Prospective randomized controlled trial: conventional versus powered phlebectomy

OBJECTIVES: Transilluminated powered phlebectomy (TriVex) is a new surgical technique that uses tumescent dissection, transillumination, and powered phlebectomy. The purpose of this study was to compare TriVex with conventional varicose vein surgery in terms of pain, cosmesis, recurrence, complications, and operating time. METHODS: One hundred eighty-eight limbs in 141 patients (33 men, 108 women; mean age, 42.5 years) with varicose veins were randomised to conventional (n = 100) or TriVex (n = 88). Exclusion criteria were venous ulceration or deep venous disease. Varicosities were graded with CEAP and clinical assessment (grades 1-3), and were similar in both groups. Randomization was single blinded. Long or short saphenous vein ligation or stripping was performed as indicated with duplex scanning. Operative time was from skin incision to leg bandaging. Phlebectomy was performed with conventional stab avulsions or TriVex. Patients completed assessment forms preoperatively and postoperatively (2, 6, 26, 52 weeks), and this was supplemented with physician clinical evaluation. Pain was assessed with visual analog score. RESULTS: There was a significant difference in the number of incisions for phlebectomy in the two groups (conventional, n = 29; TriVex, n = 5; P <.0001). TriVex was faster in the grade 3 (extensive) group, but this did not reach statistical significance. There was no difference in mean postoperative pain score over 8 days in the two groups (P =.4624). At 2 weeks there was no significant difference between the groups with regard to bruising (P =.77), cellulitis (P =.33), and numbness (P =.33). At 6 weeks there was no significant difference between the groups with regard to nerve injury (P =.97), residual veins (P =.79), cosmetic score (P =.837), and overall satisfaction (P =.878). At 6 and 12 months, there was no significant difference in cosmesis (P =.955, P =.088, respectively) or recurrence (P =.27, P =.11, respectively). CONCLUSIONS: TriVex is a safe and effective method for excision of varicosities and compares well, after a learning curve, with conventional surgery in regard to complications and recurrence. It has the advantage of a trend toward reduced operating time in extensive varicosities, and significantly fewer incisions, although there was no perceived difference in cosmesis during follow-up.     

Seronegative and seropositive rheumatoid arthritis: radiographic differences

Patients with seronegative and patients with seropositive rheumatoid arthritis (RA) have clinical, genetic, and immunologic differences. This study was undertaken to determine whether the two populations differ radiologically. Seventeen patients with seronegative RA were closely matched with seropositive control subjects. Radiographs of the hands and wrists were studied blindly, and disease severity was quantified with use of a modification of the Beaver Creek grading sheet. The following distinguishing features were also evaluated: osteosclerosis, new bone formation, carpal predominance, ankylosis (fusion), symmetry, and classical erosions. Seropositive patients had more severe disease, with larger and more numerous erosions, while the seronegative group had more osteosclerosis, carpal predominance, fusion, and new bone formation. Symmetry was equal in both groups. Although there were definite quantitative and qualitative differences between the two populations, radiologists should be cautious in using these criteria because of the great deal of overlap between the two groups.     

Lipoprotein [Lp(a)] and peripheral vascular disease.

Lipoprotein(a) [Lp(a)], which combines structural elements of the lipid and fibrinolytic systems, is a major independent risk factor for the development of coronary heart disease. Eighty-four consecutive patients with peripheral vascular disease (of whom 42 had concomitant ischaemic heart disease) and 43 healthy controls were enrolled in a case-control study. We found that the mean Lp(a) concentration in male patients with peripheral vascular disease (PVD) was almost threefold higher than that of controls, while in female patients the Lp(a) concentration was more than twice that of controls. This marked difference was borne out in patients with and without concomitant ischaemic heart disease (IHD). A multivariate logistic regression analysis indicated that Lp(a) is independently associated with PVD when adjusted for age and sex (odds ratio per 100 mg l-1 increase in Lp(a) = 1.35; P < 0.01). A similar association is observed for patients with concomitant IHD (odds ratio per 100 mg l-1 increase in Lp(a) = 1.65; P < 0.01).     

神经细胞营养（诱向）因子与运动神经元疾病

本文从神经营养（诱向）因子有选择地保障运动神经元健康存活和执行功能，防止它凋亡和损伤所引起的神经元退变及促进其再生等生物学效应，结合运动神经元病的病理退变的主要特点及本实验室对运动神经元营养（诱向）因子的工作，综述了这方面的新进展，期望对探索运动神经元病的病因和治疗提供新的线索和可能性。     

Blood coagulation and the risk of atherothrombosis: a complex relationship

The principles of Virchov's triad appear to be operational in atherothrombosis or arterial thrombosis: local flow changes and particularly vacular wall damage are the main pathophysiological elements. Furthermore, alterations in arterial blood composition are also involved although the specific role and importance of blood coagulation is an ongoing matter of debate. In this review we provide support for the hypothesis that activated blood coagulation is an essential determinant of the risk of atherothrombotic complications. We distinguish two phases in atherosclerosis: In the first phase, atherosclerosis develops under influence of "classical" risk factors, i.e. both genetic and acquired forces. While fibrinogen/fibrin molecules participate in early plaque lesions, increased activity of systemic coagulation is of no major influence on the risk of arterial thrombosis, except in rare cases where a number of specific procoagulant forces collide. Despite the presence of tissue factor - factor VII complex it is unlikely that all fibrin in the atherosclerotic plaque is the direct result from local clotting activity. The dominant effect of coagulation in this phase is anticoagulant, i.e. thrombin enhances protein C activation through its binding to endothelial thrombomodulin.The second phase is characterized by advancing atherosclerosis, with greater impact of inflammation as indicated by an elevated level of plasma C-reactive protein, the result of increased production influenced by interleukin-6. Inflammation overwhelms protective anticoagulant forces, which in itself may have become less efficient due to down regulation of thrombomodulin and endothelial cell protein C receptor (EPCR) expression. In this phase, the inflammatory drive leads to recurrent induction of tissue factor and assembly of catalytic complexes on aggregated cells and on microparticles, maintaining a certain level of thrombin production and fibrin formation. In advanced atherosclerosis systemic and vascular wall driven coagulation becomes more important and elevated levels of D-dimer fragments should be interpreted as markers of this hypercoagulability.     

沙苑子化学成分的研究Ⅱ

沙苑子为豆科黄芪属植物扁茎黄芪(Astragalus complanatus R.Brown)的种子,有益肾固精、补肝明目之功能。有关沙苑子的化学成分,除本文作者曾从水溶液中分离得到氨基酸外,其他化学成分的研究尚未见报道。本文从脱脂沙苑子的乙醇提出物中分得一新的黄酮甙,确定为鼠李柠檬素-3,4′-O-β-D-双葡萄糖甙,命名为沙苑子甙(complanatuside)。     

落新妇和岩菖蒲中岩白菜素的高效液相色谱测定法

本文报道用高效液相色谱法测定落新妇和岩菖蒲中岩白菜素的含量。样品用甲醇以超声波法提取,通过YWG-C₁₈H₃₇键合相柱,用甲醇—乙醚—乙腈—水(30:2:3:65)为流动相,在275nm波长检测,用对氨基苯磺酸为内标,峰面积内标法定量。方法简便,快速,结果较好。     

The influence of duplex scanning on early patency rates of in situ bypass to the tibial vessels

Duplex scanning was used in the follow up of 49 in situ infrapopliteal bypasses per formed for limb salvage using the valve incision method. In 19 cases (39%) the peroneal artery was the best available vessel for distal insertion; the anterior tibial and dorsalis pedis were used in 17 cases (35%) and the posterior tibial artery and tibioperoneal trunk in 13 cases (26%). In the early postoperative period three AV fistulas presented with painful skin lesions. These were located using duplex scanning and following ligation rapid resolution followed. Primary patency at one month was 87% and was increased to 96% by successful correction of four out of six failed bypasses. A total of 11 stenoses were found in five bypasses between three and 15 months postoperatively. In four of these patients the ankle/arm index decreased by at least 0.15 between examinations. A comparison was made between the spectral analysis on duplex scanning and the findings on arteriography and at operation. Peak systolic frequencies greater than 6 000 Hz were associated with 50% or greater reduction in vein bypass diameter. The majority were corrected using vein patch angioplasty. Primary cumulative patency at two years was maintained at 68% while correction of two out of seven bypass failures raised this to 80%. Duplex scanning allows precise definition of vein bypass pathology, facilitates operative correction and increases long-term limb salvage.