[Efficacy of medicamentous treatment of transient premenstrual phlebopathy of lower limbs]. / Éffektivnost' medikamentoznogo lecheniia tranzitornoi predmenstrual'noi flebopatii nizhnikh konechnostei.

AIM: The purpose of the study was to examine changes of the clinical pattern and the great saphenous vein in women with premenstrual leg heaviness and distal oedema in repetitive 15-day courses of micronized purified flavonoid fraction, initiated in the second half of the menstrual cycle. PATIENTS AND METHODS: A total of 39 parous women (mean age 31.3±7.9 years) with premenstrual leg heaviness were examined on days 1-4 (menstrual phase) and days 25-28 (secretory phase). The clinical pattern and the state of the veins were compared before and 3 months after 15-day courses of micronized purified flavonoid fraction. RESULTS: Leg heaviness decreased from 39 (100%) cases to 4 (14.3%) and intensity according to the VAS-10 from 5.2 (95% CI: 4.7 5.7) to 0.3 (85% CI: 0.0-0.6) (p<0.0001). During the secretory phase after treatment the great saphenous vein in the groin decreased from 5.94 mm to 5.02 in the morning and from 6.56 mm to 5.43 mm in the evening. In the reflux zone during the secretory phase the great saphenous vein decreased from 6.45 mm to 5.03 mm in the morning and from 7.32 mm to 5.45 mm in the evening (p=0.00001), which became in this zone equal to its diameter in the inguinal region. As the result, in all patients there was no reflux in the morning, and the evening reflux decreased to 6 (15.4%) cases. CONCLUSION: Repetitive 15-day courses of micronized purified flavonoid fraction, initiated 15 days before menstruation at a dose of 1000 mg daily ensured in 85.3% of women with premenstrual transient phlebopathy the removal of premenstrual leg heaviness, a significant decrease in swelling, normalization of the diameter of the great saphenous vein, including the reflux zone and complete elimination of morning transitory premenstrual reflux in the great saphenous vein.

[Transitory (evening) venous reflux in patients with intracutaneous varicosity and medicamentous correction thereof].

The authors carried out a study aimed at revealing transitory refluxes along the great saphenous vein (GSV) in patients with intracutaneous varicosity, and at investigating the possibility of removing them by means of preparations of micronized purified flavonoid fraction (MPFF). The study included a total of one hundred and forty-seven 21-to-47-year-old (mean age 31±4.4 years) women presenting with cutaneous varicosity (class C1s). The duration of skin manifestations amounted to 9.4±3.9 years (varying from 4 to 24 years). Telangiectasias were present in 69 (46.9%) women, 36 (24.5%) women had reticular varicosity, and 42 (28.6%) a combination thereof. An author-devised test was used with prolonged orthostatic load consisting in carrying ultrasound duplex scanning twice: in the evening after 6 p. m. and in the morning before 10 a.m., assessing the evening and morning parameters of the GSV, as well as the increment of the diameter of the vein at evening measurement as compared with the morning indices. Women with transitory refluxes along the GSV (n=59) underwent treatment with MPFF preparations (Detralex, Servier) during 60 days at a daily dose of 1,000 mg. The morning examination showed that there was no reflux along the GSV. The evening examination revealed refluxes along the GSV of various pattern and extent in 59 (40.1 %). All the 59 patients with evening refluxes presented complaints for increased fatigability, heaviness in the lower limbs by the end of the day. After 2 months of treatment, of the 59 women with initial reflux, 38 (64.4%) patients had no reflux and in 21 (35.6%) the extent of reflux decreased more than twofold. The evening diameter of the GSV decreased from 5.7 mm (95% CI 4.0-7.1) to 5.2 mm (95% CI 5.5-6.5) and the orthostatic gradient decreased from 0.9 mm (95% CD 0.6-1.3) to 0.6 mm (95% CI 0.4-0.8), p=0.000001. The initial complaints for heaviness in the legs after treatment disappeared in 76.6% of patients (50 of 59 subjects); in 9 women intensity of complaints decreased. The quality of life index decreased from 42 (95% CI 28-55) to 31 (95% CI 15-52) points (p=00001). Conclusions were drawn that in intracutaneous reflux in 40.1% of cases there appear transitory evening refluxes along the GSV revealed in the day-time orthostatic test. Taking MPFFs at a dose of 1,000 mg daily during 2 months removes evening transitory reflexes in 64.4% of cases and in 35.6% of cases decrease them, thus promoting contributing to decreased intensity of venous complaints and an increase in quality of life.

[Monitoring of the state of the proximal portion of thrombus in conservative treatment of patients with varicothrombophlebitis].

Ultrasound duplex scanning (USD) was used to study dynamics of the state of the proximal portion of the thrombus in patients presenting with acute varicothrombophlebitis of saphenous veins during conservative treatment. We examined a total of fifty-four 29-to-78-year-old (mean age 53.5 years) patients with acute varicothrombophlebitis of saphenous veins, including 15 (27.8%) men and 39 (72.2%) women. USD was used to determine: localization and extent of thrombosis, proximal level of the thrombus, presence of the free portion of the thrombus, density and structure of the proximal and distal portion of the thrombus, thickness of the inflamed venous wall and paravasal fat at the level of the proximal and distal portions of the thrombus. Twelve (22.2%) patients were found to have signs of thrombus flotation with high embologenic risk; these patients underwent the operation of Troyanov-Trendelenburg and were excluded from the study. The remaining 42 patients received conservative treatment and were dynamically followed up by means of USD. All patients on the background of comprehensive conservative treatment showed positive dynamics consisting in decreased mass and density of the thrombus, shift of its proximal border in the distal direction, decreased thickness of the inflamed venous wall and paravasal fat. Two variants of dynamics were singled out: relatively rapid (during a week) - group 1 (n=11) and relatively slow (during one month) - group 2 (n=31). It was determined that the most significant factors promoting rapid lysis of the proximal portion of the thrombus were as follows: the term of seeking medical attention (duration of thrombosis), low echogenicity of the thrombus, cellular pattern of the thrombus and thickness of the paravasal fat. A conclusion was drawn that monitoring of the state of the proximal portion of the thrombus by means of USD makes it possible to maximally approach solving the problem of individualized treatment of patients with thrombosis of saphenous veins.

[Condition of the proximal portion of the thrombus in varicophlebitis of the great saphenous vein].

AIM: To assess the state of the proximal portion of a thrombus of the great saphenous vein (GSV) in patients with varicophlebitis by means of duplex scanning of veins. MATERIAL AND METHODS: We examined a total of 40 patients with acute varicophlebitis of the GSV: 11 (27.5%) men and 29 (72.5%) women, the patients' average age amounted to 53.5 years (range 29-78). Duplex scanning (DS) was used to determine: localization and extent of thrombosis, the presence of a free portion, density and configuration of the contour of the proximal portion of the thrombus, proximal level of the inflammatory wall and paravasal fat. RESULTS AND DISCUSSION: Inflammation was located on the crus in 12 (30%) patients, on the femur in 10 (25%), on the crus and femur in 18 (45%) patients. According to the findings of DS, of 28 (70%) patients with femoral inflammation the upper end of the thrombus was located in the lower third of the femur in 9 (22.5%) patients, in the middle third in 11 (27.5%) patients and in 8 (20%) patients in the upper third. In 29 (72.5%) patients the thrombus had no free part, eleven (27.5%) were found to have a floating portion 1.0-10 cm long (averagely 3.58 cm). The incidence of floating thrombi is determined by the diameter of the thrombosed vessel: in femoral localization the floating part was in 9 (22.5%) patients, in crural localization - in 2 (5%). A distinct edge of the proximal contour was present in 30 (75%) patients, diffuse contour in 10 (25%). In 8 (20%) patients the proximal portion of the thrombus by density did not differ from the patients' body. In 3 (7.5%) patients it approximated to density of blood. In the majority of cases (60%) the proximal portion was of cellular character with alternation of portions of various density. Thickness of the altered paravasal fat amounted to 7-20 mm (averagely 8.68 mm). The boarder of the thrombus in 56 (90%) patients located proximal to inflammation of the wall and paravasal fat by 4.0-60.0 cm (averagely 6.0 cm). This demonstrates that clinical symptoms induce phlebitis and paravasal cellulitis. CONCLUSION: Detailed examination of the proximal portion of the thrombus in patients with varicophlebitis of the GSV by means of DS makes it possible to accurately evaluate its condition: assessment of density and configuration provides a more detailed characterisation of the degree of maturity of the proximal portion of the thrombus. Thrombus density comparable with density of liquid blood in combination with its extended free portion may increase the risk of thrombus migration.

[Medicamentous protection of lower limb veins in a subacute period of varicophlebitis of the great saphenous vein].

The study was aimed at determining the dynamics of saphenous veins in patients with varicophlebitis of the great saphenous vein (GSV) in a subacute period (during compression therapy) and at assessing efficacy of 4-month medicamentous protection thereof. We examined a total of 32 patients presenting with the first episode of non-embolic varicophlebitis of the great saphenous vein. The comparison group comprised 16 patients undergoing 4-month compression (degree 2) therapy alone, and the study group patients (n = 16) were subjected to compression therapy combined with a 4-month course of micronized diosmin (1 tablet twice a day). The patients were included into the groups alternately as they attended our medical facility. Duplex scanning before and after the treatment course was used to measure the following parameters: 1) the evening diameter of veins and 2) an increase in the vein's diameter measured overnight as compared to the morning measures - the orthostatic gradient. The obtained results showed that the subacute period of varicophlebitis of the GSV is accompanied and followed by an increase in the diameter of the GSV and SSV and that of their orthostatic gradient, caused by imparted tonicity and viscoelastic properties. Compression therapy alone in the subacute period of varicophlebitis does not provide complete safety of saphenous veins from secondary lesions. Compression therapy combined with a 4-month-long course of taking micronized diosmin increases the efficacy of treatment.

[Hygienic evaluation of air and soil pollution with mercury in the area of location of a coke plant]. / Gigienicheskaia otsenka zagriazneniia atmosfernogo vozdukha i pochvy rtut'iu v raione razmeshcheniia koksokhimicheskogo proizvodstva.

It has been established that processes of coal carbonization are accompanied by intensive mercury discharge into the air and soil. The maximum levels of ambient air contamination by mercury are determined 0.5 km away from the source--0.0016 mg/m3, 3 km away from the source--lower than 0.00024 mg/m3. Technogenic area of mercury is almost twice the territory of the plant, and it is stretched along the prevalent direction of the winds. Mercury concentrations at different distances away from the plant were 2.76 mg/kg (0.5 km), 1.97 mg/kg and 0.26 mg/kg. Simultaneous isolation of mercury from coals in the process of coal carbonization is recommended.