Enhancing venous outflow in the lower limb with intermittent pneumatic compression. A comparative haemodynamic analysis on the effect of foot vs. calf vs. foot and calf compression.

OBJECTIVES: intermittent pneumatic compression (IPC), an established method of deep-vein thrombosis prophylaxis, is also an effective means of leg inflow enhancement, improving the walking capacity and ankle pressure of claudicants, long-term. This study, using duplex ultrasonography, compares the haemodynamic effect of IPC of the (a) foot (at 120 mmHg [IPC(foot/120 mmHg)], and 180 mmHg [IPC(foot/180 mmHg)]), (b) calf (IPC(calf), 120 mmHg) and (c) both simultaneously (IPC(foot+calf), 120 mmHg), on the venous outflow of 20 legs of normals and 25 legs of claudicants. RESULTS: the peak and mean velocities, volume flow and pulsatility index in the superficial femoral and popliteal veins of both groups increased significantly with all IPC modes (p<0.001). IPC(foot+calf)produced the highest enhancement followed by IPC(calf)(p<0.01), which was more effective (p<0.001) than either IPC(foot/180 mmHg)or IPC(foot/120 mmHg). The venous volume expelled with IPC(calf)and IPC(foot+calf)was 2-2.5 and 3-3.5 times that with IPC(foot/180 mmHg)respectively. Velocity enhancement with IPC was similar between groups and the superficial femoral and popliteal veins. IPC(foot/180 mmHg)produced higher (p<0. 01) flow velocities than IPC(foot/120 mmHg)in both groups and veins examined; however, differences were limited. CONCLUSIONS: all IPC modes proved effective, IPC(foot+calf)generating the highest venous outflow enhancement. Higher venous volumes expelled with IPC(foot+calf)explain its reported superiority on leg inflow over the other modes. Increase of applied pressure from 120 to 180 mmHg with IPC(foot)offered only a small outflow improvement. Venous haemodynamics at rest and with IPC in claudicants do not differ significantly from those in healthy subjects.     

Tissue Engineering of Ligament/tendon-Part II-Importance of Biochemical and Mechanical Factors on the Neogenesis of Ligament

1 IntroductionLigaments and tendons are bands of parallel fibers, made of dense connective tissue, that play an important role in mediating normal movement and stability of joints. Injury to these structures can cause significant joint instability, which may lead to injury of others tissues and the development of degenerative joint diseases. Tissue engineering offers the potential to improve the reconstruction of tendons and ligaments. The concept is based on the manipulation of cellular and molecular media...     

Diagnosis and evaluation of mitral endocarditis complicating obstructive cardiomyopathy using cardiac echo-Doppler

The authors report a case of mitral endocarditis diagnosed by cardiac echo-Doppler and complicating an obstructive cardiomyopathy (OCM) in a 37-year-old woman. Despite the high degree of sub-aortic obstruction and the existence of an apparently severe mitral leak by Doppler analysis, the patient remained totally asymptomatic and the outcome was favourable with appropriate antibiotics. A review of the literature revealed 11 cases of endocarditis in a context of OCM, documented by echocardiography. Echo-Doppler enables precise evaluation of this grave and often poorly tolerated complication of OCM.     

Chronic gastritis in children

BACKGROUND: Active gastritis, atrophic gastritis (AG) and intestinal metaplasia are lesions associated with Helicobacter pylori (H. pylori) infection in adults. AIM: To assess the prevalence of chronic gastritis, its histological characteristics and clinical features in children. METHODS: 345 children (M/F: 151/194, mean age: 8.6 +/- 3.7 years; range: 1-18 years) were enrolled, referred for upper gastrointestinal endoscopy (UGI endo) with clinical manifestations of gastritis, i.e., recurrent abdominal pain (n = 232, 67.2%), upper gastrointestinal bleeding (n = 59, 17.1%) and miscellaneous (n = 53, 15.3%). Four perendoscopic gastric biopsy specimens (antrum: 2, fundus: 2) were taken. Biopsies were assessed and graded according to the updated Sydney system. H. pylori infection was considered if 2 out 3 tests were positive (culture, histology and rapid urease test), whereas 3 concordant negative results identified H. pylori negative children. RESULTS: H. pylori infection and chronic gastritis were detected in 215/345 (62.3%) (M/F: 104/117, sex ratio M/F = 0.89) and 221/345 (64.05%) children, respectively. Recurrent abdominal pain (n = 149, 67.4%) was the main clinical features of chronic gastritis followed by vomiting (n = 43, 19.5%) and upper gastrointestinal bleeding (n = 41, 18.6%). Any clinical features were however found to be specific. UGI endo showed; nodular gastritis (n = 90, 40.72%), congestive gastritis (n = 84, 38%), gastric ulcer (n = 9), bulbar ulcer (n = 5) and normal (n = 47, 21.2%). Chronic gastritis was active in 115 cases (52%) and was significantly associated with nodular gastritis (p < 0.05). Thirty two chronic gastritis (14.4%) exhibited AG (M/F: 16/16, mean age: 9.4 +/- 3.4 years) and 30/32 (93.7%) were H. pylori positive. AG was significantly associated with H. pylori infection (p < 0.0001) and nodular gastritis (p < 0.005). Active, follicular and AG were significantly associated with H. pylori infection (p < 0.00001). Three patients exhibited intestinal metaplasia. CONCLUSION: Chronic gastritis is frequent in children. Any clinical features were found to be specific. It significantly associated H. pylori infection and nodular gastritis. Atrophic gastritis was found in 14.5% of children.     

Chronic laryngitis in adults

BACKGROUND: Chronic laryngitis is a lingering inflammation of the laryngeal mucosa, caused by specific aetiology and often irritative factors. AIM: To discuss clinic and therapeutic aspects of the pathology. METHODS: We report a retrospective stuy about 25 patients treated and followed for non specific chronic laryngitis over a period of 11 years (1994-2004). RESULTS: The average age of the patients was 54.2 years. Tobacco intoxication was noted in 72.7 of cases and Gastroesophageal reflux in 2 cases. The endoscopic examination of laryngeal lesions, realised in all cases, notes laryngeal keratosis in 88% of cases and congestive laryngitis in 12%. Histological analysis of the lesions reveals a dysplasia in 44% of cases. Clinical and endoscopic follow up of the patients discover malignant development in 5 patients. CONCLUSION: The treatment of chronic laryngitis is based on the suppression of etiologic factors and on laryngeal microsurgery with micro instruments and with laser techniques.