[Prospective 5-year follow-up study of hemodynamic and clinical parameters following deep leg/pelvic vein thrombosis].
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Noninvasive diagnosis of chronic diseases of the lower limb venous system is an urgent problem of modern phlebology. Ultrasonic examination (USE) makes it possible to judge adequately the condition of the deep and surface veins and, consequently, to improve significantly the management of varicose and post-thrombophlebitic diseases. The authors elaborated an original method for the diagnosis and appraisal of the condition of the lower limb venous system by means of ultrasonic scanning and various functional tests for determining the character of affection of the venous valvular apparatus. Examination of more than 200 patients with primary varicosities and post-thrombophlebitic disease, the use of highly-resolving ultrasonic equipment, and comparison of the results of USE with the findings of radiocontrast phlebography (agreement in 99.8% of cases) allow the conclusion that noninvasive ultrasonic methods must be used widely in appraising the venous status in patients with chronic diseases of the venous system of the lower limbs.
In subjects with lymphatic problems and postphlebitic edema there is a significant difference in the ratio between lymphatic and plasma concentration of protein (CL/CP) in the foot. Two groups of patients were studied (one group with lymphedema and the other with postphlebitic limbs) in order to assess the CL/CP ratio before and after TTCFA treatment (Centellase). The study confirmed the efficacy of treatment in achieving a significant reduction of CL/CP and distal edema.
The general structure and cell composition of the inguinal lymph nodes has been analysed at a direct endolymphatic antibiotic therapy, performed with the aim of prophylaxis of suppurative complications, when surgical interventions are performed in the vessels of the lower extremities. Morphokinetics of the lymph nodes depends on duration of the endolymphatic therapy. During early terms it reflects an increase in transport function of the regional inguinal lymph nodes, during late terms it reflects an increase in their immune role. In the lymph nodes, situating on the contralateral side, an analogous reaction is revealed; this appears to demonstrate presence of well developed collaterals between lymph vessels of the lower extremities.
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As distinct from the classical Palme-D'Esperon operation in which the anastomosis is established with the common femoral vein, the authors prefer to form the anastomosis in the region of the saphenofemoral communication in inadequate drainage in the iliofemoral segment in patients with the postthrombotic disease. Seven variants of crossed femorofemoral shunting (CFFS) were carried out. The anastomoses were formed by means of precision techniques; an operating microscope was used when the anastomosis measured less than 5 mm in diameter. The CFFS was found to be patent in follow-up periods of up to 2.5 years in all cases. From analysis of the late-term results of CFFS, the authors claim that functional block of venous drainage from the femoro-iliac segment, rather than anatomical occlusion, is the indication for this operation.
It is reported about the plantar LRR. This modification of the malleolar LRR distinguishes venous healthy from venous patients like the malleolar procedure. By the plantar procedure LRR becomes possible in cases where malleolar LRR is not performable like in larger leg ulcers and lymphedemas. The evaluation of plantar LRR has to regard changed normal values i.e. a prolonged refilling time and an increased delta R.
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A controlled double-blind clinical trial was performed comparing therapeutic efficacy of hidrosmin versus diosmin in patients suffering from chronic venous insufficiency with varicose symptomatology in the inferior limbs. Ten patients were treated with hidrosmin and other 10 with diosmin randomly. The controls carried out during the trial were as follows; basal control before the beginning of the trial and therapeutic controls on days 15, 30, 60 and 90 of the study. With that aim clinical examinations and different explorations were performed: physical exam, phlebography, electrocardiogram, ophthalmological examination and biochemical analyses (hemogram, globular sedimentation rate, platelet counts, etc.). The clinical therapeutic efficacy of hidrosmin in the treatment of chronic venous insufficiency of inferior limbs was superior to the diosmin in most of the studied parameters even though a lower posology was employed. From a clinical point of view the clinical improvement in the subjective symptomatology (heaviness, local tenderness, cramps, paresthesias, etc.) was very superior to the one obtained with the objective signs (phlebography, skin trophism, evolution of the edema, etc.). No significative adverse reactions appeared.
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The authors carried out an epidemiological study on a group of 10032 patients with chronic venous insufficiency, composed of 2686 males (26.77%) and 7346 females (73.23%). The case report is divided into varicose diseases (83.30%) and sequelae of deep vein thrombosis (16.70%). As well as the relationship between sex and age is considered rate of dermatological complications, with regard both to the type of venous diseases (65.54% varicose and 34.46% post-thrombotic) and to their clinical manifestations. As well as any family connection, various environmental factors are taken into account such as the patient's work, noxae iatrogenic, pregnancy and obesity.
Late post-thrombotic complaints after subclavian vein thrombosis are reported with highly varying frequencies (8-80% severe disability). The therapeutic approach depends partly on this frequency. With the aim to evaluate late sequelae a questionnaire was answered by 26 patients with arm-shoulder symptoms leading to arm phlebography, but where the examination did not reveal any thrombi. 65% had remaining symptoms 2-9 years after the examination. 3 had to change profession. 36 patients with phlebographically shown subclavian vein thrombosis answered the same questionnaire. Only 9 (25%) had remaining symptoms and in 4 it was classified as mild, in 4 as moderate and only in 1 patient as severe leading to change of profession. Venous haemodynamics in the upper extremity were also studied in 3 groups of patients; I) healthy volunteers (n = 16 arms), II) patients with arm-shoulder disabilities with negative arm phlebography (n = 7 disabled arms, n = 7 non-disabled arms), III) patients with phlebographically verified subclavian vein thrombi (n = 10 arms with DVT, n = 8 arms without DVT). Strain gauge plethysmography was used measuring venous capacity and maximal venous outflow. Venous pressure measurements were made both with the arms in a resting position and in a military position with and without work-load. Repeat phlebography of arms with symptoms were made. Maximal venous outflow was significantly lower in arms with previous subclavian vein thrombi (p less than 0.05) and venous pressure measurements with the arm in military position was significantly higher in those arms. However, no correlation between these measurements and the degree of arm disability was noted.(ABSTRACT TRUNCATED AT 250 WORDS)