Optimising outcomes in the treatment of lower limb varicose veins

Varicose veins are dilated and tortuous subcutaneous veins, which affect a significant proportion of adults. They cause physical and emotional symptoms, and affect quality of life in sufferers. The management of varicose veins has evolved since the early 20th century, when Babcock described what has now become the gold standard surgical treatment. Perhaps the most significant evolution is the development and popularisation of minimally invasive therapy, especially endovenous laser ablation (EVLA) in the last two decades. This thesis focuses on the optimisation of outcomes in the management of this very common condition.Four studies were performed to evaluate varicose vein treatment modalities and outcomes, investigating key issues such as: the proportion of patients suitable for EVLA; optimisation of EVLA; how does EVLA compare with surgery, and what is the effect of prophylactic antibiotics on wound complications following surgery? Approximately 60% of varicosities are suitable for EVLA, with vein anatomy being the commonest cause for unsuitability. The concomitant performance of phlebectomies at the time of EVLA was shown to be feasible, acceptable to patients, and improved outcomes. EVLA was shown to be clinically effective, and eliminated the early quality of life limitations of surgery. Wound complications following surgery were found to be significantly reduced by the use of prophylactic antibiotics

Optimising outcomes in the treatment of lower limb varicose veins

Varicose veins are dilated and tortuous subcutaneous veins, which affect a significant proportion of adults. They cause physical and emotional symptoms, and affect quality of life in sufferers. The management of varicose veins has evolved since the early 20th century, when Babcock described what has now become the gold standard surgical treatment. Perhaps the most significant evolution is the development and popularisation of minimally invasive therapy, especially endovenous laser ablation (EVLA) in the last two decades. This thesis focuses on the optimisation of outcomes in the management of this very common condition. Four studies were performed to evaluate varicose vein treatment modalities and outcomes, investigating key issues such as: the proportion of patients suitable for EVLA; optimisation of EVLA; how does EVLA compare with surgery, and what is the effect of prophylactic antibiotics on wound complications following surgery? Approximately 60% of varicosities are suitable for EVLA, with vein anatomy being the commonest cause for unsuitability. The concomitant performance of phlebectomies at the time of EVLA was shown to be feasible, acceptable to patients, and improved outcomes. EVLA was shown to be clinically effective, and eliminated the early quality of life limitations of surgery. Wound complications following surgery were found to be significantly reduced by the use of prophylactic antibiotics

Compatibility and genetic studies of some Carica species and their hybrids

Typescript.Thesis (Ph. D.)--University of Hawaii at Manoa, 1972.Bibliography: leaves [156]-161.xiii, 161 l illus., tablesExperiments were conducted to study floral biology, cross compatibility, heterosis, cytogenetics and inheritance of several morphological characteristics among nine Carica species: Carica cauliflora, C. goudotiana, C. monoica, C. parviflora, C. pennata, C. pubescens, C. papaya, C. horovitziana and Index number 203. All species studied except C. parviflora showed maximum anthesis between 4 and 10 p.m. C. parviflora showed maximum anthesis between 8 to 10 a.m. The hybrid, C. parviflora (8 - 10 a.m. anthesis time) x C. goudotiana (4 - 6 p.m.) showed maximum anthesis between 10 to 12 noon. Pollen was successfully germinated at six pH levels ranging from 4.5 - 9.5. A gradual rise in percentage germination of pollen from pH 4.5 - pH 7.5 followed by a sharp drop at pH 8.5 and pH 9.5 was observed in all the species. Results also showed significant differences between species. Pollen of C. goudotiana and C. papaya showed lower germination percentages than pollen of other species. All species were self compatible. Cross compatibility studies showed crosses that were fertile, crosses which set fruit but produced empty seeds, crosses that set parthenocarpic fruits and crosses that failed to set fruit. C. papaya was cross incompatible with all species used in this study. A new hybrid C. parviflora x C. goudotiana was produced. A description of ten hybrids developed in this work was presented. All hybrids were fertile. Heterosis for vegetative growth and productivity was conclusively shown in two crosses. Comparisons were made between the means of hybrids and those of their high parents. Stem color and petiole color were each shown to be under the control of a single gene pair, red being dominant to green in both cases. Variations in the intensity of red color in stems and petioles were attributed to the possible influence of modifier genes. Monogenic control was established for flower color with purple-blush and white, both dominant to pale yellow flower color. Red ripe skin color of the fruit was dominant to yellow. A cross between plants of red fruit color with those of orange fruit color produced F1 hybrids with pink colored fruits, indicating lack of dominance between red and orange. Fruit ridges were dominant to wide grooves which in turn were dominant to narrow grooves. Mode of inheritance was monogenic in both cases. Spiny and non-spiny seed coats were simply inherited with dominance lacking. A single-gene difference between succulent fruit pulp and dry pulp with recessiveness for the latter was shown. A dominant monogenic control of profuse branching over sparse branching was observed. Crosses between dioecious and monoecious species using pollen from the latter produced only monoecious F1 plants. The reciprocal cross produced F1 plants in an approximate ratio of 1 male: 1 monoecious. Differential suppression of androecium observed in crosses between C. monoica and C. goudotiana requires further investigation. Cytological observations confirmed nine pairs of chromosomes for all species and hybrids investigated. Occasional partial pairing and subsequent precocious anaphasic separation involving one pair of homologues were observed in all species and hybrids studied. Heteromorphism between these two homologues was detected in three species and three hybrids. These findings seem to support the hypothesis that sex chromosomes do exist in these species and hybrids. Chromosome lagging sometimes observed at anaphase I in two of the hybrids was a new phenomenon in the genus. This feature could result in the evolution of aneuploids in the genus. High fertility of hybrids was attributed to regularity of bivalent formation. This is suggestive of close genetic affinity between the parent species. Speculations into the potentials of the wild Carica species were discussed

Cutaneous hyperpigmentation after endovenous laser therapy: a case report and literature review

Endovenous laser therapy (EVLT) for the treatment of varicose veins has been shown to be effective and relatively safe. Reported complications are few and transient. Whereas it is not uncommon to have cutaneous hyperpigmentation following treatment modalities such as sclerotherapy, only a few reports of transient hyperpigmentation following EVLT have been mentioned in the literature. We report a case of persistent hyperpigmentation following successful varicose vein treatment by EVLT