1,721,009 research outputs found
Trattamento laser endovenoso : esperienze, evidenze, risultati
No full textThis study was conducted with the aim of showing the effects of Pycnogenol on controlling jet-lag symptoms. Oral Pycnogenol, 50 mg tablets 3 times/die, for 7 days starting 2 days prior to the flight was used. The study was divided into two separate parts. In study 1 the most common complaints of patients with jet-lag were evaluated with a rating scale consisting in of a scoring system. In study 2 a brain CT scan was performed after the flight in order to assess minimal brain edema (MBE) in association with typical signs and symptoms, observed in previous published flight studies. Study one included 38 subjects treated with Pycnogenol and 30 controls. The symptomatic jet-lag related total score was significantly lower (indicating a lower level of jet-lag) in the Pycnogenol group. The average duration of any jet lag symptom following the flight was significantly reduced from 39.3 (SD=0.8) hours in controls to an average of 18.2 (SD=3.3) hours in the Pycnogenol group (P<0.05). Study 2 included 34 subjects treated with Pycnogenol and 31 controls. The main observation was the brain CT scan performed within 28 hours after the end of the flight. The difference between the Pycnogenol and the control groups was statistically significant (P<0.05) for all items assessed including the cerebral edema score obtained by CT scan. The short-term memory was significantly altered in the control group and associated to edema and swelling of the lower limbs. The score (and the level of edema) was comparatively higher in a subgroup of hypertensive subjects in the control group. Minor alterations of cardiac function were observed in association with de-stabilisation of blood pressure. Fatigue was also significantly higher in the control group in comparison with the Pycnogenol group. A number of spontaneously reported symptoms was also scored and there was a statistically significant difference (P<0.05) between the Pycnogenol and control groups. In conlusion, Pycnogenol was useful to control jet-lag and minimal brain edema
Evidenze e non-evidenze nella terapia dell’insufficienza venosa cronica
No full textIl trattamento dell’insufficienza venosa cronica è spesso affidato a “pratiche alternative” non supportate dalla letteratura. Per una buona pratica medica dovrebbero essere utilizzate le terapie che mostrano serie evidenze scientifiche di efficacia clinica e che sono raccomandate dalle linee guida
Some new considerations on venous valvuloplasty : an international on line debate
No full textIn 2008 a paper by John Opie, regarding the renewed role of venous valvuloplasty and an intriguing discussion took place on VASCULAB, a well known network on line with about 1300 expert members in phlebology guided by F. Passariello as conceiver and coordinator. The valvuloplasty attempts to reduce blood reflux and venous hypertension in chronic venous disease (CVD). The technique requires a skilled and experienced surgeon and a careful patient evaluation and selection. It could be a good approach in selected cases with post thrombotic syndrome (PTS). Some studies indicate in the nineties that valvuloplasty or valvular replacement is an effective treatment for venous incompetence in selective cases. After a concise valvuloplasty story from Kistner to Maleti, despite the advances in valvuloplasty, we point out that the surgical mainstay to correct CVD, deep and superficial or both, or primary varicose veins is great saphenous vein (GSV) ligation and stripping but also various conservative or endovascular treatments. Nevertheless actually some clinical studies have reported achieving long-term, effective competence of deep venous system, as well as the superficial venous system, both after valvuloplasty or by implanting an external vein support device. J. Opie identified as an optional surgical solution for the large underserved patient group of PTS a new technique: «monocusp surgery». He presented a new surgical method to replace a dysfunctional aplastic / dysplastic / absent venous valve using the full thickness viable native vein wall tissue (the monocusp) and covered the defect with an ultrathin synthetic e-PTFE vascular closure patch (iVenaTMe-PTFE patch) to successfully reverse venous insufficiency and its effects both early and long-term with limited complications. The description on monoscusp valvuloplasty by Opie in Vasculab was accurate. At the same time S. Camilli presented his technique of external stretching valvuloplasty with a new device is «oval shaped external support «(OSES), made by a Nitinol net-like framework, very smooth, elastic and flexible, available in different size. The OSES device is suitable for the terminal and pre-terminal valves of the GSV and virtually for any peripheral venous valve, on superficial and deep system, also without ligation of the possible present competent collaterals. The discussion was ample and very interesting with the contributes of C. Recek, B.B. Lee, C. Franceschi, O. Maleti and others, included J. Opie and S. Camilli. In general, R. Kistner considerations about Maleti's technique are true for all valvuloplasties: «I find no fault with valvuloplasty and I am anxious to see if others can duplicate the experience. Points that need to be expanded in these experiences are how many cases were evaluated and found not to be candidates for this procedure, the length of the learning curve for producing a reliably competent valve, and whether there is any sign that these new valves will degenerate with time. If this technique can be successful, the next question will be whether it can be achieved in a more minimally invasive method»
Trattamento medico della malattia venosa cronica : evoluzione o involuzione?
No full textMedical treatment of chronic venous disease: evolution or involution ?
Chronic venous disease (CVD) is an important clinical condition with substantial epidemiological implications and socio-economic repercussions. In the western world the consequences of its high prevalence, the costs of diagnosis and therapy, the significant loss of working hours and the repercussions on patients’quality of life are well known.
Pharmacotherapy for CVD has greatly developed over the last 40 years and largely used in the symptomatic treatment of CVD together with compression therapy and to make patients more comfortable. The clinical efficacy on the symptoms (feeling of heaviness, pain, paresthesia, heat and burning sensations, night cramps, etc.) has long been confirmed by Level III, IV and V evidence, but there are now Level I and II trials on specific drugs. For the bioflavonoids double-blind, randomised trials have used micronized diosmin-hesperidin; rutosides; escin; anthocyanosides; and synthetic calcium dobesilate. It was therefore surprising some recent difficulties in the use of this important treatment in health national system in Italy. In this up-date we use the method on evidence-based medicine from the medical literature. We have started a governance and economic analysis of the problem in Italy. Particular consideration was given to the evidence set out in review, meta-analysis, guidelines and Consensus Statements in this field.
The evidence for pharmacological agents in the treatment of CVD suggests today a wide use in all CEAP classes
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