Biomedical subjects
A A Ramelet
Publications and source records attributed to A A Ramelet.
The efficacy and safety of a coumarin-/troxerutin-combination (SB-LOT) in patients with chronic venous insufficiency: a double blind placebo-controlled randomised study.
BACKGROUND: The objective was to evaluate the oedema-protective effect of a vasoactive drug (coumarin/troxerutin [SB-LOT]) plus compression stockings in patients suffering from chronic venous insufficiency after decongestion of the legs as recommended by the new guidelines. PATIENTS AND METHODS: 231 patients were randomly assigned medical compression stockings plus SB-LOT (90 mg coumarin and 540 mg troxerutin per day) or medical compression stockings plus placebo for the first 4 weeks and SB-LOT or placebo for the second 12 weeks of the study. The primary efficacy endpoint was the lower leg volume measured by well-established water plethysmometry. RESULTS: 226 patients were evaluated. After ceasing compression stockings, an edema protective effect was detected in the SB-LOT-group but not in the controls. Recurrence of leg volume increase was by 6.5 +/- 12.1 ml and by 36.7 +/- 12.1 ml in the SB-LOT and placebo group, respectively (p = 0.0402). The local complaint score and general aspects of quality of life were also superior for the SB-LOT-group (p = 0.0041). Significant differences were also observed with regard to clinical global impression and therapeutic effect. No serious adverse drug reaction or clinically relevant impairment of laboratory parameters occur. CONCLUSION: This study confirms the oedema-protective effect of SB-LOT in chronic venous insufficiency and provides a treatment option for patients who discontinue compression after a short time.
Compression therapy.
Compression therapy, either active or passive, is the cornerstone of treatment for all venous and lymphatic disorders. Its major limitations are poor patient compliance, difficulty to apply in the elderly, and insufficient knowledge and skill in the majority of physicians. New modalities, such as four-layer bandage, tubular gradient compression, or new textile technologies, may secure a better application in difficult cases such as leg ulcers.
Clinical benefits of Daflon 500 mg in the most severe stages of chronic venous insufficiency.
Chronic venous insufficiency (CVI) affects a large number of people in Western countries, and is responsible for considerable inconvenience, discomfort, suffering, and costs. Micronized purified flavonoid fraction (MPFF, 450 mg diosmin plus 50 mg hesperidin-Daflon 500 mg) is a potent venotropic drug used in the treatment of venous insufficiency. Pharmacological and clinical studies demonstrated the comprehensive mode of action of Daflon 500 mg: it increases venous tone, it improves lymph drainage, and it protects the microcirculation. Clinical international, prospective, multicenter, randomized, controlled studies versus placebo studies documenting the effects of Daflon 500 mg in CVI at advanced stages with edema, skin changes, and venous leg ulcer are reviewed. In edema, one of the most frequent complaints of patients, Daflon 500 mg brings about a significant reduction in leg circumference, thanks to its capacity to inhibit inflammatory reactions and to decrease capillary hyperpermeability. The rationale for the use of Daflon 500 mg for treatment of skin disorders and venous leg ulcer is its action on the microcirculation-damaging processes. Regarding skin changes, Daflon 500 mg has been shown to improve venous trophic disorders, like gravitational (stasis) dermatitis, and dermatofibrosclerosis. In venous leg ulcer, Daflon 500 mg's clinical efficacy has been demonstrated in addition to standard treatment or versus standard treatment alone. Daflon 500 mg, thanks to its comprehensive mode of action on the veins, lymphatics, and microcirculation, is the method of choice not only in the early stages of CVI treatment, but also in the severe stages of this condition, in combination with compression treatment, sclerotherapy, and surgery if appropriate.
[News of the Association of French speaking dermatologists. Memories from Cayenne].
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Teledermatoscopy in Switzerland: a preliminary evaluation.
BACKGROUND: Since devices for digital epiluminescence microscopy and for telemedicine have become affordable, a critical evaluation of this new method has been needed. OBJECTIVE: Our aim was a critical evaluation of teledermatoscopy under routine conditions in private practice. METHODS: Pigmented skin lesions (PSLs) scheduled for excision were documented with a digital epiluminescence microscopy (DELM) system. Images were sent to the PSL consultation at the Department of Dermatology of the University Hospital Geneva, where a diagnosis was established. The histopathologic report including the initial diagnosis was sent afterward. Both approaches were compared concerning diagnostic accuracy. RESULTS: Over a period of 6 months, 55 lesions on 51 patients have been included in this study. Picture quality was good or very good in more than 90%. Diagnostic accuracy of the teledermatoscopy approach was superior to that of the conventional approach for malignant melanocytic lesions. CONCLUSION: We have shown the feasibility of a teledermatoscopic consultation. The gain of diagnostic accuracy in this teledermatoscopic approach, especially for malignant melanocytic lesions, suggests that patients might benefit directly from such a consultation at distance.
Homeopathic Arnica in postoperative haematomas: a double-blind study.
OBJECTIVE: To determine whether homeopathic Arnica can reduce postoperative haematomas in venous surgery. DESIGN: Randomized, prospective, multicentric, double-blind placebo-controlled trial. PARTICIPANTS: 130 consecutive patients undergoing saphenous stripping (204 legs), hospitalized in a clinic. INTERVENTIONS: A homeopathic medicine (Arnica CH5) and an indistinguishable placebo, administered sublingually by a nurse the night before and immediately after the operation. OUTCOME MEASURES: Clinical evaluation of haematomas 6 days postoperatively. RESULTS: Groups were well matched (sex, age, history of bleeding or thrombosis, drug intake, previous intake of homeopathic drugs, type of operation and anaesthesia, operator). One drop-out has been replaced. No statistically significant difference in postoperative haematomas was found between the Arnica and placebo groups (p = 0.342). Subanalysis of all other items did not reveal any statistical difference either. CONCLUSIONS: In this study, with this dosage, we did not observe any preventive effect of homeopathic Arnica CH5 on poststripping haematomas.
Pharmacologic aspects of a phlebotropic drug in CVI-associated edema.
Several phlebotropic drugs, or edema-protecting drugs, are available, the most important of which are found in the gamma-benzopyrone family (flavonoids). gamma-Benzopyrones can be plant extracts, semisynthetic preparations, or synthetic preparations. This family is divided into two different groups: flavones and flavonols, and flavanes (flavanones). The flavone group contains various types of molecule and includes diosmin. Here we discuss the pharmacologic aspects in edema associated with chronic venous insufficiency (CVI) of one of the reference phlebotropic drugs, micronized purified flavonoid fraction (MPFF), a semisynthetic preparation from the diosmin group, which represents the latest improvement in flavonoid formulation. Before we detail the pharmacologic aspects, a brief summary of the pathophysiology of edema in CVI is necessary. Several factors are implicated: the veins, which create the conditions favorable to edema; the microcirculation, which is the site of fluid transfer into the interstitial tissue; and the lymphatics, which have a limited possibility to reduce edema. Major discoveries are currently being made in CVI and the microcirculation. Results of studies show that MPFF decreases capillary permeability and increases capillary resistance, which could partly be explained by inhibition of leukocyte activation, migration, and adhesion. This inhibition is linked to a significant decrease in plasma levels of endothelial adhesion molecules (VCAM-1 and ICAM-1) after MPFF treatment. Thus, the CVI-induced damage to the microcirculation is counteracted by MPFF. The lymphatic system is also improved by MPFF treatment. The lymphagogue activity of MPFF has been demonstrated in experimental animal models and confirmed by microlymphographic measurement in patients suffering from severe CVI. The pharmacologic activity of MPFF in lymphedema was observed in a study using an animal model of acute lymphedema and in a study in patients with upper limb lymphedema secondary to breast cancer treatment. All these findings point to the importance of acting on each factor involved in the formation and maintenance of edema. This pharmacologic activity is indeed reflected by the clinical efficacy on edema observed during treatment with MPFF.
Post-stripping sclerodermiform dermatitis.
BACKGROUND: Cutaneous sclerosis, a process that results in hardening of the skin, is the hallmark of scleroderma and sclerodermoid disorders. Cutaneous sclerosis is usually classified as secondary or primary, depending on the presence or absence of underlying diseases. Primary cutaneous sclerosis is a feature of idiopathic inflammatory processes that are often associated with autoimmune disorders, whereas secondary cutaneous sclerosis arises in the context of many pathological processes of varying causes, including chronic graft-vs-host disease, defined metabolic or genetic disorders, and exposure to certain infectious organisms, drugs, or chemicals. OBSERVATIONS: Three patients had localized cutaneous sclerosis overlying the site of a surgically removed (stripped) great saphenous vein. In all 3 patients, lesions were clinically characterized by multiple hypopigmented and indurated plaques distributed linearly along the path of the preexisting vein. Extensive history, physical examination, and diagnostic tests did not reveal known predisposing factors for cutaneous sclerosis. CONCLUSIONS: Although the observed association of sclerodermiform dermatitis and venous stripping in these 3 patients does not imply a causal relationship, the absence of other identifiable predisposing factors and the striking linear distribution of the cutaneous lesions along the path of the preexisting vein are suggestive. This poststripping sclerodermiform dermatitis may be a rare late complication of saphenous vein stripping.
Management of leg ulcers.
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Bacteriology of leg ulcers.
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Controversies on emerging and obsolete therapies in venous leg ulcers.
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Chronic leg ulcers and eczema.
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[Rapid healing of venous ulcers and lack of clinical rejection with an allogeneic cultured human skin equivalent].
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Compression therapy: a new demonstration of its effectiveness.
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Complications of ambulatory phlebectomy.
BACKGROUND: Ambulatory phlebectomy, as described by Muller, is a remarkable esthetic, effective, and cost-sparing technique for definitive removal of varicose veins. As this technique is becoming more and more popular, potential complications and incidents have to be recognized by all phlebologists. OBJECTIVE: To review all possible complications after ambulatory phlebectomy and establish their frequency, relevance, treatment, and prevention. METHODS: Extensive review of the European and American literature devoted to phlebectomy, with particular consideration of the complications, are discussed in comparison with the author's personal experience. CONCLUSIONS: Notable adverse incidents after ambulatory phlebectomy are rare. Minor inconveniences are common, depending partially on surgical indications, operator's skill, and experience. Adequate training allows one to minimize untoward reactions. A great risk of ambulatory phlebectomy is the presumed facility of this surgical technique combined with its easy accessibility to poorly trained physicians in phlebology and dermatologic surgery.
Failure of cyclosporine in Netherton's syndrome.
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Necrobiosis lipoidica and silicotic granulomas on Muller's phlebectomy scars.
We report an unusual case of concomitant necrobiosis lipoidica and silicotic granulomas in scars of phlebectomies on the legs, suggestive of a Koebner phenomenon.