Red vine leaf extract (AS 195) can improve some signs and symptoms of chronic venous insufficiency, a systematic review.

AIM: Chronic venous insufficiency (CVI) is common in adults. Some complications include skin changes, edema, heavy legs, muscle cramps, pain, and varicose veins. In traditional medicine, red vine leaf extract (AS 195) has been used to cure the symptoms of CVI. This systematic review was aimed to assess the effects of AS 195 in patients with CVI. MATERIAL AND METHODS: A systematic literature search was performed to identify trials that reported the impact of red vine leaf extract on CVI. The primary outcomes investigated were Leg (limb) volume, calf circumference, ankle circumference, tired and heavy legs, a sensation of tension, tingling sensation, and pain. RESULTS: From the 56 studies, 5 trials were selected according to our inclusion criteria. Red vine leaf extract significantly improved numbers of outcomes (lower leg volume, calf and ankle circumference, tired, heavy legs, tingling sensation, pain, the sensation of tension in the legs, cutaneous microcirculation, and transcutaneous oxygen pressure) in only some trials. The tolerability for red vine leaf extract was reported good or satisfactory. CONCLUSIONS: Red vine leaf extract had a beneficial therapeutic role in patients with CVI. Further high-quality trials are required to be carried out to provide strong evidence.

Looking after your health. 3. Avoiding varicose veins.

This article is to summarise key concepts for the health of the midwife with particular focus on standing for prolonged periods. One of the resultant factors relating to standing postures is the slow but avoidable progression of varicose veins. There is a strong genetic bias to these veins, which can be distressing, but here we will highlight awareness and current research.

[Drug-mediated correction of negative phlebotropic effects of hormone replacement therapy in women].

OBJECTIVE OF THE STUDY: to specify a negative effect of hormone replacement therapy (HRT) on lower-limb veins in women and to assess feasibility of its correction with phleboprotectors. Examined were a total of thirty-seven 45-to-68-year-old (average age 55.4 +/- 13.7 years) women with the CEAP grade 0-2 chronic venous disease of the legs. Of these, grade C0 was diagnosed in 14 patients, grade C1 in 17, and grade C2 in the remaining six cases. Inclusion criterion: administration of oestrogen-progestin drugs with the replacement purposes. EXCLUSION CRITERIA: a history of previously sustained operations on the veins and venous sclerotherapy, as well as venous thrombosis. Of the 37 women receiving hormone replacement therapy for more than 4 months, 31 (66.7%) complained of uneasiness and a feeling of dilatation in the crural region, cramps, convulsions, pain, and leg heaviness. Eleven women reported to have had no such complaints prior to HRT, and twenty were found to have an apparent progression of the previously existing complaints. The comparative study using duplex scanning of limb veins before and 4 months after HRT revealed enlargement of the lumens of the common femoral, posterior tibial and great saphenous veins, as well as an increased incidence rate of reflux along the femoral and great saphenous veins. The women after 4 months of HRT were assigned to simultaneously undergo a therapeutic course with Phlebodia 600 taken at a dose of I tablet once a day for 2 months. On the background of this therapy, there was a decrease in and gradual disappearance of such symptoms as a feeling of heaviness, pain and dilatation in 31 patients, occurring 7 to 10 days after the beginning of treatment. Thirty (81.0%) women self-assessed the results of treatment with Phlebodia 600 as good, five (13.5%) as satisfactory, and two (5.4%) women reported no positive effect. Duplex scanning performed in women after 2 months of taking the bioflavonoid on the background of the continuing HRT revealed a decrease in the lumens of the common femoral, posterior tibial and great saphenous veins, as well as a decrease in the orthostatic gradient of the veins' diameter. Also observed was a decrease in the incidence rate of reflux along the femoral and great saphenous veins, with clinically diminished symptoms and improved well-being of the women. A conclusion was drawn that hormone replacement therapy in women for a period longer than 4 months leads to the development of orthostasis-dependent phlebopathy of the lower extremities, manifesting itself in decreased venous tonicity and the development of refluxes. The course of treatment with the phlebotonic notable for high compliance (a single morning administration) for two months was noted to have resulted in a significant decrease in the intensity of both subjective and objective signs and symptoms of phlebopathy secondary to long-term administration of oestrogen-gestagen-containing hormonal drugs.

Pathogenesis of varicose veins and implications for clinical management.

Varicose veins (VVs) classically result from venous hypertension owing to incompetence of the major communications between the superficial and deep veins of the lower extremity. In a significant number of patients, there is no demonstrable truncal saphenous reflux and varicosities are the result of isolated perforating and nonsaphenous vein incompetence. The clinical and histologic features of VVs are the result of disruption of the normal architectural structure of the venous wall as a consequence of remodeling of the extracellular matrix (ECM) in response to increased venous distention and altered hemodynamic shear stress. Although a number of genes, growth factors, proteases, and their inhibitors known to modulate the ECM have been implicated in the pathogenesis of VVs, their etiology remains unknown. The complex variations in venous anatomy in patients with VVs require detailed vein mapping to determine the source and drainage locations of reflux if the rates of residual and recurrent varicosities are to be reduced. The distinct pathogenic mechanisms involved in the development of VVs have important implications for the management of VVs that include a wide spectrum of treatment modalities ranging from reassurance, alternative medicines, conservative management or compression therapy, and surgical or endovascular therapy.

Terapia alternativa para microvarizes e telangiectasias com uso de agulha / Alternative therapy for microvarices and telangiectasias with use of needle

Contexto: O desenvolvimento de terapia alternativa à convencional para a destruição de microvarizes e telangiectasias sem o uso de produtos químicos tem como objetivo reduzir os efeitos colaterais, faz uso de agulha para lise mecânica dos vasos e tem como modelo experimental galinhas da linhagem Lohmann Brown. Objetivo: Elaborar uma nova técnica, desenvolvendo um tratamento alternativo, sem uso de produtos químicos, objetivando a redução dos efeitos colaterais. Métodos: Foram utilizadas 30 galinhas Lohmann Brown, sendo que 15 foram submetidos ao método convencional do tratamento de microvarizes e telangiectasias (grupo controle) e as outras 15 receberam o tratamento experimental proposto (grupo experimental). O grupo experimental foi tratado com agulha de lise vascular, percorrendo todo o trajeto dos vasos escolhidos em punções escalonadas até que todo o vaso ser atingido. O grupo-controle foi tratado com o oleato de monoetanolamina e glicose a 50 por cento puncionando-se o vaso com agulha 13 x 3 mm e injetando se, em média, 0,3 mL da solução de cada vaso. Resultados: Dos 50 vasos tratados no grupo experimental, dois apresentaram recidiva total, cinco apresentaram recidiva parcial, e 43 apresentaram destruição (lise) satisfatória, enquanto que, no grupo grupo-controle, dos 51 vasos tratados, quatro apresentaram recidiva total, 12 recidiva parcial, 22, destruição satisfatória, e em 13 ocorreu endurecimento de trajeto. Conclusão: O presente estudo demonstrou que o método experimental proposto, com uso de agulha de lise vascular, possuir mais eficiência no tratamento de microvarizes se comparado com o método convencional, devido à redução das recidivas e à ausência de hipercromia de trajeto endurecido.

[Kneipp hydrotherapy, sclerotherapy, crossectomy. What really helps in varicose veins and spider veins?]. / Kneipp-Kur, Sklerosierung, Krossektomie. Was hilft wirklich gegen Krampfadern und Besenreiser?

Varicose veins are irreversibly dilated epifascial and perforating veins resulting from degenerative vascular wall changes. Depending on etiology, they are classified into primary and secondary forms. The majority of the primary varicosities (75%) are hereditary. A clinical differentiation is made between varicosities of major vessels, side branch varicosities, varicosis of the perforating veins, reticular, and cutaneous vessel varicosities, with mixed forms also being known. Inspection and palpation are of predominant importance for the diagnosis, while Doppler and duplex ultrasonography serve mainly to document valvular incompetence. Treatment is determined by the findings, symptoms and the individual situation, and comprises, in addition to such general measures as activity, hot/cold foot baths, obliteration and surgery. A conservative alternative is rigorously applied compression treatment, which is also the most important concomitant measure to sclerotherapy and surgical operation.

Role of the endothelium and blood stasis in the development of varicose veins.

Today, chronic venous insufficiency affects millions of people but the investigation of veins and of venous diseases is still very poor. Additionally, the mechanism of the occurrence of varicose veins is not understood. Blood stasis is often associated with these pathological situations and we propose that resulting ischemic conditions can trigger the endothelium to release inflammatory mediators and growth factors. On one hand, the inflammatory mediators will recruit and activate neutrophils, which then infiltrate the venous wall and damage components of the extracellular matrix. On the other hand, growth factors induce smooth muscle cell migration, proliferation and de-differentiation into the synthetic phenotype, all together leading to the formation of neointima. These processes, being repeated over time, would eventually lead to alterations of the venous wall as observed in varicose veins. Venotropic drugs are used to treat chronic venous insufficiency. They are able to increase venous tone and to decrease vein and capillary permeability but they are also able to protect the endothelial cells against ischemia. Indeed, they target complexes of the mitochondrial respiratory chain and maintain ATP production during hypoxia. Hence, the cells are resistant to ischemia and do not release inflammatory mediators and growth factors. These drugs should thus be able to prevent the alterations of the venous wall induced by blood stasis.

[Colonic varices; a case report].

Colonic varices is a rare entity that is caused by portal hypertension in most instances. In the case reported here, barium enema and colonoscopy showed multiple tortuous polypoid lesions with intact mucosal surface. Inferior mesenteric angiography showed arteriovenous malformation in the sigmoid colon, complete obstruction of the inferior mesenteric vein, and tortuous dilated marginal veins. We assume that the colonic varices of this case was secondary to complete obstruction of the inferior mesenteric vein following AVM of the sigmoid colon. Close follow-up should is warranted in cases of colonic varices because of the risk of bleeding.

Diagnosis and treatment in the management of chronic venous insufficiency.

Chronic venous insufficiency (CVI) is caused mainly by an alteration in the elasticity of venous walls and the dysfunction of venous valves. The diagnosis and treatment for CVI management are discussed in this paper.

Cholecystojejunostomy varices demonstrated by enteroclysis.

Varices in unusual sites constitute a minor but significant cause of gastrointestinal bleeding in patients with liver disease. We report a case of varices across the anastomotic line between the jejunum and gallbladder after cholecystojejunostomy. Although such varices have been demonstrated by angiography, to our knowledge they have never been demonstrated by small bowel enema (enteroclysis). We report a case and describe the findings on enteroclysis.

Case report: transrectal ultrasound in the diagnosis of ano-rectal varices.

Extensive ano-rectal varices were diagnosed by transrectal ultrasound (TRUS) in a patient with portal hypertension who presented with an altered bowel habit. The diagnosis of ano-rectal varices is usually made by direct inspection during procto-sigmoidoscopy in patients who present with rectal bleeding. However, the sigmoidoscopic and barium enema appearances of varices may mimic that of a tumour. A firm diagnosis can readily be made using TRUS and the local extent of varices clearly mapped out.

Varicosis coli totalis: report of a case of idiopathic aetiology.

A case of colonic varices manifesting with rectal bleeding in a young patient is presented. There was no evidence of portal hypertension or any other cause. Familial history was also negative. Diagnosis was established by barium enema, colonoscopy and angiography. On colonoscopy, varices involved the entire colon. At operation, dilatation of the subserosal small veins of the entire small and large bowel was confirmed. The patient underwent a subtotal colectomy with ileorectal anastomosis with satisfactory result.