8-Epi-PGF2alpha and 6-oxo-PGF1alpha in human (varicose) veins: influence of age, sex, and risk factors.

The isoprostane 8-epi PGF2alpha is a vasoconstrictive, mitogenic, proliferative, and mild proaggregatory agent. We examined 8-epi-PGF2alpha and 6-oxo-PGF1alpha from venous tissue derived from varicose (venous) surgery by means of a specific radioimmunoassay. A total of 336 samples from 82 patients (50 females, 32 males; aged 22-68 years) were examined. Tissue samples were classified according to normal, dilated, and varicose. Of these, 94 samples from 31 patients (20 females, 11 males; aged 29-64 years) with additional risk factors (cigarette smoking, hyperlipidemia, diabetes mellitus) were determined in the same way. Mean absolute values for 6-oxo-PGF1alpha are not significantly higher for dilated segments followed by varicose and intact samples. No significant age and sex differences can be monitored. Presence of risk factors, however, results in a significantly diminished 6-oxo-PGF1alpha, irrespective of morphology. 8-Epi-PGF2alpha again showed no age and sex dependence, its presence in varicose segments, however, was significantly (p<0.01) decreased. Risk factors resulted in a significantly increased 8-epi-PGF2alpha. These data indicate that the influence of risk factors on vasomodulatory (iso-)eicosanoids of human veins is more pronounced than the actual morphologic stage. Lower 8-epi-PGF2alpha in varicose veins may shift the venous tone toward vasodilatation and contribute to development and progression of varicosis.

Do telangiectases communicate with the deep venous system?

Telangiectases of the legs occur frequently, with most patients seeking treatment for cosmetic reasons. Sclerotherapy continues to gain popularity as a safe and valuable therapeutic approach; however, deep vein thrombosis as well as pulmonary embolism have been reported even after sclerotherapy of small intradermal venectases. Hoping to uncover anatomic risk factors predisposing a patient to iatrogenic thrombosis, we investigated 15 patients with telangiectases of the legs applying ascending venography concomitantly with direct injection of the telangiectases. A digital radiographic technique was used as an imaging system. In two patients an unrestrained flow of the contrast medium into the venae femorales was noticed. As far as we know this is the first in vivo demonstration of venae communicantes connecting intradermal venectases to the deep veins. That means that particular anatomic conditions favor the spillage of sclerosant into the deep veins, which might contribute to the development of iatrogenic deep vein thromboses in compression sclerotherapy.

[Local treatment of ulcus cruris venosum (author's transl)]. / Die Lokaltherapie des Ulcus cruris venosum.

In this survey, the principles of local ulcer treatment and the most common therapeutic techniques are discussed. The data concerning the risk of sensitisation by local therapeutics are presented in the tables 1, 2, 3, 4.

[Compression therapy of lymphedema (author's transl)]. / Kompressionstherapie der Lymphödeme.

In spite of the development of micro-surgical techniques which enable functioning lymphovenous anastomoses to be formed, surgical interventions are not usually indicated in extremities with lymphedema which are for the most part already irreparably damaged. For want of an effective medicinal alternative compression therapy is still the method of choice. Its mode of action, indication and performance are dealt with. The "manual lymph drainage" which has received much propaganda in recent years shows good results only in the initial stages which are still reversible. In pronounced indurative scleredermas a considerable reduction in volume can be achieved by wrapping the extremity in non-elastic or tubular bandages which must be consistently preserved by compression stockings of class 3 and 4.

[The effect of high-heeled shoes on the venous pressure of the legs (author's transl)]. / Der Einfluss der Schuhabsatzhöhe auf den Venendruck des Beines.

The influence of high-heeled shoes on the venous pressure in the lower limbs is studied. In a test series on an exercise band subjects with high heels showed a significantly smaller drop in pressure than subjects wearing flat shoes.

[Limitations of venous function diagnosis using laboratory apparatus - possibility of errors]. / Limites du diagnostic de la fonction veineuse par l'emploi d'appareils - possibilités d'erreurs.

The authors discuss some questions concerning the limitations and the errors of methods involving the Sonar Doppler, Plethysmography and Phlebodynamics in phlebology diagnosis. The Doppler technique is the most useful one in detecting a valvular insufficiency or a venous obstruction of the thigh. Plethysmography is a simple method of detecting a pelvic or femoral thrombosis. It does not make it possible, on the level of the calf, to make a distinction between a recent thrombosis or a post-thrombotic state. It cannot be used when there is a large edema. It is inadequate for studying the function of the muscular pump of the calf, which can also be done by phlebodynamics. This method is now the most precise technique for quantitatively studying the total function of the muscular pump of the calf. It can be easily reproduced, and the effect of therapeutic measures can thus be anticipated.

[Fibrinolytic activity of the vein wall]. / L'activité fibrinolytique de la paroi veineuse.

The author reviews this classically held opinion, that the older sclerosants cause coagulation of the blood, while the newer sclerosants bring about an endothelial change which itself generates a thrombus. He attempts to analyse the clotting activity of the vein wall before and after the sclerosant injection. The first series of experiments gave the impression that the walls of veins subjected to a sclerosant injection had an increased fibrinolytic activity, in comparison with untreated veins. It was noted that this increase in activity was not permanent but transient. Further studies have shown that this interpretation may be premature, since there are several possible sources of error. A new series of experiments is in progress, and it would be premature to draw conclusions.

[Trophic phenomena in dermatology (author's transl)]. / Trophische Störungen der Haut

After a description of trophic disorders in 2 patients the great variety of trophic disorders and their diagnostic problems are discussed. Neurovascular dysfunction may be the main cause of trophic phenomena. The general opinion ist that so-called "trophic" nerve fibres do not exist, but there is evidence of the production of "trophic" substances by the nerve endings. So long as these problems remain unresolved, the term "trophic" should be avoided in favour of "neurovascular disorder".