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At least 739 records · Page 41Linked to original sources
PubMed1994

[The role of skin transplantation in the treatment plan of venous (post-thrombotic) varicose ulcer].

Under both inpatient and outpatient conditions several skin grafting techniques (eg. split-skin meshgraft, postage stampgrafts) can be useful in treating already phlebosurgically operated venous ulcers. 82 already phlebosurgically longterm treated venous ulcers were skin grafted under clinical conditions in the time from 1983 to 1992. Various characteristics of this patient-group (eg. age, sex, duration of disease, localization and size of venous ulcer) were put retrospectively into comparison with those of 72 patients suffering from venous ulcers treated exclusively in a conservative manner. Patients of the skin grafted group - aged mostly 55 to 65 years - suffered longer from chronic venous ulcers, of which 15 were circulatory. The time interval between clinical admission and skin grafting (16th to 28th day), the index of healing dependent indicator for the dermato-surgical intervention, as well as short and long term results, were investigated. In contrast to favourable short term results (39 patients with complete, 17 with > 50% settlement of skin graft) long term results were rather disappointing. 27 of 39 operated patients with initially successfully treated venous ulcers answered a questionnaire in which, as a result, only 15 did not suffer a relapse one to nine years after the dermatosurgical intervention. Despite of these results, simple techniques of skin grafting will still be in future of great value.

Aged↗
PubMed1994

[The microcirculatory activity of Centella asiatica in venous insufficiency. A double-blind study].

In 87 patients with chronic venous hypertensive microangiopathy the efficacy of oral FTTCA (Centella asiatica) administered for 60 days was tested. The microcirculatory effects of two dosages (30 mg bid and 60 mg bid) versus placebo was assessed in a double blind study. The compound was well tolerated and no unwanted effects were observed. Microcirculatory parameters--peri-malleolar skin flux at rest (RF) and transcutaneous PO2 and PCO2--improved as did the abnormally increased RF, PCO2 decreased and PO2 increased in comparison with values measured at inclusion. These results confirm the efficacy of FTTCA in venous hypertensive microangiopathy. Furthermore the effects of FTTCA appear to be dose-related.

Adult↗
PubMed1994

[Anatomo-topographic basis for operations of transposition of the superficial femoral vein in post-thrombophlebitic disease of the lower extremities].

Post-thrombophlebitic disease of the lower limbs may be occlusive, (2%), recanalized (54%), and mixed (44%) in character. Operations for restoration of the normal flow of blood cannot remove the retrograde flow in veins with destroyed valves. Many variants of valve restoration have been suggested. The simplest among them are transplantation of the superficial femoral vein, the lateral circumflex femoral vein, and the great saphenous vein. The anatomical structure of the lower limb venous system was studied on the corpses of humans without venous pathology. In most cases the deep femoral vein was found to have one valve (46.8%), two (30.6%), and three (12.8%) valves. Valves were found at a distance of 1.0 to 4.5 cm from the site of drainage of the deep femoral vein into the superficial vein in 48.35% of cases, 43.5% had a sufficient diameter (0.6 cm). Thus, implantation of the superficial femoral vein into the deep vein can be conducted in less than half of the patients. Study of the anatomy of the lateral circumflex femoral vein showed that the operation can be performed in 9.6% of cases. The great saphenous vein is the main route of blood drainage in post-thrombophlebitic disease. Its use as a valvular protection is very risky. It should also be taken into account that in post-thrombophlebitic disease the great saphenous vein is dilated and marked by relative venous incompetence. Though they are relatively simple, these operations, can be therefore, performed in less than half of the patients. Examination of patients should include ultrasonic angioscanning and retrograde transfemoral phlebography, which allow precise determination of the anatomical features of the lower limb venous system in each patient.

Cadaver↗
PubMed1994

[Venous post-thrombotic disease].

Venous post-thrombotic disease is a common complication of deep venous thrombosis of the lower limbs. Prevalence is around 75% after a five-year follow-up and 25% of these patients suffer from severe disorders. The clinical symptoms are non-specific and begin months or years after the acute thrombosis. The patients' claims range from uncomplicated oedema, leg cramps and superficial varicose veins to permanent skin changes (dermatitis, hypodermatitis, leg ulcers). Functional vascular exploration (continuous-wave Doppler, plethysmography, pulsed-wave echo-Doppler, exceptionally venography) allows a better knowledge of the haemodynamic consequences of the post-thrombotic disease: deep persistent truncular obstruction, partial or total recanalization, valvular incompetence and reflux in the deep veins, superficial varicose veins, incompetence of the perforating veins in the gaiter area, failure of the calf venous pump and microangiopathy.

Humans↗
PubMed1993

Results of venous thrombectomy in the treatment of deep vein thrombosis.

Despite the infrequent use in the United States, venous thrombectomy seems to have a beneficial effect in carefully selected patients with acute iliofemoral thrombosis. The final decision to proceed with venous thrombectomy should be based on a balanced analysis of two factors--the characteristics of the thrombus and the characteristics of the patient. First, the diagnosis of acute deep vein thrombosis must be unequivocally established preoperatively. Accurate anatomic localization is usually achieved with venography, but duplex Doppler examination may be sufficient in selected instances. Second, the distribution of thromboses should be determined. Venous thrombectomy should be considered only in instances of deep vein thrombosis involving the iliofemoral venous segment. Thrombectomy for venous thrombosis below the inguinal ligament has not been consistently beneficial. Third, the age of the thrombus should be estimated. This can usually be accomplished though a careful analysis of the clinical history, but may be corroborated by duplex Doppler or venographic features of the thrombus. Venous thrombectomy should rarely be attempted if the age of the thrombus is thought to be greater than 72 hours. Unfortunately, in many instances the clinical history substantially underestimates the actual age of the underlying thrombus. Fourth, patient characteristics must be assessed preoperatively. While venous thrombectomy can usually be accomplished using local anesthesia, substantial shifts in fluid and acid base balance may be poorly tolerated by elderly, frail patients. In the setting of widespread metastatic disease, rethrombosis rates may be too high to justify thrombectomy in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Femoral Vein↗
PubMed1993

[Correlation between an occupational accident and death 55 years later. Evidence despite 2 1/2 months burial--a contribution to the value of insurance medicine autopsy also after exhumation].

Analysis of 24 autopsy cases ordered by insurances and performed at the Institute of Legal Medicine, Johannes Gutenberg University, Mainz (FRG), in the years from 1985 to 1991 revealed that even if there was a long period of time between accident and death (average: 20.3 years; maximum: 55 years) and in cases of exhumation necropsy was a useful tool in checking the relative's claim to insurance premium. Nevertheless post mortem examination should be performed as soon as possible to ensure evident pathomorphological findings and to avoid unjustified waiting periods with economical problems (e. g. case report: 78 years old widow couldn't pay electricity and call charge; she had a right to a pension due to an accident of her husband 55 years before, proved by exhumation 2 1/2 months after death.

Accidents, Occupational↗
PubMedDate not supplied

[Value of thrombolytic therapy in deep venous thrombosis].

Thrombolytic therapy in a large number of patients may prevent post-thrombotic symptoms occurring as late consequences of deep vein thrombosis. In clinical studies, streptokinase either in conventional low dose, longterm, intravenous or in repeated intravenous short term ultra high dose regimens, urokinase and recombinant tissue-type plasminogen activators: all these plasminogen activators have been confirmed to successfully restore the patency of veins. As deep vein thrombosis generally extends over longer distances and are mostly older before being diagnosed, a lysing period of a couple of days must be taken into account. On the other hand, deep vein thromboses aged more than 2 weeks generally are no longer amenable to thrombolytic treatment. Due to their lack of short-term and long-term hazards, thromboses of the arms and the lower legs are not regarded an ideal indication for thrombolysis. Up to now, none of the currently available plasminogen activators has demonstrated superiority over the others, neither in respect of efficacy nor safety. With streptokinase intermittent intravenous ultra-high doses success rates of up to 80% (complete plus partial recanalization) can be achieved within a three-day treatment period. For its accompanying increased hazard of fatal pulmonary embolism, however, it is considered to be contraindicated in patients with pelvine thrombosis. Furthermore, contraindications to streptokinase such as streptococcal infections and prior lysis with streptokinase should always be kept in mind. In these cases streptokinase may be substituted by rt-PA, which, however, in the indication of deep vein thrombosis, is still not well documented today.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Coagulation Tests↗
PubMed1993

[Value of nuclear magnetic resonance tomography in leg edema of unknown origin. Preliminary report].

Edemas of the leg sometimes pose problems for diagnosis. Invasive procedures like lymphography or phlebography are either difficult to perform or might endanger the lymphatics. The value of magnetic resonance imaging was assessed in 20 patients with lymphedema, lipedema and phlebedema. Images of patients with lipedema showed homogenous enlarged subcutaneous tissue. In lymphedema a honeycomb pattern in the subcutaneous tissue was observed; in phlebedema there was an increase of fluid within the muscle. Magnetic resonance imaging is useful in differentiating lymphedema, lipedema or phlebedema.

Adipose Tissue↗
PubMed1993

[Venous thromboembolic disease].

Prevention and treatment of venous thrombosis and pulmonary embolism have improved dramatically in the last few years owing to: 1) better control of the coumarin activity with the International Normalized Ratio system; 2) appearance on the market of the low-weight molecular heparins and enlargement of their field of prescription; 3) indications of thrombolysis in severe pulmonary embolism; 4) availability of inferior vena cava filters, effective in preventing recurrent pulmonary embolism.

Anticoagulants↗
PubMed1993

[Color-coded duplex ultrasound and contrast medium enhanced duplex ultrasound in deep venous thrombosis].

Even with highly developed ultrasound systems, diagnosis of deep leg vein thrombosis is difficult in lower leg veins and in the area of the adductor channel. In order to evaluate color duplex-sonography, contrast media duplex-sonography and phlebography in comparison, 79 patients (38 men and 40 women aged 54 to 89) with deep leg vein thrombosis were examined. As a result, patients suffering from thrombosis were characterized by a vein-artery quotient of > 2.0 (p < 0.01). In color Doppler duplex-sonography false negative findings occurred in 12 cases of lower leg vein thrombosis and in 3 cases of thrombosis within the adductor channel. By contrast media duplex-sonography the diagnostic reliability could be increased to a sensitivity of over 95 per cent.

Aged↗
PubMed1992

[The diagnosis and treatment of postthrombotic disease].

A 10-year experience in the analysis of stationary examination and treatment of 163 patients with post-thrombotic disease of lower extremities is given in this article. Surgical treatment was conducted in 102 cases, medical treatment was applied for 61 patients. There is a classification of diseases which defines medical tactics. On the basis of the data obtained during these studies the authors make a conclusion that in cases of varicose, indurative of indurative-ulcerated forms of this disease surgical treatment is indicated in the accordance with the character of vein affection. Otherwise, it is more preferable to apply medical treatment in cases of eodemata.

Adult↗
PubMed1996

Influence of healing on the disturbed blood flow regulation in venous ulcers.

Cutaneous blood flow regulation is disturbed in severe chronic venous insufficiency (CVI). The feedback system between the transmural pressure in the postcapillary venules and the precapillary resistance regulating arterioles has gone awry. The upregulated control system causes "luxus"-hyperperfusion. In this study laser Doppler fluxmetry was performed in 6 patients' florid venous ulcers (U) and later in the former ulcer area after healing (H) and in the inner ankle area of 12 healthy volunteers (C). Laser Doppler flux (LDF) changes were measured with the leg elevated and lowered as well as after arterial and during venous occlusion. The results proved a diminished (p < 0.01) flux increase with the leg elevated (U: LDF = -9%, H: LDF = 3.1%, C: LDF = 80%) and after arterial occlusion (U: LDF = 1.3%, H: LDF = 0%; C: 189.6%) in severe CVI both in florid ulcers and after healing. The ability to reduce flux when transmural pressures were increased remained. Leg lowering reduced flux by 46.4% in ulcers and by 36.8% after healing. This postural response to high transmural pressures, however, seemed weakened compared to controls, where LDF decreased by 65.8%. Our findings suggest that the postural feedback system remains disturbed and upregulated even after a venous ulcer has healed.

Adult↗
PubMed1996

[The results of correcting venous insufficiency and disorders of the peripheral lymph circulation in postthrombotic disease].

Isolated correction of venous component of chronic lymph-venous insufficiency by a way of dressing of perforated veins, extravasated correction of valves of deep veins and femoral cross shunting (24 patients of control group), and also combined correction, supposing the same operations in combination with creation lymph-venous anastomosis (22 patients of main groups) at infringement of peripheric flow of lymph and venous insufficiency in patients with edematous form of posttraumatic diseases have been carried. The complex estimation of efficiency of operative treatment on subjective and objective attributes of illness is offered. Direct and remote postoperative results proved to be more preferable in main group.

Adult↗
PubMedDate not supplied

[Physical factors in the combined treatment of patients with postthrombophlebitic disease of the legs].

95 patients with postthrombophlebitis affection of the lower limbs were treated according to three schemes: conventional therapy alone (anticoagulants, anti-inflammatory therapy, etc.), training of collateral circulation plus minimal standard chemotherapy, training of collateral circulation plus local and endovasal laser radiation plus minimal standard chemotherapy. A total of 75 patients were treated (27, 32 and 36 patients of group 1, 2 and 3, respectively). The best results were achieved in group 3.

Adult↗