Efectividad del tratamiento de las úlceras venosas con vendaje compresivo multicapa asociado a protección de la piel perilesional con Cavilon® (película barrera no irritante) / Effectiveness of the association of multilayer compression therapy and periwound protection with Cavilon® (no sting barrier film) in the treatment of venous leg ulcers

Introducción: el adecuado tratamiento de las úlceras de extremidad inferior de etiología venosa es fundamental para mejorar la calidad de vida de los pacientes. El uso de terapia compresiva con vendaje multicapa es el tratamiento que mejores resultados presenta. En la práctica, se utiliza en combinación con unos adecuados cuidados locales de la herida y de la piel perilesional. El objetivo del estudio fue evaluar la efectividad clínica de un vendaje multicapa de compresión y el impacto de la utilización de la película barrera Cavilon® en úlceras vasculares de origen venoso.Metodología: ensayo clínico controlado, aleatorizado, abierto, multicéntrico y pragmático en España. Todos los pacientes incluidos fueron tratados con terapia de compresión con el mismo vendaje multicapa y asignados aleatoriamente al grupo de intervención, tratados con la PBNI Cavilon®,o al grupo control. Se realizaron un máximo de 13 visitas de estudio separadas entre ellas por una semana. El estudio fue evaluado y aprobado por los comités éticos de investigación clínica (CEIC) de los siete centrosparticipantes. Resultados: participaron 98 pacientes en el estudio (49 en elgrupo intervención y 49 como control). Tras cuatro semanas, el grupo intervención presentó una reducción media (DE) del tamaño de úlcerasuperior al grupo control (56,7% (30,3) vs. 45,5% (47,4); p = 0,087).A las 12 semanas de tratamiento, las diferencias observadas fueron estadísticamente significativas (83,4% (31,1) vs. 71,6% (44,1); p = 0,046) (..) (AU)

Aim: appropriate treatment of venous leg ulcers is essential to improve the quality of life of patients. Compression therapy using multilayer bandages show to the best clinical results. In practice, it is used in combination with a suitable local care of the wound and periwound skin. The aim of this study was toevaluate the clinical effectiveness of a multi-layer compression bandageand the impact on it of the use of barrier film Cavilon® in venous leg ulcers. Methods: controlled clinical trial, randomized, open, multicentre and pragmaticin Spain. All included patients were treated with compression therapy with the same multilayer bandages and randomized to the intervention group, treated with NSBF Cavilon®, or to the control group. Up to 13 weekly visits were performed. The study was reviewed and approved by the institutional research board (IRB) of the 7 participating centres. Results: ninety eight patients were included in the study (49 in the intervention group and 49 in control group).At 4 weeks of treatment, the intervention group showed a mean ulcer size reduction (SD) greater than the control group (56.7% (30.3) vs. 45.5% (47.4),(p=0.087). At 12 weeks of treatment, differences were statistically significant(83.4% (31.1) vs. 71.6% (44.1), p=0.046). In the intervention group, 69.4%of patients reduced the ulcer area * 50% in the first 4 weeks of treatment,instead of 46.9% of patients in the control group (p <0.01). Conclusions: the clinical effectiveness of a multi-layer compression bandage (Coban® 2) in patients with venous leg ulcers, assessed in terms of percentage reduction of area, is increased by concomitant use of a protective treatment of periwound skin withNSBF (Cavilon®) (AU)

Occurrence and management of chronic venous disease in primary health care in Spain. A comparison of DETECT-2006 with DETECT-2000.

AIM: The aim of this study was to investigate the prevalence and initial treatment of chronic venous disease (CVD) in the Spanish primary health care system during 2006 and to compare the results with those obtained in 2000. METHODS: The survey involved 1 118 general practitioners co-ordinated by 37 specialists in angiology and vascular surgery, assessing 15 consecutive patients, each attending the clinics between 29 May and 2 June 2006. RESULTS: Of the16 186 patients reported, 82% had CVD risk factors. When asked about CVD signs or symptoms 11 277 patients (69.7%) mentioned some kind of clinical manifestation/sign compatible with the disease. Diagnosis was established in accordance with the clinical section of the CEAP classification, 38% of the total being classified as C2-C6. Sixty-two percent of the symptomatic patients had received prior treatment (vs 24.8% in year 2000), and following the survey 88% of the patients diagnosed with CVD were treated (vs 62% in 2000). CONCLUSIONS: The results for 2006 confirm the high prevalence of CVD in primary health care in Spain. In comparison with the results for 2000, an improvement in the patterns of medical advice use, treatment and prescriptions are observed. Despite these findings, specific training programs in primary health care regarding the diagnosis and treatment of CVD continue to be necessary.

Chronic venous insufficiency of the lower limbs: suitability of transcutaneous blood gas monitoring as an endpoint to evaluate the outcome of pharmacological treatment with calcium dobesilate.

This pilot clinical trial was designed to further investigate the effects of calcium dobesilate in the treatment of chronic venous insufficiency (CVI) by means of a novel endpoint, transcutaneous oxygen pressure (TcPO2), and to evaluate the suitability of this endpoint for future research. Patients with mild to moderate CVI without active ulcers were randomized to receive calcium dobesilate 1000 mg/day, 2000 mg/day or placebo for 12 weeks. The primary efficacy endpoint was TcPO2 in the distal third of the internal side of the leg. Secondary endpoints included assessment of venous reflux and clinical symptoms. Patients in the dobesilate 1000 mg/day and placebo groups showed a mild increase in TcPO2 (adjusted mean change 2.67 mmHg and 1.56 mmHg, respectively), while those treated with 2000 mg/day of the active drug showed a decrease (adjusted mean change -0.53 mmHg). Conversely, clinical symptoms and venous reflux improved in all groups, especially with dobesilate, but differences with placebo were not significant. Treatment was very well tolerated. Although the absence of significant differences prevented confirmation of sensitivity, a trend favoring calcium dobesilate in clinical and hemodynamic parameters was observed. This improvement was not reflected by TcPO2.

[Angioscopy, the potentials and limits of its use in angiology and vascular surgery]. / La angioscopia, posibilidades y límites de su aplicación en angiología y cirugía vascular.

Possibilities from arterial and venous angioscopy in the diagnostic, angioplasty and surgical protocols are analyzed. Indications for angioscopy, additional informations compared to angiography and potentials for endovascular therapy guided by angioscopy will be discussed according to personal preliminary experience and review of the bibliography.

[Non-invasive monitoring of cardiac output with Doppler in aortoiliac surgery. Preliminary study]. / Monitorización incruenta del gasto cardíaco por Doppler en cirugía aorto-ilíaca. Estudio preliminar.

The experience about 18 patients subjected to aortoiliac surgery is exposed. The cardiac flow was bloodless monitorized by means of an apparatus, based in Doppler effect, which proved its accuracy and usefulness. Authors considers necessary to monitorize the cardiac flow in this sort of surgery, and this bloodless method has showed its validity and simplicity.