RESUMEN

UNLABELLED: Based on the recommendations of experts, and supported by a low level of proof, compression after sclerotherapy is applied all over the world. OBJECTIVE: Investigating the practice of French vascular physicians for sclerotherapy and the use of post-sclerotherapy compression. METHODS: A questionnaire concerning their practices was sent to French vascular physicians through their regional vascular medicine professional development associations. RESULTS: A total of 366 vascular physicians replied to the questionnaire, of whom 63% (229/366) were in private practice, 6% (21/366) in hospitals and 31% (115/366) had a mixed private-hospital practice. Sclerotherapy was practised by 88% (323/366) of them. Two-thirds of the vascular physicians used sclerosing foam and practised sclerotherapy using ultrasound guidance. Less than one-third of the vascular physicians regularly applied compression after sclerotherapy. When compression was applied, it was usually after treatment of saphenous or accessory saphenous veins and, in most cases, medical compression stockings of 15-20 mm Hg were used. With respect to the period recommended for wearing compression, this ranged from 48 h to 1 week for 65% (193/299) of the vascular physicians questioned. CONCLUSION: The great majority of vascular physicians who answered the questionnaire employ ultrasound guidance to perform sclerotherapy and use sclerosing foam. Compression after sclerotherapy is diversely applied in France and does not comply with the recommendations of the French Health Authorities who recommend wearing a stocking of 15-20 or 20-36 mm Hg for a period of 4-6 weeks. Thus, less than one-third of the vascular physicians regularly used elastic compression and when they did, it was usually a medical compression stocking of 15-20 mm Hg, for 1 week or less.

Asunto(s)

Escleroterapia/métodos , Várices/terapia , Adulto , Factores de Edad , Anciano , Cardiología , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina , Vena Safena/diagnóstico por imagen , Vena Safena/fisiopatología , Soluciones Esclerosantes , Medias de Compresión , Encuestas y Cuestionarios , Factores de Tiempo , Ultrasonografía Doppler Dúplex

RESUMEN

UNLABELLED: Isolated iliac venous thrombosis (IIVT) is uncommon. Duplex ultrasonography of the iliac vessels is not recommended and not generally performed. OBJECTIVE: The purpose of this study was to determine the frequency of IIVT in a hospital recruitment population and to identify characteristic features of onset which might be associated with this localization in order to better target explorations. MATERIAL AND METHODS: The study included 18,297 patients referred for Duplex-ultrasonographic exploration of possible deep vein thrombosis of the lower limbs between January 1st 1994 and December 31st 2000. Selection of isolated iliac thrombosis, defined as the absence of retrograde extension to the common femoral vein, was made from the digitalized data recorded daily. The following factors were tested: sex, age, absence of clinical signs in the lower limb, presence of pulmonary signs. The raw odds ratios were calculated followed by construction of a multivariate logistic regression model. The circumstances of onset were retrieved from the patient's medical files. RESULTS: Isolated iliac venous thrombosis was discovered in 48 patients, i.e. 0.26% (95% CI 0.19%-0.35%) in the recruitment population and 0.82% (95% CI 0.61%-1.09%) among the 5827 patients with thrombosis. The common iliac was involved predominantly (35 out of 48). The left side predominated in women compared with men (24/36 versus 4/12) (p = 0.04). Specifically female circumstances (oral contraceptives, peri-obstetrical period) always led to a left localization. For the other identified circumstances (cancer, inflammatory bowel disease, orthopedic surgery, pelvic trauma), there was no predominant side. Variables explaining the multivariate model were sex, age (less than or more than 35 years), suspected pulmonary embolism, and age interaction with suspected pulmonary embolism. For women, the risk of IIVT was twice as high as for men (OR = 1.97, 95% CI 1.02-3.81). Young age was also a risk factor for IIVT and increased with suspected pulmonary embolism. The odds ratio for subjects under 35 varied from 4.20 (95% CI 1.79-9.84) without suspected pulmonary embolism to 35.01 (95% CI 14.78-82.89) with suspected pulmonary embolism. CONCLUSION: The incidence of isolated iliac venous thrombosis is very low (0.26) in this hospital recruitment population but reached 9.40% in young women under 35 with suspected pulmonary embolism. These age and sex characteristics are also the principal circumstances for the development of these thrombotic events (pregnancy, post partum period, oral contraception). Under these circumstances, it is necessary to carefully explore the iliac vessels with duplex ultrasonography.

Asunto(s)

Vena Ilíaca , Ultrasonografía Doppler , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trombosis de la Vena

RESUMEN

A sample of humic acid was divided by ultrafiltration into five fractions of different molecular size (F1; 300 000: F2; 100 000-300 000: F3; 50 000-100 000: F4; 10 000-50 000: F5; 1000-10 000 daltons). Characterization by IR, and CPMAS C-13 NMR spectroscopy indicated that the molecules of the fraction of >/=100 000 daltons were primarily aliphatic, while the smaller molecules of the >/=10 000 dalton fraction were predominantly aromatic. Titration (pH) data were consistent with an increase in the number of carboxylate groups per unit mass as molecular size became smaller. A comparative study with unpurified and purified (by treatment with ion exchange elution, acid precipitation and alkaline dissolution) humic acid samples showed chemical alteration with some loss of carboxyl groups in the humic acid.