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Biomedical subjects

F Vin

Publications and source records attributed to F Vin.

At least 19 recordsLinked to original sources
PubMed2005

Prognostic factors for venous ulcer healing in a non-selected population of ambulatory patients.

OBJECTIVE: To identify wound prognostic indicators in a non-selected patient population with leg ulcers. METHOD: This was a prospective observational survey involving 151 physicians. Ambulatory patients with venous leg ulcers were treated with a non-adherent foam dressing and usual leg ulcer management. At follow-up after three to six weeks, ulcer healing parameters and local treatment tolerability were recorded and concordance with compression therapy was validated. RESULTS: A > or = 40% reduction in the largest wound length was selected as an indicator of a favourable healing outcome. A total of 330 patients were included and seen at follow-up. The mean largest wound length was 4.9 +/- 3.6 cm. A > or = 40% decrease in this parameter was noted in 178 patients. Dressing acceptability and tolerability were excellent. Compression therapy, while heterogeneous among physicians, was used regularly and applied correctly (by patients and practitioners) in 81.2% of patients. Predictors for not reaching the main outcome were the presence of an arterial lower limb disease, an ulcer duration of more than three months and an initial ulcer length of 10 cm or more. Linear regression showed that old age and a high body mass index were independent predictors of a poor outcome. CONCLUSION: Clinical indicators such as simple ulcer length measurement and ulcer duration may help physicians to detect patients with a prognosis of poor healing.

Age Factors↗
PubMed2005

Compression and peri-ulcer skin in outpatients' venous leg ulcers: results of a French survey.

OBJECTIVE: To evaluate concordance with compression therapy in ambulatory patients with venous leg ulcers. METHOD: This was a prospective observational survey conducted in general practice. Consecutive patients with venous leg ulcers about to receive a non-adherent primary dressing and with no contraindication to compression bandaging were selected. At the inclusion visit, size, local aspect of the ulcer and the peri-ulcer skin were scored. Patients were asked about concordance with compression and were given a questionnaire to be completed at home. If patients were seen at a three-week follow-up visit, ulcer and peri-ulcer characteristics and concordance were reassessed. RESULTS: A total of 2842 patients were included, of whom 2532 were re-evaluated at three weeks and 1397 (49%) returned their questionnaire. A compression bandage was already available for 62.9% of these patients, and 62.7% said they used it on a daily basis, 23.3% wore it one or two days per week and 13.7% wore it irregularly or never. There was a statistically significant correlation between concordance with compression and ulcer and peri-ulcer skin severity scores (p < 0.001 and p = 0.042 respectively). At the follow-up visit, concordance with compression therapy improved (80.1% were wearing it regularly). Ulcer, peri-ulcer skin severity scores and ulcer size were significantly lower (p < 0.001) when concordance with compression therapy was good. However, 65.6% of patients considered applying compression very difficult; 45% considered it very unaesthetic and 23% judge wearing it to be very painful, while 9% thought it may worsen their ulcer. CONCLUSION: On a short-term basis, concordance with compression can be substantially improved by simple measures with a clear favourable consequence on both ulcer status and peri-ulcer skin aspect when a non-adherent primary dressing is used. However, the acceptability of compression to patients is poor, and continuous effort is required to convince them of its importance.

Adolescent↗
PubMed2003

Efficacy of Class 1 elastic compression stockings in the early stages of chronic venous disease. A comparative study.

AIM: The aim of this study was to compare the efficacy of Class 1 (10-15 mmHg at the ankle) compression stockings with that of reference stockings of identical appearance during the early stages of chronic venous disease (CVD). METHODS: A prospective multi-center randomized double blind crossover study was conducted on 2 groups of female patients presenting with CVD with a CEAP classification of C1-3SEp As1-5. The efficacy of Class 1 compression stockings was evaluated with respect to global painful discomfort (visual analog scale), each symptom of CVD, the daily behavior of the patient, changes in the volume of the legs, and the functioning of the venous pump (D-PPG). The compliance level of each patient was measured by the number of days that she wore the stockings for at least 6 hours, and tolerance was measured by the reporting of ensuing undesirable events. RESULTS: A total of 125 patients were included in the study and were analyzed for intent to treat. Highly significant differences favoring Class 1 compression stockings were noted with respect to both global painful discomfort and each symptom of CVD with the exception of paresthesia. The relief of symptoms that resulted from the use of the Class 1 compression stockings was twice that which resulted from the use of the reference stockings. Differences that favored the Class 1 compression stockings were also observed with respect to 2 quality-of-life factors (mood and daily work activity). Good compliance in the use of the stockings was reported for 95% of the patients, and tolerance was higher for the Class 1 compression stockings group than for the reference group. CONCLUSION: The regular wearing of Class 1 graduated elastic compression stockings during a 15-day period results in a significant improvement in the symptomatology of early-stage chronic venous disease, i.e., in the relief of global painful discomfort as well as in quality-of-life criteria. A high level of patient compliance in the wearing of the stockings was achieved in this study.

Adolescent↗
PubMed2002

The healing properties of Promogran in venous leg ulcers.

OBJECTIVE: To evaluate the healing rate of venous leg ulcers treated with Promogran. METHOD: Patients with stagnating venous leg ulcers were recruited. Target wounds were > or = 2 cm but < or = 10 cm in any one dimension. Subjects were randomly allocated to receive either Promogran or a non-adherent dressing (Adaptic) with a secondary dressing of gauze followed by short-stress compression (Biflex). Weekly wound assessments occurred over 12 weeks and dressings were changed twice weekly by the investigator and/or nurse team. Planimetry tracings and photographs were blindly reviewed and assessed by two independent investigators. An intent-to-treat analysis was performed. RESULTS: Seventy-three patients were included. Thirty-seven were randomly allocated Promogran and 36 Adaptic. Twenty-nine patients completed the 12-week follow-up visit, 25 healed before week 12 and 19 stopped follow-up before week 12 for reasons unrelated to healing. Significantly more patients in the Adaptic group than in the Promogran group switched to another dressing (22.2% versus 5.4%; p = 0.035). Eleven venous leg ulcers healed in the control group (31%) and 15 in the Promogran group (41%) (p = 0.373). Overall, 15 venous leg ulcers healed or improved in the control group (42%) and 23 in the Promogran group (62%) (p = 0.079). Surface area decreased, on average, by 36.5 +/- 11.4% (median decrease: 44.6%) in the Adaptic group and by 54.4 +/- 10.9% (median decrease: 82.4%) in the Promogran group (p < 0.001). A < or = 20% surface area reduction was observed in 15 patients in the Adaptic group and in seven in the Promogran group (42% versus 19%; p = 0.034). No severe local adverse events were noted in either group, although poor tolerability caused a dressing switch in five patients in the control group and three in the Promogran group. Dressing acceptability was good or excellent in more than 60% of subjects in both groups. CONCLUSION: The results suggest that Promogran may accelerate healing in venous leg ulcers and was well tolerated compared with the current standard of care.

Adult↗
PubMed2001

[Ultrasonography of postoperatively recurrent varicose veins in the area of the short saphenous vein].

STUDY AIM: The aim of this retrospective study was to classify postoperative recurrent varicose veins in the area of the short saphenous vein. PATIENTS AND METHOD: This retrospective ultrasound Doppler exploration was performed in 60 patients (77 limbs) who had been operated with crossectomy, isolated or associated with a stripping of the short saphenous vein, after a mean 9.2-year interval. RESULTS: Recurrences were classified in five categories: 14.8% of the patients had a recurrence in relation to a venous stump at the level of the crossectomy; 32.1% had a saphenous vein in its anatomical location, 21% had reflux due to incompetence; in 28.4%, recurrence was not correlated with the short saphenous vein; and in only 3.8%, there was a pseudo-angiomatosis appearance. In half of these patients, recurrence was related to an incomplete stripping of the short saphenous vein. CONCLUSION: In order to avoid incomplete and inefficient treatments leading to recurrent varicose veins, an ultrasound Doppler exploration is necessary before and after crossectomy and stripping of the short saphenous vein.

Adult↗
PubMed2000

[Esthetic treatment of varicosities].

Telangiectasia is dilatation of the subpapillary venous plexus of the epidermis of the lower limbs, which can lead to aesthetic embarrassment. Before treating telangiectasia, patient history and clinical examination help establishing its origin. It can be with isolated, associated reticular drainage veins, or be part of superficial venous insufficiency. Several types of treatment have been proposed. Microsclerotherapy is the most effective and least costly. Muller's phlebectomy can be performed when telangiectasia is fed by large reticular veins, either afferent or efferent. Treatment by laser and pulsed light appear best reserved to treatment of finer venous dilatations, either complementary or after failure of sclerotherapy.

Electrocoagulation↗
PubMed1998

[Echo Doppler classification of postoperative recurrence of varicose veins in the region of the internal saphenous vein].

OBJECTIVES: Surgical treatment of varicose veins of the lower limbs is frequently complicated by recurrence. Although recurrence was long thought to result from technical errors, certain patients have progressive disease. METHODS: We used duplex-Doppler to assess 102 patients (160 limbs) with recurrence after resection of the saphene-femoral junction with stripping of the internal saphenous vein and the varicose network on the medial aspect of the leg. A vein map was established to classify recurrences. RESULTS: Type I, junctional stump with incontinent collateral, was observed in 22.5% of the cases. Type II, sapheno-femoral junction in an anatomic position, was found in 18.1%. Type III, backward flow from a perforating vein or a collateral of the common femoral was found in 13.1% and type IV, cavemomous aspect, in 7.5%. In 45% of the cases, the patient had a progressive condition with backward flow from collateral branches in the perineal or inguinal area unconnected to the common femoral. DISCUSSION: The cause of recurrent varicose veins is a question of debate: inadequate or incomplete treatment versus disease progression. Due to the chronic and evolutive nature of varicose veins, duplex Doppler exploration is essential for the preoperative work-up. Follow-up examinations should also be performed every year when the clinical examination suggests recurrence.

Adult↗
PubMed1997

[Sclerotherapy section of incompetent short saphenous veins: indications, technique, results].

UNLABELLED: Sclerotherapy section of the long consists of a combination of ligations, with section and injection of the proximal and distal segment of the long saphenous vein. This technique is performed under local anesthesia 10 centimeters from the saphenofemoral junction and can be performed as an outpatient procedure. MATERIALS AND METHODS: Inclusion criteria are incompetent long saphenous vein diameter over 9 millimeters in older patients whose Duplex-scan examination eliminated other leaking points such as anterior or posterior tributaries or the junction, reflux coming from superficial iliac circonflex veins or from vulvo-pudendal varicose veins. Our study concerned 75 patients. 78 limbs were operated, 72 were reviewed after 1 year and 65 after 3 years. RESULTS: 66 of the 72 limbs (91.6%) had an incompressibility without flux or reflux at the sapheno-femoral junction level after 1 year and 59 of the 65 limbs (90.8%) after 3 years. Sclerosis with incompressibility without flux or reflux was observed in the lower third of the thigh in 51 of the 72 limbs (70.8%) after 1 year and in 40 of the 65 limbs (61.5%) after 3 years, without any clinically detectable underlying varicose recurrence. DISCUSSION: This technique is ambulatory and economic and ensures control of sapheno-femoral junction reflux. In the majority of reflux cases, the reflux observed in the lower third of the thigh is related to a Hunter perforanting vein that can feed an underlying varicose network. They were treated by ultrasound-guided ossifying injection. CONCLUSION: The indications for this technique are incompetence of the sapheno-femoral junction in older patients with trophic disorders, allowing effective treatment of the source of the reflux with rapid healing of underlying trophic disorders.

Adult↗
PubMed1996

An ambulatory treatment of varicose veins associating surgical section and sclerotherapy of large saphenous veins (3S technique). Preliminary study with results at one year.

BACKGROUND: The 3S technique enables treatment of large incontinent greater saphenous veins in patients who, for medical or social reasons, refuse traditional surgical methods. It associates phlebectomy with section-ligation and injection of a sclerosing solution in the proximal and distal segments. The 3S technique is merely one stage in the treatment of the saphenous vein, aimed at suppressing reflux, and associated with sclerosis of the junction. It must always be combined with later sclerotherapy sessions. METHODS: One hundred and eight patients were operated on by the 3S technique, of which 100 had 1-year follow-up. Each patient was checked by duplex scan examination before treatment, and 1 month and 1 year after. RESULTS: We obtained good results without reflux in 96% at the sapheno-femoral junction at 1 year. CONCLUSIONS: Superficial venous insufficiency is a chronic disease with evolution or recurrences. To appreciate the efficiency of 3S technique, it will be better to have 5 years worth of follow-up. This is a preliminary study with a short follow-up.

Aged↗
PubMed1992

Influence of estrogens and progesterone on the venous system of the lower limbs in women.

Treatments with estrogens and progestogens are suspected of causing vascular complications either directly or by metabolic consequences. Although many studies have demonstrated an increased incidence of arterial and deep venous thrombosis, since 1970 the dose of estrogens and progesterones have been lowered with a proportional lowering of side effects. After classification of estrogens and progestogens, we studied their peripheral vascular effects. In our study, we demonstrated that the effects of estroprogestogen treatment on the superficial venous system depend on the dose of estrogen and progestogen.

Adult↗
PubMed1990

[Vulvar varices].

Vulval or vulvoperineal varicose veins generally appear in the course of child-bearing under the influence of hormonal impregnation on susceptible terrain. The vulval venous network is drained by the external pudendal veins, collateral with the internal saphenous veins, and by the internal pudendal veins affluent from the internal iliacs. Hormonal influence appears to play a major role in associating estrogen, progesterone, gonadotropin and corticosteroids, which have a lytic action on elastic tissues during motherhood. In the course of pregnancy, functional symptomatology is generally visible from the fifth month. The varices located at the vulva are generally unilateral, and gradually become congestive, appearing as purple protrusions of a soft consistency. After delivery, they are attenuated without usually totally disappearing. Outside pregnancy, clinical manifestations are less frequent and vulvoperineal varices are only revealed by close clinical examination. They are often the causal factor for reflux which, regardless of whether it is associated with incontinence of the saphenous trunks, provokes varicose dilatation of the lower limbs. Differential diagnosis is performed with the post-phlebitic syndrome. Doppler echography allows any participation of the deep venous trunks to be ruled out. Phlebography is reserved for severe angiomatous dilatations of the vulval region. In the non-pregnant patient, treatment consists of sclerotherapy, surgery being reserved for cases refractory to this method. In our direct experience with 386 cases, only 85 females presented isolated vulvoperitoneal varices. Of the 83 patients, treated by sclerotherapy, 63% of the cases have shown no recurrence within the subsequent three years.

Adult↗
PubMed1987

[Prevalence of gastric or duodenal ulcer in patients with arteritis. 100 systematic fibroscopies].

A 19% prevalence rate of gastric or duodenal ulcer was found by systematic fibroscopy in a population of 100 patients with lower limb arteritis hospitalized in a vascular surgery unit. This morbid association raises pathogenic problems which remain unsolved, but peptic ulcers were unevenly distributed throughout this population. Their prevalence was higher in patients under 50 years of age (P less than 0.05) and in those who had trophic disorders and occlusive lesions of digestive tract arteries or progressive coronary disease. Systematic fibroscopy may be justified in these categories of patients, since 7% of those with ulcer were asymptomatic.

Adult↗
PubMed1986

[Thoracic outlet syndrome. Value of non-invasive arterial studies].

The value of non-invasive clinical evaluation of arterial compression at thoracic outlet was evaluated in 150 normal subjects and in 103 patients operated upon (127 sides). The specificity of arm abduction manoeuvres was good for angles of 90 degrees or less. Their sensitivity was poor in forms with neurological symptoms and better in forms with vascular symptoms. In these two forms, their predictive value was excellent (congruent 90%) with angles of less than 90 degrees. Their negative predictive value was mediocre in forms with neurological symptoms. It is concluded that a positive response to manoeuvres at an angle of less than 90 degrees is a strong argument in favour of arterial compression in the thoracic outlet, but that a negative response should not rule out a diagnosis of thoracic outlet syndrome, especially when neurological symptoms are present.

Adolescent↗
PubMedDate not supplied

Leg ulcers and the Urgocell Non-Adhesive wound dressing.

The objectives of this clinical trial were to evaluate the efficacy and tolerance of the Urgocell Non-Adhesive (NA) dressing in the local management of venous or mixed leg ulcers. The study was a non-comparative, prospective, multicentre (15 centres) phase III, clinical trial. The studied population was composed of non-immunodepressed adults presenting a venous or mixed leg ulcer, uninfected, non-cancerous, present for less than 18 months. Patients were followed up for 6 weeks with a weekly visit, including a clinical examination, area tracings and photographs. Evaluation by nursing staff and patients was performed at each dressing changed. Forty-three patients were included, presenting a leg ulcer with a mean surface area of 10.7 cm2. The surface area was reduced by a mean of 38% after 6 weeks of treatment. Four local adverse events were deemed to be related to the tested treatment and acceptability was noted very good for patients and nursing staff. The Urgocell NA dressing, combined with compression therapy, promoted the healing of the chronic wounds under study. The good tolerance and acceptability of the tested dressing were greatly appreciated.

Aged↗