.001). The volume difference between normal legs and legs with varicose veins in the supine position was 172.5 ml, and in the upright position 187.0 ml ( p < 0.001). After putting on compression thigh-length stockings, the volume of both normal legs and legs with varicose veins decreased by 314.5 ml and 358.0 ml (acute compression effect). Elastic compression for 8 h produced no significant additional reduction in the leg volumes. Wearing the stockings for 7 successive days failed to reduce the volume in the normal legs, whereas a further reduction in the legs with varicose veins was measured (supine position 61.0 ml, p < 0.05; upright position 72.0 ml, p < 0.05) (long-term compression effect). Conclusions: Wearing compression stockings rapidly reduces venous blood pools of the legs. Long-term wear is necessary to mobilize the interstitial limb oedema in patients with superficial venous insufficiency.
Higher Migratory Activity of Arterial Smooth Muscle Cells Than of Venous Smooth Muscle Cells on Different Collagen Matrices
Authors: Jimi S. , Takebayashi S. , Ryu S. , Saku K. , Sakata N. 
Published: January 2017

Objective: To examine the biological differences between arteries and veins, we compared the migratory activities of arterial and venous smooth muscle cells (SMCs) using a modified Boyden chamber method. Design: Migratory activities of porcine arterial and venous smooth muscle cells (SMCs) were compared by a modified Boyden chamber method using coated filters with type I, III, IV and V collagens. Results: At the basal level of migration activity without stimulation, arterial SMCs showed greater migratory activity than venous SMCs in all of the substrata. When platelet-derived growth factor was added to the lower wells, all of the migration activities increased, and arterial SMCs showed significantly higher activity than venous SMCs. When cell-associated fibronectin was determined by an enzyme-linked immunoassay and immunohistochemistry, arterial SMCs secreted significantly more cell-associated fibronectin than venous SMCs. Type IV collagen had the greatest positive effect, and also induced the lowest level of cell-associated fibronectin. Conclusion: These in-vitro results indicate that fibronectin secreted by vascular smooth muscle is an important regulatory protein for cell migration even when SMCs migrate on collagen substrates. Arterial SMCs have higher migratory activities than venous SMCs as a result of their lower production of fibronectin.
The Influence of Minimal-Stretch and Elasticated Bandages on Calf Muscle Pump Function in Patients with Chronic Venous Disease
Authors: Yang D. , Vandongen Y. K. , Stacey M. C. 
Published: January 2017

Objective: To evaluate the influence of minimal-stretch and elasticated bandages on calf muscle pump function in patients with chronic venous disease. Design: An open, randomised, crossover study. Setting: University Department of Surgery, Fremantle Hospital, Perth, Australia. Subjects: Twenty patients with chronic venous disease and recently healed chronic venous ulcers. Method: Five different bandaging regimens were applied on each patient, and calf muscle pump function was assessed by using air plethysmography. Results: There was no significant difference in the venous filling index (VFI) and ejection fraction (EF) between the five different bandage regimens, and also no significant difference in four of the five bandage regimens over a 7-day period ( p>0.05). However, the VFI was significantly reduced and the EF was not significantly altered after the application of both elasticated and minimal-stretch bandages ( p<0.05, = p>0.05 respectively). Conclusion: All the bandage regimens used in this study have a similar influence on calf muscle pump function, and may therefore have a similar effect on the healing of chronic venous ulcers.
The Physiological Effect of Graded Compression Stockings on Blood Flow in the Lower Limb: An Assessment with Colour Doppler Ultrasound
Authors: Benkö T. , Kalik I. , Chetty M. N. 
Published: January 2017

Objectives: To assess the physiological effect of low-pressure graded compression stockings (GCS) on the blood flow of the lower limb with the use of colour Doppler. Design: A randomised controlled study. Setting: X-ray Department in a teaching hospital. Patients: Forty-five healthy, adult, voluntary subjects. Method: Subjects were randomised into three groups to either wear thigh- or knee-length GCS of the same type or no stockings. The diameter and cross-sectional area of the femoral and popliteal veins and the peak venous velocities were measured with colour Doppler before the application of GCS and after 20 min bed rest with the stockings in situ. Results: Measurements showed a significant increase of the peak velocity in the femoral vein with thigh-length GCS ( p<0.002). There was a significant decrease of the popliteal vein diameter and cross-sectional area with thigh-length GCS ( p<0.05). There was no significant change in the knee-length GCS group and the control group, in which patients did not wear stockings. A paired t-test was used to determine the significance of the changes. Conclusions: Thigh-length GCS have an effect of increasing venous peak velocity in the femoral vein, hence decreasing venous stasis. Furthermore, they decrease the dilatation of the popliteal vein, which may reduce the risk of intimal tears occurring, which may contribute to venous thrombogenesis. Other methods can given more information in assessing the effect of various lengths of stocking on venous stasis.
The Beneficial Augmentative Effect of Micronised Purified Flavonoid Fraction (MPFF) on the Healing of Leg Ulcers: An Open, Multicentre, Controlled, Randomised Study
Authors: Gliński W. , Chodynicka B. , Roszkiewicz J. , Bogdanowski T. , Lecewicz-Toruń B. , Kaszuba A. , Bowszyc J. , Nowak A. , Wnorowski J. , Wąsik F. , Glińska-Ferenz M. , Błaszczyk M. , Strzyga P. , Pachocki R. 
Published: January 2017

Objective: To determine the increase in healing rate of venous ulcer in patients receiving a micronised purified flavonoid fraction (MPFF) as supplementation to standard local care. Design: A randomised, open, controlled, multicentre study. Setting: Departments of Dermatology and University Outpatients Clinics. Patients: One hundred and forty patients with chronic venous insufficiency and venous ulcers. Intervention: Patients received standard compressive therapy plus external treatment alone or 2 tablets of MPFF daily in addition to the above treatment for 24 weeks. Main outcome measure: Healing of ulcers and their reduction in size after 24 weeks of treatment. Results: The percentage of patients whose ulcers healed completely was found to be markedly higher in those receiving MPFF in addition to standard external and compressive treatment than in those treated with conventional therapy alone (46.5% vs 27.5%; p<0.05, OR = 2.3, 95% CI 1.1–4.6). Ulcers with diameters <3 cm were cured in 71% of patients in the MPFF group and in 50% of patients in the control group, whereas ulcers between 3 and 6 cm in diameter were cured in 60% and 32% of patients ( p<0.05), respectively. The mean reduction in ulcer size was also found to be greater in patients treated with MPFF (80%) than in the control group (65%) ( p<0.05). The cost-effectiveness ratio (cost per healed ulcer) in the MPFF group was €1026.2 compared with €1871.8 in the control group. Conclusions: These results indicate that MPFF significantly improves the cure rate in patients with chronic venous insufficiency.
Lycra Support Tights: Are They Effective?
Authors: de Boer E. M. , Broekhuijsen R. W. , Nieboer C. , Bezemer P. D. 
Published: January 2017

Objective: To investigate the effect of two Lycra support panty hose (8 and 12 mmHg) on the development of oedema of the lower legs and on feelings such as tiredness, heaviness and burning or pain in the legs. Design: Prospective study. Setting: Department of Dermatology, Free University Hospital, Amsterdam, The Netherlands. Subjects: One hundred and eight healthy women, 20–60 years of age, who had no signs of chronic venous insufficiency on examination (including Doppler ultrasound) and who worked full-time. Main outcome measures: Diurnal lower leg volume changes (DVC) recorded by opto-electronic volume measurements and questionnaires on subjective feelings while wearing a control panty hose in comparison with the support panty hose. Results: The mean DVC with control panty hose was +2.7%. With both types of support panty hose the mean DVC was significantly decreased to 2.3% ( p < 0.001). At inclusion complaints were common (81%). Support panty hose A (8 mmHg) decreased feelings of heaviness and tiredness significantly. No relation between the reduction in DVC and a decrease in complaints was shown. Support panty hose B was often ill-fitting due to an inadequate size-table. Conclusion: Both types of support panty hose reduced the normal diurnal volume increase significantly and equally. Further investigations are needed in order to find the minimum compression for (almost) complete prevention of oedema. The decrease in subjective unpleasant feelings, significant for tiredness and heaviness in the case of panty hose A, was unrelated to a reduction in DVC.
Oxypertine (Integrin) in the Treatment of Morbid Anxiety. Report of a New Low Dosage Schedule
Authors: Murphy J E , Donald J F , Molla A L 
Published: January 2017

One hundred patients were admitted to a double-blind group comparative trial of two doses of oxypertine (Integrin) in the treatment of morbid anxiety in a general practice setting. The two dosage regimes were 10 mg thrice daily and 5 mg thrice daily respectively, patients being allocated in a random manner to one or other of these. Physicians assessment were made on a modified Hamilton Anxiety Rating Scale on admission and after two and four weeks treatment. A patient's self-rating scale was also carried out on these occasions using a nine item visual analogue scale embracing some symptoms of anxiety states. Eighty-nine completed case records were available for analysis. Each dosage regime brought about a similar and highly significant improvement after both two and four weeks of treatment. In both the magnitude of clinical response and rapidity of onset of action the lower dose regime was found to compare favourably with the higher dosage. Each was well tolerated and associated with a very low incidence of undesirable effects.