RESUMO
BACKGROUND: Foam sclerotherapy is well established in the treatment of varicose veins of different sizes. METHODS: A literature review was performed to determine whether specific anatomical findings could be a limitation for foam sclerotherapy. RESULTS: The following anatomical aspects are relevant as a potential limitation for foam sclerotherapy: treatment of pudendal veins, varicose veins in patients with chronic lymphedema and lymph fistulas. CONCLUSION: In some indications foam sclerotherapy is the treatment of choice. It is an effective and safe treatment option.
Assuntos
Escleroterapia , Varizes , Humanos , Soluções Esclerosantes , Resultado do Tratamento , Varizes/terapiaRESUMO
BACKGROUND: Livedoid vasculopathy (LV) is a rare cutaneous thrombotic disease. It is characterized by occlusion of dermal vessels resulting in livedo racemosa, ulceration and atrophie blanche. Clear guidelines for diagnosis and treatment are missing. OBJECTIVE: The purpose of this study was to better characterize epidemiology, clinical appearance and treatment reality of LV in a well-defined patient cohort. METHODS: The cohort was allocated within a prospective, multicentre, phase IIa trial that investigated the effect of rivaroxaban in LV. RESULTS: Analysis of 27 patients revealed that LV patients had an increased Body Mass Index (BMI; 11/27), hypertension (19/27) and increased levels of lipoprotein (a) (5/12) and homocysteine (10/12) in the blood. The female-to-male ratio was 2.1 : 1, and the median age was 53.0 years [interquartile range (IQR) 40.5-68]. Investigation of the clinical appearance found that 82% of patients had livedo racemosa, and the ankle region was most likely to be affected by ulceration (56-70%). The analysis of patient treatment history showed that heparin was most effective (12/17), while anti-inflammatory regimens were, although often used (17/24), not effective (0/17). CONCLUSION: We add clinical clues for a data supported diagnosis of LV, and we provide evidence that anticoagulants should be administered in monotherapy first line (EudraCT number 2012-000108-13-DE).
Assuntos
Inibidores do Fator Xa/uso terapêutico , Livedo Reticular/tratamento farmacológico , Rivaroxabana/uso terapêutico , Adulto , Idoso , Feminino , Humanos , Livedo Reticular/complicações , Livedo Reticular/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
BACKGROUND: Systemic sclerosis (SSc) is characterized by heterogeneous clinical symptoms. Peripheral skin fibrosis can be a common symptom. Nevertheless, a variety of diseases with different etiologies are associated with a thickening of the skin and make the initial diagnosis of systemic sclerosis more difficult. OBJECTIVE: The different disease entities that can lead to dermal fibrosis should be differentiated. An earlier diagnosis of SSc would therefore be facilitated. METHODS: A literature search was carried out for clinical pictures that can be associated with skin fibrosis. The clinical picture, the etiology and the treatment of the individual diseases are described. RESULTS: Diseases that can mimic the cutaneous symptoms of SSc include morphea, scleroderma, diabetic cheirarthritis, scleromyxedema, nephrogenic systemic fibrosis and eosinophilic fasciitis. The characteristic pronounced skin involvement, an accompanying Raynaud's phenomenon, capillary microscopy, histopathology and antinuclear antibodies help to enable a differentiation of SSc from its mimics. CONCLUSION: An early differential diagnostic distinction between SSc and other sclerosing diseases is important due to SSc-associated and potentially life-threatening systemic organ involvement. If a diagnosis of SSc has been made, a critical and organ-specific evaluation with respect to pulmonary, gastrointestinal, renal and cardiac involvement is mandatory and should be repeated at regular intervals.
Assuntos
Doenças do Tecido Conjuntivo/diagnóstico , Esclerodermia Localizada , Escleroderma Sistêmico , Diagnóstico Diferencial , Eosinofilia/diagnóstico , Fasciite/diagnóstico , Humanos , Escleredema do Adulto/diagnóstico , Esclerodermia Localizada/diagnóstico , Escleroderma Sistêmico/diagnóstico , Escleromixedema/diagnóstico , Pele , SinoviteRESUMO
BACKGROUND: Foam sclerotherapy is well established in the treatment of varicose veins of different sizes. METHODS: A literature review was performed to determine which specific indications for foam sclerotherapy exist. RESULTS: Treatment of venous leg ulcers, varices that might rupture, varicose veins in geriatric patients, pudendal veins and seroma could be determined as specific indications for foam sclerotherapy. CONCLUSION: In some indications, foam sclerotherapy is the treatment option of first choice. It is an effective and safe treatment option.
Assuntos
Malformações Arteriovenosas/terapia , Escleroterapia/métodos , Seroma/terapia , Varizes/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Soluções Esclerosantes/uso terapêutico , Úlcera Varicosa/terapiaRESUMO
OBJECTIVE/BACKGROUND: Hemodynamic measurements of blood flow in the common femoral vein and artery can be performed readily using duplex sonography. The ratio of venous to arterial volume flow in these vessels, the venous arterial flow index (VAFI), is increased in patients with varicose veins and/or chronic venous disease. The objective was to determine the reproducibility of sonographically measured hemodynamic flow parameters using phase contrast magnetic resonance imaging (MRI). METHODS: Based on hemodynamic volume flow measurements from the common femoral vein and artery the VAFI was calculated in seven patients with varicose veins (C2, Ep, As, Pr) and 32 healthy controls using standard duplex sonography and MRI. RESULTS: Based on duplex sonography, the average VAFI (VAFI_d) was 1.05 ± 0.17. The same ratio, using MRI (VAFI_mri) was 1.05 ± 0.19. There was a significant correlation between the VAFI_d and the VAFI_MRI (p = .0021). In patients with venous disease, the average VAFI_d and VAFI_mri were 1.36 ± 0.21 and 1.36 ± 0.20, respectively. In contrast, in the healthy cohort the VAFI_d was 1.00 ± 0.12 and the VAFI_mri measured 1.01 ± 0.15. As expected, there was a significant difference between the VAFI measured in those with venous disease when compared with that of healthy controls (p < .0001). CONCLUSION: There is a significant correlation between the VAFI measured using sonography and MRI. The study confirmed the elevation of VAFI in patients with chronic venous disease.
Assuntos
Artéria Femoral/diagnóstico por imagem , Veia Femoral/diagnóstico por imagem , Hemodinâmica , Imageamento por Ressonância Magnética , Ultrassonografia Doppler Dupla , Varizes/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Feminino , Artéria Femoral/fisiopatologia , Veia Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Reprodutibilidade dos Testes , Varizes/fisiopatologia , Adulto JovemAssuntos
Neoplasias Abdominais/diagnóstico , Neoplasias Abdominais/cirurgia , Dor Abdominal/etiologia , Endometriose/diagnóstico , Endometriose/cirurgia , Umbigo/cirurgia , Neoplasias Abdominais/complicações , Dor Abdominal/prevenção & controle , Adulto , Endometriose/complicações , Feminino , Humanos , Ciclo Menstrual , Resultado do TratamentoRESUMO
OBJECTIVES: The aim of this study was to evaluate occlusion rates of great saphenous veins (GSV) with a diameter between 5-10 mm that received a pre-treatment size reduction via perivenous tumescent application (TA) followed by catheter-directed foam sclerotherapy (CDFS). METHODS: A prospective blinded randomized clinical trial comparing the occlusion rates of GSV at 1-, 6-, and 12-month follow-up. Fifty patients were included and randomized into two groups. CDFS was performed accessing the GSV at knee level and applying 8 mL of 2% polidocanol-foam (EasyFoam) while the catheter was withdrawn. Strictly perivenous TA was performed in group 1 before applying the sclerosant agent. Occlusion rates and clinical scores were assessed by blinded examiners. RESULTS: After 12 months in group 1 full occlusion was achieved in 73.9%, partial occlusion in 8.7%, and 17.4% were classified as treatment failure. In group 2, 75% of the targeted GSV were fully occluded, 20% were partially occluded, and 5% were diagnosed as treatment failure. Both groups showed a significant reduction of the vein diameter. Patient's tolerance and satisfaction with the treatment was high in both groups. CONCLUSION: No benefit could be found using additional TA to reduce the vein diameter before the treatment.
Assuntos
Anestesia Local , Cateterismo Periférico , Procedimentos Endovasculares , Polietilenoglicóis/administração & dosagem , Veia Safena , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Insuficiência Venosa/terapia , Administração Intravenosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Local/efeitos adversos , Cateterismo Periférico/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Projetos Piloto , Polidocanol , Polietilenoglicóis/efeitos adversos , Estudos Prospectivos , Veia Safena/diagnóstico por imagem , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia , Insuficiência Venosa/diagnóstico , Adulto JovemRESUMO
Antiphospholipid syndrome features not only deep vessel thrombosis but also may have cutaneous manifestations such as Raynaud phenomenon, acral necrosis, livedo reticularis, subcutaneous nodules, and leg ulcers. A 72-year-old man presented with a rapidly progressing leg ulcer. He was already on anticoagulation with warfarin due to atrial fibrillation and disclosed a history of stroke with temporary paresis of the left leg. Histopathology of a biopsy of the edge of the ulcer revealed occlusive arteriosclerosis of medium-sized arteries. Serology showed autoantibodies against cardiolipin, ß2- glycoprotein I, and phosphatidylserine which led to the diagnosis of antiphospholipid syndrome. Therapy with low molecular weight heparin, dexamethasone, and azathioprine in combination with stage-adjusted wound care led to complete healing of the ulcer within 5 months.
Assuntos
Anti-Inflamatórios/uso terapêutico , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/terapia , Úlcera da Perna/diagnóstico , Úlcera da Perna/terapia , Acidente Vascular Cerebral/prevenção & controle , Idoso , Bandagens , Quimioterapia Combinada , Humanos , Masculino , Acidente Vascular Cerebral/diagnóstico , Resultado do TratamentoRESUMO
BACKGROUND: Chronic venous insufficiency (CVI) comprises all symptoms caused by permanent venous and capillary hypertension. While the clinical manifestations of the disease have been well characterized, there is little knowledge on the skin barrier function in the affected patients. OBJECTIVES: The aim of the study was to assess noninvasively the barrier function in patients with CVI stage C2 and stage C4 according to the CEAP classification in comparison with healthy controls (stage C0). METHODS: Thirty patients with CVI without concomitant diseases and 15 healthy, aged-matched controls were recruited for the study. The skin barrier function was assessed by measuring transepidermal water loss (TEWL), capacitance and skin colour symmetrically on the calf, medial and lateral malleolus, posterior arch (arcus venosus) and volar forearm. RESULTS: Compared with the forearm, there was a tendency for increased TEWL and significant reduction of capacitance on all measurement sites on the lower limb. Compared with the control group, the patients with CVI had significantly higher TEWL values on all measurement sites on the lower extremities while no difference in capacitance between patients and controls was observed. CONCLUSIONS: Changes in the epidermal barrier function in patients with CVI are readily detectable by bioengineering methods as early as stage C2 and are manifested by significantly increased TEWL. Our results suggest that the reduced stratum corneum hydration in patients with CVI is due to anatomical differences rather than venous disease. These findings may help better understand the factors contributing to disease progression and its complications.
Assuntos
Pele/fisiopatologia , Insuficiência Venosa/fisiopatologia , Perda Insensível de Água/fisiologia , Idoso , Bioengenharia/métodos , Doença Crônica , Feminino , Resposta Galvânica da Pele/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pigmentação da Pele/fisiologia , Varizes/fisiopatologiaRESUMO
Life-threatening vascular complications of the skin are rare and usually reflect underlying systemic diseases. Lesions are sudden in onset, become necrotic and may be severe or life-threatening. Effective management requires an understanding of the underlying medical condition, such as arterial thrombosis, temporal arteritis, calciphylaxis and purpura fulminans. In contrast, the acute painful symptoms of erythromelalgia often lead to an urgent dermatologic consultation but pose no acute risk.
Assuntos
Emergências , Dermatopatias Vasculares/diagnóstico , Doença Aguda , Administração Oral , Calciofilaxia/diagnóstico , Calciofilaxia/etiologia , Calciofilaxia/terapia , Cumarínicos/administração & dosagem , Cumarínicos/toxicidade , Eritromelalgia/diagnóstico , Eritromelalgia/etiologia , Eritromelalgia/terapia , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/etiologia , Arterite de Células Gigantes/terapia , Humanos , Vasculite por IgA/diagnóstico , Vasculite por IgA/etiologia , Vasculite por IgA/terapia , Necrose , Pele/patologia , Dermatopatias Vasculares/etiologia , Dermatopatias Vasculares/terapiaRESUMO
Lactate dehydrogenase (LDH) in serum has recently been introduced into the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma because of its prognostic value. We hypothesised LDH to be of value in discriminating melanoma patients entering AJCC stage IV from patients staying in AJCC stages I, II or III. Lactate dehydrogenase was compared to the acute phase protein C-reactive protein (CRP), which we observed to reflect the course of melanoma metastasis in a previous report. In this prospective study, we measured LDH and CRP in the serum of 91 consecutive melanoma patients progressing into AJCC stage IV in comparison to 125 patients staying in AJCC stages I, II or III. Comparing distributions of the parameters by median values and quartiles by Mann-Whitney test, LDH was not significantly elevated in patients entering AJCC stage IV melanoma (P=0.785), whereas CRP was (P<0.001). Analysing the sensitivity and the specificity jointly by the areas under the receiver operating characteristics curves (ROC-AUC), LDH did not discriminate between the defined groups of patients (AUC=0.491; 95% confidence interval, 0.410, 0.581), whereas CRP did (AUC=0.933; 95% confidence interval, 0.900, 0.966; P<0.001). Upon logistic regression analysis to calculate the ROC-AUC values upon the predictive probabilities, LDH provided no additional information to CRP. Choosing a cutoff point of 3.0 mg l(-1), CRP yielded a sensitivity of 0.769 together with a specificity of 0.904 in diagnosing AJCC stage IV entry. Altogether, for first diagnosing AJCC stage IV melanoma, CRP is the superior serum marker when compared to the conventional LDH.
Assuntos
Biomarcadores Tumorais/análise , Proteína C-Reativa/análise , L-Lactato Desidrogenase/análise , Melanoma/diagnóstico , Estadiamento de Neoplasias/métodos , Neoplasias Cutâneas/diagnóstico , Idoso , Área Sob a Curva , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Metástase Neoplásica , Valor Preditivo dos Testes , Prognóstico , Análise de Regressão , Sensibilidade e Especificidade , Neoplasias Cutâneas/patologiaRESUMO
BACKGROUND: The ratio of volume flow in the common femoral vein and artery denoted as venous-arterial Flowindex (VAFI) is significantly increased in venous insufficiency according the clinical grade of the disease. This study was done to investigate the reliability and reproducibility of VAFI as quantitative pattern. PATIENTS AND METHODS: In 43 patients with varicose veins C4-6 EPAS,D,PPR (PVV), 40 with postthrombotic syndrome C4-6 ESAS,D,PPR,O (PTS) and 48 healthy volunteers volume flow in the common femoral vein (VFV) and artery (VFA) were measured by duplex. Division of VFV by VFA calculated VAFI. VAFI-measurement was repeated 5 times at an interval of ten minutes in 63 subjects (23 PVV, 20 PTS, 20 healthy) and it was performed at three different days in 68 subjects (20 PVV, 20 PTS, 28 healthy). RESULTS: Mean VAFI +/- standard deviation was 1.39 +/- 0.26 in PVV, 1.42 +/- 0.26 in PTS and 0.93 +/- 0.13 in healthy veins (p < 0.001). VAFI remained stable and significantly increased (p < 0.001) in PVV and PTS compared to healthy veins during 40 minutes and also within three different days. CONCLUSION: The venous-arterial flowindex VAFI is a reproducible pattern of the hemodynamic severity in venous insufficiency.
Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Volume Sanguíneo/fisiologia , Artéria Femoral/diagnóstico por imagem , Veia Femoral/diagnóstico por imagem , Síndrome Pós-Flebítica/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Varizes/diagnóstico por imagem , Insuficiência Venosa/diagnóstico por imagem , Humanos , Síndrome Pós-Flebítica/fisiopatologia , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Varizes/fisiopatologia , Insuficiência Venosa/fisiopatologiaRESUMO
Birt-Hogg-Dubé-syndrome, first described 20 years ago, is an autosomal dominant inherited disease, characterized by the occurrence of multiple cutaneous hamartomas with adnexal differentiation. An association with intestinal neoplasms has been mentioned repeatedly. Recently, the cutaneous lesions in this syndrome have been interpreted as different developmental stages of one single hamartoma with sebaceous differentiation, called mantleoma. Numerous dermatohistopathologic studies contribute to the certain diagnosis of Birt-Hogg-Dubé-syndrome. In contrast, little information is available on the therapy of the multiple skin lesions. A father and his daughter with Birt-Hogg-Dubé-syndrome were treated with the CO2 laser, producing satisfactory results.
Assuntos
Aberrações Cromossômicas , Transtornos Cromossômicos , Fibroma/cirurgia , Hamartoma/cirurgia , Terapia a Laser , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Cutâneas/cirurgia , Adulto , Biópsia , Criança , Aberrações Cromossômicas/genética , Feminino , Fibroma/patologia , Hamartoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/patologia , Pele/patologia , Neoplasias Cutâneas/patologia , Síndrome , Terminologia como AssuntoRESUMO
The Stewart-Bluefarb syndrome is defined as an unilateral angiodermatitis due to multiple arterio-venous fistules accompanied by acroangiodermatitis resembling Kaposi sarcoma (pseudo-kaposi sarcoma). The acroangiodermatitis is most common on the lower limb. It leads to ulcerated nodules with a high risk of bleeding and infection, as well as edema, pain and seldom limb hypertrophy. Curative therapy requires elimination of the arteriovenous shunts. Surgical destruction of the multiple small fistulae is a limitating factor. A better alternative is embolisation, but this approach carries the risk of ischemia and necrosis. A 32 year old female patient with Stewart-Bluefarb syndrome is presented; she has been successfully treated with embolisation on eight occasions.
Assuntos
Malformações Arteriovenosas/terapia , Embolização Terapêutica , Úlcera do Pé/terapia , Pé/irrigação sanguínea , Pele/irrigação sanguínea , Adulto , Malformações Arteriovenosas/diagnóstico , Malformações Arteriovenosas/patologia , Endotélio Vascular/patologia , Feminino , Pé/patologia , Úlcera do Pé/diagnóstico , Úlcera do Pé/patologia , Humanos , Recidiva , Retratamento , Pele/patologia , SíndromeRESUMO
OBJECTIVE: The volume flow in the common femoral vein (SV) as a representative parameter of the venous hemodynamics of the leg can be measured using duplex-sonography. A direct correlation between the SV-data and the clinical grade of the venous disease was postulated. PATIENTS/METHODS: SV was measured in 36 patients (62 limbs) with complete varicosis of the long saphenous vein, 18 patients (24 limbs) with an incomplete form of varicosis and 40 healthy persons (78 limbs). The assessments were done under standardized conditions. We found a significant difference of the SV-data between the three groups. RESULTS: The values of SV were significantly elevated in varicosis compared with the healthy limbs. The data determined in legs with complete varicosis were significantly raised compared to incomplete varicosis. The means were 0.38 l/min in complete varicosis, 0.26 l/min in incomplete varicosis and 0.13 l/min in healthy limbs. During a time course of 30 minutes the values were stable. CONCLUSIONS: The results demonstrate a significant correlation between the measured SV data and the grade of venous disease.