Four new cases of isolated foot vein thrombosis: Is the first metatarsal interspace perforator responsible?

Isolated foot vein thrombosis is an infrequently reported condition, the cause of which is still questioned. Four new cases are detailed, covering different physio-pathological situations ranging from plantar vein to Lejars' sole thrombosis. They are compared to the literature. The common vein altered in most of the cases is the first metatarsal interspace perforator, which is hypothesized as the area of the onset of many cases of foot vein thrombosis. Diagnostic workup could reveal neoplasia, inflammatory diseases, or coagulation abnormality. There is no consensus regarding plantar vein thrombosis treatment, and conservative therapy, non-steroidal anti-inflammatory drugs and anticoagulant therapy have been reported.

Swollen Lower Limbs in Patients with Negative Pitting Test Leg Oedema: Prediction of Water Displacement Changes by Anthropometry and Bioimpedance Spectroscopy.

The assessment of lower limb oedema almost always involves measuring leg volume, and the gold-standard for this is the water displacement technique. As it is not very practical to use in a clinical routine, physicians prefer indirect methods such as anthropometric or bioimpedance measurements. In the case of "non-pitting" leg oedema, i.e. where the presence of oedema is not obvious, it may be challenging to estimate changes in leg volume using these methods separately. The combination of these two methods, however, gives interesting results, such as a new composite parameter that is much more robust and efficient than commonly used parameters.Clinical Relevance- This study demonstrates the benefit of using a composite anthropometric-impedimetric parameter to predict water displacement variations in the leg over the course of a day, rather than using parameters based solely on anthropometry or impedance. Our new parameter (C²-A²)/R0 showed a robust r² value of 61%, which is more than twice the r² values obtained using other simple or composite parameters.

Immediate and transient faintness following a course of foam sclerotherapy treatment for saphenous vein incompetence in an elderly patient.

INTRODUCTION: Adverse effects of sclerotherapy are rare. They are divided into two categories: immediate and delayed. Immediate adverse effects are mainly represented by visual disturbances. We are reporting the case of an immediate transient faintness following two sessions of foam sclerotherapy. OBSERVATION: An 80-year-old active female with superficial chronic venous disorder and no significant medical or surgical backgrounds experienced two similar immediate general adverse events following two sessions of sclerotherapy from a total of five. Adverse reactions included faintness, associated with headache but without visual disturbance, lasting ten minutes with full short and long-term recoveries. The common factor between those two sessions was the injection of a higher volume of sclerosing agent compared to the other sessions, 5mL of which was foam. CONCLUSION: Age is not a contraindication of foam sclerotherapy. Nevertheless, we must proceed with caution even when moderate quantities of foam are required.

Treatment by medical compression stockings among 144 consecutive patients with non-complicated primary varicose veins: results on compliance.

Compression stockings are the major long-term treatment of non-complicated primary varicose veins recommended by international consensus. Nevertheless there are few data concerning the patient compliance to treatment. Hundred and forty-four patients with varicose veins of primary origin were prospectively recruited and questioned about their compression therapy: 29.2% patients are wearing compression stockings, and for 10.4% on a daily basis; 32.6% do not wear their compression mainly because it is not well tolerated; 38.2% do not have compression treatment because it is not recommended or not prescribed by the physician.

Biomechanical response of varicose veins to elastic compression: a numerical study.

A patient-specific finite-element (FE) model of the human leg is developed to model the stress distribution in and around a vein wall in order to determine the biomechanical response of varicose veins to compression treatment. The aim is to investigate the relationship between the local pressure on the soft tissues induced by wearing the compression garment and the development and evolution of varicose veins and various skin-related diseases such as varicose veins and ulcers. Because experimental data on the mechanical properties of healthy superficial veins and varicose veins are scarce in literature, ultrasound images of in vivo varicose veins are acquired and analysed to extract the material constants using Finite Element Model Updating. The decrease in trans-mural pressure, which conditions the effectiveness of compressive treatments, is computed from the simulation results. This constitutes the original added value of the developed model as decrease in trans-mural pressures cannot be assessed experimentally by any other means. Results show that external compression is effective in decreasing the trans-mural pressure, thereby having a positive effect in the control and treatment of vein-related diseases.

[Designing a therapeutic education program for patients with lymphedema: live with lymphedema]. / Conception d'un programme d'éducation thérapeutique pour les patients porteurs de lymphœdème: « vivre avec un lymphœdème ¼

BACKGROUND: Lymphedema is a chronic condition considered to be rare in its primary form and potentially frequent in women after breast surgery for cancer: 27,000 new cases annually. Therapeutic management is a serious challenge. In France, the health authorities (Haute Autorité de santé [HAS]) have recently proposed that appropriate management practices for lymphedema include "patient education". The HAS and the National institute for health care prevention and education also published a methodology guide devoted to structuring a therapeutic education program for patients with chronic disease. Current hospital regulations state that this education program is part of the care to be delivered to patients with chronic disease and that it must comply with the national directives. The purpose of our present work was to present the concept and the contents of a patient education program entitled "Live with lymphedema" designed for patients with lymphedema and developed within the inpatient-outpatient network GRANTED in Sud-Isère. METHODS: A standard detailed educative approach was applied. It was designed after the educational program for patients with lower limb arterial occlusive disease authorized by the Rhône-Alpes regional health agency. It was adapted to the specific problematic of patients with lymphedema, including medical management, rehabilitation, dermatology and nutritional aspects. It was developed in cooperation with patients and favors local associative actions. RESULTS: The specifically structured program included three therapeutic education consultations and five workshops. Less than one year after its institution, more than 30 patients have participated in the program. DISCUSSION: We report a structured patient education program designed for patients with lymphedema. This program was authorized by the Rhône-Alpes regional health agency in March 2011 and is in compliance with the national directives and HAS guidelines.

[Evaluation of an education program for patients taking oral anticoagulants: Experience of the GRANTED network in Isère]. / Evaluation d'un programme d'éducation thérapeutique pour les traitements anticoagulants oraux : expérience du réseau Ville-Hôpital GRANTED du secteur Sud-Isère.

BACKGROUND: The guidelines for good clinical practices issued by the French Agency for Health and Drug Safety and the Superior Health Authority are designed to improve management of oral anticoagulants which can be an important source of iatrogenic morbidity. These guidelines have focused on the need for special education. The GRANTED network in Isère developed an education program for patients taking oral anticoagulants. OBJECTIVE: The purpose of this study was to evaluate quantitatively the therapeutic education of these patients taking oral anticoagulation, irrespective of their risk factor(s). PATIENTS AND METHODS: This was a retrospective analysis of 100 randomly selected patients taking oral anticoagulants for at least three months who participated in the GRANTED education program in 2007. The evaluation criterion was the number of hemorrhagic and/or thromboembolic events. RESULTS: Among the 97 patients contacted, 3.1% had a serious hemorrhagic event and 1.03% a recurrent thromboembolic event. CONCLUSIONS: The quality of a scientific study depends on the quality of the methodology, leading to a preference for prospective studies. It would nevertheless be pertinent to determine whether or not official management recommendations are applied correctly in real life conditions. We report a first evaluation of a therapeutic education program designed for patients taking oral anticoagulants. The education program within the GRANTED network has enabled a reduction in the iatrogenic morbidity related to oral anticoagulation despite the selection bias of the probably high-risk population enrolled in the GRANTED network.

Elastic stockings, performance and leg pain recovery in 63-year-old sportsmen.

This study was undertaken to determine whether or not elastic compression stockings (ECS) can be used in elderly sportsmen to increase performance and leg pain recovery between two maximal exercises. For 2 weeks, 12 trained elderly cyclists, 63 (3) years old, performed two 5-min maximal exercises, Plim1 and Plim2, separated by an 80-min recovery period, twice a week with a 2-day rest interval. During the 80-min recovery period, they randomly wore or did not wear grip-top ECS Ganzoni-Sigvaris. ECS exerted a 44 hPa pressure at the ankle. Blood lactate concentrations, hematocrit, and plasma volume were measured after a 60-min rest and every 20 min during recovery. Leg sensations were assessed with a questionnaire. The decrease in maximal power between Plim1 and Plim2 was lower when wearing the ECS during the 80-min recovery period; when expressed as a percentage of Plim1, the difference reached 2.1 (1.4)%, P < 0.01. Between the two exercises, blood lactate concentrations and hematocrit were significantly decreased when wearing ECS. The increase in plasma volume was not significant. The 12 cyclists stated that wearing the ECS had a positive effect on their leg pain. Ten of the cyclists thought that it could have influenced their performance. However, no relationship was found between the gain in performance and the leg pain sensation. It was concluded that wearing ECS during an 80-min recovery period significantly increased subsequent performance. This was associated with a reduction in lactate and hematocrit.

[Compressive therapy after varicose vein surgery: results of a French national inquiry]. / Résultats d'une enquête sur les techniques compressives et contensives utilisées dans le traitement chirurgical des varices.

OBJECTIVES: A survey on postoperative compression after varicose vein surgery was undertaken in 2001 among surgeons of the French-speaking Vascular Surgery Society as well as non-members with a heavy caseload in varicose vein surgery. The aims of the study were to 1) identify the various medical devices and protocols used postoperatively, 2) estimate the frequency and duration of use, and 3) identify the surgeon's rationale for prescribing postoperative compression. The first part of the inquiry was devoted to surgical procedures and has been previously published (J Mal Vasc 2003; 28: 277-86). MATERIAL AND METHODS: A questionnaire with 11 items for postoperative treatments and a patient form was mailed to 675 surgeons. RESULTS: The response rate was 41.5% (280 surgeons). Results were assessed by a scientific committee. Surgeons were classified into different groups according to their membership in the French-speaking Vascular Surgery Society or not, the type of practice (private, public hospital, mixed), and caseload. Compression was widely used (97.1%). It was the only postoperative treatment for 25.2% of the surgeons, was associated with anticoagulant treatment for 38.8% or non-steroidal antiinflammatory drugs for 11.2%. Prescription was evidence-based for only 11.6%. Compression therapy was mainly started postoperatively (93.2%). Elastic bandages (long stretch) were used by 87%. Duration of bandage therapy was variable (less than 8 days for 38.8%, 8-15 days for 24.5%). After bandage therapy, medical compression stockings (above knee 74.7%) or French class II (77.9%) were used. Compression stockings were prescribed for 8-15 days or 15-30 days by 12.7% and 84.6% of the surgeons respectively. Prolonged postoperative treatment was not common (28%) and was prescribed for patients with trophic changes.

[Surgical techniques used for the treatment of varicose veins: survey of practice in France]. / Résultats d'une enquête sur les techniques chirurgicales utilisées dans le traitement des varices.

UNLABELLED: This survey was undertaken in 2001 among surgeons of the French speaking Vascular Surgery Society (SCV-Société de Chirurgie Vasculaire de Langue Française) and SCV non-members with a heavy caseload in varicose vein surgery. AIM OF THE STUDY: To identify --the various surgical procedures used for treating chronic venous disease and in particular varicose veins; --the current use of preoperative investigation with duplex ultrasound; --the type of anesthesia used; --the postoperative treatment prescribed, and specifically compression therapy. MATERIAL AND METHODS: This survey was conducted by mail through a "half open" questionnaire including 17 questions and a patient form (see appendices I and II). 675 surgeons were questioned (501 were SCV members and 174 non members). RESULTS: Two-hundred and eighty surgeons answered (41.5%). The level of replies for French surgeons was 45.3%. A scientific committee assessed these replies. The surgeons were classified into different groups according to their membership of the SCV, own practice, and caseload. The 2 most performed procedures were respectively high ligation + saphenous trunk stripping + tributaries stab avulsion (71.9%) and high ligation + saphenous trunk stripping (17.3%). Isolated phlebectomy was 5.6%, high ligation + tributaries stab avulsion + saphenous trunk preservation 2.8%, isolated high ligation 2.2%, and ambulatory hemodynamic and conservative treatment of venous insufficiency (CHIVA) 0.3% ). The various procedures used (total number, average and percentage) inside the different groups are displayed in, and. Concerning trunk stripping modality the 2 most frequently used techniques were invagination and Babcock techniques. Both were evaluated respectively for the great saphenous vein (invagination 78.1%, Babcock technique 44.2%) and the small saphenous vein (invagination 77.1%, Babcock technique 31.8%). Complete resection of the saphenous trunk was more frequently performed than partial stripping. Pre-operative duplex scanning was systematically undertaken by 85.4% of surgeons without a statistical difference between the different groups. General anesthesia remains the most used form of anesthesia (83.9%) followed by spinal or epidural anesthesia (70.4%), and local or loco-regional (29.2%). As multiple answers were allowed, the most frequent procedures associated with general anesthesia were spinal or epidural (36.9%). Responders prescribed postoperative compression and anticoagulation in 97.1% and 55.8% respectively. Intra-group comparison was then undertaken in order to determine if their practice was different. Annual caseload was significantly (P=0.001) higher in Group I (353) than in Group II (226) and Group III (152). There was no difference in terms of the various surgical procedures used between the different groups. Group 1 favored the trunk stripping modality invagination for avulsion of the great saphenous vein and small saphenous vein. Concerning anesthesia, local and loco-regional anesthesia was used more by Group I than by the other groups as was anticoagulation. Responders perform perforator ligation and deep venous reconstructive surgery respectively in 70.3% and 22.4% without any intra group difference, however we have no information on frequency and indications for this type of surgery as these items were not included in the questionnaire. DISCUSSION: Total number of procedures recorded in this survey is in keeping with the yearly French data concerning surgical treatment of varicose veins (ie, approximately 200,000 procedures). Since the emphasis was on surgical procedures sparing the saphenous trunks in varicose vein treatment only 10.9% of the techniques used in this survey were compatible with this purpose. Invagination technique for stripping both the great and small saphenous trunk was preferentially used by the Group I. Although it is surprising that all groups favored total trunk stripping particularly for the small saphenous vein. It is not surprising that a large majority, despite very little controversy on this point, performed preoperative duplex scanning. Although postoperative compression can be only quoted as a grade C recommendation according to evidence-based medicine, it was prescribed in almost all cases. CONCLUSION: Surgery for varicose veins is one of the most frequently performed surgical procedures in France, mainly by surgeons exercising in private practice. There is no significant difference between the various groups (SCV Member or not, type of practice and annual case load) concerning the various procedures used, although through careful analysis certain different tendencies may be identified. In addition postoperative compression is systematically prescribed.

Percentage of free serum prostate-specific antigen: a new tool in the early diagnosis of prostatic cancer.

Prostate-specific antigen (PSA) is a protease able to bind to serum antiproteases as alpha 1 antichymotrypsin (ACT). Free PSA (FPSA) corresponds to the fraction of total PSA (TPSA) which is unbound to ACT. Specific detection of the FPSA seems to be a valuable tool in the distinction between prostatic cancer (PCa) and benign prostatic hyperplasia (BPH). Our aim was to evaluate retrospectively the FPSA/TPSA ratio in comparison to TPSA or FPSA determination, using two new immunoradiometric assays (PSA-RIACT and FPSA-RIACT, CIS bio international, Gif Sur Yvette, France) in the early diagnosis of PCa. 256 men, with TPSA levels between 0.7 and 44.7 ng/ml (median age = 69 years), including 164 sera obtained from patients with BPH and 92 sera from patients with untreated PCa were assayed. All diagnoses were histologically confirmed and patients tested before any adjuvant treatment. The evaluation of the median FPSA/TPSA ratio in the two groups showed significantly different values (BPH group: 24.2%, PCa group: 12.1%, P < 0.0001). By R.O.C. (Receiver-Operating-Characteristics) analysis, we show that the FPSA/TPSA ratio is the method of choice for discriminating BPH and PCa, since the area under curve is the greatest for the FPSA/TPSA ratio curve, as compared to the TPSA or FPSA curves (P < 0.0001). The best accuracy (number of true positive + true negative/total = 82.4%) was obtained with a FPSA/TPSA ratio < or = 15% with high odds ratio (20.5; confidence interval (CI): 11.2; 37.7). Of interest, similar results were also confirmed even in the subpopulation with serum TPSA levels between 2.5 and 10 ng/ml (161 patients including 99 BPH and 62 PCa). We thus confirm that combined serum measurement of FPSA and TPSA is of particular interest in the early diagnosis of PCa for patients with non-suspicious digital rectal examination and a TPSA value between 2.5 and 10 ng/ml. In those patients, biopsy should be reserved to the cases with FPSA/TPSA below 15%, which allows significant odds ratio (12.8; CI: 5.2; 31.4). Otherwise, to avoid the risk of missing any PCa, usual follow-up with combined TPSA and FPSA determination would be required with the same criteria of biopsy (i.e. FPSA/TPSA ratio < or = 15% when TPSA value is between 2.5 and 10 ng/ml; or TPSA > 10 ng/ml).

CYFRA 21-1, a sensitive and specific new tumour marker for squamous cell lung cancer. Report of the first European multicentre evaluation. CYFRA 21-1 Multicentre Study Group.

The present study was designed to determine whether CYFRA 21-1, measuring cytokeratin 19, could be a specific and sensitive tumour marker for non-small cell lung cancer (NSCLC). Serum measurements were made at diagnosis in 2250 patient samples by an immunoradiometric "sandwich type" assay, using two cytokeratin 19 specific monoclonal antibodies. Among healthy individuals (n = 711) and patients with benign lung disease (n = 546), 95 percentiles were 1.2 and 2.95 ng/ml, respectively. Cumulative distribution analysis curves were established. From these data, 3.3 ng/ml gave 96% specificity. Using this cutoff, the sensitivity for small cell lung cancer was 16% (n = 74) compared to 41% for NSCLC (n = 547). In histological sub-groups, sensitivity was 57% for squamous cell lung cancer, 34% for undifferentiated large cell carcinoma and 27% for adenocarcinoma, the level of CYFRA 21-1 was correlated with tumour size and UICC stage. In squamous cell lung cancer, the sensitivity of the squamous cell carcinoma marker was 30%, 25% for carcinoembryonic antigen and 46% for tissue polypeptide antigen, using the same series of samples and cutoffs defined at 96% specificity. In conclusion, CYFRA 21-1 is a sensitive tumour marker for NSCLC, especially squamous cell lung cancer.

An original organotypic culture method to study the organ of Corti of the newborn rat in vitro.

The inner ear growth is related to several factors which are not yet well known. In order to study the effect of growth factors on the development of the auditory receptor cells, we have chosen first to establish an in vitro model of the inner ear. Newborn rats were selected as the source of tissue because the inner ear is immature enough at this stage of development for studying some relations between receptors and their innervation. Until recently, the Maximov slide assembly technique was the only organ culture system available and silver neurofibrillary methods were used to stain the nervous structures. These are difficult and time-consuming techniques. With the use of a collagen gel drop floating in the culture medium, we have developed a simple and reliable method. Furthermore, an immunohistochemical fiber-staining technique with anti-neurofilament and histochemical staining technique with phalloidin allows us to check in a few days the organotypy at the spiral ganglion and hair cell levels. This floating drop method gave us some preliminary information about the spiral neuron cells which survived.