RESUMEN
Several small studies have indicated that the systemic administration of pentoxifylline may accelerate healing of venous leg ulcers. The goal of this study was to further evaluate these findings in a larger scale placebo controlled trial and to explore the effect of the dose of pentoxifylline on healing. The study used a prospective, randomized, double-blind, parallel group placebo controlled design in a multicenter outpatient setting. Patients with one or more venous ulcer were enrolled, with all patients receiving standardized compression bandaging for treatment for their ulcers. Patients were also randomized to receive either pentoxifylline 400 mg, pentoxifylline 800 mg (two 400 mg tablets), or placebo tablets three times a day for up to 24 weeks. The main outcome measure was time to complete healing of all leg ulcers, using life table analysis. The study was completed as planned in 131 patients. Patients receiving 800 mg three times a day of pentoxifylline healed faster than placebo (p = 0.043, Wilcoxon test). The median time to complete healing was 100, 83, and 71 days for placebo, pentoxifylline 400 mg, and pentoxifylline 800 mg three times a day, respectively. Over half of all patients were ulcer free at week 16 (placebo) and at week 12 in both pentoxifylline groups. Whereas the placebo group had only achieved complete healing in half of the cases by week 16, all of the subjects remaining in the group receiving the high dose of pentoxifylline had healed completely. Treatment with pentoxifylline was well tolerated with similar drop-out rates in all three treatment groups. Complete wound closure occurred at least 4 weeks earlier in the majority of patients treated with pentoxifylline by comparison to placebo. A higher dose of pentoxifylline (800 mg three times a day) was more effective than the lower dose. We conclude that pentoxifylline is effective in accelerating healing of leg ulcers.
Asunto(s)
Fibrinolíticos/administración & dosificación , Pentoxifilina/administración & dosificación , Úlcera Varicosa/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Femenino , Fibrinolíticos/efectos adversos , Humanos , Tablas de Vida , Masculino , Persona de Mediana Edad , Pentoxifilina/efectos adversos , Estudios Prospectivos , Cicatrización de HeridasRESUMEN
BACKGROUND: Bleeding is a well-recognized but seemingly uncommon complication of varicose vein disease. Some deaths have occurred in which bleeding developed from vessels in the base of chronic venous ulcers. OBJECTIVE: To elucidate a more common type of venous bleeding that can be identified and treated by an experienced sclerotherapist. METHODS: The records of a group of patients with bleeding superficial phlebectasias, primarily on the feet and ankles, are reviewed. All patients received injection sclerotherapy after the initial bleeding episode. A comparison was made between those patients whose bleeding points were sutured in the emergency department and those who were treated only with compression. RESULTS: Suture-ligation of the bleeding site delayed healing when compared with simple compression. Concomitant injection sclerotherapy proved to be a successful and permanent method of treating these veins. No recurrent bleeding developed in any of the patients, even in those with previous episodes of bleeding. CONCLUSIONS: Initial treatment of the bleeding blue bleb requires only compression of the tiny open vessel. Later injection sclerotherapy provides a permanent method of obliterating the thin-walled veins and prevents future bleeding. It is essential to treat the entire incompetent venous system as well as the bleeding site itself.
Asunto(s)
Hemorragia/terapia , Escleroterapia/métodos , Várices/complicaciones , Adulto , Anciano , Femenino , Estudios de Seguimiento , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: The deep veins of the leg and their associated perforating veins provide the major conduits for the return of blood from the legs to the heart. In health intrinsic valves maintain a one-way flow of blood from distal to proximal leg. OBJECTIVE: To describe and illustrate the different deep veins, their relationship to each other, and to the superficial venous system. Of particular interest is the demonstration of the deep plantar plexus and its relationship to the anterior and posterior tibial veins and to the greater and lesser saphenous veins. The valvular system, which protects them from the effects of gravity, is also illustrated. METHODS: The various deep veins as well as their tributaries and perforating veins are described in detail and illustrated with simple line drawings. These depictions help clarify the relationships between the paired veins and the higher single veins. RESULTS: Hopefully this unified approach to the various groups of deep veins will allow a better understanding of their form and function. CONCLUSIONS: The deep venous system is an integrated group of veins beginning in the deep venous plexus of the foot and terminating in the lower pelvis. Following contraction of the foot, calf, and thigh muscles the blood flows from a multitude of high pressure veins to a single low pressure vein.
Asunto(s)
Pierna/irrigación sanguínea , Venas/anatomía & histología , Pie/irrigación sanguínea , Humanos , Músculos/irrigación sanguíneaRESUMEN
A 20-year experience using sodium tetradecyl sulfate (Sotradecol, Elkins-Sinn, Inc., Cherry Hill, NJ) for the injection treatment of spider telangiectasias is reviewed. Of 1426 legs injected, 882 were treated with a 1%-solution injected directly into the spider veins, and 264 were injected directly with a 1/3%-solution. With the 1/3%-solution, the remaining 280 legs had the blue veins feeding the spider telangiectasias injected rather than the spider itself. When injected directly into the spider veins, the lesser concentration gave fewer ulcerations and less pigmentation, but equal treatment results. Injecting the subcutaneous feeder veins appears to provide more permanent clearing of the lesions with fewer recurrences and no side effects. No allergic or other major complications occurred with the injection treatments.
Asunto(s)
Alcoholes Grasos/uso terapéutico , Soluciones Esclerosantes/uso terapéutico , Tetradecil Sulfato de Sodio/uso terapéutico , Telangiectasia/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Úlcera de la Pierna/inducido químicamente , Masculino , Persona de Mediana Edad , Trastornos de la Pigmentación/inducido químicamente , Trastornos de la Pigmentación/terapia , Recurrencia , Soluciones Esclerosantes/efectos adversos , Tetradecil Sulfato de Sodio/efectos adversosAsunto(s)
Obesidad/terapia , Estómago/cirugía , Adulto , Peso Corporal , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Findings in this study correlated a low circulating gastrin level with an incompetent lower esophageal sphincter mechanism and abnormal reflux. Such reflux, in amounts causing esophagitis distally, was treated surgically by a mechanically simple method of fundoplication. The success of this reefing method of fundoplication was explained by using physiologically active sling fibers of the gastric fundus to augment the lower esophageal sphincter. Available gastrin was used more effectively in this manner. The high incidence of associated foregut diseases suggested an embryologic factor in the development of gastroesophageal reflux. The dilated hiatus and its attendant hernia had no apparent relationship to the development of reflux esophagitis. The term symptomatic sliding hiatal hernia, therefore, seemed to be a diagnostic and therapeutic misnomer.