Vein Disease Research Articles

Branch pulmonary artery flows calculated using velocity time integral correlate with MRI in pediatric pulmonary vein stenosis

Abstract Background/Introduction In pulmonary vein stenosis (PVS), serial echocardiograms are the mainstay in assessment of pulmonary vein disease. Development of gradients in stenotic pulmonary veins indicate progression of disease and influences timing of intervention. However, pulmonary vein gradients should be interpreted in the context of relative branch pulmonary artery (PA) flows to avoid misinterpretation of worsening PVS. To date, the comparison of branch PA flows derived from echocardiography compared to gold-standard from MRI has not been described. Purpose To determine if branch PA flows calculated using velocity time integral (VTI) correlate with MRI. Methods Single-center retrospective assessment of cardiac MRIs and echocardiograms in pediatric patients with pulmonary vein stenosis between February 2019 to May 2022. Cardiac MRIs and echocardiograms obtained within a 6-month period were compared. All causes and severity of PVS were included. Patients were excluded if echocardiographic assessment did not adequately visualize either branch PA or pulse wave Dopplers in the PAs were not performed. 20 patients with a mean age of 7.72 ± 5.93 years were included. Branch PA flows were derived using PA diameter in systole from the high parasternal view from which cross-sectional area (CSA) was calculated using CSA = pi(radius)^2. Using pulse wave Doppler in the branch PAs, VTI was measured as an averaged area under the curves over 3 beats. Relative branch PA flows were calculated using a product of CSA and VTI. We present branch PA flows indexed to body surface area. Results Mean RPA flows by VTI and MRI were 2.18 ± 1.36L/min/m2 and 2.34 ± 1.29L/min/m2, respectively. Mean LPA flows by VTI and MRI were 1.64±0.77L/min/m2 and 1.94±1.13L/min/m2, respectively. There were statistically significant correlations in branch PA flows comparing VTI to MRI (RPA correlation coefficient 0.549, p=0.02, LPA correlation coefficient 0.621, p=0.01). Conclusion Relative branch PA flows calculated using VTI correlate significantly with gold-standard from MRI. Lower correlation in the RPA may be due to Doppler angle. This is a feasible, complementary tool easily integrated as part of the standard echocardiographic assessment of PVS, that allows early detection of disease progression while decreasing the frequency of general anesthesia required for MRIs in young children. Expansion to a larger cohort is necessary to strengthen demonstrated correlations. Future work includes integration of branch PA flows in addition to pulmonary vein gradients to develop a PVS severity score in pediatrics to guide management.

Hemodynamic sclerotherapy in comprehensive management of varicose disease of lower-limb veins in patients with morbid obesity

Introduction. Endovenous laser ablation combined with sclerotherapy are effective treatment options for varicose veins of the lower limb. However, sclerotherapy is associated with an increased risk of side effects in patients with morbid obesity, which makes it challenging.Aim. To improve efficiency of the varicose veins of the lower limb treatment in patients with morbid obesity by using the aspects of “hemodynamic sclerotherapy”.Materials and methods. Prospective comparative study included 109 patients with C3–C5 classes of chronic venous diseases and morbid obesity was performed. All patients were treated with endovenous laser ablation combined with sclerotherapy. In the main group (n = 56) sclerotherapy was performed in the Trendelenburg position, in the control group (n = 53) – in the horizontal position.Results. The diameter reduction of the great saphenous vein by 22.5% in the Trendelenburg position with 15° incline was statically significant (p < 0.001). The perforating veins reflux in the Trendelenburg position with 15° incline was not detected in 72.3% of patients (p < 0.001). The occlusion rates of the varicose tributaries not treated with sclerosant in the main group was 41% (p = 0.032). In the main group only 12.5% of patients were found to have phlebitis (p = 0.029), the Visual Analog Score (p = 0.036) and local temperature (p = 0.049) were also significantly lower. The incomplete occlusion rate of the varicose tributaries in the main group was only 5.3%; however, the difference was not statically significant.Discussion. The perforating veins reflux in the Trendelenburg position and the incomplete occlusion of the varicose tributaries were only in obese patients with body mass index more than 55 kg/m2 and C4b–C5 classes.Conclusions. Sclerotherapy in the Trendelenburg position with the legs elevated at least 15° incline improves the efficiency of the varicose vein’s occlusion in patients with morbid obesity. Sclerotherapy in obese patients with body mass index more than 55 kg/m2 has less effect.

Experience With Dabigatran on Rate of Portal Vein Thrombosis Recanalization, Disease Progression and Survival.

We assessed clinical, procoagulant and genetic risk factors and clinical outcomes in dabigatran-treated patients with non-tumoural acute and acute-on-chronic portal vein thrombosis (PVT). Patients with a new diagnosis of non-tumoural acute and acute-on-chronic PVT between January 2021 and January 2024 (aged ≥ 18 years) in those without/with cirrhosis (Child-Pugh (CP)-A/B/C ≤ 10) were started on dabigatran and followed and compared with those on vitamin K antagonist (VKA) and untreated individuals. Dabigatran was prescribed in 119 patients with PVT type 1 (61, 51.3%), type 2 (34, 28.6%), type 3 (24, 20.2%); 72 (60.5%) with cirrhosis [CP-A (27, 37.5%), CP-B (43, 59.7%) and CP-C10 (2, 2.8%)]. Procoagulant factors noted were JAK2V617F (10.1%), CALR (2.5%) and factor V Leiden (1.6%) mutations, antiphospholipid syndrome (APS, 15.2%), isolated Protein C (14.3%) and Protein S (16.8%) deficiency. 28 patients who declined anticoagulation/were unable to come for follow-up, and six with CP-C received VKA. Overall recanalization rate (RR) on dabigatran was 56 (47.1%); 25 (21%) complete recanalization, 31 (26%) partial recanalization and 63 (52.9%) stable PVT over median follow-up of 32 months. Patients not anticoagulated had a spontaneous RR in 21.4% (28 patients; p = 0.005 compared with dabigatran group) and none recanalized on VKA. On multivariable analysis, predictors of recanalization on dabigatran were Factor VIII Antigen level (FVIII:Ag, HR 0.6; 95% CI 0.3-0.9, p = 0.032), non-occlusive PVT (HR 3.5, 95% CI 1.9-5.6, p = 0.025) and acute PVT (HR 2.1; 95% CI 1.5-3.2, p = 0.003). Mortality was 14 (11.8%). On dabigatran, 47% of 119 patients achieved portal vein recanalization over 32 months of follow-up which was higher than the spontaneous RR (21.4%) in an untreated cohort. High Factor VIII:Ag was a predictor of non-recanalization. Dabigatran was safe in cirrhosis (CP-A and B) while further work is needed in CP-C.

A Review on Varicose Vein

This article's goal was to cover the various varicose vein disease treatments and preventative strategies. Varicose veins are a common vascular condition known for causing discomfort. A weakening of the venous valves and walls is a common cause of varicose veins. Varicose veins are twisted, swollen veins that are typically located in the lower limbs. They damage blood vessels, causing excruciating swelling and blood clots that impair a person's ability, productivity, and quality of life. Their prevalence increases with age. Obesity and extended standing are the main causes of varicose vein disease. This overview explains varicose vein processes, prevention, risk factors, consequences, and therapy. Generally varicose vein is found in females especially in case of pregnancy. Varicose veins generally found in lower extremity, leg and the epididymis. Varicose vein disease can be prevented by doing regular yoga/exercise and consumption of several fruits and vegetables such as Grapes, blackberries, avocados, ginger, and rosemary. Patients with varicose veins should take an antioxidant medicament from the flavonoid groups to reduce the arterial blood pressure value, risk of atherosclerosis development, prevent thrombotic incidents. This review gives the information about the different ayurvedic treatments for varicose veins. As a result, the current review critically assesses the possible utility of herbal medications in the treatment of varicose veins.

Availability of the Great Saphenous Veins as Conduits for Arterial Bypass Surgery in Patients with Varicose Veins.

Background: The great saphenous vein (GSV) has long been recognized as the best conduit for vascular bypass procedures. Concomitant varicose veins disease may be a reason for GSV unavailability either due to dilatation and tortuosity of the vein or due to its destruction during invasive venous treatment. Objectives-to assess the rate of varicose vein patients with concomitant lower extremity arterial disease (LEAD) who have previously lost their GSV due to venous ablation. Material and Methods: A total of 285 patients (76 F, 209 M) with LEAD were consecutively enrolled. A total of 111 patients (222 limbs) underwent a detailed duplex ultrasound of the lower extremity veins for assessing suitability of the GSV as a conduit. We registered presence of varicose veins (VVs), type of previous invasive procedure and availability of saphenous veins as possible grafts. Results: The mean age of screened patients was 70.5 ± 9.1.62 (21.75%) patients had varicose veins or were operated on before due to varicose veins. A total of 42 patients with varicose veins had C2 disease, 10 had C3, 9 had C4 and 1 had C6 according to CEAP classification. A total of 222 lower extremities were examined by duplex ultrasound of which 51 limbs had VVs. Despite the presence of varicose tributaries, the GSV was suitable for bypass in 9 of those lower extremities. The GSV was not available as a conduit in 34 (19.9%) ipsilateral lower extremities in the LEAD with no VVs group and in 42 (82.6%) ipsilateral lower extremities in the LEAD with VVs group (p = 0.0001). Varicose vein disease was associated with a higher frequency of the GSV unavailability (odds ratio 18.8, 95% confidence interval 8.35-42.35). On the 11 ipsilateral limbs (5% of LEAD patients and 21.6% of LEAD with VVs patients), the GSV was unavailable due to previous venous interventions. Conclusions: Almost 20% of patients may have both LEAD and VVs. Among those with VVs, most have the ipsilateral GSV unavailable as a potential conduit. Additionally, one fifth of limbs with VVs had GSVs destroyed previously due to saphenous ablative procedures.

Molecular Diagnosis of Major Emerging Tomato Infecting Viruses and Their Vector Population Dynamics

Tomato is an important vegetable crop in Bangladesh, growing year-round in both kitchen gardens and large-scale commercial farming. Many diseases affect the solanaceous vegetable crop, particularly viral diseases. Using modern molecular methods and vector population dynamics, we attempted to detect major emerging viral infections of tomato. A survey was conducted in different locations of Bangladesh, namely Rajshahi, Jamalpur, Jessore, and Joydebpur to assess viral infections in tomato and associated insect vectors. Various forms of viral disease symptoms were observed to infect tomato in the examined area, including mosaic, yellowing, mottling, leaf curling, and bud necrosis, with a incidence ranging from 20 to 100%. Among the different viral diseases, leaf curl was the most common, accounting for 100% of the cases. Field resistance to viral infections was investigated among the BARI released tomato varieties, and all of the tomato types tested were infected with the leaf curl virus. In addition, the examined area had a moderate to high prevalence of chlorosis and purple vein disease. The viruses identified by DACELISA, PCR, and RT-PCR were tomato leaf curl virus (ToLCV) and groundnut bud necrosis virus (GBNV). J. of Sci. and Tech. Res. 6(1): 161-167, 2024

Changes in the Epidemiology of Thoracic and Cardiovascular Diseases in Korea During the COVID-19 Pandemic: A Nationwide Analysis.

Background/Objectives: There is limited evidence regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on the epidemiology of thoracic and cardiovascular diseases. This study aimed to investigate changes in medical visits for these conditions during the COVID-19 pandemic. Methods: We analyzed the entire Korean population (~50 million) for monthly medical visits for 15 common thoracic and cardiovascular conditions, including pneumothorax, large bullae, lung cancer, esophageal cancer, thymoma, empyema, mediastinitis, esophageal rupture, multiple rib fractures, hemothorax, rib mass, varicose vein, pectus excavatum, aortic dissection, aortic aneurysm, and valve disease from January 2019 to December 2021. Data were obtained from the Korean National Health Insurance Service using the International Classification of Disease (ICD)-10 codes. Variations in the mean monthly medical visits of 15 frequent thoracic and cardiovascular diseases before and during the COVID-19 pandemic were compared using the Mann-Whitney U test, while changes in variance were assessed using Levene's test. Results: The mean monthly number of medical visits for pneumothorax and large bullae significantly decreased during the COVID-19 pandemic compared to before the pandemic (by 10.1% and 12.8%; both p < 0.001). On the contrary, there was a significant increase in the mean monthly counts of medical visits for lung cancer, esophageal cancer, thymoma, and valve disease diagnosis (by 6.6%, 5.3%, 8.8%, and 5.0%, respectively; all p < 0.05). Conclusions: In Korea, the number of diagnosed cases of pneumothorax significantly decreased during the COVID-19 pandemic compared to before COVID-19, while diagnoses of thoracic cancers and valve disease increased.

Surgical treatment of patients with varicose veins of the lower extremities from the origins to the present day

Varicose vein disease of the lower extremities is a common problem today. In various countries, approximately 25–30% of women and 10–15% of men sufferfrom this condition. Surgical methods hold a special place in the treatment of such patients. Currently, despite the development of effective minimally invasive endovenous techniques, doctors still face recurrences of the disease due to insufficiency of radical surgery, as well as the natural progression of varicose vein disease as genetically determined, which necessitates further exploration for solutions to improve treatment outcomes. The article describes the history of the development of surgical methods, including the first mentions of this disease, vessel ligation, phlebectomy, minimally invasive techniques, and others.

Modern concepts on the mechanisms of endovasal laser coagulation in varicose vein disease

Mechanisms of endovasal laser coagulation (EVLC) applied in varicose vein disease are not fully understood.Purpose. To analyze currently applied EVLC mechanisms so as to prevent hemorrhagic complications and paresthesia caused by these mechanisms.Methods. This review analyses modern theories on EVLC mechanisms when applied in varicose vein disease in the lower extremities.Results. Published experimental and clinical trials, including histological ones, have shown that the degree of vein damage during EVLC session depends on many factors, such as wavelength, intensity, and optical fiber speed. Damage to veins during EVLC procedure depends on various factors, such as direct contact of the vein wall with an optical fiber tip, carbonization of blood elements leading to the increased intravenous blood temperature and to the formation of gas bubbles as well as heat convection on the vein wall through the blood.Conclusion. Destruction of the vein wall during EVLC procedure is the result of a synergistic effect of various damaging factors. Currently, 2-μm laser irradiation is being implemented into clinical practice. This technique provides better vein coagulation under less power values which promotes less postoperative complications.

Case report of varicose veins treatment in patient with a prosthetic mitral valve

This clinical case may be of interest in situations where a patient with varicose veins of the lower limbs and concomitant heart disease, who is on long-term anticoagulant therapy and is scheduled to undergo minor surgery, may present the possibility of endovenous laser ablation (EVLA) against the background of warfarin use. Patient, G., 68 years old, with rheumatic combined mitral valve disease (mitral valve replacement in 2019, permanent atrial fibrillation), also had varicose vein disease of the lower limbs. History included acute cerebrovascular accident (19.01.2023). Duplex Ultrasonography Screening (DUS) showed failure of the left great saphenous vein valve. Hypocoagulation was also observed in coagulogram and the risk of bleeding on HAS-BLED score was average. On Caprini score, the risk was very high. Endovenous laser ablation of the large saphenous vein on the left side was performed. During follow-up examinations, there were no signs of bleeding from puncture sites. The target trunk was obliterated in dynamics at DUS. Therefore, it is possible to carry out EVLA of a large subcutaneous vein while taking therapeutic doses of warfarin without switching to bridge therapy. Endovascular laser ablation allowed it to be done with less risk of bleeding and, against the background of taking warfarin, reduced the risk of thrombosis.

Varicose vein disease in the context of insulin resistance

The prevalence of insulin resistance (IR) is growing every year, which determines the risks of developing type 2 diabetes and cardiovascular diseases. Currently, IR is not recognized as a risk factor for the development of varicose veins (VVs), but the connection between the two is tacitly obvious because obesity and diabetes are risk factors for VVs. In this review, we have attempted to highlight the common nature of these two conditions in the context of mitochondrial dysfunction, inflammation, endothelial dysfunction, and tissue hypertrophy, and spotlight the role of IR in the development of VVs. We conclude that IR can contribute to the appearance of VVs.

Insights Into the Neutrophil-Lymphocyte Ratio in Primary Varicose Vein Disease Screening and Prognosis.

Introduction Varicose veins are a common cause of deterioration in quality of life. Chronic venous disease (CVD) is highly prevalent yet underdiagnosed. This discrepancy in care may change with better insights into the pathophysiological development of CVD. Objective In this retrospective study, we aimed to assess the ability of the neutrophil-lymphocyte ratio (NLR), a single inflammatory marker, in screening for primary varicose veins. Methods A total of 130 patients aged 21-70 years diagnosed with primary varicose veins from January 1, 2016, to January 30, 2023, were retrospectively studied at the Department of General Surgery, Kasturba Medical College, Manipal. Patients were divided into two groups based on their degree of primary varicose veins using the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. Group 1 included patients with varicose veins with CEAP stage ≤ C3 and group 2 included patients with varicose veins with CEAP stage > C3. Complete blood counts taken at diagnosis were used for NLR calculation. Results Absolute neutrophil counts (CI 95%), absolute lymphocyte counts (CI 99%), and NLRs were all statistically significant inflammatory markers in both groups. NLR was found to have a strong statistically significant association with the diagnosis of primary varicose veins (p-value<0.001). NLRs were lower in group 1 than in group 2. Conclusion This study conclusively finds that NLR may effectively be considered to track the incidence of primary varicose veins in patients after further studies.

Protocol-based treatment of spontaneous hemorrhage from varicose veins prevents recurrence of bleeding

BackgroundSpontaneous hemorrhage from erosion of varicose veins through the skin is a serious and occasionally fatal complication of varicose vein disease. Various treatments, both acute and delayed, have been advocated. Our two-step clinical protocol was designed to prevent further hemorrhage without delay and to provide durable freedom from recurrent bleeding. MethodsAll patients referred to our surgical vein practice with hemorrhage from varicose veins were entered into a prospective registry. On presentation, all patients underwent diagnostic duplex ultrasound for venous reflux. Immediate treatment consisted of ultrasound-guided polidocanol/CO2 foam sclerotherapy of the bleeding varicosity and adjacent veins. Subsequent endovenous ablation of underlying incompetent axial veins, with concurrent microphlebectomy when indicated, was scheduled and performed within 8 weeks. ResultsFifty-nine patients were referred with recent hemorrhage from varicose veins over a period of 4 years. Fifty-six (95%) had an ultrasound-identified tributary varicosity underlying the point of bleeding, and three had a skin-surface erosion only and no ultrasound-identified underlying tributary. Of the 59 study patients, 52 underwent prompt polidocanol/CO2 foam sclerotherapy, targeted to both the underlying tributary (when present) as well as the cutaneous bleeding varicosity. The remaining seven either declined sclerotherapy or were ineligible. Underlying incompetence of axial (great, small, or anterior saphenous) veins was found in 54 patients (92%). Of these patients with truncal vein incompetence, 48 underwent ablation—5 declined and 1 was too frail for any further intervention. There were no recurrent bleeds in the interval between immediate sclerotherapy and scheduled ablation. During a mean follow-up of 2.2 years, 55 of the 59 patients (93%) had no recurrence of bleeding. Four patients (7%) had late, recurrent hemorrhage: one had failed to return for their scheduled ablation, two were on chronic anticoagulation, and one had severe right heart failure. All four were retreated without further recurrence. ConclusionsA two-step protocol of immediate ultrasound-guided foam sclerotherapy, followed within 8 weeks by endovenous ablation of incompetent axial veins and concurrent microphlebectomy, provided rapid and efficient treatment with durable freedom from subsequent hemorrhage.

ASSESSMENT OF PATIENTS' KNOWLEDGE REGARDING VARICOSE VEINS DISEASE

This study aims to present a complete epidemiological overview of the knowledge of patients about varicose vein disease in the city of Vlore. The study summarized all cases diagnosed by the angiologist, identifying risk factors, different age groups, surgical intervention, complications, and progress of these patients. In this cross-sectional study, we included 600 patients diagnosed with varicose veins. The patients participating in the study completed a questionnaire with questions divided into several sections. The first part belonged to questions about demographic data; the second part was related to the recognition of risk factors by sick patients; and finally, there was a section of questions related to surgical intervention for varicose veins. Regarding the age group, it turned out that patients with varicose veins belong to different age groups. 2.7% of patients belonged to the age group of 20–24 years. The age group of 61–65 years old made up 8.3% of the sample, and 6.5% were those patients in the age group over 65 years old. 32.5% of the sample belonged to the male gender, and 67.5% belonged to the female gender. Regarding hereditary as a risk factor, 4.17% of those who do not consider heredity an important factor belong to the age group of 56–60 years. There are only 30.8% of patients who stated that they underwent a surgical intervention. 69.2% have not done such a thing. The patients with varicose veins were of different age groups. According to the patient's point of view, there are several main factors that could cause the disease of varicose veins. Among the most important factors, it is worth mentioning heredity, hypertension, and pregnancy. Regarding the consequences caused by the disease of varicose veins, patients have clearly stated that phlebitis is an inflammation that occurs frequently. Since surgical intervention is considered an effective solution to treat vein disease, some patients have undergone surgery. Those patients who underwent surgery have been diagnosed with this disease for more than a year and belong to the age group of 56–60 years.

Clinical Profile of Leg Symptoms and Reflux in the Legs From Varicose Veins Disease Reported at a Tertiary Healthcare Institute in Jharkhand, India.

Background Varicose veins, affecting 8-10% of the population, are categorized as primary or secondary, depending on the etiology. The aim of thestudy is to assess the clinical profile of leg symptoms and reflux in the legs of varicose veins disease among patients reported in a tertiary hospital. Patients and methods An institution-based cross-sectional exploratory study comprising 56 patients with reflux in legs of varicose veins disease selected through purposive sampling, conducted in the OPD (outpatient department), general surgery, AIIMS (All India Institute of Medical Sciences) Deoghar. The standardized study instrument includes the Aberdeen varicose veins questionnaire, and patients' symptoms and concerns questionnaire, followed by a brief clinical examination based on CEAP (clinical, etiological, anatomical, and pathophysiological)classification and VCSS (venous clinical severity score) for C5/6 and color-flow duplex imaging of both lower limbs. Descriptive and inferential statistics were used for data analysis using IBM SPSS Statistics for Windows, Version 23 (IBM Corp.,Armonk, NY). Results Bilateral presentation of the disease had been seen in 57.1% (n=32) participants, and the common history of present illness reported by participants included swelling along the veins (n=55, 98.2%), pain (n=51, 91.1%), and discoloration (n=33, 58.9%). The clinical grading revealed that most participants, i.e., 87.5% (n=49) had C2 and 75% (n=42) had C3 disease. The majority of participants 96.4% (n=54) suffered from primary varicose veins. Furthermore, all subjects exhibited superficial vein involvement, alongwith one individual having deep vein involvement and a few participants (n=35, 62.5%)having perforators. With this, the majority of participants (n=55, 98.2%) showed reflux pathology. Conclusion Varicose veins typically afflict men in their 40s and 50s who work in positions of extended standing. Limited awareness in the Santhal Pargana division, Jharkhand state, India may result in poor healthcare outcomes. Improving public awareness may help lessen disease-related consequences.

NLRP3 inflammasomes as a target for hesperidin and diosmin flavonoids in varicose vein disease and its complications

Varicose vein disease of the lower extremities is an inflammatory disorder with abnormal structure and functional activity of the venous valves, venous walls and cells, as well as with abnormal activity of the infiltrating leukocytes. The abnormally changed varicose vein are characterized by increased venous pressure, blood accumulation and congestion, ischemia, and metabolic and energy turnover derangement, which result in clinical manifestations of complications, such as pain, edema and formation of trophic ulcers. For many years, flavonoids have been used to treat varicose veins. The most effective flavonoids used in varicose vein disease and its complications, are hesperidin and diosmin, as well as their combinations. The review sets forth the state-of-the-art knowledge on the universal inflammatory processes playing a leading role in the pathophysiology of many cardiovascular disorders, including venous ones. In the recent years, it has been found that one of the main causes of inflammation is the formation of intracellular protein complexes (inflammasomes), which both produce a set of proinflammatory cytokines and are responsible for their excretion from the cells. In addition, inflammasomes control the development of regulated necrosis (pyroptosis) that takes part in the process of ulceration. The inflammasome activity can be modified by various mechanisms, of which the gene independent synthesis of the inflammasomal proteins has been recognized as the leading one. It has been shown that flavonoids inhibit the activation of a key factor NF-kappa B and suppress the synthesis of proteins, including NOD-like receptor protein 3 (NLRP3) inflammasome components, decrease the expression of NLRP3 receptor, protein ASC and caspase 1, as well as diminish interleukin 1 beta, interleukin 6 and tumor necrosis factor-alpha expression. Thus, this is the explanation of positive effects observed with the use of hesperidin, diosmin and their combination in clinical practice.

Wedged hepatic vein portovenography for assessment of Rex vein patency in children with extrahepatic portal venous obstruction.

Meso-Rex bypass is the surgical intervention of choice for children with extrahepatic portal vein obstruction (EHPVO). Patency of Rex vein, umbilical recessus of the portal vein, is a prerequisite for this surgery. Conventional diagnostic modalities poorly detect patency, while transjugular wedged hepatic vein portography (WHVP) accurately detects patency in 90%. We aimed to assess Rex vein patency and portal vein branching pattern in children with EHPVO using transjugular WHVP and to identify factors associated with Rex vein patency. Transjugular WHVP was performed in 31 children with EHPVO by selective cannulation of left and right hepatic veins. Rex vein patency, type of intrahepatic portal venous anatomy (Types A-E), and factors associated with patency of Rex vein were studied. The patency of Rex recess on transjugular WHVP was 29%. Complete obliteration of intrahepatic portal venous radicles was the commonest pattern (Type E, 38.7%) while Type A, the favorable anatomy for meso-Rex bypass, was seen in only 12.9%. Patency of the Rex vein, but not the anatomical pattern, was associated with younger age at evaluation (patent Rex: 6.6 ± 4.9 years vs. nonpatent Rex: 12.7 ± 3.9 years, p = 0.001). Under-5-year children had a 12 times greater chance of having a patent Rex vein (odds ratio: 12.22, 95% confidence interval: 1.65-90.40, p = 0.004). Patency or pattern was unrelated to local factors like umbilical vein catheterization, systemic thrombophilia, or disease severity. Less than one-third of our pediatric EHPVO patients have a patent Rex vein. Younger age at evaluation is significantly associated with Rex vein patency.

Impact of Yoga Therapy on D-dimer Level in Asymptomatic Varicose Vein Disease – a Randomized Controlled Trial

Background: Varicose veins (VV) affect a significant portion of the population, particularly middle-aged men, causing discomfort and potential complications. Elevated D-dimer levels may indicate thrombotic risk in VV patients. Yoga therapy (YT) has emerged as a complementary approach for managing vascular disorders, but its impact on biomarkers like D-dimer remains unclear, especially in middle-aged men with VV. Material and Methods: This randomized controlled trial recruited 80 middle-aged men diagnosed with VV. Participants were equally and randomly assigned to a yoga therapy group (YTG) or a control group (CG). The YTG received tailored YT sessions three days a week for 12 weeks, focusing on specific asanas, pranayama techniques, and meditation. The CG continued with their usual activities. Outcome assessments included Systolic blood pressure (SBP), Diastolic blood pressure, Heart rate (HR), high-sensitivity C-reactive protein (hs-CRP), and D-dimer levels. Assessments were conducted before and after the intervention period for both groups. Results: Following the yoga intervention in varicose vein patients, significant improvements were observed compared to the CG. SBP decreased from 140 mmHg to 128 mmHg in the YTG, whereas in the CG, it decreased from 142 mmHg to 138 mmHg. Similarly, DBP decreased from 90 mmHg to 85 mmHg in the YTG, while in the CG, it decreased from 92 mmHg to 90 mmHg. Heart rate also showed improvement in both groups, with a decrease from 80 bpm to 70 bpm in the YTG and from 82 bpm to 78 bpm in the CG. Furthermore, levels of hs-CRP decreased from 3.5 mg/L to 2.8 mg/L following the intervention in the YTG, whereas in the CG, there was a slight increase from 3.6 mg/L to 3.7 mg/L. Moreover, D-dimer levels, indicative of thrombotic risk, decreased from 1.6 mg/L to 1.4 mg/L after the YT, whereas in the CG, they remained relatively stable at 1.7 mg/L before and after the intervention. Conclusion: This study highlights the potential of YT as a non-invasive intervention for managing VV and reducing thrombotic risk in middle-aged men. Further research is warranted to validate these findings and explore the mechanisms underlying the observed effects of yoga on biomarkers like D-dimer.

Varicose vein disease in cabin crews and a screening scale

Aim: Varicose vein disease (VVD) and related symptoms are expected to be encountered more frequently in cabin crews. Considering their working environment, standing still for long periods of time and lacking mobility on flights may contribute to VVD. For this reason, our study aimed to determine the rate and the risk factors of VVD in cabin crew members and to develop a screening scale for VVD. Material and Methods: A questionnaire including 43 questions was applied to the participants, querying their socio-demographic, occupational characteristics, smoking history, family history, and VVD. Eight survey questions were used to establish a VVD Evaluation Scale (VVDES). Results: A total of 264 civil cabin crews participated in this study. 23.5% of civil aviation cabin crews had VVD. The diagnosis of VVD in the female group was higher than in the male group (p&lt;0.001). A family history of varicose veins was crucial for VVD diagnosis and significantly increased the VVD risk in female cabin crew (p&lt;0.001). It was determined that the rate of VVD was higher in cabin crews who worked on short flights (4 hours or less). It was shown that VVDES could accurately detect VVD at a rate of 77.4%. Conclusion: Family history of VVD was a crucial factor in terms of VVD. Multiple short flights have been linked to an increased risk of VVD. A VVDES has been developed in this study and can be used clinically as a screening scale for cabin crews.

A Double-Blind Study on the Effectiveness of Polarized Light Therapy in the Treatment of Venous leg Ulcers-Pilot Study.

Vein diseases are one of the most common civilization diseases. The most advanced form chronic venous insufficiency are venous leg ulcers. The study included 40 patients, 20 male (50%) and 20 female (50%) in age between 52 and 88 years (mean age: 68.00 ± 8.55 years) with venous leg ulcers lasting 12.50 ± 5.45 months. Patients were distributed randomly in a double-blind study into two equal groups including 20 patients each (group 1-polarized light therapy and group 2-sham exposure). Patients from both groups received routine pharmacological treatment, specialistic medical dressings and compression therapy. In addition, patients were exposed to a cycle of polarized light therapy procedures or to sham exposures (30 procedures performed in two series of 15 procedures). Wound surface area was evaluated by computerized planimetry and pain intensity was assessed with the use of Visual Analog Scale (VAS) before and after therapy (2.5 months). The analysis showed a statistically significant reduction of surface ulcers area between groups 1 and 2. The median (IQR) size of wounds in group 1 was 2.4 (1.95-2.9) cm2, in group 2; 2.8 (2.6-3.1) cm2 (p = 0.038). The level of pain (VAS) after treatment was assessed in group 1, median (IQR): 2 (2-3) points, in group 2 4.5 (4-5) points; and the observed difference was also statistically significant (p < 0.001). In group 1, after treatment, the area of ulcers decreased-median (IQR): 33.05 (28.7-41.48) %, in group 2 by 18.99 (15-24.4) % (p < 0.001). In group 1, the pain intensity measured using the VAS scale decreased with a median (IQR): 71.42 (61.25-71.42) %, in group 2: 37.5 (28.57-50) % (p < 0.001). Complex therapy with polarized light therapy added to standard care was more effective than standard care alone in reducing of ulcers surface area and intensity of pain ailments in patients with chronic venous leg ulcers.