bluuebunny/crossref_metadata_2025_split huggingface dataset:
A three-parameter model for the venous pressure volume relation of the lower leg
Authors: van Langen H 
Published: January 2004

Objectives: To derive a three-parameter model for the curvilinear venous pressure volume relation of the lower leg, and to test its consistency. Methods: A model with venous pressure at rest (P0, mmHg), the venous compliance at P0 (C0, %/mmHg) and the venous stiffness constant ( k, 1/%) was derived. With strain gauge plethysmography the venous pressure volume relations of both legs at the mid-calf and at the ankle region were measured and fitted in 120 consecutive patients in the supine position. Results: No difference was observed between the mid-calf P0 (right 8.1 ± 2.2, left 8.4 ± 2.1) nor between ankle P0 (right 10.1 ± 2.3, left 10.0 ± 2.1). A significant pressure difference of -1.8 mmHg was found between mid-calf and ankle. Leg side differences were not observed for either C0 at the ankle (right 0.36 ± 0.29, left 0.49 ± 0.85) or in the mid-calf region (right 0.54 ± 1.1, left 0.46 ± 1.0). Differences for the leg region but not for the leg side were found for k (mid-calf right 0.54 ± 0.38, left 0.64 ± 0.52, ankle right 1.32 ± 0.66 and left 1.33 ± 0.65). Conclusion: The model demonstrated provided a proper description of the curvilinear venous pressure volume relation.
Eighty-five consecutive cases of cellulitis: clinical features, management and implications for hospital care
Authors: Butcher W B , Papworth S E , Parvin S D , Darke S G 
Published: January 2004

Objectives: To determine lessons learned from a consecutive series of patients admitted with cellulitis, regarding factors leading to admission, management and duration of hospitalization. Methods: Prospective data over a 12-month period within a district general hospital. Centralized admitting policy of all patients with a principle diagnosis of cellulitis under the vascular surgical department. Data comparison of younger patients vs older and of those hospitalized for less than one week vs more than one week. Results: Of 85 patients admitted, 44 had previous oedema and 50 had a skin lesion as a portal for entry of infection; only nine had neither prior to the attack. Thirty-two had had at least one previous attack of cellulitis. Younger patients tended to have a more virulent systemic infection whereas older patients had more comorbidity and social problems. Fourteen patients required surgical intervention: eight had arterial and six had venous contributory circulatory disorders. Microbiological information was of minimal practical value. Surgical intervention and social problems were associated with delayed discharge. Conclusions: The majority of patients with cellulitis had predisposing oedema/skin lesions and where these persisted or recurrent infection occurred long-term antibiotic prophylaxis may have been useful. Social problems and comorbidity remained complicating factors but more patients could probably have been managed in a domiciliary setting.
Prevalence of chronic venous insufficiency in men and women in Poland: multicentre cross-sectional study in 40,095 patients
Authors: Jawien A , Grzela T , Ochwat A 
Published: January 2004

Objective: To study the prevalence, clinical expression and risk factors of chronic venous insufficiency (CVI) in 40,095 Polish adults. Method: This was a multicentre cross-sectional study with 803 participating primary care physicians. Results: The study population was mainly female (84%). The mean age was 44.8 years. Of the total population, 10% presented with oedema, 34.3% had varicose veins, with approximately the same proportion in males and females and 1.5% presented with past or active ulceration. A similar prevalence of CVI to that observed in the developed countries was reported in Poland. Obesity, the number of pregnancies and a positive family history were found to be risk factors for CVI. Female gender was not shown to be a risk factor for varicose veins. Conclusions: The relationship between the presence of symptoms and signs of CVI was high, whatever the gender. Thus, the previously described dominance of the disease in females is losing its significance.
Multi-layer compression: comparison of four different four-layer bandage systems applied to the leg
Authors: Ruckley C V , Dale J J , Gibson B , Brown D , Lee A J , Prescott R J 
Published: January 2004

Objective: To compare on standardized laboratory models the performance of four commercially available four-layer bandage systems. Methods: Four experienced bandagers applied each of the four systems [Profore® Regular (Smith & Nephew, Hull, UK), Ultra Four (Robinsons, Chesterfield, UK), System 4 (SSL International, Knutsford, UK) and K-Four® (Parema, Loughborough, UK)] to two models: a 12.5 cm diameter padded cylinder and a 9.5-14.5 cm padded cone. Bandages were applied individually in single layers and as a completed system using standard application techniques. Pressures were measured by the Borgnis Medical Stocking Tester at positions corresponding to ankle, gaiter and mid-calf areas as determined by the pressure sensor. Results: A total of 768 observations were made: 384 for each model, 192 for each bandaging system, 192 for each bandager and 128 for each measuring point. The increase in pressure produced by each additional layer was in the range of 50-60% of the pressure achieved by the same bandage when used as a single layer. Each bandage system and each bandager produced a gradient of final mean pressure irrespective of whether the bandage was applied to a cylinder or a cone. However, there were no significant differences in the gradients between the four bandage systems or between the four bandagers. There were significant differences in the final pressures achieved among the bandage systems when applied as completed systems (mean: Profore® = 42 mmHg; System 4 = 45 mmHg; K-Four® = 48 mmHg; and Ultra Four = 51 mmHg; P<0.001). Conclusions: These results challenge a commonly-held assumption concerning the additive effect of pressures generated by successive bandage layers. When applied as part of a multi-layered system each bandage adds just over half the pressure achieved by the same bandage when applied alone. The four completed systems produced pressures within a range appropriate for ulcer therapy, although there were significant differences in mean pressures. This capability of the systems to produce different pressures could be clinically important in the hands of inexperienced bandagers or with patients at risk of pressure damage..
Randomized clinical trial of varicose vein surgery with compression versus compression alone for the treatment of venous ulceration
Authors: Guest M , Smith J J , Tripuraneni G , Howard A , Madden P , Greenhalgh R M , Davies A H 
Published: January 2004

Objectives: No randomized controlled trials exist to show whether varicose vein surgery improves healing of venous ulcers. In this study we investigated whether superficial venous surgery gave additional benefit to compression therapy in terms of healing rate, time to healing and quality of life of patients with venous ulcers. Methods: A total of 121 consecutive patients with venous ulceration were identified, of which 45 were unfit/unwilling to be included. The remaining 76 (aged 38-89, 39 female) were randomized to receive either four-layer bandaging ( n =39) or superficial venous surgery (long and short saphenous with or without perforator surgery) and four-layer bandaging ( n =37). Ulcer healing and health-related quality of life (HRQL) were assessed. Results: The healing rate was 64% (25/39) in the compression treatment group and 68% (25/37) in the surgical treatment group. This difference was not statistically significant (Pearson 2 P=0.75). There was no significant difference between the time to ulcer healing in the two treatment groups (log rank statistic=0.69, P value=0.41): median time 83 days for surgery vs 98 days for compression. After adjusting for duration of ulcer, size of ulcer and previous deep vein thrombosis, there was still no significant difference between time to healing for the two treatment groups (adjusted hazard ratio=0.79, 95% confidence interval 0.45-1.39). There was no difference in HRQL between the two groups, using the scores of a disease-specific questionnaire (CXVUQ). Conclusions: This study suggests that for venous ulceration, superficial venous surgery gives no additional benefit to compression therapy from the point of view of healing rate and quality of life.
External valvuloplasty in the treatment of greater saphenous vein insufficiency: a five-year follow up
Authors: Geier B , Voigt I , Marpe B , Deska T , El-Gammal S , Stücker M , Barbera L , Mumme A 
Published: January 2004

Objective: To present the results of external valvuloplasty of the saphenofemoral junction in selected patients with insufficiency of the greater saphenous vein after a mean follow up of 54 months. Methods: A total of 54 legs were prospectively studied and re-examined a mean of 54 months after the operation. The severity of the patients' symptoms and their satisfaction with the procedure were recorded. Furthermore, the venous refill time, the severity of reflux and the diameter of the greater saphenous vein were recorded preoperatively and again at follow up. Results: In 46 cases (85%) the patients were satisfied with the outcome of the procedure. At follow up, the mean severity of symptoms was significantly lower in every symptom category. The venous refill time was reduced by a mean of 5 seconds and the diameter of the greater saphenous vein was reduced by a mean of 3 mm. Reflux in the saphenofemoral junction despite the valvuloplasty was demonstrated in six legs (11.1%), and reflux in the distal saphenous trunk despite a competent valvuloplasty was seen in 18 cases (33.3%). When reflux was present at the follow-up examination, it affected a significantly shorter segment of the greater saphenous vein than preoperatively. Treatment for recurrent symptoms was necessary in 10 (18.5%) limbs. Conclusions: External valvuloplasty of the saphenofemoral junction offers good results in terms of patient satisfaction, relief of symptoms and recurrence rate. With long-term results still pending, this vein-sparing operation might be an alternative to stripping in selected patients.
Popliteal venous reflux is not abolished by superficial venous ligation
Authors: Sharp M A , Nawabi D H , Walton J , Hands L 
Published: January 2004

Introduction: The role of superficial venous surgery in the presence of deep venous reflux is not well defined. Abolition of deep reflux in the femoral segment after superficial venous surgery has been reported. The popliteal segment has not been investigated similarly. Aims: To investigate if popliteal venous reflux can be abolished by superficial venous ligation. Method: Retrospectively identified consecutive patients with mild category exclusive popliteal reflux were invited by post to attend for a repeat duplex scan after surgery. They had previously undergone superficial venous surgery aiming to eliminate all sites of superficial reflux identified on duplex scanning. Results: Of the 34 patients invited, 21 attended: eight males and 13 females, mean age 60 years. Seven patients were suitable for bilateral investigation. Of the 28 segments scanned, the reflux category improved in three, deteriorated to the moderate category in six and remained unchanged in 18. Conclusion: Superficial venous surgery does not abolish mild popliteal reflux.
Quality of evidence underlying the management of thrombophlebitis
Authors: Mottahedeh M , da Silva A F 
Published: January 2004

Objective: Superficial thrombophlebitis (ST) is commonly associated with varicose veins, although it may occur anywhere else in the body. The aim of this study was to review the quality of the evidence underlying the management of ST. Methods: Review of the literature on the management of ST over a 20-year period carried out using Medline and manual searching. The current management of ST was then divided into levels of evidence as defined by the US Agency for Health Care Policy and Research. Results: Superficial thrombophlebitis of varicose veins of the lower limb can be treated by saphenofemoral ligation with stripping of the proximal vein and surgical excision of the thrombosed segment (levels Ib and III). In the presence of deep vein thrombosis, oral anticoagulant (OC) is recommended (levels Ib and IIa). Hypercoagulable state should be investigated if ST occurs in the absence of varicose veins. In primary hypercoagulable state, disconnection of the saphenofemoral junction should be performed in patients at high risk of pulmonary embolism. Oral anticoagulant should be instituted after the first thrombotic event (level III). In secondary hypercoagulable state, OC with treatment of the underlying cause is recommended (level IV). Conclusions: The quality of evidence supporting the management of ST varies considerably. Further randomized studies are required to support some of the current management methods.
Clinical spectrum of recurrent postoperative varicose veins and efficacy of sclerotherapy management using the compass technique
Authors: McDonagh B , Sorenson S , Gray C , Huntley D E , Putterman P , King T , Eaton T , Martin C , Harry J L , Cohen A , Guptan R C 
Published: January 2004

Objectives: Tostudy the clinical spectrum of recurrent varices after surgery (REVAS) and the efficacy of sclerotherapy under the comprehensive objective mapping, precise image-guided injection, antireflux positioning and sequential sclerotherapy (COMPASS) technique in their management. Methods: Design: prospective open study with 1.5-5.7-year follow up. Patients: 253 legs of 168 consecutive patients who had received previous surgery for primary varicosity. Main outcome measures: obliteration, recanalization, residual reflux, neovascularization, venous dysfunction score and cumulative obliteration. Results: REVAS presents as a symptomatic chronic venous disease of women in their fifties, a decade later than primary varicosities are reported. Almost 75% of REVAS occurred at the groin, mostly with features of chronic venous disease. The COMPASS technique achieved sustained obliteration in 97% of the groin varices and in 100% of the thigh and isolated refluxes around the popliteal fossa. The cumulative obliteration rate was sustained at >90% and obliteration of perforator reflux was sustained. There was a significant decrease in the venous dysfunction score. In the mean 3.1±1.7 years of follow up, only 3% possible neovascularization was seen. There were no serious adverse experiences reported. Conclusions: REVAS is a symptomatic chronic venous disease requiring skilled medical attention. The COMPASS technique appears to be more efficacious than the presently available surgical approaches to its long-term management.
Exclusion of deep vein thrombosis by measuring spot skin temperatures using a hand-held thermo-comparator
Authors: Enoch S , Blair S D 
Published: January 2004

Objectives: Thermograms have shown that deep vein thrombosis (DVT) causes an increase in temperature in the leg. We have studied for the first time, the viability of measuring spot skin temperatures using a hand-held instrument called a thermo-comparator as an inexpensive, simple and reliable method of excluding the diagnosis of DVT. Methods: A total of 33 patients with suspected DVT had spot skin temperatures taken on specified areas of each leg using the instrument. The results were compared with duplex scans of the patient and with venography in some patients. Results: There was a mean temperature gradient of 3.38°C down each normal leg. All 10 patients with DVT confirmed by duplex scan or venogram also had raised temperatures compared with surrounding areas, without the normal temperature gradient down the leg (true positive, 100%). This instrument did not have any false negatives and achieved 100% sensitivity and 100% negative predictive value. Conclusions: The thermo-comparator excluded a diagnosis of DVT in 39% of patients and has the potential for use in primary care as a screening tool to reduce the number of patients sent to hospital unnecessarily.
Compression therapy and pressure in the deep venous system
Authors: Veraart J C J M , Oei T K , Neumann H A M 
Published: January 2004

Objectives: To evaluate the effect of five different elastic compression stockings on the venous pressure in the deep venous system in the supine and standing positions. Methods: Setting: Departments of Dermatology and Radiology, University Hospital Maastricht, The Netherlands. Patients: A total of eight limbs of seven subjects (five patients and two healthy volunteers) with a mean age of 53 years (range 33-79) were measured. The patients were known to have severe venous insufficiency and recurrent leg ulceration. A catheter connected to an external pressure transducer was placed in one of the deep veins of the lower leg after puncturing the popliteal vein. The position of the catheter was established with contrast medium. Venous pressure recordings were made in the supine and standing positions while wearing an anti-embolism stocking and while wearing four different compression stockings (class II and III). Results: All stockings worn in the supine position caused a significant increase in pressure when compared with no compression at all ( P <0.05; Wilcoxon rank test). Only the strong compression class III stockings caused a significant and clinically relevant pressure increase, compared with the other four elastic compression stockings ( P <0.05; Wilcoxon rank test). In the standing position no differences in pressure were found between the elastic stockings, or when any stocking was compared with the use of no stocking at all. Conclusions: The results demonstrate that only strong compression class III stockings (>40 mmHg at the ankle) increase the pressure in the deep venous system in the supine position. Because of this, these elastic stockings may be the only stockings that have a positive influence on the pathologic deep venous system in patients with deep venous insufficiency, such as after deep venous thrombosis. The study confirms earlier clinical observations that in the treatment of patients with post-thrombotic symptoms and deep venous insufficiency only strong elastic compression stockings are effective.
Effect of body position and graduated compression stocking length on femoral venous blood flow velocity
Authors: Limpus A , Chaboyer W P , Purcell C , Schluter P J , Gibbs H , Beller E , Hetherington R 
Published: January 2004

Objectives: To measure the effect of graduated compression stocking (GCS) length and body position on peak femoral venous blood flow velocity (PVV) and vessel diameter (VD). Methods: Twenty healthy adult volunteers had PVV and VD measured, using colour Doppler ultrasound, at baseline in three body positions. Knee- or thigh-length GCS were assigned randomly.Arandom sequence of the three positions was used to measure PVV and VD. The procedure was repeated, after a two-hour washout period, using the other length GCS. Results: There was no significant difference in the mean change of PVV ( P =0.74) or VD ( P =0.54) measurements from the baseline between thigh- and knee-length GCS. However, significant mean changes in PVV ( P =0.02) and VD ( P <0.001) measurements were observed for the three body positions, after adjusting for baseline values. Conclusions: In healthy volunteers, thigh- and knee-length GCS do not have an effect on PVV or VD, and body position affects PVV significantly, with or without GCS.
The Aqueous Adsorption of Copper and Cadmium Ions onto Sheep Manure
Authors: Kandah Munther I. , Al-Rub Fahmi A. Abu , Al-Dabaybeh Naser 
Published: January 2004

Dried sheep manure (SM) has been found to be an effective adsorbent for the removal of copper and cadmium ions from dilute aqueous solutions. Batch adsorption experiments using different concentrations of copper and cadmium ions (2.0–20.0 mg/ml) were carried out for different periods of agitation. Adsorption uptakes were found to increase with an increase in the initial metal ion concentration, SM concentration and solution pH for both copper and cadmium ions. Maximum uptakes for 100 ppm Cu2+ and 100 ppm Cd2+ ions were found to be 17.8 mg/g and 10.8 mg/g, respectively. The equilibrium uptakes for both copper and cadmium ions were attained within the first 10 min. The Langmuir isotherm model failed to represent the adsorption of both copper and cadmium ions on SM. In contrast, the Freundlich isotherm model fitted the experimental data for both copper and cadmium ions very well. The presence of EDTA in the solution decreased the equilibrium uptake of both copper and cadmium ions significantly.
The Relationship between pH and Heavy Metal Ion Sorption by Algal Biomass
Authors: Tang Ying-Zhong , Gin Karina Y.H. , Aziz M.A. 
Published: January 2004

The relationship between pH and heavy metal ion sorption by the biomass of two algal species was studied under controlled experimental conditions. It was observed that increasing heavy metal ion sorption by algal biomass with pH mainly arose from a change in algal cell properties, provided that the pH was below the level where the heavy metal ions started to precipitate. A drastic increase in metal ion sorption capacity (‘inflection point’) was observed at pH 4.5 for the algal biomass used in the study. All the experimental observations on the mutual effects between pH and metal sorption for four heavy metal ions (Cd2+, Cu2+, Pb2+ and Zn2+) and two algal species suggested that the mutual effects between pH and heavy metal ion sorption can be explained in terms of ion exchange and coulombic attraction between the heavy metal ions and the algal biomass. A ‘positive feedback’ was also suggested for the mutual effects between pH and heavy metal ion removal at higher initial pH levels, where the sorption of heavy metal ions may enhance their hydrolysis.