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Biomedical subjects

G Geroulakos

Publications and source records attributed to G Geroulakos.

At least 19 recordsLinked to original sources
PubMed2007

Immediate hemodynamic effect of the additional use of the SCD EXPRESS Compression System in patients with venous ulcers treated with the four-layer compression bandaging system.

OBJECTIVES: To test the hypothesis that the SCD EXPRESS intermittent pneumatic compression applied in combination with a four-layer bandage in patients with venous ulcers increases popliteal vein volume flow and velocity. DESIGN: Twenty limbs of 18 patients with venous leg ulcers were studied, median age 76 years. The Total Volume Flow (TVF) and the Peak Systolic Velocity (PSV) were recorded in the popliteal vein using duplex ultrasonography. Measurements were made (i) without bandage, (ii) with four layer bandage and (iii) following the application of the SCD Compression System on top of a four-layer bandage for at least 15 minutes. RESULTS: The median VCSS was 17 (range, 12-22) while the median VSDS for reflux was 4.5 (range, 1-7.5). The median TVF was 71 mL/min (inter-quartile range 57-101) without bandage, 112 (IQR 89-148) with four-layer bandage and 291 (IQR 241-392) with the addition of the SCD System (P<.001, Wilcoxon signed ranks test). The median PSV was 8.4 cm/sec (IQR 6.8-14) without bandage, 13 (9.0-19) with four-layer bandage and 27 (21-31) with the addition of the SCD System (P<.001, Wilcoxon signed ranks test). Both TVF and PSV increased slightly with the addition of the four-layer bandage. However, with the addition of the SCD System these parameters increased three fold. CONCLUSIONS: The SCD EXPRESS Compression System accelerates venous flow in the legs of patients with venous ulcers already treated with a four-layer bandage. The combination of four-layer compression with the SCD System on healing venous ulcers needs to be tested by a clinical effectiveness study.

Aged↗
PubMed2006

Texture analysis of ultrasonic images of symptomatic carotid plaques can identify those plaques associated with ipsilateral embolic brain infarction.

OBJECTIVES: The aim of our study was to determine the association between objective, computerised texture analysis of carotid plaque ultrasonic images and embolic CT-brain infarction in patients presenting with hemispheric neurological symptoms. DESIGN: Cross-sectional study in patients with 50%-99% (ECST) carotid stenosis. PATIENTS AND METHODS: Carotid plaque ultrasonic images (n=54, 26 with TIAs and 28 with stroke) obtained during carotid ultrasound were normalised and standardised for resolution and subsequently assessed visually for the presence of discrete echogenic or juxtaluminal echolucent components and overall echogenicity (plaque type). Using computer software, 51 histogram/textural features of the plaque outlines were calculated. Factor analysis was subsequently applied to eliminate redundant variables. Small cortical, large cortical and discrete subcortical infarcts on CT-brain scan were considered as being embolic. RESULTS: Twenty-five cases (46%) had embolic infarcts. On logistic regression, grey-scale median (GSM), a measure of echolucency, spatial grey level dependence matrices (SGLDM) correlation and SGLDM information measure of correlation-1, measures of homogeneity were significant (p<0.05), but not grey level runlength statistics (RUNL) Run Percentage (RP), stenosis severity, type of symptoms or echolucent juxtaluminal components. Using ROC curves methodology, SGLDM information measure of correlation-1 improved the value of GSM in distinguishing embolic from non-embolic CT-brain infarction. CONCLUSION: Computerised texture analysis of ultrasonic images of symptomatic carotid plaques can identify those that are associated with brain infarction, improving the results achieved by GSM alone. This methodology could be applied to prospective natural history studies of symptomatic patients not operated on or randomised trials of patients undergoing carotid angioplasty and stenting in order to identify high-risk subgroups for cerebral infarction.

Algorithms↗
PubMed2005

Ultrasound-guided foam sclerotherapy combined with sapheno-femoral ligation compared to surgical treatment of varicose veins: early results of a randomised controlled trial.

AIM: This study is a prospective randomised controlled trial comparing sapheno-femoral ligation, great saphenous stripping and multiple avulsions with sapheno-femoral ligation and ultrasound guided foam sclerotherapy to the saphenous vein. Primary end points were patient recovery period and quality of life and secondary end points frequency of complications on the two arms of the trial and the cost of the treatment. MATERIAL AND METHOD: Sixty patients with primary varicose veins due to GSV incompetence and suitable for day case surgery were randomly allocated to undergo ultrasound-guided sclerotherapy with sapheno-femoral ligation under local anaesthesia (n=30) or sapheno-femoral ligation, stripping and multiple avulsions under general anaesthesia (n=30). The study protocol included history, physical examination, assignment of CEAP class and assessment venous clinical severity score (VCSS), completion of the aberdeen vein questionnaire (AVQ) and colour duplex ultrasound. RESULTS: All treatments were completed as intended. Median time to return to normal activities was significantly reduced in the foam sclerotherapy group (2 days) compared to the surgical group (8 days) (p<0.001, Mann-Whitney). AVQ score was also significantly reduced at 3 months by 46% in the sclerotherapy group, and by 40% in the conventional surgery group (p<0.001, Wilcoxon). The time taken to complete treatment was shorter in the foam sclerotherapy plus SFJ ligation group: 45 vs. 85 min (p<0.001, Mann-Whitney). The overall cost of the procedure in the sclerotherapy group ( 672.97 pounds) was significantly less compared to conventional surgery ( 1120.64 pounds). At 3 weeks, there was no statistical difference in the complication rate between the two groups. At 3 months, median CEAP class dropped from four pre-operatively to one following treatment in both groups and the median VCSS score dropped from five to one in group one and from seven to three in group two (p<0.001, Wilcoxon test). In group one four patients (13%) had a recanalised vein which needed further sessions of foam sclerotherapy, resulting in a short-term closure rate of 87%. CONCLUSION: Ultrasound guided sclerotherapy combined with sapheno-femoral ligation was less expensive, involved a shorter treatment time and resulted in more rapid recovery compared to sapheno-femoral ligation, saphenous stripping and phlebectomies.

Adult↗
PubMed2005

Autologous fashioned graft for aneurysm repair in a contaminated field.

BACKGROUND: In situ synthetic grafts are not routinely used for aortoiliac reconstruction in the presence of active or potential infection, while the use of a venous autologous graft in these circumstances is limited by the size and length of the venous conduit that is required, the superficial femoral vein being most frequently used. METHODS: We describe a new technique in which an autologous venous conduit was constructed with side-to-side anastomosed segments of a longitudinally opened greater saphenous vein. Thus the diameter of the new conduit was increased. RESULTS: This venous graft was successfully used to repair an isolated common iliac aneurysm in a patient with sigmoid cancer, as part of a combined procedure. At 1 year follow-up the venous graft has not shown any signs of dilatation or stenosis on CT scanning. CONCLUSIONS: If validated by further work, our novel graft could be used in cases of intraabdominal graft infections and mycotic aneurysms instead of deep leg veins.

Adenocarcinoma↗
PubMed2005

Improvement of the walking ability in intermittent claudication due to superficial femoral artery occlusion with supervised exercise and pneumatic foot and calf compression: a randomised controlled trial.

OBJECTIVES: To compare the effect of unsupervised exercise, supervised exercise and intermittent pneumatic foot and calf compression (IPC) on the claudication distance, lower limb arterial haemodynamics and quality of life of patients with intermittent claudication. METHODS: Thirty-four eligible patients with stable intermittent claudication were randomised to IPC (n = 13, 3h/d for 6 months), supervised exercise (n = 12, three hourly sessions/week for 6 months) or unsupervised exercise (n = 9). In each patient, initial claudication distance (ICD), absolute claudication distance (ACD), resting ankle brachial pressure index (ABPI), and resting hyperaemic calf arterial inflow were measured before, 6 weeks, 6 months and 1 year after randomisation. Quality of life was assessed with the short form (SF)-36, walking impairment (WIQ) and intermittent claudication questionnaires (ICQ). RESULTS: Compared with unsupervised exercise, both IPC and supervised exercise, increased ICD and ACD, up to 2.83 times. IPC increased arterial inflow (p < 0.05 at 6 weeks) and ABPI. Supervised exercise decreased arterial inflow and increased ABPI (p < 0.05 at 6 months). Unsupervised exercise had no effect on arterial inflow or ABPI. IPC improved significantly the ICQ score and the speed score of the WIQ, while supervised exercise improved the WIQ claudication severity score. At 1 year clinical effectiveness of supervised exercise and IPC was largely preserved. CONCLUSIONS: IPC, by augmenting leg perfusion, achieved improvement in walking distance comparable with supervised exercise. Long-term results in a larger number of patients will provide valuable information on the optimal treatment modality of intermittent claudication.

Aged↗
PubMed2005

Severity of asymptomatic carotid stenosis and risk of ipsilateral hemispheric ischaemic events: results from the ACSRS study.

OBJECTIVES: This study determines the risk of ipsilateral ischaemic neurological events in relation to the degree of asymptomatic carotid stenosis and other risk factors. METHODS: Patients (n=1115) with asymptomatic internal carotid artery (ICA) stenosis greater than 50% in relation to the bulb diameter were followed up for a period of 6-84 (mean 37.1) months. Stenosis was graded using duplex, and clinical and biochemical risk factors were recorded. RESULTS: The relationship between ICA stenosis and event rate is linear when stenosis is expressed by the ECST method, but S-shaped if expressed by the NASCET method. In addition to the ECST grade of stenosis (RR 1.6; 95% CI 1.21-2.15), history of contralateral TIAs (RR 3.0; 95% CI 1.90-4.73) and creatinine in excess of 85 micromol/L (RR 2.1; 95% CI 1.23-3.65) were independent risk predictors. The combination of these three risk factors can identify a high-risk group (7.3% annual event rate and 4.3% annual stroke rate) and a low risk group (2.3% annual event rate and 0.7% annual stroke rate). CONCLUSIONS: Linearity between ECST per cent stenosis and risk makes this method for grading stenosis more amenable to risk prediction without any transformation not only in clinical practice but also when multivariable analysis is to be used. Identification of additional risk factors provides a new approach to risk stratification and should help refine the indications for carotid endarterectomy.

Brain Ischemia↗
PubMed2005

Antegrade revascularisation for chronic visceral ischaemia.

There is no consensus of opinion on the best surgical approach for the management of chronic visceral ischaemia. The antegrade revascularisation has several advantages. It provides an excellent exposure of the supraceliac aorta, the option of originating the bypass from several areas of the distal thoracic and supraceliac aorta that is usually spared of atherosclerosis and the bypass is placed in the direction of normal blood flow (antegrade direction). The supraceliac aorta can be approached through an abdominal or a low thoracoabdominal extraperitoneal route. The results on several series indicate that it is a durable and effective technique.

Abdominal Pain↗
PubMed2005

Measuring the impact of venous leg ulcers on quality of life.

OBJECTIVE: To identify health-related quality-of-life (HRQoL) issues in patients with venous leg ulcers, with the aim of generating items for a treatment outcome measure. METHOD: Thirty-eight patients with venous leg ulcers were interviewed by a psychologist using a semi-structured guide; they also completed a HRQoL questionnaire (modified Skindex). Data from the questionnaire were examined to explore the impact of venous leg ulcers on patients' lives. Interview transcripts were analysed using qualitative methods to identify additional venous leg ulcer-specific HRQoL items. RESULTS: Skindex scores indicated that older patients had worse HRQoL (p<0.05), as did those with pain and non-healing ulcers. Ulcer duration and size did not correlate with HRQoL. Interviews revealed the following effects of ulceration: pain (80.5%); itching (69.4%); altered appearance (66.7%); loss of sleep (66.6%); functional limitation (58.3%); and disappointment with treatment (50%). Based on the interview transcripts, items were generated and discussed with an expert panel, with a view to including them in a venous leg ulcer-specific HRQoL questionnaire. CONCLUSION: Disease-specific HRQoL outcome measures should be considered when evaluating treatments for venous leg ulcers.

Activities of Daily Living↗
PubMed2005

Factors associated with mortality in patients with asymptomatic carotid stenosis: results from the ACSRS Study.

AIM: This study determines the factors associated with mortality in patients with asymptomatic carotid stenosis. METHODS: Patients (n=1,101) with asymptomatic internal carotid artery stenosis greater than 50% in relation to the bulb diameter were followed up for a period of 6 to 84 (median 38) months. Stenosis was graded using duplex scanning and expressed as a percentage of the carotid bulb diameter. Clinical and biochemical risk factors were recorded. The end-points were ipsilateral ischemic stroke, cardiovascular death and all cause mortality. RESULTS: In a Cox multivariate analysis 6 factors emerged as independent predictors of risk. Age, male gender, cardiac failure, left ventricular hypertrophy on electrocardiogram (ECG) and myocardial ischemia on ECG were associated with increased risk. Antiplatelet therapy was associated with decreased risk. Based on these risk factors a high-risk group consisting of one third of the population with a 40% cumulative cardiovascular death rate and a 66% all cause death rate at 7 years could be identified. The remaining 2/3 consisted of a low-risk group with a 10% cumulative cardiovascular death rate and a 21% all cause death rate at 7 years (P<0.0001 compared to the high risk group). There was not any significant difference in the cumulative ipsilateral stroke rate, which was 12% in the low and 13% in the high cardiovascular risk group (Log Rank P>0.05). CONCLUSIONS: The methodology and findings from the ACSRS natural history study need to be applied to randomized controlled trials on the value of carotid endarterectomy or stenting in patients with asymptomatic carotid stenosis. They may help refine the indications for intervention in patients with carotid endarterectomy.

Cardiovascular Diseases↗
PubMed2005

Comparison of two intermittent pneumatic compression systems. A hemodynamic study.

AIM: Sequential leg compression has been previously shown to be superior to uniform compression. The aim of our study was to compare the hemodynamic effectiveness of the portable sequential compression device (SCD Express Compression System, Tyco Healthcare Group LP, Mansfield, MA, USA) with a rapid inflation device (VenaFlow, Aircast, Inc, Summit, NJ, USA). The former, by sensing venous refill time, commences compression when the calf veins are refilled. METHODS: The two devices were tested in 12 normal volunteers in the semirecumbent position using duplex ultrasound. Baseline and augmented flow velocity and volume flow were measured at the level of the common femoral vein, above the saphenofemoral junction. Refilling time was determined from velocity recordings of the common femoral vein. Total and peak volume of blood expelled per hour during compression were calculated using flow data and the individual cycling rate. RESULTS: Both devices increased venous flow velocity, up to 3.8 times the baseline (all P<0.001). Refill time of the rapid inflation device was shorter in comparison with the sequential compression device (15+/-2.2 vs 25+/-4 s; P<0.001), suggesting incomplete vein evacuation. The sequential compression device, by augmenting flow throughout a significantly longer compression period per cycle (10.9 s vs 6.3 s), expelled significantly more venous blood (121+/-68 vs 81+/-63 mL; P<0.001). Similarly, the total volume of blood expelled per hour with the sequential compression device was 100% higher than the rapid inflation device (9685+/-5426 vs 4853+/-3658 mL; P<0.001). Although peak velocity enhancement was higher with the rapid inflation device, flow augmentation (a product of average blood flow velocity) was comparable (669+/-367 vs 771+/-574 cm/s; P=0.223) with the sequential compression device, mainly because the rapid inflation device failed to maintain flow enhancement beyond the initial flow surge. CONCLUSIONS: Sequential compression showed hemodynamic superiority compared to a rapid inflation device. This was enhanced further by the sensing of refill time, which resulted in more compression cycles over time. The relative efficacy of the two devices in deep vein thrombosis prevention should be tested in future studies.

Blood Flow Velocity↗
PubMed2004

Economy class stroke syndrome: case report and review of the literature.

OBJECTIVES: Venous thromboembolism associated with travelling, or economy class syndrome, is increasingly recognised as a sequence of long haul flights and so paradoxical cerebral embolism through a patent foramen ovale. Materials and methods. We present a new case of economy class stroke syndrome and review of the literature using MEDLINE search. RESULTS: Literature review identified 12 additional cases. In most of them, stroke occurred in close approximation with landing of the aircraft following a long-haul flight. Venous thromboembolism was present in 58%, while a patent foramen ovale was diagnosed with contrast echocardiography in all but one case. Our case presented with severe left hemispheric stroke, and significant delay, two days after a long-haul flight. CONCLUSIONS: The small number of reported cases indicates either the rarity of this entity or unawareness of its existence. The true incidence of this condition remains unknown. However, because of treatment implications such as the need to treat venous thromboembolism or close the patent foramen ovale, clinicians should be aware of this entity.

Aerospace Medicine↗
PubMed2003

Flight microangiopathy on long-haul flights: prevention of edema and microcirculation alterations with Venoruton.

The aim of this study was the evaluation of the effects of Venoruton (HR) on the prevention and control of flight microangiopathy and edema in subjects with varicose veins flying for more than 7 hours. A group of 80 patients with varicose veins, edema, and initial skin alterations due to chronic venous hypertension were included. Measurements of skin laser Doppler (LDF) resting flux (RF), PO2 and rate of ankle swelling (RAS), were made before and after the flights (within 2 hours before the flights and within 2 hours after the flights). The length of the flights was between 7 and 9 hours; all seats were in coach class. The two groups (treatment and control) were comparable for age and sex distribution. The variation (decrease) in PO2 was significant in both groups. In subjects treated with HR the decrease in PO2 was smaller (p < 0.05). The decrease in LDF-RF was significant in both groups with a higher flux at the end of the flight in the treated subjects (p < 0.05). The venoarteriolar response was decreased at the end of the flights. The decrease was less evident in the treatment group (p < 0.05). The increase in RAS was significant in the control group while it was limited in the HR group. In conclusion, HR is useful for reducing the increased capillary filtration and in controlling edema in patients with chronic venous disease in long-haul flights. HR is effective to control flight microangiopathy associated with edema.

Adult↗
PubMed2003

Prevention of venous thrombosis with elastic stockings during long-haul flights: the LONFLIT 5 JAP study.

The aim of this study was to evaluate deep venous thrombosis (DVT) prophylaxis with specific elastic stockings in long-haul flights (11-13 hours), in high-risk subjects. A group of 300 subjects was included; 76 were excluded for several problems including concomitant treatments; 224 were randomized into two groups (stockings vs. controls) to evaluate prophylaxis with below-knee stockings. An exercise program was used in both groups. Scholl (UK) Flight Socks (14-17 mmHg of pressure at the ankle) were used. DVT was diagnosed with ultrasound scanning. The femoral, popliteal, and tibia] veins were scanned before and within 90 minutes after the flights. Of the 205 included subjects, 102 controls and 103 treated subjects completed the study. Drop-outs were due to flight connection problems. Age, gender, and risk distributions were comparable in the two groups. In the treatment group (103 subjects; mean age, 42; SD 9; M:F, 55:48), one limited, distal DVT was observed (0.97%). In the control group (102 subjects; mean age, 42.1; SD 10.3; M:F, 56:46), six subjects (5.8%) had a DVT. There were no superficial thromboses. The difference in DVT incidence is significant (p<0.0025; six times greater in the control group). Intention-to-treat analysis counts 18 failures in the control group (12 lost to follow-up + six thromboses) of 112 subjects (15.8%) versus eight failures (7.3%) in the treatment group (p<0.05). The tolerability of the stockings was very good and there were no complaints or side effects. All events were asymptomatic. Considering these observations, Scholl Flight Socks are effective in reducing the incidence of DVT in high-risk subjects.

Adult↗
PubMed2003

[Treatment of a femoral venous aneurysm with foam-sclerotherapy].

Venous aneurysms are uncommon. Venous dilatation and large varices could be treated with injections of foam and sclerosing agents followed by local compression which obliterate or thrombose the aneurysmal space. However, the use of foam-sclerotherapy to obliterate venous aneurysms has never been reported before. The obstruction or sclerosis of the aneurysmal space should be obtained without altering the femoral flow. The patient is a 65-year old lady without history of trauma involving the femoral region. A compressible lump is present at the third, internal part of the left femoral fold. The lump is painless and easily obliterated by compression. Color duplex shows a large cavity (4 x 4 x 6 cm) and venous flow is visible. Flow produces a venous jet, visible with color and ejecting from the common femoral vein. A first injection is made under ultrasound guide using a foaming agent: 10 ml of foam including 4 ml of 3% sclerosing solution are injected. During the injection the femoral vein is compressed with the probe to avoid passage of the sclerosing foam into the femoral vein. After 2 weeks, ultrasound indicate only a partial occlusion of the aneurysm. The procedure is repeated and after 2 more weeks the ultrasound scan shows a complete occlusion of the aneurysm. The femoral vein and the long saphenous vein are patent. After 12 weeks the situation is unchanged and the results appear to be permanent. This new method, never described before is an important, minimally invasive method in case of venous aneurysms. Results from larger studies should be available to define indications and modalities of treatment.

Aged↗
PubMed2003

The Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study. Aims and results of quality control.

AIM: The results of the Asymptomatic Carotid Atherosclerosis Study (ACAS) study have provided the first scientific evidence that in patients with asymptomatic carotid stenosis greater than 60% carotid endarterectomy reduces the risk of stroke from 2% to 1% per year. The implications are that approximately 20 operations need to be performed in order to prevent 1 stroke in 5 years. The aims of the Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study are to identify a subgroup or subgroups at a risk for stroke higher than 4% and a group at a risk for stroke less than 1% per year using systemic and local risk factors (plaque characterization) in addition to the degree of stenosis. The aim of this paper is to present the protocol and the results of the quality control. METHODS: The ACSRS is a multicentre natural history study of patients with asymptomatic internal carotid diameter stenosis greater than 50% in relation to the bulb. The degree of stenosis is graded using multiple established ultrasonic duplex criteria. In addition, ultrasonic plaque characterization is performed and clinical risk factors and medications are recorded. Training is provided centrally. All carotid ultrasound examinations are recorded on video-tape which together with CT-brain scans and ECG are analysed at the coordinating centre with feedback information to partner centres. RESULTS: The video recordings and analysis of data centrally with feed back information have provided quality control with a significant improvement not only in the completion of data forms but also in the grading of internal carotid stenosis and plaque recordings using ultrasound. CONCLUSION: The high level of quality of data collected will add credibility to the results of the ACSRS study and may eventually promote the development of international standards of plaque imaging and characterization.

Carotid Artery, Internal↗
PubMed2002

The role of platelets in peripheral arterial disease: therapeutic implications.

Peripheral arterial disease (PAD) is associated with platelet hyperaggregability as well as an increase in morbidity and mortality from myocardial infarction and stroke. Enhanced platelet activation in PAD may substantially contribute to these adverse outcomes. A relative resistance to aspirin therapy has been reported in patients with PAD. Therefore, clopidogrel may be superior to aspirin in treatment of PAD. Furthermore, the aspirin + clopidogrel combination could be more effective than monotherapy but its risk-benefit ratio has yet to be evaluated. Clopidogrel is preferable to ticlopidine because of its safer profile and the convenience of once-daily administration. The glycoprotein (Gp) IIb/IIIa inhibitors may also find a place as short-term therapy after peripheral angioplasty. There is a need to consider the use of clopidogrel in patients who cannot tolerate aspirin. Patients who have an event while taking aspirin also present a problem. One possibility here is to substitute aspirin with clopidogrel or to add clopidogrel to the aspirin. Although these options are currently not evidence based in patients with PAD, there is emerging evidence showing that they are realistic choices.

Aspirin↗