The place of heparins in the treatment of venous thromboembolism

Venous thromboembolism, in the form of lower limb deep vein thrombosis and its most dangerous complicationthat is a pulmonary embolism, is a common disease with an increasing incidence associated with the ageingpopulation. The scheme of VTE treatment underwent changes when a new drug group — directly and selectivelyacting oral anticoagulants — was introduced. However, the scope of VTE therapy with parenterally administeredlow-molecular-weight heparins was wide, i.e., they produced vast progress in the disease’s treatment in the 1980s

Neurocognitive dysfunctions and functional state of patients after internal carotid endarterectomy

Introduction. Carotid endarterectomy (CEA) is a method of treatment of carotid stenosis, which significantlyreduces the risk of ischemic stroke. This procedure may affect the patient’s neurocognitive functioning. Theaim of the study was to evaluate the occurrence of neurocognitive disorders and to determine the functionalstatus of the patients undergoing CEA. Material and methods. The study group consisted of 102 people who underwent CEA. Studies wereperformed preoperatively and repeated on the fourth postoperative day. The following scales were used: theMini-Mental State Examination (MMSE), Activities of Daily Living Scale (ADL), Instrumental Activities of DailyLiving (IADL) and the Hamilton Depression Rating Scale (HAM-D). Results. The average number of points obtained by patients in the MMSE, both before and after surgery is26 points to 30 that may be obtained, which shows a subtle cognitive impairment. Almost every patient showedfitness both in terms of basic (ADL), as well as complex (IADL) activities before and after surgery. Conclusions. Low or average level of cognitive performance is observed in most subjects, both before andafter CEA. There are many different factors that can affect the cognitive functions. The functional status ofpatients stood without significant changes

The novel minimally invasive mechano-chemical technique of the saphenous vein ablation. Our center experience: results of 24 months follow-up

Introduction: The aim of the study was to evaluate the efficacy of the endovascular ablation method of GSV//SSV superficial venous insufficiency using Flebogrif® catheter, the safety of the method, expressed in numberand quality of observed complications in 24-month observation. Material and methods: Initially, the observed group included 200 patients undergoing ablation of insufficientGSV/SSV. During 24 months of observation, this number decreased to 158, which seems to be a natural process.All patients signed the informed consent form approved by the Bioethics Committee of the Medical Universityof Lublin. Based on clinical evaluation, including ultrasound assessment, 200 patients, including 170 womenand 30 men, were admitted to the study using the adopted criteria of inclusion/exclusion. In the studied groupof patients, 172 great saphenous veins (GSV) and 28 short saphenous veins (SSV) were ablated. The treatedinefficient veins were punctured at three levels depending on the length of the segment of insufficient GSV/SSV.Each patient was treated with a compression agent in the form of a second compression class elastic stockings(20–30 mm Hg). Control visits on the basis of the accepted protocol were established in 1, 3, 6, 12, 24, 36months after the procedure. Results: During 24 months of observation, the evaluation of the Flebogrif® catheter method was based on theanalysis of results obtained in four categories: effectiveness of the method, expressed as the ratio of the numberof successfully closed veins ablated with the Flebogrif® catheter to the number of observed cases of recanalization;clinical improvement of venous insufficiency symptoms, based on the VCSS, CEAP, VAPS scale; safety ofthe method, expressed in terms of quantity and quality of observed complications; technical characteristicsof the method. The obtained results were analyzed statistically using tests for non-parametric variables. Theeffectiveness of the method based on the obtained results was 92%. A statistically significant decrease in theintensity of clinical symptoms in relation to the preoperative condition was observed. The number and quality ofthe observed complications allow considering the procedure of vein ablation with the use of Flebogrif® catheteras safe, possible to perform in ambulatory conditions. Conclusions: Effectiveness of the method of 92% in 24-month observation; good cosmetic effect; a statisticallysignificant decrease in the intensity of clinical symptoms in 24-month observation; the low incidence ofcomplications allows to consider the method safe; the method of surgery allows to perform the procedure inambulatory conditions

The role of VEGF in psoriasis: an update

Psoriasis is a common, chronic immune-mediated multifactorial skin disease. In its pathogenesis altered differentiationand hyperproliferation of keratinocytes, dysregulation of immunological cell functions, together withabnormal angiogenesis are involved. Angiogenesis is defined as the formation of new blood vessels from thepre-existing vascular bed. This complex and multistep process is regulated by different factors among whichvascular endothelial growth factor (VEGF) is considered to be the most important. The aim of this paper isa review of the current literature considering the role of vascular endothelial growth factor in psoriasis. Manystudies have focused on the role of VEGF in psoriasis and revealed its increased serum and tissue levels whichcorrelated with disease severity. Recent data indicate that VEGF is not only responsible for angiogenesis, butalso regulates keratinocyte differentiation. Moreover, it has been suggested that vascular endothelial growthfactor could be a link between psoriasis and its comorbidities. So far, there are single clinical cases that reportedclearance of psoriasis after anti-VEGF therapy. Therefore, the VEGF pathway might be a potential new therapeuticalternative leading to improvement of psoriasis. However, further clinical studies are needed to evaluatethe efficacy and safety of this therapy in psoriasis

Intravitreal anti-VEGF therapy in macular oedema secondary to racemose haemangiomatosis of the retina

Racemose haemangiomatosis of the retina is a sporadic, mostly unilateral, congenital arteriovenous malformation (AVM), comprising abnormal junctions between arteries and veins that omit capillaries. Typically, vascular malformations are asymptomatic and incidentally discovered. Advanced changes may be related to the presence of subretinal fluid and exudates, even though these lesions are classified as benign. Many complications can lead to severe or permanent visual impairment. Direct methods of treatment of primary retinal vascular anomalies have not been developed yet. The aim of this case report is to present the anti-VEGF therapy in the treatment macular oedema secondary to racemose haemangioma

Respiratory endurance training by means of a Spirotiger in extending intermittent claudication distance — a case study

According to Fontaine’s classification, intermittent claudication is a symptom of the 2nd stage of peripheralarterial occlusive disease. Intermittent claudication is described as muscle pain that occurs during walking. Patientsexperiencing it observe major reduction of exercise tolerance. Rehabilitation of patients with peripheral arterialocclusive disease uses many different training programs which lead to extension of intermittent claudicationdistance. Respiratory training is one of them and it is the training of the respiratory muscles that improves theirendurance, force, speed, coordination, and elasticity. Respiration therapy causes delayed metaboreflex, whichin turn the blood flow in lower limbs increases..We present a case of a patient who underwent percutaneous balloon angioplasty of iliac artery and then conductedrespiratory training by means of Spirotiger what resulted in further increase of claudication distance

Przewlekła choroba żylna

Chronic venous disease encompasses a syndrome composed of multiple morphological and/or functional changes in the venous system, particularly of the lower limbs. CVD consists in a disturbance of blood return to the deep venous system, superficial venous system, and communicating (perforating) veins. Chronic venous disease is complex and involves various clinical manifestations: visible teleangiectasias, reticular veins, varicose veins, lower limb oedemas, skin lesions and leg ulcers. The most often modified risk factors of chronic venous disease are sedentary lifestyle, extended periods of standing or sitting, hemosydery obesity, lack of physical activity, usage contraceptives, multiple pregnancies and unmodified are genetic factors, age and female sex. The fundamentals of the CEAP classification include a description of the clinical class (C) based upon objective signs, the etiology (E), the anatomical (A) distribution , and the underlying pathophysiology (P). CEAP classification is now accepted standard for classifying chronic venous disorders. Use of prevention should eliminate or modified risk factors of chronic venous disease. Among the prevention activities must be mentioned: eating a healthy balanced diet, exercising regularly, reducing weight if you are overweight, avoiding prolonged sitting or standing, compression therapy, avoiding excessive exposure to the sun and warmth. Treatment options of CVD range from medications, compression stockings, lifestyle changes to minimally invasive (eg. sclerotherapy or endoluminal ablation), invasive (surgical techniques), and hybrid (combination of ≥ 1 therapies). The knowledge about clinical manifestations of venous disorders is necessary to implement of adequate methods of prophylaxis and treatment of these persistent disorders.Przewlekła choroba żylna (CVD) obejmuje zespół złożonych zmian morfologicznych i/lub funkcjonalnych w układzie żylnym, szczególnie dotyczących kończyn dolnych. Dochodzi do niej w wyniku braku możliwości powrotu krwi do głębokiego, powierzchownego i przeszywającego układu żylnego. Przewlekła choroba żylna jest złożona i obejmuje różnorodne objawy kliniczne: widoczne teleangiektazje, żyły siatkowate, żylaki, obrzęki kończyn dolnych, zmiany skórne i owrzodzenia kończyn dolnych. Do najczęstszych modyfikowalnych czynników ryzyka CVD należą: siedzący tryb życia, przedłużające się stanie lub siedzenie, otyłość, brak aktywności fizycznej, stosowanie doustnych środków antykoncepcyjnych, wielokrotne ciąże, zaś do niemodyfikowalnych — czynniki dziedziczne, wiek i płeć żeńska. Podstawy klasyfikacji CEAP zawierają opis objawów klinicznych (C), etiologii (E), lokalizacji anatomicznej (A) i przyczyn patofizjologicznych (P). Skala CEAP jest obecnie podstawą klasyfikacji przewlekłej niewydolności żylnej. Profilaktyka ma na celu eliminację lub modyfikację czynników ryzyka CVD. Wśród działań zapobiegawczych należy wymienić: prawidłowe odżywianie się, systematyczne ćwiczenie, redukcję wagi w przypadku nadwagi, unikanie długiego stania lub siedzenia, kompresjoterapię, unikanie nadmiernej ekspozycji na słońce i ciepło. Metody leczenia CVD są bardzo zróżnicowane, począwszy od farmakoterapii, noszenia pończoch uciskowych, przez zmianę stylu życia do metod małoinwazyjnych (np. skleroterapia czy ablacja laserem), inwazyjnych (techniki chirurgiczne), aż po metody mieszane. Wiedza na temat obrazu klinicznego chorób naczyń żylnych jest konieczna do wdrożenia odpowiednich metod profilaktyki i leczenia tych uporczywych dolegliwości

Role of 18F-FDG PET/CT in the diagnosis of inflammatory and infectious vascular disease

This review article discusses the utility of 18F-FDG PET/CT in diagnosis and management of vascular disease. We stress usefulness of this method in large vessel inflammation and infection. In our work we based on the literature analysis and clinical cases diagnosed in our institution by use of 18F-FDG PET/CT. The literature exploration was focusing on vascular inflammation and infections and 18-FDG PET. The search was performed on PubMed database and cross referencing. We present the practical review with several images of vascular diseases like: Takayasu arteritis, giant cell arteritis, vascular graft infections, abdominal aortic aneurysm infections and cases of aortitis and periaortitis. From this work inflammation associated with atheromatic process and vulnerable atherosclerotic plaque we excluded. 18F-FGD PET/CT is a sensitive metabolic, reliable, non-invasive imaging modality suitable for diagnosis and follow-up of inflammation and infections in vascular system. This review article discusses the utility of 18F-FDG PET/CT in diagnosis and management of vascular disease. We stress usefulness of this method in large vessel inflammation and infection. In our work we based on the literature analysis and clinical cases diagnosed in our institution by use of 18F-FDG PET/CT. The literature exploration was focusing on vascular inflammation and infections and 18-FDG PET. The search was performed on PubMed database and cross referencing. We present the practical review with several images of vascular diseases like: Takayasu arteritis, giant cell arteritis, vascular graft infections, abdominal aortic aneurysm infections and cases of aortitis and periaortitis. From this work inflammation associated with atheromatic process and vulnerable atherosclerotic plaque we excluded. 18F-FGD PET/CT is a sensitive metabolic, reliable, non-invasive imaging modality suitable for diagnosis and follow-up of inflammation and infections in vascular system

A new device for minimally invasive mechano-chemical method of saphenous vein ablation. Report of 12 months of follow up

Introduction. The purpose of the study was to assess the effectiveness of endovascular mechanochemicalablation of the Great Saphenous vein and the Small Saphenous vein (GSV/SSV) using the use of Flebogrif®catheter and method, based on results obtained from the analysis of 200 patients. Material and methods. 200 patients underwent mechanochemical ablation using the Flebogrif® technique,of the 200 patients, 172 patients experienced insufficiency of the GSV and 28 experienced insufficiencies ofthe SSV. Follow-up assessment was established by outpatient appointments at 1, 3, 6, and 12 months postoperatively.During each subsequent visit, the result of the procedure was evaluated with the use of ultrasound.Furthermore, the intensity of clinical manifestations was assessed with the use of VCSS, CEAP, VASP scales. Anycomplications were also noted. Results. During 12-month follow-up the number of participants decreased to 168 (152 female, 16 male).Complete closure of the vein was achieved in 154 patients (140 female, 14 male). According to adoptedcriteria, 15 cases of recanalization were detected (10 complete and 5 partial). Based on the obtained resultsthe effectiveness of the method was assessed at 92%. Conclusions. The statistical analysis of the 12-month follow-up data allowed us to conclude the following theprocedural method had 92% of effectiveness at 12-month follow-up, vein diameter was not a significant limitationfor the application of the technique, there was a low rate of serious complications, and adverse cosmetic effectwas minimal. However , the method requires further long-term follow-up to allow for a complete assessment